Being a citizen of the global community can be an exciting experience, yet one that can pose potential complications. Your health care while abroad should not be one of those concerns. Global Medical Insurance is a revolutionary program from International Medical Group^® (IMG^®) that offers the flexible worldwide coverage you need, backed by the world-class services you expect. Unlike other health care programs on the market, Global Medical Insurance allows you to custom build a plan that is specifically tailored for you. With this booklet, you can easily create the blueprint for your own benefits package. You can conveniently compare the benefits of several plan options, and learn about the unique services and the dynamic company that provides them. Choosing and applying for the best coverage available is easy.

Global Medical Insurance is designed to meet your total needs. The program offers you the flexibility to select from an assortment of unique benefit options. From the scheduled benefits of the Silver plan option to the benefit-rich Platinum plan option, there are a large variety of specialized coverages to meet any need. To accommodate your financial means, you can customize your length and area of coverage with the flexibility to select from multiple deductibles and modes of payment. With your medical history in mind, the program also provides flexible underwriting methods to extend coverage to you that may be declined by other companies.

Additionally, the program provides world-class services. To maximize the outcome of your medical care, our on-site clinical staff is ready to assist you at a moment's notice, and our extensive global provider networks are quickly and easily accessible. You also have direct access to our Medical Concierge, an unequalled service that provides you with personalized assistance in locating the best provider for your specific needs, while saving you on out-of-pocket and medical expenses. You can also efficiently save time managing routine areas of your account by utilizing our secure, online service tools.

You need to know that you have the proper worldwide coverage. When you select Global Medical Insurance, you receive IMG's commitment to deliver exceptional health benefits, medical assistance and service - all designed to give you Global Peace of Mind^®.


For more than 20 years, IMG has dedicated its efforts to providing international medical insurance, travel insurance and world-class services to the international community. It's our specialty. We understand the intricacies of international health care. Our team of quality assured professionals is committed to helping you solve any problems, while making sure you receive superior service.

Many companies claim to offer great service. At IMG, we have set a higher industry standard by integrating independent credentialing services with in-house, fully owned and operated service divisions. These accreditations promote continuous improvement in quality and efficiency while ensuring ongoing compliance. This allows us to deliver the world-class service you deserve. We've served over a million people worldwide in more than 170 countries and we're with you, wherever you go - bringing support for all your insurance needs.

International Service Centers - To ensure that we are available when and where needed, we maintain multiple international service and assistance centers. From our offices, we provide administrative support and marketing services to our international producers, and claims administration and emergency medical assistance to those living and traveling worldwide. Our offices offer the benefit of multiple time zones and services in tune with local practices.

Single Resource - All IMG service centers are designed to have the necessary services, staff and capabilities to provide international service to you, regardless of your location. Every department and service division is integrated on the same proprietary system and in real-time. One call. One company. We are your single international resource.

International Provider Access^SM (IPA) - In addition to our extensive PPO network available for treatment received within the U.S., our proprietary IPA network of over 17,000 accomplished physicians and facilities allows you to access quality care worldwide. Our direct billing arrangements can also ease the time and up front expense at select providers.

International Emergency Care - When you're overseas and a medical emergency occurs, you may not be able to wait for regular business hours. With our onsite physician and registered nurses, you have 24 hour access to highly qualified coordinators of emergency medical services and international treatment.

Accessible Technology - Through technology we make it easy for you to reach us and vice versa. We provide you with a secure member Web site to quickly and easily access real-time information, view the status of your claims and manage your accounts.

Financial Stability - Our globally recognized underwriter, Sirius International Insurance Corporation (publ), offers the financial security and reputation demanded by international consumers. Rated A (excellent) by A.M. Best and A- by Standard & Poor's*, Sirius International shares our vision of the international marketplace and offers the stability of a well-established insurance company.

*Sources: A.M. Best affirmed their rating in a press release dated October 7, 2011; Standard & Poor's affirmed their rating in a press release dated September 13, 2011.


Global Medical Insurance is versatile and tailored for you so you can easily design the benefits package that you need. The program provides comprehensive benefits suitable for individuals and families, fully portable 24 hour coverage and the peace of mind you need. On the following pages, you can build your plan by reviewing and choosing from the coverage options and services available. More detailed benefit and service descriptions are provided as an insert in the pocket in the back of this booklet. Please refer to the Supplemental Brochure Inserts while reviewing the information herein.


Silver plan option - Affordable medical security designed for the more budget-conscious consumer and those planning to receive care in lower cost areas of the world. Silver offers a wide range of scheduled benefits equipped to meet your essential needs.

Gold plan option - Ideally suited for those who desire full major medical coverage, but for a limited period of time. Gold provides comprehensive benefits for the first three years of coverage. After three years, certain benefits and lifetime maximums are reduced (see Summary Schedule of Benefits below). As a result, Gold is priced more competitively than the Gold Plus option.

Gold Plus plan option - Comprehensive major medical plan designed for people who need longterm coverage. Benefit levels continue beyond year three as long as the plan remains in effect.

Platinum plan option - Provides the superior benefits package for the most discerning global consumer. Platinum offers a package of enhanced benefits and services. It is designed for the consumer who wants the convenience of comprehensive medical, dental, and vision benefits in one plan.

Optional Riders - All plan options offer additional, optional coverages (see below for more information).

• Global Term Life Insurance^SM (including AD&D)
• Global Daily Indemnity^SM
• Maternity (Silver, Gold & Gold Plus plan options)
• Terrorism (Platinum plan option)
• Sports (Platinum plan option)

Two coverage areas: Worldwide or Worldwide Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan - You have the opportunity to select the coverage area that best reflects your geographic area of need. Each provides full coverage, but premiums reflect the cost of care in different parts of the world. Regardless of the coverage area you choose, you maintain the freedom to choose your own provider.

Multiple deductible options - To accommodate your financial resources, you can select from seven different deductible options - all providing different premium levels. Additionally, your deductible can be reduced up to 50% to a $2,500 maximum (see the Summary Schedule of Benefits below for more about this savings).

• $100* (Platinum plan option)
• $250
• $500
• $1,000
• $2,500
• $5,000
• $10,000

No additional cost for children - No matter the plan option or coverage area you choose, for families the first two children between 14 days and 9 years are covered at no additional cost for the first year (see below for further details). This is a valuable savings for any budget.

Four premium modes - Schedule the frequency of payment that meets your means.

• Annual
• Semi-annual
• Quarterly
• Monthly

We have earned our reputation for excellence in the international community by maintaining the ability to be flexible and respond to our clients' needs. Understanding that everyone has a unique medical background, with Global Medical Insurance we have developed multiple ways to administer coverage to you - including situations where you may have been declined by other companies.

Your application will be reviewed based on the full disclosure of your medical history that you provide.

Standard underwriting - Standard underwriting provides the full pre-existing conditions benefit as outlined below.

Exclusionary rider(s) - With an exclusionary rider, we are able to extend coverage for your medical needs, with the exception of the specific excluded condition named in the rider. This allows standard pre-existing condition benefits for non-ridered conditions that may otherwise have been declined.

Flexible underwriting rider - The flexible underwriting rider will allow us to extend coverage to you even if you have significant, ongoing and/or chronic pre-existing conditions. For a nominal annual administration fee, coverage is extended for a preexisting condition following 24 months of continuous coverage, during which you are symptom, advice or treatment free for that particular condition.

For further underwriting information, please see below
* For convenience, all amounts listed in this booklet are in U.S. dollars.


From routine care to complex case management to emergency medical situations, you're never far from IMG's support services. Global Medical Insurance not only provides flexible coverage, it also provides you with prompt access to the invaluable international services and IMG resources - regardless of your location. For a further description of services, please see below/.


Freedom to choose your provider - Global Medical Insurance allows you the freedom to choose your own health care provider no matter where you are in the world. With open access to health care providers, you have improved access to quality care.

Locating a provider - For your convenience and to help you reduce your out-of-pocket expenses, we provide you access to two extensive provider networks that include established, globally credentialed physicians and hospitals.

• The independent Preferred Provider Organization (PPO) - when seeking care within the U.S.
• The International Provider Access (IPA) - when seeking care outside the U.S.

