Long Term Insurance for Student Groups 2 or More

Benefits

SCHEDULE OF BENEFITS
(All amounts are in U.S. dollars. URC - Usual, Reasonable, Customary)

PLAN INFORMATION
Lifetime Maximum
Student	$500,000
Dependent	$50,000

Per Illness/Injury Maximum
Student	$300,000
Each eligible dependent	$50,000

Deductible
$100 per Illness/Injury
$50 per Illness/Injury if Treatment received in Student Health Center

Coinsurance
Charges incurred outside the U.S.: 100% of eligible expenses Charges incurred within the U.S.: In PPO network or Student Health Center: 100% of eligible expenses Out of PPO network: 80% of the first $5,000 of eligible charges, then 100% thereafter

Medical Benefits
Hospital Room & Board	Average semi-private room

Intensive Care	URC

Maternity	URC following 10 month waiting period up to policy maximum
Subject to a waiting period for the first 10 months of coverage, the plan provides coverage for maternity the same as any illness. Routine nursery care of newborns is also subject to the maximum limit.

Routine Nursery Care	$750 maximum per certificate period

Emergency Room
Injury	URC
Illness resulting in hospitalization	URC
No hospitalization	Subject to additional $250 deductible

Mental Health (Treatment at Student Health Center is not eligible)
Outpatient	$50 per day $500 lifetime maximum
Inpatient	URC to $10,000 lifetime maximum

Prescription Drugs
Inpatient	URC
Outpatient	50% of actual charges

Physical Therapy	URC – limit once per day

Local Ambulance
Per Injury	Up to $350
Per Illness only if admitted Inpatient	Up to $350

Dental
Injury due to covered Accident	$500
Sudden & Unexpected Pain	$350

All Other Eligible Medical Expenses	URC

INTERNATIONAL EMERGENCY CARE
Emergency Medical Evacuation	Up to maximum limit per Illness/Injury
Student Health Advantage 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 the Policy Limit.

Emergency Reunion	$2,500 lifetime maximum
Student Health Advantage provides emergency reunion coverage 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. The coverage also includes a round trip air ticket for a relative if the member is hospitalized for seven days or longer.

Return of Mortal Remains	$25,000 maximum
If a covered illness/injury results in death, expenses for repatriation of bodily remains or ashes to the home country will be covered.

Political Evacuation	Up to $10,000 lifetime maximum
If the United States Department of State, Bureau of Consular Affairs issues a mandatory evacuation order of the host country 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 lifetime maximum for transportation to the nearest place of safety or for repatriation to the insured person’s home country or country of residence provided that: The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs issues the evacuation order; Political Evacuation and Repatriation is approved and coordinated by the Company.

ADDITIONAL BENEFITS
Intercollegiate/Interscholastic/ Intramural or Club Sports	$5,000 per Injury/Illness Medical Expenses only

Pre-existing Conditions	After 12 months of continuous coverage

Terrorism Coverage	Up to $50,000 lifetime maximum
Student Health Advantage 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 six 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.

AD&D
Student	$25,000
Dependent Spouse	$10,000
Dependent Child	$5,000
Dismemberment Levels	Scheduled

Benefit Period	60 Days

This web page contains only a consolidated and summary description of all current Student Health Advantage 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 application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

Exclusions

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under Student Health Advantage.

1. Pre-existing Conditions. A pre-existing condition is defined as any Injury, Illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the 12 months prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
3. War, military action, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person's date of arrival in the Host Country.
4. Immunizations and routine physical exams.
5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
6. Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
7. Pre-natal, post-natal, and newborn care, unless related to a Covered Pregnancy, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.

8. Expenses in excess of $5,000 for Injury or Illness sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding,snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.

9. Vision or ear tests and the provision of visual or hearing aids.
10. Vocational, recreational, speech or music therapy.
11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
12. Charges, Injuries and/or Illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
13. Treatment for, and Injuries and/or Illnesses resulting or arising from, substance abuse or drug addiction.
14. Injury and/or Illness resulting or arising from being under the influence of alcohol or drugs; and Injury or Illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
15. Willful self-inflicted Injury or Illness.
16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
18. Organ or tissue transplants or related services.
19. Illness or Injury where the trip to the host country is undertaken for treatment or advice for such Illness or Injury, except as expressly provided for in the certificate of insurance.
20. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

This web page contains only a consolidated and summary description of all current Student Health Advantage 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 application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

Premiums

Student Health Advantage
An international health care plan designed to specifically meet the needs of international students involved in long-term educational programs.

All premium rates are in U.S. dollars and are effective through 31-Oct-2008. Rates include 2.5% surplus lines tax. A dependent child is your child shown on the Application Form over 14 days and under 19 years of age, traveling with the group as a dependent of a group member, and for whom premium has been paid.

U.S. Citizens - Monthly Rates

Age	Student	Spouse	Dep. Child
Under 19	$46	$260	$54
19-23	$51	$260	$54
24-30	$67	$285	$54
31-40	$102	$380	$54
41-50	$165	$390	$54
51-64	$220	$380	$54

Non-U.S. Citizens - Monthly Rates

Age	Student	Spouse	Dep. Child
Under 19	$58	$300	$71
19-23	$77	$300	$71
24-30	$89	$330	$71
31-40	$160	$440	$71
41-50	$262	$455	$71
51-64	$349	$440	$71

Quality Guarantee

The group's satisfaction is very important to the plan underwriter, and to IMG as the plan administrator. If, for any reason, the sponsoring organization or the group is not pleased with this product, a written request for cancellation and refund of the premium may be submitted. The request must be received by IMG prior to the effective date of coverage.

Precertification, Emergency Evacuation and Repatriation

For precertification, emergency evacuation and repatriation, please call: IMG in the U.S.: 1.800.628.4664 (toll free) or 1.317.655.4500. Call IMG outside the U.S.: 001.317.655.4500 (collect if necessary). This information will also be provided on your ID card.

IMG must be notified prior to treatment or within 48 hours of an emergency.

To Report Claims

Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 1.317.655.4505.