SecureValue for Business

Transcription

1 SecureValue for Business Fixed Indemnity Medical Insurance Flexible Affordable Secure Exclusively marketed by: Taking Steps To Make Health Coverage Affordable SECvalBUS-br-TX-flic-04

2 The Cost Of Health Coverage Is The # Concern Of Small Business Owners. Why As a member of the American Independent Business Coalition, You have the right to apply for coverage under one of Freedom Life s Fixed Indemnity Medical Plans issued to the Association, including the SecureValue for Business plan. The plan s five levels of coverage are designed to meet Your individual needs and budget. Innovative We are the ONLY company in America that allows You to BUY MORE COVERAGE WHEN YOU NEED IT MOST with NO ADDITIONAL UNDERWRITING. Pioneered long term fixed rate insurance. Over 85% of Our customers renew their Fixed Rate Health Plans. Experienced Over 50 collective years of industry experience. Over 5 MILLION customers served. Dependable Over billion dollars in CLAIMS PAID! Average claim paid in LESS THAN 0 CALENDAR DAYS! Dedicated PROFESSIONAL insurance agents to assist You! Convenient PERSON to PERSON CUSTOMER SERVICE you don t have to talk to a machine! Tools to manage your healthcare. Access to online tools and resources so you can make informed decisions about your healthcare. National Federation of Independent Business; 008 Survey of Small Business Owners. Freedom Life Insurance Company of America, 0 Policy Owner Services Data 0 Analysis of Major Medical Expense Claims Processing Time by insurance subsidiaries of USHEALTH Group

3 Why choose SecureValue for Business? The SecureValue for Business Difference No Annual Deductible! Enables You to receive benefits payments sooner than a traditional Major Medical plan! Buy more coverage, if you need it, without additional underwriting! Ask Your Agent about the Optional Step Up Riders! Any Hospital! But You can stretch Your dollars further by choosing an In-Network Provider. Our Surgeon s fee schedule provides larger fixed indemnity payments than many competitors that limit their surgeon s fixed indemnity payments to the Medicare allowable charge for the same surgery! Not subject to federal healthcare reform mandates! Lock in Your rate for, 4 or, 6 months!* Ask Your Agent how You can lock in Your rate for up to 6 months! Flexible Plan Options As part of Your plan selection, You choose when Your Hospital Room and Board and Miscellaneous Expense benefits begin by selecting Your Elimination Period of ZERO, ONE or TWO days. Increasing Lifetime Maximum! Get rewarded for Your Good Health with our Increasing Lifetime Maximum. 4 hour coverage, on or off the job Coverage You can depend on when You need it the most. Portable coverage You can take it with You even if You move or change jobs. *The Premium Rate Guarantee Period does not apply to any rate change due to: change of address; addition of Insureds; change of benefits or options; change of Mode Of Premium Payment; group policy coverage, benefits, limitations, exclusions or premium change; requirements of any federal or state law..5% were $50K or more.% were $5k to $50K Annual Health Claims Review 96.4% of our Insureds Annual Claims were Under $5K A Fixed Indemnity Medical Insurance plan allows You to receive specific first dollar payments for covered healthcare services, regardless of what Your medical provider charges. This differs from traditional Major Medical plans where You must first satisfy a deductible every year before You are eligible to receive benefit payments. Freedom LIfe Insurance Company of America, 0 Claims Paid Per Policy You will be responsible for charges that exceed Your fixed benefit amount and the network discount The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsible for all amounts charged in excess of the fixed benefit amount and network discount.

