Signature WorldwideSM Medical Plan

Signature Worldwide^SM Medical Plan

Sample - Certificate of Insurance

Underwritten by:

The MEGA Life and Health Insurance Company

NOTICE

All scheduled admissions in a hospital, emergency admission to a hospital, outpatient treatments or Eligible Benefits which will exceed $1,000 in the United States, transplants worldwide, must follow the U.M. Program or benefits will be reduced by 50% including hospitals and doctors charges.

See page 12 of this certificate regarding the U.M. Program

To verify benefits, please call Specialty Risk International, Inc. (SRI)

1. Call 1-800-335-0477 within the United States or from outside the United States call 0-317-575-2656 (collect) between 9:00 am and 4:00pm Eastern Standard Time: or

2. Fax 0-317-575-2659 at any time; or

3. E-mail: claims@specialtyrisk.com at any time.

(For number 2 and 3 above please provide your name, telephone number, and Certificate Number stated on the attached ID card. Someone will contact you during normal business hours.)

To Precertify a scheduled admission in a hospital, emergency admission to a hospital, outpatient treatments or Eligible Benefits which will exceed $1,000 in the United States, transplants worldwide, please call SRI’s U.M. firm:

1. Call 1-800-690-6295 within the United States or from outside the United States call 0-305-913-1842. There is 24 hour service in English and Spanish.

Do not call this number for verification of benefits.

Anyone can access the providers in the U.M. program by connecting to www.multiplan.com on the world wide web to see if the doctor or hospital is a participant in SRI’s U.M. program.

The Company hereby insures all persons whose Application has been accepted by the Administrator, Specialty Risk International, Inc. (SRI), on behalf of the Company and whose name is identified on the ID Card, subject to all of the exclusions, limitations and provisions as set forth herein and in the Master Policy of Insurance issued by the Company. Coverage is afforded only with respect to the person, coverage, amounts and limits specified herein and as identified in the Schedule of Benefits for the Insurance requested on the Application and for which the specified premium has been paid.

SCHEDULE OF BENEFITS

Verification of Benefits: 800-335-0477 or 317-575-2656. Call this number to verify eligibility for program benefits before the charges are incurred. All charges are covered under the Major Medical portion of your policy.

Major Medical Benefits

Deductible, each Policy Year: Per person: $Selected

Family Unit: $Selected (max. 3 per family)

Coinsurance Percentage Payable after Deductible has been met........

Eligible Benefits Incurred Outside the United States: The Company pays 100% of Eligible Benefits up to the Medical Maximum. All Hospital admissions must be Pre-Certified through the U.M. Program.

Eligible Benefits Incurred Inside the United States: The Company pays 80% of the next 5,000 of Eligible Benefits and then 100% up to the Medical Maximum. All Hospital admissions and expenses above $1,000 must be Pre-Certified through the U.M. Program.

The maximum out of pocket expenses incurred by an individual in the United States after satisfying the deductible is $1000. The maximum out of pocket expenses incurred by a family unit after satisfying the deductible is $3000.

Eligible Benefits Maximum Limits

I. Medical Benefit (per each Insured Person) $5,000,000 Lifetime

II. Pregnancy Benefit $7,500 per Pregnancy

III. Well-Child Care Benefit $100,000 Lifetime (3 visits per policy year)

IV. Mental and Nervous Benefit $10,000 Coverage Period maximum. Inpatient limited to a maximum of 45 days per coverage period.

Outpatient Benefit limited to a maximum of 40 visits per Coverage Period at 70% (separate from overall coinsurance) of Eligible Benefits.

V. Alcohol or Drug Abuse Benefit $10,000 Lifetime. Inpatient Benefit limited to a maximum of 28 days per Coverage Period.

Outpatient Benefit limited to a maximum of 30 visits per Coverage Period.

For Benefits VI through XII, the applicable Deductibles and Coinsurance Percentage Payable shall be separate from Benefits I through V.

VI. Spinal Manipulation Benefit $5,000 Lifetime, limited to 12 visits per Coverage Period. The Company pays 50% of all Eligible Benefits not to exceed $50.00 per visit.

VII. Dental Benefit (due to Accident only) $500.00 per Coverage Period, subject to a $50.00 per occurrence Deductible.

VIII. Preventive Benefits $50 Policy Period Maximum

IX. Emergency Medical Evacuation Benefit $50,000 per Coverage Period

X. Return of Mortal Remains Benefit $20,000

XI. Emergency Medical Reunion Benefit $10,000 per occurrence

XII. Accidental Death and Dismemberment

24 Hour

Insured and Spouse $10,000 Principal Sum

Dependent Children $2,000 Principal Sum

Common Carrier Accidental Death and Dismemberment

Insured and Spouse $40,000 Principal Sum

Dependent Children $8,000 Principal Sum

Part I Insurance Provisions
Eligibility

The Primary applicant and named Dependents, who have completed an Application and have been accepted by the Company. Dependents are the Primary Insured’s Spouse and natural or legally adopted unmarried children over fourteen (14) days old and under nineteen (19) years old, but not older than twenty-three years old if enrolled as a full-time student (at least 12 credit hours) at an accredited school or college and is not employed on a full-time basis. All applicants and Insured Persons will not reside in the United States for more than six (6) months during any 12 month Policy Period. Dependents over the age of 19 will be covered to the end of the policy period that they turn 19.

Individual Effective Date of Coverage

After review and approval of the Application by SRI underwriters, coverage will become effective on one of the following dates: (1.) The date requested on the Application, (2.) The date the appropriate premium and Application are received and approved by SRI.

Individual Termination Date of Coverage

Coverage will terminate upon the earlier of the following: (1.) The date to which premium has been paid,

(2.), The date the Insured Person resides for more than six (6) months in the United States, during any twelve (12) month coverage period, (3.) The date the Company cancels coverage for a specific class of Insured Persons, which the individual Insured Person may be included.

Part II Scope of Coverage

Benefits are payable under Signature Worldwide^SM Medical Plan for Eligible Benefits incurred by an Insured Person for the following benefits. Benefits shall be payable to either the Insured Person or the Service Provider for Eligible Benefits incurred worldwide. For all Hospital admissions worldwide, or for any Outpatient Surgery or Eligible Benefits which will exceed $1,000 in the United States, the Insured Person must utilize SRI’s Utilization Management (U.M.) Program. FAILURE TO UTILIZE THE U.M. PROGRAM WILL RESULT IN A 50% REDUCTION OF THE ELIGIBLE BENEFITS STATED IN THE SCHEDULE OF BENEFITS.