Emergency Medical Treatment - The ability to access quality health care is of paramount importance when a life-threatening medical emergency arises abroad. Global Medical Insurance provides you with important emergency benefits backed by the services of an accredited 24/7/365 clinical staff with over 250 years of combined experience.

• Emergency Medical Evacuation benefit
• Return of Mortal Remains benefit
• Remote Transportation benefit (Platinum plan option)
• Political Evacuation benefit (Platinum plan option)

Unique medical service - Whether you are seeking care in a local facility or in a location you are not familiar with, the quality of the care you are receiving is a primary concern. Our Medical Concierge program is designed to provide you critical information on provider ratings, treatment outcome and cost of care prior to receiving medical treatment. Your personal Medical Concierge will review your specific non-emergency medical condition and provide you with complete information on provider ratings, past outcomes and general costs - all in the area where you are planning treatment.

IMG's Medical Concierge helps you make an informed decision when seeking medical care within the U.S. Also, you can receive a reduction in your deductible for utilizing this unique medical service. This level of individualized service is unmatched in the international arena. Please note due to the high level of data required for this service, Medical Concierge service is restricted to facilities within the U.S.


Medical professionals to coordinate your care - In the event you need medical care, our on-site clinical staff coordinates with the medical provider and treating facility to respond to the unique needs and circumstances you may face. Having provided services in more than 170 countries, we are experts at assessing the need for services and ensuring they are delivered in a timely, cost-effective manner.

This individualized approach gives you peace of mind knowing that you have experienced, knowledgeable professionals ready to help at a moment's notice, anywhere around the globe.


International service assistance - IMG's international services are designed to help you maximize the outcome of your medical care.

• Access to quality health care worldwide
• Professionally trained multilingual claims administrators and service professionals with proven international experience
• Professionally trained multilingual claims administrators and service professionals with proven international experience
• Experienced international currency conversion
• Claim settlement directly to providers or to you via check or direct deposit
• Verification of benefits and explanation of benefits to providers

24/7/365 access to information - To help you save time managing routine areas of your account, we make it easy for you to get the information you need.

• MyIMG^SM - secure member Web site
• Online renewals
• Easy online U.S. and international provider searches
• Retrieve explanation of benefits
• Check the status of claims - real time information available
• Update address information & request ID cards
• Change your mode of payment
• Multiple international service and assistance centers

The following is a summary schedule of benefits. Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness).

Benefit	Silver	Gold (1st 36 months of continuous coverage)	Gold (Beginning the 1st day of the 37th month)	Gold Plus	Platinum (See below for Platinum Advantages)
Lifetime Maximum Limit	$5,000,000 per individual	$5,000,000 per individual	$5,000,000 per individual	$5,000,000 per individual	$8,000,000 per individual
Deductible (Per Period of Coverage)	$250 to $10,000	$250 to $10,000	$250 to $10,000	$250 to $10,000	$100 to $10,000
Family Deductible	3 times the individual deductible	3 times the individual deductible	3 times the individual deductible	3 times the individual deductible	2 times the individual deductible
Treatment outside the U.S. and Canada	Subject to deductible No coinsurance	Subject to deductible No coinsurance	Subject to deductible No coinsurance	Subject to deductible No coinsurance	Subject to deductible No coinsurance
Treatment inside the U.S. (Out-patient/In-patient Emergency)	PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance.	PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance	PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance.	PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance.	PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance.
Treatment inside the U.S. (In-patient Non-emergency)	Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance.	Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance.	Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance.	Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance.	Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance.
Treatment inside the U.S.- Non-PPO Network and Canada	Subject to deductible Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage	Subject to deductible Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage	Subject to deductible Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage	Subject to deductible Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage	Subject to deductible Plan pays 90% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage
Hospitalization/Room & Board	In U.S./Canada - URC of average semiprivate room rate. Outside of U.S./ Canada - URC of private room rate (not to exceed 150% of semi-private room rate) All subject to $600 per day - 240 day max.	In U.S./Canada - URC of average semiprivate room rate. Outside of U.S./ Canada - URC of private room rate (not to exceed 150% of semi-private room rate)	Up to a limit of $2,250 per day - semi-private room rate	In U.S./Canada - URC of average semiprivate room rate. Outside of U.S./ Canada - URC of private room rate (not to exceed 150% of semi-private room rate)	Private room rate
Intensive Care Unit	$1,500 per day - 180 day per event	URC	Up to a limit of $4,500 per day	URC	URC
Surgery	URC	URC	URC	URC	URC
Anesthetist's Charges Associated with Surgery	20% of surgery benefit	URC	20% of surgery benefit	URC	URC
Transplants	$250,000 per transplant	$1,000,000 lifetime maximum	$500,000 lifetime maximum	$1,000,000 lifetime maximum	$2,000,000 lifetime maximum
Out-patient	25 visits: $70 doctor/specialist; $60 psychiatrist; $50 chiropractor; $250 X-ray per exam maximum limit; $500 surgery intervention consultation; $300 lab tests per exam maximum limit	URC	Physician Charges - limit of $150 per visit; Hospital Charge - $100 co-pay unless admitted; Urgent Care Facility - $25 copay; Diagnostic Lab and X-Rays limited to $5,000 per certificate period	URC	URC
Emergency Room Illness (Additional $250 deductible if not admitted)	URC	URC	URC	URC	URC
Emergency Room Accident	URC	URC	URC	URC	URC
Supplemental Accident	NA	$300 per occurrence	$300 per occurrence	$300 per occurrence	$500 per occurrence
Local Ambulance	$1,500 per event - not subject to deductible or coinsurance	URC	$100 per event - not subject to deductible or coinsurance	URC	URC
Mental/Nervous	Out-patient only after 12 months of continuous coverage	$10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage	$2,500 maximum per certificate period; In-patient limited to 25 days per certificate period; Out-patient limited to max of 20 visits per certificate period at 70% eligible expenses, up to $75 maximum per visit; Lifetime maximum of $30,000	$10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage	SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage
Emergency Evacuation	$50,000 per period of coverage - not subject to deductible or coinsurance	Up to maximum limit - not subject to deductible or coinsurance	$250,000 limit per person per certificate period	Up to maximum limit - not subject to deductible or coinsurance	Up to maximum limit - not subject to deductible or coinsurance
Emergency Reunion	NA	$10,000 lifetime maximum	$10,000 lifetime maximum	$10,000 lifetime maximum	$10,000 lifetime maximum
Return of Mortal Remains	$25,000 lifetime maximum per insured - not subject to deductible or coinsurance	$25,000 lifetime maximum per insured - not subject to deductible or coinsurance	$15,000 lifetime maximum per insured - not subject to deductible or coinsurance	$25,000 lifetime maximum per insured - not subject to deductible or coinsurance	$50,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation	NA	NA	NA	NA	Limited to $5,000 per certificate period up to $20,000 lifetime maximum
Political Evacuation and Repatriation	NA	NA	NA	NA	Limited to $10,000 lifetime maximum
Child Wellness (Under 18 years of age)	3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage	$200 maximum per period of coverage - not subject to deductible or coinsurance. Available after 12 months of continuous coverage	$200 maximum per period of coverage - not subject to deductible or coinsurance. Available after 12 months of continuous coverage	$200 maximum per period of coverage - not subject to deductible or coinsurance. Available after 12 months of continuous coverage	$400 maximum per period of coverage - not subject to deductible or coinsurance. Available after 6 months of continuous coverage
Adult Wellness	NA	$250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage	$250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage	$250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage	$500 per period of coverage - not subject to deductible or coinsurance - Available for those 18 years of age and over after 6 months of continuous coverage
Rx Coverage	URC	URC	$5,000 per certificate period for each insured person, out-patient only	URC	Outside U.S. - URC. Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available (Certain monthly per prescription amount limits may apply and require pre-approval by the Company.)
Other Services	Extended care: first 30 days; Radiation: URC; Home nursing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all URC	URC	URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum	URC	URC
Physical Therapy	Maximum $40 per visit - 30 visit maximum	Maximum $50 per visit	Maximum $50 per visit - $1,000 max per certificate period. $10,000 lifetime maximum	Maximum $50 per visit	Maximum $50 per visit
Complementary Medicine	NA	Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage	Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage	Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage	Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage
Recreational Scuba	NA	URC	URC	URC	URC
Non-emergency Dental	NA	NA	NA	NA	Calendar year maximum: $750; Individual deductible - $50 Schedule of Benefits - Class I 90%; Class II 70%; Class III 50%; 6 month waiting period
Emergency Dental due to Accident	$1,000 per period of coverage	URC	$500 per period of coverage	URC	URC
Emergency Dental due to Sudden Unexpected Pain	NA	$100 per period of coverage	$100 per period of coverage	$100 per period of coverage	See Non-emergency Dental benefits
High School Sports Injury	NA	NA	NA	NA	Up to $20,000 per certificate period
Vision	NA	NA	NA	NA	Exams - up to $100 Materials - up to $150 per 24 months
Maternity Delivery, wellness, new born care & congenital disorders, Family Matters Maternity Program (*not subject to deductible or coinsurance - available after 10 months of coverage)	Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage)	Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage)	Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage)	Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage)	SAAI - $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days