4 Medical & Surgical Services At a Glance We will pay the fixed indemnity benefit dollar amount (see pages 6-7 for plan options) for the following covered medical and surgical services. Terms, conditions, limitations and exclusions may apply. Hospital Confinement Fixed Indemnity Benefits Hospital Inpatient Admission* Hospital Room & Board ICU Room & Board Hospital Miscellaneous Expenses Increased Hospital Miscellaneous Expenses for Specific Critical Illness or Injury: Coronary Artery Bypass Coma Heart Attack Life Threatening Cancer Major Organ Transplant Severe Burn Stroke Inpatient Surgery* Surgeon & Assistant Surgeon Anesthesia Outpatient Fixed Indemnity Benefits Emergency Room Emergency Air/Ground Ambulance Radiation/Chemotherapy* Outpatient Surgery Facility Surgeon Anesthesia Kidney Dialysis* *Not available on SecureValue for Business Plan See page 6-7 for plan specified dollar amounts for Medical and Surgical Services. The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsible for all amounts charged in excess of the fixed benefit amount and network discount. 4

5 Build Security for Yourself & Your Family in 5 Easy Steps 5 Choose the level of coverage that best suits Your needs. Choose when Your Hospital Room & Board and Miscellaneous Expense Benefits begin by selecting Your Elimination Period of ZERO, ONE or TWO days. Choose Lock in Your rate! 99 months 994 months, or 996 months! 4 Increase optional supplemental coverage to enhance Your overall protection: 99Critical Illness 99Accident 99Dental 99Life Insurance These optional plans also underwritten by Freedom Life Insurance Company of America. Exclusions and limitations apply. Not available in all states. Your coverage if You need it with our exclusive Step Up Rider Option. Your Optional Step Up Rider gives You the one-time exclusive option to Step Up Your level of coverage up to full plan levels at any time, even during a claim, with no additional underwriting... EVER!! Lock in Your Step Up option to buy more coverage when You need it the most! See page 9 for details on the Optional Step Up Rider & the Optional Double Step Up Rider! Taking Steps to Make Health Coverage Affordable 5

6 SecureValue for Business Plans - Hospital Confinement Fixed Indemnity Benefits Benefits Paid Per Insured Plan Plan Hospital Inpatient Admission Benefit (No Elimination Period) $50 Hospital Room & Board Daily Benefit* $400 $600 Hospital Miscellaneous Expense Daily Benefit* + $400 + $600 Hospital Room & Board + Hospital Miscellaneous Total Daily Benefit = $800 = $,00 OR ICU Room & Board Daily Benefit* $800 $,00 Hospital Miscellaneous Expense Daily Benefit* + $400 + $600 ICU Room & Board + Hospital Miscellaneous Total Daily Benefit = $,00 = $,800 If Confinement is due to one of the specified illnesses or injuries below, the following Hospital Miscellaneous Benefits Apply: Hospital Miscellaneous Expense Daily Benefit for Specified Illnesses or Injuries* (in lieu of Hospital Miscellaneous Daily Expense) Stroke Daily Benefit $,000 $,000 Coma Daily Benefit $,400 $,600 Heart Attack Daily Benefit $4,800 $5,400 Life Threatening Cancer Daily Benefit $,600 $5,400 Coronary Artery Bypass Daily Benefit $,600 $7,00 Severe Burn Daily Benefit $4,800 $7,00 Major Organ Transplant Daily Benefit $5,00 $7,800 Inpatient Surgeon,4 (No Elimination Period) Benefit varies by Procedure, range is: $80-$8,000 Assistant Surgeon(% of Surgeon s Fee Benefit) 0% Anesthesia (% of Surgeon s Fee Benefit) 5% *Hospital Confinement subject to the Elimination Period Selected Paid once per Hospital Admission per Policy Year Maximum thirty days per Policy Year Maximum of one Inpatient procedure per Policy Year 4 Please see Surgical Schedule for full details Outpatient Fixed Indemnity Benefits Benefits Paid Per Insured Plan Plan Emergency Room Daily Benefit $50 $50 Emergency Ambulance Benefit Ground $00 $00 Air $,000 $,000 Radiation/Chemotherapy Oral Chemotherapy Per Day $500 Oral Chemotherapy Per Policy Year $5,000 Intravenous Chemotherapy Per Day $,000 Intravenous Chemotherapy Per Policy Year $5,000 Radiation Therapy Per Day $,000 Radiation Therapy Per Policy Year $5,000 Surgical Facility $50 $500 Surgeon,4 Benefit Range Per Procedure $80-$8,000 $80-$8,000 Anesthesia (% of Surgeon s Fee Benefit) 5% 5% Kidney Dialysis Daily Benefit $500 Days Per Policy Year 60 Maximum of one per Insured per Policy Year Maximum of one trip by ground and one by air per Policy Year Maximum of one Outpatient procedure per Policy Year 4 Please see Surgical Schedule for full details Policy Year Fixed Indemnity Benefit Maximum Benefits Paid Per Insured Plan Plan Policy Year Maximum Per Policy Year Per Insured $00,000 $50,000 All Plans have a Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured of $5 Million. Get rewarded for your GOOD HEALTH with our Increase in Lifetime Maximum! See page 9 for details. The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsible for all amounts charged in excess of the fixed benefit amount and network discount. 6

