InterMedical™ Insurance

Brief Outline of Coverages

• Medical Expense Benefit
• Emergency Medical Evacuation Expense Benefit
• Accidental Death and Dismemberment (AD&D) Benefit
• Optional Accidental Death and Dismemberment (AD&D) Benefit Upgrade
• Repatriation of Remains Expense Benefit
• Bedside Visit
• Escort for Minor
• Exclusions
• Worldwide Emergency Assistance Service
• Effective Date
• Expiration Date

This is a descriptive "brochure," not a Policy. Your Certificate of Insurance will describe the provisions of the Master Policy which will prevail. Your benefit limits depend upon your selection of Plan A or Plan B, plus your purchase of the Optional AD&D Upgrade.

Medical Expense Benefit - A: $25,000/B: $100,000 per Injury or Illness

If injury or illness occurs when coverage is effective and you, your covered spouse or covered children require medical or surgical treatment, InterMedical™ will pay after a $50 deductible per injury or illness, 100 percent of all reasonable and customary charges for Covered Expenses up to the maximum amount and incurred within 26 weeks of the covered accident or commencement of the covered illness applicable to the selected Injury or Illness Medical Expense Benefit.

Covered Expenses

1. Charges made by a hospital for room and board, floor nursing and other services, including charges for professional services and with the exception of personal services of a non-medical nature, provided however, that expenses do not exceed the hospital's average charge for semiprivate room and board accommodation.
2. Charges made for diagnosis, treatment and surgery by a physician.
3. Charges made for the cost and administration of anesthetics.
4. 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.
5. Charges for physiotherapy, if recommended by a physician for the treatment of a specific disablement and administered by a licensed physiotherapist.
6. Dressings, drugs and medicines that can only be obtained upon a written prescription of a physician or surgeon. 
7. Hotel room charge, when insured, otherwise necessarily confined in a hospital, shall be under the care of a duly qualified physician in a hotel room owing the unavailability of a hospital room by reason of capacity or distance or to any other circumstances beyond the control of the insured.

Initial treatment must begin within 30 days of the covered accident or commencement of covered illness. All benefits provided in this policy will cease when an eligible insured person returns to his home country. This policy will not pay for medical expenses incurred in the insured person's home country.

Illness must be contracted and manifest itself during the Period of Coverage. An accident which causes an injury must occur during the Period of Coverage.

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Emergency Medical Evacuation Expense Benefit - A: $50,000/B: $75,000

If Injury or Illness commencing during the Period of Coverage requires emergency evacuation to either the nearest medical facility where appropriate medical treatment can be obtained, or back to the insured's home country, all covered expenses incurred are payable up to the maximum benefit selected. An emergency evacuation must be recommended by a legally licensed physician who certifies that the severity of injury or illness necessitates such emergency evacuation and agreed to by you or your representative. Arrangements must be made by AIGAssist.

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Accidental Death and Dismemberment (AD&D) Benefit - A: $10,000/B: $100,000

If an Injury occurs during your Period of Coverage and results in one of the following losses within 365 days after an accident, the Policy will pay as follows:

• Loss of Life...............................A:$10,000.............B:$100,000
• Loss of two Members.............A:$10,000.............B:$100,000
• Loss of one Member...............A:$5,000...............B:$50,000

"Loss" with regard to hand or foot means actual severance through or above the wrist or ankle joints; with regard to eye means entire and irrecoverable loss of sight. "Member" means hand, foot or eye. Only one amount, the largest to which you are entitled, is paid for all losses resulting from one accident.

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Optional Additional Accidental Death and Dismemberment: $400,000

This optional benefit may be purchased in addition to Basic Plan A or Plan B. If the optional benefit is selected and the premium paid in advance of the Period of Coverage, and If an Injury occurs during your Period of Coverage and results in one of the following losses within 365 days after an accident, the policy will pay, in addition to Basic Plan limits, as follows:

• Loss of Life...............................$400,000
• Loss of two Members.................$400,000
• Loss of one Member..................$200,000

"Loss" with regard to hand or foot means actual severance through or above the wrist or ankle joints; with regard to eye means entire and irrecoverable loss of sight. "Member" means hand, foot or eye. Only one amount, the largest to which you are entitled, is paid for all losses resulting from one accident.

