Global Health Options

CIGNA GLOBALINDIVIDUAL PLANSTAILOR A HEALTH
INSURANCE PLAN TO
MEET THE NEEDS OF
YOU AND YOUR FAMILY.

2

A HEALTHY PARTNERSHIP
STARTS HERE
When it comes to staying well - physically,financially, emotionally - we’re with you
all the way. We don’t just want you to feelbetter. We want you to stay that way.
Cigna Global plans provide peace ofmind for customers in over 200 countries
worldwide. Maybe you’re living away fromhome and need someone who’s got yourback. Or maybe you want to see a doctor
you can count on who is based in anothercountry. Whatever your circumstances,
Cigna Global plans are here to see you
through the good times, as well as the
crunch times.

CONTENTS
Why choose a Cigna Global plan4

Why we are your best choice5

How to create your plan6

How deductible, cost share and out of pocket maximum work8

Benefits in detail

10

Online Customer Area

34

Your Travel Safety companion

35

What you can expect from us

36

3

WHY CHOOSE A CIGNA
GLOBAL PLAN
Our mission
Our passion and our mission is to help the people we serve to improve their health, wellbeing,and sense of security.

4

Why choose us

Why you may need us

Our customers choose us because Cigna
gives them all of the following:

There are lots of different reasons you mightneed a Cigna Global plan. Here are a few:

> Access to our network of trusted
hospitals, physicians and other
healthcare professionals.

> The quality of your local country’s
healthcare system does not meet yourstandards or needs.

> The flexibility to tailor a cost-effective
plan to suit their individual needs.

> Or, even if you are to find good quality
local healthcare, it’s too expensive.

> Making sure our Customer Care Teamis always available to speak with you
day and night.

> You find the local healthcare systemconfusing or a struggle due to language
or cultural barriers.

> The reassurance of our experience indelivering international healthcare.

> Your country of residence requires you
to have international private medical
insurance.

WHY WE ARE YOUR BEST CHOICE
Cigna’s experience
We’ve provided global health insurance for many years. Today we have 86 million customer
relationships in over 200 countries and jurisdictions. Looking after them is an international
workforce of 37,000 people, plus a medical network comprising of over 1 million partnerships,
including 89,000 behavioural health care professionals, and 11,400 facilities and clinics.

Put your health in the right hands
Decision on yourapplication within 24
hours

Flexibility to tailor
a plan to suit yourindividual needs

Secure online
Customer Area

Multi-language sales
and service

Direct billing with aprovider in most cases

Choose to receive
your policy documents
online or posted toyour address

Customer Satisfaction Survey, July 2015.

““

THEY FOUND THE RIGHT HEALTH POLICY FOR MY
FAMILY AND WERE VERY UNDERSTANDING OF OUR
PARTICULAR NEEDS AND THE REQUIREMENTS WE
HAD REGARDING OUR OVERSEAS COVER NEEDS.
RESPONSE TO QUESTIONS WAS ALWAYS GOOD,QUICK AND HELPFUL.

5HOW TO CREATE YOUR PLAN
Creating a comprehensive, tailored plan with
Cigna is simple. It’s flexible, so you can choose
and pay for only the cover you need. Our planscomprise of three levels of cover: Silver, Goldand Platinum. Each plan includes International
Medical Insurance. Choose from two areas ofcoverage, depending on needs and location:
Worldwide including USA and Worldwide
excluding USA.
In addition, you can select optional
modules, including: International Outpatient;International Medical Evacuation; International
Health and Wellbeing; and International Vision
and Dental which enables you the flexibility tocreate a health insurance plan that suits yourunique needs.

6

As well as this, we offer a wide range of costshare and deductible options on International
Medical Insurance and International Outpatient,
allowing you to tailor a plan to suit yourbudget.
The diagram on the next page shows you how
Cigna Global health plans work.

Creating a comprehensive, tailored plan with Cigna Global is simple.

1

SELECT YOUR CORE PLAN - INTERNATIONAL MEDICAL INSURANCE

Start with one of our core inpatient plans,
which covers you for essential hospital
stays and treatments, such as:> Surgeon & consultation fees
> Hospital accommodation> Cancer treatment

Choose from two areas ofcoverage:> Worldwide including USA or> Worldwide excluding USA

Annual benefits
Up to the maximum amount per beneficiary per period of cover

SILVER:$1,000,000 / €800,000 / £650,000

GOLD:$2,000,000 / €1,600,000 / £1,300,000
PLATINUM: Unlimited

2 ADD OPTIONAL MODULES
International OutpatientInternational Medical Evacuation

International Health & Wellbeing

International Vision & Dental

More extensive outpatient care fortreatments that don’t require an
overnight stay in hospital. Including
prescribed outpatient drugs anddressings and much more.

Proactively manage yourown health. Screen against disease,test against common illnesses and getreassurance with routine physical exams.

3

Medical evacuation in the event thattreatment is not available locally in an
emergency, as well as repatriation, allowing
the beneficiary to return to their country of
habitual residence or nationality.

Vision care including an eye test anda wide range of preventative, routine
and major dental treatments.

MANAGE YOUR PREMIUM
Choose if you would like to add a deductible or cost share*.

Please see page 8 for a full description and example of how the deductible
and cost share work.
*the voluntary amount you have chosen to pay that’s not covered by your plan.

4

PAY FOR YOUR PLAN

You can choose to pay for your premiums on a monthly, quarterly,or annual basis. You can make payments by debit or credit card, or
alternatively if you pay annually, you can pay by bank wire transfer.

7

HOW THE DEDUCTIBLE, COST SHARE ANDOUT OF POCKET MAXIMUM WORK
Our wide range of deductible and cost shareoptions allow you to tailor your plan to suit
your needs.
You can choose to have a deductible and /or cost share on the International Medical
Insurance and / or International Outpatient
option. No deductible applies to inpatient
cash benefits or newborn care benefits.
You will be responsible for paying the amountof any deductible and cost share directly tothe hospital, clinic or medical practitioner. We

will let you know what this amount is. If you
select both a deductible and a cost share,
the amount you will need to pay due to the
deductible is calculated before the amount
you will need to pay due to the cost share.
The out of pocket maximum is the maximum
amount of cost share any beneficiary must
pay per period of cover.
The following examples show how thedeductible, cost share and out of pocket
maximum work.

EXAMPLE 1: DEDUCTIBLE(also known as ‘excess’)This is the amount of money you pay
towards your medical expenses per periodof cover.
Claim value:
Deductible:$1,200$500

YOU PAY..

WE PAY...

Deductible of

$700

$500

WHAT THIS MEANS FOR YOU...
You only pay the deductible amount andwe pay the rest.

EXAMPLE 2: COST SHARE ANDOUT OF POCKET MAXIMUMAFTER DEDUCTIBLE(when your cost share after deductible
amount is under the out of pocket maximum)
Cost share is the percentage of every claim
you will pay. Out of pocket is the maximum
amount you would have to pay in costshare per period of cover.
Claim value:
Deductible:
20% cost share:
Out of pocket maximum:

8$5,000$0$1,000$2,000YOU PAY..

WE PAY...

The 20% cost

$4,000share of $1,000

WHAT THIS MEANS FOR YOU...
Your cost share is 20% of $5,000 ($1,000).
This is less than your out of pocket maximum,
so you pay $1,000 and we cover the rest.

