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
New Business Annual Premiums Effective 1 July 2015 - 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. 398 200 170 130 116 105 93 10-18 416 218 179 139 125 113 101 19-24 785 491 446 330 292 244 188 25-29 867 542 495 367 323 274 200 30-34 965 604 550 426 368 307 235 35-39 1,060 663 597 460 404 339 248 40-44 1,252 783 697 540 479 385 304 45-49 1,355 847 759 590 523 416 327 50-54 1,559 974 881 687 624 511 401 55-59 1,883 1,176 1,079 842 743 625 488 60-64 2,611 1,632 1,505 1,253 1,144 931 766 65-69 5,215 3,259 3,133 2,881 2,292 1,985 1,636 283 134 114 87 78 71 63 10-18 296 147 120 93 84 75 67 19-24 526 329 299 222 196 164 127 25-29 581 363 332 246 216 184 134 30-34 647 404 368 286 248 206 158 35-39 710 444 400 308 271 227 166 40-44 839 524 466 362 321 259 204 45-49 907 568 508 395 351 279 218 50-54 1,045 653 590 460 419 343 269 55-59 1,261 788 722 564 497 419 327 60-64 1,749 1,093 1,009 840 766 624 514 65-69 3,493 2,183 2,099 1,930 1,536 1,329 1,096 237 111 94 72 64 58 52 10-18 246 120 99 76 69 62 55 19-24 431 270 245 181 161 134 103 25-29 477 298 272 202 178 151 110 30-34 531 332 302 234 203 169 130 35-39 582 364 328 253 223 187 137 40-44 689 430 383 297 263 212 167 45-49 746 466 418 325 288 228 179 50-54 858 536 485 377 344 281 221 55-59 1,035 647 592 463 409 344 269 60-64 1,436 897 828 689 629 512 421 65-69 2,868 1,792 1,723 1,585 1,260 1,092 899 Available only between ages 19-69 years (per unit - Max 2) 6 / $10 / 8 16 / $28 / 23 $55 / 31 / 46 $100 / 56 / 83 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 2/31
New Business Annual Premiums Effective 1 July 2015 - 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. 457 230 195 150 133 121 108 10-18 477 251 206 159 144 130 116 19-24 903 564 512 381 336 281 216 25-29 997 623 569 422 371 315 230 30-34 1,110 693 632 489 424 353 270 35-39 1,219 762 685 529 465 390 286 40-44 1,439 899 800 620 551 444 349 45-49 1,558 973 874 679 601 478 375 50-54 1,792 1,120 1,014 790 718 587 461 55-59 2,164 1,352 1,239 968 853 719 561 60-64 3,000 1,875 1,730 1,440 1,315 1,071 881 65-69 5,993 3,746 3,601 3,311 2,634 2,281 1,880 272 127 108 83 74 66 59 10-18 283 138 113 87 80 72 64 19-24 496 310 282 209 185 155 119 25-29 549 343 312 232 204 174 127 30-34 610 382 347 269 233 195 149 35-39 670 419 377 290 255 215 157 40-44 792 495 440 342 302 244 193 45-49 857 535 480 373 330 263 206 50-54 986 616 557 435 394 323 253 55-59 1,189 744 682 532 469 395 308 60-64 1,650 1,032 952 792 724 589 485 65-69 3,296 2,060 1,980 1,821 1,448 1,254 1,034 325 155 131 101 90 81 72 10-18 339 168 138 108 96 86 77 19-24 605 377 344 254 225 188 146 25-29 668 417 381 283 249 212 155 30-34 744 465 423 328 284 236 181 35-39 816 511 459 354 311 262 190 40-44 964 603 536 416 370 297 234 45-49 1,044 652 585 455 402 320 252 50-54 1,201 750 679 529 480 393 309 55-59 1,449 906 830 648 571 482 376 60-64 2,010 1,257 1,159 965 880 717 590 65-69 4,015 2,510 2,412 2,219 1,764 1,529 1,260 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual Available only between ages 19-69 years (per unit - Max 2) 6 / $10 / 8 $28 / 16 / 23 $55 / 31 / 46 $100 / 56 / 83 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 3/31
New Business Annual Premiums Effective 1 July 2015 - 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. 535 308 260 198 179 160 144 10-18 561 335 273 212 193 171 156 19-24 1,204 753 682 520 459 374 288 25-29 1,329 831 758 562 495 420 306 30-34 1,480 924 842 638 566 470 361 35-39 1,624 1,016 914 704 620 520 380 40-44 1,920 1,200 1,066 827 735 591 466 45-49 2,076 1,297 1,165 905 801 636 501 50-54 2,389 1,493 1,351 1,053 956 783 615 55-59 2,884 1,802 1,652 1,290 1,138 958 747 60-64 4,001 2,500 2,307 1,921 1,753 1,427 1,175 65-69 8,690 5,431 4,800 4,415 3,511 3,042 2,507 315 169 143 109 99 88 80 10-18 329 184 150 116 106 94 85 19-24 662 414 375 286 253 206 159 25-29 731 457 417 309 272 232 168 30-34 813 508 464 352 311 259 198 35-39 894 559 503 388 342 286 208 40-44 1,056 660 587 455 404 325 256 45-49 1,141 713 641 497 440 349 276 50-54 1,314 821 743 579 526 431 338 55-59 1,586 991 908 710 626 526 411 60-64 2,200 1,375 1,269 1,056 963 785 646 65-69 4,779 2,987 2,640 2,428 1,931 1,673 1,379 377 206 174 133 120 108 96 10-18 395 224 183 142 129 114 104 19-24 806 504 457 348 308 251 193 25-29 890 557 507 377 332 281 205 30-34 991 619 564 428 379 315 241 35-39 1,179 680 612 472 416 348 254 40-44 1,287 804 715 554 492 395 311 45-49 1,391 869 781 606 536 427 335 50-54 1,600 1,000 905 704 641 525 412 55-59 1,932 1,207 1,107 865 763 642 501 60-64 2,680 1,676 1,546 1,287 1,174 956 786 65-69 5,823 3,639 3,217 2,958 2,353 2,038 1,680 the Premium Above : $570 / 314 / 381 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 4/31
New Business Annual Premiums Effective 1 July 2015 - 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. 754 267 234 181 159 147 129 10-18 760 273 244 202 187 176 153 19-24 1,175 688 636 491 429 340 298 25-29 1,243 756 700 540 470 381 317 30-34 1,344 840 759 588 513 408 355 35-39 1,550 969 825 640 556 451 373 40-44 1,820 1,138 956 694 608 521 461 45-49 2,018 1,262 1,053 815 710 570 507 50-54 2,355 1,473 1,258 974 858 720 641 55-59 2,726 1,705 1,481 1,146 999 843 752 60-64 3,909 2,443 2,220 1,826 1,665 1,384 1,233 65-69 7,881 4,927 4,714 4,361 3,307 3,005 2,673 460 147 129 101 87 81 72 10-18 464 151 134 110 103 96 85 19-24 691 379 349 270 236 187 164 25-29 729 416 384 297 259 209 175 30-34 775 461 417 324 282 224 195 35-39 852 533 454 352 306 249 205 40-44 1,001 626 526 382 334 288 254 45-49 1,110 693 580 448 391 312 279 50-54 1,295 810 693 536 473 396 354 55-59 1,500 937 813 631 550 464 413 60-64 2,149 1,344 1,221 1,005 916 762 679 65-69 4,336 2,709 2,593 2,399 1,819 1,653 1,472 545 178 156 122 106 97 86 10-18 551 184 164 134 125 119 103 19-24 738 461 426 329 287 228 199 25-29 810 506 468 362 315 255 213 30-34 900 563 508 393 344 273 237 35-39 1,038 648 552 428 373 302 250 40-44 1,220 763 641 466 408 349 310 45-49 1,353 844 706 547 476 382 340 50-54 1,578 986 843 653 575 484 430 55-59 1,827 1,142 992 768 670 566 504 60-64 2,619 1,636 1,487 1,224 1,116 928 825 65-69 5,282 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 / 20 37 / $67 / 56 73 / $132 / 110 133 / $240 / 200 Second Unit ( 19-64 years ) 10 / $18 / 15 28 / $50 / 42 55 / $99 / 83 100 / $180 / 150 Child ( 31 days-18 years ) 6 / $10 / 8 16 / $28 / 23 31 / $55 / 46 56 / $100 / 83 Available only between ages 19-69 years (per unit - Max 2) 6 / $10 / 8 16 / $28 / 23 31 / $55 / 46 56 / $100 / 83 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 5/31
