SCHEDULE OF BENEFITS

TRANSPORTATION BENEFITS

ADDITIONALBENEFITS

ADDITIONALSERVICES

*Not subject to Deductible
** This is a non-insurance service and is not a part of the insurance underwritten by Zurich Insurance Europe AG Belgian branch.

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 BENEFITS
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 Period of Insurance. The first Covered Expenses must be incurred within 90 days after the date of the covered Sickness or Injury. No benefits will be paid for any expenses incurred which are in excess of the Usual and Customary Charge.
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. HOSPITAL INTENSIVE CARE UNIT EXPENSES will be provided based on the Allowable Charge for Medically Necessary Intensive Care Services.
3. 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 approved medicines in the jurisdiction where treatment is being rendered; 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.
4. PHYSICIAN’S SURGICAL TREATMENT EXPENSES.
5. ANESTHESIOLOGIST EXPENSES: for pre-operative screening and administration of anesthesia during a Surgical Procedure on an inpatient basis.
6. ASSISTANT PHYSICIAN’S SURGICAL EXPENSES: if 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 VISIT EXPENSES: 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 EXPENSES: when requested by attending Physician.
9. PRE-ADMISSION TEST EXPENSES: within 7 days of Admission.
10. DIAGNOSTIC X-RAYS AND LAB SERVICES EXPENSES: to include X-ray, laboratory and other diagnostic tests, biological anesthesia and oxygen services, inhalation therapy, and administration of blood products.
11. OUTPATIENT SURGICAL FACILITY EXPENSES.
12. PHYSICIAN’S AND URGENT CARE VISIT EXPENSES.
13. HOSPITAL EMERGENCY ROOM VISIT EXPENSES.
14. PRESCRIPTION DRUGS AND MEDICATIONS EXPENSES: 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.
15. 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.
16. DENTAL TREATMENT FOR INJURY OF SOUND NATURAL TEETH DUE TO ACCIDENT EXPENSES:
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.
17. CARDIAC CONDITIONS AND STROKE EXPENSES: up to the maximum as stated in the Schedule of Benefits.
18. COVID-19, SARS-CoV-2 MEDICAL EXPENSES: Not Covered
19. EMERGENCY MEDICAL TREATMENT OF PREGNANCY EXPENSES.
20. MENTAL OR NERVOUS DISORDERS EXPENSES: 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.
21. UNEXPECTED RECURRENCE OF A PRE-EXISTING CONDITION EXPENSES: Benefits are payable for
an Unexpected Recurrence of a Pre-Existing Condition up to the maximum as stated in the Schedule of Benefits provided the condition or 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 Unexpected Recurrence of a Pre-Existing Condition and will not be eligible for additional coverage. This benefit covers only one (1) Unexpected Recurrence of a Pre-Existing Condition per Period of Insurance. Sudden and Unexpected Recurrence 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 Unexpected Recurrence 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 Unexpected Recurrence of the 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 seventy (70) 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.

TRANSPORTATION BENEFITS
AMBULANCE SERVICE BENEFITS
Ambulance Service Benefits are provided for Medically Necessary emergency ground or air 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 Insurance: (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 UNEXPECTED RECURRENCE 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 REPATRATION
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 Insurance.
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.

EMERGENCY REUNION
The following costs and expenses incurred in respect of travel by a Relative or friend of the Covered Person will be reimbursable to the Covered Person upon the recommendation and prior approval of the Company:
a) the cost of a round-trip economy commercial airline ticket for one (1) Relative or friend from the airport
nearest to the location of the Relative or friend at the time of the Emergency to the airport serving the area where the Covered Person is Hospitalized as a result of the Emergency or is to be Hospitalized as a result of the Emergency Medical Evacuation and return from whichever of such locations is actually selected to the point of the original departure (b) Related Costs for meals (up to the amount shown in the Summary of Benefits), transportation and accommodation expenses incurred in relation to the Emergency Reunion (but excluding entertainment). The allowable maximum coverage for the Emergency Reunion shall not exceed ten (10) days, including travel days, (b) the Emergency Reunion must be due to an Emergency Medical Evacuation covered under the Terms of this insurance (c) the Covered Person must be so seriously ill that the attending Physician deems it necessary and recommends the presence of a Relative at either the location where the Covered Person is being evacuated from or the destination of the Emergency Medical Evacuation, whichever is considered by the attending Physician and the Company to be the more reasonable (d) all Emergency Reunion travel, transportation and accommodation arrangements and benefits must be approved in advance by the Company in order to be eligible for coverage under this insurance (e) the Covered Person, Relative friend must submit to the Company upon completion of the Emergency Reunion travel legible and verifiable copies of all paid receipts for the travel and transportation costs and expenses so incurred for which reimbursement is sought.
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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 a 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.

ADDITIONAL BENEFITS
HOSPITAL CONFINEMENT
Subject to the Terms of this insurance and in the event the Covered Person has been Hospitalized in a Facility outside the Country of Residence and the United States, during the Period of Insurance, the Company will pay the Covered Person for each overnight Hospitalization as an Inpatient, so long as the Treatment received during the overnight Hospitalization is considered to be an Eligible Medical Expense provided; 1. The Hospital stay is the direct result, from no other causes, of Injuries sustained in a Covered Accident or Sickness that occurs while the coverage is in effect; and 2. The Hospital stay begins within 3 days of a Covered Accident or Sickness and lasts for at least 3 days. The benefit will be paid retroactive to the first day of the Hospital stay. Benefit payments will end on the first of the following: 1. The date the Hospital Stay ends; 2. The date the Covered Person dies; 3. The 10th day of hospitalization; or 4. The date the coverage terminates.

ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) – 24 Hour
Accidental Death and Dismemberment will apply to Covered Accidents incurred by a Covered Person. 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.

