TERMS AND CONDITIONS FOR LIMITED HEALTH INSURANCE OF THE EXPAT-SERIES FOR LONG-TERM JOURNEYS PART II EXPAT FLEXIBLE

Transcription

1 TERMS AND CONDITIONS FOR LIMITED HEALTH INSURANCE OF THE EXPAT-SERIES FOR LONG-TERM JOURNEYS PART II EXPAT FLEXIBLE 1. INSURANCE COMPANY: Swiss Life Prévoyance et Santé, 7 rue Begrand, F Levaois-Perret, France 2. POLICY HOLDER: BDAE EXPAT GmbH 3. PARTIES ENTITLED TO Natura persons and ega entities INSURANCE: 4. INDIVIDUALS INSURABLE: Natura persons as parties entited to insurance or natura persons who are notified by ega entities as parties entited to insurance and their famiy members, if they are insurabe according to the terms and conditions of insur-ance part I, A, 1. The maximum insurabe age is 66 years. Insurance cover automaticay ceases at the end of the month prior to the month in which the insured person turns 67 years. Famiy members are spouses and chidren iving in the same househod. If Germany is the country of usua domicie the foowing appies: Persons who are required by aw to be insured under a compusory heath insurance are not insurabe. Insurance can be taken out within 31 days after entering Germany. The date of entry must be proven on request. Insurance can be provided for up to one year after entering Germany as ong as proof of continuous heath insurance cover provided by a German insurance company can be suppied or if the persons to be insured submit a heath certificate at their own expense which is not oder than 14 days. The poicy hoder reserves the right to conduct an independent risk assessment. 5. CONTRACTUAL BASIS: Terms and conditions for imited heath insurance of the EXPAT-series for ongterm journeys part I and part II (EXPAT FLEXIBLE). 6. AREA OF APPLICATION: 1. For temporary stays outside the countries where the insured person is usuay domicied, wordwide insurance cover is provided under consideration of the terms and conditions of insurance part I, A, 1, para. 4 and 5 and part II, number Countries of usua domicie of the insured person are fuy incuded in this insurance cover as ong as the respective coverage area incuding these countries has been opted for (Pease note the terms and conditions of insurance, part II, number 15). 3. It is in the insured persons responsibiity to ensure that this insurance cover meets the ega and oca requirements of a specific country. 4. This insurance cover does not correspond to a compusory heath insurance which is mandatory for a permanent domicie in the Federa Repubic of Germany. 7. START OF INSURANCE COVER: At the time specified in the insurance confirmation document subject to the terms and conditions of insurance part I, A, 4, but not before the commencing date of the stay abroad. 8. INSURANCE YEAR: From 1 January unti 31 December of a year. 9. DURATION OF INSURANCE EXPAT FLEXIBLE BASIS EXPAT FLEXIBLE PLUS COVER: Up to 60 months According to the duration of the Expat Fexibe basis modue 10. TERMINATION OF INSURANCE 1. The poicyhoder is obiged to inform the party entited to insurance and the insured persons about a termination COVER: of the framework insurance agreement at east two months before the termination becomes effective. 2. The insurance cover for singe insured persons may be terminated by the party entited to insurance or the respective insured person at any time. In this case the insurance cover ceases at the end of the month foowing the month in which the notice of termination has been submitted in writing to the poicy hoder. 3. If the party entited to insurance and the insured person are not identica, a termination becomes effective ony if the insured person affected by the termination has been informed accordingy and if the poicyhoder can prove to the insurance company at deregistration from the framework insurance agreement knowedge of the insured person about the termination of insurance cover. The insured person affected by the termination is entited to continue the insurance contract under designation of a new party entited to insurance. An appropriate decaration must be submitted within two months after receipt of the notice of termination. 11. PREMIUM PAYMENTS: The premium is an annua premium, which is broken down into equa monthy instaments. It is payabe in advance up to the end of each insurance year. 12. DATA ON INSURED PERSON'S Pease note the terms and conditions of insurance part II, 4.2. EXPAT FLEXIBLE as we as the excusion of benefits in STATE OF HEALTH: the terms and conditions of this insurance. effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com HEADQUARTERS: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ 1

2 13. BENEFITS: EXPAT FLEXIBLE BASIS EXPAT FLEXIBLE PLUS 13.1 OUTPATIENT TREATMENT: 100% of the amount invoiced for medicay necessary Not appicabe. outpatient treatment as a private patient, incuding radioogy, ight therapy and other physica treatments, if prescribed by a doctor, at reasonabe and customary rates INPATIENT TREATMENT: 100% for medicay necessary inpatient treatment and Not appicabe. treatment reated accomodation in a hospita for medicay necessary surgery, X-rays, radioogica treatment and diagnostics. As a private patient in a semi-private room outside Germany; in a standard room with statutory basic treatment inside Germany. (Pease note the terms and conditions of insurance Part I, B, 1 para. 6). Notwithstanding the terms and conditions of insurance part I, A, 6 para. 2b medicay necessary rehabiitation foowing inpatient treatment is covered PHARMACEUTICALS, BANDAGES AND MEDICINES: 100%, if prescribed by a doctor and medicay necessary. Not appicabe DENTAL TREATMENT: 100% of the invoiced amount for medicay necessary Not appicabe. outpatient denta treatment. Inays and onays are not covered. For each year of insurance cover a one-time checkup and prophyactic treatment for preventive purposes (incuding tooth poish and tooth ceaning) is covered TOOTH REPLACEMENT / OR- Not appicabe. Notwithstanding the terms and conditions of insurance THODONTIC TREATMENT: part I, A, 6, para. 2q after the expiry of the waiting period of 8 months 60% of the costs for newy occurred and medicay necessary tooth repacement are covered subject to authorized medica fee schedues for the respective treatment and - for orthodontic treatment up to the age of 18, - up to a maximum amount, however, of EUR 500 in the first insurance year, - up to EUR 800 in the second insurance year, - in every foowing insurance year up to EUR The waiting period does not appy to tooth repacement necessary due to an accident occuring during the insurance period subject to the imits isted above. The imits appy on a pro-rata basis for registration / deregistration during the insurance year. Benefits of a specific insurance year may not be transferred to other insurance years PREVENTIVE CHECKUPS: Not appicabe. Preventive outpatient medica examinations for eary detection of cancer in accordance with statutory programmes which have been introduced in Germany BENEFITS FOR PREGNANCY AND DELIVERY: Not appicabe. Not appicabe MEDICAL AIDS: Not appicabe. Notwithstanding the terms and conditions of insurance Part I, A, 6, para. 2g insurance cover is granted for medica aids in simpe form and their repair costs up to 80% of the amount invoiced, up to a maximum of EUR 1,000 per insurance year, provided the medica aid is medicay necessary and prescribed by a doctor. Visua aids are covered within the imits, up to EUR 50 per insured person and insurance year. The imits appy on a pro-rata basis for registration / deregistration during the insurance year PSYCHOLOGICAL THERAPY: Not appicabe. Not appicabe OTHER BENEFITS: a) 100% of the transportation costs to the nearest suitabe Not appicabe. hospita for inpatient treatment and for first aid after an accident to the nearest suitabe doctor and back. b) For medicay necesssary evacuation to the country where the insured person is usuay domicied, the insurance company wi reimburse - up to EUR 5,000 within a continent, - up to EUR 10,000 between continents. If an authorised air ambuance is medicay required, these imits do not appy. effective:

