Full Medical Underwriting & Moratorium Rates Effective 1 July 2015

Transcription

1 GlobalFusion I N T E R N A T I O N A L M E D I C A L I N S U R A N C E SM Full Medical Underwriting & Moratorium Rates Effective 1 July 2015 Flexible, long-term, international medical insurance plan for individuals, families and groups

2 New Business Annual Premiums Effective 1 July Bronze Sub-Plan Full Medical Underwriting (Note: On the Bronze sub-plan there is no pre-existing medical condition coverage irrespective of your choice of medical underwriting.) Refer to Silver, Gold, Gold-Plus or Platinum plans for Full Medical Underwriting or Moratorium Underwriting options in regard to pre-existing medical conditions. Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , , ,883 1,176 1, ,611 1,632 1,505 1,253 1, ,215 3,259 3,133 2,881 2,292 1,985 1, , , ,749 1,093 1, ,493 2,183 2,099 1,930 1,536 1,329 1, , , ,868 1,792 1,723 1,585 1,260 1, Available only between ages years (per unit - Max 2) 6 / $10 / 8 16 / $28 / 23 $55 / 31 / 46 $100 / 56 / International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 2/31

3 New Business Annual Premiums Effective 1 July Bronze Sub-Plan Full Medical Underwriting (Note: On the Bronze sub-plan there is no pre-existing medical condition coverage irrespective of your choice of medical underwriting.) Refer to Silver, Gold, Gold-Plus or Platinum plans for Full Medical Underwriting or Moratorium Underwriting options in regard to pre-existing medical conditions. Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , , ,792 1,120 1, ,164 1,352 1, ,000 1,875 1,730 1,440 1,315 1, ,993 3,746 3,601 3,311 2,634 2,281 1, , ,650 1, ,296 2,060 1,980 1,821 1,448 1,254 1, , , , ,010 1,257 1, ,015 2,510 2,412 2,219 1,764 1,529 1,260 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual Available only between ages years (per unit - Max 2) 6 / $10 / 8 $28 / 16 / 23 $55 / 31 / 46 $100 / 56 / International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 3/31

4 New Business Annual Premiums Effective 1 July Bronze Sub-Plan Full Medical Underwriting (Note: On the Bronze sub-plan there is no pre-existing medical condition coverage irrespective of your choice of medical underwriting.) Refer to Silver, Gold, Gold-Plus or Platinum plans for Full Medical Underwriting or Moratorium Underwriting options in regard to pre-existing medical conditions. Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , ,624 1, ,920 1,200 1, ,076 1,297 1, ,389 1,493 1,351 1, ,884 1,802 1,652 1,290 1, ,001 2,500 2,307 1,921 1,753 1,427 1, ,690 5,431 4,800 4,415 3,511 3,042 2, , , , , ,200 1,375 1,269 1, ,779 2,987 2,640 2,428 1,931 1,673 1, , , , ,600 1, ,932 1,207 1, ,680 1,676 1,546 1,287 1, ,823 3,639 3,217 2,958 2,353 2,038 1,680 the Premium Above : $570 / 314 / International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 4/31

5 New Business Annual Premiums Effective 1 July Silver Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , , ,820 1, ,018 1,262 1, ,355 1,473 1, ,726 1,705 1,481 1, ,909 2,443 2,220 1,826 1,665 1,384 1, ,881 4,927 4,714 4,361 3,307 3,005 2, , , , , ,149 1,344 1,221 1, ,336 2,709 2,593 2,399 1,819 1,653 1, , , , , ,827 1, ,619 1,636 1,487 1,224 1, ,282 3,302 3,158 2,922 2,215 2,013 1,791 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual First Unit of Cover 13 / $24 / / $67 / / $132 / / $240 / 200 Second Unit ( years ) 10 / $18 / / $50 / / $99 / / $180 / 150 Child ( 31 days-18 years ) 6 / $10 / 8 16 / $28 / / $55 / / $100 / 83 Available only between ages years (per unit - Max 2) 6 / $10 / 8 16 / $28 / / $55 / / $100 / International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 5/31

