AnnualT R A V E L P L A N

More than just insurance. Pacific Cross provides peace of mind.

2 0 1 9

Medical Expense

Follow-up Care$6,500 $6,500

Emergency EvacuationEmergency evacua�on to the nearest facility capable of providing adequate medical care.

Included Included

Included Included

Included Included

Included Included

Repatriation

Hospital Expenses Guarantee

Additional Cost of Travel & Accommodation

Guarantee eligible medical expenses when hospital bills exceed US$2,500.

$5,000 $3,500

Family Member Visit $5,000 $3,500

Return of Children$5,000 $3,500

Burial and FuneralTransporta�on charges for repatria�on of the mortal remains to the Country of Residence or origin.

$3,000 $2,000

Referral Services

3. HOSPITAL CASH ALLOWANCE

$1,000 $750

4. BAGGAGE & PERSONAL EFFECTS

$2,000 $1,000

Addi�onal CoverLoss of laptop computer

$1,000 $500

5. BAGGAGE DELAY

$250 $125

$100,000 $75,000

BENEFIT(IN US$)

Benefits (in US$) Premier Plan Executive Plan1. PERSONAL ACCIDENT

2. MEDICAL EXPENSES & EMERGENCY ASSISTANCE (The cost of medical treatment arising from illness or accidental injury).

Medical ExpenseFees for hospita l iza on, surgery, ambulance , medicine and tests with a maximum of US$300 perday for hospita l room and board, and US$1,000 i�he room fee includes the fees for a l lprofess iona l services .

Follow-up CareMedica l expenses reasonably incurred immediate ly fol lowing discharge from hospita l wi thin 90days of return to home country.

$6,500 $6,500

Emergency Evacua onEmergency evacua on to the neares�aci l i ty capable of providing adequa te medica l care .

Unlimited Unlimited

Repatria onRepa tria on to the country of res idence when the Company and a ending phys ician determinetha��s necessary.

Unlimited Unlimited

Hospital Expenses GuaranteeGuarantee e l igible medica l expenses when hospita l bi l l s exceed US$2,500.

Addi onal Costs of Travel & Accommoda onAddi ona l trave l l ing costs o�he Insured Person for returning to the country of res idence andaddi ona l costs of accommoda on incurred by the Insured Person and an insured ami ly emberor trave l l ing companion when such costs ari se from hospita l iza on due to a covered disabi l i tynecess i ta ng medica l trea tment o�he Insured Person.

$5,000 $3,500

Family Member VisitTrave l l ing costs for 2 immedia te fami ly members to join the Insurance Person who is confined inhospita l for more than 3 days or i s dead abroad.

$5,000 $3,500

Return of ChildrenReasonable addi ona l accommoda on and trave l l ing expenses for una ended insured chi ldren(age be low 14) return to the country of res idence .

$5,000 $3,500

Burial and FuneralTransporta on charges for repa tria on o�he morta l remains to the country of res idence .

$3,000 $2,000

Referral ServicesAl l referra l services such as lega l ass is tance , interpreter, obta ining replacement oflos�rave ldocument or a ir cket, etc.

3. HOSPITAL CASH ALLOWANCE

$1,000 $750US$50 for each complete day the Insured Person i s hospita l ized over 24 hours as a resul t of acovered disabi l i ty.

4. BAGGAGE & PERSONAL EFFECTS

$2,000 $1,000Loss or damage directly resul ng from accident, the , burglary, robbery or mi shandl ing by carriersto the Insured Person’s baggage or persona l i tems carried. The l imi�s US$250 per i tem andUS$500 per pa ir or set.

Addi onal CoverLoss oflaptop computer

$1000 $500

5. BAGGAGE DELAY

$2,000 $1,500Emergency purchases of essen a l i tems o�oi letries and clothing up to a maximum of US$65 perar cle when the checked baggage i s de layed for a t least 12 hours from the me of arriva l a tdes na on.