EXAMPLE 3: COST SHARE ANDOUT OF POCKET MAXIMUMAFTER DEDUCTIBLE(when your cost share after deductible
amount is over the out of pocket maximum)
Cost share is the percentage of every claim
you will pay. Out of pocket is the maximum
amount you would have to pay in costshare per period of cover.
Claim value:
Deductible:
20% cost share:
Out of pocket maximum:$20,000$0$4,000$2,000YOU PAY..

WE PAY...

The out of pocket
maximum of$18,000$2,000

WHAT THIS MEANS FOR YOU...
Your cost share is 20% of $20,000 ($4,000).
This is more than your out of pocket
maximum, so you only pay $2,000 and wecover the rest.

EXAMPLE 4: DEDUCTIBLE, COST
SHARE AND OUT OF POCKET
MAXIMUM AFTER DEDUCTIBLE(when your cost share after deductible
amount is under the out of pocket maximum)
Cost share is the percentage of every claim
you will pay. Out of pocket is the maximum
amount you would have to pay in costshare per period of cover.
Claim value:
Deductible:
20% cost share:
Out of pocket maximum:$20,000$375$3,925$5,000YOU PAY..

WE PAY...

The deductible of$15,700$375 and thecost share of$3,925

WHAT THIS MEANS FOR YOU...
After you paid your deductible of $375, yourcost share is 20% of $19,625 ($3,925). This is
not more than your out of pocket maximum,
so you pay the $3,925 towards satisfying theout of pocket maximum for the cost share(and the initial $375 deductible that you paid
at the outset) and we cover the rest.

Please note:
The deductible, cost share after deductible, and out of pocket maximum is determined separately
for each beneficiary and each period of cover.

9

INTERNATIONAL MEDICAL
INSURANCE
Our plans comprise of 3 distinct levels of cover: Silver, Gold and Platinum.
Choose your level of cover from the table below. All amounts apply per beneficiary and perperiod of cover (except where otherwise noted).
International Medical Insurance is your essential cover for inpatient, daypatient andaccommodation costs, as well as cover for cancer, mental health care and much more. Our
Gold and Platinum plans also give you cover for inpatient and daypatient maternity care.

YOUR OVERALL LIMIT
SilverGold

Platinum$1,000,000€800,000£650,000$2,000,000€1,600,000£1,300,000

Unlimited

SilverGold

Platinum

Paid in full for asemi-private
room

Paid in full for a
private room

Paid in full for a
private room

Annual benefit - maximum perbeneficiary per period of cover.

This includes claims paid across all sections ofInternational Medical Insurance.

YOUR STANDARD MEDICAL BENEFITS
Hospital charges for:Nursing and accommodation for inpatient anddaypatient treatment and recovery room.

› We will pay for nursing care and accommodationwhilst a beneficiary is receiving inpatient or
daypatient treatment; or the cost of a treatment
room while a beneficiary is undergoingoutpatient surgery, if one is required.

› We will only pay these costs if:• it is medically necessary for the beneficiary to

be treated on an inpatient or daypatient basis;• they stay in hospital for a medicallyappropriate period of time;• the treatment which they receive is provided••

10

or managed by a specialist; andthey stay in a standard single room with a
private bathroom or equivalent (applicable on
the Gold and Platinum plans only).
they stay in a semi-private room with sharedbathroom (applicable on the Silver plan only).

› If a hospital’s fees vary depending on the typeof room which the beneficiary stays in, thenthe maximum amount which we will pay is theamount which would have been charged if thebeneficiary had stayed in a standard single
room with a private bathroom or equivalent(applicable on the Gold and Platinum plans only),or a semi-private room with shared bathroom orequivalent (applicable on the Silver plan only).

› If the treating medical practitioner decides

that the beneficiary needs to stay in hospitalfor a longer period than we have approvedin advance, or decides that the treatment
which the beneficiary needs is different to thatwhich we have approved in advance, then that
medical practitioner must provide us with areport, explaining: how long the beneficiary
will need to stay in hospital; the diagnosis (ifthis has changed); and the treatment which thebeneficiary has received, and needs to receive.

Hospital charges for:› operating theatre.
› prescribed medicines, drugs anddressings for inpatient or daypatient
treatment.
› treatment room fees for outpatient
surgery.
Operating theatre costs› We will pay any costs and charges relating to

the use of an operating theatre, if the treatment
being given is covered under this policy.

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

Medicines, drugs and dressings› We will pay for medicines, drugs and dressings
which are prescribed for the beneficiary whilst
he or she is receiving inpatient or daypatient
treatment.

› We will only pay for medicines, drugs anddressings which are prescribed for use at home if
the beneficiary has cover under the International
Outpatient option (unless they are prescribed aspart of cancer treatment).

Intensive care:› intensive therapy.
› coronary care.
› high dependency unit.

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for a beneficiary to be treated in an intensive care, intensive therapy, coronary care or highdependency facility if:that facility is the most appropriate place for them to be treated;the care provided by that facility is an essential part of their treatment; andthe care provided by that facility is routinely required by patients suffering from the same type of
illness or injury, or receiving the same type of treatment.

•••

Surgeons’ and anaesthetists’ fees

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for inpatient, daypatient or outpatient costs for:• surgeons’ and anaesthetists’ surgery fees; and• surgeons’ and anaesthetists’ fees in respect of treatment which is needed immediately before or after
surgery (i.e. on the same day as the surgery).

› We will only pay for outpatient treatments received before or after surgery if the beneficiary has coverunder the International Outpatient option (unless the treatment is given as part of cancer treatment).

Specialists’ consultation fees

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for regular visits by a specialist during stays in hospital including intensive care by a specialist
for as long as is required by medical necessity.

› We will pay for consultations with a specialist during stays in a hospital where the beneficiary:• is being treated on an inpatient or daypatient basis;• is having surgery; or• where the consultation is a medical necessity.

11

Hospital accommodation for a parent or
guardian
Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$1,000€740£665$1,000€740£665Paid in full

› If a beneficiary who is under the age of 18 years old needs inpatient treatment and has to stay in hospitalovernight, we will also pay for hospital accommodation for a parent or legal guardian, if:• accommodation is available in the same hospital; and• the cost is reasonable.

› We will only pay for hospital accommodation for a parent or legal guardian if the treatment which thebeneficiary is receiving during their stay in hospital is covered under this policy.

Transplant services for organ, bonemarrow and stem cell transplants

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for inpatient treatment directly associated with an organ transplant, for the beneficiary if:• the transplant is medically necessary, and the organ to be transplanted has been donated by a memberof the beneficiary’s family or comes from a verified and legitimate source.

› We will pay for anti-rejection medicines following a transplant, when they are given on an inpatient basis.
› We will pay for inpatient treatment directly associated with a bone marrow or peripheral stem celltransplant if:• the transplant is medically necessary; and• the material to be transplanted is the beneficiary’s own bone marrow or stem cells, or bone marrow
taken from a verified and legitimate source.

› We will not pay for bone marrow or peripheral stem cell transplants under this part of this policy if thetransplants form part of cancer treatment. The cover which we provide in respect of cancer treatment is
explained in other parts of this policy.

› If a person donates bone marrow or an organ to a beneficiary, we will pay for:• the harvesting of the organ or bone marrow;• any medically necessary tissue matching tests or procedures;• the donor’s hospital costs; and• any costs which are incurred if the donor experiences complications, for a period of 30 days after theirprocedure;
whether or not the donor is covered by this policy.

