insurance program

Thousands of students and other educational professionals travel internationally each year. These travelers experience both the educational benefit and the thrill of studying outside of their home country. Proper medical coverage is required in order to protect against unforeseen events. Seven Corners has established Liaison® Student to provide valuable benefits to students and other educational professionals when they travel outside of their home country.

Whether you are a foreign national studying in the United States for several years or a U.S. citizen studying abroad, Liaison® Student is designed to protect you during your time away from home.

why choose liaison® student?

• Seven Corners has been providing international medical and travel insurance to citizens of all countries since 1993.

• Liaison Student’s benefits are specifically designed and priced for international students.

• 24 Hour Assistance Service is ready to assist in locating proper medical care when you are traveling away from

1 home.

who is eligible for liaison®student?

Non-U.S. Citizens:

International Students, visiting Faculty, Scholars, or other persons age 12 and older who are temporarily residing outside their

Home Country. The Insured must remain engaged in full-time educational or research activities outside their Home Country during the Period of Coverage.

Education or research activities shall mean the Insured: 1) is enrolled and participating in an educational, vocational, cultural exchange, or training programs; and 2) has a valid J-1, H-3, F, M, or

Q Visa.

U.S. Citizens:

All United States Students, visiting Faculty, Scholars, or other persons with a current passport who are temporarily residing outside the United States and are engaged in full-time educational or research activities.

description of benefits

who is eligible for liaison®student? (cont.)

For Both U.S. citizens and non-U.S. citizens:

Eligible individuals may also purchase coverage for their eligible dependents (must be covered along with a Parent). An eligible spouse shall be defined as the Primary Insured’s legal spouse. An Eligible Dependent Child shall mean the Primary Insured Person’s unmarried child(ren) over 30 days and under nineteen (19) years of age or under 25 years of age if they are attending an accredited institution of higher learning on a regular full-time basis and/or wholly dependent upon the Insured Person for maintenance and support. Maximum age of coverage is 64.

period of coverage

The minimum period of coverage under Liaison Student is 5 days, maximum is 12 months (see Continuing Coverage section).

Coverage can be purchased in a combination of monthly and/ or daily periods by paying the appropriate plan cost. If you are studying abroad for an extended period of time, please refer to

“Additional Period of Coverage” section

3 effective date

Your coverage will begin at 12:01 AM North American Eastern

Time on the latest of the following:

1.The date Seven Corners receives a completed application and premium for the period requested; or

2.The Effective Date requested on the application; or

3.The moment the Insured Person departs their Home Country airspace; or

4.The date Seven Corners approves the application.

expiration date

Coverage will end at 12:01 AM North American Eastern Time on the earlier of the following:

1.The moment the Insured Person returns to their Home Country (with the exception of Home Country Coverage); or

2.The expiration of 12 months from the Effective Date of Coverage (see Continuing Coverage section); or

3.The date shown on the ID Card issued by Seven Corners; or

4.The end of the period for which premium has been paid; or

5.The Date the Insured Person fails to be considered an Eligible

Person; or

6.The date / moment the maximum benefit amount has been paid.

medical expenses

This Plan shall pay Reasonable and Customary charges for

Covered Expenses, excess of the Deductible and Coinsurance up to the Medical Maximum, incurred by you due to a covered Injury or Illness which occurred during your Period of Coverage outside your Home Country (except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes shall be considered one Disablement. If a Disablement is due to causes which

are the same or related to the cause of a prior Disablement, the Disablement shall be considered a continuation of the prior Disablement and not a separate Disablement. The initial

Treatment of an Injury or Illness must occur within 30 days of the date of Injury or onset of Illness.

Only such expenses which are specifically enumerated in the following list of charges are incurred within your Period of Coverage, and which are not excluded shall be considered Covered Expenses:

1. Charges made by a hospital for semi-private room and board, floor nursing and other services inclusive of charges for professional 4 service and with the exception of personal services of a non- medical nature; provided, however, those expenses do not exceed

the hospital’s average charge for semi-private room and board accommodation.

2.Charges made for Intensive Care or Coronary Care charges and nursing services.

3.Charges made for diagnosis, Treatment and Surgery by a Physician.

4.Charges made for an operating room.

5.Charges made for Outpatient Treatment, same as any other Treatment covered on an Inpatient basis. This includes ambulatory

Surgical centers, Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations.

6.Charges made for the cost and administration of anesthetics.

7.Charges for Medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood, transfusions, iron lungs, and medical Treatment.

