Global Medical Insurance

Transcription

1 Global Peace of Mind Global Medical Insrance The flexible, long-term, worldwide medical insrance program for individals and families. Secrity rated A (excellent) A.M. Best Version 0114 Plan Options: Silver Gold Gold Pls Platinm

2 Global Medical Insrance Flexible Worldwide Coverage. Comprehensive World-class Services. Being a citizen of the global commnity can be an exciting experience, yet one that can pose potential complications. Yor health care while abroad shold not be one of those concerns. Global Medical Insrance is a revoltionary program from International Medical Grop (IMG ) that offers the flexible worldwide coverage yo need, backed by the world-class services yo expect. Unlike other health care programs on the market, Global Medical Insrance allows yo to cstom bild a plan that is specifically tailored for yo. With this booklet, yo can easily create the bleprint for yor own benefits package. Yo can conveniently compare the benefits of several plan options, and learn abot the niqe services and the dynamic company that provides them. Choosing and applying for the best coverage available is easy. Global Medical Insrance is designed to meet yor total needs. The program offers yo the flexibility to select from an assortment of niqe benefit options. From the schedled benefits of the Silver plan option to the benefit-rich Platinm plan option, there are a large variety of specialized coverages to meet any need. To accommodate yor financial means, yo can cstomize yor length and area of coverage with the flexibility to select from mltiple dedctibles and modes of payment. With yor medical history in mind, the program also provides flexible nderwriting methods to extend coverage to yo that may be declined by other companies. Additionally, the program provides world-class services. To maximize the otcome of yor medical care, or on-site clinical staff is ready to assist yo at a moment s notice, and or extensive global provider networks are qickly and easily accessible. Yo also have direct access to or Medical Concierge, an neqalled service that provides yo with personalized assistance in locating the best provider for yor specific needs, while saving yo on ot-of-pocket and medical expenses. Yo can also efficiently save time managing rotine areas of yor accont by tilizing or secre, online service tools. In addition, IMG is available for service at yor convenience - via phone, or Live Chat. Yo need to know that yo have the proper worldwide coverage. When yo select Global Medical Insrance, yo receive IMG s commitment to deliver exceptional health benefits, medical assistance and service - all designed to give yo Global Peace of Mind. 1. Global Peace of Mind A Company and a Program Designed to Meet Yor Total Needs All amonts shown in this booklet are in U.S. dollars. Please refer to the Certificate Wording for specific terms, conditions and other details regarding the benefits, limitations, eligibility, and exclsions otlined in this booklet. Certificate Wordings are available pon reqest.

3 The IMG Advantage For more than 20 years, IMG has dedicated its efforts to providing international medical insrance, travel insrance and world-class services to the international commnity. It s or specialty. We nderstand the intricacies of international health care. Or team of qality assred professionals is committed to helping yo solve any problems, while making sre yo receive sperior service. Many companies claim to offer great service. At IMG, we have set a higher indstry standard by integrating independent credentialing services with in-hose, flly owned and operated service divisions. These accreditations promote continos improvement in qality and efficiency while ensring ongoing compliance. This allows s to deliver the world-class service yo deserve. We ve served over a million people worldwide in more than 170 contries and we re with yo, wherever yo go - bringing spport for all yor insrance needs. Qality assred professionals providing spport for all yor needs International Service Centers - To ensre that we are available when and where needed, we maintain mltiple international service and assistance centers. From or offices, we provide administrative spport and marketing services to or international prodcers, and claims administration and emergency medical assistance to those living and traveling worldwide. Or offices offer the benefit of mltiple time zones and services in tne with local practices. Single Resorce - All IMG service centers are designed to have the necessary services, staff and capabilities to provide international service to yo, regardless of yor location. Every department and service division is integrated on the same proprietary system and in real-time. One call. One company. We are yor single international resorce. Service Withot Obstacles - Working in mltiple time zones, langages, and with nmeros crrencies are not obstacles for s. We maintain an international staff for or international client base. Or claims specialists and mltilingal cstomer service professionals work seamlessly with yo in order to commnicate withot barriers. We back p what we promise - Coverage Withot Bondaries that provides Global Peace of Mind. International Provider Access SM (IPA) - In addition to or extensive PPO network available for treatment received within the U.S., or proprietary IPA network of over 17,000 accomplished physicians and facilities allows yo to access qality care worldwide. Or direct billing arrangements can also ease the time and p front expense at select providers. International Emergency Care - When yo re overseas and a medical emergency occrs, yo may not be able to wait for reglar bsiness hors. With or onsite physician and registered nrses, yo have 24 hor access to highly qalified coordinators of emergency medical services and international treatment. Accessible Technology - Throgh technology we make it easy for yo to reach s and vice versa. We provide yo with a secre member Web site to qickly and easily access real-time information, view the stats of yor claims and manage yor acconts. Yo also have access to Live Chat to speak directly to a Cstomer Care representative online, and yo can easily reach s via . We will respond to all inqiries promptly. Of corse, the phone and fax lines are open as well. Financial Stability - Or globally recognized nderwriter, Siris International Insrance Corporation (pbl), offers the financial secrity and reptation demanded by international consmers. Rated A (excellent) by A.M. Best and A- by Standard & Poor s*, Siris International shares or vision of the international marketplace and offers the stability of a well-established insrance company. *Ratings are accrate as of the date of print. Global Peace of Mind 2.

