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Certain Underwriters at Lloyd’s, LondonCertain Underwriters at Lloyd’s, London, herein referred to as “the Company” hereby insures all persons whose Application has been Approved, bySeven Corners, herein referred to as “the Administrator” on behalf of the Company and whose name is identified on the ID Card and/or recorded withthe Administrator, subject to all of the Exclusions, Limitations and Provisions as set forth herein and in the Certificate of Insurance issued by theCompany to the Policyholder. Coverage is afforded only with respect to the Named Insured Person(s), Coverage, amounts and limits specifiedherein and as identified in the Schedule of Benefits for the Insurance requested on the Application and for which the specified Premium has beenpaid to the Administrator.Inbound GuestThis document is a Program Summary outlining the full description in the Master PolicyAdministratorSeven Corners303 Congressional Boulevard - Carmel, IN 46032 USA800-335-0611 or 317-575-2652 fax: 317-575-2659 - www.Sevencorners.comSeven Corners Assist must be contacted:As soon as non-emergency hospitalization is recommended. Within 48 hours of an emergency admission. When your physician recommends any surgery, including outpatient. Before receiving any medical treatment inside the United States For emergency evacuation, return of remains and assistance services.Claims Submission: All claims must be submitted to Seven Corners within 90 days of the date of service. Claims may be mailed, faxed, or scanned. Contact details provided above. A Proof of Loss form must be completed and provided for each medical condition. A copy of your passport with entry/exit/visa stamps is required. Detailed bills for services received and detailed receipts for payments made. A signed authorization from the Insured is necessary to reimburse any person other than the Insured.ELIGIBILITYPersons who are non-US citizens, fourteen (14) days of age and older who are traveling to the United States for business, pleasure, or to study, whohave arrived in the United States within one hundred and eighty (180) days preceding the proposed Effective Date of the program, who have paidpremium as outlined in the enrollment application, and who have completed the enrollment form in complete detail are eligible for Inbound Guest.The Company maintains its right to investigate to verify that the eligibility requirements have been met. If and whenever the Company discovers thatthe eligibility requirements have not been met, its only obligation is refund of premium.For the purposes of this program, persons fourteen (14) days of age through sixty-nine (69) years are considered one class of Insured Person, andpersons age seventy (70) and over are considered another class of Insured Person.The eligibility date for Dependent Child(ren) of a Named Insured (as defined) shall be determined in accordance with the following: (1) If a NamedInsured has Dependent Child(ren) on the date he or she is eligible for insurance; or (2) If a Named Insured acquires Dependent Child(ren) after theEffective date, such Dependent Child(ren) becomes eligible on the date the Insured acquires a Dependent Child who is within the limits of adependent, unmarried child set forth in the “Definition” section of the Certificate. Dependent Child(ren) eligibility expires concurrently with that of theNamed Insured.EFFECTIVE DATEEffective Date under the program shall become effective at 12:01 AM North American Eastern Time on the latest of the following dates:1. The day after the Company receives your application and correct premium if application and payment is made online or by fax; or2. The day after the postmark date of your application and correct premium if application and payment is made by mail; or3. The moment you depart your Home Country; or4. The date you request on your application.Dependent Child(ren) coverage will not be effective prior to that of the Named Insured.EXPIRATION DATEThe coverage provided with respect to the Named Insured shall terminate at 12:01 AM North American Eastern Time on the earliest of the followingdates:1. The date shown on the insurance confirmation card, for which the premium is paid; or2. The date the Insured Person returns to his Home Country;3. One hundred and eighty (180) days after the Insured Person’s original effective date; or4. The date the Insured Person becomes a United States citizen; or5. The date of entry into active duty military service.6. The date the Master Policy terminates (unless the Company agrees, in writing, to permit coverage to continue to the end of the period forwhich premiums have been paid in lieu of a return of unearned premiums);7. In addition, for Dependent Child(ren), coverage expires the date the Named Insured(s) coverage expires or the date they cease to beconsidered a Dependent Child.Inbound Guest5-LON16-160810-03TM