8.Charges for physiotherapy, to a maximum of $500, if recommended by a Physician for the Treatment of a specific Disablement following hospitalization and administered by a licensed physiotherapist.

9.Dressings, drugs, and Medicines that can only be obtained upon a written prescription of a Physician or Surgeon.

10.Emergency local transportation to or from the nearest hospital or to and from the nearest hospital with facilities for required

Treatment. Such transportation shall be by licensed ground ambulance only to a limit of $350, within the metropolitan area in which you are located at the time the service is used. If you are in a rural area, and ground ambulance is not available then licensed air ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense.

description of coverage

pre-notification

In order to ensure Your claims are addressed as efficiently as possible,

You or the provider of service must contact Seven Corners Assist for pre-notification prior to any medical Treatment in the U.S. as well as hospital admissions and inpatient / outpatient surgeries incurred worldwide. Seven Corners Assist has trained personnel available 24 hours a day, 7 days a week throughout the year to answer Your questions, provide assistance, and guide You to an appropriate facility if necessary. In the case of an Emergency Admission, the Assistance Company must be contacted within 48 hours, or as soon as reasonably possible. Pre-notification does not guarantee that benefits will be paid.

unexpected recurrence of a pre-existing condition

(This benefit is only available to U.S. citizens traveling outside the United States and Canada) This Plan shall pay up to $500

subject to the chosen Deductible and Coinsurance, for Covered

Expenses resulting from a sudden, unexpected recurrence of a

Pre-Existing Condition while traveling outside the United States.

This benefit does not include coverage for known, scheduled,

5required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.

maternity

When covered maternity expenses are incurred by You or Your eligible dependents, the Company will pay Reasonable

Charges for medical expenses in excess of the Deductible and Coinsurance. In no event shall the Company’s maximum liability exceed the maximum stated in the Schedule of Benefits, as to

Covered Expenses during any one period of individual coverage.

You or Your representative must notify the Company of a Pregnancy within the first trimester.

As stated in the Schedule of Benefits, benefits will be payable for covered expenses You incur before, during, and after delivery of a child, including physician, hospital, laboratory, and ultrasound services. Coverage for the Inpatient postpartum stay for You and Your newborn child in a hospital, will, at a minimum, be for the length of stay recommended by the American Academy

of Pediatrics and the American College of Obstetricians and

Gynecologists per their guidelines for perinatal care.

maternity (cont.)

Coverage for a length of stay shorter than the minimum period mentioned above may be permitted if Your attending physician determines further Inpatient postpartum care is not necessary for You or Your newborn child provided the following are met:

1.In the opinion of Your attending physician, the newborn child meets the criteria for medical stability in the guidelines for perinatal care prepared by the Academy of Pediatrics and the American

College of Obstetricians and Gynecologists that determine the appropriate length of stay based upon the evaluation of:

a)The antepartum, intrapartum, postpartum course of the mother and infant;

b)The gestational stage, birth weight, and clinical condition of the infant;

c)The demonstrated ability of the mother to care for the infant after discharge; and

d)The availability of post discharge follow up to verify the condition of the infant after discharge; and

2.One (1) at-home post delivery care visit is provided to You at Your residence by a physician or nurse performed no later than forty- eight (48) hours following discharge for You and Your newborn

	child from the hospital. Coverage for this visit includes, but is not	6
	limited to:

a)Parent education;

b)Assistance and training in breast or bottle feeding; and

c)Performance of any maternal or neonatal tests routinely performed during the usual course of Inpatient care for You

or Your newborn child, including the collection of an adequate sample for the hereditary and metabolic newborn screening. (At Your discretion, this visit may occur at the physician’s office.)

mental illness

For the purpose of this section, only such expenses, incurred as the result of Treatment or Medication for Mental Illness, which are specifically enumerated in the following list of charges, and which are not excluded, shall be considered as Covered Expenses:

1.Inpatient Care:

a)Charges made by a Hospital or mental institution for room and board, floor nursing and other services inclusive of charges for professional service and with the exception of personal services of a non-medical nature, provided, however, that expenses do not exceed the Hospital’s or mental institution’s average charge for semi-private room and board accommodation.

b)Charges made for diagnosis and Treatment by a Physician.

c)Charges made for the cost and administration of anesthetics.

description of coverage

mental illness (cont.)

d)Charges for Medication, x-ray services, laboratory tests and services, oxygen, and medical Treatment.

e)Drugs and Medicines that can only be obtained upon a written prescription of a Physician.

