ROYAL Student health insurance plans for F-1, M-1, and J-1 visas are designed to meet most University waiver requirements and offer comprehensive coverage at an affordable price. From preventive care to mental health support, ROYAL ensures Students receive the care they need while studying in the USA. ROYAL Series ACA-Comparable Student Health Insurance meets MANY Univ ersity Waivers After purchase you will receive a Certification of Coverage to upload into your University waiver portal. University Waiver Forms also can be emailed to info@visitinsurance.com for processing. ROYAL Student Insurance ACA-Comparable Unlimited Medical Plan Cheaper than your School Plan! En roll & Save Today! Accepted by These Schools List of ROYAL Schools ROYAL Coverage Highlights & Brochure ROYAL Plans are dedicated to students with F-1 , M-1 or J-1 (student) visas, offering comprehensive and affordable health insurance to students going to the USA for an undergraduate or graduate program. Unlimited Medical Insurance Maternity Pre-Existing Conditions Medical Evacuation & Repatriation Preventive Care Mental Health ROYAL Series Brochure ACA-Comparable Student Health Insurance ROYAL 500 ROYAL 500 is ACA-Comparable Health Insurance with Unlimited Medical Coverage $500 Annual Deductible Ages Annual Premium Cost 17-24 $1,025.65 25-29 $1,496.50 30-35 $2,507.55 Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. $500 Annual Deductible Unlimited Medical Coverage Coinsurance 80% Pre-Existing Conditions (No Wait) Preventive Care 100% Hospitalization 80% Mental Health 80% Maternity 80% Student Health $0 copay Prescriptions $15/$40/$75 Recreational Sports Medical Evacuation $100,000 Repatriation $25,000 5-Month Enrollment Required ACA-Comparable Health Insurance Lower Deductible! ROYAL 500 is Accepted by Your School! Quote & Enroll ROYAL Today! ACA-Comparable Student Health Insurance ROYAL 100 ROYAL 100 is ACA-Comparable Health Insurance with Unlimited Medical Coverage $100 Annual Deductible Ages Annual Premium Cost 17-24 $1,419.85 25-29 $1,923.55 30-35 $3,376.25 Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. $100 Annual Deductible Unlimited Medical Coverage Coinsurance 80% Pre-Existing Conditions (No Wait) Preventive Care 100% Hospitalization 80% Mental Health 80% Maternity 80% Student Health $0 copay Prescriptions $5/$50/$75 Recreational Sports Medical Evacuation $100,000 Repatriation $25,000 5-Month Enrollment Required ACA-Comparable Health Insurance Low Deductible! ROYAL 100 is Accepted by Your School! Quote & Enroll ROYAL Today! ACA-Comparable Student Health Insurance ROYAL Plus ROYAL Plus is ACA-Comparable Health Insurance with Unlimited Medical Coverage $0 (NO) Annual Deductible Ages Annual Premium Cost 17-24 $1,996.55 25-29 $2,861.60 30-35 $7,270.80 Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. NO Deductible! Unlimited Medical Coverage Coinsurance 100% Pre-Existing Conditions (No Wait) Preventive Care 100% Hospitalization 100% Mental Health 100% Maternity 100% Student Health $0 copay Prescriptions $5/$40/$60 Recreational Sports Medical Evacuation $100,000 Repatriation $25,000 12-Month Enrollment Required Fully ACA-Compliant Plan Best Coverage! ROYAL Plus is Accepted by Your School! Quote & Enroll ROYAL Today! WAIVE and SAVE! School Plans Cost More than You Think! WAIVE your School Health Plan & SAVE Money with ROYAL instead! IT'S EASY TO WAIVE! Let Us Show You How Money Back Guarantee If your school denies your waiver, you may request a full refund. Refund requests must be submitted within 14 days of the waiver denial date and only if the plan has not been used. Proof of the school's denial is required. Please email your request to VISIT® Insurance at info@visitinsurance.com Please Note: VISIT® Insurance provides this information as a helpful resource for international students. However, its inclusion does not imply any affiliation or official relationship between your school and VISIT® Insurance or our website. Please confirm directly with your school and our customer service team to ensure that our insurance plans meet your school's requirements for international student coverage. More Health Insurance for Students, J-Visa, OPT & Study Abroad Protection while STUDYING Away from Home Students Ideal for F-1, M-1, J-1 & OPT Affordable International Student health insurance that meets visa requirements and provides the coverage required by Schools , including Mental Health, Maternity and Sports. Choose the health insurance plan that’s just right for your needs, your budget and your School requirements! J-Visa Ideal for J-1 or J-2 Visa Health Insurance designed to meet the US Department of State J-Visa insurance requirements to protect Students, Scholars, Families and Cultural Exchange Visitors & Groups while in the USA. Includes $100,000 Medical (or more), Medical Evacuation & Repatriation and Mental Health. (J-2s may enroll without the J-1) OPT Students Ideal for F-1 Students on OPT Health Insurance desiged for OPT Students with F-1 Visa as low as $42 per month! OPT students may no longer be eligible for the University Plan and not yet be eligible for an employer's health insurance plan. We offer many OPT Student Health Insurance Plans for your entire year on OPT. Study Abroad Ideal for Study Abroad Health Insurance designed for Study Abroad , ideal for Individuals, Groups & Faculty-Led Programs. Choose from several competitively priced Study Abroad plans, including our proprietary VISIT® EXPLORER that includes important Mental Health coverage while Traveling & Studying Abroad! About VISIT ® International STUDENT & TRAVELER Health Insurance At VISIT ® International Health Insurance, we offer superior health insurance plans designed to meet the specific needs of International Students, Study Abroad, Schools & Travelers. With a focus on reliability and customer satisfaction, we are your trusted partner for the best health coverage. Since 1979, we've satisfied over 1 Million clients just like you! Try us Today!

Mountbatten Program International Medical Insurance Coverage 2024-2025 Contact VISIT Insurance by Email: mountbatten@visitinsurance.com or by Phone: 1-703-660-9062 BENEFIT SUMMARY COVERAGES Medical Maximums per Injury or Illness Lifetime Maximum COVID-19 TELADOC Common issues treated through Teladoc includes: allergies, bronchitis, cold and flu symptoms, respiratory infections, skin problems, sinus problems, and much more. Click here to Get Started Deductible per Period of Coverage *For a covered medical expense, the Deductible is the portion of your medical bill that is your responsibility to pay to the doctor or hospital. Deductible – Emergency Room (applies only to Emergency Room visits) COPAYS COINSURANCE Pre-existing Conditions Hospital Room and Board Local Ambulance Intensive Care Unit Outpatient Treatment Mental Health Disorders Prescription Drugs Physical Therapy Team/Club/League Sports (Collision Sports are excluded from this coverage. The following sports are NOT covered American football, boxing, ice hockey, lacrosse, full contact martial arts, rodeo, rugby and wrestling.) Click here for Sport Coverage Overview Adventure Sports/Hazardous Sports Dental Treatment due to Accident Dental Treatment to alleviate pain Emergency Medical Evacuation (not subject to Deductible or Coinsurance) Repatriation of Remains (not subject to Deductible or Coinsurance) Emergency Reunion (not subject to Deductible or Coinsurance) Political Evacuation (not subject to Deductible or Coinsurance) Terrorism (not subject to Deductible or Coinsurance) Accidental Death and Dismemberment (not subject to Deductible or Coinsurance) Incidental Home Country Coverage Travel Assistance March 18, 2025-2026 - Click Here to review the policy Exclusions / Click Here Additional Sports Rider March 18, 2024-2025 - Click Here to review the policy Exclusions / C lick Here Additional Sports Rider BENEFTIS $250,000 per illness or injury $5,000,000 Lifetime When the Lifetime Maximum is reached, no further benefits, reimbursements or payments will be available under this insurance. Special Note regarding Alcohol-Related Illness or Injury: Illness or Injury sustained as the result of being under the influence alcohol, liquor, intoxicating substances, narcotics or drugs are excluded on the policy. COVID-19 , the disease caused by the novel coronavirus, generally WILL be covered as would any other illness under the MOUNTBATTEN PROGRAM Health Plan, including testing and treatment up to the policy limit. For testing to be covered by the Insurance, you must be symptomatic. Please be sure your Doctor’s Office submits your test as a SICK visit. If the test is submitted as a Preventive Care visit the claim will be denied. Call 1-800-TELADOC (835-2362) or visit www.teladoc.com to access the TELADOC services – Service is FREE! With TELADOC you can be connected with a licensed physician in minutes, not hours or days like you would at the ER, Urgent Care, or with your Doctor. And, you can get care from wherever you are home, work or traveling. Except for Emergency Room, $100 per Illness or Injury. Subject to $500 but only if no in-patient admission The $500 ER Deductible applies to illnesses only, and only those illness that do not result in hospital admission. If the ER visit is due to an Injury, the $500 Deductible does not apply. (For an Injury, the standard $100 Deductible would apply.) Urgent Care - $50 Walk-in Clinic - $20 (Deductible does not apply when there is a co-pay) In-Network: Plan pays 90% of Eligible Medical Expenses, up to a USD $1,000. Out-of-Network: Plan pays 80% of Eligible Medical Expenses, up to the Maximum Limit. (maximum out-of-pocket resets after 12 months from the coverage start date) Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within thirty-six (36) months prior to the Effective Date are excluded until the Insured Person has maintained twelve (12) months of continuous coverage under this insurance. • Period of Coverage Limit (after 12 months): $500 • Maximum Limit: $1,500 Average Semi-Private room rate, including nursing services Injury: Paid at 100% Illness: Paid at 100% for an illness resulting in hospitalization Eligible Medical Expenses are limited to Usual, Reasonable and Customary Charges Subject to deductible Usual, Reasonable and Customary Charges Usual, Reasonable and Customary Charges Inpatient Mental or Nervous / Substance Abuse • Maximum Limit: $10,000 • Not covered if incurred at the Student Health Center Outpatient Mental and Nervous / Substance Abuse • Maximum Limit per day: $50 • Maximum Limit: $500 Usual, Reasonable and Customary Charges - Reimbursement Covered as a medical expense and is subject to the Deductible and co-insurance. If the medical condition is covered, the prescriptions will also be covered. Prescriptions are a reimbursable expense. You will need to pay for your prescription first and then complete a claim form to be reimbursed. Click here to download a copy of the card to be used at your local pharmacy. Click here to compare prices for your prescription. Limit one visit per day Medical order or Treatment plan required Usual, Reasonable and Customary Charges 100% after deductible is met NO COVERAGE CLICK HERE to apply for a short term policy that includes Hazardous Sports for the following sports: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snowmobiling, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris, and windsurfing. $500 Maximum per Certificate Period, No Maximum per Tooth $350 Maximum per Certificate Period $50,000 per Participant Lifetime Maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $25,000 Maximum Cremation/Burial: $5,000 maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $15,000 Lifetime Maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $10,000 Lifetime Maximum Please call (317) 655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $50,000 Lifetime Maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $25,000 per Participant Up to (2) cumulative weeks 24-hour Worldwide Assistance 24-Hour Worldwide Assistance Services: 1-866-799-8270/ 1-317-927-6896 August 19, 2024-2025 - Click Here to review the policy Exclusions / C lick Here Additional Sports Rider TELADOC Call 1-800-TELADOC (835-2362) visit www.teladoc.com Access TELADOC services – Service is FREE! TELADOC Service is FREE! With TELADOC you can be connected with a licensed physician in minutes, not hours or days like you would at the ER, Urgent Care, or with your Doctor. And, you can get care from wherever you are home, work or traveling. Common issues treated through Teladoc includes allergies, bronchitis, cold and flu symptoms, respiratory infections, skin problems, sinus problems, and much more. Click here to Get Started TELADOC should be used for NON-EMERGENCY health issues ONLY! To set-up your account, please go to www.teladoc.com or download the APP. When setting up your account, please use the IMG Insured ID Number listed on the attached ID card and Zip Code 46208. Hazardous Sports Coverage (not covered by the MOUNTBATTEN PROGRAM Health Insurance Plan) If you will be participating in any hazardous sports during your stay in the USA, please consider purchasing a short term policy that includes Hazardous Sports coverage for the following sports: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snowmobiling, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris, and windsurfing. Be sure to only purchase for the days you will be participating in the sports activity. Click Here to order the Patriot Plan, please be sure to include the Adventure Sports Rider when purchasing. COVID-19 Coverage COVID-19 , the disease caused by the novel coronavirus, generally WILL be covered as would any other illness under the Mountbatten Health Insurance policy, including testing and treatment up to the policy limit. COVID-19 TESTING - COVID-19 Testing is only covered if you are symptomatic. The test will not be covered for travel or non-illness related testing. Your doctor must submit the COVID-19 test as a “sick visit” and provide the medical records when submitting your claim. You should also submit a Patient Claim Form through your MyIMG Account explaining your symptoms. COVID-19 VACCINES - Vaccines are currently being offered for FREE at most facilities. An administrative fee may apply. The COVID-19 vaccine is NOT covered on your Mountbatten Health Insurance Patriot Exchange Plan. COVID-19 TREATMENT - If you test positive for COVID-19, your medical expense will be covered by the UnitedHealthcare Plan up to the policy maximum of $250,000. If you are experiencing symptoms related to COVID-19, it is important that you first contact your doctor or urgent care facility by phone to review the proper protocol to receive a test and treatment for COVID-19 . Be sure to follow the current CDC Guidelines . When going to the doctor, please be sure to take your UnitedHealthcare Insurance card Health Insurance Coverage During 30-Day Grace Period Your health insurance ends on last day of your program. If you are planning to stay in the USA for up to an additional 30 days, be sure to purchase a health insurance plan to cover you for medical illnesses or injuries during this time period. To purchase a short-term health insurance plan online Click Here or contact VISIT® Insurance at 1-703-660-9062. How To Set-up Your MYIMG Account MyIMG Service at your fingertips anytime, anywhere - that’s what MyIMG provides. MyIMG is our proprietary online service that allows you to access information and manage your IMG accounts, 24 hours a day, seven days a week, from anywhere in the world. Our service centers in the U.S. and Europe are always available to help or handle emergencies 24 hours a day, but through MyIMG you have immediate access to a wealth of information about your account and can manage routine areas to help you save time when you may need it most. Some features include: Get explanation of benefits Initiate precertification Obtain certificate documents Locate a provider Recommend a provider/facility Request or print ID cards Submit a Claim online Check the status of a Claim Don't have an account? Create an account You will need to put in your Health Insurance ID Number and Date of Birth to set-up an account. If you do not have your Health Insurance ID Number, please contact our office at 7 03-660-9062 Important Insurance Terms What is a Deductible? For a covered medical expense, the deductible is the portion of your medical bill that is your responsibility. The deductible will first be subtracted from the total medical bill and you will need to pay this portion directly to the doctor or hospital. The deductible is “per illness or injury,” not per visit to the doctor. This means if you have to go to the doctor more than once for the same illness or injury, you will only need to pay the deductible one time. Your deductible is $100 per illness or injury. The Emergency Room deductible is $250 per ER visit. What is Co-insurance? Coinsurance is the term used by health insurance companies to refer to the amount that you are required to pay for a medical claim, apart from the deductible. Your plan pays 100% of Eligible Medical Expenses subject to Usual, Reasonable and Customary charges. Charges above Usual, Reasonable and Customary will be your responsibility. You are strongly encouraged to utilize the independent Preferred Provider Organization (PPO) network to avoid being responsible for medical expenses over and above Usual, Reasonable and Customary. How do I Pay for My Prescriptions? Your Plan includes a Discount Prescription Drug Benefit through Universal Rx . When going to a pharmacy, please present the MOUNTBATTEN PROGRAM HEALTH Plan ID Card, the prescription discount information is included on the right side of the card. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after any discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription cost, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible of $100 per illness or injury applies. Important Information: Universal Rx Pharmacy Help Desk: 1-800-329-0988 or www.imgpoc.com What is a pre-existing condition? Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within thirty-six (36) months prior to the Effective Date are excluded until the Insured Person has maintained twelve (12) months of continuous coverage under this insurance. • Period of Coverage Limit (after 12 months): $500 • Maximum Limit: $1,500 Definition of Pre-existing Condition as defined by the Certificate: “Pre-existing Condition: Any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the three (3) years prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.” What is Precertification? Precertification is a requirement under your certificate for certain medical services. Pre-certification is a general determination of medical necessity only, not an assurance of coverage, verification of benefits or a guarantee of payment. The following must always be precertified for medical necessity before admission or receiving the treatments and/or supplies: Any treatment requiring inpatient hospitalization Surgery or surgical procedure, including outpatient surgery CAT scans or MRI's Care in an extended care facility Home nursing care Chemotherapy Radiation Therapy Interfacility Ambulance Transfer During the precertification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary. Precertification may be initiated by you, your representative or your medical provider. This can be done through MyIMG, through the Client Resources page of www.IMGLOBAL.com or by calling IMG at 1-317-655-4500. Most U.S. hospitals and physicians are familiar with the precertification process and will make the phone call for you, though they are not required to do this. You are responsible for ensuring the precertification process is done five days before you are hospitalized or within 48 hours after an emergency admission to the hospital. Click here to submit a Precertification online What is a Reasonable & Customary charge? A Usual, Reasonable & Customary (URC) charge is the amount normally charged by medical service providers for similar services and supplies within the geographic area in which the charge is incurred. What is Medical Evacuation? Medical Evacuation means transferring the insured person to the nearest hospital or medical facility in case of an emergency injury or sickness or back to his/her home country. It can be done by any necessary means of transportation. What is Repatriation? In case of death, the Repatriation benefit covers the transportation of your remains back to your family and your home country. Are Injuries from Sports Covered? Recreational sports only are covered through the regular medical coverage. Should you need coverage for Hazardous/Adventure Sports Click Here to order the Patriot Plan, please be sure to include the Adventure Sports Rider when purchasing. When purchasing coverage, please be sure that your particular sport is covered. Is there Dental Coverage? There is limited coverage for dental pain and injury to natural teeth on your policy. Relief of sudden and unexpected pain to sound, natural teeth, including but not limited to fillings will be covered up to $350 maximum. Injury due to an accident will be covered up to $500 per Accident maximum. Do I need a referral to go to a Specialist? A doctor’s referral typically is not required. If you have a special medical condition, we recommend that you check with the Claims Office 1-317-655-4500 prior to making an appointment with a Specialist. Where Can I Find a Doctor or Hospital? What are the Provider Networks? A provider network is a list of the doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that isn't contracted with the plan is called an “out-of-network provider.” When contacting a doctor or hospital, please be sure to let them know that you are in the United Health Care (PPO) Network. How do I search for a local doctor or hospital? To search for a medical care provider within the United Health Care (PPO) network, please go to: United Health Care Local Doctors and Hospitals in Brooklyn Doctors Primary Care Clinics Urgent Care Hospitals Local Doctors and Hospitals in New York City Doctors Primary Care Clinics Urgent Care Hospitals Local Doctors and Hospitals in New Jersey Doctors Primary Care Clinics Urgent Care Hospitals *Please note - In-network medical care providers may be subject to change. How to File a Claim Where do I find my Insurance ID Number? Your ID Number is located on your Insurance Card. What do I do if I lose my ID Card? Please contact VISIT at 1-703-660-9062 or by email at mountbatten@visitinsurance.com . Be sure to let us know that you are in the Mountbatten program. You can also print your ID Card by going to your MyIMG account. Do I need to go to a specific doctor or hospital if I need medical attention? You are strongly encouraged to search for doctors or hospitals that utilize the United Health Care (PPO) network. Refer to 'Where Can I Find a Doctor or Hospital? ' for details. If an emergency: • Go directly to the hospital, or call 911 for emergency response • Call the 24-hour assistance service center at the number listed on your ID card to alert the center of your situation. 