| Medical Maximum per Policy: | $50,000, $100,000, $250,000, $500,000, $1,000,000 |
| Deductible Options per Policy: | $0, $50, $100, $250, $500, $1,000, $2,500, $5,000 |
| Co-insurance per Policy: | 100% of Covered Expenses up to the policy maximum |
| Medical Expense Benefits (subject to Policy Maximum, Deductible and Co-Insurance) | |
| Hospital Room and Board Charges: | The average semi private room rate |
| ICU Room and Board Charges: | three times the average semi private room rate |
| Outpatient Medical: | Usual customary charge to the selected Medical Maximum |
| Emergency Medical Treatment of Pregnancy: | $2,500 per Policy Period |
| Mental or Nervous Disorders: | $2,500 per Policy Period |
| Physiotherapy/Physical Medicine/ Chiropractic: | $50 per visit per day; up to 10 visits per Policy Period |
| Dental Treatment (Injury and emergency alleviation of pain): | $500 per Policy Period |
| Doctor Visits, X-rays and Prescriptions, Ambulance: | Usual customary charge to the selected Medical Maximum |
| Unexpected Recurrence of a Pre- existing Condition: | the first $20,000 of Covered Expenses up to age 65 or the first $10,000 for over age 65 |
| Benefit Period: | 1 year from the date of the Covered Accident or Sickness |
| Additional Benefits (not subject to Policy Maximum, Deductible or Co-Insurance) | |
| Accidental Death & Dismemberment Principal Sum: | $25,000 |
| Coma Benefit: | $10,000 |
| Felonious Assault and Violent Crime: | 100% up to $50,000 |
| Adaptive Home and Vehicle: | $5,000 |
| Seatbelt Benefit: | 10% up to $50,000 |
| Airbag Benefit: | 10% up to $50,000 |
| Hijacking and Air or Water Piracy: | Covered |
| Emergency Medical Evacuation: | 100% up to $2,000,000 |
| Political/Natural Disaster Evacuation: | $25,000 |
| Repatriation of Remains: | 100% up to $1,000,000 |
| Emergency Reunion: | $15,000 |
| Return of Minor Child(ren) or Travel Companion: | $5,000 |
| Hospital Confinement: | $150 per day 15 day Maximum |
| Basic Lost Baggage: | $1,000 per Policy Period |
| Trip Interruption: | $7,500 per Policy Period |
| Optional Benefits | |
| Enhanced Baggage | Up to $3,500 |
| Upgrade AD&D | Up to $1,000,000 |
| Home Country Coverage/Follow Me Home Coverage | See benefit page 11 |
| Athletic Sports Coverage | See benefit page 12 |
| Extreme Sports/Hazardous Activities | See benefit page 12 |
