Institute of International Education
Table of Benefits
      If this Policy provides outpatient x-ray or radiation therapy,
16. Participation in a riot or civil disorder; fighting or brawling,
Covered Person means any Eligible Person who makes                       Total Disability means with respect to the Covere...
                                                           Please keep this document...
flight arrangements, securing visas, and logistical arrangements such as                  Our obligation to pay for Your S...
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Iie Brochure (Ford Intl Fellow) & Medex 1 1 07


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Iie Brochure (Ford Intl Fellow) & Medex 1 1 07

  1. 1. INTERNATIONAL EDUCATIONAL EXCHANGE SERVICES Institute of International Education Ford Foundation International Fellowships Program A Medical Expense Insurance Policy for Fellows in the U.S.A. and Canada Policy # IES-00022 Administered by: International Educational Exchange Services Underwritten by: BCS Insurance Company Policy terms and conditions are briefly outlined in this Description of Benefits Description of Coverage. Complete provisions pertaining to Basic Medical 100% of $250,000 of covered this insurance are contained in the Master Policy on file with expenses for Participants. the IEES trustee and the Participating Organization. In the Deductible Amount* $25 event of any conflict between this Description of Coverage and the Master Policy, the Policy will govern. *The deductible is the dollar amount of eligible Medical Coverage begins at 12:01 AM on the effective date (please Expenses which must be incurred as an out-of-pocket refer to the ID card). Thereafter, the insurance is effective 24 expense by each Covered Person on a per Injury or hours a day, worldwide. Coverage will terminate on the Sickness basis before certain benefits are payable under the earliest of the following dates: (1) the date the Master Policy policy. terminates; or (2) the premium due date for which the required premium has not been paid; or (3) the date on which the COVERED MEDICAL EXPENSES Covered Person ceases to meet the eligibility requirements; or • (4) the date the Covered Person requests cancellation of Fees for diagnosis and treatment by a Physician, coverage. Coverage will end 12:01 AM on the last date of surgeon, Registered Nurse, professional anesthetist, or insurance. radiologist. • DESCRIPTION OF COVERAGE Assistant Surgeons are allowed at 20% of the surgery If a Covered Person incurs expenses while insured under the allowance. • Policy due to an Injury or Sickness, We will pay the Usual, Hospital charges. • Customary and Reasonable Expenses for any Medically Laboratory, diagnostic and X-ray examinations. Necessary Covered Medical Expenses listed below. All • Outpatient prescription drugs, including contraceptive Covered Medical Expenses incurred as a result of the same or related cause, including any complications, shall be drugs and devices. • considered as resulting from one Sickness or Injury. The Rental charge for durable medical equipment, or the amount payable for any one Injury or Sickness will not exceed purchase of this equipment, whichever is less. the Maximum Benefit Limit of $250,000. Benefits are subject • Home health care (must follow a hospital confinement of to the Deductible Amount and Coinsurance Percentages, at least 3 days). specified benefits set forth under Covered Medical Expenses, • the limitations appearing under Limitations on Covered Annual mammogram. • Medical Expenses, the General Policy Exclusions, the Pre- Annual cervical cytologic screening. (Pap smear) Existing Condition Limitation and to all other limitations and • provisions of the Policy. Reconstructive Breast Surgery The expenses must be incurred after the date treatment was Expenses incurred by a Covered Person for first rendered, following the effective date of the Covered Reconstructive Breast Surgery as described below are Person’s insurance, while coverage remains continuously in considered Covered Expenses and will be payable under force under the Policy. this Policy to the same extent as any other covered surgery, provided such Reconstructive Surgery is required EXCESS PROVISION This policy is in excess of any other as a result of a covered Sickness. Covered Expenses for valid and collectible insurance or service contract. Reconstructive Breast Surgery will also include the cost of prostheses. IIE 1/1/07 Ford Intl. Fellow 1
  2. 2. Table of Benefits If this Policy provides outpatient x-ray or radiation therapy, Covered Loss then the cost of outpatient chemotherapy following Loss of Life………………………………………...The Principal Sum Reconstructive Breast Surgery that is performed in Loss of Two or more members………………….The Principal Sum connection with the treatment of breast cancer also will be Loss of Entire Sight of Both Eyes………….……The Principal Sum included as a Covered Expense. Loss of One Member and Sight of One Eye…...The Principal Sum • Colonoscopy. Colorectal cancer screenings, performed in Loss of Speech and Hearing in Both Ears……..The Principal Sum accordance with the latest screening guidelines issued by Loss of One member or sight of One Eye…1/2 The Principal Sum the American Cancer Society. Loss of Speech………………………............1/2 The Principal Sum Loss of Hearing in Both Ears………………..1/2 The Principal Sum Loss of Thumb and Index Finger LIMITATIONS ON COVERED MEDICAL EXPENSES of the Same Hand….................................