6 New Business Annual Premiums Effective 1 July Silver Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , ,782 1, ,092 1,308 1, ,320 1,450 1, ,707 1,692 1,446 1, ,134 1,959 1,702 1,317 1, ,492 2,808 2,551 2,099 1,914 1,592 1, ,060 5,663 5,419 5,013 3,801 3,454 3, , , , ,724 1, ,471 1,544 1,403 1,155 1, ,983 3,115 2,980 2,757 2,091 1,900 1, , , , , ,813 1, ,100 1,313 1, ,009 1,880 1,709 1,407 1,282 1, ,072 3,795 3,630 3,359 2,547 2,314 2,059 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 6/31

7 New Business Annual Premiums Effective 1 July Silver Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage ,687 1, ,852 1,158 1, ,059 1,287 1, ,372 1,483 1, ,790 1,744 1,466 1, ,093 1,933 1,615 1,250 1, ,723 2,257 1,929 1,493 1,315 1, ,179 2,612 2,270 1,756 1,532 1,295 1, ,989 3,743 3,401 2,798 2,551 2,122 1, ,081 7,551 7,224 6,684 5,068 4,604 4, , , , , ,701 1, ,986 1,241 1, ,298 1,437 1, ,294 2,059 1,872 1,539 1,403 1,167 1, ,644 4,153 3,974 3,676 2,788 2,532 2, , , , , ,869 1, ,072 1,295 1, ,418 1,511 1,292 1, ,800 1,749 1,521 1,177 1, ,012 2,508 2,279 1,875 1,709 1,422 1, ,094 5,059 4,840 4,478 3,396 3,086 2,745 the Premium Above : $570 / 314 / 381 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 7/31

8 New Business Annual Premiums Effective 1 July Gold Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage. Refer to Gold Plus Sub-Plan for long-term level / enhanced coverage , ,646 1, ,762 1, ,859 1,163 1, ,238 1,399 1, ,492 1,558 1,422 1, ,803 1,752 1,585 1,268 1, ,482 2,176 1,935 1,577 1,332 1, ,824 3,015 2,811 2,237 2,102 1,734 1, ,455 5,909 5,645 5,219 4,172 3,670 3, , , , , , ,670 1, ,877 1,173 1, ,333 1,458 1,297 1, ,232 2,020 1,884 1,499 1,409 1, ,335 3,959 3,781 3,497 2,796 2,460 2,017 Optional Add-On Coverages - Silver, Gold & Gold Plus Sub-Plans Only GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual , , , , ,915 1,196 1, ,653 1,659 1,547 1,230 1, ,199 3,249 3,105 2,871 2,295 2,019 1, International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 8/31

9 New Business Annual Premiums Effective 1 July Gold Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage. Refer to Gold Plus Sub-Plan for long-term level / enhanced coverage , ,779 1,111 1, ,893 1,183 1, ,025 1,266 1, ,137 1,336 1, ,573 1,608 1,467 1,128 1, ,865 1,791 1,635 1,249 1, ,222 2,014 1,822 1,457 1,347 1, ,002 2,501 2,224 1,812 1,531 1,287 1, ,545 3,465 3,231 2,570 2,416 1,992 1, ,867 6,792 6,488 5,999 4,796 4,219 3, , , , , , ,773 1,108 1, ,201 1,375 1, ,050 1,906 1,777 1,413 1,329 1, ,976 3,735 3,568 3,300 2,638 2,321 1, , , , , ,724 1, ,920 1,200 1, ,158 1,348 1, ,681 1,676 1,491 1,214 1, ,715 2,322 2,165 1,723 1,620 1,335 1, ,281 4,551 4,347 4,020 3,213 2,827 2,318 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 9/31

