Dear Students/Scholars:

Greetings from International Community Service (ICS)!

We are pleased to introduce the ICS Health Insurance Program. The policies
for 2015-2016 school year retain the same distinctive features (i.e.,
low rates, high benefits, and comprehensive coverage) that have over the
years become most popular among international students/scholars. ICS plans
have served students/scholars and families at 300+ colleges/universities
across USA since 1995.

As a tradition, ICS has always enjoyed working with campus organizations
to best serve the needs of their members and beyond. We would gratefully appreciate your assistance in distributing ICS info to Students/Scholars
in your school or local area (e.g., post this release to your email lists
and websites, or link ICS website).

Included below are some highlights for your consideration. Enrollment Form
is attached at the end for your convenience. Please visit ICS website for online enrollment and related info (brochures, forms, etc.).

Sincerely,


(Signed)

INTERNATIONAL COMMUNITY SERVICE

------------------------------------------------------------------------- Email: info@icsweb.org
WebSite: http://www.icsweb.org/
Toll Free: 1-800-356-1235 [English, 8:00-5:00 EDT Mon-Fri]
Fax: 954-772-0872 [For enrollment, compliance forms, etc.]
e-fax: 561-300-5678 -------------------------------------------------------------------------

Some highlights of the 2015-2016 ICS PLANs

[Please read ICS brochures/certificates for more details]

ELIGIBILITY

1) All Students/Scholars (from all parts of the world) with valid
non-immigration visas (F-1, J-1, etc.), including Students
on practical training or temporary vacation.

2) Legal dependents - Spouse and unmarried Children under age 25 (may
not enroll unless the principal Student/Scholar is also enrolled).

3) Individuals with dependent visas (F-2, J-2, etc.), who are
normally considered dependents, may enroll independently (at the
Student/Scholar rate) if enrolled in legitimate classes at a US
college (including community colleges) or university for at least
six (6) credit hours in a semester/quarter.

PREMIUM RATES

Student/Scholar Spouse Child
Age Annual Monthly* Annual Monthly* Annual Monthly*
Basic Plan 0-24 $ 492 $ 41 $ 1,236 $ 103 $ 624 $ 52
25-30 $ 492 $ 41 $ 1,236 $ 103
31-40 $ 492 $ 41 $ 1,236 $ 103
41-64 $ 492 $ 41 $ 1,236 $ 103

Discount Plan 0-24 $ 792 $ 66 $ 2,976 $ 248 $1,356 $ 113
25-30 $1,140 $ 95 $ 2,976 $ 248
31-40 $1,464 $ 122 $ 2,976 $ 248
41-64 $2,100 $ 175 $ 2,976 $ 248

PrimePlus Plan 0-24 $ 984 $ 82 $ 5,124 $ 427 $3,348 $ 279
25-30 $1,368 $ 114 $ 5,124 $ 427
31-40 $2,340 $ 195 $ 5,124 $ 427
41-64 $4,992 $ 416 $ 5,124 $ 427


*Minimum Enrollment of 3 Months

COMPREHENSIVE COVERAGES

Covered Medical Expenses (Injury/Sickness): Inpatient/Outpatient, plus:
Medical Emergency; Prescription Drugs; Elective Abortion; Maternity (conception must occur after the Insured's effective date of coverage);
Child Coverage; Mammographic Exams; Repatriation; Medical Evacuation; Accidental Death & Dismemberment (AD&D); Psychotherapy (Mental or
Nervous Disorders, Alcoholism, or Drug Abuse); etc.
[Please refer to ICS brochures/certificates for Policy details.]

Covered Medical Expenses* BASIC PLAN DISCOUNT PLAN PRIMEPLUS PLAN (Per Injury or Sickness)
$ 0.01 - $ 2,500.00 80% 80% 80%
$ 2,500.01 - $ 5,000.00 80% 80% 80%
$ 5,000.01 - $ 7,500.00 80% 80% 80%
$ 7,500.01 - $ 10,000.00 80% 80% 80%
$ 10,000.01 - $ 35,000.00 80% 80% 80%
$ 35,000.01 - $ 50,000.00 80% 100% 80%
$ 50,000.01 - $ 55,000.00 N/A 100% 80%
$ 55,000.01 - $250,000.00 N/A 100% 80% $250,000.01 - $ Unlimited N/A N/A 80%

Deductible per Injury/Sickness $ 25
Maximum Deductible per Policy Year $250 $200
(The Deductible will be waived when treatment is rendered at a recognized Student Health Center.)

* Coinsurance percentage is for "In-PPO" expenses; benefits are reduced
if outside of PPO. Benefits are subject to all applicable policy
terms and conditions (including restrictions and limitations).

Attached

..................................Cut Here.................................

International Community Service
Enrollment Form for Student/Scholar Accident & Health Insurance
2015-2016
=================================================
Please Print All Applicable Information Clearly -
Failure to do so may delay or void your insurance =================================================
[Please refer to ICS brochures for Policy details]

Last Name:
First Name & MI:
Address:
City:
State & Zip:
Social Security No. (or Student ID):
Date of Birth (mm/dd/yyyy):
Gender (Male or Female):
Telephone (include area code):
Fax (include area code):
Email:

Status (Student, Scholar, or ICS Member):
Visa Type (F-1, J-1, etc.):
School Advisor's Name (Last/First):
College or University Attending:
CIN # (leave blank if unknown):
Home Country (Country of Origin):

Indicate Period/Coverage Selected -
Period (Annual; 11, 10, ... 3 Months Minimum):
Plan (Discount Plan, Vantage Plan, etc.):
Desired Starting Date (mm/dd/yyyy):
Specify "New Application" or "Renewal":

List All Dependent(s) To Be Insured -
Spouse Name (Last/First):
Spouse Birth Date (mm/dd/yyyy):
Spouse Gender (Male or Female):
Child_1 Name (Last/First):
Child_1 Birth Date (mm/dd/yyyy):
Child_1 Gender (Male or Female):
Child_2 Name (Last/First):
Child_2 Birth Date (mm/dd/yyyy):
Child_2 Gender (Male or Female):
Child_3 Name (Last/First):
Child_3 Birth Date (mm/dd/yyyy):
Child_3 Gender (Male or Female):

Credit Card Payment Authorization -
Card Type (MasterCard/VISA/Discover/American Express):
Cardholder's Name (Last/First):
Card No.:
Card Expiration Date (mo/yr):
Total Premium to be charged: $

..................................Cut Here................................. Submit completed application (Enrollment Form + Premium Payment):

By Mail:
Insurance for Students
5295 Town Center Road #101
Boca Raton, FL 33486

By Fax (Credit Card Payment Authorization required):
Insurance for Students
Fax: 954-772-0872
Efax: 561-300-5678

By Email:
enroll@icsweb.org (For Enrollments Only)

[For assistance, please contact Insurance for Students at 1-800-356-1235] ___________________________________________________________________________
$THE END$

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