World Class Coverage Plan Designed for Oakland University

Questions? 24/7 Emergency Assistance – Team Assist

Phone:
1-(855) 951-2326 (in the U.S.) or +001-(443) 470-3043 (call collect from outside the U.S.)

Emails:
medassist-usa@axa-assistance.us

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

Blanket Coverage Policy

Policy #:

24 STB010053401-OUT-ENR

INSURANCE COVERAGE UNDER SECTION I

This plan is ONLY for travel outside the U.S.
Travel within the US is not coverable and should not proceed in enrolling.

For Students

For Faculty and Staff

Note: After you put in your coverage dates and go to the next screen when registering, it will show up as $0.00 since this has already been paid by Oakland University.

Schedule of Benefits

(for additional plan details, see the Plan Information posted on the left sidebar)

INSURANCE COVERAGE UNDER SECTION I

INSURANCE BENEFITS	MAXIMUM LIMITS
Accidental Death and Dismemberment Per Insured	$10,000
Medical expenses (per Covered Accident or Sickness):
Deductible	zero
Benefit Maximum	$250,000
Scope	Primary
Home Country Extension Benefit:	$10,000 (up to 30 days)
Baggage Delay	Up to $200
Lost Baggage	($0 deductible, $100 per article) $250 max
Trip Cancellation	Up to $1,000
Trip Delay	$200/day up to 10 days
Trip Interruption	Up to $2,500

INSURANCE COVERAGE UNDER SECTION II

INSURANCE BENEFITS	MAXIMUM LIMITS
Emergency Reunion Benefit	up to $12,500 (incl. lodging, max $200/day and meals, max $100/day)
Emergency Medical Evacuation	$250,000
Repatriation of Mortal Remains	$250,000
Natural Disaster Evacuation	$100,000
Security Evacuation	$100,000

NON INSURANCE SERVICES

Team Assist Plan (TAP): 24/7 medical, travel, technical assistance

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