Yu Chen Wei

215 Hoosick St

29 March 2012

New York, NY 12180

Confirmation of Coverage
This letter is to confirm that a completed Enrollment Form and premium payment have been received on behalf of the
person named herein. Medical insurance coverage will be provided under the terms of the master policy for the
International Student and Scholar Medical Insurance Plan, underwritten by Markel Insurance Company.
Coverage begins on the effective date indicated below. The plan provides the following basic benefits:

$250,000 Accident and Sickness Benefit

$50,000 Medical Evacuation Benefit
$50,000 Repatriation of Remains Benefit
Coverage Valid Worldwide (Except in home country of Insured person.)

Insured: Yu Chen Wei

Policy Number: 11-200332
Insurance ID Number: 946450282
Effective Date: 29-MAR-12
Expiration Date: 29-MAR-13
In the event the check presented for payment of premium is not honored by the financial institution on which it is drawn,
all coverage will be terminated, retroactive to the Effective Date of Coverage. Please note that the Insured will receive a
personalized Insurance ID card, which is for the Insured's use only. In the event the Insured needs to seek medical
treatment prior to receiving the ID card, please ask the medical provider to contact The Harbour Group.
Sincerely,
Becky Amburgey
Customer Service Coordinator

The Harbour Group of Ohio, L.L.C.

66 Remick Drive

Springboro, Ohio 45066

Voice: 800.252.8160

Fax: 937.885.5380

Email: info@hginsurance.com