3 13.10 OTHER BENEFITS: The most economica method of evacuation has to be seected, as ong as this is possibe from the medica point of view. An evacuation is considered as medicay necessary, if at the actua ocation of the insured sufficient medica care is not avaiabe. A quaified certificate stating the medica necessity of an evacuation provided by the treating doctor has to be submitted CONTINUED LIABILITY: In the event that an evacuation of an insured person is Not appicabe. not possibe prior to the end of the ong-term journey due to a necessary and not predictabe treatment the insurer covers the costs of medica treatment up to the date of transportabiity for a period of maximum 30 days after the reguar insurance period has ceased. 14. WAITING PERIOD: No waiting period. 8 months for tooth repacement and orthodontic treatment. 15. MONTHLY PREMIUM: EXPAT FLEXIBLE BASIS EXPAT FLEXIBLE PLUS WORLDWIDE EXCLUDING USA / CANADA: USUAL DOMICILE INSIDE GER- 79,00 EUR 45,00 EUR MANY USUAL DOMICILE OUTSIDE GER- 79,00 EUR 45,00 EUR MANY If the coverage area wordwide excuding USA / Canada (with usua domicie inside or outside Germany) has been opted for this insurance aso covers hoiday or business trips to the USA or Canada with a duration of maximum 42 days per insurance year. However, the insurance cover is imited to acute necessary treatment. Chronic diseases, or diseases which have been treated or which preexisted before entering the USA / Canada, are not covered. The insurance company has to be notified before entering USA / Canada. Evidence of beginning and ending of the trip have to be provided if requested. WORLDWIDE INCLUDING 255,00 EUR 135,00 EUR USA / CANADA: 16. OTHER MATTERS: Changing of modues or adding an additiona modue is not permitted. No pension reserve fund wi be estabished. You are recommended to take out a dormant insurance poicy scheme. effective:

4 TERMS AND CONDITIONS FOR LIMITED HEALTH INSURANCE OF THE EXPAT-SERIES FOR LONG-TERM JOURNEYS (PART I - SWISS LIFE PRÉVOYANCE ET SANTÉ) PART A - GENERAL PROVISIONS 1 INSURABLE PERSONS AND INSURABILITY So far as has not been agreed to the contrary, the foowing sha appy: 1. The appication of insured persons in the framework insurance agreement can ony be submitted by the party entited to insurance. Parties entited to insurance are juridica and natura persons according to the respektive underying tariff conditions. 2. Natura persons may be insured. 3. Not insurabe and despite premium payment not insured are a) Persons who are in need of constant care. A person is in need of care if he/ she for the most parts needs externa hep in order to manage the tasks of daiy ife. b) Persons who are constanty excuded from participating in daiy ife. For this cassification, in particuar the menta state and the objectiv ife circumstances of the person must be considered. 4. No insurance cover is granted for insured persons, who are on a ong term domicied in the Federa Repubic of Germany. 5. Natura persons with a imited residence permit for the Federa Repubic of Germany may not be insured, if at the time of appying for registration in the framework insurance agreement the entire insurance duration of a heath insurance agreements concuded during the visit exceed a period of 5 years. 2 CONCLUSION AND DURATION OF THE INSURANCE CONTRACT 1. The framework insurance contract wi be concuded between the insurance company and the poicy hoder for the duration of a year. The framework insurance contract wi be extended by one year if notice of termination is not given with a term of notice of three months to the expiry date. 2. The ega reguations on the extraordinary right to give notice of termination remain unaffected. 3. At termination of the framework insurance agreement, the insurance company wi offer the insured persons continuation of the insurance cover. 3 PREMIUM, BENEFIT ADJUSTMENT, INSURANCE YEAR 1. The poicyhoder is entited to deregister individua insured persons from the framework insurance agreement because of non-payment of the premium. 2. Insurance company sha be entited to make changes in the premium eve or the extent of the benefits at the beginning of a new insurance year, provided that it notifies the poicyhoder of this with a term of notice of three months to the end of the agreed tariff insurance year. 3. The insurance year wi be defined in the conditions of insurance for heath insurance and sickness daiy aowance cover of the EXPAT-series for ong-term journeys conditions of insurance part II. 4. The poicyhoder sha be obiged to give the party entited to insurance and the insured person written notice of an adjustment of the premium eve or of the eve of benefits paid within a term of two months to the end of the agreed tariff insurance year. 4 SCOPE, START, DURATION, AND END OF INSURANCE COVER The insurance company sha offer insurance cover to insured persons, who are resident for a imited time in the context of a imited visit to the agreed tariff area in the context of these conditions of insurance. So far as has not been agreed to the contrary, the foowing sha appy: 1. The insurance cover starts for the insured person after binding registration into the framework insurance agreement at the time (start of insurance) specified in the insurance confirmation document, a) however not before start of the stay of the insured person in the agreed tariff area; b) not before effectiveness of the insurabiity of the insured person according to tariff; c) not before payment of the premium; d) not before expiration of waiting periods agreed according to tariff. 2. No insurance cover is granted for caims occasioned before or at start of insurance. 3. No benefits wi be paid for caims occasioned during the waiting period as agreed in the tariff. 4. The maximum duration of insurance cover for the insured person is defined in terms of the reevant tariff. 5. Insurance cover for individua persons insured comes to an end, even in connection with pending caims, with a) end of the insurance reationship of the insured person, at the atest however upon expiration of the maximum duration of insurance of the seect ed tariff; b) deregistration from the group of persons insured by the party entited to insurance, taking into account the terms of notice and conditions defined in the tariff; c) death of the person insured; d) with the ending of the insurabiity of an insured person according to conditions of insurance part I, A, 1; e) at the end of the month foowing termination of the temporary visit of the insured person in the agreed tariff area or fina return of the insured person to their native country; f) as soon as the tariff terms on the insurabiity of an insured person are inappicabe; g) with termination of the framework insurance agreement between the insurance company and the poicy hoder. 5 OBJECT OF INSURANCE COVER AND SCOPE OF INSURANCE BENEFITS So far as has not been agreed to the contrary, the foowing sha appy: 1. The insurance company sha offer insurance cover for urgent and unexpected insured events occurring during the stay in the agreed tariff area. 2. The insurance cover resuts from the insurance confirmation, these conditions of insurance, the seected tariffs, statutory reguations of the Federa Repubic of Germany. 6 GENERAL LIMITATIONS OF THE OBLIGATION TO PAY BENEFIT So far as has not been agreed to the contrary, the foowing sha appy: 1. Insurance cover is not granted for damage occasioned by active participation in strikes, war, war-ike events, civi disturbance, damages by nucear energy, as we as for such events, resuting from intentiona activities of the poicyhoder, effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ

5 the party entited to insurance or the insured person. 2. There is no obigation to pay benefit: a) On account of inesses and compaints incuding their consequences existing and known at start of the insurance cover. Furthermore, there is no insurance cover for the consequences of such inesses and accidents, which have been treated in the ast six months before start of insurance. b) For spa and sanatorium treatments as we as rehabiitation measures organised by party egay responsibe for rehabiitation; c) For treatments during a stay in a spa or a heath resort, even if this invoves a stay in hospita. This imitation sha no onger appy if the person insured has his/her constant pace of residence there or if he/she becomes unabe to work as a resut of a sickness independent of the purpose of his/her visit or as a resut of an accident that has occurred there, so ong as this resuts, on medica testimony, in his/her being unabe to journey home. This imitation aso sha no onger appy if and to the extent that the insurance company has given written consent to benefit being paid before the start of residence abroad. d) In consequence of an accommodation occasioned by the need of ingering iness, care or custody; e) For the treatment of menta or emotiona disturbances, or for hypnosis, psychoanaysis or psychotherapy; f) For immunisation measures; g) For medica aids; h) For treatment of steriity, incuding in vitro fertiisation we as pertinent preiminary examinations and subsequent treatments; i) For preventive medica examinations; j) For treatments by spouses, parents, chidren or persons iving together in the immediate domestic circe or persons iving together with the insured person within his/her own or guest famiy. Costs of materias wi be reimbursed in keeping with the given tariff. k) For treatment on account of such inesses, incuding their consequences, or consequences of such accidents as are occasioned through professiona participation in sporting competitions organised by sporting federations and associations or prenotory measures reated to these, or such as are recognised as war injuries and are not expicity incuded in the insurance cover. ) On account of withdrawa measures incuding courses of withdrawa treatment; m) On account of such inesses, incuding their consequences, which arise as a resut of the person's having negected to obtain the protective inocuations recommended by the Word Heath Organisation or prescribed by statute, uness there shoud be medica reasons why protective inocuation cannot be carried out. In this case, the medica reasons are to be proved to the insurance company by the submission of a doctor's certificate. n) For treatment of a dependency syndrome and its consequences; o) For attempted suicides and their consequences; p) For organ donations and their consequences; q) For tooth repacement (such as e.g. pivot teeth, insert fiings, crowns, impants) and orthodontic treatment, occusive overay aids and gnathoogic measures. Note: Pease aso regarded the Specia Obigations on excusions in the conditions of insurance, part I, B. 7 OBLIGATIONS AND CONSEQUENCES OF FAILURE TO OBSERVE TO OBLIGATIONS 1. Poicyhoder, parties entited to insurance and insured person are obigated, after occurrence of the insured event a) To avoid everything that coud ead to an unnecessitated increase in costs; 3. Start and end, as we as an interruption of a stay in the area according to tariff, as we as the presence of the tariff terms concerning insurabiity must be proved by the insured person on request of the insured company in the case of benefit. 4. If the poicy hoder, the party entited to insurance or the person insured wifuy infringes one of the contractuay agreed obigations, the insurance company sha be reeased from its obigation to pay benefits. In the case of a grossy negigent infringement of the obigation, the insurance company is entited to reduce the benefits by an amount commensurate with the seriousness of the faut of the poicyhoder, the party entited to insurance or the person insured. The onus of proving that there has been no gross negigence rests with the poicyhoder, the party entited to insurance or the person insured. 5. The party entited to insurance and the person insured are obigated to immediatey communicate changes of address to the poicyhoder. 8 PAYMENT OF INSURANCE BENEFITS So far as has not been agreed to the contrary, the foowing sha appy: 1. The insurance company sha be obiged to pay out benefits ony if the foowing documentary proof is suppied, which then become the property of the insurance company: a) Paid origina receipts, which must carry the first name, surname and date of birth of the person treated, name and address of the doctor treating the patient, the description of the iness, nature of the services provided by the treating doctor according to type, pace and treatment period. If compensation may be caimed under another insurance contract in connection with an insured event and if the caim has first been asserted for the other contract, then dupicates of the invoices wi be considered sufficient, provided that the other insurance company has made a note on the document of the benefit paid. The insurer may request transation into German or Engish, if the origina receipts or documents reevant for compensation are submitted in a foreign anguage. b) Prescriptions must be presented together with the doctor's bi, the bi for pharmaceuticas and medica aids together with the prescription. c) Proof of the amount of costs, which woud have ensued in the case of a reguar return journey, if benefits are asserted for a medicay necessitated return transport. Furthermore, a doctor's certificate, which shoud ceary demonstrate the medica necessity of return transport, must be submitted. d) For the assertion of caims in connection with conveyance of the body or funera costs an officia death certificate and medica certificate giving the cause of death must additionay be submitted. 2. Costs that have been incurred in a foreign currency wi be converted into the currency vaid in Germany at the exchange rate of the day on which the receipts are received by the insurance company, uness the foreign currency required for payment of the invoice was acquired at a ess favourabe rate and that this was caused by a change in the currency vauation. 3. Costs incurred for the payment of insurance benefit by banker's draft to a foreign country, or for specia forms of fund transfer which have been agreed on, wi be deducted from the benefit paid. 4. Caims to insurance benefit can neither be assigned nor given in pedge. 5. In connection with examining the benefits to be provided, it may be necessitated for the insurance company to obtain persona-reated heath data within the egay permitted scope. If the party entited to insurance or insured person fai to consent to this and the examination of benefits is not made possibe in other ways, and if the insurance company as a resut, is unabe finay to determine the amount and scope of its obigation to provide benefits, the benefits are not payabe. 6. One month after notification of a caim, the minimum amount which is payabe as matters then stand may be caimed as a payment on account. The said period stops running as ong as the insurance company s examination of the caim is hindered by faut on the part of the poicyhoder, the party entited to insurance, the insured person. 7. Caims under this framework insurance agreement sha become time-barred after three years. The imitation period begins at the end of the year in which the benefit may be demanded. b) To immediatey notify the insurance company or its agent of a damages that coud presumaby exceed a sum of EUR 1,000.00, c) To permit the insurance company or its agent to make a reasonabe examinations regarding the cause and amount of its duty to pay benefits, provide a reevant information in this connection, to submit origina documents, and submit a death certificate in the case of death. 2. If required by the insurance company, the insured person is obigated to be examined by a doctor assigned by the insurance company. 9 COMPENSATION FROM OTHER INSURANCE CONTRACTS AND CLAIMS AGAINST THIRD PARTIES 1. If compensation may be caimed under another insurance contract in an insured case, the other contract sha take precedence over this contract. This appies ikewise, even if a subordinate iabiity has aso been agreed upon in one of these insurance contracts, irrespective of when the other insurance contract was concuded. If the insured event was first communicated to the insurance company via this framework insurance agreement, the insurance company wi pay in advance and wi contact the other insurance company directy 2 effective:

6 concerning distribution of costs. 2. Caims of the poicyhoder, the party entited to insurance or the insured person against third parties pass to the insurance company to the statutory extent, as far as the insurance company has reimbursed the damage. If necessary, the poicyhoder, the party entited to insurance or the insured person is obigated to provide a statement of assignment to the insurance company. The insurance company s obigation to provide benefits is suspended unti the statement of assignment has been submitted. 3. Caims of the poicyhoder, the party entited to insurance or the insured person against a medica practitioners due to excessive fees pass to the insurance company to the statutory extent, if the insurance company has reimbursed the appropriate bis. If necessary, the poicyhoder, the party entited to insurance or the insured person are obigated to assist during assertion of caims. Furthermore, the poicyhoder, the party entited to insurance or the insured person are obigated, if necessary, to provide a decaration of assignment to the insurance company. The insurance company s obigation to provide benefits is suspended unti the decaration of assignment has been submitted. 10 OFFSET Poicyhoder, the party entited to insurance or the insured person is ony entited to a set-off against caims of the insurance company in the case of undisputed or finay asserted countercaims. 11 DECLARATIONS OF INTENTION AND NOTIFICATIONS Decarations of intention and notifications to the insurance company require the written form (Letter, fax, e-mai, eectronic data medium, etc.). The person insured has an intrinsic right to assert caims based on the contract against the insurance company. 12 APPLICABLE LAW / LANGUAGE OF THE CONTRACT German aw sha appy uness internationa aw takes precedence. The anguage of the agreement is German. 13 SURPLUS SHARING The insurance specified here is not entited to surpus. 14 SUPERVISORY AUTHORITY AND OMBUDSMAN If you shoud not be satisfied with a granted benefit or a decision of the insurance company, pease contact the respective insurance company directy. The Bundesanstat für Finanzdiensteistungsaufsicht (BAFin), Graurheindorfer Straße 108, Bonn, and the Autorité de Contrôe Prudentie et de Résoution (ACPR - French reguating authority), 61 rue Taitbout Paris France, are the responsibe authorities for any itigation regarding this insurance contract. In the case of any disputes regarding the practice of this contract, the poicyhoder and the insured persons need to expain the reason for the compaint or rejection in writing to the service department (Direction Services Cients), Assurances Coectives SwissLife Prévoyance et Santé - 7, rue Begrand Levaois-Perret Cedex France. If the answer is not satisfying, the poicyhoder and the insured persons may request the opinion of an independent mediator. The terms and conditions for impementation of the Ombudsman are avaiabe on request at the head office of Swiss Life Prévoyance et Santé 7, rue Begrand Levaois-Perret France. PART B SPECIAL PROVISIONS FOR INDIVIDUAL INSURANCES THE RELEVANT SECTION APPLIES IN DEPENDENCE ON THE INSURANCE COVER AND TARIFF SELECTED 1 OBJECT OF INSURANCE So far as has not been agreed to the contrary, the foowing sha appy: 1. Grounds of a caim sha be the medicay necessitated treatment of a person insured on account of iness or in consequence of an accident. The caim sha be considered to begin with the treatment, and sha end when medica findings indicate that there is no further need of treatment. If the medica treatment must be extended to an iness or consequence of an accident, with no causa connection to the previousy treated condition, then this is considered a new caim. abortions and deiveries up to the end of the 36th week of pregnancy (premature birth), even if the pregnancy had aready commenced at the start of the insurance reationship of the insured person, if the necessity for treatment was not yet obvious at this time; c) Deiveries after expiry of the waiting period according to the agreed tariff; d) Outpatient examinations for eary diagnosis of inesses according to programmes and introduced to the Federa Repubic of Germany and prescribed by statute (purposefu preventive medica checkups); e) Death. 3. The nature and amount of the insurance benefits sha be derived from these conditions of insurance of the respectivey seected tariff. 4. In the area of cover the insured person may choose from those medica doctors, dentists, icensed genera practitioners speciaised on aternative medicine and midwives who are practising on a egay approved basis in the insured s country of residence and who invoice on a ocay customary basis or - if appicabe - according to the officia scae of charges for their profession. 5. Pharmaceuticas, bandages, medicines and medica aids must be prescribed by the quaified practitioners mentioned in conditions of insurance section I, B, I, 1, para. 4. Pharmaceuticas may aso be obtained from a pharmacy. Nutriments, tonics, minera water, disinfectants and cosmetics, minera water, dietary, and baby food and the ike are not considered pharmaceuticas even if they have been prescribed. 6. In case of medicay necessitated hospita treatment, the person insured has free choice from among those pubic and private hospitas that are under constant medica supervision, possess sufficient diagnostic and therapeutic equipment and conduct case histories and do not provide heath resort respectivey sanatorium treatments or accept convaescent patients. Insurance protection is granted for the genera cass (mutipe bedrooms) without coverage options (private treatment by doctor). 7. In case of medicay necessitated hospita treatment in icensed hospitas, which aso carry out heath resort or sanatorium or convaescent treatments but which in other respects conform to the conditions of section I, B, I, 1, para. 6, benefits at the agreed rate wi ony be paid if the insurance company has given written consent to this before the start of the treatment. In case of a TB condition, benefit wi be paid to the extent defined by the contract for hospita treatment in TB treatment centres and sanatoria as we. 8. The insurance company wi pay benefit to the extent defined by the contract for examination and treatment methods and pharmaceuticas that are generay recognised by schoo medicine. It wi in addition pay benefit for methods and pharmaceuticas, which have proved themseves in practice to be equay ikey to achieve success; the insurance company may however reduce the eve of benefit to the amount that woud have been paid if existing schoo medicine methods or pharmaceuticas had been used. 9. The insurance company wi pay to the extent defined in the tariff the conveyance and funera costs, if the death of an insured person is the consequence of an insured event. 10.The insurance company carries additiona costs to the extent defined in the tariff for a medicay necessitated return transport prescribed by a doctor to the nearest suitabe hospita in the native country or to the permanent pace of residence of the insured person. Medica necessity for a return journey is given, if it is proven that in the agreed tariff area sufficient medica treatment is not ensured and the return journey is recommended by the doctor of the insurance company. The costs of an aso insured accompanying person are assumed, in as far the accompaniment is medicay necessitated, officiay ordered or required by the accompishing transport company. 2 SPECIAL EXCLUSIONS 1. So far as has not been agreed to the contrary, there is no obigation to provide benefits for treatments by doctors, dentists, icensed genera practitioner speciaised on aternative medicine, hospitas or midwives whose invoices the insurance company has excuded from reimbursement on good grounds. Precondition for this is that the insurance company has notified the party entited to insurance and the insured person before occurrence of the insured event and of the practitioner who wi not be reimbursed. In so far as at the time of notification a caim shoud be pending, no obigation to pay benefit for the practitioner concerned sha exist for expenses incurred after the expiry of three months from the time of notification being given. 2. In so far as the tariff defines the reevant benefits, further grounds for a caim sha aso be: a) Medicay necessitated treatment incuding pregnancy examinations, pregnancy treatments, in as far the pregnancy had not yet commenced at the beginning of the insurance reationship of the insured personas we as treatment for miscarriage; b) Medicay necessitated pregnancy treatment due to acute compaints caused by and treatment due to miscarriage as we as medicay necessitated 3 2. If the medica treatment or other measure for which benefit has been agreed upon shoud exceed the medicay necessitated imits, or if the remuneration caimed is out of proportion, the insurance company may reduce benefit to an acceptabe eve. 3 SPECIAL OBLIGATIONS AFTER OCCURRENCE OF THE INSURED EVENT 1. The insurance company is to be notified of any hospita treatment within ten days from its starting. effective:

7 2. The person insured must submit the reevant documentary evidence to the insurance company within three months from the time of each individua course of treatment. 3. If a person insured has concuded a contract for the insurance of medica expenses with another insurance company, if such exists or a person insured avais himsef/hersef of the entitement to insurance in connection with statutory heath insurance cover, the party entited to insurance or the person insured sha be obiged to notify the insurance company without deay of the other insurance cover arranged. 4. The insurance company is to be informed of a case of pregnancy within four weeks after the existence of a pregnancy has been estabished, uness defined otherwise in terms of the reevant tariff. 5. The insurance company is to be informed of medicay necessitated return transports before being carried out. 6. The ega consequences of a breach of one of these obigations are set out in conditions of insurance part I, A 7, para. 4. d to insurance and the person insured sha be obiged to inform the insurance company forthwith of the other insurance poicy. 3. The insurance company is to be notified without deay of any change of career by the person insured. 4. The party entited to insurance and the insured person must immediatey notify the insurance company of the termination of the empoyment contract between the party entited to insurance and the insured person. 5. A new insurance poicy with a third party insurer that incudes a caim to sickness daiy aowance may be taken out, or an existing one increased, ony with the consent of the insurance company. 6. Persons insured are obiged to notify the insurance company immediatey of a reduction in their net income derived from professiona activity, if this is not just a temporary condition, or of a change in the duration of continued saary payment by their empoyer. 4 effective:

8 B D A E G R U P P E PATIENT LEGAL EXPENSES INSURANCE FOR BDAE CLIENTS NEW: PATIENT LEGAL EXPENSES INSURANCE WORLDWIDE FOR THE FIRST TIME In addition to your heath insurance, BDAE has now arranged a patient ega expenses insurance for your stays abroad. This increase of benefits is provided on a compimentary-basis to your existing cover. Originay deveoped by the renowned ega insurer ARAG Group at the beginning of 2010, this product, foowing the cooperation between BDAE and ARAG, is now avaiabe on a wordwide basis. WHAT IS INSURED? The poicy responds to situations where the professiona negigence of doctors or other medica personne cause you serious harm. Athough the reationship between patient and doctor is based on a high eve of trust, even medica professionas are capabe of making mistakes. In such situations, it is difficut for patients to assert and protect their rights whie trying to resove a compicated confict about errors in treatment. Even more so when they are not abe to communicate directy with the doctor, but have to address his professiona indemnity insurers. The poicy covers ega cases up to One Miion Euro, word-wide. ARAG accepts a costs for ega and court expenses up to this imit. If required, ARAG wi aso recommend a awyer speciaised in heathcare aw. Additionay you have access to ARAG's onine patform where you have access to more than sampe etters and contracts from different areas, e.g. abour aw, famiy aw and transportation aw. The team of ARAG- JuraTe wi assist you with a free initia ega consutation for indemnity caims and vioations of crimina aw. Once per year you are aso entited to consut a awyer accredited in Germany to create or edit a Patient Decree and Power of Attorney - up to the costs of 250 Euro. WHAT ARE TREATMENT ERRORS AND AN INCORRECT CONSULTATION? Treatment errors are not merey instances of a pair of scissors being forgotten in the abdomen during a surgery they can aso incude incorrect advice given about the dosage of a medicine. A treatment error can aso be in the form of inappropriate or deayed treatment of a patient by a physician or surgeon. The faiure of a physician or a surgeon to advise a patient about the necessity or risks of a treatment is aso considered to be an act of professiona negigence and hence woud be covered under the poicy. This not ony appies to physicians but aso to hospita staff, psychotherapists, pharmacists and nursing service providers. They are equate to physicians in the patient ega expenses insurance. ABOUT ARAG The ARAG Group is an internationay renowned independent provider of ega services and is the argest famiyowned company in the insurance market. Apart from Germany, ARAG aso operates in 12 European countries and in the USA, where it has taken a eading position in the ega insurance market. ARAG is aso market eader with its ega insurance products in Spain and Itay. BDAE has been associated with ARAG since 2008 and the two companies have now deveoped the first ega expenses insurance for overseas stay and trave on a wordwide basis. effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ

9 MEDICAL ASSISTANCE FOR PERSONS INSURED BY BDAE AND MEMBERS OF BDAE For fast and smooth processing of medica services anywhere in the word, the BDAE GROUP has integrated an Assistance Programme into its insurance concept. The BDAE makes its Assistance services i.e. the aid, emergency and service offer avaiabe to its persons insured and members in coaboration with the speciaist AGA Service Deutschand GmbH (ALLIANZ GLOBAL ASSISTANCE). The foowing services to insured and members are incuded: 24 H BDAE EMERGENCY VIA Mutiingua, quaified 24-hour Emergency Hotine A wordwide network of medica service providers Information about (denta) medicine service providers (e.g. names, addresses and teephone numbers as we as consuting hours for doctors, dentists, hospitas and cinics within the region of the current pace of residence) Patient advice in routine cases and emergencies Assistance in arranging treatment appointments at hospitas and with doctors for outpatient treatment Organisation of hospita admission in the event of iness Hep and support to famiy members by means of provision of country specific heath care data and information Transfer of information between genera practitioner and hospita as we as message transfer service, where necessary Support in the obtention and shipment of prescription medicines (insofar as statutoriy permitted) Organisation of interpreting and transation services Access to wordwide medica information in German and in Engish Advice and support in the event of oss of important documents and means of payment In addition to the services isted above, BDAE assumes the costs for the services it covers, for which ALLIANZ GLOBAL ASSISTANCE seeks authorisation directy from BDAE and its risk carriers (insurer). These services incude: Organisation of emergency evacuations as we as transfers to appropriate hospitas in cases of medica necessity Organisation and impementation of repatriations to a vaue of up to 250,000 Euro per insurance event Impementation of and cost assumption for body repatriation in the event of death, for up to 10,000 Euro These services are avaiabe to persons insured by BDAE and members of BDAE 365 days a year, 24 hours a day. To ensure smooth processing in your deaings with the Assistance company, pease aways have your BDAE poicy or membership number ready when you contact ALLIANZ GLOBAL ASSISTANCE. effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ

10 NOTIFICATION AS PER 19 ABS. 5 VVG REGARDING THE CONSEQUENCES OF BREACHING THE DUTY OF DISCLOSURE In order for the Insurer to comprehensivey evauate an insurance appication a questions asked in the appication forms must be answered truthfuy and competey. Any information that the Appicant may consider to bear no significance must aso be provided. Any information the Appicant does not wish to provide to an insurance broker is to be reported to the Insurer directy without deay and in writing. Kindy be advised that insurance cover may be withdrawn or canceed in case fase, incompete or miseading information is provided to the Insurer. Pease find beow further detais regarding the consequences of breaching the duty of discosure. WHAT ARE THE DETAILS OF THE PRE-CONTRACTUAL DUTY OF DISCLOSURE? At the time of submitting the insurance appication the Appicant sha discose a information reevant to the risk requested by the Insurer in writing. A questions must be answered truthfuy and competey. A circumstances which may affect the evauation of the appication and the decision of the Insurer are considered being of reevance to the risk. Upon submission of the appication the Appicant is aso obiged to provide any additiona information requested by the Insurer prior to the poicy approva. WHAT ARE THE CONSEQUENCES OF BREACHING THE PRE-CONTRACTUAL DUTY OF DISCLOSURE? 1. RESCINDMENT OF CONTRACT AND WITHDRAWAL OF COVER The Insurer is entited to rescind the contract shoud the Appicant or an insured member suppress, misrepresent or misstate any materia fact, uness proof of absence of wifu intent or gross negigence is provided. In case of gross negigence, the Insurer is not entited to rescind the contract if the poicy woud have been issued despite the knowedge of the fu circumstances, even if contract aterations by the Insurer woud have been appicabe. Insurance cover is withdrawn in the event of contract rescindment. Shoud the Insurer rescind the contract after a caim has been submitted the Insurer is sti obiged to reimbursement, if the Insured Person proves that the reasons for the caim have no connection with the reasons for contract rescindment. The reimbursement obigation ceases, however, in case of wifu intent. The Insurer is entited to retain the insurance premium in case of contract rescindment up to the effective date of the rescindment. 2. CANCELLATION Shoud any breach of the pre-contractua duty of discosure not have occured due to wifu intent or gross negigence the Insurer is entited to cance the poicy with a notice period of one month. The right of poicy canceation by the Insurer sha not be appicabe if the poicy woud have been issued despite the knowedge of the fu circumstances, even if contract aterations by the Insurer woud have been appicabe. 3. CHANGE OF CONTRACT Shoud the Insurer not be entited to cance or rescind the existing contract, because cover woud have been offered despite the fu knowedge of the circumstances, abeit under different conditions, the circumstances sha become part of the contract retroactivey upon request by the Insurer, provided the Insured Person has suppressed, misrepresented or misstated any materia fact out of negigence. In case the premium after the change of contract is more than 10% higher than before or cover for the respective benefit ceases then the Insured Person sha be entited to cance the contract with immediate effect within one month after receiving the notification by the Insurer. The Insurer wi inform the Appicant about this right in the change of contract notification. 4. EXECUTION OF THE RIGHTS OF THE INSURER ( 21 VVG) The Insurer is entited to assert his rights of resindment, canceation or change of contract in writing within a period of one month. The term begins on the date on which the Insurer obtains knowedge of the breach of duty of discosure on which they caim and constitute their entitement to recede, cance or change the contract. Assertion of these rights sha be accompanied by a notification decaring the reasons for the Insurer as to why the contract is rescinded, canceed or changed. Further reasons may be added within the notification period. The right to rescind, cance or change the contract ceases if the Insurer had been aware of the circumstances or the breach of duty of discosure. The right to rescind, cance or change the contract ceases three years after concusion of the contract. This sha not appy to caims dated to within the period of three years after concusion of the contract. The period sha be extended to ten years if the breach of duty of discosure has occured out of wifu or maicious intent. 5. WILLFUL DECEIT ( 22 VVG) The right of the Insurer to contest the vaidity of the contract remains unaffected. 6. REPRESENTATIVE PERSON ( 20 VVG) In case of a third party representing the Insured Person at the time of appication and concusion of the contract any possibe wifu or maicious intent of both, the Representative and the Insured Person, are to be considered regarding any actions invoving breach of the duty of discosure, rescindment, canceation and the change of contract. The Insured Person sha ony be entited to caim absence of wifu intent or gross negigence when neither is to be imposed on the Insured Person nor its Representative. Pace, date: LEGAL INSTRUCTION AS PER 19 ABS. 5 SATZ 1 VVG LEGAL INSTRUCTION BY SWISS LIFE PRÉVOYANCE ET SANTÉ (INSURER) ADDITIONAL DECLARATION: The insurance contract appied for is governed by German aw, and is to be interpreted excusivey consistent with German aw and usage of terminoogy. This incudes, without imitation, the ega concepts and terms contained in the contract, the Engish transations of which may not be identica with the origina German terms in their respective ega understanding. In case of discrepancy between the German version of this contract and the Engish version, the German version prevais. Signatures: (appicant or ega guardian of persons who are to be incuded in the insurance and a aduts to be insured) effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ

11 B D A E G R U P P E DECLARATION AND INFORMATION ON DATA PROCESSING BY SWISS LIFE PRÉVOYANCE ET SANTÉ (INSURER) I. CONSENT TO THE COLLECTION AND USE OF HEALTH DATA AND DECLARATION OF RELEASE FROM SECRECY. The decarations of consent and of reease from secrecy printed under I. were prepared as coordinated between the Gesamtverband der deutschen Versicherungswirtschaft e.v. (GDV) and data protection authorities. The Insurance Contract Act, the Federa Data Protection Act and other data protection provisions do not incude an adequate ega basis for the coection, processing and use of heath data by the insurer. For this reason we need your consent as required by data protection aws. In the event of a caim, we may require your reease from secrecy in order to obtain your heath data from parties subject to secrecy (e.g. physicians). Furthermore, we require your reease from secrecy in order to discose your heath data or other data protected under Section 203 of the German Crimina Code, e.g. the fact that there is a contract with you, your customer number or other identification data, to other parties, e.g. assistance, ogistics or IT service providers. The foowing decarations of consent are indispensabe for the impementation or termination of your insurance contract (processing of your caim). Shoud you not submit these, it wi not usuay be possibe to enter into any contract. The decarations reate to the way we hande your heath data and other data subject to secrecy (under 1.), in connection with requesting these from third parties (under 2.) and when discosing them to parties externa to the insurer (under 3.) The decarations aso appy to persons egay represented by you who are incuded in the insurance, e.g. to your chidren, if they do not recognise the significance of this consent and thus cannot submit their own decarations. 1. CONSENT TO THE COLLECTION, SAVING AND USE OF YOUR HEALTH DATA I consent to Swiss Life Prévoyance et Santé coecting, saving and using the heath data notified by me in the future, provided hat this is required to impement or terminate the insurance contract. 2.REQUEST OF HEALTH DATA FROM THIRD PARTIES TO VERIFY THE DUTY TO INDEMNIFY To check our duty to indemnify it may be necessary for us to check information on your state of heath which you provided to substantiate caims or which is shown in the documents submitted (e.g. bis, prescriptions, expert opinions) or notifications, e.g. by a physician or other member of the heath profession. This verification is carried out ony to the extent necessary. To do so, we require your consent incuding a reease from secrecy for us and for these parties if, in the course of these requests, heath data or other information subject to secrecy are discosed. We wi inform you in each individua case of the persons or estabishments that are required to provide information and for what purpose. You can then decide in each case whether you consent to the coection and use of your heath data by the insurer, reease the persons or estabishments named and their empoyees from secrecy and consent to the transfer of your heath data to the insurer, or whether you wi provide the required documents yoursef. 3. DISCLOSURE OF YOUR HEALTH DATA AND OTHER DATA SUBJECT TO SECRECY TO PARTIES OUTSIDE SWISS LIFE PRÉVOYANCE ET SANTÉ We contractuay obige the parties named beow to observe provisions on data protection and data security DISCLOSURE OF DATA FOR MEDICAL ASSESSMENT To check our duty to indemnify, it may be necessary to ca in medica experts. We require your consent and reease from secrecy for this purpose if your heath data and other data subject to secrecy are transferred in this connection. You wi be informed of each transfer of data TRANSFER OF TASKS TO OTHER PARTIES (BUSINESS ENTERPRISES OR PERSONS) Heath data might be coected, processed and used. We have therefore transferred these tasks to other companies. If your data subject to secrecy are discosed in the course of this, we require your reease from secrecy for us and, where necessary, for other parties. We carry out a constanty updated ist of the parties and categories of parties that coect, process or use data subject to secrecy on our behaf as agreed. This ist shows the tasks which have been transferred to the individua parties. The currenty vaid ist is encosed directy with the decarations.1*). An up-to-date ist can aso be viewed on the Internet under We need your consent for the discosure of your heath data and for use of such data by these parties. I consent to Swiss Life Prévoyance et Santé transferring my heath data to the parties named in the ist mentioned above and to the coection, processing and use of my heath data by those parties for the purposes stated to the same extent as Swiss Life Prévoyance et Santé woud be aowed to do. Insofar as necessary, I reease the empoyees of the parties entrusted with this task from secrecy for the discosure of heath data and other data protected under Section 203 of the German Crimina Code. 4. DISCLOSURE OF DATA TO REINSURERS To ensure that your caims are satisfied, Swiss Life Prévoyance et Santé can concude contracts with reinsurers that partiay or competey assume the risk insured by us. In some cases the reinsurers use other reinsurers for this purpose to whom they aso transfer your data. To aow the reinsurer to check whether Swiss Life Prévoyance et Santé has correcty assessed a caim, Swiss Life Prévoyance et Santé might be required to present your caim documents to the reinsurer. effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ 1

