FRA-endorsed Insurance Plans P.O. Box 14464 Des Moines, IA 50306-8993 Dear, The FRA-Patriot Cancer Insurance Plan can help. It pays benefits to help maintain financial security if you are diagnosed with cancer. Here are some of the plan features: Benefits are paid for cancer care and treatment, including hospital stays, private duty nurse care, chemotherapy, pints of blood and plasma, ambulance service and much more. Benefits are paid directly to you or to anyone you choose (not your doctor or hospital, unless you tell us to). Benefits are paid regardless of what anybody pays includes Medicare, any company Major Medical or other health insurance plan. You may want to think about coverage for yourself, your spouse and all eligible children (unmarried, up to age 21, 23 if full-time student). Family coverage is available at group rates. If you are an FRA member and have not had cancer in the last ten years, you cannot be turned down for coverage. To apply, simply complete and return the enclosed Application. Upon acceptance, you'll then have 30 days after receiving your Certificate of Insurance to decide if this plan is right for you. Do not send money now. 26463160.LTR 1 Stock: 092779
With recent cancer breakthroughs on many fronts, it is easier today to fight cancer and win. With the FRA Patriot Plan, you'll have cash benefits to help pay for the treatments you may need, while helping to maintain your financial security. Sincerely, Timothy R. Weber, Partner Mercer Health & Benefits Administration LLC FRA-endorsed Insurance Programs Administrator License #17526255 P.S. Remember, if you haven't been diagnosed with cancer in the last ten years, you're guaranteed acceptance in the FRA Cancer Insurance Plan. Simply complete and return your Application today. Send no money now. Underwritten by: Transamerica Premier Life Insurance Company Cedar Rapids, IA 52499 26463160.LTR Copyright 2016 Mercer LLC. All rights reserved. ICA110L FRA 2
Fleet Reserve Association 09804-Q 074030010144 Name: Add 1: Add 2: Last First MI FRA-PATRIOT CANCER INSURANCE PLAN APPLICATION For Residents of Wisconsin Only TO APPLY: Send this completed application to: ADMINISTRATOR FRA GROUP INSURANCE PROGRAM P.O. Box 14464 Des Moines, IA 50306-8993 QUESTIONS? Call: 1-800-424-1120 E-Mail: fra.service@mercer.com Our hearing-impaired or voice-impaired members may call the Relay Line at 1-800-855-2881. City, St., Zip: 4333 Edgewood Road N.E. Cedar Rapids, IA 52499 1. Please complete application in ink. Phone Numbers Home ( ) Work ( ) Date of Birth FRA Member Number (Mo./Day/Yr.) Sex q M q F 2. Check coverage desired: Monthly Rates Under age 65 65-69 70 & Over q Member Only (1011) $13.30 $16.23 $19.80 q Member/Spouse (1012) $19.15 $31.03 $38.05 q Family Coverage (1013) $20.77 $33.80 $41.24 q Member/Children (1014) $14.92 $19.00 $22.98 If, in addition to yourself, you are applying for family coverage, complete below as applicable: Name Date of Birth (Mo./Day/Yr.) Spouse / / Child / / Child / / Child / / Are you or any dependants eligible for Medicare? Yes No BE SURE TO COMPLETE ALL PAGES AND SIGN 26463160.APP 1 Stock: 908786
3. Read, sign and date: To the best of your knowledge and belief, have you or your dependents (if applying for dependent coverage) received Treatment or been medically advised of Cancer (excluding Skin Cancer), Leukemia, or Hodgkin's Disease during the last 10 years? q Yes q No If you answered "Yes," please indicate name of person and their corresponding medical condition: (Treatment means medical and surgical care by a licensed provider to detect or cure Cancer. This includes examination, diagnostic procedures, surgery [including pre- and post-operative care], prescribed medication, and the application of remedies and therapy. It does not include any diagnostic procedures or examinations performed to monitor a previous removal or remedy of Cancer, provided there is no positive diagnosis of Cancer or of a recurrence of Cancer.) It is understood that any person listed will not be eligible for coverage (except any person listed with Skin Cancer will be eligible for coverage. Benefits, however, will not be payable for Skin Cancer.) Your coverage will be effective on the first day of the month following acceptance of your application, provided your first premium is paid and you are not hospital confined on that date. Member's Signature X Spouse's Signature X CA 1000GEM (4/95).series MZ0910358H0002A (if applying for coverage) Date X Date X Copyright 2016 Mercer LLC. All rights reserved. 26463160.APP ICA11OE - FRA 2
