Traveling abroad can be an exciting experience. But what would happen if you or one of your family members became ill or injured while away from home? International travel can quickly turn frightening if you’re not prepared for a med- ical emergency.

Most travelers assume they will be covered by their standard med- ical plan. The truth is, while traditional plans may offer adequate domestic coverage, they are not designed for international travel. Without even realizing it, you may be putting your health - and that of your family - at risk.

You have enough to worry about when you’re traveling. Don’t let your medical coverage be an uncertainty. International Medical Group® (IMG®) has developed two Patriot Travel Medical Insurance® plans to provide you and your family Coverage Without Boundaries® so you can spend more time enjoying your international experience, and less time worrying about your med- ical security.

Why Patriot Travel?

The two Patriot® travel plans offer a complete package of interna- tional benefits available 24 hours a day. Patriot International® provides coverage for U.S. citizens traveling outside the U.S. with coverage for brief returns to the U.S., while Patriot America® pro- vides coverage for non-U.S. citizens traveling outside their home country. Both plans are available for a minimum of 10 days up to a maximum of two years.

Additionally, the plans offer excellent benefits and services to meet your global needs. You have access to international, multilingual customer service centers, claims administrators who process claims from all over the world, handling virtually every language and cur- rency, and 24 hour access to highly qualified coordinators of emer- gency medical services and international treatment. You can also choose from a wide range of deductibles, several Maximum Limits, and you have access to more than 17,000 providers through our International Provider AccessSM (IPA) when seeking treatment out- side the U.S. You can also reduce your out-of-pocket costs when seeking treatment in the U.S. by locating providers through the independent Preferred Provider Organization.

At IMG, we know that the reasons to travel abroad are many and varied - that’s why our

services are designed to provide you with the security you need no matter where you are.

Our goal is to make the medical process smooth and efficient. By providing global products and services to vacationers, those work- ing or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence, IMG is the single resource for all your inter- national travel needs.

How we service and support your needs is what sets us apart. Since 1990, we’ve served more than a million people around the globe - always focused on the specific needs of each individual. We’ve set the benchmark for industry service levels by integrating independ- ent credentialing services with in-house, fully owned and operated service divisions. At IMG, we’re with you, wherever you go - bring- ing support for all your insurance needs around the globe - provid- ing you Global Peace of Mind®.

PLAN INFORMATION & HIGHLIGHTS

PATRIOT INTERNATIONAL RATES

Rates are based on a $250 deductible option.

For other deductible options, please see the application.

ONE MONTH RATES (Five Maximum Limit options. Maximums are per covered insured per certificate period.)

*Available to the primary insured only. Available with a minimum purchase of 3 months of medical and AD&D rider coverage. Premium is charged in whole month increments.

EVACUATION PLUS RIDER MONTHLY RATE*

*Must be purchased for a minimum of 3 months regardless of the minimum number of days being traveled. Premium is charged in whole month increments.

5.

PATRIOT AMERICA RATES

Rates are based on a $250 deductible option.

For other deductible options, please see the application.

ONE MONTH RATES (Four Maximum Limit options. Maximums are per covered insured per certificate period.)

*Available to the primary insured only. Available with a minimum purchase of 3 months of medical and AD&D rider coverage. Premium is charged in whole month increments.

EVACUATION PLUS RIDER MONTHLY RATE*

*Must be purchased for a minimum of 3 months regardless of the minimum number of days being traveled. Premium is charged in whole month increments.

All premium rates are effective through 8/1/2012. Rates include surplus lines tax where applicable. A depend- ent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid. The maximum amount of coverage for applicants who are 80

years of age or older is $10,000.

6.

CONDITIONS OF COVERAGE

1)Coverage and benefits are subject to the deductible and coin- surance, and all terms of the certificate of coverage and Master Policy.

2)Coverage under a Patriot plan is secondary to any other coverage.

3)Coverage and benefits are for medically necessary, usual, rea- sonable and customary charges only.

4)Charges must be administered or ordered by a physician.