…1/4 The Principal Sum • Loss of hand or foot means complete Severance through or Payment for Hospital room and board, which includes all above the wrist or ankle joint. general nursing charges, will be limited to the Hospital's Loss of Entire Sight means the total, permanent loss of sight normal charge for semi private accommodation. Intensive of the eye. The loss of sight must be unrecoverable by Care Unit charges will be limited to two times the semi- natural, surgical or artificial means. private room and board rate per day. Loss of a thumb and index finger means complete Severance • Expenses incurred for treatment of mental illness are through or above the metacarpophalangeal joints (the joints limited to treatment for Inpatient or residential care in a between the fingers and the hand). Hospital or non-Hospital residential facility for up to 45 quot;Severancequot; means the complete separation and days. Outpatient benefits shall be 75% of covered dismemberment of the part from the body. expenses for the first 40 visits and 60% thereafter. Family Air Fare Expense • Expenses incurred for treatment of substance abuse are The Company will pay, up to $2,500, if the Insured is limited to 28 days for Inpatient or residential care in a hospitalized for at least seven (7) days due to an Accident or Hospital or non-Hospital residential facility, and up to 30 Sickness. The benefit will be provided for round trip air fare outpatient visits. The process whereby a person who is (tourist class) expenses to the host country for a parent, spouse, sibling (over age 21) or legal guardian and their hotel, intoxicated by or dependent on drugs or alcohol or both is and meals to a maximum of $75 per day. assisted through the period of time necessary to eliminate the intoxicating agent from the body shall be covered for In the event of death, or life-threatening Accident or illness of up to 12 days. a parent, spouse, child, sibling, or legal guardian, requiring the • Insured to return home after arriving at their placement, the Therapeutic or elective termination of pregnancy up to Company will arrange, and pay for their returning air fare $500. (tourist class) from the host country to their home country • Professional ground or air ambulance service to the point of departure. IEES must be advised and approve the nearest Hospital up to $1,000. flight, which must be arranged through IEES. Retroactive • claims will not be accepted. This benefit is limited to $2,500. Expenses incurred for physiotherapy, including Right of Subrogation If the covered person is injured or acupuncture are payable up to a) a maximum of $10,000 on an Inpatient basis, and b) $50.00 per visit, maximum becomes ill through the act or commission of another person, and if benefits are paid under this Policy due to that Injury or 20 visits on an outpatient basis. • Sickness, then to the extent the Covered Person recovers for Dental Treatment: (a) when performed by a Physician and the same Injury or Sickness from a third party, his insurer, or (b) made necessary by Injury to sound, natural teeth shall the Covered Person’s uninsured motorist insurance, BCS be limited to $250 per tooth per Injury. Routine dental Insurance Company will be entitled to a refund of all benefits it care and treatment to the gums are not covered. has paid up to the amount of such recovery. Further, BCS Insurance Company has the right to offset subsequent SUPPLEMENTAL BENEFITS benefits payable to the Covered Person under the Policy Accidental Death & Dismemberment - $25,000 per against such recovery. Participant Preferred Provider Network (Within the U.S.A.) If, within 365 days of an Accident covered under this Policy in This Policy utilizes the Hygeia Corporation Preferred Provider accordance with the Coverage Description to which this hospital and physician network for the purpose of delivering benefit applies, bodily Injury results in any of the following quality health care at a preferred fee. You are not required to losses, the Company will pay the benefit amount shown use the PPO network, but can receive information on opposite such loss in the Table of Benefits. If the Covered participating providers by visiting the Hygeia web page at Person sustains more than one such loss as the result of any and select the “Public Provider Search” one Accident, the Company will pay only the one largest option. amount to which the Covered Person is entitled. IIE 1/1/07 Ford Intl. Fellow 2
  3. 3. 16. Participation in a riot or civil disorder; fighting or brawling, GENERAL POLICY EXCLUSIONS except in self-defense; commission of or attempt to This policy does not cover loss, charges, or expenses commit a felony. caused by or resulting from: 17. Suicide, attempted suicide or intentionally self-inflicted 1. Pre-existing Condition Limitation: the Policy does not pay Injury while sane or insane. benefits for loss due to a Pre-existing Condition during the 18. Skydiving, parachuting, hang gliding, glider flying, first 12 months of coverage, except as provided below: parasailing, sail planing, bungee jumping, or flight in any The Policy will pay for Covered Medical Expenses type of aircraft, except while riding as a fare-paying incurred in connection with a Covered Person’s Pre- passenger on a regularly-scheduled airline. existing Condition during the first 12 months of coverage, 19. Organ transplant. subject to a maximum benefit of $25,000. After the 20. Birth control, including surgical procedures and devices. Covered Person has been covered under the Policy for 12 months, Pre-existing Conditions will be covered the same 21. Treatment that is not incurred by an Insured Person while as any other Injury or Sickness. insured hereunder. 