3 1./PRESENTATION OFASFE,ITS ADMINISTRATOR MSHINTERNATIONAL AND PURPOSE OFTHE INSURANCE 1.1./PRESENTATION OF ASFEAND ITS ADMINISTRATOR(MSHINTERNATIONAL) You have chosen anASFE(Association of Services for Expatriates)international health insurance planfrom Groupama Gan Vie, managed by MSH International, and we are delightedto welcome you as a member. ASFE, the Association of Services For Expatriates, was created in 1992 and is governed by the French law of 1901 on associations. Its purpose is to provide expatriates all over the world with solutions in the fields of healthcare coverage, life& disability, medical assistance / repatriation and third-party liability.Throughout this document ASFEwill be referred toas “ASFE” or the “Contracting association”. MSH International,the designer andAdministratorof ASFE plans, isa world leader in international benefits withover400,000 globally- mobile individuals insured worldwide.MSH Internationalprovides you with the services of adedicated team which is on hand to support and advise you day after day.MSHInternational, anorganization mandatedby theInsurerto administer the plan will be referredto throughout this document as“MSHInternational”,“theAdministrator”, “theAdministrating Organization”whenever this term is used in the context of theadministrative management of the plan. The plan is insured byGroupama Gan Vie–a French“société anonyme”with a capital of 1,371,100,605 euros (fully paid)-registered with the Paris Trade and Companies Register under number340 427 616-APE 6511 Z Head office: 8-10 rue d’Astorg-75383 PARIS Cedex 08, France-Company regulated by the French Insurance Code and subject to the French Prudential Supervision and Resolution Authority (ACPR)–4 place de Budapest-CS 92459-75436 Paris Cedex 09, France,hereinafter referredto as “theInsurer”. 1.2./PURPOSE OF THE INSURANCE The ASFE Insurance plans in which you are enrolled are a type of plan known as “open group”. They provide coverage from the 1st euro/1stdollar orin addition to benefits provided by the CFE (Caisse des Français de l’Etranger), to the exclusion of any other healthcare insurance scheme. Their purpose, within the limit of actual costs, is the payment of Benefits, from the 1steuro/1stdollar or in addition to benefits paid by the CFE, as a reimbursement of medical expenses incurred by ASFE Members living outside theirHome country, in a private or professional capacity as well as any Dependents as defined below, whether or not they are residing in the same foreign country, if they are enrolled in the plan. Yourmembership of these plans will be referred to throughout this document as “Your membership”. You and any dependents enrolled in the plan will be referredtoas “Insured member”. Each plan provides basic healthcare coverage which can be supplemented by optional benefits and 4 levels of coverage within these options,Quartz, Pearl, Sapphire,andDiamond(see section1.3/Coverage optionsp.3).Each plan also includes 5 coverage zones (see section1.4//Coverage zonesunder the planp.4). These plans are numbered as follows: FIRST’ EXPAT (1steuro/1stdollar): -No.0210/863689/00010,No.0210/863689/00020,No.0210/863689/00030,No. 0210/863689/00040 andNo.0210/863689/55555; -No.0210/863691/00020,No.0210/863691/00030,No.0210/863691/00040and No.0210/863691/55555; RELAIS’ EXPAT (as a top-up to the CFE): -No.0210/863690/00010,No.0210/863690/00020,No.0210/863690/00030,No. 0210/863690/00040 andNo.0210/863690/55555; -No.0210/863692/00020,No.0210/863692/00030,No.0210/863692/00040andNo. 0210/863692/55555. As part of your membership, your healthcare benefits are supplemented as standard bymedical assistancebenefits.Europ Assistance, a company regulated by the French Insurance Code, insures and operates theAssistance Services. The plans provide a very comprehensive and flexible offer tailored to individual needs. You can also purchase life & disability benefits to protect you in the event of death or sick leave from work. 1.3./COVERAGE OPTIONS The plan provides: a range of BASIC BENEFITS (commercialized as ‘HEALTH’) covering costs related to hospitalization, Routine healthcare on an outpatient basis, Preventive andalternative medicine, pharmacy items, equipment and medical Prostheses, two OPTIONAL BENEFITS available in addition to the BASIC BENEFITS (HEALTH), chosen by each Member, covering the following costs: LEVEL 1 OPTIONAL BENEFITS (commercialized as ‘HEALTH+’): Vision and Dental LEVEL 2 OPTIONAL BENEFITS (commercialized as ‘HEALTH+CHILD’): Maternity.
