AFFORDABLE SHORT-TERM, PPO

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1 THE #1 HEALTH INSURER IN ILLINOIS NOW OFFERS AFFORDABLE SHORT-TERM, HEALTH INSURANCE COVERAGE SelecTEMP PPO INDIVIDUAL AND FAMILY HEALTH INSURANCE it just fits.

2 SelecTEMP PPO Individual, Family and Children s Temporary Health Insurance Coverage from Blue Cross and Blue Shield of Illinois We are pleased to present our unique range of temporary health insurance plans for individuals and families. Each plan is backed by the financial strength and stability of Blue Cross and Blue Shield of Illinois. While each of our health care plans is tailored to the needs and budgets of Illinois individuals and families, all of the plans have a number of features and benefits in common, including: $5,000,000 in lifetime benefits, hospital and surgical services, emergency benefits, membership card recognition nationwide and savings on health care products and services through our Members First Discount Program. We are confident that Blue Cross and Blue Shield of Illinois has a health care plan that is right for you. Regardless of the plan you select, you will benefit from the experience, expertise and stability of the leading health insurer in Illinois. Specific Product Highlights Apply on-line today, you may have coverage as soon as tomorrow Get basic protection against unexpected accidents or illness Choose from one or up to six months of coverage Freedom to choose providers from one of the largest contracting hospital and physician networks in Illinois Up to $5,000,000 in lifetime coverage Save with our Members First Program at no additional cost

3 If you find yourself temporarily without health insurance coverage because COBRA is too expensive, you are in between jobs, or waiting for employer coverage to begin, SelecTEMP PPO is the plan for you. No matter how well you take care of yourself, unexpected health issues sometimes arise. SelecTEMP PPO is individual health insurance coverage that provides you, your spouse and your children essential, basic protection against unexpected accidents or illness. SelecTEMP PPO offers various benefit periods and deductibles to give you the control to tailor coverage, premium rates and out-of-pocket expenses according to your own needs. SelecTEMP PPO is an affordable short-term, limited duration insurance plan. With SelecTEMP PPO you get choices.you can design the plan that best fits your time frame and budget.you can choose: The date you want the coverage to begin The coverage period one, two, three, four, five or six months The deductible from $500 to $5,000

4 SelecTEMP PPO SHORT-TERM, LIMITED DURATION HEALTH INSURANCE COVERAGE FOR MANY OF THE MOST COSTLY HEALTH CARE SERVICES Strong benefits for hospitalization, surgery and more SelecTEMP PPO provides benefits for the hospital and medical/surgical services you need to help protect your financial security. SelecTEMP PPO offers you: Inpatient/outpatient medical/surgical services Emergency care Inpatient/outpatient hospital services Diagnostic services (lab and X-ray) Office visits Prescription drug coverage Physical, occupation and speech therapy A Choice of Benefit Periods and Deductibles to Fit Your Budget You can choose a benefit period of one, two, three, four, five or six months, depending on your needs. A deductible is the amount for which you are responsible before the plan begins to pay benefits for covered services. SelecTEMP PPO gives you the flexibility of choosing a $500, $1,000, $1,500, $2,000, $2,500 or $5,000 deductible. Given this range of choice, you are certain to find an option that fits your budget. 80% Coverage Level Helps Control Your Costs The coverage level (percentage) that SelecTEMP PPO pays for covered services after you meet your deductible is called coinsurance. SelecTEMP PPO will pay 80% of covered expenses after you ve met your deductible when you use PPO hospitals and physicians. That means you pay 20% of your eligible bills until you ve paid $1,000. When you reach that point, SelecTEMP PPO will pay 100% of covered services for the remainder of your contract term. Freedom of Choice SelecTEMP PPO is supported by one of the largest contracting hospital and physician networks in Illinois. In fact, with more than 200 Illinois hospitals included, it s likely that hospitals near you participate.

5 Who is Eligible? Illinois residents may apply for family coverage if the applicants are at least 60 days of age and under 65 years of age. Applicants must not be entitled to Medicare benefits. For an individual children s policy, the child must be at least one year of age. Each child applying for coverage will need a separate application. You can choose coverage for yourself, your spouse and children under a single contract. You can also select coverage for a spouse-only or children-only contract. Coverage is not renewable. However, you may purchase up to two successive policies if you meet eligibility requirements for the health care plan. You must complete a new application for each policy and send it in for approval with the appropriate premium. If you answer yes to any of the health questions on the application you will be declined. If you are not a legal U.S. citizen, or a non-resident alien who has not lived in the United States for two years your application will also be declined. Pre-existing Conditions Limitation Pre-existing condition means any disease, illness, sickness, malady or condition which was diagnosed or treated by a Provider within 12 months prior to your Coverage Date, or which produced symptoms within 12 months prior to your Coverage Date which would have caused an ordinarily prudent person to seek medical diagnosis or treatment. Pre-existing conditions are not covered under this policy. When does SelecTEMP PPO coverage begin? The benefit period begins on the date requested by the applicant after signing the application and within 45 days of the signature date. If no specific date for coverage is requested, then the policy will become effective the day after the postmark date affixed by the U.S. Post Office. If the envelope containing the application is not postmarked by the U.S. Post Office, or if the postmark is not legible, the effective date will be the later of: the requested effective date; or the date received by Blue Cross and Blue Shield of Illinois Your completed signed and dated application and the entire premium must be received by Blue Cross and Blue Shield of Illinois within 10 days of the signature date. You must include the entire premium for your term of coverage with your submitted application. If we do not receive the entire premium payment amount, the processing of your application will be delayed.