Exposure and Disappearance Benefit – Benefits are payable if a Covered Person is exposed to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which They were traveling. The Covered Person is presumed dead if They are in a vehicle that disappears, sinks, or is stranded or wrecked and Their body is not found within six (6) months of the Covered Accident.
If a Covered Person is Injured while wearing a seatbelt and operating or riding as a passenger in an Automobile resulting in any one of the losses shown above within 90 days from the date of the Covered Accident, we will pay benefits as outlined in the Schedule of Benefits.

FELONIOUS ASSAULT ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)
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 Coverage. Any assault by a Relative is not covered under this benefit.

COMA BENEFIT
Benefits are payable if the Covered Person becomes comatose within 31 days of a Sickness or Injury and remain in a coma for at least 31 days.

ADAPTIVE HOME AND VEHICLE
Benefits are payable if the Covered Person has an Injury which results in a Covered Loss under the Accidental Death and Dismemberment Benefit, We will pay an additional benefit equal to the least of the actual cost of the alterations for the one-time cost of alterations to the Covered Person’s principal residence and/or private Automobile to make the residence accessible and/or the private Automobile drivable or rideable.

LOST CHECKED BAGGAGE
Up to $1,000 maximum to reimburse the Covered Person for the replace cost of Necessities when such Luggage was permanently lost in transit by a Common Carrier during the Period of Insurance, subject to the following conditions: (1) the Covered Person must submit to the Company a copy of the Common Carrier’s claim form and such other documentation as the Company may reasonably require proof that the Covered Person’s Luggage was permanently lost (2) the Common Carrier must first reimburse the Covered Person the full amount that it is legally required to pay for lost Checked Luggage, and proof of such reimbursement shall be provided to the Company by the Covered Person. Lost Luggage benefits under this plan will be provided only if and to the extent the amount of the Covered Person’s loss suffered as a result of Lost Luggage exceeds any such reimbursement by the Common Carrier.

TRIP INTERRUPTION
Subject to the Terms of this insurance and in the event of the Unexpected death of a Relative of the Covered Person, or in the event the Covered Person’s Trip or travel plans must be cancelled or interrupted as a result of a break-in or substantial destruction due to a fire or Natural Disaster of the Covered Person’s principal residence in their Country of Residence, the Company will reimburse the Covered Person’s actual expense up to the amount shown in the BENEFIT SUMMARY for the costs of a one-way commercial airline or ground transportation ticket of the same class as the unused travel ticket to transport the Covered Person from the International airport nearest to where the Covered Person was located at the time of learning of such death or destruction to the International airport nearest to (1) the location of the Relative’s funeral or place of burial, or (2) the Covered Person’s destroyed principal residence. Subject to
the following conditions and limitations: (1) the Covered Person must be outside of their Country of Residence at the time of the Unexpected death of the Relative or the substantial destruction of the principal residence (2) the Unexpected death of the Relative or the substantial destruction of the residence must have occurred during the Period of Insurance and was not caused by, due to, or a result of negligence or willful misconduct by the Covered Person (3) the Company will deduct from any Trip Interruption benefits payable hereunder the value of any unused, return tickets held by the Covered Person at the time of the event. The Covered Person must promptly undertake all necessary actions to apply for and receive credit for any unused tickets. The Company will not provide any benefits, reimbursements or coverages for any of the costs or expenses incurred by the Covered Person for a return trip, if any, to the location of the Covered Person at the time of learning of such death or destruction. EXCLUSIONS: Except as expressly provided for in the BENEFIT SUMMARY, all Charges, costs, expenses and/or claims incurred by the Covered Person, and any claim for death or dismemberment benefits, and directly or indirectly relating to or arising or resulting from or in connection with any of the following acts, omissions, events, conditions, Charges, consequences, claims, Treatment (including diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Company shall provide no benefits or reimbursements and shall have no liability or obligation for any coverage thereof or therefor.

PUBLIC HEALTH EMERGENCY
Subject to all other Terms of this insurance, in the event of a Public Health Emergency of International Concern, Epidemic, Pandemic, other disease outbreak, or Natural Disaster, that may affect an Insured Person’s health, the Company will cover an Illness or Injury incurred during the Period of Insurance and caused by the Public Health Emergency of International Concern, Epidemic, Pandemic, other disease outbreak, or Natural Disaster when, prior to the issuance of a Travel Warning for the Destination Country or a Global Travel Warning: (1) the Effective Date of Coverage has occurred; and (2) the Insured Person has arrived in the Destination Country or Affected Area.

In the event that the applicable Travel Warning is removed for the Destination Country or Affected Area, coverage for an Illness or Injury incurred during the Period of Insurance after the Travel Warning is removed, which was caused by the Public Health Emergency of International Concern, Epidemic, Pandemic, other disease outbreak, or Natural Disaster will be considered by the Company the same as any other Illness or Injury, subject to all other Terms and conditions of this insurance.

DEFINITIONS
Please note, certain words used in this document have specific meanings. These terms will be capitalized throughout the document.
“Accident” means a sudden, Unexpected, and unintended event directly caused by external, visible means
and resulting in physical Injury to the Covered Person.

“Adventure Sports” means Activities undertaken for the purposes of recreation, an unusual experience or excitement. These activities are typically undertaken outdoors and involve a medium degree of risk including, but not limited to abseiling; BMX; bobsledding; bungee jumping; canyoning; caving; hot air ballooning; jungle zip lining; parachuting; paragliding; parascending; rappelling; skydiving; spelunking; and windsurfing.

“Affected Area(s)” Any and all countries, states, provinces, territories, cities, or other areas experiencing
ongoing transmission of an Epidemic, Pandemic or other disease outbreak, or Natural Disaster.
“Against Medical Advice, Discharge Against Medical Advice” means against Medical Advice, or AMA, sometimes known as DAMA, Discharge Against Medical Advice, is a term used with a patient who checks themself out of a Hospital against the advice of their Treating Physician.

