Home Country Coverage

Home Country Coverage (If Benefit is Purchased):

The Home Country Coverage provides limited coverage under your Medical Expense Benefit while in your Home Country. The plan pays 80% up to $5,000 of Eligible Expenses, then 100% to a maximum of 1) $50,000 for Incidental Trip(s) to your Home Country or 2) $10,000 for Extension of Benefits (Follow Me Home Coverage).

1) Incidental Trip(s) to your Home Country: During the period of coverage, You may return to Your Home Country for incidental visits of up to 60 days per 12 months of coverage, or pro rata thereof (approximately 5 days per month of purchased coverage). If during an incidental trip home, You suffer an Injury or Sickness, this Plan will pay up to $50,000 of Eligible Expenses.

2) Extension of Benefits (Follow Me Home Coverage): This plan will pay up to a maximum of $10,000 for Eligible Expenses incurred in Your Home Country related to an Injury or Sickness which originally occurred, was diagnosed and treated outside Your Home Country during Your period of coverage.

Home Country Coverage (If Benefit is Purchased):

The Home Country Coverage provides limited coverage under your Medical Expense Benefit while in your Home Country. The plan pays 80% up to $5,000 of Eligible Expenses, then 100% to a maximum of 1) $50,000 for Incidental Trip(s) to your Home Country or 2) $10,000 for Extension of Benefits (Follow Me Home Coverage).

1) Incidental Trip(s) to your Home Country: During the period of coverage, You may return to Your Home Country for incidental visits of up to 60 days per 12 months of coverage, or pro rata thereof (approximately 5 days per month of purchased coverage). If during an incidental trip home, You suffer an Injury or Sickness, this Plan will pay up to $50,000 of Eligible Expenses.

2) Extension of Benefits (Follow Me Home Coverage): This plan will pay up to a maximum of $10,000 for Eligible Expenses incurred in Your Home Country related to an Injury or Sickness which originally occurred, was diagnosed and treated outside Your Home Country during Your period of coverage.

Extension of Benefits in Home Country:

The Company will reimburse You for Covered Expenses incurred in Your Home Country, including those incurred in Your Home Country following an Emergency Medical Evacuation or an Emergency Medical Repatriation, up to the amount set forth in the Schedule of Benefits for one hundred eighty days (180) from the onset of a new, covered Injury or Illness that begins while You are traveling and is first diagnosed and treated outside Your Home Country. The Deductible, Copay and Coinsurance options set forth in Section 3.1 apply to this coverage and will be Your responsibility. This coverage does not apply for Pre-Existing Conditions. The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this section.

The limit for this coverage is the amount shown on the Schedule of Benefits under “Extension of Benefits in Home Country,” not the amount shown for “Medical Maximum Options.”

Incidental Trips to Home Country:

If the Period of Coverage is greater than thirty (30) days, the Company will reimburse You for Covered Expenses up to the amount set forth in the Schedule of Benefits for a new covered Injury or Illness that begins while You are on an incidental trip to Your Home Country. You must first depart Your Home Country before utilizing this benefit, and it does not apply to the final trip to Your Home Country. You may be required to provide proof of your travel intentions. Additionally, this coverage will not apply (i) if the Illness began or Injury occurred while You were outside Your Home Country or (ii) for Pre-Existing Conditions.

Under this section, You will receive five (5) days of coverage per month of coverage purchased up to a maximum of sixty (60) days per three hundred sixty-four (364) days of purchased coverage. The Deductible, Copay and Coinsurance options set forth in Section 3.1 apply to this coverage and will be Your responsibility. The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this section.

The limit for this coverage is that amount shown on the Schedule of Benefits under “Incidental Trips to Home Country,” not the amount shown for “Medical Maximum Options.”

3.8 Incidental Trips to Home Country.

If the Period of Coverage is greater than thirty (30) days, the Company will reimburse You for Covered Expenses up to the amount set forth in the Schedule of Benefits for a new covered Injury or Illness that begins while You are on an incidental trip to Your Home Country. You must first depart Your Home Country before utilizing this benefit, and it does not apply to the final trip to Your Home Country. You may be required to provide proof of your travel intentions. Additionally, this coverage will not apply (i) if the Illness began or Injury occurred while You were outside Your Home Country or (ii) for Pre-Existing Conditions.

Under this section, You will receive five (5) days of coverage per month of coverage purchased up to a maximum of sixty (60) days per three hundred sixty-four (364) days of purchased coverage. The Deductible, Copay and Coinsurance options set forth in Section 3.1 apply to this coverage and will be Your responsibility. The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this section.