7 SecureValue for Business Plans -5 Hospital Confinement Fixed Indemnity Benefits Benefits Paid Per Insured Plan Plan 4 Plan 5 Hospital Inpatient Admission Benefit (No Elimination Period) $50 $50 $50 Hospital Room & Board Daily Benefit* $700 $800 $,000 Hospital Miscellaneous Expense Daily Benefit* + $700 + $800 + $,000 Hospital Room & Board + Hospital Miscellaneous Total Daily Benefit = $,400 = $,600 = $,000 ICU Room & Board Daily Benefit* $,400 $,600 $,000 Hospital Miscellaneous Expense Daily Benefit* + $700 + $800 + $,000 ICU Room & Board + Hospital Miscellaneous Total Daily Benefit = $,00 = $,400 = $,000 Outpatient Fixed Indemnity Benefits Benefits Paid Per Insured Plan Plan 4 Plan 5 Emergency Room Daily Benefit $50 $50 $50 Emergency Ambulance Benefit Ground $00 $00 $00 Air $,000 $,000 $,000 Radiation/Chemotherapy Oral Chemotherapy Per Day $750 $,000 $,50 Oral Chemotherapy Per Policy Year $0,000 $5,000 $0,000 Intravenous Chemotherapy Per Day $,500 $,000 $,500 Intravenous Chemotherapy Per Policy Year $0,000 $40,000 $50,000 Radiation Therapy Per Day $,500 $,000 $,500 Radiation Therapy Per Policy Year $0,000 $40,000 $50,000 Surgical Facility 4 $750 $,000 $,50 Surgeon,5 Benefit varies by Procedure, range is: $80-$8,000 $80-$8,000 $80-$8,000 Anesthesia (% of Surgeon s Fee Benefit) 5% 5% 5% Kidney Dialysis Daily Benefit $500 $500 $500 Days Per Policy Year Maximum of one visit per Policy Year Maximum of one trip by ground and one by air per Policy Year OR If Confinement is due to one of the specified illnesses or injuries below, the following Hospital Miscellaneous Benefits Apply: Hospital Miscellaneous Expense for Specified Illnesses or Injuries* (in lieu of Hospital Miscellaneous Daily Expense) Stroke Daily Benefit $,500 $4,000 $5,000 Coma Daily Benefit $4,00 $4,800 $6,000 Heart Attack Daily Benefit $6,00 $7,00 $9,000 Life Threatening Cancer Daily Benefit $6,00 $7,00 $9,000 Coronary Artery Bypass Daily Benefit $8,400 $9,600 $,000 Severe Burn Daily Benefit $8,400 $9,600 $,000 Major Organ Transplant Daily Benefit $9,00 $0,400 $,000 Inpatient Surgeon,4 (No Elimination Period) Benefit Range Per Procedure $80-$8,000 $80-$8,000 $80-$8,000 Assistant Surgeon (% of Surgeon s Fee Benefit) 0% 0% 0% Anesthesia (% of Surgeon s Fee Benefit) 5% 5% 5% *Hospital Confinement subject to the Elimination Period Selected Paid once per Hospital Admission per Policy Year Maximum thirty days per Policy Year Maximum of one Inpatient procedure per Policy Year for plans and 4, maximum of two Inpatient procedures per Policy Year for plan 5 4 Please see Surgical Schedule for full details Maximum of one Outpatient procedure per Policy Year for plans and 4, maximum of two Outpatient procedures per Policy Year for plan 5 4 Maximum of one visit per Policy Year for plans and 4, maximum of two visits per Policy Year for plan 5 5 Please see Surgical Schedule for full details Policy Year Fixed Indemnity Benefit Maximum Benefits Paid Per Insured Plan Plan 4 Plan 5 Policy Year Maximum Per Policy Year Per Insured $00,000 $50,000 $00,000 All Plans have a Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured of $5 Million. Get rewarded for your GOOD HEALTH with our Increase in Lifetime Maximum! See page 9 for details. The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsible for all amounts charged in excess of the fixed benefit amount and network discount. 7

