WPS MEDICARE COMPANION

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1 AZ WPS MEDICARE COMPANION re never alone we re committed to helping you with your health care Rates effective June 1, 2018 Underwritten by: The EPIC Life Insurance Company A WPS Company Plans A, C, F, G, K, L, and N Choose the right Medicare supplement insurance with complete customer support! Visit mywpsmedicare.com AZ_SALES_1712 Neither Wisconsin Physicians Service Insurance Corporation, nor The EPIC Life Insurance Company, nor their products nor agents are connected with or endorsed by the United States government or the federal Medicare program. WPS Health Insurance is underwritten by The EPIC Life Insurance Company.

2 Contents Medicare alone is not enough...2 Stable rates provide peace of mind...2 Top 7 reasons to choose WPS Medicare Companion...3 Valuable options included with your plan WPS provides convenient payment options...8 Optional dental coverage...9 Enrollment timeline...10 Premium rates Parts of Medicare...15 Limitations and exclusions...15 Medicare alone is not enough WPS Medicare Companion has your back Medicare is a valuable benefit, but it doesn t pay everything. Deductibles and coinsurance can add up. If you have Medicare alone, there s a chance a serious illness or injury could exhaust your savings. WPS Medicare Companion supplement plan helps protect your health and retirement savings. Stable rates provide peace of mind As you look at Medicare supplement plans, you may find that some companies offer lower initial premiums than WPS does. However, a lower rate can increase quickly in subsequent years. Choose WPS Medicare Companion supplement plan for valuable benefits and a stable rate. can help protect your health and finances and count on a consistent premium payment. Local service ensures you get the kind of attention you need when you have questions. We know your concerns and are equipped to help you get the answers you need to your Medicare supplement questions. WPS has your back! Wayne R. helps seniors get the most from their Medicare supplements. Eliminate the worry I know other people who are frightened by Medicare. But not us WPS helps us every step of the way. Linda K. member since mywpsmedicare.com

3 Medicare supplements are a great choice Medicare supplement plans give you the freedom to choose your own doctors and hospitals that accept Medicare anywhere in the U.S. This means you can keep your doctor or select a new doctor at any time. have complete freedom to choose! And if you move, your coverage moves with you anywhere in the U.S. Plus, you can always keep your plan as long as you pay your premium. r policy will never be canceled because of your health. As long as you pay your premium on time, your plan is guaranteed renewable for life. Also, there is less paperwork and fewer worries. Automatic claims service means you don t have to worry about filing claims or dealing with medical bills. Medicare sends WPS your claims electronically, so we handle them while you enjoy almost no paperwork. Top reasons to choose WPS Medicare Companion Save money with our discounts WPS offers a 7% discount when you and a second household member are enrolled in a WPS Medicare supplement plan. 1 also can get a 2% discount when you choose automatic bank withdrawal. get treated like family When you call WPS, you reach caring people right here in our home state of Wisconsin. r questions are answered promptly and accurately by our highly trained Customer Support team. Strong commitment to ethics In 2018, WPS Health Solutions was named one of the World s Most Ethical Companies for the ninth year in a row by the international Ethisphere Institute. 2 deserve to live your life Health care and health insurance are important, but honestly, you ve got better things to do than worry about all of it. Let WPS help handle your medical bills while you handle all the activities you enjoy. 1 Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex World s Most Ethical Companies, Ethisphere Institute, worldsmostethicalcompanies.ethisphere.com WPS Medicare Companion 3

