ICHIP International Comprehensive Health Insurance Programme

ICHIP Distributed by Caribbean Assurance Brokers LimitedInternational Comprehensive Health Insurance Programme (ICHIP)Version 0216

A Partnership of ExcellenceCaribbean Assurance Brokers Ltd. (CAB) has partnered with claims administrators and highly trained customer serviceInternational Medical Group® (IMG®) and certain underwriters professionals, IMG is confident in its ability to provide the productsat Lloyd’s to bring you world-class medical insurance benefits international travelers need, backed by the services they want.backed by unparalleled services. Located in Indianapolis, Indiana, U.S.A., IMG has provided Global Peace of Mind® to more than one million people worldwide inCaribbean Assurance Brokers Ltd. (CAB) more than 170 countries. IMG is committed to‘being there’with itsCAB was incorporated on June 13, 2005 and began operations international clients wherever life takes them.on November 1, 2005, as a retail and facultative placement brokerfor Life, Health and Personal Accident insurance business. Today, Lloyd’sCAB’s combined team has over four hundred years of experience ICHIP is underwritten by Certain Underwriters at Lloyd’s. Lloyd’s isin the health, life, disability and general insurance business. CAB the world’s specialist insurance and reinsurance market, bringingis committed to consistently delighting customers by delivering together an outstanding concentration of underwriting expertisethe highest quality service and the best value for money. We are and talent. It is often the first to insure emerging, unusual andcognizant of the fact that our clients have choices and as such complex risks.the organization must be guided by the principle of not merelysatisfying, but indeed delighting customers with first class Around 80 syndicates are underwriting insurance at Lloyd’s,customer care. The team members, at all levels, are committed to covering all classes of business. Together they interact withthis philosophy and are constantly striving for excellence. thousands of brokers daily to create insurance solutions for businesses in over 200 countries and territories around the world.International Medical Group (IMG) Lloyd’s insures the majority of FTSE 100 and Dow Jones industrialFor 25 years, IMG has provided high quality global medical average companies. Lloyd’s enjoys strong financial securityinsurance benefits and developed a reputation of excellence and supported by excellent ratings.leadership in the international medical insurance market. Witharound-the-clock medical management services, multilingual Visit www.lloyds.com for more information.www.cabjm.com

ICHIP Global 1 - Summary of BenefitsMaximum benefit payable for eligible conditions per person per year $2,000,000 Deductible Options $0 deductible in Country of Residence /$2,000 deductible worldwide orDeductible is waived for Health Checks, $500 deductible in Country of Residence /$5,000 deductible worldwide Dental & Vision, and Emergencies Outpatient Treatment Diagnostic procedures 80% of eligible expenses Medical Services in a Doctor’s Office Limited to a total of 20 visits each period of cover Psychiatric treatment Limited to total of 20 visits each period of coverRehabilitation (physical, occupational and speech therapy) Limited to a total of 60 visits each period of coverMRI, CT and PET scans Paid in fullDrugs & dressings (not including oncology drugs) Paid in full up to $1,000Surgical procedures Paid in fullOncology (therapeutic services including radiotherapy, Paid in full chemotherapy and drugs)Dialysis 80% of eligible expenses Day-case and Inpatient TreatmentHospital and related services Paid in fullIntensive care unit Paid in fullMRI, CT and PET scans Paid in fullDoctors’ fees for surgical and medical services Paid in fullOncology (therapeutic services including radiotherapy & chemotherapy) Paid in full Psychiatric treatment Paid in fullLimited to 30 days each period of cover and 90 days lifetime maximumDialysis Paid in FullParent Accommodation Paid in full up to $250 per day Other benefitsEmergency (including local road ambulance) Paid in full Home nursing Paid in fullLimited to 20 days each period of cover Maternity cover Paid in fullAvailable after being a member for 10 months Complications of Pregnancy Paid in fullAvailable after being a member for 10 months Health checks Paid in full up to $300Available after the first 10 months from the date of entry and every subsequent period of coverOutpatient dental and vision treatment 50% of eligible expenses, up to combined maximum of $2,000 • Routine dental 50% of eligible expenses, up to combined maximum of $2,000 • Major restorative 80% of eligible expenses, up to combined maximum of $2,000 • Emergency dental • Vision 100% of eligble expenses, up to combined total of $2,000Organ Transplants Paid in fullCongenital anomalies Paid in full up to US $500,000 per lifetimeEvacuation cover Paid in fullMortal remains Paid in full up to US $10,000AIDS Paid in full up to US $25,000Hospice (Inpatient and Outpatient) Paid in full 1.876.978.5508

