Cultural Insurance Services International
Colorado School of Mines – Office of Global Education - International Visitors
Questions?
24/7 Emergency Assistance – Team Assist
Phone:
1-877-714-8179 (in the U.S.)
or
+001 603-952-2660
(call collect from outside the U.S.)
Emails:
mail@oncallinternational.com
Benefit or Claim Questions?
Contact CISI
(9AM-5PM EST Mon-Fri)
Phone: 1-203-399-5130
(toll free 1-800-303-8120)
Email: Claimhelp@mycisi.com
World Class Coverage Designed for Colorado School of Mines Office of Global Education - International Visitors
Rates:
| Visiting Student/Scholar | $146.95/month |
| Dependent | $323.00/month |
Important Enrollment Information: Please Read
Rates are based on full months and are not prorated. You may purchase coverage for additional days directly before and/or after the actual dates of your program, but the total number of additional days may not exceed 30.
Coverage must be in place for the full duration of time on the program, including any time spent on campus prior to the commencement of classes and must be purchased in a single transaction (month-by-month enrollments are not permitted). If coverage is desired for a subsequent term at a later time due to a change of plans, it should be purchased with an effective date which directly follows the end date of the current policy so as to ensure there are no gaps in coverage.
Certain policy conditions (such as the waiting period for pre-existing conditions) will automatically reset in the event that coverage periods are not consecutive.
Please note that this is considered a short-term limited duration policy. The policy does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”). Benefits and exclusions can be found within the brochure on the left-side menu and should be carefully reviewed prior to waiving out of the Colorado School of Mines Student Health Insurance Plan (SHIP).
Visitor Enrollment Information:
Dependent Enrollment Information:
To enroll your dependents, please complete the “Dependent Enrollment Form” posted on the left-side menu bar and submit to enrollments@mycisi.com. You must be enrolled in this coverage in order for your dependent(s) to be enrolled. Dependent coverage dates cannot exceed your coverage dates.
Please see the brochure posted on the left-side bar under ‘Brochure/Plan Info’ to view all plan benefits and exclusions.
Schedule of Benefits
| Coverages and Services | Maximum Limits |
|---|---|
| Accidental Death and Dismemberment Per Insured Person | $10,000 |
| Medical expenses (per Covered Accident or Sickness): | |
| Benefit Maximum | $2,000,000 |
| Annual Deductible | $100 In-Network / $250 Out-of-Network |
| Coinsurance | 80% In-Network / 60% Out-of-Network |
| Out-of-Pocket Expense Maximum | $2,000 In-Network / $4,000 Out-of-Network |
| Student Health Center Copay | $0 |
| Office Visit Copay | $25 In-Network / $50 Out-of-Network |
| Hospital Copay | $100 In-Network / $200 Out-of-Network |
| Emergency Room Copay** | $250 In-Network / $500 Out-of-Network |
| MRI/Cat Scan Copay | $100 In-Network / $200 Out-of-Network |
| Extension of Benefits | 30 days (up to $10,000) |
| Emergency Medical Reunion | (incl. hotel/meals, max $100/day) $2,500 |
| Emergency Medical Evacuation | $100,000 |
| Repatriation/Return of Mortal Remains | $100,000 |
| Team Assist Plan (TAP): 24/7 medical, travel, technical assistance | |
| **The Emergency Room Copay will be waived if the Insured Person is admitted to the Hospital as an inpatient or if the illness is life threatening. Life threatening means the illness will likely cause the death of the Insured Person. | |