2010-2011Student Accident & Sickness

Insurance Plan

MARITIME COLLEGEState University

of New York(“the Policyholder”)

Bronx, New York

Underwritten by:National Union Fire Insurance Company of

Pittsburgh, Pa. (“the Company”),with its principal place of business in

New York, NY

Please keep this brochure as a general summaryof the insurance

Administrator Policy Number: CHH0071371Underwriter Reference Number: CAS9499806

SUNY Maritime College offers an Accident andSickness Insurance Plan for Regimental andNon-Regimental Students. This Accident andSickness Insurance Plan provides worldwidecoverage 24 hours a day whether the student ison campus, on a training ship, at home orabroad. This is only a brief description of thecoverage available under policy seriesS3049NUFIC-NY. The Policy may contain defini-tions, reductions, limitations, exclusions and ter-mination provisions. Full details of the coverageare contained in the Policy. If there is any conflictbetween the contents of this document and thePolicy, the Policy shall govern in all cases. TheCoverage document is on file for review at theCollege.

EFFECTIVE AND TERMINATION DATESThe Master Policy becomes effective at 12:01a.m. on August 11, 2010 and it terminates at11:59 p.m. on August 10, 2011. Coverage forCovered Students will be effective on the Policyeffective date; the effective date of the coverageperiod elected; or the day after the date theenrollment form and correct premium arereceived, whichever is latest. Coverage for theCovered Student terminates on the earliest of: a)the date the Policy terminates; b) the last day forwhich premium has been paid; or c) the date heor she enters the armed forces. CoveredStudents entering the armed forces of any coun-try will not be covered under the Policy as of thedate of such entry. A pro-rata refund of premiumwill be made to such persons upon writtenrequest received by the Company. No otherrefunds of premiums will be allowed. Should aCovered Student graduate or withdraw from theCollege, the insurance shall remain in effect untilthe end of the period for which the premium hasbeen paid.

ELIGIBILITYAll full-time undergraduate students are automat-ically enrolled in the Student Accident andSickness Insurance Plan, unless proof of compa-rable coverage is provided and confirmed (see“WAIVER PROCESS/PROCEDURE” on page 4).The premium for this coverage will be added tothe student’s tuition bill.

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that the eligibility requirements have not been orare not being met, its only obligation is refund ofpremium less any claims paid.

IDENTIFICATION CARDSThe Student Accident and Sickness InsurancePlan Identification Card is located on the inside ofthe back cover of this brochure. Please detachand retain this card in a safe place. No other IDCard will be issued.

DEFINITIONS“Accident” means an occurrence which (a) isunforeseen; (b) is not due to or contributed to bySickness or disease of any kind; and (c) causesInjury.

“Biologically based mental illness” means amental, nervous, or emotional disorder causedby a biological disorder of the brain which resultsin a clinically significant, psychological syndromeor pattern that substantially limits the functioningof the person with the illness. The following dis-orders covered by this definition are: schizophre-nia/psychotic disorders; major depression; bipo-lar disorder; delusional disorders; panic disorder;obsessive compulsive disorders, anorexia andbulimia.

“Covered Person” means a Covered Studentwhile coverage under the Policy is in effect.

“Covered Student” means a student of thePolicyholder who is insured under the Policy.

“Deductible/Deductible Amount” means thedollar amount of Eligible Expenses a CoveredPerson must pay before benefits becomepayable.

“Doctor” means: (a) legally qualified physicianlicensed by the state in which he or she prac-tices; and (b) a practitioner of the healing artsperforming services within the scope of his or herlicense as specified by the laws of the state ofsuch practitioner; and (c) certified nurse mid-wives and licensed midwives while acting withinthe scope of that certification. The term “Doctor”does not include a Covered Person’s immediatefamily member.

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A student who initially waives coverage for theStudent Accident and Sickness Insurance Plan,but subsequently experiences ineligibility underanother plan, may elect to enroll for coverageunder the Plan within 30 days of the date of in-eligibility under another comparable plan. Proofis required at the time of enrollment. Coveragewill become effective the day after the date theenrollment form and premium are received.Premiums will not be pro-rated.

WAIVER PROCESS/PROCEDUREFull-time students who are currently insured byother health insurance may waive out of theStudent Accident and Sickness Insurance Planwith proof of comparable coverage. The waivermust be completed by the waiver deadline ofSeptember 15, 2010. Failure to meet the waiverdeadline will result in the student being responsi-ble for the insurance premium added to the stu-dent’s tuition bill. Waivers are available in theSUNY Maritime Student Accounts Office. You willneed a copy of your insurance ID card and proofof worldwide coverage. Waivers are also avail-able at www.haylor.com/sunymaritime.

