Florida Gulf Coast University – Business Travel

Policy Number

20 GLM N04983336BT-ENR

Plan Information

Claim Form

myCISI Participant Guide

FAQ

Questions?

24/7 Emergency
Assistance – Team Assist

Phone:
(inside the U.S.)
+1 855-327-1411
(call collect from outside the U.S.)
+001 312-935-1703

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 Florida Gulf Coast University – Business Travel

This international travel insurance program is provided to Florida Gulf Coast University employees only for university authorized business travel abroad and may not be used for personal travel or for persons not employed with the university. Questions about this insurance program may be directed to the FGCU International Services Office 239-590-7925.

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Coverage Summary for Policy #

20 GLM N04983336BT-ENR

Coverages & Services	Maximum Limits
Medical expenses (per Covered Accident or Sickness):
Deductible	zero
Benefit Maximum	$250,000 at 100%
Emergency Medical Reunion	$5,000 (incl. hotel/meals, max $200/day)
Quarantine Benefits	$2,500
Team Assist Plan (TAP): 24/7 medical, travel, technical assistance
Emergency Medical Evacuation	$200,000
Repatriation/Return of Mortal Remains	$50,000
Security Evacuation (Comprehensive)*	$100,000
*Aggregate of $1M

In Case of Emergency

Need a Doctor?

For help locating a doctor or hospital overseas, you can do either of the following:

-Contact Team Assist at +1 312-935-1703 or email medassist-usa@axa-assistance.us. Team Assist can make appointments for you;

-Log into the myCISI Participant Portal website and go to ‘International Provider Search’ or download our myCISI Traveler App (if you have not already done so) and utilize the ‘Locate a Provider’ tool. Select your Country and City, and a list of providers will populate. Please note that you can seek treatment at any medical facility abroad. There is no in-network nor out-network restrictions. (If you are enrolled, and you have not already created a myCISI log in, directions on how to create a log in after you are enrolled are provided in the ‘myCISI Participant Guide’. Please note: You cannot log in or create an account if you are not enrolled.)

Who Pays for Services?

CISI will make every effort to pay invoices directly to medical providers. Please notify CISI by contacting Team Assist and we will make every effort to arrange to pay the doctor or hospital directly. If you prefer to pay yourself, then we will reimburse you (you may scan/email or fax the claim information to CISI and we will process it while you are still abroad, OR you may file the claim information after your trip). The average claim processing time at CISI is 2 weeks from receipt of claim information. For additional information and guidance, please see click on myCISI Participant Guide or click on Plan Information to access the Brochure and see page 9, ‘Claim Information’.

Schedule of Benefits
Benefits	Limits
Medical Expenses Limits:
Lifetime/Annual Maximum	Unlimited
Per Accident or Sickness	$250,000
Per Occurrence Deductibles:
Emergency Room Deductible (waived if admitted)	$250
Call-A-Doc	$0
Physician/Outpatient/Dr. Visit	$100
Urgent Care	$50
Walk in Clinic	$25
MRI/CAT Scan	$0
Rx Copay	$0
Pre-Existing Conditions-12 Month Look Back; thereafter up to policy max	Up to $500
Coinsurance Percentage (%)	100% Coinsurance
Prescription Drugs (inpatient/outpatient)	Inpatient: 100% of Covered Expenses Outpatient: 100% of Covered Expenses
Mental Health	Inpatient up to 30 days/Outpatient 30 visits
Pregnancy (conception must occur while covered under this plan)	Treated as any other illness
Physiotherapy	Covered
Chiropractic Care & Therapeutic Services	Up to $500 max, $50 per visit
Emergency Reunion	$15,000 (hospitalized 3 days)
Home Country (Incidental Trips)	$1,000
Trip Delay (applies mid trip as well) 24-hour time	Up $1,500/daily limit $100
Political Evacuation	$10,000
Dental Injury Only	Up to policy max
Palliative Dental	$1,000max/$200 per tooth
24/7 Assistant Services & In-house Crisis Team	Included
Medical Evacuation	$50,000
Repatriation of Remains	$25,000
Accidental Death & Dismemberment	$15,000 ($1M aggregate limit)

Schedule of Benefits
Benefits	Limits
Medical Expenses Limits:
Lifetime/Annual Maximum	Unlimited
Per Accident or Sickness	$2,000,000
Per Occurrence Deductibles:
Emergency Room (waived if admitted)	$250
Call-A-Doc	$0
Physician/Outpatient/Dr. Visit	$50
Urgent Care	$50
Walk in Clinic	$25
MRI/CAT Scan	$0
Rx Copay	$0
Pre-Existing Conditions-12 Month Look Back; thereafter up to policy max	Up to $500
Coinsurance Percentage (%)	100% Coinsurance
Prescription Drugs (inpatient/outpatient)	Inpatient: 100% of Covered Expenses Outpatient: 100% of Covered Expenses
Mental Health	Inpatient up to 30 days/Outpatient 30 visits
Pregnancy (conception must occur while covered under this plan)	Treated as any other illness
Emergency Reunion	$15,000 (hospitalized 3 days)
Physiotherapy	Covered
Chiropractic Care & Therapeutic Services	Up to $500 max, $50 per visit
Home Country (Incidental Trips)	$1,000
Trip Delay (applies mid trip as well) 24-hour time	Up $1,500/daily limit $100
Political Evacuation	$10,000
Dental Injury Only	Up to policy max
Palliative Dental	$1,000max/$200 per tooth
24/7 Assistant Services & In-house Crisis Team	Included
Medical Evacuation	$50,000
Repatriation of Remains	$25,000
Accidental Death & Dismemberment	$15,000 ($1M aggregate limit)
Trip Interruption	$1,000
Personal Liability
Personal Liability Limit	$2,000,000
Liability deductible	$100
Medical Payments to Others	$25,000
Additional Living Expenses	$10,000
Payment of Homeowners Deductible	$1,000
Personal Property	$1,500