FOR

• Foreign Nationals Visiting the USA
• Foreign Nationals Working in the USA
• Foreign Nationals in their Home Country Working for a USA Company
• USA Citizens Returning to the USA

USES

• Tourism
• Immigration
• Religious Pursuits
• VISA Requirements
• Occupation Outsourcing
• Foreign Exchange Students
• Relatives Visiting From Abroad

HOW TO APPLY
• Paper Application
• Online Enrollment

Choice of Deductible
Age 0-69: $100, $250, $500, $1,000, $2,500 or $5,000
Age 70-79: $1,000, $2,500 or $5,000
Age 80-84: $2,500 or $5,000

(Deductibles listed are per person, per policy period)

Coinsurance
After Deductibles are paid, Underwriters will reimburse 80% of next $5,000 in eligible expenses and then 100% of eligible expenses up to the Maximum Benefit

Maximum Benefit
Age 0-69: up to $1,000,000
Age 70-74: up to $250,000
Age 75-79: up to $100,000
Age 80-84: up to $50,000

(Benefits listed are per person, per policy period)

The insurance being described is a temporary major medical insurance plan. 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 has been validated.

Eligible Expenses
Hospital Expenses: All medically necessary expenses while hospitalized.

Physician Services: All medically necessary expenses for treatment.

Skilled Nursing Facilities: All medically necessary expenses if confinement begins following a medically necessary hospital confinement of 3 days or longer.

Home Health Care: All medically necessary expenses if hospitalization would have been required if Home Health Care was not provided and the care is provided in accordance with a written plan established, approved and followed by a physician.

Ambulance Services Expenses: To and from a hospital within 100 miles in the same geographic area.

Prescription Drugs: Outpatient prescription medications covered up to a maximum of $500.

Repatriation of Remains: In the event of death, Underwriters will reimburse the cost of delivery of your remains to a mortuary nearest your home up to $100,000.

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: All medically necessary expenses for stabilization and transportation to the facility nearest your home, which can provide the appropriate care up to $100,000.

Lost Luggage: In the event that your checked on luggage is completely and totally lost, Underwriters shall reimburse you to a maximum of $500, excess of any and all other valid and collectible coverages.

Emergency Return Home: If, after you have departed, you learn of the death of an Immediate Family Member, or you learn of the substantial destruction of your home by fire, wind, flood, or earthquake, Underwriters shall reimburse you the cost of an economy one way air or ground transportation ticket for you to your home, up to a maximum of $5,000.

Trip Cancellation Benefit: If within two weeks prior to your pre-paid ticketed or vouchered initial trip departure your entire trip must be cancelled due to 1) your death, illness or injury causing hospitalization or outpatient surgery, or 2) the death of an Immediate Family member, or 3) the substantial destruction of your home due to fire, wind, flood, or earthquake, any unused and nonrefundable portion of expenses shall be reimbursed up to a maximum of $1,000, excess of $100 each and every loss and excess of all other valid Insurances.

$25,000 Accidental Death: Double indemnity ($50,000 total) if accidental death occurs while riding as a passenger of a common carrier.

Sports or Activity Coverage
If you elect this option, underwriters will reimburse you for eligible expenses which are incurred due to an injury resulting from the participation in a sport or activity that is specifically named on the Schedule of Coverage. (See exclusions for a list of commonly excluded sports and activities.)

Accidental Death & Dismemberment (AD&D)
Underwriters will pay you the principal sum insured (not to exceed $500,000) as designated on the Schedule of Coverage in the event of your accidental death. Underwriters will also pay the principal sum insured in the event that you suffer a loss resulting from an injury as shown in the Schedule of Losses below.

War & Terrorism Coverage
If you elect this option Underwriters will reimburse You for Eligible Expenses which are incurred as a result of Injuries or Illnesses sustained due to war/terrorism or act of war/terrorism. Injuries or Illnesses due to war/terrorism or act of war/terrorism involving the use or release of any nuclear weapon or device or chemical or biological agent, regardless of any contributory cause(s) are not covered with this optional benefit.

Kidnap & Ransom Coverage (K&R)
If you elect this option Underwriters will reimburse you for the ransom expenses paid on your behalf in order to release you from a kidnapping event which had taken place in the USA as well as reimburse you for the crisis response fees up to $100,000 in the aggregate. Although ransom benefits appear to be the primary benefit, the core benefit of any plan is the Crisis Response Team that will assess and advise the family. Most kidnappings are carried out in order to obtain a ransom, and in most cases a ransom is paid. The average percentage of deaths following a kidnapping is 9%. In cases involving The Crisis Response Team, less than 2% of people are killed.

