SCHEDULE OF BENEFITS

WHY INTERNATIONAL MEDICAL INSURANCE?                                                  Form M\COMB328
Each year, millions of people travel outside of their Home Countries, beyond the boundaries of their medical insurance. They're concerned with the potential out-of-pocket expenses that could result from an injury or sickness abroad. Liaison International offers medical coverage and emergency services to individuals and families traveling outside their Home Countries. This brochure is a brief description of Liaison International. For a full description, see the Program Summary, which will be mailed to you once you are approved for insurance.

ELIGIBILITY
Liaison International provides coverage as outlined in this brochure for individuals and families (including unmarried dependent children over 14 days and under 19 years of age) while traveling outside of their home country. Home Country is defined as - The country where an insured person(s) has his/her true, fixed and permanent home and principal establishment.

PERIOD OF COVERAGE
The minimum period of coverage under Liaison International is 15 days, maximum is 12 months (up to 3 years available, see Renewal Option section on page 11). Coverage can be purchased in a combination of monthly and 15 day periods by paying the appropriate premium. If you are interested in our renewable coverage, please refer to "Renewal Option" section.

Expiration Date
Coverage will end on the earlier of the following: 1) The arrival of the Insured Person back in their Home Country *; or 2) The date shown on the ID Card, for which premium has been paid; *See Home Country Coverage Section.

DESCRIPTION OF BENEFITS

Medical
When the Insured incurs a covered Injury or Illness, the program will pay Usual, Reasonable and Customary medical charges for Covered Expenses, excess of the chosen Deductible and Coinsurance, up to the selected Policy Maximum.  Only such expenses, incurred as the result of a disablement, which are specifically enumerated in the following list of charges, are incurred within six months from the onset of an Injury or Illness, and which are not excluded in the Exclusions, shall be considered as Covered Expenses:

1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and with the exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the Hospital's average charge for semiprivate room and board accommodation; charges made for an operating room.
2. Charges made for Intensive Care or Coronary Care charges and nursing services.
3. Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics.
4. Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis.  This includes ambulatory Surgical centers, Physicians' Outpatient visits/examinations, clinic care, and Surgical opinion consultations.
5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment;  dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon.
6. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist.
7. Local transportation to and from the nearest Hospital with facilities for required treatment.  Such transportation shall be by licensed ground ambulance only, within the metropolitan area in which the Insured Person is located at that time the service is used.  If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense.

Dental - Emergency Only
The Emergency Dental Benefit is only available to programs purchased for 1 month or more. Treatment necessary to resolve acute, spontaneous and unexpected inception of pain to natural teeth ($100) or Dental treatment necessary to restore or replace sound natural teeth lost or damaged in an Accident which is covered under the program ($500).

Emergency Medical Evacuation / Repatriation
The Program will pay Covered Expenses incurred if any covered Injury or Illness commencing 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. *

Return of Mortal Remains
The Program will pay the reasonable Covered Expenses incurred up to a maximum of $20,000 to return the Insured Person's remains to his/her Home Country, if he or she dies. *

Emergency Medical Reunion
When Emergency Medical Evacuation or Repatriation is ordered and the attending Physician recommends that a family member travel with the Insured, the program will arrange and pay, up to $10,000, for round trip economy-class transportation for one individual selected by the Insured Person, from the Insured Person’s Home Country to the location where the Insured Person is hospitalized and return to the Home Country.*

Return of Minor Child(ren)
Should the Insured Person be traveling alone with a Minor Child(ren) and is hospitalized because of a covered Illness or Injury and the Minor Child(ren), under age 19, is left unattended, the program will arrange and pay up to $5,000 for one way economy fare to their Home Country (including the cost of an attendant/escort, if necessary to insure the safety and welfare of the Minor Child(ren)). *

Hospital Indemnity
If you are hospitalized while traveling outside of the United States or Canada, and the hospitalization is considered a Covered Expense, the program will indemnify the Insured $100 for each night spent in the hospital (this benefit is in addition to any other covered expenses of the program).

Interruption of Trip
If the Insured is unable to continue the Trip due to the death of an Immediate Family member (parent, spouse, sibling or child) or due to serious damage to the Insured's principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.). The program will reimburse (up to $5,000) the Insured for the cost of economy travel, less the value of applied credit from an unused return travel ticket, to return home to their area of principal residence.*

Loss of Checked Luggage
If the Insured's checked luggage is permanently lost by the airline, the program will reimburse the Insured for the replacement of clothing and personal hygiene items lost to a maximum per bag limit of $50 (up to $250). This benefit is secondary to any other (including airline) coverage available. The Insured must furnish proof to the Company that full reimbursement has been obtained from the airline.*

Home Country Coverage
This benefit covers you for incidental trips to your Home Country (60 days per 12 months of purchased coverage or pro rata thereof - example: approximately 5 days per month). Maximum benefit is reduced to $50,000 while in your Home Country.

Assistance Services
Upon enrollment into Liaison International, you are eligible to use any of the assistance services provided by the Assistance Service Provider. Additional information is contained in the Program Summary.

• Open 24 hours/day, 365 days a year.
• Multilingual personnel.
• Physicians/Nurses on staff.
• Locate local facilities.
• Help with emergency situations.

* NOTE: In the event of an Emergency Medical Evacuation, Repatriation, Return of Mortal Remains, Emergency Reunion, Return of Minor Child(ren), Interruption of Trip, Loss of Checked Luggage benefit is needed or utilized, arrangements must be made by the Assistance Service Provider. Complete details about the benefits and about the required notification of the Assistance Service Provider are contained in the Program Summary.