› The amount which we will pay towards a donor’s medical costs will be reduced by the amount which ispayable to them in relation to those costs under any other insurance policy or from any other source.

› We will not pay for outpatient treatment for either the beneficiary or donor, unless the beneficiary has
cover under the International Outpatient option for the specific outpatient treatment required.

› If a beneficiary donates an organ for a medically necessary transplant, we will cover the medical costs

incurred by the beneficiary associated with this donation up to any policy limits. However, we will only pay
for the harvesting of the donated organ if the intended recipient is also a beneficiary under this plan.

› We will consider all medically necessary transplants. Other transplants (such as transplants which areconsidered to be experimental procedures) are not covered under this policy. This is because of conditions
or limitations to coverage which are explained elsewhere in this policy.

Important note

› A beneficiary must contact us and get approval in advance before they incur any costs relating to organ,bone marrow or stem cell donation or transplant.

12

Kidney dialysis

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Treatment for kidney dialysis will be covered if such treatment is available in the beneficiary’s country ofresidence. We will pay for this on an inpatient, daypatient, or outpatient basis.

› We will pay for kidney dialysis treatment outside the beneficiary’s country of habitual residence if thecountry where that treatment is provided is within the beneficiary’s selected area of coverage. We will
pay for this on a daypatient basis. Travel and accommodation expenses incurred in connection with suchtreatment will not be covered.

Pathology, radiology and diagnostic tests(excluding Advanced Medical Imaging)

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Where investigations are provided on an inpatient or daypatient basis.
› We will pay for:• blood and urine tests;• X-rays;• ultrasound scans;• electrocardiograms (ECG); and• other diagnostic tests (excluding advanced medical imaging);
where they are medically necessary and are recommended by a specialist as part of a beneficiary’s
hospital stay for inpatient or daypatient treatment.

Advanced Medical Imaging (MRI, CT and
PET scans)
Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$5,000€3,700£3,325$10,000€7,400£6,650

Paid in full

› We will pay for the following scans if they are recommended by a specialist as a part of a beneficiary’s
inpatient, daypatient or outpatient treatment:• magnetic resonance imaging (MRI);• computed tomography (CT); and / or
• positron emission tomography (PET);› We may require a medical report in advance of a magnetic resonance imaging (MRI) scan.

Physiotherapy and complementary
therapies

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› Where treatment is provided on an inpatient or daypatient basis.
› We will pay for treatment provided by physiotherapist and complementary therapists; (acupuncturists,

homeopaths, and practitioners of Chinese medicine) if these therapies are recommended by a specialistas part of the beneficiary’s hospital stay for inpatient or daypatient treatment (but are not the primary
treatment which they are in hospital to receive).

13

Home nursing

Up to 30 days and the maximum amount shown
per period of cover.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› We will pay for a beneficiary to have up to 30 days of home nursing care per period of cover if:• it is recommended by a specialist following inpatient or daypatient treatment which is covered by thispolicy;• it starts immediately after the beneficiary leaves hospital; and• it reduces the length of time for which the beneficiary needs to stay in hospital.
Important note

› We will only pay for home nursing if it is provided in the beneficiary’s home by a qualified nurse and it

comprises medically necessary care that would normally be provided in a hospital. We will not pay forhome nursing which only provides non-medical care or personal assistance.

Rehabilitation

Up to 30 days and the maximum amount shown
per period of cover.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› We will pay for rehabilitation treatments (physical, occupational and speech therapies), which arerecommended by a specialist and are medically necessary after a traumatic event such as a stroke or spinal
injury.

› If the rehabilitation treatment is required in a residential rehabilitation centre we will pay foraccommodation and board for up to 30 days for each separate condition that requires rehabilitation
treatment.
In determining when the 30 day limit has been reached:• we count each overnight stay during which a beneficiary receives inpatient treatment as one day• we count each day on which a beneficiary receives outpatient and daypatient treatment as one day.

› Subject to prior approval being obtained, prior to the commencement of any treatment, we will pay

for rehabilitation treatment for more than 30 days, if further treatment is medically necessary and isrecommended by the treating specialist.

Important note

› We will only pay for rehabilitation treatment if it is needed after, or as a result of, treatment which iscovered by this policy and it begins within 30 days of the end of that original treatment.

› All rehabilitation treatment must be approved by us in advance. We will only approve rehabilitation
treatment if the treating specialist provides us with a report, explaining:i) how long the beneficiary will need to stay in hospital;ii) the diagnosis; andiii) the treatment which the beneficiary has received, or needs to receive.

Hospice and palliative care

Up to the maximum amount shown per lifetime.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› If a beneficiary is given a terminal diagnosis, and there is no available treatment which will be effectivein aiding recovery, we will pay for hospital or hospice care and accommodation, nursing care, prescribed
medicines, and physical and psychological care.

14

Internal prosthetic devices / surgicaland medical appliances

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for internal prosthetic implants, devices or appliances which are put in place during surgery as
part of a beneficiary’s treatment.

› A surgical appliance or a medical appliance can mean:• an artificial limb, prosthesis or device which is required for the purpose of or in connection with surgery;or• an artificial device or prosthesis which is a necessary part of the treatment immediately following
surgery for as long as required by medical necessity; or• a prosthesis or appliance which is medically necessary and is part of the recuperation process on ashort-term basis.

External prosthetic devices/surgical andmedical appliances
Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

For eachprosthetic
deviceFor eachprosthetic
deviceFor eachprosthetic
device$3,100€2,400£2,000$3,100€2,400£2,000$3,100€2,400£2,000› We will pay for external prosthetics, devices or appliances which are necessary as part of a beneficiary’s
treatment (subject to the limitations explained below).

› We will pay for:• a prosthetic device or appliance which is a necessary part of the treatment immediately following
surgery for as long as is required by medical necessity;• a prosthetic device or appliance which is medically necessary and is part of the recuperation process ona short-term basis.

› We will pay for an initial external prosthetic device for beneficiaries aged 18 or over per period of cover. We
do not pay for any replacement prosthetic devices for beneficiaries who are aged 18 and over.

› We will pay for an initial external prosthetic device and up to two replacements for beneficiaries aged 17 oryounger per period of cover.

› By an external ‘prosthetic device’, we mean an external artificial body part, such as a prosthetic limb or

prosthetic hand which is medically necessary as part of treatment immediately following the beneficiary’s
surgery or as part of the recuperation process on a short-term basis.

15

Local ambulance and air ambulanceservices

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Where it is medically necessary, we will pay for a local ambulance to transport a beneficiary:• from the scene of an accident or injury to a hospital;• from one hospital to another; or• from their home to a hospital.
› We will only pay for a local road ambulance where its use relates to treatment which a beneficiary needs
to receive in hospital. Where it is medically necessary, we will pay for an air ambulance to transport thebeneficiary from the scene of an accident or injury to a hospital or from one hospital to another.

Important notes› Air ambulance cover is subject to the following conditions and limitations:• In some situations it will be impossible, impractical or unreasonably dangerous for an air ambulance•

to operate. In these situations, we will not arrange or pay for an air ambulance. This policy does
not guarantee that an air ambulance will always be available when requested, even if it is medicallyappropriate.
We will only pay for a local air ambulance, such as a helicopter, to transport a beneficiary for distances
up to 100 miles (160 kilometres) and we will only pay for an air ambulance where its use relates totreatment which a beneficiary needs to receive in hospital.