ICHIP Global 2 - Summary of BenefitsMaximum benefit payable for eligible conditions per person per year $1,000,000 Deductible Options $0 deductible in Country of Residence /$2,000 deductible worldwide orDeductible is waived for Health Checks, and Emergencies $500 deductible in Country of Residence /$5,000 deductible worldwide Outpatient TreatmentSurgical procedures Paid in fullMRI, CT and PET scans Paid in full Oncology Paid in full(therapeutic services including radiotherapy & chemotherapy) Dialysis 80% of eligible expenses Day-case and Inpatient TreatmentHospital and related services Paid in fullIntensive care unit Paid in fullDoctors’ fees for surgical and medical services Paid in full Oncology Paid in full(therapeutic services including radiotherapy & chemotherapy)MRI, CT and PET scans Paid in full Psychiatric treatment Paid in fullLimited to 30 days each period of cover and 90 days lifetime maximum Dialysis Paid in fullParent Accommodation Paid in full up to $250 per day Other benefitsOutpatient Dialysis 80% of eligible expensesEmergency (including local road ambulance) Paid in full Home nursing Paid in fullLimited to 20 days each period of cover Maternity cover Paid in fullAvailable after being a member for 10 months Complications of Pregnancy Paid in fullAvailable after being a member for 10 months Health checks Paid in full up to $300Available after the first 10 months from the date of entry and every subsequent period of coverOrgan Transplants Paid in fullCongenital anomalies Paid in full up to $500,000 per lifetimeEvacuation cover Paid in fullMortal remains Paid in full up to $10,000 AIDS Paid in full up to $15,000 per insured personwww.cabjm.com

ICHIP Global Share - Summary of BenefitsMaximum benefit payable for eligible conditions per person per year $1,000,000 Deductible Options $1,000 deductible in Country of Residence / $2,500 deductible worldwideDeductible is waived for Health Checks and Emergencies Outpatient Treatment MRI, CT and PET scans Paid in full up to $750 per scanDiagnostic Imaging (including EKG, Ultrasound and Endoscopy) Paid in full up to $700 per exam Paid in full up to $400 per scan X-ray pathology Medical Service in a Doctor’s Office Paid in full up to $80 per visit Limited to a total of 20 visits each period of cover Paid in full up to $80 per visit Psychiatric treatment Limited to a total of 20 visits each period of cover Paid in full up to $40 per visitRehabilitation (physical, occupational and speech therapy) and Paid in full up to $500 Alternative Treatment 100% of eligible expenses Limited to a total of 60 visits each period of cover Drugs & dressings (not including oncology drugs) Surgical proceduresOncology (therapeutic services including radiotherapy, 100% of eligible expenses chemotherapy and drugs) Dialysis Day-case and Inpatient Treatment Paid in full up to $80 per visitHospital and related services Paid in full up to $750 per day Intensive care unit Paid in full up to $2,000 per dayDoctors’ fees for surgical and medical services Paid in full Paid in full MRI, CT and PET scans Oncology Paid in full(therapeutic services including radiotherapy & chemotherapy)Psychiatric treatment Paid in full up to $750 per day, limited to 30 days each period of cover and 90 days lifetime maximumDialysis Paid in full up Parent Accommodation Paid in full up to $250 per day Other benefitsEmergency Local Road Ambulance Home nursing Paid in full. Local road ambulance limited to $1,500 per incidentLimited to 20 days each period of cover Paid in full up to $250 per day Maternity cover Paid in full up to $5,000 per normal deliveries or $9,000 for medically necessaryAvailable after being a member for 10 months caesarean deliveries Complications of Pregnancy Paid in full Available after being a member for 10 months Paid in full up to $200 Health checksAvailable after the first 10 months from the date of entry and Paid in full up to $500,000 per lifetime Paid in full up to $500,000 per lifetime every subsequent period of cover Paid in full up to $50,000 Organ Transplants Paid in full up to $10,000 Up to $15,000 per insured person Congenital anomalies Evacuation cover Mortal remains AIDS Optional CoverageOutpatient dental and vision treatment Deductible is waived • Routine dental 50% of eligible expenses, up to combined maximum of $1,000 • Emergency dental 80% of eligible expenses, up to combined maximum of $1,000 • Vision 100% of eligible expenses, up to combined maximum of $1,000 1.876.978.5508

