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What’sCoveredby AtlasTravel ?TerrorismEmergency Medical Evacuation andIn these turbulent times, the risk of aterrorist attack is a reality. If you are in thewrong place at the wrong time, and thecountry or region you’re visiting is NOTunder a level 3 or level 4 travel advisory,Atlas Travel offers coverage for eligiblemedical expenses resulting from thoseacts. Coverage excludes countries orregions for which the U.S. Departmentof State has issued a level 3 (“reconsidertravel”) or level 4 (“do not travel”) advisory.Emergency ReunionPolitical EvacuationWould you know what to do if you foundyourself in a life-threatening situationfar from home? Tokio Marine HCC - MISGroup is experienced in arranging emergency medical evacuations. Atlas Travelwill cover eligible expenses necessaryto transport you from an initial treatingfacility to the nearest hospital qualifiedto treat your life-threatening condition.We also understand the importanceof family support in these difficultsituations. Atlas Travel will also cover thetransportation, lodging, and meal costsfor a relative to join you after a coveredemergency medical evacuation, up tothe lifetime limit.If, during the coverage period and afteryour arrival, the United States governmentissues a level 3 or level 4 travel advisoryfor your destination country, Atlas Travelwill coordinate your alternate departurearrangements from that country and covereligible associated costs.International CoverageRepatriation of RemainsWhat would your family do if disasterstrikes while you are away from home?The death of a loved one is nevereasy, no matter the circumstances. Inthe unfortunate event of your deathwhile traveling abroad, Atlas Travel willarrange for and cover eligible costsassociated with the repatriation of yourremains.Return of Minor ChildrenIf you are expected to be hospitalizedfor more than 36 hours due to a coveredinjury or illness and covered childrenunder 18 years of age will be leftunattended as a result, Atlas Travel willcover the eligible transportation cost forthe children to return home.Natural Disaster – ReplacementAccommodationsNatural disasters can happen anywhereand at any time. If a natural disaster occurson your trip, causing you to become displaced from your accommodations, AtlasTravel will provide relief of a maximum of 250 a day for 5 days to help cover thecosts of alternative accommodations.Atlas Travel* Quality BenefitsAcute Onset of Pre-Existing ConditionsAtlas Travel provides a limited benefitup to the medical coverage lifetimemaximum for eligible medical expenses.If you are younger than 80, you maybe covered for an acute onset of apre-existing condition. This also includesup to a 25,000 lifetime maximum foremergency medical evacuation.An acute onset of a **pre-existingcondition is a sudden and unexpectedoutbreak or recurrence of a pre-existingcondition which occurs spontaneouslyand without advance warning either inthe form of physician recommendationsor symptoms. Treatment must beobtained within 24 hours of the suddenand unexpected outbreak or recurrence.Chronic and congenital conditions areexcluded from coverage.Hospitalization and Outpatient TreatmentIf a covered illness or injury requireshospitalization, the plan provides coverage for eligible costs associated withhospitalization, including intensive careunit and outpatient treatment.Sports CoverageAtlas Travel includes coverage for eligibleinjuries and illnesses that could occurwhile participating in many popularvacation sports - skiing, snowboarding,snorkeling, water skiing, and others - atno additional cost. Certain extremesports are excluded from coverage.Complications of PregnancyAtlas Travel offers coverage for complications of pregnancy during the first 26weeks of gestation.Crisis ResponseAtlas Travel offers up to 10,000 (or upto 100,000 if **additional coverageis selected) to offset costs associatedwith kidnapping, such as ransom, crisisresponse expenses, and loss of personalbelongings. This benefit includes accessto the services of Unity Crisis Group foradvice, coordination with law enforcement,and negotiations during a kidnapping.Personal LiabilityAtlas Travel offers up to 10,000 (or up to 100,000 if additional coverage is selected)to offset the following types of courtentered eligible judgments or approvedsettlements incurred by the member: Third-party injury; Damage/loss of a third party’s personalproperty; Damage/loss of a related third party’spersonal property.*The description of coverage in these pages is for informational purposes only. Actual coverage will vary based the terms and conditions of the policy issued. The information described herein does not amend or otherwise affect theterms and conditions of any insurance policy issued by Tokio Marine HCC -MIS Group or its affiliates. In the event that a policy is inconsistent with the information described herein, the language of the policy will take precedence.**A pre-existing condition is any condition: for which medical advice, diagnosis, care, or treatment was recommended or received within 2 years prior to your effective date of coverage which would cause a reasonably prudent person to seek medical advice, diagnosis, care, or treatment within 2 years prior to your effective date of coverage that existed (with reasonable medical certainty) with 2 years prior to your effective date of coverage, whether or not it was known to you***A buy-up of an additional 90,000 is available for selection, which includes the added benefit of a 10,000 maximum for natural disaster evacuation.