“AIDS” means Acquired Immune Deficiency Syndrome.
“Amateur Athletics” means an amateur or other non-professional sporting, recreational, or athletic activity that is organized, sponsored and/or sanctioned, and/or involves regular or scheduled practices, games and/or competitions. Amateur Athletics does not include athletic activities that are non-organized, non- Collision, and engaged in by the Covered Person solely for recreational, entertainment or fitness purposes.

“Ancillary Services” means All Hospital services for a patient other than room and board and professional
services. Laboratory tests and Radiology are examples of Ancillary Services.
“Application” means the fully answered and electronically signed individual enrollment form submitted by or on behalf of the Covered Person for acceptance into, coverage under this insurance plan, and which information shall become part of this Certificate of Coverage.
“Appropriate Authority(ies)” means the government authority(ies) in the Covered Person’s Home Country or
the government authority(ies) of the Host Country.

“ARC” AIDS-related complex.

“Assistance Provider” means On Call International.

“Authorization for Release of Medical Information” means a written authorization by the Covered Person for health providers to release medical records and information regarding their past and current Treatment.

"Automobile" means a self-propelled, private passenger motor vehicle with four or more wheels that is a type both designed and required to be licensed for use on the highway of any state or country. Automobile includes, but is not limited to, a sedan, station wagon, sport utility vehicle, or a motor vehicle of the pickup, van, camper, or motor-home type. Automobile does not include a mobile home or any motor vehicle that is used in mass or public transit.

“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.

“Certificate of Coverage” means the applicable certificate issued by the Company to the Assured, and under which insurance coverage and benefits are provided by the Company to the Covered Person, subject to the Terms thereof, and as outlined and evidenced by this certificate and subject to the Terms hereof. The Company, as insurance carrier and underwriter of the certificate, is solely liable and responsible for the coverage and benefits provided thereunder.

“Charges” means any cost, fee or tax incurred for Medical Expenses incurred in the Treatment of an Injury
or Sickness.

“Checked Baggage” means the Covered Person’s Luggage placed in possession of the Common Carrier
during travel in exchange for a receipt for the Luggage.

“Claimant” means the Covered Person or Provider.

"Class VI” means a section of a river, stream or other waterway or watercourse where the current moves with enough speed or force to meet, but not to exceed, the qualifications of Class VI as determined by the International Scale of River Difficulty or as commonly published by a local authority or government agency.

“Coinsurance” means Our share of payment of Medical Expenses at the percentage specified in the Schedule of Benefits contained herein and not including any applicable Deductible or Out-of-Pocket Maximum.

“Copayment” means the amount the Covered Person is responsible to pay for each Urgent Care or Walk-in Clinic visit.
“Collision Sports” means a sport in which the participants purposely hit or collide with each other or inanimate objects, including the ground, with great force and including, but not limited to the following (or other similar style) sports: American football, boxing, hockey, lacrosse, full contact martial arts, rodeo, rugby, and wrestling.

“Common Carrier" means a company or organization that holds itself out to the public as engaging in the business of transporting persons from place to place by air, rail, bus and/or water for compensation, offering its scheduled services to the public generally, and is licensed by a recognized and approved government authority to transport fare-paying passengers. The term Common Carrier does not include private car, taxi, rideshare, motorcar, motorcycle, or limousine services, or transportation by animal or human means (for example, by horse, camel, elephant, or rickshaw).

“Company” means Zurich Insurance Europe AG Belgian branch. This insurance and its risks are underwritten by the Company as the insurer and carrier, and the Company is solely obligated and liable for the coverage and benefits provided by this insurance. “Congenital” means any abnormality, deformity, disease, Sickness, Injury, or medical condition present at birth, whether diagnosed or not.

“Congenital Disorder” means any abnormality, deformity, disease, Illness, Injury, or medical condition
present at birth, whether diagnosed or not.

“Covered Accident” means an Accident that occurs while coverage is in force for a Covered Person and
results in a loss or Injury covered by the Certificate of Coverage for which benefits are payable.

“Covered Expenses” means expenses actually incurred by or on behalf of a Covered Person for treatment, services and supplies covered by the Certificate of Coverage. Coverage must remain continuously in force from the date of the Accident or Sickness until the date treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date such treatment, service, or supply, which gave rise to the expense or the charge, was rendered or obtained.

“Covered Loss” or “Covered Losses” means an accidental death, dismemberment or other Injury covered
under the Certificate of Coverage.

“Covered Person” means any Insured and Dependent for whom the required Premium is paid (herein also referred to as “You” or “Your” or “They” or “Their”).

“Declaration” means the Declaration of Insurance issued by the Plan Administrator for and on behalf of the Company to the Covered Person contemporaneously with this Certificate of Coverage (and/or upon renewal hereof) evidencing the Covered Person’s insurance coverage.

"Deductible" means the dollar amount, as selected on the Application, and specified in the Declaration, that the Covered Person must pay of ELIGIBLE MEDICAL EXPENSES per Period of Insurance prior to receiving benefits or coverage under this insurance, and not including any applicable Coinsurance. The Deductible is applied to the first eligible claim processed.

“Designated Security Consultant” means an employee of a security firm under contract with Us or our Assistance Provider who is experienced in security and measures necessary to ensure the safety of the Covered Person(s) in his or her care.

“Destination Country” means all the geographical areas that the Covered Person is traveling to or within,
other than the primary place of residence declared on the Application as the Country of Residence.

"Diagnosis" means the result of examination or test by a licensed physician providing a specific international CPT or ICD10 code. Failure to obtain a covered Diagnosis will result in the denial of the claim.

“Durable Medical Equipment (DME)” means exclusively the following items: a standard basic hospital bed
and/or a standard basic wheelchair.