New Business Annual Premiums Effective 1 July 2015 - 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. 867 307 269 208 183 168 148 10-18 875 315 280 232 215 203 177 19-24 1,351 791 731 564 493 391 343 25-29 1,429 869 804 620 541 438 364 30-34 1,544 965 872 675 590 468 408 35-39 1,782 1,113 949 735 638 519 429 40-44 2,092 1,308 1,100 799 699 599 531 45-49 2,320 1,450 1,211 937 816 655 584 50-54 2,707 1,692 1,446 1,120 987 828 737 55-59 3,134 1,959 1,702 1,317 1,148 970 864 60-64 4,492 2,808 2,551 2,099 1,914 1,592 1,417 65-69 9,060 5,663 5,419 5,013 3,801 3,454 3,073 529 169 148 115 101 93 82 10-18 533 174 155 127 119 111 97 19-24 794 435 402 310 271 215 188 25-29 838 478 441 342 298 241 200 30-34 890 531 479 372 325 258 224 35-39 980 613 522 404 352 286 235 40-44 1,151 720 605 439 384 330 292 45-49 1,276 797 666 515 449 360 320 50-54 1,488 931 796 616 543 456 407 55-59 1,724 1,077 935 725 632 533 475 60-64 2,471 1,544 1,403 1,155 1,053 876 780 65-69 4,983 3,115 2,980 2,757 2,091 1,900 1,691 627 205 179 140 122 112 100 10-18 633 211 188 155 144 137 119 19-24 848 530 489 379 329 262 230 25-29 931 582 539 416 362 293 244 30-34 1,035 647 585 452 395 314 273 35-39 1,194 746 635 492 429 347 287 40-44 1,402 877 737 535 468 402 356 45-49 1,555 971 811 628 548 439 391 50-54 1,813 1,133 969 750 661 556 494 55-59 2,100 1,313 1,140 883 769 650 579 60-64 3,009 1,880 1,709 1,407 1,282 1,067 949 65-69 6,072 3,795 3,630 3,359 2,547 2,314 2,059 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 6/31
New Business Annual Premiums Effective 1 July 2015 - 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. 970 410 357 278 243 223 198 10-18 979 419 373 308 287 270 237 19-24 1,687 1,054 976 754 656 522 456 25-29 1,852 1,158 1,071 829 720 584 485 30-34 2,059 1,287 1,163 900 787 625 542 35-39 2,372 1,483 1,262 979 851 690 571 40-44 2,790 1,744 1,466 1,063 932 796 708 45-49 3,093 1,933 1,615 1,250 1,089 874 777 50-54 3,723 2,257 1,929 1,493 1,315 1,104 982 55-59 4,179 2,612 2,270 1,756 1,532 1,295 1,151 60-64 5,989 3,743 3,401 2,798 2,551 2,122 1,889 65-69 12,081 7,551 7,224 6,684 5,068 4,604 4,098 586 226 197 153 133 123 110 10-18 589 230 205 169 157 148 131 19-24 940 580 536 414 361 287 251 25-29 1,019 637 589 456 396 321 267 30-34 1,132 708 641 495 433 344 299 35-39 1,306 816 694 539 468 380 315 40-44 1,534 959 806 585 512 438 390 45-49 1,701 1,063 888 688 599 482 428 50-54 1,986 1,241 1,060 821 722 607 540 55-59 2,298 1,437 1,249 967 842 712 634 60-64 3,294 2,059 1,872 1,539 1,403 1,167 1,039 65-69 6,644 4,153 3,974 3,676 2,788 2,532 2,255 697 274 240 186 162 149 133 10-18 702 280 250 206 192 181 160 19-24 1,130 707 654 504 440 349 306 25-29 1,241 775 718 556 483 391 325 30-34 1,380 862 778 604 528 419 363 35-39 1,590 995 846 656 570 461 383 40-44 1,869 1,168 982 712 624 533 475 45-49 2,072 1,295 1,082 838 729 586 521 50-54 2,418 1,511 1,292 1,000 880 740 659 55-59 2,800 1,749 1,521 1,177 1,027 867 772 60-64 4,012 2,508 2,279 1,875 1,709 1,422 1,266 65-69 8,094 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 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 7/31
New Business Annual Premiums Effective 1 July 2015 - 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 852 365 312 234 213 189 170 10-18 892 404 330 259 235 209 189 19-24 1,548 967 875 672 581 461 356 25-29 1,646 1,029 926 708 613 478 364 30-34 1,762 1,101 982 763 663 531 408 35-39 1,859 1,163 1,011 777 676 541 414 40-44 2,238 1,399 1,277 981 886 682 536 45-49 2,492 1,558 1,422 1,086 978 781 617 50-54 2,803 1,752 1,585 1,268 1,173 939 741 55-59 3,482 2,176 1,935 1,577 1,332 1,120 885 60-64 4,824 3,015 2,811 2,237 2,102 1,734 1,425 65-69 9,455 5,909 5,645 5,219 4,172 3,670 3,011 612 244 209 156 142 127 114 10-18 638 271 221 174 158 140 127 19-24 1,036 648 587 450 389 309 239 25-29 1,104 690 620 475 410 320 244 30-34 1,180 738 657 512 445 356 273 35-39 1,245 778 678 521 452 363 278 40-44 1,500 937 856 657 594 458 360 45-49 1,670 1,044 954 728 656 523 413 50-54 1,877 1,173 1,062 850 786 628 496 55-59 2,333 1,458 1,297 1,056 893 749 594 60-64 3,232 2,020 1,884 1,499 1,409 1,161 955 65-69 6,335 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 514 202 172 129 116 103 94 10-18 536 223 181 142 129 115 103 19-24 851 532 482 370 319 253 196 25-29 905 566 510 390 337 263 199 30-34 969 605 540 420 365 292 224 35-39 1,024 640 557 428 372 297 228 40-44 1,231 768 702 540 487 375 296 45-49 1,371 858 783 598 539 430 340 50-54 1,542 963 872 698 645 515 408 55-59 1,915 1,196 1,064 867 732 616 486 60-64 2,653 1,659 1,547 1,230 1,157 954 784 65-69 5,199 3,249 3,105 2,871 2,295 2,019 1,655 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 8/31
New Business Annual Premiums Effective 1 July 2015 - 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 980 420 360 269 244 217 196 10-18 1,025 465 380 298 270 241 217 19-24 1,779 1,111 1,006 773 668 530 409 25-29 1,893 1,183 1,064 814 704 550 418 30-34 2,025 1,266 1,129 877 763 610 468 35-39 2,137 1,336 1,163 894 777 622 476 40-44 2,573 1,608 1,467 1,128 1,018 784 617 45-49 2,865 1,791 1,635 1,249 1,124 897 709 50-54 3,222 2,014 1,822 1,457 1,347 1,079 852 55-59 4,002 2,501 2,224 1,812 1,531 1,287 1,017 60-64 5,545 3,465 3,231 2,570 2,416 1,992 1,637 65-69 10,867 6,792 6,488 5,999 4,796 4,219 3,461 591 232 198 148 134 119 108 10-18 616 256 208 164 148 132 119 19-24 978 612 553 424 367 291 225 25-29 1,040 651 586 448 388 302 230 30-34 1,113 696 620 483 420 336 258 35-39 1,176 735 640 492 428 342 262 40-44 1,415 884 808 620 560 431 339 45-49 1,576 986 899 688 619 494 391 50-54 1,773 1,108 1,002 802 741 592 468 55-59 2,201 1,375 1,223 997 842 708 559 60-64 3,050 1,906 1,777 1,413 1,329 1,096 902 65-69 5,976 3,735 3,568 3,300 2,638 2,321 1,903 703 281 241 179 164 146 131 10-18 734 311 254 199 181 161 146 19-24 1,191 745 674 517 447 355 274 25-29 1,269 793 713 545 472 368 280 30-34 1,356 848 756 588 511 409 314 35-39 1,431 895 778 598 520 417 319 40-44 1,724 1,077 983 756 682 526 413 45-49 1,920 1,200 1,096 837 754 601 475 50-54 2,158 1,348 1,221 977 904 722 570 55-59 2,681 1,676 1,491 1,214 1,026 861 682 60-64 3,715 2,322 2,165 1,723 1,620 1,335 1,098 65-69 7,281 4,551 4,347 4,020 3,213 2,827 2,318 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 9/31