22. Charges used to meet any deductible, or in excess of the 2. Treatment or services provided by any member of the coinsurance level, or in excess of those considered Usual, Covered Person's immediate family; or for which no Customary, and Reasonable Charges. charge is normally made. 23. Rest cures or custodial care (whether or not prescribed by 3. Routine physical examinations and routine testing; a Physician), or transportation. preventive testing or Treatment; screening examinations or testing in the absence of Injury or Sickness. 24. Treatment, services or supplies provided by a Hospital or facility owned or run by the United States Government, 4. Elective Treatments and voluntary testing. unless a charge is made for such services in the absence 5. The diagnosis and treatment of TMJ dysfunction, or of insurance; or in a Hospital which does not skeletal irregularities of one or both jaws, including unconditionally require payment. orthognathia and mandibular retrognathia. 25. Injury or Sickness covered by Worker's Compensation or 6. Dental care or Treatment other than care of sound, Employer's Liability Laws, or by any coverage provided or natural teeth and gums required due to an Injury resulting required by law (including, but not limited to group, group from an Accident while the Covered Person is insured type, and individual automobile quot;No-Faultquot; coverage). under this Policy, and rendered within 12 months of the 26. Treatment, services or supplies provided or paid for by Accident. any governmental program or law, except Medicaid. 7. Eye examinations; prescriptions or fitting of eyeglasses 27. Injury or death contributed to by the use of drugs or and contact lenses; eyeglasses, contact lenses or other alcohol, unless administered by a Physician. Treatment for visual defects and problems, except as required as a result of a covered Injury. quot;Visual defectsquot; 28. Operating any vehicle while under the influence of alcohol means any physical defect of the eye that does or can or without being properly licensed and insured to do so. impair normal vision. 29. Impotence, whether organic or otherwise. 8. Hearing examinations or hearing aids; or other Treatment 30. Sleeping disorders, including testing thereof. for hearing defects and problems, except as required as a result of a covered Injury. quot;Hearing defectsquot; means any 31. Routine newborn care, well baby nursery and related physical defect of the ear that does or can impair normal physician charges. hearing. DEFINITIONS 9. Routine foot care, including the treatment of corns, calluses and bunions. Unless specifically defined elsewhere, wherever used in the 10. Treatment of congenital anomalies and conditions arising Policy: or resulting directly therefrom. Accident means a sudden, unexpected and unintended 11. The diagnosis and treatment of acne. incident. quot;Covered Accidentquot; means an Accident that results 12. Cosmetic surgery, except cosmetic surgery which the in Injury or loss covered by this Policy. Covered Person needs as the result of an Accident which Activities sponsored and under the direct and immediate happens while he is insured under this Policy. supervision of the School means any activity which the School 13. The diagnosis and treatment of Infertility. requires the Covered Person to attend, or any activity of the 14. Nasal or Sinus Surgery (unless required due to an Injury School which is under the sole control and supervision of resulting from an Accident while the Covered Person is School authorities, but not including activities which are under insured under this Policy). joint sponsorship or supervision arrangement with any non- 15. War or any act of war, declared or undeclared; or while School group. serving in the armed forces of any country (a pro-rata BCS Insurance Company or The Company will be premium will be refunded for such period of service). referred to as quot;Wequot;, quot;Ourquot; or quot;Usquot;. IIE 1/1/07 Ford Intl. Fellow 3
  4. 4. Covered Person means any Eligible Person who makes Total Disability means with respect to the Covered Person, who would otherwise be employed: application for, or for whom application is made and who is approved to participate in the benefit plans issued under this 1) his complete inability to perform all the substantial and Policy, provided the required premium for such Person’s material duties of his regular occupation; with insurance is paid when due. 2) care and treatment by a Physician, and Hospital means a legally constituted institution having means with respect to the Covered Person, who is not organized facilities for the care and Treatment of sick or otherwise employed: injured persons on a registered Inpatient basis, including 1) his inability to engage in normal activities of a person of facilities for diagnosis and surgery under the supervision of a like age and sex; with staff or one or more licensed Physicians and provides 24-hour