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Pan-American PreferredAccess

Membership Guide/ Terms and Conditions

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Welcome to Pan-American Private Client 1

About Pan-American Life Insurance Group 1

Introduction 2

Your Welcome Documents 2-3

About Your Health Plan 3

How To Contact Us 3

How To Serve You Best 4

Your Pan-American Preferred Access Policy Explained 5 Agreement 5

Policy Terms And Limits 5

Insured’s Rights 5

Company’s Rights 5

Eligibility 5

Waiting Periods 6

Waiting Periods For Changes 7

Preferred Providers 8

Table Of Benefits 8-9

Provisions 15-19

1. Ambulance - air and ground 10

2. Anesthesiologist fees 10

3. Cancer treatment 10

4. Companion of a hospitalized minor 10

5. Congenital and hereditary conditions 10

6. Dialysis 10

7. Durable medical equipment 10-11

8. Emergency dental treatment 11

TABLE OF CONTENTS

9. Emergency medical treatment 11

10. Emergency room visits 11

11. High risk hobbies and amateur sports 11

12. Home health care 11

13. Hospice care 11

14. Intensive care unit 11

15. Laboratory tests, pathology and diagnostic imaging 11

16. Maternity care 11-12

17. Medications 12

18. Newborn care 12-13

19. Nose and nasal septum deformity 13

20. Organ transplants 13

21. Physical therapy and rehabilitation 13

22. Preexisting conditions 13-14

23. Prosthesis and corrective devices 14

24. Repatriation of human remains 14

25. Room and board 14

26. Second surgical opinion 14

27. Special treatments 14

28. Surgeon and assisting physician fees 14 29. Visits to physicians and medical specialists 14

Exclusions And Limitations 15-17

Definitions 17-21

General Policy Information 21-25

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WELCOME TO PAN-AMERICAN PRIVATE CLIENT

Global access to life and health insurance

Thank you for selecting Pan-American Private Client coverage from Pan-American Accident and Health Insurance Company, N.V. This guide describes in detail the use of your Policy and how to access our services. Please take a few minutes to read this and your Certificate of Coverage.

It is important to us that you are fully satisfied with the selection of coverage you have made. If you have any questions about your plan, please contact your broker, agent or call us today. You can find our contact information in the “How to Contact us” section of this guide. Pan-American Private Client is a member of Pan-American Life Insurance Group (PALIG).

ABOUT PAN-AMERICAN LIFE INSURANCE GROUP

A century of promises kept

Pan-American Life Insurance Group’s family of companies has delivered trusted financial security to thousands of individuals, families and businesses for over a century. Our Group’s unparalleled experience and multicultural understanding are the foundation of our success in reaching new heights in serving and uniting the Americas. Based in New Orleans, Pan-American Life Insurance Company, the Group’s flagship Company, offers life, accident and health products throughout the United States, Puerto Rico, Latin America and the Caribbean. The Company’s financial strength and claims-paying ability have been rated “A” (Excellent) by A.M. Best, and “A” (Strong)

by Fitch Ratings. The Group’s member companies in Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama and 15 Caribbean markets have achieved success in brand recognition, overall operations in Latin America year after year and have differentiated themselves with stability and innovation, solidly guided by financial strength.

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INTRODUCTION

Details of your health insurance Policy

Your Policy is an annual contract between Pan-American Accident and Health Insurance Company N.V. and the main insured named in the Certificate of Coverage. The Policy is comprised of:

• This guide, the Certificate of Coverage and any Policy endorsements

• Information provided to us in the signed Application Form (hard copy or electronic format), including medical questionnaires and other supporting medical information, by, or on behalf of, the Insured persons

The product you have chosen will be indicated in this guide, and the Deductible selected will appear on your Certificate of Coverage and your membership card. Any further endorsements or special conditions unique to your coverage will be indicated on your Certificate of Coverage.

YOUR WELCOME DOCUMENTS

As an insured of Pan-American Private Client you will receive welcome documents (hardcopy or electronic if you choose) which contains:

Your personalized membership card After your Policy is issued

you will receive two cards per Family Group or one card if you are the only person insured by your Policy. This card contains the names of all the members Insured under each Family Group, your Policy number, your annual Deductible and our contact information. Please carry this card with you at all times. In the event that you need to correct a name, order additional cards or to print a temporary card, please visit palig.com/privateclient. Replacement cards are free of charge

Your membership guide In this guide you will find a wealth of

information on how to use your health insurance Policy, including its benefits and limitations, how to submit a claim and how to make a premium payment. We have created this guide to help you understand how your Policy works and what you can expect from us

Your certificate of coverage This document states the product

you have chosen and the Deductible you have selected for you and your Dependents (if applicable). It also indicates the Effective Date of your coverage, the Deductible and any special endorsements or limitation to your Policy. If any corrections need to be made, please let us know as soon possible

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A claim form In the event you need to file a claim for

reimbursement, you will need to use this form. If you need assistance completing it, please contact your broker, agent or

call us. For your convenience the claim form is available online at palig.com/privateclient

ABOUT YOUR HEALTH PLAN

Pan-American PreferredAccess gives you access to high rated Hospitals all around the world. Pan-American PreferredAccess was designed to help you save premium by passing on the savings the Company obtains through its network of Preferred Providers in the U.S.A.

When seeking medical treatment for an elective procedure within the U.S.A. you must select a provider that is part of our preferred provider network, you can choose from a list of hundreds of top rated U.S.A.

Hospitals. As a Pan-American PreferredAccess Insured you will have the choice of any Hospital in the rest of the world, including those in your home country. There are significant advantages when treated by one of our Preferred Providers; such as these benefits include reducing the out of pocket expenses for eligible hospital charges, after you meet your Deductible and guaranteed direct payment to the hospital. For a list of our Preferred Providers, please ask your broker, agent or visit palig.com/privateclient.

HOW TO CONTACT US

We want to assure you that we will always be available to assist you. We have a team of dedicated professionals that are always willing to help. Excellent service is our number one goal.

For questions related to the administration of your Policy or to find out the status of a Claim, please visit palig.com/privateclient or contact our Customer Experience Team at:

Telephone: +5999-4613.232- Monday through Friday from 9:00 a.m. to 5:00 p.m. Email: serviceimm@palig.com

For coordination of benefits and notifications please contact our Private Client Medical Team at:

Telephone: +1 (305) 961-1606 - 24 hours a day, 7 days a week, including holidays Email: notificationsimm@palig.com

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HOW WE SERVE YOU BEST

Pan-American Private Client Medical Service Team

We have our own exclusive in-house team of medical professionals dedicated to you. Our multilingual medical team has the knowledge and expertise to provide you with the help you need, 24 hours a day, 365 days a year.

From coordinating an air ambulance and arranging a hospital stay to obtaining a second medical opinion or simply scheduling a doctor’s appointment, we are here to guide you through the process. Our medical professionals will monitor your progress from day one, by maintaining constant communication with your physician and your family to help you make the right choices.