All graduate students enrolled for at least 6.0credits are eligible to enroll in the StudentAccident and Sickness Insurance Plan asdescribed in this brochure on a voluntary basis.Graduate students may enroll through the SUNYMaritime College Student Accounts Office, or bydownloading and completing the enrollment format www.haylor.com/sunymaritime. Send the com-pleted form and premium remittance with a checkor money order payable to National Union FireInsurance Company of Pittsburgh, Pa. and mailto: Maksin Management Corp, PO Box 2849,Camden, NJ 08101-2849. The deadline toenroll for the annual coverage is September15, 2010, and the deadline to enroll for theSpring Semester is January 30, 2011. No en-rollment will be accepted after these deadlines.

Eligibility requirements must be met each time apremium is paid to continue coverage. TheCompany maintains the right to investigate stu-dent status and attendance records to verify thatPolicy eligibility requirements have been andcontinue to be met. If the Company discovers

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health, could reasonably expect the absence ofimmediate medical attention to result in: (a) plac-ing the health or pregnancy of the person afflict-ed with such condition in serious jeopardy, or inthe case of a behavioral condition, placing thehealth of such person or others in serious jeop-ardy; (b) serious impairment to such person’sbodily functions; (c) serious impairment or dys-function of any bodily organ or part of such per-son; (d) serious disfigurement of such person.

“Hospital” means a short-term, acute, generalhospital, which: (a) is primarily engaged in pro-viding, by or under the continuous supervision ofDoctors, to inpatients, diagnostic services andtherapeutic services for diagnosis, treatment andcare of injured and sick persons; (b) has organ-ized departments of medicine and major surgery;(c) has a requirement that every patient must beunder the care of a Doctor or dentist; (d) provides24-hour nursing service by or under the supervi-sion of a registered professional nurse (R.N.); (e)if located in New York State, has in effect a hos-pitalization review plan applicable to all patientswhich meets at least the standards set forth insection 1861(k) of United States Public Law 89-97, (42 USCA 1395x[k] ); (f) is duly licensed bythe agency responsible for licensing such hospi-tals; and (g) is not, other than incidentally, a placeof rest, a place primarily for the treatment oftuberculosis, a place for the aged, a place fordrug addicts, alcoholics, or a place for convales-cent, custodial, educational, or rehabilitativecare. Hospital also includes tax-supported institu-tions, which are not required to maintain surgicalfacilities.

“Injury” means bodily injury due to an Accidentwhich: (a) results solely, directly and independ-ently of disease, bodily infirmity or any othercauses; (b) occurs after the Covered Person’seffective date of coverage; and (c) occurs whilecoverage is in force. All injuries sustained in anyone Accident, including all related conditions andrecurrent symptoms of these injuries, are consid-ered one Injury.

“Intermediate Care Facility” means a facilitywhich provides for the use, in a full 24-hour resi-dential therapy setting, or in a partial, less than24-hour, residential therapy setting, any of thefollowing therapeutic techniques, as identified in

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“Durable Medical Equipment” consists of, but isnot restricted to, the initial fitting and purchase ofbraces, trusses and crutches, renal dialysisequipment, hospital-type beds, traction equip-ment, wheelchairs and walkers. Durable MedicalEquipment must be prescribed by the attendingDoctor and be required for therapeutic use.

The following items are not considered to beDurable Medical Equipment: adjustments to vehi-cles, air conditioners, dehumidifiers and humidi-fiers, elevators and stair glides, exercise equip-ment, handrails, improvements made to a homeor place of business, ramps, telephones,whirlpool baths, and other equipment which hasboth a non-therapeutic and therapeutic use.

“Elective Treatment” means medical treatment,which is not necessitated by a pathologicalchange in the function or structure in any part ofthe body, occurring after the Covered Person’seffective date of coverage. Elective treatmentincludes, but is not limited to: tubal ligation;vasectomy; breast reduction unless as a result ofmastectomy; sexual reassignment surgery; sub-mucous resection and/or other surgical correctionfor deviated nasal septum, other than necessarytreatment of covered acute purulent sinusitis;treatment for weight reduction; learning disabili-ties; immunizations; botox injections; treatmentof infertility and routine physical examinations.