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Repatriation of Remains Expense Benefit - A: $7,500/B: $7,500

If injury or illness commencing during the Period of Coverage results in death, all reasonable expenses incurred for preparation and return of the remains to the Insured's home country will be paid by InterMedical.™ Covered expenses include, but are not limited to expenses for embalming, cremation, coffins and transportation. Arrangements must be made by AIGAssist.

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Bedside Visit - A: $1,500/B: $1,500

The Policy will pay for strictly necessary traveling costs incurred by a friend or relative to visit the insured when in the opinion of a medical practitioner acceptable to the Company, such a visit is necessary due to bodily injury or illness which constitutes an immediate danger to life. These expenses must be authorized in advance by AIGAssist.

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Escort for Minor

If you are hospitalized for more than 7 days, the policy will pay to return your accompanying dependent children under age 18 to their home, limited to the cost of a one-way economy airfare less the value of applied credit from an unused return travel ticket, with an attendant if necessary. These expenses must be authorized in advance by AIGAssist.

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Exclusions

For Medical Expense Benefits, this insurance does not cover:

1. Pre-Existing Conditions, defined as any injury or any illness which was contracted or which manifested itself, or for which a licensed physician was consulted, or for which treatment or medication was prescribed within three (3) years prior to the effective date of this insurance.
2. Services, supplies or treatment, including any period of hospital confinement, which are not recommended, approved and certified as necessary and reasonable by a physician, or expenses which are non-medical in nature.
3. Expenses incurred as a result of or in connection with: a) Declared or undeclared war, or any act thereof; b) Injury sustained while participating in professional athletics; c) Intentionally self-inflicted injury, suicide or any attempt thereat while sane or insane; d) Motorcycle driving, mountain climbing, sky diving, professional or amateur racing, or piloting an aircraft; or e) Commission of a felony.
4. Expenses for: a) Pregnancy, childbirth, or miscarriage; b) Routine physical; c) Cosmetic or plastic surgery except as the result of an accident; d) Elective surgery; e) Any mental or nervous disorders or rest cures; f) Dental care, except as the result of injury to natural teeth caused by an accident; g) Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or contact lenses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured; or h) Alcoholism, drug addiction, or use of any drug or narcotic agent.
5. 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 a mandatory government program or facility set up for treatment without cost to any individual.
6. Medical expenses incurred in the United States or the insured person's country or countries of citizenship.

With respect to Accidental Death and Dismemberment, Emergency Medical Evacuation Expense, and Repatriation of Remains Expense, this plan 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. Acting as a pilot, operator or member of the crew of any aircraft or as a passenger in any aircraft used for or in connection with acrobatic or stunt flying, racing or endurance tests, crop dusting, seeding, spraying, fire fighting, exploration, pipe or power line inspection, any form of hunting, bird or fowl herding, aerial photography, banner towing, test or experimental purposes, flying in any rocket propelled aircraft engaged in any flight requiring a special permit or waiver;
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 or Repatriation of Remains, exclusions 2,3, and 4 above shall be deleted.

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Worldwide Emergency Assistance Service provided by AIGAssist

InterMedical™ includes a special service. You are eligible to use any of the assistance services provided during the Period of Coverage:

• 24-hour verification of medical coverage for clinics, hospitals and physicians.
• 24-hour medical care location referral service.
• Medical care monitoring, arranging communication between patient, family, physicians, employer, consulate or embassy.
• Emergency medical transportation/evacuation 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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Effective Date

Coverage begins at 12:01 a.m. on the latest of:
(1) the departure of the Insured Person from his home country;
(2) the date after the Insured Person's completed enrollment form and correct premium are postmarked to Travel Insurance Services; or
(3) the requested effective date on the enrollment form.

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Expiration Date

Coverage will terminate on the earliest of:
(1) the return of the Insured Person to his home country;
(2) one year after the effective date of coverage; or
(3) the requested termination date on the Insured Person's enrollment form for which premium has been paid.

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