10 New Business Annual Premiums Effective 1 July Gold Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage. Refer to Gold Plus Sub-Plan for long-term level / enhanced coverage 11, , ,404 1,502 1,361 1, ,559 1,599 1,438 1, ,736 1,710 1,525 1,185 1, ,888 1,805 1,570 1,207 1, ,478 2,173 1,984 1,523 1,375 1, ,872 2,420 2,210 1,689 1,520 1, ,353 2,720 2,462 1,969 1,822 1,457 1, ,407 3,379 3,005 2,449 2,070 1,738 1, ,494 4,684 4,367 3,473 3,265 2,691 2, ,685 9,178 8,768 8,108 6,479 5,703 4, , , , , ,912 1,195 1, ,129 1,331 1, ,395 1,496 1,354 1,084 1, ,975 1,859 1,653 1,346 1, ,122 2,576 2,402 1,911 1,795 1,481 1, ,076 5,048 4,823 4,460 3,564 3,137 2, ,612 1, ,715 1, ,833 1,146 1, ,935 1,210 1, ,330 1,456 1,329 1, ,594 1,622 1,482 1,131 1, ,916 1,823 1,649 1,319 1, ,622 2,264 2,013 1,641 1,387 1, ,021 3,138 2,927 2,327 2,187 1,803 1, ,838 6,149 5,874 5,432 4,341 3,820 3,134 the Premium Above : $570 / 314 / International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 10/31

11 New Business Annual Premiums Effective 1 July Gold Plus Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage , ,939 1,212 1, ,140 1,338 1, ,383 1,490 1,357 1, ,617 1,636 1,473 1, ,092 1,933 1,719 1,332 1, ,347 2,091 1,876 1,457 1,291 1, ,849 2,406 2,177 1,696 1,541 1, ,648 2,904 2,662 2,079 1,832 1,543 1, ,446 4,029 3,717 3,095 2,824 2,299 1, ,874 8,046 7,735 7,113 5,658 4,901 4, , , , , ,700 1, ,840 1,150 1, ,118 1,323 1, ,556 1,598 1,465 1,144 1, ,545 2,215 2,044 1,702 1,553 1,264 1, ,081 4,426 4,254 3,912 3,111 2,695 2, , , , ,754 1, ,072 1,296 1, ,241 1,401 1, ,579 1,613 1,458 1,136 1, ,115 1,947 1,783 1,392 1,228 1, ,319 2,699 2,491 2,072 1,893 1,540 1, ,625 5,392 5,182 4,766 3,790 3,283 2, International Medical Group, Inc. All rights reserved. Version 0715 FMU Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus and Platinum Only) Page 11/31

12 New Business Annual Premiums Effective 1 July Gold Plus Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage. 1, , ,229 1,393 1, ,461 1,538 1,404 1, ,740 1,712 1,560 1,208 1, ,008 1,880 1,692 1,305 1, ,555 2,222 1,976 1,531 1,360 1, ,846 2,404 2,156 1,674 1,484 1, ,425 2,765 2,502 1,949 1,772 1,450 1, ,342 3,339 3,060 2,389 2,107 1,774 1, ,409 4,630 4,273 3,557 3,246 2,643 2, ,799 9,249 8,891 8,176 6,504 5,634 4, , ,649 1, ,836 1,147 1, ,016 1,260 1, ,382 1,490 1,324 1, ,576 1,611 1,445 1, ,965 1,854 1,677 1,305 1, ,580 2,238 2,050 1,600 1,411 1, ,964 3,102 2,863 2,382 2,175 1,771 1, ,914 6,197 5,956 5,478 4,357 3,773 3, , , , ,654 1, ,954 1,222 1, ,116 1,323 1, ,434 1,521 1,375 1, ,938 1,837 1,683 1,314 1, ,075 2,547 2,350 1,957 1,785 1,454 1, ,139 5,087 4,890 4,497 3,576 3,098 2,554 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus and Platinum Only) International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 12/31

