Maximum plan benefit GBP ( ) limit In-patient benefits¹ - please refer to notes for more information on Treatment Guarantee

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1 International Healthcare Plans Table of Benefits Treatment Guarantee (pre-authorisation) may be required for some benefits as indicated by a '1' or a '2' in the table(s) below. Please refer to the "Notes" section for further details. All benefit and deductible amounts are per person, per year of cover, unless otherwise indicated. Maximum plan benefit GBP ( ) 1,500,000 Core Plan Maximum plan benefit GBP ( ) Included within overall limit In-patient benefits¹ - please refer to notes for more information on Treatment Guarantee Hospital accommodation Intensive care Prescription drugs and materials Surgical fees, including anaesthesia and theatre charges Physician and therapist fees Surgical appliances and prostheses Diagnostic tests Organ transplant Psychiatry and psychotherapy Accommodation costs for one parent staying in hospital with an insured child under 18 Emergency in-patient dental treatment Private room Other benefits - please refer to notes for more information on Treatment Guarantee Day-care treatment Out-patient surgery Nursing at home or in a convalescent home (immediately after or instead of hospitalisation) Local ambulance Emergency treatment outside area of cover (for trips of a maximum period of six weeks) Medical evacuation Where necessary treatment is not available locally, we will evacuate the insured person to the nearest appropriate medical centre Where ongoing treatment is required, we will cover hotel accommodation costs Evacuation in the event of unavailability of adequately screened blood, max. 42 days If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs max. 7 days

2 Repatriation of mortal remains CT and MRI scans PET and CT-PET scans Oncology (in-patient, day-care and out-patient treatment) Routine maternity 20,000 Complications of pregnancy and childbirth Laser eye surgery (one treatment per lifetime) In-patient cash benefit (per night) (where treatment has been received free of charge) Palliative care Long term care Medically necessary Bariatric surgery Circumcision (Limited to one treatment per lifetime) 5,000 per lifetime 150, max. 30 nights, max. 90 days per lifetime Out-patient Plan Maximum plan benefit Out-patient benefits Medical practitioner fees and prescription drugs Specialist fees Diagnostic tests Vaccinations Chiropractic treatment, osteopathy, homeopathy, Chinese herbal medicine and acupuncture (max. 12 sessions per condition for chiropractic treatment and max. 12 sessions per condition for osteopathic treatment, subject to the benefit limit) Physiotherapy Prescribed speech therapy, oculomotor therapy and occupational therapy Prescribed physiotherapy Psychiatry and psychotherapy Infertility treatment (Female must be aged under 39) Included within overall limit These benefits have a Combined limit of 60 visits. Prescribed medical aids 5,000

3 (Excluding hearing aids separate benefit) Hearing aids 3,500 Dietician fees (Specialist referral required) Ear piercing for new born females (Limited to one treatment per lifetime) Cost of gold/silver stud earrings Prescribed glasses and contact lenses including eye examination 400 Braille machine (Limited to one per lifetime) Max 20 per lifetime 700 per lifetime Dental Plan Maximum plan benefit 5,000 Dental benefits Dental treatment Dental surgery Periodontics Dental prostheses Orthodontic treatment 5,000* *This benefit limit is paid in addition to the Dental Plan limit Repatriation Plan Medical repatriation Where the necessary treatment is not available locally, you can choose to be medically repatriated to your home country instead of to the nearest appropriate medical centre Where ongoing treatment is required, we will cover hotel accommodation costs² Repatriation in the event of unavailability of adequately screened blood If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs max. 7 days NOTES Treatment Guarantee/Pre-authorisation Treatment Guarantee/Pre-authorisation is a process whereby we guarantee cover for certain required treatment and costs (where covered) as follows: All in-patient benefits¹ listed. Day-care treatment². Kidney dialysis². Out-patient surgery². MRI (Magnetic Resonance Imaging) scan. Treatment Guarantee is only required for this test if you would like us to settle the bill directly with the medical provider. PET² (Positron Emission Tomography) and CT-PET² scans.

4 Nursing at home or in a convalescent home². Routine maternity² and complications of pregnancy and childbirth² (in-patient treatment only). Oncology². Occupational therapy² (out-patient treatment only). Rehabilitation treatment². Medical evacuation² (or repatriation where covered). Travel costs of insured family members in the event of an evacuation/repatriation². Repatriation of mortal remains². Travel costs of insured family members in the event of the repatriation of mortal remains². Expenses for one person accompanying an evacuated/repatriated person² Palliative care². Long term care². For the treatments listed above, please note that you and your physician should complete the relevant sections of a Treatment Guarantee Form and send it to us for approval prior to the commencement of your treatment. It is highly recommended that you take advantage of this facility as this will provide you with the benefit of cashless access to hospitals for in-patient treatment, as well as the added advantage of having your treatment overseen by our team of medical professionals. For further details please refer to our Benefit Guide, or simply contact our Helpline. Chronic conditions Chronic conditions are covered within the terms of your policy. Please refer to the Definitions section of our Benefit Guide for further information or simply contact our Helpline. Pre-existing conditions Pre-existing conditions are covered within the terms of your policy. For further details please refer to the Definitions section of our Benefit Guide or simply contact our Helpline. Benefit limits There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit, which applies to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that particular plan. Some benefits also have a specific benefit limit, which may be provided on a "per Insurance Year" basis, a "per lifetime" basis or on a "per event" basis, such as per trip, per visit or per pregnancy. In some instances we will pay a percentage of the costs for the specific benefit e.g. "65% refund, up to 4,150". Where a specific benefit limit applies or where the term "Full refund" appears next to certain benefits, the refund is subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per Insurance Year, unless otherwise stated in your Table of Benefits. Policy Terms and Conditions The Table of Benefits outlines the cover we offer under your policy. Please note that cover is subject to our standard policy definitions, limitations and exclusions. These are detailed in our Benefit Guide, which is issued to you upon policy inception. Our current Benefit Guide can also be downloaded from our website Policy Endorsement(s) If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully in conjunction with our Benefit Guide. The following additional definitions shall apply:

5 Bariatric surgery refers to surgical procedures aimed at the achievement of weight loss, out of medical necessity. Cover is only provided where all of the following conditions are met; The insured member has a BMI of 40, or a BMI between 30 and 40 in addition to another significant disease (including but not limited to Type 2 Diabetes, High Cholesterol, or High Blood Pressure) that could be improved with weight loss The insured member has tried all appropriate non-surgical measures but has failed to achieve or maintain adequate, clinically beneficial weight loss for at least six months The insured member has received, or will be receiving intensive management in a specialist obesity service The insured member is deemed fit for anaesthesia and surgery and The insured member commits to the need for long term follow up and supervision Braille machine refers to the cost of a writing machine specifically designed for blind or visually impaired people. This benefit is provided only to insured members who are blind or who are visually impaired to an extent requiring the use of such a communication aid. Cover is limited to one machine per lifetime and up to the monetary amount specified on the Table of Benefits. Laser eye treatment refers to the surgical improvement of the refractive quality of the cornea using laser technology, including necessary pre-operative investigations. The following amended definition shall apply: Orthodontics is the use of devices to correct malocclusion and restore the teeth to proper alignment and function. The medical necessity needs to be determined by the Index of Orthodontic Treatment Need (IOTN). Cover will be subject to the limits of your dental benefits and need to be classified as grade 4 and above on the IONT.

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