You can contact our Pan-American Private Client Medical Team at:

Telephone: +5999-461-3232

24 hours a day, 7 days a week: +1-305-961-1606 Fax: +5999-461-3240

Email: notificationsimm@palig.com

For your convenience, these numbers are also listed on the back of your membership card.

Notification

To assure we meet your service expectations, it is necessary that you notify us when receiving a medical treatment. This will give us the opportunity to verify that your treatment is covered by your Policy, arrange the direct payment with your selected hospital or doctor, whenever possible, thus reducing the chances of unexpected out-of-pocket expenses, so that there are no surprises later on. Notification for guaranteed direct payments and for coordination of

benefits is required for all hospital admissions, ambulatory surgeries and other benefits. Benefits that require notification will be marked in this membership guide with a symbol.

Private Client is not a healthcare service provider, and as such our services are not intended to be used for medical diagnosis or treatment. The information provided by our personnel should not be relied upon for that purpose.

Preferred Providers Search

Through palig.com/privateclient you can access our exclusive Preferred Providers’ directory, listing the hospitals currently contracted by our Company. This directory allows you to search for hospitals and clinics by city and state.

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YOUR PAN-AMERICAN PREFERRED

ACCESS

POLICY EXPLAINED

This section provides complete details on the product you have selected. Please read all the benefits, coverages, exclusions and definitions. If you have any questions regarding your Policy, please contact your Agent or call our Customer Experience Department.

AGREEMENT

Pan-American Accident and Health Insurance Company N.V. (hereinafter referred to as the “Company”) agrees to pay the Main Insured under the Policy (hereinafter referred to as the “Main Insured”) the benefits provided by this Policy. All benefits are subject to the terms and limits of this Policy. All capitalized terms used in this Agreement shall have the meaning assigned to such terms in the “Definitions” portion of this document.

Policy terms and limits: The information contained in this Policy and

the information disclosed in the Application are part of the Policy.

Insured’s rights: The Main Insured can cancel this Policy and return

it to the Company within a period of 21 calendar days after receiving it. If during such period no Claims have been made under the Policy the Company will reimburse the premium paid to the Insured, minus the $75.00 administrative fee (where applicable), and the Policy will be considered null as if it had never been issued.

Company’s rights: This Policy is issued based on the information

disclosed by the Applicant on the Application and any medical information provided to the Company. If this information is incorrect or incomplete, the Policy shall be rescinded, canceled or modified at the discretion of the Company.

Eligibility

Adults: When applying for coverage, the Applicant, spouse, parents,

and parents-in-law, must be at least 18 years old and no more than 75 years old.

Dependents: Main Applicant and spouse’s Dependents are eligible

to apply for coverage as Dependents under the Main Insured’s Policy. There is no maximum age for the renewal of any Insured, and there is no maximum age for Dependents children to renew under the Main Insured’s Policy paying the applicable premium rates. Upon

reaching age 18, Dependents are eligible for coverage under their own Policy paying the applicable premium rates, with an equal or higher Deductible, with the same conditions and restrictions of their previous Policy, and without further underwriting evaluation. If the Dependent wishes to change to a lower Deductible or to increase benefits then an underwriting evaluation will be required. The Application for the new Policy must be received by the Company before the end of the Grace Period of the Policy under which the Applicant was insured as a Dependent. This Policy can only provide coverage for Insureds that are residents of Curaçao and Sint Maarten.

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Waiting periods

60-day waiting period: During the first 60 days from the Effective

Date of this Policy, only Accidents and Illnesses of Infectious Origin will be covered. If the waiting period is not waived, any diagnosed condition during the 60-day waiting period will be permanently excluded, except for Accidents and Illnesses of Infectious Origin.

Waiving the 60-day waiting period: The Company will waive the

60-day waiting period if:

• The Insured has been covered by a health insurance policy (individual or group) for an uninterrupted period of at least 12 months before the Effective Date of this Policy

• The Effective Date of the approved coverage is within 30 days from the expiration of the former policy

• A copy of the insurance certificate of coverage of the previous policy and proof of the corresponding premium payments for the previous 12 months is submitted to the Company before approval of this Policy

When the Company waives the 60-day waiting period, coverage starts on the Effective Date of the Policy.

Waiting period for HIV/AIDS: During the first 12 months from

the Effective Date of this Policy there is no coverage for HIV/AIDS. This waiting period is never waived.

Waiting period for maternity coverage: There is a 10 month waiting

period for maternity and newborn benefits. This waiting period begins on the effective date of the mother’s coverage. This waiting period will not be waived.

Waiting Period for Plan Changes

The Main Insured may request a change of Plan or Product on the Anniversary Date of the Policy. The request for the change of Plan or Product must be received in writing prior to the Anniversary Date of the Policy. Changes in plan or product are subject to approval by the Underwriting Department. During the first (60) calendar days after the change in Plan or Product the benefits payable for any illness or injury not caused by an accident or infectious disease will be limited to the lesser of the benefit amount provided between both Plans or Products.

During the first (10) months after the effective date of the change, the coverage for: maternity care, maternity complications, complications

of the ill newborn and congenital conditions will be limited to the lesser of the benefit amount provided between both Plans or Products.

During the first (12) months after the effective date of the change, the benefit for HIV/AIDS and its complications will be limited to the lesser of the benefit amount provided between both Plans or Products. During the first (6) months after the effective date of the change, the benefit for Organ Transplant will be limited to the lesser of the benefit amount provided between both Plans or Products.

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Notification to the company: A notification for elective medical

treatment must be made at least 72 hours before receiving treatment. Emergency medical treatment must be notified within the first 72 hours of receiving treatment. If the required notification is not made, the Company will reduce or deny payment of the Claim. Notifications can be made at any time via:

Telephone: +5999-4613.232

24 hours, 7 days a week: +1-305-961-1606 Fax: +5999-4613.240

Email: notificationsimm@palig.com

Our Private Client Medical Service Team is available 24 hours a day, 365 days a year.

Deductible: The deductible will be applied as follows:

• There will be (1) Deductible applied per Insured, per Policy Year according to the approved plan. Once (2) Deductibles per Family Group have been met, no further Deductibles will apply to that Family Group on that particular Policy Year

• Covered medical expenses incurred by the Insured in the last (3) months of the Policy Year, will be applied towards the Deductible in that Policy Year and will be carried over and applied towards the Insured’s Deductible for the following Policy Year as well

• No Deductible will be applied towards the first Hospitalization of an Insured due to a Serious Accident

• There are some benefits in this Policy that are exempt of Deductible. Benefits that are exempt of Deductible will be marked in this membership guide with a symbol

Deductible reduction: Each Insured that remains free of Claims for

3 consecutive Policy Years, is entitled to a 50% Deductible reduction on the Policy Year when the Insured incurs a Claim. The Policy Year subsequent to the Deductible Reduction will be subject to the total Deductible. The Deductible reduction benefit will be available to the Insured after being free of Claims for every period of 3 consecutive Policy Years.

Non-covered Claims and Routine Medical Health Checkups Claims will not be taken into account for this Claims free rule. This benefit does not apply if the Deductible approved is $10,000 or higher.