4 Valuable programs included with your plan WPS strives to provide the greatest value possible to its members. WPS Medicare Companion includes an impressive collection of added benefits that, unlike in other plans, costs absolutely nothing extra for members. The Silver&Fit Exercise and Healthy Aging Program 1 When you choose Plans A, C, F, G, or N (not available with cost-sharing Plans K and L), you also get this great perk! At no extra cost, the Silver&Fit program gives you a fitness club or exercise center membership. The Silver&Fit network in Arizona includes national and regional fitness chain locations as well as many independent local gyms. Participating facilities include: 2 Scottsdale Phoenix Desert Foothills Family YMCA Scottsdale/Paradise Valley Family YMCA Scottsdale Community College Fitness and Wellness Center Edge Fitness Tucson Mid-valley Athletic Club Desert Sports & Fitness YMCA of Southern Arizona Chuze Fitness The Salvation Army South Mountain Kroc Center LifeStart Paradise Valley Community College Fitness Center SETAY Dance & Fitness BellaBody Pilates Ahwatukee Foothills Family YMCA Yuma Yuma Family YMCA World Gym Fitness Center Mesa Flex Fit Blast Fitness Oasis Health Spa at Leisure World Ross Farnsworth East Valley YMCA Mesa Family YMCA Desert Fitness Plus, additional facilities in these areas and in many other parts of the state! Fitness Chains with Locations Across Arizona EoS Fitness Curves Planet Fitness LA Fitness Anytime Fitness Snap Fitness YMCA Fit The Silver&Fit network is continually growing, including the additions of facilities nominated by WPS members. Visit silverandfit.com for a complete list of participating facilities. Please note that these programs are not insurance. 1 The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit, Silver&Fit logo, and the Silver&Fit Signature Series are registered trademarks of ASH. ChooseHealthy is a product of American Specialty Health Administrators, Inc., a subsidiary of American Specialty Health Incorporated. Services that require an additional cost are not included in the Silver&Fit program. should check any insurance benefits you have before using this discount program, as those benefits may result in lower costs to you than using this discount program. The discount program provides for discount specialty health care services from participating practitioners. are obligated to pay for all health care services, but will receive a discount from those health care practitioners who have contracted with the discount program. The discount program does not make payments directly to the participating practitioners in the discount program. The discount program has no liability for providing or guaranteeing services and assumes no liability for the quality of services rendered. Fitness discount programs are not part of the insurance policy and are offered at no additional charge. Enrollment in these programs is subject to contract renewal. The Silver&Fit and ChooseHealthy programs are not included with Medicare supplement cost-sharing Plans K and L. 2 The facilities listed are participating in the Silver&Fit network as of April For the most up-to-date listing of participating facilities, please visit silverandfit.com. 4 mywpsmedicare.com

5 The Silver&Fit program also offers: Fitness clubs with group classes for older adults, where available, such as: Signature Series Senior Dance Senior Yoga Aqua Cardio Strength And more Or, if you would prefer to work out at home, home fitness kits are available which can include: DVDs Pedometer Quick starts guides And more Fitness challenges and rewards And more The ChooseHealthy Affinity Program 1 All WPS Medicare Companion plan options, except cost-sharing Plans K and L, also include the ChooseHealthy program at no extra cost. receive valuable discounts on services from nearly 33,000 providers in the ChooseHealthy network, including: Chiropractors Acupuncturists Massage therapists Registered dietitians also get a broad choice of health and wellness products in the online store: Vitamins and minerals Food supplements Sports nutrition Herbs and botanicals 4 ChooseHealthy is a product of American Specialty Health Administrators, Inc., an affiliate of ASH Group and a subsidiary of American Specialty Health Incorporated WPS Medicare Companion 5

6 EyeMed Vision Care discount program Vision Care Services Member Benefits All WPS Medicare Companion members receive access to the EyeMed Vision Care discount program at no additional cost. 1 EyeMed offers substantial savings on eye care and eyewear at thousands of provider locations nationwide. WPS Medicare Companion members receive a discount simply by showing their WPS ID card at participating EyeMed providers and mentioning EyeMed discount No EyeMed s provider network includes many familiar optical retailers, including: America s Best Contacts & Eyeglasses Arizona Optical Dispensers JCPenney Optical LensCrafters Pearle Vision Southwestern Eye Center Target Optical Total EyeCare Centers Walmart Vision Center and many more! Find a vision care provider in your area: Call EyeMed toll-free at EnrollWithEyeMed.com/access Eye exam (with dilation, as necessary) Complete Pair Eyeglass Purchase 2 Frames Any available frame at provider location Standard Plastic Lenses Single vision $50 Bifocal $70 Trifocal $105 Lens Options UV coating $15 Tint (solid and gradient) $15 Standard scratch-resistant coating $15 Standard polycarbonate $40 Standard anti-reflective coating Standard progressive (add-on to bifocal) Other add-ons and services $5 off routine exam $10 off contact lens exam 35% off retail price $45 $65 20% off retail price Contact Lenses (discount applies to materials only) Conventional Laser Vision Correction LASIK or PRK from U.S. Laser Network 15% off retail price 15% off retail price 5% off promotional price Frequency of use for examination, frames, lenses, or contact lenses unlimited 1 Vision discount program is not insurance, nor is it part of the insurance policy, and is offered at no additional charge. Enrollment in this program is subject to contract renewal. 2 Frame, lens, and lens option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price. Benefits may not be combined with any discount, promotional offering, or other group benefit plans, except as indicated. plan is effective Oct. 1, 2017 through Sept. 30, mywpsmedicare.com

