Student Health Advantage (SHA) Platinum
Platinum comprensive medical insurance for J1 students and scholars & J2 spouses and/or dependents
Designed for individuals or groups five or more students or scholars participating in a sponsored study abroad program, and who desire a platinum-level annually renewable medical plan. This plan meets student visa requirements, includes benefits for maternity, mental health, organized sports and international emergency care. By choosing the Platinum plan option, you can rest assured knowing you have the highest level of benefits providing the coverage you need.
Your educational adventure should be enjoyable and gratifying. Maintaining the ability to be flexible and responsive, IMG developed Student Health Advantage, an international health care plan designed to specifically meet the needs of international students involved in long-term educational programs. The plan offers a complete package of international benefits available 24 hours a day.
For students, scholars, and cultural exchange participants when inside the U.S., the UnitedHealthcare Options network is a longstanding reputable Tier 1 network that gives you more access to more doctors and services. When outside the U.S., you can also enjoy access to quality healthcare worldwide with our proprietary IPA network that includes over 18,550 physicians and facilities. Student Health Advantage also offers some maternity and newborn care benefits.
How SHA Platinum meets or exceeds all J1/J2 Visa Insurance requirements
| J1/J2 Visa Insurance Requirement | Plan Benefits | Meets or Exceeds | J1/J2 Compliance |
|---|---|---|---|
| Medical benefits (per accident/injury or illness) of $100,000 or more | Medical benefits limit (per illness or injury): Student $500,000, Dependent $100,000 | Exceeds for Student, Meets for Dependent |  |
| Deductible of $500 (or less) | Deductible (per illness or Injury): In-Network $100, Out-of-Network $150, International $25 | Exceeds | |
| Coinsurance of 75% (or more) | Coinsurance (after deductible) : 90% In-Network, 80% Out-of-Network, 100% Outside U.S. | Exceeds | |
| Expenses for medical evacuation to home country in the amount of $50,000 (or more) | Medical evacuation benefits: up to $500,000 | Exceeds | |
| Repatriation of remains in the amount of $25,000 (or more) | Repatriation of remains: up to $50,000 | Exceeds | |
| Coverage of pre-existing conditions after a reasonable waiting period | Coverage of pre-existing conditions after 6 months (reasonable) | Meets | |
| Financial Strength of underwriter (A.M. Best rating of A-) or better | Underwriter SiriusPoint has A.M. Best rating of A- | Meets | |
DISCLAIMER: Please note that this table is provided as an overview and for comparison only. For more detailed information on Plan Benefits, please refer to the Plan Brochure and the Sample Certificate of Insurance. If there are discrepancies between the summary of Plan Benefits provided anywhere by J1VI and the wording in the Certificate of Insurance, the wording in the Certificate of Insurance will always prevail.
Highlights
- Comprehensive medical insurance for international students or scholars participating in a sponsored study abroad program
- Coinsurance in PPO network or student health center within the U.S.: Company pays 100%
- Maximum limit for student: $1,000,000
- Provides coverage for maternity
- Students / Scholars
Coverage Information
Conditions of Coverage
- Coverage and benefits are subject to the deductible, limits and coinsurance, and all terms of the Certificate of Insurance and Master Policy
- Coverage under this plan is secondary to any other coverage
- Coverage and benefits are for eligible medical expenses which are medically necessary and usual, reasonable, and customary
- Charges must be administered or ordered by a physician
- Charges must be incurred during the period of coverage or benefit period
- Claims must be presented to IMG for payment within 180 days from the date the claim was incurred
Eligibility
To be eligible to apply to the Student Health Advantage, you must:
- Be a participant: a student, scholar, intern, teacher, or trainee enrolled in an educational or cultural exchange program for the purposes of teaching, study, research, or receiving on the job training for a temporary period of time
- Be the spouse of a participant or children of a participant and residing outside his/her primary country of residence for a temporary period of time. Primary applicant must hold a J, M, F, or A visa
- Be at least 31 days old but not yet 65 years old
- Be physically and legally residing in the destination country with the intent to reside there for at least 30 days on the effective date and at renewal
Renewal of Coverage
Eligible insureds can request coverage under the plan be renewed a minimum of five (5) days, up to a maximum of 60 continuous months, as long as the premium is paid when due and the insured continues to meet the eligibility requirements of the plan.
See Student Health Advantage – brochure – Platinum
How Does the Affordable Care Act (ACA) Affect My Coverage?
Non-U.S. citizens: As non-resident aliens, international students, scholars, and people involved in cultural exchange programs on F, J, M and Q visas (and certain family members) are not subject to the individual mandate for their first five years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for two years (out of the past six). Since international students are not subject to the mandate, they are not required to purchase a plan that meets PPACA requirements and can purchase Student Health Advantage.
