Medical Coverage

• All eligible inpatient and outpatient medical expenses — physician and specialist visits (1 per day unless different specialty), hospital room and board (average semi-private room rate, including nursing and ancillary services), intensive care, surgery, and anesthesia
• Outpatient surgical facility, laboratory, radiology, and X-ray
• Pre-admission testing
• Reconstructive surgery (incidental to and following a covered surgery)
• Assistant surgeon (20% of primary surgeon's eligible fee)
• Durable medical equipment
• Chiropractic care (medical order or treatment plan required)
• Physical therapy — 1 visit per day maximum; medical order or treatment plan required
• Extended care facility and home nursing care (upon direct transfer from an acute care hospital)
• Prescription drugs and medications — up to $250,000 per period of coverage; 90-day dispensing maximum per retail pharmacy prescription; not covered in-network inside the U.S.
• Student Health Center — $5 copay per visit; plan pays 100% after copay; not subject to deductible or coinsurance; mental health services not covered at the student health center
• Urgent Care — $50 copay; not subject to deductible (copay waived with $0 deductible)
• Walk-in Clinic — $20 copay; not subject to deductible (copay waived with $0 deductible)
• Hospital Emergency Room (U.S.) — injury not subject to ER deductible; illness subject to a $500 deductible per visit not resulting in direct inpatient admission
• Hospital Emergency Room (International) — 100%, no ER deductible

Mental Health & Substance Abuse

A benefit unique to the Patriot Exchange Program — mental health support built in for students navigating the challenges of living and studying abroad.

• Inpatient Mental Health / Substance Abuse — up to $10,000 per period of coverage; not covered if incurred at the student health center
• Outpatient Mental Health / Substance Abuse — up to $50/day; $500 maximum per period of coverage; not covered if incurred at the student health center
• Virtual counseling access available through IMG's assistance network

Emergency Services

All emergency services paid at 100% regardless of network or location, and are not subject to deductible unless otherwise noted.

• Emergency Medical Evacuation — up to $50,000; must be approved in advance and coordinated by IMG; no coverage if pre-certification requirements are not met
• Repatriation for Medical Treatment — up to $100,000 in addition to the per illness/injury limit for medically necessary return to your home country; must be approved and coordinated by IMG
• Interfacility Ambulance Transfer — 100%; covered for inpatient hospital admissions inside the U.S.; no coverage if pre-certification requirements are not met
• Emergency Local Ambulance — subject to deductible; covered for injury or illness resulting in hospitalization
• Emergency Reunion — up to $15,000 for reasonable travel costs and accommodations for one person to join you when hospitalized; up to 15 days; $25/day meal maximum; must be approved by IMG
• Return of Mortal Remains — up to $25,000 to return remains to your country of residence; local burial or cremation up to $5,000; must be approved by IMG
• Political Evacuation & Repatriation — up to $10,000; must be approved in advance by IMG
• Bedside Visit — up to $1,500 for a visitor's reasonable expenses when you are hospitalized in the ICU; not subject to deductible

Accidental Death & Dismemberment

• AD&D — $25,000 Principal Sum; death must occur within 90 days of the accident; covers loss of sight of one eye or one hand/foot (50%), and various combinations at 100%

Additional Benefits

• Pre-Existing Conditions — charges from pre-existing conditions that existed within the 36 months prior to the effective date are excluded until the insured has maintained 12 continuous months of coverage; after 12 months, covered up to $500 per period of coverage, $1,500 lifetime maximum
• Sudden and Unexpected Reoccurrence of a Pre-Existing Condition — up to $5,000; emergency evacuation arising from a covered sudden reoccurrence: up to $25,000 (individual plan only; refer to certificate)
• Incidental Trip — up to 14 days of coverage during a brief return to your country of residence (available only when your country of residence is not the United States)
• Terrorism — up to $50,000; not subject to deductible
• Dental Treatment — up to $350 for unexpected pain to sound natural teeth; up to $500 per injury for non-emergency dental treatment following an accident; not covered in-network in the U.S.
• Traumatic Dental Injury — up to the policy maximum for hospital treatment due to accident; additional dental provider treatment for the same injury paid at 100%

COVID-19

Not specifically excluded — treated the same as any other illness under the plan's terms and conditions.