Preferred providers: Preferred Access provides coverage in any

Hospital in the world. However, when the Insured seeks elective treatment in the USA, the Insured is limited to the Company’s Preferred Providers. This rule does not apply for Emergency treatment, which means that if an Insured receives Emergency treatment in the USA the Insured can access any hospital. For a list of Preferred Providers, please ask your agent or visit

palig.com/privateclient.

Table of benefits: Unless otherwise stated herein and throughout

this Policy, all benefits are subject to all terms and limits of the Policy and will be paid to each Insured, each Policy Year. All benefits are subject to the corresponding Deductible, unless stated otherwise, and are paid based on Usual, Customary and Reasonable charges (UCR).

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PAN-AMERICAN PREFERRED

ACCESS

TABLE OF BENEFITS

Maximum annual coverage $2,000,000

Area of coverage Worldwide including the USA

HOSPITALIZATION

Room and board 100%

Intensive care unit 100%

Companion of a hospitalized minor, per night 100%

Surgeon and assisting physician fees 100%

Anesthesiologist fees 100%

Medications 100%

Laboratory tests, pathology and diagnostic imaging 100%

Cancer treatment 100%

Dialysis 100%

Prosthesis and corrective devices 100%

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OTHER BENEFITS

Maternity (normal) and healthy newborn care (Plans I & II only)

Dependent daughters that are insured under the Main Insured’s policy and are 18 years or older can choose to have a standalone policy so that they may have maternity benefits.

$4,000

Complication of pregnancy and ill newborn care, per lifetime $500,000

Ambulance - air and ground $50,000

Congenital or hereditary conditions before age 18, per lifetime $300,000

Congenital or hereditary conditions on or after age of 18, per lifetime $1,000,000

High risk hobbies and amateur sports, per lifetime $250,000

Emergency dental treatment 100%

Hospice care 100%

Repatriation of human remains $6,000

OUTPATIENT TREATMENT

Visits to physicians and medical specialists 100%

Emergency room visits 100%

Cancer treatment 100%

Laboratory tests, pathology and diagnostic imaging 100%

Dialysis 100%

Medications $6,000

Physical therapy and rehabilitation $6,000

Home health care $6,000

Durable medical equipment $6,000

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PROVISIONS

1. Ambulance - air and ground: Up to a maximum of $50,000 will be paid for all Emergency transportations by Air or Ground Ambulance, when:

• The Insured’s diagnosis is related to a condition covered by this Policy

• The medical treatment required by the Insured cannot be provided locally

• Transportation by any other method can risk the life or physical integrity of the Insured

• Transportation is provided by an entity licensed for such purpose

• The Insured is transported to the nearest medical facility where adequate treatment for the medical diagnosis can be provided

All Air Ambulance transportations must be coordinated and approved in advance by the Company. In the event the Insured was originally transported outside the Insured’s Country of Residence via an Air Ambulance paid by the Company, the Company at its own discretion and only when Medically Necessary, may approve an Air Ambulance to to his or her Country of Residence.

The Company is not liable for complications resulting from negligence in the services received from the transportation providers or their affiliates including any delays or flight restrictions. No Deductible applies for this benefit.

2. Anesthesiologist fees: Shall be covered according to the Usual, Customary and Reasonable Anesthesiologist Fees charged within a certain area or country. This coverage must be approved in advance by the Company.

3. Cancer treatment: The Insured will be covered for diagnostic testing, specialist fees, radiotherapy, chemotherapy and Hospital charges incurred with the cancer treatment. This coverage must be coordinated and approved in advance by the Company.

4. Companion of a hospitalized minor: Up to $100 per night will be paid for charges included in the Hospital bill, for the overnight stay in the same room for a companion of an Insured child (under the age of 18) that is hospitalized. This coverage must be coordinated and approved in advance by the Company.

5. Congenital and hereditary conditions: Up to a maximum of $300,000 per lifetime, will be paid for Congenital or Hereditary Conditions manifested for the first time before the Insured’s 18th birthday. Congenital or Hereditary Conditions manifested for the first time on or after the Insured’s 18th birthday will be covered up to a maximum of $1,000,000 per lifetime. This benefit must be coordinated and approved in advance by the Company.

6. Dialysis: Inpatient and outpatient hemodialysis, peritoneal dialysis or any other type of dialysis will be covered up to the Policy limits. This coverage must be coordinated and approved in advance by the Company.

7. Durable medical equipment: When medically prescribed durable medical equipment will be covered up to a maximum of $6,000. This including but are not limited to; wheel chairs, canes,

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crutches, respirators, pressure mattress and walkers. This coverage must be coordinated and approved in advance by the Company.

8. Emergency dental treatment: This Policy shall cover all expenses related to Emergency Dental Treatment for injuries resulting from a covered Accident. Treatment must begin within a period of 120 days from the date of the covered Accident.

9. Emergency medical treatment: All expenses for Emergency medical or surgical procedures will be covered up to the Policy limits, if compensable.

10. Emergency room visits: When it is Medically Necessary due to the severity of an illness or injury, visits to the Emergency room will be covered up to the Policy limits.

11. High risk hobbies and amateur sports: Up to a maximum of $250,000 per Insured, per lifetime, will be paid for all expenses resulting from Accidents related to High Risk Hobbies and the practice of Amateur Sports.

12. Home health care: An initial period of up to 30 days will be covered during a Policy Year, up to a maximum of $6,000. A treatment plan must be provided to the Company. An extension could be approved if deem Medically Necessary by the Insured’s Physician. This benefit must be coordinated and approved in advance by the Company.

13. Hospice care: When Medically Necessary all expenses will be covered up to the Policy limits for Hospice Care treatment involving physical care, psychological care, and nursing. This benefit is considered to improve the quality of life for terminally-ill patients with a life expectancy of less than six months. This benefit must be coordinated and approved in advance by the Company.

14. Intensive care unit: Covered up to the Policy limits when the Insured is treated in one our Preferred Providers’ facilities. Benefits are limited to Usual, Customary and Reasonable charges when the Insured is treated for an Emergency condition in a non-Preferred Providers’ facility. This benefit must be coordinated and approved in advance by the Company.

15. Laboratory tests, pathology and diagnostic imaging: Inpatient and outpatient diagnostic procedures will be covered up to the Policy limits when prescribed by the attending Physician.

16. Maternity care: Maternity care coverage will only be available for Plans I and II (with deductible options of $1,000 and $2,000) and only when the (10) month waiting period requirement for this coverage has been met. This waiting period begins on the effective date of coverage of the Insured mother.

Up to a maximum of ($4,000) will be paid for a normal delivery, elective C-section and prenatal treatments per event. Within this maximum benefit, the Company will pay for up to (5) well-baby care visits for the healthy newborn. For Maternity Complications and Ill Newborn care the Company will pay up to a maximum of ($500,000) per lifetime.

No Deductible applies for this benefit.

A newborn who is born from a covered maternity will be eligible for automatic inclusion into the policy, if the request if made to the Company within 90 days from the date of birth of the newborn. The medical care and treatment of Congenital Conditions of the newborn will be limited to the Congenital Conditions benefit of this policy.

