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PATRIOTEXCHANGEInternational Student Health InsuranceCommittedto you!Underwritten by Sirius Specialty Insurance CorporationRated A- (excellent) by A.M. Best and A- by Standard & Poor'sAdministered by International Medical Group (IMG)1SM
ContentsSeeking Treatment3General Information4Claims Information5Policy Benefits6Policy Pricing11Policy Exclusions12NoticeFor further information on this Plan, visit iot-exchange/Please keep this summary as a brief description of the important features of the plan. It is not a contract of insurance. The terms and conditionsof coverage are set forth in the Plan issued to you. For a detailed plan description, exclusions, and limitations please view the certificate ofinsurance online (Worldwide including USA, Worldwide excluding USA). The certificate contains a complete description of all of the terms,conditions, and exclusions of the insurance plan as underwritten by Sirius Specialty Insurance Corporation. The Policy will prevail in the event ofany discrepancy between this Brochure and the Policy.Note: This insurance is not subject to, and does not provide benefits required by, PPACA. On January 1, 2014, PPACA requires United Statescitizens, United States nationals and resident-aliens to obtain PPACA compliant insurance coverage unless they are exempt from PPACA.Penalties may be imposed on persons who are required to maintain PPACA compliant coverage but do not do so.Eligibility to purchase or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law,including PPACA. Please note that it is solely your responsibility to determine if PPACA is applicable to you and the Company and IMG shallhave no liability whatsoever, including for any penalties that you may incur, for your failure to obtain required PPACA compliant coverage.Privacy StatementWe know that your privacy is important to you and we strive to protect the confidentiality of your non-public personal information. We do notdisclose any non-public personal information about our insureds or former insureds to anyone, except as permitted or required by law. Wemaintain appropriate physical, electronic and procedural safeguards to ensure the security of your non-public personal information. You mayobtain a detailed copy of our privacy policy by calling us (877) 758-4391 or by visiting us at https://www.internationalstudentinsurance.com2
SeekingTreatmentCampus Health CareDoctors/HospitalsSchool on-campus health services areavailable to most members. The campushealth center offers limited services for no orlow cost to students. For other services,students must pay up front and then submita claim for reimbursement by the insurance.Please contact your campus health centerfor further details.In the USA this plan includes a network ofmedical professionals, including physiciansand hospitals, known as the PreferredProvider Organization (PPO). This PPO isavailable through the UnitedHealthcareNetwork.Non-Emergency CareFor immediate care in non-emergencysituations, you SHOULD go to a Walk-inClinic, Urgent Care center or local doctor.Urgent Care and Walk-in Clinics are oftenthe best places to seek medical care asyou can walk right in and they require noappointment.If you need to see a doctor or visit ahospital, you should utilize a PPO provider.While you are allowed to visit any providerof your choosing, if you use a PPOphysician or facility, you may pay lessmoney out-of-pocket and claims will besubmitted to the claims team forprocessing.You SHOULD NOT go to the EmergencyRoom (ER) for this type of care unless it isa real emergency situation!Outside of the USA, you are allowed tovisit any provider of your choice.TelemedicineEmergency CareThe Emergency Room (ER) is designedfor medical emergencies. If you needemergency care for any reason, pleaseget to the nearest Emergency Room (ER)or call the emergency services (911 in theUSA) for immediate treatment.You are free to use any telemedicineprovider of your choice to seek medicalcare. Please pay the provider directly andkeep copies of all your receipts and submitthose to the claims team for processingand reimbursement as per the plan policyconditions and exclusions.Prescription DrugsA few popular telemedicine providers are:Prescriptions should be filled at any availablepharmacy and paid upfront directly to thepharmacy. Please keep copies of all yourreceipts and the prescription label andsubmit those to the claims team, along witha completed claim form for processing. Teladoc MeMD MDLive3