nursing service by Registered Nurses on duty or call. 2) care and treatment by a Physician for the Injury or Sickness causing the inability; or Injury means accidental bodily harm sustained by the Covered Person that resulted directly and independently of all 3) his Hospital confinement or home confinement at the other causes from an Accident and occurs while coverage direction of his Physician due to Injury or Sickness, except under this Policy is in force. for visits to receive medical treatment. Inpatient means confinement for which the Covered Person Usual, Customary, and Reasonable Charges - quot;Usualquot; is charged at least one full day's room and board. means those charges made by a provider for services and supplies rendered to all patients for the same or similar Injury Medically Necessary or Medical Necessity means the or Sickness; quot;Customaryquot; means those charges made by the services or supplies provided by a Hospital, Physician, or majority of providers in the area for the same or similar other provider that are required to identify or treat an Injury or services or supplies. quot;Reasonablequot; means those charges that Sickness and which, as determined by the Company, are: (1) do not exceed the majority of prevailing fees in the area for consistent with the symptom or diagnosis and Treatment of the same or similar services or supplies. Area means a the Injury or Sickness; (2) appropriate with regard to county or larger geographically significant area as determined standards of good medical practice; (3) not solely for the by the Company. convenience of the Covered Person; (4) the most appropriate supply or level of service which can be safely provided. When applied to the care of an Inpatient, it further means that the For questions please contact: Covered Person's medical symptoms or condition requires that the services cannot be safely provided as an Outpatient. Administered by: International Educational Exchange Nurse means a person who has been registered or licensed Services (IEES) to practice by the State Board of Nurse Examiners or other P.O. Box 370, Ithaca, NY 14851-0370 state authority in the state where he works, and who is TOLL FREE: 866-433-7462 (within USA) practicing within the scope and limitation of that license. The Phone: 607-272-2707 (collect from overseas) term Nurse will not include the Covered Person or his spouse, FAX: 607-272-2703 children, brothers, sisters, or parents, or any person residing WEB: in his household. EMAIL: Physician means a practitioner of the healing arts who is Assistance Services Provided By: duly licensed in the state where he is practicing and who is MEDEX Assistance Corporation treating within the scope and limitation of that license. The term Physician will not include the Covered Person or his IEES Group ID #319691 spouse, children, brothers, sisters, or parents, or any person P. O. Box 19056 residing in his household. Baltimore, MD 21284 TOLL FREE: 800-527-0218 (within USA) Pre-existing Conditions means a condition for which a Phone: 410-453-6330 (collect from overseas) Covered Person received medical treatment, care or advice within 6 months before being insured under this Policy. WEB: www. EMAIL: School means any facility under the management of the Policyholder which operates for the purpose of educating its students. Sickness means illness or disease contracted and causing loss as to the Covered Person whose Sickness is the basis of claim. Any complications or any condition arising out of a Sickness for which the Covered Person is being treated or has received Treatment will be considered as part of the original Sickness. Treatment means a specific in-office or Hospital physical examination of, or care rendered to, the Covered Person. IIE 1/1/07 Ford Intl. Fellow 4
  5. 5. MEDEX SECURE (IEES MEDEX ID # 319691) Please keep this document with You while You travel. A comprehensive program providing You with worldwide 24/7 emergency medical and security assistance - including emergency evacuations - when you are 100 or more miles away from your permanent residence in your home country. PROGRAM DESCRIPTION MEDICAL EVACUATION & REPATRIATION SERVICES How To Access MEDEX SECURE Services Emergency Medical Evacuation: If You sustain an Injury or suffer a sudden 24 hours a day, 7 days a week, 365 days a year and unexpected Illness and adequate medical treatment is not available in Your MEDEX identification card is Your key to travel security. If You have a Your current location, We will arrange and pay for a medically supervised medical, personal safety or travel problem, simply call Us for assistance. Our evacuation to the nearest medical facility We determine to be capable of toll-free and collect-call telephone numbers are printed on Your ID card. providing appropriate medical treatment. Your medical condition and Either call the toll-free number of the country You are in, or call the situation must be such that, in the professional opinion of the health care Assistance Center collect at: provider and MEDEX, You require immediate emergency medical treatment, without which there would be a significant risk of death or serious Baltimore, Maryland - 410-453-6330 impairment. A multilingual assistance coordinator will ask for Your name, Your company Transportation to Join a Hospitalized Member: If You are traveling alone and or group name, the group number