EXCLUSIONS
We will not pay benefits or expenses for any loss, treatment or services that is caused by, contributed by or that results from:
1.    Pre-Existing Conditions: Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded from coverage under this insurance except and unless the Charges resulted directly from an ACUTE ONSET OF A PRE-EXISTING CONDITION, in which case the Charges will be covered only according to the Terms of ACUTE ONSET OF A PRE-EXISTING CONDITION provision.
2.    Chronic, Congenital, or recurrent Sicknesses.
3.    Charges incurred at a Hospital or Facility when the Covered Person checks themself out Against Medical Advice of their Physician and leaves before reaching a Medically Necessary specified endpoint of Treatment.
4.    Charges incurred for the Worsening of a Sickness or Injury after the Covered Person left a Hospital or Facility Against Medical Advice or was a Discharge Against Medical Advice.
5.    Charges related to medical examination, treatment and surgical intervention which are not administered in a licensed healthcare institution.
6.    Charges related to medical examination where no Sickness has been diagnosed or Accident has been ascertained; for non-specified pain; or preventative or routine exams, except as specifically provided for in this Certificate of Coverage.
7.    Charges for childbirth, miscarriage, pre-natal care, delivery, post-natal care, and care of Newborns, including complications of delivery and/or of Newborns, birth control, artificial insemination, treatment for fertility or impotency, sterilization, or reversal thereof or abortion (except as provided by Emergency Medical Treatment of Pregnancy).
8.    Charges for immunizations, routine physical or other examinations where there are no objective indications or impairment in normal health, or laboratory diagnostic or x-ray examinations except in the course of a disability established by the prior call or attendance of a Physician, except as specifically provided for by the Well Visit.
9.    Charges related to medical examination where no Sickness has been diagnosed or Accident has been ascertained; for non-specified pain; or preventative or routine exams, except as specifically provided for in this.
10.    Charges for Any visit to a medical provider that does not result in a covered Diagnosis code after medical review or testing.
11.    Charges or Treatment for cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is Medically Necessary and is directly related to and follows a Surgery which was covered under this insurance Charges for modification of the physical body in order to change or improve or attempt to change or improve the physical appearance or psychological, mental or emotional well-being of the Covered Person (such as but not limited to sex-change Surgery or Surgery relating to sexual performance or enhancement thereof).
12.    Charges for Elective Surgery or Treatment of any kind Charges incurred for Surgeries, Treatment or supplies which are Investigational, Experimental and for research purposes.
13.    Charges for weight modification or any Inpatient, Outpatient, Surgical or other Treatment of obesity (including without limitation morbid obesity), including without limitation wiring of the teeth and all forms or procedures of bariatric Surgery by whatever name called, or reversal thereof, including
 
without limitation intestinal bypass, gastric bypass, gastric banding, vertical banded gastroplasty, biliopancreatic diversion, duodenal switch, or stomach reduction or stapling.
14.    Charges for any mental or nervous disorders or rest cures relating to treatment for Bulimia; Anorexia; Non-medical causes of insomnia; testing that attempts to measure aspects of a Covered Person’s mental ability, intelligence, aptitude, personality, and stress management. Such testing may include but is not limited to psychometric, behavioral, and educational testing.; Psychiatric services extending beyond the period necessary for evaluation and Diagnosis of mental deficiency; Services for mental disorders or Sickness which are not amenable to favorable modification; Bereavement; Family counseling of any kind; Marriage counseling of any kind.
15.    Charges for Treatment or supplies that are not incurred, obtained, or received by a Covered Person during the Period of Insurance.
16.    Charges not presented to the Company for payment by way of a completed Proof of Claim within one hundred eighty (180) days from the date such Charges are incurred.
17.    Charges for Treatment not administered or ordered by a Physician.
18.    Charged for Treatment not Medically Necessary for the diagnosis, care or Treatment of the physical condition involved. This also applies when and if they are prescribed, recommended, or approved by the attending Physician.
19.    Charges for Treatment provided at no cost to the Covered Person or for which the Covered Person is not otherwise liable.
20.    Charges in excess of Usual and Customary Charges
21.    Charges related to Hospice Care
22.    Charges related to eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or for the fitting thereof, unless caused by accidental bodily Injury incurred while covered under the Certificate of Coverage.
23.    Charges for eye Surgery, such as but not limited to radial keratotomy, when the primary purpose is to correct or attempt to correct nearsightedness, farsightedness, or astigmatism.
24.    Charges for Congenital anomalies and conditions arising out of or resulting therefrom.
25.    Charges for services, supplies, or treatment expenses which are non-medical in nature.
26.    Charges for the ordinary cost of a one-way airplane ticket used in the transportation back to the
Covered Person’s country where an air ambulance benefit is provided.
27.    Suicide or attempted suicide, intentional self-injury, the effect of intoxicating liquors or drugs.
28.    Charges for Treatment paid for or furnished under any other individual or group policy, or other service or medical pre-payment plan arranged through an 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.
29.    Charges for Organ or tissue transplants or marrow procedures.
30.    Charges for any sexually transmitted or venereal disease; and/or any testing for the following: HIV, Vaccine induced seropositivity to the AIDS virus, AIDS related Sicknesses, ARC Syndrome, AIDS. This exclusion includes Charges for any Treatment or supplies for a Covered Person who was HIV + on or before the Initial Effective Date of this insurance, whether or not the Covered Person had knowledge of their HIV status prior to the Effective Date, and whether or not the Charges are incurred in relation to or as a result of said status. As well as conditions arising or resulting directly or indirectly from HIV, AIDS virus, AIDS related Sickness, ARC Syndrome, AIDS and/or any other Sickness arising or resulting from any complications or consequences of any of the foregoing conditions.
31.    Charges for any Treatment, service or supply not specifically covered by the Certificate of Coverage.
 
32.    Charges for Treatment performed or provided by a Relative of the Covered Person or provided by a person who resides or has resided with the Covered Person or in the Covered Person's home.
33.    Charges for Treatment of hernia; Osgood-Schlatter’s Disease; osteochondritis; osteomyelitis;
congenital weakness whether or not caused by a Covered Accident.
34.    Charges for any non-surgical Sickness or Treatment of the feet, including without limitation: orthopedic shoes; orthopedic prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable, or unbalanced feet; metatarsalgia, bone spurs, hammer toes or bunions; and any Treatment or supplies for corns, calluses, or toenails; except as otherwise expressly set forth.
35.    Charges for Treatment or supplies for temporomandibular joint (TMJ) including but not limited to TMJ syndrome, craniomandibular syndrome, chronic TMJ pain, orthognathic Surgery, Le-Fort Surgery, or splints.
36.    Charges related to Genetic Medicine, genetic testing, surveillance testing and/or wellness screening procedures for genetically predisposed conditions indicated by Genetic Medicine or genetic testing, including, but not limited to amniocentesis, drugs, recombinant adeno-associated virus vector-based gene therapy, and other Medication Treatments associated with diagnoses related to genetic testing and discovery, genetic screening, risk assessment, preventive and prophylactic surgeries recommended by genetic testing, and/or any procedures used to determine genetic pre-disposition, provide genetic counseling, or administration of gene therapy.
37.    Charges for any Substance Abuse
38.    Charges for any Injury or Sickness sustained as a result of being under the influence of or due wholly or partly to the effects of alcohol, liquor, intoxicating substance, narcotics or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician.
39.    Charges for any Sickness or Injury resulting from or occurring during the commission of a violation of law by the Covered Person, including, without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
40.    Charges for contact lenses, hearing aids, wheelchairs, braces, appliances, examinations or prescriptions for them, or repair or replacement of existing artificial limbs, orthopedic braces, orthotic devices, orthoptics, visual therapy or visual eye training, artificial eyes, or larynx.
41.    Charges for treatment or service provided by a private duty nurse or while confined primarily to receive custodial care, Educational or Rehabilitative Care or nursing care.
42.    Charges for covered medical expenses for which the Covered Person would not be responsible for in the absence of the Certificate of Coverage.
43.    Charges or fees incurred for the completion of Medical Claim Forms.
44.    Charges for biofeedback, acupuncture, music, occupational, recreational, sleep, speech, or vocational therapy
45.    Charges for any sleep disorder, including without limitation sleep apnea.
46.    Charges for hair loss, including without limitation wigs, hair transplants or any drug that promises to promote hair growth, whether or not prescribed by a Physician.
47.    any exercise and/or fitness program or equipment, whether or not prescribed or recommended by a Physician.
48.    traveling against the advice of a Physician, traveling while on a waiting list for inpatient Hospital or clinic treatment, or traveling for the purpose of obtaining medical treatment abroad.
49.    Charges for Treatment provided by or at the direction or recommendation of a chiropractor, unless ordered in advance by a Physician.
 
50.    Charges for any Sickness or Injury sustained while participating in any activity where such activity is undertaken in disregard of or against the recommendations, Treatment programs, or medical advice of a Physician or other healthcare provider.
51.    Charges for any potentially fatal condition which was diagnosed before the date your coverage became effective or any condition for which You are traveling to seek treatment.
52.    Charges for care or treatment in the Covered Person’s Country of Residence, except as otherwise
expressly provided for in this insurance.
53.    Charges for any infection of the urinary tract (including, without limitation, infection of the kidney, ureter, bladder, prostate, or urethra) and any complication, medical condition or other Sickness directly or indirectly arising therefrom, that occurs within ninety (90) days of the Effective Date of this Insurance and that requires Treatment of the Covered Person in a Hospital as an inpatient.
54.    Complications arising from or treatment of an Injury or Sickness that is not covered under this Certificate of Coverage.
55.    Charges for a) any Sickness or Injury sustained while taking part in, practicing or training for, participating in, a Professional or Semi-Professional Sport; or b) any Sickness or Injury sustained while taking part in, practicing or training for, participating in, an amateur, club, intramural, interscholastic or intercollegiate sport or athletic activities that are sponsored by any Governing Body or Authority, including but not limited to the National Collegiate Athletic Association.
56.    Charges for any Sickness or Injury sustained while taking part in activities designated as Adventure Sports, which include, but are not limited to the following: abseiling; BMX; bobsledding; bungee jumping; canyoning; caving; hot air ballooning; jungle zip lining; parachuting; paragliding; parascending; rappelling; skydiving; spelunking; and windsurfing.
57.    Charges for any Sickness or Injury sustained while taking part in activities designated as Extreme Sports, which include but are in no way limited to the following (and include any combination or derivative of the following): BASE jumping; big game hunting; cave diving; cliff diving; downhill mountain biking and racing; extreme skiing; freediving; free flying; free running; free skiing; freestyle scootering; gliding; heli-skiing; ice canoeing; ice climbing; kitesurfing; mixed martial arts; motocross; motorcycle racing; motor rally; mountaineering or trekking above elevation of 3500 meters; parkour; piloting a commercial or non-commercial aircraft; powerbocking; scuba diving; sub aqua pursuits; snowmobile racing; truck racing; whitewater kayaking or whitewater rafting Class VI and higher difficulty; and wingsuit flying.
58.    Charges for any Sickness or Injury sustained while taking part in snow skiing, snowboarding, or snowmobiling where the Covered Person is in violation of applicable laws, rules, or regulations of a ski resort, out of bounds or in unmarked or unpatrolled areas; backcountry skiing, skiing off-piste.
59.    Charges for any Sickness or Injury sustained while taking part in Collision Sports.
60.    Charges for any Sickness or Injury sustained while taking part in athletic or recreational activities where the Covered Person is not physically or medically fit or does not hold the necessary qualifications to engage in said activities.
61.    Charges for any Sickness or Injury sustained while participating in any sporting, recreational or adventure activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations, and procedures of a recognized Governing Body for the sport or activity.
62.    Charges for Dental Treatment, except as specifically provided for hereunder.
 
