Center ISD BENEFIT GUIDE

Transcription

1 Center ISD BENEFIT GUIDE Plan Year: September 1, 2014 to August 31, 2015 Benefit Information Provided By: First Financial Group of America Houston Branch Office North Freeway, Suite 900 Houston, TX 77060

2 Table of Contents Topic Page Benefit Overview... 1 Section 125 Cafeteria Plan... 2 FFGA Flexible Spending, Medical Reimbursement and Dependent Care... 3 American Fidelity Disability Insurance... 4 American Fidelity Accident Insurance American Fidelity Cancer Insurance Allstate Group Cancer (NEW) Allstate Heart & Stroke Lincoln Group Term Life Texas Life Permanent Life Insurance AmeriDoc (NEW) Chartis Critical Illness Ameritas Dental Insurance Ameritas Vision Insurance Customer Service Numbers and Websites... 71

3 2014 Benefit Overview Center Independent School District and First Financial Group of America would like to take this opportunity to present to you the benefit information for the upcoming plan year. This information has been created to bring forth a brief overview of your benefit choices as well as offer you a reference guide when questions may arise regarding your insurance plans. Please take the time to look over the information contained in this booklet to familiarize yourself with the benefits that are provided to you as an employee with Center ISD. Representatives from First Financial will be at the district on March 17, 2014 to review plan options and make changes to your supplementary benefit elections under the Cafeteria Plan. The Plan Year for Center ISD is September 1, 2014 through August 31, This guide contains a summary of the benefits offered by Center ISD. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail. For a more detailed explanation of benefits you may contact First Financial Administrators at or visit the website listed below. Your Benefits Website: Visit for detailed information

4 SECTION 125 Cafeteria Plan Medical Expense & Dependent Care Reimbursement What is a Section 125 Cafeteria Plan? A Cafeteria Plan (under IRS Code Section 125) is a benefit available when you choose an eligible health plan with your employer. It allows you to withhold a portion of your pretax salary to cover your insurance premiums and certain medical and child care expenses. This allows you to pay less taxes and increase your take home pay at the same time. Section 125 Plan Sample Paycheck The example below shows how a married employee claiming one exemption can reduce their taxable income when they pay for their insurance coverage on a pre-tax basis. Without Section 125 With Section 125 Monthly Salary $2, Monthly Salary $2, Less Medical Deductions N/A Less Medical Deductions $ Taxable Gross Income $2, Taxable Gross Income $1, Less Taxes 20%) - $ Less Taxes 20%) - $ Less Estimated FICA (7.65%) - $ Less Estimated FICA (7.65%) - $ Less Medical Deductions - $ Less Medical Deductions - N/A Take Home Pay $1, Take Home Pay $1, You saved $70 per month in taxes by paying for your benefits on a pre-tax basis! Participation in the Section 125 Plan will increase your spendable income. First Financial is proud to be your Section 125/Flexible Spending Accounts Plan Provider. For more information or to enroll in this plan, see your Account Representative.

5 Flexible Spending Accounts There are two types of Flexible Spending Accounts (FSAs): Unreimbursed Medical (URM) and Dependent Day Care (DDC). Your participation in an FSA program allows a portion of your salary to be redirected to provide reimbursement for these types of expenses on a tax-exempt basis. At the beginning of each plan year, you elect a specific dollar amount for each FSA you wish to participate. Money remaining in your FSA account(s) will not be returned to you at the end of the plan year. Any amount remaining after the end of the runoff or grace period, if your employer offers one, will be forfeited. Because of the use-it-or-lose-it rule, it is important for you to carefully estimate your out-of-pocket URM and DDC expenses for the upcoming plan year. Unreimbursed Medical FSA With the FSA, you can pay out-of-pocket health care expenses for yourself, your spouse and all of your eligibile dependents for health, dental, and vision care expenses. The services must be incurred while you are actively participating in the FSA plan. The eligible expenses may be reimbursed regardless of whether you, your spouse or dependents are covered by your employer s medical, dental, or health plan. Please be aware of change in tax law Beginning Jan. 1, 2011, money from flexible spending accounts will no longer be available to pay for most over-the-counter drugs and medicines without a doctor s prescription. Due to Healthcare Reform, all URM Accounts will have an annual maximum of $2,500 starting January 1, Common Eligible Expenses» Co-Payments» Co-Insurance» Deductibles» Over-the Counter Drugs (with physician s prescription)» Dental Treatment» Orthodontia» Lab Fees Common Ineligible Expenses» Cosmetic Surgery» Teeth Whitening» Veneers» Botox» Non Prescribed Vitamins and Supplements» X-Rays» Vision Expenses» Lasik Surgery» Physical Therapy» Chiropractor Services» Acupuncture» Eye Contact Solution» Eye Drops» Toiletries» Medical Insurance Premiums» Health Club Membership Fees Common Eligible Expenses» Day Camps» Before/After School Care» Babysitters/Day Care Centers» Au Pair» Nanny» Nursery School Common Ineligible Expenses» Registration Fees» Care for child while not working» Kindergarten» Food/Activity expenses if separate from cost of care» Care provided by anyone under age 19» Pre-School» Books and Supplies» Field Trips Dependent Care FSA The Dependent Care FSA allows you to pay for day care expenses for your qualified dependent/child with pre-tax dollars while you (and your spouse) are working, seeking employment, or attending school as a full-time student for at least 5 months during the year. A maximum of $5,000 is allowed for reimbursement of dependent day care expenses per calendar year (the amount changes to $2,500 if you are married and file a separate tax return).

6 LONG-TERM DISABILITY Income Insurance Underwritten by: American Fidelity Assurance Company Enhanced Disability Income Plan Coverage Options Benefits Paid Directly to You Excellent Customer Service Learn More»» Marketed by: First Financial Capital Corporation P.O. Box Houston, TX Local (281) Toll Free (800)

7 Disabilities Happen. Are You Prepared? What would you do if you experienced a disability today and your paycheck suddenly stopped? Nearly 70% of American employees live paycheck to paycheck 1, staying current on bill payments, but not preparing for the loss of that valuable income. How Long Would You Go Without A Paycheck? A Week... A Month... A Year... The example below shows the potential lost income from a typical disability. This example also shows the estimated benefit payment this customer would have received under their Disability Income Insurance Plan. SAMPLE CLAIM - Hypothetical Example * STROKE Annual Salary $50,000 Length of Disability 2.5 years Lost Income $125,000 Think It Couldn t Happen to You? Know The Facts: I don t have a significant risk of being disabled. 1/3 of Americans entering the work force today will become disabled before they retire. 2 Disability Income Insurance Can Help! Monthly Benefit (70% of income) $2,900 Elimination (Waiting) Period 30 days Month 1 $0 (not paid due to 30 day waiting period) Month2 $2,900 Month 3 $290 (Full Potential Sick Leave Deducted) Month 4 thru 30 $22,050 ( a month after Disability Retirement deducted) Total Benefit Payment $25,240 (Paid directly to you!) *The example above is an illustration only. Every disability claim event is unique. Based on pre-existing conditions, offsets related to fully-paid sick leave, retirement pay, state disability, and other Sources of Income could support this employee s lost income and would be offset against their disability benefit, meaning the insurance payment would be less. The illustration above includes reductions due to fully-paid sick leave and state disability/retirement offsets. 68% I ll use my sick leave or savings. 68% of American employees live from paycheck to paycheck. 1 1 Reuters. More than two-thirds in U.S. live paycheck to paycheck: survey, September 19, Chances of Disability: Overview. Council for Disability Awareness Web. 24 Mar Ready To Learn More? Contact your First Financial Account Representative for more details or to schedule a one-on-one appointment.

8 Find the plan that s best for you! 1. Locate your current salary and review the monthly benefit offered based on your income. 2. Review Elimination Period and Premium columns to choose the one that best fits your needs. 3. See your First Financial Representative to enroll in your plan! SALARY BENEFIT ELIMINATION PERIOD/MONTHLY PREMIUM Annual Salary Monthly Salary* Monthly Disability Benefit** Accidental Death Benefit 14 day Elimination Period 30 day Elimination Period 60 day Elimination Period 90 day Elimination Period 150 day Elimination Period $3, $5, $ $ $ $20, $7.28 $5.80 $4.92 $4.16 $3.12 $5, $6, $ $ $ $20, $10.92 $8.70 $7.38 $6.24 $4.68 $6, $8, $ $ $ $20, $14.56 $11.60 $9.84 $8.32 $6.24 $8, $10, $ $ $ $20, $18.20 $14.50 $12.30 $10.40 $7.80 $10, $11, $ $ $ $20, $21.84 $17.40 $14.76 $12.48 $9.36 $12, $13, $1, $1, $ $20, $25.48 $20.30 $17.22 $14.56 $10.92 $13, $15, $1, $1, $ $20, $29.12 $23.20 $19.68 $16.64 $12.48 $15, $17, $1, $1, $ $20, $32.76 $26.10 $22.14 $18.72 $14.04 $17, $18, $1, $1, $1, $20, $36.40 $29.00 $24.60 $20.80 $15.60 $18, $20, $1, $1, $1, $20, $40.04 $31.90 $27.06 $22.88 $17.16 $20, $22, $1, $1, $1, $20, $43.68 $34.80 $29.52 $24.96 $18.72 $22, $23, $1, $1, $1, $20, $47.32 $37.70 $31.98 $27.04 $20.28 $24, $25, $2, $2, $1, $20, $50.96 $40.60 $34.44 $29.12 $21.84 $25, $27, $2, $2, $1, $20, $54.60 $43.50 $36.90 $31.20 $23.40 $27, $29, $2, $2, $1, $20, $58.24 $46.40 $39.36 $33.28 $24.96 $29, $30, $2, $2, $1, $20, $61.88 $49.30 $41.82 $35.36 $26.52 $30, $32, $2, $2, $1, $20, $65.52 $52.20 $44.28 $37.44 $28.08 $32, $34, $2, $2, $1, $20, $69.16 $55.10 $46.74 $39.52 $29.64 $34, $35, $2, $2, $2, $20, $72.80 $58.00 $49.20 $41.60 $31.20 $36, $37, $3, $3, $2, $20, $76.44 $60.90 $51.66 $43.68 $32.76 $37, $39, $3, $3, $2, $20, $80.08 $63.80 $54.12 $45.76 $34.32 $39, $41, $3, $3, $2, $20, $83.72 $66.70 $56.58 $47.84 $35.88 $41, $42, $3, $3, $2, $20, $87.36 $69.60 $59.04 $49.92 $37.44 $42, $44, $3, $3, $2, $20, $91.00 $72.50 $61.50 $52.00 $39.00 $44, $46, $3, $3, $2, $20, $94.64 $75.40 $63.96 $54.08 $40.56 $46, $47, $3, $3, $2, $20, $98.28 $78.30 $66.42 $56.16 $42.12 $48, $49, $4, $4, $2, $20, $ $81.20 $68.88 $58.24 $43.68 $49, $51, $4, $4, $2, $20, $ $84.10 $71.34 $60.32 $45.24 $51, $53, $4, $4, $3, $20, $ $87.00 $73.80 $62.40 $46.80 $53, $54, $4, $4, $3, $20, $ $89.90 $76.26 $64.48 $48.36 $54, $56, $4, $4, $3, $20, $ $92.80 $78.72 $66.56 $49.92 $56, $58, $4, $4, $3, $20, $ $95.70 $81.18 $68.64 $51.48 $58, $59, $4, $4, $3, $20, $ $98.60 $83.64 $70.72 $53.04 $60, $61, $5, $5, $3, $20, $ $ $86.10 $72.80 $54.60 $61, $63, $5, $5, $3, $20, $ $ $88.56 $74.88 $56.16 $63, $65, $5, $5, $3, $20, $ $ $91.02 $76.96 $57.72 $65, $66, $5, $5, $3, $20, $ $ $93.48 $79.04 $59.28 $66, $68, $5, $5, $3, $20, $ $ $95.94 $81.12 $60.84 $68, $70, $5, $5, $4, $20, $ $ $98.40 $83.20 $62.40 * Higher benefit amounts available up to a maximum Monthly Disability Benefit of $7,500. Ask your First Financial Representative for details. ** Not to exceed 70% of your covered monthly compensation.

9 Plan Features ACCIDENTAL DEATH BENEFIT A lump sum of $20, will be paid if you die as the direct result of an Injury and death occurs within 90 days after the Injury. The benefit will be increased 1% for each full month that your Certificate was continuously in force just prior to death. The total increase shall not be more than 60% of the benefit amount. DIRECT DEPOSIT DISABILITY BENEFITS In the event you choose the direct deposit option on an approved claim, we will deposit your benefits directly into your bank account at no additional cost. This can accelerate access to your benefits by several days. We also have a toll-free fax that allows you instant transmission of your claim forms to our Benefits Department. DONOR BENEFIT If you are Disabled as a result of being an organ or tissue donor, we will pay your benefit as any other Sickness under the terms of the plan. FAMILY CARE BENEFIT If you are Disabled and Working, qualify to receive a Disability Payment from us, and have one or more eligible family members, you may be eligible to receive a Family Care Benefit. This may include payment for the care of an eligible family member by a licensed childcare provider or licensed caregiver who is not related to you by blood or marriage. We will provide a Family Care Benefit for expenses incurred of up to 25% of your monthly Disability Benefit provided the total of your Disability Earnings, the gross Disability Benefit, and the Family Care Benefit do not exceed 100% of your Monthly Compensation. Payment of the Family Care Benefit will end on the earlier of the following: the date you no longer incur Family Member expenses; or the date you no longer qualify as Disabled and Working; or the date Disabled and Working benefits have been paid for a total of 24 months. HOSPITAL CONFINEMENT BENEFIT The Hospital Confinement Benefit will not begin until the elimination period has been satisfied and will pay up to 60 days. The Hospital Confinement Benefit will be paid each day the insured is confined as a patient in a Hospital due to an Injury or Sickness. The amount payable is one times the Disability Benefit which will be pro-rated on a daily basis. This benefit is not reduced by Deductible Sources of Income. The Hospital Confinement must be at least 18 hours of continuous duration. PHYSICIAN EXPENSE BENEFIT Injury - $ per Injury Sickness - $50.00 If you need personal treatment by a Physician due to an Injury or Sickness, we will pay the amount shown above provided no other claim has been paid under the Policy. This benefit will be paid for Sickness only if the treatment is received during one full day of Disability during which you missed one full day of work. To be eligible for more than one payment for the same or related condition due to Sickness, you must have returned to Active Employment for at least 14 consecutive scheduled workdays. You are not required to miss one full day of work in order to receive the Injury benefit. PORTABILITY CONVERSION The Conversion Plan will be a separate group plan with a 30 day elimination period and 2 year benefit period. Certain other qualifications may apply. A brochure is available for this plan upon request after termination. RETURN TO WORK INCENTIVE BENEFIT: DISABLED WHILE WORKING We will provide a Disability Payment if you are Disabled and your monthly Disability Earnings, if any, are less than 20% of your Monthly Compensation due to the same Disability. If you are Disabled and your Disability Earnings are greater than 20% of your Monthly Compensation due to the same Disability, we will figure your payment as follows: During the first 24 months of payments while Disabled and Working: Your Disability Payment will not be reduced as long as the Disability Earnings plus the gross Disability Benefit does not exceed 80% of your Monthly Compensation. If the Disability Earnings plus the gross Disability Benefit exceeds 80% of your Monthly Compensation, the Disability Payment will be reduced by the amount exceeding 80% of your Monthly Compensation. After 24 months of payments, while Disabled and Working, you will receive payments based on the percentage of Monthly Compensation you are losing due to Lost Earnings based on your Disability. We will stop payments and your claim will end, if at any time you are no longer Disabled or if your Disability Earnings exceed 80% of your Monthly Compensation. The Elimination Period cannot be satisfied with days you are Disabled and Working. SOCIAL SECURITY FILING ASSISTANCE If we determine you are a likely candidate for Social Security Disability benefits, we can assist you with the application and appeal process. SPECIAL CONDITIONS LIMITED BENEFIT The Special Conditions Limited Benefit provides a benefit up to 2 years, due to Special Conditions if you are disabled and under the regular and appropriate care of your physician. Benefits will be paid for only one disability when more than one disability exists at the same time or a disability results from two or more causes. Special Conditions means: Chronic Fatigue Syndrome; Fibromyalgia; Any disease, disorder, accident or injury of the neck or back not resulting in hemiplegia, paraplegia or quadriplegia; Environmental allergic illness including, but not limited to sick building syndrome and multiple chemical sensitivity; and Self-reported symptoms. Self-reported symptoms are symptoms