13 New Business Annual Premiums Effective 1 July Gold Plus Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage. 1, , ,972 1,857 1,686 1,284 1, ,283 2,052 1,872 1,390 1,222 1, ,652 2,283 2,080 1,577 1,397 1, ,011 2,507 2,256 1,738 1,532 1, ,741 2,962 2,633 2,042 1,813 1,458 1, ,126 3,203 2,876 2,233 1,978 1,570 1, ,898 3,686 3,334 2,598 2,361 1,934 1, ,121 4,451 4,080 3,185 2,809 2,365 1, ,877 6,173 5,696 4,743 4,327 3,524 2, ,457 13,411 11,854 10,901 8,671 7,511 6, ,990 1,244 1, ,200 1,374 1, ,447 1,529 1,393 1, ,688 1,680 1,511 1,165 1, ,176 1,986 1,764 1,368 1, ,434 2,146 1,928 1,496 1,325 1, ,951 2,470 2,233 1,740 1,583 1,296 1, ,771 2,981 2,733 2,134 1,883 1,585 1, ,618 4,136 3,817 3,179 2,899 2,361 1, ,376 8,985 7,942 7,304 5,809 5,032 4, ,635 1, ,805 1,129 1, ,008 1,256 1, ,206 1,379 1, ,608 1,630 1,448 1, ,818 1,762 1,581 1,228 1, ,245 2,027 1,833 1,429 1,299 1, ,917 2,448 2,244 1,753 1,546 1,301 1, ,432 3,395 3,133 2,608 2,380 1,938 1, ,801 7,376 6,520 5,995 4,769 4,132 3,405 the Premium Above : $570 / 314 / 381 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus and Platinum Only) International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 13/31

14 New Business Annual Premiums Effective 1 July Platinum Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage. NIL $100 $250 $500 $1,000 $2,500 $5,000 $10,000 2,962 2,038 1,851 1,681 1,463 1,390 1,324 1, ,111 2,139 1,944 1,730 1,512 1,439 1,369 1, ,848 4,708 4,280 3,858 3,137 2,862 2,629 2, ,318 5,031 4,574 4,260 3,343 3,033 2,699 2, ,016 5,512 5,011 4,648 3,700 3,362 2,931 2, ,568 5,890 5,355 4,901 3,951 3,568 3,121 2, ,789 6,729 6,119 5,527 4,455 4,042 3,395 2, ,903 6,121 5,564 5,070 4,106 3,726 3,117 2, ,062 6,917 6,289 5,761 4,654 4,302 3,659 3, ,896 8,178 7,435 6,878 5,535 4,971 4,310 3, ,126 11,019 10,078 9,302 7,880 7,249 6,042 5, ,802 21,176 19,252 18,535 17,106 13,760 12,021 10,041 NIL ,675 3,350 6,700 1,985 1,366 1,241 1, ,084 1,432 1,303 1,158 1, ,589 3,154 2,867 2,585 2,102 1,917 1,687 1, ,903 3,371 3,064 2,854 2,239 2,033 1,809 1, ,370 3,692 3,357 3,115 2,479 2,252 1,964 1, ,740 3,947 3,587 3,284 2,648 2,390 2,092 1, ,559 4,508 4,099 3,703 2,986 2,708 2,275 1, ,965 4,101 3,728 3,397 2,752 2,496 2,089 1, ,742 4,635 4,213 3,860 3,118 2,882 2,452 2, ,971 5,479 4,981 4,609 3,709 3,331 2,887 2, ,805 7,383 6,752 6,233 5,273 4,856 4,049 3, ,637 14,187 12,898 12,417 11,461 9,219 8,054 6,727 NIL ,375 2,750 5,500 1,631 1,121 1, ,711 1,176 1, ,767 2,589 2,354 2,122 1,726 1,575 1,384 1, ,024 2,768 2,514 2,342 1,839 1,668 1,485 1, ,408 3,032 2,755 2,557 2,035 1,849 1,612 1, ,712 3,240 2,946 2,696 2,174 1,962 1,717 1, ,144 3,702 3,364 3,040 2,451 2,193 1,867 1, ,897 3,367 3,061 2,789 2,259 2,050 1,714 1, ,534 3,805 3,459 3,168 2,559 2,365 2,013 1, ,543 4,499 4,089 3,782 3,045 2,733 2,370 1, ,869 6,060 5,543 5,116 4,329 3,986 3,324 2, ,941 11,646 10,587 10,194 9,409 7,568 6,611 5,522 Optional Add-On Coverages - Platinum Sub-Plan Only Terrorism Coverage: To increase Terrorism Coverage to $50,000 / 27,500 / 33,500 Lifetime Limit : Annual Premium x1.25 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus, Platinum Only) International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 14/31