6 SelecTEMP PPO Includes This Unique Combination of Features from Blue Cross and Blue Shield of Illinois T H E S E C U R I T Y O F $ 5, 0 0 0, I N L I F E T I M E P R O T E C T I O N S With SelecTEMP PPO, each person will be eligible for up to $5,000,000 in lifetime benefits. That s substantial protection for a limited, short-term durability plan. Travel with Confidence You re Covered Away from Home As a member of Blue Cross and Blue Shield of Illinois, you ll have access to a program called BlueCard PPO. This is a nationwide network of contracting providers that allows you to receive benefits for covered services when you travel. Simply present your Blue Cross and Blue Shield of Illinois ID card to a participating BlueCard PPO provider wherever you are. To find a participating provider while you re away, just call the toll-free number on the back of your card. It s that easy! Financial Stability You Can Count On Today one American in three carries a Blue Cross and Blue Shield membership card. In fact, over 6.5 million residents across Illinois Carry the Caring Card because they trust Blue Cross and Blue Shield of Illinois to give them more health care value for their premium dollar. Blue Cross and Blue Shield of Illinois has been servicing the health insurance needs of Illinois residents for more than 65 years.we re one of the largest and most financially secure insurance companies in the state. A.M. Best, one of the leading rating agencies of the insurance industry, has awarded us an A+ (Superior) rating.* We re here to stay! No Paperwork Your Claims are Handled For You In most cases, all you have to do is show your Blue Cross and Blue Shield ID card at the doctor s office or hospital, and your claim will be filed for you.we want you to concentrate on regaining your health not worrying about hospital and doctor bills. *As of November 2007

7 Members First Substantial Savings on Dental, Vision, and Hearing Care Products and Services... E X C L U S I V E LY F R O M B L U E C R O S S A N D B L U E S H I E L D O F I L L I N O I S Members First is a money-saving discount program* that automatically comes with SelecTEMP PPO. You and your covered family members will receive Members First identification cards for on-the-spot savings on dental, vision, hearing care products and services and chiropractic care. You can even save on vitamins and nutritional supplements. Members First is not insurance and adds nothing to the cost of your coverage.you re free to use the Members First discounts as often as you wish. With the cooperation of thousands of licensed professionals and providers all across the country, we have been able to secure lower prices for Blue Cross and Blue Shield members on a wide range of health care items and services. To receive Members First discounts, you need only present your Members First ID card to a participating provider, and then pay the provider directly for the item purchased or services rendered. Save Up to 60% on Vision Care Save on eyeglasses and contact lenses at more than 12,000 participating locations nationwide, including LensCrafters, Sears, JCPenney, and Pearle Vision. You ll also be entitled to discounts on eye examinations and surgical procedures, including Lasik surgery where available. Save Up to 40% on Dental Care Save on routine and extensive dental care treatments (such as root canals, crowns, and dentures) at more than 19,000 participating providers located all across the country. Save Up to 20% on Hearing Care Services Save up to 20% on hearing aids, and get discounts on consultations and hearing aid evaluations from one of the largest network of audiologists in the U.S. Save Up to 40% on Chiropractic Care Save at nearly 300 participating chiropractors across Illinois with unlimited visits for care. Save on Vitamins and Nutritional Supplements Through Mail Order Choose from a variety of vitamins and nutritional supplements and save 30% to 50% on already-low mail-order catalog prices. The Members First Discount Program is our way of saying Thank You for being a Blue Cross and Blue Shield of Illinois member. No additional charge for delivery of diabetes testing supplies from Liberty With this service, you can have blood glucose testing strips, lancet strips and lancet devices, insulin and syringes delivered right to your home. There s no additional charge for shipping, and you ll get a friendly reminder when it s time to reorder. Save with over $350 in grocery coupons You choose the coupons you want from hundreds of nationally advertised brand names. Shop at your favorite grocery store and watch the savings add up! * For specific details related to your health care savings program, please refer to the Members First discount brochure.