The Platinum plan option is the complete international protection plan. It offers enhanced and additional benefits, access to a dedicated service team ready to assist you, and access to our exclusive Global Concierge and Assistance ServicesSM. For a further description of Platinum benefits and services, please refer to the Supplemental Brochure Insert included in the back of this booklet.

Comprehensive Major Medical Plan - The Platinum plan option offers higher benefit maximums and additional coverages - Lifetime Maximum of $8,000,000, Transplants up to $2,000,000, as well as increased benefits for Hospital Room & Board, Return of Mortal Remains, Supplemental Accident, Mental & Nervous and Adult & Child Wellness. The plan also includes benefits for Remote Transportation, Political Evacuation & Repatriation and High School Sports Injuries.

One Plan with Medical, Dental and Vision Benefits - In addition to the medical benefits, the Platinum plan option includes a dental plan with coverage for Class I Diagnostic & Preventive Services, Class II Basic Services and Class III Major Services. It also includes a vision benefit that provides coverage for exams and materials.

Remote Transportation Benefit - If you experience a medical problem that is not immediately lifethreatening, but severe enough to result in death or permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising out of the transportation for you to a qualified facility for further treatment.

Political Evacuation and Repatriation Benefit - In the event the U.S. Department of State issues an evacuation order of the host country, IMG will coordinate the evacuation of any covered insured(s) to the nearest place of safety or repatriation to the insured's home country of residence.

Mental & Nervous and Maternity Coverage - Expenses associated with these conditions are covered the same as any illness.

High School Sports Injury Benefit - Protection is available for your children while participating in sanctioned, organized sports at the high school level or below.

Consultation for care and advice - The Platinum plan option offers you direct access to a medical information service which allows you to communicate with licensed physicians, psychologists, pharmacists, dentists, dieticians and fitness trainers. They are available to assist you with routine health related questions 24 hours a day.

Global Concierge and Assistance Services - The Platinum plan option provides you with more than insurance protection - you also have exclusive access to a list of additional services handled by a dedicated service team available 24/7.


Global Medical Insurance is designed to protect individuals and families from the high cost of medical expenses. In addition to tailored benefits packages, the program offers several optional coverages. You may review and choose any from the following list that meet your needs. To apply, simply add in the appropriate premiums, as outlined in the application, into the calculation for the total premium due.

Rider	Description
Global Term Life Insurance (Amounts shown are the Principle Sums per unit)	Age 31 days - 18 years: $5,000 Age 50 - 54 years: $20,000 Age 19 - 29 years: $75,000 Age 55 - 59 years: $15,000 Age 30 - 39 years: $50,000 Age 60 - 64 years: $10,000 Age 40 - 44 years: $35,000 Age 65 - 69 years: $7,500 Age 45 - 49 years: $25,000
Accidental Death & Dismemberment (AD&D) - included with Global Term Life Insurance (* Benefit based on age at time of death; ** "Member" means hand, foot or eye)	Accidental Loss of Life: Principle Sum* Accidental Total Loss of 2 Members**: Principle Sum* Accidental Total Loss of 1 Member**: 50% of Principle Sum*
Global Daily Indemnity (Amount shown is the Principle Sum per unit. Available between age 31 days - 69 years up to two units)	$100 per day
Maternity (Silver, Gold, Gold Plus plan options)	$50,000 lifetime maximum, $5,000 maximum for normal delivery, $7,500 for C-section (Newborn covered for first 31 days only without additional premium. Refer to page 6 for more information)
Terrorism (Platinum plan option)	$50,000 lifetime maximum
Sports (Platinum plan option)	$25,000 lifetime coverage for some adventure sports including mountaineering, parachuting, and whitewater rafting (Refer to Certificate Wording for a comprehensive list)

Global Medical Insurance provides flexible underwriting methods so your application may be underwritten by Standard Underwriting or the Flexible Underwriting Rider.

Standard Underwriting - There are two levels of underwriting when all medical conditions have been disclosed and they have not been specifically excluded or restricted by a rider (subject to the foregoing limits and the other terms of the plan¹).

The Silver, Gold and Gold Plus plan options provide a $50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of $5,000 per period of coverage after coverage has been in effect for 24 continuous months. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period of continuous coverage.

The following illnesses which exist, manifest themselves, or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered preexisting conditions and are subject to the waiting period and other limitations of coverage described above: acne, asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall bladder or gall stones and kidney stones, any condition of the breast, and any condition of the prostate.

On the Platinum plan option, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are not fully disclosed on the application will not be covered.

Flexible Underwriting Rider - Where you may have otherwise been declined for coverage, the Flexible Underwriting Rider allows us to extend coverage to you. After 24 months of continuous coverage, a disclosed pre-existing condition which has not been specifically excluded by a rider will be covered the same as any other pre-existing condition, so long as in that 24 month period no treatment has been received for that condition. If treatment has been sought or should have been sought, then the 24 month period starts over from the treatment date.

• Adult routine physical examinations are excluded under the Silver plan option, and for the first 12 months for the Gold and Gold Plus plan option, and for the first 6 months for the Platinum plan option
• Out-patient mental and nervous is excluded for the first 12 months on all plan options
• In-patient mental and nervous is excluded under the Silver plan option and for the first 12 months for the Gold, Gold Plus and Platinum plan options
• Maternity, newborn and congenital disorders (unless the maternity rider or Platinum plan option is purchased - see the Summary Schedule of Benefits above) Note: all Maternity expenses including prenatal, delivery, postnatal, newborn and congenital disorders are excluded when the pregnancy is a result of fertility treatment even if you have Maternity coverage
• Organ transplants not specifically listed
• Devices to correct sight are excluded under the Silver, Gold and Gold Plus plan options
• Devices to correct hearing
• Treatment or supplies not medically necessary
• Treatment not ordered or received by a physician
• Treatment by a relative or family member
• Treatment as a result of war, riot or terrorism
• Treatment resulting from illegal activities
• Organized amateur or professional sports
• Services and treatment eligible for payment by any government or other insurance
• Investigational, experimental or research procedures
• Routine foot care
• Elective cosmetic or plastic surgery
• Drug and alcohol abuse treatment
• Speech therapy
• Custodial care
• Weight modification
• Treatment of impotency
• Contraceptive medication or treatment
• Persons HIV+ at effective date

¹This brochure contains only a consolidated and summary description of some of the current Global Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance program in the event this application and/or brochure/booklet has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

*Pre-existing Condition: Any Illness, Injury or Mental or Nervous Disorder that, with reasonable medical certainty, existed on or at any time prior to the Initial Effective Date of this insurance, whether or not previously manifested or symptomatic, diagnosed, treated or disclosed on the Application or on any Claim Form or otherwise, including any chronic, subsequent or recurring complications or consequences associated therewith or arising or resulting therefrom. For examples of how the pre-existing condition provision applies, please see Appendix A.