New Business Annual Premiums Effective 1 July 2015 - 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 11,28 568 486 364 330 292 264 10-18 1,189 629 513 402 364 325 292 19-24 2,404 1,502 1,361 1,043 902 717 552 25-29 2,559 1,599 1,438 1,101 952 743 566 30-34 2,736 1,710 1,525 1,185 1,032 824 633 35-39 2,888 1,805 1,570 1,207 1,049 840 644 40-44 3,478 2,173 1,984 1,523 1,375 1,061 834 45-49 3,872 2,420 2,210 1,689 1,520 1,213 958 50-54 4,353 2,720 2,462 1,969 1,822 1,457 1,151 55-59 5,407 3,379 3,005 2,449 2,070 1,738 1,373 60-64 7,494 4,684 4,367 3,473 3,265 2,691 2,212 65-69 14,685 9,178 8,768 8,108 6,479 5,703 4,676 673 314 267 199 183 161 146 10-18 706 346 281 221 199 178 161 19-24 1,323 827 748 573 496 394 305 25-29 1,408 880 791 605 523 409 310 30-34 1,504 941 840 652 567 454 348 35-39 1,588 992 864 664 578 461 354 40-44 1,912 1,195 1,061 838 757 584 459 45-49 2,129 1,331 1,215 930 836 668 526 50-54 2,395 1,496 1,354 1,084 1,002 802 633 55-59 2,975 1,859 1,653 1,346 1,138 955 755 60-64 4,122 2,576 2,402 1,911 1,795 1,481 1,217 65-69 8,076 5,048 4,823 4,460 3,564 3,137 2,572 803 381 326 243 222 196 177 10-18 843 421 344 270 243 218 196 19-24 1,612 1,007 912 699 605 480 371 25-29 1,715 1,072 963 738 637 498 380 30-34 1,833 1,146 1,021 794 691 552 423 35-39 1,935 1,210 1,053 809 703 562 431 40-44 2,330 1,456 1,329 1,020 922 710 559 45-49 2,594 1,622 1,482 1,131 1,018 813 642 50-54 2,916 1,823 1,649 1,319 1,221 977 772 55-59 3,622 2,264 2,013 1,641 1,387 1,164 921 60-64 5,021 3,138 2,927 2,327 2,187 1,803 1,483 65-69 9,838 6,149 5,874 5,432 4,341 3,820 3,134 the Premium Above : $570 / 314 / 381 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 10/31
New Business Annual Premiums Effective 1 July 2015 - 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. 981 494 420 321 288 259 230 10-18 1,026 539 441 343 309 279 250 19-24 1,939 1,212 1,100 818 724 604 465 25-29 2,140 1,338 1,222 907 797 678 494 30-34 2,383 1,490 1,357 1,052 911 759 581 35-39 2,617 1,636 1,473 1,136 999 838 612 40-44 3,092 1,933 1,719 1,332 1,183 953 750 45-49 3,347 2,091 1,876 1,457 1,291 1,026 806 50-54 3,849 2,406 2,177 1,696 1,541 1,262 991 55-59 4,648 2,904 2,662 2,079 1,832 1,543 1,205 60-64 6,446 4,029 3,717 3,095 2,824 2,299 1,893 65-69 12,874 8,046 7,735 7,113 5,658 4,901 4,039 586 273 231 177 159 142 127 10-18 609 296 243 189 170 153 137 19-24 1,066 666 605 449 398 332 255 25-29 1,178 736 672 498 439 372 272 30-34 1,312 820 746 578 502 418 319 35-39 1,439 899 810 625 549 461 337 40-44 1,700 1,063 945 732 651 524 413 45-49 1,840 1,150 1,032 801 710 564 444 50-54 2,118 1,323 1,196 933 848 693 544 55-59 2,556 1,598 1,465 1,144 1,008 849 663 60-64 3,545 2,215 2,044 1,702 1,553 1,264 1,040 65-69 7,081 4,426 4,254 3,912 3,111 2,695 2,222 699 332 281 216 193 174 153 10-18 729 362 296 230 206 186 167 19-24 1,299 812 738 548 484 403 311 25-29 1,435 896 819 608 534 454 332 30-34 1,597 998 909 704 610 507 390 35-39 1,754 1,096 986 760 670 562 410 40-44 2,072 1,296 1,151 893 793 638 503 45-49 2,241 1,401 1,257 977 865 687 541 50-54 2,579 1,613 1,458 1,136 1,033 846 663 55-59 3,115 1,947 1,783 1,392 1,228 1,034 808 60-64 4,319 2,699 2,491 2,072 1,893 1,540 1,268 65-69 8,625 5,392 5,182 4,766 3,790 3,283 2,716 2011-2015 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
New Business Annual Premiums Effective 1 July 2015 - 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. 1,128 568 483 370 330 298 264 10-18 1,179 619 507 394 355 320 287 19-24 2,229 1,393 1,264 940 831 693 534 25-29 2,461 1,538 1,404 1,043 916 778 568 30-34 2,740 1,712 1,560 1,208 1,047 872 668 35-39 3,008 1,880 1,692 1,305 1,148 963 703 40-44 3,555 2,222 1,976 1,531 1,360 1,095 862 45-49 3,846 2,404 2,156 1,674 1,484 1,179 927 50-54 4,425 2,765 2,502 1,949 1,772 1,450 1,139 55-59 5,342 3,339 3,060 2,389 2,107 1,774 1,385 60-64 7,409 4,630 4,273 3,557 3,246 2,643 2,175 65-69 14,799 9,249 8,891 8,176 6,504 5,634 4,642 803 381 324 249 222 199 177 10-18 838 416 339 264 237 214 192 19-24 1,493 933 848 629 557 464 358 25-29 1,649 1,030 941 699 614 521 381 30-34 1,836 1,147 1,045 810 701 584 448 35-39 2,016 1,260 1,133 875 769 646 472 40-44 2,382 1,490 1,324 1,026 912 734 578 45-49 2,576 1,611 1,445 1,122 993 790 622 50-54 2,965 1,854 1,677 1,305 1,187 972 763 55-59 3,580 2,238 2,050 1,600 1,411 1,188 928 60-64 4,964 3,102 2,863 2,382 2,175 1,771 1,457 65-69 9,914 6,197 5,956 5,478 4,357 3,773 3,110 673 314 265 204 183 164 146 10-18 700 340 279 217 196 176 157 19-24 1,225 766 696 516 457 381 293 25-29 1,354 846 773 573 504 428 312 30-34 1,508 942 858 664 577 480 367 35-39 1,654 1,034 931 718 631 530 388 40-44 1,954 1,222 1,086 842 748 603 475 45-49 2,116 1,323 1,186 921 816 648 510 50-54 2,434 1,521 1,375 1,072 974 797 626 55-59 2,938 1,837 1,683 1,314 1,159 976 762 60-64 4,075 2,547 2,350 1,957 1,785 1,454 1,196 65-69 8,139 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 12/31
New Business Annual Premiums Effective 1 July 2015 - 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. 1,322 762 641 489 442 396 357 10-18 1,387 827 674 522 476 423 383 19-24 2,972 1,857 1,686 1,284 1,135 923 711 25-29 3,283 2,052 1,872 1,390 1,222 1,037 755 30-34 3,652 2,283 2,080 1,577 1,397 1,163 889 35-39 4,011 2,507 2,256 1,738 1,532 1,284 937 40-44 4,741 2,962 2,633 2,042 1,813 1,458 1,149 45-49 5,126 3,203 2,876 2,233 1,978 1,570 1,236 50-54 5,898 3,686 3,334 2,598 2,361 1,934 1,518 55-59 7,121 4,451 4,080 3,185 2,809 2,365 1,846 60-64 9,877 6,173 5,696 4,743 4,327 3,524 2,900 65-69 21,457 13,411 11,854 10,901 8,671 7,511 6,189 932 510 430 328 296 265 240 10-18 976 553 452 351 318 283 256 19-24 1,990 1,244 1,129 860 760 619 476 25-29 2,200 1,374 1,254 931 818 696 506 30-34 2,447 1,529 1,393 1,057 936 778 596 35-39 2,688 1,680 1,511 1,165 1,026 859 628 40-44 3,176 1,986 1,764 1,368 1,215 978 771 45-49 3,434 2,146 1,928 1,496 1,325 1,053 828 50-54 3,951 2,470 2,233 1,740 1,583 1,296 1,017 55-59 4,771 2,981 2,733 2,134 1,883 1,585 1,236 60-64 6,618 4,136 3,817 3,179 2,899 2,361 1,943 65-69 14,376 8,985 7,942 7,304 5,809 5,032 4,147 778 419 353 270 243 218 197 10-18 814 455 372 287 262 233 212 19-24 1,635 1,021 927 707 624 507 392 25-29 1,805 1,129 1,029 765 672 571 416 30-34 2,008 1,256 1,144 867 768 638 489 35-39 2,206 1,379 1,241 956 842 706 515 40-44 2,608 1,630 1,448 1,122 998 802 633 45-49 2,818 1,762 1,581 1,228 1,088 864 680 50-54 3,245 2,027 1,833 1,429 1,299 1,063 834 55-59 3,917 2,448 2,244 1,753 1,546 1,301 1,015 60-64 5,432 3,395 3,133 2,608 2,380 1,938 1,595 65-69 11,801 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 13/31