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Dependent daughters that are insured under the Main Insured’s policy and are between the ages of (18) and (24) years of age will have Maternity benefits if all of the following requirements are met: The current plan of the Main Insured’s policy offers maternity benefits, Plans I or II.

The dependent daughter must have been insured for a period of at least 10 months in her parents’ policy The dependent daughter of the Main Insured must have been paying adult premium during the 10 months prior to the effective date of the birth of her child. The company must have been notified in writing of the dependent’s pregnancy within the first (3) months of being pregnant.

To receive maternity benefits, the dependent daughter is obligated to obtain a standalone individual policy prior to the birth of the child, this policy will be issued with the same conditions and limitations of the previous policy, the new policy will be approved without an Underwriting Evaluation so long as the plan selected by the dependent is the same or with lesser benefits.

To have maternity benefits, the dependent must select Plan I or II, if the plan selected has greater benefits than the previous policy, the Company reserves the right to deny the change of plan and it will be subject to an Underwriting Evaluation. In addition to being subject to an Underwriting Evaluation, the coverage for Maternity Care, Maternity Complications, Illness and Injury of the Newborn and Congenital Conditions will be limited to the lesser of the benefits between both Products and Plans.

17. Medications: These will be paid if indicated by a Physician to treat a condition covered by this Policy. This applies to medications prescribed during a Hospitalization or during and after an Outpatient surgery. Outpatient prescription medications

are also paid by the Company for any condition covered by this Policy up to a maximum of $6,000. A copy of the written prescription must be sent to the Company along with the Claim. The effectiveness of the prescription to treat a particular condition must have been scientifically tested and approved by the Food and Drug Administration of the United States of America (“FDA”) or a similar governing agency and approved by the Department of Health and Health Affairs of Curaçao and/or the Department of Health of Sint Maarten, or approved in the country where the medical services are rendered.

18. Newborn care:

Automatic addition: A child born from a Covered Pregnancy for Plans I and II and as defined in this Policy will be added to the Policy as a Dependent without underwriting evaluation. The child’s name, sex and date of birth must be received in writing by the Company within the first (90) days after the birth of the newborn, along with the applicable premium payment.

Coverage for the newborn will become effective from the date of birth without a waiting period. Medical expenses for Injury and Illness of the Newborn (not related to Congenital or Hereditary Conditions), such as respiratory distress, prematurity, hypoglycemia, low birth weight and birth trauma, which are diagnosed within the first (31) days of life, will be covered up to a maximum of $500,000 per lifetime under the complications of pregnancy and ill Newborn care benefit as described in Maternity Care. Conditions diagnosed after the Newborn’s thirty first (31) days of life will be covered according to the terms and limits of this Policy. For the Company to provide benefits, a newborn must be have been added to the Policy and the corresponding premium must have been paid in full.

Addition subject to underwriting evaluation:The addition of a newborn will be subject to an Underwriting Evaluation when the following occurs:

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• When the notification of birth or the premium payment is received after the first (90) days following the birth of a newborn; or

• When a newborn is born from a non-Covered Pregnancy; or

• When the newborn is a product of a pregnancy conceived under artificial methods of fertilization, assisted fertilization or infertility treatment.

A Newborn that is not born from a maternity covered by this Policy is not eligible for the Congenital and Hereditary Conditions coverage and the addition of the newborn will be subject to an Underwriting Evaluation.

19. Nose and nasal septum deformity: When needed to treat an Injury resultant from trauma caused in a covered Accident, the surgery for a nose or nasal septum deformity will be covered if the evidence of the trauma is confirmed radiographically (X-ray and CT scan). This benefit must be coordinated and approved in advance by the Company.

20. Organ transplant: The maximum coverage for this benefit is ($500,000) per Insured, per lifetime. Transplant procedures are only covered within the Company’s network of specialized Transplant Providers. This benefit must be coordinated and approved in advance by the Company. A second medical opinion may be required by the Company once a Physician has determined and documented the need for an organ or human tissue Transplant.

The maximum coverage for Transplant procedures includes the following three stages:

Pre-transplant stage:It includes the medical assistance and medical exams required for the diagnosis, evaluation and preparation of the

Insured to receive an organ or tissue Transplant. The Company shall cover up to $25,000 per Transplant, per lifetime, which is included as part of the maximum Organ Transplant benefit, for the cost of medical and surgical procedures involved in donating organs, tissues or cells, all of human origin, including the expenses of the live human Donor, and the transportation and storage of the organs, tissues or cells donated. The live human Donor does not have to be insured by the Company.

Transplant stage: It includes the medical and surgical procedures performed during the Transplant.

Post-transplant stage: It includes the follow-up medical or surgical procedures necessary after completion of the Transplant, any treatment of complications of the Transplant and any medications necessary to maintain the correct function of the transplanted organ or tissue, such as immune-regulatory drugs.

All medical treatment or surgery related to the medical condition which generated the need for the Organ Transplant will be excluded and not have coverage once the maximum lifetime benefit amount for Organ Transplant has been reached.

21. Physical therapy and rehabilitation: An initial period of up to 30 days will be covered per Policy Year, up to a maximum of $6,000. A treatment plan must be provided to the Company. An extension could be approved if deemed Medically Necessary by the Insured’s Physician. This benefit must be coordinated and approved in advance by the Company.

22. Preexisting conditions: Those medical conditions disclosed in the Application will be covered, unless these are restricted or excluded by the Company by written Amendment added to the Policy and included in the Insured’s Certificate of Coverage. Non-disclosed Preexisting Conditions will never be covered by this

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Policy. The Company reserves the right to rescind, cancel or modify the Policy due to nondisclosure of Preexisting Conditions.

23. Prosthesis and corrective devices: Will be covered up to the Policy limits when they are Medically Necessary and are implanted during a covered surgery. This benefit must be coordinated and approved by the Company.

24. Repatriation of human remains: If an Insured dies outside their Country of Residence and the cause of death is a condition covered by this Policy, the Company will pay up to a maximum of $6,000 for all basic costs incurred in the process of the repatriation of the human remains or the cremation of the body, that are required by the corresponding authorities. This benefit must be coordinated and approved by the Company.

25. Room and board: Standard Room is covered up to the Policy limits when the Insured is treated at one our Preferred Providers’ facilities. Benefits are limited to Usual, Customary and Reasonable charges when the Insured is treated for an Emergency condition in a non-Preferred Providers’ facility. This benefit must be coordinated and approved in advance by the Company.

26. Second surgical opinion: The Company reserves the right to request a Second Surgical Opinion when deemed necessary. When a Second Surgical Opinion is required by the Company, it must be conducted by a Physician selected and paid for by the Company. If the Second Surgical Opinion does not confirm the need for said surgery, the Company will also coordinate and pay for a third surgical opinion. When the second or third surgical opinion confirms the need for the surgery, benefits will be paid; otherwise the Company reserves the right to deny benefits.

27. Special treatments: Prosthesis, orthopedic equipment, medical equipment, implants, chemotherapy, radiation therapy and

specialized medications are covered up to the terms and restrictions of this Policy. This benefit must be coordinated approved in advance by the Company.

