Unlimited coverage with free-choice of hospitals worldwide, and access to the best provider network in the U.S, and includes optimal maternity and specialized treatments

2020

Geographic Coverage Areas

Global 360 Health provides worldwide coverage with access to a U.S. Preferred Provider Network containing more than 5,000 hospitals and 550,000 providers with an option for coverage out-of-network. Outside of the U.S, members can access any provider of their choice. This extensive geographic coverage area and use of provider networks allow GBG to provide first rate worldwide coverage while maintaining affordable rates.

Global 360 Health is tailored exclusively for individuals and families residing in Brazil who seek comprehensive international health insurance with access to the highest quality medical providers in Brazil and worldwide.

The plan offers a range of deductibles for members and provides coverage for inpatient care, outpatient care, preventive services, plus a pharmacy benefit and more.

As with all GBG plans, Global 360 Health includes the world-class services of GBG Latin America for medical assistance and evacuations, if necessary, anywhere in the world any time of day. GBG services include a vast network of medical facilities that will bill GBG directly, eliminating the need for a member to pay up-front for services.

Global 360 Health also includes the GBG Personal Medical Advisor, one of the world’s leading Medical Second Opinion services.

HOSPITALIZATION BENEFITSPrivate/Semi-private room 100%

Intensive care unit 100%

Medical treatment, medicines, laboratory an diagnostic tests (including cancer treatment, chemotherapy/radiotherapy) 100%

Inpatient consultation by a physician or specialist 100%

Medical fees for Inpatient surgery 100%

Accommodation charges for companion of a hospitalized Insured Up to $3,000, max $300 per day

Extended Care / Inpatient Rehabilitation (must be confined to facility immediately following a Hospital stay) 100%

Private duty nursing 100%; maximum 100 days per Policy Period

Inpatient psychiatric hospitalization 100%

OUTPATIENT BENEFITSPhysician/Specialist visit 100%

Mental health Outpatient 100%; maximum 50 visits per Policy Period

Diagnostic exams including laboratory and imaging tests 100%

Outpatient surgery medical fees 100%

Therapeutic services: Physical Therapy, Chiropractic, Occupational Therapy, VocationalSpeech Therapy, Homeopathy and Acupuncture

100%; maximum80 combined visits per Policy Period

Prescription Drugs following hospitalization or Outpatient surgery 100%; for a maximum of 6 months;$3,000 thereafter per Policy Period

Prescription Drugs after consultation 100%; maximum of$2,500 per Policy Period

EMERGENCIES

Serious Accident hospitalization (24 hours or more) 100%; Deductible waived for period offirst hospitalization only

Ground ambulance 100%

This is only a brief summary of key Plan provisions. Please refer to the Policy for complete details. Benefits are per person per Policy Period and are based upon medical necessity and Usual, Customary and Reasonable (UCR) charges, after Policy Period Deductible. Currency: USD

Global 360 Health Schedule of Benefits

MAXIMUM BENEFIT

No Annual or Lifetime Maximum

PROVIDER NETWORK• Worldwide excluding USA: Free choice of Provider.

• USA: The Insurer maintains a Preferred Provider Network. In-network benefits are paid at 100%. Out-of-network benefits are paid at 80% .

POLICY PERIOD DEDUCTIBLESPlan In Country of Residence Out of Country of Residence Plan In Country of Residence Out of Country of Residence

Plan 1 N/A N/A Plan 4 $5,000 $5,000

Plan 2 N/A N/A Plan 5 $10,000 $10,000

Plan 3 $2,000 $2,000 Plan 6 $20,000 $20,000

Family Maximum Deductible: 2 x Individual Deductible

This is only a brief summary of key Plan provisions. Please refer to the Policy for complete details. Benefits are per person per Policy Period and are based upon medical necessity and Usual, Customary and Reasonable (UCR) charges, after Policy Period Deductible. Currency: USD

EMERGENCIES (Cont.)Air Ambulance 100%; Deductible waived

Emergency room and Emergency medical services 100%

Emergency dental Care - limited to accidental injury 100%

Travel Reimbursement Benefit Up to $5,000 per Policy Period

SPECIALIZED TREATMENTS

Prophylactic surgery (only for gynecological cancer) A 12-month Waiting Period applies: 100%;

up to $25,000 Lifetime Maximum (including breast reconstruction)