The charges enumerated herein shall in no event include any amount of such charges which are in excess of Reasonable and Customary charges. A charge incurred by an Insured Person shall be deemed a Reasonable and Customary charge for the services and supplies for which the charge is made if it is not in excess of the average charge for such services and supplies 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. If the charge incurred is in excess of such average charge such excess amount shall not be recognized as a Covered Expense. All charges shall be deemed to be incurred on the date such services or supplies which give rise to the expense or charged, rendered or obtained.

Description of Coverage

Medical Benefits

The Company will pay Eligible Benefits, as per the limits stated on the Schedule of Benefits page. Coverage is limited to Eligible Benefits incurred subject to the Exclusions. 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 (including complications arising therefrom), the Disablement shall be considered a continuation of the prior Disablement and not a separate Disablement.

When a covered Illness or Injury is incurred by the Insured Person, the Company will pay Reasonable and Customary medical expenses in excess of the Deductible and Coinsurance as stated on the Schedule of Benefits page. In no event shall the Company's maximum liability exceed the maximum stated on the Schedule of Benefits page, as to Eligible Benefits during any one period of individual coverage.

Eligible Benefits

For the purpose of this section, only such expenses, incurred as the result of a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in the Exclusions, shall be considered as Eligible Benefits:

1.) Charges made by a Hospital 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 average charge for semiprivate 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 skilled care facility services and supplies furnished by the facility during the first thirty (30) days of convalescent confinement. Admittance to a Skilled Care facility must follow Hospital confinement by a period of no more than three (3) days. Only charges incurred in connection with convalescence from the Illness or Injury for which the Insured Person is confined will be eligible for benefits. These expenses include:

a. room and board, paid at the skilled care facility’s private room rate, including any charges such as general nursing, made by the facility as a condition of occupancy, or on a regular daily or weekly basis.

b. medical services customarily provided by the convalescent facility, including private duty or special nursing services and Physician’s fees; and

c. drugs, solutions, dressings and casts, furnished for use during the convalescent period, but no other supplies.

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

8.) Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, chemotherapy, oxygen, blood, transfusions, iron lungs.

9.) Charges for physiotherapy, if recommended by a Physician for the treatment of a specific disablement and administered by a licensed physiotherapist.

10.) Charges made for hospice charges as follows:

a. nursing care by a Registered Nurse; or a licensed practical nurse, a vocational nurse, or a public health nurse who is under the direct supervision of a Registered Nurse;

b. physical therapy when rendered by a licensed therapist;

c. medical supplies, including drugs and the use of medical appliances;

d. Physicians’ services; and

e. services, supplies, and treatments deemed Medically Necessary and ordered by a licensed Physician.

11.) Hotel room charge, when the Insured Person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond control of the Insured Person.

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

13.) Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.

14.) Local transportation to the nearest Hospital or to the nearest Hospital with facilities for required treatment. Such transportation shall be by licensed ground ambulance only, within the metropolitan area in which the Insured Person is located at that time the service is used. If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense.

Only those expenses specifically described above which are incurred from the onset of the Illness or Injury and which are not excluded in the Exclusions, are considered Eligible Benefits. Initial treatment of an Illness or Injury must occur within 365 days of the onset of the Illness or Injury. Illness or Injury must first manifest itself during the Insured Person’s Period of Coverage.

Pregnancy Benefits

When a covered Pregnancy is incurred by an Insured Person, who is not a Dependent Child, the Company will pay Reasonable and Customary medical expenses, excess of the Deductible and Coinsurance as stated in the Schedule of Benefits. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during any one Pregnancy.

The Insured Person or their representative must pre-notify SRI of a Pregnancy within the first ninety (90) days of the Pregnancy. The Insured Person may pre-notify a Pregnancy with SRI by utilizing the following:

1.) Call 1-800-335-0477 within the United States or from outside the United States call (collect) 0-317-575-2656 between 9:00 a.m. and 4:00 p.m. Eastern Standard Time, or;

2.) Fax 317-575-2659 at anytime, or;

3.) E-mail: info@specialtyrisk.com at anytime.

FAILURE TO PRE-NOTIFY SRI OF A PREGNANCY WITHIN 90 DAYS WILL RESULT IN A 100% REDUCTION OF THE ELIGIBLE BENEFITS STATED IN THE SCHEDULE OF BENEFITS. (PLEASE NOTE THAT IN ADDITION, THE U.M. PROGRAM MUST BE FOLLOWED.)

Benefits will be payable for Eligible Benefits incurred before, during, and after delivery of a Child, including Physician, Hospital, laboratory, and ultrasound services. Coverage for the Inpatient postpartum stay for the Insured Person and her newborn Child in a Hospital will, at a minimum, be for the length of stay recommend by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in their guidelines for Perinatal Care, but not to exceed a maximum of 31 days. In no event shall the Company's maximum liability exceed the maximum stated on the Schedule of Benefits page, as to Eligible Benefits during any one Pregnancy.

Coverage for a length of stay shorter than the minimum period mentioned above may be permitted if the Insured Person's attending Physician determines further Inpatient postpartum care in not necessary for the Insured Person or her newborn Child provided the following are met:

1.) In the opinion of the Insured Person's 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 postdischarge follow up to verify the condition of the infant after discharge; and

2.) One (1) at-home post delivery care visit is provided to the Insured Person at her residence by a Physician or nurse performed no later than forty-eight (48) hours following discharge of the Insured Person and her newborn Child from the Hospital. Coverage for this visit includes, but is not limited to: (a) parent education; (b) assistance in 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 the Insured Person or newborn Child, including the collection of an adequate sample for the hereditary and metabolic newborn screening. At the Insured Person's discretion, this visit may occur at the Physician's office.

Well-Child Care Benefits

This benefit applies to Dependent Children, who have been underwritten and accepted as Insured Persons. The benefit includes: the necessary care and treatment of medically diagnosed congenital defects, birth abnormalities, and prematurity. In addition, it includes coverage for preventive and primary care services, including physical examinations, measurements, sensory screening, neuropsychiatric evaluation, and development screening, which coverage shall include three (3) visits per year for Dependent Children under nineteen (19) years of age. Preventive and primary care services shall also include, as recommended by the Physician, hereditary and metabolic screening at birth, immunizations, urinalysis, tuberculin tests, and hematocrit, hemoglobin, and other appropriate blood tests, including tests to screen for sickle hemoglobinopathy.