28. Surgeon and Assisting physician fees: When it is Medically Necessary, surgeon and surgical assistant fees will be covered according to the Usual, Customary and Reasonable fees charged for surgical procedures within a certain area or country. This coverage must be coordinated and approved in advance by the Company.

29. Visits to physicians and medical specialists: Inpatient and outpatient fees of physicians and medical specialists will be covered up to the Policy limits.

30. Waiver of premium in case of death: In the event of the death of the Main Insured, the Company will assume the renewal premium payment of the Policy for (1) year for the surviving Insured belonging to the Main Insured’s Family Group. For this benefit to take effect, the death of the Main Insured must have been caused by an Injury, Illness or medical condition covered by this Policy. This benefit will automatically terminate for the Family Group in the event of marriage of the surviving spouse/domestic partner. Any claim reimbursements to be issued to the Main Insured after his/ her death, will be issued to the last designated beneficiary and in case the beneficiary no longer exists the reimbursement will be issued to the successor as established by law.

In the event that the Main Insured’s surviving Family Group is comprised of underage Dependents, the legal guardian will be required to be the policyholder for this benefit to take place. If the legal guardian is not a previous Insured of the Policy, but would like to be insured by the Policy, he/she must submit a new application for coverage.

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EXCLUSIONS AND LIMITATIONS

This Policy does not provide benefits or coverage for:

1. Any medical or surgical treatment of any Illnesses or injuries which are not:

• Medically Necessary

• Performed by a licensed Physician or skilled professional

• Prescribed by a Physician

• Scientifically recognized or is still in an investigative phase or clinical trial, as well as not approved by the USA Food and Drug Administration (FDA); and by the Department of Health and Health Affairs of Curaçao and/or the Department of Health of Sint Maarten or a similar governing agency in the country where the medical services are rendered

2. Preexisting Conditions not disclosed in the Application.

3. Medical complications related to any condition excluded in this Policy.

4. Medical expenses not related to an Illness of Infectious Origin or injuries originated in Accidents occurred within the first 60 days after the Effective Date of this Policy, unless the waiting period was waived.

5. Any maternity or Newborn treatment and its complications related to a non-Covered Pregnancy.

6. Complications of pregnancies or Newborn resulting from an

assisted fertility or infertility treatment or related to any condition excluded or not covered by this Policy.

7. Voluntarily induced termination of a pregnancy, except when the Covered Pregnancy places the life of the mother in danger.

8. Routine Medical Health checkups.

9. Expenses exceeding the Usual, Customary and Reasonable (UCR) charges for a specific medical service or supply, even when the benefit is covered at 100%.

10. Treatment of injuries or Illnesses resulting from participation in war, riot, civil commotion, strike action, or illegal activities or imprisonment.

11. Treatment of injuries while the Insured is an active member of the police or military.

12. Treatment of injuries or Illnesses caused by nuclear or radioactive material, pollution or environmental contamination.

13. Treatment for HIV/AIDS and related illnesses and its complications.

14. Treatment of injuries or Illnesses while the Insured is sane or insane, which are self-inflicted, or resulting from failed suicide, suicide, or caused by use, or while influence of alcohol, drugs, illegal substances or inappropriate use of medications.

15. Podiatric care to treat disorders of the feet, including but not limited to bunions, corns, calluses, plantar warts, Morton’s neuroma,

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Hallux valgus, plantar fasciitis, flat feet and hammer toe, weak feet and weak arches, pedicures, special shoes and inserts.

16. Medical services rendered in a governmental facility where the Insured is entitled to free care, or when a third party is responsible for the Insured’s medical expenses, either by contract or extra contractual civil liability. This also includes the treatment of epidemics that are under the direction of the corresponding government.

17. This policy provides worldwide coverage excluding the following countries: Cuba, Iran, Iraq, Libya, North Korea, and Sudan.

18. Hospital admissions for services that can be provided on an Outpatient basis, or Hospital admissions more than 23 hours before a planned surgery.

19. Custodial Care and expenses related to services or supplies commonly used at home.

20. Home based or mobile artificial kidney equipment, unless authorized by the Company.

21. Food supplements unless required to sustain the life of a critically ill patient who is admitted in a Hospital.

22. Over the counter and/or nonprescription medications.

23. Replacement of permanent or removable prosthesis, external prosthesis or ear implants, except when the insertion of the original prosthesis has been covered under the terms of this Policy.

24. Routine ear exams, hearing aids, eye exams, eye glasses, contact lenses and/or other procedures or devices to correct eye refraction disorders.

25. Any type of chiropractic or homeopathic treatment or any type of alternative medicine, even if is required due to a complication of a condition covered by this Policy.

26. Dental treatment not related to a covered Accident, or when a covered dental treatment starts after 120 days from the date of a covered Accident.

27. Treatment of the upper maxilla, the jaw, temporo-mandibular joint, and their complex of muscles, nerves and other related tissues, unless secondary to a cancer treatment or an Accident covered by this Policy.

28. Male or female sterilization, reversal of sterilization, infertility treatment, birth control, sex change procedures and sexual or erectile dysfunction treatments regardless of whether these are secondary to a condition covered by this Policy. Disorders related to Human Papilloma Virus (HPV) and sexually transmittable Illnesses.

29. Treatment for Injury, medical conditions, and/or complications related to the Insured’s participation in Professional Sports.

30. Sleep disorders, sleep apnea, chronic fatigue syndrome, alopecia and behavioral or learning disorders. Psychiatric or psychological disorders, except if required to treat a complication of a covered medical condition as defined in the terms and limits of this Policy.

31. Treatment for obesity or weight control.

32. Elective cosmetic and reconstructive surgery or medical treatment which main purpose is aesthetic, except when medically prescribed during or after the treatment of a covered Injury or Illness that first happened after the Effective Date of this Policy. This also includes any surgical treatment for nasal or septum deformity that is not related to a covered Accident.

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33. Bone growth stimulation or growth hormone treatment.

34. Medical services provided by the spouse, child, sibling or parent of the Insured.

35. Treatment related to implantation of artificial or animal organs. Expenses for cryopreservation for more than 24 hours, preservation of bone marrow, stem cell, cord blood, and any other tissue or cell, except as provided under the terms and restrictions of this Policy.

36. Any surgical medical treatment related to the medical condition

that generated the need for an Organ Transplant once the maximum lifetime benefit for Organ Transplant has been reached.

37. Preventive Medical Treatments.

38. Medical fees, professional fees, as well as hospitalization costs for Medical or Surgical Treatments received in medical institutions within the United States that do not belong to the Preferred Provider Network, with the exception of the care or treatment received as a result of a Medical Emergency as it is defined in this policy.

DEFINITIONS

In this Policy and related documents, “you” and “your”, refers to the Main Insured. “We”, “us” and “our” refer to the Company providing the coverage. In addition, the following definitions apply to the terms, conditions and restrictions of this Policy:

1. Accident: An event that takes place suddenly and unexpectedly due to an external factor that can result in injuries.

2. Air ambulance: Aircraft staffed by medical personnel and equipped to provide the required medical care during Emergency air transportation. This service is provided by a licensed and authorized air transportation company.