SCHEDULE OF BENEFITSINJURY AND SICKNESS MEDICAL BENEFITS (PART A)Maximum Benefit Limit Per Sickness or Injury:Ages 14 days through 69: Option 25,000 (Plan A), 45,000 (Plan B), Option 65,000 (Plan C), 85,000 (Plan D), or 120,000 (Plan E)Age 70 and over:Option 40,000 (Plan J), Option 60,000 (Plan K), or Option 100,000 (Plan L)Deductible Per Person Per Sickness or Injury:Ages 14 days through 69: Option 0, 50 or 100Age 70 and over: 200.00No Coinsurance applies.Age 14 Days throughPlan APlan BPlan CPlan DPlan E69Medical Maximum 25,000 Max per 45,000 Max per 65,000 Max per 85,000 Max per 120,000 Max jury/SicknessInjury/SicknessINPATIENTHospital Room &Up to 910/day, 30 Up to 1260/day,Up to 1565/day,Up to 1725/day,Up to 2340/day,30 day max30 day max30 day max30 day maxBoard Includingday maxLaboratory Tests,X-Rays, PrescriptionMedical, ExtendedCare Facility and othermiscellaneousHospital IntensiveCare UnitSurgical TreatmentAdditional 430/day, 8 daymaxUp to 2150Additional 595/day, 8 daymaxUp to 2970Additional 720/day, 8 daymaxUp to 3960Additional 790/day, 8 daymaxUp to 4840Additional 1020/day, 8 daymaxUp to 6600AnesthetistUp to 500Up to 740Up to 990Up to 1210Up to 1650Assistant SurgeonUp to 500Up to 740Up to 990Up to 1210Up to 1650Physician’s NonSurgical VisitsUp to 40/visit,1/day, 30 visitsmaxUp to 60/visit,1/day, 30 visitsmaxUp to 65/visit,1/day, 30 visitsmaxUp to 75/visit,1/day, 30 visitsmaxUp to 100/visit,1/day, 30 visitsmaxA ConsultingPhysician, whenrequested by attendingPhysicianPrivate Duty NurseUp to 350Up to 405Up to 465Up to 485Up to 600Up to 400Up to 495Up to 550Up to 550Up to 660Pre-Admission Testsw/in 7 days beforeHospital admissionOUTPATIENTSurgical TreatmentUp to 750Up to 990Up to 1100Up to 1100Up to 1100Up to 2150Up to 2970Up to 3960Up to 4840Up to 6600AnesthetistUp to 500Up to 740Up to 990Up to 1210Up to 1650Assistant SurgeonUp to 500Up to 740Up to 990Up to 1210Up to 1650Physician’s NonSurgical/ Urgent CareVisitsUp to 50/visit,1/day, 10 visitsmaxUp to 60/visit,1/day, 10 visitsmaxUp to 65/visit,1/day, 10 visitsmaxUp to 75/visit,1/day, 10 visitsmaxUp to 100/visit,1/day, 10 visitsmaxDiagnostic X-rays &Lab ServicesUp to 295 Additional 250One CAT scan,PET scan or MRIUp to 405 Additional 250 One CAT scan,PET scan or MRIUp to 465 Additional 375 –One CAT scanPET or MRIUp to 485 Additional 450 One CAT scan,PET scan or MRIUp to 600 Additional 500One CAT scan,PET scan or MRIHospital EmergencyRoom (all expensesincurred therein)Up to 215Up to 295Up to 395Up to 465Up to 660Inbound Guest6-LON16-160810-03TM

Prescription DrugsUp to 150 PerPeriod of CoverageUp to 250 PerPeriod of CoverageUp to 125 PerPeriod of CoverageUp to 135 PerPeriod of CoverageUp to 180 PerPeriod of CoverageOutpatient SurgicalFacilityOTHER TREATMENTAND SERVICESAmbulance ServicesUp to 750Up to 900Up to 1030Up to 1070Up to 1320Up to 295Up to 450Up to 450Up to 475Up to 475Initial OrthopedicProsthesis/braceDurable MedicalEquipmentChemotherapy and/orradiation therapyDental Treatment forInjury to Sound,Natural TeethMental & NervousDisorder & SubstanceAbusePhysiotherapyUp to 715Up to 990Up to 1160Up to 1240Up to 1560Up to 1,100Up to 1,200Up to 1,300Up to 1,700Up to 1,700Up to 715Up to 990Up to 1175Up to 1275Up to 1620Up to 360Up to 550Up to 550Up to 550Up to 550Same as anySicknessSame as anySicknessSame as anySicknessSame as anySicknessSame as anySicknessUp to 30/visit,1/day, 12 visitsmaxUp to 40/visit,1/day, 12 visitsmaxUp to 40/visit,1/day, 12 visitsmaxUp to 40/visit,1/day, 12 visitsmaxUp to 40/visit,1/day, 12 visitsmaxExtended Care FacilityCovered under theHospital Room &Board benefit 50,000Covered under theHospital Room &Board benefit 50,000Covered under