Inbound^® USA - Visitor Insurance USA

Non-US Citizens. 5 Days - 364 Days

medical coverage for non-u.s. citizens visiting the u.s.

foreign visitors traveling to the u.s.: emergency • medical evacuation • repatriation of remains • 24 hour assistance service • scheduled benefit coverage & premiums

The United States offers the most comprehensive medical care, but it is often complicated as well as very expensive. For a visitor to the United States or a recent immigrant, finding an insurance program that is easy to understand and reasonably priced is often difficult.

As a solution, Inbound^® USA was developed to provide a simple program to visitors and immigrants.

This is a brief description of the Inbound^® USA program. Detailed wording is outlined in the Program Summary, which will be sent to you once you have enrolled in Inbound^® USA.

This program is available to non-United States citizens who come to the U.S. for business, pleasure, or to study. The program must become effective within twelve (12) months of arrival in the United States.

What does this mean for you? If you visit one of our network physicians or facilities, the bill from your provider will automatically be reviewed for possible discounts. The scheduled benefit limits and the deductible will then be applied. If there is a remaining balance, you will be notified of the amount you owe. Please note: the amount of the discount varies based on the doctor, hospital and procedure. In some cases, a reduction in pricing may not be available.

You are not required to use our network; however any treatment received outside of the network will not be presented for possible discounts.

MultiPlan PPO Network

You may initially enroll in Inbound^® USA for as little as 5 days and up to maximum of three hundred and sixty four (364) days. Total period of coverage for Inbound^® USA cannot exceed three hundred and sixty four (364) days (in order to reapply after the three hundred and sixty four (364) days, you must first return to your home country). Please note: Once you reapply for a new policy, the pre-existing condition(s) look back starts over.

effective date - Your coverage will begin at 12:01 AM North American Eastern Time on the latest of the following:

1. Your departure from your Home Country; or
2. The date your Application and premium are received by Seven Corners; or
3. The date your Application and premium are accepted by Seven Corners; or
4. The date you request on the Application.

expiration date - Your coverage will end at 12:01 AM North American Eastern Time on the earlier of the following:

1. The date shown on the Insurance Confirmation Card, for which premium has been paid; or
2. The date you return to your Home Country; or
3. Three hundred and sixty four (364) days after your original Effective Date; or
4. The day an insured becomes a U.S. citizen; or
5. The date of entry into active military service.

Home Country is defined as the country where an Insured Person has his or her true, fixed and permanent residence.

Upon each renewal, the rates, benefits, and program in general are subject to change.

When you apply online, you will have the option to renew in whatever increment you choose (Minimum five (5) day purchase). There is a $5 administration fee each time you renew. Again, the total period of coverage for Inbound^® USA cannot exceed three hundred and sixty four (364) days.

If your covered Injury or Sickness requires treatment by a physician, this program will provide benefits up to the Scheduled amount, as listed in the Schedule of Benefits which exceed the chosen Per Person Deductible ($0, $50 or $100, and a $100 or $200 deductible for age seventy (70) and over) for each Injury and each Sickness and which are incurred within the twenty-six (26) weeks following the Injury or Sickness. Payment for any covered service will not exceed the Benefit Maximum shown. The maximum amount payable for all benefits will be no more than $50,000, $75,000, $100,000, or $130,000 for each Injury and each Sickness.

For persons age seventy (70) and over, the maximum benefit limit is $50,000 or $70,000 for each Injury or Sickness. The period in which covered expenses must be incurred is twenty-six (26) weeks following the Injury or Sickness, and a separate schedule applies.

