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Benefits

1. Benefit (A) - Medical Expenses.

This Benefit provides indemnity for medical expenses which are deemed necessary by a Physician and which are incurred during the Period of Insurance as a result of the Insured Person becoming ill or suffering an Accident and/or sustaining a bodily Injury as a consequence of an Accident, for which treatment cannot be postponed until, in the opinion of the physician treating the insured person, the return to the Country of Origin and which are not recoverable from any other source, including any Hospital or medical benefit fund.

The following medical expenses will be considered for payment under this Benefit, subject to the benefit limits shown on the Certificate:

• All necessary costs of medical attendance of licensed Physicians and/or surgeons, the medicines and dressing prescribed by them, X-ray examination and similar costs directly connected with the medical treatment.
• All reasonable costs of medical or surgical treatment in the public ward of a Hospital for so long as attendance of treatment in a Hospital is necessary.
• The reasonable costs of an ambulance to transport the Insured Person to the nearest hospital should he be disabled to such an extent that making use of public transport is impractical.

If the Insured Person is hospitalized during the Period of Insurance, the Company will pay in connection with further treatment in a Hospital the costs of the necessary provision of an air ambulance or similar service including the fees of a nurse and/or Physician to accompany the Insured Person on his journey to the Country of Origin, provided that:

• Evacuation cannot take place by other means of transport due to the state of health of the Insured Person;
• Evacuation takes place in order to save the life of the Insured Person or to prevent and/or diminish the expected permanent disablement; and
• The prior approval of Care Management Network is obtained.

An air ambulance is a special chartered plane (private), fully equipped with medical instruments and with professional medical assistance. If the Insured Person refuses such evacuation (Benefit A) this could result in an immediate cancellation of cover.

Maternity Expenses - Apex Plan

This Benefit provides indemnity for maternity expenses which are medically necessary and which are incurred during the Period of Insurance as a result of the Insured Person becoming pregnant during the Period of Insurance (excluding conception within the first 12 months of enrolment in the insurance plan), which cannot be postponed until, in the opinion of the physician treating the insured person, the return to the County of Origin and which are not recoverable from any other source, including any Hospital or medical fund.

Maternity Expenses (Special Exclusion)

• Maternity expenses in the first 12 months after enrolment in the insurance plan;

Dental Treatment as a Result of an Accident

The maximum amount payable outside of the Country of Origin for Emergency dental treatment and restoration of sound natural teeth; required as a result of an accident. Routine dental treatment not covered under this benefit.

This Benefit does not cover treatment necessary as a result of the previous deteriorated state of the teeth, gums or jaw.

Physiotherapy

The amount payable for physiotherapy arising out of an Accident or Sickness, if recommended by a Physician for the medically necessary treatment of a specific disablement, and administered by a licensed professional is as follows:

Outpatient therapy will be limited to a maximum of $250 (Advanced) or $500 (Apex) in total during the Period of Insurance except following surgery when the maximum amount will be $1,000 (Advanced) or $2,000 (Apex).

Mental or Nervous Disorders

The maximum amount payable outside of the Country of Origin for emergency treatment for any mental or nervous disorders the Insured Person suffers during the Period of Insurance is shown in the Schedule of Coverage.

This Benefit does not cover the costs of any treatment necessary in respect of any psychiatric, mental or nervous disorder (including anxiety and/or depression) from which the Insured Person suffered symptoms or sought medical or psychiatric advice prior to departure from the Country of Origin.

Pharmacy Benefit

Only medications which are prescribed by a physician, and which would not be available without such prescription are covered. Certain treatments and medications, such as vitamins, herbs, aspirin, and cold remedies, medicines, experimental or Investigative drugs, or supplies even when recommended by a physician, do not qualify as prescription drugs.

If you choose to purchase a brand-name prescription when a generic equivalent is available, you will have to pay the difference between the cost of the brand-name drug and the generic drug in addition to the regular co-pay. This penalty does not apply to prescriptions filled that your physician has indicated must be dispensed as written.

USA Pharmacy Network

• A preferred pharmacy network is available in the United States. Failure to use a network pharmacy will result in additional co-pays. Please refer to your identification card or access the web at http://www.claimssite.com/studysafe/elecphnw.aspx
• Prescription drugs filled in the U.S. at a non-network pharmacy are subject to a 20% co-payment, in addition to the co-pays applicable to the formulary plan.
• 120 day prescription supply can be dispensed

Co-payments:

Co-payment and quantity limit is determined by Formulary Drug Guide, which can be found in at http://www.claimssite.com/studysafe/elecphnw.aspx).