Preventive Benefits

The Company will pay expenses, as per the limits stated in the Schedule of Benefits, for the following preventive Benefits. Coverage is limited to the following expenses incurred subject to any exclusions listed in the Exclusion Section [This benefit is not subject to Deductible or Coinsurance.] In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits as to expenses during

any one period of individual coverage. Covered preventive expenses include:

1. Routine physical examinations:

a. Females must be over the age of 30 and have been continuously covered under the Policy for 6 consecutive months prior to receiving treatment.

b. Males must be over the age of 30 and have been continuously covered under the Policy for 6 consecutive months prior to receiving treatment.

2. Female preventive examinations. Females must be over the age of 30 and have been continuously covered under the Policy for 6 consecutive months prior to receiving treatment.

a. Mammogram:

- A baseline mammogram for women.

- An annual screening for mammogram for women.

b. Cervical Cytologic:

- An annual cervical cytologic screening for women.

Mental and Nervous / Alcohol or Drug Abuse Benefits

When covered Mental and Nervous / Alcohol or Drug Abuse expenses are incurred by the Insured Person the Company will pay Reasonable and Customary expenses in excess of the Deductible and Coinsurance as stated in the Schedule of Benefits. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits as to Eligible Benefits during the stated period of time.

Mental or Nervous

For the purpose of this section, only such expenses, incurred as the result of Mental or Nervous treatment or Medication, which are specifically enumerated in the following list of charges, and which are not excluded in the Exclusions, shall be considered as Eligible Benefits:

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 semiprivate room and board accommodation.

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

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

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 Limits stated in the Schedule of Benefits from the onset of the Mental Illness and which are not excluded in the Exclusions, are considered Eligible Benefits. Mental Illness must first manifest itself during the Insured Person’s Period of Coverage.

Alcohol and Drug Abuse

For the purpose of this section, only such expenses, incurred as the result of Alcohol and Drug Abuse treatment or Medication, which are specifically enumerated in the following list of charges, and which are not excluded in the Exclusions, shall be considered as Eligible Benefits:

1. The process whereby a person who is intoxicated by or dependent on drugs or alcohol or both is assisted through the period of time necessary to eliminate the intoxicating agent from the body, while keeping the physiological risk to the patient at a minimum, shall be considered a Covered Expense.

2. Additional treatment as a Covered Expense shall be provided by a Hospital, a nonhospital residential facility, an Outpatient treatment facility, a Physician, a psychologist, or a social worker, and shall include Inpatient services, Outpatient services, or any combination of these, certified as medically or psychologically necessary by a Physician, psychologist, or social worker.

Dental Benefit

When covered Dental expenses are incurred by the Insured Person the Company will pay Reasonable and Customary expenses in excess of the Deductible as stated in the Schedule of Benefits. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during any one period of individual coverage.

For the purpose of this section, only such expenses, incurred as the result of an eligible Dental condition, in which services or Medications are prescribed, performed, or ordered by a Dentist and enumerated below, and which are not excluded in the Exclusions, shall be considered as Eligible Benefits.

With respect to Dental, an eligible Dental condition shall mean emergency dental repair or replacement to sound, natural teeth damaged as a result of a covered Accident. Treatment must be completed within 12 months of the Accident.

Spinal Manipulation Benefit

When covered Spinal Manipulation expenses are incurred by the Insured Person the Company will pay Reasonable and Customary expenses as stated in the Schedule of Benefits. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during any one Coverage Period.

For the purpose of this section, only such expenses, incurred by the Insured Person, which are prescribed, performed, or ordered by a licensed Physician for the relief of pain, and which are not excluded in the Exclusions, shall be considered as Eligible Benefits. The Spinal Manipulation condition must first manifest itself during the Insured Person’s Period of Coverage.

Emergency Medical Evacuation/Repatriation Benefit

The Company shall pay benefits for Eligible Benefits incurred up to the maximum stated in the Schedule of Benefits, if any covered Illness or Injury commencing during the Insured Person’s Period of Coverage results in the Medically Necessary Emergency Medical Evacuation or Repatriation of the Insured Person. The decision for an Emergency Medical Evacuation or Repatriation must be ordered by the Company’s appointed Assistance Company in consultation with the Insured Person’s local attending Physician.

Emergency Medical Evacuation or Repatriation means: a) the Insured Person's medical condition warrants immediate transportation from the place where the Insured Person is Ill or Injured to the nearest adequate medical facility where medical treatment can be obtained; or b) after being treated at a local medical facility as a result of an Emergency Medical Evacuation, the Insured Person's medical condition warrants transportation with a qualified medical attendant to his/her current Home Country to obtain further medical treatment or to recover; or c) both a) and b) above.

Eligible Benefits are expenses, up to the maximum stated in the Schedule of Benefits for transportation, medical services and medical supplies necessarily incurred in connection with an Emergency Medical Evacuation or Repatriation of the Insured Person. 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 Company’s appointed assistance company representative and (b) required by the standard regulations of the conveyance transporting the Insured Person. Transportation means any land, water or air conveyance required to transport the Insured Person. Special transportation includes, but is not limited to, licensed ground and air ambulances, commercial airlines, and private motor vehicles.

All transportation in connection with an Emergency Medical Evacuation or Repatriation must be pre-approved and arranged by an assistance company representative appointed by the Company.

Return of Mortal Remains Benefit

The Return of Mortal Remains Benefit shall only apply when the Insured Person is traveling outside of their current Home Country.

The Company will pay the reasonable Eligible Benefits incurred up to the maximum as stated in the Schedule of Benefits to return the Insured Person's remains to his/her then current Home Country, if he or she dies.

Eligible Benefits include, but are not limited to, expenses for embalming, a container appropriate for transportation, shipping costs, and the necessary government authorizations.

All Eligible Benefits in connection with a Return of Mortal Remains must be pre-approved and arranged by an assistance company representative appointed by the Company.

Emergency Medical Reunion Benefit

The Emergency Medical Reunion Benefit shall only apply when the Insured Person is traveling outside of their current Home Country.

