MAXIMUM COVERAGE US$ 5,000,000 US$ 2,000,000 (US$ 1,500,000 OPTIONAL) (US$ 1,500,000 OPTIONAL) COVERAGE & THE CARIBBEAN ELIGIBILITY UP TO 70 S OF AGE UP TO 70 S OF AGE UP TO 50 S OF AGE UP TO 70 S OF AGE UP TO 70 S OF AGE UP TO 70 S OF AGE RENEWALS GENERAL CONDITIONS HOSPITALS OUTSIDE THE U.S.A. HOSPITALS INSIDE THE U.S.A. CO-INSURANCE APPLIES IN THE U.S.A. WAITING PERIOD (CAN BE ELIMINATED WITH PROOF OF CURRENT INTERNATIONAL HEALTH INSURANCE COVERAGE) IMMEDIATE COVERAGE IN 60 DAYS OUTSIDE COUNTRY OF RESIDENCE AZURE NETWORK FOR THOSE STATES NOT INCLUDED IN THE NETWORK, USE THE UNITED HEALTHCARE NETWORK IDEAL NETWORK 10% OF THE FIRST IN LATIN AMERICA & THE CARIBBEAN MATERNITY WAITING PERIOD TEMPORARY EMERGENCY COVERAGE FOR COVERED MEDICAL EXPENSES RESULT- ING FROM AN ACCIDENTAL BODILY INJURY WAIVER OF PREMIUMS 2 S UPON DEATH OR DISABILITY OF 2 S UPON DEATH OR DISABILITY OF 2 S UPON DEATH OR DISABILITY OF 2 S UPON DEATH OR DISABILITY OF 2 S UPON DEATH OR DISABILITY OF 2 S UPON DEATH OR DISABILITY OF Page 1
BENEFICIOS SERIE 3000 MERIDIAN II MERIDIAN AZURE FLEXI PLAN III A.L. PREFERRED PLUS AMÉRICA LATINA AMERICA MEDICAL AND SURGICAL CHARGES HOSPITALIZATION BENEFITS LABORATORY TESTS, X-RAY, MRI, CT SCANS AND ULTRASOUND HOSPITAL ROOM AND BOARD INTENSIVE CARE UNIT PRESCRIPTION DRUGS CHEMOTHERAPY, RADIOTHERAPY AND DIALYSIS HOSPITAL ROOM CHARGES FOR COMPANION OF HOSPITALIZED DEPENDENT UNDER 18 S OLD ELIMINATION OF DEDUCTIBLE DURING HOSPITALIZATION IN US$ 400 COVERAGE OF HOSPITALIZATION RESULTING FROM AN ACCIDENT WITHIN. US$ 500 - - US$ 2,500 - US$ 5,000 US$ 100, US$ 500 - - US$ 2,500 US$ 100, US$ 500 - - US$ 2,500 US$ 100, (MAX. 240 DAYS) (MAX. 240 DAYS) US$ 100, 50% DEDUCTIBLE REDUCTION FOR HOSPITALIZATION IN. US$ 500 - - US$ 2,500 US$ 400 (US$ 800 OPTIONAL) US$ 800 (US$ 2,400 OPTIONAL) OUTPATIENT BENEFITS OUTPATIENT PRESCRIPTION DRUGS CHEMOTHERAPY, RADIOTHERAPY AND DIALYSIS FOR FOR OUTPATIENT DRUGS IN FOR FOR OUTPATIENT DRUGS IN FOR US$ 2,000 FOR OUTPATIENT DRUGS IN 80% (MAX. ) IN COUNTRY OF RESIDENCE 80% OUTSIDE COUNTRY OF RESIDENCE ( OR 80% OPTIONAL) WITH OUTPATIENT SUPPLEMENT 80% SURGERY FOR WITH OUTPATIENT SUPPLEMENT Page 2
BENEFICIOS SERIE 3000 MERIDIAN II MERIDIAN AZURE FLEXI PLAN III A.L. OUTSIDE THE U.S.A. (DEDUCTIBLE DOES NOT MATERNITY BENEFIT (AVAILABLE FOR DEPENDENT DAUGHTERS) INSIDE THE U.S.A. POLICIES WITH POLICY- HOLDER (DEDUCTIBLE APPLIES) US$ 15,000 INSIDE THE U.S.A. POLICIES WITH POLICHOLDER AND SPOUSE (DEDUCTIBLE APPLIES) US$ 7,000 US$ 7,500 US$ 5,000 US$ 2,500 MATERNITY BENEFIT DOES NOT APPLY COVERAGE FOR COMPLICATION OF PREGNANCY (ECTOPIC PREGNANCY, SPONTANEOUS ABORTION) MATERNITY BENEFITS MATERNITY COMPLICATIONS (WITH COVERED MATERNITY) UMBILICAL CORD STEM CELLS PRESERVATION NEWBORN COVERAGE (AUTOMATIC WITH COVERED MATERNITY), IV US$ 2,000 PER NEWBORN US$ 1,500 PER NEWBORN OF LIFE () (INCLUDING CONGENITAL CONDITIONS) US$ 1,500 PER NEWBORN OF LIFE () (INCLUDING CONGENITAL CONDITIONS) US$ 100,000 US$ 1,500 PER NEWBORN OF LIFE () (INCLUDING CONGENITAL CONDITIONS) OF LIFE () TUBAL LIGATION (DURING DELIVERY) (, DEDUCTIBLE DOES NOT CIRCUMCISION OF NEWBORN (IN HOSPITAL) (PER CHILD, DEDUCTIBLE DOES NOT Page 3