Exclusions:

This Benefit does not cover:

• Anything listed as an exclusion under the GENERAL EXCLUSIONS section.
• Vaccinations, acupuncture, routine medical treatment and any routine check-ups for pregnancy, cosmetic or plastic surgery (except as the result of an Accident), and elective surgery;
• Treatment which, in the opinion of the Physician treating the Insured Person, can reasonably be delayed until the return to the Country of Origin;
• Any treatment that is experimental, un-proven, or deemed by the medical profession as being alternative or of non standard practice;
• Physiotherapy, unless prescribed by a Physician and as a direct result of an Accident or Sickness;
• In-patient treatment of mental illness, psychiatric or psychological disorders in excess of 30 days during the Period of Insurance. This provision applies during the 12 month period starting from the first day of coverage for the first Period of Insurance (if less than 12 months) during such 12 month period.
• Treatment in a private hospital room;
• Dental treatment involving the provision of dentures or artificial teeth or the use of precious metals, or any dental treatment that is exceeds the minimum treatment required for the sole purpose of relieving pain, or any dental treatment arising out of a pre-existing dental condition/problems or as a result of the previous deteriorated state of teeth, gums or jaw; or
• Optical prescriptions, eye refraction or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereon, unless caused by an Accident and or Sickness occurring during the Period of Insurance.

Emergency coverage absolutely excludes:

• Treatment related to the condition that existed prior to arrival in the United States
• Routine medical treatment
• Treatment that has been planned in advance.

Please read the General Exclusions carefully as they restrict the circumstances in which this Benefit may be payable.

2. Benefit (B) - Accidental Death

This Benefit is payable in the event of the Insured Person's death caused solely and directly by an Accidental Bodily Injury resulting directly and independently of any other cause in death within 12 calendar months of the date of injury. Indemnification of this Benefit is to be paid to Insured Person's beneficiary as soon as the claim is found to be correct.

Death shall not be presumed by reason of disappearance only of the Insured Person.

Death caused as a direct result of exposure, drowning, gassing or poisoning shall be deemed to have been caused by accidental means, unless evidence exists to the contrary.

Exclusions:

The Company is not obligated to indemnify on account of:

Accidental Bodily Injury as a consequence of needless self-exposure to peril, except in an endeavor to save human life;
1. Accidents which arise as a consequence of any disease, physical defect, infirmity or illness of a Insured Person, unless these circumstances are a result of an Accident for which the Company was obligated to pay indemnification under this insurance;
2. psychiatric, mental or nervous disorders, as a result of any cause, unless medically determinable as a direct result of brain damage caused by the Accident;
3. the consequences of medical treatment, which the Insured Person has undergone, without there being any link with an Accident covered under the Certificate making this treatment necessary;
Accidental Bodily Injury arising as a result of participation in a Dangerous Sport;
4. Anything mentioned in the General Exclusions.

3. Benefit (C) - Repatriation Transportation Costs of the Mortal Remains

(In Case of Death by Accident or Sickness Only)

Transportation costs will be the actual costs of taking the mortal remains of the Insured Person to his Country of Origin in case of death during the Period of Insurance, provided that the insurance has been deemed to have been affected in the Country of Origin as shown on the Certificate.

Indemnification of this Benefit will be paid to the beneficiary of the Insured Person.

Benefit (D) - Permanent Disablement

This Benefit is payable in the event of the Insured Person's permanent disablement caused solely and directly by an Accidental Bodily Injury.

An Accident also includes:

• Acute poisoning as a result of the sudden and involuntary exposure to gasses, liquids or solid substances other than poisoning by medicines or exposure to allergens;
• Infection by disease germs or an allergic reaction, if the infection or reaction is a direct result of inadvertently falling into water or into any other substance, or a result of attempting to save a human life;
• Unintentionally and suddenly absorbing substances or objects into the alimentary canal, the bronchia, the eyes or auditory canals, causing internal damage, with the exception of disease germs or allergens;
• Spraining, dislocation and tearing of muscular and ligament tissue, provided that these injuries occurred suddenly and that their nature and location are medically determinable;
• Suffocation, drowning, freezing, sunstroke, heat-seizure;
• Exhaustion, starvation, dehydration and sunburn as a result of unforeseen circumstances;
• Wound infection or blood-poisoning as a result of exposure to disease germs as a result of a bodily Injury caused by a covered Accident;
• Complications or worsening of an Accidental Bodily Injury as a direct result of first aid or necessary medical treatment as a result of an Accident.