4 Flexible Worldwide Coverage Global Medical Insrance is versatile and tailored for yo so yo can easily design the benefits package that yo need. The program provides comprehensive benefits sitable for individals and families, flly portable 24 hor coverage and the peace of mind yo need. On the following pages, yo can bild yor plan by reviewing and choosing from the coverage options and services available. More detailed benefit and service descriptions are provided as an insert in the pocket in the back of this booklet. Please refer to the Spplemental Brochre Inserts while reviewing the information herein. Flexible Benefits q Silver plan option - Affordable medical secrity designed for the more bdget-conscios consmer and those planning to receive care in lower cost areas of the world. Silver offers a wide range of schedled benefits eqipped to meet yor essential needs. q Gold plan option - Ideally sited for those who desire fll major medical coverage, bt for a limited period of time. Gold provides comprehensive benefits for the first three years of coverage. After three years, certain benefits and lifetime maximms are redced (see Smmary Schedle of Benefits - pages 5 & 6). As a reslt, Gold is priced more competitively than the Gold Pls option. q Gold Pls plan option - Comprehensive major medical plan designed for people who need longterm coverage. Benefit levels contine beyond year three as long as the plan remains in effect. q Platinm plan option - Provides the sperior benefits package for the most discerning global consmer. Platinm offers a package of enhanced benefits and services. It is designed for the consmer who wants the convenience of comprehensive medical, dental, and vision benefits in one plan. q Optional Riders - All plan options offer additional, optional coverages (see page 7 for more information). XX XX XX XX XX XX Global Term Life Insrance SM (inclding AD&D) Global Daily Indemnity SM Maternity (Silver, Gold & Gold Pls plan options) Terrorism (Platinm plan option) Sports (Gold Pls and Platinm plan options) Dental & Vision (Silver, Gold & Gold Pls plan options) 3. Global Peace of Mind Coverage Area Options/Bdget q Two coverage areas: Worldwide or Worldwide Exclding the U.S., Canada, China, Hong Kong, Japan, Maca, Singapore, and Taiwan - Yo have the opportnity to select the coverage area that best reflects yor geographic area of need. Each provides fll coverage, bt premims reflect the cost of care in different parts of the world. Regardless of the coverage area yo choose, yo maintain the freedom to choose yor own provider. q Mltiple dedctible options - To accommodate yor financial resorces, yo can select from seven different dedctible options - all providing different premim levels. Additionally, yor dedctible can be redced p to 50% to a $2,500 maximm (see the Smmary Schedle of Benefits, page 5, for more abot this savings). $100* (Platinm plan option) $250 $500 $1,000 $2,500 $5,000 $10,000 q No additional cost for children - No matter the plan option or coverage area yo choose, for families the first two children between 14 days and 9 years are covered at no additional cost for the first year (see page 9 for frther details). This is a valable savings for any bdget. q For premim modes - Schedle the freqency of payment that meets yor means. Annal Semi-annal Qarterly Monthly Underwriting to Fit Yor Needs We have earned or reptation for excellence in the international commnity by maintaining the ability to be flexible and respond to or clients needs. Understanding that everyone has a niqe medical backgrond, with Global Medical Insrance we have developed mltiple ways to administer coverage to yo - inclding sitations where yo may have been declined by other companies. Yor application will be reviewed based on the fll disclosre of yor medical history that yo provide. q Standard nderwriting - Standard nderwriting provides the fll pre-existing conditions benefit as otlined on page 8. q Exclsionary rider(s) - With an exclsionary rider, we are able to extend coverage for yor medical needs, with the exception of the specific exclded condition named in the rider. This allows standard pre-existing condition benefits for non-ridered conditions that may otherwise have been declined. q Flexible nderwriting rider - The flexible nderwriting rider will allow s to extend coverage to yo even if yo have significant, ongoing and/or chronic pre-existing conditions. For a nominal annal administration fee, coverage is extended for a preexisting condition following 24 months of continos coverage, dring which yo are symptom, advice or treatment free for that particlar condition. For frther nderwriting information, please refer to page 8. * For convenience, all amonts listed in this booklet are in U.S. dollars.

