DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

MAERSK TANKERS Healthcare

Cover Schedule of Benefits
Officers and their Dependents

Comprehensive Insurance for Your Employees and Families

General Conditions of Insurance

(Status date: 01.01.2021, Version 1.00)
DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

SCHEDULE OF BENEFITS

To be read in conjunction with the Policy Wording. In the event of any differences between this Schedule and
the Policy Wording – the Schedule shall take priority over the wording.

Members
Coverage: Country of Residence Medical Expenses

Geographical Limits: Country of Residence only as shown in the Schedule of

Members and extended to worldwide holiday vacation travel as
set out below.

Category of Members as set out below:

Membership Level
Senior Officers No change for existing members
New Members After 12 months from first signing with Maersk Tankers.

Junior Officers including Cadets

No change for existing members

New Members After 12 months from first signing with Maersk Tankers.

Ratings
No cover Not applicable

Deductible(s): Sections I & IV USD25 per claim for Hospitalisation/Inpatient Care

Sections II, llI & V USD30 per claim plus 20% Outpatient Co-Pay as set out below,
Excess of any more specific underlying medical cover
Age Eligibility
Members from 18 to under 71 years old
Spouses from 18 (or local legal age) to under 71 years old
Dependent children from 30 days and under 19 years old
can be covered but it is limited to the three youngest
children per family (as registered by Mayfair at the
insured Officer’s start date).

Medical Expenses maximum limit per policy period Up to USD 35,000 per Member
Medical Expenses incurred in the 12 months from the first onset of the medical condition covered by this policy
or until the expiry of this Employer’s benefit plan where all benefits will then cease.

Lifetime limit USD 70,000 per Member

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Your Data Protection

This Privacy Notice describes how the insurer together, “we”, “us” or the “Insurer”) collect and use the personal information of insureds,
claimants and other parties (“you”) when we are providing our insurance and reinsurance services.
The information provided to the Insurer, together with medical and any other information obtained from you or from other parties about
you in connection with this policy, will be used by the Insurer for the purposes of determining your application, the operation of
insurance (which includes the process of underwriting, administration, claims management, analytics relevant to insurance,
rehabilitation and customer concerns handling) and fraud prevention and detection. We may be required by law to collect certain
personal information about you, or as a consequence of any contractual relationship we have with you. Failure to provide this
information may prevent or delay the fulfillment of these obligations.
Information will be shared by the Insurer for these purposes with group companies and third party insurers, reinsurers, insurance
intermediaries and service providers. Such parties may become data controllers in respect of your personal information. Because we
operate as part of a global business, we may transfer your personal information outside the European Economic Area for these
purposes including to the UK and to India and/or the Philippines where your claims are managed.

You have certain rights regarding your personal information, subject to local law. These include the rights to request access,
rectification, erasure, restriction, objection and receipt of your personal information in a usable electronic format and to transmit it to a
third party (right to portability).
If you have questions or concerns regarding the way in which your personal information has been used, please contact:
compliance@xlcatlin.com
We are committed to working with you to obtain a fair resolution of any complaint or concern about privacy. If, however, you believe
that we have not been able to assist with your complaint or concern, you have the right to make a complaint to the UK Information
Commissioner’s Office.
For more information about how we process your personal information, please see our full privacy notice at:
www.xlgroup.com/footer/privacy-and-cookies.

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

SENIOR OFFICERS

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

I. HOSPITALISATION/INPATIENT For all membership level:

Hospitalisation / Inpatient
Room and Board according to type of enrolment Covered – Semi Private Room (flexible –
common sense interpretation)

Services of Physician, Surgeon and Specialist, Inpatient treatment, Covered

Inpatient Medications, Diagnostic Procedures, Intensive Care
Treatment

STANDARD:
Cover for complications arising from pregnancy, to include pre-existing Covered
medical conditions for dependents.
Not covered
All forms of mental health conditions
Not covered
Normal pregnancy or maternity conditions
Deductible
For this section there is a USD25 deductible
on each and every medical condition.

II. OUTPATIENT BENEFIT

Standard:
Outpatient Up to USD400 combined per
person per policy period with
Consultation including specialists evaluation 20% Co-Pay
First aid treatment of injury
20% Co-Pay shall apply in
Treatment for minor injuries such as lacerations, mild burns, sprain and excess of the USD30
strain fractures deductible

Laboratory examinations and all other diagnostic procedures required Any claim USD30 or below will
not be reimbursed.
Outpatient Medication

Minor surgery not requiring confinement Nursing Care - up to six months .

Ill. EMERGENCY BENEFIT There is a USD30 deductible on all claims as

well as a 20% Co-Pay for all membership
Emergency care services levels:

Emergency Care in Areas where there are No accredited specialists at Covered

the accredited hospital

Emergency Care in Areas where there are No accredited hospital, 100% Covered
coverage

Emergency care services in Non-accredited hospitals Covered

Unavailability of Room during emergency confinement when room Covered for board difference and
category is not available incremental cost of upgrade to
next available room category.
Ambulance conduction (surface) Covered
Emergency care services in medical facilities in foreign territories while on
Covered
official business for the Policyholder

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

SENIOR OFFICERS

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

Up to USD400 combined per person per policy

IV. SPECIAL MODALITIES OF TREATMENTS period with 20% Co-Pay plus a USD25 per
claim deductible.

Percutaneous Adrenalectomy, Laparoscopic procedures, Heart Surgery, Covered

Angioplasty

New Diagnostic Procedures Covered

Speech Therapy Covered

Dialysis Covered

Chemotherapy Covered – up to a total lifetime cancer limit

of USD5,000

Radiotherapy Covered – within the lifetime cancer limit of

USD5,000
Physical Therapy Covered

All sophisticated diagnostic modalities or methods of treatment for Covered

which there are no comparable conventional or traditional equivalent or
counterparts.

