Coverage is in effect 24 hours a day. For students enrolled during the Fall Semester, coverage will be in effect from either August 15, 2007 or the date of Premium Payment, whichever is later, until August 15, 2008. For students enrolled during the Spring Semester, coverage will be in effect from either January 15, 2008, or the date of Premium Payment, whichever is later, until August 15, 2008. The plan covers injuries sustained and sickness contracted and causing loss commencing during the coverage period. The policy expires August 15, 2008. (Please note that this policy cannot establish physician’s fees, and therefore, cannot guarantee that payments made by Peoples Benefit Life Insurance Company, hereafter referred to as the Company, will cover all physician and surgeon charges in full.)

Benefits are provided up to $2,500 for accidental injuries for which medical treatment by a physician, surgeon, dentist, registered nurse,
hospital services, ambulance services, or x-rays are rendered. The initial treatment must be rendered within 180 days of the accident and benefits are limited to treatment rendered within 52 weeks of the date of accident. Specific benefit levels are as shown below:

Hospital Room and Board: The expense actually incurred is allowed not to exceed $500 per day.

Hospital Inpatient Miscellaneous Expense: The expenses actually incurred are allowed not to exceed $2,000 as the result of any one
injury.

Surgical Expense: The expense actually incurred is allowed not to exceed $100 times the unit value of the MDR allowance, or $2,000 in
total for all surgical operation(s) performed for any one injury.

Day Surgery Miscellaneous Expense: The expense actually incurred is allowed up to a maximum of $1,500 per covered accident.

Ambulance Expense: The expense actually incurred is allowed not to exceed $250 for any one injury.

Physician’s Expense: Inpatient, limited to one visit per day, paid at the usual and customary rate, up to $50 per visit, to a $700 maximum. Outpatient, limited to one visit per day, paid at the usual and customary rate, up to $70 per visit, to a $700 maximum. Second surgical opinions will be covered up to the expense incurred subject to a maximum of $50.

Inpatient Graduate Nurse Expense: The expense actually incurred is allowed subject to a maximum benefit of $50 per 24-hour period, or $500 maximum per injury.

Outpatient Miscellaneous Expense: The expense actually incurred is allowed subject to a maximum $400 as the result of any one injury. Diagnostic procedures deemed necessary by a physician, or nurse practitioner, are covered on the same basis as any other medical condition, regardless of the results.

Dental Expense: The Company will pay up to a maximum of $500 per injury.

Physiotherapy Benefit: Up to $35 per visit is allowed subject to a maximum of $150 for any one injury.

Anesthesia Expense: The expense actually incurred is allowed up to 30% of the surgeon’s allowance.

Consultant’s Expense: The expense actually incurred is allowed up to $50 per covered injury.

Prescription Medicine Expense: (Caremark Provider) Prescriptions are dispensed by a Caremark network pharmacy and are limited to one 30 day supply per prescription at a time subject to the following: There is a $3 Copay for Generic Drugs, and a $10 Copay for Brand Name Drugs, up to an aggregate maximum benefit of $500.

$1,000 payable when Injury results in the loss of life within 180 days of the accident.

$1,000 payable per the schedule as shown in the Master Policy.

Sickness benefits will be paid up to $2,500 for medical expenses incurred within 52 weeks of the date of the first medical treatment subject to the following:

Hospital Room and Board: The expense actually incurred is allowed not to exceed $500 per day.

Hospital Inpatient Miscellaneous Expense: The expenses actually incurred are allowed not to exceed $2,000 as the result of any one
Sickness.

Surgical Expense: The expense actually incurred is allowed not to exceed $100 times the unit value of the MDR allowance, or $2,000 in total for all surgical operations performed for any one Sickness. (Note: Treatment of impacted wisdom teeth is covered on the same basis as any other medical condition.)

Day Surgery Miscellaneous Expense: The expense actually incurred is allowed up to a maximum of $1,500 per covered Sickness.

