CorpsCare

HEALTH INSURANCE FOR THE RETURNING PEACE CORPS VOLUNTEER

Program Extension, Payment and General Information Clements International 1.202.872.0060 (collect calls accepted) or 1.800.872.0067 (US toll free) corpscare@clements.com 24/7 Assistance with Coverage Questions, Pre-certification of Medical Services, Physician Referral and Claims Information CorpsCare Assistance at HCC Medical Insurance Services (HCCMIS) 1.317.221.8094 (collect calls accepted) or 1.866.400.6090 (US toll free) corpscare-claims@hccmis.com Peace Corps Post-Service Benefits Peace Corps Medical Services 1.202.692.2000 or 1.800.424.8580 (ext 1540)
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Plans and rates effective September 1, 2010

AFFORDABLE HEALTH INSURANCE

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CLEMENTS INTERNATIONAL
WAS HINGTON, DC | LONDON

Welcome to CorpsCare

Questions & Answers Schedule of Benefits

Healthcare from COS to your next adventure.

Whether you are heading home to start a new career, advancing your education or continuing to explore the world, this program is designed to meet your needs as a returning Volunteer. Our program offers optional healthcare plans tailored to meet your needs, and offers competitive premiums, affordable doctors visits and coverage for prescriptions, such as birth control.

Plan Options
The following plan information will help you make the best choice. We have also included a summary of benefits on the next page and information on how to receive a complete policy.

CorpsCare

Why is CorpsCare the plan for you?

First Month Free When you close service, Peace Corps automatically enrolls you in the CorpsCare plan, and pays for the first month of coverage. All Volunteers are guaranteed coverage and can choose to extend their coverage up to 18 months. Affordable Health Insurance Options Two unique insurance plans are offered to meet the diverse health and budget needs of returning Volunteers. Payment Flexibility Flexible monthly payment plans are available and this is the only healthcare program that allows payment through the Peace Corps Readjustment Allowance.

The CorpsCare insurance plan is designed to provide worldwide medical insurance, including international medical evacuation. This competitively priced insurance plan offers protection against current and future medical expenses. This plan is strongly recommended for all Volunteers, especially those currently seeking medical treatment for an illness or condition, including pregnancy and maintenance prescriptions.

CorpsCare

This alternative insurance plan offers Volunteers an option for more affordable, quality health coverage. CorpsCare Edge is for Volunteers who are healthy and not currently seeking medical treatment. This program features a lower monthly premium, affordable office visits and coverage for major medical expenses. While less expensive, this plan has additional coverage limitations and an increased share of medical costs for the Volunteer.

Edge

What are your next steps?

1. Confirm eligibility. All Peace Corps and Response Volunteers, Trainees and their families are eligible for the program. 2. Choose your plan. Following your first month of free coverage, you have the option to extend your coverage up to an additional 18 months with the CorpsCare plan or choose the alternative CorpsCare Edge plan. As each person has unique insurance requirements, it is important to understand the benefits and coverage provided under each plan. 3. Extend your coverage. It is important for all Volunteers to extend their coverage and enroll their families within 31 days of their COS date.

Health Insurance 101

What is health insurance?
A necessary investment to protect you from the high cost of medical care by providing coverage for specific healthcare services. Although you share in the costs, you pay far less than you would if you didn't have it.

What is a premium?
A fee you pay to your insurance company to participate in a health insurance plan.

What is a deductible?
A total amount that you are responsible to pay in a specified time period before your plan will begin to pay benefits.

What is a co-payment?
A specified dollar amount or percentage you are required to pay at the time you receive certain services, such as office visits and prescription drugs.

Where can you find more information?

Contact Clements International Our representatives are available to discuss your options and guide you to a solution that is right for you. Information is also available on our website.
ONE THOMAS CIRCLE NW, 8TH FLOOR, WASHINGTON, DC 20005

What is meant by in-network?

In order to manage healthcare costs, most plans participate in provider networks. The program provides higher benefits and lower costs for all services obtained in-network.

What is a pre-existing condition?

An illness or medical condition that existed prior to the effective date of your health insurance policy.