U.S. citizens: Under ACA, all U.S. citizens, nationals and resident aliens are required to purchase minimum essential coverage (ACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S. for 330 of any 365-day period, or have a tax home (main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and is a bona fide resident of a foreign country.
Summary of Benefits
All amounts in U.S. dollars
Coverage limit / Maximum amount for Eligible Medical Expenses
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Maximum Limit | Student: $1,000,000 Dependent: $100,000 | Student: $1,000,000 Dependent: $100,000 | Student: $1,000,000 Dependent: $100,000 |
| Per Illness or Injury limit | Student: $500,000 Dependent: $100,000 | Student: $500,000 Dependent: $100,000 | Student: $500,000 Dependent: $100,000 |
| Deductible -Per Illness or Injury | $100 | $150 | $25 |
Coinsurance for Eligible Medical Expenses
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Coinsurance (in addition to Deductible) | Plan pays 90% Insured pays 10% | Plan pays 80% Insured pays 20% | Plan pays 100% Insured pays 0% |
| Out of Pocket Maximum | $1,000 | Up to the Maximum Limit | $0 |
Pre-certification
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Interfacility Ambulance Transfer, Emergency Medical Evacuation | No coverage if Pre-certification requirements are not met | No coverage if pre-certification requirements are not met | No coverage if pre-certification requirements are not met |
| Maternity | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met |
| All other Treatments & supplies | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met |
Pre-existing conditions
Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded until the Insured Person has maintained 6 months of continuous coverage under this insurance.
Student Health Center
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Copayment per visit -Not subject to the per Illness or Injury Deductible | $5 | $5 | $5 |
| Coinsurance | Plan pays 100% Insured pays 0% | Plan pays 100% Insured pays 0% | Plan pays 100% Insured pays 0% |
Inpatient / Outpatient benefits
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Eligible Medical Expenses | 90% | 80% | 100% |
| Physician / Specialist Visit: - Maximum Visits per day: 1 -Surgery is not subject to the Maximum visit limit | 90% | 80% | 100% |
| Hospital Emergency Room: - Injury: Not subject to Emergency Room Deductible - Illness: Subject to a $250 Deductible for each Emergency Room visit for Treatment that does not result in a direct Hospital admission. | 90% | 80% | 100% |
| Teleconsultation (Groups only) | -Not subject to Deductible and Coinsurance -Mental or Nervous Disorders are not covered -Coverage for a Teleconsultation is not a determination that any specific condition discussed, raised or identified during such consultation is covered under this insurance. The Company reserves the right to decline future claims relating to or arising from any condition discussed, raised or identified during a Teleconsultation where the Illness or Injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Certificate of Insurance | ||
| Hospitalization / Room & Board -Average semi-private room rate -Includes nursing, miscellaneous and Ancillary Services | 90% | 80% | 100% |
| Intensive Care | 90% | 80% | 100% |
| Outpatient Surgical / Hospital Facility | 90% | 80% | 100% |
| Laboratory | 90% | 80% | 100% |
| Radiology / X-ray | 90% | 80% | 100% |
| Chemotherapy / Radiation Therapy | 90% | 80% | 100% |
| Pre-admission Testing | 90% | 80% | 100% |
| Surgery | 90% | 80% | 100% |
| Reconstructive Surgery: - Surgery is incidental to and follows Surgery that was covered under the plan | 90% | 80% | 100% |
| Assistant Surgeon - 20% of the primary surgeon’s eligible fee | 90% | 80% | 100% |
| Anesthesia | 90% | 80% | 100% |
| Maternity and Newborn Care -Maximum Limit: $5,000 -Pre-natal care, delivery of a Newborn, and post-natal care of an Insured Person, including complications -Newborn routine care during the first 31 days of life | 90% | 60% | 100% |
| Durable Medical Equipment | 90% | 80% | 100% |
| Chiropractic Care: - Medical order or Treatment plan required | 90% | 80% | 100% |
| Physical Therapy: - Maximum Visits per day: 1 - Medical order or Treatment plan required | 90% | 80% | 100% |
| Extended Care Facility: - Upon direct transfer from an acute care Hospital | 90% | 80% | 100% |
| Home Nursing Care: - Provided by a Home Health Care Agency - Upon direct trasnfer from an acute care Hospital | 90% | 80% | 100% |
Prescription Drugs and Medication - The following Prescription Drugs and Medication Period of Coverage limit accumulates toward the Maximum Limit