Age 14 days to Age 69	Plan A	Plan B	Plan C	Plan D
INPATIENT	$50,000 Max per Injury/Sickness	$75,000 Max per Injury/Sickness	$100,000 Max per Injury/Sickness	$130,000 Max per Injury/Sickness
Hospital Room & Board including Laboratory Tests, X-Rays, Prescription Medical and other miscellaneous	Up to $1,400/day, 30 day max	Up to $1,675/day, 30 day max	Up to $1,950/day, 30 day max	Up to $2,535/day, 30 day max
Hospital Intensive Care Unit	Additional $660/day, 8 day max	Additional $755/day, 8 day max	Additional $850/day, 8 day max	Additional $1,105/day, 8 day max
Surgical Treatment	Up to $3,300	Up to $4,400	Up to $5,500	Up to $7,150
Anesthetist	Up to $825	Up to $1,100	Up to $1,375	Up to $1,775
Assistant Surgeon	Up to $825	Up to $1,100	Up to $1,375	Up to $1,775
Physician"s Non-Surgical Visits	Up to $55/visit, 1/day, 30 visits max	Up to $70/visit,1/day, 30 visits max	Up to $85/visit, 1/day, 30 visits max	Up to $110/visit, 1/day, 30 visits max
A Consulting Physician, when requested by attending Physician	Up to $450	Up to $475	Up to $500	Up to $650
Private Duty Nurse	Up to $550	Up to $550	Up to $550	Up to $700
Pre-Admission Tests w/in 7 days before Hospital admission	Up to $1,100	Up to $1,100	Up to $1,100	Up to $1,450
OUTPATIENT
Surgical Treatment	Up to $3,300	Up to $4,400	Up to $5,500	Up to $7,150
Anesthetist	Up to $825	Up to $1,100	Up to $1,375	Up to $1,775
Assistant Surgeon	Up to $825	Up to $1,100	Up to $1,375	Up to $1,775
Physician"s Non-Surgical / Urgent Care Visits	Up to $55/visit, 1/day, 10 visits max	Up to $70/visit, 1/day, 10 visits max	Up to $85/visit, 1/day, 10 visits max	Up to $110/visit, 1/day, 10 visits max
Diagnostic X-rays & Lab Services	Up to $450 - Additional $250 - One Cat scan, PET scan or MRI	Up to $475 - additional $375 - One Cat scan, PET scan or MRI	Up to $500 - Additional $400 - One Cat scan, PET scan or MRI	Up to $650 - Additional $550 - One Cat scan, PET scan or MRI
Hospital Emergency Room (all expenses incurred therein)	Up to $330	Up to $440	Up to $550	Up to $700
Prescription Drugs	Up to $100	Up to $125	Up to $150	Up to $200
Outpatient Surgical Facility	Up to $1,000	Up to $1,050	Up to $1,100	Up to $1,400
OTHER TREATMENT & SERVICES
Ambulance Services	Up to $450	Up to $450	Up to $450	Up to $450
Initial Orthopedic Prosthesis/brace	Up to $1,100	Up to $1,200	Up to $1,300	Up to $1,700
Chemotherapy and/or radiation therapy	Up to $1,100	Up to $1,225	Up to $1,350	Up to $1,750
Dental Treatment for Injury to Sound, Natural Teeth	Up to $550	Up to $550	Up to $550	Up to $550
Mental & Nervous Disorder & Substance Abuse	Same as any Sickness	Same as any Sickness	Same as any Sickness	Same as any Sickness
Physiotherapy	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max
Emergency Evacuation	$50,000	$50,000	$50,000	$50,000
Repatriation of Remains	$7,500	$7,500	$7,500	$7,500
AD&D Principal Sum	$25,000 Common Carrier	$25,000 Common Carrier	$25,000 Common Carrier	$25,000 Common Carrier
OPTIONAL PRE-EX BENEFIT
PRE-EXISTING CONDITIONS (the above maximum schedule still applies)	Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke	Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke	Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke	Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke

If an insured person turns seventy (70) years old during the purchased coverage period, the seventy (70) and over benefit schedule becomes effective upon the day the insured turns seventy (70). Individuals with the $100,000 or $130,000 per injury or sickness policy maximum will receive the $70,000 per injury or sickness schedule for age seventy (70) and older. Individuals with the $75,000 or $50,000 per injury or sickness policy maximum will receive the $50,000 per injury or sickness schedule for age seventy (70) and older.