› This policy does not provide cover for mountain rescue services.
› Cover for medical evacuation or repatriation is only available if you have cover under the International

Medical Evacuation option. Please refer to the relevant section of this Customer Guide for details of that
option.

Inpatient cash benefit

Per night up to 30 nights per period of cover.

SilverGold

Platinum

$100
€75
£65

$100
€75
£65

$200
€150
£130

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will make a cash payment directly to a beneficiary when they:• receive treatment in hospital which is covered under this plan;• stay in a hospital overnight; and• have not been charged for their room, board and treatment costs.

Emergency inpatient dental treatment› We will cover dental treatment in hospital after a serious accident, subject to the conditions set out below.
› We will pay for emergency dental treatment which is required by a beneficiary while they are in hospitalas an inpatient, if that emergency inpatient dental treatment is recommended by the treating medical
practitioner because of a dental emergency (but is not the primary treatment which the beneficiary is in
hospital to receive).

› This benefit is paid instead of any other dental benefits the beneficiary may be entitled to in thesecircumstances.

16

Treatment for mental health conditions
and disorders and addiction treatment

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$5,000€3,700£3,325$10,000€7,400£6,650

Paid in full

› Subject to the limits explained below we will pay for:• the treatment of mental health conditions and disorders; and• the diagnosis of addictions (including alcoholism);
Addiction treatment› We will pay for one course or programme of addiction treatment at a specialist centre providing evidencebased treatment, if that treatment is medically necessary and recommended by a medical practitioner.

› We pay for up to three attempts at detoxification, following which we will only pay for further

detoxification treatment if the beneficiary completes a formal outpatient course or programme of
addiction treatment.

› We will not pay for any other treatment related to alcoholism or addiction; or treatment of any related

condition (such as depression, dementia or liver failure); where we reasonably believe that the condition
which requires treatment was the direct result of alcoholism or addiction.

Important notes› For treatment of mental health conditions and disorders and addiction treatment, we will only pay forevidence-based, medically necessary treatment and recommended by a medical practitioner.

› We will pay for up to a combined maximum total of 90 days of treatment for mental health conditions
and disorders and addiction treatment in any one period of cover, including up to 30 days of inpatient
treatment.

› We will pay for up to a combined maximum total of 180 days of treatment for mental health conditions

and disorders; and addiction treatment in any five year period. For example, if a beneficiary uses 90 daysof mental health or addiction treatment in one period of cover, and 90 days of mental health or addiction
treatment in the following period of cover, we will not pay for any further mental health or addiction
treatment for the next three consecutive years of cover.

› In determining when these 30, 90 and 180 day limits have been reached:• we count each overnight stay during which a beneficiary received inpatient treatment as one day; and• we count each day on which a beneficiary receives outpatient and daypatient treatment as one day.
› We will not pay for prescription drugs or medication prescribed on an outpatient basis for any of these
conditions, unless you have purchased the International Outpatient option.

› Subject to prior approval and provided the medical practitioner is within your selected area of coverage,
we may pay for consultations that take place by use of electronic means or telephone.

Cancer care

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Following a diagnosis of cancer, we will pay for costs for the treatment of cancer if the treatment is

considered by us to be active treatment and evidence-based treatment. This includes chemotherapy,
radiotherapy, oncology, diagnostic tests and drugs, whether the beneficiary is staying in a hospitalovernight or receiving treatment as a daypatient or outpatient.

› We do not pay for genetic cancer screening.

17

PARENT AND BABY CARE
Routine maternity benefit care
(Gold and Platinum plans only)

Up to the maximum amount shown per periodof cover. Available once the mother has been
covered by the policy for twelve (12) months or
more.

SilverGold

PlatinumNot covered$7,000€5,500£4,500$14,000€11,000£9,000› We will pay for the following parent and baby care and treatment, on an inpatient or daypatient basis

as appropriate, if the mother has been a beneficiary under this policy for a continuous period of at least
twelve (12) months or more:• hospital, obstetricians’ and midwives’ fees for routine childbirth; and• any fees as a result of post-natal care required by the mother immediately following routine childbirth.

› We will not pay for surrogacy or any related treatment. We will not pay for maternity benefit care ortreatment for a beneficiary acting as a surrogate or anyone acting as a surrogate for a beneficiary.

Complications from maternity(Gold and Platinum plans only)

Up to the maximum amount shown per periodof cover. Available once the mother has been
covered by the policy for twelve (12) months or
more.

SilverGold

PlatinumNot covered$14,000€11,000£9,000$28,000€22,000£18,000› We will pay for inpatient or outpatient treatment relating to complications resulting from pregnancy orchildbirth if the mother has been a beneficiary under this policy for a continuous period of at least twelve(12) months or more. This is limited to conditions which can only arise as a direct result of pregnancy orchildbirth, including miscarriage and ectopic pregnancy.

› This part of the policy does not provide cover for home births.
› We will only pay for a Caesarean section, where it is medically necessary. If we cannot confirm that it was
medically necessary, we will only pay up to the limit of the mother’s routine maternity benefit care cover.

› We will not pay for surrogacy or any related treatment. We will not pay for maternity benefit care ortreatment for a beneficiary acting as a surrogate or anyone acting as a surrogate for a beneficiary.

Homebirths(Gold and Platinum plans only)

Up to the maximum amount shown per periodof cover. Available once the mother has been
covered by the policy for twelve (12) months or
more.

SilverGold

PlatinumNot covered

$500
€370
£335

$1,100€850£700› We will pay midwives’ and specialists’ fees relating to routine home births if the mother has been abeneficiary under this policy for a continuous period of twelve (12) months or more.

› Please note that the Complications from maternity cover explained above does not include cover for homechildbirth. This means that any costs relating to complications which arise in relation to home childbirthwill only be paid in accordance with the home childbirth limits, as explained in the list of benefits.

18

Newborn care

Up to the maximum amount shown for treatment
within the first 90 days following birth. Available
once at least one parent has been covered by thepolicy for 12 months or more.

SilverGold

Platinum$25,000€18,500£16,500$75,000€55,500£48,000$156,000€122,000£100,000› Provided the newborn is added to the policy, we will pay for:• up to 10 days routine care for the baby following birth; and• all treatment required for the baby during the first 90 days after birth instead of any other benefit; if at
least one parent has been covered by the policy for a continuous period of 12 months or more prior to
the newborn’s birth.

We will not require information about the newborn’s health or a medical examination if an applicationis received by us to add the newborn to the policy within 30 days of the newborn’s date of birth. If
an application is received after 30 days of the newborn’s date of birth, the newborn will be subject tomedical underwriting and we will require the completion of a medical health questionnaire whereby we
may apply special restrictions or exclusions.

› We will pay for:• up to 10 days routine care for the baby following birth; and• all treatment required for the baby during the first 90 days after birth instead of any other benefit; ifneither parent has been covered by the policy for a continuous period of 12 months or more prior to thenewborn’s birth and an application is received by us to add the newborn to the policy as a beneficiary.
The newborn will be subject to medical underwriting and we will require the completion of a medical
health questionnaire. Cover for the newborn will be subject to medical underwriting whereby we may
apply special restrictions or exclusions.