10 that the insured tells their physician that are not verifiable using tests, procedures or clinical examinations. Examples include: headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness, or loss of energy. SUCCESSIVE DISABILITIES Disabilities which result from the same or related causes will be considered one period of Disability unless the Disabilities are separated by your return to Active Employment or any other gainful occupation for at least 3 consecutive months. WAIVER OF PREMIUM No premium payments are required while you are receiving payments under the plan after Disability Payments have been received under the plan for 180 consecutive days. We will require proof on an annual basis that you remain Disabled during this time. WORKSITE ACCOMMODATION If worksite modifications may assist your return to work, we will evaluate your claim for appropriate action. Important Policy Provisions ELIGIBILITY All permanent employees in subscribing group working 20 hours or more per week. Proof of good health may be required by us in order to be eligible for disability coverage. We will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation. WHEN COVERAGE BEGINS Certificates will become effective on the requested effective date following the date we approve the application, providing you are on Active Employment and premium has been paid. IF YOU ARE DISABLED DUE TO A COVERED DISABILITY AND NOT WORKING Your Disability Payment will be the Disability Benefit described in the Benefit Schedule less any Deductible Sources of Income you receive or are entitled to receive. OFFSETS WITH OTHER SOURCES OF INCOME Deductible Sources of Income include: Other group disability income. Governmental or other retirement system, whether due to Disability, normal retirement or voluntary election of retirement benefits. United States Social Security Act or similar plan or act, including any amounts due your dependent(s) on account of your Disability. State Disability. Unemployment compensation. Sick leave or other salary or wage continuance plans provided by the Employer which extend beyond 60 (14, 30, 60 day Elimination Periods), 90 (on 90 day Elimination Period) and 150 (on 150 day Elimination Period) calendar days from the Date of Disability. We reserve the right to estimate these Deductible Sources of Income that you may receive as defined in your Certificate. MINIMUM DISABILITY BENEFIT The minimum Monthly Disability Benefit is 10% of the Monthly Disability Benefit or $100.00, whichever is greater. INCREASE OF INCOME DUE TO COST OF LIVING ADJUSTMENTS The Disability Payment will not be reduced due to a cost of living increase if the increase from a Deductible Source of Income takes effect after the onset of Disability and while benefits are payable under the Policy. MENTAL ILLNESS LIMITED BENEFIT If you are Disabled due to a mental illness, regardless of the cause, Disability Payments will be provided for up to 2 years, not to exceed the Maximum Disability Period. ALCOHOLISM AND DRUG ADDICTION LIMITED BENEFIT If you are disabled due to alcoholism or drug addiction, a limited benefit of up to 15 days for each Disability will be paid. Benefits will not be paid beyond the Maximum Benefit Period. If drug addiction is sustained at the hands of, or while under the regular and appropriate care of a physician in the course of treatment for Injury or Sickness, it will be covered the same as any other Sickness. PRE-EXISTING CONDITION LIMITATION A limited benefit up to 1 month s Disability Benefit will be payable for Disability caused by or resulting from a Pre-Existing Condition. This provision will not apply if you have: gone treatment-free; incurred no expense; taken no medication; and received no diagnosis or advice from a Physician, for 12 consecutive months for such condition(s). This limitation will not apply to a Disability resulting from a Pre-Existing Condition that begins after you have been continuously covered under the Policy for 24 months. Any increase in benefits will be subject to this Pre-Existing Condition limitation. A new Pre-Existing Condition period must be satisfied with respect to any increase applied for and approved by us. EXCLUSIONS The Policy does not cover any loss, fatal or non-fatal, resulting from: Intentionally self-inflicted injury while sane or insane. An act of war, declared or undeclared.»» Injury sustained or Sickness contracted while in the service of the armed forces of any country.

11 Committing a felony. Penal incarceration. We will not pay benefits for Disability or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer. Injury or Sickness arising out of and in the course of any occupation for wage or profit or for which you are entitled to Workers Compensation*. *The term entitled to Workers Compensation shall also include Workers Compensation claim settlements that occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which you are entitled to Workers Compensation benefits. LEAVE OF ABSENCE Your coverage may be continued for up to 1 year during a Leave of Absence approved in writing by your Employer. TERMINATION OF INSURANCE Your insurance coverage will end on the earliest of these dates: the date you do not meet the Eligibility requirements as defined in the Eligibility paragraph in this brochure; the date you retire; the date you cease to be on Active Employment, except as provided for under the Leave of Absence provision; the end of the last period for which premium has been paid; the date the Policy is discontinued; or the date your employment terminates. If: your coverage ends as a result of your termination of Active Employment; such termination is caused by an Injury or Sickness for which Disability Benefits would be payable; and Disability is established prior to the termination of Active Employment, then: Disability Benefits will be paid as if such termination had not occurred. Termination of the Policy will have no affect on Disability Payments which began before termination. We may end your coverage if you submit a fraudulent claim. DEFINITIONS ACTIVE EMPLOYMENT: Means you are doing in the usual manner all of the regular duties of your employment on a full-time basis on a scheduled work day and these duties are being done at one of the places of business where you normally do such duties or at some location to which your employment sends you. You will be said to be on Active Employment on a day which is not a scheduled work day only if you are not Disabled and would be able to perform in the usual manner all the regular duties of your employment if it were a scheduled work day. DISABILITY: Disability or Disabled for the first 12 months of Disability means that you are unable to perform the material and substantial duties of your Regular Occupation. After that, Disability means you are unable to perform the material and substantial duties of any Gainful Occupation for wage or profit for which you are reasonably qualified by training, education, or experience. DISABILITY EARNINGS: Means the gross monthly earnings you receive while Disabled and Working. DISABILITY PAYMENT: Means your Disability Benefit minus Deductible Sources of Income. ELIGIBLE FAMILY MEMBERS: With regards to the Family Care Benefit, this means your child (natural, step, or adopted) living in your household and under age 13; or your family member who is: living in your household; dependent upon you for support; and in need of supervision or assistance due to physical or mental incapacity. HOSPITAL: The term Hospital shall not include an institution used by you as: a place for rehabilitation; a place for rest or for the aged; a nursing or convalescent home; a long-term nursing unit or geriatrics ward; or as an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients. LOST EARNINGS: Means the percentage of Monthly Compensation you are losing due to your Disability while Disabled and Working. This is computed as follows: subtract your Disability Earnings from your Monthly Compensation; divide this answer by your Monthly Compensation. This will be your percentage of lost earnings. Multiply your Disability payment by your percentage of lost earnings. MONTHLY COMPENSATION: Means for contracted employees, onetwelfth (1/12) of your contract salary through your Employer; or for noncontracted employees, one-twelfth (1/12) of your annual salary through your Employer, in effect on the date Disability began. It excludes any additional compensation including but not limited to, overtime pay, weekend or summer work compensation, bus or other allowances, bonuses or district-funded fringe benefits. If you become Disabled while on an approved leave of absence, we will use your gross Monthly Compensation from your Employer in effect just prior to the date your absence began.

12 PRE-EXISTING CONDITION: The term Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you: had treatment; incurred expense; took medication; received care or services including diagnostic testing or related measures; or received a diagnosis or advice from a Physician, during the 12-month period immediately before your Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition, or mental illness. OPTIONAL RIDERS See your First Financial Account Representative regarding available riders, including Critical Illness Rider, Accident Only Spousal Rider, Hospital Indemnity Rider, Survivor Benefit Rider, and COBRA Funding Rider. ELIMINATION PERIOD Period of time you must be disabled before benefit payments begin. Marketed by: First Financial Group of America BENEFITS BEGIN Benefits begin on the following days, upon satisfying any required elimination period. 14 Day Elimination Period: Benefits begin on the 15th day of Disability due to a covered Injury or Sickness. 30 Day Elimination Period: Benefits begin on the 31st day of Disability due to a covered Injury or Sickness. 60 Day Elimination Period: Benefits begin on the 61st day of Disability due to a covered Injury or Sickness. 90 Day Elimination Period: Benefits begin on the 91st day of Disability due to a covered Injury or Sickness. 150 Day Elimination Period: Benefits begin on the 151st day of Disability due to a covered Injury or Sickness. BENEFITS ARE PAYABLE Up to the period of time shown in the table below, based on your age as of the date Disability due to a covered Injury or Sickness begins. Age Less than age 60 Maximum Benefit Period To Social Security Normal Retirement Age (SSNRA)* months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater Age 69 or older 12 months, or to SSNRA*, whichever is greater *Age at which you are entitled to unreduced Social Security benefits based on current Social Security Amendments. Disability Income Insurance Can Help! Ask Your First Financial Account Representative For More Details. If you reside in a state other than your employer s state of domicile, where required by law, policy provisions and benefits may vary.

13 PLAN HIGHLIGHTS Effective Date Your Effective Date is different than the date you sign your application. Your Effective Date of coverage is the date shown on your certificate. Please be sure to view your group certificate to understand when your coverage begins upon approval of application it can either be mailed to you or you can receive an with a link to view securely online. Hospital Confinement Benefit Pays an immediate benefit each day you are confined to a hospital for an injury or sickness, and will not begin until the elimination period has been satisfied. Benefit will pay up to 60 days. Limitations and Exclusions This policy has limitations and/or exclusions to select benefits during certain situations, including self inflicted injury, an act of war, injuries contracted not to cover any loss, fatal or non-fatal, resulting from while serving in the armed forces, while committing a felony or during penal incarceration, or an injury or sickness in which you are entitled to Workers Compensation. Physicians Expense Benefit Receive a benefit if you receive treatment by a Physician due to a covered Injury. Pre-Existing Means a disease, Injury, Sickness, physical condition or mental illness that received medical advice or treatment prior to enrollment in a new disability insurance plan. Offsets If applicable, your disability benefit will be reduced by deductible sources of Income that include, but are not limited to: other group disability income benefits; sick leave or other salary or wage continuance government or retirement system benefits; plans provided by your employer that extend Social Security benefits (if applicable in your over 60 days, State disability benefits and state), including any amounts due to your unemployment benefits. dependent(s) on account of your disability; Salary Increases Your Monthly Disability Benefit does not automatically increase if you have an increase in pay! It is important to notify your Account Manager when applying for a new, higher benefit that is aligned with your current income. Waiver of Premium Premiums may be waived while you are disabled based on the length of your disability and the plan selected. Please review the full benefit definition of each section above under Plan Features inside this brochure for plan details, limitations and exclusions. Sign up for online secured access to view and print your policies at americanfidelity.com. American Fidelity s Online Service Center provides you convenient, secure 24/7 access to your detailed certificate. We understand your privacy is important so we will not use your address for solicitation purposes. Underwritten and administered by: 2000 N. Classen Boulevard Oklahoma City, Oklahoma SB-29298(FF)(ENHANCED)-1113 G-120-TX ; MCH#1309; , , , ,

14 Limited Benefit ACCIDENT ONLY Insurance Plan Underwritten by American Fidelity Assurance Company Wellness Benefit Benefits Paid Directly to You Excellent Customer Service Learn More»» Marketed by: First Financial Capital Corporation P.O. Box Houston, TX Local (281) Toll Free (800) THIS IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THIS POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

15 Accident Only Insurance Life Provides the Accidents, First Financial Offers a Solution! Whether you re a weekend warrior with an active lifestyle or just a busy family, accidents can happen to you anytime, anywhere without warning. First Financial is pleased to offer American Fidelity Assurance Company s (AFA) Limited Benefit Accident Only Insurance. Accident Only Insurance can offer a solution to help you and your family prepare for those rising medical costs if you have to receive medical treatment for an Accidental injury. Think It Couldn t Happen to You? Consider this... Know The Facts: Total costs of accidental injuries averaged $19,216 per injury in National Safety Council, Injury Facts, 2012 Edition, p $19,216 How Would You Cover Your Out-of-Pocket Costs? Just going for a walk around the block or heading to your driveway could lead to a twisted knee and torn meniscus, one of the more common claims submitted under this plan. EMERGENCY ACCIDENT - Hypothetical Example 1 Twisted knee in the parking lot resulting in a torn meniscus and treatment is received within 72 hours. ENHANCED PLAN BENEFITS Accident Emergency Treatment $200 Accident Follow-Up Treatment (4 visits) $200 Physical Therapy (8 treatments) $200 Medical Imaging $200 X-Ray $100 Appliances $100 Surgical Facility $250 Torn Knee Cartilage Repair $500 Anesthesia $200 Total $1,950 Paid Directly To You! 1 Hypothetical example of a covered accident based on policy AO-03 and rider AMDI-258.

16 Marketed by: First Financial Group of America Solutions For Life s Accidents... The Accident Only Plan is the insurance policy that provides payments direct to you protecting you and your family from some of the expenses brought about by injuries suffered in an Accident, regardless of any additional coverage you may have. It s guaranteed renewable for as long as you pay your premiums. Accident Only Insurance Features: No medical questions. Benefits paid directly to you, to be used however you see fit. Benefits regardless of other coverage. Coverage for you and each covered family member 24 hours a day, 7 days a week.» Available conveniently through your employer with payroll deduction. Policy is guaranteed renewable at the option of the primary insured for life as long as premiums are paid as required. Any additional insureds must meet eligibility as outlined in the policy. The company has the right to change premium rates by class. Currently participating in, or possibly moving to a High Deductible Health Plan? Health Savings Account (HSA) and qualified High Deductible Health Plan enrollments have quadrupled in the past six years and are on the rise 2. The Choice is Yours: Be prepared with either of American Fidelity s two plan options (Basic and Enhanced) that provide the benefit amounts you require. Plus, American Fidelity supplies the coverage you need with four choices of coverage including individual, individual and spouse, individual and child(ren), and family. Ready To Learn More? Contact your First Financial Account Representative for more details or to schedule an one-on-one appointment. First Financial Group of America N. Freeway, Suite 900 Houston, TX Local: (281) / Toll Free: (800) AHIP: January 2012 Census Shows 13.5 Million People covered by HSA/High-Deductible Health Plans, May 2012, p.3.