1-317-655-4500. Precertification Precertification is a requirement under your certificate for certain medical services. Pre-certification is a general determination of medical necessity only, not an assurance of coverage, verification of benefits or a guarantee of payment. The following must always be precertified for medical necessity before admission or receiving the treatments and/or supplies: Any treatment requiring inpatient hospitalization Surgery or surgical procedure, including outpatient surgery CAT scans or MRI's Care in an extended care facility Home nursing care Chemotherapy Radiation Therapy Interfacility Ambulance Transfer During the precertification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary. Precertification may be initiated by you, your representative or your medical provider. This can be done through MyIMG, through the Client Resources page of www.IMGLOBAL.com or by calling IMG at 1-317-655-4500. Most U.S. hospitals and physicians are familiar with the precertification process and will make the phone call for you, though they are not required to do this. You are responsible for ensuring the precertification process is done five days before you are hospitalized or within 48 hours after an emergency admission to the hospital. Click here to submit a Precertification online Do I Need To Submit A Claim Form? ONLINE CLAIM SUBMISSION PROCESS CLAIM FORMS: There are TWO (2) different claim forms, and BOTH ARE REQUIRED FOR EACH SEPARATE CLAIM. There is a DOCTOR claim form that must be completed and submitted by the doctor/hospital/medical provider. There is a PATIENT claim form, that must be completed and submitted BY YOU. If the insurance company does not receive BOTH completed claim forms, they will not begin to process your claim. PATIENT Claim Form The PATIENT Claim Form can be downloaded at www.visitinsurance.com/mountbatten.html or alternatively you can submit your claim online through your MyIMG Account. (You may also submit a completed PATIENT Claim Form by email: customercare@imglobal.com or fax: 1-317-655-4505). The PATIENT Claim Form must be submitted within 90 days of treatment. All documents from you and your doctor must be received within 180 days to process your claim. DOCTOR Claim Form Be sure your Doctor files your claim through UnitedHealthcare using the information found on your ID Card. This will allow your doctor to file your claim electronically which will help expedite the claims process. Your ID card includes a Member ID Number and a Group Number your Doctor must use to file the claim properly. Improperly filed claims may be delayed or denied. Should your Doctor’s Office have any questions, please have them call UnitedHealthcare directly at: 1-888-543-1238. UnitedHealthcare Member ID: xxxxx (This number is found on your ID Card and is unique for each person) Group Number: 76570070 (This number is the same for all Mountbatten Trainees) Payor ID: USN01 (This number is the same for all Mountbatten Trainees) DOCTOR CLAIM FORMS can be filed electronically to UnitedHealthcare or mailed to: UHC Global P.O. Box 30526 Salt Lake City, UT 84130-0526 (This address is only for the Doctor’s Office to submit their Claim Forms) PRESCRIPTIONS: In addition to your MOUNTBATTEN PROGRAM Health Plan ID card, attached is your Prescription Discount Card for your medications. When going to a pharmacy, please present the MOUNTBATTEN PROGRAM HEALTH Plan ID Card, the prescription discount information is included on the right side of the card. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after any discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription cost, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible of $100 per illness or injury applies. For faster service on your claim, we suggest that you use the MyIMG system online to submit your claim. Where do I send my Claim Form? Click here to download a CLAIM FORM Mail PATIENT CLAIM Forms to: International Medical Group, Inc. Claims Department PO BOX 240429 Apple Valley, MN 55124 Phone: 1-317-655-4500 Fax: 1.317.655.4505 Email: customercare@imglobal.com How do I check the status of a claim? Log into your MyIMG Account and check the Claims tab for updates Call 1-317-655-4500 Email the Claims Office at customercare@imglobal.com to request an update on your claim. Be sure to include your full name, your IMG ID Number from your health insurance ID card and the date of the doctor's visit that you are requesting an update. What do I do if the claim is showing as PENDING? If your Claim is showing as PENDING, please be sure to check the status of the claim on your MyIMG Account to see what information is needed to finalize your claim. There is no record of my claim Contact your doctor's office and ask them to submit the claim to IMG. If they say they have already submitted the claim, be sure to verify the address they sent the claim to and the date it was sent. Email this information to customercare@imglobal.com and ask the Claims Office to research their records to see if the claim is in their system. If the Claims Office is unable to locate the claim, please contact your doctor's office and ask them to resubmit the claim. Claims can be mailed to: UHC Global P.O. Box 30526 Salt Lake City, UT 84130 Patient to submit a completed IMG Claim Form You must complete a PATIENT IMG Claim Form to process your claim. This form can be completed online through your MyIMG Account or you can download the IMG Claim Form and mail it or fax it to the claims office. Charges pending receipt of medical records requested from provider To process your claim, your doctor must provide the medical records to IMG for your treatment. Please contact your doctor's office and ask them to submit your medical records to the IMG. Medical records can be mailed to: UHC Global P.O. Box 30526 Salt Lake City, UT 84130 Your file has been closed due to a lack of response This means that additional information has been requested but the Claims Office has not received the information. The file can be reopened once the information is received. In order to process these charges, please submit on a HCFA/UB Form Indicating Standardized procedure (CPT) and Diagnosis (ICD) codes. These forms are standard forms that doctors use to file a claim with an insurance company. Your doctor should have these forms available. If they are not sure what to file or have questions, please have the them call UHC Global at 1-888-543-1238. How long do I have to file a claim? Your IMG PATIENT Claim Form must be submitted to the IMG Claims Office within 90 days of your visit to the doctor, urgent care, emergency room and/or hospital. You and your doctor, hospital and other healthcare and medical service providers and suppliers shall have one hundred eighty (180) days from the date a claim is incurred to submit a complete Proof of Claim, medical records and any additional information needed to process your claim. IMG Privacy Policy - www.imglobal.com/legal/privacy-policy How to Pay for My Prescription? Your MOUNTBATTEN PROGRAM Health Plan ID card includes your Prescription Discount information for your medications. When going to a pharmacy, please present the MOUNTBATTEN PROGRAM HEALTH Plan ID Card, the prescription discount information is included on the right side of the card. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after any discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription cost, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible of $100 per illness or injury applies. Prescriptions can be filled at ANY Pharmacy . Please present your Mountbatten Program Health Plan ID card to the Pharmacy. If the prescription is eligible for a discount, it will be applied when you purchase your prescription. The Universal Rx Discount information is located on the right side of your Health Insurance ID card (as shown below) or you can download a copy of the card by going to https://imgpoc.com . Please pay any remaining pharmacy costs due after the discount and keep the receipt and a copy of the prescription. Steps for submitting your CLAIM for REIMBURSEMENT Complete and submit a PATIENT Claim Form (include your Doctor visit and prescriptions on the same PATIENT CLAIM FORM) Include a copy of the Receipt. Include a copy of the Prescription (this can be the Prescription Information that is typically stapled to the prescription bag) The Claim can be submitted online through your MyIMG Account Reimbursements are only for covered medical expenses, not for pre-existing conditions. Additional discounts may be available through the pharmaceutical company that manufactures your prescription.) Important Contact Numbers Plan Administrator: International Medical Group, Inc. (IMG) To a Report a Claim, Verify Eligibility or Check on the Status of a Claim Contact: International Medical Group, Inc. Claims Department PO BOX 240429 Apple Valley, MN 55124 Phone: 1-317-655-4500 Fax: 1-317-655-4505 Email: customercare@imglobal.com 24-Hour Worldwide Assistance Services: 1-317-927-6896 Provider Claim Submission: UHC Global P.O. Box 30526 Salt Lake City, UT 84130 Telephone: 1-888-543-1238 Preferred Provider Network: United Health Care Agent: VISIT® International Health Insurance For answers to General Questions, ID card replacement, General Claims Questions contact your Agent: VISIT® International Health Insurance Email: mountbatten@visitinsurance.com Phone: 1-703-660-9062 Fax: 1-703-991-9164 Office Hours: Monday – Friday, 9am to 6pm USA Eastern Time Emergency 24/7 Assistance: 1-317-655-4500 After Hours: Please contact us by email at mountbatten@visitinsurance.com Underwriter: SiriusPoint Specialty Insurance The Mountbatten Health Insurance plan is underwritten by SiriusPoint Specialty Insurance . This insurance and its risks are underwritten by the Company as the insurer and carrier, and the Company is solely obligated and liable for the coverage and benefits provided by this insurance. Address 8000 Fort Hunt Road Alexandria, VA 22308 Phone 703-660-9062 USA ET Email info@visitinsurance.com Connect Contact VISIT Health Insurance

Explore comprehensive International Student Health Insurance Plans for F-1 students. Affordable coverage for global students, ensuring health and safety while studying in the U.S. CHS Schools Health Insurance for International Students The following insurance plans are ideal for International Students on an F-1 Student Visa Please Call 703-660-9062 or Email info@visitinsurance.com for Assistance! International STUDENT Insurance ACA Plans with "Unlimited" Medical Coverage ROYAL ACA-Comparable ROYAL is ACA-Comparable Health Insurance with Unlimited Medical Coverage and Choice of Deductibles ROYAL 500 as low as $967 /year ROYAL 100 as low as $1,314 / year ROYAL PLUS as low as $1,843 / year For Students with F-1 , M-1 or J-1 visas, ROYAL offers comprehensive and affordable health insurance to Students going to the USA for an undergraduate or graduate program. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. ROYAL Quote & Buy ELITE ACA-Compliant ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and Choice of Deductibles ELITE 450 as low as $1,500 / year ELITE 250 as low as $1,740 / year ELITE PLUS as low as $2,135 / year For Students with an F-1 student visa whose University requires a fully ACA-Compliant health plan with your choice of either $450 or $250 or ELITE PLUS with $0 deductible. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. ELITE Quote & Buy UNITED ACA-Comparable UnitedHealthcare is ACA-Comparable Insurance with Unlimited Medical Coverage & Choice of Deductibles BASIC ($500K) as low as $893 / year PLUS as low as $1,289 / year ELITE as low as $1,670 / year Choice of 4 Student health insurance plans to meet a variety of needs and budgets. UnitedHealthcare is the largest medical insurance provider network in the USA. Includes Pre-Existing Conditions (waiting period may apply), Preventive Care, Mental Health & Maternity. UNITED Quote & Buy Basic Coverage EXPLORER No Visa Required! EXPLORER (Plan E Plus) is essential health insurance for Students, Study Abroad, Schools & Any Travelers Worldwide and includes Mental Health Inexpensive Daily Rates, with a choice of Medical ($50,000 to $1,000,000) and Deductibles ($0 up to $500), EXPLORER meets many needs & budgets. $100K+ is J-1 Visa compliant EXPLORER Quote & Buy STUDENT Secure StudentSecure offers FOUR levels of coverage, Basic, Smart and Elite to meet most needs and budgets for Students studying away from home. Smart and Elite plans include Maternity and some Pre-Existing Conditions coverage. StudentSecure Quote & Buy CROMO $100K or $250K CROMO is recommended for Students with an F-1, M-1 or J-1 visa, and provides comprehensive and VERY affordable health insurance for Students going to the USA for an undergraduate or graduate program. CROMO Quote & Buy Patriot PEP Exchange Plan PATRIOT EXCHANGE PLAN ("PEP") is Medical Insurance for Individuals and Groups involved in Educational or Cultural Exchange. Pays 100% of covered medical expenses and prescriptions after deductible, and includes Mental Health coverage. PEP Quote & Buy STUDENT Health Advantage Student Health Advantage (SHA) provides a higher level of coverage for Students studying abroad worldwide, and the SHA Platinum plan offers some additional coverage for Maternity and Pre-Existing Conditions. SHA Quote & Buy GEOBlue Navigator GeoBlue Navigator is medically-underwritten health insurance for more comprehensive coverage while Studying Abroad outside your home country. Get better coverage with GeoBLUE Navigator today! Navigator Quote & Buy How do I Choose my International Health Insurance? Students, J-Visa, OPT & Study Abroad Health Insurance while Studying Away from Home Students Ideal for F-1, M-1, J-1 & OPT Affordable International Student health insurance that meets visa requirements and provides the coverage required by Schools , including Mental Health, Maternity and Sports. Choose the health insurance plan that’s just right for your needs, your budget and your School requirements! J-Visa Ideal for J-1 or J-2 Visa Health Insurance designed to meet the US Department of State J-Visa insurance requirements to protect Students, Scholars, Families and Cultural Exchange Visitors & Groups while in the USA. Includes $100,000 Medical (or more), Medical Evacuation & Repatriation and Mental Health. (J-2s may enroll without the J-1) OPT Students Ideal for F-1 Students on OPT Health Insurance desiged for OPT Students with F-1 Visa as low as $42 per month! OPT students may no longer be eligible for the University Plan and not yet be eligible for an employer's health insurance plan. We offer many OPT Student Health Insurance Plans for your entire year on OPT. Study Abroad Ideal for Study Abroad Health Insurance designed for Study Abroad , ideal for Individuals, Groups & Faculty-Led Programs. Choose from several competitively priced Study Abroad plans, including our proprietary VISIT® EXPLORER that includes important Mental Health coverage while Traveling & Studying Abroad! Please Note: VISIT® Student Insurance provides this information as a helpful resource for international students. However, its inclusion does not imply any affiliation or official relationship between your school and VISIT® Insurance or our website. Please confirm directly with your school and our customer service team to ensure that our insurance plans meet your school's requirements for international student coverage. About VISIT International STUDENT & TRAVELER Health Insurance At VISIT ® International Health Insurance, we offer superior health insurance plans designed to meet the specific needs of International Students, Study Abroad, Schools & Travelers. With a focus on reliability and customer satisfaction, we are your trusted partner for the best health coverage. Since 1979, we've satisfied over 1 Million clients just like you! Try us Today! Address Post Office Box 210 Mount Vernon, VA 22121 Telephone 703-660-9062 9am-6pm USA ET Email info@visitinsurance.com Connect

Health Insurance for International Students & Travelers going to Canada CANADA Student & Traveler Insurance Studying and/or Traveling in Canada can be the opportunity of your lifetime! But Health Insurance is not only important, it may also be required by your visa and/or your school. Choose your health plan below & Enroll Today! Avyza Student Plan Study in Canada with Peace of Mind While studying in Canada, you are not covered by the provincial health insurance plan, and a doctor’s visit or a short hospital stay can be very expensive. In addition, the vast majority of higher education institutions require you to have health insurance before the start of the semester. Start shopping for an insurance policy tailored to your student budget today! Avyza Canada Student Plan StudentSecure Student Health Plans for Every Need StudentSecure is for Students studying abroad in the UK or worldwide, and offers a choice of 4 levels of coverage: Budget, Select, Smart & Elite . Enroll in StudentSecure Today! Quote & Enroll Now PATRIOT EXCHANGE (PEP) Student & Cultural Exchange PEP is for Students or Cultural Exchange in the UK or worldwide! PEP includes all insurance requirements for Study Abroad. Enroll in PEP Today! Quote & Enroll Now EXPLORER Student & Traveler Students & Any Travelers Worldwide EXPLORER is ideal for ANY Travel or Study Abroad Worldwide, with your choice of Medical & Deductible and includes Mental Health & Telehealth. EXPLORER does not require any visa! Quote & Enroll Now

WAIVE & SAVE! Waive your School Insurance Plan and Save Money with Our Plan instead! Waiver Guaranteed or Money Back! WAIVERS You Have Freedom of Choice! STUDENT Insurance Accepted by Most Schools It's Easy to Waive & Save! Search YOUR School to Find the Plan Accepted at your School Try our helpful AI Tools at lower left or contact us at info@visitinsurance.com or 703-660-9062 Waive & Save! Our Student Health Plans are Less Expensive than your School Plan Our Fully ACA-Compliant ELITE , ACA-Comparable ROYAL , USCHIP & UnitedHealthcare plans are acceptable as Waivers at most Schools. Or Choose BASIC plans like EXPLORER , StudentSecure or Cromo ! Enroll Today and we'll submit your Insurance Waiver for you! WAIVER APPROVAL GUARANTEE Full Refund within 14 days (restrictions may apply) Search for Your SCHOOL Here Read the WAIVER Blog! IT'S EASY TO WAIVE! Let Us Show You How Money Back Guarantee If your school denies your waiver, you may request a full refund. Refund requests must be submitted within 14 days of the waiver denial date and only if the plan has not been used. Proof of the school's denial is required. Please email your request to VISIT® Insurance at info@visitinsurance.com Student & Scholar Unlimited Medical Insurance (ACA Plans) Accepted by Most Schools! Enroll in Minutes & Save Search for Your SCHOOL Here ELITE Fully ACA-Compliant Insurance Starting at $1,621 per year! Quote Now ELITE Details ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and Choice of Deductibles ELITE 450 as low as $1,621 / year ELITE 250 as low as $1,909 / year ELITE PLUS as low as $2,460 /year For Students with an F-1 or J-1 student visa whose University requires a fully ACA-Compliant health plan with your choice of $800, $450, $250 or ELITE PLUS with $0 deductible. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. ROYAL ACA-Comparable Insurance Starting at $1,026 per year! Quote Now ROYAL Details ROYAL is ACA-Comparable Health Insurance with Unlimited Medical Coverage and Choice of Deductibles ROYAL 500 as low as $1,026 / year ROYAL 100 as low as $1,420 / year ROYAL PLUS as low as $1,997 / year For Students with F-1, M-1 or J-1 visas, ROYAL offers comprehensive and affordable health insurance to Students going to the USA for an undergraduate or graduate program. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. US CHIP Plans Search your School to find the Acceptable Insurance Plans! Quote Now USCHIP Details Search Your School to find the USCHIP Student Plan accepted by your School! UnitedHealthcare Plans Compare ACA-Comparable & other Student & Scholar Plans! Quote Now UHC Details UnitedHealthcare is ACA-Comparable Insurance with Unlimited Medical Coverage & Choice of Deductibles BASIC ($500K) as low as $893 / year PLUS as low as $1,289 / year ELITE as low as $1,670 / year Choice of 4 Student health insurance plans to meet a variety of needs and budgets. UnitedHealthcare is the largest medical insurance provider network in the USA. Includes Pre-Existing Conditions (waiting period may apply), Preventive Care, Mental Health & Maternity. Student - Cultural Exchange - Traveler Essential Coverage at a Lower Price (non-ACA Plans) Accepted by Many Schools! Enroll in Minutes & Save StudentSecure 4 Student Plans for Every Need Quote Now Plan Details StudentSecure offers FOUR levels of coverage, Basic , Smart , Select and Elite to meet most needs and budgets for Students studying away from home. The Elite plan includes Maternity and Pre-Existing (6-month waiting period) Conditions coverage as well as $200 for Preventive Care after 6-months of continuous coverage. Select and Elite plans include $5,000 per injury coverage for athletics sports, Maternity and some Pre-Existing Conditions coverage. CROMO Coverage at a Lower Price Quote Now Plan Details CROMO is recommended for Students with an F-1, M-1 or J-1 visa, and provides comprehensive and VERY affordable health insurance for Students going to the USA for an undergraduate or graduate program. CROMO is $100,000 Medical Cover CROMO PREMIER is $250,000 PATRIOT EXCHANGE Student & Cultural Exchange Quote Now Plan Details PATRIOT EXCHANGE PLAN (PEP) offers coverage for Students and Cultural Exchange Programs worldwide! EXPLORER Student & Traveler Worldwide Quote Now Plan Details EXPLORER (Plan E Plus) is essential health insurance for Students, Study Abroad, Schools & Any Travelers Worldwide and includes Mental Health Inexpensive Daily Rates, with a choice of Medical ($50,000 to $1,000,000) and Deductibles ($0 up to $500), EXPLORER meets many needs & budgets. $100K+ is J-1 Visa compliant! NO Visa Required! Worldwide Travel! Student Health Advantage 4 Student Plans for Every Need Quote Now Plan Details Student Health Advantage (SHA) provides a higher level of coverage for Students studying abroad worldwide, and the SHA Platinum plan offers some additional coverage for Maternity and Pre-Existing Conditions. BlueCross (Geo) Coverage at a Lower Price Quote Now Plan Details Navigator is medically-underwritten health insurance for more comprehensive coverage while Studying Abroad outside your home country. Get better coverage with Navigator today! WellAway Student Student Insurance in the USA WellAway STUDENT Insurance for F, M, Q & J-Visa or OPT Students in the USA Search for Your SCHOOL Here ACA-Compliant for F-1, M & J Students ELITE ACA-Compliant Student Insurance Accepted by MOST Schools! ELITE 450 as low as $1,621 / year ELITE 250 as low as $1,909 / year ELITE PLUS as low as $2,461 / year ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and Choice of Deductibles. (Minimum 12-month purchase unless graduation sooner) Designed for Students with an F-1, M-1 or J-1 student visa whose University requires a fully ACA-Compliant health plan with your choice of either $800 or $450 or $250 or ELITE PLUS with $0 deductible. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. School List Requiring ELITE ELITE Details Quote & Buy ELITE ACA-Comparable for F-1, M & J Students ROYAL ACA-Comparable Student Insurance Accepted by MANY Schools! ROYAL 500 as low as $1,026 / year ROYAL 100 as low as $1,420 / year ROYAL PLUS as low $1,997 / year ROYAL is ACA-Comparable Health Insurance with Unlimited Medical Coverage and Choice of Deductibles. (Minimum 5-month purchase) Designed for Students with F-1 , M-1 or J-1 visas, ROYAL offers comprehensive and affordable health insurance to Students going to the USA for an undergraduate or graduate program. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. School List Requiring ROYAL ROYAL Details Quote & Buy ROYAL Basic Insurance for Less (non-ACA) CROMO Insurance designed at a lower price. Choose CROMO $100,000 or PREMIER $250,000 Medical + Pre-Existing Conditions + Mental Health. (Minimum 5-month purchase) Ideal for Schools without ACA insurance requirements! CROMO PREMIER $100,000 $250,000 Ages 17-24 $ 496.40 $ 671.60 25-29 $ 821.25 $1,069.45 30-45 $1,441.75 $2,317.75 CROMO & CROMO Premier Cost Less! CROMO Details Quote & Buy CROMO Designed for OPT Students OPT Students Insurance designed especially for OPT Students with F-1 Visa. Choose OPT $200,000 or PREMIER $400,000 Medical Coverage with $500 Deductible (Minimum 5-month purchase) OPT is after your school insurance but before employer plan OPT PREMIER $200,000 $400,000 Ages 17-24 $ 452.60 $ 675.25 25-29 $ 726.35 $1,091.35 30-45 $1,244.65 $1,865.15 Less Expensive Plan for OPT Students! OPT Details Quote & Buy OPT Designed for J-1 SCHOLARS J-1 Scholars Insurance designed especially for Scholars, Full-Time Researchers or Visiting Faculty with J-1 & J-2 Visas (Minimum 5-month purchase) Meets ALL J-1 Visa minimum insurance requirements! SCHOLAR PREMIER $250,000 $500,000 Ages 17-24 $ 569.40 $ 905.20 25-29 $ 901.55 $1,445.40 30-45 $1,810.40 $2,890.80 Meets J-1 & J-2 Visa Requirements! J-1 Details Quote & Buy J-1 Designed for EXPATS Worldwide! EXPATRIATES Expatriate insurance designed for all STUDY, WORK or LIVE Abroad, including Graduates! Basic & ACA Coverage Plans! Compare EXPATRIATE , HORIZON & AMERICAN Plans! EXPATRIATE - Choose Gold, Diamond or Plus HORIZON - Lower Cost ACA-Compliant Plan AMERICAN - More Coverage ACA-Compliant Plan Ideal for recent Graduates seeking work or not yet eligible for an Employer Health Plan! Work or Live Abroad Worldwide! EXPAT Details Quote & Buy EXPAT University of Southern California ELITE USC World Elite Insurance designed for F-1 Students at University of Southern California only ELITE 450 as low as $1,500 / year ELITE 250 as low as $1,967 / year ELITE PLUS as low as $2,208 / year USC ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and Choice of Deductibles Designed for USC Students with an F-1 student visa which requires a fully ACA-Compliant health plan with your choice of either $450 or $250 deductible or ELITE PLUS with $0 deductible. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. Lower Priced Plan for USC Only! USC Brochure Quote & Buy USC Plan University of South Florida ELITE USF World Elite Insurance designed for F-1 Students at University of South Florida only Ages 17-24 $1,102.30 / year 25-29 $1,321.30 / year 30-45 $2,423.60 / year USF ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and $450 Deductible Designed for USF Students with an F-1 student visa which requires a fully ACA-Compliant health plan with a $450 deductible. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. Lower Priced Plan for USF Only! USF Brochure Quote & Buy USF Plan EXPLORER Quote & Buy EXPLORER EXPLORER (Plan E Plus) Students, Study Abroad & Travelers VISIT® EXPLORER is Travel Medical insurance for anyone Traveling or Studying Abroad outside their Home Country. EXPLORER is ideally suited for STUDY ABROAD for Individuals, Groups and Faculty-Led Programs, to meet every Budget and School/ Visa Requirement. EXPLORER is designed to be J-1 Visa compliant ($100,000 Medical Coverage minimum required), and is ideal for Cultural Exchange Visitor Programs. STUDENTS & SCHOLARS EXPLORER is Ideal for basic STUDENT Health Insurance Coverage or J-Visa SCHOLARS meeting J-1 Visa insurance requirements. Also Ideal for SCHOOLS without an insurance requirement, or desiring a basic Student Health Insurance Plan (SHIP) STUDY ABROAD EXPLORER is Ideally suited for STUDY ABROAD for Individual Students, Groups or Faculty-Led Programs, and includes important Mental Health Coverage while far away from Home. Group Rates Available! TRAVELERS EXPLORER is ideal for TRAVEL Worldwide, with Daily Rates to match your itinerary and a broad range of Medical Coverage and Deductibles including important Mental Health, Assistance, Liability & Lost Baggage INDIVIDUAL Quote GROUP Quote Media Resource Center Print or Download Brochures below... or share with Students! About VISIT International STUDENT & TRAVELER Health Insurance At VISIT ® International Health Insurance, we offer superior health insurance plans designed to meet the specific needs of International Students, Study Abroad, Schools & Travelers. With a focus on reliability and customer satisfaction, we are your trusted partner for the best health coverage. Since 1979, we've satisfied over 1 Million clients just like you! Try us Today! Address Post Office Box 210 Mount Vernon, VA 22121 Telephone 703-660-9062 9a-6p USA ET Email info@visitinsurance.com Connect

Explore comprehensive International Student Health Insurance Plans that meet Angelo State University waiver requirements. Affordable coverage for global students, ensuring health and safety while studying in the U.S. Angelo State University Student Health Insurance that meets the Angelo State University Waiver International STUDENT Insurance ACA "Unlimited Coverage" Accepted by MOST Schools ROYAL ACA-Comparable ROYAL is ACA-Comparable Health Insurance with Unlimited Medical Coverage and Choice of Deductibles for about $1,314 per year! ROYAL Quote ELITE ACA-Compliant ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and Choice of Deductibles for about $1,740 per year! ELITE Quote UNITED ACA-Comparable UnitedHealthcare is ACA-Comparable Insurance with Unlimited Medical Coverage & Choice of Deductibles for about $1,500 per year! UNITED Quote Students , J-Visa , OPT & Study Abroad Health Insurance while Studying Away from Home Students Ideal for F-1, M-1, J-1 & OPT J-Visa Ideal for J-1 or J-2 Visa OPT Students Ideal for OPT Students Study Abroad Ideal for Study Abroad Affordable International Student health insurance that meets visa requirements and provides the coverage required by Schools, including Mental Health, Maternity and Sports. Choose the health insurance plan that’s just right for your needs, your budget and your School requirements! Health Insurance designed to meet the US Department of State J-Visa insurance requirements and to protect Students, Scholars, Families and Cultural Exchange Visitors & Groups while in the USA. Includes $100,000 Medical (or more), Medical Evacuation & Repatriation and Mental Health coverage! (J-2’s may enroll without the J-1) Health Insurance designed for OPT Students with F-1 Visa as low as $42 per month! OPT students may no longer be eligible for the University Plan and not yet be eligible for an employer’s health insurance plan. We offer many OPT Student Health Insurance Plans for your entire year on OPT. Health insurance designed for Study Abroad , ideal for Individuals, Groups and Faculty-led Programs. Choose from several competitively-priced Study Abroad plans, including our proprietary VISIT® EXPLORER that includes important Mental Health coverage while Studying or Traveling Abroad! About VISIT International STUDENT & TRAVELER Health Insurance At VISIT International Health Insurance, we are dedicated to offering top-notch health insurance solutions tailored to meet your specific needs. With a focus on transparency, reliability, and customer satisfaction, we strive to be your trusted partner in securing the best health coverage for you and your family. Address 8000 Fort Hunt Road Alexandria, VA 22308 Phone 703-660-9062 USA ET Email info@visitinsurance.com Connect Contact VISIT Health Insurance

Explore our comprehensive International Student Health Insurance Plans that are ACA Compliant. Our USC International Student Health Insurance Plans are specifically designed to meet the USC Waiver requirements and are pre-approved. Affordable coverage for global students, ensuring health and safety while studying in the U.S. USC University of Southern California Waiver Acceptable Plans After purchase you will receive a certification of coverage to upload into the University waiver portal. University Waiver Forms also can be emailed to info@visitinsurance.com for processing. International STUDENT Insurance Special Insurance Plan for USC Students ACA-Compliant Student Health Insurance USC ELITE 450 ELITE 450 is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage $450 Annual Deductible Ages Annual Premium Cost 17-24 $1,500.15 25-27 $2,003.85 28-29 $3,022.20 30-35 $6,997.05 Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. $450 Annual Deductible Unlimited Medical Coverage Coinsurance 80% Pre-Existing Conditions (No Wait) Preventive Care 100% Hospitalization 80% Mental Health 80% Maternity 80% Student Health $0 copay Prescriptions $15/$40/$75 Recreational Sports Medical Evacuation $120,000 Repatriation $25,000 12-Month Enrollment Required Fully ACA-Compliant Plan Lower Deductible! ELITE 450 is Accepted by USC Quote & Enroll ELITE Today! ACA-Compliant Student Health Insurance USC ELITE 250 ELITE 250 is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage $250 Annual Deductible Ages Annual Premium Cost 17-24 $1,788.50 25-27 $2,281.25 28-29 $3,551.45 30-35 $8,267.25 Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. $250 Annual Deductible Unlimited Medical Coverage Coinsurance 80% Pre-Existing Conditions (No Wait) Preventive Care 100% Hospitalization 80% Mental Health 80% Maternity 80% Student Health $0 copay Prescriptions $5/$50/$75 Recreational Sports Medical Evacuation $120,000 Repatriation $25,000 12-Month Enrollment Required Fully ACA-Compliant Plan Low Deductible! ELITE 250 is Accepted by USC Quote & Enroll ELITE Today! ACA-Compliant Student Health Insurance USC ELITE Plus ELITE Plus is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage $0 (NO) Annual Deductible Ages Annual Premium Cost 17-24 $2,208.25 25-27 $2,580.55 28-29 $4,620.90 30-35 $9,862.30 Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. NO Deductible! Unlimited Medical Coverage Coinsurance 100% Pre-Existing Conditions (No Wait) Preventive Care 100% Hospitalization 100% Mental Health 100% Maternity 100% Student Health $0 copay Prescriptions $5/$40/$60 Recreational Sports Medical Evacuation $120,000 Repatriation $25,000 12-Month Enrollment Required Fully ACA-Compliant Plan Best Coverage! ELITE Plus is Accepted by USC Quote & Enroll ELITE Today! WAIVE and SAVE! School Plans Cost More than You Think! WAIVE the USC Health Plan & SAVE Money with ELITE instead! IT'S EASY TO WAIVE! Let Us Show You How Money Back Guarantee If your school denies your waiver, you may request a full refund. Refund requests must be submitted within 14 days of the waiver denial date and only if the plan has not been used. Proof of the school's denial is required. Please email your request to VISIT® Insurance at info@visitinsurance.com Student - Scholar - OPT - Study Abroad Protection while STUDYING Away from Home Students F, M & J Visa Affordable International Student health insurance that meets visa requirements and provides the coverage required by Schools , including Mental Health, Maternity and Sports. Choose the health insurance plan that’s just right for your needs, your budget and your School requirements! J-Visa Scholars J-1 or J-2 Visa Health Insurance designed to meet the US Department of State J-Visa insurance requirements to protect Students, Scholars, Families and Cultural Exchange Visitors & Groups while in the USA. Includes $100,000 Medical (or more), Medical Evacuation & Repatriation and Mental Health. (J-2s may enroll without the J-1) OPT Students F-1 Students on OPT Health Insurance desiged for OPT Students with F-1 Visa as low as $42 per month! OPT students may no longer be eligible for the University Plan and not yet be eligible for an employer's health insurance plan. We offer many OPT Student Health Insurance Plans for your entire year on OPT. Study Abroad Study Abroad Worldwide Health Insurance designed for Study Abroad , ideal for Individuals, Groups & Faculty-Led Programs. Choose from several competitively priced Study Abroad plans, including our proprietary VISIT® EXPLORER that includes important Mental Health coverage while Traveling & Studying Abroad! About VISIT International STUDENT & TRAVELER Health Insurance At VISIT ® International Health Insurance, we offer superior health insurance plans designed to meet the specific needs of International Students, Study Abroad, Schools & Travelers. With a focus on reliability and customer satisfaction, we are your trusted partner for the best health coverage. Since 1979, we've satisfied over 1 Million clients just like you! Try us Today!

