Monthly Premium Plans A, F, High Ded F, G & N Effective March 1, 2013

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1 Administrative Office: PO Box 906, Oxnard, CA Toll Free Telephone Number: Effective March, 0 5-Digit Zip Code Guide (Continued) To determine your premium, refer to the zip code listing to determine which area you live in, then select your age as of your requested policy effective date from the following pages.. Go to Column and locate. Then move to Column and the (first digits of your locate the last two digits of Zip Code) (P.O. Box addresses your Zip Code. are not acceptable.) 95 0, 0, 04, 06, 07,,, 5-0, -6, 8, 0,, 4, 6-8, 40, 4, 4-45, 48, 50-58, 60, 6, 6, 65-69, 74, 76, 78, 80-8, 85-89, 97 95,, 9, 77, 9,, * 954 0, 5, 7, 8, 0, -4, 6-9,, 5, 7, 4, 45, 49, 5, 5, 54, 56-6, 6, 64, 66-70, 8, 8, 85, 88, 90, 9, , 09,, 6, 9,, 0,,, 6, 9, 4, 4, 44, 46, 48, 50, 5, 6, 65, 7-7, 76, 80, 86, 87, 9, , * ,, 4, 8, 9,, 4-8,,, 4, 6-8, 40, 4, 4, 45-56, 58, 59, 60, 6-7, 7, 85, 87, 89, , -4, 7, 9,, 7, 9,, -7, 40, 4, 44-46, 48, 50, 5, 5, 54, 56, 58, 59, 6, 6-69, 7, 74-79, 8, 8, 84, 85, 89, 9, 9, 95, , 5, 0,, 4, 5, 8, 0,, 8, 9, 4, 5, 55, 60, 6, 70, 7, 7, 80, 8, 86-88, 90, 9, 96. Column is your Rating. (note: Some zip codes are assigned Multiple Rating s.*) 956 6, 8, 6, 94, * 957 0, 0, 09, -5, 7, 0-, 4, 6, 8, 5, 6, 46, 47, 6, 65, 76, 98, See Premium Chart for your area , 4, 57-59, , 8, 40-4, 5-5, 60, 64-67, 87, 94, , 7, * 959 0, 0, 0, -0, -0,, 4-5, 5-6, 65-84, 86-88, , 06-, -7, 9-5, 7-9, -5, 7-4, 44, 46-5, 54-59, 6-65, 67-7, 7-76, 78-80, 84-97, , 0-0, -7, 40-4, 45, 46, 48, 50-5, 54-58, * Counties With Zip Codes That Cross Rating Boundaries: Includes Calaveras, Inyo, Kings, Mendocino, Monterey, Placer, San Benito, Sutter, Tulare, Tuolumne, and Yolo. Includes Fresno, Imperial, Kern, Mariposa, Sacramento, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Sonoma, and Stanislaus. Includes Alameda, Contra Costa, Santa Barbara, and Santa Clara. 4 Includes Orange. 5 Includes Los Angeles. 6 Includes Riverside, San Bernardino, San Diego, and Ventura. 0 Outline of Medicare Supplement Coverage 7

2 Administrative Office: PO Box 906, Oxnard, CA Toll Free Telephone Number: Effective March, 0 Premium 65 and Over Plan A Plan F $ $ $ $6.7 $6.7 $9.4 $6.6 $6.6 $6.6 $77.70 $77.70 $ Outline of Medicare Supplement Coverage 8

3 Administrative Office: PO Box 906, Oxnard, CA Toll Free Telephone Number: Effective March, 0 Premium 65 and Over (Continued) Plan High Ded F Plan G $4.0 $4.0 $4.0 $57.40 $57.40 $54.5 $7. $7. $7. $76.95 $76.95 $ Outline of Medicare Supplement Coverage 9

4 Administrative Office: PO Box 906, Oxnard, CA Toll Free Telephone Number: Effective March, 0 Premium Information 65 and Over (Continued) Plan N $ $ $ $8.8 $8.8 $ Save $ on your monthly premium! Enroll in our Automatic Bank Draft or Electronic Fund Transfer (EFT) program and you will save $ on your monthly premium. (To enroll, simply complete the Premium Payment Form.) OR Save $48 by paying your premium for the entire year! (Note: Based on the policy effective date, the discount may be pro-rated the first year.) Save 5% when more than one member in the household enrolls in a Medicare Supplement plan with us. The discount is for policies with effective dates of June, 00 or after and available to those members who occupy the same housing unit. 0 Outline of Medicare Supplement Coverage 0

5 Administrative Office: PO Box 906, Oxnard, CA Toll Free Telephone Number: Plans A, F, High Ded F & N Effective March, 0 Premium Under 65 A F < 65 $85.4 $85.4 $85.4 $57.7 $57.7 $4.57 $78.5 $78.5 $78.5 $6.0 $6.0 $06.44 Plan High Ded F Plan N < 65 $84.6 $84.6 $84.6 $7.5 $7.5 $0.8 $74.6 $74.6 $74.6 $4.7 $4.7 $ Outline of Medicare Supplement Coverage