17 Schedule of Benefits3 Emergency Accident Benefits Basic Enhanced Emergency Accident Treatment Emergency Accident Treatment $150 $200 Emergency Accident Follow-up Treatment (up to four visits) $50 $50 Accident Injury Benefits Benefit amounts for the following Benefits are the same for Basic and Enhanced Plans for all Persons: Primary, Spouse, and Child(ren). Basic / Enhanced Injury Treatment Fractures Benefit (Depending on open or closed reduction, bone involved, or chip fracture). $25 to $3,000 Lacerations Benefit Not requiring sutures Sutured lacerations up to two inches Sutured lacerations totaling two to six inches Sutured lacerations totaling over six inches $25 $100 $200 $400 Appliances Benefit (crutches, leg braces, etc.) $100 Torn Knee Cartilage or Ruptured Disc Benefit $500 Eye Injury Benefit Injury with surgical repair, for one or both eyes. Removal of foreign body by a Physician, for one or both eyes. Dislocations Benefit Depending on open or closed reduction, with or without anesthesia and joint involved. No other amount will be paid under this benefit. $250 $50 $25 to $3,000 Concussion Benefit $200 2nd & 3rd Degree Burns(Skin grafts are 25% of benefit) $100 to $10,000 Internal Injuries Benefit Resulting in open abdominal or thoracic surgery $1,000 Paralysis Benefit: Paraplegia / Quadriplegia $5,000 / $10,000 Tendons, Ligaments and Rotator Cuff Benefit One Tendon, Ligament or Rotator Cuff More than One Tendon, Ligament or Rotator Cuff $500 $750 Blood, Plasma and Platelets $250 Exploratory Surgery without Surgical Repair $250 Physical Therapy (per treatment up to eight treatments) $25 Prosthesis $500 Emergency Dental Work Broken teeth repaired with crown Extraction of broken teeth (regardless of number) Refer to Plan Benefit Highlights for complete Benefit Descriptions and limits on the Accident Only Insurance Plan. $150 $50

18 A Highlight of Benefits Available Under The Plan Wellness Benefit Basic Enhanced Wellness Annual Routine Physical Exam (Requires a 12-month waiting period before use and one exam per policy per calendar year.) $50 $75 Accidental Death & Dismemberment Benefit Accidental Death & Dismemberment Basic Primary Spouse Child Common Carrier $50,000 $50,000 $25,000 Other Accident $15,000 $15,000 $7,500 Dismemberment $1,000 to $15,000 $1,000 to $15,000 $500 to $7,500 Enhanced Primary Spouse Child Common Carrier $100,000 $100,000 $50,000 Other Accident $30,000 $30,000 $15,000 Dismemberment $1,500 to $30,000 $1,500 to $30,000 $750 to $15,000 Additional Accident Benefits Basic Enhanced Non-Emergency Accident Treatment Non-Emergency Accident Treatment $75 $100 Non-Emergency Follow-up Treatment (up to two visits) $50 $50 Hospital Confinement Hospital Admission $500 $1,000 Intensive Care Unit (up to 15 days) $300 $600 Hospital Confinement (up to 365 days) $100 $200 Medical Imaging MRI, CT, CAT, PET, US $200 $200 X-Rays $50 $100 Ambulance Ground $300 $300 Air $1,500 $1,500 Treatment Outpatient Hospital or Ambulatory Surgical Center $150 $250 Anesthesia $150 $200 Transportation Benefits Transportation (Patient Only) (per round trip for up to three round trips per calendar year) Family Member Lodging and Meals (per day per Accident; up to 30 days per confinement) $300 $300 $100 $100

19 Plan Benefit Highlights A Covered Person (thereafter referred to as Person ) under American Fidelity s Limited Benefit Accident Only Policy can expect the following benefits when a Covered Accident (thereafter referred to as Accident ) happens. All benefits are paid once per Person per Accident unless otherwise specified. All benefits are only paid as a result of Injuries received in an Accident that occurs while coverage is in force. All treatment, procedures, and medical equipment must be diagnosed, recommended and treated by a Physician. These references are not intended to change or modify any definitions in the AO-03 policy series. Accident Emergency Treatment Benefit Payable for receiving emergency treatment in a Physician s office or emergency room within 72 hours, including physician fees and emergency services. Accident Follow-up Treatment Benefit Payable for necessary follow-up treatment of Injuries in addition to the emergency treatment administered within 72 hours for up to four treatments. Not payable for a visit in which a Physical Therapy Benefit or Non-Emergency Follow-Up Benefit is paid. Accidental Death and Dismemberment Benefit The applicable benefits apply when an Accidental Death or Dismemberment occurs within 90 days of an Accident. In the event that Accidental Death and Dismemberment result from the same Accident, only the Accidental Death Benefit will be paid. Ambulance Benefit If air and ground transportation is required for the same Accident, only the highest benefit will be paid. Anesthesia Benefit Pays the amount shown in the Schedule of Benefits for the services of an anesthesiologist for a surgery performed due to an Accident. Hospital Confinement is not required to receive this benefit. We will only pay one Anesthesia Benefit per Person in a 24-hour period even if more than one surgical procedure is performed. This benefit is not payable for local anesthesia. Appliances Benefit Payable for one of the following: crutches, leg braces, back braces, walkers, or wheel chairs. Not payable for Prosthetic Devices. Blood, Plasma and Platelets Benefit Payable for blood, plasma and platelets. This benefit does not provide benefits for immunoglobulins. Burns Benefit Payable for burns when treated by a Physician within 72 hours. Concussion Benefit Payable for a Person who sustains a concussion and is diagnosed by a Physician within 72 hours using any type of medical imaging. Dislocations Benefit Amount payable varies by the joint involved, type of treatment, and type of anesthesia. If a Person receives more than one Dislocation in an Accident, we will pay for all Dislocations up to two times the amount shown in the Schedule of Benefits for the Dislocation involved that has the highest benefit amount. No other amount will be paid under this benefit. Benefits are payable only for the first dislocation of a joint which occurs while this policy is in force. Emergency Dental Work Benefit Payable for repair to natural teeth when treated by a Physician or dentist. Initial dental treatment must be received within 72 hours. Exploratory Surgery Benefit Payable when an exploratory surgical operation without surgical repair is performed. Eye Injury Benefit Payable for one or both eyes requiring treatment. Family Member Lodging and Meals Benefit Payable for lodging and meals for a family member to be near a Person who is Confined in a non-local Hospital. The Hospital must be at least 50 miles one way from the Person s residence or site of the Accident. Fractures Benefit Varies based on the bone involved, type of fracture and type of treatment. If the Person fractures more than one bone, payment is made for all fractures up to two times the amount for the bone involved that has the highest benefit amount. Hospital Admission Benefit Pays per admission for confinement to a Hospital. This benefit does not pay for outpatient treatment, emergency room treatment, or a stay of less than 18 hours in an observation unit. Hospital Confinement Benefit Payable for a one-time Hospital Admission Benefit due to accidental Injuries (does not include emergency room and outpatient treatment). You will also receive a daily benefit for a Hospital Confinement that is longer than 18 hours for up to 365 days and an additional daily benefit for Confinement in an Intensive Care Unit up to 15 days. Intensive Care Unit Benefit Payable for each day of confinement in an Intensive Care Unit, as defined in the policy, up to 15 days. This benefit is paid in addition to the Hospital Confinement Benefit amount. Internal Injuries Benefit Payable for an open abdominal or thoracic surgery performed within 72 hours. Lacerations Benefit This benefit varies based on the severity of the laceration. Medical Imaging Benefit Payable for a Magnetic Resonance Imaging (MRI), a Computed Tomography (CT) scan, a Computed Axial Tomography (CAT) scan, a Positron Emission Tomography (PET) scan or an ultrasound.

20 Non-Emergency Accident Initial Treatment Benefit Payable for initial medical treatment when treatment is received more than 72 hours after the Accident. Initial medical treatment must: (1) be received in a Physician s office or emergency room; and (2) be the first treatment; and (3) occur within 30 days. Non-Emergency Accident Follow-up Treatment Benefit Payable only if the Non-Emergency Accident Initial Treatment Benefit is payable and later requires additional treatment: we will pay over and above the initial medical treatment administered. We will pay for up to two treatments. Not payable for the same visit that the Physical Therapy Benefit or the Accident Follow-Up Benefit is paid. Outpatient Hospital or Ambulatory Surgical Center Benefit When a surgical procedure is performed on an outpatient basis in a Hospital or at an Ambulatory Surgical Center, we will pay the indemnity amount shown in the Schedule of Benefits for the facility fee charged by such Hospital or Ambulatory Surgical Center. We will only pay one Outpatient Hospital or Ambulatory Surgical Center Benefit in a 24-hour period even if more than one surgical procedure is performed. This benefit will not be paid for surgery performed in a Hospital emergency room or in a Physician s office. Paralysis Benefit The duration of the Paralysis must be a minimum of 3 consecutive months. Paid once per lifetime per Person. Physical Therapy Benefit Payable for one treatment per day for up to eight treatments by a caregiver licensed in physical therapy. This benefit is not payable for the same visit that the Accident Follow-up Treatment Benefit or Non- Emergency Follow-Up Benefit. Prosthesis Benefit Payable for the use of a Prosthesis. This benefit is not payable for hearing aids; dental aids; eyeglasses; false teeth; or for cosmetic aids such as wigs. Tendons, Ligaments and Rotator Cuff Benefit Payable for the repair of one or more tendons, ligaments, or rotator cuffs. The tendons, ligaments, or rotator cuff must be repaired through surgery. Torn Knee Cartilage or Ruptured Disc Benefit Payable for surgical repair. Transportation Benefit Payable for the transportation when specialized treatment and Hospital Confinement in a non-local Hospital is required. A non-local Hospital must be at least 50 miles away, one way, using the most direct route, from the closer of the Person s residence or site of the Accident. Travel must be by scheduled bus, plane, train, or by car. Ambulance service does not qualify for this benefit. The treatment must be prescribed by a Physician and not be available locally. Wellness Benefit After coverage is in force for the waiting period shown, you can receive a benefit for an annual routine physical exam, including immunizations and preventive testing. Services must be supervised by a Physician and a charge must be incurred for the service. The benefit does not apply to dental or eye exams and is payable once per policy per calendar year. Limitations and Exclusions Base Policy No benefits will be provided for an Accident that is caused by or occurs as a result of: (1) intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; (2) participation in any form of flight aviation other than as a farepaying passenger in a fully licensed/passenger-carrying aircraft; (3) any act that was caused by war, declared or undeclared, or service in any of the armed forces; (4) participation in any activity or event while under the influence of any narcotic unless administered by a Physician or taken according to the Physician s instructions; (5) participation in, or attempting to participate in, a felony, riot or insurrection. (A felony is as defined by the law of the jurisdiction in which the activity takes place.) (6) participation in any sport for pay or profit; (7) participation in any contest of speed in a power driven vehicle for pay or profit; (8) participation in parachuting, bungee jumping, rappelling, mountain climbing or hang gliding. Benefits will not be provided for medical treatment for an Accident received outside the United States or its territories. Benefits will not be paid for services rendered by a member of the immediate family of a Person. An Accident is defined as a sudden, unexpected and unintended event, which results in bodily injury, which is independent of disease or bodily infirmity or any other cause. The policy will not pay benefits for injuries received prior to the Effective Date of coverage that are aggravated or re-injured by any event that occurs after the Effective Date. A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. You cannot be singled out for a rate increase for any reason. The Insurer has the right to increase premium rates only if rates for all policies in this class change. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy, AO-03, and Accident Only Benefit Enhancement Rider, AMDI-258 Series. This coverage does NOT replace Workers Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage.

21 Accident Only Insurance Premiums Monthly Premiums Basic Enhanced Individual $19.90 $26.10 Individual & Spouse $28.30 $34.90 Individual & Child(ren) $31.50 $41.00 Family $39.90 $ The premium and amount of benefits provided vary based upon the plan selected. Plan Options Individual Plan The Insured, age 18 through 64, at the date of policy issue, is the only Person. Individual and Lawful Spouse Plan Covers you and your Lawful Spouse (ages 18 to 64 at Policy Issue). Individual and Child(ren) Plan Covers you (ages 18 to 64 at Policy Issue) and each Eligible Child, as defined in the policy, under the age of 21 or 25 if attending school full-time.»» Family Plan Covers you, your Lawful Spouse (ages 18 to 64 at Policy Issue) and each Eligible Child, as defined in the policy, under the age of 21 or 25 if attending school full-time. Underwritten and administered by: 2000 N. Classen Boulevard Oklahoma City, Oklahoma SB-25787(TX)-0113 AO-03 Series and AMDI-258 Series

22 AMERICAN FIDELITY ASSURANCE COMPANY'S Cancer Insurance Basic and Enhanced -11 tans A LiInited Bel1efit Cancer Expense Insurance Policy

23 Cancer Can Be A Costly Disease. Anyone can develop Cancer. Most Cancers are not inherited, but rather are the result of damage to genes that occurs during one's lifetime: If you think it can't happen to you, think again. CONSIDER THESE FACTS American men have a 1 in 2 lifetime risk of developing Cancer. American women have a 1 in 3 chance of developing some folm of Cancer: 1 in 2 1 in 3 With statistics like this, it would help to prepare for Cancer early. Ask yomself, "If! were to be diagnosed, how would I pay for tilis costly disease?" & Men Women Will Develop Some Form Of Cancer In Their Lifetime: Non-medical expenses, such as travel, lodging, and meals, are usually not covered by most medical policies. Only 41 % of the overall medical cost of Cancer is for direct expenses, while 59% of Cancer treatment costs are not direct medical costs." It is essential to have a plan set in place tilat would help if you were diagnosed. Cancer screenings can help detect Cancer earlier which could increase yom smvival rate if you were to be diagnosed with Cancer. The 5-year relative survival rate for all Cancers diagnosed is 66%.* Yet, sadly, many Americans camlot afford tile expense of these all-important screenings. The good news is that American Fidelity provides a product that can help with these expenses. Om Limited Benefit Cancer Insmance plan can help cover the cost ofthese screenings, giving you the early detection that can be so impoj1ant when fighting tile illness. American Fidelity Can Help. American Fidelity's Limited Benefit Cancer Policy may help with the indirect costs of Cancer such as: Loss of yom income Travel expenses (auto & air) Meals away from home Spouse's loss of income Long distance phone calls Motel rooms Babysitters Our policy provides wellness benefits to help with the costs of screenings for the early detection of some Cancers as well as the financial aid you may need if diagnosed with Cancer. Limited Benefit Cancer Expense Protection benefits are paid directly to you, so they can be used however you need. *Americ(lil (1ll/cer Societl': (ullcer FOCIS alld Figures ]009