New Business Annual Premiums Effective 1 July 2015 - 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 1,271 10-18 3,111 2,139 1,944 1,730 1,512 1,439 1,369 1,308 19-24 6,848 4,708 4,280 3,858 3,137 2,862 2,629 2,110 25-29 7,318 5,031 4,574 4,260 3,343 3,033 2,699 2,162 30-34 8,016 5,512 5,011 4,648 3,700 3,362 2,931 2,415 35-39 8,568 5,890 5,355 4,901 3,951 3,568 3,121 2,468 40-44 9,789 6,729 6,119 5,527 4,455 4,042 3,395 2,835 45-49 8,903 6,121 5,564 5,070 4,106 3,726 3,117 2,612 50-54 10,062 6,917 6,289 5,761 4,654 4,302 3,659 3,036 55-59 11,896 8,178 7,435 6,878 5,535 4,971 4,310 3,527 60-64 16,126 11,019 10,078 9,302 7,880 7,249 6,042 5,109 65-69 30,802 21,176 19,252 18,535 17,106 13,760 12,021 10,041 NIL 67 168 335 670 1,675 3,350 6,700 1,985 1,366 1,241 1,127 979 932 888 851 10-18 2,084 1,432 1,303 1,158 1,014 964 918 876 19-24 4,589 3,154 2,867 2,585 2,102 1,917 1,687 1,413 25-29 4,903 3,371 3,064 2,854 2,239 2,033 1,809 1,448 30-34 5,370 3,692 3,357 3,115 2,479 2,252 1,964 1,618 35-39 5,740 3,947 3,587 3,284 2,648 2,390 2,092 1,653 40-44 6,559 4,508 4,099 3,703 2,986 2,708 2,275 1,900 45-49 5,965 4,101 3,728 3,397 2,752 2,496 2,089 1,749 50-54 6,742 4,635 4,213 3,860 3,118 2,882 2,452 2,035 55-59 7,971 5,479 4,981 4,609 3,709 3,331 2,887 2,363 60-64 10,805 7,383 6,752 6,233 5,273 4,856 4,049 3,424 65-69 20,637 14,187 12,898 12,417 11,461 9,219 8,054 6,727 NIL 55 138 275 550 1,375 2,750 5,500 1,631 1,121 1,018 925 805 765 729 699 10-18 1,711 1,176 1,068 952 831 792 754 720 19-24 3,767 2,589 2,354 2,122 1,726 1,575 1,384 1,160 25-29 4,024 2,768 2,514 2,342 1,839 1,668 1,485 1,188 30-34 4,408 3,032 2,755 2,557 2,035 1,849 1,612 1,328 35-39 4,712 3,240 2,946 2,696 2,174 1,962 1,717 1,357 40-44 3,144 3,702 3,364 3,040 2,451 2,193 1,867 1,559 45-49 4,897 3,367 3,061 2,789 2,259 2,050 1,714 1,436 50-54 5,534 3,805 3,459 3,168 2,559 2,365 2,013 1,670 55-59 6,543 4,499 4,089 3,782 3,045 2,733 2,370 1,939 60-64 8,869 6,060 5,543 5,116 4,329 3,986 3,324 2,810 65-69 16,941 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 14/31
New Business Annual Premiums Effective 1 July 2015 - 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 1,462 10-18 3,576 2,458 2,234 1,989 1,738 1,654 1,574 1,504 19-24 7,871 5,412 4,919 4,435 3,606 3,289 2,893 2,425 25-29 8,411 5,783 5,257 4,897 3,843 3,487 3,102 2,484 30-34 9,214 6,335 5,759 5,342 4,254 3,865 3,369 2,775 35-39 9,848 6,770 6,154 5,634 4,542 4,101 3,588 2,837 40-44 11,252 7,735 7,032 6,353 5,121 4,646 3,902 3,258 45-49 10,233 7,036 6,395 5,827 4,720 4,283 3,583 3,002 50-54 11,565 7,951 7,228 6,623 5,349 4,945 4,206 3,490 55-59 13,673 9,400 8,546 7,906 6,363 5,713 4,954 4,053 60-64 18,535 12,665 11,584 10,692 9,057 8,332 6,945 5,873 65-69 35,404 24,340 22,128 21,305 19,662 15,817 13,817 11,542 NIL 67 168 335 670 1,675 3,350 6,700 2,281 1,570 1,426 1,295 1,126 1,071 1,020 979 10-18 2,396 1,646 1,497 1,332 1,165 1,109 1,055 1,007 19-24 5,274 3,625 3,296 2,971 2,416 2,204 1,939 1,624 25-29 5,636 3,875 3,522 3,280 2,574 2,336 2,079 1,664 30-34 6,173 4,244 3,858 3,580 2,849 2,589 2,258 1,860 35-39 6,598 4,536 4,124 3,774 3,043 2,747 2,405 1,901 40-44 7,539 5,182 4,712 4,256 3,432 3,112 2,614 2,183 45-49 6,857 4,714 4,285 3,904 3,163 2,869 2,401 2,010 50-54 7,749 5,327 4,843 4,436 3,584 3,313 2,818 2,339 55-59 9,162 6,298 5,725 5,298 4,264 3,828 3,319 2,716 60-64 12,419 8,486 7,762 7,164 6,061 5,582 4,654 3,936 65-69 23,720 16,307 14,825 14,273 13,173 10,596 9,258 7,732 NIL 55 138 275 550 1,375 2,750 5,500 1,874 1,289 1,170 1,063 925 879 838 803 10-18 1,967 1,352 1,229 1,094 955 911 866 828 19-24 4,330 2,976 2,706 2,439 1,984 1,810 1,592 1,334 25-29 4,626 3,181 2,891 2,692 2,113 1,917 1,707 1,366 30-34 5,067 3,484 3,167 2,939 2,340 2,126 1,852 1,527 35-39 5,416 3,724 3,386 3,099 2,499 2,256 1,973 1,560 40-44 6,188 4,255 3,867 3,494 2,817 2,556 2,146 1,792 45-49 5,628 3,870 3,518 3,205 2,596 2,355 1,970 1,651 50-54 6,360 4,374 3,975 3,642 2,942 2,719 2,313 1,920 55-59 7,521 5,171 4,701 4,348 3,500 3,142 2,724 2,229 60-64 10,194 6,965 6,372 5,880 4,976 4,582 3,820 3,230 65-69 19,472 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 15/31
New Business Annual Premiums Effective 1 July 2015 - 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 1,658 10-18 4,310 2,964 2,694 2,359 2,025 1,915 1,808 1,714 19-24 10,026 6,923 6,266 5,812 4,518 4,095 3,567 2,941 25-29 10,752 7,390 6,720 6,235 4,834 4,355 3,843 3,017 30-34 11,819 8,126 7,386 6,834 5,378 4,862 4,200 3,408 35-39 12,657 8,702 7,911 7,223 5,762 5,176 4,492 3,489 40-44 14,533 9,993 9,083 8,179 6,536 5,904 4,911 4,053 45-49 13,169 9,055 8,231 7,209 6,003 5,417 4,481 3,712 50-54 14,362 9,874 8,976 8,536 6,843 6,301 5,317 4,362 55-59 17,759 12,210 11,099 10,249 8,193 7,328 6,308 5,114 60-64 24,091 16,564 15,057 13,963 11,772 10,752 8,970 7,535 65-69 46,735 32,134 29,210 28,114 25,924 20,798 18,131 15,096 NIL 67 168 335 670 1,675 3,350 6,700 2,732 1,877 1,708 1,530 1,306 1,234 1,168 1,110 10-18 2,886 1,985 1,804 1,580 1,356 1,284 1,212 1,148 19-24 6,718 4,639 4,199 3,894 3,026 2,744 2,390 1,970 25-29 7,204 4,950 4,502 4,179 3,239 2,918 2,575 2,022 30-34 7,920 5,444 4,949 4,579 3,603 3,258 2,815 2,283 35-39 8,480 5,831 5,300 4,840 3,861 3,468 3,009 2,337 40-44 9,737 6,694 6,086 5,480 4,379 3,956 3,291 2,715 45-49 8,823 6,067 5,515 4,831 4,022 3,630 3,003 2,488 50-54 9,621 6,616 6,013 5,718 4,584 4,221 3,563 2,922 55-59 11,898 8,180 7,437 6,867 5,489 4,910 4,226 3,426 60-64 16,141 11,098 10,088 9,355 7,887 7,249 6,011 5,049 65-69 31,313 21,530 19,571 18,836 17,369 13,935 12,148 10,115 NIL 55 138 275 550 1,375 2,750 5,500 2,243 1,541 1,402 1,257 1,072 1,014 959 912 10-18 2,370 1,630 1,482 1,298 1,114 1,053 993 942 19-24 5,514 3,807 3,446 3,196 2,484 2,252 1,962 1,617 25-29 5,914 4,064 3,696 3,431 2,659 2,396 2,113 1,660 30-34 6,500 4,469 4,062 3,759 2,958 2,675 2,309 1,875 35-39 6,961 4,787 4,350 3,973 3,170 2,847 2,471 1,920 40-44 7,992 5,496 4,995 4,498 3,595 3,247 2,701 2,229 45-49 7,243 4,981 4,527 3,966 3,301 2,979 2,464 2,042 50-54 7,898 5,431 4,937 4,695 3,764 3,465 2,923 2,399 55-59 9,768 6,716 6,104 5,637 4,507 4,031 3,469 2,812 60-64 13,250 9,110 8,281 7,680 6,475 5,951 4,934 4,144 65-69 25,705 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 FMU Page 16/31
