University of Connecticut

Policy Number

GLM N10876795

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World Class Coverage Plan Designed For University of Connecticut

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

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Coverage Summary for Policy

GLM N10876795

Coverages and Services Maximum Limits
Accidental Death & Dismemberment:
Per Insured $10,000
Aggregate Limit Per Accident $1,000,000
Medical Expense (per Accident or Sickness):
Deductible $0 (zero)
Basic Medical $250,000 @100%
Accidental Dental 100% of Covered Expenses, up to policy limits
Pre-existing Conditions Coverage Limit 100% up to the first $10,000, secondary thereafter to policy max
Mental and Nervous Inpatient up to $5,000, Outpatient up to $2,500
Prescription Drugs (Inpatient/Outpatient) 100%
Maternity Covered
Nursery Newborn covered child Up to $500
Physiotherapy If recommended by a Physician and administered by a licensed physiotherapist
Specified Therapies and Spinal Manipulation, including acupuncture and physiotherapy:
Outpatient Limit Max of $50/visit; maximum of 10 visits; $500 overall maximum
Emergency Medical Evacuation $100,000
Repatriation/Return of Mortal Remains $100,000
Security Evacuation Comprehensive $100,000 ($1M aggregate limit)
Emergency Medical Reunion $3,000 ($300/day,10 day max)Hospitalized after 5 days
Trip Interruption $1,500
Trip Cancellation $1,500
24/7 Team Assist Package & CISI Crisis Team Included

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).