shown on Your ID card, and a description are or will be hospitalized for more than three days, We will coordinate and of Your situation. We will immediately begin assisting You. A full listing of pay for economy round-trip airfare for a person of Your choice to join You. services follows. Return of Dependent Children: If Your dependent child(ren) age 18 or under If the condition is an emergency, You should go immediately to the nearest are present but left unattended as a result of Your Injury or Illness, We will physician or hospital without delay and then contact the 24-hour Assistance coordinate and pay for one-way economy airfare to send them back to Your Center. We will then take the appropriate action to assist You and monitor Home Country. We will also arrange and pay for the services and Your care until the situation is resolved. transportation expenses of a qualified escort, if required. Transportation After Stabilization: Following emergency medical evacuation MEDEX SECURE provides You with Medical Assistance Services, Medical and stabilization, We will coordinate and pay for one-way economy airfare to Evacuation & Repatriation, Security & Political Evacuation and Security Your point of origin. If following stabilization We determine that Services, and Travel Assistance Services as described below. These services hospitalization or rehabilitation should occur in Your Home Country, We will are subject to certain Conditions, Limitations, and Exclusions also described alternatively coordinate and pay for Your transportation there. below. Repatriation of Mortal Remains: We will assist in obtaining the necessary MEDEX Assistance Corporation clearances for Your cremation or the return of Your mortal remains. We will P.O. Box 19056 coordinate and pay for the expenses of the preparation and transportation of Baltimore, MD 21284 Your mortal remains to Your Home Country. In addition, We will coordinate and 1-800-537-2029 pay for the transportation home of personal effects (up to $2,500) in the event of Your death. MEDICAL ASSISTANCE SERVICES SECURITY AND POLITICAL EVACUATION & SECURITY SERVICES Worldwide Medical and Dental Referrals: We will provide referrals to help You locate appropriate treatment or care. Real-time Security Intelligence: In the event You feel threatened by political Monitoring of Treatment: Our Assistance Coordinators will continually unrest, social instability, weather conditions, or health or environmental monitor Your case. In addition, Our Regional Medical Advisors provide Us hazards, We will provide You with the latest authoritative information and consultative and advisory services, including review and analysis of the guidance for over 180 countries and select cities. Our global intelligence quality of medical care You are receiving. database is continuously updated and includes destination intelligence from over 5,000 worldwide sources. Facilitation of Hospital Payment: Upon securing payment or a guarantee to reimburse, We will either wire funds or guarantee required emergency Security Evacuation: In the event of an Emergency Security Situation, We will hospital admittance deposits. You are ultimately responsible for the on a best-effort basis arrange for Your evacuation from an international payment of the cost of medical care and treatment, including hospital airport or other safe departure point We designate to the nearest safe haven. expenses. We will pay for Your evacuation up to and including seven (7) days from the date of evacuation notice given by the recognized government of Your Home Transfer of Insurance Information to Medical Providers: We will assist You Country or Host Country. You will be responsible for the cost and with hospital admission, such as relaying insurance benefit information, to arrangement of ground transportation to the designated international airport help prevent delays or denials of medical care. We will also assist with or other safe departure point. If evacuation becomes impractical due to discharge planning. hostile or dangerous conditions, We will maintain contact with You and Medication, Vaccine and Blood Transfers: In the event medication, vaccines, advise You until evacuation becomes viable or the Emergency Security or blood products are not available locally, or a prescription medication is Situation has passed. lost or stolen, We will coordinate their transfer to You upon the prescribing Political Evacuation: In the event the officials of Your Home Country issue a physician’s authorization, if it is legally permissible. written recommendation that You leave Your Host Country for non-medical Replacement of Corrective Lenses and Medical Devices: We will coordinate reasons, or if You are expelled or declared “persona non grata” on the written the replacement of corrective lenses or medical devices if they are lost, authority of Your Host Country, We will on a best-effort basis arrange for Your stolen, or broken during travel. evacuation from an international airport or other safe departure point We Dispatch of Doctors/Specialists: In an Emergency where You cannot designate to the nearest safe haven. We will pay for Your evacuation up to adequately be assessed by telephone for possible evacuation, or You cannot and including seven (7) days from the date of evacuation notice given by the be moved and local treatment is unavailable, We will send an appropriate