Enrollmentand Filing aClaimto continue his or her international tripClaim Filingor the members return to their homeYou may file a claim by submitting a claim-country for the sole purpose of obtainingtreatment for an illness or injury thatbegan while traveling shall void anyhome country coverage provided underthe terms of this agreement.ant’s statement and authorization form. Thisform may be found online, in ClientZone,or you may contact Tokio Marine HCC-MISGroup for a copy. Complete the form, attachall itemized invoices and payment receipts,Home Country CoverageBenefit Period Medical Coverageand send them to the address shown onIncidental Home Country CoverageWhile the certificate is in effect, the benefitthe claimant’s statement.For individuals with U.S. as homeperiod does not apply. Upon termination ofcountry, for every three month periodduring which the Member is coveredhereunder, medical expenses incurredin the U.S. are covered up to a maximum of 15 days for any three monthperiod.For individuals with a home country otherthan the U.S., for every three monthperiod during which the Member iscovered hereunder, medical expensesthe certificate, underwrit ers will pay eligible medical expenses, as defined herein,for up to 90 days beginning on the firstday of diagnosis or treatment of a coveredinjury or illness while the member is outside his or her home country and while thecertificate was in effect. The benefit periodapplies only to eligible medical expensesrelated to the injury or illness that beganwhile the certificate was in effect.incurred in the member’s home countryEnrollmentare covered up to a maximum of 30 daysYou may access the online quoting andfor any three month period.purchasing system or you may completeAny benefit accrued under a sin gle 3an application and mail or fax along withmonth period does not accumulate toyour payment to your agent or to Tokioanother period. Failure of the memberMarine HCC - MIS Group.Patient Protection and Affordable Care Act(“PPACA”): This insurance is not subject to, anddoes not provide certain insurance benefits requiredby the United States’ Patient Protection andAffordable Care Act (“PPACA”). PPACA requirescertain US citizens or US residents to obtain PPACAcompliant health insurance, or “minimum essentialcoverage.” PPACA also requires certain employers tooffer PPACA compliant insurance coverage to theiremployees. Tax penalties may be imposed on U.S.residents or citizens who do not maintain minimumessential coverage, and on certain employers whodo not offer PPACA compliant insurance coverage totheir employees. In some cases, certain individuals may be deemed to have minimum essentialcoverage under PPACA even if their insurancecoverage does not provide all of the benefits requiredby PPACA. You should consult your attorney or taxprofessional to determine whether this policy meetsany obligations you may have under PPACA.Atlas Travel is underwritten by Lloyd’s, London.Tokio Marine HCC - Medical Insurance ServicesGroup (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies.Tokio Marine HCC - MIS Group has authority to enterinto contracts of insurance on behalf of the Lloyd’sunderwriting members of Lloyd’s Syndicate 4141,which is managed by HCC Underwriting Agency Ltd.

