Summary Of Benefits

United Hockey Union — Import Insurance

Accident & Sickness Insurance Benefits

Coverage, Benefit, Limit and Rate Summary

BENEFITS & LIMITS

· Accident Medical Expense $25,000 (per covered person, per condition)

· Sickness Medical Expense $50,000 (per covered person, per condition)

· Benefit Amount 80% of the Usual & Customary Charge, player pays 20%

· Deductible $750

· Accident Dental Expense Included in Medical

· Benefit Period 52 Weeks from the Date of Loss

· Accidental Death & Dismemberment $25,000

· AD&D Aggregate $1,000,000

· Emergency Medical Evacuation $25,000

· Repatriation of Remains $25,000

· Travel Assistance Services Offered Through On Call International

· All Claims payments are based on normal and customary charges

· There is no coverage if the player is injured due to involvement in a fight

· Players who do not wear a full face shield (full facemask) waive insurance benefits for facial, dental, eye injury only. All other benefits remain full force and effect