“Eligible Expense” means a charge for anytreatment, service or supply which is performedor given under the direction of a Doctor for theMedically Necessary treatment of a Sickness orInjury: (a) not in excess of the Reasonable andCustomary charges; or (b) not in excess of thecharges that would have been made in theabsence of this coverage; (c) is the negotiatedrate, if any and (d) incurred while the Policy is inforce as to the Covered Person except withrespect to any expenses payable under theExtension of Benefits Provision.

“Emergency Medical Condition” means a med-ical or behavioral condition the onset of which issudden, that manifests itself by symptoms of suf-ficient severity, including, but not limited to,severe pain that a prudent lay person, possess-ing an average knowledge of medicine and

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“Pre-Existing Condition” means a Sickness,Injury or condition, whether physical or mental,regardless of its cause, for which medical advice,diagnosis, care or treatment was recommendedor received within the 6 month period ending onthe Covered Person’s effective date of coverageunder the Policy or a pregnancy existing on theCovered Person’s effective date of Coverageunder the Policy. Genetic information shall not betreated as a pre-existing condition in the absenceof a diagnosis of the condition related to suchinformation.

“Reasonable and Customary” (“R&C”) meansthe charge which is the smallest of: (a) the actualcharge; (b) the charge usually made for a cov-ered service by the provider who furnishes it; and(c) the prevailing charge made for a coveredservice in the geographic area by those of similarprofessional standing.

“Residential Treatment Facility” means a facil-ity which provides 24 hour treatment for peoplewith drug abuse, alcohol abuse on an inpatientbasis. It must provide at least the following: roomand board; medical services; nursing and dietaryservices; patient diagnosis, assessment andtreatment; individual, family and group counsel-ing; and educational and support services. TheCompany will recognize a Residential TreatmentFacility if it’s accredited for its stated purpose bythe Joint Commission, and carries out its statedpurpose in compliance with all relevant state andlocal laws.

“Sickness” means disease or illness includingrelated conditions and recurrent symptoms of theSickness. Sickness also includes pregnancy andComplications of Pregnancy. All Sicknesses dueto the same or a related cause are consideredone Sickness.

BASIC ACCIDENT & SICKNESSEXPENSE BENEFITS

If, as a result of a covered Injury or Sickness, aCovered Person incurs Eligible Expenses, theCompany will pay according to the following ben-efit schedule: (1) 100% of the Eligible Expensesup to the first $1,000; (2) then 90% of the EligibleExpenses up to an aggregate maximum of

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a treatment for individuals physiologically or psy-chologically dependent upon or abusing alcoholor drugs:(a) chemotherapy;(b) counseling;(c) detoxification services;(d) other ancillary services, such as medical test-

ing, diagnostic evaluation and referral toother services identified in the treatment plan.

“Medical Necessity/Medically Necessary”means that a drug, device, procedure, service orsupply is necessary and appropriate for the diag-nosis or treatment of a Sickness or Injury basedon generally accepted current medical practice inthe United States at the time it is provided. Aservice or supply will not be considered asMedically Necessary if: (a) it is provided only asa convenience to the Covered Person orprovider; or (b) it is not the appropriate treatmentfor the Covered Person’s diagnosis or symptoms;or (c) it exceeds (in scope, duration or intensity)that level of care which is needed to provide safe,adequate and appropriate diagnosis or treat-ment; or (d) it is Experimental/Investigational orfor research purposes; or (e) could have beenomitted without adversely affecting the patient’scondition or the quality of medical care; or (f)involves treatment of or the use of a medicaldevice, drug or substance not formally approvedby the U.S. Food and Drug Administration (FDA);or (g) involves a service, supply or drug not con-sidered reasonable and necessary by the Centerfor Medicare and Medicaid Services IssuesManual; or (h) it can be safely provided to thepatient on a more cost-effective basis such asoutpatient, by a different medical professional orpursuant to a more conservative form of treat-ment. The fact that any particular Doctor mayprescribe, order, recommend, or approve a serv-ice or supply does not, of itself, make the serviceor supply Medically Necessary.

“Mental or Nervous Disorder(s)” means anycondition or disease regardless of its cause, list-ed in the most recent edition of the AmericanPsychiatric Association Diagnostic and StatisticalManual of Mental Disorders (other than thoseconditions caused by Biologically Based MentalIllness) on the date the medical care or treatmentis rendered to the Covered Person.

