Cultural Insurance Services International
Yale University - International
Policy Number
CC005741
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
| Participants (under 35 years old) | $93.75 | $24 |
| Participants (over 35 years old) | $145.50 | $37 |
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).