International Student Accident and Sickness: Comparison Chart

Schedule of Benefits

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 $10,000 $10,000 $10,000
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
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenza type b
  • Hepatitis A, Hepatitus B
  • Human Papillomavirus
  • Inactivated Poliovirus
  • Influenza (Flu Shot)
  • Measles
  • Meningococcal, Pneumococcal
  • Rotavirus, Varicella
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 $1,000 $1,000
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
Hospital 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 $2,500 $2,500 $2,500
Outpatient expense benefit maximum $1,000 $1,000 $1,000

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.

Attention College Students: If you are interested in ISM's International College Student Accident and Sickness coverage please contact Tascha Gourley for more information and an enrollment application, or click here to enroll online.

Learn More

Contact ISM's International Student Accident and Sickness Administrator, Tascha Gourley by email, or call 302-656-4944.

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