OPTIONS

Hazardous Sport Coverage
To cover motorcycle / motor scooter riding, mountaineering (4500 meter limit), hang gliding, parachuting, bungee jumping, water skiing, snow skiing, snowmobiling, and snow boarding.

PRENOTIFICATION / REFERRAL
In order to ensure your claims are addressed as efficiently as possible, the Insured or the provider of service, must contact the Assistance Company for prenotification prior to: hospital admissions and inpatient / outpatient surgeries. The Assistance Company has trained personnel available 24 hours a day, 7 days a week throughout the year to answer your questions, provide assistance, and guide you to an appropriate facility if necessary. In the case of an Emergency Admission, the Assistance Company must be contacted within 48 hours, or as soon as reasonably possible. Prenotification does not guarantee that benefits will be paid. Failure to prenotify will result in a 20% reduction in Eligible Benefits.

Please be aware that this is not a general health insurance policy, but an interim, limited benefit period, travel medical program intended for use while away from your Home Country.  Liaison International does not guarantee payment to a facility or individual for medical expenses until SRI determines that it is an eligible expense.

REFUND OF PREMIUM
Refund of premium will be considered only if written request is received by SRI prior to the Effective Date of Coverage.  After the Effective Date of Coverage, the premium is considered fully earned and nonrefundable.

CLAIM SUBMISSION
Filing a claim with SRI is easy. You will receive a Liaison International identification card and claim form once you are approved for insurance. When you receive treatment, you send the original, itemized bills to SRI within 90 days. Eligible bills are automatically converted from local currencies to US dollars. For payment of eligible medical expenses, notify SRI of pending treatments and we can refer you to approved health care providers worldwide. You're simply responsible for your deductible, coinsurance amounts and non-eligible expenses. For more details, consult the Program Summary that is provided with your insurance kit, or contact the SRI Claim Department.

EXCLUSIONS

For Medical benefits, this Insurance does not cover:

1. Any Injury or Illness which meets the following criteria: a) condition(s) that would have caused a person to seek medical advise, diagnosis, care or treatment during the 36 months prior to the Effective Date of coverage under this Policy; 2) condition(s) for which manifestation, medical advise, diagnosis, care or treatment was recommended, received, or noticed during the 36 months prior to the Effective Date of coverage under this Policy; If the Injury or Illness is an Unexpected Recurrence and the Insured Person is traveling outside the United States and Canada, the program will reimburse up to $1000 for treatment of that particular condition. An Unexpected Recurrence is a sudden and unexpected outbreak or recurrence of a condition defined in a & b above. The condition must occur spontaneously and without advanced warning, for example: prior symptoms, Physician visit, failing to take medication. For Insured Persons traveling outside the United States and Canada, the period is 12 months instead of 36 months.
2. Charges for treatment which exceed Reasonable and Customary charges; or Charges incurred for Surgeries or treatments which are Investigational, Experimental, or for research purposes; expenses which are nonmedical in nature; expenses for Vocational, Speech, Recreational or Music Therapy;
3. Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician;
4. Suicide or any attempt there at, while sane or self destruction or any attempt there at, while insane; intentionally self-inflicted Injury or Illness; or expenses as a result or in connection with the commission of a felony offense;
5. 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;
6. Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics;
7. Routine physicals, innoculations, or other examinations where there are no objective indications or impairment in normal health;
8. Treatment of the Temporomandibular joint.
9. Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person.
10. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids, cosmetic or plastic Surgery (including deviated nasal septum), routine dental expenses, eye care or eye related expenses, unless caused by Accidental bodily Injury incurred while insured hereunder;
11. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent; any Mental and Nervous disorders or rest cures; Injury sustained while under the influence of or Disablement due to wholly or partly to the effects of intoxicating liquor or drugs;
12. Congenital abnormalities and conditions arising out of or resulting therefrom;
13. Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
14. 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, snowmobiling, motorcycle / motor scooter riding, scuba diving involving underwater breathing apparatus (unless PADI certified), water skiing, snow skiing and snow boarding; *
15. Treatment paid for or furnished under any other individual, government, or group policy or charges provided at no cost to the Insured Person.
16. Treatment of venereal or sexually transmitted disease.
17. Pregnancy expenses or Illness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from Accident.
18. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth;
19. Expenses incurred while the Insured Person is in their Home Country (except after approved Emergency Evacuation/Repatriation or if treatment is a follow-up to a covered disablement during coverage or if the expenses pertain to the Home Country Coverage benefit); *
20. Expenses incurred for which travel was undertaken to seek medical treatment for a condition; or incurred after the Insured Person’s physician has limited or restricted travel.

* Options are available to include all or part of these risks.

Detailed Exclusions pertaining to the benefits of this product are listed in the Program Summary, which will be mailed to you along with the ID Card once coverage is purchased.

About SRI

Since 1993, Specialty Risk International has provided medical insurance to corporations, international travelers, expatriates, students, overseas visitors, immigrants and global citizens. With expertise and efficiency, we've served clients in more than a hundred countries.

For those Traveling to the United States
(If the applicant is traveling to, temporarily residing in, or visiting the United States, please use these rates.

For those Traveling Outside the U.S.
(If the applicant is traveling outside the United States, use these rates.  This includes US citizens traveling overseas as well as persons traveling between countries (ie, a Brazilian traveling to Spain)