63.    Charges for Wear and tear of teeth due to cavities and chewing or biting down on hard objects, such as but not limited to pencils, ice cubes, nuts, popcorn, and hard candies.
64.    Charges for Dental Injury without associated face, skull, neck and/or jaws Injury or that can be evaluated and Treated in a dental office.
65.    Charges for Dental Treatment for services which provide oral care maintenance including tooth repair by fillings, root canals, tooth removal and x-rays.
66.    Charges for Treatment of a Sickness or Injury for which payment is made or available through a workers' compensation law or a similar law.
67.    Charges for massage therapy.
68.    Charges for required or recommended as a result of complications or consequences arising from or related to any Treatment, Sickness, Injury, or supply received prior to coverage under this insurance or that is excluded from coverage, or which is otherwise not covered under this insurance.
69.    Charges for any travel, meals, transportation and/or accommodations, except as otherwise expressly provided for in this insurance.
70.    Charges for any artificial or mechanical devices designed to replace human organs temporarily or permanently after termination of Inpatient status.
71.    Charges for any efforts to keep a donor alive for a transplant procedure.
72.    Charges for Sickness or Injury incurred in the Destination Country, Affected Area, or Country of Residence as a result of a Public Health Emergency of International Concern, Epidemic, Pandemic, other disease outbreak, or Natural Disaster, which may affect a Covered Person’s health, unless coverage is expressly provided under the PUBLIC HEALTH EMERGENCY provision of this insurance.
73.    Charges for a Sickness or Injury requiring an unapproved U.S. Food and Drug Administration (FDA) medical product, services, Surgery, Surgical Procedure, prescription medication, drug, biological product, Durable Medical Equipment (DME) or device when an Emergency Use Authorization (EUA) is in place issued by the U.S. Food and Drug Administration (FDA).
74.    Charges or expenses incurred for nonprescription drugs, medicines, vitamins, food extracts, or nutritional supplements; IV vitamin or herbal therapy; drugs or medicines not approved by the United States Food and Drug Administration (FDA), or which are considered “off-label” drug use; and for drugs or medicines not prescribed by a Physician.
75.    The Company will not cover any person as under this insurance, if such cover would result in the Company being exposed to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws, or regulations of the European Union, United Kingdom, or the United States of America.
76.    The Company shall not be liable for and will not provide coverage or benefits for any claim or Charges incurred with respect to any Sickness, Injury, death and dismemberment, or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising or incurred in connection with or as a result of any of the following acts or occurrences: (a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war (b) mutiny, riot, strike, military or popular uprising, insurrection, insurgency, rebellion, revolution, military or usurped power (c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by violence of any type (d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege (e) any use of radiological, chemical, nuclear or biological weapons or any other radiological, chemical, nuclear or biological events of any type
 
(including in connection with an act of Terrorism). Any claim, Charges, Sickness, Injury or other consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether or not directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said occurrences shall be deemed and considered to be consequences for which the Company shall not be liable under this Certificate of Coverage, except to the extent that the Covered Person shall prove that such claim, Charges, Sickness, Injury or other consequence happened independently of the existence of such abnormal conditions and/or occurrences.
77.    The Company shall not be liable for any claim or Charges, Sickness, Injury, or other consequence, whether directly or indirectly, proximately, or remotely occasioned by, contributed to by, or traceable to or arising in connection with any act of Terrorism. Further, the Company shall not be liable for and will not provide any coverage or benefits for any claim, Charges, Sickness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising in connection with the following: (a) the Covered Person’s active and voluntary planning or coordination of or participation in any act of Terrorism (b) any act of Terrorism that takes place in a location, post, area, territory or country for which a Travel Warning or Emergency Travel Advisory was issued or in effect on or within six (6) months prior to
the Covered Person’s date of arrival in said location, post, area, territory or country (c) any act of Terrorism that takes place in a location, post, area, territory or country for which a Travel Warning or Emergency Travel Advisory becomes effective or is in effect on or after the Covered Person’s date of arrival in said location, post, area, territory or country, and the Covered Person unreasonably fails or refuses to heed such warning and thereafter remains in said location, post, area, territory or country.
78.    Charges incurred due to fluctuations in exchange rates or for any bank charges the Covered Person incurs when a check, bank transfer, or payment is received from the Company.
79.    Charges for failure to keep a scheduled appointment.
80.    Charges for Custodial Care.
81.    any exposure to any non-medical nuclear or atomic radiation, and/or radioactive material(s).

We will not pay Political Evacuation benefits for expenses and fees:
1.    payable under any other provision of the Certificate of Coverage.
2.    that are recoverable through the Covered Person’s employer.
3.    arising from or attributable to an actual fraudulent, dishonest, or criminal act committed or attempted by the Covered Person, acting alone or in collusion with other persons.
4.    arising from or attributable to an alleged: a) violation of the laws of country in which the Covered Person is traveling while covered under the Certificate of Coverage; or b) violation of the laws of the Covered Person’s Home County.
5.    due to the Covered Person’s failure to maintain and possess duly authorized and issued required
travel documents and visas.
6.    for repatriation of remains expenses.
7.    for common or endemic or epidemic diseases or global pandemic diseases as defined by the World Health Organization.
8.    for medical services.
9.    for monies payable in the form of a ransom, if a Missing Person case evolves into a kidnapping.
 
10.    arising from or attributable, in whole or in part to a) a debt, insolvency, commercial failure, the repossession of any property by any title holder or lien holder or any other financial cause; b) non- compliance by the Covered Person with regard to any obligation specified in a contract or license.
11.    due to military or political issues if the Covered Person’s Security Evacuation request is made more
than 30 days after the Appropriate Authority(ies) Advisory was issued.
12.    if there is a Travel Warning or Emergency Travel Advisory in effect on or within six (6) months prior
to the Covered Person’s date of arrival in the Destination Country.

We will not pay Natural Disaster benefits for expenses and fees:
1.    If You do not evacuate an area due to a potential Natural Disaster, when evacuation notice (mandatory or voluntary) has been issued or posted by the local, state or country government of Your Home Country or the Host Country for a period of more than three (3) days prior to the Natural Disaster Event.
2.    The benefits and services described herein are provided to You only if authorized, arranged, and coordinated by Us or Our designated Assistance Provider.
3.    We will not pay for any loss or expense recoverable under any other valid and collectible insurance or through an employer.
4.    We or Our designated Assistance Provider has sole discretion regarding the means, methods, and timing of a Natural Disaster Evacuation. However, the decision to travel is Your sole responsibility.
5.    We are not responsible for the availability, timing, quality, results of, or failure to provide any service caused by conditions beyond Our control. This includes Our inability to provide You an evacuation or any additional services when United States of America law, local laws or regulatory agencies prohibit the rendering of such evacuation or service. We will not cover a Natural Disaster Evacuation from OFAC designated countries.
6.    the actual or threatened use or release of any nuclear, chemical, or biological weapon or device, or exposure to nuclear reaction or radiation, regardless of contributory cause.
7.    We will not pay for more than one (1) Natural Disaster Evacuation from a country or territory per Period of Insurance.
8.    We will not pay for any loss or expense arising from or attributable to a) fraudulent or criminal acts committed or attempted by You; b) alleged violation of the laws of the country You are visiting unless We determine such allegations to be fraudulent; or c) failure to maintain required documents or visas.
9.    We will not pay any costs or expenses arising from: a) Natural Disaster Evacuation from Your Home Country; b) Natural Disaster Evacuation when the Natural Disaster Event precedes Your arrival in the Host Country.

Plan Benefits	Safe Travels Advantage 25k	Safe Travels Advantage 50k	Safe Travels Advantage 100k	Safe Travels Advantage 150k
Policy Maximum	$25,000 Max per Incident / $25,000 Annual Max for Ages 70-89	$50,000 Max per Incident / $50,000 Annual Max for Ages 70-89	$100,000 Max per Incident / $100,000 Annual Max for Ages 70-89	$150,000 Max per Incident / $150,000 Annual Max for Ages 70-89
Deductible per Incident	$0	$0	$0	$0
Co-Insurance	80% Coinsurance	80% Coinsurance	80% Coinsurance	80% Coinsurance
Out of Pocket Maximum PER PERIOD OF INSURANCE:	$5,000 (Ineligible Charges do not count towards the Out-of- Pocket Maximum)	$5,000 (Ineligible Charges do not count towards the Out-of- Pocket Maximum)	$5,000 (Ineligible Charges do not count towards the Out-of- Pocket Maximum)	$5,000 (Ineligible Charges do not count towards the Out-of- Pocket Maximum)
Pre-Certification	Coverage Contingent meeting Pre-Certification Requirements	Coverage Contingent meeting Pre-Certification Requirements	Coverage Contingent meeting Pre-Certification Requirements	Coverage Contingent meeting Pre-Certification Requirements

INPATIENT HOSPITAL EXPENSE

OUTPATIENT - MAXIMUM DAILY BENEFIT ALL SERVICES $10,000 – UP TO THE SELECTED POLICY MAXIMUM

ADDITIONAL MEDICAL TREATMENT AND SERVICES

* Not subject to the Medical Deductible
** This is a non-insurance service and is not a part of the insurance underwritten.