GeneralInformationEnrollmentEligibilityEnrollment and waivers can be done via our website at:If an Insured Person is not eligible, this Certificate isvoid ab initio and all Premium paid will be refunded. Inorder to be eligible and qualified for coverage under thisinsurance, a person must meet all of the rance.comToll Free (877) 758-4391Direct 1 (904) 758-43911. Be an active Participant, Spouse of the Participant, orChildren traveling with the Participant and residingoutside his/her primary Country of Residence for atemporary period of time, and if Destination Country isthe United States, Insured Person must hold one of thefollowing visa types: F1/F2, J1/J2, M1/M2 or A1/A22. Be at least thirty-one (31) days old but not yet sixty-five(65) years old3. Complete and sign an Application as the Insured Person(or be listed thereon by proxy as an applicant andproposed Insured Person), and/or as the InsuredPerson’s Spouse and/or Child4. On the Effective Date and on subsequent renewal dates,be physically and legally residing in the DestinationCountry with the intent to reside there for at least thirty(30) days5. Pay the required Premium on or before the Effective Dateof Coverage6. Receive written acceptance of his/her Application orrenewal from the Company7. Not be Pregnant, Hospitalized or Disabled on the InitialEffective Date8. Not be HIV on the Initial Effective DateStudent ZoneOnce you have purchased coverage, you can manageyour policy online. Through your Student Zone, you’llbe able to extend or renew your plan, track claims,locate a doctor/hospital and download copies of yourinsurance ID card and visa letter.Your student zone is available Cancellation/RefundsYou can cancel your policy and receive a full refund aslong as we receive written notification prior to yourcertificate effective date, or within 3 days after the planhas started. After the 3-day review period of your policystarting, there is a 50 cancellation fee and any wholeunused months will be refunded to you. No refunds arepossible if claims are filed against the policy.ID CardTerms of CoverageOnce you are enrolled in the plan, you will receive an email with all your policy documents and a copy of yourPDF Insurance ID card. Carry your ID card with you atall times! You will need your card when you visit thecampus health center, physician’s office, urgent care,hospital, or pharmacy.Plan Participant’s Effective DateCoverage becomes effective 12:01am U.S. EasternTime on the date requested on the application.Plan Participant’s Termination DateCoverage terminates as of 12:01 AM U.S. Eastern Timeas of the next day following the end of the coverageperiod for which Premium has been fully paid.Maximum Enrollment TermThe maximum total coverage period for any oneCovered Person cannot exceed 365 days per policyperiod. Coverage is renewable for up to forty-eight (48)months.4
ClaimsInformationIn-Network ClaimsOut-of-Network ClaimsWhen seeking medical care within the UnitedHealthcareNetwork in the USA, the medical provider will submityour claims electronically for processing. You will stillneed to follow these steps to get your claimsprocessed and paid:If you seek medical care from a provider that is outsidethe plans provider network or outside the USA, they willnot be able to submit your bills directly. You will needfollow these steps to get your claims processed andpaid:1. Download a claim form from the Student Zone.1. Download a claim form from the Student Zone.2. Complete the claim form with all the details aboutyour injury/illness. You will need to complete a newform for each new injury/illness. If your visit was dueto an accident, you’ll also need to complete theaccident questionnaire.2. Complete the claim form with all the details aboutyour injury/illness. You will need to complete a newform for each new injury/illness. If your visit was dueto an accident, you’ll also need to complete theaccident questionnaire.3. Submit your claim form to:3. Attach copies of your bills, receipts, lab chargesand prescriptions.International Medical Group, Inc.Claims, P.O. Box 9162,Farmington Hills, MI 48333-9162 [email protected]. Submit your claim form to:International Medical Group, Inc.Claims, P.O. Box 9162,Farmington Hills, MI 48333-9162 [email protected] of BenefitsOnce all your details are submitted, you will receive an Explanation of Benefits (EOB) thatshows what the insurance company paid, and what is your responsibility to pay. If there isany patient responsibility, you will need to pay this amount directly to the medical providerthat you sought medical care from.If you have any questions about the claims process, please contact our team forassistance and support:[email protected] Free (877) 758-4391Direct 1 (904) 758-43915
