How to File a Claim:

Whenever possible, GLOBAL ASSURANCE GROUP, INC. will work directly with the medical provider (physician or hospital) to pay eligible claims directly. If the Insured Person has not satisfied the deductible and/or co-insurance, the Insured Person will need to pay the medical provider directly for these amounts at the time of service. On those occasions when the Insured Person is required to pay medical expenses for which eligible benefits are reimbursable for the MEDIS Plan, a claim form must be completed, signed and filed with GLOBAL ASSURANCE GROUP, INC. within ninety (90) days of the onset of the claim expense. When filing a claim, the Insured Person must:

1.) Fully complete and sign the Medical Claim Form (A copy is included with your Certificate of Coverage, make as many copies as needed.)

2.) Attach all original invoices and bills to the Medical Claim Form (only originals will be accepted and considered for claim reimbursement), complete information will include:

a.) Name, address and phone number of the medical provider
b.) Name, address and phone number of the treating physician
c.) Name and certificate number found on the front of the Insurance ID card of the patient
d.) Date of service
e.) Description of procedures, including cost per procedure
f.) Total amount of the invoice, please specify currency.

3.) Send the completed Medical Claim Form and all original invoices to:

GLOBAL ASSURANCE GROUP, INC. Claims Department 7491 W. Oakland Park Blvd. 2nd Floor Tamarac, Fl 33027

Pre-Notification of Claims Worldwide and PPO Network Utilization in the United States:

The Pre-Notification Program requires that the Insured Person (or someone on his behalf) obtain Pre-Notification by contacting Federal Assist, as soon as possible, but not less than 48 hours prior to the date of a scheduled Hospital admission or within 48 hours after an Emergency Hospital admission anywhere in the world. Additionally, Outpatient services to be rendered in the United States which will exceed $1,000 must be Pre-Notified in the same manner. The Pre-Notification Program also requires that the Insured Person utilize an approved Preferred Provider Organization (PPO) Provider for services and treatments received in the United States.

Failure to follow the protocol outlined above in the Pre-Notification Program will result in a 30% reduction of the Eligible Benefits stated in the Schedule of Benefits.

If you have a claim or a Medical Emergency:

Contact WORLDWIDE ASSISTANCE which provides 24 hour, worldwide assistance services, which include benefit and eligibility verification, claims status, claim forms, access to the United States PPO providers and claims Pre-Notification. To Pre-Notify a hospital admission, outpatient treatment or Eligible Benefits which may exceed US$1,000, contact WORLDWIDE ASSISTANCE

Acceptable methods of contacting WORLDWIDE ASSITANCE include phone, fax, and e-mail.

In order to complete Pre-Notification, WORLDWIDE ASSISTANCE will need to obtain the following information from the Insured Person: Certificate Number, Patient’s name, patient’s telephone number (and/or email address), name and telephone number of the Hospital, the name and telephone number of the referring Physician and the diagnosis and approximate number of days to be confined.

FEDERAL ASSIST can be contacted at:

Toll Free within the United States and Canada 1-866-295-4891

Call Collect from outside the United States and Canada(202)331-1596

Fax: 954.749.1025

E-mail: claims@medishealth.com

A list of approved, United States PPO Providers (physicians and hospitals) can be found at www.medishealth.com/ppo

Pre-Existing Conditions and Exclusionary Riders:

Pre-Existing Conditions are any Injury or Illness which meets the following criteria:

1) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment prior to the Individual Effective Date of Coverage under this Certificate;

2) A condition for which medical advice, diagnosis, care or Treatment, including Medication, was sought, recommended or received prior to the Individual Effective Date of Coverage under this Certificate;

3) the symptoms which occurred prior to the Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the condition producing the symptoms;

4) a condition which manifested prior to the Individual Effective Date of Coverage under this Certificate;

5) Expenses for Pregnancy within twelve (12) months after the Individual Effective Date of Coverage under this Certificate.

Exclusionary Riders may be issued by GLOBAL ASSURANCE GROUP, for certain Pre-Existing Conditions. Pre-Existing Conditions that are fully and accurately disclosed on the Application and Approved and accepted by GLOBAL ASSURANCE GROUP, INC without an Exclusionary Rider or other restriction will be covered up to a lifetime maximum of $50,000 ($5,000 limit per Period of Coverage) after the Insured Person has been continuously insured under a MEDIS Plan for 24 months.

Eligibility for Coverage:

Applicants and/or Insured Persons must be outside the United States at the time of application and/or renewal of coverage. In addition, the Insured Person must reside outside the United States at least 6 months during any 12-month Certificate Period to meet the Eligibility Requirements of an Insured Person. Should any Insured Person reside in the United States longer than 6 months during any 12-month Certificate period, their Coverage shall immediately terminate.

Modification of Medical Condition Prior to Issuance of Certificate:

Any conditions which manifest themselves between the date the Application is signed and the date the Coverage is issued by GLOBAL ASSURANCE GROUP, INC., shall be considered Pre-existing and not covered for the entire Certificate Period. Additionally, some conditions which manifest themselves between the date the Application is signed and the date the Coverage is issued may affect your eligibility for Insurance.

THIS ABOVE DESCRIPTION IS FOR INFORMATION PURPOSES ONLY AND A FULL DESCRIPTION OF THE BENEFITS EXCLUSIONS AND LIMITS ARE IN THE CERTIFICATE OF COVERAGE.