Accident & Illness Protection Packages

Transcription

1 Accident & Illness Protection Packages The MEGA Life and Health Insurance Company SM HealthMarkets is the brand name for products underwritten and issued by the insurance subsidiaries of HealthMarkets, Inc. The Chesapeake Life Insurance Company, Mid-West National Life Insurance Company of Tennessee SM and The MEGA Life and Health Insurance Company. SM M PKG A 709_709

2 Table of Contents 1 Important Facts to Consider 2 Accident & Illness Protection Packages Benefit Descriptions 4 Daily Hospitalization Benefit 5 Lump Sum Accident Benefit 6 Lump Sum Specified Disease Benefit 7 Monthly Disability Accident Only Benefit 8 Monthly Disability Accident & Illness Benefit 9 Monthly Disability Accident Only and Accident & Illness Benefit 10 Exclusions & Limitations (may vary by state) 12 Other Important Information 14 State Variations 15 Acknowledgement of Receipt

3 Important Facts to Consider In 2006, approximately 33.2 million people sought medical attention with three million of those hospitalized for injuries. The economic impact of these injuries amounted to $684.4 billion in 2007, with $344.4 billion were attributable to lost wages and productivity $134.0 billion were attributable to medical expenses Unintentional-injury deaths were up 2% in 2006 compared to the revised 2005 estimate Unintentional-injury deaths were estimated to total 120,000 in 2006 and 118,000 in 2005 About 28.4 million were treated in hospital emergency departments and about 5.4 million visits to hospital outpatient departments were for unintentional injuries About 40.9 million visits to physicians' offices were for unintentional injuries. The economic impact of these fatal and nonfatal unintentional injuries amounted to $652.1 billion in This is equivalent to about $2,200 per capita, or about $5,700 per household. These are costs that every individual and household pays whether directly out of pocket, through higher prices for goods and services, or through higher taxes. The MEGA Accident and Illness Protection Packages offer additional protection that can help offset these unforeseen medical expenses. We will not provide benefits for any loss resulting from a pre-existing condition, as defined within the Exclusions and Limitations and the state variations. National Safety Council Injury Facts, 2008 & 2009 Edition ( ) M PKG A 709 1

4 Accident & Illness Protection Packages It s been said the most important thing a person has is their health, but an accident or illness can happen without warning. Being hospitalized and unable to work is bad enough but it s even worse if you can t pay the bills. Our Accident and Illness Protection Packages can help if you are injured, sick or unable to work. These packages pay a cash benefit to you to use as you see fit. With an Accident and Illness Protection Package, you'll feel better knowing that if an accident or illness occurs, you will have some financial assistance to help with your expenses. MEGA Benefit Packages from HealthMarkets accident and illness protection that FITS your life. Pays a cash benefit directly to you Use the benefit dollars any way you choose Pays a benefit in addition to any other coverage you may have 2 M PKG A 709

5 PACKAGE OPTIONS Packages Daily Hospitalization Benefit Lump Sum Accident Benefit Lump Sum Specified Disease Monthly Disability Accident Only Monthly Disability Accident & Illness ProtectFit - - HospitalFit - - CombinedFit - ProtectFit -Accident Protection Package Coverage on or off the job, unless covered by Workers' Compensation or similar plan. The ProtectFit Package includes a daily hospital benefit, lump sum accident payment, and accident only disability income protection in a single package. Benefits are payable directly to you to help cover medical costs and supplement potential lost income. ProtectFit offers coverage 24 hours a day, 7 days a week, while in the U.S. or Canada. HospitalFit -Hospital Protection Package An unexpected hospital stay or a critical illness could quickly impact your lifestyle. The HospitalFit Package can help protect what you have worked so hard to earn. The HospitalFit Package includes daily hospital benefit, a lump sum specified disease benefit, and disability income protection for both accidents and illnesses, which are paid directly to you. CombinedFit -Accident & Hospital Protection Package CombinedFit includes features of our Protectfit and HospitalFit plans into a single package and provides daily hospital confinement benefit, lump sum cash benefits, and disability income coverage for both illnesses and accidents. Benefits that are payable directly to you to use as you see fit, and are payable in addition to any other coverage you may have. M PKG A 709 3

