Colorado School of Mines – Office of Global Education

Policy Number

GLM N16816826

Questions?

24/7 Emergency
Assistance – Team Assist
Phone: +1 855-327-1411
(in U.S.)
+001 312-935-1703
(call collect from outside the U.S.)
Email:
medassist-usa@axa-assistance.us

Benefit or Claim Questions?
Contact CISI
(9AM-5PM EST Mon-Fri)
Phone: 1-203-399-5130
(toll free 800-303-8120)
Email: Claimhelp@mycisi.com

World Class Coverage Designed for Colorado School of Mines – Office of Global Education

All Participants, except for
those who require a visa for Spain

Participants who require a visa
for Spain (90+ Days)

Rates

Trips up to 2 weeks in duration: $23.56

Trips over 2 weeks in duration: $47.89/month

Rates

Trips up to 2 weeks in duration: $26.74

Trips over 2 weeks in duration: $54.36/month

Coverage Summary for Policy

GLM N16816826

Schedule of Benefits

Coverages and Services Maximum Limits
Accidental Death and Dismemberment Per Insured Person $10,000
Medical expenses (per Covered Accident or Sickness):
Deductible zero
Benefit Maximum $100,000 at 100%
Benefit Maximum for Spain participants (90+days Visa Requirement)
Unlimited
Extension of Benefits 30 days
Emergency Medical Reunion $3,000
(incl. hotel/meals, max $300/day)
Quarantine $2,000
Trip Delay $1,000 ($200/day)
Trip Interruption $1,000
Team Assist Plan (TAP): 24/7 medical, travel, technical assistance
Emergency Medical Evacuation $200,000
Repatriation/Return of Mortal Remains $100,000
Security Evacuation (Comprehensive)
* Aggregate of $1M
$100,000

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).