The Patriot Exchange Program is specifically built for non-U.S. citizens studying or participating in cultural exchange programs outside their home country — primarily those coming to or traveling through the United States on J1 or J2 visas, though the plan is available for exchange participants traveling to many destinations worldwide.

This plan is an excellent fit for:

• International students studying at U.S. colleges and universities
• J1 and J2 visa holders — the plan is designed to meet U.S. Department of State visa insurance requirements
• Participants in cultural, educational, and work-based exchange programs
• Exchange students traveling to destinations outside the U.S.
• Spouses and dependent children traveling with the exchange participant
• Exchange program sponsors and educational institutions seeking a compliant group plan
• High school and college exchange students (with optional sports rider)

J1/J2 Visa Compliance: The Patriot Exchange Program is designed to meet U.S. Department of State insurance requirements for J1 and J2 visa holders. To be compliant, you must select a per illness/injury limit of at least $100,000 — the $50,000 option does not satisfy J1/J2 visa requirements.

Why the Patriot Exchange Program vs. a standard travel medical plan: Exchange students have unique needs that general travel medical plans don't address — student health center access, mental health coverage, an extended pre-existing condition provision that "unlocks" after 12 months of continuous coverage, and the flexibility to be renewed annually for long-term academic programs. This plan was designed from the ground up for that population.

Eligibility notes:

• Available to individuals and groups of two or more participants
• Coverage is available for spouses and unmarried, dependent children traveling with the student/participant
• Maximum period of coverage: 365 days; annually-renewable group long-term plans available
• Area of coverage: worldwide excluding the insured person's country of residence
• Underwritten by SiriusPoint Specialty Insurance Corporation
• Pre-certification required for certain services; failure to pre-certify results in a 50% reduction of eligible expenses (maximum $1,000 penalty); interfacility ambulance transfer and emergency medical evacuation receive no coverage without pre-certification

Customize your Patriot Exchange Program coverage with add-on riders available for both individuals and groups.

Personal Liability Rider (Group & Individual)

Provides limited coverage for accidental bodily injury to a third party or damage to a third party's property.

• Injury to third party: up to $2,000 per period of coverage (after $100 per-incident deductible)
• Damage to third party's property: up to $500 per period of coverage (after $100 per-incident deductible)

Lost Personal Property Rider (Group & Individual)

Covers loss or theft of personal belongings during your exchange program.

• Maximum: $250 per period of coverage

Limited High School and College Sports Rider (Group & Individual)

Extends medical coverage to injuries sustained while participating in school-sponsored or organized recreational sports. Available with or without collision sports coverage.

• Plan pays 100% after deductible
• Available with or without collision sports (football, rugby, etc.)
• Refer to the rider documentation for the complete list of covered sports and activities

Legal Assistance Rider (Group & Individual)

Provides reimbursement for legal assistance expenses incurred during your exchange program.

• Maximum: $500 per period of coverage; applies in-network, out-of-network, and internationally

Mobile Device Protection Rider (Individual Only)

Covers repair or replacement of your cell phone if it is lost, stolen, or accidentally damaged during your exchange program.

Provided by International Medical Group (IMG) — 24/7 Global Assistance Services

Every Patriot Exchange Program plan includes access to IMG's multilingual global assistance team, available around the clock to support exchange students wherever they are in the world.

To reach IMG Assistance:

• Phone: +1 (317) 655-4500
• Online: www.imglobal.com
• MyIMG Member Portal & Mobile App — manage your plan, submit and track claims, view Explanations of Benefits, and search for providers 24/7

What assistance services include:

• Coordination and pre-authorization of Emergency Medical Evacuation and Repatriation for Medical Treatment
• Coordination of Political Evacuation and Emergency Reunion
• Return of Mortal Remains coordination
• Location of physicians, hospitals, and student health facilities worldwide
• U.S. Board Certified Physicians on staff around the clock
• Multilingual nurses, doctors, and case managers
• Access to virtual counseling and mental health support resources
• Travel Intelligence — location-specific health, security, and safety alerts via the IMG mobile app
• International Provider Access (IPA): 18,550+ physicians and facilities worldwide with direct billing capabilities

Important: Emergency Medical Evacuation and Interfacility Ambulance Transfer require advance approval and coordination by IMG — no coverage is provided without pre-certification. Failure to obtain pre-certification for other required services results in a 50% reduction of eligible expenses (maximum $1,000 penalty).