Age 70 to Age 99	Plan J	Plan K
INPATIENT	$50,000 Max per Injury/Sickness	$70,000 Max per Injury/Sickness
Hospital Room & Board including Laboratory Tests, X-Rays, Prescription Medical and other miscellaneous	Up to $1,050/day, 30 day max	Up to $1,470/day, 30 day max
Hospital Intensive Care Unit	Additional $460/day, 8 day max	Additional $640/day, 8 day max
Surgical Treatment	Up to $2,750	Up to $3,850
Anesthetist	Up to $685	Up to $960
Assistant Surgeon	Up to $685	Up to $960
Physician"s Non-Surgical Visits	Up to $55/visit, 1/day, 30 visits max	Up to $75/visit, 1/day, 30 visits max
A Consulting Physician, when requested by attending Physician	Up to $400	Up to $560
Private Duty Nurse	Up to $450	Up to $450
Pre-Admission Tests w/in 7 days before Hospital admission	Up to $775	Up to $1,085
OUTPATIENT
Surgical Treatment	Up to $2,750	Up to $3,850
Anesthetist	Up to $685	Up to $960
Assistant Surgeon	Up to $685	Up to $960
Physician"s Non-Surgical / Urgent Care Visits	Up to $55/visit, 1/day, 10 visits max	Up to $75/visit, 1/day, 10 visits max
Diagnostic X-rays & Lab Services	Up to $400 - Additional $250 - One Cat scan, PET scan or MRI	Up to $560 - additional $300 - One Cat scan, PET scan or MRI
Hospital Emergency Room (all expenses incurred therein)	Up to $250	Up to $350
Prescription Drugs	Up to $80	Up to $110
Outpatient Surgical Facility	Up to $850	Up to $1,190
OTHER TREATMENT AND SERVICES
Ambulance Services	Up to $450	Up to $450
Initial Orthopedic Prosthesis/brace	Up to $850	Up to $1,190
Chemotherapy and/or radiation therapy	Up to $850	Up to $1,190
Dental Treatment for Injury to Sound, Natural Teeth	Up to $550	Up to $550
Mental & Nervous Disorder & Substance Abuse	Same as any Sickness	Same as any Sickness
Physiotherapy	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max
Emergency Evacuation	$50,000	$50,000
Repatriation of Remains	$7,500	$7,500
AD&D Principal Sum	$25,000 Common Carrier	$25,000 Common Carrier
OPTIONAL PRE-EX BENEFIT
PRE-EXISTING CONDITIONS (the above maximum schedule still applies)	Up to $3,000 in coverage for Myocardial Infarction (heart attack) or Stroke	Up to $3,000 in coverage for Myocardial Infarction (heart attack) or Stroke

Inbound^® USA now offers the following benefit: Should the Insured Person suffer a Myocardial Infarction or Stroke during the Period of Coverage and it is determined to be a "Pre-Existing Condition," coverage for those expenses will be covered up to the Pre-Existing Condition Benefit maximum, according to the Schedule of Benefits.

An insured person may travel to additional countries, other than the United States, up to a maximum of thirty (30) days. You must purchase a minimum of one (1) month of coverage. International travel coverage does not include travel back to the insured person’s home country, and it does not extend after your current expiration date. International travel must be utilized during your current Period of Coverage.

The program will pay up to $50,000 in Covered Expenses incurred if any covered Injury or Sickness originating during the Period of Coverage results in the Medically Necessary Emergency Medical Evacuation or Repatriation of the Insured Person (the Insured Person’s medical condition warrants immediate transportation from the medical facility where the Insured Person is located to the nearest adequate medical facility where medical treatment can be obtained). The benefit must be ordered by the Assistance Company in consultation with the Insured Person’s local attending Physician.*

The program will pay for Covered Expenses incurred, up to a maximum of $7,500, to return the Insured Person’s remains to his/her Home Country if he or she dies.*

Accidental Death and Dismemberment shall apply to covered accidents sustained by an insured person while riding as a passenger in or on any land, water or air conveyance operated under a license for the transportation of passengers for hire. A loss must occur within 365 days after the date of accident causing the loss.

* NOTE: If event of an Emergency Medical Evacuation or Repatriation of Mortal Remains benefit is needed or utilized, arrangements must be made by the Assistance Service Provider.

No benefits will be paid for loss or expense caused by, contributed to, or resulting from:

1. Pre-existing Conditions as defined;
2. Any expenses incurred when travel was undertaken solely for the purpose of obtaining medical treatment or while traveling against the advice of a Physician;
3. Expense incurred within the Insured Person’s Home Country or country of regular domicile;
4. Routine physicals, inoculations, or other examinations where there are no objective indications of impairment of normal health, well baby care, new-born baby care; well-baby nursery and related Physician charges;
5. Prescriptions or fitting of eyeglasses and contact lenses; eye examinations; or other treatment for visual defects and problems. "Visual defects": means any physical defect of the eye which does or can impair normal vision;
6. Hearing examinations or hearing aids; or other treatment for hearing defects and problems. "Hearing defects": means any physical defect of the ear which does or can impair normal hearing:
7. Dental treatment, except as the result of injury to sound, natural teeth;
8. Services or supplies performed or provided by a Member of the Insured Person’s family, or anyone who lives with the Insured Person;
9. Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician;
10. Weak, strained or flat feet, corns, calluses, or toenails;
11. Cosmetic surgery, or treatment for congenital anomalies (except as specifically provided), except reconstructive surgery as the result of a covered Injury or Sickness. Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or covered Sickness;
12. Elective Surgery and Elective Treatment;
13. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth;
14. Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics;
15. Organ transplants;
16. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war; terrorist activity; nuclear, chemical, biological; (details in program summary)
17. Participation in a riot or civil disorder, commission of or attempt to commit a felony in the country in which it was attempted or committed;
18. Suicide or attempted suicide (including drug overdose), while sane or insane (while sane in Missouri), or an intentionally self-inflicted Injury;
19. Expenses of an institution, health service, or infirmary for whose service payment is not required in the absence of insurance;
20. Treatment of nervous or mental disorders, except as stated in the Schedule of Benefits, or treatment of alcoholism or drug abuse, except as provided for treatment of mental or nervous disorders, according to the Schedule of Benefits;
21. Loss incurred from riding in any aircraft, other than as a passenger in an aircraft licensed for the transportation of passengers;
22. Treatment services, supplies or facilities in a hospital owned or operated by: a) The Veteran"s Administration; or b) A national government or any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Insured is required by law to pay);
23. Duplicate services actually provided by both a certified nurse-midwife and Physician;
24. Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
25. Expenses incurred for outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or sublimation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column;
26. Injury sustained while taking part in mountaineering where ropes or guides are normally used, hang gliding, parachuting, bungee jumping, racing by horse or motor vehicle or motorcycle, motorcycle/motor scooter riding, scuba diving involving underwater breathing apparatus (unless PADI or NAUI certified), water skiing, snow skiing, snow boarding and snowmobiling;
27. Treatment paid for or furnished under any other individual, government, or group policy; previous policy; payable under any Worker"s Compensation or Occupational Disease Law or Act; or charges provided at no cost to the Insured Person;
28. Expense incurred after the Expiration Date for an Insured Person except as may be specifically provided;
29. Expenses for treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent or for Injury or Sickness due wholly or partly to the effects of intoxicating liquor or drugs, unless prescribed by a Physician;
30. Sexually transmitted diseases, including AIDS.
31. Pregnancy expenses or Sickness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from Injury; or voluntary or elective abortion;
32. Treatment while confined primarily to receive custodial care, educational or rehabilitative care and nursing services in a long term facility, spa, hydroclinic, weight loss clinic, sanatorium, nursing home or similar facilities;
33. Expenses for Speech therapy, Occupational therapy or Vocational Rehabilitation

hospital shall mean a place that 1.) Is legally operated for the purpose of providing medical care and Treatment to Sick or Injured persons for which a charge is made that the Insured Person is legally obligated to pay in the absence of insurance 2.) Provides such care and Treatment in medical, diagnostic, or surgical facilities on its premises, or those prearranged for its use; 3.) Provides 24-hour nursing service under the supervision of a Registered Nurse at all times; and 4.) Operates under the supervision of a staff of one or more Physicians. Hospital also means a place that is accredited as a Hospital by the Joint Commission on Accreditation of Hospitals, American Osteopathic Association, or the Joint Commission on Accreditation of Heath Care Organizations (JCAHO). Hospital does not mean: A Convalescent, nursing, or rest home or facility, or a home for the aged; A place mainly providing Custodial, Educational, or Rehabilitative Care; or A facility mainly used for the Treatment of drug addicts or alcoholics.

injury shall mean bodily Injury listed in the most recent edition of the International Classification of Diseases and caused solely and directly by Accidental, external, and visible means occurring while this Certificate is in force and resulting directly and independently of all other causes resulting in a Covered Event under this Program.

inpatient shall mean a person who is confined in an institution for a period of 24 hours or more and is charged for room and board.

myocardial infarction shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of Diseases version 9 (ICD9).

outpatient shall mean a person who receives care in a Hospital or another institution, including an ambulatory surgical center, a convalescent/skilled nursing facility, or a Physician’s office, for an Illness or Injury, but who is not confined and is not charged for room and board.