6 Daily Hospitalization Benefit (Direct Benefit Plan) - A Hospital Confinement Indemnity Plan This plan is a hospital confinement indemnity insurance plan that pays a cash benefit directly to you. You may use your benefit any way you want. Benefits increase for intensive care hospital confinement. Benefits Benefits are payable for each day of medically necessary hospital confinement of an insured person due to an injury or covered sickness 1 after satisfaction of the 30-day waiting period 2 (measured from your effective date of coverage) up to the lifetime maximum as follows: Lifetime Maximum Benefit: 365 days of hospital confinement DAILY HOSPITALIZATION BENEFIT AMOUNT $250 per person Services Hospital Confinement Benefit 1-5 days 100% of the daily benefit amount 6-10 days 50% of the daily benefit amount 11+ days $100 per day ICU/CCU Confinement Benefit (pays in lieu of hospital confinement benefit) 1-2 days 200% of the daily benefit amount 3-10 days 100% of the daily benefit amount days 50% of the daily benefit amount 31+ days $100 per day Additional Benefits Operating Room Benefit for inpatient only Ambulance Benefit Member Benefit 100% of the daily benefit amount paid in addition to the daily confinement benefit $250 for ground ambulance transportation when admitted to a hospital Continued Care Benefit 3 $50 per day for skilled nursing / private duty nursing / home health care / hospice care 1 Sickness means an illness or disease which first occurs after the insured person s coverage becomes effective and while coverage is in force. 2 A waiting period of 30 consecutive days, measured from your effective date of coverage, applies to sickness. No waiting period applies to a hospital confinement due to injury. 3 There is a 30-day lifetime maximum for continued care benefits. Care must begin within seven days after confinement in a hospital ( for skilled nursing care) or in a skilled nursing facility or hospital ( for home health care/private duty nursing ) for the same sickness or injury from that confinement. Hospice Care applies to an insured person who has less than six months life expectancy and care is provided to reduce or abate pain and not for a cure. Form C, or its state variation Daily Hospitalization Benefit available with ProtectFit, HospitalFit and CombinedFit. See Exclusions & Limitations and State Variations. 4 M PKG A 709

7 Lump Sum Accident Benefit (Accident Advantage Plan) - An Accidental Injury Only Insurance Plan Benefits payable for accidental injuries Benefit amount paid directly to you Covers you 7 days a week and 24 hours a day, on or off the job, while in the U.S. or Canada Benefits This is an Accidental Injury Only Insurance Plan. It does not cover sicknesses. This Accident Plan is not a replacement for Workers' Compensation and should not be construed as such. All benefits are subject to the maximum benefit per year, the exclusions and limitations of the plan and any other provisions of the Certificate. Benefits are payable for accidental injuries that result in a hospitalization within 45 days of that accidental injury. Once the benefit amount selected is exhausted for each person, no further benefits will be available for that person for the remainder of that plan year, except for common accidents, as shown below. LUMP SUM ACCIDENT BENEFIT AMOUNT $10,000 per person, per year The benefit amount will be payable according to the following schedule Event Benefit Amount Accidental Injury Benefit 14 days or more of hospital confinement with or without surgery 100% 7 to 13 days of hospital confinement with or without surgery 60% 3 to 6 days of hospital confinement with or without surgery 30% 2 days of hospital confinement with surgery requiring general anesthesia 30% Less than 2 days of hospital confinement No benefit payable Common Accidental Injury Benefit (pays in addition to the Accident Injury Benefit) 3 or more days of hospital confinement with or without surgery; 2 or more days of hospital confinement with surgery requiring general anesthesia (at least 2 or more insured persons must be injured in the same accidental injury to qualify) Less than 2 days of hospital confinement 50% of accidental injury benefit amount (limited to one common accidental injury benefit amount under the Certificate per year) No benefit payable Common Accidental Injury Benefit If at least two insured persons involved in a common accident qualify for the common accidental injury benefit amount shown in the Certificate schedule, we will pay such amount in addition to any available accidental injury benefit amounts for such insured persons involved in the common accident. In the event any or all insured persons involved in the common accident have exhausted their available accidental injury benefit amounts, only the common accidental injury benefit amount will be paid for such insured persons. Only one common accidental injury benefit amount will be payable under the Certificate per year, regardless of how many common accidents occur, or which insured persons are/are not involved in a common accident within that year. Form C, or its state variation Lump Sum Accident Benefit available with ProtectFit and CombinedFit. See Exclusions & Limitations and State Variations. M PKG A 709 5