5 Comprehensive World-class Services From rotine care to complex case management to emergency medical sitations, yo re never far from IMG s spport services. Global Medical Insrance not only provides flexible coverage, it also provides yo with prompt access to the invalable international services and IMG resorces - regardless of yor location. For a frther description of services, please refer to the Spplemental Brochre Insert inclded in the back of this booklet. Rotine Care q Freedom to choose yor provider - Global Medical Insrance allows yo the freedom to choose yor own health care provider no matter where yo are in the world. With open access to health care providers, yo have improved access to qality care. q Locating a provider - For yor convenience and to help yo redce yor ot-of-pocket expenses, we provide yo access to two extensive provider networks that inclde established, globally credentialed physicians and hospitals. The independent Preferred Provider Organization (PPO) - when seeking care within the U.S. The International Provider Access (IPA) - when seeking care otside the U.S. Emergency Care q Emergency Medical Treatment - The ability to access qality health care is of paramont importance when a life-threatening medical emergency arises abroad. Global Medical Insrance provides yo with important emergency benefits backed by the services of an accredited 24/7/365 clinical staff with over 250 years of combined experience. Emergency Medical Evacation benefit Retrn of Mortal Remains benefit Remote Transportation benefit (Platinm plan option) Political Evacation benefit (Platinm plan option) Medical Concierge q Uniqe medical service - Whether yo are seeking care in a local facility or in a location yo are not familiar with, the qality of the care yo are receiving is a primary concern. Or Medical Concierge program is designed to provide yo critical information on provider ratings, treatment otcome and cost of care prior to receiving medical treatment. Yor personal Medical Concierge will review yor specific non-emergency medical condition and provide yo with complete information on provider ratings, past otcomes and general costs - all in the area where yo are planning treatment. IMG's Medical Concierge helps yo make an informed decision when seeking medical care within the U.S. Also, yo can receive a redction in yor dedctible for tilizing this niqe medical service. This level of individalized service is nmatched in the international arena. Please note de to the high level of data reqired for this service, Medical Concierge service is restricted to facilities within the U.S. Clinical Staff Available for Yo q Medical professionals to coordinate yor care - In the event yo need medical care, or on-site clinical staff coordinates with the medical provider and treating facility to respond to the niqe needs and circmstances yo may face. Having provided services in more than 170 contries, we are experts at assessing the need for services and ensring they are delivered in a timely, cost-effective manner. This individalized approach gives yo peace of mind knowing that yo have experienced, knowledgeable professionals ready to help at a moment s notice, anywhere arond the globe. Managing Yor Plan q International service assistance - IMG s international services are designed to help yo maximize the otcome of yor medical care. Access to qality health care worldwide Professionally trained mltilingal claims administrators and service professionals with proven international experience Claim inqiries, stats of claim information and reimbrsement options available online, by phone, fax, and Live Chat Experienced international crrency conversion Claim settlement directly to providers or to yo via check or direct deposit Verification of benefits and explanation of benefits to providers q 24/7/365 access to information - To help yo save time managing rotine areas of yor accont, we make it easy for yo to get the information yo need. MyIMG SM - secre member Web site Online renewals Easy online U.S. and international provider searches Retrieve explanation of benefits Check the stats of claims - real time information available Update address information & reqest ID cards Change yor mode of payment Mltiple international service and assistance centers Live Chat, , phone, fax Global Peace of Mind 4.