15 New Business Annual Premiums Effective 1 July Platinum Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage. NIL $100 $250 $500 $1,000 $2,500 $5,000 $10,000 3,405 2,343 2,128 1,932 1,681 1,598 1,522 1, ,576 2,458 2,234 1,989 1,738 1,654 1,574 1, ,871 5,412 4,919 4,435 3,606 3,289 2,893 2, ,411 5,783 5,257 4,897 3,843 3,487 3,102 2, ,214 6,335 5,759 5,342 4,254 3,865 3,369 2, ,848 6,770 6,154 5,634 4,542 4,101 3,588 2, ,252 7,735 7,032 6,353 5,121 4,646 3,902 3, ,233 7,036 6,395 5,827 4,720 4,283 3,583 3, ,565 7,951 7,228 6,623 5,349 4,945 4,206 3, ,673 9,400 8,546 7,906 6,363 5,713 4,954 4, ,535 12,665 11,584 10,692 9,057 8,332 6,945 5, ,404 24,340 22,128 21,305 19,662 15,817 13,817 11,542 NIL ,675 3,350 6,700 2,281 1,570 1,426 1,295 1,126 1,071 1, ,396 1,646 1,497 1,332 1,165 1,109 1,055 1, ,274 3,625 3,296 2,971 2,416 2,204 1,939 1, ,636 3,875 3,522 3,280 2,574 2,336 2,079 1, ,173 4,244 3,858 3,580 2,849 2,589 2,258 1, ,598 4,536 4,124 3,774 3,043 2,747 2,405 1, ,539 5,182 4,712 4,256 3,432 3,112 2,614 2, ,857 4,714 4,285 3,904 3,163 2,869 2,401 2, ,749 5,327 4,843 4,436 3,584 3,313 2,818 2, ,162 6,298 5,725 5,298 4,264 3,828 3,319 2, ,419 8,486 7,762 7,164 6,061 5,582 4,654 3, ,720 16,307 14,825 14,273 13,173 10,596 9,258 7,732 NIL ,375 2,750 5,500 1,874 1,289 1,170 1, ,967 1,352 1,229 1, ,330 2,976 2,706 2,439 1,984 1,810 1,592 1, ,626 3,181 2,891 2,692 2,113 1,917 1,707 1, ,067 3,484 3,167 2,939 2,340 2,126 1,852 1, ,416 3,724 3,386 3,099 2,499 2,256 1,973 1, ,188 4,255 3,867 3,494 2,817 2,556 2,146 1, ,628 3,870 3,518 3,205 2,596 2,355 1,970 1, ,360 4,374 3,975 3,642 2,942 2,719 2,313 1, ,521 5,171 4,701 4,348 3,500 3,142 2,724 2, ,194 6,965 6,372 5,880 4,976 4,582 3,820 3, ,472 13,386 12,170 11,717 10,815 8,699 7,599 6,348 Optional Add-On Coverages - Platinum Sub-Plan Only Terrorism Coverage: To increase Terrorism Coverage to $50,000 / 27,500 / 33,500 Lifetime Limit : Annual Premium x1.25 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus, Platinum Only) International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 15/31