New Business Annual Premiums Effective 1 July 2015 - 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. 398 200 170 130 116 105 93 10-18 416 218 179 139 125 113 101 19-24 785 491 446 330 292 244 188 25-29 867 542 495 367 323 274 200 30-34 965 604 550 426 368 307 235 35-39 1,060 663 597 460 404 339 248 40-44 1,252 783 697 540 479 385 304 45-49 1,355 847 759 590 523 416 327 50-54 1,559 974 881 687 624 511 401 55-59 1,883 1,176 1,079 842 743 625 488 60-64 2,611 1,632 1,505 1,253 1,144 931 766 65-69 5,215 3,259 3,133 2,881 2,292 1,985 1,636 283 134 114 87 78 71 63 10-18 296 147 120 93 84 75 67 19-24 526 329 299 222 196 164 127 25-29 581 363 332 246 216 184 134 30-34 647 404 368 286 248 206 158 35-39 710 444 400 308 271 227 166 40-44 839 524 466 362 321 259 204 45-49 907 568 508 395 351 279 218 50-54 1,045 653 590 460 419 343 269 55-59 1,261 788 722 564 497 419 327 60-64 1,749 1,093 1,009 840 766 624 514 65-69 3,493 2,183 2,099 1,930 1,536 1,329 1,096 237 111 94 72 64 58 52 10-18 246 120 99 76 69 62 55 19-24 431 270 245 181 161 134 103 25-29 477 298 272 202 178 151 110 30-34 531 332 302 234 203 169 130 35-39 582 364 328 253 223 187 137 40-44 689 430 383 297 263 212 167 45-49 746 466 418 325 288 228 179 50-54 858 536 485 377 344 281 221 55-59 1,035 647 592 463 409 344 269 60-64 1,436 897 828 689 629 512 421 65-69 2,868 1,792 1,723 1,585 1,260 1,092 899 Available only between ages 19-69 years (per unit - Max 2) 6 / $10 / 8 $28 / 16 / 23 $55 / 31 / 46 $100 / 56 / 83 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 17/31
New Business Annual Premiums Effective 1 July 2015 - 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. 457 230 195 150 133 121 108 10-18 477 251 206 159 144 130 116 19-24 903 564 512 381 336 281 216 25-29 997 623 569 422 371 315 230 30-34 1,110 693 632 489 424 353 270 35-39 1,219 762 685 529 465 390 286 40-44 1,439 899 800 620 551 444 349 45-49 1,558 973 874 679 601 478 375 50-54 1,792 1,120 1,014 790 718 587 461 55-59 2,164 1,352 1,239 968 853 719 561 60-64 3,000 1,875 1,730 1,440 1,315 1,071 881 65-69 5,993 3,746 3,601 3,311 2,634 2,281 1,880 325 155 131 101 90 81 72 10-18 339 168 138 108 96 86 77 19-24 605 377 344 254 225 188 146 25-29 668 417 381 283 249 212 155 30-34 744 465 423 328 284 236 181 35-39 816 511 459 354 311 262 190 40-44 964 603 536 416 370 297 234 45-49 1,044 652 585 455 402 320 252 50-54 1,201 750 679 529 480 393 309 55-59 1,449 906 830 648 571 482 376 60-64 2,010 1,257 1,159 965 880 717 590 65-69 4,015 2,510 2,412 2,219 1,764 1,529 1,260 272 127 108 83 74 66 59 10-18 283 138 113 87 80 72 64 19-24 496 310 282 209 185 155 119 25-29 549 343 312 232 204 174 127 30-34 610 382 347 269 233 195 149 35-39 670 419 377 290 255 215 157 40-44 792 495 440 342 302 244 193 45-49 857 535 480 373 330 263 206 50-54 986 616 557 435 394 323 253 55-59 1,189 744 682 532 469 395 308 60-64 1,650 1,032 952 792 724 589 485 65-69 3,296 2,060 1,980 1,821 1,448 1,254 1,034 GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 18/31
New Business Annual Premiums Effective 1 July 2015 - 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. 535 308 260 198 179 160 144 10-18 561 335 273 212 193 171 156 19-24 1,204 753 682 520 459 374 288 25-29 1,329 831 758 562 495 420 306 30-34 1,480 924 842 638 566 470 361 35-39 1,624 1,016 914 704 620 520 380 40-44 1,920 1,200 1,066 827 735 591 466 45-49 2,076 1,297 1,165 905 801 636 501 50-54 2,389 1,493 1,351 1,053 956 783 615 55-59 2,884 1,802 1,652 1,290 1,138 958 747 60-64 4,001 2,500 2,307 1,921 1,753 1,427 1,175 65-69 8,690 5,431 4,800 4,415 3,511 3,042 2,507 337 206 174 133 120 108 96 10-18 395 224 183 142 129 114 104 19-24 806 504 457 348 308 251 193 25-29 890 557 507 377 332 281 205 30-34 991 619 564 428 379 315 241 35-39 1,179 680 612 472 416 348 254 40-44 1,287 804 715 554 492 395 311 45-49 1,391 869 781 606 536 427 335 50-54 1,600 1,000 905 704 641 525 412 55-59 1,932 1,207 1,107 865 763 642 501 60-64 2,680 1,676 1,546 1,287 1,174 956 786 65-69 5,823 3,639 3,217 2,958 2,353 2,038 1,680 315 169 143 109 99 88 80 10-18 329 184 150 116 106 94 85 19-24 662 414 375 286 253 206 159 25-29 731 457 417 309 272 232 168 30-34 813 508 464 352 311 259 198 35-39 894 559 503 388 342 286 208 40-44 1,056 660 587 455 404 325 256 45-49 1,141 713 641 497 440 349 276 50-54 1,314 821 743 579 526 431 338 55-59 1,586 991 908 710 626 526 411 60-64 2,200 1,375 1,269 1,056 963 785 646 65-69 4,779 2,987 2,640 2,428 1,931 1,673 1,379 the Premium Above : $570 / 314 / 381 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 19/31
New Business Annual Premiums Effective 1 July 2015 - 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. 921 433 398 342 317 304 274 10-18 927 440 409 364 347 336 311 19-24 1,417 905 830 674 607 512 467 25-29 1,534 959 898 727 652 556 486 30-34 1,679 1,049 962 777 699 584 528 35-39 1,901 1,188 1,034 833 744 632 548 40-44 2,192 1,370 1,175 893 800 707 643 45-49 2,404 1,503 1,278 1,024 911 759 682 50-54 2,766 1,728 1,499 1,194 1,068 920 836 55-59 3,347 2,091 1,813 1,445 1,293 1,113 1,011 60-64 4,619 2,886 2,502 1,994 1,784 1,535 1,395 568 255 236 206 192 184 174 10-18 573 260 242 215 208 200 189 19-24 816 504 474 388 351 298 273 25-29 871 544 511 417 376 323 284 30-34 950 595 545 446 401 338 307 35-39 1,073 671 586 476 427 364 318 40-44 1,233 771 663 507 457 407 371 45-49 1,350 843 721 580 517 433 396 50-54 1,557 968 842 673 605 524 477 55-59 1,884 1,171 1,019 814 732 634 577 60-64 2,600 1,616 1,406 1,124 1,010 875 797 671 304 280 243 226 217 206 10-18 676 309 289 256 248 240 223 19-24 974 607 570 466 420 357 326 25-29 1,051 656 616 501 450 386 340 30-34 1,148 717 659 535 482 405 367 35-39 1,296 810 707 572 513 437 380 40-44 1,492 933 801 613 550 488 446 45-49 1,632 1,020 870 700 625 522 477 50-54 1,876 1,173 1,018 813 730 632 573 55-59 2,270 1,419 1,232 984 884 764 694 60-64 3,133 1,958 1,700 1,358 1,219 1,055 958 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 20/31
