Summary of Benefits:
International Students Medical Insurance

Renaissance Agencies
1437 7th Street, 4th Floor
Santa Monica, CA 90401
1-800-537-1777

Claims
Personal Insurance Administrators, Inc.
P.O. Box 6040
Agoura Hills, CA 91376
1-800-468-4343
1-818-735-3567 fax

This is a summary of the master insurance policy. The master policy will govern. Please refer to the master policy for complete details of the policy.

Eligibility

Student:

• Must be engaged full-time in international educational activities.
• Temporarily outside the student’s home country or country of regular domicile as a non-resident alien in the U.S.
• Has a current passport or student visa.
• Has not applied for permanent residency status in the U.S.
  

Dependent:

• Must be a dependent of an Eligible Student who has a current passport or visa.
• Temporarily outside the dependent’s home country or country of regular domicile as a non-resident alien in the U.S.
• Has not applied for permanent residency status in the U.S.
• Is the Eligible Student’s lawful spouse or unmarried child (under age 19) and dependent upon the Eligible Student or the student’s spouse for the child’s main support and care.
• Resides with the Eligible Student.
• Enrolled for coverage under the policy at the same time the Eligible Student enrolls.

Coverage Period

• First day of the school term for which coverage is applied for.
• Coverage will automatically terminate on the earliest of:
  • The date the policy terminates.
  • The last day of the period for which premium has been timely paid according to policy provisions.
  • The date the Insured Individual is no longer eligible for coverage.
  • The date the Insured Individual departs the U.S. for the individual’s home country or country of regular domicile.
  • The date requested by the Insured Individual and approved by the Policyholder in writing that is no sooner than five days after the date the Company receives written notice.

Medical Expense Benefits

Maximum Benefit Per Cause:

• $100,000

Deductible:

• After a $25 deductible, PPO will pay 100% of expenses due to a covered injury or sickness.
  
• After a $25 deductible, a non-PPO will pay 60% for injury or sickness.
  

Medical Benefits:

• 100% for a PPO covered expense if:
  • Deductible is paid
  • The expense is incurred due to a covered injury or sickness
  • The insured individual has not exceeded the maximum benefit for the injury or sickness for which the expense is incurred
  • 60% for most services for non-PPO
    

Serious Medical Condition Notification:

Must notify Renaissance Agencies once insured is aware of a serious injury or sickness before to any hospital stay.

Pregnancy Benefits:

• Same as covered expenses for any other sickness.
• No coverage for dependent child's pregnancy.

Newborn Infants:

• Automatically insured for 31 days from date of birth.
• Beyond 31 days, must notify the company and pay premium, if any, or coverage will terminate for baby.

Medical Evacuation Benefit:

• $25,000
• Certification from doctor
• Results from a covered injury/sickness
• Does not occur before the benefit approval

Repatriation Benefit:

• $10,000
• Does not include transportation expenses of any person
  accompanying the body.
• Prior approval from the company is required.

Extension Benefits:

• Up to a maximum of $5,000 or 13 weeks, whichever comes first, for continuing claim on the date the individual's insurance terminates.

Mental and Nervous Disorders:

• 100%; Up to 30 day aggregate period per calendar year.
• 100%; Outpatient subject to a limit of 10 visits per calendar year.

Exclusions: See master policy.