“Economy Fare” means the lowest published rate for a one-way economy ticket.

“Educational or Rehabilitative Care” means care for restoration (by education or training) of a person’s ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to job training, counseling, vocational or occupational therapy, and speech therapy.

“Effective Date or Effective Date of Coverage” the date the coverage begins. See EFFECTIVE DATE.

“Elective Surgery or Treatment” means any Treatment or Surgery that is elected by the Covered Person, a Physician, or a medical provider, which is scheduled in advance, is not urgent, and does not involve a Medical Emergency or can be postponed until the Covered Person returns to their Habitual Residence.

“Emergency” means a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Covered Person's life or limb in danger if medical attention is not provided within twenty-four (24) hours, based upon a reasonable medical certainty. Immediate medical intervention and attention is required as a result of a severe, life threatening or potentially disabling condition.

“Emergency Medical Evacuation” means Emergency transportation from the Hospital or medical Facility where the Covered Person is located to a non-local Hospital or medical Facility following the recommendation by the attending Physician who certifies, to a reasonable medical certainty, that the Covered Person has experienced: (a) a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Covered Person's life or limb in danger if medical attention is not provided within twenty-four (24) hours; and (b) where Medically Necessary Treatment cannot be provided locally, either in the Facility of the attending Physician or another local Facility.

“Emergency Use Authorization (EUA)” means a temporary authorization issued by the U.S. Food and Drug Administration (FDA) to allow the use of unapproved medical product, service, a Surgery or Surgical Procedure, prescription medication, drug, biological product, Durable Medical Equipment (DME) or device; or by allowing an otherwise unapproved use or application of an approved medical product, service, Surgery or Surgical Procedure, prescription medication, drug, biological product, Durable Medical Equipment (DME) or device.

“Epidemic” means the occurrence of more cases of disease than expected in a given area or among a specific
group of people over a particular period of time.

“Evacuation Advisory” means a formal recommendation issued by the Appropriate Authorities that the Covered Person or citizens of his or her Home Country or Country of Residence or citizens of the Host Country leave the Host Country.

“Experimental” or “Investigational” means a service for which one or more of the following is true:

• The prevailing opinion within the appropriate specialty of the United States medical profession is that the service or supply needs further evaluation for the particular diagnosis or set of indications before it is used outside clinical trials or other research settings. We will determine if this item 1. is true based on:

1. Published reports in authoritative medical literature; and
2. Regulations, reports, publications, and evaluations issued by government agencies.

• In the case of a drug, a device or other supply that is subject to FDA approval:

1. It does not have FDA approval; or
   1. It has FDA approval, but it is being used for an indication or at a dosage that is not an accepted off label use. Unlabeled uses of FDA-approved drugs are not considered Experimental or Investigational if they are determined to be:
      1. Included in substantially accepted peer-reviewed medical literature;
      2. Included in a Prescription Drug reference compendium; or
      3. In addition, the medical appropriateness of unlabeled uses not included in the compendia can be established based on supportive clinical evidence in peer-reviewed medical publications.

• The Provider’s institutional review board acknowledges that the use of the service or supply is

Experimental or Investigational and subject to the board’s approval.

• Research protocols indicate that the service or supply is Experimental or Investigational. This item applies for protocols used by the Covered Person’s Provider as well as for protocols used by other Providers studying substantially the same service or supply.

“Extreme Sports” means any high-risk non-team sport or recreation activity that is dangerous and if performed optimally, even by the highly skilled, risks loss of life or limb. Extreme Sports often involve speed, height, a high level of physical exertion and/or highly specialized gear.

“Facility” means a licensed health care entity such as a Hospital or clinic.

“Family” means a Covered Person, their Spouse, any Child or Children, and any Grandchild or Grandchildren

or those who are listed as a Covered Person under this insurance plan.

“Genetic Medicine” means the study of the etiology, pathogenesis, and natural history of diseases and disorders that are fully or partially genetic in origin and the application of genetics to medicine or to medical practice, including the prevention, screening, diagnosis, surveillance, and Treatment of these diseases.

“Global Travel Warning” means a published statement, warning or advisory, including any website document, issued by the United States Centers for Disease Control & Prevention (CDC), United States Department of State, United States Bureau of Consular Affairs, or similar government or non-governmental agency of the Covered Person’s Country of Residence or Destination Country, warning that any global travel (travel anywhere) poses serious risks to health, safety and security or exposes the Covered Person to a greater likelihood of life-threatening risks, including all United States Department of State global advisories or global warnings Levels “3 - reconsider travel” and “4 -do not travel” and CDC global advisories or global warnings Level “3 – avoid nonessential travel” or any higher level. When multiple government or non- governmental agencies have issued different levels of warnings or advisories, the highest warning or advisory applicable to the Covered Person’s Country of Residence or Destination Country will be considered for coverage under this insurance. For the avoidance of doubt, a Global Travel Warning covers all Affected Areas, including the United States of America and all of its territories.

“Governing Body or Authority” means a nationally recognized controlling organization for a sport or activity, or an organization that provides guidelines and recommendations in safety practices for a sport or activity.

“Grandchild; Grandchildren” means a family member who is at least fourteen (14) days old but less than nineteen (19) years of age.

“Habitual Residence; Habitual Residency” means the country in which the Covered Person resides or is their usual place of abode, or any country to which the Covered Person pays income taxes based upon employment in that country, at time of purchase. In the event there is more than one Country of Residence under the above-listed criteria, the Country of Residence is the country meeting the above-listed criteria and listed by the Covered Person as their Country of Residence on the Application.