4 Important:Level 2 optional benefits can only be selectedif Level 1 optional benefits have themselves been selected. Within each of these benefits, four packages are offered to eachMemberon enrollment: Quartz, Pearl, Sapphire andDiamond, providing increasing levels of benefits and services. The plan also offers, in respect of Basic benefits and Level 1 Optional benefits (excluding Level 2 optional Maternitybenefits), the possibility for theMemberto choose aDeductibleas defined in chapter3/p.11. Four levels ofDeductibleare available as well as the option of having noDeductible. For Zone 5 (USA), the plan also offers various levels of co-payment. It is specified that: the optional benefits, if they are selected by the Member, also apply to all of their Dependents listed on the Certificate of enrollment, a Member who has purchased optional benefits will only be able to withdraw from these optional benefits once for the entire duration of the plan in order to retain only the basic benefits. 1.4./COVERAGE ZONESUNDER THE PLAN There are 5 differentCoverage zonesunder the plan, defined as follows: -Zone 5: USAand territoriesunder US jurisdiction(Porto Rico, United States Virgin Islands, Northern Mariana Islands,United States Minor Outlying Islands, American Samoa) as well ascountries of Zones 1, 2, 3 and 4 -Zone 4: Bahamas, Brazil, China, Hong Kong, Jersey, St. Barthelemy, St. Martin, Singapore,Switzerland,United Kingdomand countries inZones 1, 2and3 -Zone 3: Australia, Austria, Canada, French Polynesia, Greece, Ireland, Israel, Italy, Japan, New Zealand, Portugal Qatar, Russia, Saint Pierre and Miquelon, Spain, Taiwan, Turkey,United Arab Emirates,Vanuatu and countriesinZones 1 and 2 -Zone 2: Andorra, Angola, Argentina, Azerbaijan, Bahrain, Barbados, Belarus, Belgium, Bolivia,Bosnia and Herzegovina, Bulgaria, Chile, Colombia, Costa Rica, Croatia, Cyprus, Czech Republic, Denmark, Djibouti, Dominican Republic, Ecuador,Finland, Georgia, Germany, Guatemala, Hungary, Iceland, Kazakhstan, Kuwait, Latvia, Lebanon, Liechtenstein, Luxembourg, Malaysia, Mexico,Monaco, Mozambique, Netherlands, Nigeria, Norway, Oman, Panama, Peru, Saudi Arabia, Slovakia,South Africa, Sweden, Thailand, Ukraine, Uruguay, Venezuela,Vietnam,Wallis and Futuna and countriesinZone1 -Zone 1: Worldwide (including France) excludingcountries inZones 2 to 5
6 Contracting association:ASFE. Legal entityhaving purchasedthe planfor the benefit ofits Members andwhichagrees to fulfill the corresponding obligations. Co-payment:Fixed amount specified in the plan per treatment, procedure or visit which is payable by the Member and their Dependents. It is applicable per person. Cost-sharing:Cost-sharing is the percentage of each claim thatis not coveredby yourinsuranceplan. Country of nationality:Any country for which the Insured member holds a valid passport and of which they are a citizen,national or subject, as specified in the Application for coverage. Date of termination:Date on which the benefits provided under the insurance plan come to an end, on the initiative of the Member, the Insurer or the Contracting association (see section5.2/Life of your planp.32in thechapterCESSATION OF MEMBERSHIP AND END OF COVERAGE (right of withdrawal and termination)). Deductible:Refers to the amount payable by the Member and any Dependents which is deducted from the reimbursable amount. It is applicable per person and per Insurance year. If this option is selected it will be specified on the Certificate of enrollment. Dental surgery:Refers to any Dental surgical procedure with anesthesia including dental extraction and bone or gum grafts. Dentures and dental implants:Refers to appliances used for fixed reconstruction or repair, bridges, crowns, dentures and implants, inlays, onlays, inlay cores and any auxiliary treatment required. Dependent:The following are classed as dependents if they are enrolled in the plan: theMember’s Spouse, Civil partner or Common- law spouse and Dependent children as defined in this section. Dependent children:Children of the Member, their Spouse, Partner or Common-law spouse: Undera FIRST’EXPAT+ plan (1stEuro/Dollar): children under the age of 26 will be considered dependentifthey are in full- time education and are covered under the plan Undera RELAIS’EXPAT+ plan(in addition to CFE benefits): children under the age of 20 will be considered dependent if they are in full-time education and are covered under the plan In all cases, forchildren over the age of 18 who are in in full-time education and are covered under the plan as Dependents, a school certificate is required at the time of enrollment