New Business Annual Premiums Effective 1 July 2015 - 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. 1,058 498 457 392 364 348 316 10-18 1,066 506 469 418 399 386 358 19-24 1,628 1,040 954 775 698 588 536 25-29 1,764 1,102 1,033 836 749 638 559 30-34 1,930 1,206 1,105 894 803 671 606 35-39 2,184 1,365 1,188 958 855 726 629 40-44 2,519 1,575 1,351 1,026 920 812 739 45-49 2,763 1,727 1,469 1,176 1,046 872 784 50-54 3,180 1,987 1,723 1,372 1,184 1,057 960 55-59 3,847 2,404 2,084 1,660 1,432 1,279 1,161 60-64 5,309 3,318 2,876 2,291 1,977 1,765 1,603 653 293 271 236 221 212 199 10-18 659 299 278 248 240 231 217 19-24 939 579 544 446 403 343 315 25-29 1,001 626 587 479 432 371 327 30-34 1,092 683 627 512 461 389 353 35-39 1,233 771 673 547 491 419 365 40-44 1,418 886 763 584 525 467 427 45-49 1,551 969 829 666 595 498 456 50-54 1,790 1,112 968 774 696 603 549 55-59 2,166 1,346 1,171 936 842 729 664 60-64 2,989 1,857,1616 1,292 1,161 1,006 916 772 349 321 279 260 250 236 10-18 777 355 332 295 284 276 256 19-24 1,120 698 655 535 483 411 375 25-29 1,207 755 708 576 517 445 391 30-34 1,319 824 757 615 553 466 422 35-39 1,490 931 812 657 590 502 437 40-44 1,715 1,072 921 704 632 561 512 45-49 1,876 1,173 1,000 804 718 600 549 50-54 2,156 1,347 1,170 935 839 726 660 55-59 2,609 1,630 1,416 1,132 1,015 878 798 60-64 3,600 2,250 1,954 1,562 1,401 1,212 1,102 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 21/31
New Business Annual Premiums Effective 1 July 2015 - 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. 1,168 608 552 467 429 408 381 10-18 1,178 618 569 500 476 458 423 19-24 2,082 1,301 1,216 978 874 729 636 25-29 2,260 1,413 1,319 1,060 942 795 689 30-34 2,482 1,551 1,418 1,136 1,015 840 750 35-39 2,819 1,762 1,525 1,221 1,083 909 782 40-44 3,268 2,043 1,744 1,310 1,169 1,024 928 45-49 3,594 2,246 1,904 1,512 1,338 1,108 1,004 50-54 4,151 2,594 2,241 1,773 1,581 1,355 1,224 55-59 5,022 3,139 2,712 2,145 1,914 1,640 1,481 60-64 6,931 4,331 3,742 2,960 2,641 2,263 2,044 715 355 324 277 255 244 230 10-18 718 358 333 293 281 271 253 19-24 1,177 736 689 558 500 420 385 25-29 1,276 797 745 603 539 458 399 30-34 1,397 872 801 644 578 482 433 35-39 1,584 990 859 691 615 520 450 40-44 1,828 1,142 979 740 662 582 531 45-49 2,007 1,254 1,066 851 756 629 572 50-54 2,314 1,446 1,251 995 888 765 692 55-59 2,800 1,750 1,514 1,203 1,075 926 838 60-64 3,864 2,414 2,089 1,661 1,483 1,277 1,156 846 423 386 328 304 289 272 10-18 852 430 398 351 335 324 301 19-24 1,421 888 832 671 601 504 466 25-29 1,539 962 900 726 647 549 478 30-34 1,689 1,056 965 777 696 604 519 35-39 1,916 1,198 1,038 834 741 625 541 40-44 2,215 1,384 1,185 967 800 702 640 45-49 2,433 1,521 1,328 1,029 913 758 689 50-54 2,804 1,753 1,519 1,204 1,075 925 837 55-59 3,393 2,121 1,838 1,457 1,301 1,119 1,012 60-64 4,683 2,927 2,536 2,010 1,795 1,545 1,397 the Premium Above : $570 / 314 / 381 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 22/31
New Business Annual Premiums Effective 1 July 2015 - 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. 1,026 539 483 398 374 349 329 10-18 1,068 581 501 424 399 371 349 19-24 1,896 1,185 1,086 869 771 641 529 25-29 2,004 1,252 1,141 908 805 661 536 30-34 2,128 1,331 1,203 967 859 717 584 35-39 2,233 1,396 1,233 982 874 728 591 40-44 2,641 1,651 1,518 1,202 1,098 880 724 45-49 2,913 1,821 1,676 1,315 1,197 986 809 50-54 3,248 2,029 1,850 1,510 1,406 1,155 943 55-59 3,930 2,456 2,239 1,827 1,701 1,397 1,141 60-64 5,424 3,389 3,090 2,521 2,347 1,928 1,575 627 315 282 236 223 208 198 10-18 650 337 292 251 236 221 208 19-24 1,071 670 615 494 441 371 308 25-29 1,129 707 645 516 460 380 311 30-34 1,196 748 679 549 491 412 338 35-39 1,256 784 696 558 501 417 343 40-44 1,478 924 852 679 622 501 416 45-49 1,631 1,019 939 740 676 559 463 50-54 1,813 1,133 1,035 848 791 652 535 55-59 2,194 1,371 1,252 1,026 957 789 648 60-64 3,028 1,893 1,728 1,416 1,320 1,088 894 743 375 337 280 265 249 235 10-18 771 403 349 298 281 263 248 19-24 1,294 809 743 596 530 445 368 25-29 1,366 853 780 623 553 457 374 30-34 1,448 905 820 662 589 494 405 35-39 1,518 949 840 671 598 502 410 40-44 1,792 1,120 1,032 820 750 604 498 45-49 1,975 1,233 1,137 895 816 674 557 50-54 2,197 1,373 1,254 1,025 958 787 645 55-59 2,659 1,661 1,518 1,240 1,159 953 781 60-64 3,669 2,293 2,095 1,711 1,599 1,315 1,077 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 23/31
New Business Annual Premiums Effective 1 July 2015 - 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 1,179 619 554 457 430 402 379 10-18 1,228 668 576 488 458 427 402 19-24 2,180 1,362 1,249 999 886 737 607 25-29 2,303 1,439 1,312 1,044 925 759 617 30-34 2,446 1,529 1,382 1,111 988 824 671 35-39 2,567 1,604 1,418 1,129 1,004 837 680 40-44 3,035 1,897 1,745 1,381 1,262 1,011 831 45-49 3,349 2,093 1,926 1,511 1,376 1,132 930 50-54 3,733 2,333 2,127 1,735 1,616 1,327 1,084 55-59 4,517 2,823 2,574 2,099 1,956 1,606 1,312 60-64 6,233 3,896 3,551 2,897 2,699 2,216 1,810 721 362 325 271 256 240 227 10-18 747 388 336 288 271 254 240 19-24 1,231 769 707 568 507 426 354 25-29 1,298 812 741 594 529 437 358 30-34 1,375 860 780 631 563 474 389 35-39 1,443 902 800 641 576 479 394 40-44 1,699 1,062 980 780 715 576 477 45-49 1,875 1,172 1,079 851 777 643 532 50-54 2,084 1,303 1,189 974 909 749 615 55-59 2,522 1,576 1,439 1,179 1,100 907 744 60-64 3,480 2,175 1,986 1,627 1,519 1,251 1,027 853 431 388 321 305 286 270 10-18 886 464 402 343 324 302 274 19-24 1,487 930 853 685 609 511 423 25-29 1,570 981 896 716 636 525 430 30-34 1,664 1,040 942 760 678 568 466 35-39 1,745 1,091 965 772 688 577 472 40-44 2,060 1,287 1,186 942 862 694 573 45-49 2,269 1,418 1,307 1,028 939 775 640 50-54 2,526 1,578 1,441 1,178 1,101 905 741 55-59 3,056 1,909 1,744 1,426 1,332 1,095 897 60-64,4217 2,635 2,407 1,967 1,838 1,511 1,238 Available only between ages 19-69 years (per unit - Max 2) $10 / 6 / 8 $28 / 16 / 23 55 / 31 / $ 46 $100 / 56 / 83 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 24/31