6 Smmary Schedle of Benefits The following is a smmary schedle of benefits. Benefits are sbject to the dedctible and coinsrance nless otherwise noted. NA (Not Applicable); (Usal, Reasonable and Cstomary); SAAI (Same As Any Illness). For a frther description of benefits, please refer to the Spplemental Brochre Insert inclded in the back of this booklet. Benefit Silver Gold (1 st 36 months of continos coverage) Gold (Beginning the 1 st day of the 37 th month) Gold Pls Platinm (See page 7 for Platinm Advantages) Lifetime Maximm Limit $5,000,000 per individal $5,000,000 per individal $5,000,000 per individal $5,000,000 per individal $8,000,000 per individal Dedctible (Per Period of Coverage) $250 to $10,000 $250 to $10,000 $250 to $10,000 $250 to $10,000 $100 to $10,000 Family Dedctible 3 times the individal dedctible 3 times the individal dedctible 3 times the individal dedctible 3 times the individal dedctible 2 times the individal dedctible Treatment otside the U.S. and Canada No coinsrance No coinsrance No coinsrance No coinsrance No coinsrance Treatment inside the U.S. (Ot-patient/In-patient Emergency) PPO Network - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - dedctible 50% waived (to a $2,500 maximm). No coinsrance. Treatment inside the U.S. (In-patient Non-emergency) Medical Concierge - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - sbject to dedctible. No coinsrance. Medical Concierge - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - sbject to dedctible. No coinsrance. Medical Concierge - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - sbject to dedctible. No coinsrance. Medical Concierge - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - sbject to dedctible. No coinsrance. Medical Concierge - dedctible 50% waived (to a $2,500 maximm). No coinsrance. PPO Network - sbject to dedctible. No coinsrance. Treatment inside the U.S.- Non-PPO Network and Canada Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximm per period of coverage Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximm per period of coverage Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximm per period of coverage Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximm per period of coverage Plan pays 90% of the next $5,000 of eligible expenses, then 100% to the overall maximm per period of coverage Hospitalization/Room & Board In U.S./Canada of average semiprivate room rate. Otside of U.S./ Canada - of private room rate (not to exceed 150% of semi-private room rate) All sbject to $600 per day day max. In U.S./Canada of average semiprivate room rate. Otside of U.S./ Canada - of private room rate (not to exceed 150% of semi-private room rate) Up to a limit of $2,250 per day - semi-private room rate In U.S./Canada of average semiprivate room rate. Otside of U.S./ Canada - of private room rate (not to exceed 150% of semi-private room rate) Private room rate Intensive Care Unit $1,500 per day day per event Up to a limit of $4,500 per day Srgery Anesthetist s Charges Associated with Srgery 20% of srgery benefit 20% of srgery benefit Transplants $250,000 per transplant $1,000,000 lifetime maximm $500,000 lifetime maximm $1,000,000 lifetime maximm $2,000,000 lifetime maximm Ot-patient 25 visits: $70 doctor/specialist; $60 psychiatrist; $50 chiropractor; $250 X-ray per exam maximm limit; $500 srgery intervention consltation; $300 lab tests per exam maximm limit Physician Charges - limit of $150 per visit; Hospital Charge - $100 co-pay nless admitted; Urgent Care Facility - $25 copay; Diagnostic Lab and X-Rays limited to $5,000 per certificate period Emergency Room Illness (Additional $250 dedctible if not admitted) Emergency Room Accident Spplemental Accident NA $300 per occrrence $300 per occrrence $300 per occrrence $500 per occrrence Local Amblance $1,500 per event - not sbject to dedctible or coinsrance $100 per event - not sbject to dedctible or coinsrance Mental/Nervos Ot-patient only after 12 months of continos coverage $10,000 per period - $50,000 maximm - Available after 12 months of continos coverage $2,500 maximm per certificate period; In-patient limited to 25 days per certificate period; Ot-patient limited to max of 20 visits per certificate period at 70% eligible expenses, p to $75 maximm per visit; Lifetime maximm of $30,000 $10,000 per period - $50,000 maximm - Available after 12 months of continos coverage SAAI - $50,000 lifetime maximm - Available after 12 months of continos coverage 5. Global Peace of Mind