PolicyBenefitsCoverageCertificate Period ofCoverageMaximum Limit: 365 daysMaximum Limit 5,000,000Per Illness or Injury limit 50,000, 100,000, 250,000 or 500,000The per Illness or Injury limits accumulate towards the Maximum Limit.Area of CoverageWorldwide excluding Country of ResidenceDeductible for Eligible Medical ExpensesDeductible 0, 100, 250 or 500Per Injury or IllnessStudent Health CenterCopayment 5 per visitNot subject to the per Illness/InjuryDeductibleCoinsurance for Eligible Medical ExpensesCoinsuranceIn addition to DeductiblePlan pays 100%Insured pays 0%Pre-certification/Pre-existing ConditionsPre-certification Interfacility Ambulance Transfer: No coverage if Pre-certification requirementsare not met. Medical Evacuation: No coverage if not approved by the Company. Refer tothe EMERGENCY MEDICAL EVACUATION provision for completerequirements and coverage. All other Treatments & supplies: fifty percent (50%) reduction of EligibleMedical Expenses if Pre-certification requirements are not met. MaximumPenalty: 1,000 Deductible is taken after reduction. Coinsurance is applied to remainder of the reduced amount. Refer to PRE-CERTIFICATION REQUIREMENTS provision in the certificate ofinsurance for a complete list of services that require Pre-certification.Pre-existing ConditionsCharges resulting directly or indirectly from or relating to any Pre-existingCondition that existed within thirty-six (36) months prior to the Effective Dateare excluded until the Insured Person has maintained twelve (12) months ofcontinuous coverage under this insurance. Period of Coverage Limit (after 12 months): 500 Maximum Limit: 1,5006
Inpatient or Outpatient ServicesSubject to Deductible unless otherwise notedEligible Medical Expenses are limited to Usual, Reasonable and CustomaryLimits per Period of Coverage unless stated as Maximum LimitEligible Medical Expenses100%Physician/Specialist Visit100%Maximum Visits per day: 1Unless visit is for a different medical/surgical specialtyUrgent Care100%Not subject to DeductibleCopayment: 50Copayment is not applicable if theDeclaration states 0 DeductibleWalk-in Clinic100%Not subject to DeductibleCopayment: 20Copayment is not applicable if theDeclaration states 0 DeductibleHospital Emergency RoomInjury: Not subject to Emergency RoomDeductibleIllness: Subject to a 250 Deductible foreach Emergency Room visit forTreatment that does not result in a directHospital admissionHospitalization/Room &Board100%100%Average semi-private room rateIncludes nursing, miscellaneous andAncillary ServicesIntensive Care100%Bedside Visit100%Not subject to DeductibleMaximum Limit: 1,500Hospitalized in an Intensive Care UnitRefer to the BEDSIDE VISIT provisionfor further detailsOutpatient gy/X-Ray100%Pre-admission Testing100%Surgery100%7
Reconstructive Surgery100%Surgery is incidental to or followsSurgery that was covered under theplanAssistant Surgeon100%20% of the primary surgeon’s eligiblefeeAnesthesia100%Durable Medical Equipment100%Chiropractic Care100%Medical order or Treatment planrequiredPhysical Therapy100%Maximum Visits per day: 1Medical order or Treatment planrequiredExtended Care Facility100%Upon direct transfer from acute careHospitalHome Nursing Care100%Provided by a Home Health CareAgencyUpon direct transfer from acute careHospitalPrescription Drugs and MedicationSubject to Deductible unless otherwise notedEligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period ofCoveragePrescription Drugs andMedicationObtained through Retail Pharmacy,Inpatient and Outpatient Surgery,Emergency Room and OutpatientOffice VisitsDispensing maximum for RetailPharmacy: 90 days per prescriptionThe following Prescription Drugs and Medication Period of Coverage limitaccumulates toward the Maximum LimitPeriod of Coverage limit: 250,000 per personMental or Nervous / Substance AbuseSubject to Deductible unless otherwise notedEligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period ofCoverage unless stated as Maximum LimitInpatient Mental or Nervous /Substance Abuse100%Maximum Limit: 10,000Not covered if incurred at the StudentHealth Center8
Outpatient Mental andNervous / Substance Abuse100%Maximum Limit per day: 50Maximum Limit: 500Not covered if incurred at the StudentHealth CenterEmergency ServicesNOT Subject to Deductible unless otherwise notedEligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period ofCoverage unless stated as Maximum LimitEmergency LocalAmbulance100%Subject to DeductibleInjuryIllness resulting in a HospitalizationadmissionEmergency MedicalEvacuation100%Maximum Limit: 50,000Must be approved in advance andcoordinated by the CompanyEmergency Reunion100%Maximum Limit: 15,000Maximum Days: 15Meal Maximum per day: 25Reasonable and necessary travel costsand accommodationsMust be approved in advance by theCompanyInterfacility AmbulanceTransfer100%Up to the per Injury or Illness limitServices rendered in the United StatesTransfer must be a result of anInpatient Hospital admissionPolitical Evacuation andRepatriation100%Maximum Limit: 10,000Must be approved in advance by theCompanyReturn of Mortal Remains100%Maximum Limit: 25,000Local Burial / Cremation at place ofdeath Maximum Limit: 5,000Return of Insured Person’s MortalRemains to Country of ResidenceMust be approved in advance by theCompanyOther ServicesNOT subject to Deductible unless otherwise notedEligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period ofCoverage unless stated as Maximum Limit9