Health care costs are different in the United States than other countries around the world. The United States health care system is principally funded through private insurance. Access to socialized health care is typically restricted to United States Veterans, Medicare recipients and legal residents using Medicaid. Reciprocity between some countries which both have socialized health care does not occur in the United States.

Examples of Coverage
• A Foreign National visiting the USA.
• A USA Citizen who is temporarily unable to purchase domestic coverage due to residence restrictions.
• A Foreign National working for a USA company in their home country or outside their home country.

• Dependent child rate is applicable only when applying in conjunction with an adult, otherwise use the 0-18 rate.
* $1,000 minimum deductible only.
** $2,500 or $5,000 deductible only (Reminder: Multiply by deductible factor)

1. Determine the daily premium based on actual age on the effective date.
2. Multiply by the number of days required (10 day minimum & 366 maximum).
3. Multiply by the deductible premium factor.
4. Add any optional coverages.
  - Sports/Activity coverage = add 10% of sub-total or $80, whichever is greater
  - AD&D*: $100,000 add $110, $250,000 add $275, $500,000 add $550
  *Benefits listed are for individuals under age 70.
  - War & Terrorism add 20% to the Sub-Total***
  - K&R: Up to 3 months add $200, 3-6 months add $400, 6-12 months add $500
5. Add a $100 processing fee
6. Do not send money until AFTER approval by Underwriters.

Reminder: The $100 processing fee is not applied with the online enrollment.

***War & Terrorism rates based on coverage in the USA, additional fees may apply for other countries.

1. Services and supplies for Cardiac Related Conditions and Cancer Related Conditions are limited to either (i) the medical costs of stabilizing your condition and the transportation costs of returning you to your Home Country or (ii) a maximum reimbursement for Eligible Expenses of $25,000, at the option of Underwriters.
2. The maximum Eligible Expense for Repatriation of Remains or Global Medical Transportation is $100,000 in the aggregate.
3. The maximum Eligible Expense for room and board charges for an intensive care unit is three times the Provider’s semi-private room.
4. The maximum Eligible Expense for outpatient prescription medication(s) is $500.00 in the aggregate and for a maximum prescribed period of ninety (90) days for any one prescription.
5. Insured age 70-74 is limited to $250,000 maximum benefit or as shown on the Schedule of Benefits page, whichever is the least. All other terms and conditions apply.
6. Insured age 75-79 is limited to $100,000 maximum benefit or as shown on the Schedule of Benefits page, whichever is the least. All other terms and conditions apply.
7. Insured age 80-84 is limited to $50,000 maximum benefit or as shown on the Schedule of Benefits page, whichever is the least. All other terms and conditions apply.

A preexisting condition means a condition, disease or Injury for which medical advice, diagnosis, care or treatment, including the use of prescription medication including but not limited to ongoing condition(s), was recommended by or received from a licensed health care practitioner, and/or any symptom(s) and/or any condition(s) which would have caused a reasonable prudent person to seek medical attention during the 12 months immediately preceding the Effective Date of the insurance described in this Certificate, whether disclosed or not on Your application

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. Self-inflicted injuries while sane or insane.
6. Treatment for alcoholism, drug addiction, allergies, and/or Mental or Nervous Disorders.
7. Rest cures, quarantine or isolation.
8. Cosmetic surgery unless necessitated by an accidental Injury.
9. Dental exams, dental x-rays and general dental care except as a result of an accidental Injury.
10. Eye glasses or eye examinations.
11. Hearing aids or hearing examinations.
12. General or routine examinations.
13. Injuries sustained from participation in Hazardous Sports or Activities.^*
14. Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or postpartum conditions.
15. Injuries or Illnesses due to War or any act of War whether declared or undeclared.^*
16. Injuries or Illnesses due to Terrorism or any act of Terrorism whether declared or undeclared.^*
17. Injuries or Illnesses due to an act of Terrorism involving the use or release of any nuclear weapon or device or chemical or biological agent, regardless of any contributory cause(s).
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, including but not limited to complications of previous elective or cosmetic surgeries.
22. Custodial Care.
23. Expenses for supplies and services that were not incurred with in the specified Geographic Area.
24. Pre-existing conditions.
25. Racing of any kind, all professional or semi-professional sports, and collegiate, sponsored, or interscholastic athletics.^**

* This exclusion can be removed if the appropriate additional premium has been paid and the optional benefit is indicated on the Schedule or attached by an endorsement.

** This exclusion can be removed if the appropriate additional premium has been paid and the optional benefit is indicated on the Schedule or attached by an endorsement. Please note this exclusion cannot be removed with the online enrollment.

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.