Bariatric surgery(A 24-month Waiting Period applies) 100%; up to $10,000 Lifetime Maximum

Congenital and Hereditary Conditions Covered according to the limits of this Policy

Transplants procedures(In the U.S., must use the Institutes of Excellence approved by GBG)

100%; $750,000 Lifetime Maximum perdiagnosis, includes donor expenses

Hallux valgus ( a 24-month Waiting Period applies) 100%

PREVENTIVE CARE/ CHECK UP - Deductible WaivedChildren up to 6 months of age (including immunizations, exams and consultation) 100%; maximum 5 visits

Children 6 months or older and adults 100%; maximum $600 per person, per Policy Period

OTHER BENEFITSOncologic treatment 100%

Dialysis 100%

Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS),AIDS Related Complex (ARC). A 24 month Waiting Period applies. Benefit is not coveredif condition was diagnosed as Pre-existing Condition.

100%

GBG Personal Medical Advisor – Medical Second Opinion service 100%

Home Health Benefits/ Home Care 100%; maximum 100 daysper Policy Period

Special treatments (prosthesis, implants, appliances, and orthotic devices, and highly specialized drugs) 100%

Hospice Care 100%; maximum of 240 daysper Policy Period

Durable Medical Equipment 100%

Repatriation of mortal remains $20,000

War and Terrorism benefit 100%

Free Coverage for eligible dependents after the policyholder’s death 2 Years. (Death must had occurred from a covered condition)

Additional payment for covered Critical Illness $2,500; Lifetime Maximum per person

ATMSafe benefit $300 per Policy Period

MATERNITY BENEFITS (Covered on plans 3 and 4 only)• The Deductible is waived for this benefit only on Plan 3 ($2,000 Deductible) unless stated otherwise• The Deductible applies for this benefit on Plan 4 ( $5,000 Deductible)• A 10-month Waiting Period applies; no maternity related treatment for the mother or the newborn is covered during this period

Standard benefit: If only the mother is covered in the Policy (normal delivery or c-section) $10,000 benefit maximum per pregnancy

This is only a brief summary of key Plan provisions. Please refer to the Policy for complete details. Benefits are per person per Policy Period and are based upon medical necessity and Usual, Customary and Reasonable (UCR) charges, after Policy Period Deductible. Currency: USD

• No Annual or Lifetime Maximum• Inpatient and Outpatient coverage• Worldwide direct-bill network• Emergency medical evacuation• Online claims filing• Live customer service• Maternity and newborn care benefits• Transplant procedure benefit• Worldwide portability

Key Benefits

THE FOLLOWING SERVICES REQUIRE PRE-AUTHORIZATION• Hospitalization• Exams or Outpatient procedures that requires more than local anesthesia• Oncologic treatment in excess of $10,000• Home Health Benefits/ Home Care• Organ, bone marrow, stem cell transplants, and other similar procedures• Air Ambulance – Air Ambulance service will be coordinated by Insurer’s Air Ambulance Provider• Specialty Treatments and Highly Specialized drugs• Any condition that is expected to accumulate over $10,000 of medical treatment per Policy Period

NOTE: Failure to pre-authorize a procedure that requires Pre-authorization will result in a 30% penalty. (Except Air Ambulance, organ, bone marrow, stem cell transplants, and other transplant similar procedures not Pre-Authorized by the Company will not be covered).

MATERNITY BENEFITS (Covered on plans 3 and 4 only) (Cont.)Increased benefit: If both the mother and the father are covered in the Policy (normal delivery or c-section) $15,000 benefit maximum per pregnancy

Complications of Maternity and Perinatal (provided the child was born from a Covered Pregnancy).

Provisional coverage for newborn (for a maximum of 90 days); Covered Pregnancies only $5,000 benefit maximum per pregnancy

Optional Rider for Complications of Maternity and Perinatal (Plans 5 and 6). Coveragefor Policyholder or spouse only.

$500,000 Lifetime Maximum,all pregnancies combined; Deductible applies

GBG Latin America7600 Corporate Center Drive, Suite 500

Miami, FL 33126 USA

latam.gbg.com

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