BENEFIT PERIOD
• While the coverage is in effect, we will pay eligible medical expenses for up to 180 days beginning on the first day of diagnosis or treatment of a covered Sickness or Injury or
• Upon termination of the coverage, provided the Covered Person remains outside their Home Country and has not traveled back to their Home Country, we will continue to pay eligible medical expenses; up to 2 days following your Termination Date; or for up to 180 days beginning on the first day of diagnosis or treatment of a covered Sickness or Injury; or up to the maximum as stated under the Medical Maximum; whichever occurs first; or
• Upon termination of the coverage, whereas the Covered Person returns to their Home Country the Benefit Period shall discontinue on the date of termination and the plan will no longer pay eligible medical expenses.

EXCESS INSURANCE
The coverage provided in this plan shall be in excess of all other valid and collectable insurance or indemnity and shall apply only when such other benefits are exhausted. In the event no other insurance exists this coverage becomes primary. The Insurance Company reserves the right to review and potentially subrogate with any undeclared coverage whether known or unknown to the Covered Person. The Covered Person agrees to cooperate with all efforts to coordinate benefits and the failure to cooperate is a basis to limit or deny benefits that may be covered by other insurance.
TERMS AND CONDITIONS
All benefits payable are subject to the Maximum Benefit Limits, and any applicable sub-limits, listed in the Schedule of Benefits.
MEDICAL EXPENSE BENEFIT
If a covered Sickness or Injury occurs during the Period of Insurance, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses that are incurred during the Benefit Period. The first covered expenses must be incurred within 90 days after the date of the Covered Accident or Sickness. No benefits will be paid for any expenses incurred which are in excess of Usual and Customary Charges.
INPATIENT HOSPITAL BENEFITS
Inpatient means a person was admitted to an approved Hospital or other health care facility for a Medically Necessary overnight stay. Inpatient Hospitalization services as specified in the Schedule of Benefits include, but are not limited to:
1. Hospital Room and Board Expenses: the Usual and Customary Charge for a semi-private room when a Covered Person is Hospital Confined (In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge), and general nursing care and the following additional facilities; services and supplies as Medically Necessary and approved and covered by the Certificate of Coverage, meals and special diets (only for the patient). Use of operating room and related facilities, use of intensive care and related services. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.
2. Inpatient Ancillary Hospital Services - If medically necessary for the diagnosis and treatment of the Sickness or Injury for which a Covered Person is hospitalized, the following services are also covered: use of operation room and recovery room; all medicines listed in the U.S. Pharmacopoeia or National Formulary; Blood transfusions, blood plasma, blood plasma expanders, and all related testing, components, equipment and services; Surgical dressings; Laboratory testing; Durable Medical Equipment; Diagnostic x-ray examinations; Radiation therapy rendered by a radiologist for proven malignancy or neoplastic diseases; Respiratory therapy rendered by a Physician or registered respiratory therapist; chemotherapy rendered by a Physician or Nurse under the direction of a Physician; Physical and Occupational therapy (if covered) must be rendered by a Physician or registered physical or occupational therapist and relate specifically to the physician's written treatment plan. Therapy must: Produce significant improvement in the Insured's condition in a reasonable and predictable period of time and be of such a level of complexity and sophistication, and/or the condition of the patient must be such that the required therapy can safely and effectively be performed only by a registered physical or occupational therapist or be necessary to the establishment of an effective maintenance program. Maintenance itself is not covered. All Inpatient Ancillary benefits are paid in accordance with the current Schedule of Benefits.
3. Hospital Intensive Care Unit services will be provided based on the Allowable Charge for Medically Necessary Intensive Care Services.
4. Physician’s Surgical Treatment.
5. Anesthesiologist Expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an inpatient basis.
6. Assistant Physician’s Surgeon (When Medically Necessary) for professional services rendered, including Surgery; provided, however, Charges by or for an assistant surgeon will be limited and covered at the rate of up to twenty percent (20%) of the Usual and Customary Charge of the primary surgeon; and provided, further, that the standby availability of a Physician or surgeon will not be deemed to be a professional service and is not eligible for coverage.
7. Physician’s Non-Surgical Visits: Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.
8. Consulting Physician, when requested by attending Physician.
9. Private Duty Nurse.
10. Pre-Admission Test within 7 days of Admission.
OUTPATIENT HOSPITAL BENEFITS
Outpatient means a person is admitted to a Hospital or other healthcare facility for treatment that does not require an overnight stay. Outpatient Hospitalization services as specified in the Schedule of Benefits include, but are not limited to:
1. Outpatient Surgical Facility.
2. Physician’s Surgical Treatment.
3. Anesthesiologist Expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an inpatient basis.
4. Assistant Physician Surgical Expenses.
5. Physician Visits and visits to Urgent Care Facilities.
6. Diagnostic X-Rays and Lab Services: to include X-ray, laboratory and other diagnostic tests, biological anesthesia and oxygen services, radiation therapy, inhalation therapy, chemotherapy, and administration of blood products. Chemotherapy and/or Radiation Therapy.
7. Scans, PET scan or MRI.
8. Hospital Emergency Room Visits. Emergency Room Visit for a Sickness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.
9. Prescription drugs and medications for treatment of a Covered Sickness or Injury, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs. Limited to a maximum ninety (90) days’ supply of any one (1) prescription.

ADDITIONAL MEDICAL EXPENSE BENEFITS
1. ACUTE ONSET OF A PRE-EXISTING CONDITION: Benefits are payable for an Acute Onset of a Pre- Existing Condition up to the maximum as stated in the Schedule of Benefits provided the Acute Onset Event: 1. occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent and immediate medical care; 2. occurs a minimum of 48 hours after the Effective Date of the Coverage; and 3. treatment is obtained within 24 hours of the sudden and Unexpected outbreak or recurrence.
Any repeat/reoccurrence within the same Period of Insurance will no longer be considered Acute Onset of a Pre-Existing Condition and will not be eligible for additional coverage. This benefit covers only one (1) Acute Onset episode of a Pre-Existing Condition. Sudden and Acute Onset of a Pre- Existing Condition Coverage expires upon medical advice that the condition and onset is no longer acute, or the Covered Person is discharged from a medical facility.

To be eligible for the foregoing limited coverage and benefits for an Acute Onset of a Pre-existing Condition, the Covered Person must be in compliance with all Terms of this insurance. The Company will provide such coverage and benefits only when all of the following conditions and restrictions have been met.
At the time of the Acute Onset of a Pre-existing Condition:
(a) Treatment must be obtained within twenty-four (24) hours of the sudden and Unexpected outbreak or reoccurrence.
(b) the Covered Person must be under ninety (90) years of age.
(c) the Covered Person must not be traveling against or in disregard of the recommendations. established Treatment programs, or medical advice of a Physician or other healthcare provider.
(d) the Covered Person must not be traveling with the intent or purpose to seek or obtain Treatment for the Pre-existing Condition.
(e) the Covered Person must not be traveling during a period of time when the Covered Person is preparing or waiting for, involved in, or undertaking a new, changed or modified Treatment program with respect to the Pre-existing Condition, and is not traveling subsequent to any such new, changed or modified Treatment program having been advised or recommended.
(f) the Pre-existing Condition must have been stabilized for at least thirty (30) days prior to the Effective Date without change in Treatment.
(g) the Covered Person must be traveling outside their Habitual Country.
2. CARDIAC CONDITIONS: Treatment for Cardiac Conditions up to the maximum as stated in the Schedule of Benefits.
3. COVID-19, SARS-CoV-2 MEDICAL EXPENSES: Medically Necessary treatment for COVID-19, SARS- CoV-2, and any mutation or variation of SARS-CoV-2 up to the maximum as stated in the Schedule of Benefits.
4. WELL DOCTOR VISIT: Benefits will be payable for a Well Doctor Visit per person during the Period of Insurance. The Covered Person may use any Physician. Telemedicine is not eligible. To be covered: 1. the visit must occur within the first 21 days from the effective date of coverage and 2. the Covered Person must purchase at least 30 days of coverage initially; and 3. the Physician must use specific ICD10 codes for the Well Visit which are the following three Diagnosis Codes only a) V70.0-Routine medical exam; b) Z00.00 - Encounter for general adult medical examination without abnormal findings c) Z00.129-Encounter for routine child health examination without abnormal findings. Visits with ICD10 Codes not listed here are not considered Well Doctor Visits and are not covered as such
but may be covered under another benefit. Please register for this benefit with the Plan Administrator. https://TrawickInternational.com/wellness/Register
5. DENTAL TREATMENT: Emergency dental treatment, including x-rays, and restoration of Sound Natural Teeth when required and as a result of an Injury or to relieve pain due to an Accident. Routine dental treatment is not covered.
6. MENTAL AND NERVOUS DISORDERS TREATMENT: Benefits are provided for psychotherapeutic treatment and psychiatric counseling and treatment for an approved psychiatric diagnosis. Benefits are for both inpatient mental health treatment in Hospital, or approved facility and for outpatient mental health treatment will be applied toward the Period of Insurance per person Maximum. A Physician or a licensed clinical psychologist must provide all mental health care services. Services of a clinical psychologist must be rendered in the provider's office or in the outpatient department of a Hospital.
7. PHYSIOTHERAPY PHYSICAL MEDICINE/CHIROPRACTIC EXPENSES: Benefits provided on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy.
8. INITIAL ORTHOPEDIC PROSTHESIS EXPENSES: Prosthesis and corrective devices such as Durable Medical Equipment which are medically required as an integral part of treatment prescribed by a physician; Prosthesis/ Durable Medical Equipment does not include: motor driven wheelchairs or bed; comfort items such as telephone arms and over bed tables; items used to alter air quality or temperature such as air conditioners, humidifiers, dehumidifiers, and purifiers (air cleaners); disposable supplies; exercise cycles, sun or heat lamps, heating pads, bidets, toilet seats, bathtub seats, sauna baths, elevators, whirlpool baths, exercise equipment, and similar items.
9. RETURN TO HOME COUNTRY: The Covered Person may return to their Home Country for up to 30 days per 12 months of Coverage Purchased during the Period of Insurance for an Incidental Trip. If a Covered Injury or Sickness occurs while on their Incidental Trip, this benefit will pay to the maximum as outlined in the Schedule of Benefits for covered medical expenses incurred during the Incidental Trip. To be eligible for an Incidental Trip the Covered Person’s Period of Insurance must be greater than 30 days in length. If the Covered Person does not return from their Incidental Trip on their scheduled return date, the coverage will be Terminated on the date of their scheduled return from their Home Country. If the Covered Person’s scheduled return date cannot be verified, the coverage will terminate on the date the Covered Person departed for their Home Country. Any Injury or Sickness that occurred during the Incidental Trip will be considered a Pre-Existing Condition once the Incidental Trip has concluded and no further expenses for that Injury or Sickness will be covered.