Accidental Death &DismembermentPrincipal Sum Maximum: 25,000Death must occur within 90 days ofthe AccidentDental TreatmentAccidental Death: 100% of Principal SumAccidental Dismemberment:Sight of 1 eye - 50% Principal Sum1 hand or 1 foot - 50% Principal Sum1 hand and loss of sight of 1 eye - 100% Principal Sum1 foot and loss of sight of 1 eye - 100% Principal Sum1 hand and 1 foot - 100% Principal SumBoth hands or both feet - 100% Principal SumSight of both eyes - 100% Principal Sum100%Period of Coverage Limit: 350(Treatment due to Unexpected pain tosound, natural teeth)Period of Coverage Limit per Injury: 500(Non-emergency Treatment at a DentalProvider due to an Accident)Traumatic Dental Injury100%Subject to Deductible andCoinsuranceUp to the Maximum LimitTreatment at a Hospital Facility due toan AccidentAdditional Treatment for the sameInjury rendered by a Dental Providerwill be paid at 100%Incidental Trip100%Maximum days: 14Country of Residence is outside theUnited StatesRefer to the INCIDENTAL TRIPprovision for further detailsTerrorism100%Maximum Limit: 50,000All coverage and benefits in the plan are in United States (U.S.) dollars. Benefits are subject to the exclusions and limitations and are payable onlyat Usual, Reasonable and Customary charges. This is a summary of a selection of plan benefits offered only as an illustration and does notsupersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract isthe only source of the actual benefits provided. This table is a summary of the plan benefits, for full details and policy wording please consult and download a copyof the description of coverage- Worldwide coverage including the USA- Worldwide coverage excluding the USA You will be responsible for all out of pocket expenses in excess of the insurance policy benefits based on thelimitations contained in the Schedule of Medical Expense Benefits.10
PolicyPricingWorldwide, including the USAMonthly rates 50,000 100,000 250,000 500,00031 days - 24 years old 54 63 67 7225 - 49 years old 72 82 89 9350 - 64 years old 152 176 189 199 50,000 100,000 250,000 500,00031 days - 24 years old 38 45 48 5025 - 49 years old 45 52 56 5950 - 64 years old 116 125 144 152Worldwide, excluding the USAMonthly ratesOptional Add-On Rider Adventure sports - up to 50,000 maximum limit Please visit our website to run a quote and for more information.For daily rates, and to run a free quote, please visit our com/patriot-exchange/apply/11
PolicyExclusionsExcept as expressly provided for in the BENEFIT SUMMARY,all Charges, costs, expenses and/or claims incurred by theInsured Person, and any claim for death or dismembermentbenefits, and directly or indirectly relating to or arising orresulting from or in connection with any of the following acts,omissions, events, conditions, Charges, consequences,claims, Treatment (including diagnoses, consultations, tests,examinations and evaluations related thereto), services and/orsupplies are expressly excluded from coverage under thisinsurance, and the Company shall provide no benefits orreimbursements and shall have no liability or obligation for anycoverage thereof or therefor:1. ECONOMIC SANCTIONS: The Company will not coverany person as an Insured Person if such cover wouldresult in the Company being exposed to any sanction,prohibition or restriction under United Nations resolutionsor the trade or economic sanctions, laws, or regulationsof the European Union, United Kingdom or the UnitedStates of America.2. WAR; MILITARY ACTION: The Company shall not beliable for and will not provide coverage or benefits for anyclaim or Charges incurred with respect to any Illness,Injury, death and dismemberment, or other consequence,whether directly or indirectly, proximately or remotelyoccasioned by, contributed to by, or traceable to orarising or incurred in connection with or as a result of anyof the following acts or occurrences:a) war, invasion, act of foreign enemy hostilities, warlikeoperations (whether war be declared or not), or civilwarb) mutiny, riot, strike, military or popular uprising,insurrection, rebellion, revolution, military or usurpedpowerc) any act of any person acting on behalf of or inconnection with any organization with activitiesdirected towards the overthrow by force of theGovernment de jure or de facto or to the influencingof it by violence of any typed) martial law or state of siege or any events or causeswhich determine the proclamation or maintenance ofmartial law or state of siegee) any use of radiological, chemical, nuclear orbiological weapons or any other radiological,chemical, nuclear or biological events of any type(including in connection with an act of Terrorism).connection with, any of the said occurrences shall bedeemed and considered to be consequences forwhich the Company shall not be liable under theMaster Policy or this Certificate, except to the extentthat the Insured Person shall prove that such claim,Charges, Illness, Injury or other consequencehappened independently of the existence of suchabnormal conditions and/or occurrences.3. TERRORISM: The Company shall