7 Hear In America program The Hear In America discount program, available to all WPS Medicare Companion members, makes you eligible to receive: Free hearing screenings A three-year warranty on new hearing aids Free office services (including retests, cleanings, and adjustments) for three years A 45-day trial period for your hearing aid s from 35 to 70% off of manufacturer s suggested retail price (MSRP) for hearing aids from all 9 major manufacturers including: Phonak Starkey ReSound Rexton Siemens Sonic Innovations Oticon Unitron Widex Examples of how you can save Sample Savings MSRP or Average Price Pay* Savings % Saved FREE annual hearing screening $0 100% Three-year repair warranty, three-year loss and damage warranty $500 $0 $ % Three years of hearing aid batteries $315 $0 $ % Three years of office service $600 $0 $ % 12 months financing (to those who qualify) $0 service charges and interest Up to $1,160 Basic digital hearing aid $1,450 $995 $455 31% Mid-level hearing aid $3,995 $1,475 $2,520 63% Premium digital hearing aid $5,996 $2,540 $3,456 58% *These are savings examples only. May be used in conjunction with your existing insurance coverage. Hearing discount programs are not part of the insurance policy and are offered at no additional charge. Enrollment in these programs is subject to contract renewal WPS Medicare Companion 7

8 WPS Medicare Companion has seven smart plan options Coverage of Plan A Plan C Plan F Plan G Plan K Plan L Plan N Basic benefits 1 2 Part B coinsurance Part A deductible 50% 75% Skilled nursing facility coinsurance 50% 75% Foreign travel emergency Part B excess charges Part B deductible 1 After deductible, hospitalization and preventive care paid at 100%; other basic benefits paid at 50%. Out-of-pocket limit set by CMS; pays at 100% after limit reached. 2 After deductible, hospitalization and preventive care paid at 100%; other basic benefits paid at 75%. Out-of-pocket limit set by CMS; pays at 100% after limit reached. 3 After deductible, requires up to $20 copayment for office visits; up to $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible. Choose from convenient payment options Automatic bank withdrawal (includes 2% discount!) Credit/debit card payment Direct billing Please see the WPS Medicare Companion enrollment application for additional instructions for selecting a payment option. 8 mywpsmedicare.com

9 Optional dental coverage re free to visit any licensed dentist. Also, these plans offer members more than 235,000 Ameritas PPO (participating provider organization) access points for dental care nationwide. Ameritas PPO network providers have agreed to charge discounted fees to our members, so you can almost always save money. In Texas, the PPO network is referred to as the Ameritas Dental Network. When you purchase the plan, you have 10 days from the date you receive your policy to cancel it with no penalty or obligation. Following that 10-day period, we require that members make a commitment through the initial 12 monthly periods. Optional dental coverage includes: Preventive/Type 1: Routine exams, cleanings, fluoride treatments, sealants, and more. Basic/Type 2: X-rays, filling restoration, extractions, and more. Major/Type 3 (Platinum, Gold, Silver Plans): Onlays, dentures, denture repair, endodontics root canal, periodontal scaling and root planing, crown and crown repairs, pontics, fixed bridges, surgical removal of teeth, deep sedation/general anesthesia, and more. A six-month waiting period applies to all Type 3 Procedures before benefits are payable. Teeth Whitening (Platinum, Gold, Silver Plans): Professional tooth bleaching, also referred to as whitening. With this benefit, members can have a healthy, white smile that may boost self confidence and enhance their appearance. Dental Rewards : A valuable feature which allows qualifying plan members to carry over part of their unused annual maximum. LASIK Vision Correction: These plans also include access to savings on LASIK vision correction. LASIK Advantage provides for LASIK and related procedures. Contact us for more information about enrolling in this optional dental coverage. Monthly Rates Platinum Gold Silver Value Calendar year maximum $2,500 $1,500 $1,000 $1,000 Individual only $51 $41 $31 $21 Individual and spouse $97 $77 $57 $37 Eligibility: Anyone at least 18 years of age who is not a current Ameritas dental plan member is eligible for these dental plans. Please refer to the website for plan availability in your state. EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE POLICY r policy will contain a complete listing of procedures covered and any frequency or other limitations on specific procedures. Certain covered expenses may be subject to a waiting period (an elimination period). Alternate Benefit Provision At times, two or more procedures are considered adequate and appropriate treatment. In this case, the benefit paid will be based on the charge for the least expensive procedure. Certain expenses are not covered For instance, procedures begun prior to your effective date are not covered. The policy does not provide benefits for lost or stolen appliances or cosmetic procedures. It does not cover hospitalization or prescription drugs. This is not a complete list of exclusions. A full list will be included in your policy. To preview the policy, please send us a request using the contact form on our website, Plans are marketed by SASid, Inc., administered by InsuranceTPA.com and insured by Ameritas Life Insurance Corp. Plan designs may not be available in all areas. Ameritas Group s individual plans [Indiv Ed ] are issued by Ameritas Life. Ameritas, the bison symbol, Dental Rewards, LASIK Advantage and We re Ameritas. We re for people. are registered service marks of Ameritas Life or Ameritas Mutual Holding Company and are used with permission WPS Medicare Companion 9