8 Lump Sum Specified Disease Benefit (Critical Care Plus Plan) - A Limited Benefit Insurance Plan for Specified Disease/Condition or Major Organ Transplant Pays one-time lump sum benefit directly to you upon first occurrence diagnosis of the below listed specified diseases. Pays IN ADDITION to any other existing coverage Use the money for any purpose you want Includes an organ donor benefit Benefits This benefit provides assistance with additional expenses such as deductibles, co-payments, experimental treatment, transportation and lodging, home modifications, or whatever you choose. LUMP SUM SPECIFIED DISEASE BENEFIT AMOUNT $10,000 per person Provides a one-time lump sum benefit upon a First Occurrence Diagnosis, subject to the 30-day waiting period and the qualification period for that condition. Event Qualification Period Maximum Benefit Amount Type A Event Alzheimer s Disease, Benign Brain Tumor, Coma, Heart Attack,Life-Threatening Cancer Major Organ Transplant (Heart, Lung(s), Liver, Kidney, Pancreas, Heart/Lung combined or Bone Marrow) 30 Days 100% Stroke Multiple Sclerosis, Renal Failure Type B Event Coronary Angioplasty Coronary Bypass Surgery 60 Days 90 Days 30 Days 25% Organ Donor Benefit When you require a major organ transplant, we pay you 100% of the total first occurrence benefit and we pay 25% of the total first occurrence benefit to the major organ donor, whether or not they are an insured person. Definitions First Occurs, First Occurred or First Occurrence - With respect to a major organ transplant qualifying event means a major organ transplant performed on an insured person while the Certificate is in force for such insured person. With respect to all other qualifying events, first occurs, first occurred or first occurrence means diagnosis, treatment, surgery or advice by a physician or manifested symptoms having initially occurred for the first time in the insured person's lifetime and while the Certificate is in force for the insured person. Qualification Period - The period of time beginning on the date of the insured person's surgery or physician's first diagnosis of a qualifying event that continues for the duration of the period stated in the Certificate schedule for that disease, condition or procedure. Waiting Period -The consecutive period of time beginning from the effective date of coverage in which an insured person must be insured under the Certificate before a qualifying event first occurrs. Form C, or its state variation Lump Sum Specified Disease available with HospitalFit and CombinedFit. See Exclusions & Limitations and State Variations. 6 M PKG A 709

9 Monthly Disability Accident Only Benefit (Income Protection Plan) - An Accident-Only Disability Income Insurance Plan Benefit paid directly to you Provides protection on and off the job Use benefit as you choose Benefits The Monthly Disability Accident Only Benefit provides a monthly total disability benefit if you become totally disabled, due to an accident only, while you are insured under the plan and are actively employed. Your monthly total disability benefit will begin on the first day following the elimination period. MONTHLY INDEMNITY AMOUNT 1 $500 per person The monthly indemnity benefit will be the lesser of this amount or your prior monthly income (as defined in the Certificate). MAXIMUM PERIOD PAYABLE 12 months for each period of total disability ELIMINATION PERIOD 2 30 days The elimination period is the consecutive period of time beginning on the date you are considered totally disabled before the monthly indemnity benefit is payable. Total disability must begin within 30 days of the injury which caused your total disability. 1 Benefit cannot exceed 60% of gross monthly earnings, including other disability income benefits. 2 The elimination period begins on the date you are considered totally disabled. Form C, or its state variation Monthly Disability - Accident Only available with ProtectFit. See Exclusions & Limitations and State Variations. M PKG A 709 7