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$5,000 per Injury or Sickness per Policy Year.The first Eligible Expense must be within 180days from the date of the Accident.

Hospital Room and Board Expense Benefit:When a covered Injury or Sickness requiresHospital confinement, the Company will pay theEligible Expenses up to the average semi-privateroom rate.

Hospital Miscellaneous Expense Benefit: TheCompany will pay the Eligible Expenses incurredduring a Hospital confinement, or for day surgeryservices on an outpatient basis, according to thebenefit schedule. Expenses include: (a) anesthesia,anesthesia supplies and services; (b) operating,delivery and treatment rooms and equipment; (c)diagnostic x-ray and laboratory tests (includingprofessional fees); (d) lab studies; (e) oxygentent; (f) blood and blood services; (g) prescribeddrugs (excluding take-home drugs) and medicines;(h) medical and surgical dressings, supplies,casts and splints; (i) radiation therapy, intra-venous chemotherapy, kidney dialysis, andinhalation therapy; (j) chemotherapy treatmentand radioactive substances; (k) intravenousinjections and solutions, and their administration;(l) physical and occupational therapy; and (m)other Medically Necessary and prescribedHospital expenses.

Surgical Expense Benefit (Inpatient of Out-patient): The Company will pay the EligibleExpenses incurred according to the benefitschedule for surgery performed by a Doctor (in orout of the Hospital).

Anesthesia Expense Benefit: If the CoveredPerson requires an anesthetist during surgery,the Company will pay the Eligible Expensesincurred according to the benefit schedule.

Assistant Surgeon Expense Benefit: If theCovered Person requires an assistant surgeonfor a surgery, the Company will pay the EligibleExpenses incurred according to the benefitschedule.

Inpatient Doctor’s Fees and Medical ExpenseBenefit: If a Covered Person, who is confined as

a resident in-bed patient in a Hospital, requiresthe services of a Doctor, who may or may nothave performed surgery on the Covered Person,the Company will pay the Eligible Expensesincurred according to the benefit schedule, limit-ed to one visit per day.

Consultant Expense Benefit (Inpatient orOutpatient): If a Covered Person requires theservices of a consultant or specialist, whendeemed Medically Necessary and ordered by anattending Doctor for the purpose of confirming ordetermining a diagnosis, the Company will pay100% of the Eligible Expenses.

Outpatient Doctor Visit Expense Benefit: If aCovered Person requires the services of aDoctor, the Company will pay Eligible Expensesincurred according to the benefit schedule.

Hospital Outpatient Department ExpenseBenefit: If, while not Hospital confined, aCovered Person requires the services of theHospital outpatient department or other outpa-tient facility, the Company will pay the EligibleExpenses incurred according to the benefitschedule.

Emergency Room Expense Benefit: If aCovered Person requires the use of a Hospitalemergency room as a result of an EmergencyMedical Condition, the Company will pay theEligible Expenses incurred according to the ben-efit schedule.

Outpatient Diagnostic X-ray and LaboratoryExpense Benefit: If a Covered Person is pre-scribed diagnostic x-ray and laboratory serviceson an outpatient basis by the attending Doctor,the Company will pay the Eligible Expensesaccording to the benefit schedule.

Outpatient Prescribed Medicines ExpenseBenefit: After a co-payment of $15 for genericdrugs or $30 for brand name drugs, the cost ofprescription drugs is payable in full to a PolicyYear maximum of $500. Prescriptions must befilled at an Express-Scripts participating pharmacy(visit the website at www.express-scripts.com).

SUPPLEMENTAL ACCIDENT ANDSICKNESS EXPENSE BENEFITS

After the Company has paid $5,000 per Injury orSickness under the Basic Accident & SicknessExpense Benefits plan, and a $100 per Injury orSickness deductible has been met, the Companywill pay: (a) 85% of the Eligible Expensesincurred up to an aggregate maximum of$30,000 for a non-intercollegiate sports Injuryor Sickness; or (b) 85% of Eligible Expenseincurred if injured during the supervised play orpractice of a covered intercollegiate sport up toan aggregate maximum of $90,000; or (c) 85% ofthe Eligible Expenses incurred if injured duringthe supervised play or practice of a covered clubsport up to an aggregate maximum of $30,000.

The first Eligible Expense must be incurred with-in 180 days from the date of the Accident.