Eligibility
Global Medical Insurance is available to individuals and families of all nationalities. U.S. citizens must reside abroad or plan to leave the U.S. on their effective date and plan to reside abroad for at least six of the next 12 months. Coverage for non-U.S. citizens is worldwide, although certain eligibility restrictions may apply. Persons from the ages of 14 days to 74 years old may apply for coverage. Persons 75 years of age and older are not eligible and coverage ends at age 75. Certain other restrictions may also apply. Please ask your independent insurance agent or broker for further details.

For families, when both parents are covered under Global Medical Insurance, the first two eligible dependent children from the ages of 14 days to 9 years are covered at no additional cost*. Children under the age of 19 applying individually should use the male 19-24 age bracket when applying for coverage. Each person requesting coverage must complete the information required in the application.

Renewal of Coverage
Subject to the terms of the plan, Global Medical Insurance is annually renewable and coverage is continuous when renewed. Prior to the end of each period of coverage (12 months) you will receive renewal information. You must continue to meet the eligibility requirements outlined above in order to renew. You have the option to renew online or you may complete a paper renewal form. There are no additional medical questions at renewal, and we can work with you to provide flexible renewal options. Please select your deductible and plan option carefully, as you will be unable to select a lower deductible or increase your plan option when you renew your coverage.

Lifetime Coverage
Lifetime medical coverage is available if you are enrolled in the Global Medical Insurance program by your 65th birthday and maintain continuous coverage to age 75. Prior to your 75th birthday you will receive a summary of benefits for a new plan, Global Senior Plan^®, and an enrollment form for coverage. There is no additional medical underwriting. You simply need to review the benefits, and complete and return the enrollment form with your premium.

How to Apply
To apply for Global Medical Insurance, you can either Online or complete a paper application . If you are applying as a family, you may include yourself, your spouse and dependents on one application. If you are 19 years of age or older, you must complete your own application. You must accurately complete all questions outlined in the application in order to be considered for coverage. An attending physician statement may be required depending upon your answers to the medical questions, and IMG reserves the right to request additional medical information.

When we receive your completed application with premium, IMG will process it as quickly as possible. Once accepted, you will be mailed a fulfillment kit which includes an identification card, declaration of insurance and a Certificate of Insurance (containing a complete description of benefits, exclusions and terms of the plan), claim filing information, and claim forms. You are required to notify IMG, as required by the terms of the plan, if you or any family member suffers from or is treated for any illness, injury or other medical condition between the time of your application and the issuance of the certificate. If your application is not accepted, you will receive a full refund of premium.

Once you are accepted in the plan, IMG is confident that you will be pleased with the full terms of coverage. To ensure your satisfaction, IMG provides a 15 day period to review the fulfillment kit contents. If, during that 15 day period, you find that you are not happy with the plan for any reason, you may submit a written request for cancellation and full refund of your premium. See the Certificate of Insurance for full details.

Cancellation requests received after this 15 day period will be granted at the sole discretion of IMG as the plan administrator. Any refund you may receive will be based on an established refund schedule, not a pro-rated basis. See the Certificate of Insurance for full details.

* For families, the first two eligible dependent children from the ages of 14 days to 9 years are covered at no additional cost for the first year of coverage. On the first renewal date, premium will be 50% of the published rate. For subsequent renewals, the regular renewal premium will apply.


The following is a partial list of benefits and terms. For further comparison of benefit levels, please reference above. Please refer to the Certificate Wording for specific terms, conditions and other details regarding the benefits. All amounts listed are in U.S. dollars.

Silver, Gold, Gold Plus & Platinum plan options
The following benefits are offered on all four plan options.

Hospitalization - Offers benefits for the following: room and board • nursing services • prescription medication • physician charges • diagnostic and laboratory testing • X-rays, chemotherapy and radiation • durable medical equipment • treatment, services and supplies routinely provided.

Surgery - Offers benefits for the following: surgical care • second surgical opinion • physician charges for surgery • treatment, in-patient and outpatient services and supplies routinely provided.

Transplants - The plan options will reimburse an insured person with respect to a covered transplant incurred up to the benefit limit for each plan option. These are limited to certain transplants and covered only within designated transplant facilities that are members of the independently contracted PPO network.

Out-patient - Medically necessary treatment by a physician or other health care provider that does not require an overnight stay.

Emergency Room Illness - Services received in the emergency room are covered up to the maximum limit. Emergency room charges that do not require admittance to the hospital will be subject to an additional $250 deductible.

Emergency Room Accident - Charges incurred for the use of the emergency room are covered up to the maximum limit.

Child Wellness - Routine physical exams, inoculations, vaccinations, and other related well child care for eligible children.

Emergency Medical Evacuation - This coverage is available when there is not a qualified facility in the immediate area to treat your life-threatening illness or injury. See the Description of Services insert for additional information.

Return of Mortal Remains - Covers expenses for repatriation of bodily remains or ashes to the insured person's home country for death resulting from a covered injury or illness.

Maternity - Coverage for pre- and postnatal care, normal delivery or C-section for each pregnancy, well baby care, treatment of newborn and congenital disorders for the first 31 days.
Coverage may be purchased as a rider at the time of initial application under the Silver, Gold and Gold Plus plan options. Under the Platinum plan option, Maternity is covered the same as any illness. (Note: all Maternity expenses including prenatal, delivery, postnatal, newborn and congenital disorders are excluded when the pregnancy is a result of fertility treatment even if you have Maternity coverage.)

• The Family Matters^® Maternity Program - designed to provide you with educational information on your pregnancy, and suggestions for a healthy lifestyle for the expecting mom and family. A complimentary copy of the book "What to Expect When You're Expecting" is provided to help answer the day-to-day questions faced by all expectant families. This program can also assist you in early detection of potential pregnancy complications, and encourage proper prenatal medical treatment.

Rx Coverage - Medication prescribed by a physician for treatment of a covered illness or injury. These plan options also include a discount drug card administered by Universal Rx.

Mental / Nervous - Charges for the diagnosis, treatment, and prescribed medication by a licensed physician for a mental or nervous state of health; physical, emotional, or behavioral illness. This benefit is part of the Silver plan option as out-patient only.

Other Services - Chiropractor when referred by a physician, radiation treatment, home nursing care, hospice care, physical therapy and prosthetic devices.

Optional Riders

Global Term Life Insurance^SM - Provides protection for families following a traumatic loss. Includes Accidental Death and Dismemberment (AD&D) coverage at no additional cost. AD&D is paid in addition to any amount paid by Global Term Life Insurance and can double the amount of the benefit.

Those approved for Global Medical Insurance and under age 70 are automatically eligible for Global Term Life Insurance at the time of application. Global Term Life Insurance is an optional program purchased in units. The number of units applicants may purchase is based upon their age at the time of application and each subsequent renewal. Applicants from age 31 days through 18 years and from 65 through age 69 are eligible for one unit of coverage. Applicants from age 19 through age 64 are eligible for two units of coverage.

Global Daily Indemnity^SM - Will pay the benefit amount directly to you for each required overnight stay in a hospital. The hospital stay must be eligible for coverage under your Global Medical Insurance plan. Hospital stays related to maternity are not eligible.

Gold, Gold Plus & Platinum plan options
In addition to the benefits previously listed, the following are included on the Gold, Gold Plus and Platinum plan options.

Adult Wellness - Includes routine physicals, mammograms and ob/gyn visits. Visits must be separated by at least 12 months.

Emergency Reunion - Expenses incurred for the travel of a relative or friend of the insured person during an emergency medical evacuation.

Complementary Medicine - Alternative treatments deemed medically necessary and prescribed by a licensed physician for a covered illness.

Recreational Scuba - Covers usual, reasonable and customary charges for illness or injury incurred while scuba diving if the insured person is using safe diving practices as laid down by an authoritative diving body.

Platinum plan option
In addition to the benefits previously listed, the following are included on the Platinum plan option.

Remote Transportation - In addition to Emergency Medical Evacuation, the Platinum plan option provides Remote Transportation. In the event of a diagnosis of a critical medical condition which is not necessarily immediately life-threatening, but severe enough to result in death or a permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising out of the transportation of an insured person to a qualified facility for further treatment (if the current facility is unable to provide such treatment).

To be eligible, Remote Transportation must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.