Right to Benefit as a result of permanent disablement

In case of the Insured Person's permanent disablement as a direct and exclusive result of an Accident, the Benefit is determined as a percentage of the Benefit for Total Permanent Disablement.

If the Covered Person dies before determination of the permanent disablement, and the death is not a result of the Accident, then the right to the benefit remains.

The Benefit is determined based on the expected definite degree of disablement based on the medical reports, if the Insured Person has not died.

Term for Determination of Total Permanent Disablement

Permanent and total disability - resulting from Accidental Bodily Injury - which, having lasted for a period of at least twelve consecutive months from the date of occurrence will, in the opinion of the Company's medical advisor, entirely prevent the Insured Person from engaging in, or giving any attention to, any and every business or occupation for the remainder of his life.

Determination of the Benefit in case of permanent disablement(Continental Scale)

A. Determination of the Indemnity Percentage: Sum Insured = US$15,000

From the percentage (functional) Loss, as determined by the Physician, an indemnity percentage of the Sum Insured is determined for permanent disablement, according to the following Continental Scale: For Total Permanent Disablement 100%

For permanent (functional) Loss of:

Visual power of both eyes	100%
Visual power of one eye	30%
Visual power of one eye if the Company previously paid a Benefit for The Loss of visual power of the other eye	70%
Auditory power of both ears	60%
Auditory power of one ear	25%
Auditory power of one ear if the Company previously paid a Benefit for the Loss of auditory power of the other ear	35%
An arm	65%
A forearm	60%
A hand	55%
A thumb	25%
An index finger	15%
A middle finger	10%
A ring finger	5%
A little finger	5%
A leg	60%
A lower limb at or below knee level	55%
A foot	40%
A big toe or another toe	3%
Spleen	5%
The sense of taste and/or the sense of smell	6%

Determination of the degree of permanent disablement

B. Manner of Determining the Permanent Disablement:

Continental Scale Provisos:

• Where permanent disability of a nature other than those defined above occurs then the Benefit will be a percentage which, in the opinion of the Company's medical advisor, equates to the degree of disability relative to the above scale without reference to any occupation.
• The total aggregation of Benefit payable shall not exceed 100% of the Sum Insured for each Insured Person as the result of any one Accident.
• If Benefit is payable for the Loss of, or loss of use of, a whole member of the body then Benefits for parts of that member cannot also be claimed.
• If there is a total (functional) loss of one or more fingers, then the aggregate Benefit cannot exceed that for the total loss of the whole hand.
• Any existing disability will be taken into account in assessing Benefits payable in respect of any subsequent Accidental Bodily Injury.
• Un-raised scarring shall be compensated to the extent of half the amount payable for prominently raised scarring.
• Complete immobility of a finger or toe (other than thumb and big toe) shall be compensated to the extent of half the amount specified for total Loss.

C. Accumulation Benefits:

In the event of one or more Accidents affecting the Insured Person during the Period of Insurance, the total sum of all Benefits payable will not exceed 100% of the Sum Insured.

Influence of existing disablement or sickness

• If the consequences of an Accident have been increased due to the Insured Person's Sickness, disease, physical defect or infirmity, for determination of the Benefit, the consequences of the Accident will be taken into account which would have occurred had the Insured Person been able-bodied and healthy. However, this limitation does not apply if the existing Sickness, disease, physical defect or infirmity of the Insured Person is a consequence of an earlier Accident, for which the Company has already paid, or will pay, a Benefit under the Policy.
• Insofar an existing medical condition has been aggravated by an Accident, no Benefit will be paid by the Company.
• If a (functional) Loss of a part of the body already existed before an Accident, then the Benefit for permanent disablement will be reduced proportionally.

Exclusions:

The Company is not obligated to indemnify on account of:

Accidental Bodily Injury as a consequence of needless self-exposure to peril, except in an endeavor to save human life;
1. Accidents which arise as a consequence of any disease, physical defect, infirmity or illness of a Insured Person, unless these circumstances are a result of an Accident for which the Company was obligated to pay indemnification under this insurance;
2. psychiatric, mental or nervous disorders, as a result of any cause, unless medically determinable as a direct result of brain damage caused by the Accident;
3. the consequences of medical treatment, which the Insured Person has undergone, without there being any link with an Accident covered under the Certificate making this treatment necessary;
Accidental Bodily Injury arising as a result of participation in a Dangerous Sport; Accidental Bodily Injury arising as a result of participation in a Hazardous Sport;
4. Anything mentioned in the General Exclusions.

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