Outstanding Customer ServicePre-Trip Destination InformationOther Travel Assistance Services*Client Zone and World Service CenterUp-to-date information regarding required Prescription Drug Replacementvaccinations, health risks, travel restric - Emergency Travel ArrangementsTokio Marine HCC - MIS Group ClientZone is an online account managementand resource tool available to:tions, and weather conditions specific tothe destination country. Extend coverage and reprint ID cardsMedical Monitoring Obtain details about claim filing anddownloading formsConsultations with attending medical Locate providers within the PPO Networkand establishment of a single point-of-Log In to Client Zone at:ongoing updates regarding medicalhttps://zone.hccmis.com/clientzoneIf you prefer to speak to a professionalprofessionals during hospitalizationcontact for family members to receivestatus.Provider Referralsservice representative, contact the TokioContact information for Western-styleMarine HCC - MIS Group World Servicemedical facilities, medical and dentalCenter by calling toll-free from variouspractices, and pharmacies in the desti-countries or by calling collect. The Worldna tion country.Service Center can provide service inTravel Document Replacementmany different languages.Worldwide Travel and MedicalAssistanceAtlas Travel includes valuable travel andmedical assistance services, which areavailable 7 days a week, 365 days a year.Contact Tokio Marine HCC - MIS Group toaccess any of these services.Assistance with obtaining replacementpassports, birth certificates, visas,airline tickets, and other travel-relateddocuments.Lost Luggage AssistanceTracking service to assist in locatingluggage or other items lost in transit.Contact UsTokio Marine HCC - Medical Insurance Services Group251 North Illinois Street, Suite 600, Indianapolis, IN 46204Tel: 1 (800) 605 2282Fax: 1 (317) 262 2140hccmis.comA member of the Tokio Marine HCC group of companiesKHE2FFFYH6SP-152-1242 Dispatch of Physician Translation Assistance Credit Card / Traveler’s Check Replacement*For a complete list of available assistance servicesor for more information, please contact TokioMarine HCC - MIS Group. Travel and MedicalAssistance Services are not insurance benefits. Anytravel or medical assistance service provided is nota guarantee of any insurance benefit.

ƚůĂƐ /ŶƚĞƌŶĂƚŝŽŶĂůΠ Ͳ &Žƌ ƚƌĂǀĞů ŽƵƚƐŝĚĞ ŽĨ ƚŚĞ h͘ 9.79N/AN/A80 *12.65N/AN/AN/AN/A 100,000 250,000 500,000 100,000 250,000 500,000 1 Million 2 4.394.48N/A70-794.515.476.33N/AN/AN/AN/A80 *8.09N/AN/AN/AN/AN/A 100,000 250,000 500,000 1 Million 2 MillionMaximum 50,000LimitAgeDaily 1 Million 2 6.056.1670-796.227.538.61N/AN/A80 *11.14N/AN/AN/AN/A 100,000 250,000 3.843.92N/A70-793.954.795.63N/AN/AN/AN/A80 *7.08N/AN/AN/AN/AN/A 100,000 250,000 500,000 1 Million 2 MillionMaximum 50,000LimitAgeDaily 1 Million 2 5.505.6070-795.656.867.86N/AN/A80 *10.11N/AN/AN/AN/A 100,000 250,000 500,000DailyDailyDailyDailyDailyMaximum 50,000LimitAgeDailyΨϭϬϬϬ ĞĚƵĐƚŝďůĞDailyMaximum 50,000LimitAgeDaily 1 Million 2 MillionΨϮϱϬϬ ĞĚƵĐƚŝďůĞΨϭϬϬ ĞĚƵĐƚŝďůĞ 500,0000.96Maximum 50,000LimitAgeDailyΨϮϱϬ ĞĚƵĐƚŝďůĞ 250,00014d-29yMaximum 50,000LimitAgeDailyΨϱϬϬ ĞĚƵĐƚŝďůĞ 3.443.57N/A70-793.294.144.98N/AN/AN/AN/A80 *5.90N/AN/AN/AN/AN/A 1 Million 2 MillionΨϱϬϬϬ ĞĚƵĐƚŝďůĞΨϬ ĞĚƵĐƚŝďůĞMaximum 50,000LimitAgeDailyRates are shown in US dollars and are effective 04/01/2018. Rates are subject to change.Charges will include Surplus Lines taxes and fees when 3.713.78to Tokio Marine HCC Medical Insurance Services Group in order to receive a refund or premium.65-693.464.194.644.904.955.05Cancellation requests received after the policy effective date will be subject to the following conditions:70-795.086.157.07N/AN/AN/A1) a 25 cancellation fee will apply; and80 *9.10N/AN/AN/AN/AN/A2) only the unused portion of the