The following Eligible Expenses will be paidunder the Supplemental Accident and SicknessExpense Benefits: (a) Hospital room & board; (b)miscellaneous Hospital expenses; (c) inpatientand outpatient surgery; (d) inpatient andoutpatient anesthesia; (e) inpatient and out-patient Doctor visits; (f) inpatient and outpatientconsultant; (g) licensed nurse; (h) Hospital out-patient department; (i) emergency room; (j) diag-nostic x-ray and laboratory tests; (k) outpatientprescription drugs; (l) pre-Hospital emergencymedical services; (m) Durable Medical Equip-ment, prosthetic appliances and orthotic devices;and (n) other Medically Necessary EligibleExpenses for treatment of an Injury or Sickness.

ACCIDENTAL DEATH &DISMEMBERMENT BENEFITS

If a Covered Person sustains any of the followinglosses as the result of a covered Accident within365 days after the date of the Accident, theCompany will pay the amount shown below.

Loss of Life..............................................$25,000Loss of one Member ...............................$25,000Loss of two or more Members ................$25,000Loss of Thumb and Index Finger of same hand ................................................$5,000

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Pre-Hospital Emergency Medical ServicesExpense Benefit: The Company will pay theEligible Expenses for pre-hospital emergencymedical services that are provided in the event ofan Emergency Medical Condition according tothe benefit schedule. Eligible Expenses incurredinclude a licensed ambulance service.

Durable Medical Equipment and SuppliesExpense Benefit: If a Covered Person requiresthe use of Durable Medical Equipment prescribedby a Doctor, the Company will pay the EligibleExpenses according to the benefit schedule.

Chemical Abuse or Dependence InpatientExpense Benefit: The Company will pay EligibleExpenses for a Covered Person for diagnosisand treatment consistent with the level of bene-fits for any other Sickness under the Policy: 1) upto seven days of care during any calendar yearfor active treatment for chemical dependencyand 2) up to 30 days of care during any calendaryear for rehabilitations services. Such coverageis limited to Eligible Expenses incurred in a Hospital, Residential Treatment Facility, orIntermediate Care Facility. No chemical abuse ordependence inpatient coverage is providedunder any supplemental expense benefits whichmay be provided under the Policy.

Chemical Abuse or Dependence OutpatientExpense Benefit: For Expenses for a CoveredPerson for outpatient treatment provided by analcoholism or substance abuse treatment facilityor an alcoholism or substance abuse treatmentprogram, the Company will pay the greater of: a)outpatient benefits in the same manner as anyother Sickness, but not to exceed: 1) one visit perday for any Covered Person; or 2) 60 visits in anycalendar year; or b) outpatient benefits as other-wise provided under the Policy for alcohol or sub-stance abuse. Under part a) above, up to 20 ofthe 60 visits may consist of counseling forCovered family members of the Covered Person,even if the Covered Person does not receivetreatment. Such coverage is limited to facilities inNew York State which are certified by the Officeof Alcoholism and Substance Services and, inother states, to those which are accredited byThe Joint Commission on Accreditation ofHospitals as alcoholism, substance abuse orchemical dependence treatment programs.

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(iii) aviation, other than as a fare-paying pas-senger on a scheduled or charter flight oper-ated by a scheduled airline.

4. cosmetic surgery, except that cosmetic sur-gery shall not include reconstructive surgerywhen such service is incidental to or followssurgery resulting from trauma, infection orother diseases of the involved part. How-ever, if the Policy provides hospital, surgicalor medical expense coverage, this exclusionshall not apply with respect to cosmetic sur-gery determined, as a result of utilizationreview and External Review, to be MedicallyNecessary.

5. foot care, in connection with corns, calluses,flat feet, fallen arches, weak feet, chronicfoot strain or symptomatic complaints of thefeet.

6. care in connection with the detection andcorrection by manual or mechanical meansof structural imbalance, distortion or sublux-ation in the human body for purposes ofremoving nerve interference and the effectsthereof, where such interference is the resultof or related to distortion, misalignment orsubluxation of or in the vertebral column.

7. treatment provided in a government hospital;benefits provided under Medicare or othergovernmental program (except Medicaid),any state or Federal workers’ compensation,employers’ liability or occupational diseaselaw; benefits to the extent provided for anyloss or portion thereof for which mandatoryautomobile no-fault benefits are recoveredor recoverable; services rendered and sepa-rately billed by employees of hospitals, labo-ratories or other institutions; services per-formed by a member of the covered person’simmediate family; and services for which nocharge is normally made.