not be liable for and willnot provide coverage or benefits in excess of the amountshown in the BENEFIT SUMMARY for any claim orCharges, Illness, Injury or other consequence, whetherdirectly or indirectly, proximately or remotely occasionedby, contributed to by, or traceable to or arising inconnection with any act of Terrorism. Further, theCompany shall not be liable for and will not provide anycoverage or benefits for any claim, Charges, Illness, Injuryor other consequence, whether directly or indirectly,proximately or remotely occasioned by, contributed to by,or traceable to or arising in connection with the following:a) the Insured Person’s active and voluntary planning orcoordination of or participation in any act of Terrorismb) any act of Terrorism that takes place in a location,post, area, territory or country for which a TravelWarning or Emergency Travel Advisory was issued orin effect on or within six (6) months prior to theInsured Person’s date of arrival in said location, post,area, territory or countryc) any act of Terrorism that takes place in a location,post, area, territory or country for which a TravelWarning or Emergency Travel Advisory becomeseffective or is in effect on or after the InsuredPerson’s date of arrival in said location, post, area,territory or country, and the Insured Personunreasonably fails or refuses to heed such warningand thereafter remains in said location, post, area,territory or country.4. PRE-EXISTING CONDITIONS: Charges resulting directlyor indirectly from or relating to any Pre-existing Condition,(whether physical or mental, regardless of the cause ofthe condition) are excluded from coverage under thisinsurance until the Insured Person has maintainedcoverage under this insurance plan continuously for atleast twelve (12) months5. MATERNITY AND NEWBORN CARE: All Charges for prenatal care, delivery, post-natal care, and care ofNewborns, including complications of Pregnancy,miscarriage, complications of delivery and/or ofNewborns, the Pregnancy is a result of in vitro fertilization(IVF), artificial insemination or conception was the directresult of infertility Treatment received by the InsuredAny claim, Charges, Illness, Injury or otherconsequence happening or arising during theexistence of abnormal conditions (whether physicalor otherwise), whether or not directly or indirectly,proximately or remotely occasioned by, orcontributed to by, traceable to, or arising in12
Person, the Spouse of the Insured Person or the father ofthe Newborn are excluded from this insurance.6. PREVENTATIVE CARE: Charges for Routine PhysicalExaminations and immunizations are excluded fromcoverage under this insurance7. Charges for any Treatment or supplies that are:a) not incurred, obtained or received by an InsuredPerson during the Period of Coverageb) not presented to the Company for payment by wayof a completed Proof of Claim within one hundredeighty (180) days from the date such Charges areincurredc) not administered or ordered by a Physiciand) not Medically Necessary for the diagnosis, care orTreatment of the physical or mental conditioninvolved. This also applies when and if they areprescribed, recommended or approved by theattending Physiciane) provided at no cost to the Insured Person or forwhich the Insured Person is not otherwise liablef) in excess of Usual, Reasonable, and Customaryg) related to Hospice careh) incurred by an Insured Person who was HIV on orbefore the Initial Effective Date of this insurance,whether or not the Insured Person had knowledge ofhis/her HIV status prior to the Effective Date, andwhether or not the Charges are incurred in relation toor as a result of said status. This exclusion includesCharges for any Treatment or supplies relating to orarising or resulting directly or indirectly from HIV, AIDSvirus, AIDS related Illness, ARC Syndrome, AIDSand/or any other Illness arising or resulting from anycomplications or consequences of any of theforegoing conditionsi) provided by or at the direction or recommendation ofa chiropractor, unless ordered in advance by aPhysicianj) performed or provided by a Relative of the InsuredPersonk) not expressly included in the ELIGIBLE MEDICALEXPENSES provisionl) provided by a person who resides or has residedwith the Insured Person or in the Insured Person'shomem) required or recommended as a result ofcomplications or consequences arising from orrelated to any Treatment, Illness, Injury, or supplyreceived prior to coverage under this insurance orthat is excluded from coverage or which is otherwisenot covered under this insurancen) for Congenital Disorders and conditions arising out ofor resulting therefrom8. Charges incurred for failure to keep a scheduledappointment9. Telehealth or Telemedicine services not consideredMedically Necessary as determined by the Companyunder the plan10. Charges incurred for Surgeries, Treatment or supplieswhich are Investigational, Experimental, and for