2.Outpatient care:

a)Charges made for diagnosis and Treatment by a Physician.

b)Charges made for the cost and administration of anesthetics.

c)Charges for Medication, x-ray services, laboratory tests and services, oxygen, and medical Treatment.

d)Drugs and Medicines that can only be obtained upon a written prescription of a Physician.

Only those expenses specifically described above which are incurred within the following Limits from the onset of the Mental

Illness and which are not excluded are considered Covered

Expenses. Mental Illness must first manifest itself during the

Period of Coverage.

Inpatient Care – Shall be payable at 50% to $10,000, subject to a maximum of 45 days of Inpatient care.

Outpatient – Shall be payable at 80% up to a maximum of $500.

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alcohol and drug abuse

Benefits are paid for Treatment or medication for Alcohol and Drug Abuse, which are not excluded and covered under this policy, shall be considered a Covered Expense. Benefits shall be payable at 50% up to $1,000.

emergency dental treatment

Benefits are paid for Reasonable and Customary expenses in excess of the Deductible and Coinsurance of $250 per tooth up to a maximum of $500, for the emergency repair or replacement of sound, natural teeth damaged as the result of a Covered

Accident.

emergency medical evacuation & repatriation

Benefits are paid for Covered Expenses incurred up to $100,000, for any covered Injury or Illness commencing during Your Period of Coverage that results in a Medically Necessary Emergency Medical Evacuation or Repatriation. The decision for an Emergency Medical Evacuation or Repatriation must be pre- approved and arranged by Seven Corners Assist in consultation with your local attending Physician.

emergency medical evacuation &repatriation(cont.)

Emergency Medical Evacuation or Repatriation means: a) your medical condition warrants immediate transportation from the place where you are located (due to inadequate medical facilities) to the nearest adequate medical facility where medical Treatment can be obtained; or b) after being treated at a local medical facility, your medical condition warrants transportation with a qualified medical attendant to your Home Country to obtain further medical Treatment or to recover; or c) both a) and b) above.

Covered Expenses are expenses for transportation, medical
services and medical supplies necessarily incurred in connection
with Emergency Medical Evacuation or Repatriation. All
transportation arrangements must be by the most direct
and economical route. Expenses for special transportation
and medical supplies and services must be: a) pre-approved
and ordered by the Assistance Company and b) required by
the standard regulations of the conveyance transportation.
Transportation means any land, water or air conveyance required
to transport you. Special transportation includes, but is not
limited to, licensed ground and air ambulances, commercial
airlines, and private motor vehicles.	8

return of mortal remains

Benefits will be paid for Reasonable and Customary Covered

Expenses incurred up to $25,000, to return your remains to your

Home Country, if you should die. Covered Expenses include, but are not limited to, expenses for embalming or Cremation, a minimally necessary container appropriate for transportation, shipping costs, and the necessary government authorizations.

All Covered Expenses in connection with a Return of Mortal Remains or Cremation must be pre-approved and arranged by Seven Corners Assist.

emergency medical reunion

When Seven Corners Assist and your attending Physician determine that it is necessary and prudent for you to have an

Emergency Medical Evacuation or Repatriation, this Plan will arrange to bring an individual of your choice, from your Home

Country, to be at your side while you are hospitalized and then accompany you during your return to your Home Country. Benefits will be paid up to $5,000 for a round-trip economy airfare ticket as well as for reasonable travel and accommodation expenses up to a maximum of 10 days, as pre-approved and arranged by Seven Corners Assist.

description of coverage

accidental death & dismemberment

Benefits shall be paid to you if you sustain an accidental Injury or

Loss. The Injury must occur during the Period of Coverage and death or dismemberment as a result of that accident must occur within 365 days from the date of Accident. Benefits payable for any such loss shall be in accordance with the following table: If you incur more than one Loss stated in the following Table as the result of one Accident, only the largest amount, shall be payable.

Description of loss	Percent of principal sum
Life	100%
Both Hands or Both Feet or Sight
of Both Eyes	100%
One Hand and One Foot	100%
Either Hand or Foot and
Sight of One Eye	100%
Either Hand or Foot	50%

spinal manipulation

Benefits shall be paid for Spinal Manipulation which is prescribed,

9performed, or ordered by a licensed chiropractor for the relief of pain. Benefits are payable up to $500.

home country coverage

Incidental Trips to the Home Country – During Your Period of Coverage, the Insured may return to their Home Country for incidental visits of up to 30 days per year (or pro-rata thereof). If during an incidental trip home, the Insured suffers an Injury or Illness, this Plan shall pay up to $1,000 of Covered Expenses for

that Injury or Illness. Treatment for this Injury or Illness must occur within the Insured’s Home Country while on the incidental visit.