When an Insured Person is eligible for a covered Emergency Medical Evacuation or Repatriation under this Certificate and the assistance company representative (appointed by the Company), and the attending Physician determine that Emergency Medical Evacuation or Repatriation is necessary and prudent for the Insured Person, the Company will arrange and pay for round trip economy-class transportation for one individual selected by the Insured Person, from the Insured Person’s current Home Country to the location where the Insured Person is hospitalized and return to the current Home Country. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during any one period of individual coverage.

The benefits payable will include:

1) The cost of a round trip economy air fare;

2) Reasonable travel and accommodation expenses incurred in relation to the Emergency Medical Reunion up to the maximum stated in the Schedule of Benefits, not to exceed $250 per day.

3) The period of Emergency Medical Reunion is not to exceed 10 days, including travel.

All transportation in connection with an Emergency Medical Reunion must be pre-approved and arranged by an assistance company representative appointed by the Company.

Accidental Death & Dismemberment (AD&D)

Table of Losses

Description of Loss (For Loss 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%

Sight of One Eye 50%

Quadriplegia 100%

Paraplegia (total paralysis of both lower limbs) 75%

Hemiplegia (total paralysis of upper and lower limbs of one side of the body) 50%

Uniplegia (total paralysis of one limb) 25%

Aggregate Limit of Indemnity Per Accident: Five Times the Principal Sum to a Maximum Aggregate of $200,000.

The Company shall pay an indemnity determined from the Schedule of Benefits and the Table of Losses, if an Insured Person sustains a Loss stated therein resulting from Injury, provided that:

(a) such Loss occurs within 90 days after the date of Accident causing such Loss; and

(b) the indemnity payable for any such Loss shall be the Principal Sum stated in the Schedule of Benefits and Table of Losses as applicable to such Insured Person and this Insurance; and

(c) if more than one Loss stated in said Table is sustained as the result of one Accident, only one of the amounts so stated in said Table, the largest, shall be payable.

Exposure

If by reason of an Accident covered by the Policy an Insured Person is unavoidably exposed to the elements and as a result of such exposure suffers a Loss for which the Principal Sum is otherwise payable hereunder such Loss will be covered under the terms of the Policy.

Disappearance

If the body of an Insured Person has not been found within one year of the disappearance, forced landing, stranding, sinking, or wrecking of a conveyance in which such Insured Person was an occupant, than it shall be deemed, subject to all other terms and provisions of the Policy, that such Insured Person shall have suffered Loss of life within the meaning of the Policy.

Beneficiary Designation and Change

The beneficiary or beneficiaries of an Insured Person shall be that person or those persons designated by the Insured Person and filed with the Company. Any Insured Person who has not made an irrevocable designation of beneficiary may designate a new beneficiary at any time, without the consent of the beneficiary, by filing with the Company a written request for such change but such change shall become effective only upon receipt of such request at the office of the Company. When such request is received by the Company, whether the Insured Person be then living or not, the change of beneficiary shall relate back to and take effect as of the date of execution of the written request, but without prejudice to the Company on account of any payment theretofore made by it.

Common Carrier Accidental Death and Dismemberment - Additional Description

Accidental Death and Dismemberment Insurance is afforded to an Insured Person which shall apply only to Injury, as defined in Part III, Definitions, sustained by such Insured Person during the course of coverage. Such Insurance includes such Injury sustained during such trip while the Insured Person is riding as a passenger (but not as a pilot, operator or member of the crew) in or on, boarding or alighting from:

(1) any civilian aircraft having a current and valid Airworthiness Certificate, and piloted by a person who then holds a valid and current certificate of competency of a rating authorizing him to pilot such aircraft; or

(2) any transport type aircraft operated by the Military Airlift Command (MAC) of the United States, or by the similar air transport service of any duly constituted governmental authority of any other recognized country;

provided that this Insurance shall not apply while such Insured Person is riding in any civilian or military aircraft other than a expressly described above, unless previously consented to in writing by the Company.

Utilization Management (U.M.) Program

An Insured Person must follow the Utilization Management Program (hereafter called U.M. Program) in order to receive full benefits under the Certificate. If the Insured Person does not properly follow the U.M. Program, his/her benefits under the Certificate will be reduced, as described below. The Insured Person is responsible for obtaining any required Pre-Certification for all Hospital admissions or transplants worldwide, or for any Outpatient Surgery or Eligible Benefits which will exceed $1,000 in the United States. The Insured Person, or someone on his behalf, must notify the Company prior to treatment, by telephoning the Company’s Utilization Management firm. The telephone numbers are listed on the Insured Person’s ID Card.

The Utilization Management (U.M.) Program requires that an Insured Person obtain Pre-Certification (unless otherwise noted herein) for the following:

1.) For Scheduled Admissions in a Hospital, Worldwide: The U.M. Program requires that the Insured Person, or someone on his behalf, contact the Company as soon as possible, but not less than 48 hours, prior to the date of admission for any scheduled admission, including to a United States Hospital, to obtain the following:

a. Pre-Certification for the Hospital admission, including the number of days of stay. If additional days of Hospital confinement are necessary beyond the initial number of Pre-Certified days, the attending Physician or an official representative of the facility where the Insured Person is confined, must contact the Company (no later that the last day originally Pre-Certified) to obtain Pre-Certification for any additional days of Hospital confinement. The Company will review with the attending Physician the request for the additional days of Hospital confinement.

b. To obtain a list with name(s) and address(es) of the United States Hospitals and doctors that are members of the Participating Provider Network, to which the Insured Person will have access as an Insured Person under the Certificate. The Insured Person must use a Hospital, Outpatient facility, skilled care facility and doctor which are a member of the Participating Provider Network in order to receive full benefits under the Certificate, as described below.

2.) For Emergency Admissions to a Hospital, Worldwide: The U.M. Program requires that the Insured Person, or someone on his behalf, contact the Company as soon as reasonably possible, but no later than 48 hours after the date of admission for an Emergency confinement, including admission to a United States Hospital, to obtain the following.

3.) For Outpatient Treatments or Eligible Benefits which will exceed $1,000 in the United States: The U.M. Program requires that the Insured Person, or someone on his behalf, contact the Company as soon as reasonably possible, but not less than 48 hours prior to the date that Outpatient Treatment in the United States is to begin, to obtain the following:

a. Pre-Certification for the Outpatient Treatment or Eligible Benefits which will exceed $1,000 in the United States.

