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
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 ($200/day, max 10 days) |
Trip Delay | $1,000 ($200/day) |
Trip Interruption | $1,000 |
Emergency Medical Evacuation | $200,000 |
Repatriation/Return of Mortal Remains | $100,000 |
Security Evacuation (Comprehensive)* | $100,000 ($1M Aggregate) |
Team Assist Plan (TAP): 24/7 medical, travel, technical assistance |
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).