The limit for this coverage is that amount shown on the Schedule of Benefits under “Incidental Trips to Home Country,” not the amount shown for “Medical Maximum Options.”

3.7 Extension of Benefits in Home Country.

The Company will reimburse You for Covered Expenses incurred in Your Home Country, including those incurred in Your Home Country following an Emergency Medical Evacuation or an Emergency Medical Repatriation, up to the amount set forth in the Schedule of Benefits for one hundred eighty days (180) from the onset of a new, covered Injury or Illness that begins while You are traveling and is first diagnosed and treated outside Your Home Country. The Deductible, Copay and Coinsurance options set forth in Section 3.1 apply to this coverage and will be Your responsibility. This coverage does not apply for Pre-Existing Conditions. The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this section.

The limit for this coverage is the amount shown on the Schedule of Benefits under “Extension of Benefits in Home Country,” not the amount shown for “Medical Maximum Options.”

3.8 Incidental Trips to Home Country.

If the Period of Coverage is greater than thirty (30) days, the Company will reimburse You for Covered Expenses up to the amount set forth in the Schedule of Benefits for a new covered Injury or Illness that begins while You are on an incidental trip to Your Home Country. You must first depart Your Home Country before utilizing this benefit, and it does not apply to the final trip to Your Home Country. You may be required to provide proof of Your travel intentions. Additionally, this coverage will not apply (i) if the Illness began or Injury occurred while You were outside Your Home Country or (ii) for Pre-Existing Conditions.

Under this Section, You will receive five (5) days of coverage per month of coverage purchased up to a maximum of sixty (60) days per three hundred sixty-four (364) days of purchased coverage. The Deductible, Copay and Coinsurance options set forth in Section 3.1 apply to this coverage and will be Your responsibility.

The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this Section.

The limit for this coverage is that amount shown on the Schedule of Benefits under “Incidental Trips to Home Country,” not the amount shown for “Medical Maximum Options.”

3.7 Extension of Benefits in Home Country. The Company will reimburse You for Covered Expenses incurred in Your Home Country, including those incurred in Your Home Country following an Emergency Medical Evacuation or an Emergency Medical Repatriation, up to the amount set forth in the Schedule of Benefits for one hundred eighty days (180) from the onset of a new, covered Injury or Illness that begins while You are traveling and is first diagnosed and treated outside Your Home Country. The Deductible, Copay and Coinsurance options set forth in Section 3.1 apply to this coverage and will be Your responsibility. This coverage does not apply for Pre-Existing Conditions. The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this Section.

The limit for this coverage is the amount shown on the Schedule of Benefits under “Extension of Benefits in Home Country,” not the amount shown for “Medical Maximum Options.”

RETURN TO HOME COUNTRY – if purchased

$50,000 per Policy Period Maximum days covered Up to 60 days per 12 months

RETURN TO HOME COVERAGE – If Purchased You may return to your Home Country of residence for up to 60 days during the Policy Period. The benefits available are those as outlined in the Schedule of Benefits and may ONLY be utilized after initially leaving the Home Country of residence and then returning for an Incidental Trip. The benefits are subject to any policy limitations and all of the exclusions.

In consideration of additional premium paid, the following modifications have been made to your policy:

Under the Exclusions section the following is deleted in its entirety:

35. expenses incurred in your Home Country.

And replaced with the following Exclusion:

35. expenses incurred in your Home Country except as provided under the Medical Expense Benefits;

The following is added under the Medical Expense Benefits section:

This benefit covers you for Injury or Sickness that occur during an incidental trip to your Home Country. Maximum benefit is reduced to $50,000 for any illness or injury occurring while on an incidental trip to your Home Country. The chosen deductible and Coinsurance apply.

This plan shall pay for Covered Expenses incurred in your Home Country up to $5,000 for conditions first diagnosed outside Your Home Country. This Benefit does not apply when an Emergency Evacuation has occurred. The chosen deductible applies and Coinsurance: 80% of the first $5,000 of Covered Expenses, then 100% to the $5,000 maximum

This benefit is limited to 60 days per 12 months of purchased coverage or pro rata thereof. (Example: 5 days per month of purchased coverage).

RETURN TO HOME COUNTRY – if purchased

$50,000 per Policy Period. Maximum days covered Up to 60 days per 12 months.

RETURN TO HOME COVERAGE – If Purchased

You may return to your Home Country of residence for up to 60 days during the Policy Period. The benefits available are those as outlined in the Schedule of Benefits and may ONLY be utilized after initially leaving the Home Country of residence and then returning for an Incidental Trip. The benefits are subject to any policy limitations and all of the exclusions.