“Health Care Plan” means a policy or other benefit or service arrangement for medical or dental care or treatment under: 1. group or blanket coverage, whether on an insured or self-funded basis; 2. Hospital or medical service organizations on a group basis; 3. Health Maintenance Organizations on a group basis; 4. group labor-management plans; 5. employee benefit organization plans; 6. association plans on a group or franchise basis; or 7. any other group employee welfare benefit plan.

“HIV” means Human Immunodeficiency Virus.

“HIV +” means Laboratory evidence of being positive for Human Immunodeficiency Virus infection.

"Home Country or Country of Residence " means the country in which the Covered Person maintains their current primary residence or usual place of abode and any country to which the Covered Person pays income taxes based upon employment in that country. In the event there is more than one Country of Residence under the above-listed criteria, the Country of Residence is the country meeting the above- listed criteria and listed by the Covered Person as their Country of Residence on the Application.

“Hospice; Hospice Care” means care provided in an Inpatient Facility or at a patient’s home. Hospice Care must be certified by a Physician and life expectancy is six (6) months or less.

“Hospital” means an institution that: 1. operates as a Hospital pursuant to law for the care, treatment, and providing of in-patient services for sick or injured persons; 2. provides 24-hour nursing service by Registered Nurses on duty or call; 3. has a staff of one or more licensed physicians available at all times; 4. provides organized facilities for diagnosis, treatment and surgery, either: (i) on its premises; or (ii) in facilities available to it, on a pre-arranged basis; 5. is not primarily a nursing care facility, rest home, convalescent home, or similar establishment, or any separate ward, wing or section of a Hospital used as such; and 6. is not a place solely for drug addicts, alcoholics, or the aged or any separate ward of the Hospital.

“Hospital Confined” means an overnight stay as a registered resident bed-patient in a Hospital.

“Host Country” means any country, other than an OFAC excluded country, in which the Covered Person is traveling while covered under the Certificate of Coverage.

"Illness” means Sickness.

“Immediate Family Member” means the Spouse, parent, parent-in-law, grandparent, child, Grandchild, brother, sister, fiancé, such person being related to the Covered Person.

“Imminent Bodily Harm” means the existence of any condition or circumstance that cannot be avoided through reasonable precautionary measures and could be expected to cause death or serious physical harm to the Covered Person if the Covered Person were to remain in the Affected Area where the Natural Disaster event has occurred.

“Incidental Trip” means a short-scheduled trip with a defined departure and return date prior to the start of the Incidental Trip to the Covered Person’s Home Country, during their Period of Insurance. To be an eligible Incidental Trip, the Incidental Trip must take place after the Covered Person’s Effective Date and end prior to the Covered Person’s Termination Date.

"Incident" Any situation in which the Terms and conditions of the Certificate of Coverage are activated for either a Sickness, Accident, or Injury.

"Injury" means accidental bodily harm sustained by a Covered Person that results, directly and independently from all other causes, from a Covered Accident. All injuries sustained by one person in any one Accident, including all related conditions and recurrent symptoms of these injuries, are considered a single Injury.

"Inpatient” means a person who has been admitted to and charged by a Hospital for bed occupancy for purposes of receiving Inpatient Hospital services. Generally, a patient is considered an Inpatient if billed by the Hospital for Charges as an Inpatient, and formally admitted as an Inpatient with the expectation that person will occupy a bed and (a) remain at least overnight or (b) is expected to need Hospital care for twenty-four (24) hours or more.

“Intensive Care Unit” means an area or unit of a Hospital that meets the required standards of the Joint Commission on Accreditation of Healthcare Organizations for Special Care Units.

“Interfacility Ambulance Transfer” means movement of the patient locally within the United States from one licensed health care Facility to another licensed health care Facility via air or land ambulance (examples: Hospital to Hospital, clinic to Hospital). The Interfacility Ambulance Transfer must be Medically Necessary and Pre-certified in advance to be an Eligible Medical Expense.

“Investigational” means any Treatment that includes drugs, procedures, or services that are still in the clinical stages of evaluation and not yet approved for use by the U.S. Food and Drug Administration (FDA) including an Emergency Use Authorization by the FDA.

“Local Ambulance Transport; Local Ambulance Expense” means transportation and accompanying Treatment provided by designated, licensed, qualified, professional emergency personnel from the location of an Accident, Injury or acute Illness to a Hospital or other appropriate health care Facility.

“Maximum Limit” means the cumulative total dollar amount of benefit payments and/or reimbursements available to a Covered Person under this insurance. When the Maximum is reached, no further benefits, reimbursements or payments will be available under this insurance.

“Medical Emergency” means a condition caused by an Injury or Sickness that manifests itself by symptoms of sufficient severity that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of the person in serious jeopardy.

“Medically Necessary; Medical Necessity” means a Treatment, service, medicine, or supply which is necessary and appropriate for the Diagnosis or Treatment of an Illness or Injury based on generally accepted standards of current medical practice as determined by the Company. By way of example but not limitation, a service, Treatment, medicine or supply will not be considered Medically Necessary or a Medical Necessity if it is provided or obtained only as a convenience to the Covered Person or their provider; and/or if it is not necessary or appropriate for the Covered Person's Treatment, Diagnosis or symptoms; and/or if it exceeds (in scope, duration or intensity) that level of care which is needed to provide safe, adequate, and appropriate Diagnosis or Treatment.

“Mental or Nervous Disorders” means any mental, nervous, or emotional Sickness which generally denotes a Sickness of the brain with predominant behavioral symptoms; a Sickness of the mind or personality, evidenced by abnormal behavior; or a Sickness or disorder of conduct evidenced by socially deviant behavior. Mental or Nervous Disorders include without limitation: psychosis; depression; schizophrenia; bipolar affective disorder; learning disabilities and attitudinal or disciplinary problems; any disease or condition, regardless of whether the cause is organic, that is classified as a Mental Disorder in the current edition of the International Classification of Diseases; and those psychiatric and other mental Sicknesses listed in the current edition of the Diagnostic and Statistical Manual for Mental. For purposes of this insurance, Mental or Nervous Disorders does not include Substance Abuse Disorder.