pre-existing condition shall mean: 1.) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment within the six (6 )months (or twelve (12) months for persons seventy (70) and older) prior to the Individual Effective Date of Coverage under this program; 2.) A condition for which medical advice, diagnosis, care or Treatment, including Medication, was sought, recommended or received within the six (6) months (or twelve (12) months for persons age seventy (70) and older) prior to the Individual Effective Date of Coverage under this program; 3.) The symptoms which occurred within the six (6) months (or twelve (12) months for persons seventy (70) and older) prior to the Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the condition producing the symptom; 4.) A condition which manifested itself within the 6 months (or twelve (12) months for persons seventy (70) and older) prior to the Individual Effective Date of Coverage under this Certificate; Should the Insured Person suffer a Myocardial Infarction or Stroke during the Period of Coverage and it is determined to be a "Pre-Existing Condition," coverage for those expenses will be covered up to the Pre-Existing Condition Benefit maximum, according to the Schedule of Benefits. (Optional Coverage must be selected on the application, and appropriate premium received.)

sickness shall mean Illness or Disease of any kind listed in the most recent edition of the International Classification of Diseases. All related conditions and recurrent symptoms of the same or a similar condition will be considered one Sickness.

stroke shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of Diseases version 9 (ICD9).

Premium:	45-year-old non-US citizen traveling to the United States, from March 15th to April 10th
Example:	$50 per Injury / Sickness deductible and $50,000 per incident maximum, with pre-existing condition option
Daily Rate for 45 year old, $1.26 per day: Optional Pre-Ex Benefit $1.26 x 1.26 =	$1.59 (New Daily rate)
	x
March 15th through April 10th equals 27 days:	27 days
Total Premium Submitted:	$42.93

Please be aware that this is not a general health insurance policy, but an interim program intended for temporary use. Inbound^® USA does not guarantee payment to a facility or individual for medical expenses until the Company determines that it is an eligible expense.

Upon successful enrollment in Inbound^® USA, you will receive an information packet from Seven Corners, if you choose written fulfillment. If an email address is provided, you will receive electronic fulfillment which provides complete policy details. Both methods will include your ID Card and Program Summary. The Program Summary describes all the benefits of Inbound^® USA in complete detail. In addition, the Program Summary explains the procedure for submitting claims.

Seven Corners realizes that there is uncertainty in international travel. Refund of total plan cost will only be considered if written request is received by Seven Corners prior to the Effective Date of Coverage. If written request is received after the Effective Date of coverage, the unused portion of the plan cost may be refunded minus a cancellation fee, provided no claim has been submitted to Seven Corners for reimbursement.

Inbound^® USA is underwritten by Certain Underwriters at Lloyd’s of London and is rated A "Excellent" by A.M. Best. In addition to being one of the largest insurance entities in the world, Lloyd’s has over 300 years of experience in the international insurance business.

**Attention Applicants: Certain Underwriters at Lloyd’s of London, operates as an approved Surplus Lines market in the United States. The premiums listed include a general Surplus Lines Tax. Your State of Residence may warrant an additional Surplus Lines Tax, Stamping Fees and administration fee. Upon receipt and review of your application, Seven Corners will inform you if additional Surplus Lines Taxes and fees will apply. If so, Seven Corners will request the payment of the additional Surplus Lines Taxes and fees from you prior to issuing coverage. The additional Surplus Lines Taxes and fees shall be listed on the declaration page of your policy.

Monthly Rates Effective February 1, 2012**

$0 Per Injury / Sickness Deductible Per Person
Policy Maximum Options

	Plan A	Plan B	Plan C	Plan D
Age	$50,000 Monthly/Daily	$75,000 Monthly/Daily	$100,000 Monthly/Daily	$130,000 Monthly/Daily
2 weeks - 18	$45 / $1.51	$53 / $1.78	$61 / $2.04	$80 / $2.65
19 - 29	$38 / $1.25	$44 / $1.46	$51 / $1.68	$66 / $2.18
30 - 39	$42 / $1.40	$50 / $1.65	$57 / $1.89	$74 / $2.46
40 - 49	$45 / $1.51	$53 / $1.78	$61 / $2.04	$80 / $2.65
50 - 59	$62 / $2.06	$72 / $2.39	$82 / $2.73	$106/ $3.54
60 - 69	$69 / $2.29	$80 / $2.66	$91 / $3.03	$118 / $3.94
Dependent Child (Age 2 weeks - 18)*	$43 / $1.43	$51 / $1.69	$58 / $1.94	$76 / $2.52