› The newborn care benefits explained above are not available for children who are born following fertility
treatment (such as IVF), are born to a surrogate, or have been adopted. In these circumstances children
can only be covered by the policy when they are 90 days old. Cover for the baby will be subject tocompletion of a medical health questionnaire whereby we may apply special restrictions or exclusions.

Congenital conditions

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$5,000€3,700£3,325$20,000€14,800£13,300$39,000€30,500£25,000› We will pay for treatment of congenital conditions on an inpatient or daypatient basis which manifest

themselves before the beneficiary’s 18th birthday if:• at least one parent has been covered by the policy for a continuous period of 12 months or more prior
to the newborn’s birth and the newborn is added to the policy within 30 days of the birth.
• they were not evident at policy inception.

YOUR DEDUCTIBLE AND COST SHARE OPTIONS
Deductible (various)

A deductible is the amount which you must pay
before any claims are covered by your plan.

Cost share after deductible and out of
pocket maximum

Cost share is the percentage of each claim notcovered by your plan.
The out of pocket maximum is the maximum
amount of cost share you would have to pay ina period of cover.
The cost share amount is calculated after the
deductible is taken into account. Only amounts
you pay related to cost share contribute to theout of pocket maximum.

$0 / $375 / $750 / $1,500 / $3,000 / $7,500 / $10,000€0 / €275 / €550 / €1,100 / €2,200 / €5,500 / €7,400£0 / £250 / £500 / £1,000 / £2,000 / £5,000 / £6,650

First, choose your cost share percentage:
0% / 10% / 20% / 30%
Next, choose your out of pocket maximum:$2,000 or $5,000€1,480 or €3,700£1,330 or £3,325

19

THE FOLLOWING PAGES DETAIL THE
OPTIONAL BENEFITS AVAILABLE TO ADDTO YOUR CORE COVER – INTERNATIONALMEDICAL INSURANCE.
YOU CAN ADD AS MANY OPTIONAL
BENEFITS AS YOU WISH TO BUILD A PLAN
THAT SUITS YOUR NEEDS.

20

INTERNATIONAL OUTPATIENTInternational Outpatient covers you more comprehensively for outpatient care and medical
emergencies that may arise where a hospital admission as a daypatient or inpatient is not
required. As well as this, consultations with specialists and medical practitioners, prescribedoutpatient drugs and dressings, pre-natal and post-natal outpatient care, physiotherapy,
osteopathy, chiropractic and much more.

YOUR OVERALL LIMIT
Annual benefit - maximum perbeneficiary per period of coverThis includes claims paid across all sections ofInternational Outpatient.

SilverGold

Platinum$10,000€7,400£6,650$25,000€18,500£16,625

Unlimited

SilverGold

Platinum$125/€90/£80
limit per visit.
Up to 15 visits
per year.

$250/€185/£165 limit per
visit. Up to 30
visits per year.

Paid in full

YOUR STANDARD MEDICAL BENEFITS
Consultation with medical practitioners
and Specialists

Up to the maximum amount shown per periodof cover.

› We will pay for consultations or meetings with a medical practitioner which are necessary to diagnose an

illness, or to arrange or receive treatment up to the maximum number of visits shown in the benefit table.

› We will pay for non-surgical treatment on an outpatient basis, which is recommended by a specialist as
being medically necessary.

› Subject to prior approval and provided the medical practitioner is within your selected area of coverage,
we may pay for consultations that take place by use of electronic means or telephone.

Pre-natal and post-natal care
(Gold and Platinum plans only)

Up to the maximum amount shown per periodof cover. Available once the mother has been
covered on this option for twelve (12) months or
more.

SilverGold

PlatinumNot covered$3,500€2,750£2,250$7,000€5,500£4,500› We will pay for medically necessary pre-natal and post-natal care on an outpatient basis, if the mother has

been a beneficiary under the International Outpatient optional benefit for a continuous period of at least 12
months or more.
Examples of such treatment and tests include:• Routine obstetricians’ and midwives’ fees;• All scheduled ultrasounds and examinations;• Prescribed medicines, drugs and dressings;• Routine pre-natal blood tests, if required;• Amniocentesis procedure (also referred to as amniotic fluid test or AFT) or chorionic villous sampling(also referred to as CVS);• Non-invasive pre-natal testing (NIPT) for high risk individuals; and• Any fees as a result of post-natal care required by the mother immediately following routine childbirth.

21

Pathology, radiology and diagnostic tests(excluding Advanced Medical Imaging)
Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› We will pay for the following tests where they are medically necessary and are recommended by aspecialist as part of a beneficiary’s outpatient treatment:• blood and urine tests;• X-rays;• ultrasound scans;• electrocardiograms (ECG); and• other diagnostic tests (excluding advanced medical imaging).

Physiotherapy treatment

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› We will pay for physiotherapy treatment on an outpatient basis that is medically necessary and restorativein nature to help you to carry out your normal activities of daily living. The treatment must be carried out
by a properly qualified practitioner who holds the appropriate license to practice in the country where thetreatment is received. This excludes any sports medicine treatment.

› We will require a medical report and treatment plan prior to approval.
Osteopathy and chiropractic treatment

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

Paid in full up
to 15 visits

Paid in full up
to 15 visits

Paid in full up
to 30 visits› We will pay up to a combined maximum total of visits in any one period of cover for osteopathy andchiropractic treatment which is evidence-based treatment, medically necessary and recommended bya treating specialist, if a medical practitioner recommends the treatment and provides a referral. The
treatment must be carried out by a properly qualified practitioner who holds the appropriate license topractice in the country where the treatment is received. We will require a medical report and treatment
plan prior to approval. This excludes any sports medicine treatment.

Acupuncture, Homeopathy, andChinese medicine

Up to a combined maximum of 15 visits perperiod of cover.

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for a combined maximum total of 15 consultations with acupuncturists, homeopaths andpractitioners of Chinese medicine for each beneficiary in any one period of cover, if those treatments
are recommended by a medical practitioner. The treatment must be carried out by a properly qualified
practitioner who holds the appropriate license to practice in the country where the treatment is received.

22

Restorative speech therapy

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$2,500€1,850£1,650$5,000€3,700£3,325

Paid in full

› We will pay for restorative speech therapy if:• it is required immediately following treatment which is covered under this policy (for example, as part ofa beneficiary’s follow-up care after they have suffered a stroke);• it is confirmed by a specialist to be medically necessary on a short-term basis.
Important notes› We will only pay for speech therapy if the aim of that therapy is to restore impaired speech function.
› We will not pay for speech therapy which:• aims to improve speech skills which are not fully developed;• is educational in nature;• is intended to maintain speech communication;• aims to improve speech or language disorders (such as stammering); or• is as a result of learning difficulties, developmental problems (such as dyslexia), attention-deficit
hyperactivity disorder or autism.

Prescribed drugs and dressings

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$500
€370
£330

$2,000€1,480£1,330

Paid in full

› We will pay for prescription drugs and dressings which are prescribed by a medical practitioner on an
outpatient basis.

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

Rental of durable equipment

Up to a maximum of 45 days in the period ofcover.

› We will pay for the rental of durable medical equipment for up to 45 days per period of cover, if the use ofthat equipment is recommended by a specialist in order to support the beneficiary’s treatment.

› We will only pay for the rental of durable medical equipment which:• is not disposable, and is capable of being used more than once;• serves a medical purpose;• is fit for use in the home; and• is of a type only normally used by a person who is suffering from the effect of a disease, illness or injury.

