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Student Health Advantage - Standard

Limited Coverage,  Rated A- (Excellent)By: IMG,  UW: Sirius SpecialitySirius Specialty Insurance Corporation
AM Best Rating
A- (Excellent)
Carrier/Underwriter
Sirius Specialty Insurance Corporation
Administrator
IMG
COVID-19 Included
extendable-cancelable
Extendable & Cancelable
ppo
PPO
UnitedHealthcare Network
urgent-care
Urgent Care
Coverage from 5 days to 365 days
BUY

Student Health Advantage is designed to meet the needs of international students, scholars, and faculty, their families, and groups of two or more involved in long-term educational programs. In addition to meeting the requirements of the J1 Visa, this plan includes benefits for maternity, mental health and organized sports. After a period of 12 months, pre-existing conditions will be covered as well.


Please review Student Health Advantage Insurance Brochure brochure or policy document for complete and accurate coverage information.

Out-Patient

Dr. / Physician Visit

Inside PPO Network or Student Health Center: Insurance pays 100 % after deductible, to coverage maximum.
Outside PPO Network : Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum.

Prescription Drugs / Medicines

Inside PPO Network or Student Health Center: Insurance pays 100 % after deductible, to coverage maximum.
Outside PPO Network : Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum.
(For Outpatient Perscription insurance pays 50% of Actual Charges),

Lab & X-rays

Inside PPO Network or Student Health Center: Insurance pays 100 % after deductible, to coverage maximum.
Outside PPO Network : Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum.

Physical Therapy

Inside PPO Network or Student Health Center: Insurance pays 100 % after deductible, to coverage maximum.(Limit Once per day)
Outside PPO Network : Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum. (Limit Once per day)

In-Patient

Hospital Room

Inside PPO Network or Student Health Center: Insurance pays 100 % after deductible, to coverage maximum.
Outside PPO Network : Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum.

Hospital Intensive Care Unit

Inside PPO Network or Student Health Center: Insurance pays 100 % after deductible, to coverage maximum.
Outside PPO Network : Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum.

Emergency Services

Ambulance Expenses

Up to $500 per injury
Up to $350 per illness (only if admitted as in-patient)

Dental

Acute, spontaneous and unexpected pain

Up to $350 (Not Available for Basic Short Term Plan )

Accidental emergency

Up to $500 (Not Available for Basic Short Term Plan )

Travel

Emergency Medical Evacuation / Repatriation

Up to $500,000 life maximum (independent of Maximum limit)

Return of Remains

Up to $50,000 Maximum

Emergency Reunion

Up to $50,000 Maximum

Return of minor Child(ren)

Not Covered

Loss of checked Baggage

Covered under Optional Add-On plan

Life

AD&D

Student : $25,000
Dependent Spouse :$10,000
Dependent Child :$5000

Other

Pre-Existing Conditions

Covered after 12 months of continuous coverage( Rider Available for certain states resident . See policy details)

Maternity

Covered

Incidental Home Country Coverage

Available only for non-US citizens

General Physical full Checkup

Not Covered

Terrorism Coverage

Up to $50,000 Life Time Maximum

Brochure

Student Health Advantage Insurance Brochure brochure

Support

24-Hrs Emergency Assistance

Yes. Contact number and details can be found on the ID card.

Plan Administrator Company

IMG

Carrier / Underwriter

Sirius Specialty Insurance Corporation

AM Best Rating

A- (Excellent)

Deductible Content

Deductible Per Incident
What is Deductible?

Deductible is the amount that you are responsible for, before insurance company starts paying for any covered expenses. Deductible for this type of plan is applicable once per incident.


For example: If you visit a doctor for a medical problem, and after consultation, the doctor prescribes Medicines, X-rays, and Lab tests, then since all these services are part of one incident, your deductible will be applicable for these services only once. If you visit a doctor again after a few days for a new problem, the deductible will be applicable again for that new incident.
What deductible to choose with this Plan?

Since deductible is per incident for these type of plans. It is a good idea to select a lower deductible such as “0“.

Note : For Age 70 and above, lower deductible like Zero “0“ is not available.

Plan Type

Comprehensive Coverage Plan

Coverage in U.S.A.

Covered

Coverage outside U.S.A.

Covered

Co-Pay

$5 per visit for Student Health Center

Co-Insurance

Inside PPO Network or Student Health Center: Insurance company will pay 100 % after deductible, to coverage maximum.
Outside PPO Network: Insurance company will pay 80% of $5,000 of Eligible Expenses after deductible, then 100% to coverage maximum.

Coverage Type

Per Illness or Injury

Deductible Type

$100 per Illness or Injury

Renewability

Extendable (Only if initially purchased for 3 month) provided there is no break in coverage , up to a maximum period of 5 years.

Cancellation

Full refund available if cancelled before start date. Only Monthly refund available after start date if no claims have been made( $50 Cancellation Fee Applicable)

PPO Network

UnitedHealthcare Network

Coverage Length

Min 1 month to Max 5 years

Available Deductibles

$100

Available Coverage

Ages 14 days - 64 years
Student: $300,000 (Lifetime Maximum :$500,000)
Dependent: $100,000 (Lifetime Maximum :$100,000)

Provider Directory

By Provider, 24 hours Worldwide, Phone Nos. : 866-281-1688

Plan Brochure

Student Health Advantage Insurance Brochure brochure

Disclaimer

Plan features listed here are high level, provided for your convenience and information purpose only. Please review the Evidence of Coverage and Plan Contract (Policy) for a detailed description of Coverage Benefits, Limitations and Exclusions. Must read the Policy Brochure and Plan Details for complete and accurate details. Only the Terms and Conditions of Coverage Benefits listed in the policy are binding.