10 Monthly Disability Accident & Illness Benefit (Income Protection Plus Plan) - A Disability Income Insurance Plan Benefit paid directly to you Provides protection on an off the job Use benefit as you choose Elimination period waived if hospitalized for more than 7 days Benefits The monthly total disability benefit will be the lesser of $500 or your prior monthly income (as defined in the Certificate). The 21-day elimination period is the consecutive period of time before the monthly indemnity benefit is payable. The total disability must commence within 30 days of the sickness or injury that caused your total disability. Your monthly total disability benefit will begin on the first day following the elimination period. MONTHLY INDEMNITY AMOUNT 1 $500 per person MAXIMUM PERIOD PAYABLE 2 36 months for each period of total disability The elimination period will be waived if you are hospitalized for more than 7 days. ELIMINATION PERIOD 21 days The elimination period is the consecutive period of time beginning on the date you are considered totally disabled before the monthly indemnity benefit is payable. Total disability must begin within 30 days of the injury which caused your total disability. INCLUDED BENEFIT RIDER Waiver of Premium Benefit Rider Rider is marketed with the base plan and is not optional. The premium for this rider is packaged with the base plan premium. Additional Benefit Waiver of Premium Benefit Rider (25917 or its state variation) This additional rider will waive disability income insurance premiums on a monthly basis during the period that total disability benefits are payable, after you have been continuously totally disabled for a period of 90 days. Your coverage and its benefits will continue during the benefit period. When you are no longer eligible for the waiver of premium, you can continue your coverage in force by resuming premium payments within 31 days of the date you become ineligible for this benefit. 1 Benefits cannot exceed 60% of gross monthly earnings, including other disability income benefits. 2 Benefit is payable if you become totally disabled while you are covered under the Certificate and are actively at work. Form C, or its state variation Monthly Disability - Accident & Illness available with HospitalFit and CombinedFit. See Exclusions & Limitations and State Variations. 8 M PKG A 709

11 Monthly Disability - Accident Only and Accident & Illness Benefit Commonly Asked Questions What if I m totally disabled for less than a full month? We will pay 1/30th of the monthly indemnity benefit otherwise payable for each day of a period of total disability that is less than a full month. What if I have a recurrent disability? After a period of total disability for which we paid benefits ends, if you become totally disabled again within 12 months from the same or related cause, we will consider it a continuation of the previous period of total disability. If you have been actively at work for more than 12 consecutive months between those two periods of total disability, then we will consider it a new period of total disability. Definitions Actively at Work: 1) working on a permanent basis at least 25 hours per week; and 2) performing the material and substantial duties of your regular job or any other job for which you are qualified by reason of education, training or experience. Injury: Bodily harm caused by an accident resulting in unforeseen trauma requiring immediate medical attention and is not contributed to, directly or indirectly, by disease. The injury must occur after your coverage becomes effective and while coverage is in force. Total Disability or Totally Disabled: Due to injury, you are under a physician's care and unable to engage in any employment or occupation for which you are qualified by reason or education, training or experience, and are not, in fact, actively at work as certified by a physician upon our request. Form C and C, or its state variation M PKG A 709 9