16 New Business Annual Premiums Effective 1 July Platinum Sub-Plan Full Medical Underwriting (Moratorium Underwriting Basis Rates also available) Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage. NIL $100 $250 $500 $1,000 $2,500 $5,000 $10,000 4,079 2,802 2,549 2,285 1,948 1,842 1,743 1, ,310 2,964 2,694 2,359 2,025 1,915 1,808 1, ,026 6,923 6,266 5,812 4,518 4,095 3,567 2, ,752 7,390 6,720 6,235 4,834 4,355 3,843 3, ,819 8,126 7,386 6,834 5,378 4,862 4,200 3, ,657 8,702 7,911 7,223 5,762 5,176 4,492 3, ,533 9,993 9,083 8,179 6,536 5,904 4,911 4, ,169 9,055 8,231 7,209 6,003 5,417 4,481 3, ,362 9,874 8,976 8,536 6,843 6,301 5,317 4, ,759 12,210 11,099 10,249 8,193 7,328 6,308 5, ,091 16,564 15,057 13,963 11,772 10,752 8,970 7, ,735 32,134 29,210 28,114 25,924 20,798 18,131 15,096 NIL ,675 3,350 6,700 2,732 1,877 1,708 1,530 1,306 1,234 1,168 1, ,886 1,985 1,804 1,580 1,356 1,284 1,212 1, ,718 4,639 4,199 3,894 3,026 2,744 2,390 1, ,204 4,950 4,502 4,179 3,239 2,918 2,575 2, ,920 5,444 4,949 4,579 3,603 3,258 2,815 2, ,480 5,831 5,300 4,840 3,861 3,468 3,009 2, ,737 6,694 6,086 5,480 4,379 3,956 3,291 2, ,823 6,067 5,515 4,831 4,022 3,630 3,003 2, ,621 6,616 6,013 5,718 4,584 4,221 3,563 2, ,898 8,180 7,437 6,867 5,489 4,910 4,226 3, ,141 11,098 10,088 9,355 7,887 7,249 6,011 5, ,313 21,530 19,571 18,836 17,369 13,935 12,148 10,115 NIL ,375 2,750 5,500 2,243 1,541 1,402 1,257 1,072 1, ,370 1,630 1,482 1,298 1,114 1, ,514 3,807 3,446 3,196 2,484 2,252 1,962 1, ,914 4,064 3,696 3,431 2,659 2,396 2,113 1, ,500 4,469 4,062 3,759 2,958 2,675 2,309 1, ,961 4,787 4,350 3,973 3,170 2,847 2,471 1, ,992 5,496 4,995 4,498 3,595 3,247 2,701 2, ,243 4,981 4,527 3,966 3,301 2,979 2,464 2, ,898 5,431 4,937 4,695 3,764 3,465 2,923 2, ,768 6,716 6,104 5,637 4,507 4,031 3,469 2, ,250 9,110 8,281 7,680 6,475 5,951 4,934 4, ,705 17,674 16,065 15,463 14,259 11,440 9,971 8,304 Optional Add-On Coverages - Platinum Sub-Plan Only Terrorism Coverage: To increase Terrorism Coverage to $50,000 / 27,500 / 33,500 Lifetime Limit : Annual Premium x 1.25 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus, Platinum Only) International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 16/31

17 New Business Annual Premiums Effective 1 July Bronze Sub-Plan Moratorium Underwriting (Note: On the Bronze sub-plan there is no pre-existing medical condition coverage irrespective of your choice of medical underwriting.) Refer to Silver, Gold, Gold-Plus or Platinum plans for Full Medical Underwriting or Moratorium Underwriting options in regard to pre-existing medical conditions. Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , , ,883 1,176 1, ,611 1,632 1,505 1,253 1, ,215 3,259 3,133 2,881 2,292 1,985 1, , , ,749 1,093 1, ,493 2,183 2,099 1,930 1,536 1,329 1, , , ,868 1,792 1,723 1,585 1,260 1, Available only between ages years (per unit - Max 2) 6 / $10 / 8 $28 / 16 / 23 $55 / 31 / 46 $100 / 56 / International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 17/31

18 New Business Annual Premiums Effective 1 July Bronze Sub-Plan Moratorium Underwriting (Note: On the Bronze sub-plan there is no pre-existing medical condition coverage irrespective of your choice of medical underwriting.) Refer to Silver, Gold, Gold-Plus or Platinum plans for Full Medical Underwriting or Moratorium Underwriting options in regard to pre-existing medical conditions. Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , , ,792 1,120 1, ,164 1,352 1, ,000 1,875 1,730 1,440 1,315 1, ,993 3,746 3,601 3,311 2,634 2,281 1, , , , ,010 1,257 1, ,015 2,510 2,412 2,219 1,764 1,529 1, , ,650 1, ,296 2,060 1,980 1,821 1,448 1,254 1,034 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 18/31