and subsequently at the beginning of eachacademic year. Dietitian:A qualified health professional specializing in nutrition and food who is officially registered, qualified and recognized in the country in which they practice and who has the additional experience and qualifications required todeliver this service. Doctor:Health professional holding a degree of Doctor of Medicine who is authorized to practice medicine under the laws of the country where the treatment is administered, within the limits of the license they have been granted and who is not a family member of the person covered under this plan. Duration of membership:Period of coverage under the plan from the effective date of enrollment shown on the certificate of enrollment to the date of termination of membership as set out undersection5.2/Life of your planp.32in the chapter CESSATION OF MEMBERSHIP AND END OF COVERAGE (rightof withdrawal and termination). Effective date of benefits:Date specified on theCertificate of enrollment on which the benefits provided under the plan take effect, after application of the Waiting periods. Effective date of enrollment:Date specified on the Certificate of enrollment on which the benefits provided under the plan take effect. Emergency:Refers to the medical condition or symptoms resulting from an Illness or injury occurring suddenly and which clearly requires immediate treatment, usually within 24 hours of onset, without which there would be a risk of endangering the health of the affected person. Emergency dental and vision care with hospitalization:Term referring to extremely urgent dental and vision care dispensed following a serious Accident or the sudden onset of an infection requiring hospitalization. Treatment must be administered within 24 hours of the Accident or infection. This benefit does not cover routine Dental surgery, routine dental care, Dentures, routine vision care, vision correction, laser vision correction and Orthodontics and Periodontics. These treatments are covered under the optional Dental/Vision benefits. Emergency dental and vision care without hospitalization:Term referring to extremely urgent dentaland vision care not requiringhospitalization but which must be administered as an Emergencyto relieve pain which is hard to tolerate. This benefit does not cover routine Dental surgery, routine dental care, Dentures, routine vision care, vision correction, laser vision correction and Orthodontics and Periodontics.These treatments are covered under the optional Dental/Vision benefits. Emergency hospitalization:Treatment administered following admission to a Hospital or medical center as a result of the onset of a sudden and unexpected health concern, following an Illness, Accident, infection, etc. Emergency treatment outside the coverage zone:Refers to Emergency treatment receivedin a higher zone thanthe Selected coverage zone, during a trip for the purposes of either business or leisure. Coverage is acquired for a maximum of 60 days per tripand is also limited to the Aggregate limit and only covers treatment required in the event of an Accident or the onset of a sudden, unexpected and unforeseen Illness, requiring surgery or Medical treatment that cannot wait until repatriation to the Main country of residence or the worsening of a serious Illness representing an immediate and serious dangerto the health of the Member and/or their Dependents. Treatment dispensed by a General practitioner or a Specialist must begin within 24 hours of the event which triggered the claim. The following are therefore not covered by this benefit: non-urgent therapeutic treatment which did not result from an Accident or unforeseenIllness requiring surgery, or Medical treatment that cannot wait until repatriation to the Main country of residence or the worsening of a serious Illness representing an immediate and serious danger to the health of the Member and follow-up care, even in cases where the Member or their Dependents were not able to travel to a country within their Selected coverage zone. Costs related to Pregnancy, Maternity, childbirth or any other Complication during Pregnancy or childbirth are also excluded from the benefit. It is recommended thatMembers and anyDependents contact the Administrator, MSHInternational, if trips of more than 60 days are planned outside the Selected coverage zone. Excluded countries:As a result of events (civil or foreign war, insurrection, etc.) which may be taking place there and, in all circumstances, in accordance withthe classification ofat-risk countries published by the French Ministry of Foreign Affairs, coverage