12 Exclusions & Limitations (may vary by state) Daily Hospitalization Benefit (Form C, or its state variation) We will not provide any benefits for loss caused by, resulting from or in connection with: Any care not medically necessary or charges for which benefits are not specifically provided for in the Certificate; Any act of war, declared or undeclared; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Any injury or sickness arising out of, or in the course of, employment for wage or profit, provided the insured person is covered under any Workers Compensation Act, Occupational Disease Act, or similar act or law, unless the insured person is self-employed; Mental or nervous disorders, unless otherwise stated in the Certificate; Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics, or hallucinogens, unless taken as prescribed by a physician; An overdose of drugs, being intoxicated or under the influence of intoxicants, hallucinogens, narcotics or other drugs, unless taken as prescribed by a physician; Mandibular or maxillofacial surgery to correct growth defects after one year from the date of birth, jaw disproportions or malocclusions, or to increase vertical dimension or reconstruct occlusion; Weight loss or modification, or complications arising therefrom, or procedures resulting therefrom, or for surgical treatment of obesity, including wiring of the teeth and all forms of surgery performed for the purpose of weight loss or modification; Breast reduction or augmentation unless necessary in connection with breast reconstructive surgery following a mastectomy performed while insured under the Certificate; Modification of the physical body in order to improve the psychological, mental or emotional well-being of the insured person, such as sex-change surgery; Engaging in an illegal occupation or illegal activity; Care in a nursing home, custodial institution or domiciliary care or rest cures; Payment for care for military service connected disabilities for which the insured person is legally entitled to services and for which facilities are reasonably available to the insured person and payment for care for conditions that state or local law requires be treated in a public facility; Experimental or investigational medicine; Cosmetic surgery; Dental care, treatment or surgery unless necessitated by injury to sound, natural teeth which occurs while insured under the Certificate. (The dental care must be received within one year from the date of injury, and while hospital confined); Normal pregnancy, except for complications of pregnancy while hospital confined; Any treatment or procedure that either promotes or prevents conception or prevents childbirth, including but not limited to: 1) artificial insemination; 2) in-vitro fertilization or other treatment for infertility; 3) treatment for impotency; 4) sterilization or reversal of sterilization; or 5) abortion (unless the life of the mother would be endangered if the fetus were carried to term), unless otherwise stated in the Certificate; Radial keratotomy or any eye surgery when the primary purpose is to correct nearsightedness, farsightedness, astigmatism, or any other refractive error; Routine newborn care; Treatment, services or supplies received outside the U.S. or Canada. However, benefits will be payable for confinement as a result of an acute sickness or injury sustained during the first 30 days of travel outside of the U.S. or Canada. In no event will benefits be payable beyond the first 30 days of travel outside of the U.S. or Canada. Pre-Existing Condition We will not provide benefits for any loss resulting from a pre-existing condition, as defined, unless the loss is incurred at least one-year period after the effective date of coverage for an insured person. A pre-existing condition means a medical condition, sickness or injury not excluded by name or specific description for which: 1) Medical advice, consultation, or treatment was recommended by or received from a physician within the two-year period before the effective date of coverage; or 2) Symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the two-year period before the effective date of coverage. Lump Sum Accident Benefit (Form C or its state variation) We will not provide any benefits for loss caused by, resulting from or in connection with: Sickness Accidental injuries that do not result in a hospital confinement; Accidental injuries that do not first occur while the Certificate is in force for the insured person; Any act of war, declared or undeclared; Active military duty in the service of any country; Participation in a riot, civil commotion or insurrection; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Mental or nervous disorders; Any accidental injury arising out of, or in the course of, employment for wage or profit, provided the insured person is covered under any Workers Compensation Act, Occupational Disease Act, or similar act or law, unless the insured person is self-employed; Operating any motorized passenger vehicle for wage, compensation or profit; Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics, or hallucinogens, directly or indirectly; An overdose of drugs, being intoxicated or under the influence of intoxicants, hallucinogens, narcotics or other drugs, directly or indirectly; Directly or indirectly engaging in an illegal occupation or illegal activity or your being incarcerated; Committing or trying to commit a felony; Accidental injuries resulting from or during travel outside of the U.S. or Canada; and Sky diving, scuba diving below 50 feet, motorized racing, mountaineering, para-sailing, experimental aviation, ultra-light flying, hang-gliding or base jumping. 10 M PKG A 709

