The University of New Haven

Policy Number

GLM N18157159


World Class Coverage Plan Designed For The University of New Haven

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

Coverage Summary for Policy

GLM N18157159

Coverages and Services Maximum Limits
Accidental Death & Dismemberment Per Insured: $10,000 ($1,000,000 Aggregate limit Per Accident)
Medical Expense (per Accident or Sickness):
Deductible $-0- (zero)
Basic Medical $150,000 @100%
Accidental Dental 100% of Covered Expenses, up to policy limits
Dental Palliative $50 max/$250 per tooth
Pre-existing Conditions Coverage Limit Up to $2,500
Mental and Nervous Inpatient up to $5,000, Outpatient up to $2,500
Pregnancy Treated as any other illness
Newborn Nursery Care $500 max
Therapeutic Termination of Pregnancy $500 max
Prescription Drugs (Inpatient/Outpatient) 100%
Extension of Benefits 30 Days (secondary)
Physiotherapy If recommended by a Physician and administered by a licensed physiotherapist
Outpatient Chiropractic Care Max of $50/visit; maximum of 10 visits; $500 overall maximum
Emergency Medical Evacuation $100,000
Repatriation/Return of Mortal Remains $50,000
Security Evacuation Comprehensive $100,000 ($1M aggregate limit)
Emergency Medical Reunion $3,000 ($300/day,10 day max) Hospitalized after 5 days
Trip Delay Up to $500, delayed for over 12 hours, 5 day max, $100 per day
Trip Interruption Up to $1,000
24/7 Team Assist Package & CISI Crisis Team Included

Optional Coverage for Cancel for Any Reason and Trip Interruption for Any Reason
This plan is not mandatory and completely separate from the above CISI medical policy. The Cancel for Any Reason and Trip Interruption for Any Reason policy can be purchased by going to the following page.

Please contact the Team Assist line by phone at +1 312-935-1703 (collect calls accepted) or email 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).