6. LOSS OF TRAVEL DOCUMENT $2,000 $1,500

Cost of obta ining replacements of passport, a ir ckets , trave l expenses and accommoda onincurred to obta in such replacement ari s ing from the , burglary, robbery and accidenta l loss .

$250,000 $100,000

$100,000 $75,000

Annual Travel plans are ideal for the frequent traveler or business execu�ve who needs cover for an unlimited number of overseas trips per year. Pacific Cross provides peace of mind for your travel.

Fees for hospitaliza�on, surgery, ambulance, medicine and tests with a maximum of US$300 per day for hospital room and board, and US$1,000 if the room fee includes the fees for all professional services.

Medical expenses reasonably incurred immediately following discharge from hospital within 90 days of return to Country of Residence.

Repatria�on to the Country of Residence when the Company and a�ending physician determine that it is necessary.

Accidental death or permanent disability including loss of one or more limbs or loss of sight in one or both eyes. The limit of cover for children under 18 years of age is US$20,000.

Addi�onal travelling costs of the Insured Person for returning to the Country of Residence and addi�onal costs of accommoda�on incurred by the Insured Person and an insured family member or travelling companion when such costs arise from a hospital confinement due to a covered Disability necessita�ng medical treatment of the Insured Person.

Travelling costs for 2 Immediate Family Members to join the Insured Person who is confined in hospital for more than 3 days or is dead abroad.

Reasonable addi�onal accommoda�on and travelling expenses for una�ended insured children (age below 14) return to the Country of Residence.

All referral services such as legal assistance, interpreter, obtaining replacement of lost travel document or air �cket, etc.

US$50 for each complete day the Insured Person is hospitalized over 24 hours as a result of a covered Disability.

Loss or damage directly resul�ng from Accident, the�, burglary, robbery or mishandling by carriers to the Insured Person’s baggage or personal items carried. The limit is US$250 per item and US$500 per pair or set.

Emergency purchases of essenital items of toiletries and clothing up to a maximum of US$65 per ar�cle when the checked baggage is delayed for at least 12 hours from the �me of arrival at des�na�on.

Rev. 04/2019

Emergency purchases of essen a l i tems o�oi letries and clothing up to a maximum of US$65 perar cle when the checked baggage i s de layed for a t least 12 hours from the me of arriva l a tdes na on.

6. LOSS OF TRAVEL DOCUMENT

7. PERSONAL MONEY

Loss of cash, bank notes and travellers checks arising from the�, burglary or robbery.

8. TRAVEL DELAY

Addi�onal Travel Cost

Cash Allowance

$175 $125

9. CURTAILMENT OF TRIP & CANCELLATION CHARGES

10. PERSONAL LIABILITY

11.(for adult between age 23 and 75)

Loss or damage occurs to a rental car result directly from fire,the�, collision or vandalism.Deduc�ble: US$500

12. ADDITIONAL PERSONAL ACCIDENT BENEFIT(for adult between age 18 and 65)

(up to Total Sum Insured of $500,000)

(up to Total Sum Insured of $500,000)

AGE LIMIT

MAIN EXCLUSIONS

1. Suicide, self-inflicted injury, childbirth, miscarriage, dental treatment (except as necessitated by accidental injuries to sound and natural teeth), psychiatric and mental disorders, insanity,

related complex.

3.

1. Losses not reported to police within 24 hours, and / or to the carrier immediately as appropriate.2. No proof is provided for relevant expenses / loss.

3. Liability or damage whether or not the Insured Person is responsible under the car rental agreement.

CLAIMS PROCEDURE

occurrence which may give rise to a claim under this insurance. All claims shall be made together

responsible authority.

PREMIUM (IN US$)

$350 $205

$83 $83

$39 $39

Op�onal Rental Car Protec�on

Addi�onal Personal Accident (each US$50,000 increase)

Plans

Annual Premium

$100,000 $65,000

$6,500 $4,500

$800 $500

$500 $325

$2,000 $1,500

$10,000 (op�on) $10,000 (op�on)

RENTAL CAR PROTECTION BENEFIT

BENEFIT(IN US$)

If the Insured Person need not pay addi�onal travelling cost in the event of travel delay, the Insured Person will be indemnified at US$25 for each full 6 hours delay.