PHYSICAL THERAPY HAZARDOUS SPORTS EMERGENCY DENTAL TREATMENT CONGENITAL CONDITIONS (DIAGNOSED AFTER OF BIRTH) (DIAGNOSED AFTER OF BIRTH) (DIAGNOSED AFTER OF BIRTH) DURING HOSPITALIZATION. DURING HOSPITALIZATION. US$ 100,000 (DIAGNOSED BEFORE 18 S) / (DIAGNOSED AFTER 18 S) DURING HOSPITALIZATION. DURING HOSPITALIZATION. ORGAN TRANSPLANTATION US$ 1,500,000 US$ 1,500,000,000 US$ 300,000 LIVING DONOR BENEFIT US$ 15,000 US$ 20,000 US$ 20,000 OTHER BENEFITS HOME NURSING ROUTINE MEDICAL CHECK-UP AIDS TREATMENT DURABLE MEDICAL EQUIPMENT, PROSTHESES AND ORTHOPEDIC DEVICES 180 DAYS US$ 300 PER PERSON ( & SPOUSE) US$ 30,000 ( & SPOUSE) US$ 3,000 ( & SPOUSE) US$ 3,000 30 DAYS ( & SPOUSE) US$ 2,000 30 DAYS US$ 50 PER PERSON ( & SPOUSE) US$ 500 30 DAYS ( & SPOUSE) PSYCHIATRIC CONSULTATIONS US$ 200 PER VISIT/SESSION MAX. 20 VISITS/SESSIONS COSMETIC BREAST RECONSTUCTION US$ 4,000 /PER POLICY ( AND/OR SPOUSE) CHIROPRACTIC TREATMENT US$ 4,000 PERMANENT AND TOTAL DISABILITY DUE TO ACCIDENT VASECTOMY (, DEDUCTIBLE DOES NOT ROUTINE IMMUNIZATIONS FOR DEPENDENT UNDER 18 S OLD US$ 250 LOCAL AMBULANCE Page 4
BENEFICIOS SERIE 3000 MERIDIAN II MERIDIAN AZURE FLEXI PLAN III A.L. EMERGENCY MEDICAL AIR TRANSPORTATION (INCLUDED) (OPTIONAL RIDER) (OPTIONAL RIDER) (OPTIONAL RIDER) (OPTIONAL RIDER) MEDICAL REPATRIATION REPATRIATION OF MORTAL REMAINS RETURN OF MINORS TRAVEL EXPENSES FOR COMPANION ACCOMMODATION EXPENSES FOR COMPANION US$ 100, MAX. 5 DAYS US$ 100, MAX. 5 DAYS US$ 100, MAX. 5 DAYS US$ 100, MAX. 5 DAYS US$ 100, MAX. 5 DAYS TRAVEL ASSISTANCE REDUCTION OF DEDUCTIBLE 24 HOUR TELEPHONE AVAILABILITY PERSONAL TRANSPORTATION WILL BE PAID AT BY BMI WILL BE PAID AT BY BMI WILL BE PAID AT BY BMI WILL BE PAID AT BY BMI WILL BE PAID AT BY BMI ACCOMODATION ARRANGEMENTS MEDICAL MONITORING Page 5
COBERTURAS ADICIONALES RIDER SERIE 3000 MERIDIAN II MERIDIAN AZURE IDEAL FLEXI PLAN III BENEFICIOS SERIE 3000 SERIE 3000 PREFERRED SERIE 3000 PLUS SERIE 3000 SERIE 3000 LATIN SERIE AMERICA 3000 (OPTIONAL RIDER) (OPTIONAL RIDER) (OPTIONAL RIDER) (OPTIONAL RIDER) (OPTIONAL RIDER) (OPTIONAL RIDER) TERM LIFE INSURANCE HOSPITAL INCOME THE PROTECTOR (PERMANENT AND TOTAL DISABILITY) ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (AD&D) (AUTOMATICALLY INCLUDED IN ALL HEALTH PLANS AT NO ADDITIONAL COST) SECOND MEDICAL OPINION Medical review to confirm or modify the original diagnosis or treatment proposed by the attending physician for serious illnesses or major medical conditions BMI ACCESS PROGRAM TRANSPORTATION SERVICE SPECIALISTS AND HOSPITALS RX DRUGS AND MEDICAL EQUIPMENT ACCOMMODATION SERVICE Transportation to airports, hospitals and hotel in case of admission to hospital or medical appointments in the U.S. Advice and guidance for the selection of specialists or hospitals for the insured's specified health condition. Additionally, this benefit offers assistance with scheduling medical appointments as well as coordinating in-patient procedures Assistance in obtaining discounts on medicine and medical equipment required during their stay in the U.S. Recommendations for the insured to receive special rates and coordination of their stay, whether short or long term, during treatment of a given medical condition in the U.S. VIP Coordination of requirements or special care during the clients stay in the US; such as child care, home nursing, dentist and car rental Page 6