theHospital Room &Board benefit 50,000Covered under theHospital Room &Board benefit 50,000Covered under theHospital Room &Board benefit 50,000 25,000 5,000 25,000 25,000 5,000 25,000 25,000 5,000 25,000 25,000 5,000 25,000 25,000 5,000 25,000EmergencyEvacuationReturn of Remains/Local Cremation/BurialCommon CarrierAD&D Principal SumAcute Onset of Preexisting Condition(s) 45,000 per 65,000 per 85,000 per 120,000 per 25,000 perPeriod ofPeriod ofPeriod ofPeriod ofPeriod rage forMedical ExpenseMedical ExpenseMedical ExpenseMedical ExpenseMedical ExpenseBenefits (subject to Benefits (subject to Benefits (subject to Benefits (subject toBenefits (subject tothe sublimits forthe sublimits forthe sublimits forthe sublimits foreach benefit shown each benefit shown each benefit shown each benefit shownthe sublimits forabove) & 25,000above) & 25,000above) & 25,000above) & 25,000each benefit shownperPeriodofperPeriodofperPeriodofper Period ofabove) & 25,000Coverage forCoverage forCoverage forCoverage forper Period ofEmergencyEmergencyEmergencyEmergencyCoverage n.If an insured person turn 70 years old during the purchased coverage period, the 70 and over benefit schedule becomeseffective upon the day the insured turns 70. Individuals with the 20,000 and 45,000 per Injury or Sickness Certificatemaximum will receive the 40,000 per Injury or Sickness schedule for age 70 and older. Individuals with the 65,000 and 85,000 per Injury or Sickness Certificate maximum will receive the 60,000 per Injury or Sickness schedule for age 70 andolder. Individuals with the 120,000 per Injury or Sickness Certificate maximum will receive the 100,000 per Injury or Sicknessschedule for age 70 and older.Inbound Guest7-LON16-160810-03TM

Age 70-99INPATIENTPlan J 40,000 Max perInjury/SicknessUp to 870/day, 30 day maxPlan K 60,000 Max perInjury/SicknessUp to 1,260/day, 30 day maxPlan L 100,000 Max perInjury/SicknessUp to 2,050/day, 30 day maxAdditional 380/day, 8 day maxAdditional 550/day, 8 day maxAdditional 900/day, 8 day maxSurgical TreatmentUp to 2,285Up to 3,300Up to 5,365AnesthetistUp to 570Up to 825Up to 1,340Assistant SurgeonUp to 570Up to 825Up to 1,340Physician’s Non-Surgical VisitsUp to 45/visit, 1/day, 30 visitsUp to 65/visit, 1/day, 30 visitsmaxUp to 100/visit, 1/day, 30 visitsmaxA Consulting Physician, whenrequested by attendingPhysicianPrivate Duty NurseUp to 330Up to 480Up to 780Up to 375Up to 450Up to 880Pre-Admission Tests w/in 7days before Hospital admissionOUTPATIENTSurgical TreatmentUp to 775Up to 775Up to 1,500Up to 2,285Up to 3300Up to 5,365AnesthetistUp to 570Up to 825Up to 1,340Assistant SurgeonUp to 570Up to 825Up to 1,340Physician’s Non-Surgical /Urgent Care VisitsUp to 45/visit, 1/day, 10 visitsUp to 65/visit, 1/day, 10 visitsmaxUp to 100/visit, 1/day, 30 visitsmaxDiagnostic X-rays & LabServicesUp to 330 - Additional 250 One CAT scan, PET scan orMRIUp to 480 – additional 300 –One CAT scan PET or MRIUp to 780 – additional 300 One CAT scan, PET scan orMRIHospital Emergency Room (allexpenses incurred therein)Prescription DrugsUp to 208Up to 300Up to 480Outpatient Surgical FacilityUp to 250 Per Period ofCoverageUp to 705Up to 250 Per Period ofCoverageUp to 1020Up to 250 Per Period ofCoverageUp to 1,660OTHER TREATMENT ANDSERVICESAmbulance ServicesUp to 450Up to 450Up to 880Initial OrthopedicProsthesis/braceDurable Medical EquipmentUp to 705Up to 1020Up to 1,660Up to 1,100Up to 1,200Up to 1,300Chemotherapy and/or radiationtherapyDental Treatment for Injury toSound, Natural TeethMental & Nervous Disorder &Substance AbusePhysiotherapyUp to 705Up to 1020Up to 1,660Up to 550Up to 550Up to 1,075Same as any SicknessSame as any SicknessSame as any SicknessUp to 40/visit, 1/day, 12 visitsUp to 40/visit, 1/day, 12 visitsmaxUp to 80/visit, 1/day, 12 visitsmaxExtended Care FacilityCovered under the HospitalRoom & Board benefit 50,000 25,000Covered under the HospitalRoom & Board benefit 50,000 25,000Covered under the HospitalRoom & Board benefit 50,000 25,000 25,000 5,000 25,000 Common Carrier 25,000 5,000 25,000 Common Carrier8- 25,000 5,000 25,000 Common CarrierLON16-160810-03TMHospital Room & Boardincluding miscellaneousHospital Intensive Care UnitEmergency EvacuationReturn of RemainsReturn of Remains/Local Cremation/BurialAD&D Principal SumInbound Guest