4.) For Transplants Worldwide: The Insured Person, or someone on his behalf, must contact the Company immediately, but not later than 48 hours after he is identified by his attending Physician as a candidate for a bone marrow, cornea, heart, heart and lung, single lung, single lung, pancreas and kidney or liver transplant, and at least 10 days prior to any scheduled admission to a Hospital, to obtain the following:

U.M. PROGRAM EFFECT ON BENEFITS

Subject to all provisions of the Certificate, when the requirements of the U.M. Program are properly followed and the Hospital admission or transplant worldwide or United States Outpatient treatment is Pre-Certified and a PPO facility and doctor are used. Benefits for Eligible Benefits will be payable as described in the Schedule of Benefits of the Certificate and in any amendments or endorsements to the Certificate.

If an Insured Person does not properly follow the U.M. Program (using a PPO provider and obtaining a pre-certification) the benefit percentage payable for Eligible Benefits incurred for all treatment services and supplies related to the Disablement will be reduced to and payable at 50% (whether or not the Coinsurance has been met). The reduction in the benefit percentage payable will not apply where there is no Participating Provider in the city or immediate vicinity (60 miles) where the Insured Person is to receive care, provided the Insured Person complied with the Pre-Certification requirements.

The additional amounts an Insured Person is required to pay as a result of the lower percentage payable due to noncompliance with this U.M. Program will not be used to satisfy any Deductible amount or the Coinsurance in this Certificate.

PRE-CERTIFICATION DOES NOT GUARANTEE BENEFITS

Benefits payable under the Certificate are still subject to eligibility at the time charges are actually incurred, and to all other terms, limitations, and exclusions of the Certificate. Pre-Certification does not guarantee or confirm benefits under the Certificate.

Part III Definitions

The term "Accident or Accidental" shall mean an event, independent of Illness or self inflicted means, which is the direct cause of bodily Injury to an Insured Person.

The term "Alcohol or Drug Abuse" shall mean any pattern of pathological use of alcohol or drug that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.

The term "Baseline Mammogram" shall mean a screening mammogram that is used as a comparison for future examinations.

The term "Certificate" shall mean this document created from the Master Policy, the Insured Person’s Application and any endorsements, riders or amendments that will attach during the Insured Person’s Period of Coverage.

The term "Child" shall mean the Primary Insured Person's natural child, step-child or a Child under the Insured Person's legal guardianship, but only if such Child depends on the Primary Insured Person's support and maintenance and lives with the Primary Insured Person in a parent-Child relationship.

The term Child does not include a foster Child who is eligible for benefits provided by a governmental program or law, unless required by the law of the State.

The term "Coinsurance" shall mean the percentage amount of eligible Eligible Benefits, after the Deductible, which are the responsibility of the Insured Person and must be paid by the Insured Person. The Coinsurance amount is stated in the Schedule of Benefits.

The term "Company" shall mean The MEGA Life and Health Insurance Company.

The term "Complications of Pregnancy" shall mean any or all of the following conditions which are made worse by, occur during, or are caused by Pregnancy: acute nephritis, nephrosis, cardiac decompensation, missed abortion, hyperemesis gravidarum, ectopic Pregnancy that is ended, non-elective cesarean section, pre eclampsia, gestational diabetes, spontaneous end of Pregnancy which occurs when a viable birth is not possible, and other medical problems of similar severity.

The term "Coverage Period or Period of Coverage" shall mean the period between the Effective Date and Renewal Date of this Insurance as stated on the ID Card.

The term "Eligible Benefits" shall mean expenses which are for Medically Necessary services, supplies, care, or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; Reasonable and Customary charges; incurred while insured under this Certificate; and which do not exceed the maximum limits stated in the Schedule of Benefits.

The term "Custodial Care" shall mean that type of care or service, wherever furnished and by whatever name called, that is designed primarily to assist an Insured Person, whether or not totally disabled, in the activities of daily living.

The term "Cytologic Screening" shall mean a pap test to detect cervical cancer through the simple microscopic examination of cells scraped from the surface of the cervix.

The term "Deductible" shall mean the amount of eligible Eligible Benefits which are the responsibility of each Insured Person and must be paid by each Insured Person, before benefits under this Certificate are payable by the Company. The Deductible amount is stated in the Schedule of Benefits.

The term "Dentist" shall mean a legally licensed doctor of dental surgery; dental medicine or dental science. A dental hygienist who works within the scope of his/her license, under the supervision of a Dentist, is a covered practitioner.

The term "Dependent" shall mean the spouse who is legally married to the Primary Insured Person; the Primary Insured Person's natural or legally adopted unmarried Child from fourteen (14) days old until his/her nineteenth (19th) birthday; or the Primary Insured Person's unmarried Child who is at least nineteen (19) years old but under twenty-four (24) years old and enrolled as a full-time student at an accredited school or college and is not employed on a full-time basis.

The age limits that apply to Dependent Child(ren) will not apply to any insured Child of the Primary Insured Person who remains dependent on the Primary Insured Person for support and maintenance because he or she becomes incapable of working due to a physical handicap or mental retardation which occurs before reaching the age limit; and while insured under this Certificate.

The term "Disablement" as used with respect to medical expenses shall mean an Illness or an Accidental bodily Injury necessitating medical treatment by a Physician as defined in this Certificate.

The term "Educational or Rehabilitative Care" shall mean the care for restoration (by education or training) of one’s ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to, physical therapy or occupational therapy.

The term "Effective Date" shall mean the date coverage under this Certificate begins. After review and approval of the Application by SRI underwriters, coverage will become effective on one of the following dates: (1.) The date requested on the Application, (2.) The date the appropriate premium and Application are received by SRI.

The term "Emergency" shall mean a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Insured Person’s life or limb in danger if medical attention is not provided within 24 hours.

The term "Exclusionary Rider" shall mean that the applicant will be accepted under coverage, but expenses for a certain medical condition or treatment will be excluded from coverage.