PRE-CERTIFICATION REQUIREMENTS
Pre-certification is a general determination of Medical Necessity only, and all such determinations are made by the Company (acting through its authorized agents and representatives) in reliance and based upon the completeness and accuracy of the information provided by the Covered Person and/or their Relatives, guardians and/or healthcare providers at the time of Pre-certification. The Company reserves the right to challenge, dispute and/or revoke a prior determination of Medical Necessity based upon subsequent information obtained. Pre-certification is not an assurance, authorization, preauthorization, or verification of Treatment or coverage, a verification of benefits, or a guarantee of payment. The fact that Treatment or supplies are Pre-certified by the Company does not guarantee the payment of benefits,
the availability of coverage, or the amount of or eligibility for benefits. The Company’s consideration and determination of a Pre-certification request, as well as any subsequent review or adjudication of all medical claims submitted in connection therewith, shall remain subject to all of the Terms of this insurance, including exclusions for Pre-existing Conditions and other designated exclusions, benefit limitations and sub-limitations, and the requirement that claims be Usual and Customary Charge. Any consideration or determination of a Pre-certification request shall not be deemed or considered as the Company’s approval, authorization, or ratification of, recommendation for, or consent to any diagnosis or proposed course of Treatment. Neither the Company nor the Plan Administrator (nor anyone acting on their respective behalf) has any authority or obligation to select Physicians, Hospitals, or other healthcare providers for the Covered Person, or to make any diagnosis or medical Treatment decisions on behalf of the Covered Person, and all such decisions must be made solely and exclusively by the Covered Person and/or their family members or guardians, Treating Physicians and other healthcare providers. If the Covered Person and their healthcare providers comply with the Precertification requirements of this coverage, and the Treatment or supplies are Pre-certified as Medically Necessary, the Company will reimburse the Covered Person for Eligible Medical Expenses up to the amount shown in the SCHEDULE OF BENEFITS incurred in relation thereto, subject to all Terms of this insurance. Eligibility for and payment of benefits are subject to all of the Terms of this insurance.
1. SPECIFIC REQUIREMENTS: The following must always be Pre-certified for Medical Necessity by the Company through the Plan Administrator before admission or receiving the Treatments and/or supplies: (a) Chemotherapy (b) Inpatient Hospitalization (c) Surgery or Surgical procedure.
2. GENERAL REQUIREMENTS: To comply with the Pre-certification requirements of this insurance for the Treatments and/or supplies or services listed in the SPECIFIC REQUIREMENTS provision, above, the Covered Person or their Physician or healthcare provider must perform all of the following: (a) contact the Company through the Plan Administrator at the contact information below and on the Covered Person's ID card as soon as possible and before the Treatment or supply is to be obtained. Inside the United States: (b) comply with the instructions of the Company and submit any information or documents required by the Company (c) notify all Physicians, Hospitals, and other healthcare providers that this insurance contains Pre-certification requirements and ask them to fully cooperate with the Company.
3. LOSS OF COVERAGE / BENEFITS FOR NON-COMPLIANCE OF PRE-CERTIFICATION REQUIREMENTS: If
the Covered Person or their healthcare providers do not comply with the Pre-certification requirements for the Treatment or supplies identified in the SPECIFIC REQUIREMENTS subparagraphs above, or if such Treatment or supplies are not Pre-certified then (a) Eligible Medical Expenses incurred with respect to said Treatment and/or supplies will be reduced by the amount shown in the BENEFIT SUMMARY (b) any Deductible will be subtracted from the remaining amount (c) Coinsurance will be applied.
4. EMERGENCY PRE-CERTIFICATION: In the event of an Emergency Hospital admission, Pre-certification must be completed within forty-eight (48) hours after the admission, or as soon as is reasonably possible.
5. CONCURRENT REVIEW: For Inpatient Treatment of any kind, the Company will Pre-certify a limited number of days of confinement based upon the disclosed medical condition. Thereafter, Pre- certification must again be requested and approved if additional days of Inpatient Treatment are necessary.

TRANSPORTATION BENEFITS

AMBULANCE SERVICE BENEFITS
Ambulance Service Benefits are provided for medically necessary emergency ground ambulance transportation as required from the emergency site to the nearest Hospital able to provide the required level of care.
EMERGENCY MEDICAL EVACUATION
Subject to the applicable Maximum Limit set forth in the BENEFIT SUMMARY, and the other Terms of this insurance, including the EXCLUSIONS provision and the CONDITIONS AND RESTRICTIONS subparagraph below, the Company will reimburse the Covered Person for the following transportation costs, when the Company or Plan Administrator arranges such transportation, and expenses incurred by the Covered Person arising out of or in connection with an Emergency Medical Evacuation occurring while this coverage is in effect and during the Period of Coverage: (a) Emergency air transportation to a suitable airport nearest to the Hospital where the Covered Person will receive Treatment (b) Emergency ground transportation necessarily preceding Emergency air transportation and from the destination airport to the Hospital where the Covered Person will receive Treatment (c) Return ground and air transportation, upon medical release by the attending Physician, to the country where the evacuation initially occurred or to the Covered Person’s Country of Residence, at the Covered Person’s option.
CONDITIONS and RESTRICTIONS: To be eligible for coverage for Emergency Medical Evacuation benefits, the Covered Person must be in compliance with all Terms of this insurance. The Company will provide Emergency Medical Evacuation benefits only when the condition, Sickness, Injury, or occurrence giving rise to the Emergency Medical Evacuation is covered under the Terms of this insurance.
The Company will provide Emergency Medical Evacuation benefits only when all of the following conditions and restrictions are met:
(a) Medically Necessary Treatment cannot be provided locally.
(b) transportation by any other means or methods would result in loss of the Covered Person’s life or limb
within twenty-four (24) hours, based upon a reasonable medical certainty.
(c) Emergency Medical Evacuation is recommended by the attending Physician who certifies to the matters in subparagraphs (a) and (b), above.
(d) Emergency Medical Evacuation is agreed to by the Covered Person or a Relative of the Covered Person.
(e) Emergency Medical Evacuation is provided by designated, licensed, qualified, professional emergency personnel acting within the scope of such license and approved in advance and all arrangements are coordinated by the Company.
(f) the condition, Illness, Injury or occurrence giving rise to the need for the Emergency Medical Evacuation: (i) occurred outside the Covered Person’s Country of Residence suddenly, Unexpectedly, and spontaneously, and without: (1) advance warning, or (2) advance Treatment, diagnosis or recommendation for Treatment by a Physician, or (3) prior manifestation of symptoms or conditions that would have caused a reasonably prudent person to seek medical attention prior to the onset of the Emergency (ii) was not a Pre-existing Condition unless otherwise expressly provided for under the ACUTE ONSET OF PREEXISTING CONDITIONS provision.
(g) The Company will cover reimbursement for the above-described costs and expenses and will arrange Emergency Medical Evacuation only to the nearest Hospital that is qualified to provide the Medically Necessary Treatment to prevent the Covered Person's loss of life or limb.
The Covered Person may select a different Hospital in their Country of Residence at their option, but in such event the Covered Person shall be solely responsible for all costs and expenses in excess of the amounts that would have been incurred had the Covered Person used the nearest qualified Hospital. If a

Hospital other than the nearest qualified Hospital is selected by the Covered Person, then the attending Physician, Covered Person or a Relative of the Covered Person shall certify to the Company the Covered Person’s understanding and acknowledgement of such responsibility for excess costs and expenses in addition to the matters set forth in the CONDITIONS AND RESTRICTIONS subparagraph, above. In all cases the Company will make the necessary arrangements for the Emergency Medical Evacuation and will use its best efforts to arrange with independent, third-party contractors any Emergency Medical Evacuation within the least amount of time reasonably possible.
By acceptance of this Certificate of Coverage and request for Emergency Medical Evacuation benefits hereunder, the Covered Person understands, acknowledges and agrees that the timeliness, duration, occurrences during and outcome of an Emergency Medical Evacuation can be directly and indirectly affected by events and/or circumstances that are not within the supervision or control of the Company, including but not limited to: the availability, limitations, physical condition, reliability, maintenance and training schedules and procedures and performance or non-performance of competent transportation equipment, supplies and/or staff of such third-party contractors; delays or restrictions on flights or other modes or means of transportation caused by mechanical problems, government officials, telecommunications problems, non-availability of routes, Destination and/or other travel, geographical or weather conditions; and other acts of God and unforeseeable and/or uncontrollable occurrences.

The Covered Person agrees to release and to hold the Company, the Plan Administrator and their agents and representatives harmless from, and agrees that the Company, the Plan Administrator and their agents and representatives shall not be held liable or responsible for, any delays, losses, damages, further Injuries or Illnesses, or any other claims that arise from or are caused in whole or in part by the acts or omissions of such independent third-party contractors or their agents, employees or representatives, or that arise from or are caused in whole or in part by any acts, omissions, events or circumstances that are not within the direct and immediate supervision and control of the Company, the Plan Administrator and/or their authorized agents and representatives, including without limitation the events and circumstances set forth above.
The Covered Person further agrees that upon seeking an Emergency Medical Evacuation, he or she will cooperate fully as required by the CONDITIONS AND GENERAL PROVISIONS, COOPERATION provision. Failure to so cooperate and/or failure to use or accept Emergency Medical Evacuation once it has been arranged by the Company or Plan Administrator will require the Covered Person to reimburse the Company for costs incurred for any Emergency Medical Evacuation that was arranged, but not used, by the Covered Person. Furthermore, the Covered Person may be required to arrange for payment of any subsequent Emergency Medical Evacuation and seek reimbursement thereafter for eligible costs associated with that subsequent Emergency Medical Evacuation.
MEDICALLY NECESSARY REPATRIATION
Subject to the applicable Maximum Limit set forth in the BENEFIT SUMMARY, and the other Terms of this insurance, including the EXCLUSIONS provision and the CONDITIONS AND RESTRICTIONS subparagraph below, the Company will reimburse the Covered Person for the following transportation costs, when the Company or Plan Administrator arranges such transportation, and expenses incurred by the Covered Person arising out of or in connection with a Medically Necessary Repatriation occurring while this Certificate of Coverage is in effect and during the Period of Coverage.