19 New Business Annual Premiums Effective 1 July Bronze Sub-Plan Moratorium Underwriting (Note: On the Bronze sub-plan there is no pre-existing medical condition coverage irrespective of your choice of medical underwriting.) Refer to Silver, Gold, Gold-Plus or Platinum plans for Full Medical Underwriting or Moratorium Underwriting options in regard to pre-existing medical conditions. Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage , , , ,624 1, ,920 1,200 1, ,076 1,297 1, ,389 1,493 1,351 1, ,884 1,802 1,652 1,290 1, ,001 2,500 2,307 1,921 1,753 1,427 1, ,690 5,431 4,800 4,415 3,511 3,042 2, , , , ,600 1, ,932 1,207 1, ,680 1,676 1,546 1,287 1, ,823 3,639 3,217 2,958 2,353 2,038 1, , , , , ,200 1,375 1,269 1, ,779 2,987 2,640 2,428 1,931 1,673 1,379 the Premium Above : $570 / 314 / International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 19/31

20 New Business Annual Premiums Effective 1 July Silver Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage , , ,679 1, ,901 1,188 1, ,192 1,370 1, ,404 1,503 1,278 1, ,766 1,728 1,499 1,194 1, ,347 2,091 1,813 1,445 1,293 1,113 1, ,619 2,886 2,502 1,994 1,784 1,535 1, , , , , ,884 1,171 1, ,600 1,616 1,406 1,124 1, , , , , ,632 1, ,876 1,173 1, ,270 1,419 1, ,133 1,958 1,700 1,358 1,219 1, International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 20/31

21 New Business Annual Premiums Effective 1 July Silver Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage. 1, , ,628 1, ,764 1,102 1, ,930 1,206 1, ,184 1,365 1, ,519 1,575 1,351 1, ,763 1,727 1,469 1,176 1, ,180 1,987 1,723 1,372 1,184 1, ,847 2,404 2,084 1,660 1,432 1,279 1, ,309 3,318 2,876 2,291 1,977 1,765 1, , , , , , ,790 1, ,166 1,346 1, ,989 1,857,1616 1,292 1,161 1, , , , , ,715 1, ,876 1,173 1, ,156 1,347 1, ,609 1,630 1,416 1,132 1, ,600 2,250 1,954 1,562 1,401 1,212 1, International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 21/31

22 New Business Annual Premiums Effective 1 July Silver Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage. 1, , ,082 1,301 1, ,260 1,413 1,319 1, ,482 1,551 1,418 1,136 1, ,819 1,762 1,525 1,221 1, ,268 2,043 1,744 1,310 1,169 1, ,594 2,246 1,904 1,512 1,338 1,108 1, ,151 2,594 2,241 1,773 1,581 1,355 1, ,022 3,139 2,712 2,145 1,914 1,640 1, ,931 4,331 3,742 2,960 2,641 2,263 2, , , , , ,828 1, ,007 1,254 1, ,314 1,446 1, ,800 1,750 1,514 1,203 1, ,864 2,414 2,089 1,661 1,483 1,277 1, , , ,689 1, ,916 1,198 1, ,215 1,384 1, ,433 1,521 1,328 1, ,804 1,753 1,519 1,204 1, ,393 2,121 1,838 1,457 1,301 1,119 1, ,683 2,927 2,536 2,010 1,795 1,545 1,397 the Premium Above : $570 / 314 / International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 22/31

23 New Business Annual Premiums Effective 1 July Gold Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage. 1, , ,896 1,185 1, ,004 1,252 1, ,128 1,331 1, ,233 1,396 1, ,641 1,651 1,518 1,202 1, ,913 1,821 1,676 1,315 1, ,248 2,029 1,850 1,510 1,406 1, ,930 2,456 2,239 1,827 1,701 1,397 1, ,424 3,389 3,090 2,521 2,347 1,928 1, , , , , , ,631 1, ,813 1,133 1, ,194 1,371 1,252 1, ,028 1,893 1,728 1,416 1,320 1, , , , , ,792 1,120 1, ,975 1,233 1, ,197 1,373 1,254 1, ,659 1,661 1,518 1,240 1, ,669 2,293 2,095 1,711 1,599 1,315 1, International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 23/31