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Period of Coverage limit -Subject to the Coinsurance amounts listed below | -Primary Insured Person: $250,000 per person -Spouse and Child: Up to the Maximum Limit ($100,000) | -Primary Insured Person: $250,000 per person -Spouse and Child: Up to the Maximum Limit ($100,000) | -Primary Insured Person: $250,000 per person -Spouse and Child: Up to the Maximum Limit ($100,000) |
| Inpatient and Outpatient Surgery Prescription Drugs and Medication | 90% | 80% | 100% |
| Emergency Room and Outpatient Office Visits Prescription Drugs and Medication | 90% | 80% | 100% |
| Retail Pharmacy Prescripton Drugs and Medication -Dispensing maximum for Retail Pharmacy: 90 days per prescription | N/A | 50% | 50% |
Mental or Nervous / Substance Abuse
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Inpatient Mental or Nervous / Substance Abuse: - Maximum Limit: $10,000 - Not covered if incurred at the Student Health Center | 90% | 80% | 100% |
| Outpatient Mental or Nervous / Substance Abuse: - Maximum Limit per day: $50 - Maximum Limit: $500 - Not covered if incurred at the Student Health Center | 90% | 80% | 100% |
Emergency Services
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Emergency Local Ambulance: - Period of Coverage Limit per Injury $750 - Period of Coverage Limit per Illness $750 (resulting in an Inpatient Hospitalization) | 100% | 100% | 100% |
| Emergency Medical Evacuation: - Maximum Limit: $50,000 - Must be approved in advance and coordinated by the Company | 100% | 100% | 100% |
| Emergency Reunion - Maximum Limit: $50,000 - Maximum Days: 15 - Meal Maximum per day: $25 - Reasonable and necessary travel costs and accommodations - Must be approved in advance by the Company | 100% | 100% | 100% |
| Interfacility Ambulance Transfer - Up to the per Injury or Illness limit - Services rendered in the United States - Transfer must be a result of an Inpatient | 100% | 100% | N/A |
| Political Evacuation and Repatriation: - Maximum Limit: $10,000 - Must be approved in advance by the Company | 100% | 100% | 100% |
| Repatriation for Medical Treatment: - Maximum Benefit: $100,000 - Approved in advance and coordinated by the Company - Refer to the REPATRIATION FOR MEDICAL TREATMENT provision for further details | 100% | 100% | 100% |
| Return of Mortal Remains: - Maximum Limit: $25,000 - Local Burial / Cremation at place of death - Maximum Limit: $5,000 - Return of Insured Person’s Mortal Remains to Country of Residence - Must be approved in advance by the Company | 100% | 100% | 100% |
Other Services
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Terrorism: - Not subject to Deductible and Coinsurance - Maximum Limit: $50,000 | 100% | 100% | 100% |
| Dental Treatment: - Period of Coverage Limit: $350 - (Treatment due to Unexpected pain to sound, natural teeth) - Period of Coverage Limit per Injury: $500 (Non-emergency Treatment at a Dental Provider due to an Accident) | N/A | 90% | 100% |
| Traumatic Dental Injury: - Treatment at a Hospital Facility due to an Accident - Additional Treatment for the same Injury rendered by a Dental Provider will be paid at 100% | 90% | 80% | 100% |
| Intercollegiate, Interscholastic, Intramural, or Club Sports | 90% | 80% | 100% |
| Accidental Death & Dismemberment: - Not subject to Deductible and Coinsurance - Death must occur within 90 days of the Accident | Accidental Death: 100% of Principal Sum Student: $25,000 Spouse: $10,000 Child: $5,000 Accidental Dismemberment: | ||
| Loss Sight of 1 eye 1 hand or 1 foot 1 hand and loss of sight of 1 eye 1 foot and loss of sight of 1 eye 1 hand and 1 foot Both hands or both feet Sight of both eyes | Percent of Principal Sum 50% 50% 100% 100% 100% 100% 100% | ||
| Incidental Trip: - Maximum days: 14 - Country of Residence is outside the United States Refer to the INCIDENTAL TRIP provision for further details | 90% | 80% | 100% |
| Personal Liability -Secondary to any other insurance -No coverage for Injury to a related Third Party or damage to related Third Person’s property -Refer to the PERSONAL LIABILITY provision for further details and requirements | Combined Maximum Limit: $10,000 Injury to Third Person: Per Injury Deductible: $100 Damage to Third Person’s property: Per damage Deductible: $100 | Combined Maximum Limit: $10,000 Injury to Third Person: Per Injury Deductible: $100 Damage to Third Person’s property: Per damage Deductible: $100 | Combined Maximum Limit: $10,000 Injury to Third Person: Per Injury Deductible: $100 Damage to Third Person’s property: Per damage Deductible: $100 |
DISCLAIMER: This benefits table is provided as an overview only. For more detailed information, please refer to the Plan Brochure and the Sample Certificate of Insurance. If there are discrepancies between the summary of plan benefits and the wording in the certificate of insurance, the certificate of insurance wording will always prevail.