This plan is provided by Cultural Insurance Services International
and underwritten by Ace American Insurance Company
Coverages and Services | Maximum Limits |
---|---|
Accidental Death & Dismemberment: | |
Per Insured |
$10,000 |
Aggregate Limit Per Accident |
$1,000,000 |
Medical Expense (per Accident or Sickness): | |
Deductible | $0 (zero) |
Basic Medical | $200,000 @100% |
Accidental Dental | 100% of Covered Expenses, up to policy limits |
Dental Palliative | Up to $500 max, $250 per tooth |
Pre-existing Conditions Coverage Limit | Up to $10,000 primary, secondary thereafter up to policy max |
Mental and Nervous | Inpatient up to $5,000, Outpatient up to $2,500 |
Prescription Drugs (Inpatient/Outpatient) | 100% |
Nursery Newborn covered child | Up to $500 |
Pregnancy | Treated as any other illness |
Physiotherapy | If recommended by a Physician and administered by a licensed physiotherapist |
Specified Therapies and Spinal Manipulation, including acupuncture and physiotherapy: | |
Outpatient Limit | Max of $50/visit; maximum of 10 visits; $500 overall maximum |
Emergency Medical Evacuation | $250,000 |
Repatriation/Return of Mortal Remains | $50,000 |
Security Evacuation Comprehensive | $100,000 ($2.5M aggregate limit) |
Emergency Medical Reunion | $3,000 (300/day,10-day max) Hospitalized after 5 days. Immediate coverage for Felonious Assault. |
Quarantine Coverage | $2,000 |
Trip Delay | $500(12 hours, $100/day) |
Trip Cancelation | $2,000 |
Trip Interruption | $1,500 |
24/7 Team Assist Package (AXA) & CISI Crisis Team | Included |
Please contact the Team Assist line by phone at +1 312-935-1703 (collect calls accepted) or email medassist-usa@axa-assistance.us. The TeamAssist Emergency Assistance Provider is AXA Assistance.
Non-Emergency questions may be directed to CISI at 203-399-5130 (toll free 800-303-8120).
To seek recommendations for doctors or hospitals, please contact Team Assist at +1 312-935-1703 or email medassist-usa@axa-assistance.us. *We can make appointments for you.
CISI will make every effort to pay invoices directly to medical providers. Please notify CISI by contacting TeamAssist and we will make every effort to arrange to pay the doctor or hospital directly. If you prefer to pay yourself, then we will reimburse you (you may scan/email or fax the claim information to CISI and we will process it while you are still abroad, OR you may file the claim information after your trip). The average claim processing time at CISI is 2 weeks from receipt of claim information.
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