Summary Schedule of Benefits

US NetCare Health Plans and Benefits
Plan	Coverage	Apex 90002AP	Advanced 90003AV	Essential 90004ES
Benefit A1	Medical Expenses - Lifetime Maximum	$1,000,000	$500,000	$100,000
	Medical Expenses - Annual Maximum	$250,000	$250,000	$100,000
	Medical Evacuation, including Air Ambulance	$50,000	$20,000	$20,000
	Outpatient Treatment	Covered	Covered	Not Covered
	Deductible - Per Medical Event Claim ¹	$25	$50	$100
	Coverage in Network (PPO) / Out of Network²	90% / 70%	80% / 60%	80% / 60%
	Pre-existing Conditions	After 12 months Waiting Period	After 12 months Waiting Period	Not Covered
	Maternity Expenses	Up to $50,000 After 12 Months Waiting Period	Not Covered	Not Covered
	Dental Treatment as the result of an accident	$200	$150	$150
	Physiotherapy following Accident or insured sickness - Annual Maximum	$2,000	$1,000	$1,000
	Outpatient mental or nervous disorders - Annual Maximum; Co-Payments apply	$500	$250	Not Covered
	Mental or nervous disorders inpatient treatment (max. 30 days) - Annual Maximum	50% of eligible expenses with a maximum of: $1,000	50% of eligible expenses with a maximum of: $1,000	50% of eligible expenses with a maximum of: $1,000
	Pharmacy Benefit (medicine prescribed on outpatient basis) - Annual maximum; Co-pays apply	$1,500	$1,000	Not Covered
Benefit B	Accidental Death	$25,000	$15,000	$10,000
Benefit C	Repatriation - Transportation cost in case of death	$50,000	$20,000	$15,000
Benefit D	Permanent disablement as per sliding scale with a maximum of:	$15,000	$15,000	$10,000
		Buy Now	Buy Now	Buy Now
¹A per medical event deductible applies to these Benefits. In addition co-insurance applies, with the percentage applied depending on whether the Network Provider Organization (PPO) has been used or whether treatment has been received from an Out of Network organization. Once this amount is satisfied, payments will commence as outlined above. ² After $20,000 covered expenses 100% coverage in PPO. Amounts covered for Benefits other than Accidental Death are the maximum amounts paid while coverage is in force for the Insured Person. Expenses incurred during a hospital emergency room visit will not be covered if the visit is not deemed to be of an emergency nature. All Benefits subject to usual, reasonable and customary allowances.