Political Evacuation and Repatriation - If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person's Home Country, orders the evacuation of all non-emergency government personnel from the Host Country, due to political unrest, that becomes effective on or after the Insured Person's date of arrival in the Host Country, the Company will pay up to a $10,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the Insured Person's home country or country of residence provided that:

1. The Insured Person contacts the Company within 10 days of the government issuance of the evacuation order; and
2. The evacuation order pertains to persons from the same Home Country as the Insured Person; and
3. Political Evacuation and Repatriation is approved and coordinated by the Company;

In no event will the Company pay for a Political Evacuation if there is a Travel Warning in effect on or within six (6) months prior to the Insured Person's date of arrival in the Host Country.

Two Tier U.S. Prescription Drug Card - Provides additional Rx coverage for medication prescribed by a physician for the treatment of a covered illness or injury beyond the Universal Rx discount program. In addition to the extra savings, Platinum members can help control their health care costs by choosing effective, low cost generic drugs over the more expensive brand name versions.

Dental - Provides coverages for Class I (Diagnostic and Preventive Services), Class II (Basic Services) and Class III (Major Services) as defined by the Certificate. These benefits are available after a six month waiting period and exclude orthodontia care.

High School Sports Injury - Covers up to $20,000 per certificate period for injuries incurred during sanctioned, organized sports at the high school level and below.

Vision - Provides coverage for the cost of vision exams and materials (includes frames, lenses and contacts).

Optional Riders

Terrorism Rider - If an insured person is injured as a result of an act of Terrorism*, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum.

This benefit does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

* For limitations and the definition of Terrorism, please see the Certificate Wording.

Sports Rider - Provides up to $25,000 of lifetime coverage for adventure sports such as mountaineering, parachuting, and whitewater rafting. Also provides up to $10,000 of lifetime coverage for amateur sports when not engaged for wage, reward, or profit including contact sports such as soccer and hockey.


The following is a partial list of services offered through Global Medical Insurance. For corresponding information, please see above.

Silver, Gold, Gold Plus & Platinum plan options
The following services are offered on all four plan options.

Locating a Provider in the U.S. - Whenever or wherever you travel, it's comforting to know that the extensive Preferred Provider Organization (PPO) Network is there to serve you. The independent PPO includes hundreds of thousands of established, highly qualified physicians and facilities, including some of the most well-recognized university medical centers and transplant facilities in the U.S.

Of course, you have the freedom to choose any physician or health care facility you wish. However, choosing a provider in the PPO network can significantly reduce your out-of-pocket expenses.

Locating a Provider Outside the U.S. - Additionally, if you are seeking treatment outside the U.S., we provide you access to our proprietary International Provider AccessSM (IPA), a database that includes more than 17,000 highly qualified physicians and facilities that encompass a comprehensive array of specialties to handle any health care emergency. Our direct billing arrangements can also ease the time and up front expense at select providers.

You can instantly access a list of providers and facilities within the PPO and IPA network through our Current Clients area. The directories allow you to search by physician or facility name, specialty, or location.

Medical Concierge - In the event that you are in need of a non-emergency medical procedure, this service will help you decide on a facility that provides the quality care you need in the most cost-effective setting. The procedure can be in or out-patient, and as simple as a MRI or as complex as a transplant. You will receive easy-to-understand information relative to the costs of the procedure at competing facilities. Armed with these facts, you can make informed decisions as to where to have procedures performed, which will effectively reduce your health care costs. This includes exploring worldwide options for care.

To take advantage of this service, just notify the Medical Concierge that a procedure is necessary. The Medical Concierge will then go to work for you, providing you with the facilities that have the highest quality rating and can provide the service in the most cost-effective manner. Additionally, you will receive verification of physician admitting privileges, verification of PPO participation, educational material concerning your procedure, assistance with scheduling appointments and more.

Emergency Medical Evacuation - Global Medical Insurance includes an Emergency Medical Evacuation benefit. This coverage is available when there is not a qualified facility in the immediate area to treat your life-threatening illness or injury.

The program covers Emergency Medical Evacuation to the nearest qualified medical facility or to the nearest qualified medical facility in the insured's home country provided that any additional travel time to the insured's home country will not cause detriment to his/her health as determined by the treating physician.

Emergency Medical Evacuation benefits under Global Medical Insurance provide access to care when you or your family need it most. During the emergency, IMG will coordinate evacuation to a qualified facility equipped to handle your illness or injury. A team of independent pilots and medical professionals will transport you and a family member (if there is room available), while arrangements for your arrival are being made with the receiving hospital. Once at the receiving hospital, IMG will continue to monitor your treatment and communicate with the physicians and your family members.

To be eligible, the evacuation must be recommended by the attending physician in life-threatening situations, and approved in advance and coordinated by IMG. IMG is available 24 hours a day, seven days a week to arrange emergency medical evacuations.

MyIMG^SM - To help enhance your global experience, we provide you with an assortment of interactive services through a secure, user-friendly Web site. Service at your fingertips anytime, anywhere - that's what MyIMG provides. MyIMG is our proprietary online service that allows you to access information and manage accounts, 24 hours a day, seven days a week, from anywhere in the world.

Our service centers are always available to help or handle emergencies, but through MyIMG you can manage routine areas of your account to help you save time when you may need it most. Quickly and easily locate providers, check claim status, retrieve explanation of benefits, request ID cards, obtain certificate documents, initiate precertification and more.

Platinum plan option
In addition to the services previously listed, the following are included under the Platinum plan option.

24 Hour Access to Health Care Professionals - As a Platinum Member, you can easily communicate with experienced health care professionals 24 hours a day, regardless of your location through MyIMG. You have access to a medical information service which allows you to consult with board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians and fitness trainers to assist you with any routine health related questions you have.

The service is not meant to replace your family physician; instead it addresses your concerns in a convenient manner and provides you with support to make informed decisions. Health care professionals will quickly respond to your questions, refer you to specialists and get you the information you need – saving you time and possibly preventing unnecessary office visits.

Global Concierge and Assistance Services^SM - Additionally, as a Platinum Member you have exclusive access to our Global Concierge and Assistance Services. More than insurance protection, these services offer the knowledge and information to keep you healthy and safe. Below is a list of services handled by a dedicated service team that is available 24 hours a day, seven days a week.*

• Dedicated Service Line An international toll-free number accessible worldwide 24/7.
• Security Updates and Country Profiles 24/7 online access to the latest advisories and travel warnings.
• Bag Tracking Assistance in locating lost checked baggage and arranging the delivery of it to you anywhere in the world.
• Pre-trip Health and Safety Advisories 24/7 online access to information concerning current passport and visa requirements; information regarding inoculations and vaccinations; and up-todate travel safety advisories.
• Embassy & Consulate Referral Provides the location and contact information of the nearest U.S. Embassy or Consulate.
• Emergency Cash Transfers Assists in arranging and obtaining cash transfers anywhere in the world.
• Emergency Message Relay Relay messages to your family, friends and co-workers, helping you maintain contact during an emergency.
• Emergency Travel Arrangements Assists in making the appropriate travel arrangements in the event you must interrupt your travel and return home.
• Legal Referrals Provides the contact information for an attorney located in your country of travel.
• Lost Passport/Travel Documents Assistance Assists in reporting, retrieval or replacement of lost or stolen travel documents.
• Dedicated Claims Team Provides members with expedited claims processing.
• Prescription Drug Replacement Assistance Assists in the replacement and shipment of lost or damaged medication.
• Drug Translation Service 24/7 online access that provides country specific brand names of common prescription and over-the-counter medications.

* Global Concierge and Assistance Services are additional services offered. They are not insurance benefits.


Precertification
Prior to receiving treatment, you may need to contact IMG to precertify your treatment and/or for verification of benefits. Precertification means calling IMG's Utilization Management and Review company to receive a determination of medical necessity for the proposed treatment or services. It is important to note that precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. Precertification may be undertaken by you, the doctor, a hospital administrator or a relative. The following treatments and services must be precertified or certain reductions in benefits may result:

• Any surgery or treatment requiring hospitalization
• Out-patient surgery
• Within 48 hours after an emergency admission to the hospital
• Care in an extended care facility
• Home nursing care
• Durable medical equipment including artificial limbs
• Transplants

Verification of Benefits
Verification of benefits is the process of verifying your general coverage and the available benefits under the plan. You may do this by contacting IMG's Customer Care department whether or not your treatment or services require precertification. Verification of benefits is not a guarantee of payment or assurance of coverage, and all medical expenses must meet eligible payment guidelines in accordance with the terms and conditions of the plan. While precertification and verification of benefits are separate determinations, both are made in reliance on the completeness and accuracy of the information provided by you and your health care providers to IMG.