Home Country Extension of Benefits – The Plan shall pay up to a maximum of $1,000 for Covered Expenses incurred in your

Home Country related to an Injury or Illness which occurred, was diagnosed and treated outside your Home Country during your

Period of Coverage. Only those covered expenses incurred within

30 days of your return to your Home Country shall be considered eligible.

definitions

benefit period shall mean the allowable time period you have to receive Treatment for a Covered Injury or Illness.

coinsurance shall mean the percentage amount of Covered

Expenses, after the Deductible, which is your responsibility to pay. deductible shall mean the amount of Covered Expenses which is your responsibility to pay before benefits under the Plan are payable. home country shall mean the country where you have your true, fixed and permanent home and principal establishment. inpatient shall mean if you are confined in an institution and are charged for room and board.

outpatient shall mean if you receive care in a hospital or another institution, including; ambulatory surgical center; convalescent/ skilled nursing facility; or Physician’s office, for an Illness or Injury, but who is confined and is not charged for room and board. pre-existing condition shall mean any Injury or Illness which meets the following criteria: 1) a condition that would have caused a person to seek medical advice, diagnosis, care or treatment during the twenty-four (24) months prior to the Effective Date of coverage under this Policy; 2) a condition for which manifestation, medical advice, diagnosis, care or treatment was recommended, received,

or noticed during the twenty-four (24) months prior to the Effective 10 Date of coverage under this Policy. If the Insured Person is covered

under the Policy for 24 consecutive months, the Pre-existing

Condition exclusion will no longer apply and any eligible expenses incurred thereafter will be considered for reimbursement. reasonable and customary shall mean the maximum amount that the Plan determines is Reasonable and Customary for Covered Expenses you receive, up to but not to exceed charges actually billed. The determination considers: 1) amounts charged by other Service Providers for the same or similar service in the locality where received, considering the nature and severity of the bodily Injury

or Illness in connection with which such services and supplies are received; 2) any usual medical circumstances requiring additional time, skill or experience; and 3) other factors included but not limited to, a resource based relative value scale.

spinal manipulation shall mean outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference as a result of or related to distortion, misalignment or subluxation of or in the vertebral column.

treatment means a specific in-office or hospital physical examination of or care rendered to you, consultation, diagnostic procedures and services, Surgery, medical services and supplies including medication prescribed or provided by a Service Provider.

exclusions and limitations

exclusions

No Benefit shall be payable for Accident Medical, Sickness Medical, Mental Illness, Alcohol and Drug Abuse, Dental, Emergency Medical Evacuation/Repatriation, Return of Mortal Remains, and Emergency Medical Reunion, as the result of:

1. Any Pre-existing Condition as defined hereunder. This exclusion does not apply to Emergency Medical Evacuation/ Repatriation or Return of Mortal Remains.

2. Injury or Illness which is not presented to the Company for payment within ninety (90) days of receiving Treatment;

3. Charges for Treatment which is not Medically Necessary;

4. Charges provided at no cost to you;

5. Charges for Treatment which exceed Reasonable and Customary charges;

6. Charges incurred for Surgery or Treatments which are,

Experimental/Investigational, or for research purposes;

7. Services, supplies or Treatment, including any period of hospital confinement, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician;

8. Suicide or any attempt thereof, self-destruction or attempt thereof while sane or insane (may vary by state of residence.);

	11	9. Any consequence, whether directly or indirectly, proximately
		or remotely occasioned by, contributed to by, or traceable to, or
		arising in connection with:
		a) war, invasion, act of foreign enemy hostilities, warlike operations
		(whether war be declared or not), or civil war.
		b) mutiny, riot, strike, military or popular uprising insurrection,
		rebellion, revolution, military or usurped power.
		c) acting on behalf of or in connection with any organization
		with activities directed towards the overthrow by force of the
		Government de jure or de facto.
		d) martial law or state of siege or any events or causes which
		determine the proclamation or maintenance of martial law
		or state of siege (Lloyd’s of London has alternative exclusionary
		wording. See program summary for details)
		10. Injury sustained while participating in professional athletics;
		11. Routine physicals, immunizations or other examinations where there
		are no objective indications or impairment in normal health, and
		laboratory diagnostic or x-ray examinations, except in the course of a
		Disablement established by a prior call or attendance of a Physician;
		12. Treatment of the Temporomandibular joint;
		13. Vocational, speech, recreational or music therapy;
		14. Services or supplies performed or provided by a Relative of yours,
		or anyone who lives with you;
		15. Cosmetic or plastic Surgery, except as the result of a covered
		Accident; for the purposes of this Plan, Treatment of a deviated
		nasal septum shall be considered a cosmetic condition;
		16. Elective Surgery which can be postponed until you return to your
		Home Country, where the objective of the trip is to seek medical
		advice, Treatment or Surgery;