“Missing Person” means a Covered Person who disappeared for an unknown reason and whose disappearance was reported to the Appropriate Authority(ies).

“Mortal Remains” means the bodily remains or ashes of a Covered Person.

“Natural Disaster” Widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the human population for its safety. The occurrence must be a disaster that is due entirely to the forces of nature and could not reasonably have been prevented.

“Nearest Place of Safety” means a location determined by the Designated Security Consultant where: 1. the Covered Person can be presumed safe from the Occurrence that precipitated the Covered Person’s Political Evacuation; and the Covered Person has access to Transportation; and 2. the Covered Person has the availability of temporary lodging, if needed.

“Necessities” means personal hygiene items and clothing.

“Occurrence” means any of the following situations involving a Covered Person: 1. expulsion from a Host Country or being declared persona non-grata on the written authority of the recognized government of a Host Country; 2. political or military events involving a Host Country, if the Appropriate Authorities issue an Advisory stating that citizens of the Covered Person’s Home Country or citizens of the Host Country should leave the Host Country; 3. deliberate physical harm of the Covered Person confirmed by documentation or physical evidence or a threat against the Covered Person’s health and safety as confirmed by documentation and/or physical evidence; 4. Natural Disaster in the area the Covered Person is traveling to and occurring after Their Effective Date; 5. the Covered Person had been deemed kidnapped or a Missing Person by local or international authorities and, when found, his or her safety and/or well- being are in question within seven days of his or her being found.

“Outpatient” means a person who receives Medically Necessary Treatment by a Physician or other healthcare provider and is not an Inpatient, regardless of the hour that the person arrived at the Hospital, whether a bed was used, or whether the person remained in the Hospital past midnight.

“Pandemic” means a global outbreak of a disease.

“Physician/Doctor” means a licensed health care provider acting within the scope of his or her license and rendering care or treatment to a Covered Person that is appropriate for the conditions and locality. It will not include a Covered Person or a member of the Covered Person’s Immediate Family or household.

“Period of Insurance” the period beginning on the Effective Date of this Certificate of Coverage and ending on the earliest of the following dates: (a) the termination date specified in the Declaration; or (b) the termination date as determined in accordance with the termination provision. The Period of Insurance can be no less than five (5) days and no more than twelve (12) consecutive months.

“Political Evacuation” means the extrication of a Covered Person from the Host Country due to an Occurrence which could result in grave physical harm or death to the Covered Person and is certified by a governing authority via declaration or warning.

“Pre-certification; Pre-certify” means a general determination of Medical Necessity only, made by the Company in reliance and based upon the completeness and accuracy of the information provided by the Covered Person and/or the Covered Person’s healthcare or medical service providers, guardians, Relatives and/or proxies at the time thereof. Pre-certification is not an assurance, authorization, pre-authorization or verification of coverage, a verification of benefits, or a guarantee of payment.

“Pre-Existing Condition” means any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the three (3) years prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, Chronic or recurring complications or consequences related thereto or resulting or arising therefrom.

“Pregnancy; Pregnant” means the process of growth and development within a woman’s reproductive organs of a new individual from the time of conception through the phases where the embryo grows and fetus develops to birth.

“Premium” means the payments required to effectuate and maintain both the Covered Person’s insurance coverage and other non-insurance benefits under this plan, in the amounts and at the times established by the Company in its sole discretion from time to time.

“Professional Sports” means a sport activity, including practice, preparation, and actual sporting events, for any individual or organized team that is a member of a recognized professional or semi-professional sports organization; is directly supported or sponsored by a professional or semi-professional team or professional or semi-professional sports organization; is a member of a playing league that is directly supported or sponsored by a professional or semi-professional team or professional or semi-professional sports organization; or has any athlete receiving for their participation any kind of payment or compensation, directly or indirectly, from a professional or semi-professional team or professional or semi- professional sports organization.

“Proof of Claim” means a duly completed and signed claim form, authorization to release medical information, Physician, Hospital, and other healthcare provider’s statement detailing the cost and services rendered and proof of payment for services rendered. Refer to the PROOF OF CLAIM provision for further details.

“Public Health Emergency of International Concern” means a formal declaration by the World Health Organization (WHO) of an extraordinary event which is determined to constitute a public health risk through the international spread of disease, Epidemic, Pandemic and potentially requires a coordinated international response.

“Quarantine” means Your strict isolation imposed by a Government authority or Physician to prevent the spread of disease. An embargo preventing You from entering a country is not a Quarantine.

“Radiology” means specialty services that use medical imaging to diagnose and Treat an Illness or Injury seen within the body. Imaging techniques used in Radiology include x-ray, radiography, ultrasound, computed tomography (CT), nuclear medicine, including positron emission tomography (PET), and magnetic resonance imaging (MRI).

“Registered Nurse” means a graduate nurse who has been registered or licensed to practice by a State Board of Nurse Examiners or other state authority, and who is legally entitled to place the letters "R.N." after their name.

“Related Costs” means food, lodging and, if necessary, physical protection for the Covered Person during the Transport to the Nearest Place of Safety.

“Relative” means a parent, legal guardian, Spouse, son, daughter, Grandchild, or Immediate Family Member of the Covered Person.

“Rider” means any exhibit, schedule, attachment, amendment, endorsement, Rider, or other document attached to, issued in connection with, or otherwise expressly made a part of or applicable to this Certificate of Coverage or the Application, as the case may be.

“Routine Physical Examination” means an examination of the physical body by a Physician for preventative or informative purposes only, and not for the Treatment of any previously manifested, symptomatic, diagnosed or known Sickness or Injury.