plan cost will be refunded; and* 10,000 Maximum Limit for age 80 and over.If for any reason you wish to cancel your policy, you must submit your cancellation request in writing3) only members who have no claims are eligible for premium refund.Tokio Marine HCC Medical Insurance Services GroupTokio Marine HCC Medical Insurance Services Group (MIS Group) is a member of the Tokio Marine HCC group of companies. Tokio Marine HCC – MIS Group has authority to enter into contractsof insurance on behalf of the Lloyd’s underwriting members of Lloyd’s Syndicate 4141, which is managed by HCC Underwriting Agency LTD. ůŽLJĚ͛Ɛ

ƚůĂƐ ŵĞƌŝĐĂΠ Ͳ &Žƌ EŽŶͲh͘ ͘ ŝƚŝnjĞŶƐ ƚƌĂǀĞůŝŶŐ ƚŽ ƚŚĞ h͘ 9.4012.0413.75N/AN/AN/A80 *14.97N/AN/AN/AN/AN/A 100,000 0.9111.4011.6370-798.2710.5912.11N/AN/AN/A80 *13.17N/AN/AN/AN/AN/A 100,000 250,000DailyDailyDailyDailyDaily 250,000 500,000 1 Million 2 96.017.708.91N/AN/AN/A80 *9.57N/AN/AN/AN/AN/A 100,000 250,000 500,000Daily 1 Million 2 7.257.4070-795.276.757.93N/AN/AN/A80 *8.38N/AN/AN/AN/AN/A 100,000 250,000 500,000DailyDailyDailyMaximum 50,000LimitAgeDaily 500,000 1 Million 2 Million 100,00014d-29yMaximum 50,000LimitAgeDaily 500,000 1 Million 2 MillionΨϮϱϬϬ ĞĚƵĐƚŝďůĞΨϭϬϬ ĞĚƵĐƚŝďůĞΨϭϬϬϬ ĞĚƵĐƚŝďůĞDaily 1 Million 2 94.405.847.02N/AN/AN/AN/A80 -797.529.6211.02N/AN/A80 *11.97N/AN/AN/AN/A 100,000 250,000DailyDailyDailyDailyDailyMaximum 50,000LimitAgeDailyMaximum 50,000LimitAgeDaily 500,000 1 Million 2 Million1.64Maximum 50,000LimitAgeDailyΨϮϱϬ ĞĚƵĐƚŝďůĞ 250,00014d-29yMaximum 50,000LimitAgeDailyΨϱϬϬ ĞĚƵĐƚŝďůĞ 100,000 500,000 1 Million 2 MillionΨϱϬϬϬ ĞĚƵĐƚŝďůĞΨϬ ĞĚƵĐƚŝďůĞMaximum 50,000LimitAgeDailyRates are shown in US dollars and are effective 04/01/2018. Rates are subject to change.Charges will include Surplus Lines taxes and fees when 8.408.57Tokio Marine HCC Medical Insurance Services Group in order to receive a refund or premium.65-694.706.018.248.939.339.51Cancellation requests received after the policy effective date will be subject to the following conditions:70-796.778.679.97N/AN/AN/A1) a 25 cancellation fee will apply; and80 *10.78N/AN/AN/AN/AN/A2) only the unused portion of the plan cost will be refunded; and* 10,000 Maximum Limit for age 80 and over.If for any reason you wish to cancel your policy, you must submit your cancellation request in writing to3) only members who have no claims are eligible for premium refund.Tokio Marine HCC Medical Insurance Services GroupTokio Marine HCC Medical Insurance Services Group (MIS Group) is a member of the Tokio Marine HCC group of companies. Tokio Marine HCC – MIS Group has authority to enter into contractsof insurance on behalf of the Lloyd’s underwriting members of Lloyd’s Syndicate 4141, which is managed by HCC Underwriting Agency LTD. ůŽLJĚ͛Ɛ

ATLAS TRAVEL APPLICATIONTokio Marine HCC - Medical Insurance Services GroupLloyd's CoverholderPlease print clearly and provide complete information.Last NameFirst NameMIComplete Mailing Address and Telephone #:Home Country:Requested Effective Date (mm/dd/yy):Countries to be visited:Date of Return (to Home Country):E-mail Address (required for Extension of Coverage notification):Maximum Coverage Limit Selected:Beneficiary (include relationship to Applicant):Maximum Deductible Selected:Please complete for all individuals to be covered. List applicable rates for the Maximum Limit Option Selected.