The term "Experimental/Investigational" shall mean all services or supplies associated with: 1.) treatment or diagnostic evaluation which is not generally and widely accepted in the practice of medicine in the United States of America or which does not have evidence of effectiveness documented in peer reviewed articles in medical journals published in the United States. For the treatment or diagnostic evaluation to be considered effective such articles should indicate that it is more effective than others available: or if less effective than other available treatments or diagnostic evaluations, is safer or less costly;. 2.) A drug which does not have FDA marketing approval; 3.) A medical devise which does not have FDA marketing approval; or has FDA approval under 21 CFR 807.81, but does not have evidence of effectiveness for the proposed use documented in peer reviewed articles in medical journals published in the United States.

For the devise to be considered effective, such articles should indicate that it is more effective than other available devices for the proposed use; or if less effective than other available devises, is safer or less costly. The Company will make the final determination as to whether a service or supply is Experimental / Investigational.

The term "Extended Care Facility" shall mean an institution, or a distinct part of an institution, which is licensed as a Hospital, Extended Care Facility or rehabilitation facility by the jurisdiction in which it operates; and is regularly engaged in providing 24-hour skilled nursing care under the regular supervision of a Physician and the direct supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation prescribed by a Physician; and provides each patient with active treatment of an Illness or Injury, or related rehabilitation, in accordance with existing standards of medical practice for that condition. Extended Care Facility does not include a facility primarily for rest, the aged, drug abuse, Custodial Care, nursing care, or for care of Mental or Nervous disorders or the mentally incompetent.

The term "Home Country" shall mean the country where an Insured Person has his or her true, fixed and Permanent Residence.

The term "Home Health Care Agency" shall mean a public or private agency or one of its subdivisions, which operates pursuant to law; and is regularly engaged in providing Home Nursing Care under the supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation and treatment by a Physician, in accordance with existing standards of medical practice.

The term "Home Nursing Care" shall mean services provided by a Home Health Care Agency and supervised by a Registered Nurse, which are directed toward the personal care of a patient; provided always that such care is provided in lieu of Medically Necessary Inpatient care in a Hospital.

The term "Hospital" as used in this Certificate shall mean except as may otherwise be provided, a Hospital (other than an institution for the aged, chronically ill or convalescent, resting or nursing homes) operated pursuant to law for the care and treatment of sick or Injured persons with organized facilities for diagnosis and Surgery and having 24-hour nursing service and medical supervision.

The term "Illness" wherever used in this Certificate shall mean sickness or disease of any kind contracted and commencing after the Effective Date of this Certificate and causing Disablement covered by this Certificate.

The term "Incident" shall mean all Illnesses that exist simultaneously and which are due to the same or related causes are considered to be one Incident. Further, if an Illness is due to causes which are the same as or related to the causes of a prior Illness, the Illness will be deemed to be a continuation of the prior Illness and not a separate Incident. All Injuries due to the same Accident shall be deemed to be one Incident.

The term "Injury" wherever used in this Certificate shall mean bodily Injury caused solely and directly by violent, Accidental, external, and visible means occurring while this Certificate is in force and resulting directly and independently of all other causes resulting in Disablement covered by this Certificate.

The term "Inpatient" shall mean an Insured Person who is confined in a institution and is charged for room and board.

The term "Insurance" shall mean the coverage that is provided under the Master Policy of Insurance and this Certificate.

The term "Insured Person(s)" shall mean a person eligible for coverage under the Certificate as stated on the ID Card and in the Schedule of Benefits, who has applied for coverage and is named on the Application and for whom the Company has accepted premium. This may be the Primary Insured Person or Dependent(s).

The term "Intensive Care Unit" shall mean a cardiac care unit or other unit or area of a Hospital which meets the required standards of the Joint Commission on Accreditation of Hospitals for Special Care Units.

The term "Loss" shall mean, in reference to quadriplegia, paraplegia, hemiplegia and uniplegia, shall mean the complete and irreversible paralysis of such limbs and with regard to hands and feet, actual severance through or above the wrist or ankle joints, and with regard to eyes, entire irrecoverable Loss of sight.

The term "Medically Necessary or Medical Necessity" shall mean services or supplies received while insured that are determined by the Company to be: 1.) appropriate and necessary for the symptoms, diagnosis, or direct care and treatment of the Insured Person's medical conditions; 2.) within the standards the organized medical community deems good medical practice for the Insured Person's condition; 3.) not primarily for the convenience of the Insured Person, the Insured Person's Physician or another Service Provider or person; 4.) not Experimental / Investigational or unproven, as recognized by the organized medical community, or which are used for any type of research program or protocol; and 5.) not excessive in scope, duration, or intensity to provide safe and adequate, and appropriate treatment.

For Hospital stays, this means that acute care as an Inpatient is necessary due to the kinds of services the Insured Person is receiving or the severity of the Insured Person's condition, in that safe and adequate care cannot be received as an Outpatient or in a less intensified medical setting.

The fact that any particular Physician may prescribe, order, recommend, or approve a service, supply, or level of care does not, of itself, make such treatment Medically Necessary or make the charge of a Covered Expense under this Certificate.

The term "Medicine or Medications" shall mean the drugs prescribed or dispensed to the Insured Person, by a licensed Pharmacist, as a result of a Covered Expense. Medicine or Medication shall mean the generic equivalent of a drug, or if the generic equivalent is not available, the brand name drug. Shall mean only prescription drugs.

The term "Mental Illness" shall mean any condition or disease listed in the most recent edition of the International Classification of Diseases as a mental disorder, which clinically significant behavioral or psychological disorder marked by a pronounced deviation from a normal healthy state and associated with a present painful symptom or impairment in one or more important areas of functioning. This disease must not be merely an expectable response to a particular stimulus. Mental Illness does not mean learning disabilities, attitudinal disorders or disciplinary problems.

The term "Outpatient" shall mean an Insured Person who receives 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 not confined and is not charged for room and board.

The term "Participating Provider Network" means the Hospitals, Physicians, or other Service Providers who have entered into a contractual agreement with the Company to provide Hospital and medical services to Insured Persons at negotiated fees.

The term "Permanent Residence" shall mean the country where an Insured Person has his or her true, fixed and permanent home and principal establishment, and to which he or she has the intention of returning.

The term "Physician" as used in this Certificate shall mean a doctor of medicine or a doctor of osteopathy licensed to render medical services or perform Surgery in accordance with the laws of the jurisdiction where such professional services are performed.

