| PLAN INFORMATION & HIGHLIGHTS - Standard Short-Term Travel Plan |
| Plan Maximum |
Choice of $50,000, $250,000 or $500,000 per illness or injury with a Lifetime Maximum of $5,000,000 |
| Coinsurance |
No coinsurance |
| Deductible |
$100 per Illness or Injury |
| Treatment Period |
60 days per chronic illness |
| MyIMGSM |
24 hour secure access from anywhere in the world to manage your account at anytime |
| International Emergency Care |
A wide range of international emergency benefits available including emergency evacuation, emergency reunion, and return of mortal remains |
| Dependent Coverage |
Coverage provided for dependents of faculty, scholars, students and exchange participants |
| Optional Add-on Plan |
Additional coverage is available for high school sports, personal liability and legal assistance |
| Pre-existing Conditions |
Available to U.S. and non-U.S. citizens - see Additional Benefits for more information |
| MEDICAL BENEFITS |
*Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. |
| Hospital Room and Board |
Up to semi-private room rate |
| Hospital Intensive Care |
URC* |
| Physical Therapy |
URC* - 1 visit per day |
| Physician Visit |
URC* |
| StudentHealthCenter |
$5 co-pay per visit |
| Prescription Drugs |
URC* |
| Eligible Medical Expenses |
URC* |
| Emergency Room |
URC* |
 |
| Emergency Room Illness with In-patient Admission |
URC* |
| Emergency Room Illness without In-patient Admission |
Additional $250 deductible |
|
| Dental |
|
| INTERNATIONAL EMERGENCY CARE |
When coordinated through the Plan Administrator |
| Emergency Medical Evacuation |
$50,000 Lifetime Maximum |
|
| Emergency Reunion |
$5,000 Lifetime Maximum |
|
| Return of Mortal Remains |
$25,000 |
|
| Political Evacuation |
Up to $10,000 |
|
| ADDITIONAL BENEFITS |
| Accidental Death |
$25,000 |
| Dismemberment |
$25,000 two limbs;
$12,500 one limb |
| Terrorism Coverage |
Up to $50,000 Lifetime Maximum |
|
| Sudden Recurrence of a Pre-existing Condition (U.S. citizens) |
|
| Pre-existing Conditions (For U.S. citizens, this benefit will begin when the Sudden Recurrence benefit is exhausted) |
$500 per year; $50,000 lifetime maximum - after 12 months of continuous coverage |
| Incidental Home Country Coverage |
Up to a cumulative two weeks |
|
| OPTIONAL ADD-ON PLAN |
| Baggage |
|
| Legal Assistance |
|
| Personal Liability |
|
| Damage to third person property |
$500 limit after $100 deductible. Secondary to any other insurance in force |
| Limited High School Sports Coverage |
URC* |
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