Benefits & Rates

STUDENT SERIES

SCHEDULE OF BENEFITS

BENEFIT DESCRIPTION

Plan Type

Gallagher Student Health Series

Coverage Area

Worldwide
Excluding Home Country

Rate Guarantee

12 months

Maximum Limit

Per Illness or Injury Maximum
Student: $750,000
Dependent: $150,000

 

Maximum Limit per Period of Coverage
Student: $1,000,000
Dependent: $150,000

Deductible

Outside of US:
$25 per illness/injury
US PPO Provider:
$25 per illness/injury
US Non PPO Provider:
$50 per illness/injury
Student Health Center: $5

Coinsurance
(following the applicable Deductible)

Outside of US:
Plan pays 100% of Eligible Expenses
US PPO Provider or
Student Health Center:
Plan pays 100% of Eligible Expenses
 US Non PPO Provider:
Plan pays 80% of the first $5,000 of Eligible
Expenses, then 100% thereafter

HOSPITAL SERVICES

Inpatient Room & Board

URC*

Intensive Care

URC*

Emergency Room – Injury

URC*

Emergency Room – Illness

URC*; subject to additional $250 deductible

Physical Therapy

URC* limited to 1 visit per day

Prescription Drugs

URC*

Mental & Nervous Disorders (including substance abuse)

URC up to $10,000 lifetime maximum
Student Health Center: $0

OUTPATIENT SERVICES
 

Outpatient Prescription Drugs

50% of actual charges

Outpatient Physical Therapy

URC* limited to 1 visit per day

Outpatient Mental & Nervous Disorders
(including substance abuse)

$50 per day; $500 lifetime maximum
Student Health Center: $0

OTHER SERVICES
 

Eligible Medical Expenses

URC*

Durable Medical Equipment

URC*

Local Ambulance

Per injury: Up to $750
Per illness: $750 only if admitted as in-patient

Dental

For Injury due to covered Accident: 
$500
For Sudden & Unexpected Pain:
$350

Maternity

Subject to Special Maternity Pre-Certification requirements, Same as any other illness.
Coinsurance:
Overseas: 100%
In PPO Network: 80%
Out of PPO Network: 60%

Routine Newborn Care

$750 maximum per period of coverage

Home Nursing Care (upon direct transfer from acute care Hospital)

URC*

Accidental Death and Dismemberment

Student: $100,000
Spouse:
$10,000
Dependent Child:
$5,000
Accident Dismemberment percentage of principal sum.

Terrorism Coverage
$50,000 lifetime maximum

Interscholastic/Intercollegiate/ Intramural or Club Sports

$5,000 maximum per injury/illness
ENHANCED OPTION - $10,000 maximum per injury/illness; 2.5% rate increase

Incidental Home Country Trip Coverage

Up to (2) cumulative weeks

Pre-existing Conditions

12 month waiting period, that can be reduced with proof of prior creditable coverage

Telemedicine

Included

Benefit/Treatment Period

60 day minimum

EMERGENCY SERVICES

 

Emergency Medical Evacuation

Up to $500,000 Lifetime Maximum
(independent of the Maximum Limit)

Emergency Reunion

Up to $500,000 Maximum

Return of Mortal Remains

Up to $50,000 Maximum

Political Evacuation

Up to $10,000 Lifetime Maximum

 

Non-US Citizens

     
Age
Student
Spouse
Dependent Child
 
0 - 30
$90.73
$476.83
$103.40
Platinum   
31 - 50
$244.78
$700.10
$103.40
 
51 - 64
$531.43
$700.10
$103.40

Non-US Citizens

     
Age
Student
Spouse
Dependent Child
 
0 - 30
$93.00
$488.75
$105.99
Enhanced   
31 - 50
$250.90
$717.60
$105.99
 
51 - 64
$544.72
$717.60
$105.99

**Please refer to the Certificate Wording for specific terms, conditions, and other details regarding benefits, limitations, eligibility, and exclusions outlined in this summary. The certificate wording prevails over any information provided in this summary and is available upon request prior to purchase.

