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1 REVOLUTIONISING TRAVEL INSURANCE

2 Welcome to HealthCare International As a specialist provider of private medical and related personal insurances, we have the experience and global knowledge to give peace of mind to the global traveller. Emergencies and accidents are never welcome and if they happen when you are away from home, they come with an extra level of stress. If you are travelling anywhere in the world, alone or with your family, for pleasure or on business, we can make sure an incident never becomes a crisis. With our Annual Worldwide Multi-Trip Travel Insurance policy, we can help with such occurrences as a medical emergency, a missed flight, or a lost passport. All it takes is a single call to our emergency helpline - and we will do the rest. What does it cover? Our Annual World-Wide Multi-Trip Insurance covers most problems that you may encounter and will cover you and your family, whenever and wherever you are abroad. Optional extra Extreme pursuits, including most winter sports, scuba-diving, horse-riding, etc. How much does it cost? A single premium costs as little as $/ / 197 per adult aged 18 up to 64 years of age, $/ / 394 per adult aged 65 up to 74 years of age and $/ / 127 per child (including IPT). This will cover you regardless of your nationality. You are covered for as many trips abroad each year you may wish to take, up to a maximum of 90 days per trip. Adults can travel independently, but children under the age of 18 must be accompanied by an insured adult.

3 Travel Plan Benefits $/ / 1. Cancellation & Curtailment 4,500 If you have to cancel or cut short your trip due to illness, injury, redundancy, jury service, damage to home, or police request following burglary, you are covered against loss of travel and accommodation costs. 2. Personal Accident 20,000 A cash sum for accidental injury resulting in death, loss of sight, loss of limb or permanent disablement. 3. Medical and Other Expenses 4. Hospital Benefit 5. Baggage and Personal Effects 6. Money and Documents 7. Loss of passport 2,000,000 The cost of hospital and other medical expenses incurred abroad, including additional hotel and repatriation expenses. A 24 Hour Emergency Service is available at any time, day or night, to provide immediate assistance. 600 An additional benefit of $/ / 15 per day for each day you spend in a hospital abroad as an in-patient. 1,500 Covers accidental loss or damage to your personal effects subject to a limit of $/ / 300 for any one article, pair or set and an overall limit of $/ / 300 for valuables such as cameras, jewellery, furs, etc. Delayed Baggage, up to $/ / Money, travel tickets and travellers cheques are covered against accidental loss or theft. (Cash Limit $/ / 200) 250 If you lose your passport whilst abroad you are covered for additional travel and accommodation costs incurred in obtaining a replacement. 8. Travel Delay 3,000 If your first outward or first return trip is delayed for more than 12 hrs due to adverse weather conditions, mechanical breakdown or industrial action, you are entitled to either (a) $/ / 20 for the first 12 hrs delay and $/ / 25 for each subsequent 12 hrs up to a maximum of $/ / 100 or (b) the cost of the trip if you elect to cancel after 12 hrs. 9. Missed Departure 800 Additional travel and accommodation expenses incurred to enable you to reach your destination if you arrive too late at your outward departure point due to failure of public transport or mechanical failure or accident involving the car in which you are travelling. 10. Personal Liability 1,000,000 Covers your legal liability for injury or damage to other people or their property, including legal expenses (subject to English Law). 11. Legal Expenses 10,000 To enable you to pursue your rights against a third party following injury. 12. Hijack 1,000 To pay up to $/ / 75 for each day you are prevented from reaching your destination.

4 How to apply To apply for you and your family, simply fill in the application form included with this brochure (extra copies of the application form, as with all our documentation, can be easily downloaded from our website at Once you ve filled in all parts of the form, you can send it to us either by Fax: + 44 (0) Post: HealthCare International, UK Administration Office, 160 Brompton Road, London, SW3 1HW United Kingdom You can also apply for the policy and pay your premium with complete security at If you have any questions about the cover provided or the conditions to your cover, us at or call us on + 44 (0) We re happy to guide you through the process. How to pay for your policy All HealthCare International Plans are issued in US Dollars, Sterling or Euros, but we are happy to accept payment in most other currencies - please contact us for the appropriate exchange rate. You can use any of the following methods of payment: bank transfer, banker s draft, cheque or American Express, MasterCard, VISA, Diners Club and most debit cards.

