Basic Short-Term Schedule of Benefits
All amounts listed are in U.S. dollars. Click the gray titles to see further information.
PLAN INFORMATION & HIGHLIGHTS - Basic Short-Term Travel Plan
| Plan Maximum |
$10,000 per illness or injury with a Lifetime Maximum of $5,000,000. |
| 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 |
$10,000 per illness or injury with a Lifetime Maximum of $5,000,000. |
| Dependent Coverage |
Coverage not only provided for dependents, but for faculty, scholars, students and exchange participants as well |
| Optional Add-on Plan |
Additional coverage is available for high school sports, personal liability and legal assistance |
| 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 |
| Student Health Center |
$5 co-pay per visit |
| Prescription Drugs |
Up to Policy Maximum |
| Eligible Medical Expenses |
URC* |
| Emergency Room |
URC* |
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Charges incurred for the use of the Emergency Room due to an accident are covered up to the per injury Plan Maximum.
| Emergency Illness - with in-patient admission |
URC* |
| Emergency Illness - without in-patient admission |
Additional $250 deductible |
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Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.
| INTERNATIONAL EMERGENCY CARE |
(WHEN COORDINATED THROUGH THE PLAN ADMINISTRATOR) |
| Emergency Evacuation |
$25,000 Lifetime Maximum |
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Each plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to $25,000.
| Emergency Reunion |
$5,000 Lifetime Maximum |
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Each plan also provides emergency reunion coverage, up to $5,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
| Return of Mortal Remains |
$7,500 |
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If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $7,500.
| Political Evacuation |
Up to $10,000 |
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If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person's date of arrival in the Host Country, the Company will pay up to $10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person's home country or country of residence provided that:
- 1. The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory;
- 2. Political Evacuation and Repatriation is approved and coordinated by the Company.
To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.
| Dismemberment |
$5,000 two limbs; $2,500 one limb |
| Terrorism Coverage |
Up to $50,000 Lifetime Maximum |
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Each plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.
Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival.
This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.
| Sudden Recurrence of a Pre- existing Condition (U.S. citizens) |
|
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| Medical |
Up to $5,000 of eligible expenses |
| Emergency Medical Evacuation |
Up to $25,000 of eligible costs and expenses |
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| Baggage |
|
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| Loss/theft of Baggage |
$250 |
| Loss/theft of Valuables |
$250 |
| Loss/theft of Personal Papers |
$250 |
| Legal Assistance |
|
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| Binder Fee |
$500 when served with summons |
| Personal Liability |
|
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| Injury to third party |
$2,000 limit after $100 deductible |
| Damage to third person property |
$500 limit after $100 deductible. Secondary to any other insurance in force |
| Limited High School Sports Coverage |
URC* |
* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.