You must enroll for the full duration of your program or sponsored activity with Texas A&M University System. The earliest your coverage can begin is two days from now. Rates are based on full months and are not prorated. You may purchase coverage for additional days directly before and/or after the actual dates of your program, but the total number of additional days may not exceed 30. Coverage must be in place for the full duration of time on the program, including any time spent on campus prior to the commencement of classes/sponsored activities and must be purchased in a single transaction (month-by-month enrollments are not permitted). If coverage is desired for a subsequent term at a later time due to a change of plans, it should be purchased with an effective date which directly follows the end date of the current policy so as to ensure there are no gaps in coverage.
Certain policy conditions (such as the waiting period for pre-existing conditions) will automatically reset in the event that coverage periods are not consecutive. Please note that this is considered a short-term limited duration policy. The policy does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”). Benefits and exclusions can be found within the brochure on the left-side menu and should be carefully reviewed prior to waiving out of any other plans that may be offered to you.

Participant Enrollment Information:

To secure coverage, sign up here:

Dependent Enrollment Information:

To enroll your dependents, please complete the “Dependent Enrollment Form” posted on the left-side menu bar and submit to enrollments@mycisi.com. You must be enrolled in this coverage in order for your dependent(s) to be enrolled. Dependent coverage dates cannot exceed your coverage dates.

Coverage Summary

Schedule of Benefits

Coverages and Services	Maximum Limits
TRAVEL ACCIDENT INDEMNITY INSURANCE
Accidental Death and Dismemberment Per Insured Person	$10,000
ACCIDENT AND SICKNESS INSURANCE
Medical expenses (per Covered Accident or Sickness):
Benefit Maximum	$500,000
Annual Deductible	$250 In-Network / $500 Out-of-Network
Coinsurance	80% In-Network / 60% Out-of-Network
Out-of-Pocket Expense Maximum	$2,500 In-Network / $5,000 Out-of-Network
Student Health Center Copay	$0
Office Visit Copay	$25 In-Network / $50 Out-of-Network
Hospital Copay	$100 In-Network / $200 Out-of-Network
Emergency Room Copay (waived if admitted)**	$200 In-Network / $400 Out-of-Network
MRI/Cat Scan Copay	$100 In-Network / $200 Out-of-Network
Prescription Drugs (Inpatient/Outpatient)	80% of Covered Expenses
**The Emergency Room Copay will be waived if the Insured Person is admitted to the Hospital as an inpatient or if the illness is life threatening. Life threatening means the illness will likely cause the death of the Insured Person.
TRAVEL ASSISTANCE INSURANCE
Emergency Medical Reunion	(incl. hotel/meals, max $100/day) $2,500
EVACUATION AND REPATRIATION INSURANCE
Emergency Medical Evacuation	$100,000
Repatriation/Return of Mortal Remains	$100,000
Security Evacuation (Comprehensive)	$50,000
NON-INSURANCE SERVICES

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

**The Emergency Room Copay will be waived if the Insured Person is admitted to the Hospital as an inpatient or if the illness is life threatening. Life threatening means the illness will likely cause the death of the Insured Person.
Please see the brochure posted on the left-side bar under ‘Brochure/Plan Info’ to view all plan benefits and exclusions.

This policy is a short-term limited duration insurance policy and provides coverage for individuals traveling outside of their home country. This policy does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”), and does not satisfy a person’s obligation to secure the requirement of minimum essential coverage under the Affordable Care Act (ACA).

In Case of Emergency

Please contact the Team Assist line by phone at 1-877-714-8179 (in the US) or +001 603-952-2660 (outside of the US - collect calls accepted) or email mail@oncallinternational.com. The Team Assist Emergency Assistance Provider is On Call International. Non-Emergency questions may be directed to CISI at 203-399-5130 (toll free 800-303-8120).

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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