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9 (POLICY DB-53 HCSC) SelecTEMP PPO With your choice of deductibles. O U T L I N E O F C O V E R A G E 1. THIS IS A SHORT-TERM LIMITED DURATION POLICY THAT IS NON-RENEWABLE. 2. READ YOUR POLICY CAREFULLY This outline of coverage provides a brief description of the important features of your Policy. This is not the insurance contract, and only the actual Policy provisions will control. The Policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READYOUR POLICY CAREFULLY! 3. SelecTEMP PPO Coverage SelecTEMP PPO coverage is designed to provide you with economic incentives for using participating health care providers. It provides, to persons insured, coverage for major Hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily Hospital room and board, miscellaneous Hospital services, surgical services, anesthesia services, In-Hospital medical services, and Out-of-Hospital care, subject to any Deductibles, Copayment provisions, or other limitations which may be set forth in the Policy. Although you can go to the Hospitals and Physicians of your choice, your benefits under the SelecTEMP PPO plan will be greater when you use the services of designated Hospitals and Physicians. BASIC PROVISIONS SelecTEMP PPO Benefit Period Options 1 month, 2 months, 3 months Participating Non-Participating 4 months, 5 months or 6 months Provider Coverage Provider Coverage Lifetime Benefit $5,000,000 Deductible Per individual (If two or more family members receive covered services as a result of injuries received in the same accident, only one Deductible will apply.) $500* $1,000* $1,000* $2,000* $1,500* $3,000* $2,000* $4,000* $2,500* $5,000* $5,000* $10,000* Family Aggregate Deductible Per family. Equal to two times the individual Deductible Hospital Admission Deductible Per admission, per individual. $0 $300* Coinsurance The level of coverage provided by the plan after the Deductible has been satisfied. Out-of-Pocket Expense Limit The amount of money an individual pays toward covered hospital and medical expenses. Items asterisked (*) do not apply to the out-of-pocket expense limit. 80% 60% $1,000 $2,000 Family Aggregate Out-of-Pocket Expense Limit Equal to two times the individual out-of-pocket limit, per family. $2,000 $4, IL

10 BASIC PROVISIONS SelecTEMP PPO Participating Provider Coverage Non-Participating Provider Coverage Inpatient/Outpatient Physician Medical/Surgical Services 80% 60% Inpatient/Outpatient Hospital Services Includes surgery, pre-admission testing and services received in a skilled nursing facility, coordinated home care program and hospice. 80% 60% Inpatient/Outpatient Hospital Diagnostic Testing Includes, but not limited to, X-rays, lab tests, EKGs, ECGs, pathology services, pulmonary 80% 60% function studies, radioisotope tests, and electromyograms. Physical, Occupational, and Speech Therapist Services ($1,000 maximum combined benefit.) Outpatient Emergency Care (Accident or Illness) For both Hospital and Physician. 80%* 60%* 80% after you pay $75 copayment Additional Surgical Opinion Program Following a recommendation for elective surgery, provides additional consultations and related 100% diagnostic service by a Physician, as needed. Other Covered Services Ambulance services; services of a private duty nursing service ($1,000 per month maximum*); naprapathic services rendered by a Naprapath ($500 maximum*); artificial limbs and other prosthetic devices; oxygen and its administration; blood plasma; leg, arm and neck braces; surgical dressings; casts and splints. Outpatient Prescription Drugs 80% 80% after Deductible $500 maximum Medical Services Advisory (MSA ) The MSA helps you maximize your benefits. The Participating Provider The Policyholder is is responsible for responsible for notifying notifying MSA when MSA for Hospital admissions services are rendered in at Non-Participating a Participating Hospital. and Non-Plan Hospitals. MSA notification is required within three business days for non-emergencies and within one business day or as soon as reasonably possible for emergencies. If Policyholder does not notify MSA, Hospital benefits are reduced by $1,000.* Benefits for covered services are provided at either the Eligible Charge or the Maximum Allowance. Consult the Policy for definitions and your financial responsibility. * Does not apply to out-of-pocket expense limit. Deductible does not apply IL