3. Amendment: A declaration added to the Policy by an authorized official of the Company to explain, modify or restrict the coverage of this Policy for an Insured in particular or for the Policy in general.

4. Anesthesiologist fees: Charges for the administration of anesthesia during a covered surgical or services required for pain control.

5. Anniversary date: Annual occurrence of the Effective Date of the Policy.

6. Applicant: Individual who completes the Application to obtain medical coverage or to modify existing health coverage.

7. Application: Written declaration in a form, Health Insurance Application, designed by the Company and signed, manually or electronically by the Applicant, containing information about themselves and their Dependents, to be used by the Company to determine the insurability of the Applicants or to evaluate the requested modification of an existing Policy. Any medical records or questionnaires submitted to the Company to the evaluation of the medical coverage requested will be made part of the Application.

8. Assisting physician fees: Charges by the Physician who assists the lead surgeon to conduct a complex surgical procedure.

9. Beneficiary: Individual designated by the Main Insured to receive any reimbursement after the death of the Main Insured.

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10. Certificate of coverage: Document of the Policy which specifies the approval conditions of the Policy for each of the Insureds. It contains the Effective Date; it identifies the approved plan, the additional coverages and any specific restriction to the coverage of an Insured in particular, or of the Policy in general.

11. Claim: Is the request for payment of Policy benefits from the Company by the Main Insured.

12. Class: Insureds who share common aspects, such as benefits, plan, Deductibles, age groups, country, region or any combination thereof.

13. Company: Pan-American is a Life and Health Insurer domiciled in Curaçao and Sint Maarten. Pan-American Accident and Health Insurance Company N.V. is a member of the Pan-American Life Insurance Group (PALIG).

14. Congenital or hereditary condition: Medical condition existing before birth which can be diagnosed before or after the birth.

15. Country of residence: Country where the Insured has lived for an uninterrupted period of more than 180 days within any 365-day period while this Policy is in effect.

16. Covered pregnancy: Pregnancy of the policyholder or insured spouse or insured partner or insured Dependent in which the delivery date is at least 10 months after the Effective Date. Plans I and II.

17. Custodial care: Assistance with the activities of daily living, including but not limited to personal hygiene, feeding and toileting, which can be provided by a non-medical or nursing trained personnel.

18. Deductible: Amount of covered expenses that must be paid by the Insured to the provider before the Policy benefits are paid by the Company.

19. Dependent(s): Natural children, stepchildren and legally adopted children of the Main Insured or children and grandchildren for whom the Main Insured has been named legal guardian.

20. Donor: Individual from whom one or more organs, tissues or cells have been obtained to be transplanted onto a human Recipient.

21. Effective date: Date in which coverage begins under this Policy for each of the Insureds.

22. Emergency dental treatment: Treatment that is Medically Necessary to restore damaged teeth due to covered Accident.

23. Family group: Any of the following groups that may be covered under the same Policy: 1) Main Insured and spouse with Dependents; 2) Parent(s) of the Main Insured, and 3) Parents-in-law of the Main Insured. A Policy may have a maximum of three Family Groups. Each Applicant is individually underwritten when applying for coverage.

24. Grace period: The 30-day period after the expiration date of the Policy during which the Company will allow the Policy to be renewed.

25. Ground ambulance: A licensed Emergency transportation staffed by medical personnel and prepared with the necessary equipment to handle a medical Emergency.

26. High risk hobbies and amateur sports: Activities that increase the risk of death or Illness of the persons who practice them. The charges resulting from Accidents related to high risk activities and amateur sports will have coverage. Examples of High Risk

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Hobbies include, but are not limited to diving, rock climbing, parachuting, free fall jumping from high altitudes with an elastic band tied to the body, paragliding, parasailing, mountain biking, off-roading. However, the professional participation in any sport must be declared on the Application.

27. Home health care: Caring for the Insured in a home by a skilled licensed professional (Nurse or Therapist).

28. Hospice care: Caring for the Insured following a diagnosis of a terminal condition, including physical, psychological and nursing care.

29. Hospital: An institution that is legally licensed as a medical or surgical facility in the country in which it is located, which primarily provides facilities for clinical and surgical diagnosis and treatment of injured and sick persons by or under the supervision of a medical staff.

30. Hospitalization: Admission of the Insured to a Hospital for more than 23 hours to receive medical or surgical treatment that cannot be provided on an Outpatient basis or at a medical office.

31. Illness: The alteration of an individual’s health which affects the normal functions of the human body and manifests itself through signs and symptoms, as well as the abnormal results of medical exams that allow reaching a diagnosis.

32. Illness of infectious origin: The alteration of one’s health condition caused by pathogenic agents such as prions, virus, bacteria, fungi, protozoa, and helminths.

33. Injury: Damage inflicted to the human body due to an external cause.

34. Insured: Individual for whom health insurance coverage has been approved by the Company.

35. Main insured: Applicant who completes and signs the Application and for whom coverage has been approved and a Policy issued. The Main Insured has the authority to request changes in the Policy and receives any reimbursements of medical payments covered under this Policy, as well as any unearned premium reimbursements.

36. Medical emergency: A sudden, serious, and acute medical condition, which requires immediate medical or surgical treatment and that may threaten the life or the function of an organ(s) of the Insured.

37. Medically necessary: Is when a treatment, service or medical supply is deemed necessary by the Company, in mutual agreement with the Insured’s Physician, to diagnose and/or treat an Illness or Injury. It is not Medically Necessary if the service:

a. Is provided only as a matter of convenience to the Insured, the Insured’s family or the Hospital/Physician

b. Is not appropriate for the diagnosis or treatment of the specific condition of the Insured

c. It exceeds the level of care required for the diagnosis or treatment of a specific condition

d. Is outside the scope of the standard practice established by the corresponding institution

38. Newborn: A child from the time of birth until the child’s 30th day of life.

39. Non-covered pregnancy: Pregnancy of the policyholder or insured spouse or insured partner or insured dependent with deductibles options III, IV and V or where the delivery date is within the first ten (10) months of the Effective Date of the coverage of the insured.

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40. Nurse: An individual licensed to provide nursing services in the country where the required treatment is being rendered.

41. Outpatient: Medical se/rvices that do not require Hospitalization. Services rendered in a Hospital with a maximum duration of (23) hours.

42. Physician or doctor: Professional who is licensed to practice medicine in the country where their practice is established and who acts within the scope established for the practice of their profession.

43. Physical therapy and rehabilitation: Medical procedures performed by an accredited professional with the goal of recovering motor or sensitive functions that may have been affected by a covered Injury, Illness or surgical treatment.

44. Policy: The contract issued to the Main Insured providing the benefits specified herein. The Membership Guide, Certificate of Coverage, Policy Endorsements, the Application and its supporting documents are incorporated into and form part of this Policy.

45. Policy year: The consecutive 12-month period that starts on the Effective Date of this Policy and any subsequent 12-month period thereafter.