Ambulance Expense: The expense actually incurred is allowed not to exceed $250 for any one Sickness.

Physician’s Expense: Inpatient, limited to one visit per day, paid at the usual and customary rate, up to $50 per visit, to a $700 maximum. Outpatient, limited to one visit per day, paid at the usual and customary rate, up to $70 per visit, beginning with the second visit, to a $700 maximum. If you use the college health center for your initial treatment, or if the student health center is closed or you are more than 50 miles from campus and see a physician, it will count as your first outpatient visit. Second surgical opinions will be covered up to the expense incurred subject to a maximum of $50.

Inpatient Graduate Nurse Expense: The expense actually incurred is allowed subject to a maximum benefit of $50 per 24-hour period or $500 as the result of any one Sickness.

Outpatient Miscellaneous Expense: The expense actually incurred is allowed subject to a maximum $400 as the result of any one sickness. Diagnostic procedures deemed necessary by a physician, or nurse practitioner, are covered on the same basis as any other medical condition, regardless of the results. Additionally, the removal of nonmalignant growths will be covered, when deemed medically necessary.

Prescription Medicine Expense: (Caremark Provider) Prescriptions are dispensed by a Caremark network pharmacy and are limited to
one 30 day supply per prescription at a time subject to the following: There is a $3 Copay for Generic Drugs, and a $10 Copay for Brand Name Drugs, up to an aggregate maximum benefit of $500.

Anesthesia Expense: The expense actually incurred is allowed up to 30% of the surgeon’s allowance.

Consultant’s Expense: The expense actually incurred is allowed up to $50 per covered Sickness.

Wellness Health Examinations: Benefits will be provided on the same basis as benefits for any other Sickness. We will pay for: (1) all Insureds 17 years of age or older, annual tests to determine blood hemoglobin, blood pressure, blood glucose level and blood cholesterol
level or, alternatively, low-density lipoprotein (LDL) level and blood high density lipoprotein (HDL) level and an annual consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being: (2) All insured 35 years of age or older, a glaucoma eye test every 5 years; (3) All Insureds 40 years of age or older, an annual stool examination for presence of blood; (4) all Insureds 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years (this examination is subject to a limit of $350); (5) all female Insureds 17 years of age or older, a pap smear every two years; (6) all female Insureds 40 years of age or older, an annual mammogram examination; and (7) all adult Insureds, recommended immunizations. Benefits payable under this section shall not exceed the following maximums for any one year: (1) $350 for Insureds between the ages of 17 and 39; (2) $350 for all male Insureds ages 40 and over; and (3) $350 for all female Insureds ages 40 and over. The cost of a left-sided colon examination is not included in these benefit limits. Testing for meningitis and sexually transmitted diseases is included in these benefit limits.

The plan will pay for the following mandated benefits and any other applicable mandate in accordance with New Jersey insurance laws: Maternity, Mammography, Prescription Health Examinations, Wellness Health Examinations, Mastectomy and Reconstructive Breast Surgery, Diabetes Treatment, Childhood Immunizations, Lead Poisoning Screening, Alcoholism Treatment, Home Health Care, Wilm’s Tumor, Blood Products and Blood Infusion Equipment, Dose-Intensive Chemotherapy, Prostate Cancer Screening, Therapeutic Treatment of Inherited Metabolic Diseases, Pap Smear Coverage, Audiology and Speech-Language Pathology, Certain Dental Services, Biologically-Based Mental Illness, Infertility Benefits, Colorectal Cancer Screening, Non-Standard Infant Formulas, Newborn Hearing Loss Screening, and Off-Label Drugs.

For Both Accident and Sickness

After the Company pays $2,500 in basic benefits under either the accident or sickness provision of the policy for any one accident or sickness, this policy will pay 80% of the expenses incurred in excess of $2,500 up to but not exceeding $47,500 for physician’s services, hospital confinement, nursing services, X-Rays, operating room, emergency room, anesthesia, laboratory service, dressings, prescription medicines, casts, use of wheel chair, crutches, or ambulance for any one covered accident or sickness. Expenses must be incurred within two years from the date of accident or sickness.