EMERGENCY EVACUATION AND RETURN OF REMAINS (PART B)BENEFITMAXIMUM AMOUNTEmergency Evacuation 50,000 maximum benefit per Injury or SicknessReturn of Remains 25,000 maximum benefitCOMMON CARRIER ACCIDENTAL DEATH & DISMEMBERMENT (PART C)BENEFITPRINCIPAL SUMAccidental Death & Dismemberment 25,000A. MEDICAL EXPENSE BENEFITS – INJURY AND SICKNESSWhen a covered Injury or Sickness requires treatment by a Physician, this program will provide benefits for the Usual and Customary Charges forMedically Necessary Covered Medical Expenses which exceed the deductible per person for each Injury or Sickness, and which are incurred withinone hundred and eighty-two (182) days following the Injury or Sickness. Payment for any Covered Medical Expense will be no more than the BenefitLimit shown for it in the Schedule of Benefits. The total payable for all Covered Medical Expenses will be no more than the Maximum Benefit Limitper Sickness or Injury. Benefits are subject to the Excess Benefits Provision.If a benefit is designated in the Schedule of Benefits, Covered Medical Expenses include:1)Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional services and (with theexception of personal services of a non-medical nature; charges made for an operating room.2) Charges made for Intensive Care of Coronary Care charges and nursing services.3) Hospital Miscellaneous Expenses: 1) while Hospital Confined; or 2) for pre-admission expenses for being Hospital Confined. Benefits will bepaid for services and supplies such as: the cost of the operating room; laboratory tests; x-ray examination; anesthesia; drugs (excluding takehome drugs) or medicines; therapeutic services; and supplies.4) Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Injury and administered by a licensed physiotherapist(inpatient).5) Charges made for diagnosis, treatment and Surgery by a Physician for inpatient surgery. Payment will be made based upon the surgicalschedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this inpatient surgery benefit; or under theoutpatient surgery benefit, but not for both.6) Charges made for the cost and administration of anesthetics: in connection with inpatient surgery.7) Private Duty Nurse’s Services: 1) private duty nursing care only; 2) while Hospital Confined; 3) ordered by a licensed Physician; and 4) aMedical Necessity. General nursing care provided by the Hospital is not covered under this benefit.8) Physician’s Visits: when Hospital Confined. Benefits are limited to one Physician’s visit per day. Benefits do not apply when related to surgery.Covered medical expenses will be paid under the inpatient benefit or under the outpatient benefit for Physician’s Visits but not both.9) Pre-admission Testing: limited to routine tests such as: complete blood count; urinalysis; and chest x-ray. If otherwise payable under theCertificate, major diagnostic procedures such as: CAT scans; NMR’s; and blood chemistries will be paid under the “Hospital Miscellaneous”benefit.10) Mental and Nervous Disorder (inpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits. Benefits are limitedto one Physician’s visit per day.11) Charges made for diagnosis, treatment and Surgery by a Physician for outpatient surgery. Payment will be made based upon the surgicalschedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this outpatient surgery benefit; or under theinpatient surgery benefit, but not both.12) Day Surgery Miscellaneous (Outpatient Surgical Facility): in connection with outpatient day surgery; excluding non-scheduled surgery, andsurgery performed in a Hospital emergency room, trauma center, Physician’s office, or clinic. Benefits will be paid for services and suppliessuch as: the cost of the operating room, laboratory tests and x-ray examinations including professional fees, anesthesia, drugs or medicines,therapeutic services and supplies.13) Anesthetist (Outpatient): in connection with outpatient surgery.14) Physician’s Visits (Outpatient): Includes injections administered during visit. Benefits do not apply when related to surgery or Physiotherapy.Covered medical expenses will be paid under the outpatient benefit or under the inpatient benefit for Physician’s visits but not both.15) Medical Emergency Expenses (Outpatient): only in connection with a Medical Emergency