5)Charges must be incurred during the Period of Coverage or the Benefit Period.

6)Claims must be presented to IMG for payment within the Period of Coverage, Benefit Period or during the three months immediately following the Period of Coverage.

ELIGIBILITY

The following conditions apply to all persons applying for and/or enrolling in Patriot Travel Medical Insurance.

3 Patriot Travel Medical Insurance is travel insurance for U.S. citi- zens traveling outside the United States with coverage for brief returns to the U.S., and for non-U.S. citizens traveling outside their home country.

3 For those under 65 years of age and visiting the U.S., your initial Period of Coverage must begin within six months of arrival in the U.S. For those 65 years of age and older, it must begin with- in 30 days of arrival. These requirements will be waived with proof of previous valid international travel insurance. Prior U.S. domestic health care coverage does not meet this eligibility requirement. Please provide the name of your international insurance carrier on the Application Form. If you are not in the U.S. at the time of application, please indicate your expected date of arrival on your Application Form.

RENEWAL OF COVERAGE

your Patriot plan is purchased for a minimum of three months, coverage may be renewed (unless there is a break in coverage) for a total of up to two years. Renewals are available in whole month or daily increments and may be completed online or by using a paper application, however, renewals of less

than one month are available only online. For each renewal of less than one month completed online, you will be charged an addi- tional $5 processing fee. Each insured person must only satisfy one deductible and coinsurance within each 12 month coverage period. Please note: Renewal rates may differ from initial rates.

QUALITY GUARANTEE

Your satisfaction is very important to IMG. If you are not pleased with this product for any reason, you may submit a written request, prior to your effective date, for cancellation and refund of your pre- mium. If you do not have any claims filed with IMG, you may cancel your plan after your effective date, however, the following condi- tions will apply:

1)You will be required to pay a $50 cancellation fee and

2)only full month premiums will be considered for refunds (e.g., if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, IMG will only consider the two full months for a refund). If you have filed claims, your premi- um is non-refundable.

ENROLLMENT PROCESS & APPLICATION FORM

You should read the following important information prior to completing the Application Form.

HOW TO ENROLL

Before you begin your travel, simply fill out the Application Form and calculate the pre- mium for the time period you and/or your family will be traveling. Once you have completed the Application Form, return it to your insurance agent or broker, and/or mail it to IMG.

You, your spouse and unmarried depend- ent children (over 14 days and under 18 years of age) listed on the Application Form

ums have been paid will be covered from the latest of the follow- ing dates:

1)The date IMG receives your completed Application Form and the appropriate premium;

2)the date you depart from your home country; or

3)the date requested on your Application Form.

Patriot Travel Medical Insurance coverage ends on the earliest of the following dates:

1)The end of the period for which premium has been paid;

2)the date requested on your Application Form; or

3)the date you return to your home country (however, see Home Country Coverage on page 12).

ENROLLMENT PROCESSING & FULFILLMENT KITS

IMG normally processes Application Forms within 24 hours of receipt. Once processing is complete, IMG will mail a fulfillment kit to the mailing address listed on the Application Form. The fulfill- ment kit will include an IMG Identification Card, IMG contact num- bers, Claim Forms and your insurance certificate providing a com- plete description of your rights and benefits under the contract.

Please note: If you require express mail delivery, there is an additional charge listed on the Application Form.

ONLINE FULFILLMENT KIT

For your convenience, you may choose to download your fulfill- ment kit from the IMG website rather than having it mailed to you. To do this, you must check the appropriate box listed in Section 2 of the Application Form. We must have your correct email address to complete this process. Once IMG has received and processed your Application Form, you will receive an email from IMG that contains all of the hyperlinks to easily obtain the fulfillment infor- mation through the Internet.

CLAIM PAYMENT

All benefits payable under Patriot Travel Medical Insurance are sub- ject to the provisions described in this brochure and as contained in the Certificate Wording and certificate of coverage. To make claim processing efficient, claims may be paid in two ways:

1)Eligible claims that have been paid by or on behalf of the Insured Person will be reimbursed by check directly to the Insured Person.