ICHIP GlobalShare Senior - Summary of BenefitsMaximum benefit payable for eligible conditions per person per year $500,000 Deductible Options $5,000 deductible in Country of Residence / $5,000 deductible worldwideDeductible is waived for Health Checks and Emergencies Outpatient Treatment MRI, CT and PET scans Paid in full up to $750 per scanDiagnostic Imaging (including EKG, Ultrasound and Endoscopy) Paid in full up to $700 per exam Paid in full up to $400 per scan X-ray pathology Medical Service in a Doctor’s Office Paid in full up to $80 per visit Limited to a total of 20 visits each period of cover Paid in full up to $80 per visit Psychiatric treatment Limited to a total of 20 visits each period of cover Paid in full up to $40 per visitRehabilitation (physical, occupational and speech therapy) and Paid in full up to $500 Alternative Treatment 100% of eligible expenses Limited to a total of 60 visits each period of cover Drugs & dressings (not including oncology drugs) Surgical proceduresOncology (therapeutic services including radiotherapy, 100% of eligible expenses chemotherapy and drugs) Dialysis Day-case and Inpatient Treatment Paid in full up to $80 per visitHospital and related services Paid in full up to $750 per day Intensive care unit Paid in full up to $2,000 per dayDoctors’ fees for surgical and medical services Paid in full Paid in full MRI, CT and PET scans Oncology Paid in full(therapeutic services including radiotherapy & chemotherapy)Psychiatric treatment Paid in full up to $750 per day, limited to 30 days each period of cover and 90 days lifetime maximum Dialysis Paid in full up Parent Accommodation Paid in full up to $250 per day Other benefitsEmergency Local Road Ambulance Home nursing Paid in full. Local road ambulance limited to $1,500 per incidentLimited to 20 days each period of cover Paid in full up to $250 per day Maternity cover Paid in full up to $5,000 per normal deliveries or $9,000 for medically necessaryAvailable after being a member for 10 months caesarean deliveries Complications of Pregnancy Paid in full Available after being a member for 10 months Paid in full up to $200 Health checksAvailable after the first 10 months from the date of entry and Paid in full up to $500,000 per lifetime Paid in full up to $500,000 per lifetime every subsequent period of cover Paid in full up to $50,000 Organ Transplants Paid in full up to $10,000 Up to $15,000 per insured person Congenital anomalies Evacuation cover Mortal remains AIDS Optional CoverageOutpatient dental and vision treatment Deductible is waived • Routine dental 50% of eligible expenses, up to combined maximum of $1,000 • Emergency dental 80% of eligible expenses, up to combined maximum of $1,000 • Vision 100% of eligible expenses, up to combined maximum of $1,000www.cabjm.com

ICHIP Plan Information Grace Period/Non-Payment of Premium:Deductible Options: In the event of any non-payment of premium, we shall be entitled to cancel this policy. We may at our discretion reinstate the coverA Deductible is the amount you pay before we pay any claims. if the premium is subsequently paid.Deductibles are applied per person, per year of cover. If yourclaimed amount does not exceed your deductible, it will be We allow the principal member up to 31 days following theapplied towards meeting your annual deductible amount. Once renewal date of the policy to make all payments of premiumsyour deductible has been met, future claims will be reimbursed due before this clause is invoked, subject to our right to cancelup to the policy limits. the policy in accordance with the cancellation provisions hereof.Select a deductible and premium that is best suited for your Special Conditions:financial situation. The Summary of Benefits identify the availabledeductibles for your selected ICHIP. You may choose to reduce »» Newborn children will be accepted for cover from birth.your premium cost by opting for a larger deductible, or you Acceptance of newborn babies is subject to written notificationmay choose to lower your deductible, which will increase your within 30 days of birth and receipt of the full premium within apremium. further 30 days following notification.Coinsurance: »» We reserve the right to alter the policy terms or cancel cover for an insured person following a change of risk; e.g., change to aCertain benefits require you to pay a percentage of the total value hazardous occupation.of the incurred expenses. This applies for each medical conditionfor each period of cover. This is called your coinsurance. The »» Post natal checkups needed as a result of a covered complicationcoinsurance percentage is found in your Summary of Benefits in of pregnancy are covered for a period of 6 weeks.your Policy Wording. Major Exclusions:Enrollment Process: »» Any pregnancy or complications of pregnancy whatsoeverTo apply for ICHIP, simply complete and return the application incurred in the first 10 months following the date of entry.along with payment information to your insurance agent or CABby mail, email or fax. If you are applying as a family, you may »» Voluntary caesarean section costs.include yourself, your spouse and dependents under age 26 on »» Costs in respect of a psychotherapist or psychologist, (unlessone application. referred to by and under the direct control of a medicalYou are required to notify IMG if you or any family member suffers practitioner), a family therapist or bereavement counselor.from or is treated for any illness, injury or medical condition »» Medical expense charges associated with, resulting from, orbetween the time of your application and the issuance of the related to cancer, heart, lung, orthopaedic or psychiatric relatedcertificate. If your application is not approved, any funds received conditions are excluded for 24 months after the enrolment date.will be returned. For additional information regarding the All other medical expense charges associated with, resultingapplication process, please contact your insurance agent or CAB. from, or related to, all pre-existing conditions are covered 12 months after the enrolment date.Fulfillment Kits: This brochure contains a brief summary of the current ICHIP benefits,IMG processes applications in a quick, timely manner. Once conditions, limitations and exclusions, and is subject to all the termsprocessing is complete, CAB will mail, or email the fulfillment kit(s) and conditions of the full Policy Wording. The complete Policyto the address/email listed in the Application. The fulfillment kit(s) Wording with all the terms, conditions and exclusions will be includedwill include an IMG Identification Card(s), Schedule of Benefits, in the fulfillment kit sent to approved applicants.Claim Forms, information on Precertification, finding a providerand MyIMG, and the Policy Wording providing a completedescription of the rights and benefits under the contract.In order to prevent possible delays, we recommend onlinefulfillment for inmediate access to your coverage information.However, if you do not choose online fulfillment, IMG will mailyour fulfillment materials. 1.876.978.5508

