TRAVEL CERTIFICATE INTERNATIONAL

EMERGENCY MEDICAL SERVICE

BENEFICIARY INFORMATION:

FIRST AND LAST NAME OF BENEFICIARY: Juan Carlos Rivera

NUMBER OF VISA CARD OR CENTRAL TRAVEL ACCOUNT (FIRST 10 DIGITS): 4593540007

TYPE OF VISA CARD: Visa Signature - Argentina - Credit

TRIP STARTING DATE: 30/10/2022 TRIP ENDING DATE: 09/11/2022

SCHENGEN COVERAGE:

The INTERNATIONAL EMERGENCY MEDICAL SERVICE covers the amount required by the Schengen agreement of €30,000
(Euros) and includes the following benefits:

Medical assistance services

Accomodation and transportation services

Emergency medical evacuation Repatriation of remains

Early return or extended stay Convalescence

This services fulfills the provisions that the European Union requires to grant Schengen visas.

The INTERNATIONAL EMERGENCY MEDICAL SERVICE covers the amount required by the Schengen agrément of €30,000
(Euros) and includes the following benefits;

These benefits are in accordance to the terms and conditions applied to this service. Please refer to your benefits guide provided by
your bank.

You as Beneficiary, will have access to the amount to the limits below based on the type of your Visa card.
 TRAVEL CERTIFICATE INTERNATIONAL
EMERGENCY MEDICAL SERVICE

MEDICAL ASSISTANCE SERVICES

Visa Platinum Visa Signature & Infinite

The medical assistance services will have a maximum benefit The medical assistance services will have a maximum benefit
amount that will not exceed 70,000 USD* per BENEFICIARY amount that will not exceed 150,000 USD* per BENEFICIARY

ACCOMMODATION AND TRANSPORTATION SERVICES

Visa Platinum Visa Signature & Infinite

The transportation or accomodation service will have a maximum The transportation or accomodation service will have a maximum
benefit amount that will not exceed the total amount of 100,000 benefit amount that will not exceed the total amount of 100,000
USD* per MEDICAL EMERGENCY or ACCIDENT USD* per MEDICAL EMERGENCY or ACCIDENT

VISA Online Medic: Included VISA Online Medic: Included

*The benefit limit for Emergency medical expenses and Emergency dental treatment of $70,000 USD for Platinum cards and $150,000 USD for

Infinite/Signature cards, are effective to claims with incidente date from October 1st, 2020.

Note: From elegible Visa Platinum, Visa signature and Visa Infinite Cards Issued in Puerto Rico and the U.S Virgin Islands, this benefit does not apply

to Covered Trips purchased in full on or after January 1, 2021. The coverage is subject to the general terms and conditions of the benefit.

International
Emergency Medical Plan A Plan C Plan D Plan E Plan F
Service - According to OPTIONAL OPTIONAL OPTIONAL OPTIONAL OPTIONAL
your issuing bank

Emergency Medical
5,000 USD 10,000 USD 15,000 USD 5,000 USD 25,000 USD
Expenses

Emergency Medical
Expenses in Schengen € 30,000 € 30,000 € 30,000 NA € 30,000
Countries

Emergency Dental
100 USD per tooth 100 USD per tooth 100 USD per tooth NA 100 USD per tooth
Treatment

Medical Emergency
20,000 USD 20,000 USD 20,000 USD 50,000 USD 20,000 USD
Evacuation

Repatriation of Mortal
7,500 USD 15,000 USD 20,000 USD 75,000 USD 20,000 USD
Remains

Early Return or Extended

1,000 USD 3,000 USD 5,000 USD 5,000 USD 5,000 USD
Stay

Convalescence 500 USD 500 USD 500 USD 250 USD 500 USD

Visa Online Medic Included

IF THE BENEFICIARY HAS VALID INSURANCE OR ANY OTHER COVERAGE UNDER ANOTHER PROGRAM, ALL BENEFICIARY EXPENSES

MUST BE PAID BY HIS/HER INSURANCE OR ANY OTHER COVERAGE UNDER ANOTHER PROGRAM BEFORE CAN MAKE USE OF THE

INTERNATIONAL EMERGENCY MEDICAL SERVICE BENEFIT, TREATMENT MUST BE RECEIVED BY RECOMMENDATION OF A

 TRAVEL CERTIFICATE INTERNATIONAL
EMERGENCY MEDICAL SERVICE

REGISTERED MEDICAL DOCTOR FURTHERMORE, THE INTERNATIONAL EMERGENCY MEDICAL SERVICE BENEFITS ARE SUBJECT TO

THE LIMITATIONS AND EXCLUSIONS SET FORTH BELOW.

ABOUT COVID ASSISTANCE:

The INTERNATIONAL EMERGENCY MEDICAL SERVICE will provide assistance for COVID cases according to the description of
benefits described above. Some exceptions will apply:

In case the BENEFICIARY is traveling to a country, specific region or event where the World Health Organization (WHO) or
any regulatory authority in the country from/to which the BENEFICIARY has advised or prohibites against travel.
In case the expenses are related direct or indirect as a consequence of the BENEFICIARY failing to obtain any
recommended vaccines or medications prior to the trip

OTHER CONSIDERATIONS:

The INTERNATIONAL EMERGENCY MEDICAL SERVICE is offered exclusively to Visa cardholders for eligible international trips. An
International trip is eligible under these circumstances:

The trip is outside of the beneficiary's country of residence and country of card issuance.
The benefits provided are only valid for an elegible trip for up to sixty (60) consecutive days from the departure date of country of
residence or country card issuance of such eligible trip.
Full amount of the international ticket, taxes and fees related were paid to a transportation company with an eligible Visa Card or Visa
Account.
The international tickets were purchased by redeeming points from a loyalty program, provided that the boarding fee and possible taxes
due have been paid with an eligible Visa card or Visa Account.
If no boarding fee or taxes are levied, the tickets were purchased by redeeming points obtained through utilization of a valid Visa rewards
program.
To be eligible to International Emergency Medical SERVICE the cardholder need to activate the benefits through the Visa benefits portal
www.visa.com/benefitportal
 TRAVEL CERTIFICATE INTERNATIONAL
EMERGENCY MEDICAL SERVICE

WHILE TRAVELING PLEASE KEEP THE FOLLOWING RECOMMENDATIONS IN

MIND:

In the event that an emergency occurs, it is required that you contact the Visa Assistance Center immediately or within 30 days following
the date on which the MEDICAL EMERGENCY or ACCIDENT occurred.

Please note guide of benefits may be very based on your Bank type of Visa card; please refer to your Bank to know the benefits guide
provided. The final determination of service is subject to terms, conditions and exclusions of AXA Assistance USA. We encourage you to
review the benefits guide for further details.

THE VISA ASSISTANCE CENTER IS AVAILABLE 24 HOURS A DAY, 7 DAYS A

WEEK AT THE FOLLOWING TELEPHONE NUMBERS:

+1 (800) 396 9665 from North America, Puerto Rico, and US Virgin Islands

(303) 967-1098 Collect call from any country outside of the United States

You can also login in www.visa.com/benefitportal and start a session

with our virtual clinic by clicking in Visa Online Medic. Please be aware
that terms and conditions will apply.