24 Summary of Benefits SCREENING & FOLLOW-UP BASIC PLAN ENHANCED PLAN Diagnostic and Prevention $60 per test; $75 per test; 1 per Calendar Year 1 per Calendar Year Pays the indemnity amount for receipt of one generally medically recognized internal Cancer screening test per Covered Person per Calendar Year including, but not limited to: mammogram; breast ultrasound; breast thermography; breast Cancer blood test (CA 15-3): colon Cancer blood test (CEA); prostatespecific antigen blood test (PSA); flexible sigmoidoscopy; colonoscopy; vii1l1a1 colonoscopy; ovarian Cancer blood test (CA-1 25); pap smear (lab test required); chest x-ray: hemocult stool specimen; serum protein electrophoresis (blood test for myeloma); or ThinPrep Pap test. Screen ing tests payable under this benefit wi ll ONLY be paid under this benefit and does not include any test payable under the Medical Imaging Benefit. Benefits will only be paid for tests performed after the 30-day period following the Covered Person's Effective Date of coverage. Cancer Screening $60 per Calendar Year; $75 per Calendar Year; Follow-Up 1 per Calendar Year 1 per Calendar Year Pays the indemnity amount when a Covered Person receives one invasive follow-up test needed due to an abnonnal covered Cancer screening result. Diagnostic surgeries which result in a positive diagnosis of Cancer will be paid under the Surgical Benefit. TREATMENT & PROCEDURES BASIC PLAN ENHANCED PLAN Radiation Therapy/ChemotherapylImmunotherapy Actual charges up to Actual charges up to $15,000 per 12-mo Period $20,000 per 12-mo Period Pays the Actual Charges up to the maximum amount shown when a Covered Person receives Radiation Therapy, Chemotherapy, or Immunotherapy as defined in the policy, per 12-month period. The 12-month period begins on the first day the Covered Person receives covered Radiation Therapy. Chemotherapy, or Immunotherapy. This benefit does not cover other procedures related to Radiation!Chemotherapy/lmmunotherapy. Anti-nausea drugs are not covered under this benefit. This benefit does not include any drugs/medicines covered under the Drugs and Medicine Benefit or the Hormone Therapy Benefit. Actual Charges means the amount actually paid by or on behalf of the insured person and accepted by the provider for services provided. AdministrativelLab Work $75 per Calendar Month $100 per Calendar Month Pays the indemnity amount once per calendar month, when the Covered Person is receiving Rad iation Therapy/Chemotherapy/Immunotherapy Benefit that month, for related procedures such as treatment planning, treatment management, etc. Hormone Therapy $50 per Treatment; Maximum $50 per Treatment; Maximum of 12 per Calendar Year of 12 per Calendar Year Pays the indemnity amount for hormone therapy treatment as defi ned in the policy, prescribed by a Physician fo llow ing a diagnosis of Cancer. This benefit covers drugs and medicines only and not associated administrative processes. This benefit does not include drugs/medicines covered under the Radiation! Chemotherapy/Immunotherapy Benefit or the Drugs and Medic ine Benefit. Surgical Benefit Unit Dollar Amount $30 per Surgical Unit $40 per Surgical Unit Maximum Per Operation $3,000 $4,000 Pays an indemnity benefit up to the Maximum Per Operation amount shown in the Sched ule of Benefits in the policy when a surgical operation is performed on a Covered Person for covered diagnosed Cancer, Skin Cancer, or reconstructive surgely due to Cancer. Benefits will be calculated by multiplying the surgical unit value assigned to the procedure, as shown in the most current Physician's Relative Value Table, by the Unit Dollar Amount shown in the Schedule of Benefits. Two or more surgical procedures perfonned through the same incision will be considered one operation and benefits will be limited to the most expens ive procedure. Diagnostic surgeries that result in a negative diagnosis of Cancer are not covered under this benefit. Any diagnostic surgery covered under the Diagnostic and Prevention Benefit wi ll not be covered under this benefit. Bone marrow surgeries are paid under the Bone Marrow Transplant Benefit. Surgeries required to implant a permanent prosthetic device are covered under the Prosthesis Benefit. This benefit is payable for reconstructive breast surgery perfonned on a non-diseased breast to establish symmetry with a diseased breast when reconstructive surgery on the diseased breast is performed whi le covered under this policy. Reconstructive surgery to the non-diseased breast must occur within 24 months of the reconstructive surgery of the diseased breast. Medical Imaging $200 per Image; Maximum $300 per Image; Maximum of 2 per Calendar Year of 2 per Calendar Year Pays the indemnity amount for a Covered Person who has been diagnosed with Cancer who receives either an MRI; CT scan; CAT scan; or PET scan when done at the request of a Physician due to Cancer or the treatment of Cancer. Anesthesia 25% of Amount Paid for 25% of Amount Paid for Covered Surgery Covered Surgery Pays 25% of the amount paid for a covered surgery for the services of an anesthesiologist. Services of an anesthesiologist for bone man'ow transplants, Skin Cancer, or surgical prosthesis implantation are not covered under this benefit. Blood, Plasma and Platelets $150 per day; Maximum $200 per day; Maximum $7,500 per Calendar Year $10,000 per Calendar Year Pays the indemnity amount for blood, plasma and platelets. This does not include any laboratory processes. Colony stimulating factors are not covered under this benefit. Benefits for Blood, Plasma and Platelets are ONLY provided under this benefit.

25 i;~ ~;\ Nd 31 i I:, J ;tii!311i);~ 3«1] 1 a :J;tj ttl U ':11_ ~n a;1a, ~ I) U Mi_ Drugs and Medicine Hospital Confinement Outpatient $200 per Confinement $300 per Confinement $50 per prescription; up to $50 per prescription; up to $100 per calendar month $150 per calendar month Pays the indemnity amou nt for anti-nausea and pain medication prescribed by a Physician for a Covered Person for treatment of Cancer, who is also receiving Radiation Therapy/Chemotherapy/Immunotherapy, a covered surgely, or a Bone Marrow/Stem Ce ll Transplant. This benefit does not cover associated administrative processes. This benefit does not include drugs/medicines covered under the Radiation/Chemotherapy/Immunotherapy Benefit or the Hormone Therapy Benefit. Bone Marrow/Stem Cell Transplant Autologous $1,000 per Calendar Year $1,500 per Calendar Year Non-autologous $3,000 per Calendar Year $4,500 per Calendar Year Pays the indemnity amount when a bone marrow transplant or peripheral blood stem ce ll transplant is performed on a Covered Person as treatment for a diagnosed Cancer. This benefit will not be paid for the harvest of bone marrow or stem ce lls from a donor. Experimental Treatment Paid as any non-experimental benefit Paid as any non-experimental benefit Pays benefits for Experimental Treatment prescribed by a Physician, as defined in the policy, the same as any other benefit covered under this policy. This benefit does not provide coverage for treatments received outside of the United States or its territories. Donor Expenses $1,000 per donation $1,000 per donation Pays the indemnity amount shown for a donor's expenses incurred on behalf of a Covered Person for a covered surgery due to organ transplant or a Bone Marrow/Stem Cell Transplant. Blood donor expenses are not covered under this benefit. Physical or Speech Therapy $25 per visit; up to 4 visits $25 per visit; up to 4 visits per Calendar' Month per Calendar Month Pays the indemnity amount if a Physician advises a Covered Person to seek physical therapy or speech therapy. Physical or speech therapy must be performed by a caregiver licensed in physical or speech therapy and be needed as a result of Cancer or the treatment of Cancer. We wi ll pay for one treatment per day up to four treatments per calendar month per Covered Person for any combination of physical or speech therapy treatments up to a lifetime maximum of$ I,OOO. FACILITIES & EQUIPMENT BASIC PLAN ENHANCED PLAN Hospital Confinement $200 per day first 30 days $300 per day first 30 days $400 per day thereafter $600 per day thereafter Pays the indemnity amount for a Covered Person while confined to a Hospita l for at least 18 continuous hours for the treatment of Cancer. A Hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or swing bed; a convalescent home; a rest or nu rsing faci lity; a rehabilitative faci lity; an extended care fac ility; a skilled nursing faci lity; or a fac ility primarily afford ing custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. This benefit will not be paid for outpatient treatment or a stay of less than 18 hours in an observation unit or emergency room. Outpatient Hospital or Ambulatory Surgical Center $400 per day of Surgery $600 per day of Surgery Pays the indemnity amount shown towards the facility fee charges of an AmbulatOlY Surgical Center or Hospital for an outpatient surgical proced ure of a diagnosed Cancer. Surgical procedures for Skin Cancer are not covered under th is benefit. U,S. Government/Charity Hospital or HMO $200 per day in lieu of most benefits $300 per day in lieu of most benefits If an itemized list of services is not available because a Covered Person is: confined in a charity Hospital or U.S. Government owned Hospital; or covered under a Health Maintenance Organization (H.M.O.) or Diagnostic Related Group (D.R.G.) where no charges are made to the Covered Person for treatment of Cancer or Dread Disease, the Primary Insured may convert benefits under the po licy to pay the indemnity amount shown. This benefit will be paid in lieu of most benefits under the policy. Extended Care Facility $75 per day $100 per day Pays the indemnity amount for each day room and board charges are incurred whi le a Covered Person is confined in an Extended Care Facility due to Cancer at the direction of a Physician that begins within 14 days after a covered Hospital Confinement. Paid for up to the same number of days benefits were paid for the Covered Person's preceding Hospital Confinement. Hospice $75 per day; $100 per day; $13,500 Lifetime Maximum $18,000 Lifetime Maximum Pays the indemnity amount for Hospice Care directed by a licensed Hospice organization, as defined in the policy, of a Covered Person expected to live six months or less due to Cancer. This benefit does not include: well baby care; vo lunteer services; meals; housekeeping services; or fami ly support after the death of the Covered Person. Prosthesis Surgically Implanted $1,500 per Device; 1 per Site $2,000 per Device; 1 per Site Non- surgically Implanted $150 per Device; 1 per Site $200 per Device; 1 per Site Pays the indemnity amount for a prosthetic device received due to Cancer that manifested after the 30th day following the Effective Date, and its surgical implantation if required as a direct result of surgery for Cancer. This benefit does not cover prosthetic related supplies. Temporary prosthetic devices used as tissue expanders are covered under the Surgical Benefit. Lifetime maximum of two surgically implanted prosthetics per Covered Person. Lifetime maxi mum of three non-surgically implanted prosthetics per Covered Person. Hair Prosthesis $150 Lifetime Maximum $200 Lifetime Maximum Pays the indemnity amount for a Covered Person's hair prosthesis needed as a direct result of Cancer or the treatment of Cancer. This benefit is payable once per Covered Person per lifetime and is only payable under this benefit.

26 CARE & CONSULTATION BASIC PLAN ENHANCED PLAN Attending Physician $40 per day while $50 per day while Hospital Confined Hospital Confined Pays the indem nity amount for one Physician's visit per day when a Covered Person requires the services of a Physician, other than a surgeon while Hospital Confi ned for the treatment of Cancer. Inpatient Special Nursing $150 per day while $150 per day while Hospital Confined Hospital Confined Pays the indem nity amount shown for Full-time special nursing care (other than that regularly furni shed by a Hospital) while a Covered Person is Hospital Confined for treatment of Cancer. "Full-time" means at least eight consecuti ve hours during a 24 hour period. Care must be provided by a Nurse, as defi ned by the Po licy, be prescribed by a Physician and be Medica lly NecessalY for the treatment of Cancer. Home Health Care $75 per day; up to same $100 per day; up to same num ber of days of paid number of days of paid Hospital Confinement Hospital Confmement Pays the indem nity amount for a Covered Person's Home Health Care, as described in the policy, required due to Cancer when prescribed by a Physician in lieu of Hospital Confinement beginning within 14 days after a Hospital Confi nement. This benefit does not include physical or speech therapy. This benefit will be paid for up to the same number of days benefits were paid for the Covered Person's preceding Hospital Confinement. If the Covered Person qualifies for coverage under the Hospice Care Benefit, the Hospice Care Benefit will be paid in lieu of this benefit. This benefit does not include: nutrition counseling: medical social services; medical supplies; prosthesis or olthopedic appliances; rental or purchase of durable medical equipment; drugs or medicines; child care: meals or housekeeping services. The caregiver may not be a family member. 2nd and 3rd Surgical Opinion $300 per diagnosis; Additional $300 for 3rd $300 per diagnosis; Additional $300 for 3rd Pays the indemni ty amount once per diagnosis for a Covered Person's second surgical opinion and if the second disagrees with the firs~ a thi rd opinion, when the attending Physician recommends surgery for the treatment of Cancer. Surgical opinions for reconstructive, Skin Cancer, or prosthesis surgeries are not covered under this benefit. TRANSPORTATION & LODGING BASIC PLAN ENHANCED PLAN Ambulance ~~ ~~~ ~ ~~ Air $2,000 per trip $2,000 per trip Pays the indemnity amount shown for either licensed air or ground ambulance transpoltation of a Covered Person to a Hospital or from one medical fac ility to another where the Covered Person is admitted as an Inpatient and Hospita l Confi ned for at least 18 consecuti ve hours for treatment of Cancer. Paid for up to two trips per Hospital Confinement for any combination of air or ground ambulance transpoltation. Patient & Family Member Transportation Round Trip Coach Fare or Round Trip Coach Fare or $0.50 pel' mile up to a $0.50 per mile up to a Maximum $1,500 per round trip Maximum $1,500 per round trip Outpatient & Family Member Lodging $60 per day up to 90 days per $80 per day up to 90 days per Calendar Year Calendar Year These benefits pay for the transportation of a Covered Person and/or one adult family member when the Covered Person has been diagnosed with Cancer and receives covered Radiation Therapy, Chemotherapy, Immunotherapy, Bone Marrow/Stem Cell Transplant, or surgery due to Cancer in a non-local Physician prescribed Hospital providing such treatment that is at least 50 miles away from the Covered Person's residence. using the most direct route. Travel must be by scheduled bus, plane or train, or by car and be within the United States or its Territories. Benefits will be provided for only one mode of transportation per round trip and will be paid for up to 12 round trips per Calendar Year. Benefits for travel will be paid: once while the Covered Person is Hospital Confined; or only for days of outpatient specialized treatment. Benefits for lodging will be paid: once for the family member while the Covered Person is Hospital Confined; or only for days of outpatient specialized treatment for the family member or Covered Person. If the family member and the Covered Person travel in the same car or lodge in the same room, benefits for travel and lodging will only be paid under the Transportation and Lodging Benefit for the patient. ADDITIONAL BENEFITS BASIC PLAN ENHANCED PLAN Dread Disease $200 per day first 30 days $300 per day first 30 days per Hospital Confinement; per Hospital Confinement; $400 per day thereafter $600 per day thereafter Pays an indemnity amount for each period of Hospital Confinement for treatment of a Dread Disease as defined in the policy, including: Addison's Disease, Amyotrophic Lateral Sclerosis, Cystic Fibrosis, Diphtheria, Encephalitis, Grand Mal Epilepsy, Legionnaire's Disease, Meningitis, Multiple Sclerosis. Muscular Dystrophy, Myasthenia Gravis, Niemann-Pick Disease, Osteomyelitis, Poliomyelitis, Reye's Syndrome, Rheumatic Fever, Rock-y Mountain Spotted Fever, Sickle Cell Anemi a, Systemic Lupus Erythematosus, Tay-Sachs Disease, Tetanus, Toxic Epidermal Necrolysis, Tox ic Shock Syndrome, Tuberculosis, Tularemi a, Typhoid Fever, and Whipple's Disease. Benefits for Dread Disease are ONLY provided under this benefit. Waiver of Premium 90 day elimination period 90 day elimination period If the Primary Insured becomes disabled due to Cancer and remains so for more than 90 continuous days, we will pay all premiums due after the 90th day so long as the Primary Insured remains disabled. "Disabled" means the Primary Insured's inability because of Cancer: to work at any job for which (s)he is qualified by education, training or experience; not working at any job for payor benefits; and under the care of a Physician for the treatment of Cancer. This policy must be in force at the time disability begins and the Primary Insured must be under age 65.

