(Not Available for New Applicants)

 SCHEDULE OF BENEFITS

• WEA Global Plan
• U.S. Coverage 100 Option
• No U.S. Coverage Option
• Dental & Vision Benefits

 Policy Change Form
 Policy Change Form (with Evidence of
  Insurability)

 Plan Application Form

• Medical Claim Form
• Dental Claim Form
• Vision Claim Form
  

• Diabetes Questionnaire
• Attending Physician Statement (A.P.S.)
• Health Verification Form
• Maternity Questionnaire