8. dental care or treatment, except for suchcare or treatment due to accidental Injury toSound Natural Teeth within 12 months of theaccident and except for dental care or treat-ment necessary due to congenital disease oranomaly.

9. eyeglasses, hearing aids, and examinationfor the prescription or fitting thereof.

10. rest cures, custodial care and transportation.

“Member” means hand, foot or eye. Loss of handor foot means the complete severance through orabove the wrist or ankle joint. Loss of eye meansthe total permanent loss of sight on the eye.Principal Sum: $25,000. The principal sum is thelargest amount payable under this benefit for alllosses resulting from any one accident.

PREFERRED PROVIDER INFORMATIONIn an effort to control insurance medical costsand enhance payment, this plan has implement-ed a Preferred Provider Organization (PPO) ofHospitals, Clinics and Doctors who are willing toprovide services at negotiated lower rates toCovered Students eligible for benefits. The use ofthis PPO may reduce the Covered Student’s out-of-pocket expenses. The primary PPO isMagnacare and you can obtain a listing of partic-ipating providers at www.magnacare.com or bycalling 1-800-235-7267. PHCS/Multiplan, a sec-ondary PPO is also available, and provider list-ings can be obtained at www.multiplan.com or bycalling 1-888-560-7427.

EXCLUSIONS AND LIMITATIONSThe Policy does not cover nor provide benefitsfor Accident, Sickness, or treatment of a medicalcondition arising out of:

1. (a) mental or emotional disorders: (i) inexcess of thirty (30) days for inpatientHospital care; or (ii) in excess of twenty (20)visits for outpatient care; or (b) outpatienttreatment for alcoholism and substanceabuse in excess of sixty (60) visits, of whichtwenty (20) may be used for family members.

2. pregnancy, except to the extent coverage isrequired pursuant to New York InsuranceLaw sections 3221 and 4318, and except forcomplications of pregnancy as defined insection 3221(k)(5) and 52.16(f).

3. illness, accident, treatment or medical condi-tion arising out of:(i) war or act of war (whether declared orundeclared); participation in a felony, riot orinsurrection; service in the Armed Forces orunits auxiliary thereto;(ii) suicide, attempted suicide or intentionallyself-inflicted injury;

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(f) a medical care program of the Indian HealthService or of a tribal organization;

(g) a state health benefits risk pool;(h) a health plan offered under chapter 89 of Title

5, United States Code;(i) a public health plan (as defined in regula-

tions); (j) a health benefit plan under section 5(e) of the

Peace Corps Act (22 U.S.C. 2504(e) ).

EXTENSION OF BENEFITSIf, on the date coverage terminates, a CoveredPerson is Totally Disabled as a result of Sicknessor Injury and is receiving treatment for suchSickness or Injury, benefits will be payable for theEligible Expenses incurred for that Sickness orInjury after the date coverage terminates until theearliest of the following: (1) the end of theSickness or Injury that caused the Total Disability;(2) the end of the 90 day period following the datecoverage terminated; or (4) the date the applica-ble Maximum Amount is reached.

IN THE EVENT OF PREGNANCY. If a CoveredPerson is pregnant on the date the Policy termi-nates and the pregnancy commenced whileinsured while the Policy was in force, benefits willbe payable for Eligible Expenses incurred afterthe Policy terminates until the earliest of: (a) thedate the pregnancy ends; (b) the date theCovered Person becomes insured under anotherpolicy; or (c) the date the applicable MaximumAmount is reached.

The Extension of Benefits will apply only to theextent the Covered Person will not be coveredunder the Policy or any other health insurancepolicy in the ensuing term of coverage.

STATE MANDATED BENEFITSTHIS PROGRAM COVERS APPLICABLE MAN-DATED BENEFITS AS REQUIRED BY THESTATE OF NEW YORK. New York mandatescoverage for the following benefits: Biologicallybased Mental Illness and Mental and NervousDisorders; Breast Cancer Treatment; BreastReconstruction; Clinical Trials Expense; Out-patient Chemical Abuse and ChemicalDependence; Mammographic Examination;Cytologic Screening; Cancer Second Opinion;

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PRE-EXISTING CONDITIONS(Applicable to voluntary coverage only)

Expenses incurred by a Covered Person as aresult of a Pre-existing Condition will not be con-sidered Eligible Expenses for a period of twelvemonths of continuous coverage while coveredunder the current Policy.

