Sample Description of Available Coverage

Accident/Sickness Medical - Choose from $15,000 - $100,000 per incident

Covered Expenses

1. For the purpose of this section, only such expenses incurred as the result of and within 26 weeks from a disablement, which are specifically enumerated in the following list of charges, and which are not excluded in the Exclusions section shall be considered covered expenses:
2. Charges made by a Hospital for room and board, floor nursing and other services, including charges for professional services, except personal services of a non-medical nature, provided, however, that expenses do not exceed the Hospital’s average charge for semi-private room and board accommodation, or two (2) times the average semi-private room charge made by the servicing Hospital if confinement to an intensive care unit is required, or the actual charge for intensive care unit made by the servicing Hospital, whichever is less;
3. Charges made for diagnosis, treatment and surgery by a Physician;
4. Charges made for the cost and administration of anesthetics;
5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment;
6. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific disablement and administered by a licensed physiotherapist;
7. Hotel room charge, when the insured person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified physician in a hotel room owing to unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond control of insured;
8. Dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or surgeon.

Charges shall be in excess of all other valid and collectible insurance indemnity. The charges enumerated above shall in no event include any amount of such charges which are in excess of regular and customary charges.

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Deductible - Choose from $50 - $1,000, one time or per incident

The deductible is paid per incident for covered expenses which must be incurred as an out-of-pocket expense by each insured, for any one disablement. This expense must be borne by the insured.

Exclusions

With respect to Accident/Sickness Medical, no benefits shall be payable for medical expenses provided herein with respect to expenses incurred:

1. For Pre-existing Conditions, defined as any Injury or Illness which was contracted or which manifested itself, or for which treatment or medication was prescribed within three years prior to the effective date of this insurance;
2. For services, supplies or treatment, including any period of Hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a Physician;
3. For suicide or any attempt thereat while sane or self-destruction or any attempt thereat while insane;
4. Declared or undeclared war or any act thereof;
5. For Injury sustained while participating in professional athletics;
6. For sickness resulting from pregnancy, childbirth or miscarriage;
7. For miscarriage resulting from an accident;
8. For routine physical or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or x-ray examinations except in the course of a disability established by the prior call or attendance of a Physician;
9. For cosmetic or plastic surgery, except as the result of an accident;
10. For elective surgery which can be postponed until the insured returns to his/her country of residence;
11. For any mental and nervous disorders or rest cures;
12. For dental care, except as the result of Injury to natural teeth caused by an accident;
13. For eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured hereunder;
14. In connection with alcoholism or drug addiction, or use of any drug or narcotic agent;
15. For congenital anomalies and conditions arising out of or resulting therefrom;
16. For expenses which are non-medical in nature;
17. For the ordinary cost of a one-way airplane ticket used in the transportation back to the insured’s country where an air ambulance benefit is provided;
18. For expenses as a result of or in connection with intentionally self-inflicted injury;
19. For expenses as a result of or in connection with the commission of a felony offense;
20. For specific named hazards: skiing, motorcycle driving, scuba diving, mountain climbing, sky diving, professional or amateur racing, and piloting any aircraft;
21. Treatment paid for or furnished under any other individual or group policy, or other service or medical pre-payment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for treatment without cost to any individual.

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Accidental Death & Dismemberment AD&D (Principal Sum) - Choose from $10,000 - $100,000

The Company shall pay an indemnity as determined from the Table of Losses below if an insured person sustains a loss stated therein resulting from accidental injury, provided that such loss occurs within 365 days after the date of accident causing such loss. If more than one loss stated in the table below is sustained as the result of one accident, only one of the amounts so stated below, the largest, shall be payable.

The term “loss” as used herein shall mean with regard to hands and feet, actual severance through or above wrist or ankle joints, and with regard to eyes, entire irrecoverable loss of sight. The aggregate limit of indemnity per accident is $50,000.

Emergency Medical Evacuation - Choose $30,000 or $50,000

The Company will pay benefits for covered expenses incurred up to a maximum of $50,000 if any Injury or Illness commencing during the course of a trip results in the necessary emergency evacuation of the insured person. An emergency evacuation must be ordered by a legally licensed Physician who certifies that the severity of the insured person’s Injury or Illness warrants the emergency evacuation of the insured person.

Emergency Evacuation means: a) the insured person’s medical condition warrants immediate transportation from the place where the insured person is injured or ill to the nearest Hospital where appropriate medical treatment can be obtained; or b) after being treated at a local Hospital, the insured person’s medical condition warrants transportation to his/her then current place of residence to obtain further medical treatment or to recover; or c) both a) and b) above.

Covered Expenses are expenses, up to the maximum, for transportation, medical services and medical supplies necessarily incurred in connection with emergency evacuation of the insured person. All transportation arrangements made for evacuating the insured person must be by the most direct and economical route. Expenses for special transportation must be: (a) recommended by the attending Physician or (b) required by the standard regulations of the conveyance transporting the insured person. Expenses for medical supplies and services must be recommended by the attending Physician. Transportation means any land, water or air conveyance required to transport the insured person during an emergency evacuation. Special transportation includes, but is not limited to, air ambulances, land ambulances, and private motor vehicles.

All emergency medical evacuations are to be organized through AIGAssist.

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Repatriation of Remains - Choose $7,500 or $10,000

The Company will pay the reasonable covered expenses incurred to prepare and return the insured person’s body home (to his/her home country) if he or she dies, not to exceed the maximum of $7,500.

All repatriations of remains are to be organized through AIGAssist.

With respect to Accidental Death & Dismemberment, Emergency Medical Evacuation, and Repatriation of Remains, this policy does not cover any loss, fatal or non-fatal, caused by, or resulting from: 1) suicide or self destruction or any attempt thereat while sane or insane; 2) *disease of any kind; 3) *bacterial infections except pyogenic infection which shall occur through an accidental cut or wound; 4) *hernia of any kind; 5) injury sustained in consequence of riding as a pilot, operator, or member of crew of any aircraft, except as a passenger; 6) declared or undeclared war or any act thereof; 7) service in the military, naval or air service of any country. *With regard to Emergency Medical Evacuation and Repatriation of Remains, exclusions 2, 3, and 4 above shall be deleted.

Definitions

The term “Hospital” as used herein shall mean, except as may otherwise be provided, a hospital (other than an institution for the aged, chronically ill or convalescent, resting or nursing homes) operated pursuant to law for the care and treatment of sick or injured persons with organized facilities for diagnosis and surgery and having 24-hour nursing service and medical supervision.

The term “Physician” as used herein shall mean a doctor of medicine or a doctor of osteopathy licensed to render medical services or perform surgery in accordance with the laws of the state where such professional services are performed, however, such definition will exclude chiropractors and physiotherapists.

The term “Injury” wherever used herein means bodily injury caused solely and directly by violent, accidental, external, and visible means occurring while this policy is in force and resulting directly and independently of all other causes in loss covered by this policy.

The term “Illness” wherever used herein means sickness or disease of any kind contracted and commencing after the effective date of this policy and causing loss covered by this policy.

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Emergency Medical Assistance Service

Your group plan includes a special service...AIGAssist. Just a free phone call away, you are eligible to use any of these assistance services during the Period of Coverage:

• 24-hour verification of medical coverage for hospitals and physicians.
• 24-hour medical care location service.
• Medical case monitoring, arranging communication between patient, family, physicians, employer, consulate or embassy.
• Emergency medical transportation arrangements.
• Emergency message service for medical situations.
• Multilingual services.
• 24-hour contact for legal emergencies.
• Legal referral, to help you locate a consular official or attorney.

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