Guarantee of Payment
In those situations where a provider requires a guarantee of payment prior to performing services, IMG will issue a "Guarantee of Payment" letter. The letter will indicate that we will process and pay charges for health services rendered, expenses and medical claims incurred relating to a covered insured's hospitalization, diagnosis and/or treatment in accordance with the valid reimbursement of eligible charges under the terms and conditions of the Certificate of Insurance.


When you receive treatment, original itemized bills must be received by IMG within 90 days of services. As a courtesy, claims may be paid in selected alternate currencies by electronic bank wire. Please see the Claim Form for more information and conditions of this service.

Claim Filing Options
Direct Payment to providers - In many cases IMG works with the hospital or clinic as an accommodation, including those outside the independent PPO, for direct payment of eligible medical expenses on your behalf. To be eligible to have a claim paid in this fashion, you or the provider must complete a Claim Form and submit it with original itemized bills. In this case, you will be responsible for direct payment of your deductible, coinsurance amounts and noneligible expenses and charges.

Reimbursement - If you have received treatment and need to be reimbursed for outof- pocket medical expenses, complete the Claim Form and submit your original itemized bills and paid receipts within 90 days. We will reimburse your eligible medical expenses after applying the deductible and coinsurance, subject to the terms of the plan.

Please remember to submit your bills and receipts as soon as you receive them. Do not hold them until the end of the year. IMG will apply eligible medical expenses to your deductible and coinsurance throughout the year.


(New Business Rates Effective 1/1/2012. IMG reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version. Rates include surplus lines tax where applicable.) Global Medical Insurance is underwritten by Sirius International Insurance Corporation (publ) (the "Company"). It is distributed, managed and administered, as agent for and on behalf of the Company, by International Medical Group^®, Inc. ("IMG^®"). © 2007-2012 International Medical Group, Inc. All rights reserved.

ANNUAL PREMIUMS
All amounts shown are in U.S. dollars. Please select your deductible carefully, as you will be unable to select a lower deductible when you renew your coverage.



WORLDWIDE COVERAGE EXCLUDING THE U.S., CANADA, CHINA, HONG KONG, JAPAN, MACAU, SINGAPORE, AND TAIWAN
Available only to applicants with addresses outside the U.S. & Canada

Deductibles	$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 232		First 2 no additional cost* - Then 203		First 2 no additional cost* - Then 158		First 2 no additional cost* - Then 138		First 2 no additional cost* - Then 127		First 2 no additional cost* - Then 112
10 to 18	238	238	212	212	175	175	163	163	153	153	134	134
19 to 24	539	671	466	660	363	506	317	441	248	355	221	306
25 to 29	569	766	497	744	385	572	336	498	264	413	234	326
30 to 34	636	846	548	798	424	618	372	538	291	432	259	369
35 to 39	714	1,000	578	888	447	689	392	595	307	496	273	387
40 to 44	901	1,098	731	955	486	748	425	655	407	510	362	451
45 to 49	1,004	1,211	823	1,030	638	797	556	694	453	548	404	487
50 to 54	1,226	1,347	1,040	1,161	803	901	702	801	595	665	530	592
55 to 59	1,482	1,482	1,288	1,288	997	996	869	869	731	738	651	657
60 to 64	2,182	2,054	1,988	1,860	1,676	1,480	1,518	1,363	1,268	1,127	1,129	1,003
65 to 69	4,556	3,953	4,361	3,781	4,080	3,443	3,136	2,559	2,742	2,456	2,441	2,185
70	5,604	4,862	5,364	4,650	5,018	4,235	3,857	3,148	3,373	3,021	3,002	2,688
71	5,884	5,105	5,632	4,883	5,269	4,447	4,050	3,305	3,541	3,171	3,153	2,822
72	6,178	5,361	5,914	5,127	5,533	4,669	4,253	3,470	3,718	3,331	3,310	2,963
73	6,487	5,629	6,209	5,383	5,809	4,902	4,465	3,644	3,904	3,497	3,476	3,111
74	6,812	5,910	6,520	5,652	6,100	5,148	4,689	3,826	4,099	3,672	3,649	3,276

WORLDWIDE COVERAGE

Deductibles	$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 310		First 2 no additional cost* - Then 270		First 2 no additional cost* - Then 210		First 2 no additional cost* - Then 184		First 2 no additional cost* - Then 169		First 2 no additional cost* - Then 150
10 to 18	317	317	282	282	233	233	217	217	204	204	180	180
19 to 24	718	895	622	881	484	675	422	588	331	473	294	407
25 to 29	758	1,020	662	991	515	764	449	663	352	551	313	433
30 to 34	848	1,128	730	1,063	566	823	496	718	389	576	345	490
35 to 39	950	1,333	770	1,182	596	918	522	793	408	661	364	516
40 to 44	1,202	1,463	976	1,273	647	997	567	873	542	676	482	602
45 to 49	1,339	1,614	1,098	1,373	850	1,062	741	925	605	730	538	650
50 to 54	1,635	1,796	1,386	1,548	1,071	1,201	935	1,068	794	886	706	789
55 to 59	1,976	1,976	1,718	1,718	1,330	1,328	1,159	1,159	976	984	868	876
60 to 64	2,909	2,738	2,651	2,480	2,235	1,973	2,024	1,816	1,691	1,502	1,505	1,337
65 to 69	6,075	5,271	5,814	5,041	5,439	4,591	4,181	3,412	3,656	3,274	3,254	2,914
70	7,472	6,483	7,151	6,200	6,690	5,647	5,143	4,851	4,497	4,027	4,002	3,584
71	7,846	6,807	7,509	6,510	7,025	5,929	5,400	5,094	4,722	4,228	4,203	3,763
72	8,238	7,148	7,884	6,835	7,375	6,225	5,670	5,349	4,958	4,440	4,413	3,952
73	8,650	7,505	8,278	7,177	7,744	6,537	5,953	5,616	5,206	4,662	4,633	4,149
74	9,083	7,881	8,692	7,536	8,131	6,864	6,251	5,897	5,466	4,895	4,865	4,357

WORLDWIDE COVERAGE EXCLUDING THE U.S., CANADA, CHINA, HONG KONG, JAPAN, MACAU, SINGAPORE, AND TAIWAN
Available only to applicants with addresses outside the U.S. & Canada

Deductibles	$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 318		First 2 no additional cost* - Then 272		First 2 no additional cost* - Then 203		First 2 no additional cost* - Then 185		First 2 no additional cost* - Then 164		First 2 no additional cost* - Then 148
10 to 18	352	352	287	287	225	225	204	204	182	182	164	164
19 to 24	736	969	633	918	507	679	438	587	342	473	270	358
25 to 29	753	1,069	648	998	518	736	448	637	350	497	276	366
30 to 34	799	1,151	687	1,058	550	803	478	698	376	567	297	424
35 to 39	814	1,251	700	1,099	560	818	487	711	382	578	302	432
40 to 44	1,069	1,397	978	1,272	783	939	673	889	525	677	415	531
45 to 49	1,238	1,498	1,127	1,373	867	1,041	781	937	636	732	503	578
50 to 54	1,472	1,587	1,325	1,444	1,060	1,155	980	1,068	784	855	620	675
55 to 59	1,917	1,863	1,706	1,655	1,390	1,348	1,175	1,139	987	957	780	756
60 to 64	2,691	2,538	2,516	2,358	2,013	1,862	1,892	1,750	1,590	1,407	1,303	1,161
65 to 69	5,384	4,840	5,222	4,527	4,856	4,152	3,764	3,463	3,312	3,047	2,716	2,499
70	7,058	6,139	6,796	5,881	6,283	5,366	4,882	4,400	4,235	3,803	3,489	3,135
71	7,410	6,446	7,136	6,175	6,597	5,635	5,126	4,620	4,447	3,993	3,664	3,292
72	7,781	6,768	7,493	6,484	6,928	5,916	5,383	4,851	4,670	4,193	3,847	3,456
73	8,171	7,106	7,869	6,808	7,275	6,212	5,653	5,094	6,538	4,904	4,403	4,040
74	3,629	8,580	7,817	8,263	7,489	7,639	6,833	5,935	5,603	5,149	4,843	4,242