24 New Business Annual Premiums Effective 1 July Gold Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Worldwide (excluding the USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan) Please select your carefully, as you will be unable to select a lower when you renew your coverage. Refer to Gold Plus Sub-Plan for long-term level / enhanced coverage 1, , ,180 1,362 1, ,303 1,439 1,312 1, ,446 1,529 1,382 1, ,567 1,604 1,418 1,129 1, ,035 1,897 1,745 1,381 1,262 1, ,349 2,093 1,926 1,511 1,376 1, ,733 2,333 2,127 1,735 1,616 1,327 1, ,517 2,823 2,574 2,099 1,956 1,606 1, ,233 3,896 3,551 2,897 2,699 2,216 1, , , , , ,699 1, ,875 1,172 1, ,084 1,303 1, ,522 1,576 1,439 1,179 1, ,480 2,175 1,986 1,627 1,519 1,251 1, , , ,664 1, ,745 1, ,060 1,287 1, ,269 1,418 1,307 1, ,526 1,578 1,441 1,178 1, ,056 1,909 1,744 1,426 1,332 1, ,4217 2,635 2,407 1,967 1,838 1,511 1,238 Available only between ages years (per unit - Max 2) $10 / 6 / 8 $28 / 16 / / 31 / $ 46 $100 / 56 / International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 24/31

25 New Business Annual Premiums Effective 1 July Gold Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Worldwide Please select your carefully, as you will be unable to select a lower when you renew your coverage. Refer to Gold Plus Sub-Plan for long-term level / enhanced coverage 1, , ,853 1,783 1,631 1,289 1, ,020 1,887 1,714 1,352 1, ,210 2,007 1,808 1,441 1,277 1, ,375 2,109 1,856 1,466 1,296 1, ,006 2,504 2,300 1,805 1,646 1,308 1, ,432 2,770 2,544 1,984 1,802 1,472 1, ,948 3,092 2,815 2,285 2,127 1,735 1, ,987 3,742 3,406 2,765 2,574 2,099 1, ,262 5,164 4,700 3,815 3,551 2,897 2, ,600 1, ,693 1, ,798 1,123 1, ,886 1,178 1, ,234 1,397 1,285 1, ,467 1,542 1,418 1,111 1, ,753 1,720 1,568 1,278 1, ,331 2,082 1,897 1,546 1,439 1, ,597 2,873 2,618 2,134 1,986 1,627 1, , ,938 1,211 1, ,050 1,281 1, ,177 1,361 1, ,287 1,429 1, ,710 1,695 1,558 1,225 1, ,996 1,873 1,721 1,345 1,223 1, ,342 2,089 1,901 1,547 1,441 1, ,044 2,527 2,300 1,872 1,744 1,426 1, ,581 3,488 3,174 2,583 2,407 1,967 1,601 the Premium Above : $570 / 314 / International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 25/31

26 New Business Annual Premiums Effective 1 July Gold Plus Sub-Plan Moratorium Underwriting (Full Medical Underwriting Basis Rates also available) Area of Cover: Europe (Refer to the Policy Wording for full country listing and definition of Europe) Please select your carefully, as you will be unable to select a lower when you renew your coverage. 1, , ,163 1,352 1, ,380 1,487 1,362 1, ,641 1,651 1,508 1,179 1, ,892 1,808 1,631 1,269 1, ,403 2,127 1,896 1,481 1,320 1, ,675 2,297 2,065 1,615 1,436 1, ,216 2,634 2,389 1,872 1,706 1,406 1, ,101 3,187 2,891 2,265 2,064 1,701 1, ,039 4,399 3,989 3,125 2,848 2,347 1, , , , ,704 1, ,985 1,241 1, ,135 1,335 1, ,433 1,520 1,383 1,100 1, ,943 1,839 1,674 1,331 1,220 1, ,062 2,538 2,310 1,837 1,683 1,408 1, , ,720 1, ,895 1,185 1, ,065 1,290 1, ,409 1,505 1,351 1, ,589 1,618 1,464 1,161 1, ,953 1,846 1,680 1,361 1,223 1, ,574 2,233 2,033 1,647 1,480 1, ,932 3,082 2,805 2,272 2,042 1,706 1,378 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus and Platinum Only) International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 26/31