The following is a description of a standard basic plan design. Alternative designs are available on a case by case basis. Each plan is designed to best fit the size and needs of the group. In some cases, provisions of the following description may be enhanced or deleted.

DEDUCTIBLE
Choice of $100, $250, $500, $1,000 or $2,500 or Higher per illness or injury

COINSURANCE
After the deductible Underwriters will reimburse 80% of next $5,000 in eligible expenses and then 100% up to the Maximum Benefit

MAXIMUM BENEFIT
$25,000 - $5,000,000

Eligible expenses caused by an illness or injury and incurred from any doctor or any hospital within a specified geographical area will be reimbursed to you. Benefits may be assignable directly to the providers once a Claim Review has been completed.

Hospital Expenses including:
Semi-private room and board, intensive care, other medically necessary hospital services and supplies, such as emergency room care, outpatient surgery, diagnostic services, supplies and therapy.

Physician Services Consisting of:
Home, office, and hospital visits, diagnostic services, supplies and therapy.

Skilled Nursing Facility including:
Room and board, provided confinement begins within 30 days following a medically necessary hospital confinement of three days or longer.

Home Health Care:
If hospitalization would have been required if Home Health Care were not provided, and the Home Health Care is provided in accordance with a written plan established and approved by a physician.

Ambulance Services:
To and from a hospital in the geographic area.

Prescription Drugs:
Covered during and following a period of hospitalization.

Repatriation of Remains:
In the case of death, underwriters will reimburse the costs of delivery of your remains to a mortuary near your home.

Common Accident Provision:
In the event that you and any additional insured family members suffer injuries from the same accident, only one deductible and coinsurance shall be applied.

Global Medical Transportation Coverage:
Underwriters will reimburse you for the costs of medically necessary transportation to return you to the facility nearest your home which can provide appropriate care, up to $100,000.

Expenses which have limitations are as follows:

1. The maximum Eligible Expense for room and board charges is $450 per day.
2. The maximum Eligible Expense room and board charge for an intensive care unit is three times the Provider's semi-private room and board charge or $1350 per day whichever is the least.
3. Insured age 70-74 are limited to $250,000.00 maximum benefit or as shown on the Schedule of benefits page, whichever is the least. All other terms and conditions apply.
4. Insured age 75-79 are limited to $100,000.00 maximum benefit or as shown on the Schedule of benefits page, whichever is the least. All other terms and conditions apply.
5. Insured age 80-84 are limited to $50,000.00 maximum benefit or as shown on the Schedule of benefits page, whichever is the least. All other terms and conditions apply.

A Preexisting Condition will not be covered until the insurance described in this certificate has been in effect for a period of 12 months. A preexisting condition is one in which an insured sought medical attention or was advised to seek medical attention during the 12 month period preceding the effective date of the policy.

Expenses which are not eligible for reimbursement are as follows:

1. Any expense which You are not legally obligated to pay.
2. Services which are not Medically Necessary or are not furnished by and under supervision of a Physician.
3. Expenses for services and supplies for which You are entitled to benefits, services or reimbursement through the Veterans' Administration, Workers' Compensation insurance, any private health plan or from any other source except Medicaid.
4. Expenses in excess of UCR.
5. Outpatient drugs, except following a hospitalization if prescribed for the same Illness or Injury.
6. Self-inflicted injuries while sane or insane.
7. Treatment for alcoholism, drug addiction, allergies
8. Mental or nervous disorders.
9. Rest cures, quarantine or isolation.
10. Cosmetic surgery unless necessitated by an injury.
11. Dental exams, dental x-rays and general dental care except as a result of an injury.
12. Eye glasses or eye examinations.
13. Hearing aids or hearing examinations.
14. General or routine examinations.
15. Injuries sustained from participation in Hazardous Sports or Activities
16. Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or postpartum conditions.
17. Injuries or illnesses due to war or any act of war whether declared or undeclared.
18. Injuries or illnesses sustained while committing a criminal or felonious act.
19. Expenses incurred for or resulting from pain which is not supported by medical diagnosis.
20. Cataract surgery.
21. Any elective surgery.
22. Custodial Care.
23. Expenses for supplies and services that were not incurred within the specified Geographic Area.
24. Pre-existing conditions.

Petersen International Underwriters want you to understand how they protect the confidentiality of non-public personal information they collected about you.

PIU collects non-public information about you from numerous sources including, but not limited to:

1. Information PIU receives from you on applications and other forms;
2. Information about your transactions with the affiliates, others or PIU;
3. Information PIU receives from consumer-reporting agencies; and
4. Financial and medical sources.

PIU does not disclose any non-public information about you to anyone except as is necessary in order to provide the products or services to you or otherwise as required or permitted by law (e.g. subpoena, fraud investigation, regulatory reporting, etc.).

You have a right to request access to or correction of your personal information in PIU's possession.

PIU restricts access to non-public personal information about you to PIU's employees, PIU's affiliates' employees or others who need to know that information to service your account. PIU maintains physical, electronic and procedural safeguards to protect your non-public personal information.

If you have any further questions about this privacy statement or would like to learn more about how PIU protects your privacy, please contact us.

This plan is administered by

Petersen International Underwriters
23929 Valencia Boulevard, Suite 215
Valencia, CA 91355-2186

It is underwritten by Certain Underwriters at Lloyd's that is rated A "Excellent" by A.M. Best.