WORLDWIDE COVERAGE

Deductibles	$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 430		First 2 no additional cost* - Then 368		First 2 no additional cost* - Then 275		First 2 no additional cost* - Then 250		First 2 no additional cost* - Then 221		First 2 no additional cost* - Then 200
10 to 18	476	476	388	388	304	304	275	275	246	246	221	221
19 to 24	995	1,310	856	1,241	685	917	592	793	462	640	365	483
25 to 29	1,018	1,445	875	1,348	700	995	606	860	473	671	373	495
30 to 34	1,080	1,555	929	1,430	743	1,085	646	944	507	766	401	573
35 to 39	1,100	1,691	946	1,485	757	1,105	658	961	517	780	408	584
40 to 44	1,445	1,888	1,322	1,719	1,058	1,269	910	1,201	710	915	561	717
45 to 49	1,673	2,024	1,522	1,856	1,172	1,407	1,055	1,266	860	989	679	781
50 to 54	1,989	2,144	1,790	1,951	1,432	1,561	1,325	1,444	1,060	1,155	837	913
55 to 59	2,590	2,517	2,305	2,236	1,879	1,822	1,587	1,540	1,333	1,293	1,053	1,022
60 to 64	3,637	3,430	3,401	3,186	2,720	2,516	2,557	2,365	2,148	1,901	1,761	1,568
65 to 69	7,275	6,541	7,057	6,118	6,563	5,611	5,086	4,679	4,476	4,118	3,670	3,377
70	9,410	8,185	9,062	7,841	8,378	7,155	6,509	5,867	5,647	5,071	4,653	4,180
71	9,880	8,594	9,514	8,233	8,796	7,513	6,835	6,161	5,929	5,325	4,885	4,389
72	10,375	9,024	9,991	8,645	9,237	7,889	7,177	6,469	6,226	5,591	5,130	4,608
73	10,895	9,475	10,492	9,077	9,700	8,283	7,537	6,792	6,538	5,870	5,387	4,839
74	11,440	10,423	11,017	9,985	10,185	9,111	7,914	7,471	6,865	6,457	5,656	5,323

WORLDWIDE COVERAGE EXCLUDING THE U.S., CANADA, CHINA, HONG KONG, JAPAN, MACAU, SINGAPORE, AND TAIWAN
Available only to applicants with addresses outside the U.S. & Canada

Deductibles	$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 430		First 2 no additional cost* - Then 365		First 2 no additional cost* - Then 280		First 2 no additional cost* - Then 250		First 2 no additional cost* - Then 225		First 2 no additional cost* - Then 200
10 to 18	469	469	384	384	298	298	269	269	242	242	217	217
19 to 24	922	1,215	794	1,156	617	825	545	731	446	620	353	467
25 to 29	954	1,420	834	1,342	646	963	568	847	467	738	366	507
30 to 34	1,054	1,591	926	1,491	755	1,109	638	981	523	827	413	618
35 to 39	1,146	1,761	1,018	1,602	788	1,231	697	1,079	571	922	448	636
40 to 44	1,477	1,931	1,306	1,726	1,012	1,338	898	1,189	733	945	579	743
45 to 49	1,663	2,009	1,484	1,812	1,151	1,409	1,021	1,247	835	963	657	756
50 to 54	2,021	2,180	1,819	1,983	1,415	1,547	1,289	1,404	1,056	1,148	828	903
55 to 59	2,559	2,487	2,345	2,279	1,830	1,780	1,614	1,570	1,360	1,321	1,062	1,031
60 to 64	3,596	3,391	3,326	3,120	2,784	2,578	2,542	2,351	2,109	1,866	1,731	1,542
65 to 69	7,426	6,476	7,154	6,205	6,615	5,662	5,144	4,648	4,463	4,017	3,677	3,312
70	11,100	8,093	10,689	7,753	9,882	7,074	7,679	5,801	6,661	5,014	5,488	4,133
71	11,655	8,497	11,224	8,140	10,376	7,428	8,062	6,091	6,994	5,264	5,762	4,339
72	12,238	8,922	11,785	8,547	10,895	7,799	8,466	6,395	7,344	5,528	6,051	4,556
73	12,850	9,368	12,374	8,975	11,440	8,189	8,889	6,715	7,711	5,804	6,353	4,784
74	13,492	10,305	12,993	9,872	12,012	9,008	9,333	7,387	8,097	6,384	6,671	5,263

WORLDWIDE COVERAGE

Deductibles	$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 576		First 2 no additional cost* - Then 485		First 2 no additional cost* - Then 370		First 2 no additional cost* - Then 335		First 2 no additional cost* - Then 300		First 2 no additional cost* - Then 200
10 to 18	625	625	510	510	395	395	360	360	320	320	290	290
19 to 24	1,230	1,620	1,058	1,541	823	1,153	726	1,021	595	825	469	623
25 to 29	1,273	1,894	1,111	1,789	861	1,284	757	1,129	623	983	487	675
30 to 34	1,406	2,120	1,235	1,988	961	1,477	852	1,307	697	1,102	549	824
35 to 39	1,527	2,349	1,357	2,135	1,049	1,641	930	1,439	760	1,229	597	847
40 to 44	1,970	2,574	1,741	2,300	1,349	1,784	1,198	1,585	976	1,260	772	989
45 to 49	2,217	2,677	1,980	2,416	1,535	1,879	1,361	1,662	1,111	1,283	876	1,008
50 to 54	2,694	2,906	2,424	2,643	1,887	2,063	1,718	1,871	1,408	1,531	1,104	1,203
55 to 59	3,411	3,315	3,127	3,038	2,441	2,373	2,153	2,092	1,813	1,761	1,415	1,374
60 to 64	4,795	4,520	4,434	4,159	3,713	3,438	3,388	3,135	2,812	2,488	2,308	2,055
65 to 69	11,385	8,634	9,539	8,273	8,820	7,549	6,859	6,196	5,950	5,356	4,903	4,415
70	14,800	10,790	14,252	10,337	13,176	9,432	10,238	7,735	8,881	6,685	7,317	5,510
71	15,540	11,330	14,965	10,854	13,835	9,904	10,750	8,121	9,326	7,019	7,683	5,786
72	16,317	11,896	15,713	11,396	14,527	10,399	11,287	8,527	9,792	7,370	8,067	6,075
73	17,133	12,491	16,499	11,966	15,253	10,919	11,852	8,954	10,281	7,739	8,471	6,379
74	17,989	13,740	17,324	13,163	16,016	12,011	12,444	9,849	10,795	8,513	8,894	7,017

WORLDWIDE COVERAGE EXCLUDING THE U.S., CANADA, CHINA, HONG KONG, JAPAN, MACAU, SINGAPORE, AND TAIWAN
Available only to applicants with addresses outside the U.S. & Canada

