Saver s Choice III. Suite of Health Coverage Options. Marketed Exclusively by. P.O. Box Salt Lake City, UT

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1 Saver s Choice III Suite of Health Coverage Options Marketed Exclusively by P.O. Box Salt Lake City, UT Phone:

2 STANDARD LIFE We ve been Protec ng American Families Since 1947 For over 64 years, we've been helping individuals, businesses, universi es, school districts, and city, county and state governments by providing innova ve products and superior service. We provide compe ve Medical, Life, Disability and Supplemental Health insurance, along with something that many insurance companies don t - personal a en on. Our administra ve and claims-paying staff is maintained in-house, not outsourced. When you call us, the phone is answered by a human being, not a machine, and our friendly, knowledgeable people are there to help you. We have stood the test of me by remaining faithful to the core values on which we were founded: personal service, compe ve products and conserva ve financial management. We look forward to earning your business and mee ng your needs now and in the future.

3 SAVER S CHOICE III Saver s Choice III benefits start right away, with NO DEDUCTIBLE. If you re looking for an alterna ve to the high premiums and costly deduc bles of a tradi onal major medical plan, take a look at Saver s Choice III. Saver s Choice III pays a daily benefit amount for hospitaliza on and provides NO-DEDUCTIBLE coverage for surgery, doctor visits and outpa ent benefits. s begin on day one for accidents, and a er a 30-day wai ng period for sickness. It s a custom-configured suite of insurance protec on op ons designed to give you stronger coverage than defined-benefit insurance policies. Saver s Choice III pays a percentage of usual, customary and reasonable charges for Accident, Cancer or Cardiovascular diseases, as defined in the policy. documents. s for other illnesses are paid according to a schedule of defined benefits, based on a mul ple of the 2011 Medicare Physicians Fee Schedule. Mul Plan NETWORK Make your money go even further when you save an average of 40% at more than 600,000 health professionals (and an average of 25% on all eligible services) by using MultiPlan, the largest network in the country, and having us pay your providers directly. ScriptSave Select We also provide, FREE OF CHARGE, membership in the ScriptSave Select program.

4 BENEFITS Overview of Covered Events and Services AGGREGATE MAXIMUM BENEFITS: All benefits are subject to policy limita ons, exclusions and benefit maximums. Each part of Saver s Choice III pays a maximum aggregate benefit of $250,000 for any one accident or illness, including all charges related to that accident or illness. Each element of the suite also has a life me limit of $1,000,000 for all benefits. ACCIDENT $250,000 per Accident $1,000,000 Life me CANCER CARDIO- VASCULAR $250,000 per Illness $1,000,000 Life me $250,000 per Illness $1,000,000 Life me OTHER ILLNESS $250,000 per Illness $1,000,000 Life me

5 BENEFITS Overview of Covered Events and Services INPATIENT HOSPITAL CONFINEMENT: Accident ACCIDENT CANCER HEART / STROKE OTHER ILLNESS Hospitaliza on: Daily Daily Daily Daily Inpa ent Medical & Surgical Services Schedule (2) OUPATIENT SURGERY: Surgical Facility: Surgical Center Surgical Center Surgical Center Surgical Center Outpa ent Facilitybased Surgical Services: Schedule (2) OUPATIENT SERVICES: Office Visits: Other Services: Limit on Outpa ent Services, per Policy-Year: $ % All Outpatient Services for Accidents are limited to your chosen Outpatient Maximum $ % All Outpatient Services for Cancer are limited to your chosen Outpatient Maximum $ % All Outpatient Services for Heart Attack/ Stroke are limited to your chosen Outpatient Maximum $50.00 Schedule (2) All Outpatient Services for all Other Illnesses are limited to your chosen Outpatient Maximum (1) of the first $15,000 of Usual, Customary and Reasonable Charges, per policy year, we pay 100% of charges for that accident or illness, through the end of the policy year. (2) 120% of 2011 Medicare Physicians Fee Schedule (Laboratory: 100% of Texas Medicare Independent Lab Schedule)

6 BENEFITS Overview of Covered Events and Services YOUR CHOICE OF BENEFIT LEVELS: DAILY HOSPITAL BENEFIT Your Choice: Daily Additional ICU Daily $1,500 $500 $2,000 $1,000 $2,500 $1,000 $3,000 $1,000 OUTPATIENT YEARLY MAXIMUMS Your Choice: $1,000 $1,500 $2,500 $5,000 OTHER PAYMENT LEVELS: Outpatient Surgical Center : $1,000 Inpatient Doctor Visit: $75 (limited to 20 visits per confinement) Anesthesiologist: Up to 20% of Surgical Assistant Surgeon: Up to 15% of Surgical Emergency Room Visit Copay for Accident, Cancer, Cardiovascular: $100

7 BENEFITS Overview of Covered Events and Services POLICY-YEAR MAXIMUM OUTPATIENT SERVICES BENEFITS: All services performed in an outpa ent se ng, not including facility-based outpa ent surgical procedures) are subject to a policy-year maximum: ACCIDENT CANCER CARDIO- VASCULAR OTHER ILLNESS OUTPATIENT YEARLY MAXIMUMS Your Choice: $1,000 $1,500 $2,500 $5,000 Each Category s Yearly Outpa ent Maximum is independent of the others. For Example, if you choose $2,500, you ve got up to: $2,500 for Accidents, AND $2,500 for Cancer, AND $2,500 for Cardiovascular Disease, AND $2,500 for Other Illnesses Per Person, per policy year WITH NO DEDUCTIBLES