ICHIP ServicesMyIMGSM Akeso Care Management® (ACM®)Service at your fingertips anytime, anywhere - that’s what MyIMG The ability to access quality health care is of paramount importanceprovides. MyIMG is our proprietary online service that allows you when a medical emergency arises abroad. To coordinate careto access information and manage your IMG accounts, 24 hours and provide U.S. and internationally based medical managementa day, seven days a week, from anywhere in the world. Some services, IMG formed ACM, an on-site specialized division devotedfeatures include: entirely to medical management.»» Explanation of benefits statements The clinical staff consists of qualified physicians and registered»» Obtain certificate documents nurses who are experts at assessing the need for medical services»» Locate a provider and ensuring those services are delivered in a timely, cost-effective»» Claim submission and status manner. ACM has international medical experience, providing»» Access ID cards services in more than 170 countries worldwide.»» Initiate Precertification»» Live chat with IMG ACM is accredited by URAC, an independent, nonprofit organization that is internationally recognized for promotingLocating a Provider continuous improvement in the quality and efficiency of health care management. Through a rigorous and comprehensiveWith ICHIP you may seek treatment anywhere in the world with review that ensures ongoing compliance, ACM earned its URACthe hospital or doctor of your choice. When seeking treatment in accreditation in Health Utilization Management.the U.S., you have access to UnitedHealthcare Options PPO, whichis a separately organized network of hundreds of thousands of From routine medical care to complex case management, fromestablished, highly qualified health care physicians and many well check-ups to emergency medical evacuations, ACM is there forrecognized hospitals in the U.S. You can quickly search the network you. They are committed to patient protection and empowerment,through MyIMG. Additionally, to help you locate health care quality operations and provider compliance. This translates intoproviders outside the U.S., IMG provides its online International better care for you - around the world, around the clock.Provider AccessSM (IPA), a database of over 17,000 providers.Our goal is to provide quality medical coverage wherever youmay be. The UnitedHealthcare Options PPO and our IPA enable usto do just that, and our online directories put the information atyour fingertips - anytime, anywhere. Simply visit: https://myimg.imglobal.com/unauth/ServiceProvider.aspxwww.cabjm.com