exclusions (cont.)

17.Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids;

18.Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or for the fitting thereof, unless caused by Accidental bodily Injury incurred while covered hereunder;

19.Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent, unless otherwise covered under this policy;

20.Injury sustained while under the influence of or Disablement due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician; ;

21.Any Mental and Nervous disorders or rest cures, unless otherwise covered under this policy;

22.Congenital abnormalities and conditions arising out of or resulting there from;

23.Expenses which are non-medical in nature;

24.Expenses as a result of, or in connection with, intentionally self- inflicted Injury or Illness;

25.Expenses as a result of, or in connection with, the commission of a felony offense;

26. Injury sustained while taking part in mountaineering where

12

ropes or guides are normally used; hang gliding, parachuting, bungee jumping, racing by horse, motor vehicle or motorcycle, snowmobiling, motorcycle/motor scooter riding (whether as a passenger or a driver), scuba diving involving underwater breathing apparatus, unless PADI or NAUI certified, snorkeling, water skiing, snow skiing, spelunking, parasailing and snow boarding;

27.Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through an employer to the extent so furnished or paid, or under any mandatory government program or facility set up for Treatment without any cost to you;

28.Dental care, except as the result of Injury to natural teeth caused by Accident, unless otherwise covered under this Plan;

29.Routine Dental Treatment;

30.For Pregnancy or Illness resulting from Pregnancy, childbirth, or miscarriage, unless otherwise covered under this Plan;

31.Drug, Treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, Treatment for infertility or impotency, sterilization or reversal thereof;

32.Treatment for human organ tissue transplants and their related Treatment;

33.Expenses incurred while in your Home Country, except as provided under the Home Country Coverage and Home Country

Extension of Benefits Coverage;

34.Expenses incurred during a hospital emergency visit which is not of an emergency nature;

exclusions and limitations

exclusions (cont.)

35.Injury sustained as the result of the Insured Person operating a motor vehicle while not properly licensed to do so in the jurisdiction in which the motor vehicle accident takes place;

36.Covered Expenses incurred for which the Trip to the Host Country was undertaken to seek medical Treatment for a condition;

37.Covered Expenses incurred during a Trip after your Physician has limited or restricted travel;

38.Policy does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act regardless of any other cause or event contributing concurrently or in any other sequence thereto;

39.Sex change operations, or for Treatment of sexual dysfunction or sexual inadequacy;

40.Weight reduction programs or the surgical Treatment of obesity.

No Benefit shall be payable for Accidental Death and

Dismemberment as the result of:

131. Suicide, or attempt thereof, while sane; or self destruction, or any attempt thereof, while insane, may vary by state of residence;

2.Disease of any kind; Bacterial infections, except pyogenic infection, which shall occur through an accidental cut or wound;

3.Hernia of any kind;

4.Injury sustained while you are riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting from, any type of aircraft;

5.Injury sustained while you are riding as a passenger in any aircraft

(a)not having a current and valid Airworthy Certificate and (b) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft;

6.Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with:

a)war, invasion, act of foreign enemy hostilities, warlike operations

(whether war be declared or not), or civil war.

b)mutiny, riot, strike, military or popular uprisinginsurrection, rebellion, revolution, military or usurped power.

c)acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by terrorism or violence.

d)martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege (Lloyd’s of London has alternative exclusionary wording. See program summary for details)

exclusions (cont.)

