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Insurance Plan


UScampus Health and Accident Insurance Plan

Underwritten by Sirius International Insurance Corporation
Administered by International Medical Group (IMG)

Enrollment Eligibility

Must be students, faculty, or scholars with F, M, J, or B visas. They must be engaged in international education or research activities outside their home country and have not applied for permanent residency. Dependents are eligible for monthly plan.

Plan Summary

Schedule of Benefits

Benefit Description (Participant)

Coverage Area Period of Coverage Maximum: $500,000
Deductible Outside of US/Canada: $100 per Policy Period
Student Health Center: $100 per Policy Period
US PPO Provider: $100 per Policy Period
US Non PPO Provider: $200 per Policy Period
Student Health Center: $100 per Policy Period 
Coinsurance
(following the applicable deductible)

Outside of US/Canada:
Plan pays 80% up to $10,000 of Eligible Expenses

Student Health Center:
Plan pays 80% up to $10,000 of Eligible Expenses

US PPO Provider:
Plan pays 80% up to $10,000 of Eligible Expenses

US Non PPO Provider:
Plan pays 60% of the first $10,000 of Eligible Expenses, then 100% thereafter
Prescription Drugs Inpatient: URC
Outpatient: 50% of actual charges
Emergency Room Subject to an additional $250 deductible if treatment does not require admittance to the hospital
Local Ambulance Per Injury: Up to $750
Per Illness (only if admitted inpatient): Up to $750
Pre-existing Conditions After six (6) months of continuous coverage
Wellness
(subject to a 12-month waiting period)
Up to $1,000 per calendar year for routine physical exams and immunizations
Mental & Nervous Disorders
(including substance abuse)
Inpatient: URC – limited to $10,000 LTM
Outpatient : $50 per visit (limited to 1 visit per day) with a $500 per period of maximum coverage
Accidental Death & Reimbursement Monthly Enrollees - $10,000 
Weekly Enrollees - $70,000 

Pre- Certification:
The following treatments and/or supplies must always be pre-certified for medical necessity by the company through the plan administrator:

- Inpatient treatment and/or supplies of any kind
- Any surgery or surgical procedure
- Durable medical equipment
- Computerized Axial Tomography (CAT scan)
- Magnetic Resonance Imaging
- Home nursing care
- Maternity

* URC – Usual, Reasonable, and Customary charges for eligible expenses in the area where you receive treatment.

 

Plan Summary & Price:

Plan A Plan B Plan C
Under 30 years of age Over 30 years of age Under 18 years of age

 

Insurance Premium

Application fee: $100
Association fee: $50 for every 3 months

Monthly Plan ( 2-12 Months)

Category Plan A and C (Under 30 years of age) Plan B (Over 30 years of age)
Participant $79 $195
Spouse $420 $560
1 Dependent Child $90 $82

 

Weekly Plan ( 2-8 Weeks)

Category Plan A and C (Under 30 years of age) Plan B (Over 30 years of age)
First 2 Weeks $36 $88
Additional 1 Week $18 $44
  • New enrollment: Application fee$100; plus association fee $50 every 3 months.
  • Renewal: Processing fee $50; plus association fee $50 every 3 months.
  • Weekly plan: Association fee $20 every 4 weeks.

Purchase Now!

Feel free to contact us if you have any question about UScampus Guide Health and Accident Insurance Plan.