7 Benefit Emergency Evacation Silver $50,000 per period of coverage - not sbject to dedctible or coinsrance Gold (1 st 36 months of continos coverage) Up to maximm limit - not sbject to dedctible or coinsrance Gold (Beginning the 1 st day of the 37 th month) $250,000 limit per person per certificate period Gold Pls Up to maximm limit - not sbject to dedctible or coinsrance Platinm (See page 7 for Platinm Advantages) Up to maximm limit - not sbject to dedctible or coinsrance Emergency Renion NA $10,000 lifetime maximm $10,000 lifetime maximm $10,000 lifetime maximm $10,000 lifetime maximm Retrn of Mortal Remains $25,000 lifetime maximm per insred - not sbject to dedctible or coinsrance $25,000 lifetime maximm per insred - not sbject to dedctible or coinsrance $15,000 lifetime maximm per insred - not sbject to dedctible or coinsrance $25,000 lifetime maximm per insred - not sbject to dedctible or coinsrance Remote Transportation NA NA NA NA Political Evacation and Repatriation Child Wellness (Under 18 years of age) Adlt Wellness $50,000 lifetime maximm per insred - not sbject to dedctible or coinsrance Limited to $5,000 per certificate period p to $20,000 lifetime maximm NA NA NA NA Limited to $10,000 lifetime maximm 3 visits per period of coverage - $70 maximm per visit - Available after 12 months of continos coverage NA $200 maximm per period of coverage - not sbject to dedctible or coinsrance. Available after 12 months of continos coverage $250 per period of coverage - not sbject to dedctible or coinsrance - Available for those 30 years of age and over after 12 months of continos coverage Rx Coverage Other Services Extended care: first 30 days; Radiation: ; Home nrsing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all Physical Therapy Maximm $40 per visit - 30 visit maximm Maximm $50 per visit Complementary Medicine NA Acpnctre $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage $200 maximm per period of coverage - not sbject to dedctible or coinsrance. Available after 12 months of continos coverage $250 per period of coverage - not sbject to dedctible or coinsrance - Available for those 30 years of age and over after 12 months of continos coverage $5,000 per certificate period for each insred person, ot-patient only - Radiation & Chemotherapy treatments (in and ot-patient) limited to $10,000 per year; $50,000 lifetime maximm Maximm $50 per visit - $1,000 max per certificate period. $10,000 lifetime maximm Acpnctre $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage $200 maximm per period of coverage - not sbject to dedctible or coinsrance. Available after 12 months of continos coverage $250 per period of coverage - not sbject to dedctible or coinsrance - Available for those 30 years of age and over after 12 months of continos coverage Maximm $50 per visit Acpnctre $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage $400 maximm per period of coverage - not sbject to dedctible or coinsrance. Available after 6 months of continos coverage $500 per period of coverage - not sbject to dedctible or coinsrance - Available for those 18 years of age and over after 6 months of continos coverage Otside U.S. -. Inside U.S. - Rx drg card co-pay: $20 for generic / $40 for brand name where generic is not available (Certain monthly per prescription amont limits may apply and reqire pre-approval by the Company.) Maximm $50 per visit Acpnctre $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage Recreational Scba NA Non-emergency Dental Optional Rider Optional Rider Optional Rider Optional Rider Emergency Dental de to Accident Emergency Dental de to Sdden Unexpected Pain Calendar year maximm: $750; Individal dedctible - $50 Schedle of Benefits - Class I 90%; Class II 70%; Class III 50%; 6 month waiting period $1,000 per period of coverage $500 per period of coverage NA $100 per period of coverage $100 per period of coverage $100 per period of coverage See Non-emergency Dental benefits High School Sports Injry NA NA NA NA Up to $20,000 per certificate period Vision Optional Rider Optional Rider Optional Rider Optional Rider Maternity Delivery, wellness, new born care & congenital disorders, Family Matters Maternity Program (*not sbject to dedctible or coinsrance - available after 10 months of coverage) Optional Rider* - $50,000 lifetime maximm, maximm of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximm of $250,000 for the first 31 days (Benefits redced by 50% for births that occr in the 11 th or 12 th month of continos coverage) Optional Rider* - $50,000 lifetime maximm, maximm of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximm of $250,000 for the first 31 days (Benefits redced by 50% for births that occr in the 11 th or 12 th month of continos coverage) Optional Rider* - $50,000 lifetime maximm, maximm of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximm of $250,000 for the first 31 days (Benefits redced by 50% for births that occr in the 11 th or 12 th month of continos coverage) Optional Rider* - $50,000 lifetime maximm, maximm of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximm of $250,000 for the first 31 days (Benefits redced by 50% for births that occr in the 11 th or 12 th month of continos coverage) Exams - p to $100 Materials - p to $150 per 24 months SAAI - $1,000 additional dedctible, $50,000 lifetime maximm, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximm of $250,000 for the first 31 days Global Peace of Mind 6.