13 Lump Sum Specified Disease Benefit (Form C or its state variation) The first occurrence benefit amount is not payable more than once for any one or all of the qualifying events, as defined in the Certificate during an insured person s lifetime. We will not pay any benefits if a qualifying event results from or is caused directly, indirectly, wholly or partly by: War, declared or undeclared, or an act incident to war; Active military duty in the service of any country; Participation in a riot, civil commotion or insurrection; Intentionally self-inflicted injury, while sane or insane; Intentionally medically induced qualifying event, except in the case of a major organ transplant; Committing or trying to commit a felony or any other illegal act; The voluntary intake of drugs or controlled substances, unless taken or administered as prescribed by a physician; Alcohol abuse or alcoholism; Poison, gas or fumes voluntarily taken, absorbed or inhaled and which are not administered on the advice of a physician; Bacterial infection, other than infection occurring simultaneously with or through an accidental cut or wound, or through accidental ingestion of contaminated materials; or Causes for which benefits are not specifically provided in the Policy. We will not pay the First Occurrence Benefit Amount for: A qualifying event, which first occurs within the waiting period as specified in the Certificate schedule; or Any condition that is not diagnosed as a qualifying event; or Loss resulting from any other disease, sickness or incapacity, other than loss resulting from a qualifying event, as defined in the Certificate. This includes any other disease or incapacity which may have been complicated or directly or indirectly affected or caused by a qualifying event or as a result of treatment of a qualifying event. Pre-Existing Condition A medical condition, sickness or injury not excluded by name or specific description for which: 1) Medical advice, consultation or treatment was recommended by or received from a physician within the one-year period before the effective date of coverage; or 2) Symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the one-year period before the effective date of coverage. Monthly Disability Accident Only Benefit and Monthly Disability Accident & Illness Benefit (Forms C and C or their state variations) We may require information regarding pre-tax personal income, allowable business expenses, and other plans, including income tax returns, for periods before and after the start of a period of total disability. Failure to provide such information may result in disqualification for benefit payment under the Certificate. Benefits are subject to coordination with other compensation. We will not provide any benefits for any loss caused by or resulting from: Sickness (for Monthly Disability Accident Benefit) Any act of war, declared or undeclared; Pregnancy or childbirth; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Mental or nervous disorders; Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics, or hallucinogens, unless taken as prescribed by a physician; An overdose of drugs, being intoxicated or under the influence of intoxicants, hallucinogens, narcotics or other drugs, unless taken as prescribed by a physician; Engaging in an illegal occupation or illegal activity or your being incarcerated; Travel in or descent from any vehicle or device for aerial navigation, except as a fare paying passenger in an aircraft operated by a commercial airline (other than a charter airline) on a regularly scheduled passenger trip; or Any condition excluded from coverage by name or specific description. Pre-Existing Condition (for Monthly Disability Accident & Illness) The plan will not cover a pre-existing condition, as defined, unless the loss is incurred at least one year after your effective date of coverage. A pre-existing condition means a medical condition, sickness or injury not excluded by name or specific description for which: 1) Medical advice, consultation or treatment was recommended by or received from a physician within the two-year period before the effective date of coverage; or 2) Symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the two-year period before the effective date of coverage. M PKG A

14 Other Important Information Coverage Begins MEGA requires evidence of insurability before coverage is provided. Once MEGA has approved your application, and you have paid your premium, coverage will begin on the Certificate date shown in the Certificate schedule. Renewability Your Certificate is guaranteed renewable to age 65, subject to MEGA s right to discontinue or terminate coverage as provided in the termination of coverage section of the Certificate. Premium Changes MEGA reserves the right to change the table of premiums, on a class basis, becoming due under the Group Policy at any time and from time to time, provided MEGA has given the Group Policyholder written notice of at least 31 days prior to the effective date of the new rates. The premium may also change due to an increase in the attained age of the insured person. For Monthly Disability Accident Only and Monthly Disability Accident & Illness Benefit, your premium may change based on your occupation. Termination of Coverage Daily Hospitalization Benefit (Form C, or its state variation) Your coverage will terminate and no benefits will be payable under the Certificate and the attached riders, if any: 1) at the end of the period for which premium has been paid; 2) at the end of the period through which premium has been paid following our receipt of your written request of termination; 3) on the date of fraud or misrepresentation by you; 4) on the date we elect to discontinue this plan or type of coverage; 5) on the date we elect to discontinue all coverage in your state; 6) on the premium due date following the date you terminate your membership in the association to which the Group Policy is issued; 7) on the date an insured person is no longer a permanent resident of the United States; or 8) upon attainment of age 65. Lump Sum Accident Benefit (Form C or its state variation) Your coverage will terminate and no benefits will be payable under the Certificate and the attached riders: 1) at the end of the period for which premium has been paid (subject to the grace period shown in the Certificate); 2) on the date you reach age 65; 3) if your mode of premium is monthly, at the end of the period through which premium has been paid following our receipt of your request of termination; 4) if your mode of premium is other than monthly, upon the next monthly anniversary day following our receipt of your request of termination. Premium will be refunded for any amounts paid beyond the termination date; 5) on the date of fraud or misrepresentation by you; 6) on the date we elect to discontinue this plan or type of coverage; 7) on the date we elect to discontinue all coverage in your state; or 8) on the date an insured person is no longer a permanent resident in the United States. Covered Dependent s Coverage Your covered dependent s coverage will terminate and no benefits will be payable on: 1) the date your coverage terminates; 2) the date such dependent ceases to be an eligible dependent; or 3) the date we receive your written request to terminate a dependent s coverage. The attainment of the limiting age for an eligible dependent will not cause coverage to terminate while that person is and continues to be both: 1) incapable of self-sustaining employment by reason of mental retardation or physical handicap; and 2) chiefly dependent on you for support and maintenance, meaning the eligible dependent receives the majority of his/her financial support from you. Lump Sum Specified Disease Benefit (Form C or its state variation) Your coverage and that of your covered dependents will terminate and no benefits will be payable on or after: 1) the date the Certificate terminates; 2) the premium due date on which the premium is not paid, subject to the grace period; 3) the date of qualification for Medicare, at any age, or upon reaching age 65; or 4) the date a first occurrence benefit amount is paid, with respect to each insured person. You may terminate your coverage and that of your covered dependent(s) by providing us with written notice of cancellation. Your coverage and/or that of your covered dependent(s) will be terminated: 1) on the next premium due date, if your mode of payment is monthly; or 2) on the latter of: (a) the date we receive your written notice of cancellation; or (b) your requested termination date, if your mode of payment is other than monthly. If a covered dependent child who has been continued beyond the limiting age as a full-time student ceases to be a full-time student, our liability under the Policy will be limited to a refund of premium from the date the child ceased to be a full-time student. 12 M PKG A 709