Cost of obtaining replacements of passport, air �ckets, travel expenses and accommoda�on incurred to obtain such replacement arising from the�, burglary, robbery and accidental loss. Maximum limit per day for travel and accommoda�on expenses is US$200 for Premier Plan and US$150 for Execu�ve Plan.

Transporta�on expenses necessarily incurred as a direct consequence of travel delay resul�ng from serious weather condi�ons, natural disasters (earthquake, flood, hurricane, tornado, tsunami, etc.), industrial ac�on, hijack, mechanical derangement only if the Insured Person has to re-route his trip due to cancella�on of a prior confirmed booking.

Reimbursement of irrecoverable prepaid travel arrangement deposits or any increased cost of travel in the event of death, serious injury or illness of the Insured Person, Immediate Family Members, Close Business Partner or travel companion of the Insured Person, witness summons, jury service, compulsory quaran�ne; natural disasters at the planned des�na�on or complete destruc�on of the Insured Person’s principal residence.

PREMIER PLAN EXECUTIVE PLAN

Rev. 04/2019

A minimum age of 6 weeks to a maximum age of 80 years and children under 7 must be accompanied by an adult who is also insured under the same policy.

KEY FEATURES

• Baggage & Personal Effects cover extends to laptop computers.Personal Accident benefit for choosing up to a maximum of US$500,000 (for adult between age18 and 65).

Whenever you travel outside Country of Residence, coverage begins automa�cally, for up to 90 days per trip.

(This benefit does not apply to the use or hire of motor vehicles.)

Indemnity against legal liability to a third party as a result of accidental injury or loss or damage to property during the Period of Insurance .

Important NoteThe policy is valid for the purpose of leisure travel or business travel

outside the Country of Residence(limited to administra�ve and non-manual work only)

This brochure is not a contract. For exact wording and complete details of the cover,terms, conditions and exclusions of the policy, please refer to the policy itself.

If you have any questions relating to this application, please forward them to Pacific Cross Insurance Company LimitedBusiness Development Team at

E-mail: inquiry@pacificcross.comWebsite: http://www.pacificcross.com

The Third Party Administrator for Pacific Cross Insurance Co., Ltd. is International Administrators Limited:11/F, O.T.B. Building, 160 Gloucester Road, Wanchai, Hong Kong, SAR, Tel: (852) 2573-2278, (852) 2573-2535Fax: (852) 2573-2917

Policyholder: Tel:

Address: Fax:

Email:

Country of Residence:

ANNUAL TRAVEL APPLICATION

appropriate box):

Total premium of this policy:

Coverage Selected: (please

Preferred Effective Date: / / (MM/DD/YY)

Premier Plan Executive Plan

Name of Insured PersonSex

Date of BirthPassport No.Occupation

Optional Rental Premium

(Last Name / First Name) (MM/DD/YY) Car Protection Additional Sum Insured US$

I enclose my check for US$ payable to ”.

Name of Cardholder: Relationship to Policyholder: Signature of Cardholder:

Declaration: I hereby apply for an Annual Travel Insurance Policy to be based on the above statements, and warrant that to the best of my knowledge and belief that

no Insured Person is travelling contrary to the advice of a medical practitioner or for the purpose of obtaining medical treatment and that I understand treatment of any

pre-existing, existing, recurring or congenital medical conditions is not insured. I further warrant that I am not aware of any condition, cause or circumstances that

may necessitate the cancellation or curtailment of the journey as planned. I further authorize the Company to provide my personal data including but not limited to

health and details of the claims incurred to reinsurance companies with whom the Company has or proposes to have dealings or to any agent, contractor or third party

service provider who provides services to the Company in connection with the operation of its business.

Policyholder’s Signature: Date: Broker:

Please charge: American Express Visa MasterCard Card No.: Expiry Date (MM/YY) /

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Rev. 04/2019