Claim Information

Outside the U.S.

CISI is always happy to pay a foreign provider directly, but many medical providers outside the United States prefer payment at the time of service for a minor illness or injury. You should be prepared to pay for services at the time of treatment for conditions such as a cold, sore throat, sinus infection or other common acute illnesses.
After payment, you can submit a claim to CISI for reimbursement. Complete the claim form and submit it along with a copy of your bill from the medical provider to CISI.

In the event of a serious illness or injury requiring expensive treatment or hospitalization, our goal is to have the hospital or facility bill CISI directly for covered treatment.
In these types of situations, you or a companion need to open a medical case with our 24/7/365 Team Assist provider. Team Assist is able to guarantee payments and has a network of local partners whom can make payments on your behalf if necessary.

For all emergency situations, seek treatment without delay. It is important to contact Team Assist, CISI’s 24/7/365 emergency assistance provider, as soon as possible once this occurs so that a case can be opened and additional arrangements can be made in a timely manner if necessary. Team Assist will then work with you and CISI to make sure that the appropriate measures are in place for proper case management. (Anyone can open up a case on behalf of an insured (overseas staff members, program administrators, parents, or friends of the insured are all acceptable options).
Once the call is made, Team Assist will:
Gather contact info for patient and nature of problem
Establish contact with a treating MD (may require translator)
Determine adequacy of care in overseas location as well as the short/long-term needs of patient
Determine stability for travel if applicable
Make all recommendations and arrangements
If a participant requires Team Assist assistance, their ID number is the policy number. That policy number, along with important contact information, can be found on the front of all CISI insurance ID cards, under “Emergency Contact Info” on the “myCISI” Participant Portal and the myCISI app.

My policy contains the letters "GLM" - Team Assist provided by AXA Assistance USA.

AXA card

They can be contacted, any time day or night at:
Toll Free in the U.S.: (855) 327-1477
Outside the U.S. (collect calls accepted): (312) 935-1703
Email: medassist-usa@axa-assistance.us

You can locate this information on the front of your insurance card.

My policy contains the letters "STI" or "STB" - Team Assist is provided by Assist America.

Assist America card

They can be contacted, anytime day or night at:
Toll Free in the U.S.: (800) 872-1414
Outside the U.S. (collect calls accepted): (609) 986-1234
Email: medservices@assistamerica.com
You will need to use reference ID# 01-AA-CIS-01133
You can also locate this information on the front of your insurance card.

By accessing your myCISI participant portal and clicking on International Provider Search, you can access a listing of over 10,000 providers worldwide. You have the ability to filter by country and city and facility type.

This listing includes CISI’s Preferred Providers listing which are indicated with an asterisks. Preferred providers are those that CISI has an existing relationship with and are more likely to bill CISI directly for more serious illnesses or injuries.

You should be prepared to pay out of pocket at the time of service for minor injuries or illnesses. After payment, you can submit a claim to CISI for reimbursement. Complete the claim form and submit it along with a copy of your bill from the medical provider to CISI.

If you’ve paid for medical services or prescription medication abroad, you can submit a claim to CISI for reimbursement. Reimbursements are made based upon your policy terms and conditions. A claim form will need to be completed and a copy of your bill from the medical provider can be submitted to CISI using one of the following methods:
Mail:
CISI
1 High Ridge Park
Stamford CT 06905
Please make a copy for your records if sending by mail.
Email: claimhelp@mycisi.com
Fax: 203-399-5596

Inside the U.S.

For illnesses or injuries that are not life threatening, please utilize our provider search tool to find a First Health Urgent Care, Walk in Clinic or Physician’s office near you. This Policy utilizes the First Health Preferred Provider hospital and Doctor network for the purpose of delivering quality health care at a preferred fee. You are not required to use the PPO network but you may incur expenses that are not covered under your policy by utilizing an out of network provider. Please contact CISI for additional information. You are also welcome to use Retail Clinics at CVS, Walgreens, Walmart, Target or Kroger stores.

If you visit a medical provider (doctor, hospital, clinic, etc) that is not in the First Health PPO network, you may be required to pay for these services yourself. If so, please specifically request an itemized bill from the medical provider to submit to your insurance. The itemized bill includes diagnosis and procedure codes necessary to process a claim. This type of bill is standard in medical billing in the United States. Once you have this, a claim form can be completed and submitted to CISI.

If you are being treated for an illness or injury which would otherwise be covered under your CISI policy, your physician prescribed medication would also be covered. All prescription medications must be paid by you to the pharmacy at the point of purchase. You are encouraged to download the Prescription Rx Card.
A claim for reimbursement can be made by submitting the prescription receipt and a completed claim form. The prescription receipt is normally stapled to the outside of the pharmacy bag and includes your name, your physician’s name, the name of the medication, the dosage and the amount charged. Cash register receipts will not be considered for reimbursement. Once you have this, a claim form can be completed and submitted to CISI.

How do I submit a claim?

A claim form should be completed. Please be sure to include a brief description of the accident or illness that treatment was received for. The claim form will need to be submitted with any itemized bills that you have.
Instructions:
Complete and sign the medical claim form, indicating whether the Doctor/Hospital has been paid.
Attach itemized bills for all amounts being claimed. *We recommend that you either make photocopies of the originals for yourself, or keep the originals and submit the photocopies to CISI in case anything gets lost in the mail.
When reimbursement of an expense is approved, it will be made to the provider of the service unless the bill is noted as having been paid by you.
Payment will be mailed in U.S. dollars unless otherwise requested.
If the payment is to you, it will be mailed to your U.S. address unless otherwise requested.

A claim for reimbursement can be made by submitting the prescription receipt and a completed claim form . The prescription receipt is normally stapled to the outside of the pharmacy bag and includes your name, your physician’s name, the name of the medication, the dosage and the amount charged. Cash register receipts will not be considered for reimbursement. If you no longer have the prescription receipt most pharmacies can reprint it for you. Reimbursement claims cannot be processed with register receipts.
For claim submission questions, call (203) 399-5130, or e-mail claimhelp@mycisi.com.

Claim forms are requested when additional information on an illness or injury is needed. Please complete the form detailing as much information as you can about your condition. Some information we could be looking for : If an illness: When did you first notice symptoms? What were the symptoms? Where you treated for this condition previously? If so, when? If an injury: Where were you when the injury happened? What were you doing? How did the injury occur?

You may have submitted a claim that did not include the diagnosis and procedure coding needed to process your claim. First, check your original submission. Did you submit a receipt or a statement from the medical provider? This is generally what is provided to patients but additional information is needed for insurance processing.
If you are looking for CISI to pay your claim to the medical provider
Contact the medical provider that has billed you and ensure that they have your insurance information. At the time you received our letter, we would have sent the same letter to the medical provider requesting the same bill. However, if you did not provide that medical provider with your insurance information, they may be unwilling or unable to send CISI the itemized bill due to privacy laws. You will need to submit your insurance information to the medical provider (there are usually spaces on the back of your statement from the facility with spaces to complete this information) and send it back to the provider. They also may be able to take this information from you over the phone. This way, they can send CISI what is needed directly.
If you are looking for reimbursement from CISI for medical services you have paid
You likely only submitted a receipt of payment to CISI. You can contact the medical provider whom you paid and ask for an itemized bill to submit to your insurance company. This type of billing is standard in the United States. The provider can send this bill to you and then you can resubmit a claim to CISI or the provider is welcome to send this directly to CISI.


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