American Work Experience International Medical Insurance Coverage 2025-2026 Contact VISIT Insurance by Email: aweusa@visitinsurance.com or by Phone: 1-703-660-9062 BENEFIT SUMMARY COVERAGES Medical Maximums per Injury or Illness Lifetime Maximum COVID-19 TELADOC Common issues treated through Teladoc includes: allergies, bronchitis, cold and flu symptoms, respiratory infections, skin problems, sinus problems, and much more. Click here to Get Started Deductible per Period of Coverage *For a covered medical expense, the Deductible is the portion of your medical bill that is your responsibility to pay to the doctor or hospital. Deductible – Emergency Room (applies only to Emergency Room visits) COPAYS COINSURANCE Pre-existing Conditions Hospital Room and Board Local Ambulance Intensive Care Unit Outpatient Treatment Mental Health Disorders Prescription Drugs Physical Therapy Team/Club/League Sports (Collision Sports are excluded from this coverage. The following sports are NOT covered American football, boxing, ice hockey, lacrosse, full contact martial arts, rodeo, rugby and wrestling.) Click here for Sport Coverage Overview Adventure Sports/Hazardous Sports Dental Treatment due to Accident Dental Treatment to alleviate pain Emergency Medical Evacuation (not subject to Deductible or Coinsurance) Repatriation of Remains (not subject to Deductible or Coinsurance) Emergency Reunion (not subject to Deductible or Coinsurance) Political Evacuation (not subject to Deductible or Coinsurance) Terrorism (not subject to Deductible or Coinsurance) Accidental Death and Dismemberment (not subject to Deductible or Coinsurance) Subrogation clause applies. Incidental Home Country Coverage Travel Assistance 2025 Policy Documents - Click Here BENEFITS $100,000 per illness or injury $5,000,000 Lifetime When the Lifetime Maximum is reached, no further benefits, reimbursements or payments will be available under this insurance. Special Note regarding Alcohol-Related Illness or Injury: Illness or Injury sustained as the result of being under the influence alcohol, liquor, intoxicating substances, narcotics or drugs are excluded on the policy. COVID-19 , the disease caused by the novel coronavirus, generally WILL be covered as would any other illness under the AWEUSA Health Plan, including testing and treatment up to the policy limit. For testing to be covered by the Insurance, you must be symptomatic. Please be sure your Doctor’s Office submits your test as a SICK visit. If the test is submitted as a Preventive Care visit the claim will be denied. Call 1-800-TELADOC (835-2362) or visit www.teladoc.com to access the TELADOC services – Service is FREE! With TELADOC you can be connected with a licensed physician in minutes, not hours or days like you would at the ER, Urgent Care, or with your Doctor. And, you can get care from wherever you are home, work or traveling. Except for Emergency Room, $100 per Illness or Injury. Subject to $250 but only if no in-patient admission The $250 ER Deductible applies to illnesses only, and only those illness that do not result in hospital admission. If the ER visit is due to an Injury, the $250 Deductible does not apply. (For an Injury, the standard $100 Deductible would apply.) Urgent Care - $50 Walk-in Clinic - $20 (Deductible does not apply when there is a co-pay) In-Network: Plan pays 100% Out-of-Network: Plan pays 80% of Eligible Medical Expenses, up to the Maximum Limit. (maximum out-of-pocket resets after 12 months from the coverage start date) Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within 36 months prior to the Effective Date are excluded under this insurance. Average Semi-Private room rate, including nursing services 100% Emergency Local Ambulance • Subject to Deductible • Injury • Illness resulting in a Hospitalization admission Usual, Reasonable and Customary Charges Usual, Reasonable and Customary Charges NO COVERAGE Usual, Reasonable and Customary Charges - 100% Reimbursement Covered as a medical expense and is subject to the Deductible and co-insurance. If the medical condition is covered, the prescriptions will also be covered. Prescriptions are a reimbursable expense. You will need to pay for your prescription first and then complete a claim form to be reimbursed. Click here to download a copy of the card to be used at your local pharmacy. Click here to compare prices for your prescription. Limit one visit per day Medical order or Treatment plan required Usual, Reasonable and Customary Charges NO COVERAGE NO COVERAGE CLICK HERE to apply for a short term policy that includes Hazardous Sports for the following sports: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snowmobiling, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris, and windsurfing. $500 Maximum per Certificate Period, No Maximum per Tooth $350 Maximum per Certificate Period $100,000 per Participant Lifetime Maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $25,000 Maximum Cremation/Burial: $5,000 maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $15,000 Lifetime Maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $10,000 Lifetime Maximum Please call (317) 655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $50,000 Lifetime Maximum Please call 1-317-655-4500 for Emergency Medical Evacuation requests. All details must be coordinated with Assist to be eligible for coverage. $25,000 per Participant 14 days 24-hour Worldwide Assistance 24-Hour Worldwide Assistance Services: 1-866-799-8270/ 1-317-927-6896 2025 Policy Documents - Click Here TELADOC Call 1-800-TELADOC (835-2362) visit www.teladoc.com Access TELADOC services – Service is FREE! TELADOC Service is FREE! With TELADOC you can be connected with a licensed physician in minutes, not hours or days like you would at the ER, Urgent Care, or with your Doctor. And, you can get care from wherever you are home, work or traveling. Common issues treated through Teladoc includes allergies, bronchitis, cold and flu symptoms, respiratory infections, skin problems, sinus problems, and much more. Click here to Get Started TELADOC should be used for NON-EMERGENCY health issues ONLY! To set-up your account, please go to www.teladoc.com or download the APP. When setting up your account, please use the IMG Insured ID Number listed on the attached ID card and Zip Code 46208. Hazardous Sports Coverage (not covered by the AWEUSA Health Insurance Plan) If you will be participating in any hazardous sports during your stay in the USA, please consider purchasing a short term policy that includes Hazardous Sports coverage for the following sports: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snowmobiling, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris, and windsurfing. Be sure to only purchase for the days you will be participating in the sports activity. Click Here to order the Patriot Plan, please be sure to include the Adventure Sports Rider when purchasing. COVID-19 Coverage COVID-19 , the disease caused by the novel coronavirus, generally WILL be covered as would any other illness under the Mountbatten Health Insurance policy, including testing and treatment up to the policy limit. COVID-19 TESTING - COVID-19 Testing is only covered if you are symptomatic. The test will not be covered for travel or non-illness related testing. Your doctor must submit the COVID-19 test as a “sick visit” and provide the medical records when submitting your claim. You should also submit a Patient Claim Form through your MyIMG Account explaining your symptoms. COVID-19 VACCINES - Vaccines are currently being offered for FREE at most facilities. An administrative fee may apply. The COVID-19 vaccine is NOT covered on your Mountbatten Health Insurance Patriot Exchange Plan. COVID-19 TREATMENT - If you test positive for COVID-19, your medical expense will be covered by the UnitedHealthcare Plan up to the policy maximum of $250,000. If you are experiencing symptoms related to COVID-19, it is important that you first contact your doctor or urgent care facility by phone to review the proper protocol to receive a test and treatment for COVID-19 . Be sure to follow the current CDC Guidelines . When going to the doctor, please be sure to take your UnitedHealthcare Insurance card How To Set-up Your MYIMG Account MyIMG Service at your fingertips anytime, anywhere - that’s what MyIMG provides. MyIMG is our proprietary online service that allows you to access information and manage your IMG accounts, 24 hours a day, seven days a week, from anywhere in the world. Our service centers in the U.S. and Europe are always available to help or handle emergencies 24 hours a day, but through MyIMG you have immediate access to a wealth of information about your account and can manage routine areas to help you save time when you may need it most. Some features include: Get explanation of benefits Initiate precertification Obtain certificate documents Locate a provider Recommend a provider/facility Request or print ID cards Submit a Claim online Check the status of a Claim Don't have an account? Create an account You will need to put in your Health Insurance ID Number and Date of Birth to set-up an account. If you do not have your Health Insurance ID Number, please contact our office at 7 03-660-9062 Important Insurance Terms What is a Deductible? For a covered medical expense, the deductible is the portion of your medical bill that is your responsibility. The deductible will first be subtracted from the total medical bill and you will need to pay this portion directly to the doctor or hospital. The deductible is “per illness or injury,” not per visit to the doctor. This means if you have to go to the doctor more than once for the same illness or injury, you will only need to pay the deductible one time. Your deductible is $100 per illness or injury. The Emergency Room deductible is $250 per ER visit. What is Co-insurance? Coinsurance is the term used by health insurance companies to refer to the amount that you are required to pay for a medical claim, apart from the deductible. Your plan pays 100% of Eligible Medical Expenses subject to Usual, Reasonable and Customary charges. Charges above Usual, Reasonable and Customary will be your responsibility. You are strongly encouraged to utilize the independent Preferred Provider Organization (PPO) network to avoid being responsible for medical expenses over and above Usual, Reasonable and Customary. How do I Pay for My Prescriptions? Your Plan includes a Discount Prescription Drug Benefit through Universal Rx . When going to a pharmacy, please present the AWEUSA Plan ID Card, the prescription discount information is included on the right side of the card. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after any discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription cost, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible of $100 per illness or injury applies. Important Information: Universal Rx Pharmacy Help Desk: 1-800-329-0988 or www.imgpoc.com What is a pre-existing condition? Definition of Pre-existing Condition as defined by the Certificate: “Pre-existing Condition: Any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the three (3) years prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.” What is Precertification? Precertification is a requirement under your certificate for certain medical services. Pre-certification is a general determination of medical necessity only, not an assurance of coverage, verification of benefits or a guarantee of payment. The following must always be precertified for medical necessity before admission or receiving the treatments and/or supplies: Any treatment requiring inpatient hospitalization Surgery or surgical procedure, including outpatient surgery CAT scans or MRI's Care in an extended care facility Home nursing care Chemotherapy Radiation Therapy Interfacility Ambulance Transfer During the precertification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary. Precertification may be initiated by you, your representative or your medical provider. This can be done through MyIMG, through the Client Resources page of www.IMGLOBAL.com or by calling IMG at 1-317-655-4500. Most U.S. hospitals and physicians are familiar with the precertification process and will make the phone call for you, though they are not required to do this. You are responsible for ensuring the precertification process is done five days before you are hospitalized or within 48 hours after an emergency admission to the hospital. Click here to submit a Precertification online What is a Reasonable & Customary charge? A Usual, Reasonable & Customary (URC) charge is the amount normally charged by medical service providers for similar services and supplies within the geographic area in which the charge is incurred. What is Medical Evacuation? Medical Evacuation means transferring the insured person to the nearest hospital or medical facility in case of an emergency injury or sickness or back to his/her home country. It can be done by any necessary means of transportation. What is Repatriation? In case of death, the Repatriation benefit covers the transportation of your remains back to your family and your home country. Are Injuries from Sports Covered? Recreational sports only are covered through the regular medical coverage. Should you need coverage for Hazardous/Adventure Sports Click Here to order the Patriot Plan, please be sure to include the Adventure Sports Rider when purchasing. When purchasing coverage, please be sure that your particular sport is covered. Is there Dental Coverage? There is limited coverage for dental pain and injury to natural teeth on your policy. Relief of sudden and unexpected pain to sound, natural teeth, including but not limited to fillings will be covered up to $350 maximum. Injury due to an accident will be covered up to $500 per Accident maximum. Do I need a referral to go to a Specialist? A doctor’s referral typically is not required. If you have a special medical condition, we recommend that you check with the Claims Office 1-317-655-4500 prior to making an appointment with a Specialist. Where Can I Find a Doctor or Hospital? What are the Provider Networks? A provider network is a list of the doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that isn't contracted with the plan is called an “out-of-network provider.” When contacting a doctor or hospital, please be sure to let them know that you are in the United Health Care (PPO) Network. How do I search for a local doctor or hospital? To search for a medical care provider within the United Health Care (PPO) network, please go to: United Health Care How to File a Claim Where do I find my Insurance ID Number? Your ID Number is located on your Insurance Card. What do I do if I lose my ID Card? Please contact VISIT at 1-703-660-9062 or by email at aweusa@visitinsurance.com . Be sure to let us know that you are in the Mountbatten program. You can also print your ID Card by going to your MyIMG account. Do I need to go to a specific doctor or hospital if I need medical attention? You are strongly encouraged to search for doctors or hospitals that utilize the United Health Care (PPO) network. Refer to 'Where Can I Find a Doctor or Hospital? ' for details. If an emergency: • Go directly to the hospital, or call 911 for emergency response • Call the 24-hour assistance service center at the number listed on your ID card to alert the center of your situation. 