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS This is not a Medicare Supplement Insurance This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance. This insurance duplicates Medicare benefits because Medicare generally pays for most of the expenses for the diagnosis and treatment of the specific conditions or diagnoses named in the policy. Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include: hospitalization physician services hospice outpatient prescription drugs if you are enrolled in Medicare Part D other approved items and services Before You Buy This Insurance q Check the coverage in all health insurance policies you already have. q For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company. q For Help in understanding your health insurance, contact your state insurance department or state health insurance assistance program. Fixed Dollar Amounts For Specified Diseases
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A SHOPPER'S GUIDE TO CANCER INSURANCE Should You Buy Cancer Insurance? Cancer Insurance is Not a Substitute for Comprehensive Coverage. Caution: Limitations On Cancer Insurance. Prepared by the National Association of Insurance Commissioners CANCER INSURANCE... Cancer insurance provides benefits only if you get cancer. No policy will cover cancer diagnosed before you applied for the policy. Examples of other specified disease policies are heart attack or stroke policies. The information in this booklet applies to cancer insurance, but could very well apply to other specified disease policies. CANCER INSURANCE IS NOT A SUBSTITUTE FOR COMPREHENSIVE COVERAGE... Cancer treatment accounts for about 10% of U.S. health expenses. In fact, no single disease accounts for more than a small proportion of the American public's health care bill. This is why it is essential to have insurance coverage for all conditions, not just cancer. If you and your family are not protected against catastrophic medical costs, you should consider a major medical policy. These policies pay a large percentage of your covered costs after a deductible is paid either by you or your basic insurance. They often have very high maximums, such as $100,000 to $1,000,000. Major medical policies will cover you for any accident or sickness, including cancer. They cost more than cancer policies because they cover more, but they are generally considered a better buy. SHOULD YOU BUY CANCER INSURANCE?... MANY PEOPLE DON'T NEED IT If you are considering cancer insurance, ask yourself three questions: Is my current coverage adequate for these costs? How much will the treatment cost if I do get cancer? How likely am I to contract the disease? If you have Medicare and want more insurance, a comprehensive Medicare supplement policy is what you need. Low income people who are Medicaid recipients don't need any more insurance. If you think you might qualify, contact your local social service agency. Duplicate Coverage is Expensive and Unnecessary. Buy basic coverage first such as a major medical policy. Make sure any cancer policy will meet needs not met by your basic insurance. You cannot assume that double coverage will result in double benefits. Many cancer policies advertise that they will pay benefits no matter what your other insurance pays. However, your basic policy may contain a coordination of benefits clause. That means it will not pay duplicate benefits. To find out if you can get benefits from both policies, check your regular insurance as well as the cancer policy. Some Cancer Expenses May Not Be Covered Even by a Cancer Policy. Medical costs of cancer treatment vary. On the average, hospitalization accounts for 78% of such costs and physician services make up 13%. The remainder goes for other professional services, drugs and nursing home care. Cancer patients often face large nonmedical expenses which are not usually covered by cancer insurance. Examples are home care, transportation and rehabilitation costs. -1-
Don't be Misled by Emotions. While three in ten Americans will get cancer over a lifetime, seven in ten will not. In any one year, only one American in 250 will get cancer. The odds are against your receiving any benefits from a cancer policy. Be sure you know what conditions must be met before the policy will start to pay your bills. CAUTION: LIMITATIONS OF CANCER INSURANCE Cancer policies sold today vary widely in cost and coverage. If you decide to purchase a cancer policy, contact different companies and agents, and compare the policies before you buy. Here are some common limitations: Some policies pay only for hospital care. Today cancer care treatment, including radiation, chemotherapy and some surgery, is often given on an outpatient basis. Because the average stay in the hospital for a cancer patient is only 13 days, a policy which pays only when you are hospitalized has limited value. Many policies