The insurance program for study abroad students View this brochure as a PDF file

Schedule of Benefits | Eligibility | Period of Coverage | Premium Refunds | Basic Plan | Team Assist Plan | Optional Extra Protection Plan | Premium Rates | Exclusions | Definitions | Enrollment Form | For More Information

Eligibility

Eligibility Requirements Citizens of the U.S. who are enrolled as full-time students at U.S. institutions or on a recognized study abroad program and who are temporarily engaged in international educational or cultural activities outside their home country are eligible for coverage.

Period of Coverage

Once we accept your application and the correct payment, the effective date of your coverage is the latest of the following: (a) your requested effective date or (b) two days after the date the completed enrollment form and premium have been received by the Administrator. Coverage terminates when the first of the following occurs: (a) expiration of the period of requested coverage for which premium has been paid, (b) termination of participation in international education programs, (c) return to your country of domicile, (d) termination of the Master Policy.

Premium Refunds

Coverage may be canceled and premium refunded to the Insured, less a $15 administrative fee, provided the request is received in writing prior to the coverage start date.

BASIC PLAN

The Company will pay Covered Expenses due to Accident or Sickness only, as per the limits stated in the Schedule of Benefits. Coverage is limited to Covered Expenses incurred subject to Exclusions. All bodily Injuries sustained in any one Accident shall be considered one Disablement, all bodily disorders existing simultaneously which are due to the same or related causes shall be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement (including complications arising there from), the Disablement shall be considered a continuation of the prior Disablement and not a separate Disablement. Treatment of an Injury or Illness must occur within 30 days of the Accident or onset of the Illness.

When a covered Injury or illness is incurred by the Insured Person the Company will pay Reasonable and Customary medical expenses excess of the Deductible and Coinsurance as stated in the Schedule of Benefits. In no event shall the Company’s maximum liability exceed the maximum stated in the Schedule of Benefits as to Covered Expenses during any one period of individual coverage.

Covered Accident and Sickness Medical Expenses
Only such expenses, incurred as the result of a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in the Exclusions section, shall be considered as Covered Expenses:

• Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service 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 semiprivate room and board accommodation

  • Charges made for Intensive Care or Coronary Care charges and nursing services

  • Charges made for diagnosis, treatment and Surgery by a Physician

  • Charges made for an operating room

  • Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations

  • Charges made for the cost and administration of anesthetics

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

  • Charges for inpatient physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist

  • Dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon

  • Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items

  • Local transportation to or from the nearest Hospital or to and from the nearest Hospital with facilities for required treatment. Such transportation shall be by licensed ground ambulance only, within the metropolitan area in which the Insured Person is located at that time the service is used. If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense

  • Nervous or Mental Disorders are payable a) up to $500 for outpatient treatment; or b) up to $2,500 on an inpatient basis. The Company shall not be liable for more than one such inpatient or outpatient occurrence per lifetime under the Policy with respect to any one Insured

  • Chiropractic Care and Therapeutic Services shall be limited to a total of $50 per visit, excluding x-ray and evaluation charges, with a maximum of 10 visits per injury or illness. The overall maximum coverage per injury or illness is $500 which includes x-ray and evaluation charges.

If injuries result in death or dismemberment within one year after the date of Accident, the plan provides these benefits for loss of:

*Member means hand, foot or eye

Only one benefit, the largest to which you are entitled, is payable for losses from the same Accident. Please note: The death benefit will be paid to your estate unless you provide the name and relationship of your beneficiary at time of enrollment.

Emergency Medical Evacuation/Repatriation
The Company shall pay benefits for Covered Expenses incurred up to the maximum stated in the Schedule of Benefits, if any Injury or covered Illness commencing during the Period of Coverage results in the Medically Necessary Emergency Medical Evacuation or Repatriation of the Insured Person. The decision for an Emergency Medical Evacuation or Repatriation must be ordered by the Company’s appointed Assistance Company in consultation with the Insured Person’s local attending Physician.

Emergency Medical Evacuation or Repatriation means: a) the Insured Person’s medical condition warrants immediate transportation from the place where the Insured Person is located (due to inadequate medical facilities) to the nearest adequate medical facility where medical treatment can be obtained; or b) after being treated at a local medical facility, the Insured Person’s medical condition warrants transportation with a qualified medical attendant to his/her Home Country to obtain further medical treatment or to recover; or c) both a) and b) above.

Return of Mortal Remains or Cremation
The Company will pay the reasonable Covered Expenses incurred up to the maximum as stated in the Schedule of Benefits, Return of Mortal Remains, to return the Insured Person’s remains to his/her then current Home Country, if he or she dies.

Covered Expenses include, but are not limited to, expenses for embalming, cremation, a minimally necessary container appropriate for transportation, shipping costs, and the necessary government authorizations.

All Covered Expenses in connection with a Return of Mortal Remains must be pre-approved and arranged by an Assistance Company representative appointed by the Company.

Team Assist Plan (TAP)
The Team Assist Plan is designed by CISI in conjunction with the Assistance Company to provide travelers with a worldwide, 24-hour emergency telephone assistance service. Multilingual help and advice may be furnished for the insured in the event of any emergency during the term of coverage. The Team Assist Plan supplements the insurance benefits provided by Virginia Surety Company, Inc.

COMPREHENSIVE PLAN
You may purchase an insurance plan with higher coverage and added benefits than the basic. A semester is any period from one to six months. The Extra Protection Plan contains these additional benefits:

Accident and Sickness Medical Expenses
Your maximum medical benefit will be increased to $250,000 (from $50,000) for usual, customary and reasonable medical expenses. The per incident deductible will be reduced from $100 to $0.

