WORLDWIDE COVERAGE
FOR
People who work or reside outside the United States permanently or for extended periods of time

New All Cause Deductible

To be Eligible for Benefits, you must reside outside the United States for more than 5 months per year.

The Worldwide Major Medical Plan began in development several years ago.

Traditional medical insurance assumes that the insured never ventures far away from a managed care facility. Having a population remain in one place is the only way a managed care program can function. This still remains true and is an important part of health insurance in the United States. Most carriers, and even countries with socialized healthcare access, often are not capable of claims administration on an international basis.

However, traditional medical plans and even the supplemental travel medical plans became limited with a new type of individual needing medical insurance - The global citizen!

Many U.S. citizens have found themselves residing outside the United States either permanently or for an unknown period of time. These people need medical coverage in the country in which they are residing, but also may desire coverage that if something serious happened, they could use the coverage for treatment in the United States. These same people also may travel to other locations necessitating a portable international medical plan.

The Worldwide Major Medical Plan provides valuable benefits in any country in which a person is located and even may provide benefits available for treatment back in the United States.

Deductibles: You may choose a $500, $1,000, $2,500, or $5,000 per person, per period of insurance.

Coinsurance: After the Deductible is paid, Underwriters will reimburse 80% of the next $5,000 in Eligible Expenses and then 100% up to the Maximum Benefit.

Maximum Benefit: $5,000,000 per person per lifetime (Ages 0 through 69)
Maximum Benefit: $500,000 per person per lifetime (Ages 70 through 74)

• MATERNITY
• MENTAL AND NERVOUS CONDITIONS

Treatment may be received anywhere in the world excluding the U.S.A. or for an additional premium the U.S.A. may be covered as well. This coverage is secondary to medical benefits, services, or reimbursements from any other source except Medicaid. Underwriters will reimburse the Eligible Expenses incurred, listed below, when Medically Necessary for the diagnosis and treatment of an Illness or Injury, subject to the terms and limitations described in the Certificate.

• Hospital room and board (limited to the semi-private daily rate).
• Hospital intensive care unit.
• Other Medically Necessary Hospital services and supplies, such as emergency room care, outpatient surgery, diagnostic services, supplies and therapy.
• Skilled Nursing Facility room and board, if confinement begins within 30 days following a Medically Necessary Hospital confinement of three days or longer.
• Home Health Care, if hospitalization would have been required if Home Health Care were not provided, and the care is provided in accordance with a written plan established and approved by a Physician.
• Local area ambulance service.
• Physician services consisting of home, office, and hospital visits, and any other medical care and treatment.
• Diagnostic services, supplies, and therapy.
• Prescription medication prescribed at the time of discharge from the hospital, not to exceed a 12 month benefit period.

This coverage is conditionally renewable based upon residency requirements and payment of premium. Underwriters reserve the right to modify coverage by class.

If, for any reason, you are not satisfied with the insurance described in the Certificate you have the right to return the Certificate within 10 days of its delivery to you and your premium will be fully refunded.

Hazardous Sports or Activities
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 Hazardous Sport or Activity that is specifically named on the Schedule of Benefits.

War or Act of War Coverage
If you elect this option, underwriters will reimburse you for eligible expenses which are incurred as a result of injuries sustained due to war or act of war.

Global Medical Transportation
If you elect this option, underwriters will reimburse you for all medically necessary expenses for stabilization and transportation to the facility nearest your home, which can provide the appropriate care.

Expenses which have limitations are as follows:

1. Maternity, normal delivery and/or well baby care covered after 15 months, to a maximum of $5,000 per year. Complications of pregnancy covered as any other condition after 15 months.
   
   
2. Mental and Nervous Disorders covered to $5,000 lifetime maximum for outpatient visits. Disorders necessitating hospitalization shall be covered as any other condition.
   
   

Expenses which are not eligible for reimbursement are as follows:

• Any expense which you are not legally obligated to pay.
• Services which are not Medically Necessary and are not furnished by or under supervision of a Physician.
• 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.
• Expenses in excess of Usual, Customary, and Reasonable fees.
• Outpatient drugs, except following a hospitalization if prescribed for the same Illness or Injury.
• Self-inflicted injuries while sane or insane.
• Treatment for alcoholism, drug addiction, and/or allergies.
• Rest cures, quarantine, or isolation.
• Cosmetic surgery, unless necessitated by an accidental injury.
• Dental exams, dental x-rays, and general dental care except as a result of an accidental injury.
• Eye glasses or eye examinations.
• Hearing aids or hearing examinations.
• General or routine examinations.
• Injuries sustained from participation in hazardous sports or activities which in part include: Professional or recreational: mountaineering, snow skiing, scuba diving, hang gliding, skydiving, bungee jumping, racing of any kind, and all professional and semiprofessional sports.
• Pregnancy and pregnancy-related conditions including, but not limited to, fertility, pre-natal care, childbirth, miscarriage, or abortion until a minimum of 15 months has elapsed, subject to the Terms and Limitations in the Certificate.
• Injuries due to war or any act of war whether declared or undeclared. Terrorism however is included in the policy benefits.
• Injuries sustained while committing a criminal or felonious act.
• Expenses incurred for, or resulting from, pain which is not supported by medical diagnosis.
• Cataract surgery which is not considered an emergency and/or which is performed at Your discretion.
• Any elective surgery.
• Custodial Care.
• Pre-existing conditions not disclosed on the application.

(Excluding Coverage in USA)
To include USA coverage all premiums to be multiplied by 2

*If applying with an adult, otherwise use 18-24 Rates

One application per person. A family will be added onto one certificate. A photocopy of the application is acceptable.

1. Use actual age.
2. Add up all insureds.
3. Multiply by 2 if U.S.A. coverage is required.
4. Add optional hazardous sports/activities.
5. Add $100 processing fee.
6. Global Medical Transportation - 30% rate
7. War or Act of War Coverage - please call

Please do not send money with the application. The earliest effective date is 24 hours after approval, or the requested effective date (up to 30 days following the approval of the application).

Recreational Scuba - add 10% or $80 whichever is greater
Recreational Snow Skiing - add 10% or $80 whichever is greater
All other Hazardous Sports/Activities - Call us

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.