promise to increase benefits after a patient has been in the hospital for 90 consecutive days. However, since the average stay in a hospital for a cancer patient is 13 days, large dollar amounts for extended benefits have very little value for most patients. Many cancer insurance policies have fixed dollar limits. For example, a policy might pay only up to $1,500 for surgery costs or $1,000 for radiation therapy, or it may have fixed payments such as $50 or $100 for each day in the hospital. Others limit total benefits to a fixed amount such as $5,000 or $10,000. No policy will cover cancer diagnosed before you applied for the policy. Some policies will deny coverage if you are later found to have had cancer at the time of purchase, even if you did not know it. Most cancer insurance does not cover cancer-related illnesses. Cancer or its treatment may lead to other physical problems, such as infection, diabetes or pneumonia. Many policies contain time limits. Some policies require waiting periods of 30 days or even several months before you are covered. Others stop paying benefits after a fixed period of two or three years.: FOR ADDITIONAL HELP... If you are considering a cancer policy, the company or agent should answer your questions. You do not need to make a decision to purchase the policy the same day you talk to the agent. Be sure to ask how long you have to make your decision. If you do not get the information you want, call or write: Office of the Commissioner of Insurance 121 East Wilson Street P.O. Box 7873 Madison, WI 53707-7873 (608) 266-0103 If you have a complaint against an insurance company or agent, write the Office of the Commissioner of Insurance at the address above, or call the Complaints Hotline, 800-236-8517. -2-
AUTOMATIC CHECK WITHDRAWAL REQUEST: By selecting Automatic Check Withdrawal, your premium will automatically be withdrawn from your checking account. Please provide the information requested below. Routing #: Account #: I request that you pay and charge my account debits drawn from my account by the Plan Administrator to its order. This authorization will stay in effect until I revoke it in writing. Until you receive such notice, I agree that you shall be fully protected in honoring any such debits. I also agree that you may, at any time, end this agreement by giving 30 days advanced written notice to me and to the Plan Administrator. You are to treat such debit as if it were signed by me. If you dishonor such debit with or without cause, I will not hold you liable even if it results in loss of my insurance. Signature of Premium Payer Date
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FRA-Patriot Cancer Insurance Plan Benefits Guide As an FRA Member, you know how important security is to you and your family. You want to protect them now and always. That's why the FRA-Patriot Cancer Insurance Plan is so important. This valuable insurance coverage pays cash benefits if you should get cancer and can help protect your family from the costs of cancer treatments. As a member of this plan, you'll receive the following benefits: Hospital Confinement: $100.00 daily per illness period, days 1-90. Then, 100% of hospital charges in lieu of all other benefits up to $200.00 a day $6,000.00 a month after 90 consecutive days. Miscellaneous Hospital Expense: $1,000.00 per illness period for miscellaneous expenses, including drugs and medicine you receive in the hospital. You're also covered for miscellaneous hospital services and supplies. Attending Physician: $20.00 daily for doctor's visits (other than your surgeon) while in the hospital. Private Duty Nurse: $30.00 daily; $750.00 per illness period for a private nurse (not employed by the hospital) when recommended by your physician. Blood and Plasma: $600.00 per illness period for pints of blood and plasma. No limit for leukemia. Chemotherapy and Radiation: $1,500.00 for each illness period (including x-ray, radium and cobalt treatments). Ambulance: $500.00 each illness period to be taken to the hospital or a skilled nursing facility. Anesthesia: $200.00 per operative session, except skin cancer, for which you receive $40.00 per operative session. No limit on number of procedures. Surgery: 20% of actual charges, $1,500.00 per operation. No limit on the number of surgeries covered. For skin cancer, you'll collect $95.00 per initial incision; $40.00 per additional incision. Outpatient Benefit: Receive $10.00 per day, $50.00 per month when you receive outpatient treatment for cancer from your physician or someone under the direct supervision of your physician. Includes chemotherapy outpatient surgery and blood transfusions. "Illness period" means a period during which benefits are payable for covered expenses incurred for the necessary care and treatment of cancer. A new Illness Period is established after 45 consecutive days during which there are no expenses for cancer care and treatment. The company will neither cancel an individual member's coverage nor single out an individual for a rate increase no matter how many claims the member may submit. Rates will not be changed unless they are changed for all insureds in your classification and group. Your coverage will never terminate because of age or medical history as long as the group policy remains in force, you remain a member and you pay your premiums. 