8 The Advantages of the Platinm Plan Option The Platinm plan option is the complete international protection plan. It offers enhanced and additional benefits, access to a dedicated service team ready to assist yo, and access to or exclsive Global Concierge and Assistance Services SM. For a frther description of Platinm benefits and services, please refer to the Spplemental Brochre Insert inclded in the back of this booklet. Comprehensive Major Medical Plan - The Platinm plan option offers higher benefit maximms and additional coverages - Lifetime Maximm of $8,000,000, Transplants p to $2,000,000, as well as increased benefits for Hospital Room & Board, Retrn of Mortal Remains, Spplemental Accident, Mental & Nervos and Adlt & Child Wellness. The plan also incldes benefits for Remote Transportation, Political Evacation & Repatriation and High School Sports Injries. One Plan with Medical, Dental and Vision Benefits- In addition to the medical benefits, the Platinm plan option incldes a dental plan with coverage for Class I Diagnostic & Preventive Services, Class II Basic Services and Class III Major Services. It also incldes a vision benefit that provides coverage for exams and materials. Remote Transportation Benefit - If yo experience a medical problem that is not immediately lifethreatening, bt severe enogh to reslt in death or permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising ot of the transportation for yo to a qalified facility for frther treatment. Political Evacation and Repatriation Benefit-In the event the U.S. Department of State isses an evacation order of the host contry, IMG will coordinate the evacation of any covered insred(s) to the nearest place of safety or repatriation to the insred s home contry of residence. Mental & Nervos and Maternity Coverage - Expenses associated with these conditions are covered the same as any illness. High School Sports Injry Benefit - Protection is available for yor children while participating in sanctioned, organized sports at the high school level or below. Consltation for care and advice - The Platinm plan option offers yo direct access to a medical information service which allows yo to commnicate with licensed physicians, psychologists, pharmacists, dentists, dieticians and fitness trainers. They are available to assist yo with rotine health related qestions 24 hors a day. Global Concierge and Assistance Services - The Platinm plan option provides yo with more than insrance protection - yo also have exclsive access to a list of additional services handled by a dedicated service team available 24/7. Please refer to the Spplemental Brochre Insert for an extensive list. Optional Riders Global Medical Insrance is designed to protect individals and families from the high cost of medical expenses. In addition to tailored benefits packages, the program offers several optional coverages. Yo may review and choose any from the following list that meet yor needs. To apply, simply add in the appropriate premims, as otlined in the application, into the calclation for the total premim de. For a frther description of optional riders, please refer to the Spplemental Brochre Insert inclded in the back of this booklet. 7. Global Peace of Mind Rider Global Term Life Insrance (Amonts shown are the Principle Sms per nit) Accidental Death & Dismemberment (AD&D) - inclded with Global Term Life Insrance (* Benefit based on age at time of death; ** Member means hand, foot or eye) Global Daily Indemnity (Amont shown is the Principle Sm per nit. Available between age 31 days - 69 years p to two nits) Maternity (Silver, Gold, Gold Pls plan options) Terrorism (Platinm plan option) Sports (Gold Pls and Platinm plan options) Dental & Vision (Silver, Gold, Gold Pls plan options) Description Age 31 days - 18 years: $5,000 Age years: $20,000 Age years: $75,000 Age years: $15,000 Age years: $50,000 Age years: $10,000 Age years: $35,000 Age years: $7,500 Age years: $25,000 Accidental Loss of Life: Principle Sm* Accidental Total Loss of 2 Members**: Principle Sm* Accidental Total Loss of 1 Member**: 50% of Principle Sm* $100 per day $50,000 lifetime maximm, $5,000 maximm for normal delivery, $7,500 for C-section (Newborn covered for first 31 days only withot additional premim. Refer to page 6 for more information) $50,000 lifetime maximm $25,000 lifetime coverage for some adventre sports inclding montaineering, parachting, and whitewater rafting (Refer to Certificate Wording for a comprehensive list) Dental $750 lifetime maximm $50 dedctible (max. 2 per family) Class I - 90%, Class II - 70%, Class III - 50% 6 month waiting period Vision Exams - p to $100 Materials - p to $150 per 24 months