1.202.872.0060 or 1.800.872.0067 fax 1.202.466.9064 corpscare@clements.com corpscare.clements.com

CorpsCare Plan Summary

Benefit
Premium (per month) Individual Deductible (per year) Family Deductible Benefit Percentage Out-of-Pocket Maximum (per year)

Instructions and Guidelines

Enrollment Volunteers are automatically eligible, enrolled and covered for one month following COS. Spouses and dependents must be enrolled within the first month of coverage at the Volunteer's expense. Coverage Extension After the first month, Volunteers, spouses and dependent children can extend coverage up to 18 months. Coverage can be extended for as many months in advance as desired or month to month, but must remain continuous. To extend your coverage, you will need your Peace Corps Volunteer ID Number. This number was issued to you at the beginning of your Peace Corps service. You may choose to continue your coverage under the CorpsCare plan or switch to the CorpsCare Edge plan at any time. If you choose the CorpsCare Edge plan, you may not switch back to the CorpsCare plan. Submit your completed Extension Request Form with the Payment Options section to Clements International or complete the form online (see below). Payment Options Peace Corps pays for the first months premium for the Volunteer and dependent children. However, spouses must pay for the first months premium. All enrollees will be responsible for payment of all extension months which can be paid for in advance. Payments may be made through the Peace Corps Readjustment Allowance, by check, credit card or Telecheck. Month-to-month coverage is available through our automatic monthly credit card deduction option. Online Information & Resources (corpscare.clements.com) Our website offers extensive online information and resources regarding the CorpsCare and CorpsCare Edge program including: Payment Verification Policy Extension Benefit Detail Prescription Benefits Doctor Search Claims Assistance Coverage Comparisons Certificate of Insurance Individual Health Plans (Insurance after CorpsCare)

CorpsCare
$163 Volunteer $149 Spouse $138 Dependent $250 in-network $500 out-of-network $750 in-network $1,500 out-of-network 90% in-network 80% out-of-network $1,000 per individual $2,000 per family

CorpsCare Edge
$99 Volunteer $99 Spouse $99 Dependent $1,500 in-network $2,500 out-of-network N/A 90% in-network 60% out-of-network $1,500 per individual in-network $15,000 per individual out-of-network $40 co-payment (in-network) $40 co-payment $110 max in-network (after 12 months) No No Yes Yes Yes Yes Yes No No

Office Visit (per visit) Preventive Care / Annual Physical Pre-existing Conditions Maternity Rx Birth Control Emergencies In-Patient Stay Out-patient Services International Evacuation Vision & Dental Care

$50 co-payment (in-network) $40 co-payment $110 max in-network (after 12 months) Volunteer Only Volunteer Only Yes Yes Yes Yes Yes Yes No

Co-payments and limitations may apply to the coverage listed above. Additional limitations may apply to spouse and dependent coverage. Detailed information is provided in the plan certificate which is available online at corpscare.clements.com.

Claims Information
For pre-certification of emergency and non-emergency medical treatment, an explanation of medical benefits, status of your medical claim, or for a U.S. physician referral, contact CorpsCare Assistance at HCC Medical Insurance Services (HCCMIS): 1.866.400.6090 or 1.317.221.8094 (collect calls accepted). Pre-certification does not guarantee benefits. Submit claims to CorpsCare claims: HCCMIS Claims Department, P.O. Box 863, Indianapolis, IN 46206 If you are unsure of your medical benefit, contact Peace Corps to determine whether your medical condition is covered by Peace Corps postservice benefits: 1.800.424.8580 ext. 1540 or 1.202.692.2000 ext. 1540 Peace Corps Authorization for Payment of Medical/Dental Services (form PC-127c) can only be processed at the address specified on the authorization form. It should not be sent to Clements International or to HCCMIS.
Insurance provided by Certain Underwriters at Lloyds of London through HCC Medical Insurance Services, Lloyd's Coverholder.

You may be asked to provide your member number (Peace Corps Volunteer ID Number).
This brochure is only an outline of the CorpsCare and the CorpsCare Edge program. Peace Corps strongly recommends all volunteers and dependents review the insurance policy prior to purchase. A complete description of this program is contained within the certificate, and defines the insurance program in precise terms. You may obtain a copy of the certificate by contacting Clements International. Peace Corps is only responsible for payment of the first month of coverage for the Volunteer and dependent children. Volunteers will be responsible for any premium for extension of coverage. The underwriter reserves the right to change the plan at any time with 31 days advance notice to anyone who is enrolled in the plan. In the event the premium rates change and an insured has paid in advance, the underwriter will refund any excess premium, or the insured person will owe the additional balance due for the period of coverage purchased in advance.