27 FAMILY COVERAGE You can take advantage of several options to extend coverage to your family: lndividual- You. Single Parent Family- You and each Eligible Child, as defined in the policy. Family Plan - You and your spouse and Eligible Children, as defined in the policy. GUARANTEED RENEWABLE You are guaranteed the right to renew your base po licy during your lifetill1e as long as you pay premiums when due or within the premium grace period. We have the right to increase premiull1s by class. C-11 MONTHLY PREMIUMS t bulividual III dividual /8-40 ] ! 4 / t / / 'The premium and amount o(benejits provided vmy dependent upon the plan selected. Hospital Intensive Care Unit Rider Intensive Care Unit Ambulance Benefit $600 per day; up to 30 days per confinement $100 per Admission Pays each day a Covered Person is confined in an ICU, as defined in the rider, due to accident or sickness. A day is defined as a 24-hour period. If confined to an lcu for a poltion of a day, a pro rata share of the daily benefit will be paid. Benefits will not be paid for an ICU confinement that begins prior to the Effective Date of the rider. Pays the amount shown for ambulance charges for transportation to a Hospital where the Covered Person is admitted to an Intensive Care Un it within 24 hours of an'iva l. Benefits reduce by 50% at age 70. HOSPITAL INTENSIVE CARE UNIT RIDER MONTHLY PREMIUMS Individual / / / I------t-~ 6 /

28 Critical Illness Rider Pays the specified Maximum Benefit Amount, depending upon the amount chosen at time of app lication, upon first diagnosis of a Covered Critical Illness, as defined in the rider and as shown on the Policy Schedule, and the Date of Diagnosis occurs after the 30th day following the Covered Person's Effective Date of coverage under the rider. Once each Benefit is paid for a Covered Person, the Benefit is no longer ava ilable for such Covered Person. All benefit amounts reduce by 50% at age 70. CRITICAL ILLNESS RIDER MONTHLY PREMIUMS t $2,500 Unit / Maximum $10,000 Per Rider I------~----~ :-----_r AO ~ ~~--~----~--~ ~ ~ 17AO I Illd HEART AnACK/STROKE ONLY $2,500 $5,000 $7,500 I 1 Parent 12 Parellt Ind 1 Parellt 2 Parellt Illd 1 Parent 2 Parellt Illd Family Family Family Family Family Family _. I-- I AO I 8AO I I I 12AO tthe premium and amounl of benefits provided vmy dependent upon the plan selected. $10,000 II Parent 12 Parellt Family Family l2ao 16AO 18AO ,

29 Limitations and Exclusions ELiGIBILI This policy will be issued only to those persons who meet American Fidelity Assurance Company's insurability requirements. This product is inappropriate for those people who are eligible for Medicaid Coverage. The policy and the Internal Cancer coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for Cancer in the previous ten years. The Heart Attack or Stroke coverage under the Critical Illness Rider wi ll not be issued to anyone who has been diagnosed or treated for any heatt or stroke related cond itions. The Hospital Intensive Care Unit Rider will not cover heatt conditions for a period of two years fo llow ing the Effective Date of coverage for anyone who has been diagnosed or treated for any heatt related condition prior to the 30th day fo llowing the Covered Person's Effective Date of coverage. Cancer means a disease which is manifested by autonomous growth (malignancy) in which there is uncontrolled growth, fun ction, or spread (local or distant) of cells in any part of the body. This includes Cancer in situ and malignant melanoma. It does not include other conditions which may be considered precancerous or hav ing malignant potential such as: leukoplakia; hyperplasia; polycythemia: actinic keratosis; myelodysplastic and non-ma lignant myelopro liferative disorders; aplastic anemia: atypia: non-malignant monoclonal gamopathy; carc inoid; or pre-ma lignant lesions, benign tumors or polyps. BASE POll All diagnosis of Cancer must be positively diagnosed by a lega lly licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This policy pays only for loss resulting from definitive Cancer treatment including direct extension. metastatic spread or recurrence. Proof must be submitted to support each claim. This policy also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. No benefits are payable for atly Covered Person for any loss incurred during the first year of this po licy as a result of a Pre-Existing Condition. A Pre-Existing Condition is a Cancer or Dread Disease for which, within 12 months prior to the Effecti ve Date of coverage, medical advice. consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms man ifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Pre-Existing Conditions specifically named or described as excluded in any palt of this contract are never covered. This policy contains a 30-day waiting period during which no benefits wi ll be paid under this policy. If any Covered Person has a Cancer or Dread Disease diagnosed before the end of the 30-day period immediately follow ing the Covered Person's Effective Date, coverage for that person will apply only to loss that is incurred after one year from the Effecti ve Date of such person's coverage. If any Covered Person is diagnosed as having a Cancer or Dread Disease during the 30-day period immediately fo llowing the Effecti ve Date, you may elect to vo id the policy from the beginning and receive a full refund of premium. All benefits payable only up to the maximum amount listed in the Schedule of Benefits in the policy. CARE UNIT RIDE No benefits will be provided during the first two years of this rider for Hospital Intensive Cat'e Unit confinement caused by any heart condition when any he3lt condition was diagnosed or treated prior to the 30th day fo llow ing the Covered Person's Effecti ve Date of this rider (The heatt condition causing the confinement need not be the same condition diagnosed or treated prior to the Effecti ve Date). Confinement caused by any other Pre-Existing Condition will be covered as long as the confinement begins on or after the Effective Date of this rider. No benefits will be prov ided if the loss results from: attempted suicide whether sane or insane: intentional se lf- il~ury: alcoholism or drug addiction; or any act of war or any act related to war, declared or undeclared; or mi l itary service for any country at war. No benefits will be paid for confinements in units such as: Surgical Recovery Rooms, Progressive Care, Bum Units, Intermediate Care, Pri vate Monitored Rooms, Observation Units, Telemetry Units or Psychiatric Units not in volving intensive med ical care; or other fac ilities which do not meet the standards for Intensive Care Un it as defined in the Rider. For a newborn child born within the ten-month period following the effective date of this rider, no benefits will be provided for Hospital Intensive Care Unit Confinement that begins within the first 30 days fo llow ing the bilth of such child. Benefits will only be paid for a Covered Critical Illness as shown on the Policy Schedule page in the policy. No benefits will be provided for any loss caused by or resulting from: intentionally self-inflicted bodily injury. suicide or attempted suicide, whether sane or insane: or intentional selfinjury; or alcoholism or drug addiction; or any act of war or any act related to war, declared or undeclared; or military service for any country at war; or a Pre-Existing Condition (Pre-Existing Condition, as used in this rider means any sickness or condition for which, prior to the Effective Date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment.); or a Covered Critical Illness when the Date of Diagnosis occurs during the Waiting Period; or participation in any activity or event while intox icated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician'S instructions: or p3lticipation in, or attempting to patticipate in, a felony, riot or insurrection (A fe lony is as defined by the law of the jurisdiction in which the activity takes place.). Internal Cancer does not include: other conditions that may be considered pre-cancerous or having malignant potential such as: Acquired immune deficiency syndrome (AJDS); or Acti nic keratosis: or Myelodysplastic and non-ma lignant myeloproliferative disorders; or Aplastic anemia; or Atypia; or Non-malignant monoclonal gamopathy: or Pre-malignant lesions, benign tumors or polyps; or Leukoplakia: or Hyperplasia; or Carcinoid; or Polycythemia; or Cancer in situ or any sk in Cancer other than invasive malignant melanoma into the denn is or deeper. This is a brief description of the coverage. For actual benefits and other provisions. please refer to the policy. This coverage does not replace Workers' Compensation Insurance.?=, i; American Fidelity ~ "Assurance Company A member of the American Fidelity Group" SB (TX) N. Classen Boulevard Oklahoma City, Oklahoma (800) :\.:1:: <'\:

30 PROTECTION solutions In the United States, about 1,529,560 new cancer cases were expected to be diagnosed in Cancer Facts & Figures, American Cancer Society, THE POLICY IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THE POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED. (TX only) GVCP3 GROUP CANCER INSURANCE Best in Benefits Series ABJ20096 Page 1 of 6

31 Group Voluntary Cancer (Texas) Benefit Amounts HOSPITAL AND RELATED BENEFITS Continuous Hospital Confinement (daily) $100 $200 Government or Charity Hospital (daily) $100 $200 Private Duty Nursing Services (daily) $100 $200 Extended Care Facility (daily) $100 $200 At Home Nursing (daily) $100 $200 Freestanding Hospice Care Center (daily) Hospice Care Team (per visit) 1. $ $ $ $200 RADIATION, CHEMOTHERAPY & RELATED BENEFITS Radiation/Chemotherapy for Cancer (every 12 months) $5,000 $10,000 Blood, Plasma, and Platelets (every 12 months) $5,000 $10,000 Hematological Drugs (yearly) $100 $200 Medical Imaging (yearly) $250 $500 SURGERY AND RELATED BENEFITS Surgery (inpatient) Surgery (outpatient) $3,000 Depends on Surgery $3,000 Depends on Surgery $3,000 Depends on Surgery $3,000 Depends on Surgery Anesthesia (% of Surgery) 25% 25% Ambulatory Surgical Center (daily) $500 $500 Second Opinion $400 $400 Bone Marrow or Stem Cell Transplant 1. Autologous 2. Non-autologous 3. Non-autologous for leukemia 1. $1, $2, $5, $1, $2, $5,000 MISCELLANEOUS BENEFITS Inpatient Drugs and Medicine (daily) $25 $25 Physician s Attendance (daily) $50 $50 Ambulance (per confinement) $100 $100 Non-Local Transportation (per trip or mile) Coach Fare or $.40 Coach Fare or $.40 Outpatient Lodging (daily) $50/Day $2,000 Max $50/Day $2,000 Max Family Member Lodging (Daily) and Transportation (per trip or mile) $50 Coach Fare or $.40 $50 Coach Fare or $.40 Physical or Speech Therapy (daily) $50 $50 New or Experimental Treatment (every 12 months) $5,000 $5,000 Prosthesis $2,000 $2,000 Hair Prosthesis (every 2 years) $25 $25 Nonsurgical External Breast Prosthesis $50 $50 Anti-Nausea Benefit (yearly) $200 $200 Waiver of Premium (primary insured only) Yes Yes ADDITIONAL BENEFITS Cancer Initial Diagnosis $2,000 $2,000 Intensive Care 1. Intensive Care Confinement (daily) 2. Step-down Confinement (daily) 3. Air/Surface Ambulance 1. $ $ Actual Charges 1. $ $ Actual Charges Wellness (yearly) $50 $50

32 Group Voluntary Cancer (Texas) Premiums Monthly Center ISD PLAN DESIGN EE EE + SP EE + CH F Option 1 $16.04 $25.21 $22.75 $31.88 Option 2 $25.16 $39.62 $35.75 $50.19 EE=Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Child(ren); and F = Family In addition to cancer, the policy also covers: Muscular Dystrophy, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis (bacterial), Brucellosis, Sickle Cell Anemia, Thallasemia, Rocky Mountain Spotted Fever, Legionnaire's Disease (confirmation by culture or sputum), Addison's Disease, Hansen's Disease, Tularemia, Hepatitis (Chronic B or Chronic C with liver failure or Hepatoma), Typhoid Fever, Myasthenia Gravis, Reye's Syndrome, Primary Sclerosing Cholangitis (Walter Payton's Liver Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, Primary Biliary Cirrhosis. Plan design and rates indicate which of the following optional items are applicable to the proposed plan. Below information includes all possible policy provisions and options available in the proposed situs state. We pay the following benefits for the necessary services and products for a covered cancer or a specified disease. Treatment must be received in the United States or its territories. HOSPITAL AND RELATED BENEFITS A. Continuous Hospital Confinement - If a covered person is admitted to and confined as an inpatient in a hospital, we pay the amount shown per day for each day. B. Government or Charity Hospital - In lieu of all other benefits in the policy (except the Waiver of Premium benefit), we pay the amount shown per day for each day a covered person is confined to: 1.) a hospital operated by or for the U.S. Government (including the Veteran's Administration); or 2.) a hospital that does not charge for the services it provides (charity). C. Private Duty Nursing Services - While a covered person is an inpatient receiving treatment, we pay the amount shown per day if such covered person requires the fulltime services of a private nurse. Full-time means at least 8 hours of attendance during a 24 hour period. These services must be required and authorized by the attending physician and must be provided by a nurse. D. Extended Care Facility - We pay the amount shown per day for each day a covered person is confined in an extended care facility. Confinement in the extended care facility must be at the direction of the attending physician and must begin within 14 days after a covered hospital confinement. This benefit is limited to the number of days of the previous continuous hospital confinement. E. At Home Nursing - While a covered person is receiving treatment, we pay the amount shown per day for private nursing care and attendance by a nurse at home. At home nursing services must be required and authorized by the attending physician. This benefit is limited to the number of days of the previous continuous hospital confinement. F. Hospice Care - When a covered person is: 1. determined by a physician to be terminally ill; and 2. expected to live 6 months or less; we pay one of the following two benefits for hospice care: 1. Freestanding Hospice Care Center. We pay the amount shown per day for confinement in a licensed freestanding hospice care center. The covered person must be diagnosed by a physician as terminally ill and the attending physician must approve the confinement. This benefit is payable only if a covered person is admitted to a freestanding hospice care center. Benefits payable for hospice centers that are designated areas of hospitals will be paid the same as inpatient hospital confinement; or 2. Hospice Care Team. We pay the amount shown per visit, limited to one visit per day, for home care services by a hospice care team. Home care services are hospice services provided in the patient's home. This benefit is payable only if: the covered person has been diagnosed as terminally ill; and the attending physician has approved such services. We do not pay for: food services or meals other than dietary counseling; or services related to well-baby care; or services provided by volunteers; or support for the family after the death of

33 Group Voluntary Cancer (Texas) the covered person. RADIATION, CHEMOTHERAPY & RELATED BENEFITS G. Radiation/Chemotherapy for Cancer - We pay the actual cost, up to the limit stated, for radiation therapy and chemotherapy received by a covered person. This benefit is limited to the amount shown per 12 month period beginning with the first day of benefit under this provision. Administration of radiation therapy or chemotherapy other than by medical personnel in a physician's office or hospital, including medications dispensed by a pump, will be limited to the costs of the drugs only, subject to the maximum amount payable per 12 month period explained above. H. Blood, Plasma and Platelets - We pay the actual cost, up to the limit stated, for: 1. Blood, plasma and platelets (including transfusions and administration charges); and 2. Processing and procurement costs; and 3. Cross-matching. This benefit is limited to the amount shown per 12 month period beginning with the first day of benefit under this provision. We do not pay for blood replaced by donors. We do not pay for immunoglobulins. I. Hematological Drugs - We pay the actual cost up to the amount shown for drugs intended to boost cell lines such as white blood cell counts, red blood cell counts and platelets. This benefit is paid only when the Radiation/Chemotherapy benefit is paid. J. Medical Imaging - We pay the actual cost once per calendar year, up to the amount shown, if a covered person receives an initial diagnosis or follow-up evaluation based upon one of the following medical imaging exams: CT scan; Magnetic Resonance Imaging (MRI) scan; bone scan; thyroid scan; Multiple Gated Acquisition (MUGA) scan; Positron Emission Tomography (PET) scan; transrectal ultrasound; or abdominal ultrasound. This benefit is limited to 1 payment per calendar year per covered person.