8 How does SecureValue for Business Work? Let s compare our Fixed Indemnity Insurance Plan with a Zero Elimination Period to a traditional Major Medical Insurance Plan: FLU - Doctor s Office Billed Charges for: Doctor Office Visit and Diagnostic Lab Total Charges: $0.00 $0.00 $0.00 Applied PPO Network Discount: -$70.5 -$70.5 -$70.5 Remaining Charges: $0.65 $0.65 $0.65 SecureValue for Business Plan SecureValue for Business Plan 5 Traditional Major Medical Plan Doctor Office Visit: $0 Doctor Office Visit: $0 Applied to Deductible: $0.65 Diagnostic Lab: $0 Diagnostic Lab: $0 Your Remaining Deductible: $5,869.5 Your Remaining Coinsurance: $4, Plan Pays: $0 Plan Pays: $0 Plan Pays: $0 Balance Due: $0.65 Balance Due: $0.65 Balance Due: $0.65 Broken Forearm ( Bones) - ER Visit Billed Charges for: X-ray, Cast, Medication, Surgeon, ER and Facility Total Charges: $,86.70 $,86.70 $,86.70 Applied PPO Network Discount: -$ $ $65.95 Remaining Charges: $,0.75 $,0.75 $,0.75 SecureValue for Business Plan SecureValue for Business Plan 5 Traditional Major Medical Plan ER Daily Benefit: $50.00 ER Daily Benefit: $50.00 Applied to Deductible: $,0.75 Outpatient Surgery: $, Outpatient Surgery: $, Your Remaining Deductible: $4,789.5 Outpatient Surgical Facility: $50.00 Outpatient Surgical Facility: $,50.00 Your Remaining Coinsurance: $4, Plan Pays: $, Plan Pays: $, Plan Pays: $0 Balance Due: ($89.5) Balance Due: ($,89.5) Balance Due: $,0.75 Appendectomy - Day Hospital Stay Billed Charges for: Hospital, Surgery, Anesthesia, Dr. Visit at Hospital, Lab, X-ray, and ER Total Charges: $,7.47 $,7.47 $,7.47 Applied PPO Network Discount: -$8,45.0 -$8,45.0 -$8,45.0 Remaining Charges: $5,6.46 $5,6.46 $5,6.46 SecureValue for Business Plan SecureValue for Business Plan 5 Traditional Major Medical Plan ER Daily Benefit: $50.00 ER Daily Benefit: $50.00 Applied to Deductible: $6, Hospital InPatient Admission Benefit: Hospital InPatient Admission Benefit: $50.00 Your Remaining Deductible: $0 Hospital Room & Board Daily Benefit: ($400 x Days) Hospital Room & Board Daily $,00.00 Benefit: ($,000 x Days) $, Your Balance After Deductible: $9,6.46 Hospital Miscellaneous Expense Daily Benefit: ($400 x Days) Hospital Miscellaneous Expense $,00.00 Daily Benefit: ($,000 x Days) $, Your Remaining Coinsurance: $,85.9 Surgical Schedule: Surgical Schedule: $, Anesthesia: Anesthesia: $ Plan Pays: $, Plan Pays: $8, Plan Pays: $7,0.6 Balance Due: $, Balance Due: $6,66.46 Balance Due: $7,85.9 The plan comparison is between our Fixed Indemnity Medical Insurance Plans and 5 and a $6,000 deductible, 80/0 cost sharing to $0,000 major medical plan. Claim scenarios derived from Freedom Life Insurance Company of America s claim experience. Individual results may vary based on the level of the Fixed Indemnity Medical Insurance Plan selected, provider charges, PPO network discounts, geographic location and any applicable covered healthcare services. Exclusions and Limitations may apply. 8