10 WPS Medicare Companion monthly premium rates Effective June 1, 2018 Determine your rate area: Area 1=Phoenix, Mesa, and surrouding area 850 : All ZIPs that begin with these 3 numbers 852 : All ZIPs that begin with these 3 numbers Area 2=All other Arizona ZIP codes Rating Area 1 2 Relocation If, in the future, you permanently relocate to another state, Area 1 rates will apply. If you relocate to another Arizona ZIP code, you will pay the rates for the area to which you move. Enrollment timeline when you turn 65 can submit an application One-time open enrollment period ends 3 Months Before 6 Months After Turn 65! or enroll in Part B If you apply during your one-time open enrollment period, you won t need to answer any health questions; simply submit a policy enrollment application. Coverage begins on the first of the month that you turn 65 and/or enroll in Medicare Part B, or on the effective date you request up to three months in the future. Enroll anytime after you turn 65 Already passed the 65-year milestone? can switch Medicare supplement plans at any time throughout the year. don t have to wait for an annual enrollment period like you do with Medicare Advantage plans. It s easy to make the switch! Just contact your agent or call a WPS sales representative at Have other coverage that s terminating or changing? If so, you may be eligible for guaranteed acceptance of this policy. Contact your agent or call a WPS sales representative at for information. 10 mywpsmedicare.com

11 Area 1 Rates Male 7% Household : Get the best rate possible when you enroll with a second member of your household.* each pay the with rate shown below. Age When Plan Takes Effect Note: Rates include a 2% discount for members who enroll in automatic bank withdrawal. Those who pay by credit card or paper bill will pay a slightly higher premium than those listed here. Please contact us with any questions. Plan A Plan C Plan F Plan G Plan K Plan L Plan N with with with with with with with 65 $ $ $ $ $ $ $ $ $ $98.27 $ $ $ $ $ $ $ $ $ $ $ $ $ $99.92 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ *Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex.

12 Area 1 Rates Female 7% Household : Get the best rate possible when you enroll with a second member of your household.* each pay the with rate shown below. Age When Plan Takes Effect Plan A Plan C Plan F Plan G Plan K Plan L Plan N with with with with Note: Rates include a 2% discount for members who enroll in automatic bank withdrawal. Those who pay by credit card or paper bill will pay a slightly higher premium than those listed here. Please contact us with any questions. with with with 65 $ $ $ $ $ $ $ $ $96.06 $89.34 $ $ $ $ $ $ $ $ $ $ $ $ $97.67 $90.83 $ $ $ $ $ $ $ $ $ $ $ $ $99.27 $92.32 $ $ $ $ $ $ $ $ $ $ $ $ $ $94.59 $ $ $ $ $ $ $ $ $ $ $ $ $ $96.84 $ $ $ $ $ $ $ $ $ $ $ $ $ $99.10 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ *Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex.

13 Area 2 Rates Male 7% Household : Get the best rate possible when you enroll with a second member of your household.* each pay the with rate shown below. Age When Plan Takes Effect Plan A Plan C Plan F Plan G Plan K Plan L Plan N with with with with Note: Rates include a 2% discount for members who enroll in automatic bank withdrawal. Those who pay by credit card or paper bill will pay a slightly higher premium than those listed here. Please contact us with any questions. with with with 65 $ $ $ $ $ $ $ $ $ $93.35 $ $ $ $ $ $ $ $ $ $ $ $ $ $94.92 $ $ $ $ $ $ $ $ $ $ $ $ $ $96.48 $ $ $ $ $ $ $ $ $ $ $ $ $ $98.84 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ *Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex.

