(866) INSUBUY467-8289

PPO Networks

Visitors to U.S.A. / Travel Outside U.S. medical plans purchased on or after 5/1/2019 and Student Medical plans purchased on or after 6/5/2019 will have the United Healthcare PPO Network.

Visitors to U.S.A. / Travel Outside U.S. medical policies purchased prior to 5/1/2019 and Student Medical Policies purchased prior to 6/5/2019 will have the First Health PPO Network and will continue to have the First Health PPO network and original benefits until they purchase a new policy.

w w w. i n s u b u y . c o m

Health Plan (80840) 911 87726 04Member ID:Network Effective Date: Group Number:

Payer ID: 87726

Insured: Insured Effective Date: IMG Insured ID:IMG Certificate Number:

Possession of this card does not guarantee coverage.

For providers inside the USA:UnitedHealthcare P.O. Box 740372Atlanta, GA 30374-0372Telephone: 1.888.543.1238

For providers outside the USA:P.O. Box 88500Indianapolis, IN 46208-0500 USATelephone: 01.317.655.4500Fax: 01.317.655.4505

UnitedHealthcare Options PPO

Failure to comply will result in a reduction of bene�ts. To precertify, prenotify, or verify eligibility and/or bene�ts, please contact IMG at:

Mail all claims to:

From the U.K.: +

Email: insurance @imglobal.com

Fax: +1.317.655.4505Online Provider Network: www . imglobal . com / provider

Electronic Claim Payor ID: IMGIN

Inside the U.S. and Canada: +1.800.628.4664

Outside the U.S. and Canada: +1.317.655.4500

From the Bahamas: +1.866.677.4500

44 2920 474 236

International Medical Group (IMG)P.O. Box 88500Indianapolis, IN 46208-0500 USA

SAMPLE ONLY

INSUBUY.COM

This coverage contains precertification requirements (see back).

Possession of this card does not guarantee coverage.

Failure to comply will result in a reduction of benefits.

To precertify, prenotify, verify eligibility, and/or benefits,

please contact IMG at:

Inside the US and Canada: 1.800.628.4664

Fax: 1.317.655.4505

Outside the US and Canada: +44(0) 1444.46.5577 or 01.317.655.4500

Fax: +44(0) 1444.46.5550

From the Bahamas: 1.866.677.4500

Email: insurance@imglobal.com

Online Provider Network: www.imglobal.com/provider

Electronic Claim Payor ID: IMGIN

Mail all claims to:

IMGP.O. Box 88500

Indianapolis, IN 46208-0500

USA

ORIMG Europe Ltd./Claims Dept.

36-38 Church Road

Burgess Hill, West Sussex

RH15 9AE, United Kingdom

GUPTA, SHANKAR83271272PATAP8162444025-JAN-201702-MAY-2017

SAMPLE ONLY

INSUBUY.COM

January 23, 2017Confirmation of Coverage

RE: Confirmation of Coverage for SHANKAR GUPTA Certificate Number: PATAP81624440

To Whom It May Concern:

Please be advised that SHANKAR GUPTA has purchased Patriot America Plus certificate number PATAP81624440 effective 25-Jan-2017 to 02-May-2017. The policy is administered by International Medical Group®, Inc., and underwritten by Sirius International Insurance Corporation (publ) located at 113 96 Stockholm, Sweden. Sirius has an "A" (Excellent) rating from A.M. Best.

Medical coverage is provided while traveling worldwide outside of the insured person's Home Country including United States of America, per policy provisions. Coverage includes the Schengen states per the policy provisions. Emergency evacuation (also known as Repatriation) is provided up to a maximum benefit of 500,000.00 USD and Return of Mortal Remains benefits up to a maximum of 50,000.00 USD are included when coordinated by IMG. A copy of the Schedule of Benefits, which provides an outline of the plan’s coverage, limitations, and maximum benefits, as well as a copy of the Declaration page of the Certificate indicated above may be presented as required. This information will verify that Eligible Expenses, including Hospitalization expenses, are subject to a 500.00 USD annual deductible. Eligible Expenses are also subject to the following coinsurance provisions: For treatment received outside of the U.S., the plan pays 100% of Eligible Expenses up to the maximum limit. For treatment received within the U.S. and in the PPO Network, the plan pays 90% of Eligible Expenses up to $5,000, then 100% up to the maximum limit. For treatment received within the U.S. but outside of the PPO Network, the plan pays 80% of Eligible Expenses up to $5,000, then 100% up to the maximum limit. The maximum limit of coverage per period of insurance is 50,000.00 USD.

If you need further information, please feel free to contact our office at the number listed below. Thank you.

Sincerely,

Certificate Holder Services317.655.4500

Your Producer Contact Information:Insubuy, Inc. - 518554700 Dexter Dr, Suite 100Plano, TX 75093 Telephone: (866) INSUBUYFax: 972-767-4470Email: info@insubuy.comWebsite: www.insubuy.com

International Medical Group®2960 North Meridian StreetIndianapolis, IN 46208-4715 USA Telephone: 1.317.655.4500 or 1.800.628.4664 Fax: 1.317.655.4505

SAMPLE ONLY

INSUBUY.COM

SAMPLE ONLY

IN

SUBUY.COM