30-Day Free Look. Once you receive your Certificate, take 30 days to look it over. If you decide the FRA Cancer Insurance Plan isn't for you, simply return it within 30 days. Your Payment Options You may have the option of paying your premiums once a year (annually), twice a year (semi-annually), or four times a year (quarterly). If you pay your premiums monthly, quarterly or semi-annually, the total amount of premiums you pay in a year may be higher than if you make one annual payment. If you are interested in learning more about these payment options, please refer to your fulfillment package for details. If you choose to pay annually, multiply the rate by 12; semi-annually, multiply the rates by 6; quarterly multiply by 4. Rates in this package will not be changed unless they are changed for all insureds in your classification. Rates are based on attained age. If applicable, an additional $2 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option. Exclusions: Only cancer is covered. Injury or sickness other than cancer is not covered. (Next page, please) Second Opinion Benefit: You're paid up to $100.00 for each illness period for a second medical opinion for cancer. First Occurrence: Collect $1,000.00 when cancer is positively diagnosed for the first time only, except for the diagnosis of skin cancer. Benefit will be paid after Rider has been in force for 30 days. 1 26463160.BRO Stock: 908786
Termination of Coverage. Coverage ends if: the Master Policy is terminated; the member is no longer a member of his/her association; or the insured fails to pay the appropriate premium. Dependent s coverage ends when member s coverage ends, its premiums are not paid, the Master Policy is terminated, or on the premium due date coinciding with or next following the date the dependent ceases to be eligible. This fact sheet provides a brief description of the benefits available. Complete details may be found in Group Policy Form No. CA1000GPM, Policy No. MZ0910358H0002A, Certificate Form No. CA1000GCM.WI. Benefits may vary by state. Coverage may not be issued to residents of all states. You'll be billed quarterly. Rates are based on member's attained age and increase as member passes from one age category to another. Administered by: Mercer Consumer, a service of Mercer Health & Benefits Administration LLC P.O. Box 14464 Des Moines, IA 50306-8993 QUESTIONS? Call: 1-800-424-1120 E-Mail: fra.service@mercer.com Web: www.frainsure.com AR Insurance License #100102691 CA Insurance License #0G39709 In CA d/b/a Mercer Health & Benefits Insurance Services LLC Other insurance in this company: Only one certificate or policy providing Cancer coverage may be in force as elected by the member. If any other certificate or policies previously issued by us or any other AEGON, U.S.A. affiliates are in force concurrently with the Certificate issued under this policy, the excess insurance will be void. All premiums paid for the excess will be returned to the Insured. A Notice About Transamerica's Privacy Policy 1. We do not sell your personal information to anyone. 2. We may collect nonpublic information about you from the following sources: Information we receive from you on applications or other forms; and Information about your transactions with us, or our affiliates. 3. We do not disclose any nonpublic personal information about you to either our affiliates or nonaffiliates, except as permitted or required by law. 4. We restrict access to your nonpublic personal information to employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards to protect your nonpublic personal information. Transamerica Premier Life Insurance Company has the right to change rates on any premium due date with 31 days advanced notice to the insured. Rates may also change at any time if the terms of the group master policy are changed. Copyright 2016 Mercer LLC. All rights reserved. ICA110P-FRA 26463160.BRO Our hearing-impaired or voice-impaired members may call the Relay Line at 1-800-855-2881. THIS IS A CANCER ONLY POLICY. Underwritten by: 4333 Edgewood Road N.E. Cedar Rapids, IA 52499 2