15 Termination of Coverage (continued) The attainment of the limiting age for a covered dependent will not cause coverage to terminate while that person is and continues to be both: (a) incapable of self-sustaining employment by reason of mental retardation or physical handicap; and (b) chiefly dependent on you for support and maintenance. Chiefly dependent means the covered dependent receives the majority of his/her financial support from you. Monthly Disability Accident & Illness Benefit and Monthly Disability Accident Only Benefit (Forms C and C or their state variations) Your coverage will terminate and no benefits will be payable under the Certificate and the attached riders, if any: 1) at the end of the period for which premium has been paid; 2) at the end of the period through which premium has been paid following our receipt of your written request of termination; 3) on the date of fraud or misrepresentation by you; 4) on the date we elect to discontinue this plan or type of coverage; 5) on the date we elect to discontinue all coverage in your state; 6) on the date the Group Policy terminates; 7) on the premium due date following the date you terminate your membership in the association to which the Group Policy is issued; 8) on the date an insured person is no longer a permanent resident of the United States; or 9) upon your attainment of age 65. M PKG A

16 State Variations The information provided below summarizes the major variations in coverage by state from those described in this brochure. ALABAMA Direct Benefit Plan - The Pre-Existing Conditions Limitation is revised by replacing the two (2) year period in the definition of Pre-existing condition with one (1) year. Income Protection Plus Benefit - (Form C), The Pre-Existing Condition has been revised by changing two years to twelve months. ARIZONA Income Protection Benefit - (Form C-AZ), For Premium Changes, the notification period is revised by changing 31 days to 60 days. MARYLAND Accident Benefit (Form MD) - Premium Changes... written notice is 45 days. MISSISSIPPI All Plans - For Premium Changes, the notification period is revised by changing "31 days" to "60 days". Income Protection Plus Plan - The definition of Pre-Existing Condition is revised to read "A medical condition, sickness or injury not excluded by name or specific description for which: 1) medical advice, consultation, or treatment was recommended by or received from a physician within the one year period before the effective date of coverage; or 2) symptoms existed which would cause an ordinarily prudent person to see diagnosis, care, or treatment within the one year period before the effective date of coverage. MISSOURI Accident Benefit - Exclusions and Limitations, Bullet 7 regarding Suicide is revised by removing the words or insane. OKLAHOMA Income Protection Plan - The definition of Injury is revised to read "Accidental bodily injury sustained by the insured person which are the direct cause, independent of disease or bodily infirmity or any other cause. The injury must occur after the insured person's coverage has become effective and while the coverage is in force. WEST VIRGINIA Accident Benefit - The definition of Accidental Injury is revised to read accidental bodily injury or injuries sustained by an insured person which directly causes the loss, independent of sickness, bodily infirmity, or any other cause, and which occurs after the insured person s coverage has become effective and while the coverage is in force. Income Protection Benefit - The definition of Injury is replaced with accidental bodily injury or injuries sustained by an insured person which are the direct cause, independent of sickness, bodily infirmity or any other cause, of the loss and occur while the coverage is in force. The definition of Total Disability or Totally Disabled is replaced with due to a sickness or injury you are unable to perform substantially all of the material duties of your current employment or occupation for which you are or become qualified, by reason of education, training or experience and are not in fact engaged in employment for wage or profit. You must be under the care of a physician. No State Variations ALASKA IOWA MICHIGAN PENNSYLVANIA SOUTH CAROLINA TEXAS VIRGINIA WISCONSIN 14 M PKG A 709