2)Eligible claims that have not yet been paid by the Insured Person will, at the option of IMG, be paid either to the Insured Person or directly to the provider.

Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 1.317.655.4505 or email: insurance@imglobal.com.

CLAIMS PROCEDURE

PRECERTIFICATION

Each proposed hospital admission, in-patient or out-patient sur- gery, and other procedures as noted in the Certificate Wording must be Precertified for medical necessity, which means the insured person or their attending physician must call the number listed on the IMG Identification Card prior to admittance to a hospital or per- formance of a surgery. In case of an Emergency Admission, the Precertification call must be made within 48 hours of the admission, or as soon as reasonably possible. If a hospital admission or a sur- gery is not Precertified, eligible claims and expenses will be reduced by 50%. It is important to note that Precertification is only a determi- nation of medical necessity, not an assurance of coverage, verifica- tion of benefits or a guarantee of payment. All eligible medical expenses must meet usual, reasonable, and customary guidelines. Please refer to the Certificate Wording for full details of the Precertification requirements.

For Precertification, emergency evacuation, and return of mor- tal remains, please call: IMG in the U.S.: 1.800.628.4664 (toll free) or 1.317.655.4500. Call IMG outside the U.S.: 001.317.655.4500 (collect if necessary). This information will also be provided on your ID card.

Note: An insured person may begin the Precertification process through MyIMG or the Client Resources section of our website, www.imglobal.com. Simply look for the Precertification option. You will be asked to provide the required information, which can then be submitted electronically to IMG. Once we have confirmed receipt of your request, our utilization management and review team will review the information provided and respond to the insured person or the provider within two business days. Please note that this online service will only initiate the Precertification process, and it should not be used to Precertify emergency admissions, procedures, or evacuations.

DESCRIPTION OF BENEFITS

The following is a partial list of benefits and terms that are offered on the Patriot plans.

DEDUCTIBLE:

On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.

EMERGENCY ROOM:

Charges incurred for the use of the Emergency Room due to an accident or illness are covered up to the Maximum Limit.

Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.

DENTAL:

Injury due to an accident - Each Patriot Travel Medical Insuranceplan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an acci- dent up to the Maximum Limit.

Sudden dental pain - Each plan will pay up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.

SUDDEN AND UNEXPECTED RECURRENCE OF A PRE-EXISTING CONDITION:

(U.S. citizens only) For those up to age 65 with a primary health plan, Patriot International will pay the Usual, Reasonable and Customary charges of a sudden and unexpected recurrence of a Pre-existing Condition (defined on page 16) up to the plan maximum. For those without a primary health plan, Patriot International will pay up to a $20,000 lifetime maximum. For those age 65 and older, with or without a primary health plan, Patriot International will pay up to a $2,500 life- time maximum. The primary health plan must have existed prior to the effective date and during coverage of the Patriot plan, and the Pre- existing Condition must be covered under the primary health plan.

In addition, up to $25,000 will be paid for the eligible costs and expenses of an Emergency Medical Evacuation arising or resulting from a sudden and unexpected recurrence of a Pre-existing Condition.

HOSPITAL DAILY INDEMNITY:

(U.S. citizens only) Patriot International will pay directly to the insured person $100 for each night of a required overnight stay in a hospital up to a maximum of 10 days. However, the hospital stay must be cov- ered under this plan in order to receive this benefit.

BENEFIT PERIOD:

If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-month Benefit Period may provide continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Maximum Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.

INTERNATIONAL EMERGENCY CARE

POLITICAL EVACUATION:

If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person’s Home Country, orders the evacuation of all non-emergency government per- sonnel from the Host Country, due to political unrest, that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to a $10,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that:

1)The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person’s Home Country, issuance of the evacuation order; and

2)The evacuation order pertains to persons from the same Home Country as the Insured Person; and

3)Political Evacuation and Repatriation is approved and coordinated by the Company;

In no event will the Company pay for a Political Evacuation if there is a Travel Warning in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.