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CorpsCare Extension Request

Volunteers and dependents must enroll within 31 days of the COS date. Applications submitted after the COS date should be mailed directly to Clements International. Volunteer Coverage (please print)
Volunteer Name Peace Corps Volunteer ID # ___ ___ ___ ___ ___ ___ ___ ___ ___ Date of Application ____ ____ ____ m d y Country of Service Mailing Address (Home of Record or Permanent Address) Street Apt. City State Zip Hm Ph # E-mail Bus Ph # End of Service Date (COS, ET or SEP) ____ ____ ____ m d y Volunteer Spouse Dependent #1 Dependent #2 Premium Calculation Please use the following chart to extend your coverage and determine your premium based on your plan of choice. Extension coverage begins after the first month. Months ______ ______ ______ ______
CorpsCare CorpsCare Edge *

Subtotal =$ ______ =$ ______ =$ ______ =$ ______ =$ ______

x $163. x $149. x $138. x $138.

x $99. x $99. x $99. x $99.

*see waiver on previous panel

Total Extension Premium

E-Customer Option r I want to be an E-Customer and receive all correspondence through my email address provided on this extension request. Payment Peace Corps Readjustment Allowance r Submitted to Peace Corps Administration Officer prior to COS Date. Check r Telecheck, pay by check instantly at www.clements.com r Check enclosed, payable to ClementsInternational Credit Card r Pay in Advance r Automatic Monthly Deduction

Spouse / Dependent Coverage

New spouses must be enrolled within 31 days of marriage, and new dependents must be enrolled within 31 days of birth/ adoption. Please use a separate piece of paper if you wish to add additional dependents. If a Volunteer is married to another

Amount $___________.00 r VISA r MasterCard r AMEX r Discover Full Name Credit Card No. Exp. Date M Y

Volunteer, they must purchase separate policies.

Spouse/Dependent Name Date of Birth ____ ____ ____ m d y

r Spouse r Dependent r Male r Female

Plan Selection Following your first month of coverage, you have the option to extend your coverage with the CorpsCare plan or choose to switch to the alternative CorpsCare Edge plan.
r Please extend my policy under the CorpsCare plan r Please extend my policy under the CorpsCare Edge plan in agreement with the following waiver.
*CorpsCare Edge Waiver "I hereby acknowledge that by electing CorpsCare Edge, the benefits provided under the policy will change and be restricted to coverages and limits set forth in the CorpsCare Edge schedule of benefits and policy. Furthermore, upon electing to covert to CorpsCare Edge, I shall not at any time have the option to convert back to the CorpsCare primary plan.

(X) Authorized Signature

IMPORTANT! This is your permanent medical ID card for your CorpsCare or CorpsCare Edge coverage. Carry it with you at all times.

Signature of Volunteer

Date

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CorpsCare
Name
Member Number Plan Type
(VOLUNTEER ID NUMBER)

Affordable Health Insurance for Returning Peace Corps Volunteers

CorpsCare

CorpsCare Edge

group health plan # 041926 medco rx # 6002617

Peace Corps authorization for payment of medical/dental services (form PC-127C) can ONLY be processed at the address specified on the authorization form. It should not be sent to Clements International or to HCC Medical Insurance Services (HCCMIS). For pre-certification of emergency and non-emergency medical treatment, an explanation of medical benefits, status of your medical claim, prescription benefit information or for a U.S. physician referral, contact CorpsCare Assistance: 1.866.400.6090 or 1.317.221.8094 (collect calls accepted). Pre-certification does not guarantee benefits. For Medco Prescription Services, members may call member services at: 1.800.251.7690; Pharmacies may call the Pharmacy Help Desk at: 1.800.922.1557. Submit claims to CorpsCare claims: HCCMIS Claims Department, P.O. Box 863, Indianapolis, IN 46206 or corpscare-claims@hccmis.com To extend your coverage or verify payment, contact CorpsCare at 1.800.872.0067 or 1.202.872.0060 or visit our website: corpscare.clements.com If you are unsure of your medical benefit, contact Peace Corps to determine whether your medical condition is covered by Peace Corps post-service benefits: 1.800.424.8580 ext. 1540 or 1.202.692.2000 ext. 1540.
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