 

SCHEDULE OF BENEFITS

BENEFIT DESCRIPTION

Plan Type

Gallagher Student Health Series

Coverage Area

Worldwide
Excluding Home Country

Rate Guarantee

12 months

Maximum Limit

Per Illness or Injury Maximum
Student: $750,000
Dependent: $150,000

 

Maximum Limit per Period of Coverage
Student: $1,000,000
Dependent: $150,000

Deductible

Outside of US:
$25 per illness/injury
US PPO Provider:
$25 per illness/injury
US Non PPO Provider:
$50 per illness/injury
Student Health Center: $5

Coinsurance
(following the applicable Deductible)

Outside of US:
Plan pays 100% of Eligible Expenses
US PPO Provider or
Student Health Center:
Plan pays 100% of Eligible Expenses
 US Non PPO Provider:
Plan pays 80% of the first $5,000 of Eligible
Expenses, then 100% thereafter

HOSPITAL SERVICES

Inpatient Room & Board

URC*

Intensive Care

URC*

Emergency Room – Injury

URC*

Emergency Room – Illness

URC*; subject to additional $250 deductible

Physical Therapy

URC* limited to 1 visit per day

Prescription Drugs

URC*

Mental & Nervous Disorders (including substance abuse)

URC up to $10,000 lifetime maximum
Student Health Center: $0

OUTPATIENT SERVICES
 

Outpatient Prescription Drugs

50% of actual charges

Outpatient Physical Therapy

URC* limited to 1 visit per day

Outpatient Mental & Nervous Disorders
(including substance abuse)

$50 per day; $500 lifetime maximum
Student Health Center: $0

OTHER SERVICES
 

Eligible Medical Expenses

URC*

Durable Medical Equipment

URC*

Local Ambulance

Per injury: Up to $750
Per illness: $750 only if admitted as in-patient

Dental

For Injury due to covered Accident: 
$500
For Sudden & Unexpected Pain:
$350

Maternity

Subject to Special Maternity Pre-Certification requirements, Same as any other illness.
Coinsurance:
Overseas: 100%
In PPO Network: 80%
Out of PPO Network: 60%

Routine Newborn Care

$750 maximum per period of coverage

Home Nursing Care (upon direct transfer from acute care Hospital)

URC*

Accidental Death and Dismemberment

Student: $100,000
Spouse:
$10,000
Dependent Child:
$5,000
Accident Dismemberment percentage of principal sum.

Terrorism Coverage
$50,000 lifetime maximum

Interscholastic/Intercollegiate/ Intramural or Club Sports

$5,000 maximum per injury/illness
ENHANCED OPTION - $10,000 maximum per injury/illness; 2.5% rate increase

Incidental Home Country Trip Coverage

Up to (2) cumulative weeks

Pre-existing Conditions

12 month waiting period, that can be reduced with proof of prior creditable coverage

Telemedicine

Included

Benefit/Treatment Period

60 day minimum

EMERGENCY SERVICES

 

Emergency Medical Evacuation

Up to $500,000 Lifetime Maximum
(independent of the Maximum Limit)

Emergency Reunion

Up to $500,000 Maximum

Return of Mortal Remains

Up to $50,000 Maximum

Political Evacuation

Up to $10,000 Lifetime Maximum

 

US Citizens

     
Age
Student
Spouse
Dependent Child
 
0 - 30
$72.20
$414.43
$78.05
Platinum   
31 - 50
$156.05
$604.55
$78.05
 
51 - 64
$335.45
$604.55
$78.05

US Citizens

     
Age
Student
Spouse
Dependent Child
 
0 - 30
$74.01
$424.79
$80.00
Enhanced   
31 - 50
$159.95
$619.66
$80.00
 
51 - 64
$343.84
$619.66
$80.00

**Please refer to the Certificate Wording for specific terms, conditions, and other details regarding benefits, limitations, eligibility, and exclusions outlined in this summary. The certificate wording prevails over any information provided in this summary and is available upon request prior to purchase.

BENEFIT LIMIT COMMENTS
Accidental Death & Dismemberment $100,000 Reduced to $10,000 for those under age 12 or age 70 and over
Medical Expenses - Primary
$100 deductible
No preexisting conditions Exclusion.
$10,000 Primary coverage; $2,500 of this limit is available to pay
U.S. or Canadian providers
Excess Medical Expenses - Optional
Preexisting conditions are Excluded.
Includes an additional $50,000 Emergency Medical Evacuation limit.
$40,000 For those age 0-59 at an additional $0.49 per diem
$90,000 For those age 0-59 at an additional $0.69 per diem
Excess Medical Expenses - Optional
Preexisting conditions are Excluded.
Does NOT include an additional Emergency Medical Evacuation limit.
$40,000 For those age 60-65 at an additional $1.40 per diem
$40,000 For those age 66-70 at an additional $3.05 per diem
Disability Income Benefit
(no benefit if under age 12 or 70 and over)
$1,000/month
$500/month
$250/month
First 100 Months — Accident
Months 101–200 — Accident
50 Months — Sickness (after 3 month waiting period)
Assistance Service Included Available 24/7/365 for assistance with worldwide medical emergencies; provided by Intana Global™
Emergency Medical Evacuation $100,000 Coordinated by Intana Global™; will bring participant back to USA if necessary
Crisis Management Service* Included Available 24/7/365 for assistance with worldwide non-medical emergencies; provided by red24
Security Evacuation* $100,000 Coordinated by red24; for evacuation due to crime, civil unrest, natural disasters, kidnap/hostage situations**
Family Coordination and Repatriation of Mortal Remains $25,000 Combined limit for both benefits and includes a sublimit of $2,500 for extra expenses incurred  during an approved evacuation
Personal Property
$100 deductible
$2,500 “Door to door” replacement cost coverage includes checked baggage; higher limits available upon request.
General Liability $1,000,000 Worldwide jurisdiction; includes coverage for injury to a volunteer; covers volunteer and sending organization
PARTICIPATION FEE $3.30 per person per day