The term "Pre-Certification and Pre-Certify" mean that the Company, following advance notification for all Hospital admissions worldwide, or for any Outpatient Surgery or Eligible Benefits which will exceed $1,000 in the United States, will provide the Insured Person with the names and addresses of United State Hospitals that are members of the Participating Provider Network, to which the Insured Person may have access, and confirm that such confinement is Medically Necessary.

The term "Preexisting Condition" for purposes of this Certificate shall mean 1.) a condition that would have caused a person to seek medical advise, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2.) a condition for which medical advise, diagnosis, care or treatment was recommended or received prior to the Effective Date of coverage under this Certificate; 3.) expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate.

Preexisting Conditions that are disclosed on the application and accepted by the Company shall be considered covered. Exclusionary Riders may be issued by the Company for certain Preexisting Conditions.

The term "Pregnancy" shall mean the physical condition of being pregnant, including Complications of Pregnancy.

The term "Primary Insured Person" shall mean the person on the Application, who is listed as the Primary Insured, and whom may have Dependents, who are Insured Persons.

The term "Reasonable and Customary" shall mean the maximum amount that the Company determines is Reasonable and Customary for Eligible Benefits the Insured Person receives, up to but not to exceed charges actually billed. The Company's determination considers: 1.) amounts charged by other Service Providers for the same or similar service; 2.) any unusual medical circumstances requiring additional time, skill or experience; and 3.) other factors the Company determines are relevant, including but not limited to, a resource based relative value scale.

For a Service Provider who has a reimbursement agreement, the Reasonable and Customary charge is equal to the amount that constitutes payment in full under any reimbursement agreement with the Company.

If a Service Provider accepts as full payment an amount less than the negotiated rate under a reimbursement agreement, the lesser amount will be the maximum Reasonable and Customary charge.

The Reasonable and Customary charge is reduced by any penalties for which a Service Provider is responsible as a result of it's agreement with the Company.

The term "Registered Nurse" shall mean a graduate nurse who has been registered or licensed to practice by a State Board of Nurse Examiners or other jurisdictional authority, and who is legally entitled to place the letters "R.N." after his or her name.

The term "Relative" shall mean spouse, parent, sibling, Child, grandparent, grandchild, step-parent, step-child, step-sibling, in-laws (parent, son, daughter, brother, or sister), aunt, uncle, niece, nephew, legal guardian, ward, or cousin of the Insured Person.

The term "Repatriation" shall mean the transport of bodily remains or ashes of an Insured Person to their Home Country.

The term "Screening Mammogram" shall mean a low dose x-ray used to visualize the internal structure of the breast.

The term "Service Provider" shall mean a Hospital, convalescent/skilled nursing facility, ambulatory surgical center, psychiatric Hospital, community mental health center, residential treatment facility, psychiatric treatment facility, alcohol or drug dependency treatment center, birthing center, Physician, Dentist, chiropractor, licensed medical practitioner, nurse, medical laboratory, assistance service company, air/ground ambulance firm, or any other such facility that the Company approves.

The term "Surgery or Surgical Procedure" shall mean an invasive diagnostic procedure; or the treatment of Illness or Injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia.

Part IV Exclusions

This Insurance does not cover:

1. Any Injury or Illness which meets the following criteria: 1.) A condition that would have caused a person to seek medical advise, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2.) A condition for which medical advise, diagnosis, care or treatment was recommended or received prior to the Effective Date of coverage under this Certificate; 3.) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate. Preexisting Conditions that are disclosed on the application and accepted by the Company shall be considered covered. Exclusionary Riders may be issued by the Company for certain Preexisting Conditions.

2. Injury or Illness which is not presented to the Company for payment within ninety (90) days immediately following the Incident.

3. Charges for treatment which is not Medically Necessary.

4. Charges provided at no cost to the Insured Person.

5. Charges for treatment which exceed Reasonable and Customary charges.

6. Charges incurred for Surgeries or treatments which are Investigational, Experimental, 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 (including by the precertification company).

8. Suicide or any attempt there at, while sane or self destruction or any attempt there at, while insane;

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. any act of any person 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 (hereinafter for the purposes of this Exclusion called the "Occurrences").

Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed to be consequences for which the Company shall not be liable under this Certificate except to the extent that the Insured Person shall prove that such consequence happened independently of the existence of such abnormal conditions.

10. Injury sustained while participating in professional, amateur, or interscholastic 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; or unless otherwise covered under this Certificate;

12. Treatment of the Temporomandibular joint.

13. Vocational, Speech, Recreational or Music Therapy.

14. Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person.

15. Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes of this Insurance, treatment of a deviated nasal septum shall be considered a cosmetic condition.

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

17. Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof (including radialkeratotomy), unless caused by Accidental bodily Injury incurred while insured hereunder;

18. Injury sustained while under the influence of or Disablement due to 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 for a condition which is covered hereunder, but not for the treatment of drug addiction.

19. Telephone consultations or failure to keep a scheduled appointment.

20. Treatment while confined primarily to receive Custodial Care, educational or rehabilitative care, or nursing services.

21. Congenital abnormalities and conditions arising out of or resulting therefrom, unless otherwise covered under this Certificate.

22. Expenses which are non-medical in nature.

23. The cost of the Insured Person’s unused airline ticket for the transportation back to the Insured Person's Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided.

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

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

26. Injury sustained while taking part in mountaineering where ropes or guides are normally used, hang gliding, parachuting, bungee jumping, racing by horse, motor or motorcycle, scuba diving, involving underwater breathing apparatus - unless PADI certified;

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

28. Injuries for which benefits are payable under any no-fault automobile insurance policy;

29. Treatment of Venereal disease, sexually transmitted disease, or expenses for a sex change;

30. Dental care, except as the result of Injury to sound, natural teeth caused by Accident;

31. Routine Dental Treatment;

32. Pregnancy expenses incurred by a Dependent Child;

33. 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, or abortion.

With regards to Accidental Death and Dismemberment, this Insurance does not cover:

1. Suicide or attempt thereof by the Insured Person while sane or self destruction or any attempt thereof by the Insured Person while insane;

2. Disease or sickness of any kind;

3. Bacterial infections except pyogenic infection which shall occur through an accidental cut or wound;

4. Hernia of any kind;

5. Injury sustained while the Insured Person is riding as a pilot, student pilot, operator or crew member (including in or on, boarding or alighting, from any type of aircraft);

6. Injury sustained while the Insured Person is 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; or in any aircraft that is not on a commercially scheduled flight.

