International Student Accident and Sickness
With three levels of kindergarten through grade 12 (K-12) coverage, there's an ISM plan for you—select the plan that meets your needs! In addition to ISM's friendly, experienced customer service, all plans offer up to $250,000 ($500,000 Gold Plan) of sickness/accident coverage, full coverage (100% of usual and customary charges) emergency medical evacuation, $25,000 or $50,000 of sports coverage (based on maximum selected by the school), and up to $1,000 of home country coverage.
Coverage is designed for students in grades K-12. Not all coverage is available in all states. Please contact us for details of coverage options in your state.
Plan Options
| Plan Levels | Bronze Plan The policy pays: (All percentages specified below are based on the customary charges incurred, except as stated otherwise.) |
Silver Plan The policy pays: (All percentages specified below are based on the customary charges incurred, except as stated otherwise.) |
Gold Plan The policy pays: (All percentages specified below are based on the customary charges incurred, except as otherwise.) |
| Accidental Death and Dismemberment Principal Sum | $10,000 | $10,000 | $10,000 |
| Total Maximum per Covered Accident and Sickness | $250,000 | $250,000 | $500,000 |
| Total Maximum per Covered Accident for Interscholastic/Intercollegiate Sports | $25,000 or $50,000 (based on maximum selected by the school) | $25,000 or $50,000 (based on maximum selected by the school) | $25,000 or $50,000 (based on maximum selected by the school) |
| Wellness Benefits Not all plans include wellness benefits |
Bronze Plan | Silver Plan | Gold Plan |
| Routine Physical Exam | 100% of U&C | 100% of U&C | 100% of U&C |
| Pediatric dental care (exam, cleaning, fluoride treatment) | 100% of U&C | 100% of U&C | 100% of U&C |
| Pediatric vision care (exam, frames) | 100% of U&C | 100% of U&C | 100% of U&C |
| Immunization vaccines | 100% of U&C | 100% of U&C | 100% of U&C |
| Alcohol, drug use and behavioral assessments | 100% of U&C | 100% of U&C | 100% of U&C |
| Blood pressure screening | 100% of U&C | 100% of U&C | 100% of U&C |
| Depression screening | 100% of U&C | 100% of U&C | 100% of U&C |
| Emergency Medical Benefit (guarantee of payment) | up to $10,000 | up to $10,000 | up to $10,000 |
| Deductible per Policy Term | $200 | $0 | $0 |
| Home Country Extension Benefit Maximum Benefit Period: 35 days | $1,000 35 days |
$1,000 35 days |
$1,000 35 days |
| Accident and Sickness Co-insurance Rate | 80% of U&C up to $5,000 then 100% of U&C | 100% of U&C | 100% of U&C |
| Acupuncture and physiotherapy charges | $2,500 100% of U&C | $2,500 | $2,500 |
| Maximum per person home country coverage | $1,000 | $1,000 | $1,000 |
| Accidental Sickness Benefit percentage | 80% of U&C | 100% of U&C | 100% of U&C |
| Acupuncture and physiotherapy charges | $2,500 | $2,500 | $2,500 |
| Medical Expense | Bronze Plan | Silver Plan | Gold Plan |
| Hospital room and board expense covered |
80% of U&C | 100% of U&C | 100% of U&C |
| Intensive care unit expense | 80% of U&C | 100% of U&C | 100% of U&C |
| Hospital miscellaneous expense | 80% of U&C | 100% of U&C | 100% of U&C |
| Inpatient hospital/emergency room services |
80% of U&C | 100% of U&C after $75 co-pay | 100% of U&C |
| Diagnostic x-ray and lab expense | 80% of U&C | 100% of U&C | 100% of U&C |
| Ambulance expense benefit | $1,000 including ground | $1,000 including ground | $1,000 including ground |
| Accidental dental expense | $200 per tooth $500 covered accident |
$200 per tooth $500 covered accident |
$200 per tooth $500 covered accident |
| Surgical expense benefit (inpatient/outpatient) |
80% of U&C | 100% of U&C | 100% of U&C |
| Physician office visit | 80% of U&C of actual charge | 100% of U&C after $25 co-pay | 100% of U&C |
| Chiropractor expense benefit | $50 per visit, $1,000 policy term |
$50 per visit, $1,000 policy term |
$50 per visit, $1,000 policy term |
| Outpatient hospital/emergency room services | 80% of U&C | 100% of U&C after$75 co-pay | 100% of U&C |
| Outpatient prescription drug | 100% of U&C charges up to a maximum of $2,000 | 100% of U&C charges up to a maximum of $2,000 | 100% of U&C charges up to a maximum of $2,000 |
| Mental and Nervous Disorders | Bronze Plan | Silver Plan | Gold Plan |
| Inpatient expense benefit maximum | $10,000 | $10,000 | $10,000 |
| Outpatient expense benefit maximum | $5,000 | $5,000 | $5,000 |
To find out more information, email insurance@isminc.com or call 302-656-4944.