Health Insurance

DME Sports recommends the Student Health Advantage for their international students because it provides comprehensive coverage at reasonable rates.

Each international student who is studying at DME Sports should purchase health insurance to protect themselves in the event that they have an accident or illness during their time in the USA. Students must have coverage for the complete duration of their stay in the US.

HIGHLIGHTS OF THE STUDENT HEALTH ADVANTAGE PLAN INCLUDE:

  • Two plan options; $500,000 or $1,000,000
  • $100 or $25 per injury/ illness deductible
  • $5 co-pay at Student Health Center
  • 100% Coinsurance in PPO
  • Universal Rx Pharmacy Savings
  • Maternity coverage (Platinum level)
  • Mental health coverage
  • Organized sports coverage
  • Physical Therapy
  • Pre-existing after 12 or 6 months

The Student Health advantage plan is available in two levels: Standard and Platinum. Please see the list of benefits
below to compare the benefits specific to each plan level.

StandardPlatinum
Lifetime Maximum
Student$500,000$1,000,000
Dependent$100,000$100,000
Per Illness/Injury Maximum
Student$300,000$500,000
Each eligible dependent$100,000$100,000
Deductible
For Treatment received outside the US & Canada$100 per Illness or Injury$25 per Illness or Injury
For Treatment received inside the US & Canada$100 per Illness or InjuryPPO: $25 per Illness or Injury
Non-PPO: $50 per Illness or Injury
Emergency Room
An additional Deductible of $250 will be applied for each Emergency Room visit for Treatment of
an Illness which does not result in a direct hospital admission.
Student Health Center
$5 co-pay per visit if Treatment received in Student Health Center (not subject to deductible)
Coinsurance
For Treatment received outside the US & CanadaThe plan pays 100% of eligible expenses up to Maximum Limit
For Treatment received within the US & CanadaIn the PPO Network or Student Health Center:
The plan pays 100% of eligible expenses up to Maximum LimitOutside of the PPO Network:The plan pays 80% of eligible expenses up to $5,000, then 100% up to Maximum Limit
Medical Benefits
Hospital Room & BoardAverage semi-private room rate
Intensive Care Unit (ICU)URC
Maternity
If incurred Outside of US/CanadaNot eligible for coverage100%
If incurred within the PPO NetworkNot eligible for coverage80%
If incurred outside the PPO NetworkNot eligible for coverage60%
Routine Newborn CareNot eligible for coverage$750 maximum per period of coverage
Physical Therapy
URC – limit once per day
Mental & Nervous Treatment
Student Health CenterNot eligible for coverage
Outpatient Treatment$50 per day; $500 Lifetime Maximum
Inpatient Treatment$10,000 Lifetime Maximum
Local Ambulance
Per Injury$350$750
Per Illness (only if admitted inpatient)$350$750
Prescription Drugs
InpatientURC
Outpatient50% of actual charges
Dental
Injury due to covered Accident$500
Sudden & Unexpected Pain$350
Benefit Period
60 days
Additional Benefits
Intercollegiate, Interscholastic, Intramural or Club$5,000 per Injury or Illness
Incidental Home Country CoverageUp to 14 day
Pre-existing ConditionsAfter 12 months of continuous coverageAfter 6 months of continuous coverage
Terrorism Coverage$50,000 Lifetime Maximum
Accidental Death & Dismemberment (AD&D)
Eligible Participant$25,000
Spouse$10,000
Dependent Child$5,000
Dismemberment LevelsScheduled
International Emergency Care
Medical Evacuation$500,000 Lifetime Maximum
Emergency Reunion$50,000 Lifetime Maximum
Return of Mortal Remains$50,000 Lifetime Maximum
Political Evacuation And Repatriation$10,000 Lifetime Maximum

* All coverages, benefits and premium amounts shown are in U.S. dollars.
* URC: Usual, Reasonable, Customary

Optional Riders

Adventure Sports Rider
(Available to insureds up to age 65)
AgeLifetime Maximum
0-49$50,000
50-59$30,000
60-64$15,000
Six Month Pre-existing Condition Rider (available only if the insured’s destination is Florida,
Hawaii, Idaho, or Massachusetts)

This website 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. DME 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. Please view the plan certificate ( StandardPlatinum ) for the full benefits and limitations of the plan.