9 Flexible Underwriting Global Medical Insrance provides flexible nderwriting methods so yor application may be nderwritten by Standard Underwriting or the Flexible Underwriting Rider. Standard Underwriting - There are two levels of nderwriting when all medical conditions have been disclosed and they have not been specifically exclded or restricted by a rider (sbject to the foregoing limits and the other terms of the plan*). The Silver, Gold and Gold Pls plan options provide a $50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, sbject to a maximm of $5,000 per period of coverage after coverage has been in effect for 24 continos months. This benefit is payable whether or not yo have received consltation or treatment for the condition(s) dring the 24-month period of continos coverage. The following illnesses which exist, manifest themselves, or are treated or have treatment recommended prior to or dring the first 180 days of coverage from the initial effective date are considered preexisting conditions and are sbject to the waiting period and other limitations of coverage described above: acne, asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reprodctive system, hysterectomy, hernia, gall bladder or gall stones and kidney stones, any condition of the breast, and any condition of the prostate. On the Platinm plan option, conditions that are flly disclosed on the application and have not been exclded or restricted by a rider will be covered the same as any illness. Conditions, inclding any complications therefrom, that are not flly disclosed on the application will not be covered. Flexible Underwriting Rider - Where yo may have otherwise been declined for coverage, the Flexible Underwriting Rider allows s to extend coverage to yo. After 24 months of continos coverage, a disclosed pre-existing condition which has not been specifically exclded by a rider will be covered the same as any other pre-existing condition, so long as in that 24 month period no treatment has been received for that condition. If treatment has been soght or shold have been soght, then the 24 month period starts over from the treatment date. Other Exclsions and Limitations* Adlt rotine physical examinations are exclded nder the Silver plan option, and for the first 12 months for the Gold and Gold Pls plan option, and for the first 6 months for the Platinm plan option Ot-patient mental and nervos is exclded for the first 12 months on all plan options In-patient mental and nervos is exclded nder the Silver plan option and for the first 12 months for the Gold, Gold Pls and Platinm plan options Maternity, newborn and congenital disorders (nless the maternity rider or Platinm plan option is prchased - see the Smmary Schedle of Benefits on page 6) Note: all Maternity expenses inclding prenatal, delivery, postnatal, newborn and congenital disorders are exclded when the pregnancy is a reslt of fertility treatment even if yo have Maternity coverage Organ transplants not specifically listed Devices to correct sight are exclded nder the Silver, Gold and Gold Pls plan options Devices to correct hearing Treatment or spplies not medically necessary Treatment not ordered or received by a physician Treatment by a relative or family member Treatment as a reslt of war, riot or terrorism Treatment reslting from illegal activities Organized amater or professional sports Services and treatment eligible for payment by any government or other insrance Investigational, experimental or research procedres Rotine foot care Elective cosmetic or plastic srgery Drg and alcohol abse treatment Speech therapy Cstodial care Weight modification Treatment of impotency Contraceptive medication or treatment Persons HIV+ at effective date *This booklet contains only a consolidated and smmary description of some of the crrent Global Medical Insrance benefits, conditions, limitations and exclsions. A certificate containing the complete Certificate Wording with all terms, conditions and exclsions will be inclded in the flfillment kit. IMG reserves the right to isse the most crrent Certificate Wording for this insrance program in the event this application and/or booklet has expired, is modified, or is replaced with a newer version. Crrent Certificate Wordings are available pon reqest. For Florida residents seeking international coverage, please see the Florida specific brochre located in the Forms Library at Global Medical Insrance effectively manages yor medical conditions Global Peace of Mind 8.