Adult vaccinations

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$250
€185
£165

Paid in full

Paid in full

› We will pay for certain vaccinations and immunisations that are clinically appropriate namely:• Influenza (flu);• Tetanus (once every 10 years);• Hepatitis A;• Hepatitis B;• Meningitis;• Rabies;• Cholera;• Yellow Fever;• Japanese Encephalitis;• Polio booster;• Typhoid; and• Malaria (in tablet form, either daily or weekly).

23

Dental accidents

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$1,000€740£665Paid in full

Paid in full

› If a beneficiary needs dental treatment as a result of injuries which they have suffered in an accident, we

will pay for outpatient dental treatment for any sound natural tooth/teeth damaged or affected by theaccident, provided the treatment commences immediately after the accident and is completed within 30
days of the date of the accident.

› In order to approve this treatment, we will require confirmation from the beneficiary’s treating dentist of:• the date of the accident; and• the fact that the tooth/teeth which are the subject of the proposed treatment are sound natural tooth/teeth.

› We will pay for this treatment instead of any other dental treatment the beneficiary may be entitled tounder this policy, when they need treatment following accidental damage to a tooth or teeth.

› We will not pay for the repair or provision of dental implants, crowns or dentures under this part of thispolicy.

Well child tests

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Payable for children at appropriate age intervals up to the age of 6.
› We will pay for well child routine tests at any of the appropriate age intervals (birth, 2 months, 4 months, 6months, 9 months, 12 months, 15 months, 18 months, 2 years, 3 years, 4 years, 5 years and 6 years) and fora medical practitioner to provide preventative care consisting of:• evaluating medical history;• physical examinations;• development assessment;• anticipatory guidance; and• appropriate immunisations and laboratory tests; for children aged 6 or younger.
We will pay for one visit to a medical practitioner at each of the appropriate age intervals (up to a total of
13 visits for each child) for the purposes of receiving preventative care services.

› In addition, we will pay for:• one school entry health check, to assess growth, hearing and vision, for each child aged 6 or younger.
• diabetic retinopathy screening for children over the age of 12 who have diabetes.

Child immunisations

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for the following immunisations for children aged 17 or younger:
•
•
•
•

24

DPT (Diphtheria, Pertussis and Tetanus);
MMR (Measles, Mumps and Rubella);
HiB (Haemophilus influenza type b);
Polio;••••

Influenza;
Hepatitis B;
Meningitis; andHuman Papilloma Virus (HPV).

Annual routine tests

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for the following routine tests for children aged 15 or younger:• one eye test; and• one hearing test.
60+ Care(Gold and Platinum plans only)

Up to the maximum amount shown per periodof cover.

SilverGold

PlatinumNot covered$1,000€740£665$2,000€1,480£1,330› If a beneficiary is aged 60 years old and above, or turning 60 years old within the period of cover, and has
one of the following conditions as declared on their medical questionnaire, we will pay for the medicallynecessary outpatient treatment costs associated with the maintenance of this condition:• Arthritis, joint or back pain
• Glaucoma• Hypertension• Osteoporosis / Osteopenia• Type 2 Diabetes

Important notes› If, during the application stage you have selected the option to have one of the above conditions

covered at an additional premium, whereby the condition is covered comprehensively on an inpatientand outpatient basis (if the International Outpatient option has been selected); this benefit will not beapplicable.

› Examples of medically necessary treatment and tests include but are not limited to: consultations withmedical practitioners and specialists; pathology and radiology; physiotherapy; prescribed drugs anddressings, osteopathy and chiropractic treatment and acupuncture, homeopathy and Chinese medicine.
Please note this benefit excludes Advanced Medical Imaging.

› You are eligible to have the condition(s) covered (but not conditions, symptoms or complications arisingfrom those conditions) on an outpatient basis, up to the maximum amounts shown per period of cover.

› The benefit is subject to any cost shares or deductibles elected on your policy.

YOUR DEDUCTIBLE AND COST SHARE OPTIONS
Deductible (various)

A deductible is the amount which you must pay
before any claims are covered by your plan.

Cost share after deductible and out of
pocket maximum

Cost share is the percentage of each claim notcovered by your plan.
The out of pocket maximum is the maximum
amount of cost share you would have to pay ina period of cover.
The cost share amount is calculated after the
deductible is taken into account. Only amounts
you pay related to cost share contribute to theout of pocket maximum.

$0 / $150 / $500 / $1,000 / $1,500€0 / €110 / €370 / €700 / €1,100£0 / £100 / £335 / £600 / £1,000First, choose your cost share percentage:
0% / 10% / 20% / 30%
Your out of pocket maximum is:$3,000€2,200£2,00025

INTERNATIONAL MEDICALEVACUATIONInternational Medical Evacuation provides coverage for reasonable transportation costs
to the nearest centre of medical excellence in the event that the treatment is not available
locally in an emergency. This option also includes repatriation coverage, allowing thebeneficiary to return to their country of habitual residence or country of nationality to betreated in a familiar location. Also includes compassionate visits for a parent, spouse, partner,
sibling or child to visit a beneficiary after an accident or sudden illness and the beneficiaryhas not been evacuated or repatriated.

YOUR OVERALL LIMIT
Annual benefit - maximum perbeneficiary per period of cover

SilverGold

Platinum

Paid in full

Paid in full

Paid in fullSilverGold

Platinum

Paid in full

Paid in full

Paid in full

YOUR STANDARD MEDICAL BENEFITS
Medical Evacuation› Transfer to the nearest centre of medical excellence if the treatment the beneficiary needs is not available
locally in an emergency.

› If a beneficiary requires emergency treatment, we will pay for medical evacuation for them:• to be taken to the nearest hospital where the necessary treatment is available (even if this is in anotherpart of the country, or in another country); and• to return to the place they were taken from, provided the return journey takes place not more than 14days after the treatment is completed.

› As regards the return journey, we will pay:
• the price of an economy class air ticket; or• the reasonable cost of travel by land or sea; whichever is lesser.
› We will only pay for taxi fares if:• it is medically preferable for the beneficiary to travel to the airport by taxi, rather than by ambulance;and• approval is obtained in advance from the medical assistance service.
› We will pay for evacuation (but not repatriation) if the beneficiary needs diagnostic tests or cancer

treatment (such as chemotherapy) if, in the opinion of our medical assistance service, evacuation isappropriate and medically necessary in the circumstances.

› We will not pay any other costs related to an evacuation (such as accommodation costs).
Important note› If you require to return to the hospital where you were evacuated for follow up treatment, we will not pay
for travel costs or living allowance costs.

26

Medical repatriation

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› If a beneficiary requires a medical repatriation, we will pay:
• for them to be returned to their country of habitual residence or country of nationality; and• to return them to the place they were taken from, provided the return journey takes place not more than
14 days after the treatment is completed.

› The above journey must be approved in advance by our medical assistance service and to avoid doubt alltransportation costs are required to be reasonable and customary.

››

As regards the return journey, we will pay:

• the price of an economy class air ticket; or• the reasonable cost of travel by land or sea; whichever is lesser.
We will only pay for taxi fares if:• it is medically preferable for the beneficiary to travel to the airport by taxi, rather than by ambulance;and• approval is obtained in advance from the medical assistance service.
›

We will not pay any other costs related to a repatriation (such as accommodation costs).

Important notes›

If you require to return to the hospital where you were repatriated for follow up treatment, we will not pay
for travel costs or living allowance costs.