By requesting that we enroll you or your group, you are agreeing to participate in International Helpers (Guernsey) Trust (IHT) for certain benefits and services. The Trust Participation Agreement is attached for signature and return with enrollment. Services & Benefits are provided by service contracts & insurance policies issued to IHT.

*The cost of a security evacuation is only insured up to $1,000 in countries and regions deemed Extreme Risk by red24, unless the volunteer is already in the country and insured by this plan when the country or region is elevated to Extreme Risk status. red24 cannot guarantee service in Extreme Risk areas. If you are traveling to an area that may be subject to this limitation, please contact us.

** While red24 will deploy a specialist or negotiator as needed, this benefit does not pay ransom amounts.

This brief summary is not an insurance policy; rather, it outlines some of the features of this coverage. For specific details, please contact our office or refer to the policy. This is not a major medical policy. Major Medical Coverage is available for individuals and groups on Short-Term and Long-Term international assignments. An Aggregate Limit of $20,000,000 applies to the above benefits. This limit provides the full $100,000 AD&D benefit for up to 200 persons in a common accident.

To participate and receive the services & benefits of IHT, complete the enrollment form and return along with your check made payable to: Gallagher Charitable International Insurance Services. In computing the number of days, count the departure day as well as the day of return. If the entire group is not traveling on the same dates, please attach a separate sheet grouping the volunteers by their travel dates.

To enroll, please visit www.TravelWithGallagher.com.

For questions, please contact gallaghercharitable@ajg.com

FACULTY SERIES

 

SCHEDULE OF BENEFITS

BENEFIT DESCRIPTION

Plan Type

Gallagher Student Health Series

Coverage Area

Worldwide
Excluding Home Country

Rate Guarantee

12 months

Maximum Limit

Per Illness or Injury Maximum
Student: $750,000
Dependent: $150,000

 

Maximum Limit per Period of Coverage
Student: $1,000,000
Dependent: $150,000

Deductible

Outside of US:
$25 per illness/injury
US PPO Provider:
$25 per illness/injury
US Non PPO Provider:
$50 per illness/injury
Student Health Center: $5

Coinsurance
(following the applicable Deductible)

Outside of US:
Plan pays 100% of Eligible Expenses
US PPO Provider or
Student Health Center:
Plan pays 100% of Eligible Expenses
 US Non PPO Provider:
Plan pays 80% of the first $5,000 of Eligible
Expenses, then 100% thereafter

 
HOSPITAL SERVICES
 

Inpatient Room & Board

URC*

Intensive Care

URC*

Emergency Room – Injury

URC*

Emergency Room – Illness

URC*; subject to additional $250 deductible

Physical Therapy

URC* limited to 1 visit per day

Prescription Drugs

URC*

Mental & Nervous Disorders (including substance abuse)

URC up to $10,000 lifetime maximum
Student Health Center: $0

 
OUTPATIENT SERVICES
 

Outpatient Prescription Drugs

50% of actual charges

Outpatient Physical Therapy

URC* limited to 1 visit per day

Outpatient Mental & Nervous Disorders
(including substance abuse)

$50 per day; $500 lifetime maximum
Student Health Center: $0

 
OTHER SERVICES
 

Eligible Medical Expenses

URC*

Durable Medical Equipment

URC*

Local Ambulance

Per injury: Up to $750
Per illness: $750 only if admitted as in-patient

Dental

For Injury due to covered Accident: 
$500
For Sudden & Unexpected Pain:
$350

Maternity

Subject to Special Maternity Pre-Certification requirements, Same as any other illness.
Coinsurance:
Overseas: 100%
In PPO Network: 80%
Out of PPO Network: 60%

Routine Newborn Care

$750 maximum per period of coverage

Home Nursing Care (upon direct transfer from acute care Hospital)

URC*

Accidental Death and Dismemberment

Student: $100,000
Spouse:
$10,000
Dependent Child:
$5,000
Accident Dismemberment percentage of principal sum.