46. Preexisting condition: A condition that is diagnosed by a Physician prior to the Effective Date of this Policy or its reinstatement; or for which medical advice or treatment was recommended by, or received from a Physician prior to the Effective Date of this Policy or its reinstatement; or for which any symptom and/or sign, if presented to a Physician prior to the Effective Date of this Policy or its reinstatement, would have resulted in the diagnosis of an Illness or medical condition.

47. Preferred providers: A group of Hospitals, diagnostic facilities and medical groups located in the U.S.A. that are approved and contracted by the Company. The list of Preferred Providers is available online at palig.com/privateclient.

48. Preventive medical treatment: Procedure, measure, pharmaceutical or program designed to prevent the onset of an illness.

49. Professional sports: A sport in which the participant routinely and voluntarily practices within the scope or direction of an organization, league or sport organization and the activity being the participant’s principal means of income.

50. Programmed medical treatment: Procedure, service, supplies or treatment needed to treat a medical condition.

51. Recipient: Individual receiving one or more organs, tissues or cells from a human Donor.

52. Renewal date: The first day of the next Policy Year (Anniversary Date of this Policy).

53. Second surgical opinion: The medical opinion of a Physician other than the Insured’s attending Physician.

54. Serious accident: One that results in serious bodily injuries that require immediate Hospitalization for more than 23 hours to avoid the loss of life or of physical integrity of the Insured. The classification of Serious Accident is determined by mutual agreement between the attending Physician and the medical professionals of the Company, after having received the complete medical information documenting the Accident.

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55. Standard room: Is a Hospital private or semiprivate room for the use of one or more patients.

56. Transplant: Procedure in which an organ, tissue or cells of a human Donor is implanted in a human Recipient. In the case of auto transplantation, the individual himself is the Donor as well as the Recipient.

57. Transplant providers: A group of Hospitals, diagnostic facilities and Physicians approved and contracted by the Company.

58. Usual, customary and reasonable (UCR): Reasonable fees customarily charged for the performance of medical and surgical services usually rendered in a country or within a geographical area.

GENERAL POLICY INFORMATION

1. Applicable law: This Policy is governed by the laws of Curaçao and Sint Maarten. If any disagreement arises as to the interpretation of this document, the English version of this document shall be deemed to be conclusive and will take precedence over any other language version of this document.

2. Authority: Modifications and changes to any Policy provision and/or Amendment shall only be valid if approved in writing by an authorized officer of the Company.

3. Cancellation or non-renewal of the policy: The Company reserves the right to cancel, modify or rescind this Policy, as well as change the rates and the Deductible, if any of the following conditions are present:

a. The information disclosed in the Application is false, incomplete or if fraud has been committed, causing the Company to approve the Policy when in fact had the Company been provided the correct information, it would have issued the Policy with restrictions or would have deemed the Applicant as a non-insurable person.

b. The Insured changes Country of Residence and fails to notify the Company.

c. If the approved product is not available in the Insured’s new Country of Residence.

d. The Insured submits any Claim deemed to be fraudulent by the Company.

e. The insured is listed on the Office of Foreign Assets Control (OFAC) or by the Financial Intelligence Unit (“Meldpunt Ongebruikelijke Transacties” MOT) in Curacao and the Financial Intelligence Unit in Sint Maarten as a person of interest or has been convicted for a Money Laundering offence.

No Insured shall individually be penalized by cancellation or modification of this Policy due to Claims.

4. Claims revision: If the Insured is in disagreement as to how the benefits of this Policy were applied, the Insured is to send a written request for review of the Claim in question to the Company’s Claims Appeals Committee. Said written request must be accompanied by all relevant information required for the review of the case. The Company’s Appeals Committee will notify the Insured within 30 days as to its decision and the basis for it.

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5. Claims, arbitration, waiver of trial by jury and legal actions: If there is a disagreement after an appeal, the case must be presented for arbitration, which can be initiated by either the Insured or the Company by notifying the other party in writing, who shall then have 20 days from the date of receipt of said written notice to choose an arbitrator, otherwise, the claimant shall have the right to select a second arbitrator. A third arbitrator shall be selected within a 10-day period, and within an additional 10-day period after his designation, the place where the arbitration is to take place shall be decided. The Company shall select an arbitrator, the Insured shall select another arbitrator, and the third arbitrator shall be selected by the other two arbitrators. The arbitration will need to take place in the city of Willemstad, Curaçao. Each party shall pay its own expenses for the arbitration process. If there is a disagreement between the arbitrators, the decision will be made by majority vote. The Insured grants exclusive jurisdiction to the city of Willemstad, Curaçao to determine any rights under this Policy. The insured and the Company hereby agree that the resolution of legal disputes which may arise from this Policy shall be resolved by a court of law.

6. Clerical errors: Clerical errors (whether by you or by the Company) will not change the benefits payable under this Policy. Such errors will call for a fair adjustment to correct the error. Errors made in completing the application, evidence of insurability as well as any other information required to underwrite coverage or to process a Claim shall not be considered a clerical error.

7. Commencement and ending of your insurance coverage: This Policy will become effective at 00:01 hours (EST) on the Effective Date given by the Company and not on the date the Application was signed (except for temporary accidental coverage. Please refer to the last page of the Application for details on this benefit). Coverage ends at 24:00 hours (EST) on earliest of the following dates: a) The date when this Policy expires; b) The date when the

Main Insured requests in writing to terminate this Policy; c) The date when the Main Insured requests in writing to terminate the coverage of one of the Dependents covered under this Policy; d) The date when the Company notifies the Insured in writing of its decision to terminate the Policy coverage, according to the Terms and conditions of this Policy; e) The due date of the premium it not paid, subject to the Grace Period. The Company will only be responsible for paying for services that were rendered before the termination date of this Policy.

8. Cooperation: The Applicant or the Insured must provide the Company with all the medical information requested. Additionally, the Insured must authorize the Company to obtain all medical records and documents deemed necessary. Failure to cooperate with the Company to obtain medical records and documents may cause the Company to conclude the underwriting process or deny the Claim.

9. Currency: All the values stated in this Policy are based on U.S dollars.

10. Fraudulent actions by third parties: If any Claim under this Policy is in any respect fraudulent or if fraudulent means or devices are used by anyone acting on the Insured’s behalf, we may deny all benefits and cancel this Policy.

11. Grace period: The Company grants a 30 day Grace Period starting on the Renewal Date of this Policy for the Insured to pay the Policy premium. If the full premium is not received by the Company before the end of the Grace Period stipulated by the Company, this Policy will be deemed terminated as of the Renewal Date of this Policy. No Policy benefits will be provided or paid during the Grace Period until the full premium is received by the Company.

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12. Inaccurate statements and omissions: In accordance with the application, the applicants are required to state in writing to the Company all facts necessary for assessing the risks which may affect the agreed terms, as to the best of their knowledge at the time of requesting insurance.