›

If a beneficiary contacts the medical assistance service to ask for prior approval for repatriation, but the
medical assistance service does not consider repatriation to be medically appropriate, we may insteadarrange for the beneficiary to be evacuated to the nearest hospital where the necessary treatment isavailable. We will then repatriate the beneficiary to his or her specified country of nationality or country of
habitual residence when his or her condition is stable, and it is medically appropriate to do so.

Repatriation of mortal remains

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› If a beneficiary dies outside their country of habitual residence during the period of cover, the medical

assistance service will arrange for their mortal remains to be returned to their country of habitualresidence or country of nationality as soon as reasonably practicable, subject to airlines requirements andrestrictions.

› We will not pay any costs associated with burial or cremation or the transport costs for someone to collector accompany the beneficiary’s mortal remains.

27

Travel costs for an accompanying person

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› If a beneficiary needs a parent, sibling, child, spouse or partner, to travel with them on their journey inconjunction with a medical evacuation or repatriation, because they:• need help getting on or off an aeroplane or other vehicle;• are travelling 1000 miles (or 1600km) or further;• are severely anxious or distressed, and are not being accompanied by a nurse, paramedic or othermedical escort and; or• are very seriously ill or injured;
we will pay for a relative or partner to accompany them. The journeys (for the avoidance of doubt shallmean one outbound and one return) must be approved in advance by the medical assistance service andthe return journey must take place not more than 14 days after the treatment is completed.

› We will pay:
• the price of an economy class air ticket; or• the reasonable cost of travel by land or sea; whichever is the lesser.
If it is appropriate, considering the beneficiary’s medical requirements, the family member or partner who
is accompanying them may travel in a different class.
If it is medically necessary for a beneficiary to be evacuated or repatriated, and they are going to beaccompanied by their spouse or partner, we will also pay the reasonable travel costs of any children aged
17 or under, if those children would otherwise be left without a parent or guardian.
Important notes› We will not pay for a third party to accompany a beneficiary if the original purpose of the evacuation was
to enable the beneficiary to receive outpatient treatment.

› We will not pay for any other costs relating to third party travel costs, such as accommodation or local
transportation.

If you have purchased this option, we will also make available the provision below forcompassionate visits to you by immediate family members.
Compassionate visits - travel costs

Up to a maximum of 5 trips per lifetime.
Up to the maximum amount shown per periodof cover.

Compassionate visits - living allowancecosts

Up to the maximum amount shown per day foreach visit with a maximum of 10 days per visit.
Up to the maximum amount shown per periodof cover.

SilverGold

Platinum$1,200€1,000£800$1,200€1,000£800$1,200€1,000
£800

$155
€125
£100

$155
€125
£100

$155
€125
£100

› For each beneficiary we will pay for up to 5 compassionate visits over the lifetime of the cover.
Compassionate visits must be approved in advance by our medical assistance service.

› We will pay the cost of economy class return travel for a parent, spouse, partner, sibling or child to visit a

beneficiary after an accident or sudden illness, if the beneficiary is in a different country and is anticipatedto be hospitalised for five days or more, or has been given a short-term terminal prognosis.

› We will also pay for living expenses incurred by a family member during a compassionate visit, for up to 10
days per visit while they are away from their country of habitual residence up to the limits shown in the listof benefits (subject to being provided with receipts in respect of the costs incurred).

Important note

› We will not pay for a compassionate visit when the beneficiary has been evacuated or repatriated. If an

evacuation or repatriation takes place during a compassionate visit, we will not pay any further third party
transportation costs.

28

INTERNATIONAL HEALTH AND
WELLBEINGInternational Health and Wellbeing covers the beneficiary for screenings, tests, examinations
and counselling support for a range of life crises and tailored advice and support through ouronline health education and health risk assessment, helping the beneficiary to take control
and manage their health the way they want.
During each period of cover we will pay for the following tests to be carried out by a
medical practitioner.

Routine adult physical examinations

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$225
€165
£150

$450
€330
£300

$600
€440
£400

› We will pay for routine adult physical examinations (including but not limited to: height, weight, bloods,
urinalysis, blood pressure, lung function etc), for persons aged 18 or older.

Pap smear

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$225
€165
£150

$450
€330
£300

Paid in full

› We will pay for one papanicolaou test (pap smear) for female beneficiaries.

Prostate cancer screening

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$225
€165
£150

$450
€330
£300

Paid in full

› We will pay for one prostate examination (prostate specific antigen (PSA) test) for male beneficiaries aged
50 or over.

Mammograms for breast cancer
screening

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$225
€165
£150

$450
€330
£300

Paid in full

› We will pay for:• Aged 35-39: one baseline mammogram for asymptomatic women.
• Aged 40-49: one mammogram for asymptomatic women every two years.
• Aged 50 or older: one mammogram each year.

29Bowel cancer screening

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$225
€165
£150

$450
€330
£300

Paid in full

› We will pay for one bowel cancer screening for beneficiaries aged 55 or older.

Bone densitometry

Up to the maximum amount shown per periodof cover.

SilverGold

Platinum

$225
€165
£150

$450
€330
£300

Paid in full

› We will pay for one scan to determine the density of the beneficiary’s bones.

Dietetic consultations

SilverGold

PlatinumNot covered

Not covered

Paid in full

› We will pay for up to 4 consultations with a dietician per period of cover, if the beneficiary requires dietaryadvice relating to a diagnosed disease or illness such as diabetes (Platinum plan only).

Life management assistance programme

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Our Life Management service is available 24 hours a day, 7 days a week, 365 days a year. Professionals areready to assist you with any issue that matters to you.

› We will pay for up to 5 counselling sessions per issue per period of cover. This could be telephonic or face
to face counselling support.

› Unlimited in the moment telephonic support for live assistance.
› Provides information, resources and counselling on any work, life, personal, or family issue that matters toyou.

› Information services provide support including assistance for day to day demands or the logistics ofrelocating. The information specialists can offer assistance over the phone and perform research andprovide pre-qualified referrals to local resources.

Please contact us for approval. The service is provided by our chosen counselling provider.

Online health education, healthassessments and web-based coaching
programmes

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› Access to our health and wellbeing section is available in your secure online Customer Area.

30

INTERNATIONAL VISION AND
DENTALInternational Vision and Dental pays for the beneficiary’s routine eye examination and pays
costs for spectacles and lenses. It also covers a wide range of preventative, routine and major
dental treatments.

VISION CARE
Eye examination

Maximum per beneficiary per period of cover.

SilverGold

Platinum

$100
€75
£65

$200
€150
£130

Paid in full

› We will pay for one routine eye examination per period of cover, to be carried out by either anophthalmologist or optometrist.

› We will not pay for more than one eye examination in any one period of cover.

Expenses for:› Spectacle lenses;› Contact lenses;› Spectacle frames;› Prescription sunglasses;
when all are prescribed by an optometrist or
ophthalmologist.

SilverGold

Platinum

$155
€125
£100

$155
€125
£100

$310
€245
£200

Up to the maximum amount shown per periodof cover.

› We will not pay for:• sunglasses, unless medically prescribed, by an ophthalmologist or optometrist;• glasses or lenses which are not medically necessary or not prescribed by an ophthalmologist or
optometrist; or• treatment or surgery, including treatment or surgery which aims to correct eyesight, such as laser eye
surgery, refractive keratotomy (RK) or photorefractive keratectomy (PRK).