EMERGENCY EVACUATION:

Each Patriot plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for rea- sonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to a $500,000 lifetime maximum (independent of the Maximum Limit).

EMERGENCY REUNION:

Each Patriot plan provides emergency reunion coverage, up to $50,000 for a maximum of 15 days, for the reasonable travel and lodging expens- es of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or travel- ing from the home country to be reunited with the insured.

RETURN OF MORTAL REMAINS:

If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $50,000.

RETURN OF MINOR CHILDREN:

If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Patriot plans will pay up to $50,000 for one way economy fare to their home country, including a chaperone, if neces- sary, for the safety of the child(ren).

To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in life-threatening medical situations, and approved in advance and coordinated by IMG.

INCIDENTAL HOME COUNTRY COVERAGE:

During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to:

1)The insured person must have left their home country,

2)The total Period of Coverage must be for a minimum of 30 days, and

3)The return to the home country may not be taken to receive treat- ment for an illness or injury incurred while traveling.

END OF TRIP HOME COUNTRY COVERAGE:

For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension cover- age, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).

SPORTS AND ACTIVITIES COVERAGE:

Each Patriot plan covers injuries incurred during ama- teur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. Some of these sports and activities include, but are not lim- ited to, motor cycle/motorscooter riding, scuba div- ing (to 10m), snorkeling, wakeboarding, and water skiing. However, activities not covered include ama- teur or professional sports or other athletic activity

which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition.

The following hazardous activities are excluded unless the Adventure Sports Rider is purchased: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, horseback rid- ing, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayak- ing, mountain biking, paragliding, parascending, piloting a non-com- mercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris. To be cov- ered under the Adventure Sports Rider, these adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.

Injury sustained while participating in contact sports of any kind, racing of any kind, BASE jumping, kiteboarding, mountaineering or climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty, scuba below 50 meters; and/or adventure sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.

ACCIDENTAL DEATH AND DISMEMBERMENT:

Each Patriot plan includes $25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage:

• Accidental Loss of life - principal sum; • Accidental Loss of two Members - principal sum; • Accidental Loss of one Member - 50% of principal sum. “Member” means hand, foot or eye.

COMMON CARRIER ACCIDENTAL DEATH:

If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family.

NATURAL DISASTER:

This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued by pre- vailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disas- ters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety.

TRIP INTERRUPTION:

If, during a covered trip, there is a death of an immediate family mem- ber (spouse, child, parent or sibling), a break-in at the insured’s princi- ple residence, or the substantial destruction of the insured’s principal residence due to a fire or natural disaster, each Patriot plan will pay to return the insured to the area of principal residence. The plan will pay for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.

TERRORISM COVERAGE:

Each Patriot plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 life- time maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.

Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or govern- ment, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the six months prior to the insured person's date of arrival.

This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

IDENTITY THEFT ASSISTANCE:

If an imposter obtains key personal information such as a Social Security or Driver's License number, or other method of identifying an insured person in order to impersonate or obtain credit, merchandise or servic- es in the insured person’s name, the Patriot plans will provide coverage for the reasonable, customary and necessary costs incurred by the

insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen identity event; notarization of legal doc- uments, long distance telephone calls, and postage that has resulted solely as a result of reporting, amending and/or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person’s knowledge of the stolen iden- tity event; and stop payment orders placed on missing or unautho- rized checks as a result of the stolen identity event.

The identity theft event must occur during the Period of Coverage and must be reported within six months of the termination of coverage date.

LOST LUGGAGE:

This benefit will be paid in the event that the Common Carrier perma- nently loses an insured person’s checked luggage. This coverage is secondary to any other available coverage, including the Carrier’s.

EVACUATION PLUS RIDER:

This optional rider is available to insureds up to age 65 and it provides coverage for medical evacuations for medical conditions that are non life-threatening and evacuations as a result of a natural disaster. This rider must be purchased for a minimum of three months regard- less of the minimum number of days being traveled.

