Group Major Medical

FOR

• Medical Expenses
• Medical Evacuation

USES

• Employee Benefits
• International Coverage

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.
• Medical Evacuation: All medically necessary expenses for stabilization and transportation to the facility nearest your home, which can provide the appropriate care up to $100,000.
• 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.
• $25,000 Accidental Death: $50,000 if accidental death occurs while riding as a passenger of a common carrier.
• 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.
• 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.
• 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.
• Common Accident Provision: In the event that you and any additional insured family members suffer injuries from the same accident, only one deductible shall be applied.

Petersen International Underwriters

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

Information PIU Collects

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

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

Information PIU Discloses

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.).

Confidentiality and Security

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.

Contacting PIU

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 is not intended to be a complete outline of coverage. Actual wording may change without notice. Underwriters reserve the right to modify terms and benefits at time of underwriting.

Please complete the Paper Application and either fax it to +1 (972) 767-4470, email it to plans@insubuy.com or mail to Insubuy, LLC.

FOR ADDITIONAL INFORMATION

Toll Free: +1 (866) INSUBUY
Phone: +1 (972) 985-4400
Fax: +1 (972) 767-4470
Website: www.insubuy.com

Version: GIMM 06.12