› A copy of a prescription or invoice for corrective lenses will need to be provided to us in support of any
claim for frames.

DENTAL TREATMENTYOUR OVERALL LIMIT
Annual benefit - maximum perbeneficiary per period of cover

SilverGold

Platinum$1,250€930£830$2,500€1,850£1,650$5,500€4,300£3,50031

Preventative dental treatment

After the beneficiary has been covered on thisoption for 3 months.

SilverGold

Platinum

Paid in full

Paid in full

Paid in full

› We will pay for the following preventative dental treatment recommended by a dentist after a beneficiaryhas had International Vision and Dental cover for at least 3 months:• two dental check-ups per period of cover;• X-rays, including bitewing, single view, and orthopantomogram (OPG);• scaling and polishing including topical fluoride application when necessary (two per period of cover);• one mouth guard per period of cover;• one night guard per period of cover; and• Fissure sealant.

Routine dental treatment

After the beneficiary has been covered on thisoption for 3 months.

SilverGold

Platinum

80% refund perperiod of cover

90% refund perperiod of cover

Paid in full

› We will pay treatment costs for the following routine dental treatment after the beneficiary has had

International Vision and Dental cover for at least 3 months (if that treatment is necessary for continued
oral health and is recommended by a dentist):• root canal treatment;• extractions;• surgical procedures;• occasional treatment;• anaesthetics; and• periodontal treatment.

Major restorative dental treatment

After the beneficiary has been covered on thisoption for 12 months.

SilverGold

Platinum

70% refund perperiod of cover

80% refund perperiod of cover

Paid in full

› We will pay treatment costs for the following major restorative dental treatments after the beneficiary has
had International Vision and Dental cover for at least 12 months:• dentures (acrylic/synthetic, metal and metal/acrylic);• crowns;• inlays; and• placement of dental implants.

› If a beneficiary needs major restorative dental treatment before they have had International Vision and
Dental cover for 12 months, we will pay 50% of the treatment costs.

Orthodontic treatment

After the beneficiary has been covered on thisoption for 18 months.

SilverGold

Platinum

40% refund perperiod of cover

50% refund perperiod of cover

50% refund perperiod of cover› We will pay for orthodontic treatment for beneficiaries aged 18 years old or younger, if they have had
International Vision and Dental cover for at least 18 months.

› We will only pay for orthodontic treatment if:• the dentist or orthodontist who is going to provide the treatment provides us, in advance, with a•32

detailed description of the proposed treatment (including X-rays and models), and an estimate of thecost of treatment; andwe have approved the treatment in advance.

WE HAVE YOU COVEREDPre-existing conditions

Out of area emergency cover

There may be some medical conditions that
we agree to include at an additional premium.
Our Underwriters will determine whether weare able to include a medical condition thatwould normally have been excluded. Where
applicable, we will present you with a quotewith the option to include the condition.

For additional peace of mind, all of our plansinclude emergency short-term medical
coverage when you are visiting a location
outside of your selected area of coverage(you can select from Worldwide including
USA or Worldwide excluding USA cover). So
if you purchase the Worldwide excluding USA
option, you will still be covered for emergency
treatment on an Inpatient or Daypatientbasis, or Outpatient basis (if the International
Outpatient additional coverage option has
been purchased under your policy) during
temporary business or holiday trips to the USA.
Coverage is limited to a maximum period of 3
weeks per trip and a maximum of 60 days perperiod of cover for all trips combined. Please
read our policy documentation for the fullterms and conditions relating to this benefit.

33

SECURE ONLINE CUSTOMER AREA
As a Cigna customer you will have access to a wealth of information wherever you are in theworld through your secure online Customer Area. Here you will be able to effectively manage
your policy including;> View your policy documentation,
including your Certificate of Insurance
and Cigna ID cards for all thebeneficiaries covered under your plan
> Check the policy rules that apply to yourpolicy> Check your coverage for you andyour family> Submit claims online

34> Search for healthcare facilities andprofessionals near your location> Country guides highlighting security
and cultural information for many
destinations around the globe> View our quarterly customer magazine> Download the Safe Travel app(Platinum and Gold plan customers
only)YOUR TRAVEL SAFETY COMPANIONOur Platinum and Gold plans include the Safe Travel by Cigna application, which includes
helpful travel advice, country profiles, real time alerts, news for specific travel destinations andmuch more.

Global incident monitoring
system, with push notification
travel news and security alerts

Extensive country profiles,
with travel safety guides
for over 200 countries

Secure personal profileand travel document
upload/storage facility

SAFE TRAVELBY CIGNA
www.cignaglobal.com/
brokers/safetravelbycigna

Pre-trip advice and information
on everything from personal
security to natural hazards

SOS tracking system thatturns your mobile phone into
a personal safety device

The Safe Travel by Cigna App is currently made available to you free of charge for use on your phone whilst you remain apolicyholder of the Cigna Global Platinum or Gold plan. We reserve the right to amend or withdraw the Safe Travel by Cigna App.
Available for Apple and Android devices only.
35

WHAT YOU CAN EXPECT FROM US
In addition to your Cigna Global plan, there are a few more things you might like to know
about us and the service you can expect as a customer of Cigna.

Comprehensive welcome packGetting treatment

Once you have joined Cigna, we will send
your policy documents electronically within
24 hours. Your policy documents are allavailable in your secure online Customer
Area also. If you have requested to receive
printed copies of your policy documents,
we will send them to the postal address you
gave us.

Prior approval should be obtained fromus for all treatment. This will help ensure
your claims are covered under the policy.
Our Customer Care Team will help you
find a high quality hospital or doctor nearyou. Wherever possible, we will pay them
directly, saving you the inconvenience of
paying for your treatment yourself andclaiming a refund later.

Please read through all your policy
documents when you receive them andmake sure you check the details of yourpolicy on the certificate of insurance. You
will need to show your Cigna ID card when
you require treatment so your doctor knows
who you are (it’s not used for payment). It
also has all the contact numbers you’ll need.
You can view and print your Cigna ID cardin your secure online Customer Area.

On the rare occasion you do pay fortreatment yourself, we’ll aim to process yourclaim within 5 working days after receiving
all necessary documentation. The Customer
Guide in your welcome pack will tell you
everything you need to know about getting
treatment and making a claim.

Your policy documents include the following:36

Customer Guide

Policy Rules

How your plan works
and your guide to thebenefits.

The terms andconditions, general
exclusions anddefinitions of yourpolicy in one handy
booklet.

Certificate ofInsurance
A record of theplan you chose, thepremium and what
and who it covers.

ID Card
Proof of your identity
and cover for when
you need treatment.

39

Important note: This document serves only as a reference and does not form part of a legal contract. The information herein is believed
accurate as of the date of publication and is subject to change. This material is intended for informational purposes only and contains apartial and general description of benefits. We recommend that you examine your (product) policy in detail to be certain of precise terms,
conditions and coverage. Coverage and benefits are available except where prohibited by applicable law.
“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporationand its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, and not by Cigna
Corporation. Such operating subsidiaries include Cigna Global Insurance Company Limited, Cigna Life Insurance Company of Europe
S.A.–N.V, Cigna Europe Insurance Company S.A.-N.V. and Cigna Worldwide Life Insurance Company Limited. © 2016 Cigna
Sales Brochure Broker 09/2016