9 Plan features Optional Step Up Rider (available for an additional premium) At the time of application, You must lock in Your one-time upgrade option to Step Up Your plan coverage at any time to the next SecureValue for Business plan level with no additional underwriting. To utilize the Optional Step Up Rider as a one-time upgrade to increase Your fixed indemnity insurance benefits to the next plan level, You must notify the Company in writing and pay the difference of premium between Your current plan and the next available plan level from Your original date of coverage. Premiums paid after exercising Your Step Up option will be at the new upgraded plan amount. Once You have exercised the Optional Step Up Rider, We will review any claims processed 90 days before the date of Step Up and re-adjudicate those claims based on the new plan level selected. Any future claims will be processed at the new level, provided that difference in the prior premium has been paid and the new premium amount is current. The Optional Step Up Rider can only be exercised once during the lifetime of the Certificate and is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Certificate. Optional Double Step Up Rider (only available for SecureValue for Business Plans, or for an additional premium) At the time of application, You must lock in Your one-time upgrade option to Step Up Your plan coverage at any time by two full SecureValue for Business plan levels with no additional underwriting. To utilize the Optional Double Step Up Rider as a one-time upgrade to increase Your fixed indemnity insurance benefits two full plan levels, You must notify the Company in writing and pay the difference of premium between Your current plan and the new available plan level from Your original date of coverage. Premiums paid after exercising Your Step Up option will be at the new upgraded plan amount. Once You have exercised the Optional Double Step Up Rider, We will review any claims processed 90 days before the date of Step Up and re-adjudicate those claims based on the new plan level selected. Any future claims will be processed at the new level, provided that difference in the prior premium has been paid and the new premium amount is current. The Optional Double Step Up Rider can only be exercised once during the lifetime of the Certificate and is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Certificate. Get Rewarded for Your Good Health with our Increase in Lifetime Maximum You will receive a $50,000 increase in the amount of the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured on each anniversary of the Issue Date, if the total amount of all fixed indemnity benefits paid per Insured and submitted to Us for consideration during the previous Certificate Year is less than or equal to $500 and a $5,000 increase in the amount of the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured on each anniversary of the Issue Date, if the total amount of all fixed indemnity benefits paid per Insured and submitted to Us for consideration during the previous Certificate Year is between $500 and $,000. The total amount of good health plan benefit increases in the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured is $ million. Premium Rate Adjustments We will not raise Your premium rates on an individual basis due to your personal claims experience. We may raise your premium rates on Your Renewal Premium Class for all Certificates in your state. Renewal Premiums are calculated based on a variety of factors some of which are plan of coverage, age, sex, place of residence, number of dependents, past claims experience of Your Renewal Premium Class, and other reasons permitted by state law. Rates for individuals of the same sex and age may vary by Issue Date. Insureds are always free to request and apply for new underwritten coverage on this or other available plans. Renewability and Termination Coverage is guaranteed renewable to age 65 or in the event You become a Medicare enrollee. Your coverage will end on the earlier of the following: the premium due date in the month following the date the Group Fixed Indemnity Insurance Policy is terminated by the Group Policyholder; with respect to Your Spouse who is covered, the premium due date in the month following the effective date of Your divorce decree or annulment; with respect to Your children who are covered the premium due date in the month following Your child reaching the limiting age as defined by Your state; the due date of any unpaid premium (subject to the grace period); the date You terminate coverage by notifying Us; We are required by an appropriate regulatory authority to non-renew or cancel the group policy; We cease offering and renewing the same form of coverage as the Certificate in Your state; the date We receive due proof that fraud or intentional misrepresentation of material fact existed in applying for coverage or filing a claim; the month following attainment of age 65 for You or Your Spouse or in the event You or Your Spouse are eligible for Medicare; or the total amount of any benefit payments made by Us are equal to the lifetime maximum. Optional Step Up Rider form number GFIMOP-OR-FLIC Optional Double Step Up Rider form number GMSBU-OR-FLIC 9