as defined. Benefits will be paid for the use of theemergency room and supplies.16) Radiation Therapy (Outpatient)17) Chemotherapy (Outpatient)18) Prescription Drugs (Outpatient)19) Mental and Nervous Disorder (Outpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits. Benefits arelimited to one Physician’s visit per day.20) Ground ambulance (within the metropolitan area) to and from the nearest Hospital with facilities for required treatment. If the Insured Person isin a rural area, then licensed group ambulance transportation to the nearest metropolitan area shall be considered.21) Braces and Appliances: 1) when prescribed by a Physician; and 2) a written prescription accompanies the claim when submitted. Replacementbraces and appliances are not covered. Braces and appliances include Durable Medical Equipment (consisting of a standard basic hospital bedand/or a standard basic wheelchair). No benefits will be paid for rental charges in excess of purchase price.22) Consultant Physician Fees: when requested and approved by the attending Physician.23) Dental Treatment: 1) performed by a Physician; and 2) made necessary by Injury to Sound, Natural Teeth. Routine dental care and treatment tothe gums are not covered.Inbound Guest9LON16-160810-03TM

24) Alcoholism/Drug Abuse Treatment: the benefits and the maximum amounts are specified in the Schedule of Benefits.25) Care in an Extended Care Facility following direct transfer from an acute care Hospital, provided such care is recommended by the Physicianfor convalescence related to the Illness or Injury for which the Member was hospitalized as Inpatient. Extended Care Facility benefits accruetoward the limits for Hospital Room and Board.B. EMERGENCY EVACUATIONThe Company shall pay benefits for Covered Expenses incurred up to 50,000, if any covered Injury or Illness commencing during the Period ofCoverage results in the Medically Necessary Emergency Medical Evacuation or Return of the Insured Person. The Emergency Medical Evacuationor Return must be ordered by the Assistance Company in consultation with the Insured Person’s local attending Physician.Emergency Medical Evacuation or Return means: a) the Insured Person's medical condition warrants immediate transportation from the place wherethe Insured Person is located to the nearest adequate medical facility where medical treatment can be obtained; or b) after being treated at a localmedical facility as a result of a Emergency Medical Evacuation, the Insured Person's medical condition warrants transportation with a qualifiedmedical attendant to his/her Home Country to obtain further medical treatment or to recover; or c) both a) and b) above. All transportationarrangements must be by the most direct and economical route and be performed by the Administrator.C. RETURN OF REMAINS / LOCAL CREMATION OR BURIAL:The Company will pay the reasonable Covered Expenses incurred up to 25,000 to return the Insured Person's remains to his/her Home Country, ifhe or she dies. Covered Expenses include, but are not limited to, expenses for embalming, [a minimally necessary container appropriate fortransportation, shipping costs, and the necessary government authorizations. All transportation arrangements must be performed by theAdministrator.The Company will pay the reasonable Eligible Expenses incurred up to the maximum stated in the SCHEDULE OF BENEFITS for preparation, localburial or cremation of the Insured Person’s mortal remains at the place of death in accordance with the commonly accepted cultural and religiousbeliefs practiced by the Insured Person. Coverage is not provided for burial and cremation costs incurred for religious practitioner, flowers, music,food or beverages.If the Local Cremation or Burial is chosen, the Return of Mortal Remains benefit will not apply.D. COMMON CARRIER ACCIDENTAL DEATH AND DISMEMBERMENT INDEMNITYAccidental Death & Dismemberment Coverage shall apply only to covered accidents sustained by an Insured Person:1. while riding as a

Insurance is effective with CERTAIN UNDERWRITERS AT LLOYD'S, LONDON. The Binding Authority Reference Number is NA16SC01 IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS CERTIFICATE, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN . 100 Per Injury/Sickness Deductible Per Person: