University of Louisville International Travel

Policy Number

GLM N14285465

Plan Information

Plan Information (90+ Days in Spain)

Security Evacuation

Claim Form

myCISI Participant Guide

FAQs

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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 Plan Designed for University of Louisville International Travel

This plan is provided by Cultural Insurance Services International and underwritten by Ace American Insurance Company

Registration Links

PLEASE READ:

If you are traveling as part of a UofL group (faculty-led, ISLP, Athletics, etc.) do not register through this link. Once all the required paperwork has been received, the Office of Study Abroad and International travel will register you as part of the group.

You must use your UofL email account for the insurance to be active.

Please use your UofL ID number as your Sponsor Participant ID.

Particpant Registration (if NOT requiring a Spanish student visa)

Particpant Registration (for those requiring a Spanish student visa)

Employee Registration

Coverage Summary for Policy #

GLM N14285465

Schedule of Benefits

Coverages and Services	Maximum Limits
TRAVEL ACCIDENT INDEMNITY INSURANCE
Accidental Death and Dismemberment Per Insured Person	$20,000
ACCIDENT AND SICKNESS INSURANCE
Medical expenses (per Covered Accident or Sickness):
Deductible	zero
Benefit Maximum	$250,000 at 100%
Benefit Maximum for Spain participants requiring a visa (90+ days)	Unlimited
Extension of Benefits	30 days
Home Country Coverage Limit	$250,000
TRAVEL ASSISTANCE INSURANCE
Emergency Medical Reunion	(incl. hotel/meals, max $250/day) $5,000
Quarantine	$2,000 ($200/day)
Trip Cancellation	$5,000
Trip Delay	$500 ($100/day)
Trip Interruption	$2,000
PERSONAL PROPERTY INSURANCE
Baggage Delay	($100/item) $250 max
Travel Document Replacement (Includes prescription replacement)	($100/item) $250 max
EVACUATION AND REPATRIATION INSURANCE
Emergency Medical Evacuation	100% of Covered Expenses
Repatriation of Mortal Remains	100% of Covered Expenses
Security Evacuation (comprehensive)	$100,000 ($1M Aggregate)
NON-INSURANCE SERVICES
Team Assist Plan (TAP): 24/7 medical, travel, technical assistance

In Case of Emergency

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).

Need a Doctor?

Who Pays for Services?

CISI will make every effort to pay invoices directly to medical providers. Please notify CISI by contacting TeamAssist 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.

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