Boston College

World Class Coverage Plan Designed For

Boston College

This plan is provided by Cultural Insurance Services International and underwritten by Ace American Insurance Company

Coverage Summary for Policy

GLM N18221871

Coverages and Services Maximum Limits
Accidental Death and Dismemberment:
Per Insured $10,000
Aggregate Limit Per Accident $1,000,000
Medical Expenses (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 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).