recognized government of Your Home Country or Host Country. You will be medical practitioner to You. responsible for the cost and arrangement of ground transportation to the Medical Records Transfer: Upon Your consent, We will assist with the transfer designated international airport or other safe departure point. of medical information and records to You or the treating physician. Transportation After Security or Political Evacuation: Following a Security or Continuous Updates to Family, Employer, and Physician: With Your approval, Political Evacuation and when safety allows, We will coordinate and pay for We will provide case updates to appropriate individuals You designate in one-way economy airfare to return You to either Your Host Country or Your order to keep them informed. Home Country. Hotel Arrangements for Convalescence: We will assist You with the Other Evacuation Assistance Services: In the event You feel Your personal arrangement of hotel stays and room requirements before or after safety is threatened, but the situation does not dictate a Security or Political hospitalization. Evacuation and You none-the-less wish to be evacuated, We will assist You on a best-effort basis in making evacuation arrangements. This may include
  6. 6. flight arrangements, securing visas, and logistical arrangements such as Our obligation to pay for Your Security and/or Political Evacuation will include a $100,000 paid benefit per member per emergency security situation, and a ground transportation and housing. In more complex situations, We will $1,000,000 aggregate limit per emergency security situation. assist You in making arrangements with providers of specialized security In the event We are arranging transportation by commercial air and You hold an services. You will be responsible for costs associated with this type of original return airline ticket, We may use that ticket and are only responsible for voluntary evacuation. any applicable change fees. TRAVEL ASSISTANCE SERVICES We will only direct-pay any transportation costs to the transportation providers, unless otherwise approved by Us in advance. Pre-Travel Information: Upon Your request, We can provide continuously We are not responsible for the availability, timing, quality, results of, or failure to updated destination intelligence for more than 180 countries covering ten provide any medical, security, legal or other care or service caused by conditions subject areas: security, health, transportation, entry/exit, finance, culture, beyond Our control. This includes Your failure to obtain care or service or where language, communication, legal, and weather/environment. the rendering of such care or service, including Security and Political Evacuations Emergency Travel Arrangements: We will make new reservations for airlines, from Afghanistan, Iraq, and Somalia, is prohibited by U.S. law, local laws, or hotels, and other travel services in the event of an Illness or Injury. regulatory agencies. Transfer of Funds: We will provide You with an emergency cash advance Your legal representative shall have the right to act for You and on Your behalf if subject to Us first securing funds from You or Your family. You are incapacitated or deceased. Replacement of Lost or Stolen Travel Documents: We will assist You in EXPENSES NOT COVERED taking the necessary steps to replace passports, tickets, and other important We shall not be responsible for any costs or expenses arising from: travel documents. (1) Hospital or medical expenses of any kind or nature. Legal Referrals: Should You require legal assistance, We will direct You to an (2) Travel arrangements that were neither coordinated by nor approved by attorney and assist You in securing a bail bond. Us in advance. Translation Services: Our multilingual Assistance Coordinators are available (3) Your traveling against the advice of a physician or traveling for the purpose of obtaining medical treatment. to provide immediate verbal translation assistance in a variety of languages (4) Taking part in military or police service operations. in an emergency; otherwise We will provide You with referrals to local (5) The commission of, or attempt to commit, an unlawful act. interpreter services. (6) Pregnancies, except in the case of a major, vital complication during Message Transmittals: You may send and receive emergency messages toll- the first two trimesters of pregnancy which presents a clear and free, 24-hours a day, through Our Assistance Center. significant risk of death or imminent serious injury or harm to the Emergency Pet Housing and/or Pet Return: We will coordinate arrangements mother or fetus. for temporary boarding or the return of a pet left unattended as a result of (7) Initial transportation to local facilities, including ground ambulance fees, except as arranged by Us. Your Injury or Illness. (8) Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planning, or bungee jumping, unless otherwise agreed in writing by Us PROGRAM DEFINITIONS prior to Your Enrollment Period. The following definitions apply: (9) Incidental expenses, including but not limited to accommodations, “Emergency Security Situation” means a civil and/or military uprising, local transportation, meals, telephone, and facsimile charges. insurrection, war, revolution, or other violent disturbance in a Host Country, which (10) Subsequent Medical Evacuations