If You have been evacuated under the Emergency Medical Evacuation, or You are Hospitalized due to an Injury or a sudden and Unexpected Sickness and it is determined that You need to be medically repatriated back to a Hospital or medical facility in your Home Country to recover, the Plan Administrator will coordinate a medical transfer, by any means necessary, to a Hospital or medical facility near Your home once your condition has reached maximum medical improvement. The Covered Person agrees to release and to hold the Company, the Plan Administrator and their agents and representatives harmless from, and agrees that the Company, the Plan Administrator and their agents and representatives shall not be held liable or responsible for, any delays, losses, damages, further Injuries or Illnesses, or any other claims that arise from or are caused in whole or in part by the acts or omissions of such independent third-party contractors or their agents, employees or representatives, or that arise from or are caused in whole or in part by any acts, omissions, events or circumstances that are not within the direct and
immediate supervision and control of the Company, the Plan Administrator and/or their authorized agents and representatives, including without limitation the events and circumstances set forth above.

CONDITIONS and RESTRICTIONS: To be eligible for coverage for Medically Necessary Repatriation benefits, the Covered Person must be in compliance with all Terms of this insurance. The Company will provide Medically Necessary Repatriation benefits only when the condition, Sickness, Injury, or occurrence giving rise to the Medically Necessary Repatriation is covered under the Terms of this insurance.

The Company will provide Medically Necessary Repatriation benefits only when all of the following conditions and restrictions are met 1. the Physician ordering the Medically Necessary Repatriation certifies Your Sickness or Injury has reached maximum medical improvement; 2. all transportation arrangements made for the Medically Necessary Repatriation are by the most direct an economical conveyance and route possible; 3. the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and 4. do not include charges that would not have been made if there were no insurance; 5. the Medically Necessary Repatriation must be pre-certified in advance.

The Covered Person further agrees that upon seeking a Medically Necessary Repatriation, he or she will cooperate fully as required by the CONDITIONS AND GENERAL PROVISIONS, COOPERATION provision. Failure to so cooperate and/or failure to use or accept Medically Necessary Repatriation once it has been arranged by the Company or Plan Administrator will require the Covered Person to reimburse the Company for costs incurred for any Medically Necessary Repatriation that was arranged, but not used, by the Covered Person. Furthermore, the Covered Person may be required to arrange for payment of any subsequent Medically Necessary Repatriation and seek reimbursement thereafter for eligible costs associated with that subsequent Medically Necessary Repatriation.

The Covered Person agrees to release and to hold the Company, the Plan Administrator and their agents and representatives harmless from, and agrees that the Company, the Plan Administrator and their agents and representatives shall not be held liable or responsible for, any delays, losses, damages, further Injuries or Illnesses, or any other claims that arise from or are caused in whole or in part by the acts or omissions of such independent third-party contractors or their agents, employees or representatives, or that arise from or are caused in whole or in part by any acts, omissions, events or circumstances that are not within the direct and immediate supervision and control of the Company, the Plan Administrator and/or their authorized agents and representatives, including without limitation the events and circumstances set forth above.

POLITICAL EVACUATION

Benefits are payable for the Covered Person’s extrication from the Host Country due to an Occurrence that results in You being placed in Imminent Bodily Harm. The Occurrence must take place while coverage is in effect, and while the Covered Person is traveling outside of Their Home Country. The Covered Person must contact the Company within ten (10) days of the United States Department of State, Bureau of Consular Affairs or similar government organization of the Covered Person’s Country of Residence issuing the evacuation order. Benefits will be paid for Transportation and Related Costs to the Nearest Place of Safety, necessary to ensure the Covered Person’s safety and well-being as determined by the Designated Security Consultant. Benefits will not be payable unless We (or Our authorized Assistance Provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by the Assistance Provider. The Assistance Provider is not responsible for the availability of transport services. Where a Political Evacuation becomes impractical due to hostile or dangerous conditions, a Designated Security Consultant will endeavor to maintain contact with the Covered Person until a Political Evacuation occurs. Political Evacuation Benefits are payable only once for any one Occurrence. If, after a Political Evacuation is completed, it becomes evident that the Covered Person was an active participant in the events that led to the Occurrence, We have the right to recover all Transportation and Related costs from the Covered Person. Benefits will be payable for evacuation during a period of civil unrest, insurrection or natural disasters that could not have been foreseen prior to the Covered Person’s departure from Their Home Country of origin. In no event will the Company pay for a Political Evacuation if there is a Travel Warning or Emergency Travel Advisory in effect on or within six (6) months prior to the Covered Person’s date of arrival in the Destination Country. This coverage will provide the most appropriate and economical means of travel consistent under the circumstances of the Covered Person’s health and safety.

NATURAL DISASTER EVACUATION
Benefits are payable for the Covered Person’s extrication due to a Natural Disaster Evacuation that results in You being placed in Imminent Bodily Harm. Natural Disaster Event results in such severe and widespread damage that the area of damage is officially declared a disaster area by the appropriate local government authorities of the Host Country, and the area is deemed to be Uninhabitable or dangerous.
We will pay, up to the Maximum Benefit Amount shown in the Schedule of Benefits, to transport You to the Nearest Place of Safety necessary to ensure Yours safety and well-being as determined by Us or Our designated Assistance Provider. We will also pay reasonable expenses incurred at the place of safety for lodging and meals, up to the Amount shown in the Schedule of Benefits, if you have been evacuated by the Assistance Provider. The Natural Disaster Evacuation must occur within 2 days of the Natural Disaster Event, and the arrangements will be by the most appropriate and by most efficient, practical, and economical means available and consistent with Your health and safety.
The Covered Person agrees to release and to hold the Company, the Plan Administrator and their agents and representatives harmless from, and agrees that the Company, the Plan Administrator and their agents and representatives shall not be held liable or responsible for, any delays, losses, damages, further Injuries or Sicknesses, or any other claims that arise from or are caused in whole or in part by the acts or omissions of such independent third party contractors or their agents, employees or representatives, or that arise from or are caused in whole or in part by any acts, omissions, events or circumstances that are not within the direct and immediate supervision and control of the Company, the Plan Administrator and/or their authorized agents and representatives, including without limitation the events and circumstances set forth above. The Covered Person further agrees that upon seeking a Natural Disaster Evacuation, he or she will cooperate fully. Failure to cooperate and/or failure to use or accept Natural Disaster Evacuation once it has been arranged by the Company or Plan Administrator will require the Covered Person to reimburse the Company for costs incurred for any Natural Disaster Evacuation that was arranged, but not used, by the Covered Person. Furthermore, the Covered Person may be required to arrange for payment of any subsequent Natural Disaster Evacuation and seek reimbursement thereafter for eligible costs associated with that subsequent Natural Disaster Evacuation.

RETURN OF MINOR CHILDREN OR TRAVELING COMPANION
If the Covered Person is the only person traveling with minor Dependent children who are under the age of 21, or with a Travel Companion, and the Covered Person who is outside their Country of Residence, suffers a Sickness or Injury and must be Hospital Confined for at least 48 consecutive hours, or are medically evacuated to another location, benefits are payable for the cost of the Dependent or Travel Companion’s one way economy airfare ticket and/or ground transportation ticket to Their Home Country. All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the usual level of charges for similar transportation in the locality where the expense is incurred. The return must occur during the Covered Person’s Hospitalization. The Company will deduct from the return transportation benefits payable hereunder the value, if any, of the unused commercial airline return ticket(s) possessed by or for the benefit of the Child or Traveling Companion at the time of the Covered Person’s Hospitalization. The Covered Person and/or the Child/Traveling Companion must first attempt to receive credit for or deduct toward the costs of the return trip. Benefits will not be paid unless all expenses are approved in advance by Us, The Company will not provide any benefits, reimbursements or coverages for any costs or expenses incurred by the Covered Person and/or by the Child/Traveling Companion for a return trip, if any, to the original location of the Child/Traveling Companion at the time of the Hospitalization.

REPATRIATION OF MORTAL REMAINS
In the event of the death of the Covered Person during the Period of Insurance as a result of an Sickness or Injury covered under this insurance while the Covered Person is outside of their Country of Residence, the Company will reimburse the authorized personal representative or the estate of the Covered Person up to the amount shown in the Schedule of Benefits for the costs and expenses incurred to return the Covered Person's Mortal Remains to their Country of Residence and thereafter to the place of burial or other final disposition (but not including any costs of burial or other disposition); provided, however, that the Company must approve all costs and expenses related to the return of the Covered Person's Mortal Remains in advance as a condition to the availability of this benefit. Covered Expenses include Expenses for embalming or cremation; The least costly coffin or receptacle adequate for transporting the remains; Transporting the remains by the most direct and least costly conveyance and route possible and pre- approved by the Assistance Provider. Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. This benefit excludes fees for return of personal effects, religious or secular memorial services, clergymen, flowers, music, announcements, guest expenses and similar personal burial preferences.

LOCAL BURIAL / CREMATION
Benefits are payable for preparation, local burial or cremation of the Covered Person's mortal remains at the country of death in accordance with the commonly accepted cultural and religious beliefs practiced by the Covered Person. Coverage is not provided for burial and cremation costs incurred for: visitation services, funeral clothing, religious practitioner, flowers, music, food, or beverages. If the Local Cremation or Burial is chosen, the Return of Mortal Remains benefit will not apply. Expenses must be approved in advance by the Assistance Provider. Failure to utilize the Assistance Provider to approve these services will result in the denial of benefits.
ADDITIONAL BENEFITS
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) – COMMON CARRIER
Accidental Death and Dismemberment will apply to Covered Accidents incurred while a Covered Person is traveling/riding as a passenger in or on Common Carrier. If Injury to the Covered Person results in any one of the losses shown below within 90 days from date of the Covered Accident, We will pay the Benefit Amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.

ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)–FELONIOUS ASSAULT & VIOLENT CRIME
We will pay the Benefit Amount for felonious assault, if Accidental Bodily Injury that results from felonious assault causes a Covered Person to suffer one of the losses shown below within 90 days from the felonious assault. The Benefit Amount for felonious assault is payable in addition to any other applicable Benefit Amounts under this Certificate of Coverage. Any assault by a Relative is not covered under this benefit.

COVERED TREATMENT OR SERVICE	MAXIMUM BENEFIT
ACUTE ONSET OF A PRE-EXISTING CONDITION	For ages up to 79, up to Medical Maximum/Coverage related to Cardiac Conditions or Stroke are limited to $25,000 per Period of Insurance For ages 80 and above, up to $15,000 per Period of Insurance/Coverage related to Cardiac Conditions or Stroke are limited to $15,000 per Period of Insurance

ACUTE ONSET OF A PRE-EXISTING CONDITION: Benefits are payable for an Acute Onset of a Pre- Existing Condition up to the maximum as stated in the Schedule of Benefits provided the Acute Onset Event:
1.    occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent and immediate medical care;
2.    occurs a minimum of 48 hours after the Effective Date of the Coverage; and
3.    treatment is obtained within 24 hours of the sudden and Unexpected outbreak or recurrence.
Any repeat/reoccurrence within the same Period of Insurance will no longer be considered Acute Onset of a Pre-Existing Condition and will not be eligible for additional coverage. This benefit covers only one (1) Acute Onset episode of a Pre-Existing Condition. Sudden and Acute Onset of a Pre- Existing Condition Coverage expires upon medical advice that the condition and onset is no longer acute, or the Covered Person is discharged from a medical facility.

To be eligible for the foregoing limited coverage and benefits for an Acute Onset of a Pre-existing Condition, the Covered Person must be in compliance with all Terms of this insurance. The Company will provide such coverage and benefits only when all of the following conditions and restrictions have been met.
At the time of the Acute Onset of a Pre-existing Condition:
a)    Treatment must be obtained within twenty-four (24) hours of the sudden and Unexpected outbreak or reoccurrence.
b)    the Covered Person must be under ninety (90) years of age.
c)    the Covered Person must not be traveling against or in disregard of the recommendations. established Treatment programs, or medical advice of a Physician or other healthcare provider.
d)    the Covered Person must not be traveling with the intent or purpose to seek or obtain Treatment for the Pre-existing Condition.
e)    the Covered Person must not be traveling during a period of time when the Covered Person is preparing or waiting for, involved in, or undertaking a new, changed or modified Treatment program with respect to the Pre-existing Condition, and is not traveling subsequent to any such new, changed or modified Treatment program having been advised or recommended.
f)    the Pre-existing Condition must have been stabilized for at least thirty (30) days prior to the Effective Date without change in Treatment.

Definitions
“Acute Onset of a Pre-existing Conditions” means a sudden and Unexpected outbreak or reoccurrence that is of short duration, is rapidly progressive, and requires urgent medical care. A Pre-existing Condition that is chronic or congenital, or that gradually becomes worse over time is not an Acute Onset of a Pre- existing Condition. An Acute Onset of Pre-existing Condition does not include any condition for which, as of the Effective date, the Covered Person
i.    knew or reasonably foresaw he/she would receive,
ii.    (ii) knew he/she should receive,
iii.    (iii) had scheduled, or
iv.    (iv) were told that he/she must or should receive, any medical care, drugs, or Treatment.

“Cardiac Conditions” means medical conditions related to coronary disease, hypertension, high cholesterol/hyperlipidemia, congestive heart failure, arrhythmias, cardiomyopathy, valvular heart disease, congenital heart disease, and rheumatic heart disease. For the purpose of this definition a heart attack and myocardial infarction fall under the definition of Cardiac Conditions.

OPTIONAL EXTENSION PROCEDURES
An extension notice will be sent to the Covered Person before the Period of Insurance ends and includes links to extend prior to the Termination Date. The Covered Person is subject to the following rules at extension: In order to extend, the Period of Insurance must be initially purchased for a minimum of 5 days. If available, an extension period can be purchased

1. at the premium rate in force at the time of the extension;
2. for a minimum of 5 days;
3. for up to a maximum of 364 days, provided the Covered Person’s Period of Insurance does not exceed 364 days in total.

There are no grace periods for extension. Once the coverage has lapsed, reapplication may be allowed provided you meet the eligibility requirements. Please note, upon application for a new coverage, the Pre-Existing Condition exclusion, deductible and coinsurance start over.

CANCELLATION AND REFUND PROCEDURE PROVISIONS
Full cancellation and refund will only be considered if We receive written request prior to or on the Effective Date of the coverage. If We receive a written request for cancellation and refund after the Effective Date of coverage, a partial cancellation and refund may be allowed. The following conditions apply

1. If any claims have been filed with Us, the premium is fully earned and is non-refundable. If no claims have been filed with the Company, then
   i. a cancellation fee of US $50 will be charged; and
   ii. only unused days
2. premiums will be considered as refundable; and
3. If after a refund is made, it is determined that a claim was presented to Us on a Covered Person’s behalf, the Covered Person will be fully responsible for that claim in its entirety.

Upon effectuation of such cancellation and refund, neither the Company nor the Covered Person shall have any further rights, liabilities, or obligations under this insurance.

CLAIMS ADMINISTRATOR
Surego Administrative Services on Behalf of Crum & Forster
PO Box 2069 Fairhope AL 36533
Click here to Submit Your Claim Online
For claim status or questions please call: Toll Free: 866-696-0409 Direct 251-928-0939 Email claims@mysurego.com

PLAN ADMINISTRATOR
Trawick International
PO Box 2284 Fairhope AL 36533
Toll Free: 888-301-9289 Direct: 251-661-0924
Email: info@trawickinternational.com

CLAIM PROCEDURES
All claims must be submitted within 90 days of the date of service. All claims MUST BE ON A FULLY COMPLETED claim form including medical history sections. A claim form must be completed and provided for each medical condition.

EXPLANATION OR VERIFICATION OF BENEFITS: In the event of any verbal or telephone inquiry, every attempt will be made to help the Covered Person and their healthcare providers and suppliers understand the status, scope and extent of available benefits and coverage under this insurance, provided, however, that no statement made by any agent, employee or representative of the Company or the Plan Administrator will be deemed or construed as an actionable representation, promise or estoppel or will create any liability against the Company or the Plan Administrator or be deemed or construed to bind the Company or to modify, replace, waive, extend or amend any of the Terms of this Certificate of Coverage, unless expressly set forth in writing and signed by an authorized agent or representative of the Company. Actual eligibility determinations, benefit verifications, final coverage decisions, claim adjudications, final payments, reimbursements of benefits, or claims shall be determined and adjudicated only after or at the time a proper and complete Proof of Claim is submitted (as the case may be), an opportunity for reasonable investigation and/or review is provided, cooperation required hereunder received, and all facts and supporting information, including relevant data, information and medical records when deemed necessary or appropriate by the Company, are presented in writing. Appealed claims may be further investigated and/or reviewed. The Terms and Conditions govern all available coverage and payments made or to be made. If a definite answer to a specific benefits or coverage question is required for any reason, the Covered Person or their healthcare providers may submit a written request to the Company, including all pertinent medical information and a statement from the attending Physician (if applicable), and a written reply will be sent by the Company and kept on file. If the Company elects to verify generally and/or preliminarily to a provider or the Covered Person that an Injury, Sickness, diagnosis or proposed Treatment is or may be covered under this insurance, or that benefits for same are or may be available as outlined in this Certificate of Coverage, any such verification of benefits does not guaranty either payment of benefits or the amount or eligibility of benefits. Final eligibility determinations, coverage decisions, claim appeals and actual reimbursement or payment of claims or benefits are subject to all Terms of this insurance, including without limitation filing a proper and complete Proof of Claim and complying with the COOPERATION provision.

GOVERNING JURISDICTION: All claims arising under this insurance shall be governed by the Laws of Cayman Islands whose courts alone shall have jurisdiction in any dispute arising hereunder.

NOTICE OF CLAIM: A Claimant must give Us or Our authorized representative written (or authorized electronic or telephonic) notice of claim within 90 days after any loss covered by the Certificate of Coverage occurs. If the Claimant or Covered Person is incapacitated within the 90 days after the loss, must be given as soon as reasonably possible. This notice should identify the Covered Person and the Certificate Number. All claims must be submitted within 90 days from date of incident, or they will be denied. Circumstances may exist in which this is not always possible. Any submissions after 90 days will be considered based on those circumstances.

CLAIM FORMS: Upon receiving written notice of claim, We will provide claim forms to the Claimant within 15 days. If We do not furnish such claim forms, the Claimant will satisfy the requirements of written Proof of Claim by sending the written (or authorized electronic or telephonic) proof as shown below. The proof must describe the occurrence, extent and nature of the loss and give authorization to release medical records.

PROOF OF CLAIM: (a) A Proof of Claim shall not be effective and will not satisfy the Terms of this insurance unless it includes all the following:
(i)    a duly completed, timely submitted and signed SureGo Claim Form for each new Sickness or Injury diagnosis unless the Company waives such requirement in writing
(ii)    an Authorization for Release of Medical Information when specifically requested by SureGo
(iii)    all original Universal Billing Forms, Superbill and statements of service rendered from Physicians, Hospitals, and other healthcare or medical service providers involved with respect to the claim
(iv)    all original receipts for any costs, prescription medications, fees or expenses that have been incurred or paid by, or on behalf of, the Covered Person with respect to the claims, including without limitation all original receipts for any cash and/or credit card payments. The provider of service’s full name, address, telephone number (including area/country code), date of service, description of service (applicable procedure codes), and diagnosis codes must be included on the receipts.
(v)    If the claims are submitted electronically, copies of the above items are acceptable; however, the Company reserves the right to request the original documents. Other documents that may be requested are proof of travel, copy of passport, and other documents to support the claim.