7. 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.

Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed to be consequences for which the Company shall no be liable under this Policy except to the extent that the Insured Person shall prove that such consequence happened independently of the existence of such abnormal conditions.

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

9. Flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing, endurance tests, rocket-propelled aircraft, 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.

10. Being under the influence of alcohol or having taken drugs or narcotics unless prescribed by a legally qualified physician or surgeon.

11. Injury occasioned or occurring while the Insured Person is committing or attempting to commit a felony or to which a contributing cause was the Insured Person being engaged in an illegal occupation.

12. While riding or driving in any kind of competition.

13. Pregnancy, childbirth, miscarriage or abortion.

14. Injury arising out of a Preexisting Condition. However, an injury for which the treatment has not been rendered or treatment medically recommended for the past thirty consecutive months shall not be considered a Preexisting Condition unless otherwise specifically excluded.

Part V Certificate Provisions

1. Entire Contract; Changes: The Certificate, including the Schedule of Benefits, endorsements and the attached papers, if any constitutes the entire contract of Insurance. No change in the Certificate shall be valid until approved by an executive officer of the Company and unless such approval is endorsed hereon. No agent has authority to change this Certificate or to waive any of its provisions;

2. Notice of Claim: Written notice of claim must be given to the Company within ninety (90) days after the occurrence or commencement of any Disablement covered by the Certificate, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the claimant to Specialty Risk International, Inc. (SRI), or to any authorized agent of the Company, with information sufficient to identify the Insured Person shall be deemed notice to the Company.

3. Claim Forms: The Company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing Proofs of Loss. If such forms are not furnished within fifteen (15) days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of the Certificate as to Proof of Loss upon submitting, within the time fixed in the Certificate for filing Proofs of Loss, written proof covering the occurrence, the character and the extent of the Disablement for which claim is made.

4. Proof of Loss: Written Proof of Loss must be furnished to Specialty Risk International, Inc. (SRI), at its said office, within ninety (90) days after the date of such Disablement. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible.

5. Payment of Claims Subject to any written direction of the Insured Person all or a portion of any indemnities provided by this Certificate on account of Hospital, nursing, medical or Surgical service may, at the Company's option and unless the Insured Person requests otherwise in writing not later than the time for filing proof of such loss, be paid directly to the Hospital or person rendering such services.

6. Physical Examination and Autopsy: The Company at its own expenses shall have the right and opportunity to examine the person of any individual whose Injury or Illness is the basis of claim when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death, where it is not forbidden by law.

7. Legal Actions: No actions at law or in equity shall be brought to recover on the Certificate prior to the expiration of sixty (60) days after written Proof of Loss has been furnished in accordance with requirements of this Certificate. No such action shall be brought after expiration of three (3) years after the time that written Proof of Loss is required to be furnished.

8. Conformity With State Statutes: Any provision of the Certificate which, on its Effective Date, is in conflict with the statutes of the state in which the Certificate was delivered or issued for delivery is hereby amended to conform to the minimum requirements of such statutes.

9. Grace Period: A Grace Period of thirty-one (31) days will be granted for the payment of each premium falling due after the first premium, during which Grace Period the Certificate will continue in force, but the Insured Person shall be liable to the Company for the payment of the premium accruing for the period the Certificate continues in force.

10. Effective Date of Individual Insurance: After review and approval of the Application by SRI underwriters, coverage will become effective on one of the following dates: (1.) The date requested on the Application, (2.) The date the appropriate premium and Application are received and approved by SRI.

11. Termination Date of Individual Insurance: Individual coverage under this Certificate shall terminate upon the earlier of the following: (1.) The date to which premium has been paid, (2.), The date the Insured Person resides for more than six (6) months in the United States, during any twelve (12) month coverage period, (3.) The date the Company cancels coverage for a specific class of Insured Persons, which the individual Insured Person may be included.

12. Not in Lieu of Worker's Compensation: This Insurance is not in lieu of and does not affect any requirements for coverage by Worker's Compensation Insurance.

13. Certificate of Insurance: The Company shall issue to each Insured Person an individual Certificate of Insurance, which shall state the essential features of Insurance to which such person is entitled and to whom benefits are payable, if required to do so by the laws of the state in which the Insured Person resides when his Insurance becomes effective.

14. Data Furnished by Insured Person(s): Insured Person shall furnish all information requested on the Application and any additional information requested by the Company. All newborn Children of the Primary Insured Person, who are not reported on the initial Application and currently covered under this Insurance, shall be underwritten by SRI, no earlier then the age of fourteen (14) days old.

Failure on the part of the Primary Insured Person to furnish an Application for a newborn Child to the Company for underwriting, shall not constitute valid Insurance under this contract for the newborn Child. A Dependent Child can not be added to this Certificate of Insurance, without a complete Application and approval of SRI.

15. Assignment: The Insurance provided hereunder is not assignable, but benefits may be assigned in accordance with #6, Payment of Claims.

16. Renewal of Individual Insurance: The initial Period of Coverage cannot exceed twelve (12) months. The Insured Person, however, may apply for renewal of coverage. The renewal Period of Coverage may not total more than twelve (12) months. Renewal(s) will be contingent upon the Insured Person submitting the applicable renewal premiums for their class, as determined by the Company. The Company can not cancel an Insured Person, unless that Insured Person is included in a class that is canceled in its entirety by the Company.

17. Excess Benefits: All coverages shall be in excess of all other valid and collectible insurance and shall apply only when such benefits are exhausted.

Other valid and collectible insurance for which benefits may be payable are insurance programs provided by:

1.) Individual, group or blanket insurance or coverage;

2.) Other prepayment coverage provided on a group or individual basis;

3.) Any coverage under labor management trusteed plans, union welfare plans, employer organizational plans, employee benefit organization plans, or other arrangement of benefits for individuals of a group;

4.) Any coverage required or provided by any statute, socialized insurance program; or

5.) Any no-fault automobile insurance;

6.) Any third party liability insurance.

18. Monetary Limits: The monetary limits stated in this Certificate and the premium shall be in United States dollars. For services outside of the territorial limits of the United States, the exchange rate used to determine the amount of United States dollars to be paid is the exchange rate effective for the date the claims expense was incurred.