1-317-655-4500. Precertification Precertification is a requirement under your certificate for certain medical services. Pre-certification is a general determination of medical necessity only, not an assurance of coverage, verification of benefits or a guarantee of payment. The following must always be precertified for medical necessity before admission or receiving the treatments and/or supplies: Any treatment requiring inpatient hospitalization Surgery or surgical procedure, including outpatient surgery CAT scans or MRI's Care in an extended care facility Home nursing care Chemotherapy Radiation Therapy Interfacility Ambulance Transfer During the precertification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary. Precertification may be initiated by you, your representative or your medical provider. This can be done through MyIMG, through the Client Resources page of www.IMGLOBAL.com or by calling IMG at 1-317-655-4500. Most U.S. hospitals and physicians are familiar with the precertification process and will make the phone call for you, though they are not required to do this. You are responsible for ensuring the precertification process is done five days before you are hospitalized or within 48 hours after an emergency admission to the hospital. Click here to submit a Precertification online Do I Need To Submit A Claim Form? ONLINE CLAIM SUBMISSION PROCESS CLAIM FORMS: There are TWO (2) different claim forms, and BOTH ARE REQUIRED FOR EACH SEPARATE CLAIM. There is a DOCTOR claim form that must be completed and submitted by the doctor/hospital/medical provider. There is a PATIENT claim form, that must be completed and submitted BY YOU. If the insurance company does not receive BOTH completed claim forms, they will not begin to process your claim. PATIENT Claim Form The PATIENT Claim Form can be downloaded at www.visitinsurance.com/mountbatten.html or alternatively you can submit your claim online through your MyIMG Account. (You may also submit a completed PATIENT Claim Form by email: customercare@imglobal.com or fax: 1-317-655-4505). The PATIENT Claim Form must be submitted within 90 days of treatment. All documents from you and your doctor must be received within 180 days to process your claim. DOCTOR Claim Form Be sure your Doctor files your claim through UnitedHealthcare using the information found on your ID Card. This will allow your doctor to file your claim electronically which will help expedite the claims process. Your ID card includes a Member ID Number and a Group Number your Doctor must use to file the claim properly. Improperly filed claims may be delayed or denied. Should your Doctor’s Office have any questions, please have them call UnitedHealthcare directly at: 1-888-543-1238. UnitedHealthcare Member ID: xxxxx (This number is found on your ID Card and is unique for each person) Group Number: 76570070 (This number is the same for all AWEUSA Students) Payor ID: USN01 (This number is the same for all AWEUSA Students) DOCTOR CLAIM FORMS can be filed electronically to UnitedHealthcare or mailed to: UHC Global P.O. Box 30526 Salt Lake City, UT 84130-0526 (This address is only for the Doctor’s Office to submit their Claim Forms) PRESCRIPTIONS: In addition to your AWEUSA Health Plan ID card, attached is your Prescription Discount Card for your medications. When going to a pharmacy, please present the AWEUSA PROGRAM HEALTH Plan ID Card, the prescription discount information is included on the right side of the card. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after any discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription cost, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible of $100 per illness or injury applies. For faster service on your claim, we suggest that you use the MyIMG system online to submit your claim. Where do I send my Claim Form? Click here to download a CLAIM FORM Mail PATIENT CLAIM Forms to: International Medical Group, Inc. Claims Department PO BOX 240429 Apple Valley, MN 55124 Phone: 1-317-655-4500 Fax: 1.317.655.4505 Email: customercare@imglobal.com How do I check the status of a claim? Log into your MyIMG Account and check the Claims tab for updates Call 1-317-655-4500 Email the Claims Office at customercare@imglobal.com to request an update on your claim. Be sure to include your full name, your IMG ID Number from your health insurance ID card and the date of the doctor's visit that you are requesting an update. What do I do if the claim is showing as PENDING? If your Claim is showing as PENDING, please be sure to check the status of the claim on your MyIMG Account to see what information is needed to finalize your claim. There is no record of my claim Contact your doctor's office and ask them to submit the claim to IMG. If they say they have already submitted the claim, be sure to verify the address they sent the claim to and the date it was sent. Email this information to customercare@imglobal.com and ask the Claims Office to research their records to see if the claim is in their system. If the Claims Office is unable to locate the claim, please contact your doctor's office and ask them to resubmit the claim. Claims can be mailed to: UHC Global P.O. Box 30526 Salt Lake City, UT 84130 Patient to submit a completed IMG Claim Form You must complete a PATIENT IMG Claim Form to process your claim. This form can be completed online through your MyIMG Account or you can download the IMG Claim Form and mail it or fax it to the claims office. Charges pending receipt of medical records requested from provider To process your claim, your doctor must provide the medical records to IMG for your treatment. Please contact your doctor's office and ask them to submit your medical records to the IMG. Medical records can be mailed to: UHC Global P.O. Box 30526 Salt Lake City, UT 84130 Your file has been closed due to a lack of response This means that additional information has been requested but the Claims Office has not received the information. The file can be reopened once the information is received. In order to process these charges, please submit on a HCFA/UB Form Indicating Standardized procedure (CPT) and Diagnosis (ICD) codes. These forms are standard forms that doctors use to file a claim with an insurance company. Your doctor should have these forms available. If they are not sure what to file or have questions, please have the them call UHC Global at 1-888-543-1238. How long do I have to file a claim? Your IMG PATIENT Claim Form must be submitted to the IMG Claims Office within 90 days of your visit to the doctor, urgent care, emergency room and/or hospital. You and your doctor, hospital and other healthcare and medical service providers and suppliers shall have one hundred eighty (180) days from the date a claim is incurred to submit a complete Proof of Claim, medical records and any additional information needed to process your claim. IMG Privacy Policy - www.imglobal.com/legal/privacy-policy How to Pay for My Prescription? Your AWEUSA Health Plan ID card includes your Prescription Discount information for your medications. When going to a pharmacy, please present the AWEUSA HEALTH Plan ID Card, the prescription discount information is included on the right side of the card. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after any discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription cost, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible of $100 per illness or injury applies. Prescriptions can be filled at ANY Pharmacy . Please present your AWEUSA Program Health Plan ID card to the Pharmacy. If the prescription is eligible for a discount, it will be applied when you purchase your prescription. The Universal Rx Discount information is located on the right side of your Health Insurance ID card (as shown below) or you can download a copy of the card by going to https://imgpoc.com . Please pay any remaining pharmacy costs due after the discount and keep the receipt and a copy of the prescription. Steps for submitting your CLAIM for REIMBURSEMENT Complete and submit a PATIENT Claim Form (include your Doctor visit and prescriptions on the same PATIENT CLAIM FORM) Include a copy of the Receipt. Include a copy of the Prescription (this can be the Prescription Information that is typically stapled to the prescription bag) The Claim can be submitted online through your MyIMG Account Reimbursements are only for covered medical expenses, not for pre-existing conditions. Additional discounts may be available through the pharmaceutical company that manufactures your prescription.) Important Contact Numbers Plan Administrator: International Medical Group, Inc. (IMG) To a Report a Claim, Verify Eligibility or Check on the Status of a Claim Contact: International Medical Group, Inc. Claims Department PO BOX 240429 Apple Valley, MN 55124 Phone: 1-317-655-4500 Fax: 1-317-655-4505 Email: customercare@imglobal.com 24-Hour Worldwide Assistance Services: 1-317-927-6896 Provider Claim Submission: UHC Global P.O. Box 30526 Salt Lake City, UT 84130 Telephone: 1-888-543-1238 Preferred Provider Network: United Health Care Agent: VISIT® International Health Insurance For answers to General Questions, ID card replacement, General Claims Questions contact your Agent: VISIT® International Health Insurance Email: aweusa@visitinsurance.com Phone: 1-703-660-9062 Fax: 1-703-991-9164 Office Hours: Monday – Friday, 9am to 6pm USA Eastern Time Emergency 24/7 Assistance: 1-317-655-4500 After Hours: Please contact us by email at aweusa@visitinsurance.com Underwriter: SiriusPoint Specialty Insurance The AWE Insurance plan is underwritten by SiriusPoint Specialty Insurance . This insurance and its risks are underwritten by the Company as the insurer and carrier, and the Company is solely obligated and liable for the coverage and benefits provided by this insurance. Address 8000 Fort Hunt Road Alexandria, VA 22308 Phone 703-660-9062 USA ET Email info@visitinsurance.com Connect Contact VISIT Health Insurance

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ADD YOUR SCHOOL Please email your School Health Insurance Requirements to info@visitinsurance.com . We will review your School's requirements, and email you the Plans that meet the requirements and add Your School Page to our website. Have questions about the right coverage to meet your visa or school requirements? We are here to help! 703-660-9062 ACA Unlimited Medical Plans for F-1 & M-1 Students Affordable Care Act ("ACA") Plans Accepted by Most Schools Less Expensive than your School "SHIP" Plan! ROYAL ACA-Comparable ROYAL is ACA-Comparable Health Insurance with Unlimited Medical Coverage and Choice of Deductibles ROYAL 500 as low as $967 /year ROYAL 100 as low as $1,314 / year ROYAL PLUS as low as $1,843 / year For Students with F-1 , M-1 or J-1 visas, ROYAL offers comprehensive and affordable health insurance to Students going to the USA for an undergraduate or graduate program. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. ROYAL Quote & Buy ELITE ACA-Compliant ELITE is fully ACA-Compliant Health Insurance with Unlimited Medical Coverage and Choice of Deductibles ELITE 450 as low as $1,500 / year ELITE 250 as low as $1,740 / year ELITE PLUS as low as $2,135 / year For Students with an F-1 student visa whose University requires a fully ACA-Compliant health plan with your choice of either $450 or $250 or ELITE PLUS with $0 deductible. Includes Pre-Existing Conditions (no waiting period), Preventive Care, Mental Health & Maternity coverages. ELITE Quote & Buy UNITED ACA-Comparable UnitedHealthcare is ACA-Comparable Insurance with Unlimited Medical Coverage & Choice of Deductibles BASIC ($500K) as low as $893 / year PLUS as low as $1,289 / year ELITE as low as $1,670 / year Choice of 4 Student health insurance plans to meet a variety of needs and budgets. UnitedHealthcare is the largest medical insurance provider network in the USA. Includes Pre-Existing Conditions (waiting period may apply), Preventive Care, Mental Health & Maternity. UNITED Quote & Buy BASIC Plans (non-ACA) Accepted by MANY Schools - Less Expensive! EXPLORER No Visa Required! EXPLORER (Plan E Plus) is essential health insurance for Students, Study Abroad, Schools & Any Travelers Worldwide and includes Mental Health Inexpensive Daily Rates, with a choice of Medical ($50,000 to $1,000,000) and Deductibles ($0 up to $500), EXPLORER meets many needs & budgets. $100K+ is J-1 Visa compliant EXPLORER Quote & Buy STUDENT Secure StudentSecure offers FOUR levels of coverage, Basic, Smart and Elite to meet most needs and budgets for Students studying away from home. Smart and Elite plans include Maternity and some Pre-Existing Conditions coverage. StudentSecure Quote & Buy CROMO $100K or $250K CROMO is recommended for Students with an F-1, M-1 or J-1 visa, and provides comprehensive and VERY affordable health insurance for Students going to the USA for an undergraduate or graduate program. CROMO Quote & Buy Why Health Insurance is Important for International Students Students, J-Visa, OPT & Study Abroad Health Insurance while Studying Away from Home Students Ideal for F-1, M-1, J-1 & OPT Affordable International Student health insurance that meets visa requirements and provides the coverage required by Schools , including Mental Health, Maternity and Sports. Choose the health insurance plan that’s just right for your needs, your budget and your School requirements! J-Visa Ideal for J-1 or J-2 Visa Health Insurance designed to meet the US Department of State J-Visa insurance requirements to protect Students, Scholars, Families and Cultural Exchange Visitors & Groups while in the USA. Includes $100,000 Medical (or more), Medical Evacuation & Repatriation and Mental Health. (J-2s may enroll without the J-1) OPT Students Ideal for F-1 Students on OPT Health Insurance desiged for OPT Students with F-1 Visa as low as $42 per month! OPT students may no longer be eligible for the University Plan and not yet be eligible for an employer's health insurance plan. We offer many OPT Student Health Insurance Plans for your entire year on OPT. Study Abroad Ideal for Study Abroad Health Insurance designed for Study Abroad , ideal for Individuals, Groups & Faculty-Led Programs. Choose from several competitively priced Study Abroad plans, including our proprietary VISIT® EXPLORER that includes important Mental Health coverage while Traveling & Studying Abroad! Address PO Box 210 Mount Vernon, VA 22121 Phone 703-660-9062 USA ET Email info@visitinsurance.com Connect About VISIT International STUDENT & TRAVELER Health Insurance At VISIT ® International Health Insurance, we offer superior health insurance plans designed to meet the specific needs of International Students, Study Abroad, Schools & Travelers. With a focus on reliability and customer satisfaction, we are your trusted partner for the best health coverage. Since 1979, we've satisfied over 1 Million clients just like you! Try us Today!