7.Service in the military, naval or air service of any country;

8.Flying in any aircraft being used for, or in connection with, acrobatic or stunt flying, racing or endurance tests;

9.Flying in any rocket-propelled aircraft;

10.Flying in any aircraft being used for, or in connection with, crop dusting or seeding or spraying, fire fighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography, banner towing or any experimental purpose;

11.Flying in any aircraft which is engaged in any flight which requires a special permit or waiver from the authority having jurisdiction over civil aviation, even though granted;

12.Sickness of any kind;

13.Being under the influence of alcohol or having taken drugs or narcotics unless prescribed by a legally qualified Physician or surgeon;

14.Injury occasioned or occurring while you are committing or attempting to commit a felony or to which a contributing cause was your being engaged in an illegal occupation;

15.While riding or driving in any kind of competition;

16.This plan does not insure against loss or damage (including death or Injury) and any associated cost or expense resulting directly

or indirectly from the discharge, explosion or use of any device,

weapon or material employing or involving nuclear fission, nuclear 14 fusion or radioactive force, or chemical, biological, radiological

or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless or any other cause or event contributing concurrently or in any other sequence thereto.

Excess Benefits: All coverages, except Accidental Death and Dismemberment, shall be in excess of all other valid and collectible Insurance Indemnity and shall apply only when such benefits are exhausted.

additional information

additional period of coverage

Participants whose initial Period of Coverage is less than twelve

(12) months may apply for a new Period of Coverage. Your original effective date will be used with regards to determining any Pre-existing Conditions. This option is available as long as you continue to meet the Eligibility Requirements. It is important to note that rates and benefits may change for each subsequent

Period of Coverage. A $5.00 Administrative Fee will be included on each notice. This option is not available if you allow coverage to expire prior to reapplying. If this happens, an entirely new program must be purchased (Pre-existing Conditions will begin again). An Additional Period of Coverage is available in periods as short as 5 days at a time when purchased using Seven Corners’ online system.

refund of premium

United States Fire Insurance Company and Certain Underwriters at Lloyd’s of London realize that there is uncertainty in international travel. Refund of total plan cost will only be considered if written request is received by Seven Corners prior

15to the Effective Date of Coverage. If written request is received after the Effective Date of Coverage, the unused portion of the plan cost may be refunded minus a cancellation fee, provided no claim has been submitted to Seven Corners for reimbursement.

filing a claim

Filing a claim with Seven Corners is easy. You will receive a Liaison Student identification card once you are approved for insurance. When you receive treatment, send the original itemized bills to Seven Corners within ninety (90) days, along with a completed claim form. Eligible bills are automatically converted from local currencies to US dollars. For payments

of eligible medical expenses, notify Seven Corners of pending treatments and we can refer you to approved health care providers worldwide. You’re only responsible for your deductible, coinsurance amounts and non-eligible expenses. For more details, consult the Program Summary that is provided with your

ID card, or contact the Seven Corners Claim Department.

about the administrator

Medical care is different throughout the world and providing quality medical attention should be the ultimate goal of any program. Most companies are not prepared to meet the unique needs of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. Liaison Student is designed and administered by Seven Corners, Inc. The claim and assistance professionals at Seven Corners collectively have over 250 years of experience in claim processing and administration.

the insurance company

Liaison Student is underwritten by United States Fire Insurance

Company (States not underwritten by United States Fire Insurance Company are underwritten by Certain Underwriters at Lloyd’s of London. Please contact Seven Corners for a listing of these states).

seven corners

Since 1993, Seven Corners, Inc. has alleviated many of the

16

concerns with international travel by providing insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. Each year, thousands of insureds purchase coverage from Seven Corners in order to obtain the most comprehensive and reliable products in the international insurance industry.

Our assistance professionals are experienced in the complexity and importance of receiving medical care internationally. As an insured of Seven Corners, you can feel confident that there is someone ready to assist you with a medical situation 24 hours a day, 7 days a week, 365 days a year.

In California, operating under the name Seven Corners Insurance Services.

additional information

wellabroad.com

In our ever changing world, Seven Corners’ WellAbroad® seeks to prepare individuals and groups with the advanced tools for successful travel. WellAbroad® offers medical, political and

cultural information and includes many benefits and educational resources, such as:

•Text messaging alerts - Registered users receive updates regarding weather emergencies, security issues, customs alerts, and health care or pandemic warnings.

•Provider network directory - Clients and travelers can create customized country profiles which allow instant access to

providers in the specified regions to which they are traveling.

•Online forums - Fellow travelers and Seven Corners’ staff post experiences and travel tips which can be accessed at any time.