DESCRIPTION OF OPTIONAL RIDERS

ADVENTURE SPORTS RIDER:

The Adventure Sports Rider is available on both Patriot plans for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed on page four: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, horseback riding, hot air ballooning, inline skating, jet skiing, jungle zip lin- ing, kayaking, mountain biking, paragliding, parascending, pilot- ing a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground

level), scuba diving (to 50m), skydiving, snow boarding, snowmobil- ing, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris. These adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.

ENHANCED AD&D RIDER:

This optional coverage is available for the primary insured person only. This coverage is in addition to the Accidental Death and Dismemberment already included in the Patriot plans. This rider is available with a minimum purchase of three months of medical and AD&D rider coverage.

CITIZENSHIP RETURN RIDER:

When purchased at the time of application, the Citizenship Return Rider provides temporary medical coverage for non-U.S. citizens returning to their country of citizenship. For U.S. citizens, the rider pro- vides up to 60 days of coverage for brief returns to the U.S. provided you have a current health plan in force and have resided outside the U.S. continuously for the past six months. Coverage for sudden recur- rence of pre-existing conditions is excluded if the rider is selected. For premium information, please see the back of the Application Form.

EXCLUSIONS

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot plans.

1.A Pre-existing Condition is defined as any injury, illness, sick- ness, disease, or other physical, medical, mental or nervous con- dition, disorder or ailment that, with reasonable medical certain- ty, existed at the time of application or at any time during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.

2.Treatment or surgeries which are elective, investigational, experi- mental or for research purposes.

3.War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.

4.Immunizations and routine physical exams.

5.Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.

6.Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.

7.Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.

8.Injury sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanc- tioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded unless the Adventure Sports Rider is purchased: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, horseback riding, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain bik- ing, paragliding, parascending, piloting a non-commercial air- craft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), sky- diving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris.

Injury sustained while participating in contact sports of any kind, racing of any kind, BASE jumping, kiteboarding, mountaineering or climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty, scuba below 50 meters; and/or adventure sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.

9.Vision or ear tests and the provision of visual or hearing aids.

10.Vocational, recreational, speech or music therapy.

11.Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.

12.Charges, injuries and/or illnesses resulting or arising from or occur- ring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.

13.Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.

14.Injury and/or illness resulting or arising from being under the influ- ence of alcohol or drugs; and injury or illness resulting from operat- ing any type of vehicle after consuming any alcohol or drugs.

15.Willful self-inflicted injury or illness.

16.Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.

17.Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.

18.Treatment for mental and nervous disorders.

19.Organ or tissue transplants or related services.

20.Illness or injury where the trip to the host country is undertak- en for treatment or advice for such illness or injury, except as expressly provided for in the certificate of insurance.

21.Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

This brochure contains only a consolidated and summary description of all current Patriot Travel Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. The Patriot Travel Medical Insurance plans are amended, modified or replaced from time to time, and IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

ADDITIONAL BENEFITS & SERVICES

MyIMGSM

Service at your fingertips anytime, anywhere - that’s what MyIMG pro- vides. MyIMG is our proprietary online service that allows you to access information and manage accounts, 24 hours a day, seven days a week, from anywhere in the world. Our service centers in the U.S. and Europe are always available to help or handle emergencies 24 hours a day, but through MyIMG you have immediate access to a wealth of information about your account and can manage routine areas to help you save time when you may need it most. Some fea- tures include:

Locating a Provider

With the Patriot plans, you may seek treatment with the hospital or doctor of your choice. When seeking treatment in the U.S., you can reduce your out-of-pocket costs by using the independent Preferred Provider Organization (PPO), a separately organized network of hun- dreds of thousands of established, highly qualified health care physi- cians and many well-recognized hospitals in the U.S. contracted by IMG. You can quickly search the network through MyIMG. Additionally, to help you locate health care providers outside the U.S., IMG provides its online International Provider Access (IPA), a database of over 17,000 providers.

Universal Rx Pharmacy Discount Savings

This is a discount savings program available to every certificate holder of the Patriot plans. This program allows card members to purchase prescriptions at one of over 35,000 participating pharmacies in the U.S. and receive the lower of 1) Universal Rx contract price or 2) the pharmacy regular retail price.