$50 Per Injury / Sickness Deductible Per Person
Policy Maximum Options

	Plan A	Plan B	Plan C	Plan D
Age	$50,000 Monthly/Daily	$75,000 Monthly/Daily	$100,000 Monthly/Daily	$130,000 Monthly/Daily
2 weeks - 18	$38 / $1.26	$44 / $1.47	$51 / $1.69	$66 / $2.19
19 - 29	$31 / $1.04	$37 / $1.22	$42 / $1.39	$54 / $1.81
30 - 39	$35 / $1.17	$41 / $1.37	$47 / $1.57	$61 / $2.03
40 - 49	$38 / $1.26	$44 / $1.47	$51 / $1.69	$66 / $2.19
50 - 59	$52 / $1.72	$60 / $2.00	$68 / $2.28	$89 / $2.96
60 - 69	$57 / $1.91	$67 / $2.22	$76 / $2.53	$99 / $3.29
Dependent Child (Age 2 weeks - 18)*	$36 / $1.20	$42 / $1.40	$48 / $1.61	$62 / $2.08

$100 Per Injury / Sickness Deductible Per Person
Policy Maximum Options

	Plan A	Plan B	Plan C	Plan D
Age	$50,000 Monthly/Daily	$75,000 Monthly/Daily	$100,000 Monthly/Daily	$130,000 Monthly/Daily
2 weeks - 18	$35 / $1.16	$41 / $1.37	$47 / $1.57	$62 / $2.05
19 - 29	$29 / $0.96	$34 / $1.13	$39 / $1.30	$51 / $1.69
30 - 39	$32 / $1.08	$38 / $1.27	$44 / $1.46	$57 / $1.90
40 - 49	$35 / $1.16	$41 / $1.37	$47 / $1.57	$62 / $2.05
50 - 59	$48 / $1.59	$57 / $1.90	$67 / $2.22	$86 / $2.88
60 - 69	$53 / $1.78	$64 / $2.12	$74 / $2.47	$96 / $3.21
Dependent Child (Age 2 weeks - 18)*	$33 / $1.10	$39 / $1.30	$45 / $1.49	$59 / $1.95

* Dependent Child rate is applicable when at least one parent will also be covered under Inbound^® USA.

$100 Per Injury / Sickness Deductible Per Person
Policy Maximum Options

	Plan J	Plan K
Age	$50,000 Monthly/Daily	$70,000 Monthly/Daily
Age 70 - 74	$89 / $2.98	$125 / $4.16
Age 75 - 79	$98 / $3.28	$137 / $4.58
Age 80 - 84	$198 / $6.60	$278/ $9.26
Age 85 - 89	$286/ $9.52	$400 / $13.33
Age 90 - 94	$309 / $10.30	$433/ $14.43
Age 95 - 99	$356 / $11.84	$497 / $16.56

$200 Per Injury / Sickness Deductible Per Person
Policy Maximum Options

	Plan J	Plan K
Age	$50,000 Monthly/Daily	$70,000 Monthly/Daily
Age 70 - 74	$74 / $2.48	$104 / $3.47
Age 75 - 79	$82 / $2.73	$115 / $3.82
Age 80 - 84	$166/ $5.51	$232 / $7.71
Age 85 - 89	$244 / $8.11	$341 / $11.36
Age 90 - 94	$264 / $8.78	$369 / $12.29
Age 95 - 99	$303 / $10.08	$424 / $14.11

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Since 1993, Seven Corners has provided medical insurance to corporations, worldwide travelers, expatriates, students, overseas visitors, immigrants and global citizens. With expertise and efficiency, we’ve served clients in more than a hundred countries.

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

Toll Free: (866) INSU-BUY

Fax: (972) 767-4470

1. Complete and sign entire application
2. Select method of payment.
3. If paying by check or money order, make payable to: "Seven Corners" and enclose it together with completed Application.
4. If paying by credit card, complete Application and mail or fax to the address below. Be sure to sign both sections, including the Method of Payment section.

Complete and return the Application with your payment for the total premium to:

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

Fax: (972) 767-4470

(You may only fax your application if paying by credit card. Originals are not required if application is faxed to Seven Corners with credit card payment)

Inbound^® is a registered trademark of Seven Corners, Inc.
Seven Corners^® is a registered trademark of Seven Corners, Inc.
v.02.16.2012