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CIGNA INTERNATIONAL COVERAGE

PERSONAL TRAVEL

When traveling outside of the United States for non Dartmouth related business, Dartmouth's OAP, CCF and HDHP coverage through Cigna, offers urgent and emergency care services for you and your covered family members. Click here for more information on the Cigna international urgent and emergency care program.


DARTMOUTH BUSINESS TRAVEL

MEDICAL BENEFITS ABROAD

As part of Dartmouth's OAP, CCF and HDHP coverage through Cigna, the MBA product, has everything you need to rest easy when you travel overseas on company business.

Cigna provides around the clock support, no matter what time zone you're in. Should something happen or you need assistance, all you have to do is call the number on the back of your Cigna MBA ID card. Assistance is available 24 hours a day, 7 days a week. From help coordinating your treatment plan to assistance with medical appointments and hospital admissions outside the U.S., with the exception of preventive care.  All you have to do is call the dedicated MBA phone number on your ID card. Access is also available to Cigna's medical team through the dedicated MBA phone number.

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CIGNA ENVOY®

Cigna offers Cigna Envoy, a central online resource designed exclusively for your needs. You can access Cigna Envoy for international business travelers through the Cigna Envoy website at www.CignaEnvoy.com

Cigna Envoy allows you to access information on nearly 200 countries before you even leave for your trip.

Through Cigna Envoy you can easily look up:

   •  Currency and exchange rates

   •  Immunization requirements

   •  Voltage requirements

   •  Country weather and time

   •  Disease prevention tips

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ELECTRONIC WELCOME KIT

You will also receive an electronic MBA Welcome Kit from Cigna. The MBA Welcome Kit will include:

   •  Concierge and Travel Assistance Services Flyer

   •  Notice of Privacy Practices

   •  Claim Form (in English; other languages available through the website)

   •  MBA Eligibility Verification Form

   •  MBA Envoy Flyer

   •  Certificate of Insurance

   •  MBA ID card

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ELIGIBILITY

Employee Eligibility: All active benefit eligible employees, enrolled in one of Dartmouth's Cigna health plans (OAP, CCF or HDHP), who are traveling on the business of, or at the expense of, the Policyholder outside their country of residence or permanent assignment.

Dependent Eligibility: For Dependent spouses, or domestic partner and dependent children {up to age 26 years} to be insured, they too must be enrolled in the eligible employee's health plan through Dartmouth, and will need to be traveling with the eligible employee, who is traveling at the expense of the policyholder outside their country of residence or permanent assignment. Dependents are not eligible for Accidental Death and Dismemberment coverage.

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COVERAGE/SCHEDULE OF BENEFITS

Effective Date:  February 1, 2014

BENEFIT BENEFIT AMOUNT
Accidental Death & Dismemberment Not Covered
Medical Evacuation/Repatriation Not Covered
Preventive Care Not Covered
Calendar Year Medical Benefit Maximum $500,000
Calendar Year Deductible $0.00
Coinsurance (paid by Cigna) 100%
Out of Pocket Coinsurance Maximum None
Prescription Drug 100% covered expenses
Emergency Dental Unlimited, subject to the calendar year maximum
Room & Board Outside US $1,000
Room & Board Inside US ** Average Semi-Private Room Rate
Pre-Existing Conditions None, Subject to the medical maximum
War Risk (Medical) Not Covered
War Risk (AD&D) Not Covered

* covered expenses when medically necessary while on an approved international business trip. This benefit also includes replacement medicine for lost prescriptions that are medically necessary during an international business trip.

**Pre-Admission Certification / Continued Stay Review is Required for all U.S. Hospitalizations

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CLAIMS

In order for your health claim to be considered for reimbursement, you and your employer must complete and sign the Eligibility Verification statement certifying that you are an eligible employee on an approved international business trip. Please return this completed statement, the MBA Claim Form and all original documentation/receipts from the treating doctor or hospital, including the date of treatment, the diagnosis and pertinent charges to Cigna at:

Cigna

Attn: Eligibility Unit

P.O. Box 15111

Wilmington, DE 19850-5111

Phone: (800) 243-1348 (US and Canada only)

Fax: (302) 797-3150

Website: www.CignaEnvoy.com

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INTERNATIONAL SOS (ISOS)

Dartmouth advises both business and vacation travelers to prepare in advance for emergencies. To help you prepare, Dartmouth has contracted with International SOS (ISOS). ISOS provides assistance to travelers and expatriates all over the world and offers the highest possible level of travel, medical, and security advice and services. Services range from telephone advice, medical referrals, legal aid, to full-scale evacuation by private air ambulance. The ISOS network of 5,000 employees, including multilingual critical care and aero-medical specialists, operates 24 hours a day, 365 days a year from over 26 ISOS Alarm Call-In Centers around the world. (http://www.internationalsos.com).  For more information on ISOS, please click here or contact the Risk Management Department at 603-646-2442.

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Last Updated: 7/7/17