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1 Endorsed by: National Active and Retired Federal Employees Association Name: Add 1: Add 2: City, St., Zip: Last First MI TO ENROLL: Send this completed form with your premium check payable to: ADMINISTRATOR NARFE GROUP INSURANCE PROGRAM P.O. BOX Des Moines, IA QUESTIONS? Call: Underwritten by: a Transamerica company 4333 Edgewood Road N.E.. Cedar Rapids, IA Yes, enroll me in the NARFE Cancer Plan. I understand I will have 30 days to review my Certificate /31337/ 1018/

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5 Cancer Insurance Plan For National Active and Retired Federal Employees Association Members and Their Families PROTECTING YOURSELF According to the Cancer Facts and Figures 2013, in the US, men have slightly less than a 1 in 2 lifetime risk of developing cancer; for women, the risk is a little more than 1 in 3.* Fortunately, advances in cancer treatment are saving more lives than ever before. With these advances in care, however, come rising health care costs. There are hospital expenses, specialists' fees, prescription drugs, operations, day and night nursing care, therapists...and more. Most medical plans don't cover all of the costs of cancer treatment, and that's why you should consider the benefits of this Plan. It provides you with cash benefits to help cover the costs of cancer treatment and other incidental costs. That means it pays you benefits regardless of any other coverage you have. If you're on Private Insurance Health plans are struggling for profitability as health care costs continue to rise. Insurers and employersthe major buyers of health plansare turning to sterner measures to contain costs. If you haven't looked at the fine print on your insurance policy recently, make sure you do so BEFORE you get sick. *These statistics have been made available by "Cancer Facts and Figures, 2013." WHAT YOU CAN DO ABOUT IT 1. Take Charge No one has a greater stake in your health care than you do. Do not be passive and don't accept everything you're told. Educate yourself and ask questions. The most helpful is to ask your doctors: "What would you do if you were me?" 2. Have More than One Source of Help The problems that come with fighting cancersearching for research hospitals, managing symptoms and side effects, understanding what the specialist is sayingall are more difficult when you don't have enough money. Many NARFE members and their families rely on the NARFE Cancer Insurance Plan as a second source of help. You can, too (if you haven't had cancer in the past ten years). It covers you, plus your spouse and children under age 19 (under age 22 if full-time student) when you select family coverage. Please note: dependent eligibility ages vary by state. Your Certificate/Policy will provide the full details. You can go anywhere in the U.S. for care and use whatever doctor you choose. There are no networks or lists of "preferred providers." Once your application is approved, your coverage becomes effective on the first of the month after you've paid your first premium. Your rates won't increase if you get cancer, and your coverage can't be canceled as you get older. The only way your rates will increase is if they are increased for everyone in the group, no matter how many claims you submit. And your protection will never be canceled as long as the master policy stays in force for the entire group, you pay your premiums and you remain a NARFE member. Monumental Life has the right to increase premiums on any premium due date with 31 days notice to you, rates may increase if the group master policy changes. #'%$'$' The NARFE Cancer Insurance Plan Pays Cash Benefits Directly to You or to Anyone You Choose And It Pays REGARDLESS OF Other Coverage You Have Hospital Confinement$ daily per illness period, days Extended Hospital Expense100% of hospital charges in lieu of any other benefits up to $6, a month after 90 consecutive days. If you leave the hospital and then return within 45 consecutive days, as is common, your benefit period picks up from your last "benefit day." Private Duty Nurse$30.00 daily to $ per illness period for private duty nursing care while hospitalized for cancer. Attending Physician$20.00 daily for doctor's visits(other than your surgeon) while in the hospital. Surgical10% of actual charges up to $1, per operative session. No limit on the number of surgeries covered. Anesthesia$ per operative session, except skin cancer, for which you receive $40.00 per removal session. No limit on the number of procedures. Blood & Plasma$ per illness period for pints of blood and plasma costs. No limit for leukemia up to the overall lifetime maximum. Chemotherapy & Radiation$1, per illness period (including x-ray, radium and cobalt treatments). Skin Cancer RemovalUp to $62.50 for the initial incision, $25.00 per additional incision. Ambulance Service$50.00 for each ambulance trip to or from the hospital or skilled nursing facility maximum per illness $500. Second Opinion Benefit$ per illness period to receive a second medical opinion about your initial cancer diagnosis. First Occurrence$1, for one time only if you are diagnosed as having cancer. (Excludes skin cancer.) (Not available in MN) Wellness Care Benefit50% of the actual cost for covered screenings; $50.00 annual maximum benefit for the mammography screening and diagnostic radiology/imaging benefit. Miscellaneous Hospital Expense$1, per illness period for drugs, medicine and medical supplies necessary for the treatment of cancer. The lifetime maximum amount for all above benefits is $500, 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. Monumental Life has the right to change premiums on any premium due date with 31 days notice to the insured. Premiums may also change if the group master policy changes

6 How to Enroll 1. Complete, date, and sign the Enrollment Form. 2. Mail it in the postage-paid envelope to: ADMINISTRATOR NARFE GROUP INSURANCE PROGRAM P.O. Box Des Moines, IA Be sure to include your first quarterly premium payment payable to NARFE Insurance Services. All billing modes except annual will include a $2.00 billing fee. To avoid the fee, select EFT as a safe and secure payment option. QUESTIONS? Once you receive your Certificate, take 30 days to look it over. If you decide the NARFE Cancer Insurance Plan isn't for you, simply return it within 30 days and receive full refund of any premiums paid. Researched and Tailored for our Members Exclusions Benefits will not be paid under this Policy and any attached Rider for any expenses which result from:. injury or sickness other than Cancer;.expenses the Cover Person is not legally obligated to pay or those charged only because you have insurance;. treatment or services preformed outside of the United States. Pre-existing Condition Limitation No benefits will be payable for the Covered Person's Pre-Existing Conditions. They are defined as a Cancer that was positively diagnosed within 10 year(s) prior to the Covered Person's Effective Date of Coverage under the Group Policy, or a Cancer for which treatment has been received before the Covered Person has been insured for 30 days from his Effective Date of Coverage (N/A in AZ, MN, MO and OK). We will, however, pay benefits for Cancer diagnosed and treated within the first 30 days the Covered Person has been insured only if incurred after coverage has been in force for 12 consecutive months from the Effective Date. Any increase in benefits will be subject to a new Effective Date of Coverage on that increased amount or benefits only. A Notice About Monumental's Privacy Policy 1. We do not sell your personal information to anyone. 2. We may collect nonpublic personal 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 non-affiliates, 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. Administered by: Marsh U.S. Consumer, a service of Seabury & Smith, Inc. P.O. Box Des Moines, IA AR Ins. Lic. # CA Ins. Lic. # d/b/a in CA Seabury & Smith Insurance Program Management This plan is underwritten by Monumental Life Insurance Company. Monumental Life Insurance Company is a Transamerica company and is one of the oldest and largest life insurance companies in the US. Monumental Life Insurance Company is rated A+ (Superior, 2 nd of 16 ratings categories) for financial strength by A.M. Best Company as of April 13, 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. THIS IS A CANCER ONLY POLICY Underwritten by: a Transamerica company 4333 Edgewood Road N.E. Cedar Rapids, IA This brochure provides a brief description of the benefits available. Complete details may be found in Group Policy Form No. CA 1000GPM, Policy No. MZ H0000A, Certificate Form No. CA1000GCM.series. Benefits may vary by state. Coverage may not be issued to residents of all states. You'll be billed quarterly. œseabury & Smith, Inc. May 2013 * * CA187PA #'%$'$'

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