researchpurposes11. Charges incurred related to genetic medicine, genetictesting, surveillance testing and/or wellness screeningprocedures for genetically predisposed conditionsindicated by genetic medicine or genetic testing,including, but not limited to amniocentesis, geneticscreening, risk assessment, preventive and prophylacticsurgeries recommended by genetic testing, and/or anyprocedures used to determine genetic pre-disposition,provide genetic counseling, or administration of genetherapy12. Charges incurred for testing that attempts to measureaspects of an Insured Person’s mental ability, intelligence,aptitude, personality and stress management. Suchtesting may include but is not limited to psychometric,behavioral and educational testing13. Charges incurred for Custodial Care14. Charges incurred for Educational or Rehabilitative Carethat specifically relates to training or retraining an InsuredPerson to function in a normal or near-normal manner.Such care may include but is not limited to job orvocational training, counseling, occupational therapy andspeech therapy15. Charges for weight modification or any Inpatient,Outpatient, Surgical or other Treatment of obesity(including without limitation morbid obesity), includingwithout limitation wiring of the teeth and all forms orprocedures of bariatric Surgery by whatever name called,or reversal thereof, including without limitation intestinalbypass, gastric bypass, gastric banding, vertical bandedgastroplasty, biliopancreatic diversion, duodenal switch,or stomach reduction or stapling16. Charges for modification of the physical body in order tochange or improve or attempt to change or improve thephysical appearance or psychological, mental oremotional well-being of the Insured Person (such as butnot limited to sex-change Surgery or Surgery relating tosexual performance or enhancement thereof)17. Charges or Treatment for cosmetic or aesthetic reasons,except for reconstructive Surgery when such Surgery isMedically Necessary and is directly related to and/orfollows a Surgery which was covered under this insurance18. Elective Surgery or Treatment of any kind19. Charges incurred for any Treatment or supply that eitherpromotes or prevents or attempts to promote or preventconception, insemination (natural or otherwise) or birth,including but not limited to: artificial insemination; oralcontraceptives; Treatment for infertility or impotency;vasectomy, or reversal of vasectomy; sterilization; reversalof sterilization; surrogacy or abortion20. Charges incurred for any Treatment or supply that eitherpromotes, enhances or corrects or attempts to promote,enhance or correct impotency or sexual dysfunction21. Any Illness or Injury sustained while taking part in,practicing or training for: Amateur Athletics; ProfessionalAthletics; or athletic activities that are sponsored by anyGoverning Body or Authority including but not limited tothe National Collegiate Athletic Association, any othercollegiate sanctioning or Governing Body or theInternational Olympic Committee13
22. Any Illness or Injury sustained while taking part in activitiesdesignated as Adventure Sports, which are limited to thefollowing: abseiling; BMX; bobsledding; bungee jumping;canyoning; caving; hot air ballooning; jungle zip lining;parachuting; paragliding; parascending; rappelling;skydiving; spelunking; wildlife safaris; and windsurfing23. Any Illness or Injury sustained while taking part in activitiesdesignated as Extreme Sports, which include but are inno way limited to the following (and include anycombination or derivative of the following): BASE jumping;cave diving; cliff diving; downhill mountain biking andracing; extreme skiing; freediving; free flying; free running;free skiing; freestyle scootering; gliding; heli-skiing; icecanoeing; ice climbing; kitesurfing; mixed martial arts;motocross; motorcycle racing; motor rally;mountaineering above elevation of 4500 meters fromground level; parkour; piloting a commercial or noncommercial aircraft; powerbocking; scuba diving or subaqua pursuits below a depth of 50 meters; snowmobileracing; truck racing; whitewater kayaking or whitewaterrafting Class VI and higher difficulty; and wingsuit flying24. Any Illness or Injury sustained while taking part in snowskiing, snowboarding or snowmobiling where the InsuredPerson is in violation of applicable laws, rules orregulations of a ski resort, out of bounds or in unmarkedor unpatrolled areas25. Any Illness or Injury sustained while taking part inbackcountry skiing26. Any Illness or Injury sustained while taking part in skiingoff-piste27. Any Illness or In
insurance online (Worldwide including USA, Worldwide excluding USA). The certificate contains a complete description of all of the terms, conditions, and exclusions of the insurance plan as underwritten by Sirius Specialty Insurance Corporation. The Policy will prevail in the event of any discrepancy between this Brochure and the Policy.