New Business Annual Premiums Effective 1 July 2015 - 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 1,338 778 691 559 523 483 452 10-18 1,404 844 719 600 559 517 483 19-24 2,853 1,783 1,631 1,289 1,137 939 762 25-29 3,020 1,887 1,714 1,352 1,192 967 776 30-34 3,210 2,007 1,808 1,441 1,277 1,054 848 35-39 3,375 2,109 1,856 1,466 1,296 1,071 860 40-44 4,006 2,504 2,300 1,805 1,646 1,308 1,065 45-49 4,432 2,770 2,544 1,984 1,802 1,472 1,197 50-54 4,948 3,092 2,815 2,285 2,127 1,735 1,406 55-59 5,987 3,742 3,406 2,765 2,574 2,099 1,701 60-64 8,262 5,164 4,700 3,815 3,551 2,897 2,347 809 449 399 326 308 286 269 10-18 843 484 414 349 326 304 286 19-24 1,600 1,000 916 728 645 535 439 25-29 1,693 1,058 962 763 674 551 446 30-34 1,798 1,123 1,015 813 721 599 486 35-39 1,886 1,178 1,040 893 734 608 493 40-44 2,234 1,397 1,285 1,012 926 739 606 45-49 2,467 1,542 1,418 1,111 1,010 830 678 50-54 2,753 1,720 1,568 1,278 1,189 974 792 55-59 3,331 2,082 1,897 1,546 1,439 1,179 958 60-64 4,597 2,873 2,618 2,134 1,986 1,627 1,322 961 539 479 390 367 339 319 10-18 1,004 581 498 419 390 364 339 19-24 1,938 1,211 1,109 880 780 645 528 25-29 2,050 1,281 1,165 922 814 664 536 30-34 2,177 1,361 1,226 982 871 722 584 35-39 2,287 1,429 1,261 998 885 734 592 40-44 2,710 1,695 1,558 1,225 1,120 893 726 45-49 2,996 1,873 1,721 1,345 1,223 1,002 819 50-54 3,342 2,089 1,901 1,547 1,441 1,178 959 55-59 4,044 2,527 2,300 1,872 1,744 1,426 1,160 60-64 5,581 3,488 3,174 2,583 2,407 1,967 1,601 the Premium Above : $570 / 314 / 381 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 25/31
New Business Annual Premiums Effective 1 July 2015 - 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. 1,067 580 500 394 357 327 296 10-18 1,114 627 523 417 381 348 317 19-24 2,163 1,352 1,232 927 827 697 549 25-29 2,380 1,487 1,362 1,024 905 776 580 30-34 2,641 1,651 1,508 1,179 1,028 865 673 35-39 2,892 1,808 1,631 1,269 1,122 950 707 40-44 3,403 2,127 1,896 1,481 1,320 1,073 856 45-49 3,675 2,297 2,065 1,615 1,436 1,151 916 50-54 4,216 2,634 2,389 1,872 1,706 1,406 1,113 55-59 5,101 3,187 2,891 2,265 2,064 1,701 1,347 60-64 7,039 4,399 3,989 3,125 2,848 2,347 1,859 703 391 346 289 268 251 234 10-18 729 416 358 301 281 262 244 19-24 1,301 813 748 581 525 454 372 25-29 1,421 888 821 634 569 498 390 30-34 1,566 978 899 718 637 547 441 35-39 1,704 1,064 968 768 687 592 460 40-44 1,985 1,241 1,113 885 797 661 542 45-49 2,135 1,335 1,206 959 861 703 573 50-54 2,433 1,520 1,383 1,100 1,008 843 683 55-59 2,943 1,839 1,674 1,331 1,220 1,020 827 60-64 4,062 2,538 2,310 1,837 1,683 1,408 1,141 836 468 416 345 319 298 278 10-18 868 501 430 360 334 311 291 19-24 1,576 984 905 701 633 545 447 25-29 1,720 1,075 992 766 685 599 468 30-34 1,895 1,185 1,091 869 768 657 531 35-39 2,065 1,290 1,173 931 832 716 553 40-44 2,409 1,505 1,351 1,072 964 799 653 45-49 2,589 1,618 1,464 1,161 1,042 851 693 50-54 2,953 1,846 1,680 1,361 1,223 1,021 825 55-59 3,574 2,233 2,033 1,647 1,480 1,236 999 60-64 4,932 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 26/31
New Business Annual Premiums Effective 1 July 2015 - Gold Plus 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. 1,226 666 575 454 411 376 340 10-18 1,281 721 601 479 438 400 364 19-24 2,486 1,553 1,416 1,066 950 801 631 25-29 2,735 1,709 1,566 1,177 1,040 893 666 30-34 3,035 1,897 1,733 1,355 1,182 993 774 35-39 3,324 2,078 1,875 1,458 1,290 1,092 812 40-44 3,911 2,445 2,180 1,702 1,518 1,233 983 45-49 4,224 2,640 2,373 1,856 1,651 1,324 1,053 50-54 4,846 3,028 2,746 2,152 1,961 1,615 1,280 55-59 5,864 3,664 3,323 2,603 2,373 1,954 1,549 60-64 8,092 5,057 4,586 3,593 3,275 2,697 2,138 809 449 398 332 308 288 269 10-18 838 478 412 346 323 301 281 19-24 1,496 935 860 668 604 522 428 25-29 1,634 1,021 943 728 654 572 448 30-34 1,800 1,124 1,034 825 732 628 507 35-39 1,958 1,223 1,112 884 790 681 529 40-44 2,281 1,426 1,280 1,017 916 759 623 45-49 2,454 1,534 1,387 1,102 990 809 660 50-54 2,796 1,747 1,590 1,264 1,159 969 785 55-59 3,383 2,114 1,924 1,530 1,403 1,172 950 60-64 4,668 2,917 2,656 2,111 1,936 1,618 1,311 961 539 477 396 367 343 319 10-18 998 576 494 413 384 358 335 19-24 1,811 1,131 1,040 805 727 627 514 25-29 1,978 1,236 1,140 880 788 689 539 30-34 2,178 1,362 1,254 999 883 756 610 35-39 2,373 1,483 1,347 1,070 956 823 636 40-44 2,769 1,730 1,552 1,232 1,109 917 750 45-49 2,976 1,860 1,682 1,335 1,197 978 797 50-54 3,395 2,121 1,931 1,531 1,406 1,174 949 55-59 4,108 2,567 2,336 1,853 1,701 1,420 1,148 60-64 5,669 3,542 3,224 2,557 2,347 1,960 1,584 Sports Coverage: To include Listed Extreme and Amateur Sports: $250 / 138 / 168 Per Person (Gold Plus and Platinum Only) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 27/31
New Business Annual Premiums Effective 1 July 2015 - Gold Plus 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. 1,579 987 857 665 644 595 552 10-18 1,690 1,056 893 689 680 623 580 19-24 3,463 2,164 1,980 1,548 1,388 1,160 933 25-29 3,798 2,373 2,180 1,662 1,482 1,282 980 30-34 4,194 2,622 2,404 1,864 1,670 1,418 1,124 35-39 4,580 2,863 2,593 2,036 1,816 1,548 1,176 40-44 5,364 3,352 2,998 2,363 2,117 1,736 1,403 45-49 5,778 3,612 3,260 2,569 2,294 1,856 1,497 50-54 6,609 4,131 3,752 2,961 2,706 2,248 1,800 55-59 7,997 4,998 4,540 3,583 3,274 2,720 2,178 60-64 11,036 6,897 6,265 4,945 4,518 3,753 3,005 922 562 492 402 373 347 324 10-18 961 600 512 420 394 363 339 19-24 1,936 1,210 1,109 871 783 657 533 25-29 2,121 1,326 1,219 934 834 726 559 30-34 2,339 1,462 1,342 1,044 937 799 638 35-39 2,550 1,594 1,446 1,140 1,017 870 666 40-44 2,983 1,864 1,669 1,318 1,185 974 792 45-49 3,210 2,006 1,812 1,431 1,281 1,040 843 50-54 3,666 2,292 2,083 1,649 1,509 1,254 1,009 55-59 4,436 2,773 2,521 1,995 1,825 1,518 1,221 60-64 6,121 3,826 3479 2,753 2,519 2,095 1,685 1,099 676 591 482 447 414 386 10-18 1,158 724 615 505 470 433 404 19-24 2,346 1,466 1,343 1,054 946 794 641 25-29 2,569 1,606 1,477 1,129 1,008 877 673 30-34 2,836 1,772 1,626 1,266 1,136 965 769 35-39 3,096 1,935 1,753 1,381 1,232 1,053 804 40-44 3,622 2,264 2,025 1,599 1,435 1,179 958 45-49 3,898 2,436 2,201 1,737 1,553 1,261 1,018 50-54 4,454 2,783 2,530 2,000 1,830 1,522 1,222 55-59 5,390 3,369 3,061 2,420 2,214 1,842 1,479 60-64 7,438 4,647 4,225 3,340 3,056 2,542 2,040 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 28/31