34 Group Voluntary Cancer (Texas) SURGERY AND RELATED BENEFITS K. Surgery - We pay the actual charges, up to the amount listed in the Schedule of Surgical Procedures in the policy for the specific procedure per unit of coverage when surgery is performed on a covered person: 1. for the purpose of treating a diagnosed cancer or specified disease; or 2. for the purpose of diagnosing cancer or specified disease and that surgery results in a diagnosis of cancer or specified disease; or 3. that is the first surgery performed subsequent to a diagnosis of cancer or specified disease that is performed for the purpose of verifying the complete removal of the cancer or specified disease. Two or more procedures performed at the same time through one incision or entry point are considered one operation; we pay the amount for the procedure with the greatest benefit. Payment will never exceed the maximum per unit of coverage. Surgery performed on an outpatient basis is paid at 150% of the scheduled benefit. This benefit does not pay for surgeries covered by other benefits in this policy. L. Anesthesia - We pay 25% of the amount paid for the Surgery Benefit (benefit K.) for anesthesia received. M. Bone Marrow or Stem Cell Transplant - We pay the amounts shown for the following types of bone marrow or stem cell transplants performed on a covered person: 1. A transplant which is other than non-autologous. 2. A transplant which is non-autologous for the treatment of cancer or specified disease other than Leukemia. 3. A transplant which is non-autologous for the treatment of Leukemia. This benefit is payable only once per covered person per calendar year. N. Ambulatory Surgical Center - We pay for the use of an ambulatory surgical center, up to the amount shown for a surgical procedure covered under the Surgery Benefit (benefit K.) that is performed at an ambulatory surgical center. O. Second Opinion - If surgery or treatment is recommended by a physician and the covered person chooses to obtain the opinion of a second physician, we pay the amount shown. This second opinion must be: rendered prior to surgery or treatment being performed; and obtained from a physician not in practice with the physician rendering the original recommendation. MICELLANEOUS BENEFITS P. Inpatient Drugs and Medicine - We pay the amount shown per day, for charges made by the hospital for drugs and medicine while hospital confined, for each day of continuous hospital confinement. This benefit does not pay for drugs and/or medicine covered under the Radiation/Chemotherapy benefit (benefit G.) or the Anti-Nausea benefit (benefit AA.). Q. Physician's Attendance - We pay the amount shown for a visit by a physician while a covered person is receiving treatment during hospital confinement. This benefit is limited to one visit by one physician per day of hospital confinement. A visit means personal attendance by the physician. Admission to the hospital as an inpatient is required. R. Ambulance - We pay the amount shown per continuous hospital confinement for transportation by a licensed ambulance service or a hospital owned ambulance to or from a hospital in which the covered person is confined. S. Non-Local Transportation - We pay the following benefit for transportation to receive treatment at a hospital (inpatient or outpatient); or radiation therapy center; or chemotherapy or oncology clinic; or any other specialized freestanding treatment center nearest to the covered person's home, provided the same or similar treatment cannot be obtained locally: 1.) actual cost of round trip coach fare on a common carrier; or 2.) the amount shown, up to 700 miles, for round trip personal vehicle transportation. We do not pay for: transportation for someone to accompany or visit the person receiving treatment; visits to a physician's office or clinic; or for services other than actual treatment. "Non-Local" means a round trip of more than 70 miles from the covered person's home to the nearest treatment facility. T. Outpatient Lodging - We pay a daily lodging benefit when a covered person receives radiation or chemotherapy treatment (benefit G.) on an outpatient basis, provided the specific treatment is authorized by the attending physician and cannot be obtained locally. The benefit is for a single room in a motel, hotel, or other accommodations acceptable to us, for the amount shown per day during treatment. This benefit is limited to the amount shown per 12 month period beginning with the first day of benefit under this provision. Outpatient treatment must be received at a treatment facility more than 100 miles from the covered person's home. U. Family Member Lodging and Transportation - We pay the following benefits for one adult member of the covered person's family to be near the covered person, when a covered person is confined in a non-local hospital for specialized treatment: 1. Lodging - The actual cost of a single room in a motel, hotel, or other accommodations acceptable to us, up to the amount shown per day. This benefit is limited to 60 days for each period of continuous hospital confinement; and 2. Transportation - The actual cost of round trip coach fare on a common carrier or a personal vehicle allowance of the amount shown per mile, up to 700 miles per continuous hospital confinement. Mileage is measured from the visiting family member's home to the hospital where the covered person is confined. We do not pay the Family Member Transportation benefit if the personal vehicle

35 Group Voluntary Cancer (Texas) transportation benefit is paid under the Non-Local Transportation benefit (benefit S.), when the family member lives in the same city or town as the covered person. V. Physical or Speech Therapy - We pay the amount shown per day, for physical or speech therapy for restoration of normal body function. W. New or Experimental Treatment - We pay actual charges, up to the amount shown, for new or experimental treatment for cancer or specified disease when: 1. the treatment is judged necessary by the attending physician; and 2. no other generally accepted treatment produces superior results in the opinion of the attending physician. This benefit is limited to the amount shown per 12 month period beginning with the first day of treatment under this provision. This benefit does not pay if benefits are payable for treatment covered under any other benefit in the policy. X. Prosthesis - We pay actual charges up to the amount shown for prosthetic devices which are prescribed as a direct result of surgery and which require surgical implantation. This benefit is limited to the amount shown per covered person, per amputation. Y. Hair Prosthesis - We pay the amount shown every 2 years for a wig or hairpiece if the covered person experiences hair loss. Z. Nonsurgical External Breast Prosthesis - We pay the actual cost up to the amount shown for the initial, nonsurgical breast prosthesis following a covered mastectomy or partial mastectomy that is paid for under the policy. AA. Anti-Nausea Benefit - We pay the actual cost, up to the amount shown per calendar year for anti-nausea medication prescribed for a covered person by a physician. We will not pay this benefit for medication administered while the covered person is an inpatient. BB. Waiver of Premium - If, while this coverage is in force, the insured employee or member becomes disabled due to cancer first diagnosed after the effective date of coverage and remains disabled for 90 days, we pay premiums due after such 90 days for as long as the insured employee or member remains disabled. OPTIONAL ADDITIONAL BENEFITS Wellness - We pay this benefit if a covered person has a wellness test performed. We pay the amount shown per calendar year per covered person for any one of the wellness tests. Each covered person is covered for no more than the amount shown per calendar year. We pay this benefit regardless of the result of the test. There is no limit as to the number of years we pay for wellness tests. The eligible wellness tests are: Biopsy for skin cancer; Blood test for triglycerides; Bone marrow testing; CA15-3 (cancer antigen 15-3-blood test for breast cancer); CA125 (cancer antigen blood test for ovarian cancer); CEA (carcinoembryonic antigen - blood test for colon cancer); Chest X-ray; Colonoscopy; Doppler screening for carotids; Doppler screening for peripheral vascular disease; Echocardiogram; EKG (Electrocardiogram); Flexible sigmoidoscopy; Hemocult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Pap Smear, including ThinPrep Pap Test; PSA (prostate specific antigen - blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening of the abdominal aorta for abdominal aortic aneurysms Cancer Initial Diagnosis - We pay a one-time benefit of the amount shown when a covered person is diagnosed for the first time in their life as having cancer other than skin cancer. The first diagnosis must occur after the effective date of coverage for that covered person. The benefit is payable only once per covered person. Intensive Care A. Hospital Intensive Care Unit Confinement. We pay the amount shown for each day of hospital intensive care unit confinement for any illness or accident. This benefit is limited to 45 days for each period of such confinement. A day is a 24 hour period. If confinement is for only a portion of a day, then a pro-rata share of the daily benefit is paid. B. Step-Down Hospital Intensive Care Unit Confinement. We pay the amount shown for each day of step-down hospital intensive care unit confinement for any illness or accident. This benefit is limited to 45 days for each period of such confinement. A day is a 24 hour period. If confinement is for only a portion of a day, then a pro-rata share of the daily benefit is paid. C. Ambulance. We pay the actual charges, for transportation of a covered person by licensed air or surface ambulance service to a hospital for admission to an intensive care unit for a covered confinement. We do not pay this benefit if an ambulance benefit is paid under the Ambulance benefit (benefit R.) in the policy.

36 Group Voluntary Cancer (Texas) Terms of Coverage Coverage is subject in every way to the terms of the policy that is issued to the policyholder. The group policy may at any time be amended or discontinued by agreement between us and the policyholder. Your consent is not required for this. Neither are we required to give you prior notice. Family coverage includes you, your spouse or domestic partner and eligible children. Individual and Child (ren) coverage includes you and eligible children. Individual and Spouse coverage includes you and your eligible spouse or domestic partner. Your coverage under the certificate ends on the earliest of the date the policy is canceled; or the last day of the period for which you made any required premium payments; or the last day you are in active employment or membership, except as provided under the Temporary Layoff, Leave of Absence or Family and Medical Leave of Absence provision; or the date you are no longer in an eligible class; or the date your class is no longer eligible. If your spouse is a covered person, your spouse's coverage ends upon valid decree of divorce or your death. If your domestic partner is a covered person, the domestic partner s coverage ends upon termination of the domestic partnership or your death. Coverage for your child will end on the issue day of the month that follows when the child reaches age 26 or otherwise does not meet the requirements of an eligible dependent. Portability Privilege If a covered person s coverage terminates for reasons other than non-payment of premium, such covered person will be eligible for portability coverage. This means the covered person may continue the same benefits he or she had under the group policy, subject to the conditions defined in the policy, as long as premiums are paid directly to American Heritage Life Insurance Company. Pre-Existing Condition, Exceptions and Limitations We do not pay any benefit due to or caused by a pre-existing condition during the 12 month period beginning on the date that person became a covered person. A Pre-Existing Condition is a disease or physical condition for which symptoms existed within the 12 month period prior to the effective date of coverage; or medical advice or treatment was recommended or received from a member of the medical profession within the 12 month period prior to the effective date of coverage. We do not pay for any loss except for losses due directly from cancer or a specified disease. We do not pay for any other conditions or diseases caused or aggravated by cancer or a specified disease. Diagnosis must be submitted to support each claim. For those benefits for which we pay actual charges up to a specified maximum amount (benefits K., W., and X.), if specific charges are not obtainable as proof of loss, we will pay 50% of the applicable maximum for the benefits payable. Intensive Care Exceptions and Limitations The Hospital Intensive Care Unit Confinement benefit does not pay for intensive care if a covered person is admitted because of an attempted suicide; or intentional self-inflicted injury; or intoxication or being under the influence of drugs not prescribed or recommended by a physician; or alcoholism or drug addiction. We do not pay for confinements in any care unit that does not qualify as a hospital intensive care unit. Progressive care units, sub-acute intensive care units, intermediate care units, and private rooms with monitoring, step down units and any other lesser care treatment units do not qualify as hospital intensive care units. We do not pay for step-down hospital intensive care unit confinement if a covered person is admitted and confined in the following type of units: telemetry or surgical recovery rooms; post-anesthesia care units, progressive care units; intermediate care units; private monitored rooms; observation units located in emergency rooms or outpatient surgery units; beds, wards, or private or semi-private rooms with or without telemetry monitoring equipment; and emergency room; labor or delivery rooms; or other facilities that do not meet the standards for a step-down hospital intensive care unit. We do not pay this benefit for continuous hospital intensive care unit confinements or continuous step-down hospital intensive care unit confinements that occur during a hospitalization that begins before the effective date of coverage. Children born within 10 months of the effective date are not covered for any continuous hospital intensive care unit confinement that occurs or begins during the first 30 days of such child's life. This illustration highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the insured and the insurance company. This is Limited Benefit Cancer and Specified Disease coverage which only provides benefits for cancer and specified diseases as defined or other optional benefits described herein. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review the Medicare Supplement Buyer's Guide, available from American Heritage Life Insurance Company.

37 What if you suffered from a heart attack or a stroke... could you pay for your out-of-pocket treatment expenses, plus cover daily living expenses? GROCERIES CAR HOME PRESCRIPTIONS Heart/Stroke Insurance Helps cover costs associated with heart attack, stroke, or heart disease No one likes to think about getting heart disease. While you may not be able to prevent the disease, HeartCare Plus and HeartCare Direct (HSP2) from Allstate Benefits can help protect you and your family from its costs. THE POLICY IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATION THAT MUST BE FILED AND POSTED - TX only. ABJ23504 Page 1 of 6 (A)

38 heart/stroke It s probably crossed your mind that you or your family may need treatment some day for heart disease or stroke. And you may have thought about the ways it would affect your life and your loved ones. But have you considered how cardiovascular diseases could impact your financial security? Heart/Stroke coverage can help offer peace of mind if you have a heart attack, stroke, or are diagnosed with heart disease. Below is an example of how benefits might be paid. Jane chooses benefit coverage from the Plan Benefits Offered Jane suffers a mild heart attack and is taken to the hospital by ambulance. A physician in the emergency room runs several heart-related tests, and the results show she needs an angioplasty and pacemaker surgery. Jane is admitted for a 3-day hospital stay, she is seen by her physician and receives private nursing services. Jane s prognosis is good and she is expected to make a full recovery. Our insurance policy paid Jane the following: Ambulance $ Hospital Confinement $ Physician's Attendance $ Coronary Angioplasty $ Pacemaker Insertion $ Private Duty Nursing $ Total Benefits: $1, The example shown may vary from the plan your employer is offering. Your individual experience may also vary. Please see pages 2a and/or 2b for your plan details. meeting your needs Our coverage can help provide financial support when a heart attack, heart disease or stroke occurs. Here s what you get: Pays you benefits that can be used for non-medical expenses that health insurance might not cover Benefits are paid as you go to help cover the costs of specific treatments and expenses as they happen Supplemental coverage; it pays in addition to other insurance you may have, such as medical and disability Guaranteed renewable for life, subject to change in premiums by class Coverage for yourself or your entire family your benefit coverage HOSPITALIZATION AND RELATED BENEFITS Hospital Confinement Pays a daily benefit for inpatient confinement due to heart attack, heart disease or stroke. Physician s Attendance Pays a daily benefit for one inpatient visit. Inpatient Drugs and Medicine Pays a daily benefit for inpatient drugs and medicine. Private Duty Nursing Services* Pays a daily benefit when receiving physician-authorized inpatient private nursing services. Physiotherapy* Pays a benefit for physiotherapy by a licensed physical therapist during a covered hospital stay. Oxygen** Pays a benefit for oxygen equipment during a covered hospital stay. Cardiograms** Pays a benefit for an electro, echo, phono, or vectorcardiogram required during a covered hospital stay. Cerebral or Carotid Angiogram** Pays a benefit for a cerebral or carotid angiogram required during a covered hospital stay. Page 2 of 6 ABJ23504 *Maximum of 60 days per confinement. **Maximum of 1 payment per confinement. Benefit amounts are shown on pages 2a and/or 2b. See page 3 for conditions and limits, and also see pages 4 and 5 for state variations.

