Subject: IFCSS Insurance Program Brochure

From: [email-masked] (ifcss)
Date: Mon, 14 Aug 95 23:08:07 GMT

IFCSS  MEDICAL INSURANCE PROGRAM 1995

Underwritten by:
Continental Casualty Company
Chicago, Illinois

Administered by:
Seabury & Smith
1255 23rd St. NW, Suite 300
Washington, D.C. 20037
1-800-424-9883
DC Area:  202-457-6820

The Policyholder of the Plan is: IFCSS

ELIGIBILITY OF COVERAGE:

All Chinese Students, Scholars, and their accompanying eligible dependents
from Mainland China;  who are associated with IFCSS;  who either have valid
F-1 or J-1 visa status (dependents have F-2 and J-2 visa) or are permanent
residents who are actively engaged full-time in education or educational
research activities in the United States.

Actively engaged full-time with respect to a student or scholar means a
person who is enrolled and attending classes in a college, University, or
community college for six or more credit hours.

MEDICAL TREATMENT BENEFIT:

This benefit will pay for the Medically Necessary Eligible Expenses
incurred for the treatment of a Covered Injury or Covered Sickness which
first occurs after you become insured.  This benefit covers up to the plan
maximum of $250,000 of the Eligible Expenses incurred for Covered Injury or
Covered Sickness according to the table below for Students and up
to the plan maximum of $50,000 for a Spouse or Child.

You must pay any deductible or amount not eligible for benefits under The
Plan.

Benefits Paid by Policy:

Maximum/Injury or Sickness
        Student                         $250,000
        Spouse & Child                   $50,000

Deductible Per Calendar Year      either: A. $200/Insured
                                          B. $500/Insured

Hospital and Medical Charges,
After Deductible
        Student:                Up to $20,000                    75%
                                $20,000.01 to $50,000            80%
                                $50,000.01 to $250,000          100%
                                Spouse & Child  Up to $50,000    70%

In addition, Eligible Expense Incurred for a Covered Injury or Covered
Sickness are subject to the following limits:

Therapeutic Termination of Pregnancy:         $400 of Maximum Benefit

In Hospital Room and Board:                    Usual and Customary
Semi-Private
                                                       Room Rate

Newborn 1st 31 Days/Routine Nursery Care Benefit:       $300 Maximum

Accidental Dental Expenses (Covered Injury Only):       $1,000 Maximum
Benefit (limited to $100 per tooth)

Emotional & Mental Disorders
and Substance/Alcohol Abuse
  Inpatient Limit:
    Same as any other disability (30-day Maximum Benefit)
  Outpatient Limit:                               $500 Maximum
Benefit while insured

Outpatient Prescription Drugs:                   50% of Actual Charges

Outpatient Back & Spine Disorders               $500 per year Maximum
    (including modalities):                     $35 per visit
(Maximum 3 visits/week)

Home Country Benefit:
        Benefit/30-day Limit                    $1,000 Maximum

MEDICAL EVACUATION BENEFIT:

Maximum Benefit:        Up to $25,000

If you become unable to continue your academic program because of a
Covered Injury or Covered Sickness, the insurance will pay the necessary
expenses to the Maximum Benefit for your evacuation to your Home Country;
or to a facility for the treatment of injured or ill persons in your Home
Country; or to another medical facility in the U.S.A.  A medical evacuation
would be considered only if Medically Necessary and after being
hospitalized
for at least five consecutive days.  Any expenses in respect of medical
evacuation require prior approval of the attending physician.

REPATRIATION BENEFIT:

Maximum Benefit:        Up to $10,000

If you should die from a Covered Injury or Covered Sickness, the insurance
will pay to the Maximum Benefit necessary expenses for the preparation and
transportation of your body to your Home Country.

PREMIUM RATES:

These rates are valid for coverage which has an effective date on or after
March 27, 1995 and until December 31, 1995.  For rates effective after
these dates, please call the Administrator.

Premium may be paid either semi-annually or quarterly.

Premium Rates:

         A.  $200 DEDUCTIBLE             B.  $500 DEDUCTIBLE

       Quarterly:    Semi-Annual:      Quarterly:   Semi-Annual:

Student    $102          $204              $91           $182

Student & Spouse
           $792          $1584             $710          $1420

Child      $224          $448              $201          $402

2+ Children
           $449          $898              $402          $804

Note:  Dependents may only be enrolled on the date the member is enrolled
or within 31 days of birth, or 90 days of marriage or arrival in the U.S.A.

IFCSS MEDICAL INSURANCE ENROLLMENT FORM

PLEASE PRINT -- PLEASE ANSWER ALL QUESTIONS

FAMILY NAME:            FIRST NAME (given name): ____________________

U.S.A. STREET ADDRESS________________________________________________

CITY:___________________  STATE:_____ZIP:_______

HOME TELEPHONE NUMBER:                      DATE OF BIRTH:

NAME OF UNIVERSITY/SCHOOL:

TYPE OF VISA HELD:  ________  VISA Number_____________________
Male_______Female_____

YOUR UNIVERSITY/SCHOOL ADVISOR:
__________________________________________________

Advisor Phone Number:
__________________________________________________

YOUR HOME
COUNTRY:__________________________________________

I want my insurance to begin on: ____________/___________, 1995
                                   month                day
CIRCLE DEDUCTIBLE CHOICE AND WHETHER PAYING QUARTERLY OR SEMI-ANNUALLY.

           A.  $200 DEDUCTIBLE             B.  $500 DEDUCTIBLE

           A.  QUARTERLY                   B.  SEMI-ANNUALLY

IF YOU ARE INSURING DEPENDENTS:
                Names:                           Date of Birth:

Spouse: ____________________________________    _______________

Child:  ____________________________________    _______________

Child:  ____________________________________    _______________

        I understand and agree that if I am not attending classes on a
full-time basis, or if my dependents named in this enrollment form are
hospital confined on the date the insurance would otherwise take effect,
such insurance shall not take effect until the day following the date I
began attending classes on a full-time basis and as to my dependents, on
the day following their discharge from the hospital.

___________________________________________________            __________
        SIGNATURE OF STUDENT                                   DATE

NOT AVAILABLE IN SOME STATES.  MAIL THIS ENROLLMENT FORM WITH YOUR CHECK OR
MONEY ORDER IN U.S. FUNDS, PAYABLE TO: ADMINISTRATOR, IFCSS GROUP INSURANCE
TO:

ADMINISTRATOR, IFCSS GROUP INSURANCE PLAN
1255 23rd St. NW, Suite 300
Washington, D.C.  20037

If you have any questions, please call The Administrator (toll-free):
1-800-424-9883      DC Area:   (202) 457-6820