ICHIP Claims ProcedurePrecertification: benefits or a guarantee of payment. All medical expenses eligible for reimbursement must be medically necessary and will beThe following must always be Precertified for medical necessity, paid or reimbursed at usual, reasonable, customary rates. Pleasewhich means the insured person or their attending physician must refer to the Policy Wording for full details of the Precertificationcommunicate with an IMG representative at the number listed on requirements.the IMG Identification Card prior to admittance to a hospital ormedical facility before receiving certain treatments and supplies: Claims Payment: All benefits payable under ICHIP are subject to the terms and»» Home Health Care conditions in the Policy Wording. Claims must be submitted 180»» Psychiatric Treatment days from the date the charges were incurred. To make claim»» Evacuation processing efficient, claims for eligible medical expenses may be»» Oncology (therapeutic services including radiotherapy & paid in two ways: chemotherapy) 1. Eligible expenses that have been paid by or on behalf of»» Planned inpatient or day-patient treatment (hospitalisation)»» Any Surgery or Surgical procedure the insured person may reimbursed by check directly to»» Any Treatment in an Extended Care Facility»» Any Home Nursing Care the insured person.»» Artificial limbs 2. Eligible expenses that have not yet been paid by the»» All Covered Transplant Treatment»» Computerized Axial Tomography (CAT Scan) insured person may, at the option of IMG, be paid either»» Magnetic Resonance Imaging (MRI) to the insured person or directly to the provider.In case of an Emergency Admission, the Precertification must be Claimformscanbeaccessedatwww.imglobal.com, and emailed tomade within 48 hours of the admission, or as soon as reasonably [email protected] or mailed to International Medical Group, P.O.possible. If a hospital admission or a surgery is not Precertified, Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers,eligible claims and expenses will be reduced by 50%. It is claim forms and Certificate of Insurance are included in the fulfillment kit.important to note that Precertification is only a determination of IMG may also be contacted by fax at 1.317.655.4505.medical necessity, not an assurance of coverage, verification of 1.876.978.5508

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ICHIP - 2015 Annual Rates ICHIP Global 1 ICHIP Global 2Global 1: $2000 / $0 Deductible Global 2: $2000 / $0 DeductibleAge Rate Age Rate0-20 $600 0-20 $46421-34 $1,899 21-34 $1,42335-44 $2,011 35-44 $1,59045-54 $2,544 45-54 $1,90555-64 $2,681 55-64 $2,00865-74 $8,504 65-74 $8,25475+ $8,891 75+ $8,630Global 1: $5000 / $500 Deductible Global 2: $5000 / $500 DeductibleAge Rate Age Rate0-20 $490 0-20 $38021-34 $1,547 21-34 $1,16235-44 $1,729 35-44 $1,29945-54 $2,073 45-54 $1,55755-64 $2,184 55-64 $1,64065-74 $6,940 65-74 $6,73575+ $7,255 75+ $7,041ICHIP GlobalShare Senior ICHIP GlobalShareGlobalShare Senior: $5,000 / $5,000 Deductible GlobalShare: $2,500 / $1,000 Deductiblewith dental & vision without dental & vision with dental & Vision without dental &VisionAge Annual Rate Age Annual Rate Age Annual Rate Age Annual Rate65 $4,045 65 $3,548 0-20 $338 0-20 $29666 $4,475 66 $3,925 21-34 $1,033 21-34 $90667 $4,954 67 $4,346 35-44 $1,155 35-44 $1,01368 $5,470 68 $4,841 45-54 $1,384 45-54 $1,21469 $5,858 69 $5,254 55-64 $1,459 55-64 $1,28070 $6,124 70 $5,51771 $6,372 71 $5,79372 $6,723 72 $6,11273 $7,125 73 $6,44874 $7,448 74 $6,80275+ $8,230 75+ $7,550 1.876.978.5508

P.O. Box 88509 Coverage is underwritten and issued by2960 North Meridian Street Certain Underwriters at Lloyd’s,Indianapolis, IN 46208-0509 USATel.: 1.800.628.4664 or 1.317.655.4500 rated A (excellent) by A.M. Best and A+ byFax: 1.317.655.4505 Standard & Poor’s (at the time of printing).Email: [email protected] acts as the authorized representativeand plan administrator for and on behalfof Certain Underwriters at Lloyd’sThis invitation to inquire allows eligible applicants an opportunity to inquire further about theinsurance offered and is limited to a brief description of any loss for which benefits may be payable.Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles,coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract.The contract does contain a pre-existing condition exclusion and does not cover losses or expensesrelated to a pre-existing condition.This brochure contains many of the valuable trademarks, names, titles, logos, images, designs, copyrights and otherproprietary materials owned and registered and used by of International Medical Group, Inc. and its representativesthroughout the world. ©2015 International Medical Group, Inc. All rights reserved.ICHIP (International Comprehensive Health Insurance Programme ) is the registered trademark ofCaribbean Assurance Brokers Limited. All rights reserved.This is not a legal contract. The Policy Wording contains limitations and exclusions.To obtain a more detailed explanation, consult your agent or contact: Agent Use Only