“Self-inflicted” means an action or inaction by the Covered Person that the Covered Person consciously understands will or may cause or contribute, directly or indirectly, to their personal Injury or Sickness. Self- inflicted specifically includes failure of a Covered Person to follow their Doctor’s orders, complete prescriptions as directed, or follow any health care protocol or procedures designed to return or maintain their health.

“Sickness” means an illness, disease or condition of the Covered Person that causes a loss for which a Covered Person incurs medical expenses while covered under the Policy. All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness.

“Sound Natural Teeth” means natural teeth which are the following: Free of active or chronic clinical decay; have at least 75% bony support; functional in the arch; not excessively weakened by multiple dental procedures; whole; not restored with amalgams, resin, or composite; without impairment, periodontal, or other conditions; not in need of services other than for accidental dental Injury; intact with a root, pulp, no decay, with no missing tooth structure due to fracture.

“Spouse” Means a Covered Person’s legal Spouse or domestic partner. Such relationship must have met all requirements of a valid marriage contract, domestic partnership, or civil union in the state or Country of Residence where the parties’ ceremony was performed.

“Stacked Insurance” means purchasing the same or like insurance product through the Company, for the same area of coverage, for the same or similar coverage period, and for the same coverage intent to increase a claims payment.

"Stroke” means a loss of blood flow to part of the brain, which causes damages to brain tissue. Types of strokes include but are not limited to Ischemic stroke, Hemorrhagic stroke, and transient ischemic attack (TIA).

“Substance Abuse Disorder” means alcohol, drug or chemical abuse, misuse, illegal use, overuse, or dependency.

“Supplemental Restraint System" means an airbag that inflates upon impact for added protection to the head and chest areas.

“Superbill” means an itemized list of all services provided to the Covered Person by a Physician or medical provider.

“SureGo claim form” means a form which allows the Covered Person to request reimbursement or direct payment for medical services obtained.

“Surgery; Surgical Procedure” means an invasive diagnostic or surgical procedure, or the Treatment of Sickness or Injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia.

"Termination Date" means the date coverage ends. See TERMINATION DATE.

“Terms” means all Terms, provisions, conditions, definitions, Deductibles, Coinsurance, limits, sub-limits, limitations, wordings, restrictions, requirements, qualifications and/or exclusions that bind the Covered Person as set forth in the Certificate of Coverage, Application, and any Riders.

“Terrorism” means criminal acts, including against civilians, committed with the intent to cause death or serious bodily injury, or taking of hostages, with the purpose to provide a state of terror in the general public or in a group of persons or particular persons, intimidate a population, or compel a government or international organization to do or to abstain from doing an act.

“Transport” or “Transportation” means the most efficient and available method of conveyance. Where practical, Economy Fare will be utilized. If possible, the Covered Person’s common carrier tickets will be used.

“Traveling Companion” means a person or persons with whom the Covered Person has coordinated travel arrangements, shares the same accommodations as the Covered Person, and intends to travel with the Covered Person during the Trip.

“Travel Warning Emergency Travel Advisory” means a published statement, warning or advisory, including any website document, issued by the United States Centers for Disease Control & Prevention (CDC), United States Department of State, United States Bureau of Consular Affairs, or similar government or non- governmental agency of the Covered Person’s Country of Residence or Destination Country, warning that travel to Affected Areas poses serious risks to health, safety and security or exposes the Covered Person to a greater likelihood of life-threatening risks, including all United States Department of State Travel Advisories or Warnings Levels “3 - reconsider travel” and “4 -do not travel” and CDC Travel Advisories or Warnings Level “3 – avoid nonessential travel” or any higher level. When multiple government or non- governmental agencies have issued different levels of warnings or advisories, the highest warning or advisory applicable to the Covered Person’s Country of Residence or Destination Country will be considered for coverage under this insurance. For the avoidance of doubt, a Travel Warning covers all specified Affected Areas, including the United States of America as applicable.

“Treated; Treating; Treatment” means any and all services and procedures rendered in the management and/or care of a patient for the purpose of identifying, diagnosing, treating, curing, preventing, controlling and/or combating any Sickness or Injury, including without limitation: verbal or written advice, consultation, examination, discussion, diagnostic testing or evaluation of any kind, pharmacotherapy or other medication, and/or Surgery.

“Treating Physician” means a Physician providing Treatment to a Covered Person.

“Unexpected” means sudden, unintentional, not expected, and unforeseen.

"Unexpected Recurrence Event" means any one incident in which the Covered Person requires care for acute, sudden, and unforeseen Medical and Accidental Emergencies and the direct consequence of the event. Maximum coverage is limited to amounts specified in the Schedule of Benefits.

“Unexpected Recurrence 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 Unexpected Recurrence of a Pre-existing Condition and 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) knew he/she should receive, (iii) had scheduled, or (iv) were told that he/she must or should receive, any medical care, drugs, or Treatment.

“Trip” means travel by air, land, or sea from the Covered Person’s Home Country.

“Uninhabitable” means the Covered Person’s location within the Destination Country is deemed unfit for residence, as determined by the Company and local authorities within the Destination Country, due to lack of habitable shelter, food, heat and/or potable water available within one hundred (100) miles of the disaster site.

“Universal Billing Form” means UB 04 and CMS 1500 forms, which are standard and uniform forms in the healthcare industry to submit insurance claims to health insurance companies for reimbursement.

“Urgent Care Clinic” means a standalone Facility or a Facility located inside a Hospital that staffs Physicians, nurse practitioners (NP) or physician assistants (PA). Urgent Care Clinics provide medical services that are not life-threatening Injuries or Sicknesses. Urgent Care Facilities have onsite x-ray equipment and provide Treatment for more severe urgent care services such as broken bones, burns and other non-emergent conditions that Walk-in Clinics are unable to treat.