for the same or related medical in the opinion of either the recognized government of Your Home Country or Host condition, regardless of location, or more than one Security or Political Country immediate evacuation is advised. Emergency Security Situation does not Evacuation from a country or territory per individual per annual term. include natural disasters. (11) Failure to properly procure or maintain immigration, work, residence or “Enrollment Period” means the period of time for which You are validly enrolled similar type visas, permits or documents. for MEDEX SECURE and for whom We have received the appropriate enrollment (12) Security or Political Evacuations from Your Home Country. fee. (13) Security or Political Evacuations when the Emergency Security “Home Country” means the country or territory as shown on Your passport. Situation precedes Your arrival in the Host Country, or when the “Host Country” means a country or territory You are visiting or in which You are evacuation notice issued by the recognized government of Your Home living which is not Your Home Country. Country or Host Country has been posted for a period of more than “Illness” means a sudden and unexpected sickness that manifests itself during seven (7) days. Your Enrollment Period. (14) The actual or threatened use or release of any nuclear, chemical or “Injury” means an identifiable accidental injury caused by a sudden, unexpected, biological weapon or device, or exposure to nuclear reaction or unusual, specific event that occurs during Your Enrollment Period. radiation, regardless of contributory cause. “Regional Medical Advisors” means physicians, retained by MEDEX to provide Us (15) Services not otherwise shown as covered. with consultative and advisory services, including the review and analysis of the quality of medical care You are receiving. REIMBURSEMENT TO MEDEX AND RIGHTS OF SUBROGATION “We,” “Us,” “Our,” and “MEDEX” means MEDEX Assistance Corporation. You or a responsible party on Your behalf shall either pay the cost of medical care “You” and “Your” means a person validly enrolled for MEDEX SECURE and for and treatment, including hospital expenses directly or shall reimburse Us upon whom We have received the appropriate enrollment fee. demand for all such costs and expenses which may be imposed upon Us by health care providers for the cost of medical care and treatment, including hospital CONDITIONS AND LIMITATIONS expenses, or related assistance services either authorized by You or deemed to be The services described are available to You only during Your Enrollment Period advisable and necessary by Us under urgent medical circumstances, to the extent and only when You are 100 or more miles away from Your permanent residence that such expenses are not Our responsibility. Such reimbursement shall be in Your Home Country. without regard to the specific terms, conditions, or limitations of any insurance We will only cover transportation costs if We have given Our prior approval or if policies or benefits available to You. those services are coordinated by Us. We shall be fully and completely subrogated to Your rights against parties who We have sole discretion in making the determination as to whether We will cover may be liable for the payment of, or a contribution toward the payment of, the the cost of Emergency Medical Evacuations. Our decision will be based on costs and expenses of assistance services provided by Us or medical care and medical considerations, including the opinions of the treating physicians, Our treatment, including hospital expenses, in the event that We pay or contribute to Regional Medical Advisors and Our medical director with respect to Your condition the payment of them. You must assign to Us any and all rights of recovery under and ability to travel. We will determine the appropriate method, destination, and any such insurance plans, including any occupational benefit plan, health timing of any evacuation. The destination will be the nearest facility capable of insurance, or other insurance plan or public assistance program, up to the sum of providing appropriate care, as determined by Us. any payments by Us. We have sole discretion in making the coverage determination for Your For questions relating to medical claims, please contact: Transportation After Stabilization. Our determination will be based on Your need International Educational Exchange Services (IEES) for continuing medical care. We will not return You to Your Home Country for the P.O. Box 370 sole sake of Your convenience. Ithaca, New York 14851-0370 We have sole discretion regarding the means, method and timing of a security TOLL FREE 866-433-7462 (within USA) evacuation. Our security personnel will consult with interested governments, Phone: 607-272-2707 (collect from overseas) security analysts, and the sponsor of Your MEDEX program. Security Evacuations FAX: 607-272-2703 will be from an international airport or other safe departure point We designate, WEB: and You will be responsible for the cost and arrangements of transportation to EMAIL: that point. We will arrange and pay for Your transportation to the nearest safe MXS (Collegiate) 2100 Revision Date: 02/07 haven We designate, and You will be responsible for all transportation and living costs while at the safe haven. The decision to travel is the sole responsibility of the traveler.