Terrorism Coverage
$50,000 lifetime maximum

Interscholastic/Intercollegiate/ Intramural or Club Sports

$5,000 maximum per injury/illness
ENHANCED OPTION - $10,000 maximum per injury/illness; 2.5% rate increase

Incidental Home Country Trip Coverage

Up to (2) cumulative weeks

Pre-existing Conditions

12 month waiting period, that can be reduced with proof of prior creditable coverage

Telemedicine

Included

Benefit/Treatment Period

60 day minimum

EMERGENCY SERVICES

 

Emergency Medical Evacuation

Up to $500,000 Lifetime Maximum
(independent of the Maximum Limit)

Emergency Reunion

Up to $500,000 Maximum

Return of Mortal Remains

Up to $50,000 Maximum

Political Evacuation

Up to $10,000 Lifetime Maximum

 

US Citizens

     
Age
Faculty
Spouse
Dependent Child
 
0 - 30
$72.20
$414.43
$78.05
Platinum 
31 - 50
$156.05
$604.55
$78.05
 
51 - 64
$335.45
$604.55
$78.05

 

US Citizens

     
Age
Faculty
Spouse
Dependent Child
 
0 - 30
$74.01
$424.79
$80.00
Enhanced 
31 - 50
$159.95
$619.66
$80.00
 
51 - 64
$343.84
$619.66
$80.00

**Please refer to the Certificate Wording for specific terms, conditions, and other details regarding benefits, limitations, eligibility, and exclusions outlined in this summary. The certificate wording prevails over any information provided in this summary and is available upon request prior to purchase.

 

SCHEDULE OF BENEFITS

BENEFIT DESCRIPTION

Plan Type

Gallagher Student Health Series

Coverage Area

Worldwide
Excluding Home Country

Rate Guarantee

12 months

Maximum Limit

Per Illness or Injury Maximum
Student: $750,000
Dependent: $150,000

 

Maximum Limit per Period of Coverage
Student: $1,000,000
Dependent: $150,000

Deductible

Outside of US:
$25 per illness/injury
US PPO Provider:
$25 per illness/injury
US Non PPO Provider:
$50 per illness/injury
Student Health Center: $5

Coinsurance
(following the applicable Deductible)

Outside of US:
Plan pays 100% of Eligible Expenses
US PPO Provider or
Student Health Center:
Plan pays 100% of Eligible Expenses
 US Non PPO Provider:
Plan pays 80% of the first $5,000 of Eligible
Expenses, then 100% thereafter

 
HOSPITAL SERVICES
 

Inpatient Room & Board

URC*

Intensive Care

URC*

Emergency Room – Injury

URC*

Emergency Room – Illness

URC*; subject to additional $250 deductible

Physical Therapy

URC* limited to 1 visit per day

Prescription Drugs

URC*

Mental & Nervous Disorders (including substance abuse)

URC up to $10,000 lifetime maximum
Student Health Center: $0

 
OUTPATIENT SERVICES
 

Outpatient Prescription Drugs

50% of actual charges

Outpatient Physical Therapy

URC* limited to 1 visit per day

Outpatient Mental & Nervous Disorders
(including substance abuse)

$50 per day; $500 lifetime maximum
Student Health Center: $0

 
OTHER SERVICES
 

Eligible Medical Expenses

URC*

Durable Medical Equipment

URC*

Local Ambulance

Per injury: Up to $750
Per illness: $750 only if admitted as in-patient

Dental

For Injury due to covered Accident: 
$500
For Sudden & Unexpected Pain:
$350

Maternity

Subject to Special Maternity Pre-Certification requirements, Same as any other illness.
Coinsurance:
Overseas: 100%
In PPO Network: 80%
Out of PPO Network: 60%

Routine Newborn Care

$750 maximum per period of coverage

Home Nursing Care (upon direct transfer from acute care Hospital)

URC*

Accidental Death and Dismemberment

Student: $100,000
Spouse:
$10,000
Dependent Child:
$5,000
Accident Dismemberment percentage of principal sum.