V. OTHER FEATURES Covered –with 20% Co-Pay in excess of

USD 30 deductible per claim

Congenital illnesses
Covered
Vaccines

Anti-tetanus Covered

Anti-rabies, anti-venom vaccines Covered

Work related illnesses/injuries Not covered

Dental Benefits Not covered

Mental disorders
Not covered
Congenital birth defects
Not covered
Vision Not covered

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

Holiday vacation cover including

whilst traveling with spouse and/or
dependents.
Covered
Holiday vacation cover is
extended to include spouse &/or
dependent(s) whilst travelling
onboard a Maersk Tanker’s ship
with the seafarer member &/or to Covered
or from the seafarer member’s
contractual vessel.

Business travel for the Senior

Officers (excluding spouse and/or
dependents) whilst attending
officially sanctioned and approved Covered
seminars and/or training events
(excluding those conducted on
board a vessel).

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

JUNIOR OFFICERS

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

I. HOSPITALISATION/INPATIENT For all membership level:

Hospitalisation / Inpatient
Room and Board according to type of enrolment Covered – Semi Private Room (flexible –
common sense interpretation)

Services of Physician, Surgeon and Specialist, Inpatient treatment, Covered

Inpatient Medications, Diagnostic Procedures, Intensive Care
Treatment

Cover for complications arising from pregnancy, to include pre-existing STANDARD:

medical conditions for dependents Covered

Not covered
All forms of mental health conditions
Not covered
Normal pregnancy or maternity conditions
Deductible
For this section there is a USD25 deductible
on each and every medical condition

II. OUTPATIENT BENEFIT

STANDARD:
Outpatient Up to USD400 combined per
person policy period with 20%
Consultation including specialists evaluation Co-Pay
First aid treatment of injury
20% Co-Pay shall apply in
Treatment for minor injuries such as lacerations, mild burns, sprain and excess of the USD 30
strain fractures deductible.

Laboratory examinations and all other diagnostic procedures required Any claim USD30 or below will
not be reimbursed
Outpatient Medication

Minor surgery not requiring confinement Nursing Care – up to six months

Ill. EMERGENCY BENEFIT There is a USD30 deductible on all claims as

well as a 20% Co-Pay for all membership
Emergency care services levels:

Emergency Care in Areas where there are No accredited specialists at Covered

the accredited hospital

Emergency Care in Areas where there are No accredited hospital, 100% Covered
coverage

Emergency care services in Non-accredited hospitals Covered

Ambulance conduction (surface)
Covered
Unavailability of Room during
emergency confinement when Covered for board difference and
room category is not available incremental cost of upgrade to
next available room category.
Emergency care services in medical facilities in foreign territories while on
Covered
official business for the Policyholder

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

JUNIOR OFFICERS

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

IV. SPECIAL MODALITIES OF TREATMENTS Up to USD400 combined per person per policy
Period with 20% Co-Pay plus a USD25 per
claim deductible

Percutaneous Adrenalectomy, Laparoscopic procedures, Heart Surgery, Covered

Angioplasty

New Diagnostic Procedures Covered

Speech Therapy Covered

Dialysis Covered – up to a total lifetime cancer limit

of USD5,000
Chemotherapy Covered - – within the above lifetime cancer
limit of USD5,000
Radiotherapy Covered

Physical Therapy Covered

All sophisticated diagnostic modalities or methods of treatment for

Covered
which there are no comparable conventional of traditional equivalent or
counterparts.

V. OTHER FEATURES Covered –with a 20% Co-Pay plus

a USD30 per claim deductible

Congenital illnesses

Vaccines
Covered
Anti-tetanus
Covered
Anti-rabies, anti-venom vaccines
Covered
Work related illnesses/injuries

Dental Benefits Not covered

Mental disorders
Not covered
Congenital birth defects Not covered

Vision Not covered

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

Holiday vacation cover including

whilst traveling with spouse and/or Covered
dependents.

Holiday vacation cover is

extended to include spouse &/or
dependent(s) whilst travelling
onboard a Maersk Tanker’s ship Covered
with the seafarer member &/or to
or from the seafarer member’s
contractual vessel.

Business travel for the Junior

Officers (excluding spouse and/or
dependents) whilst attending Covered
officially sanctioned and approved
seminars and/or training events
(excluding those conducted on
board a vessel).

Signed on behalf of Maersk Tankers

Tommy Thomassen

CTO
Name and Title

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DocuSign Envelope ID: D4F7E880-F796-4FD8-9FD7-C3CF6C74250D

Website: www.crewsure.com
Email: info@crewsure.com
Telephone: +44 (0) 20 7264 1377

(Status date: 01.1.2021, Version 1.00)

Crewsure Insurance Services (Europe), 112 Jermyn St, St James, London, SW1Y 6LS. We may monitor or record calls for security and to improve our
service. Crewsure Insurance Services (Europe) and Compass Underwriting (Europe) are registered trading names of Security Trus t Scandinavia AB
which is registered at Strandvägen 61, 135 62 Tyresö and the London Branch trades from 30 Dukes Place, London EC3A 7LP. Security Trust Scandinavia AB
is authorised and regulated by the Swedish Finansinspektionen under FI identification number 82568 and the London branch is authorised by the
UK’s Financial Conduct Authority under firm registration number 848689.