Medical Expense Benefit Coverage Details

Please note that Global Learning Semesters does not take responsibility for errors or omissions in the description of coverage.  Final coverage policies are determined by AIG and the policies are subject to change.  Bolded highlights added.

Overall

If accidental injury or emergency illness occurs during the Period of Coverage, the program will pay, subject to a $100 deductible, reasonable and customary charges for Covered Expenses resulting from such occurrence, up to the Medical Expense maximum selected ($100,000 for Global Learning Semesters students).  The deductible is applied only once during any period of coverage. 

Only those expenses specifically described (see Covered Expenses) which are incurred within the Maximum Benefit Period (26 weeks from the onset of an injury or emergency illness) and which are not excluded (see exclusions) are considered Covered Expenses.

Initial treatment of an injury or emergency illness must occur within 72 hours of the accident or onset of emergency illness, defined as a condition requiring emergency care and/or hospitalization.

Covered Expenses

1. Charges made by a hospital for room and board, floor nursing and other services, exclusive of charges for professional services and with the exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the hospital's average charge for a semi-private room and board accomodation, or intensive care when medically necessary

2. Charges made for physician's diagnosis, treatment and surgery

3. Charges made for the cost and administration of anesthetics

4. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions and medical treatment

5. Charges for physiotherapy, if recommended by a physician, for the treatment of a specific disablement and adminstered by a licensed physiotherapist

6. Dressings, drugs and medicines that can only be obtained upon the written prescription of a physician or surgeon

7. Charges for miscarriage subject to a maximum benefit of $1,000

8. Charges for treatment of mental and nervous disorders subject to the following limits: up to a maximum of 30 days for in-patient care and one physician visit per day, to a 30 visit maximum, for out-patient care

Not Covered Expenses

1. Charges for Pre-existing Conditions, defined as any injury or illness for which a licensed physician was consulted or for which treatment or medication was prescribed within 12 months prior to the effective date of insurance, except for conditions that remained controlled by prescribed medication as long as the prescribed drugs and medicine (maintenance prescriptions) did not change during the 12 months prior to the effective date of insurance.  The costs of maintenance prescriptions, which were required or continued during the period of coverage, are not a covered expense

2. Services, supplies or treatment, including any period of hopsital confinement, which are not recommended, approved or certified as necessary and reasonable by a physician or expenses which are non-medical in nature

3. Expenses incurred as a result of or in connection with a) declared or undeclared war, or any act thereof; b) injury sustained while participating in professional sports, sponsored interscholastic or intercollegiate sports, or amateur athletic competition; c) intentionally self-inflicted injury, suicide while sane or attempted suicide while insane; d) scuba diving, mountain climbing, sky diving, professional or amateur racing, piloting an aircraft; or, e) commission of a felony

4. Expenses for a) pregnanc or childbirth; b) routine physicals; c) cosmetic or plastic surgery except as a result of an accident; d) elective surgery; e) dental care, except as a result of injury to natural teeth caused by an accident; f) eye refraction's or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured; g) alcoholism and drug addiction; h) treatement by a family member

5. Treatment paid for or furnished under any other individual or group policy, or other service or medical pre-payment plan arranged through an employer to the extent so furnished or paid, or under any mandatory government program or facility set up for treatment without cost to the individual.