Terrorism Coverage
$50,000 lifetime maximum

Interscholastic/Intercollegiate/ Intramural or Club Sports

$5,000 maximum per injury/illness
ENHANCED OPTION - $10,000 maximum per injury/illness; 2.5% rate increase

Incidental Home Country Trip Coverage

Up to (2) cumulative weeks

Pre-existing Conditions

12 month waiting period, that can be reduced with proof of prior creditable coverage

Telemedicine

Included

Benefit/Treatment Period

60 day minimum

EMERGENCY SERVICES

 

Emergency Medical Evacuation

Up to $500,000 Lifetime Maximum
(independent of the Maximum Limit)

Emergency Reunion

Up to $500,000 Maximum

Return of Mortal Remains

Up to $50,000 Maximum

Political Evacuation

Up to $10,000 Lifetime Maximum

 

Non-US Citizens

     
Age
Faculty
Spouse
Dependent Child
 
0 - 30
$90.73
$476.83
$103.40
Platinum   
31 - 50
$244.78
$700.10
$103.40
 
51 - 64
$531.43
$700.10
$103.40

Non-US Citizens

     
Age
Faculty
Spouse
Dependent Child
 
0 - 30
$93.00
$488.75
$105.99
Enhanced   
31 - 50
$250.90
$717.60
$105.99
 
51 - 64
$544.72
$717.60
$105.99

 

**Please refer to the Certificate Wording for specific terms, conditions, and other details regarding benefits, limitations, eligibility, and exclusions outlined in this summary. The certificate wording prevails over any information provided in this summary and is available upon request prior to purchase.

BENEFIT LIMIT COMMENTS
Accidental Death & Dismemberment $100,000 Reduced to $10,000 for those under age 12 or age 70 and over
Medical Expenses - Primary
$100 deductible
No preexisting conditions Exclusion.
$10,000 Primary coverage; $2,500 of this limit is available to pay
U.S. or Canadian providers
Excess Medical Expenses - Optional
Preexisting conditions are Excluded.
Includes an additional $50,000 Emergency Medical Evacuation limit.
$40,000 For those age 0-59 at an additional $0.49 per diem
$90,000 For those age 0-59 at an additional $0.69 per diem
Excess Medical Expenses - Optional
Preexisting conditions are Excluded.
Does NOT include an additional Emergency Medical Evacuation limit.
$40,000 For those age 60-65 at an additional $1.40 per diem
$40,000 For those age 66-70 at an additional $3.05 per diem
Disability Income Benefit
(no benefit if under age 12 or 70 and over)
$1,000/month
$500/month
$250/month
First 100 Months — Accident
Months 101–200 — Accident
50 Months — Sickness (after 3 month waiting period)
Assistance Service Included Available 24/7/365 for assistance with worldwide medical emergencies; provided by Intana Global™
Emergency Medical Evacuation $100,000 Coordinated by Intana Global™; will bring participant back to USA if necessary
Crisis Management Service* Included Available 24/7/365 for assistance with worldwide non-medical emergencies; provided by red24
Security Evacuation* $100,000 Coordinated by red24; for evacuation due to crime, civil unrest, natural disasters, kidnap/hostage situations**
Family Coordination and Repatriation of Mortal Remains $25,000 Combined limit for both benefits and includes a sublimit of $2,500 for extra expenses incurred  during an approved evacuation
Personal Property
$100 deductible
$2,500 “Door to door” replacement cost coverage includes checked baggage; higher limits available upon request.
General Liability $1,000,000 Worldwide jurisdiction; includes coverage for injury to a volunteer; covers volunteer and sending organization
PARTICIPATION FEE $3.30 per person per day

By requesting that we enroll you or your group, you are agreeing to participate in International Helpers (Guernsey) Trust (IHT) for certain benefits and services. The Trust Participation Agreement is attached for signature and return with enrollment. Services & Benefits are provided by service contracts & insurance policies issued to IHT.

*The cost of a security evacuation is only insured up to $1,000 in countries and regions deemed Extreme Risk by red24, unless the volunteer is already in the country and insured by this plan when the country or region is elevated to Extreme Risk status. red24 cannot guarantee service in Extreme Risk areas. If you are traveling to an area that may be subject to this limitation, please contact us.

** While red24 will deploy a specialist or negotiator as needed, this benefit does not pay ransom amounts.

This brief summary is not an insurance policy; rather, it outlines some of the features of this coverage. For specific details, please contact our office or refer to the policy. This is not a major medical policy. Major Medical Coverage is available for individuals and groups on Short-Term and Long-Term international assignments. An Aggregate Limit of $20,000,000 applies to the above benefits. This limit provides the full $100,000 AD&D benefit for up to 200 persons in a common accident.

To participate and receive the services & benefits of IHT, complete the enrollment form and return along with your check made payable to: Gallagher Charitable International Insurance Services. In computing the number of days, count the departure day as well as the day of return. If the entire group is not traveling on the same dates, please attach a separate sheet grouping the volunteers by their travel dates.

To enroll, please visit www.TravelWithGallagher.comFor questions, please contact gallaghercharitable@ajg.com.