Rider University Study Abroad

Policy Number

25 GLM N16816516

Plan Information

Plan Information – Spain Participants (Requiring a Visa)

Claim Form

Participant Portal Guide

Dependent Enrollment Form

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 Rider University

This plan is provided by Cultural Insurance Services International and underwritten by ACE American Insurance Company, a member of the Chubb Group of Companies.

All Participants, except for those who require
a visa for Spain

Participants who require a visa for Spain
(Residing in Spain for 90+ days)

Coverage Period	Participant (Student/Faculty/Staff)	Per Dependent (Spouse/Child)
1-Week	$17.49	$37.60
2-Week	$34.98	$75.20
3-Week	$52.47	$112.80
Thereafter, Monthly*	$60.98	$131.58
(*longer than 21 days, monthly rate applies)

Enroll Now

Coverage Period	Participant (Student/Faculty/Staff)	Per Dependent (Spouse/Child)
1-Week	$18.39	$39.45
2-Week	$36.78	$78.90
3-Week	$55.17	$118.35
Thereafter, Monthly*	$63.92	$138.04
(*longer than 21 days, monthly rate applies)

Enroll Now

IMPORTANT: To enroll your dependent(s) that will be accompanying you, Click on dependent Enrollment Form and follow the instructions at the top.

Schedule of Benefits

Coverages & Services	Maximum Limits
TRAVEL ACCIDENT INDEMNITY INSURANCE
Accidental Death and Dismemberment Per Insured	$10,000
ACCIDENT AND SICKNESS INSURANCE
Medical expenses (per Accident or Sickness):
Deductible	zero
Benefit Maximum	$250,000 at 100%
Benefit Maximum for Spain participants (90+ days Visa Requirement)	Unlimited
TRAVELER ASSISTANCE INSURANCE
Emergency Medical Reunion	$2,500 (incl. hotel/meals, max $250/day)
Quarantine	$2,000 ($200/day, max 10 days)
Trip Cancellation	$2,500
Trip Interruption	$2,500
EVACUATION AND REPATRIATION INSURANCE
Emergency Medical Evacuation	$200,000
Repatriation/Return of Mortal Remains	$50,000
Security Evacuation (Comprehensive)	$100,000 ($1M Aggregate)
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