TIMELY FILING REQUIREMENTS: The Covered Person and/or Physician, Hospital and other healthcare and medical service providers and suppliers shall have ninety (90) days from the date a claim is incurred to submit a complete Proof of Claim. The Company at its option may pend resolution and adjudication of submitted claims and/or may deny coverage due to any of the following: (i) SureGo’s receipt of an incomplete Proof of Claim (ii) failure to submit any Proof of Claim (iii) Covered Person’s, Physician’s or Hospital’s failure to submit a timely Proof of Claim (c) The Company may require the Covered Person to sign an Authorization for Release of Medical Information to request medical records on their behalf or supply us with additional documentation as deemed necessary to make a benefit determination based on the submitted Proof of Claim. The Covered Person and/or Physician, Hospital and other healthcare and medical service providers and suppliers shall have ninety (90) days from the date of the request to submit the requested information. If the information is not received within the designated time period, previously
submitted and subsequent claims will be denied.

PROOF OF ELIGIBILITY: A Claimant must provide Us or Our authorized representative with written proof of eligibility as outlined in this Certificate of Coverage, at time of Claim. Proof of Eligibility is required prior to any payment of a Claim.

COOPERATION: The Covered Person and their Physicians, Hospitals and other healthcare and medical service providers and suppliers shall undertake to cooperate fully with the Company and the Plan Administrator in reviewing, investigating, adjudicating, considering an appeal of, and/or administering any claim for benefits under this insurance, including granting full right of access to all relevant, pertinent or related records, medical documentation, medical histories, reports, laboratory or test results, x-rays, and all other available evidence relating to or affecting the review, investigation, adjudication or administration of the claim. The Company at its own expense shall have the right and opportunity to examine all evidence related to a claim when and as often as it may reasonably require during the pendency of a claim hereunder. The Company at its option may suspend or pend adjudication of a claim and/or may deny benefits and/or coverage for a claim when any of the following has occurred: (a) a refusal to so cooperate (b) an unreasonable delay in such cooperation (c) any other act or omission on the part of the Covered Person and/or their healthcare providers which hinders, delays, impairs or otherwise prejudices the performance of the Company’s obligations under this insurance. Time Payment of Claims: Benefits for loss covered by the Certificate of Coverage, other than benefits that require periodic payment, will be paid not more than 60 days after We receive proper written proof of such loss.

PAYMENT OF CLAIMS: If the Covered Person dies, any death benefits or other benefits unpaid at the time of the Covered Person’s death will be paid to the beneficiary. If no beneficiary is on record with Us or Our authorized agent, payment will be made to the first surviving class of the following to the Covered Person’s:
1.    Spouse;
2.    children, in equal shares (If a child is a minor, benefits will be paid to the legal guardian);
3.    mother or father;
4.    estate. All other benefits due and not assigned will be paid to the Covered Person if living. Otherwise, the benefits may, at our option, be paid: 1. according to the beneficiary designation; or 2. to the Covered Person’s estate. If a benefit due is payable to: 1.the Covered Person’s estate; or 2. the Covered Person or a beneficiary who is either a minor or is not competent to give a valid release for the payment, We may pay any amount due to some other person. The other person will be one who we believe is entitled to the payment and who is related to the Covered Person or the beneficiary by blood or marriage. We will be relieved of further responsibility to the extent of any payment made in good faith. We may pay benefits directly to any Hospital or person rendering covered services unless the Covered Person requests otherwise in writing. The Covered Person must make the request no later than the time he or she files a written Proof of Claim.

RIGHT OF RECOVERY: In the event of overpayment by the Company of any claim for benefits under this insurance, for any reason, including without limitation because of any of the following: (a) all or part of the claim was not incurred by or paid by or on behalf of the Covered Person (b) the Covered Person or any of the Covered Person's Relatives, whether or not the Relative is or was a Covered Person under this insurance plan, is repaid or is entitled to be repaid for all or part of the claim in accordance with the conditions and other insurance provision, for defective equipment or medical devices covered under a warranty, or by or from a source other than the Company (c) all or part of the claim was not eligible for payment or coverage under the Terms of this insurance (d) all or part of the claim was paid or reimbursed
based on an incorrect or mistaken application of benefits under this insurance (e) all or part of the claim has been excused, waived, abandoned, forfeited, discounted or released by the provider (f) the Covered Person is not liable or responsible as a matter of law for all or part of a claim. The Company shall have the right to receive a refund and to recover the amount of overpayment from the Covered Person and/or the Hospital, Physician and/or other provider of services or supplies (as the case may be). The amount of the refund and recovery for overpayment of claims shall be the difference between the amount actually paid by the Company and the amount, if any, that should have been paid by the Company under the Terms of this insurance. For all other overpayments, the amount of the refund and recovery shall be the amount overpaid. If the Covered Person, Hospital, Physician, or other provider of services or supplies does not promptly make any such refund to the Company, the Company may, in addition to any other rights or remedies available to it (all of which are reserved): (i) reduce or deduct from the amount of any future claim that is otherwise eligible for coverage or payment under this insurance, to the full extent of the refund due to the Company; and/or (ii) cancel this Certificate of Coverage and all further coverage of the Covered by giving thirty (30) days advance written notice by mail to the Covered Person at their last known residence or mailing address and offset against the amount of any refund of Premium due the Covered Person to the full extent of the refund due to the Company.

ASSIGNMENT, CHANGE OR WAIVER: Notwithstanding any law, statute, judicial decision or rule to the contrary that may be or may purport to be otherwise applicable within the jurisdiction, locale or forum state of any healthcare or medical service provider, no transfer or assignment of any of the Covered Person's rights, benefits or interests under this insurance shall be valid, binding on or enforceable against the Company or Plan Administrator unless first expressly agreed and consented to in writing by the Company. Any such purported transfer or assignment not in compliance with the foregoing Terms shall be void ab initio and without effect as against the Company or Plan Administrator, and the Company shall have no liability of any kind under this insurance to any such purported transferee or assignee with respect thereto. The Terms of this Certificate of Coverage shall not be waived or modified except by the express written agreement of the Company.

BENEFICIARY: The Insured may designate a beneficiary. The Insured has the right to change the beneficiary at any time by written (or electronic and telephonic) notice. If the Insured is a minor, his or her parent or guardian may exercise this right for him or her. The change will be effective when We or Our authorized agent receive it. When received, the effective date is the date the notice was signed. We are not liable for any payments made before the change was received. We cannot attest to the validity of a change. The Insured is the beneficiary for any covered Dependent.

INSOLVENCY: The insolvency, bankruptcy, financial impairment, receivership, voluntary plan of arrangement with creditors or dissolution of the Assured or any Covered Person shall not impose upon the Company any liability or obligation other than that specifically included in this insurance.

SUBROGATION CLAUSE: The Covered Person shall undertake to pursue in their own name and stead, and to fully cooperate with the Company in the pursuit and prosecution of, any and all valid claims that the Covered Person may have against any third party who may be liable or responsible for any loss or damage arising out of any act, omission or occurrence that results or may result in a loss payment, provision of benefits or coverage of claim by the Company under this insurance and to fully account to the Company for any amounts recovered or recoverable in connection therewith, on the basis that the Company shall be reimbursed and entitled to recover first in full for any sums paid or to be paid by it before the Covered Person shares in any amount so recovered, regardless of whether or not the Covered Person has been made whole or has been fully compensated for their injuries. The Covered Person further agrees and understands that the Company requires the Covered Person to complete a subrogation questionnaire, sign an acknowledgment of the Company's subrogation rights and sign an agreement before the Company considers paying, or continues to pay, any claims. Should the Covered Person fail to so cooperate, account or prosecute any valid claims against any such third party or parties, and the Company thereupon or otherwise becomes liable or otherwise obligated to make payment under the Terms of this insurance, then the Company shall be fully subrogated to all rights and interests of the Covered Person with respect thereto and may prosecute such claims in its own name as subrogee. The Covered Person’s submission of Proof of Claim or acceptance of coverage or benefits under this insurance shall be deemed to constitute an authorization, consent, and assignment of such subrogation rights by the Covered Person to the Company. The Covered Person agrees that the Company has a secured proprietary interest in any settlement proceeds the Covered Person receives or may be entitled to receive. The Covered Person understands and agrees that the Company is entitled to a constructive trust interest in the proceeds of any settlement or recovery. The Covered Person agrees to include the Company as a co-payee on any settlement check or check from any third party or insurer. The Covered Person agrees he/she will not release any party or their insured without prior written approval from the Company and will take no action that prejudices the Company's rights. The Covered Person is obligated to inform their legal representative of the Company’s rights and lien and to make no distributions from any settlement or judgment that will in any way result in the Company receiving less than the full amount of its lien without the written approval of the Company. Any amount recovered by the Company in accordance with the foregoing shall first be used to pay in full the costs and expenses of collection incurred by the Company, including reasonable attorneys’ fees, and for reimbursement to the Company for any amount that it may have paid or become liable to pay under this insurance. Any remaining amounts recovered shall be paid to the Covered Person or other persons lawfully entitled thereto, as applicable. In the event that the Covered Person receives any form or type of settlement and either fails or refuses to abide by the Terms of this insurance contract, in addition to any other remedies the Company may have, the Company retains a right of equitable offset against future claims.

OTHER INSURANCE: The Company shall not be liable or obligated to provide any coverage or benefits or to pay or reimburse any claim under this insurance if there is any other insurance, membership benefit, workers’ or workplace compensation coverage program or other government programs, reimbursement or indemnification coverage, right of contribution, recoupment or recovery, contract, or any other third- party obligation or liability for provision of benefits (“Other Coverage”) that would, or would but for the existence of this insurance, be available or obligated to provide such benefit or to pay or reimburse or provide indemnity for such claim, except in respect of any excess beyond the amount payable or provided under such Other Coverage had this insurance not been effected. Notwithstanding the foregoing, the Company shall not be liable or obligated to provide any benefit or to pay or reimburse any claim for any Covered Person in respect to Treatment or supplies furnished by any program or agency funded by any government or governmental authority.
The Company reserves the right to cancel any and all coverage if it is determined a Covered Person has Stacked Insurance.

PHYSICAL EXAMINATIONS AND AUTOPSY: We have the right to have a Physician of Our choice examine the Covered Person as often as is reasonably necessary. This section applies when a claim is pending or while benefits are being paid. We also have the right to request an autopsy in the case of death unless the law forbids it. We will pay the cost of the examination or autopsy.