Health Insurance for International Students & Travelers going to Spain SPAIN Student & Traveler Insurance Studying and/or Traveling in Spain can be the opportunity of your lifetime! But Health Insurance is not only important, it may also be required by your visa and/or your school. Choose your health plan below & Enroll Today! StudentSecure Student Health Plans for Every Need StudentSecure is for Students studying abroad in the UK or worldwide, and offers a choice of 4 levels of coverage: Budget, Select, Smart & Elite . Enroll in StudentSecure Today! Quote & Enroll Now PATRIOT EXCHANGE (PEP) Student & Cultural Exchange PEP is for Students or Cultural Exchange in the UK or worldwide! PEP includes all insurance requirements for Study Abroad. Enroll in PEP Today! Quote & Enroll Now EXPLORER Student & Traveler Students & Any Travelers Worldwide EXPLORER is ideal for ANY Travel or Study Abroad Worldwide, with your choice of Medical & Deductible and includes Mental Health & Telehealth. EXPLORER does not require any visa! Quote & Enroll Now

Affordable International Student Athlete insurance designed with extra coverage for competitive and collegiate sports. ATHLETE Insurance Enhanced Medical Coverage for Athletic Sports International STUDENT ATHLETE Health Insurance with extra coverage for Athletic Sports! Call 703-660-9062 for more details, or info@visitinsurance.com International STUDENT ATHLETES Insurance including Athletic Sports Coverage UNITED BASIC UnitedHealthcare BASIC SPORTS $500,000 Medical Coverage & Choice of Deductibles ($100 or $500). BASIC SPORTS ($500K) as low as $108.90 / month Choice of 2 Student health insurance plans for ATHLETES to meet a variety of needs and budgets. UnitedHealthcare is the largest medical insurance provider network in the USA. Includes Pre-Existing Conditions (waiting period may apply), Preventive Care, Mental Health & Maternity. Be sure to Choose the SPORTS Plans to include Athletic Sports. The UHC SPORTS Plans include $10,000 per injury coverage. 3-month minimum purchase. ONLY available for college and university students. Not available for high school students. BASIC Sports Quote & Buy UNITED PLUS UnitedHealthcare PLUS SPORTS Plan is ACA-Comparable Insurance with Unlimited Medical Coverage & Choice of Deductibles ($100 or $500). PLUS SPORTS as low as $213.60 / month Choice of 2 Student health insurance plans for ATHLETES to meet a variety of needs and budgets. UnitedHealthcare is the largest medical insurance provider network in the USA. Includes Pre-Existing Conditions (waiting period may apply), Preventive Care, Mental Health & Maternity. Be sure to Choose the SPORTS Plans to include Athletic Sports. The UHC SPORTS Plans include $10,000 per injury coverage. 3-month minimum purchase. ONLY available for college and university students. Not available for high school students. PLUS Sports Quote & Buy ATHLETE Coverage EXTRA Coverage for Sports! $500,000 Student Health Insurance Sports BASIC BASIC is $500,000 Student Insurance $100 or $500 Deductible Ages Monthly Premiums $100 Deduct $500 Deduct 17-22 $ 121.20 $ 108.90 23-26 $ 192.00 $ 172.20 27-30 $ 401.40 $ 360.30 31+ $1,983.00 $1,718.20 UnitedHealthcare offers TWO levels of Sports coverage for Student ATHLETES, Basic & Plus to meet most needs and budgets for Student Athletes studying away from home. $500,000 per injury or sickness Intercollegiate Sports $10,000 per injury Deductible: $100 or $500 Coinsurance 80% Pre-Existing Conditions 6-month wait $300 ER co-pay Preventive Care 100% ($1,000 max) UHCP Prescription ($20/30%/45%) Maternity included Mental Health & Substance Abuse Unlimited MedEvac & Repatriation UHC Options PPO Network 3-month minimum purchase Good Coverage! Compare Sports BASIC & PLUS Quote & Enroll BASIC Today! UNLIMITED (ACA) Student Health Insurance Sports PLUS PLUS is UNLIMITED (ACA) Student Insurance $100 or $500 Deductible Ages Monthly Premiums $100 Deduct $500 Deduct 17-22 $ 237.60 $ 213.60 23-26 $ 376.20 $ 338.10 27-30 $ 922.50 $ 828.30 31+ $4,547.40 $4,084.50 UnitedHealthcare offers TWO levels of Sports coverage for Student ATHLETES, Basic & Plus to meet most needs and budgets for Student Athletes studying away from home. Unlimited Medical Coverage (ACA) Intercollegiate Sports $10,000 per injury Deductible: $100 or $500 Coinsurance 80% Pre-Existing Conditions (No wait) $250 ER co-pay Preventive Care 100% UHCP Prescription ($15/30%/45%) Maternity included Mental Health & Substance Abuse Unlimited MedEvac & Repatriation UHC Options PPO Network 3-month minimum purchase Best Coverage! Compare Sports BASIC & PLUS Quote & Enroll PLUS Today! Basic Coverage includes limited Sports Coverage Accepted by MANY Schools PATRIOT Exchange (PEP) PEP is Ideal for Students & Exchange Visitors! For Interscholastic (High School), Intramural and Club Sports. Non-collision sports only. Be sure to include the Add on Rider . Limited Sports coverage . Please contact our office to discuss your sport to be sure it is included. PEP Quote & Buy STUDENT Secure StudentSecure offers FOUR levels of coverage, Basic, Smart, Select and Elite to meet most needs and budgets for Students studying away from home. The Elite plan includes Maternity and Pre-Existing (6-month waiting period) Conditions coverage as well as $200 for Preventive Care after 6-months of continuous coverage. Elite plan include $7,500 per injury coverage for athletics sports, Maternity and some Pre-Existing Conditions coverage. StudentSecure Quote & Buy STUDENT Health Advantage Student Health Advantage (SHA) provides a higher level of coverage for Students studying abroad worldwide, and the SHA Platinum plan offers some additional coverage for Maternity and Pre-Existing Conditions . SHA Platinum plan offers some additional coverage for Sports Injuries ($5,000 per injury ), Maternity and Pre-Existing Conditions. SHA Quote & Buy Students, J-Visa, OPT & Study Abroad Protection while Studying Away from Home Students Ideal for F-1, M-1, J-1 & OPT Affordable International Student health insurance that meets visa requirements and provides the coverage required by Schools , including Mental Health, Maternity and Sports. Choose the health insurance plan that’s just right for your needs, your budget and your School requirements! J-Visa Ideal for J-1 or J-2 Visa Health Insurance designed to meet the US Department of State J-Visa insurance requirements to protect Students, Scholars, Families and Cultural Exchange Visitors & Groups while in the USA. Includes $100,000 Medical (or more), Medical Evacuation & Repatriation and Mental Health. (J-2s may enroll without the J-1) OPT Students Ideal for F-1 Students on OPT Health Insurance desiged for OPT Students with F-1 Visa as low as $42 per month! OPT students may no longer be eligible for the University Plan and not yet be eligible for an employer's health insurance plan. We offer many OPT Student Health Insurance Plans for your entire year on OPT. Study Abroad Ideal for Study Abroad Health Insurance designed for Study Abroad , ideal for Individuals, Groups & Faculty-Led Programs. Choose from several competitively priced Study Abroad plans, including our proprietary VISIT® EXPLORER that includes important Mental Health coverage while Traveling & Studying Abroad! About VISIT International STUDENT & TRAVELER Health Insurance At VISIT ® International Health Insurance, we offer superior health insurance plans designed to meet the specific needs of International Students, Study Abroad, Schools & Travelers. With a focus on reliability and customer satisfaction, we are your trusted partner for the best health coverage. Since 1979, we've satisfied over 1 Million clients just like you! Try us Today!