Happy travels – www.wellabroad.com.

seven corners assist

u.s. provider network (ppo) (foreign nationals visiting the 17 united states)

When you are in the United States, you have the ability to use any medical provider/facility of your choice. Seven Corners

Assist does, however, have a list of recommended providers/ facilities for you to use. Please visit our website at www. sevencorners.com or call our 24-hour assistance center to locate the nearest medical facility. Kindly note that when you are pre-notifying, visiting a physician or medical facility, please be sure to present your ID Card.

international network (u.s. citizens traveling overseas)

Seven Corners Assist is a leading provider of customized emergency assistance services to international organizations, corporations, government entities, insurance companies, and individual travelers. Regardless of the location, Seven

Corners Assist provides valuable assistance in locating the best possible medical treatment.

Seven Corners has access to over 12,000 doctors and hospitals worldwide. With one phone call, we can assist you in locating a physician in order to receive the care you need. Additionally, Seven Corners Assist is trained to reach outside of our network in order to locate the care you need as quickly as possible.

Contact information for Seven Corners Assist is located on your ID Card.

rates

		Effective January 1, 2012
Age Band	Participant	Participant’s	Participant’s
		Spouse	Child
	monthly/daily	monthly/daily	monthly/daily
U.S. Students Study Abroad
Plan A – 80% Coinsurance / $50 Deductible
12-18	$31.00/$1.03	$74.00/$2.46	$67.00/$2.24
19-23	$31.00/$1.03	$74.00/$2.46	$67.00/$2.24
24-30	$47.00/$1.57	$113.00/$3.77	$67.00/$2.24
31-40	$70.00/$2.33	$168.00/$5.61	$67.00/$2.24
41-50	$134.00/$4.47	$268.00/$8.94	$67.00/$2.24
51-64	$240.00/$8.00	$352.0/$11.72	$67.00/$2.24
Plan B – 80% Coinsurance / $0 Deductible
12-18	$33.00/$1.10	$79.00/$2.63	$72.00/$2.41
19-23	$33.00/$1.10	$79.00/$2.63	$72.00/$2.41
24-30	$51.00/$1.70	$122.00/$4.08	$72.00/$2.41
31-40	$75.00/$2.50	$181.00/$6.02	$72.00/$2.41
41-50	$144.00/$4.80	$288.00/$9.60	$72.00/$2.41
51-64	$257.00/$8.57	$377.00/$12.55	$72.00/$2.41
Plan C – 100% Coinsurance / $50 Deductible
12-18	$34.00/$1.13	$81.00/$2.70	$69.00/$2.30
19-23	$34.00/$1.13	$81.00/$2.70	$69.00/$2.30	18
24-30	$51.00/$1.70	$122.00/$4.08	$69.00/$2.30
31-40	$76.00/$2.53	$183.00/$6.09	$69.00/$2.30
41-50	$146.00/$4.87	$292.00/$9.74	$69.00/$2.30
51-64	$261.00/$8.70	$383.00/$12.75	$69.00/$2.30
Plan D – 100% Coinsurance / $0 Deductible
12-18	$36.00/$1.20	$86.00/$2.86	$80.00/$2.68
19-23	$36.00/$1.20	$86.00/$2.87	$80.00/$2.68
24-30	$55.00/$1.83	$132.00/$4.40	$80.00/$2.68
31-40	$81.00/$2.70	$195.00/$6.50	$80.00/$2.68
41-50	$156.00/$5.20	$312.00/$10.40	$80.00/$2.68
51-64	$279.00/$9.30	$409.00/$13.62	$80.00/$2.68
Foreign Nationals Visiting the U.S.
Plan M – 80% Coinsurance / see schedule for deductible
12-18	$48.00/$1.60	$134.00/$4.47	$133.00/$4.43
19-23	$61.00/$2.03	$238.00/$7.93	$133.00/$4.43
24-30	$128.00/$4.27	$338.00/$11.27	$133.00/$4.43
31-40	$198.00/$6.60	$411.00/$13.70	$133.00/$4.43
41-50	$252.00/$8.40	$509.00/$16.97	$133.00/$4.43
51-64	$355.00/$11.83	$509.00/$16.97	$133.00/$4.43
Plan N – 100% Coinsurance / see schedule for deductible
12-18	$135.00/$4.50	$265.00/$8.83	$263.00/$8.77
19-23	$145.00/$4.83	$339.00/$11.30	$263.00/$8.77
24-30	$250.00/$8.33	$603.00/$20.10	$263.00/$8.77
31-40	$274.00/$9.13	$775.00/$25.83	$263.00/$8.77
41-50	$299.00/$9.97	$846.00/$28.20	$263.00/$8.77
51-64	$367.00/$12.23	$896.00/$29.87	$263.00/$8.77

why liaison® student

rapid processing

rated “A” (excellent) by A.M. Best 2011

professional customer service

24 hour worldwide assistance

online quote & purchase

about seven corners

Since 1993, Seven Corners has provided medical insurance to corporations, worldwide travelers, expatriates, students, overseas visitors, immigrants and global citizens. With expertise and efficiency, we’ve served clients in more than a hundred countries.

for additional information

visitorshield.com 4420 Pecos Ave Fremont, CA 94555

United States of America

P: 408-569-8190

enrolling in liaison® student

1.Complete Entire Application.