Baggage and Personal Effects
The company will reimburse the Insured Person, up to the amount stated in the Schedule of Benefits, Baggage Loss, for loss, theft or damage to baggage and personal effects, provided the Insured Person has taken all reasonable measures to protect, save and/or recover his/her property at all times. The baggage and personal effects must be owned by and accompany the Insured Person at all times. Each claim is subject to a deductible of $50. There will be a per article limit of $100, except cameras, which have a limit of $250.

Emergency Medical Reunion
When an Insured Person is hospitalized for more than six days, the Company will arrange and pay for round trip economy-class transportation for a parent, spouse, sibling (over age 21) or legal guardian, from the Insured Person’s current Home Country to the location where the Insured Person is hospitalized. The benefits payable will include:

• The cost of a round trip economy airfare and their hotel and meals (to a maximum of $100 per day) up to the maximum stated in the Schedule of Benefits, Emergency Medical Reunion;
• All transportation in connection with an Emergency Medical Reunion must be pre-approved and arranged by an assistance company representative appointed by the Company.

Tuition Refund
The Company will pay 50% of any unreimbursed tuition expense up to $1,000 if you suffer a covered Injury or Sickness which prevents you from taking final examinations or make-up examinations. The condition must last at least four consecutive weeks and be certified by a Physician.

* This amount is in addition to the Basic Plan premium.
Rates are valid until December 31, 2009. Full months only, please.

For benefits listed in the Schedule of Benefits, this Insurance does not cover:

• • Pre-Existing conditions, defined as any Injury or Illness which meets the following criteria: 1) a condition that would have caused a person to seek medical advice, diagnosis, care or treatment anytime prior to the Effective Date of coverage under this Policy; 2) a condition for which medical advice, diagnosis, care or treatment was recommended or received anytime prior to the Effective Date of coverage under this Policy

  • Charges for treatment which is not Medically Necessary

  • Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes

  • Services, supplies or treatment, including any period of Hospital confinement, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician

  • Suicide or any attempt thereof, while sane or self destruction or any attempt thereof, while sane

  • Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war; or b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power

  • Routine physicals, immunizations, or other examinations where there are no objective indications or impairment in normal health, including routine care of a newborn infant, and laboratory diagnostic or x-ray examinations, except in the course of a Disablement established by a prior call or attendance of a Physician

  • Treatment of the Temporomandibular joint

  • Vocational, speech, recreational or music therapy

  • Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person

  • The refusal of a Physician or Hospital to make all medical reports and records available to the Company will cause an otherwise valid claim to be denied

  • Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes of this Policy, treatment of a deviated nasal septum shall be considered a cosmetic condition

  • Elective Surgery or Elective Treatment which can be postponed until the Insured Person returns to his/her Home County, where the objective of the trip is to seek medical advice, treatment or Surgery

  • Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids

  • Eye refractions 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 hereunder

  • Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent

  • Injury sustained while under the influence of or Disablement due to wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician for a condition which is covered hereunder

  • Any Mental and Nervous disorders or rest cures, unless otherwise covered under this Policy

  • Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services

  • Congenital abnormalities and conditions arising out of or resulting there from

  • Expenses which are non-medical in nature

  • The cost of the Insured Person’s unused airline ticket for the transportation back to the Insured Person’s Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided

  • Expenses as a result or in connection with intentionally self-inflicted Injury or Illness

  • Expenses as a result or in connection with the commission of a felony offense

  • Injury sustained while taking part in mountaineering where ropes or guides are normally used; hang gliding, parachuting, bungee jumping, racing by horse, motor vehicle or motorcycle, parasailing

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

  • Dental care, except as the result of Injury to natural teeth caused by Accident (limited to $250 per tooth per Injury)

• Routine Dental Treatment

• Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to:
  
  artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion

• Treatment for human organ tissue transplants and their related treatment

• Expenses incurred within the Insured Person’s home country or country of residence

• Weak, strained or flat feet, corns, calluses, or toenails

• Diagnosis and treatment of acne

• Injury sustained while the Insured Person is riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting from, any type of aircraft.

  
  
  In addition to the exclusions listed above, the following exclusions apply to Accidental Death and Dismemberment Insurance only:
  • Disease of any kind

  • Bacterial infections except pyogenic infection which shall occur through an accidental cut or wound

  • Neuroses, psychoneuroses, psychopathies, psychoses or mental or emotional diseases or disorders of any type.

Definitions

Accident or Accidental means an event, independent of Illness or self inflicted means, which is the direct cause of bodily Injury to an Insured Person.

Company Virginia Surety Company, Inc.

Hospital means except as may otherwise be provided, a Hospital (other than an institution for the aged, chronically ill or convalescent, resting or nursing homes) operated pursuant to law for the care and treatment of sick or Injured persons with organized facilities for diagnosis and Surgery and having 24-hour nursing service and medical supervision.

Illness means sickness or disease of any kind contracted and commencing after the Effective Date of this Policy and Disablement covered by this Policy.

Injury means bodily Injury caused solely and directly by violent, Accidental, external, and visible means occurring while this Policy is in force and resulting directly and independently of all other causes in Disablement covered by this Policy.

Insured Person(s) means a person eligible for coverage under the Policy as defined in “Eligible Persons” who has applied for coverage and is named on the application and for whom the company has accepted premium. Physician means a doctor of medicine or a doctor of osteopathy licensed to render medical services or perform Surgery in accordance with the laws of the jurisdiction where such professional services are performed, however, such definition will exclude chiropractors and physiotherapists.

Enrollment Form

Enrollment options:

• Enroll on-line in minutes using our new Internet enrollment feature, or
• View and print the enrollment form by first downloading a pdf file reader (if you don't already have it) and then select the enrollment brochure and form file

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