Yale University - International

Policy Number

CC005741

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Brochure/Plan Info

Claim Form

Dependent Form

Questions?

Benefit or Claim Questions?
Contact CISI
(9AM-5PM EST Mon-Fri)
Phone: 1-203-399-5130
(toll free 1-800-303-8120)
Email: Claimhelp@mycisi.com

Enrollment Questions?
Email:
cisiwebadmin@mycisi.com
Phone: 203-399-5556

World Class Coverage Designed for Yale University International Participants

Self-Enrollment Information and Self-Enrollment Refund Policy

Eligible Participants must enroll for the full duration of their program with Yale University. The earliest the coverage can begin is two days from enrollment. If coverage for another term is not purchased prior to the expiration of the current policy term, Eligible Participants will not be able to retroactively enroll (i.e. backdate the effective date) under any circumstances. Certain policy conditions (such as the waiting period for pre-existing conditions) will automatically reset in the event that coverage periods are not consecutive.

Premium refunds are based on the following:

Premium Refund – If an Eligible Participant cancels prior to their insurance start date, a full premium refund will be issued back to them.

Rates

Participant Class Monthly Rates Weekly Rates
Participants (under 35 years old) $115.20 $30
Participants (over 35 years old) $178.80 $45.60

Enroll Here

Coverage Summary

Benefits Limits (In Network/Aetna) Limits (Out-of-Network)
Medical Expenses Limits:
Lifetime/Annual Maximum Unlimited Unlimited
Per Accident or Sickness $250,000 $250,000
Deductible – One Time Annual $100 $200
Pre-Existing Conditions Up to $5,000 during initial 6-month period; Covered up to policy limits thereafter Up to $5,000 during initial 6-month period; Covered up to policy limits thereafter
Coinsurance Percentage (%) 90% Coinsurance (In Network) 70% Coinsurance (Out-of-Network)
Out-of-Pocket Maximum $5,000 $10,000
Copays:
Emergency Room Copay (waived if admitted) $300 $600
Student Health Center Copay $0 $0
Physician/Outpatient/Dr. Visit Copay $25 $50
Hospital Copay $100 $200
MRI/CAT Scan Copay $100 $200
RX COPAY $0 $0
Prescription Drugs (inpatient/outpatient) Inpatient: 100% of Covered Expenses
Outpatient: 100% of Covered Expenses		 Inpatient: 100% of Covered Expenses
Outpatient: 100% of Covered Expenses
Maximum Benefit Period 52 weeks 52 weeks
Incurral Period 30 days 30 days
Primary/Secondary Primary Primary
Mental Nervous: Inpatient (30 days max) $5,000 $5,000
Mental Nervous: Outpatient (up to 30 visits max) $1,000 $1,000
Physiotherapy As any other condition As any other condition
Chiropractic Care/Therapeutic Services $50 per visit, $500 max $50 per visit, $500 max
Pregnancy (conception must occur while covered under this plan) Treated as any other Illness Treated as any other Illness
Newborn Nursery Care $500 Max $500 Max
Therapeutic Termination of Pregnancy $500 Max $500 Max
Emergency Reunion $2,500 (hospitalized 3 days) $2,500 (hospitalized 3 days)
Dental Injury Only Treated as any other Injury Treated as any other Injury
Dental Palliative $500 Max / $250 per tooth $500 Max / $250 per tooth
Sports Coverage Club/Intramural Covered (Intercollegiate Not Covered) Club/Intramural Covered (Intercollegiate Not Covered)
24/7 Team Assist Plan (TAP) Included Included
Medical Evacuation $250,000 $250,000
Repatriation of Remains $100,000 $100,000
Accidental Death & Dismemberment $10,000 ($1M aggregate limit) $10,000 ($1M aggregate limit)

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).