10 To apply, simply complete and retrn the application form 9. Global Peace of Mind Eligibility & Enrollment Eligibility Global Medical Insrance is available to individals and families of all nationalities. U.S. citizens mst plan to leave the U.S. on or before their effective date (or renewal date) and reside otside the U.S. for at least 6 ot of the next 12 months. Coverage for non-u.s. citizens is worldwide, althogh certain eligibility restrictions may apply to non-u.s. citizens residing in the U.S. Persons from the ages of 14 days to 74 years old may apply for coverage. Persons 75 years of age and older are not eligible and coverage ends at age 75. Certain other restrictions may also apply. Please ask yor independent insrance agent or broker for frther details. For families, when both parents are covered nder Global Medical Insrance, the first two eligible dependent children from the ages of 14 days to 9 years are covered at no additional cost*. Children nder the age of 19 applying individally shold se the male age bracket when applying for coverage (please see the rate sheet inserts). Each person reqesting coverage mst complete the information reqired in the application. Renewal of Coverage Sbject to the terms of the plan, Global Medical Insrance is annally renewable and coverage is continos when renewed. Prior to the end of each period of coverage (12 months) yo will receive renewal information. Yo mst contine to meet the eligibility reqirements otlined above in order to renew. Yo have the option to renew online or yo may complete a paper renewal form. There are no additional medical qestions at renewal, and we can work with yo to provide flexible renewal options. Please select yor dedctible and plan option careflly, as yo will be nable to select a lower dedctible or increase yor plan option when yo renew yor coverage. Lifetime Coverage Lifetime medical coverage is available if yo are enrolled in the Global Medical Insrance program by yor 65 th birthday and maintain continos coverage to age 75. Prior to yor 75 th birthday yo will receive a smmary of benefits for a new plan, Global Senior Plan, and an enrollment form for coverage. There is no additional medical nderwriting. Yo simply need to review the benefits, and complete and retrn the enrollment form with yor premim. How to Apply To apply for Global Medical Insrance, simply complete and retrn the application. If yo are applying as a family, yo may inclde yorself, yor spose and dependents on one application. If yo or a dependent are 19 years of age or older, yo mst complete a separate application. Yo mst accrately complete all qestions otlined in the application in order to be considered for coverage. An attending physician statement may be reqired depending pon yor answers to the medical qestions, and IMG reserves the right to reqest additional medical information. When we receive yor completed application with premim, we will promptly evalate it based on the information provided. If approved, yo or yor agent/broker will be mailed or ed a flfillment kit which incldes an identification card, declaration of insrance and a Certificate of Insrance (containing a complete description of benefits, exclsions and terms of the plan), claim filing information, and claim forms. Yo are reqired to notify IMG, as reqired by the terms of the plan, if yo or any family member sffers from or is treated for any illness, injry or other medical condition between the time of yor application and the issance of the certificate. If yor application is not approved, yo will receive a fll refnd of premim. For additional information, please contact yor independent insrance agent or broker. We are confident that yo will be pleased with the fll terms of coverage. To ensre yor satisfaction, once yo are accepted in the plan we provide a 15 day period to review the flfillment kit contents. If dring that 15 day period yo find that yo are not satisfied with the plan for any reason, yo may sbmit a written reqest for cancellation and fll refnd of yor premim. See the Certificate of Insrance for fll details. Cancellation reqests received after this 15 day period will be granted at the sole discretion of IMG as the plan administrator. Any refnd yo may receive will be based on an established refnd schedle, not a pro-rated basis. See the Certificate of Insrance for fll details. IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insrance is not sbject to, and does not provide benefits reqired by, PPACA. On Janary 1, 2014, PPACA will reqire U.S. citizens, U.S. nationals and certain U.S. residents to obtain PPACA compliant insrance coverage nless they are exempt from PPACA. Penalties may be imposed on persons who are reqired to maintain PPACA compliant coverage bt do not do so. Eligibility to prchase, extend or renew this prodct, or its terms and conditions, may be modified or amended based pon changes to applicable law, inclding PPACA. Please note that it is an insred person s sole and exclsive responsibility to determine if PPACA is applicable to them, and the Company and IMG shall have no liability to any person whatsoever for their failre to obtain or maintain PPACA compliant insrance coverage. For information on whether PPACA applies to yo or whether yo are eligible to prchase Global Medical Insrance, please see IMG s Freqently Asked Qestions at www. imglobal.com/client-resorces/ppaca-faq.aspx. * For families, the first two eligible dependent children from the ages of 14 days to 9 years are covered at no additional cost for the first year of coverage. On the first renewal date, premim will be 50% of the pblished rate. For sbseqent renewals, the reglar renewal premim will apply.

11 Please refer to the Certificate Wording for specific terms, conditions and other details regarding the benefits, limitations, eligibility and exclsions otlined in this booklet. Certificate Wording is available pon reqest prior to prchase. The smmary description of coverages, benefits and eligibility in this booklet is accrate at the date of printing, sbject to the terms of the plan. Any pdates or changes made sbseqent to printing will be inclded in the flfillment kit sent pon approval of yor application, and/ or from time to time thereafter. IMG, International Medical Grop, the IMG block design logo, imglobal, Global Medical Insrance, Global Term Life Insrance, Global Daily Indemnity, Global Senior Plan, Coverage Withot Bondaries, and Global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Grop, Inc. Siris and Siris International are the trademarks, service marks and/or registered marks of Siris International Insrance Corporation (pbl) International Medical Grop, Inc. All rights reserved. International Medical Grop, Inc. P.O. Box Indianapolis, IN USA Telephone: or Fax:

12 Coverage Withot Bondaries