This discount program is not insurance coverage. It is purely a discount program to purchasers of the Patriot plans. Use of the discount card does not guarantee that prescribed medication is covered under the insurance benefit plan.

Akeso Care Management® (ACM®)

The ability to access quality health care is of

paramount importance when a medical emergency arises abroad. To coordinate

care and provide U.S. and internationally based medical management services, IMG formed ACM, an on-site specialized division devoted entirely to medical management.

The clinical staff consists of qualified physicians and registered nurses who are experts at assessing the need for services and ensuring those services are delivered in a timely, cost-effective manner. ACM has international medical experience, providing services in more than 170 countries worldwide.

ACM is accredited by URAC, an independent, nonprofit organization that is internationally recognized for promoting continuous improve- ment in the quality and efficiency of health care management. Through a rigorous and comprehensive review that ensures ongoing compliance, ACM earned its URAC accreditation in Health Utilization Management.

From routine medical care to complex case management, from check- ups to emergency medical evacuations, ACM is there for you. They are committed to consumer protection and empowerment, quality oper- ations and regulatory compliance. This translates into better care for you - around the world, around the clock.

One Call. One Company.

Your Complete International Resource.

IMG offers a comprehensive range of international medical insurance and travel insurance products for every insurance need. Whether you need individual coverage for a vacation, extended coverage for a long- term stay abroad, or group coverage for employees in locations around the world, we’ve got the right plan for you and the exception- al services to back them up.

3 Short-term Travel Plans 3 Long-term Travel Plans

3 Travel Insurance / Trip Cancellation Plans 3 Employer Group Plans

3 Mission Plans 3 Marine Plans

3 International Student and Educator Plans 3 Adventure Sports Plans

3 Emergency Evacuation Plans

3 Green and Environmentally Friendly Plans

PROTECTING YOUR TRAVEL

INVESTMENT

You can spend a great deal of time planning your trip and it is exciting getting everything ready. But what would happen if the airline you selected should go out of business or you’re prevented from taking your trip? Your hard-earned payments could be lost. To help protect you from losing the money you’ve spent to travel, IMG works with iTravelInsured® (iTI®) to bring you the Patriot T.R.I.P. Lite program.

PATRIOT T.R.I.P. LITE

This iTI program is designed to provide peace of mind so you can enjoy your travels. The benefits are outlined below and program cost infor- mation can be found on the back of the Application Form.

SCHEDULE OF BENEFITS

Trip Cancellation

Provides coverage for the loss of non-refundable, unused payments when a trip is cancelled prior to departure due to: emergency illness, injury or death to you, a family member or travel companion; financial default; a terrorist incident; jury duty; home made uninhabitable by fire, wind, storm, flood, or vandalism; quarantine; auto accident on way to airport; job termination; cancelled leave for active duty military, police or fire fighters.

Travel Delay

Reimburses you up to $100 per day for reasonable additional accom- modations and traveling expenses, not otherwise paid by a travel sup- plier or common carrier, when your trip is delayed for more than 24 hours caused by: travel supplier delay, lost or stolen passport, medical quarantine, natural disaster, or emergency illness or injury to you or a travel companion.

Baggage Delay

Reimburses you for the costs you incur to buy reasonable additional clothing and essential personal items when your checked baggage is delayed by a common carrier for more than 24 hours from the actual time of arrival at a destination.

9.Pregnancy or childbirth when You are expected to give birth within two months from the date of a Covered Trip or an elective abortion.

10.Traveling against the advice of a Physician, traveling while on a waiting list for inpatient Hospital or clinic treatment, or traveling for the purpose of obtaining medical treatment abroad.

11.Taking part in any scheduled athletic event or competition.

12.Any emotional, psychological, mental or nervous disorder.

13.Any potentially fatal condition which was diagnosed before the date Your coverage became effective, or any condition for which You are traveling to seek treatment.