2.Select method of payment.

3.If paying by check or money order, make payable

to: “Seven Corners” and enclose it together with the completed Application.

4.If paying by credit card, complete Application and mail or fax to Seven Corners. Be sure to sign Method of Payment section.

Complete and return the Application with your payment for the total premium to:

303 Congressional Boulevard

Carmel, IN 46032 USA

Fax: 317-575-2659

(If paying by credit card only. Originals are not required if application is faxed to Seven Corners with credit card payment)

liaison® student application

(please print or type using black ink)

Official Use Only:

Cert#: Processed:

applicant information

Choose One, you are...

qUS Citizen Studying Overseas; or

qInternational Students - Foreign National Student Studying in the United States

qMr. qMrs. qMiss qMs

Last Name:

First Name:

M.I.

Country of Permanent, fixed Residence (Home Country)

Passport Number:

For Foreign Nationals, Visa Number:

Visa Type :

Departure Date from your Home Country:

/

/

(MM/DD/YY)

for accidental death & dismemberment benefit:

Beneficiary:

Relationship:

address of correspondence (where ID card is to be sent)

Name:

Address:

City:

State:

Postal Code:

Country:

Work Phone: ( )

Home Phone: (

)

Email Address:

When would you like coverage to begin?:

/

/

(MM/DD/YY)

Destination?:

Name of School or Educational Institution:

What is your expected return date?:

/

/

(MM/DD/YY)

Please note: The minimum period of coverage is 5 days, the maximum is 12 months (please see Continuing Coverage Option). Coverage must be purchased in increments of no less than 5 days. Coverage cannot begin until your departure from your Home Country, nor will coverage begin until Seven Corners receives and accepts your application and correct payment.

coverage specifics

U.S. Citizens, please choose plan:

qPlan A: $50 deductible, 80% coinsurance qPlan B: $0 deductible, 80% coinsurance

qPlan C: $50 deductible, 100% coinsurance

qPlan D: $0 deductible, 100% coinsurance

Foreign Nationals, please choose plan:

qPlan M: After deductible, 80% coinsurance

qPlan N: After deductible, 100% coinsurance

Continuing Coverage Option:

qNo qYes (must buy at least 3 months)

effective january 1, 2012

Eff. Date:

Agent: 10781

calculating your plan cost (please complete entire section)

Date of Birth

Monthly Rate

Daily Rate

(MM/DD/YY)

Applicant:

(__/__/__)

Spouse:

(__/__/__)

Child:

(__/__/__)

Child:

(__/__/__)

Child:

(__/__/__)

Total:

$

$

Minimum period of coverage is 15 days

Multiply Monthly Rate Total by number of months:

X

Monthly Total [A]:

$

Multiply Daily Rate Total by number of days:

X

Daily Total [B]:

$

Total Payment Enclosed (Total of [A] and [B]):

$

method of payment

qCheck	qMoney Order						qMasterCard
q Visa	qDiscover						qAmerican Express
Card Number:									CVV:
Expiration Date:							Daytime Phone: ( )
Name as it appears on Card:
Signature (Required)
Billing Address:

Make Check or Money Order payable to “Seven Corners”. Total Payment for the Full Term of coverage requested must be paid in U.S. dollars (checks must be issued from a U.S. bank) at the time application for coverage is made. Coverage purchased by credit card is subject to validation and acceptance by the credit card company. I declare that I understand the terms and conditions of this product, as outlined in this brochure. I understand that pre-existing conditions, as defined in the definitions section, are excluded. I understand this program is for persons traveling outside their home country.

I hereby subscribe to the American Consumer Insurance Trust and enroll in the group coverage for which I am eligible under the group contract issued by United States Fire Insurance Company. For Special States, it is the Global International Trust by Certain Underwriters at Lloyd’s of London).

Signature of Insured or Proxy (Required)

Date