rotary-international - Welcome Cultural Insurance Service International

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

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)

Get a Quote for CFAR Coverage

You are now being directed to Travel Insured International. On this page, you will be able to review a quote for Trip Cancellation for Any Reason and Trip Interruption for Any Reason. Please keep in mind this plan is completely separate from the CISI AIFS Abroad Insurance Coverage. This plan can be purchased with a major credit card.

Click here to proceed: Trip Cancellation & Interruption Protection for Academic Travel (culturalinsurance.com)

Provider List: Rome

Salvator Mundi International
Viale Mura Gianicolensi 67
00152 Roma
Tel: +39 06 588961
(Private Hospital)

Aventino Medical Group
Via Sant’Alberto Magno, 5, apt. 3,
00153 Rome, Italy
Tel: +39 06 5728-8349 or 06 578-0738
(Private Clinic)
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.

Mater Dei
Via Bertoloni, 34
Tel: +39-068-22-01
(Private Hospital)

EuroSanita (Villa Stuart)
Via Trionfala, 5952
00136 Roma
(Private Clinic)
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.

Casi di Cura Santo Volta Hospital
Piazza del Tempio di Diana, 13 Roma
(Private Hospital)
*Student should contact Team Assist before admission.

Paideia
Via Vincenzo Tiberio, 46
Tel: +39-063-309-41
(Private Clinic)

Valle Giulia
Via de Notaris, 2/8
Tel: +39-063-247-91
(Private Clinic)

Provider List: Seville

Dr. Julia Chabrera
Av. Reina Mercedes 29, Bajo, Ext. D.
41012 Sevilla
Tel: +34-954-61-26-40
clinicachabrera@gmail.com

Clinica Fatima
C/Fglorieta de Mexico No. 1
41012 Sevilla
Tel: +34-954-613-300
(General Practice Clinic)

Usp Clinica Sagrado Corazon
C/Rafael Salgado No. 3
41013 Sevilla
Tel: +34-954-937-676
(Multi specialty clinic)

Policlinica los Remedios
c/ Fernando IV 24, 41011
Seville, Spain
Tel: 34 954 279 786
esther.policlinica@hotmail.es
(General Practice Clinic)
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.

Centro Medico Nervion
Av. San Francisco Javier No. 18
41000 Sevilla
Tel: +34-954-659-955
(General Practice Clinic)

Provider List: Paris

American Hospital of Paris
63 Boulevard Victor Hugo 92200 Neuilly-sur-Seine, France
Tel: 01 46 41 25 25
(Private Hostpital)

Clinique Ambroise Pare
7 Boulevard Victor Hugo 92200 Neuilly-sur-Seine
Tel: 08 26 20 03 00
(Private Clinic)

Centre Medical Europe
44 rue d’Amsterdam 75009
Tel: 01.42.81.93.33
(Private Clinic)

International Medical Center of Paris
29 av. General Leclerc 75014 Paris
Tel: +33(0)143950055
Email: j.duplessisnelson@gmail.com
(Private Clinic)

Dr. Anne Valerie Meyers
10, Rue Royale – Dorrway C, 4th Floor – 75008 Paris
Phone: +33 (0)1 42 66 47 82
Email: avm@prontomail.com
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.
(General Practicioner)

Dr. Nancy Salzman
1 avenue de Lowendal – 75007 Paris – France
Phone: +33 (0)1 45 63 18 43
Email: drsalzman@noos.fr
(General Practitioner & Gynecology)

Justine Du Plessis Nelson
11, Rue Bosio – 75016 Paris – France
Tel: +33 (0)1.6.17.92.62. 50
Email: j.duplessisnelson@gmail.com
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.
(Mental Health / Psychologist)

Dr. Suzanne Black
+33 (0)6 3206 5806,
Email: drsuzablack@gmail.com (Appointment location will depdend upon treatment needs)
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.
(Mental Health / Psychologist)

Sharon Korman, Psychotherapy
91 Rue du Theatre – 75015 Paris
Tel: +33 (0)6 50 02 30 66, korman.lmft@free.fr
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.
(Mental Health / Psychotherapy)

Marie Rose Richardson
66 Rue de Lisbonne 75008 Paris
*You do not need to contact TeamAssist before visiting this provider. Your ID Card is sufficient.
(Mental Health)

Get a Quote for CFAR Coverage

You are now being directed to Travel Insured International. On this page you will be able to review a quote for Trip Cancellation for Any Reason and Trip Interruption for Any Reason. Please keep in mind this plan is completely separate from the CISI Boston College Travel Abroad Insurance Coverage. This plan can be purchased with a major credit card.

Click here to proceed: Trip Cancellation & Interruption Protection for Academic Travel (culturalinsurance.com)

Coverages and Services	Maximum Limits
Accidental Death and Dismemberment Per Insured	$10,000
Medical expenses (per Accident or Sickness):
Deductible	$0
Deductible for Emergency Room visits as a result of a Covered Sickness**	$200
Basic Medical	$100,000 at 100%
**The Emergency Room Deductible will be waived if the Insured Person is admitted to the Hospital as an inpatient or if the Sickness is life threatening. Life threatening means the Sickness will likely cause the death of the Insured Person.
Emergency Medical Evacuation/Repatriation	$100,000
Return of Mortal Remains	$50,000

PLAN DESIGNED FOR ROTARY INTERNATIONAL

PURCHASE YOUR POLICY

SPRING 2018 SEMESTER

SUMMER 2018 SEMESTER

Coverage Summary for Policy # STB009988804-IN