IMG Student Journey Platinum Insurance

• Eligible Medical Expenses help	In-Network: 80% up to policy maximum Out-Network: 60% up to policy maximum
  Maternity & Newborn Care	Maternity: $5,000 normal delivery $7,500 for c-section delivery Newborn: $500 maximum
  Preventative Care Immunizations	$200
  Hospital room and board help	$300 deductible per confinement
  Physician Visits help	$15 copay Specialist $50 copay
  Urgent Care Clinic help	$50 copay 80% In-Network / 60% Out-of-Network
  Walk-In Clinic help	In-Network: 80% up to policy maximum Out-Network: 60% up to policy maximum
  Surgery help	In-Network: 80% up to policy maximum Out-Network: 60% up to policy maximum
  Intensive Care help	In-Network: 80% up to policy maximum Out-Network: 60% up to policy maximum
  Hospital Emergency Room	$350 deductible per confinementd
  Outpatient Diagnostic Laboratory / X-ray	Laboratory / X-Ray: $30 copay per day including interpretation of results Radiology: $100 copay per day including interpretation of results
  Outpatient Diagnositc Radiology	$500 per examinaiton + additional $350 if Cat scan, PET scan, or MRI
  Anesthesia help	100%
  Chiropractic Care help	Included (medical order or treatment plan required)
  Physical Therapy help	Outpatient $35 per visit, 1 visit per day, 12 visit max
  Chemotherapy / Radiation Therapy help	In-Network: 80% up to policy maximum Out-Network: 60% up to policy maximum
  Pre-Admission Testing	In-Network: 80% up to policy maximum Out-Network: 60% up to policy maximum
  Assistant Surgeon help	25% of Surgeon's payable benefit (20% of primary surgeon’s eligible fee)
  Prescription Drugs and Medication	80% out of network Dispensing maximum: 30 days per prescription
  Traumatic Dental Injury help	100% Rendered at a hospital facility due to a covered accidental injury and subject to the sublimits, deductible, coinsurance and copayment amounts listed in the benefit summary.
  Dental Treatment	$500 max (unexpected pain or non-emergent accidents only)
  Mental/Nervous help	Outpatient: 80% up to 40 visits or $5,000 max per policy period Inpatient: 80% up to 30 days max

• Repatriation for Medical Treatment help	$50,000
  Return of Mortal Remains or Cremation/Burial help	Unlimited Local Burial / Cremation at place of death Maximum Limit: $5,000
  Interfacility Ambulance Transfer	Up to 100%
  Emergency medical evacuation help	Unlimited
  Emergency local ambulance help	Up to 100%

• Pre-Existing Conditions help

  Covered after 6 months of waiting period

• Mental or Nervous/Substance Abuse help

  Outpatient: 50 copay up to $150 per session Inpatient: 80% In-Network / 60% Out-of-Network

• Accidental Death & Dismemberment help

  Principal Sum Maximum: $10,000 Death must occur within 90 days of the Accident

The Student can purchase an optional rider at the time of application. The optional riders provide additional coverage for a minimal charge.