This limitation will not apply if, during the periodimmediately preceding the Covered Person’seffective date of coverage under the currentPolicy, the Covered Person was covered underprior Creditable Coverage for 12 consecutivemonths. Prior Creditable Coverage of less than12 months will be credited toward satisfying thePre-existing Condition limitation. This waiver ofPre-existing Condition limitation will apply only ifthe Covered Person becomes eligible and enrollsfor coverage within 63 days of termination of hisor her prior coverage.

The Pre-existing Conditions Limitation does notapply to pregnancy that begins 10 months fromthe Covered Person’s effective date of coverageunder the Policy, subject to a credit for previousCreditable Coverage

CREDIT FOR PRIOR COVERAGE: A CoveredPerson whose coverage under prior CreditableCoverage ended no more than 63 days beforethe Covered Person’s effective date under thePolicy, will have any applicable Pre-ExistingCondition limitation reduced by the total numberof days the Covered Person was covered bysuch coverage. If there was a break in CreditableCoverage of more than 63 days, the Companywill credit only the days of such coverage afterthe break.

Creditable Coverage means coverage under anyof the following:(a) a group health plan;(b) health insurance coverage;(c) Part A or B of Title XVIII the Social Security

Act;(d) Title XIX of the Social Security Act, other than

coverage consisting solely of benefits undersection 1928;

(e) Chapter 55 of Title 10, United States Code;

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Travel GuardProcedures on How to Access Travel Guard

24-hour Assistance Call Center

How to Contact Travel Guard:• Inside the US and Canada, dial 1-877-249-

5362 toll-free.• Outside the US and Canada:

- Request an international operator.- Request the operator to place a collect call

to the USA at 715-295-9625.• Our fax number is 01-713-974-3422.

When to Contact Travel Guard:

• Call Travel Guard when you require medicalassistance or have a medical emergency.

• Call Travel Guard for all non-medical situations(lost luggage, lost documents, legal help, etc.).

• Call Travel Guard whenever there is a ques-tion.

Travel Guard is available 24-hours-a-day/7-days-a-week/ 365-days-a-year.

Our multi-lingual/multi-cultural Travel AssistanceCoordinators (TACs) are trained professionalsready to help you should the need arise while youare traveling or away from home.

The Travel Guard Services Medical Staff consistsof full-time, onsite Registered Nurses andEmergency Physicians who work as a team toprovide the best outcome for our clients. Thisteam is directed by a dedicated Medical Director(MD) and Manager of Medical Services (RN).Nursing staff is on-site 24-hours; a physician hasdaily responsibility for a 24-hour period and is on-site during daytime hours.

What information will you need to provide toTravel Guard when you call:

• Advise Travel Guard who you are insured by.• Provide your Policy number.• Advise Travel Guard regarding the nature of

your call and/or emergency. Be sure to provideyour contact information at your current loca-tion in the event Travel Guard needs to call youback.

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Diagnostic Screening for Prostate Cancer;Diabetes Treatment; End of Life Care; Pre-Hospital Medical Emergency Services; BoneMineral Density Measurements and Tests;Enteral Formulas not to exceed $2,500;Chiropractic Care; Maternity Expenses andContraceptive Services. All mandated benefitsare subject to the terms and conditions applica-ble to other benefits provided under the Policy.Please see the Policy on file with the College forcomplete details.

CONFORMITY WITH STATE STATUTESAny provision of this plan of insurance which, onits effective date, is in conflict with the statutes ofthe state in which it is issued, is hereby amendedto conform to the minimum requirements of suchstatutes.

COORDINATION OF BENEFITSNew York State Law permits Coordination ofBenefits when a Covered Person is coveredunder more than one valid and collectible healthinsurance plan. The Company will coordinatebenefits with other health carriers when duplicatecoverage exists. Total payment from this cover-age and other health coverages under with aCovered Person is enrolled shall not exceed100% of the R&C Charges for covered services.

CERTIFICATE OF CREDITABLECOVERAGE

Coverage under this plan is “CreditableCoverage” under federal Law. When coverageterminates, the Covered Person can request aCertificate of Creditable Coverage, which is evi-dence of coverage under this plan. In order toobtain a Certificate of Creditable Coverage,please visit our website at www.maksin.com orcontact Maksin Management Corp at (877) 440-6839.

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Medical Assistance:• Medical Referral• Out-patient Assistance• In-patient Assistance

Repatriation of Remains / Medical Evacuation:Combined Maximum Limit for Eligible Expensesof $50,000.