10 Waiting Periods and Limitations at a Glance Coverage under the Certificate is limited as provided by the definitions, limitations, exclusions, and terms contained in each and every section of the Certificate, as well as the following limitations and waiting periods: any treatment, medical service, surgery, medication, equipment, claim, loss or expense received, purchased, leased or otherwise incurred as a result of an Insured s Pre-existing Condition, is not covered under the Certificate unless such treatment, medical service, surgery, medication, equipment, claim, loss or expense constitutes Covered Medical & Surgical Services incurred by such Insured more than twelve () months after the Issue Date, and are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate; any treatment, medical service, surgery, medication, equipment, that is received by an Insured, which is incurred before the expiration of six (6) months from the Issue Date which results from the diagnosis, care or treatment of hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, tonsils and/or adenoids, or otitis media shall be limited under the Certificate to 50% of the fixed indemnity amount specified in the Schedule of Operations for that diagnosis, care or treatment provided that (i) such treatment, medical service, surgery, medication, equipment, constitutes Covered Medical & Surgical Services received by an Insured after the Issue Date, (ii) such Sicknesses are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate, and (iii) such Sicknesses are not Pre-existing Conditions; any treatment, medical service, surgery, medication, equipment, that is received by an Insured, which results from the diagnosis, care or treatment of hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, tonsils and/or adenoids, otitis media, shall be covered under the Certificate and eligible for a fixed indemnity benefit payment hereunder only if such treatment, medical service, surgery, medication, equipment, constitutes Covered Medical & Surgical Services received by an Insured after the Certificate has been in force for a period of six (6) months from the Issue Date, such Sicknesses are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate, and such Sicknesses are not Pre-existing Conditions. Pre-existing Condition Limitation Pre-existing Condition means a condition, whether physical or mental, and regardless of the cause for which medical advice, diagnosis, care or treatment was recommended or received during the month period immediately preceding the effective date of coverage under the Certificate for the Insured incurring the expense. Non-Waiver Fixed Indemnity benefit payments erroneously paid under any section or provision of the Certificate shall not constitute a waiver or modification of any conditions, terms, coverage definitions, exclusions and/or limitations, amendatory or exclusionary riders, or coverage for waiting periods or Pre-existing Conditions contained in the Certificate. Exclusions at a Glance The Group Fixed Indemnity Insurance does not provide coverage for professional or medical services or any Fixed Indemnity Payments for any of the following: treatments, care, procedures, services or supplies which do not constitute Covered Medical & Surgical Services; treatments, care, procedures, services or supplies received before the Certificate Issue Date; Covered Medical & Surgical Services received after the Certificate terminates, regardless of when the condition originated, except as Provided in the Extension of Benefits provision; Fixed indemnity payments under the Certificate for Covered Medical & Surgical Services that in combination exceed the amount of the Policy Year Maximum Fixed Indemnity Benefit Payments Per Insured or the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured; Prescription Drugs; any treatments, care, procedures, services or supplies which are not specifically enumerated in the Covered Medical and Surgical Services Section of the Certificate and any optional coverage rider attached thereto; any professional services for which the Insured and/or any covered Family member are not legally liable for payment; any professional services for which the Insured and/or any covered Family member were once legally liable for payment, but from which liability the Insured and/or Family member were released; Injury or Sickness due to any act of war (whether declared or undeclared); services provided by any state or federal government agency, including the Veterans Administration unless, by law, an Insured must pay for such services; medical and surgical services, and Prescription Drugs that are payable or reimbursable by either a plan or program of any governmental agency (except Medicaid), or Medicare Part A, Part B and/or Part D provided the coverage was purchased prior to the Insured becoming eligible for Medicare; drugs or medication not used for a Food and Drug Administration ( FDA ) approved use or indication; experimental procedures or treatment methods not approved by the American Medical Association, American Dental Association or other appropriate medical society; eye refractions, eyeglasses, contact lenses, radial keratotomy, lasik surgery, hearing aids, and exams for their prescription or fitting; cochlear implants; any professional and medical services Provided an Insured in treatment of a Sickness or Injury caused or contributed to by such Insured s being intoxicated or under the influence of any drug, narcotic or hallucinogens unless administered on the advice of a Provider, and taken in accordance with the limits of such advice; intentionally self inflicted Injury, suicide or any suicide attempt while sane or insane; 0