5 APPLICATION FORM Please complete in BLOCK CAPITALS Family Name: Mr/Mrs/Ms/Miss First Name: Address: Contact Details - Telephone: Period of Insurance: to Occupation: *Home Country: (Current residence) *Country of Origin: (Nationality on passport - see note below*) Passport Number: Disclosure: Are you aware of any circumstances, medical or otherwise, that could result in a claim under this insurance (see declaration)? YES NO If Yes, please give details on a separate page. Names of all persons to be insured (State Mr/Mrs/Ms/Miss) Date of Birth Premium $/ / Total Premium (inclusive of local tax if applicable) $/ / *1. Home Country (*HC): Means the country stated in the application form in which the Insured Person currently resides. 2. Country of Origin: (If different from the Home Country) Means the country stated in the application form for which the Insured Person holds a current passport. *Note: You are not insured for medical expenses within your country of Origin. If cover is required please advise HealthCare International. Credit Card Authorisation I authorise HealthCare International to charge my Amex Mastercard Visa Diners Club Other account in respect to my Travel Insurance Plan. Note: Please add 3% Processing Fee to the applicable rate. Card No: Expiry Date: Account mailing address if different: DECLARATION: I declare that to the best of my knowledge and belief the information given above is true and that all HEALTH CONDITIONS and MATERIAL FACTS have been disclosed to HealthCare International or the Underwriting Agents. I agree that this application shall be the basis of the Contract of Insurance. I understand that you may exchange information with other insurers or their agents to check the answers I have provided and you have authority to do so. Note: This Insurance is not effective until it has been accepted by HealthCare International and a Certificate has been issued. The policy will automatically renew each year until further notice. HealthCare International reserve the right to decline any application. DATA PROTECTION DECLARATION: We will collect certain information about you in the course of considering your application and, if we issue a policy to you, conducting our relationship with you. This information will be processed for the purposes of underwriting your insurance coverage, managing any policy issued and administering claims. We may pass your information to underwriters, medical practitioners, medical assistance companies and claims administrators for these purposes. This may involve the transfer of your information to countries that do not have data protection laws. You have a right of access to, and correction of, information that we hold about you. Please contact HealthCare International if you would like to exercise either of these rights. Some of the information we collect about you may be classified as sensitive - that is, information about racial or ethnic origin, and physical and mental health. Data protection laws impose specific conditions in relation to sensitive information, including in some circumstances the need to obtain your explicit consent before we process the information. Signature of applicant: Date:

6 TRAVEL PLAN CONDITIONS 1. Health conditions - Underwriting Agents shall not be liable for claims where at the time of taking out this insurance: (a) The Insured Person is aware of any medical condition or set of circumstances which could reasonably be expected to give rise to a claim; (b) Any person whose condition gives rise to a claim (i) has during the twelve months prior to the date of issue of this insurance suffered from any chronic and/or recurring illness of a serious nature which has necessitated consultation or treatment unless declared to and accepted by Underwriting Agents; (ii) is suffering from any previously diagnosed psychiatric disorder; or (iii) is receiving, or on a waiting list for, in-patient treatment in a hospital or nursing home; or (iv) is expected to give birth before, or within two months of the date of arrival home; or (v) is travelling against the advice of a Medical Practitioner or for the purpose of obtaining medical treatment abroad; or (vi) has been given a terminal prognosis. 2. Material facts - all must be disclosed to the Underwriting Agents. Failure to do so may affect your rights under the Insurance. A material fact is a fact likely to influence the Underwriting Agents in the acceptance or assessment of the Insurance (for example, your own state of health or that of a close relative). 3. Manual work and hazardous pursuits. 4. Winter sports (Unless underwritten by HealthCare International). 5. Self-inflicted injury or illness, AIDS, alcoholism or drug abuse. 6. Loss or theft of unattended property. 7. Loss or theft not reported to the police within 24 hours of discovery. 8. Excesses - The first $/ / 75 of any claim in respect of cancellation or curtailment, medical expenses, baggage, money or winter sports equipment is excluded. 9. This policy will automatically renew each year. This is not a private medical insurance. It is designed to help you cope with the unexpected. If you suddenly become ill or are injured overseas, this insurance will pay for emergency treatment only and if necessary any additional travel costs. Notice: Insurers and their agents exchange information for underwriting purposes and to prevent fraudulent claims. In dealing with your application, or in the event of a claim, information may be available to or sought from other insurers or their agents. UK Administration Centre, 160 Brompton Road, London, SW3 1HW, United Kingdom Tel: +44 (0) Fax: +44 (0) Web: Registration No Registered Office 2 Charles Street London W1J 5DB United Kingdom Authorised and Regulated by the Financial Services Authority HCI/TR/IB/10.07

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