CLAIM PROCEDURE(Always keep a copy of all documents sub-mitted for claims.)

Written proof of loss and itemized bill(s) mustbe submitted with your claim within ninety(90) days after the date of the loss. Failure todo may result in denial of benefits.

Please note that a signed claim form is requiredfor all Accidents. Although a claim form is notrequired for Sicknesses, in certain circumstancesone may be requested by the claims administra-tor to complete the processing of a claim.

Claims may be filed online by going towww.maksin.com. You may also file by mail bysecuring a claim form by calling MaksinManagement Corp toll free at 1-877-440-6839 orby printing a claim form from our website atwww.maksin.com.

In the event of an Accident or Sickness, theCovered Person should:1. If at the University, report to the Student

Health Center so that proper treatment can beprescribed or approved.

2. If away from the University, consult a Doctorand follow the Doctor’s advice.

3. If applicable, staple all your itemized medicaland hospital bills to the claim form and mail to:

Maksin Management CorpP.O. Box 2647

Camden, NJ 08101-2647Toll Free: 1-877-440-6839

HOW TO FILE AN APPEALOnce a claim is processed and upon receipt of anExplanation of Benefits (EOB), an insuredCovered Person who disagrees with how a claimwas processed may appeal that decision. The

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Description of Services

Information/General: These services includeadvice and information regarding travel docu-mentation, immunization requirements, politi-cal/environmental warnings, and information onglobal weather conditions. Travel Guard can alsoprovide information on available currencyexchange rates, local Bank/Government holi-days, and, by implementing our databases withthe information, provide ATM and CustomerService locations to clients. Travel Guard alsoprovides emergency message storage & relayand translation services.

• Visa & Immunization• Weather & Exchange Rates• Environmental & Political Warnings

Technical: These services provide assistance tomembers in the event of lost or stolen luggage,personal effects, documents and tickets. TravelGuard can arrange cash transfers & vehiclereturn in the event of illness or accident, providelegal referrals, and help with arrangements formembers who encounter enroute emergenciesthat force them to interrupt their trips.

• Legal Referral• Embassy/Consulate Information• Lost/Stolen Luggage & Personal Effects

Assistance• Lost Document Assistance & Cash Transfer

Assistance• Enroute Travel Assistance• Claims-related Assistance• Telephone Interpretation

Medical: These services are the most complicat-ed of those offered and can last up to severalweeks. They involve Travel Guard’s Medical Staffin addition to other network providers and ofteninclude post-case payment/billing coordinationon the traveler’s behalf. These services includephysician/dental/hospital referral, medical casemonitoring, shipment of medical records andprescription medications, medical evacuation,repatriation of remains, and insurance/claimscoordination.

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Covered Person must request an appeal in writ-ing within 60 days of the date appearing on theEOB. The appeal request must include why theydisagree with the way the claim was processed.The request must include any additional informa-tion they feel supports their request for anappeal, e.g. medical records, doctor records, etc.Please submit all appeals requests to:

Maksin Management CorpP.O. Box 2647

Camden, NJ 08101-2647

Service Representative:Haylor. Freyer & Coon, Inc.

PO Box 4743Syracuse, NY 13221-1501

1-800-289-1501Ask for a College SpecialistEmail: student@haylor.com

www.haylor.com/sunymaritime

Plan Administrator:Maksin Management Corp

P.O. Bo 2647, Camden, NJ 08101-2647Toll Free: 1-877-440-6839

At Maksin Management Corp, we value thetrust our customers have placed in us. That iswhy protecting the privacy of your personalinformation is of paramount importance tous. For more information, please go to ourwebsite at www.maksin.com.

It is the Covered Person’s responsibility tomaintain continuity of coverage by inquiringabout such coverage if he or she has notreceived the information for the new Policyyear.

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Please detach and retain

National Union Fire Insurance Company of Pittsburgh, Pa.

Covered Person: _________________________________

Group Name: Maritime College State University of New York

Policy No.: CHH0071371 Reference No.: CAS9499806

Identification No.: _________________________________

See Reverse Side for Important Information

For benefits, please call:Maksin Management Corp 1-877-440-6839

Mail Claims to:Maksin Management Corp, P.O. Box 2647, Camden, NJ 08101-2647

To secure a claim form, go to the following website for all information:http://www.maksin.com or call Maksin Management 1-877-440-6839.

For MagnaCare providers go to www.magnacare.com or call1-800-235-7267

This care does not guarantee benefits