Deductibles	$100		$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 1,773		First 2 no additional cost* - Then 1,610		First 2 no additional cost* - Then 1,462		First 2 no additional cost* - Then 1,272		First 2 no additional cost* - Then 1,209		First 2 no additional cost* - Then 1,152		First 2 no additional cost* - Then 1,106
10 to 18	1,860	1,860	1,691	1,691	1,505	1,505	1,315	1,315	1,252	1,252	1,191	1,191	1,138	1,138
19 to 24	3,168	5,227	2,880	4,752	2,571	4,315	2,147	3,440	1,972	3,121	1,734	2,746	1,508	2,234
25 to 29	3,253	5,748	2,957	5,225	2,666	4,975	2,214	3,755	2,028	3,383	1,785	3,034	1,543	2,291
30 to 34	3,518	6,351	3,199	5,773	2,889	5,452	2,394	4,226	2,197	3,814	1,919	3,319	1,653	2,647
35 to 39	3,624	6,955	3,294	6,323	2,998	5,809	2,470	4,618	2,263	4,130	1,972	3,624	1,689	2,705
40 to 44	4,461	7,554	4,055	6,868	3,661	6,208	2,986	4,961	2,723	4,483	2,343	3,697	1,989	3,048
45 to 49	4,931	5,804	4,482	5,276	4,070	4,824	3,304	3,898	3,006	3,528	2,579	2,873	2,169	2,396
50 to 54	5,834	6,238	5,304	5,671	4,841	5,218	3,911	4,215	3,623	3,886	3,087	3,299	2,563	2,736
55 to 59	7,194	7,014	6,540	6,376	6,050	5,899	4,867	4,751	4,368	4,267	3,784	3,704	3,099	3,028
60 to 64	9,816	9,298	8,923	8,573	8,304	7,829	7,058	6,586	6,502	6,062	5,507	4,947	4,640	4,205
65 to 69	19,497	17,097	17,726	15,542	17,102	14,920	15,863	13,672	12,481	11,340	10,916	9,891	9,111	8,272
70	23,983	21,029	21,803	19,116	21,036	18,352	19,512	16,817	15,352	13,948	13,427	12,167	11,207	10,173
71	25,181	22,080	22,896	20,073	22,087	19,268	18,456	20,486	16,119	14,646	14,097	12,775	11,767	10,683
72	26,441	23,183	24,037	21,076	23,191	20,232	21,511	18,540	16,925	15,378	14,803	13,413	12,355	11,218
73	27,762	24,343	25,238	22,130	24,352	21,243	22,587	19,466	17,771	16,147	15,543	14,085	12,974	11,778
74	29,151	25,561	26,501	23,237	25,569	22,305	23,716	20,441	18,660	16,954	16,320	14,789	13,622	12,365

WORLDWIDE COVERAGE

Deductibles	$100		$250		$500		$1,000		$2,500		$5,000		$10,000
Age	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
*14 days to 9 years	First 2 no additional cost* - Then 2,120		First 2 no additional cost* - Then 1,929		First 2 no additional cost* - Then 1,729		First 2 no additional cost* - Then 1,474		First 2 no additional cost* - Then 1,394		First 2 no additional cost* - Then 1,319		First 2 no additional cost* - Then 1,254
10 to 18	2,242	2,242	2,038	2,038	1,785	1,785	1,532	1,532	1,449	1,449	1,368	1,368	1,297	1,297
19 to 24	3,979	6,777	3,617	6,116	3,208	5,852	2,642	4,367	2,407	3,943	2,093	3,440	1,790	2,757
25 to 29	4,096	7,420	3,723	6,749	3,334	6,410	2,734	4,787	2,483	4,288	2,159	3,822	1,834	2,832
30 to 34	4,449	8,225	4,045	7,477	3,633	7,051	2,973	5,409	2,710	4,862	2,339	4,204	1,981	3,309
35 to 39	4,584	9,030	4,167	8,208	3,780	7,525	3,071	5,936	2,796	5,286	2,408	4,611	2,032	3,383
40 to 44	5,705	9,829	5,186	8,935	4,662	8,055	3,759	6,396	3,413	5,756	2,903	4,710	2,435	3,839
45 to 49	6,327	7,493	5,751	6,811	5,210	5,754	4,186	4,977	3,787	4,480	3,213	3,608	2,672	2,976
50 to 54	6,982	8,070	6,347	7,335	6,232	6,735	4,996	5,400	4,609	4,961	3,895	4,179	3,199	3,425
55 to 59	9,346	9,108	8,496	8,279	7,847	7,643	6,270	6,113	5,607	5,469	4,826	4,708	3,911	3,818
60 to 64	12,848	12,149	11,679	11,043	10,850	10,218	9,192	8,560	8,446	7,869	7,122	6,379	5,964	5,382
65 to 69	25,758	22,550	23,414	20,498	22,582	19,673	20,929	18,010	16,422	14,901	14,333	12,968	11,927	10,807
70	31,681	27,739	28,799	25,218	27,776	24,199	25,743	22,152	20,200	18,327	17,630	15,951	14,760	13,292
71	33,263	29,126	30,240	26,479	29,165	25,408	27,031	23,259	21,210	19,244	18,511	16,749	15,403	13,957
72	36,243	30,583	31,750	27,803	30,623	26,678	28,382	24,422	22,269	20,206	19,437	17,586	16,174	14,655
73	36,674	32,111	33,339	29,193	32,154	28,013	29,800	25,643	23,384	21,217	20,410	18,466	16,983	15,388
74	38,508	33,717	35,006	30,652	33,763	29,413	31,291	26,925	24,552	22,277	21,430	19,389	17,832	16,157

Modal Payment Factors***
Annual	1.00
Semi Annual	.55
Quarterly	.28
Monthly	.10

***For semi-annual, quarterly, and monthly payment modes, IMG will only accept valid Visa, MasterCard, American Express, Discover or JCB credit cards, or eCheck, on a preauthorized basis prior to the expiration date. Your credit card will be debited automatically on the due date(s) of your future premium installment(s).

Note: Choosing the semi-annual payment option (modal payment factor .55) results in total payments of 110% of the annual premium, choosing the quarterly payment option (modal payment factor .28) results in total payments of 112% of the annual premium, and choosing the monthly payment option (modal payment factor .10) results in total payments of 120% of the annual premium.

*The first two Dependent Children between the ages of 14 days to 9 years covered at no additional cost for the first year of coverage only when both parents or guardians are insured under the Global Medical Insurance plan. On the first renewal date, premium will be 50% of the published rates. For subsequent renewals, the renewal premium will apply.
**Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance plan. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates.

Insubuy^®, Inc.
4700 Dexter Dr.
Suite 100
Plano TX 75093

Toll Free: (866) INSU-BUY

Fax: (972) 767-4470


Pre-existing Condition Exclusion
Unless the coverage you purchase provides otherwise, there is no coverage for any Illness, Injury or Mental or Nervous Disorder that, with reasonable medical certainty, existed on or at any time prior to the Initial Effective Date of this insurance, whether or not previously manifested or symptomatic, diagnosed, treated or disclosed on the Application or on any Claim Form or otherwise. Pre-existing condition also excludes any chronic, subsequent or recurring complications or consequences associated with or arising or resulting from these conditions. Following are a few examples of how this provision may be applied:

Example of Illness Covered:

• Your effective date is January 1, 2012.
• You see a doctor on February 1, 2012 for abdominal pain.
• Your doctor diagnoses you with appendicitis.
• This condition began after the effective date of coverage and may be covered.

Example of Illness Not Covered:

• Your effective date is January 1, 2012.
• You see your doctor on February 1, 2012 for chest pain.
• Your doctor diagnoses you with angina (heart pain).
• A cardiac cauterization reveals obstructed coronary arteries.
• Coronary artery by-pass surgery is recommended on an emergency basis.
• A medical review of the case, including possibly an independent peer review, is conducted.
• The review concludes that the condition began prior to the effective date of coverage; this condition would not be covered.

Another Example of Illness Not Covered:

• Your effective date is January 1, 2012.
• You see your doctor on February 1, 2012 concerning a lump in your breast that you had never before noticed and had never before bothered you.
• Your doctor diagnoses you with breast cancer.
• A medical review of the case, including possibly an independent peer review, is conducted.
• The review concludes that the condition began prior to the effective date of coverage; this condition would not be covered.

These examples are intended to outline how the Pre-existing Condition clause applies to a given situation. Please keep in mind that each medical situation is different and will be handled accordingly.

This information summarized above is provided to help you understand various provisions of the coverage you are purchasing, and in no way represents all the provisions, conditions and exclusions which may apply. Please refer to your Declaration of Insurance for more details. The Declaration of Insurance is not an insurance policy. It is an outline of the insurance provided to you by the Master Policy identified in your Certificate of Insurance. It does not extend or change the coverage provided by such Master Policy.

Once again we thank you for the opportunity to serve your International Insurance needs.