39 Heart Disease tests covered October 18 You're admitted to the hospital Cardiogram tests received You get paid a cash benefit SURGERY AND RELATED BENEFITS Blood, Plasma and Platelets** Pays a benefit for blood, plasma, or platelets during a covered hospital stay. Cardiac Catheterization Pays a benefit for a cardiac catheterization. Pacemaker Insertion Pays a benefit for the initial insertion of a permanent pacemaker. Thromboendarterectomy Pays a benefit for a thromboendarterectomy. Heart Transplant Pays a benefit for the implantation of a natural human heart. Payable once per covered person. Coronary Angioplasty Pays a benefit for a coronary angioplasty, regardless of the number of blood vessels repaired during the procedure. Coronary Artery Bypass Graft Operation Pays a benefit for a coronary artery bypass graft, regardless of the number of grafts performed during the operation. Second Surgical Opinion Pays a benefit for a second opinion. Surgery and Anesthesia 1. Surgery - Pays a benefit for an inpatient or outpatient operation listed in the Policy Surgical Schedule. 2. Anesthesia - Pays 25% of surgery benefit. 3. Ambulatory Surgical Center - Pays when surgery benefit is paid for surgery at an ambulatory surgical center. These benefits do not pay for surgeries covered by other benefits. TRANSPORTATION AND LODGING BENEFITS Ambulance Pays a benefit for transfer to or from a hospital. Non-Local Transportation** Pays a benefit for transportation for physician-prescribed treatment not available locally (more than 100 miles from home). Family Member Lodging* and Transportation** Pays a benefit for lodging and transportation for one adult family member to accompany you when you have physician-prescribed treatment at a hospital or treatment center more than 100 miles from the family member's home. POLICY SPECIFICATIONS Please read your policy carefully. This section details some specifics of the policy. Renewability The policy is guaranteed renewable for life, subject to change in premiums by class. Eligibility/Termination (a) Family coverage may include you, your spouse and children under age 26. Spouse coverage ends upon divorce or your death. (b) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. Exclusions and Limitations (a) The policy pays benefits only for heart attack, heart disease or stroke. (b) The policy does not cover any other disease or sickness or incapacity even though caused, complicated or otherwise affected by heart attack, heart disease or stroke. (c) If a covered confinement is due to more than one covered condition, benefits are paid as though the confinement was due to one condition. Pre-Existing Condition Limitation (a) We do not pay benefits for pre-existing conditions during the 12-month period beginning on each covered person's effective date. (b) A pre-existing condition is a condition not revealed in the application for which symptoms existed within a 1-year period before the effective date; or medical advice or treatment was recommended by or received from a doctor within the 1-year period before the effective date. STATE VARIATIONS Arkansas (change affects page 3) In the Exclusions and Limitations, item (b) is deleted. Florida (change affects page 3) In the Pre-Existing Condition Limitation, item (b) is replaced with: A Pre-Existing Condition is a condition not revealed in the application for which symptoms existed within a 1-year period before the effective date; or medical advice, diagnosis, care, or treatment was recommended by or received from a doctor within the 1-year period before the application date. *Maximum of 60 days per confinement. **Maximum of 1 payment per confinement. ABJ23504 Page 3 of 6

40 Louisiana (change affects page 3) In the Pre-Existing Condition Limitation the following is added: We waive this time limit to the extent of replaced or existing coverage, as long as there are not more than 60 days between coverage. Mississippi (change affects page 3) In the Pre-Existing Condition Limitation, item (b) is replaced with: A Pre-Existing Condition is the existence of symptoms which would cause a prudent person to seek diagnosis, care or treatment within the 1-year period before the effective date or a condition for which medical advice or treatment was recommended by or received from a doctor within the 1-year period before the effective date. New Mexico (changes affect page 3) In the Pre-Existing Condition Limitation, item (a) is replaced with: We do not pay benefits for pre-existing conditions during the 6-month period beginning on each covered person's effective date. Item (b) is replaced with: A pre-existing condition is the existence of symptoms within a 6-month period before the effective date in such a manner as would cause an ordinarily prudent person to seek diagnosis, care or treatment; or medical advice or treatment was recommended by or received from a physician within the 6-month period before the effective date. Texas (change affects page 3) In the Pre-Existing Condition Limitation, item (b) is replaced with: A Pre-Existing Condition is the existence of symptoms which would cause a prudent person to seek diagnosis, care or treatment within the 1-year period before the effective date or a condition for which medical advice or treatment was recommended by or received from a doctor within the 1-year period before the effective date. ABJ23504 Page 4 of 6

41 Don t wait for a sign... A heart attack or stroke can happen unexpectedly and can be costly, especially if you are financially unprepared. Your current medical coverage will help pay for expenses associated with a heart attack or stroke, but won t cover all of the out-of-pocket expenses you may face. Don t wait until you are rushed to the emergency room to realize you need more protection. Start thinking about the future or your finances today and plan for emergencies that might come your way. You can rely on our insurance to help provide the financial assistance you need, when you need it most, so you can focus on the challenges of recovery. If you suffer a heart attack or stroke, would you be able to handle the extra expenses associated with your recovery? It s never too early to prepare for the future. Page 5 of 6 ABJ23504

42 This material is valid as long as information remains current, but in no event later than February 15, Policy benefits provided by policy form HSP2, or state variations thereof. The policy provides supplemental, limited benefit insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer's Guide available from Allstate Benefits. The policy sets forth, in detail, the rights and obligations of both the insured and the insurance company. This brochure highlights some features of the policy but is not the insurance contract. For complete details, contact your Insurance Agent, or call Underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). This brochure is for use in: AL, AR, FL, LA, MS, NM, PR, TX, VI. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation Allstate Insurance Company. or allstatebenefits.com Page 6 of 6 ABJ23504

43 heart/stroke HeartCare Direct HOSPITALIZATION AND RELATED BENEFITS LOW PLAN HIGH PLAN Hospital Confinement (daily) $100 $200 Physician s Attendance (daily) $12.50 $25 Inpatient Drugs and Medicine (daily) $12.50 $25 Private Duty Nursing Services (daily) $50 $100 Physiotherapy (daily) $25 $50 Oxygen $100 $200 Cardiograms $50 $100 Cerebral or Carotid Angiogram $75 $150 SURGERY AND RELATED BENEFITS LOW PLAN HIGH PLAN Blood, Plasma and Platelets $100 $200 Cardiac Catheterization $250 $500 Pacemaker Insertion $500 $1,000 Thromboendarterectomy $1,250 $2,500 Heart Transplant $50,000 $100,000 Coronary Angioplasty $375 $750 Coronary Artery Bypass Graft Operation $1,250 $2,500 Second Surgical Opinion $50 $100 Surgery and Anesthesia 1. Surgery 1. $2,500 max. 1. $5,000 max. 2. Anesthesia 2. 25% 2. 25% 3. Ambulatory Surgical Center 3. $ $250 TRANSPORTATION AND LODGING BENEFITS LOW PLAN HIGH PLAN Ambulance Non-Air Ambulance $100 $200 Air Ambulance $200 $400 Non-Local Transportation $100 $200 Family Member Lodging (daily) $25 $50 Family Member Transportation $100 $200 Premiums on reverse. ABJ23504-Insert-SCSETD-A Page 2a (A)

44 monthly premiums EMPLOYEE AGES LOW HIGH FAMILY AGES LOW HIGH $7.25 $ $13.50 $ $7.25 $ $13.50 $ $17.00 $ $31.50 $ $17.00 $ $31.50 $ $20.50 $ $38.50 $77.00 annual premiums EMPLOYEE AGES LOW HIGH FAMILY AGES LOW HIGH $79.75 $ $ $ $79.75 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Issue Ages: This insert is for use in: AL, AR, LA, MS, NM, PR, TX, VI This insert is part of brochure ABJ23504 and is not to be used on its own. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation Allstate Insurance Company. or allstatebenefits.com. ABJ23504-Insert-SCSETD-A Page 2b (A)

45 FOR GROUP BENEFITS EduBenefit Important enrollment information SM Steps to enroll 1. Read this information to fully understand the product. 2. Look at the rate page to determine your monthly cost. 3. Fill out the application. Complete the employee section and check the box that states, I apply for the group benefits. You and your spouse complete Evidence of Insurability form if needed (see below). Sign and date the employee s signature line at the bottom of the page. Note: You must complete the application even if you do not elect coverage. Please check the Waiver of Coverage box if you do not want to participate. PLEASE NOTE: You have a one-time open enrollment period. If you decline coverage now, you must submit to medical questions/ exams if you wish to become covered at a later time. Do I need to complete the Evidence of Insurability form for myself or my spouse? 1. If this is your open enrollment period (initial program offering or you are a new hire), complete the Evidence of Insurability form for you and/or your spouse if any of the following apply: For employee insurance a. When employee is under age 65 and the amount requested is more than $100,000 b. When employee is age and the amount requested is more than $30,000 c. When employee is age 70 or older for any amount requested For spouse insurance a. When employee is under age 60 and the amount requested is more than $50,000 b. When employee is age and the amount requested is more than $10, If this is not your open enrollment period (you have been offered the plan before), complete the Evidence of Insurability form for you and/or your spouse if any of the following apply: a. The employee wishes to increase coverage b. The spouse wishes to increase coverage Insurance above the Guarantee Issue amount is not effective until the application is approved by Lincoln Financial Group. Both the employee and spouse must complete and sign the Evidence of Insurability form. Please complete the enrollment application and the Evidence of Insurability form (if needed) and return to the District. Remember, an application must be completed and returned to your District during this open enrollment period. If you need assistance, please contact Lincoln Financial Group at GI-TXENR-FLI001 Products issued by: The Lincoln National Life Insurance Company Page 1 of 2

46 FOR GROUP BENEFITS EduBenefit Protect the ones you love with EduBenefit Optional group Term Life insurance SM Help secure their future You can help make sure your loved ones can continue to pay the mortgage, make car payments, fund a child s education, and much more with this valuable offering of Term Life and Accidental Death & Dismemberment (AD&D) insurance. All employees regularly working 10 hours or more per week and all bus drivers will have the option to purchase Term Life and AD&D insurance at competitive group rates from The Lincoln National Life Insurance Company, a Lincoln Financial Group company. Here are some program highlights: $100,000 Guarantee Issue for employees under age 65, and $50,000 Guarantee Issue for a spouse when the employee is under age 60. You can purchase optional life insurance in increments of $20,000, $40,000, $60,000, $80,000, $100,000, or additional increments of $10,000 up to a maximum of $500,000 (not to exceed five times your annual salary). Premiums are conveniently deducted from your paycheck. Optional dependent (spouse and children) life coverage is also available. Children can be covered for $10,000 of life insurance. Continuation of Coverage (portability) You can take your coverage with you if you leave the District. Accelerated Life Benefit You can collect up to 75% of your death benefit (to a maximum of $250,000) if you become terminally ill with a life expectancy of 12 months or less. AD&D equals the life insurance benefit or a percentage thereof for dismemberment. AD&D benefits are not payable for any loss resulting from any of the following contributory causes: intentional self-inflicted injury; a disease or the medical treatment of it; participation in a riot or while committing a felony; military service; war or any act of war; use of drugs, except when prescribed by a doctor; voluntary inhalation of gas; travel in any aircraft, except as a fare-paying passenger on a regularly scheduled flight; or driving while intoxicated. We are pleased to be adding this improved life insurance benefit to your current benefit package. GI-TXPLN-FLI001 Products issued by: The Lincoln National Life Insurance Company Page 1 of 2

47 FOR GROUP BENEFITS EduBenefit Special rates for educators Employee under age 25 Employee age Employee age Employee amount Employee rate Employee amount Employee rate Employee amount Employee rate $20,000 $1.60 $20,000 $1.80 $20,000 $2.20 $40,000 $3.20 $40,000 $3.60 $40,000 $4.40 $60,000 $4.80 $60,000 $5.40 $60,000 $6.60 $80,000 $6.40 $80,000 $7.20 $80,000 $8.80 $100,000 $8.00 $100,000 $9.00 $100,000 $11.00 $100,000+ per $10,000 $0.80 $100,000+ per $10,000 $0.90 $100,000+ per $10,000 $1.10 Spouse amount Spouse rate Spouse amount Spouse rate Spouse amount Spouse rate $10,000 $0.80 $10,000 $0.90 $10,000 $1.10 $20,000 $1.60 $20,000 $1.80 $20,000 $2.20 $30,000 $2.40 $30,000 $2.70 $30,000 $3.30 $40,000 $3.20 $40,000 $3.60 $40,000 $4.40 $50,000 $4.00 $50,000 $4.50 $50,000 $5.50 Employee age Employee age Employee age Employee amount Employee rate Employee amount Employee rate Employee amount Employee rate $20,000 $2.60 $20,000 $3.60 $20,000 $5.60 $40,000 $5.20 $40,000 $7.20 $40,000 $11.20 $60,000 $7.80 $60,000 $10.80 $60,000 $16.80 $80,000 $10.40 $80,000 $14.40 $80,000 $22.40 $100,000 $13.00 $100,000 $18.00 $100,000 $28.00 $100,000+ per $10,000 $1.30 $100,000+ per $10,000 $1.80 $100,000+ per $10,000 $2.80 Spouse amount Spouse rate Spouse amount Spouse rate Spouse amount Spouse rate $10,000 $1.30 $10,000 $1.80 $10,000 $2.80 $20,000 $2.60 $20,000 $3.60 $20,000 $5.60 $30,000 $3.90 $30,000 $5.40 $30,000 $8.40 $40,000 $5.20 $40,000 $7.20 $40,000 $11.20 $50,000 $6.50 $50,000 $9.00 $50,000 $14.00 Employee age Employee age Employee age Employee amount Employee rate Employee amount Employee rate Employee amount Employee rate $20,000 $8.80 $20,000 $14.00 $20,000 $17.40 $40,000 $17.60 $40,000 $28.00 $40,000 $34.80 $60,000 $26.40 $60,000 $42.00 $60,000 $52.20 $80,000 $35.20 $80,000 $56.00 $80,000 $69.60 $100,000 $44.00 $100,000 $70.00 $100,000 $87.00 $100,000+ per $10,000 $4.40 $100,000+ per $10,000 $7.00 $100,000+ per $10,000 $8.70 Spouse amount Spouse rate Spouse amount Spouse rate Spouse amount Spouse rate $10,000 $4.40 $10,000 $7.00 $10,000 $8.70 $20,000 $8.80 $20,000 $14.00 $20,000 $17.40 $30,000 $13.20 $30,000 $21.00 $30,000 $26.10 $40,000 $17.60 $40,000 $28.00 $40,000 $34.80 $50,000 $22.00 $50,000 $35.00 $50,000 $43.50 Continued on the back page. GI-TXRAT-FLI001 Products issued by: The Lincoln National Life Insurance Company Page 1 of 2