In consideration of additional premium paid, the following modifications have been made to your policy:

Under the Exclusions section the following is deleted in its entirety:

35. expenses incurred in your Home Country.

And replaced with the following Exclusion:

35. expenses incurred in your Home Country except as provided under the Medical Expense Benefits;

The following is added under the Medical Expense Benefits section:

This benefit covers you for Injury or Sickness that occur during an incidental trip to your Home Country. Maximum benefit is reduced to $50,000 for any illness or injury occurring while on an incidental trip to your Home Country. The chosen deductible and Coinsurance apply.

This plan shall pay for Covered Expenses incurred in your Home Country up to $5,000 for conditions first diagnosed outside Your Home Country. This Benefit does not apply when an Emergency Evacuation has occurred. The chosen deductible applies and Coinsurance: 80% of the first $5,000 of Covered Expenses, then 100% to the $5,000 maximum This benefit is limited to 60 days per 12 months of purchased coverage or pro rata thereof. (Example: 5 days per month of purchased coverage).

BENEFIT PERIOD & HOME COUNTRY COVERAGE

BENEFIT PERIOD

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, in accordance with this provision, we will pay eligible medical expenses for up to 90 days beginning on the first day of diagnosis or treatment of a covered injury or illness while you are outside your home country. The benefit period applies only to eligible medical expenses related to the injury or illness that began while the certificate was in effect.

In the event you begin a benefit period while the certificate is in effect, and the certificate terminates because you return to your home country, we will pay eligible medical expenses which are incurred in your home country during the benefit period. Home country coverage applies only to eligible medical expenses related to the injury or illness that began while the certificate was in effect.

INCIDENTAL HOME COUNTRY COVERAGE

U.S. home country: For every three month period during which you are covered, eligible medical expenses incurred in the U.S. are covered up to a maximum of 15 days.

Non-U.S. home country: For every three month period during which you are covered, eligible medical expenses incurred in your home country are covered up to a maximum of 30 days.

Any benefit accrued under a single three month period does not accumulate to another period. Failure to continue your international trip or your return to your home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any home country coverage provided under the terms of this agreement.

Except for a benefit period, coverage provided under this Master Policy is for a maximum duration of 364 days.

Notwithstanding the foregoing, coverage under all plans shall terminate on the date we, at our sole option, elect to cancel all members of the same sex, age, class or geographic location, provided we give no less than 30 days advance written notice by mail to your last known address.

BENEFIT PERIOD & HOME COUNTRY COVERAGE

BENEFIT PERIOD

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, in accordance with this provision, we will pay eligible medical expenses for up to 90 days beginning on the first day of diagnosis or treatment of a covered injury or illness while you are outside your home country. The benefit period applies only to eligible medical expenses related to the injury or illness that
began while the certificate was in effect.

In the event you begin a benefit period while the certificate is in effect, and the certificate terminates because you return to your home country, we will pay eligible medical expenses which are incurred in your home country during the benefit period. Home country coverage applies only to eligible medical expenses related to the injury or illness that began while the certificate was in effect.

INCIDENTAL HOME COUNTRY COVERAGE

U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in the U.S. are covered up to a maximum of 15 days.

Non-U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in your home country are covered up to a maximum of 30 days.

Any benefit accrued under a single three-month period does not accumulate to another period. Failure to continue your international trip or your return to your home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any home country coverage provided under the terms of this agreement.

HOME COUNTRY COVERAGE

BENEFIT PERIOD

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, in accordance with this provision, we will pay eligible medical expenses for up to 90 days beginning on the first day of diagnosis or treatment of a covered injury or illness while you are outside your home country. The benefit period applies only to eligible medical expenses related to the injury or illness that began while the certificate was in effect.

INCIDENTAL HOME COUNTRY COVERAGE

U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in the U.S. are covered up to a maximum of 15 days.

Non-U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in your home country are covered up to a maximum of 30 days.

Any benefit accrued under a single three-month period does not accumulate to another period. Failure to continue your international trip or your return to your home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any home country coverage provided under the terms of this agreement.

HOME COUNTRY COVERAGE

BENEFIT PERIOD

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, in accordance with this provision, we will pay eligible medical expenses for up to 90 days beginning on the first day of diagnosis or treatment of a covered injury or illness while you are outside your home country. The benefit period applies only to eligible medical expenses related to the injury or illness that began while the certificate was in effect.

INCIDENTAL HOME COUNTRY COVERAGE

U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in the U.S. are covered up to a maximum of 15 days.

Non-U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in your home country are covered up to a maximum of 30 days.

Any benefit accrued under a single three-month period does not accumulate to another period. Failure to continue your international trip or your return to your home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any home country coverage provided under the terms of this agreement.