12 To sette insurance caims, data on your existing contracts might aso be discosed to reinsurers. As far as possibe, anonymised and pseudoanonymised data are used for the purposes named above, but persona heath data might aso be used. Reinsurers use your persona data ony for the purposes named above. We wi inform you of the transfer of your heath data to reinsurers. I consent to Swiss Life Prévoyance et Santé transferring my heath data to the parties named in the ist mentioned above and to the coection, processing and use of my heath data by those parties for the purposes stated to the same extent as Swiss Life Prévoyance et Santé woud be aowed to do. Insofar as necessary, I reease the empoyees of the parties entrusted with this task from secrecy for the discosure of heath data and other data protected under Section 203 of the German Crimina Code. In accordance with artice 32 of the french data protection aw No of 6. January 1978, I am aware that my persona data is being processed by SwissLife Prévoyance et Santé. I can assert my rights of accessing and correcting my persona data in terms of artice 39 and 40 according to above-mentioned aw, by contacting SwissLife Marketing department, 1 rue du Ma de Lattre de Tassigny Roubaix Cedex 01 France, and for medica data: Swiss Life, 7 rue Begrand Levaois-Perret France. The for my process coected persona data wi be used by the Swiss Life Group, the receiver of the data aong with his deputies and reinsurers, under strict medica confidentiaity. I have to answer every given question, otherwise SwissLife Prévoyance et Santé cannot check the process. STATEMENTS BY THE INSURED PERSON(S) OR THE LEGAL REPRESENTATIVE OF THE PERSON(S) TO BE INSURED I hereby make the decarations on data processing submitted by the appicant or the person interested in insurance on my own behaf or on behaf of the person(s) to be insured. AGA Service Deutschand GmbH (assistance services) Experts (medica and nursing assessment and preparation of expert reports), Nursing services and providers of medica aids (arrangement of nursing services and medica aid providers), Patient repatriation transports (medicay necessary repatriation from abroad). BDAE Expat GmbH BDAE Diensteistungsgeseschaft mbh BDAE Hoding GmbH BDJ Versicherungsmaker GmbH & Co. KG II. DISCLOSURE OF DATA TO OTHER INSURERS Pursuant to the Insurance Contract Act the insured person must notify the insurer of a important circumstances for caim settement in case of damage. This can aso incude previous inesses and caims or notifications about other simiar insurance. In certain cases, such as doube insurance, ega subrogation and where there are cost sharing agreements, persona data must be exchanged between insurers. Aso to prevent any misuse of insurance it may be necessary to request information from other insurers or to provide suitabe information upon request. In the process, the data of the person affected are discosed, such as his or her name and address, type of insurance cover and the risk or information on the caim (type of damage, amount of caim, date of damage). Pace, date: Signatures: (appicant or ega guardian of persons who are to be incuded in the insurance and a aduts to be insured) effective:

13 effective: APPLICANT / PARTY TO INSURANCE: OVERSEAS HEALTH INSURANCE FOR OF UP TO 60 MONTHS EXPAT FLEXIBLE APPLICATION Surname: First name(s): Current occupation: No. of membership, if existing: Phone: Address: PAYMENT DETAILS: Fax: e-mai: Payment type*: oannuay oevery six month (+2%) oquartery (+3%) omonthy (+5%) Account / card hoder, if not appicant (pease sign beow aso): Bank: IBAN: BIC / SWIFT-Code: Credit Card (+6%)*: INFORMATION TO ADDITIONAL HEALTH INSURANCE: omaster-/eurocard ovisa odiners Vaid unti: Card-No.: Do you have additiona heath insurance?* ono oyes, with: Insurance -No.: THE FOLLOWING PERSONS ARE TO BE INCLUDED IN THE INSURANCE: (Pease consider appicant) Surname, First name(s) Nationaity Sex* m f Date of birth Panned country of residence EXPAT FLEXIBLE* Basis Pus Area of appication* wordwide without USA / Canada main country of residence is wordwide inc. in Germany outside Germany USA / Canada Arriva date in Germany** Monthy premium (EUR) Start of insurance (Month / Year) (*pease tick) (**Ony necessary if Germany is the choosen area of appication) In accordance with artice 32 of the french data protection aw No of 6. January 1978, I am aware that my persona data is being processed by SwissLife Prévoyance et Santé. I can assert my rights of accessing and correcting my persona data in terms of artice 39 and 40 according to above-mentioned aw, by contacting SwissLife Marketing department, 1 rue du Ma de Lattre de Tassigny Roubaix Cedex 01 France, and for medica data: Swiss Life, 7 rue Begrand Levaois- Perret France. The for my process coected persona data wi be used by the Swiss Life Group, the receiver of the data aong with his deputies and reinsurers, under strict medica confidentiaity. I have to answer every given question, otherwise SwissLife Prévoyance et Santé cannot check the process. BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ 1

14 I / we hereby appy for insurance cover as outined by the terms and conditions for imited heath insurance and sickness daiy aowance cover of the EXPAT-series for ong-term journeys Part I and Part II (EXPAT FLEXIBLE) for the persons isted above by registering them with the insurer as insured persons. The tota premium must be paid in advance in accordance with the chosen payment method. The premium debtor is the party of entited to insurance as concerns the poicyhoder, and the poicyhoder as concerns the insurer. I hereby give authorization to BDAE Hoding GmbH to debit the premiums from my account or credit card (see above). As service provider of the BDAE Expat GmbH the BDAE Hoding GmbH is authorized to administer its contracts to the fu extend and to coect debts. The debit wi be assignabe by the Creditor Identifier DE23ZZZ The individua mandate reference wi be discose on the Confirmation of Insurance Coverage. I hereby authorize my bank to redeem the debit notes presented by BDAE Hoding GmbH for the benefit of the insurer. Note: the premium is due after confirmation of insurance cover has been received and no ater than the beginning of the insurance. I / we am / are aware that the poicy hoder wi not register the isted persons as insured persons with the insurer or wi terminate their registration if the premium or other charges have not been paid in fu due to the actions of parties entited to insurance. I / we am / are aso aware that we do not have insurance cover in this case. Pace, date: Insurer: Swiss Life Prévoyance et Santé Poicy hoder: BDAE EXPAT GmbH Signatures: (Appicant or ega guardian of persons who are to be incuded in the insurance and a aduts to be insured and possiby different account hoder / card owner: effective:

15 HEALTH CERTIFICATE FOR APPROVAL OF AN APPLICATION FOR HEALTH INSURANCE EXPAT FLEXIBLE THE HEALTH CERTIFICATE IS REQUIRED IF THE USUAL DOMICILE IS GERMANY, AFTER AN ENTERING OF 31 DAYS EXAMINATION COSTS WILL BE BORNE BY THE APPLICANT! PLEASE NOTE TERMS AND CONDITIONS PART II, 4 HEALTH CERTIFICATE TOWARDS SWISS LIFE PRÉVOYANCE ET SANTÉ (INSURER) APPLICANT / PARTY ENTITLED TO INSURANCE: Surname: First name(s): Date of birth: Address: 1. DECLARATION TO THE DOCTOR: 1.a Are you currenty suffering from compaints, inesses or the resuts of accidents? 1.b Do you or have you suffered from a chronic or repetitious iness? 1.c Have you been examined, advised or treated by medica staff (e.g. doctors, consutants, medica practitioners, psychoogists, masseurs..) in the ast three years or have you been unabe to work - even temporariy? 1.d Have operations or treatment been performed, panned or advised? 1.e Has hospita treatment (incuding cinics, sanatoriums etc.) taken pace in the ast 5 years? 1.f Have bood examinations been performed? With which resuts? 1.g Has an HIV infection been determined, e.g. by an AIDS test? 1.h Have you had or are you engaged in cytostatic treatment? 1.i Do you or have you reguary imbibed medicines, acoho or drugs? 1.j Do you have impaired sight or do you re-quire an aid to vision (e.g. spectaces, contact enses)? Dioptre? 1.k Which doctor do you usuay consut? (Reguar GP) 1. Is denta treatment necessary, particuary with regard to dentures, denta surgery or parodontosis? 1.m Are you pregnant? ANSWER IF YES: WHICH, TREATED WHERE (DOCTOR), DIAGNOSIS WHEN? I hereby confirm with my handwritten signature that the above decaration is a part of my appication for heath insurance and that the I have answered the above questions dictated to me individuay by the doctor personay and truthfuy. Pace / Date: Signature of the appicant: Anamnesis performed (Stamp / Signature of the doctor): effective: BDAE EXPAT GMBH KÜHNEHÖFE 3 D HAMBURG FON FAX info@bdae.com REGISTERED OFFICE: HAMBURG HRB LOCAL COURT HAMBURG CEO: SILVIA OPITZ, ANDREAS OPITZ

16 EXAMINATION DIAGNOSIS FOR: Surname: 2. GENERAL: ANSWER 2.a Have you examined, advised or treated the person in the past? 2.b Height: cm Weight: kg 2.c Do you consider the skeeton and ocomotion to be heathy? 2.d Do you consider the skin, mucous membranes and ymph gands to be heathy? 2.e Do you consider the sensory organs to be heathy? 2.f Do you consider the nervous system and psyche to be heathy? 2.g Are the refexes norma? First name(s): DIAGNOSIS / DEVIATIONS / EXPLANATION 2.h Do you consider the hormona system to be heathy? 2.i Is the thyroid gand normay shaped? 2.j Are you suspicious of an organic disorder? 3. CARDIOVASCULAR SYSTEM: 3.a Puse at rest After 10 knee bends Return to norma in 3.b Bood pressure at rest / After 10 knee bends / 3.c Can unheathy hear sounds be heard? minutes mm Hg mm Hg 3.d Is the heart arrhythmic? 3.e Is the heart enarged or dispaced? 3.f Are there any signs of insufficiency? 3.g Does the patient have dyspnoea? 4. BLOOD VESSELS: 4.a Is the patient oedemic? 4.b Does the patient have haemorrhoids, varicose veins? (type? / extent?) 4.c Does the patient have scars, ucers? (type? / extent?) 5. RESPIRATORY ORGANS: 5.a Does the patient suffer from hoarseness, coughs, bronchitis? (since when? extent?) 5.b Is the rib cage deformed? 5.c Are the resuts of the percussion and auscutation examinations norma? 5.d Do you consider die respiratory organs to be heathy? 6. DIGESTIVE AND ABDOMINAL ORGANS: 6.a Signs of iness on the tongue, tonsis, throat? 6.b Are the examination resuts of the abdomen norma? 6.c Is the iver enarged? 6.d Is the pancreas enarged? 6.e Does the patient suffer from a rupture? effective:

17 EXAMINATION DIAGNOSIS FOR: Surname: ANSWER 6.f Unheathy diagnosis of the digestive organs? First name(s): DIAGNOSIS / DEVIATIONS / EXPLANATION 7. URINAL AND SEXUAL ORGANS: 7.a Is the condition of the rena capsue norma? 7.b urine examination: protein sugar bie pigment high exterior condition: pathoogica components: 7.c Regarding woman: Pregnancy? in month sediment: 8. MISCELLANEOUS: 8.a What other disorders and sti unnamed diagnoses were found? 8.b Are there signs of an immune disorder? OTHER ASPECTS THAN THE EXAMINATION RESULTS ARE SOMETIMES DECISIVE IN THE EVALUATION OF THE RISK. PLEASE DO NOT DISCLOSE ANY INFORMATION OF THE INSURANCE RISK. Pace / Date Stamp / Signature of the doctor DETAILS OF THE DENTAL STATUS ONLY NECESSARY IF APPLICATION INCLUDES MODULE EXPAT FLEXIBLE PLUS DENTAL STATUS DIAGNOSIS OF ALL TEETH DIAGNOSIS DIAGNOSIS DIAGNOSIS DIAGNOSIS DIAGNOSIS / LEGEND: f missing teeth e repaced teeth K crowned teeth b bridged teeth s teeth in need of rehabiitation )( space cosure 9. DENTAL: ANSWER 9.a Are there gum diseases? IF YES: WHICH, TREATED WHERE (DOCTOR), DIAGNOSIS WHEN? effective: Pace / Date Stamp / Signature of the dentist

18 CHECKLIST FOR APPLICATION TO ENSURE THAT YOUR APPLICATION IS PROCESSED QUICKLY AND PROMPTLY WE KINDLY ASK YOU TO CHECK THE FOLLOWING POINTS. 1. The appication must fied in competey and in bock capitas. 2. Each appication must incude a signed copy of the Lega Instruction and the Decaration and Information on Data processing. 3. Payment method data: Bank transfer of the premium is ony possibe once a year or every six months (+2%). A direct debit is ony possibe from a German account on a monthy (+5%), quartery (+3%), six monthy (+2%) or annua basis. As an aternative, you can aso pay the premium by credit card (+6%) using the same payment method as for a direct debit. 4. The appication must be signed by the appicant and a adut insured persons. 5. If the account hoder is different from the appicant, the signature of the account hoder is aso required. 6. The foowing must be noted for the rates Expat Fexibe, Expat Private Premium, Expat Retired and Expat Resident: EXPAT FLEXIBLE: A heath certificate or evidence of a German previous insurance must be submitted if the insured person has been staying in Germany for onger than 31 days. The heath certificate must not have been issued more than 14 days previousy. EXPAT PRIVATE PREMIUM: Information on the heath decaration must be submitted with the appication. A heath certificate which has not been issued more than 3 months previousy must be submitted for persons aged 50 and over. EXPAT RETIRED und EXPAT RESIDENT: Information on the heath decaration as we as the additiona decaration must be submitted with the appication. A heath certificate which has not been issued more than 3 months previousy must be submitted for persons aged 60 and over. 7. Heath certificate Expat Fexibe, Expat Private, Expat Retired and Expat Resident: The heath certificates must be issued in German or Engish and be egibe. Each question must be answered. Questions answered with yes or questions that indicate an abnorma resut require an expanation. The expanation in the presence of the doctor must be signed by the appicant and the doctor. The ast page of the certificate must aso be signed by the doctor. If the Expat Resident, Expat Retired Top or Expat Fexibe Pus is seected, a denta report is required. The first and ast name must be specified on each page of the findings. Aways specify your GP using their fu name and the exact address. If any inpatient treatment has taken pace, it woud speed up the inspection if corresponding discharge reports and reports on findings were submitted to us aong with the heath certificate. If there are any further inquiries, pease adhere to the deadines specified in the etter of request as acceptance is otherwise not possibe. WITH THESE REGULATIONS, WE CAN ENSURE THAT YOUR APPLICATION IS PROCESSED SMOOTHLY AND PROMPTLY. THANK YOU FOR YOUR UNDERSTANDING!