48 Continued from the front page. Employee age Rates per $10,000 of employee coverage Age Employee rate $ $ $36.40 Age Spouse rate ($5K) $ not available not available Child amount Child rate $10,000 $1.00 AD&D coverage is not available for children. Employee must purchase a minimum amount of Optional Life coverage in order to purchase child coverage. Employee Guarantee Issue is $100,000 for employees under age 65. Spouse Guarantee Issue is $50,000 for employees under age 60. Here s a hypothetical example of how much coverage an employee and spouse elected and how much it would cost. Coverage amount Monthly cost Employee John Smith, age 69 $10,000 $ % coverage on John s wife $5,000 $7.45 Total $ Lincoln National Corporation BP 4/11 Z01 Order code: GI-TXRAT-FLI001 EduBenefit and the EduBenefit swirl design are registered trademarks of Crenshaw Whitley & Associates, LLC, All Rights Reserved. Group insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), a Lincoln Financial Group company. This flier is not intended as a complete description of Lincoln Financial Group insurance coverage. The controlling provisions are provided in the policy, and this flier does not modify those provisions or the insurance in any way. State-specific restrictions, requirements, and approvals are not addressed in this flier. Available in Texas only. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. THIS IS NOT A CONTRACT. Page 2 of 2

49 Employee coverage Eligibility Amount of life and AD&D insurance Guarantee Issue Reduction All active employees working for the district at least 10 hours per week on a regular basis and all bus drivers. $20,000, $40,000, $60,000, $80,000 or $100,000, or increments of $10,000 up to a maximum of $500,000 (not to exceed five times your annual salary). Evidence of insurability is needed with an election amount above $100,000 Guarantee Issue. AD&D equals the life insurance benefit or a percentage of that benefit for dismemberment. Employees under age 65: $100,000 Employees ages 65 69: $30,000 No Guarantee Issue for employees age 70 and over. Coverage reduces 50% of the original amount at age 70. All coverage terminates at retirement; however, an insured can convert his or her group policy to an individual policy without providing evidence of insurability. Spouse coverage Eligibility Employee under age 70. Amount of life and AD&D insurance Guarantee Issue $10,000, $20,000, $30,000, $40,000 or $50,000 (not to exceed 50% of the employee s approved amount). Evidence of insurability is needed with an election amount above $50,000 Guarantee Issue. AD&D equals the life insurance benefit or a percentage of that benefit for dismemberment. Spouses of employees under age 60: $50,000 Spouses of employees ages 60 69: $10,000 No coverage available for spouses of employees age 70 and over. Reduction Will terminate when the employee attains age 70. Dependent children Eligibility Guarantee Issue Amount of life insurance Employees must purchase the minimum amount ($10,000) of optional life insurance on themselves in order to purchase child coverage. $10,000 (dependent child(ren) included) Available for unmarried dependent child(ren) ages 14 days to 19 years (up to 25 if a full-time student, higher state limits may apply) $10, Lincoln National Corporation BP 5/11 Z01 Order code: GI-TXPLN-FLI001 Important notes Insurance will be delayed for an employee if he/she is not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise be effective. Insurance will also be delayed for spouse or dependent child(ren) if confined to home or hospital and not performing normal daily activities. Guarantee Issue amounts are only available during a designated Term Life open enrollment period or your first 31 days of employment. A suicide exclusion will apply to any medically underwritten amount or increased amount of insurance during the first two years of coverage. EduBenefit and the EduBenefit swirl design are registered trademarks of Crenshaw Whitley & Associates, LLC, All Rights Reserved. Group insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), a Lincoln Financial Group company. This flier is not intended as a complete description of Lincoln Financial Group insurance coverage. The controlling provisions are provided in the policy, and this flier does not modify those provisions or the insurance in any way. State-specific restrictions, requirements, and approvals are not addressed in this brochure. Available in Texas only. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. THIS IS NOT A CONTRACT. Page 2 of 2

50 Frequently Asked Questions Q: When will my coverage become effective? A: The plan effective date will be announced during the enrollment process. However, insurance for a particular individual above the Guarantee Issue amount is not effective until the application is approved by Lincoln Financial Group. Delayed effective date may apply. Q: Can I delay my decision and enroll for coverage at a later date? A: To enroll more than 31 days after you are eligible for coverage, you ll need to provide Evidence of Insurability at your own expense. Q: What is Continuation of Coverage? A: Continuation of Coverage (Portability) allows you to continue the same (or lower) amount of insurance if you leave your employer. Portability rates are slightly higher, and you will need to obtain those rates from Lincoln Financial Group at time of termination. The premiums must be paid quarterly, and statements will be mailed directly to your residence. Some restrictions apply to this benefit. Portability benefits will end on the earliest of: the date the policy terminates or on the date you attain age 70. You are not eligible if you are terminating employment due to sickness, injury or retirement; however, you may be eligible to convert your policy to an individual policy (conversion benefit). Again, these rates are higher, and you will need to obtain the rates from Lincoln Financial Group at time of conversion. Q: Could coverage be delayed for any reason? A: If you are not actively at work when coverage begins, your coverage will begin when you resume active, full-time work. If your dependent is in a period of limited activity, coverage will begin when the person is able to perform the normal activities of a person in good health of the same age and sex. Q: What happens if I become totally disabled while insured? A: If the total disability occurs before age 60, Lincoln may approve a request that the life insurance coverage continue while you remain disabled. You must complete the Waiver of Premium forms to have the coverage continue without payment of premiums. The coverage will end when you reach Social Security normal retirement age. Q: Can I change the amount of insurance? A: Your needs may change, so in addition to choosing your coverage amount now, you can change your amount of coverage at any time. You only need to complete an application for the new amount. If you increase the amount you need, you will need to complete the Evidence of Insurability form for yourself and/or your spouse. If you apply for additional insurance, all amounts of insurance that have already been approved by Lincoln Financial Group will be grandfathered Lincoln National Corporation BP 5/11 Z01 Order code: GI-TXENR-FLI001 EduBenefit and the EduBenefit swirl design are registered trademarks of Crenshaw Whitley & Associates, LLC, All Rights Reserved. Group insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), a Lincoln Financial Group company. This flier is not intended as a complete description of Lincoln Financial Group insurance coverage. The controlling provisions are provided in the policy, and this flier does not modify those provisions or the insurance in any way. State-specific restrictions, requirements, and approvals are not addressed in this brochure. Available in Texas only. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. THIS IS NOT A CONTRACT. Page 2 of 2

51 Life Insurance Highlights For the employee purelife-plus Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10 Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit. The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features: High Death Benefit. With one of the highest death benefits available at the worksite, 1 purelife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely. Minimal Cash Value. Designed to provide high death benefit, purelife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans. Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up). Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.) Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1 Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008 See the purelife-plus brochure for details. 10M055-C 1040 (Expires 0612) Not for use in WA.

52 monthly premiums PureLife-plus Standard Risk Table Premiums Non-Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Includes Added Cost for Non-Tobacco GUARANTEED PERIOD Age to Which Issue Accidental Death Benefit (Ages 17-59) Coverage is Age Guaranteed at (ALB) $10,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 $200,000 Table Premium 15D PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-K-M-1AD R

53 monthly premiums PureLife-plus Standard Risk Table Premiums Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Includes Added Cost for Tobacco GUARANTEED PERIOD Age to Which Issue Accidental Death Benefit (Ages 17-59) Coverage is Age Guaranteed at (ALB) $10,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 $200,000 Table Premium 15D PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-K-M-1AD R

54 Feel Better...Faster 2014 AmeriDoc, LLC Preston e 975 Dallas, TX

55 We Are PAGE 2 AmeriDoc is a leading provider of 24/7/365 on-demand healthcare access. Our cloud-based platform securely connects patients with U.S. based, board-certified physicians and therapists for confidential medical consultations. Our powerful Telehealth platform has gained the confidence of over 1.5 million members nationwide. The Problems with Healthcare Nearly 48 million Americans are uninsured. A report by the Institute of Medicine & Health states that unnecessary care accounts for one-third to one-half of all health care costs, which equals hundreds of billions of dollars in addition to the half-trillion per year experts attribute to lost productivity and disability. As an expected thirty million additional Americans acquire health coverage, organizations are looking for new and innovative ways to reduce benefit costs. There is also the fear that there will be a shortage of doctors to handle the influx of new patients. As a result, there has been an increased focus on technology and, in particular, Telehealth to connect patients to doctors and therapists via telephone, video or , which reduces healthcare costs. Telehealth also provides patients with less expensive, quality care, as opposed to more expensive and less productive settings such as an urgent care center or emergency room. MOST OFFICES ARE CLOSED AVG. TIME TO MAKE AN APPOINTMENT AVG. TIME SPENT IN AN ER WAITING ROOM ER VISITS THAT ARE NON EMERGENCY 75% hours / week 3 weeks 1-2 hours 66% per day 98% PATIENT SATISFACTION 18 minutes AVG. PHYSICIAN CALL-BACK TIME Why? AmeriDoc is committed to revolutionizing healthcare by setting the highest Telehealth industry standards and designing healthcare systems in the cloud to empower consumers to get on-demand access to medical care. Our national network of 350+ U.S. based board-certified physicians and mental health therapists are some of the most credentialed in the industry today. Included in the network are primary care doctors, internists, emergency room doctors and licensed pediatricians and therapists. Our physicians can diagnose many common conditions and can recommend treatment plans including non-controlled prescription medication as necessary. Physicians are available 24/7/365 to provide members with convenient, quality medical consultations via telephone, SMS text, video and secure .

56 How Does Work? PAGE 3 Step 1. Request a consult Patient simply logs on to their secure account or calls AmeriDoc, 24/7/365, to request either a telephone or video consultation. Step 4. Resolves issue The physician recommends the proper treatment for the medical issue. If a prescription is necessary, it is sent to the member s pharmacy of choice. Step 2. Patient is triaged Patient speaks to a medically trained and HIPAA certified care coordinator who will triage and update the patient s electronic health records along with any symptoms. Step 5. Doctor updates EHR The physician documents the results of the consultation in the member s medical history. Consultation information can be sent to the member s primary care physician. Step 3. Doctor calls patient s A board-certified physician, licensed in their state, reviews the patients medical history and provides a consultation over the phone or through video, just like an in-person visit. Spanish speaking physicians are available. Step 6. Consult fee collected AmeriDoc has the flexibility to collect a consult fee (if any) in a variety of ways. The fee can be paid by the plan sponsor, the insurance carrier, or directly by the patient. Step 7. Follow up call AmeriDoc will perform a follow-up call within 24 hours of the patient s consultation to ensure patient care quality. 91% PATIENT ISSUES RESOLVED 7minutes AVERAGE CONSULTATION TIME * Plans may or may not have a consult fee.

57 How Telehealth Benefits Your Employees PAGE 4 1. Saves Time Online doctor consultations are convenient, immediate and save time. No long waits to get in to see a doctor and no time off work. 2. Saves Money Telehealth reduces costly and unnecessary office visits, urgent care visits and emergency room visits. Online consultations are usually lower than a co-pay. 3. Easier Access For people who travel, work in rural locations or live in underserved cities, Telehealth can sometimes mean the difference between receiving care or not. 4. More Options Patients have more and more options everyday with Telehealth. They can speak to a physician, a pediatrician, a naturopathic doctor, or even a behavioral therapist. 5. Increased Satisfaction Patients can save money when utilizing Telehealth as consult fees are typically lower than out-of-pocket co-pays. Also, over 80% of medical conditions can be treated by telephone or % of patients that rate their tele-visit very good or excellent 85 % of visits completely resolve the patient s issue 96 % of patient s save time with tele-medicine When Should You Use not reach your primary care physician e young children who are unable to see a doctor after y ling away from home e ted question ot sure you need to go an urgent care center or ER not afford to take time off from work r-quality, lower cost alternative to walk-in clinics

58 Why We Are Different PAGE 5 What differentiates from the competition? Physician Network Credentialed U.S. Based and Licensed On-going Education C A R E Credentialed Accessible Revolutionary Effortless

59 Cost Comparisons PAGE 6 Recent studies indicate that patients who utilize urgent care centers and emergency rooms for routine medical care incur extremely high costs. AmeriDoc consults typically are lower than the cost of a co-pay and are far less expensive than going to an urgent care center, ER or PCP. Along with longer wait times, the average PCP visit costs $100, Specialists $130, Urgent Care Centers $155 and Emergency Rooms in excess of $1,300. Our patients avoid these unnecessary medical expenses, which drive down the cost of healthcare. Visit Average Cost PCP Visit AmeriDoc $30 $100 $70 Savings Specialist Visit AmeriDoc $30 $130 $100 Savings Urgent Care Visit AmeriDoc $30 $155 $125 Savings PCP Urgent Care Specialist ER ER Visit AmeriDoc $30 $1,300 $1,270 Savings Multiple Cost Savings Telehealth is one of the only cost-savings tools that can generate multiple ROIs including: Healthcare Cost Savings AmeriDoc typically costs less than a co-pay. Redirecting unnecessary doctor, urgent and ER visits can reduce healthcare spending by up to 25% Flexible Implementation AmeriDoc can be implemented anytime of the year with minimal hassle. There are no waiting periods or exclusions for pre-existing conditions. Most of our implementations take less than 30 days. Productivity A typical doctor s appointment can take up to half of the workday. Providing patients easy access to physicians, Telehealth reduces absenteeism and the risk that medical problems become chronic. Patient Satisfaction Patients receive convenient access to a physician when they need them most: now. AmeriDoc enjoys a 98% patient satisfaction. Happy patients are healthier patients.

60 PAGE 7 Common Services Common Conditions Common Medications Prescribed Cold / Flu Sinus Infection Upper Respiratory Infection Allergy Headache Bronchitis Stomach Ache / Diarrhea Fever Eye Infection Rash / Skin Infection Yeast Infection Small Wound Urinary Tract Infection Zithromax (Z-Pack) Amoxicillin Albuterol Augmentin Ibuprofen 800mg Azithromycin Keflex Lipitor Tamiflu Prednisone Metformin Flonase Diflucan Bactrim Cipro Lisinopril HCTZ Levaquin Biaxin Allegra Nasonex Tessalon Macrobid Pyridium 27% 73% Telehealth addresses 73% of the top 25 most common conditions 18% 82% Telehealth physcians prescribe 82% of the top 25 most common medications. How long are you waiting for medical care? Average appointment wait times (IN DAYS) for five medical specialties included in the most recent Merritt Hawkins Survey Seattle Boston Portland New York Minneapolis Philadelphia Detroit Washington D.C. Denver Atlanta Los Angeles Dallas San Diego Houston 15.4 Miami

61 We will Customize a Program that Fits Your Needs Members* PMPM* PMPM* Fee FeePer Diagnostic Consult FeePer Informational Consult Non Voluntary Platinum Non Voluntary Gold Voluntary Platinum Voluntary Gold $4.50 $2.50 $9.00 $5.00 $0 $20 $0 $20 $0 $20 $0 $20 *coverage includes employee, spouse and up to 5 additional dependents under 26 years of age Responsibilities: AmeriDoc to Provide: Telehealth platform for secure video and telephone medical consultations Cloud basedhealth records Registered Medical Professionals with professional healthcare training to provide member assistance and coordinate medical consultations Market to members several times a year Employer to Provide: Member data Signed Sponsor Agreement Promotion of service to achieve utilization objectives Highlight AmeriDoc during open enrollment Feel Better Faster 20