Colorado School of Mines – Office of Global Education - International Visitors

World Class Coverage Designed for Colorado School of Mines Office of Global Education - International Visitors

Rates:

Visiting Student/Scholar $148.95/month
Dependent $325.00/month

Important Enrollment Information: Please Read

You must enroll for the full duration of your program with Colorado School of Mines. The earliest your coverage can begin is two days from now.
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.