New Business Annual Premiums Effective 1 July 2015 - Platinum 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. NIL $100 $250 $500 $1,000 $2,500 $5,000 $10,000 3,418 2,337 2,137 1,952 1,719 1,641 1,570 1,513 10-18 3,577 2,446 2,237 2,006 1,772 1,693 1,617 1,553 19-24 7,595 5,207 4,747 4,294 3,519 3,222 2,751 2,414 25-29 8,101 5,554 5,064 4,726 3,740 3,407 3,048 2,470 30-34 8,851 6,070 5,533 5,143 4,125 3,761 3,298 2,742 35-39 9,443 6,478 5,902 5,415 4,394 3,983 3,502 2,800 40-44 10,758 7,380 6,723 6,087 4,936 4,491 3,796 3,193 45-49 9,803 6,727 6,128 5,596 4,561 4,152 3,497 2,953 50-54 11,051 7,581 6,907 6,339 5,149 4,771 4,080 3,410 55-59 13,372 9,173 8,358 7,670 6,230 5,773 4,937 4,127 60-64 18,453 12,659 11,533 10,585 8,597 7,967 6,813 5,695 NIL 55 138 275 550 1,375 2,750 5,500 1,907 1,303 1,192 1,091 963 920 880 849 10-18 1,995 1,362 1,247 1,121 991 949 907 871 19-24 4,206 2,881 2,628 2,379 1,952 1,790 1,586 1,345 25-29 4,481 3,072 2,801 2,615 2,074 1,891 1,693 1,375 30-34 4,896 3,356 3,060 2,846 2,286 2,085 1,830 1,525 35-39 5,223 3,580 3,265 2,996 2,434 2,208 1,943 1,556 40-44 5,943 4,077 3,714 3,366 2,732 2,488 2,104 1,773 45-49 5,421 3,716 3,388 3,096 2,526 2,300 1,940 1,642 50-54 6,104 4,188 3,815 3,504 2,849 2,641 2,260 1,893 55-59 7,386 5,067 4,616 4,240 3,448 3,196 2,735 2,290 60-64 10,192 6,993 6,370 5,852 4,758 4,410 3,774 3,161 NIL 67 168 335 670 1,675 3,350 6,700 2,313 1,580 1,445 1,323 1,165 1,113 1,066 1,028 10-18 2,420 1,652 1,512 1,357 1,202 1,149 1,099 1,053 19-24 5,112 3,503 3,195 2,891 2,372 2,174 1,925 1,631 25-29 5,450 3,736 3,407 3,181 2,519 2,297 2,056 1,668 30-34 5,953 4,081 3,721 3,460 2,778 2,533 2,223 1,852 35-39 6,350 4,355 3,969 3,642 2,958 2,681 2,361 1,889 40-44 7,230 4,958 4,519 4,092 3,322 3,023 2,557 2,154 45-49 6,592 4,521 4,119 3,763 3,070 2,796 2,358 1,992 50-54 7,426 5,094 4,641 4,262 3,464 3,211 2,747 2,299 55-59 8,985 6,163 5,616 5,157 4,192 3,885 3,324 2,782 60-64 12,399 8,506 7,750 7,116 5,784 5,362 4,588 3,839 Optional Add-On Coverages - Platinum Sub-Plan Only Terrorism Coverage: To increase Terrorism Coverage to $50,000 / 27,700 / 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 29/31
New Business Annual Premiums Effective 1 July 2015 - Platinum 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. NIL $100 $250 $500 $1,000 $2,500 $5,000 $10,000 3,929 2,687 2,456 2,244 1,976 1,886 1,804 1,739 10-18 4,112 2,811 2,570 2,306 2,036 1,947 1,859 1,785 19-24 8,729 5,985 5,456 4,936 4,045 3,704 3,278 2,774 25-29 9,312 6,384 5,820 5,432 4,299 3,916 3,503 2,838 30-34 10,174 6,978 6,359 5,911 4,741 4,323 3,791 3,152 35-39 10,854 7,446 6,784 6,224 5,050 4,577 4,025 3,218 40-44 12,365 8,483 7,728 6,997 5,673 5,162 4,362 3,670 45-49 11,268 7,731 7,043 6,432 5,242 4,772 4,020 3,395 50-54 12,702 8,715 7,939 7,287 5,918 5,484 4,689 3,920 55-59 15,369 10,545 9,606 8,817 7,161 6,635 5,674 4,743 60-64 21,210 14,552 13,256 12,167 9,882 9,156 7,830 6,546 NIL 55 138 275 550 1,375 2,750 5,500 2,192 1,497 1,370 1,254 1,107 1,057 1,012 976 10-18 2,293 1,566 1,432 1,288 1,139 1,091 1,043 1,001 19-24 4,834 3,311 3,021 2,734 2,244 2,057 1,823 1,546 25-29 5,151 3,531 3,220 3,006 2,384 2,173 1,947 1,581 30-34 5,627 3,857 3,517 3,272 2,628 2,397 2,103 1,753 35-39 6,003 4,115 3,752 3,444 2,798 2,537 2,233 1,798 40-44 6,831 4,686 4,269 3,868 3,140 2,859 2,419 2,038 45-49 6,231 4,272 3,894 3,558 2,903 2,644 2,230 1,887 50-54 7,016 4,814 4,385 4,028 3,275 3,035 2,598 2,176 55-59 8,489 5,825 5,306 4,873 3,963 3,673 3,144 2,633 60-64 11,715 8,038 7,322 6,725 5,468 5,068 4,339 3,634 NIL 67 168 335 670 1,675 3,350 6,700 2,659 1,817 1,661 1,521 1,338 1,280 1,225 1,182 10-18 2,782 1,898 1,738 1,560 1,381 1,320 1,263 1,211 19-24 5,876 4,026 3,672 3,323 2,726 2,499 2,213 1,875 25-29 6,264 4,295 3,916 3,656 2,895 2,640 2,363 1,917 30-34 6,842 4,691 4,276 3,977 3,192 2,912 2,556 2,129 35-39 7,299 5,005 4,562 4,187 3,400 3,082 2,714 2,172 40-44 8,310 5,700 5,195 4,704 3,818 3,474 2,939 2,475 45-49 7,577 5,197 4,735 4,325 3,529 3,213 2,710 2,290 50-54 8,536 5,855 5,335 4,898 3,982 3,690 3,158 2,643 55-59 10,328 7,085 6,455 5,926 4,818 4,465 3,822 3,198 60-64 14,253 9,777 8,908 8,178 6,648 6,162 5,274 4,414 Optional Add-On Coverages - Platinum Sub-Plan Only Terrorism Coverage: To increase Terrorism Coverage to $50,000 / 27,700 / 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) 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 30/31
New Business Annual Premiums Effective 1 July 2015 - Platinum 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. NIL $100 $250 $500 $1,000 $2,500 $5,000 $10,000 4,654 3,181 2,909 2,624 2,261 2,148 2,042 1,950 10-18 4,902 3,353 3,063 2,704 2,345 2,227 2,111 2,010 19-24 11,047 7,610 6,905 6,415 5,025 4,570 4,003 3,330 25-29 11,827 8,112 7,392 6,871 5,365 4,850 4,299 3,412 30-34 12,973 8,903 8,109 7,515 5,949 5,395 4,683 3,832 35-39 13,875 9,523 8,672 7,933 6,363 5,732 4,997 3,919 40-44 15,892 10,910 9,932 8,961 7,195 6,514 5,448 4,525 45-49 14,426 9,902 9,016 7,918 6,621 5,992 4,985 4,159 50-54 15,707 10,782 9,817 9,344 7,524 6,942 5,883 4,857 55-59 19,005 13,047 11,878 11,306 9,104 8,400 7,119 5,878 60-64 26,227 18,004 16,392 15,603 12,564 11,591 9,824 8,111 NIL 55 138 275 550 1,375 2,750 5,500 2,591 1,768 1,620 1,463 1,264 1,202 1,142 1,092 10-18 2,728 1,864 1,705 1,508 1,310 1,244 1,180 1,124 19-24 6,106 4,204 3,817 3,548 2,782 2,533 2,221 1,850 25-29 6,536 4,481 4,086 3,800 2,970 2,687 2,384 1,896 30-34 7,166 4,916 4,479 4,153 3,292 2,987 2,595 2,128 35-39 7,661 5,258 4,788 4,383 3,519 3,173 2,768 2,176 40-44 8,771 6,020 5,482 4,947 3,977 3,602 3,016 2,508 45-49 7,965 5,467 4,978 4,376 3,660 3,315 2,761 2,307 50-54 8,671 5,951 5,420 5,159 4,159 3,837 3,255 2,691 55-59 10,492 7,200 6,558 6,242 5,032 4,643 3,938 3,257 60-64 14,479 9,936 9,050 8,614 6,944 6,407 5,435 4,494 NIL 67 168 335 670 1,675 3,350 6,700 3,144 2,147 1,964 1,773 1,532 1,456 1,384 1,322 10-18 3,310 2,262 2,069 1,828 1,587 1,509 1,431 1,363 19-24 7,428 5,116 4,642 4,315 3,382 3,079 2,698 2,247 25-29 7,950 5,451 4,969 4,621 3,611 3,265 2,896 2,302 30-34 8,719 5,982 5,449 5,051 4,002 3,631 3,154 2,583 35-39 9,322 6,396 5,826 5,331 4,280 3,856 3,360 2,642 40-44 10,674 7,325 6,672 6,020 4,836 4,381 3,666 3,048 45-49 9,691 6,651 6,057 5,321 4,452 4,031 3,357 2,803 50-54 10,549 7,241 6,593 6,275 5,057 4,667 3,959 3,270 55-59 12,765 8,761 7,978 7,593 6,119 5,647 4,791 3,957 60-64 17,615 12,091 11,010 10,479 8,444 7,793 6,611 5,461 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) GlobalFusion premium/instalment) Monthly Quarterly Semi-Annual Annual 2011-2015 International Medical Group, Inc. All rights reserved. Version 0715 MORI Page 31/31