14.Dental treatment due to normal wear and tear or the normal main- tenance of dental health.

NSBTHA

When you purchase a Patriot T.R.I.P. Lite program you automatically become a member of the National Small Business Travel & Health Association (NSBTHA). Through this association members may access travel insurance, emergency travel assistance services, and information about events, legislation, and other matters that affect travel. Information about NSBTHA is available at www.NSBTHA.org.

Certificate Form No. iTI100-11

T.R.I.P. LITE EXCLUSIONS

We will not pay for any Illness, Injury or loss caused by or as a result of:

1.A Pre-Existing Condition, except as waived by Us under the terms of the Policy.

2.War or any act of war (whether declared or undeclared), civil dis- turbance, riot or insurrection.

3.Serving in one of the armed forces of any country or international authority.

4.Operating, learning to operate, piloting or riding in or on any air- craft or flying device, other than riding as a passenger in a licensed commercial aircraft.

5.Suicide or attempted suicide, while sane; intentionally self-inflict- ed Injury or Illness.

6.Being under the influence of any intoxicant, drug or narcotic unless prescribed by a Physician.

7.Training, practicing or participating in any motor sport or motor racing.

8.Parachuting, hang gliding, parasailing, hot air ballooning, scuba diving below 135 feet or any type of scuba diving without the proper diving training and certification from a professional organ- ization, rock or mountain climbing, or hunting.

T.R.I.P. LITE PRE-EXISTING CONDITIONS

The Pre-Existing Condition exclusion is waived if coverage is pur- chased within 14 days after the date your initial payment for the cov- ered trip was paid to the travel supplier. Insureds also must be med- ically able to travel on the date coverage is purchased.

If the Pre-Existing Condition exclusion is not waived, your pre-existing condition might still be covered if the answer to all of the following questions is “no.”

1)Were you treated for a new illness in the last 60 days?

2)Has your condition worsened or required medical attention in the past 60 days?

3)Have you received any new medications in the past 60 days or have any of your current dosages been changed?

This is a summary of the principal provisions of the master policy offered through NSBTHA for its members. It is not considered to be a contract of insurance. Coverage may vary by state and may not be available in all states. For more infor- mation regarding the exclusions and all other terms and conditions of Patriot T.R.I.P. Lite, please see the certificate wording for your state which is available upon request.

This brochure is not intended to be an offer to sell Patriot T.R.I.P. Lite or a solicitation by iTravelInsured in any jurisdiction where such action would be unlawful or in which iTravelInsured is not qualified to do so.

Insurance products are underwritten and offered where available by Imperium Insurance Company, New York, NY 10036.

OR Expiration date of current coverage:

5. Home Country Coverage (see page 12 for details)

One month for every five months of purchased Travel Medical coverage up to a maximum of two months of Home Country Coverage.

This will be added as additional months of coverage to your planned travel period and will begin upon the date of return to your home country.

total (from Total (D) in Section 5)

Patriot T.R.I.P. Lite - To purchase

please complete the following calculation:

IMG Producer Use Only

Producer#______________________________59339

GA#____________________________________

Name___________________________________Matrix Insurance

Address_________________________________

_______________________________________

City, State, Zip____________________________

Phone:__________________________________408-986-8506

0711

Payment must be made for the total number of months you want coverage. All payments must be made in U.S. dollars and drawn on U.S. banks.