The omission or misrepresentation of information included in the application, even if it did not influence the risk assessment, will entitle the Company to terminate the Policy. If the nature of the false, inaccurate, reticent, deceptive or misleading information is such that it would have prevented the issuance of said policy, the Company will within (30) calendar days following the knowledge of said information rescind and terminate the Policy reimbursing to the Insured 100% of the unearned premium at the time of the termination plus any taxes and without any rights to the Policy. If the nature of the false, inaccurate, reticent, deceptive or misleading information is such that it would have caused the Company to issue the policy with different coverage or premium, the Company may within (30) calendar days of becoming aware of such information, present the Insured with an adjusted offer to the Policy and its premium; the Insured will have (15) working days after being notified of the modified offer to accept the same. The Insured’s silence or refusal to accept the adjusted conditions will provide the Company with the right to rescind and terminate the Policy and retain all unearned premiums.

The Applicant is responsible for immediately returning any undue payment made by the Company on account of any omission, misrepresentation, concealment or negligence in reporting by the Applicant or Main Insured during the application process. In any event, the Company reserves the right to pursue criminal or civil action against the Insureds, Insureds Dependents, successors or assignees for any compensation paid based on all or partially false information received from the Applicant, the Insureds or their

representatives in a fraudulent, reticent, deceptive or misleading fashion. The Company’s right to proceed against the Insured or its heirs shall continue for the maximum period permitted by law, even if the Policy is no longer active.

13. Language of the policy: This Policy is written and issued only in the English language.

14. Liability: The Company will not be responsible for the quality of care received by the Insured from any institution or individual. This Policy does not provide the insured or covered person any right or cause of action against the Company based on an act or omission of a hospital, Nurse, Physician or other provider of care or service. The Company is only responsible for the payment of eligible benefits under the provisions of this Policy.

15. Notices: All correspondence in writing directed to us, by the Insured, shall be delivered to the following address by certified mail: Pan-American Accident and Health Insurance Company, N.V Pan-American Private Client

Schottegatweg Oost # 104, Curaçao

16. Other health insurance coverage: When the Insured is provided coverage under another health insurance policy in the Insured’s Country of Residence, the benefits shall be paid first by the local policy. Benefit amounts paid by the local policy will be credited to the Deductible for the Insured. Once the benefits of the local policy are exhausted, and the Deductible for the Insured has been met, this Policy will begin providing benefits to the Insured. When coverage is required outside the Insured’s Country of Residence, the Company will act as the primary insurer.

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17. Policy issuance: This Policy is deemed as issued or delivered when it is received by the Main Insured in the Main Insured’s Country of Residence.

18. Premium rate changes: The premiums are calculated on an annual term and are based on each Insured’s age at the time the Insured’s coverage becomes effective and on each Renewal Date. Premiums are also based on the Insured’s Country of Residence and may be affected by other risk factors. The Company reserves the right to change the premium on the Anniversary Date of the Policy on a “Class” basis.

19. Premium refunds: If this Policy is cancelled by the Insured or the Company after issuance, renewal or reinstatement, or upon the death or deletion of an Insured, the unearned premium, with the exception of the $75 administration fee (where applicable), will be refunded to the Insured. The unearned amount of the premium is calculated based on the number of days the Insured will not be covered under this Policy. The number of days is determined from the date the cancellation is effective until the next premium due date of this Policy.

20. Refund of premiums: During the first (21) calendar days after receipt of the policy, the Policyholder is responsible for reviewing all information provided by the Company in connection with this Policy. Within these first (21) days the Policyholder may cancel this policy and return it to the Company. If no claims against the Policy during this period were filed, the Company will reimburse the Policyholder the Premium paid, less any corresponding administrative costs, and the Policy shall be null and void, as if it had never been issued.

Premium may be refunded as indicated above if the Insured cancels the Policy after the deadline specified above, or in the event of death of the Insured. The unearned portion of the premium is calculated

based in the number of days the Insured is not covered by the Policy. The number of days is determined from the effective date of cancellation of the Policy until the next renewal date.

The Policyholder should review the contents and terms of this policy in its entirety and if the Policyholder disagrees with the terms and conditions the Policyholder may request a cancellation in accordance with what is stated in the previous paragraph.

21. Reinstatement: During the 60 days following the termination of the Grace Period, the Policy may be reinstated at the Company’s discretion. The reinstatement process requires the completion of a new Application, as well as any medical records the Company may need to underwrite the Application and the corresponding premium payment.

22. Renewal: The duration of the Policy coverage is 12 months. This Policy is automatically renewed for the next Policy Year, as long as the product and Deductible selected by the Main Insured, are still available and all premiums due to the Company have been paid. The Insured is responsible for paying the premium on time. Premium notices are provided as a courtesy to the Insured and the Company does not guarantee the delivery of such notices. If the Insured does not receive a premium notice 30 days prior to premium payment due date, or the Insured does not know the amount of the premium due, the Insured should contact the Company. The Insured is ultimately responsible for tracking the expiration of this Policy, which can be done by visiting palig.com/privateclient.

23. Severability: Any provision of this contract which may be prohibited by law shall be and become without force or effect. This will not invalidate the enforceability of any other provision of the contract.

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24. Somebody else at fault: If the Insured needs medical treatment due to somebody else’s fault (i.e.: a car Accident), the Insured must inform the Company as soon as possible. The Insured is responsible for obtaining the insurance details of the person at fault. The Company reserves the right to collect any covered expenses from the Insured, which were reimbursed to the Insured by another insurance company.

25. Taxes: The Insured is responsible for paying all local taxes where applicable. The premium collected does not include any taxes for which the Insured might be responsible. Please check with your local tax authorities.

HOW TO MANAGE YOUR POLICY

Changing your country of residence: You must notify the Company in writing within 30 days after changing Country of Residence. If the Company does not offer its products in your new Country of Residence, your coverage may be cancelled or modified on the next Renewal Date of this Policy.

Changing plan or product: You may request a change of plan or product from the Company after the Policy is in force. All requests must be submitted by the Main Insured in writing and will become applicable on the next Anniversary Date of the Policy. Some changes of plan or product can be done automatically, others may require underwriting evaluation.

Paying for covered claims: Once the corresponding Deductible has been met, the Company will, when possible, make direct payments to the providers. When the direct payment is not made to the provider, the Company will reimburse the Main Insured the amount based on the contractual rates set with the provider or the Usual, Customary and Reasonable for the compensable charges presented to the Company. The Company shall receive all medical and non-medical information required by the Company. While determining the compensation of a Claim, the Company can request a second opinion from the claiming Insured, at the Company’s expense to determine if the Claim is compensable. Proof of Claim must be submitted within a 180 day period following the service date. The

proof of Claim must be received by the Company for the Claims process to begin, and it consists of the following documents:

1. All Itemized bills from the providers

2. Recent medical records

3. One Claim form per incident duly completed and signed (for reimbursements only)

The required documents must be sent to the Company by mail to: Pan-American Accident and Health Insurance Company, N.V Pan-American Private Client

Schottegatweg Oost # 104, Curaçao

The Company has full and exclusive discretion in determining whether to make payment to you or to your provider. Payments are not assignable without written approval. Any rights of the Insured to receive services are personal and may not be assigned. If the Company pays benefits in an amount more than what it is liable for, it has the right to recover such overpayments from the Insured, Hospital or other provider; or by reducing benefits paid on future Claims.

Figure

Table Of Benefits  8-9
TABLE OF BENEFITS

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