8 BENEFIT SCHEDULES How does the Schedule for Other Illness work? Indemnity Bene its for Other Illness When you receive covered treatment for an illness not defined as cancer or cardiovascular disease, we pay you a set amount based on the services received. Indemnity amounts by type of service/procedure are listed in your policy. We developed our indemnity schedule using the Resource Based Rela ve Value Schedule (RBRVS). This is the same tool that Medicare uses to set its fee schedule to physicians. The indemnity benefits we pay when you receive the covered services of a physician, surgeon, anesthesiologist, pathologist or radiologist are paid at a rate that s 20% higher than the amount Medicare pays for the same service. Doctors: 120% of Medicare The Other Illness component of Saver s Choice III pays a scheduled benefit of 1.2 mes the 2011 Na onal Medicare Physician s Fee Schedule payment amount for events that require the medically necessary services of a physician, surgeon, anesthesiologist, radiologist or pathologist. Lab: 100% of Medicare The Other Illness component of Saver s Choice III pays a scheduled benefit equal to the 2011 Texas Medicare Independent Laboratory Schedule payment amount for events that require the medically necessary services of an independent laboratory. What is the Medicare Physician Fee Schedule? Medicare fee schedules set a payment amount for virtually every service or item that a pa ent receives. The fee schedules use a set of codes in the Healthcare Common Procedure Coding System (HCPCS) that describe each item or service an associate it with a payment amount. Doctors use these codes on claim forms to describe services rendered and receive payment. Scheduled payments for events requiring physician services consider the amount of work the physician or other provider performs, the cost of malprac ce insurance and the physician s prac ce expense. These fee schedules are published by the federal government in the Federal Register.

9 SUMMARY OF EXCLUSIONS: WHAT S NOT COVERED? No benefits are provided for treatment of accidents or illnesses arising from or related to the following, except where state mandates apply: Transplants War, commission of a felony, a empted suicide, influence of an illegal substance or level of substance, or a hazardous ac vity Rou ne hearing care, rou ne vision care, hearing aids or cochlear implants, vision therapy, surgery to correct vision, rou ne foot care, or foot ortho cs Cosme c services including chemical peels, plas c surgery and medica ons Charges by a health care prac oner or medical provider who is an immediate family member Custodial care, home health care or hospice care Charges reimbursable by Medicare, Workers Compensa on or automobile insurance carriers Hormone s mula on treatment to promote or delay growth Rou ne dental care Treatment for TMJ or CMJ and certain jaw/tooth disorders Charges for educa onal tes ng or training, voca- onal or work hardening programs, transi onal living, or services provided through a school system Diagnosis and treatment of infer lity Maternity, pregnancy (except for complica ons of pregnancy), rou ne newborn care, surrogate pregnancy and rou ne nursery charges Storage of umbilical cord stem cells or other blood components in the absence of sickness or injury Gene c tes ng, counseling and services Durable or personal medical equipment Charges for sex transforma on, treatment of sexual dysfunc on or inadequacy, or to restore or enhance sexual performance or desire Charges incurred for treatment obtained outside of the United States Over-the-counter products Contracep ve drugs or devices Treatment of quality of life or lifestyle concerns, including, but not limited to: smoking cessa on; obesity; hair loss; sexual func on, dysfunc- on, inadequacy, or desire; or cogni ve enhancement Treatment used to improve memory or to slow the normal process of aging Behavior modifica on or behavioral problems, except for diabetes self-management training and educa on Prophylac c treatment Telemedicine (including but not limited to treatment rendered through the use of interac ve audio, video, or other electronic media) Experimental or inves ga onal services Charges for any amount in excess of any benefit maximum Charges for homeopathic medicines or nonmedical items Treatment of behavioral health (mental/nervous disorders) and substance abuse Charges for adjustments or subluxa on treatment Charges for non-covered services and associated complica ons Charges for take-home drugs dispensed at an ins tu on Outpa ent prescrip on medicines

10 Summary of Exclusions, Con nued... Pre-Exis ng Condi on Limita on: We will not pay benefits for expenses that result from or are related to a Pre-Exis ng Condi on, or its complica ons, un l the Covered Person has been con nuously insured under this plan for 24 months. A er this period, benefits will be available for expenses resul ng from or related to a Pre-Exis ng Condi on made known to Us during the underwri ng process and not specifically excluded from coverage. Wai ng Periods: Illnesses which first manifest within the first 30 days of coverage are not covered. There is a six-month wai ng period before the following become covered: hernia, disorder of reproduc ve organs, varicose veins, hemorrhoids, appendix, tonsils, adenoids, gall bladder Other Limita ons: 1. The maximum amount payable for the life me of this Policy for any Covered Events rela ng to the treatment of Acquired Immunodeficiency Syndrome and related effects will be $10,000; 2. The maximum amount payable for the life me of this Policy for any Covered Events rela ng to the treatment of Alzheimer s Disease and related effects will be $10,000. This brochure provides summary informa on. This brochure provides summary informa on. For a complete lis ng of benefits, exclusions and limita ons, please refer to the policy forms that comprise the Saver's Choice III suite. In the event there are discrepancies with the informa on in this brochure, the terms and condi- ons of the coverage documents will govern. Coverage for Saver s Choice III Suite is provided under the following policy forms: AC1, CA1, HC1, and OS1.