17 Acknowledgement of Receipt (Retain for your records) If you have any questions about your application, insurance coverages, need any assistance with claims or other matters, please contact: The MEGA Life and Health Insurance Company SM Administrative Office: 9151 Boulevard 26 N. Richland Hills, TX Home Office: Oklahoma City, OK Toll-Free: Received from: The following check will be deposited upon receipt by the company. Please note, acceptance of this payment does not constitute coverage. Insurance is not effective until the coverage applied for has been approved and issued by The MEGA Life and Health Insurance Company. SM The amount of $ /check # for the initial insurance premium and application fee, with application for enrollment in the following plan: ProtectFit: Accident Protection Package SM HospitalFit: Hospital Protection Package SM CombinedFit: Accident & Hospital Protection Package SM You must be an association member in order to apply. This is a Group Policy and the association is the master policy owner. The agent does not have the authority on behalf of The MEGA Life and Health Insurance Company SM to accept risks; to make, alter or amend any Group Policy; or to extend the time for making any payment due under such Group Policy. Agent Number Licensed Insurance Agent Date Phone Number of Licensed Insurance Agent This brochure is a brief description of the coverage offered under the MEGA Packages: Daily Hospitalization Benefit (Form C or its state variation); Lump Sum Accident Benefit (Form C or its state variation); Lump Sum Specified Disease Benefit (Form C or its state variation); Monthly Disability Accident Only Benefit (Form C or its state variation) and Monthly Disability Accident & Illness Benefit (Form C or its state variation). Your Certificate(s), which should be read immediately upon receipt, describes in detail the rights and obligations of both you and The MEGA Life and Health Insurance Company SM under the Association Group Policy. Specific coverages available in your state may vary The MEGA Life and Health Insurance Company SM M PKG A

18 Administrative Office: 9151 Boulevard 26 North Richland Hills, Texas HealthMarkets is the brand name for insurance products underwritten and issued by insurance subsidiaries of HealthMarkets, Inc. The Chesapeake Life Insurance Company, Mid-West National Life Insurance Company of Tennessee SM and The MEGA Life and Health Insurance Company. SM Products provided under the HealthMarkets brand are designed to provide personalized protection to individuals, families, the self-employed and small businesses. Our sales agents work closely with individuals and families to develop personalized coverage solutions that meet each customer s specific needs and budget. As those circumstances change, licensed and trained agents representing our insurance products are there to offer guidance and information that can help our customers make appropriate changes to their health coverage. Our knowledgeable agents, responsive claim specialists and customer support teams all clearly demonstrate our commitment to developing and providing health insurance protection that fits our customers various lifestyles through every stage of their lives. The products offered by our companies vary by region and state, and not all are available in all states. Each underwriting company is financially responsible for its own insurance products. Association group plans, where available, require association membership. Certain exclusions and limitations may apply depending on the product chosen. For further information on HealthMarkets products, visit HealthMarkets, Inc. was founded in 1985 and its underwriting companies administrative offices are located in North Richland Hills, Texas. Products are marketed through independent agents in sales offices across the country. For more information about our company, visit 16 M PKG A 709

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20 2009 The MEGA Life and Health Insurance Company SM M PKG A 709_709