APPEALING A CLAIM: In the event the Company denies all or part of a claim, the Covered Person shall have ninety (90) days from the date that the notice of denial was mailed to the Covered Person's last known residence or mailing address within which to appeal the determination. The Covered Person must file an appeal prior to bringing any legal action under the contract of insurance. The Covered Person should submit a written request for an appeal along with comments, all relevant, pertinent, or related documents, medical records and other information relating to the claim. The appeal must be sent to: SureGo Administrative Services Attn: Benefit Review PO Box 241989 Apple Valley, MN USA 55124 The Company’s review will take into account all comments, documents, records and other information submitted by the Covered Person relating to the claim without regard to whether such information was submitted or considered in the initial claim determination. Upon receipt of a written appeal, the Company shall have an opportunity for further reasonable investigation and/or review as set forth in the CONDITIONS AND GENERAL PROVISIONS, EXPLANATION OR VERIFICATION OF BENEFITS provision and
will respond in writing as soon as reasonably practicable, and in any event within ninety (90) days from receipt thereof.

SERVICE OF SUIT; VENUE; CHOICE OF LAW: No action or proceeding of any kind can be brought by an Covered Person to recover on the contract of insurance prior to the later of (a) expiration of sixty (60) days after written Proof of Claim has been furnished in accordance with the contract of insurance or (b) exhaustion of one (1) appeal under the CONDITIONS AND GENERAL PROVISIONS, APPEALING A CLAIM provision above. No action or proceeding can be brought after the expiration of three (3) years after the time written Proof of Claim is required to be furnished under the contract of insurance. The contract of insurance between the Covered Person and the Company, as evidenced by this Certificate of Coverage, shall be deemed issued, finalized, and made in Cayman Islands. Sole and exclusive jurisdiction and venue for any action or proceeding of any kind relating to or arising from this insurance and/or the Terms and conditions of this Certificate of Coverage (including any amendment thereto) shall be in Grand Cayman, Cayman Islands for which the Company and the Covered Person expressly consent. The subjects, risks and benefits of insurance evidenced by this Certificate of Coverage are not intended or considered by the Covered Person or the Company (or the Plan Administrator) to be resident, located, or performed in any particular State of the United States. Cayman law shall govern all rights and claims relating to or arising from this insurance and/or this Certificate of Coverage (including any amendment thereto).
In the event of the failure of the Company to provide benefits or pay or reimburse any amount claimed to be due under this insurance, the Company, at the request of the Covered Person and upon receipt of lawful process or summons, will submit to the jurisdiction of a court of competent subject matter jurisdiction located in Cayman Islands, provided there exists an independent statutory and constitutional basis for in personal jurisdiction over the Company in said court and by said forum State. The Company and the Covered Person consent to personam jurisdiction and venue in the Grand Cayman, Cayman Islands (assuming that federal jurisdiction is otherwise appropriate and lawful). The Company reserves the right, acting by and through the Plan Administrator or otherwise, to initiate and pursue actions for
declaratory judgment and/or other appropriate relief with respect to the validity, binding effect, administration of and/or any dispute, claim, or controversy relating to or arising from this insurance. In any suit instituted by or against the Company or the Covered Person pursuant to the Terms of this provision, the Company and the Covered Person will abide by the final decision of such Cayman Islands court or of any appellate court in the event of an appeal. Nothing in this provision constitutes or should be deemed, considered, or understood to constitute a waiver of the Company's or the Covered Person’s rights to oppose venue or jurisdiction in any forum other than the Grand Cayman, Cayman Islands, or all of which rights are expressly reserved and retained.
In the event that the Company is the prevailing party in any litigation, arbitration, or other proceeding of any kind relating to or arising from this insurance and/or the Terms and conditions of this Certificate of Coverage (including any amendment thereto), regardless of the nature of the claim, the Company shall be awarded its reasonable attorney fees, and costs and expenses incurred in addition to any compensatory damages or other remedies in law or equity.
WAIVER OF ANY RIGHT TO JURY TRIAL: THE COMPANY AND THE COVERED PERSON EACH KNOWINGLY, VOLUNTARILY, AND IRREVOCABLY WAIVE ANY RIGHT TO A TRIAL BY JURY FOR ANY CLAIM, DEMAND, ACTION, OR PROCEEDING OF ANY KIND, WHETHER SOUNDING IN CONTRACT, TORT, OR OTHERWISE, RELATING TO OR ARISING FROM: (I) THIS INSURANCE; AND/OR (II) THIS CERTIFICATE OF COVERAGE, INCLUDING ANY AMENDMENT THERETO. THE COMPANY AND THE COVERED PERSON EACH KNOWINGLY, VOLUNTARILY, AND IRREVOCABLY AGREE THAT ANY SUCH CLAIM, DEMAND, ACTION, OR PROCEEDING SHALL BE EXCLUSIVELY PRESENTED TO AND DETERMINED SOLELY BY THE COURT AS THE TRIER OF FACT, AND NOT BEFORE A JURY. NO ATTEMPT SHALL BE MADE TO CONSOLIDATE, BY COUNTERCLAIM OR OTHERWISE, ANY ACTION OR PROCEEDING WITH ANY OTHER ACTION OR PROCEEDING IN WHICH THERE IS A TRIAL BY JURY OR IN WHICH A JURY TRIAL CANNOT OR HAS NOT BEEN WAIVED. THE COMPANY AND THE COVERED PERSON EACH AGREE THAT A COPY OF THIS PROVISION MAY BE FILED WITH ANY COURT AS WRITTEN EVIDENCE OF THE AGREEMENT OF THE WAIVER OF ANY RIGHT TO TRIAL BY JURY.

CLAIM SETTLEMENT: Eligible and covered claims for Eligible Medical Expenses or other benefits under this insurance that have previously been paid by or on behalf of the Covered Person at the time of the Company’s favorable adjudication thereof will be reimbursed by the Company directly to the Covered Person, by check, at their last known residence or mailing address. While this insurance is in effect, in order to effectuate proper administration, the Covered Person shall undertake to promptly notify the Company of any change in such addresses. Eligible and covered claims for Eligible Medical Expenses or other benefits under this insurance that have not been paid by or on behalf of the Covered Person at the time of adjudication will be paid by the Company by check or electronic funds transfer to the Covered Person at their last known residence or mailing address, or, at the sole option and discretion of the Company (but without obligation to do so), and as an accommodation to the Covered Person, directly to the provider(s), as applicable. All claim settlements, payments and reimbursements are subject to the insurance plan shown in the Declaration and all other Terms of this insurance. No healthcare or medical service provider or supplier, or any other third-party, shall have any direct or indirect interest, claim or right of action against the Company under this Certificate of Coverage , the Declaration or the Master Certificate of Coverage , whether by purported assignment of benefits, subrogation of interests or
otherwise, unless first expressly agreed and consented to in writing by the Company, and notwithstanding the Company’s exercise or failure to exercise any option or discretion under this provision regarding the method of claim payment. No such provider, supplier or other third-party is intended to have or shall have any rights as a third-party beneficiary under this Certificate of Coverage, or the Declaration.

LEGAL ACTIONS: No lawsuit or action in equity can be brought to recover on the Certificate of Coverage:
1.    before 60 days following the date Proof of Claim was given to Us; or
2.    After 3 years following the date Proof of Claim is required.

ARBITRATION: No claim for benefits for which liability, eligibility, or coverage under this insurance has been denied in whole or in part by the Company nor any other dispute or controversy arising under or related to this insurance shall be arbitrable or subject to arbitration under any circumstances or for any reason.

NOT IN LIEU OF WORKERS’ COMPENSATION: The Certificate of Coverage is not Workers’ Compensation
coverage. It does not provide Workers’ Compensation benefits.

ECONOMIC OR TRADE SANCTIONS: Any payments under this Certificate of Coverage will only be made in full compliance with all United States of America economic or trade sanction laws or regulations, including, but not limited to, sanctions, laws, and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”). Therefore, any expenses incurred, or claims made involving travel that is in violation of such sanctions, laws and regulations will not be covered under this Certificate of Coverage. For more information, You may consult the OFAC internet website at
https://www.treasury.gov/about/organizational-structure/offices/Pages/Office-of-Foreign-Assets- Control.aspx.

ELECTRONIC COMMUNICATION: 1. Consent to receive insurance related documents and communications, including but not limited to, your Certificate of Coverage documents, disclosures, notices, explanation of benefits (EOB), claims documentation, as well as termination and cancellation or non-renewal notices, electronically to the email address you provide to us through the online application process instead of receiving these records in a paper format from us. 2. Agree and acknowledge that your consent is provided and/or obtained in connection with a transaction affecting interstate/international commerce subject to the Electronic Signatures in Global and National Commerce Act and the Uniform Electronic Transactions Act, or a similar electronic transactions law, as adopted by state law. 3. Agree that the document(s) delivered to you electronically shall have the same meaning and effect as if you were provided a paper document, whether or not you choose to view the document(s), unless you previously withdrew your consent, by written notice, to receive documents via electronic means. Electronic document(s) are considered received by you at the date and time you complete your purchase, and unless we receive notice that the email notification was not delivered to you at the email address you provided.

MISREPRESENTATION: Any false representation, incomplete information, misleading statement, misstatement, omission, concealment or fraud, whether or not innocently made, either in the Covered Person's Application or in relation to any claim form, statement, certification or warranty made by the Covered Person or their representatives, agents or proxies, whether in writing or otherwise, to the Company or the Plan Administrator or their respective agents, employees or representatives, or in connection with
the making of any claim under this insurance, shall render the Declaration and this Certificate of Coverage null and void and all claims and benefits under this insurance shall be forfeited and waived.

FRAUDULENT CLAIMS: A person who knowingly and with intent to defraud the Company files a statement of claim containing any false, incomplete, or misleading information may be prosecuted for a felony or similar charge under the applicable laws. If any claim or request for benefits under this insurance shall knowingly be in any respect false, incomplete, misleading, concealing, fraudulent or deceitful or if the Covered Person or anyone acting for or on their behalf under this insurance knowingly uses any false, incomplete, misleading, concealing, fraudulent or deceitful statements regarding the Covered Person, the insurance contract and all coverage thereunder may be cancelled, voided, rescinded and terminated by the Company in its sole and absolute discretion, and the Company shall have no obligation or liability for any such benefits, coverage or claims.