14 Area 2 Rates Female 7% Household : Get the best rate possible when you enroll with a second member of your household.* each pay the with rate shown below. Age When Plan Takes Effect Plan A Plan C Plan F Plan G Plan K Plan L Plan N with with with with Note: Rates include a 2% discount for members who enroll in automatic bank withdrawal. Those who pay by credit card or paper bill will pay a slightly higher premium than those listed here. Please contact us with any questions. with with with 65 $ $ $ $ $ $ $ $ $91.26 $84.87 $ $ $ $ $ $ $ $ $ $ $ $ $92.79 $86.29 $ $ $ $ $ $ $ $ $ $ $ $ $94.32 $87.71 $ $ $ $ $ $ $ $ $ $ $ $ $96.62 $89.85 $ $ $ $ $ $ $ $ $ $ $ $ $98.92 $92.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $94.14 $ $ $ $ $ $ $ $ $ $ $ $ $ $96.29 $ $ $ $ $ $ $ $ $ $ $ $ $ $98.43 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ *Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex.

15 Parts of Medicare The Medicare program has several different parts, which can be confusing if you re unfamiliar with them. A Medicare supplement works with your Medicare Part A and Part B coverage. Part A Part B Part D Hospital care Skilled nursing facility care Nursing home care Hospice Home health services Medically necessary outpatient services to diagnose or treat your medical condition Most preventive outpatient services, including an annual wellness exam Stand-alone prescription drug plans (PDP) help pay for medications Mail order options and access to retail pharmacies nationwide Limitations and exclusions No insurance policy covers everything. Here s a list of things this Medicare supplement doesn t cover: Personal comfort items Routine physical exams and any related diagnostic, X-ray, and laboratory tests except those covered by Medicare Eye exams or hearing exams, except for those services covered by Medicare Orthopedic shoes or other supporting devices for the feet Routine foot care not covered by Medicare Custodial care, including maintenance care or supportive care Cosmetic surgery, except as stated in the policy Outpatient prescription drugs Professional services not provided by a physician, except as required by law Routine immunizations, except if eligible under Medicare and except as stated in the policy Preparation, fitting, or purchase of eyeglasses or hearing aids, unless covered by Medicare Care, treatment, filling, removal, or replacement of teeth; dental X-rays, root canals, surgery for impacted teeth, or other surgical procedures to the teeth or supporting structures Nursing home care costs beyond what is covered by Medicare If you terminate your Medicare coverage, expenses which would have been covered by Medicare r Medicare Part A deductible, unless you purchase full or partial coverage of the Medicare Part A deductible r Medicare Part B deductible, unless you purchase Plan C or F Physician charges above Medicare s approved charge, unless you purchase Plan F or G Home health care beyond what is covered by Medicare Any health care treatments, services, or supplies received outside the United States, unless you purchase Plan C, F, G, or N Any health care treatments, services, or supplies: - Not covered by Medicare, unless specifically stated in the policy -, or anyone on your behalf, aren t legally obligated to pay for - Paid for by Medicare or another government entity or program - For any injury, occurring on or after your effective date, caused by an act of war - To the extent covered by worker s compensation or similar laws - Provided before the effective date of coverage or after coverage ends - Determined by Medicare to be unreasonable or unnecessary - For a military service-related condition treated at any military or veterans hospital, or at any hospital contracted by any national government or agency WPS Medicare Companion 15

16 Ready to take the next step? Contact your local agent or call WPS today at Medicare supplement insurance helps give you peace of mind Original Medicare covers a lot about 80% of your approved health care costs. But covering even just the 20% that Medicare leaves behind can be a real burden and hassle. WPS Medicare Companion, a Medicare supplement plan, helps reduce these out-of-pocket costs when you need medical care. Join our WPS Medicare Companion family today and get worry-free peace of mind you ll enjoy for years to come! The EPIC Life Insurance Company A WPS Company This is an advertisement for insurance. Neither Wisconsin Physicians Service Insurance Corporation, nor The EPIC Life Insurance Company, nor their products nor agents are connected with or endorsed by the United States government or the federal Medicare program. WPS Health Insurance is underwritten by The EPIC Life Insurance Company. This plan summary provides only a general description of benefits and limitations. A detailed description of coverage is in the applicable policy. If there is ever a discrepancy between the policy and this document, the policy has final authority. AZ_SALES_ All rights reserved. JO