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1 +9":-(*9(;"',",<<()"'=("+&;+9:(&9*>-( English Edition

2 WORLDWIDE EMERGENCY ASSISTANCE If you are in a Medical Emergency......or in need of emergency return travel home, you MUST call AVI Assistance - SelectCareWorldwide at : * (toll free number) or (collect calls accepted) If you are hosted in the USA or in Canada OR call AVI Assistance at : (collect calls accepted) If you are hosted in a country other than the USA or Canada When calling the Emergency Center, please identify yourself under your policy number printed on your insurance card and explain the nature of your emergency. Failure to call the Emergency Center may lead to coverage denial or to partial coverage only. Medical providers network/ Doctor visits /Guarantee of payment This service is available only in the USA. Please visit our website to find our nearest participating medical provider. YOUR INSURANCE PROFESSIONAL : Your policy, and the unique coverage it offers has been conceived and designed specifically by AVI International, an insurance broker specializing in insurance programs for youth and student travel for over 30 years. AVI International rue La Boétie Paris - France Fax : avi-international@wanadoo.fr Web : AVI International - Simplified Limited Liability Company or SAS with a capital of 100,000 - Head Office: , rue La Boétie, PARIS, France, licensed in Paris as company N , licensed to subscribe insurance contracts with ORIAS N ( The name of the companies working with AVI International can be transmitted upon request. AVI International is ruled by the Autorité de Contrôle Prudentiel (ACP) 61 rue Taitbout Paris Cedex 09, France. In case of dispute, please send your complaint by simple mail to AVI International, and if it is not solved then to the ACP. INSURANCE CARRIER : -ACE European Group Limited - France ACE European Group Limited General Management for France : Le Colisée - 8, avenue de l Arche Courbevoie Cedex -Identification number: R.C.S Nanterre - APE 65.12Z. Head Office: 100 Leadenhall street - London, EC3A 3BP - United Kingdom. S.A. with a capital of Control authority: Financial Services Authority 25 The North Colonnade, Canary Wharf, London, E14 5HS United Kingdom. Some cases could be controled under conditions different from those applicable in the United Kingdom. This is the carrier underwriting the contract at the time of printing. If need be, it can be changed by AVI International, provided coverage remains unchanged. If such an event was to occur, the insured of the policy would be notified. * free of charge from a local phone. AVI International 2012!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"#$%& 2012

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23 STEPS TO FILE A CLAIM : (Check for claims tips at Along with your Security Pass'port and insurance card you have been given an AVI International claim form. 1) Complete ALL sections of the AVI International claim form, otherwise payments cannot be made. 2) Attach all itemized ORIGINAL invoices, receipts and bills related to your claim. Keep copies of all paperwork for your records. For medical claims do not forget prescriptions and medication receipts from the pharmacy. Photocopies, cash register receipts, statements of accounts, bank or charge cards statements are not accepted. 3) Send all of the above requirements within 2 weeks of date of service or loss to the relevant claims office indicated below. if your HOST Country is the USA or CANADA, please do the following depending on your situation : For situations A and B send original paperwork to: AV I A s s i s t a n c e - S e l e c t C a r e Wo r l d w i d e D e l a w a r e Av e # B u f f a l o, N Y U S A avi-claims@selectcareworldwide.com Phone: (toll free) or A: You called the Emergency Center but still receive medical bills or statements of account OR B: You did not call the Emergency Center but the medical provider took a copy of your insurance information and agreed to bill AVI directly. For situations C and D send original paperwork to: ARMSCO -AVI Claims P.O BOX SAN RAFAEL, CA USA Fax: Phone: or C: You did not call the Emergency Center, paid for the medical services rendered, and seek reimbursement, OR D: You have a non-medical claim (luggage / third-party liability) to submit. Claims for lost/stolen/damaged property must be submitted within 5 days. if your HOST Country IS NOT the USA or Canada, send ALL claims to : AVI International rue La Boétie Paris - FRANCE fax : phone: (no collect calls) claims@avi-international.com Looking for a doctor/hospital in the USA? Need a claim form? Looking for the FAQ? Go to : Enter the policy number printed on your insurance card

24 +9":-(*9(;"',",<<()"'=("+&;+9:(&9*>-( English Edition!"#$%"%&'()&*'+,&*-"./0 "#12"#345#"26"""""" //"(8

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