“Usual and Customary Charge” means a typical and reasonable amount of reimbursement for similar services, medicines, or supplies within the area in which the Charge is incurred. In determining the typical and reasonable amount of reimbursement, the Company may, in its reasonable discretion, consider one or more of the following factors, without limitation: the amount charged by the provider; the amount charged by similar providers or providers in the same or similar locality; the amount reimbursed by other payors for the same or comparable services, medicines or supplies in the same or similar locality; whether the services or supplies were unbundled or should have been included in the allowance of another service; the amount reimbursed by other payors for the same or comparable services, medicines or supplies in other parts of the country; the cost to the provider of providing the service, medicine or supply; the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or service as compared to the length of time required to perform other similar services; the length of time required to perform the procedure or service as compared to national standards and/or benchmarks; the severity or nature of the Illness or Injury being Treated; and such other factors as the Company, in the reasonable exercise of its discretion, determines are appropriate.

“We,” “Our,” “Us” means Zurich Insurance Europe AG Belgian branch.

“Worsening” means deterioration of a Covered Person’s medical condition, symptoms or diagnosis that may lead to further complications following a Discharge Against Medical Advice or an increased likelihood or need for readmission.

Renewal

OPTIONAL EXTENSION PROCEDURES
An extension notice will be sent to the Covered Person before the Policy Period 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 Policy Period 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 Policy Period does not exceed 364 days in total. There are no grace periods for extension. Once the Policy has lapsed, reapplication is required. Please note, upon application for a new Policy, the Pre-Existing Condition exclusion, Deductible and co-insurance start over.


AUTOMATIC EXTENDED COVERAGE
Coverage will be automatically extended:
1)    If Your scheduled return is delayed due to unavoidable circumstances beyond Your control. This extension of coverage will end on the earlier of the date You reach Your originally scheduled date to return or 5 days after the Termination Date.
2)    If You incur a covered Injury or Sickness on Your Trip and a treating Physician certifies that You are not Medically Fit to Travel to Your Home Country on Your Termination Date, the Medical Evacuation and Repatriation benefit will be automatically extended for 30 days or until You are Medically Fit to Travel and transported to Your Home Country or You reached the Maximum Benefit Amount shown in the Schedule of Benefits, whichever is sooner.
3)    If You are Hospitalized due to a covered Injury or Sickness on Your Termination Date and a treating Physician certifies that You are not Medically Fit to Travel on Your Termination Date, this plan will be extended for an additional 30 days, or until You are released from the Hospital and Medically Fit to Travel, or You reached the Maximum Benefit Amount shown in the Schedule of Benefits, whichever is sooner.

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:

a) If any claims have been filed with Us, the premium is fully earned and is non-refundable.

b) If no claims have been filed with the Company, then
(i) a cancellation fee of US $25 will be charged; and
(ii) only unused days premiums will be considered as refundable; and

c)  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.

CLAIMS ADMINISTRATOR
Surego Administrative Services on Behalf of Crum & Forster
PO Box 2069 Fairhope AL 36533
Click here to Submit Your Claim Online [hyperlink should open to https://www.trawickinternational.com/claim-information/submit-claim]
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.
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 Policy 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 Policy 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 loss 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 Loss: Written (or authorized electronic or telephonic) proof of loss must be sent to the agent authorized to receive it. Written (or authorized electronic or telephonic) proof must be given within 90 days after the date of loss. In no event, except in the absence of legal capacity, will proof of loss be accepted if it sent later than 90 days from the time proof is otherwise required.
Additional information may be requested if it is deemed necessary to complete the processing of any claim. Any additional information deemed necessary for the complete processing of any claim must be received from the insured person or any treating physician, hospital, or other health service provider within ninety (90) days from the date requested, otherwise, the claim will be processed with the information received within this timeframe.

Proof of Eligibility: A claimant must provide Us or Our authorized representative with written proof of eligibility as outlined in this policy, at time of Claim. Proof of Eligibility is required prior to any payment of a Claim.
Claimant Cooperation Provision: Failure of a claimant to cooperate with Us in the administration of a claim may result in the delay or termination of a claim. Such cooperation includes, but is not limited to, providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due.

Time Payment of Claims: Benefits for loss covered by the Policy, 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 loss.
Recovery of Overpayment or Error: If benefits are overpaid, or paid in error, We have the right to recover the amount overpaid, or paid in error, by any or all of the following methods: 1. a request for lump sum payment of the amount overpaid or paid in error. 2. Reduction of any proceeds payable under the Policy by the amount overpaid or paid in error. 3. Taking any other action available to Us. We may at Our own expense take proceedings in the name of the Covered Person to recover compensation or secure an indemnity from any third party in respect of any loss, damage or expense covered by this Insurance and any amount so recovered or secured shall belong to Us.
Assignment: At the request of the Covered Person or his or her parent or guardian, if the Covered Person is a minor, medical benefits may be paid to the provider of service. Any payment made in good faith will end our liability to the extent of the payment.
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.

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.
Legal Actions: No lawsuit or action in equity can be brought to recover on the Policy: 1. before 60 days following the date proof of loss was given to Us; or 2. After 3 years following the date proof of loss is required.
Not in Lieu of Workers’ Compensation: The Policy is not a Workers’ Compensation Policy. It does not provide Workers’ Compensation benefits.

Economic or Trade Sanctions: Any payments under this policy 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 policy. 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 policy 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 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 to receive documents via electronic means as provided below. Electronic document(s) are considered received by you at the time you complete your purchase, unless we receive notice that the email notification was not delivered to you at the email address you provided.

Fraud Warning: If the Covered Person or any person acting on his/her behalf shall make any claim or statement knowing the same to be false or fraudulent as regards to amount or otherwise, then this Insurance shall become void and all claims here under shall be forfeited without refund of premium.