11 Non-covered Items at a Glance cont d Sickness or Injury while serving in one of the branches of the armed forces of the United States of America; Sickness or Injury while in a foreign country and serving on active duty in the United States Army, Navy, Marine Corp or Air Force Reserves or the National Guard; Sickness or Injury while serving on active duty in the armed forces of any foreign country or any international authority; voluntary abortions, abortifacients or any other drug or device that terminates a pregnancy; services Provided by You or a Provider who is a member of an Insured s Family; any medical condition excluded by name or specific description by either the Certificate or any riders, endorsements, or amendments attached to the Certificate; any loss to which a contributing cause was the Insured s being engaged in an illegal occupation or illegal activity; participation in aviation, except as fare-paying passenger traveling on a regular scheduled commercial airline flight; cosmetic surgery or cosmetic dentistry, except for Medically Necessary cosmetic surgery performed under the following circumstances: (i) where such cosmetic surgery is incidental to or following surgery resulting from trauma or infection to correct a normal bodily function or congenital defect, or (ii) such cosmetic surgery constitutes Breast Reconstruction that is incident to a Mastectomy provided any of the above occurred while the Insured was covered under the Certificate; charges for breast reduction or augmentation or complications arising from these procedures; Prescription Drugs or other medicines and products used for cosmetic purposes or indications; voluntary sterilization, reversal or attempted reversal of a previous elective attempt to induce or facilitate sterilization; fertility hormone therapy and/or fertility devices for any type fertility therapy, artificial insemination or any other direct conception; any operation or treatment performed, or medication prescribed in connection with sex transformations or any type of sexual or erectile dysfunction, including complications arising from any such operation or treatment; appetite suppressants, including but not limited to, anorectics or any other drugs used for the purpose of weight control, or services, treatments, or surgical procedures rendered or performed in connection with an overweight condition or a condition of obesity or related conditions; any professional fees or other medical expenses incurred as the result of an Injury which was caused or contributed by an Insured racing any land or water vehicle; any professional fees, or other medical expenses incurred for the diagnosis, care or treatment of Mental and Emotional Disorders, Alcoholism, and drug addiction/abuse; level one controlled substances; except for Complications of Pregnancy, routine maternity or any other expenses related to childbirth, including routine nursery charges and well-baby care; fluoride products; allergy kits intended for future emergency treatment of possible future allergic reactions; programs, treatment or procedures for tobacco use cessation; charges for blood, blood plasma, or derivatives that has been replaced; treatment of autism; Temporomandibular Joint Disorder (TMJ) and Craniomandibular Disorder (CMD); replacement of lost or stolen prosthetics; general anesthesia, except as specifically Provided in the Covered Medical and Surgical Benefits section; and Prescriptions, treatment or services for behavioral or learning disorders, Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). The information shown here and in any accompanying literature does not provide full details of the Certificate. Different plan provisions may apply in certain states. This brochure is only a brief description of Benefits available. The complete terms of the coverage, including limitations and exclusions, and any state required provisions are in the Certificate.

12 Taking Steps To Make Health Insurance Affordable For information contact: GRP-P-06-FLIC Insurance coverage underwritten by: Freedom Life Insurance Company of America A member company of USHEALTH Group P.O. Box 79 Fort Worth, TX Insurance coverage underwritten by: Freedom Life Insurance Company of America A member company of USHEALTH Group The underwriting insurance company in Your state has agreed to perform or cause to be performed certain monthly administrative services on behalf of the association including the collection of certain enrollment fees and monthly membership dues on behalf of the association, and transmission to the association of monthly membership census data. The underwriting insurance company in Your state is paid a monthly fee by the association for these administrative services.