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

  1. Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least six months on the Platinum level and 12 months on the Standard level. 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. Medical Expenses in excess of $5,000 for Injury or Illness sustained while participating in Amateur Athletics. Additionally, any Illness or Injury sustained while taking part in: Professional Athletics, or other athletic activity that is sponsored or sanctioned by the International Olympic Committee, and adventure sports and activities, including, without limitation the following (including any combination or derivative of the following): abseiling; mountaineering activities where specialized climbing equipment, ropes or guides are normally or reasonably should have been used; athletic or sporting activities (except for activities that are non-contact, non-collision and engaged in by You solely for recreational, entertainment or fitness purposes); aviation (except when travelling solely as a passenger in a commercial aircraft or); motocross (MOTO-X); BMX; BASE jumping; bobsledding; bungee jumping; canyoning; caving; hang gliding; heli-skiing; high diving; hot air ballooning; inline skating; jet skiing; jungle zip lining; kiteboarding; kayaking; luge; mountain biking; parachuteing; paragliding; parascending; rappelling; racing of any kind including without limitation by horse, motor or other vehicle (of any type) or motorcycle; rock climbing; any rodeo activity; ski jumping; sky diving; snow skiing except for recreational downhill and/or cross country snow skiing (provided that there is no coverage for any Illness of Injury sustained while skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body); snowboarding; snowmobiling; spelunking; surfing; trekking; whitewater rafting; windsurfing; wildlife safaris; and sub-aqua pursuits involving underwater breathing apparatus below a depth of 10 meters. Practice or training in preparation for any excluded activity which results in Illness or Injury will be considered as activity while taking part in such activity
  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 website 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. DME 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. Please view the plan certificate ( StandardPlatinum ) for the full benefits and limitations of the plan.

All premium rates are effective as of 6/1/2016. Rates include surplus lines tax where applicable. A dependent child is
your child shown on the Application Form over 14 days and under 19 years of age, traveling with the individual or
the group member as a dependent, and for whom premium has been paid.

All rates are monthly and in $USD

Standard Plan Rates

U.S. Citizens

AgeStudentSpouseDep. Child
Under 19$52$301$62
19-23$58$301$62
24-30$76$330$62
31-40$115$439$62
41-50$187$451$62
51-64$249$439$62

Non U.S. Citizens

AgeStudentSpouseDep. Child
Under 19$66$346$82
19-23$87$346$82
24-30$101$383$82
31-40$181$510$82
41-50$295$527$82
51-64$394$510$82

Platinum Plan Rates

U.S. Citizens

AgeStudentSpouseDep. Child
Under 19$88$516$95
19-23$97$516$95
24-30$128$565$95
31-40$193$753$95
41-50$314$773$95
51-64$417$753$95

Non U.S. Citizens

AgeStudentSpouseDep. Child
Under 19$111$594$126
19-23$146$594$126
24-30$169$656$126
31-40$303$873$126
41-50$496$902$126
51-64$662$873$126

As we discussed, the Student Health Advantage covers new accidents and illnesses that occur on the plan. For doctor visits, the student would need to pay $100 per injury or illness with the Standard level or $25 (in-network)/$50 (out of network) per injury or illness with the Platinum level. After the deductible, the plan will cover 100% up to the policy maximum if they stay in-network in the US. Otherwise, if they choose to go outside the network, after the deductible the plan will cover 80% of the next $5,000 and then 100% up to the policy maximum.
You can view the network right online here – www.internationalstudentinsurance.com

Jennifer Frankel – International Student Insurance, an Envisage International Company