• • • • Patriot Exchange Program Certificate of Insurance (Sample Contract) — full benefit schedule, provisions, exclusions, and definitions
      • Patriot Exchange Program Brochure — plan overview and summary of benefits
      • Find a Doctor — search IMG's international provider network
      • Get a Quote / Apply Online

      The Certificate of Insurance and governing policy documents are the only source of actual benefits provided. This page is a summary for illustration purposes only. Benefits are subject to exclusions, limitations, and Usual, Reasonable, and Customary charge requirements. Underwritten by SiriusPoint Specialty Insurance Corporation. Administered by International Medical Group, Inc. (IMG).

IMG requires claims to be submitted within 180 days of the date a claim is incurred. Claims can be filed online through the MyIMG member portal or by mail.

Step-by-step claims process:

1. Pre-certify when required — contact IMG before scheduled inpatient admissions, surgeries, or other listed services. Emergency Medical Evacuation and Interfacility Ambulance Transfer have no coverage without pre-certification. All other required services are subject to a 50% reduction of eligible expenses (maximum $1,000 penalty) if pre-certification is not obtained.
2. Log in to MyIMG at www.imglobal.com/member to complete and submit an IMG Claim Form online. One claim form is required per new illness, diagnosis, or injury.
3. Gather required documentation:
   • Completed IMG Claim Form
   • Universal Billing Forms, Superbills, and itemized statements from all treating providers
   • Original receipts for all costs, medications, and expenses paid out-of-pocket (including provider name, address, phone, date of service, procedure codes, and diagnosis codes)
   • If IMG is secondary payer: copy of the primary insurer's Explanation of Benefits (EOB)
4. Submit within 180 days of the date of service. If additional information is requested by IMG, respond within 60 days to avoid denial.

Claims mailing address:

International Medical Group Attn: Claims Department PO Box 240429 Apple Valley, MN 55124 USA

Appeals: If a claim is denied, you have 90 days from the date of the denial notice to submit a written appeal with supporting documentation to:

International Medical Group Attn: Benefit Review PO Box 240429 Apple Valley, MN 55124 USA

General contact:

Phone: +1 (317) 655-4500 Email: Insurance@imglobal.com Secure messages: www.imglobal.com/secure-message-center Online portal: www.imglobal.com/member

The Patriot Exchange Program includes a free look period — if you are not completely satisfied with your coverage, you may request cancellation and a full refund of premium provided no claims have been filed.

Free Look / Cancellation: The insured person may request cancellation of the Certificate and a refund of premium if not completely satisfied, provided the request is made before any claims have been submitted. Contact IMG directly to initiate a cancellation request.

In plain terms:

• You may cancel for a full refund before any claims are filed, provided you act promptly after receiving your policy documents
• Once a claim has been submitted, the premium is considered earned for the coverage period
• For renewals: a new deductible and pre-existing condition exclusion period may apply

To request a cancellation or refund, contact IMG:

International Medical Group, Inc. 9200 Keystone Crossing, Suite 800 Indianapolis, IN 46240 USA Phone: +1 (317) 655-4500 Email: Insurance@imglobal.com Online: www.imglobal.com/contact

This page is a general summary only and does not supersede the Certificate of Insurance or governing policy documents, which are the only source of actual benefits. Benefits are subject to exclusions, limitations, and Usual, Reasonable, and Customary charge requirements. Underwritten by SiriusPoint Specialty Insurance Corporation. Administered by International Medical Group, Inc. (IMG), 9200 Keystone Crossing, Suite 800, Indianapolis, IN 46240. This insurance is not subject to and does not provide benefits required by PPACA. This insurance is issued pursuant to applicable surplus lines law. The $50,000 per illness/injury limit option does not comply with J1 and J2 visa requirements.