11 IF USING A NON-PLAN PROVIDER... A $300 per Hospital admission Deductible will apply.* If using a Non-Plan Provider, benefits are reduced to 50%. However, Outpatient Hospital emergency care is paid at 80% after you pay a $75 copayment, regardless of your coverage level or whether services were received from a Participating, Non-Participating or Non-Plan Provider. PRE-EXISTING CONDITIONS LIMITATION Pre-existing Conditions are those health conditions which were diagnosed or treated by a Provider during the 12 months prior to the coverage effective date, or for which symptoms existed which would cause an ordinarily prudent person to seek diagnosis or treatment. Pre-existing Conditions will not be covered under the SelecTEMP PPO health insurance policy. TERMINATION Coverage under this Policy will be terminated for non-payment of premium. In addition, Blue Cross and Blue Shield of Illinois can terminate this policy in the event of fraud or an intentional misrepresentation of material fact under the terms of the coverage, written notice will be given at least 10 days before coverage is discontinued. POLICY IS NOT RENEWABLE Exclusions and Limitations: Hospitalization, Services, and supplies which are not Medically Necessary; Services or supplies that are not specifically mentioned in this Policy; Services or supplies for any illness or injury arising out of or in the course of employment for which benefits are available under any Workers Compensation Law or other similar laws whether or not you make a claim for such compensation or receive such benefits; Services or supplies that are furnished to you by the local, state, or federal government; Services and supplies for any illness or injury occurring on or after your Coverage Date as a result of war or an act of war; Services or supplies that do not meet accepted standards of medical or dental practice; Investigational Services and Supplies, including all related services and supplies; Custodial Care Service; Routine physical examinations; Services or supplies received during an Inpatient stay when the stay is primarily related to behavioral, social maladjustment, lack of discipline, or other antisocial actions which are not specifically the result of Mental Illness; Services and supplies for treatment of Mental Illness; Services and supplies for treatment of Substance Abuse; Services and supplies for treatment of Temporomandibular joint dysfunction and related disorders; Cosmetic Surgery and related services and supplies, except for the correction of congenital deformities or for conditions resulting from accidental injuries, scars, tumors, or diseases; Services or supplies for which you are not required to make payment or would have no legal obligation to pay if you did not have this or similar coverage; Charges for failure to keep a scheduled visit or charges for completion of a Claim form; Personal hygiene, comfort, or convenience items commonly used for other than medical purposes, such as air conditioners, humidifiers, physical fitness equipment, televisions, and telephones; Special braces, splints, specialized equipment, appliances, ambulatory apparatus, battery controlled implants, except as specifically mentioned in this Policy; Eyeglasses, contact lenses, or cataract lenses and the examinations for prescribing or fitting of glasses or contact lenses or for determining the refractive state of the eye, except as specifically mentioned in this Policy; Treatment of flat foot conditions and the prescription of supportive devices for such conditions and the treatment of subluxations of the foot or routine foot care; Immunizations, unless otherwise stated in this Policy; Maintenance Occupational Therapy, Maintenance Physical Therapy, and Maintenance Speech Therapy; Speech Therapy when rendered for the treatment of psychosocial speech delay, behavioral problems (including impulsive behavior and impulsivity syndrome), attention disorder, conceptual handicap, or mental retardation; Hearing aids or examinations for the prescription or fitting of hearing aids; Diagnostic Service as part of routine physical examinations or check-ups, premarital examinations, determination of the refractive errors of the eyes, auditory problems, surveys, casefinding, research studies, screening, or similar procedures and studies, or tests which are Investigational, unless otherwise specified in this Policy; Procurement or use of prosthetic devices, special appliances, and surgical implants which are for cosmetic purposes, or unrelated to the treatment of a disease or injury; Services and supplies provided for the diagnosis and/or treatment of infertility including, but not limited to, Hospital services, Medical Care, therapeutic injection, fertility and other drugs, Surgery, artificial insemination, and all forms of in-vitro fertilization; Maternity Service, including related services and supplies (Complications of Pregnancy are covered as any other illness). Services and supplies for muscle manipulation; LongTerm Care; Inpatient Private Duty Nursing Service; Maintenance Care;Wigs (also referred to as cranial prosthesis); and Services and supplies rendered or provided for human organ or tissue transplants other than those specifically named in this Policy. * Does not apply to out-of-pocket expense limit IL A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association CONSUMER MARKETS Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans Registered Service Mark of Health Care Service Corporation

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14 SelecTEMP PPO Rates Effective July 1, 2008 Area 1 Deductible Age Male Female Male Female Male Female Child Children Deductible Age Male Female Male Female Male Female Child Children Area 2 Deductible Age Male Female Male Female Male Female Child Children Deductible Age Male Female Male Female Male Female Child Children Area 3 Deductible Age Male Female Male Female Male Female Child Children Deductible Age Male Female Male Female Male Female Child Children Area 4 Deductible Age Male Female Male Female Male Female Child Children Deductible Age Male Female Male Female Male Female Child Children

15 N E W B U S I N E S S C H E C K L I S T I M P O R T A N T! Use this checklist to make sure you ve completed all needed information. Have you: Reviewed each application to verify that it is complete and legible? Assure quick processing of all applications In order to process your application, you must include a check for the entire premium payment. Any Questions? Call Toll-Free Included all the necessary signatures on the application? Determined your premium by using the zip code table and rate table contained in this booklet and the rate worksheet on the back of the application? Enclosed a check for the entire premium amount, made payable to Blue Cross and Blue Shield of Illinois? Apply on-line

16 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans Registered Service Marks of Health Care Service Corporation IL