8. SUBSCRIPTION I (we) hereby apply and subscribe to the Global Medical Services Group Insurance Trust, c/o MutualWealth Management Group, Carmel, IN, or its successor, for Patriot Travel Medical Insurance as underwritten and offered by Sirius International Insurance Corporation (publ) (the Company) on the date of receipt hereof. I (we) understand and agree: (i) the insurance applied for is not general health insurance, but is intended for my (our) use as travel coverage in the event of a sudden and unexpected illness or injury for which eligible coverage may be available, (ii) I (we) must pay premiums for the entire period of coverage in advance, and no coverage will be effective until this Application has been accepted in writing by the Company, (iii) no modification or waiver relating to this Application or the coverage applied for will be binding upon the Company or IMG unless approved in writing by an officer of the Company or IMG, and (iv) by submission of this application and/or any future claim for benefits I (we) purposefully initiate and take advantage of the privilege of conducting business with the Company in Indiana, through IMG as its managing general underwriter and plan administrator, and invoke the benefits and protections of its laws, and the contract of insurance represented by the Master Policy and evidenced by the Certificate of insur- ance will be deemed issued and made in Indianapolis, IN, and sole and exclusive jurisdiction and venue for any court action or administrative proceeding relating to this insurance will be in Marion County, Indiana, for which applicant(s) hereby consent(s). I (we) consent and agree that Indiana law shall govern all rights and claims raised under the Certificate of Insurance issued to me (us).

ACKNOWLEDGEMENT I (we) understand and agree that: (i) the insurance agent/broker soliciting, assigned to or assisting with this Application is the representative of applicant(s), (ii) this insurance does not provide benefits for any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, dis- order or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the three years prior to the effective date and time of this insurance, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date (a "pre- existing condition"), and that all charges and/or claims for pre-existing conditions will be excluded from coverage under this insurance, (iii) the subjects of insurance applied for are not intended or considered by the applicant(s), the Company or IMG to be resident, located, or expressly to be performed in any particular state of the United States, and (iv) the Company, as carrier and underwriter of the plan, is solely liable for the coverages and benefits to be provided under the insurance contract.

MEDICAL RELEASE I (we) hereby authorize any doctor, practitioner of the healing arts, hospital, clinic, health related facility, pharmacy, government agency, insurance agency, insurance company, group poli- cyholder, employee or benefit plan administrator having information as to my (our) care, advice, treat- ment, diagnosis or prognosis for any physical or mental condition, or financial and employment status, to provide such information to IMG and/or the Company.

CERTIFICATION I (we) hereby certify, represent and warrant that: (i) I (we) have read the foregoing state- ments and the brochure or that they have been read to me (us), and I (we) understand them, (ii) I am (we are) eligible to participate in the insurance program applied for as a traveler for whom domestic U.S. health care coverage is unavailable, (iii) I am (we are) currently in good health and have not been diagnosed with, sought consultation or been treated for, and have not experienced manifestation or symptoms of and do not suffer from any pre-existing or other medical condition which I (we) foresee may require treatment during this insurance or for which I (we) intend to claim under this insurance. If signed as guardian or proxy of the applicant, the signer warrants their authority and capacity to so act and to bind the applicant. By acceptance of coverage and/or submission of any claim for benefits, the applicant ratifies the authori- ty of the signer to so act and bind applicant.

FOR PATRIOT T.R.I.P. LITE (only applicable if applicant has completed section 7H): MEMBERSHIP I (we) hereby apply for membership to NSBTHA.

CERTIFICATION I (we) hereby certify that I (we) have read, or have had read to me (us), all statements on this application. I (we) represent that the responses are true, complete and correctly recorded; and that all travelers listed on this application are medically able to travel on the date this program is purchased. I (we) understand and agree that subject to your acceptance of this application and payment of the Total Program Cost, coverage will begin at 12:01 a.m. on the day after this completed application is received. I (we) under- stand that if payment is returned unpayable for any reason, coverage becomes null and void.

X Signature of Insured or Proxy (Required)__________________________________________________

Date____________________ Phone___________________________________________________________________

If paying by credit card, I authorize IMG to debit my credit card account for the total charge as specified in Total Amount. Coverage purchased by credit card is subject to validation and acceptance by credit card company. I agree to comply with the cardholder agreement. For your convenience, only one payment for the total amount due is required. You agree and understand that if your purchase includes Patriot T.R.I.P. Lite, the cost for this pro- gram will be allocated directly to iTravelInsured.

Card#_______________________________________Expiration date___________________

Name on Card________________________________________________________________

Signature___________________________________________________________________

Your Daytime Phone___________________________________________________________

Your Billing Address___________________________________________________________

___________________________________________________________________________