The Policy does not cover:

1. Routine physical examinations and routine testing preventive testing or treatment; screening exams or testing in the absence of Injury or Sickness, except for treatment or examinations specifically covered under the Sickness Expense provision;
2. Eye examinations; prescriptions or fitting of eyeglasses and contact lenses; or other treatment for visual defects and problems. “Visual defects” means any physical defect of the eye which does or can impair normal vision;
3. Hearing examinations or hearing aids; or other treatment for hearing defects and problems. “Hearing defects” means any physical defect of the ear which does or can impair normal hearing;
4. Dental treatment, except for accidental injury;
5. War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered);
6. Participation in a riot or civil disorder; commission of or attempt to commit a felony;
7. Injury sustained while (a) participating in any interscholastic, intercollegiate or professional sport, contest
   or competition; (b) traveling to or from such sport, contest or competition as a participant; or (c) while participating
   in any practice or conditioning program for such sport, contest or competition;
8. Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, or flight in any kind of aircraft, except while riding as a passenger on a regularly scheduled flight of a commercial airline;
9. Treatment in a Government Hospital, unless there is a legal obligation for the Insured to pay for such treatment.
10. The Insured’s being intoxicated or under the influence of any narcotic, unless administered on the advice of a
    Physician;
11. Elective Surgery and Elective Treatment;
12. Routine new-born baby care, well-baby nursery and related Physician charges;
13. Pre-existing Conditions, except for: (a) individuals who have been continuously insured under the school’s policy
    for at least 6 consecutive months; or (b) individuals who have been insured under another group policy issued by this Company immediately preceding the individual’s Effective Date under the Policy, and the Company paid benefits for the Pre-Existing Condition under the preceding group policy;
14. Congenital conditions, except as specifically provided for Newborn Infants;
15. Injury or Sickness for which benefits are paid or payable under any Worker’s Compensation or Occupational Disease Law or Act, or similar legislation;
16. Organ transplants;
17. Assistant Surgeon Fees; and
18. Supplies, except as specifically provided in the Policy.

This optional benefit is subject to payment of the additional premium as specified on the enrollment card. Optional benefits may only be purchased at the time of initial enrollment in the plan and may not be added later. When recommended and approved by the attending Physician, arrangements will be made for the evacuation of the Insured to his natural country. Evacuation will be arranged and paid for by Medex. No additional benefits will be paid under Basic or Major Medical coverage for Medical Evacuation.

This optional benefit is subject to payment of the additional premium as specified on the enrollment card. Optional benefits may only be purchased at the time of initial enrollment in the plan and may not be added later. If the Insured dies while Insured under the policy, arrangements will be made for preparing and transporting the remains of the deceased’s body to his home country. Repatriation will be arranged by and paid for by Medex. No additional benefits will be paid under Basic or Major Medical coverage for Repatriation.

Written notice of claim must be given to the Insurer within 90 days after loss occurs, or as soon as reasonably possible.

A Company claim form is required for filing a claim. Mail to the address below all Medical and Hospital bills along with the patient’s name and insured student’s name, address, social security number and name of the college under which the student is insured. Claim forms are available at the Student Health Center or your college’s Student Insurance

THIS PLAN UNDERWRITTEN BY:

101 JFK PARKWAY
SHORT HILLS, NJ 07078
(866) 267-0092 (Claims/Coverage)
(800) 526-1379 (Other Questions)

PREFERRED PROVIDER NETWORK PROVIDED BY:

PLEASE PRINT OUT THIS BROCHURE AND KEEP IT AS A GENERAL SUMMARY OF THE INSURANCE BENEFITS. The Master Policy on file at the College contains all of the provisions, limitations, exclusions and qualifications of your insurance benefits, some of which may not be included on this brochure. If any discrepancy exists between the brochure and the Master Policy, the Master Policy will govern and control the payment of benefits.

1038008