#Last Name, First Name as it should appear on ID CardBirth Date (mm/dd/yy)GenderCitizenshipColumn RDaily Rate* 1 234 *FLORIDA SURPLUS (Tax): Traveling to FL to work? Yes / NoATrip Duration (# of Days)BSubtotal (add Column R, #1 - #4 above)CADD BUY-UPS?DEF (If Yes, multiply individual rates & Buy-Ups** by 1.051 x # days)A B **(If FL, FL Tax applies)C TOTAL Premium Due (multiply Lines B and C by Line A) *(If FL, FL Tax applies) (Then add Lines B & C for Total for Line D)D OPTIONAL Express Delivery Charge: Add 20.00 for US Delivery, 30.00 Non-US DeliveryE TOTAL AMOUNT DUE (Add above Lines D and E together)F Form of Payment:*(If FL, FL Tax applies)Accidental Death & DismembermentCredit CardCredit Card #:Crisis ResponseCheck/Money OrderExpiration Date (mm/yy):Personal LiabilityName as it appears on card:Complete Billing Address (include daytime phone #):Signature:Payment by Credit Card: By signing above, the cardholder authorizes Tokio MarineHCC - Medical Insurance Services Group to debit his or her Discover, VISA,MasterCard or American Express account for the amount specified above. Pleasesubmit this completed Application by mail or by fax to your Agent or to Tokio MarineHCC - MIS Group.Tokio Marine HCC - Medical Insurance Services Group251 North Illinois Street, Suite 600Indianapolis, IN 46204Checks and Money Orders should be made payable to HCC Medical InsuranceServices. Please send your Check or Money Order along with this Application via mailor courier to:HCC Medical Insurance Services15748 Collection Center Dr.Chicago, IL 60693-0157Total payment for the initial term of coverage requested must be entirely paid in U.S. dollars at time of application or prior to the Effective Date of Coverage. Coverage purchasedby credit card is subject to validation and acceptance by the credit card company.I hereby apply for membership in the Atlas/International Citizen Group Insurance Trust, Hamilton, Bermuda, and for the insurance provided to members by Lloyd’s. I understand that theinsurance applied for is not a general health insurance policy, but is intended for use in the event of a sudden and unexpected event while traveling outside my Home Country. I understand thatmy insurance terminates upon my return to my Home Country unless I qualify for a Benefit Period or Home Country Coverage. I understand this insurance contains a Pre-existing Conditionexclusion and other restrictions and exclusions. I understand that, prior to my current coverage expiration date, I can visit the Tokio Marine HCC – MIS Group Client Zone for transactioninstructions regarding policy extensions and/or renewal eligibility. I understand that the information contained herein is a summary of the Master Policy and that I may obtain a complete copy ofthe Master Policy upon request to Tokio Marine HCC - Medical Insurance Services Group. I understand that Lloyd’s, as underwriter of the plan, is solely liable for the coverage and benefitsprovided under the insurance. I understand that Lloyd’s operates as an approved, non-admitted insurer in all states of the United States except Illinois and Kentucky where they are admitted.As such, claims under this insurance may not be made against any state guaranty fund. I understand and agree that the insurance agent/broker, if any, assisting with this Application is arepresentative of the Applicant. Licensed insurance brokers and independent agents are compensated through commissions calculated as a percentage of premium for the purchase, renewal,placement or servicing of insurance coverage. Additionally, some licensed producers may also receive bonuses and incentive trips or prizes associated with sales contests based on salescriteria, such as the overall sales volume or for the percentage of completed sales through Tokio Marine HCC - Medical Insurance Services Group. Please contact your insurance broker toobtain information about the specific compensation they may receive in conn

The Atlas Travel plan from Tokio Marine HCC - MIS Group (MIS Group), a member of Tokio Marine HCC, is with you almost anywhere in the world you may travel for vacation, study abroad, corporate travel, or mission work. . Atlas Travel provides international coverage as well as important benefits like Emergency Medical Evacuation, Hospital .