AMERITAS DENTAL INSURANCE

AMERITAS DENTAL INSURANCE Low Option w/o Orthodontic Services High Option w/ Orthodontic Services John D Webb 600 S. Santa Fe, Suite C Salina, KS 67...
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AMERITAS DENTAL INSURANCE

Low Option w/o Orthodontic Services High Option w/ Orthodontic Services

John D Webb 600 S. Santa Fe, Suite C Salina, KS 67401 (888)-756-6670 [email protected] www.webbandassociatesfinancial.com

OFG Financial Services Dental Highlight Sheets

Dental Summary

Effective Date: 1/01/2010 High Plan

Low Plan Coinsurance Type 1 Type 2 Type 3 Deductible

Maximum (per person) PPO Allowance Type 1 Type 2 Type 3 Dental Rewards® Waiting Period

100% 50% NA $50/Plan Year Waived Type 1 3 Family Maximum $1,000/Plan Year

100% 50% 50% $50/Plan Year Waived Type 1 3 Family Maximum $1,000/Plan Year

Passive PPO 90th U&C 90th U&C None NA None

Passive PPO 90th U&C 90th U&C 90th U&C Included Type 3 Procedures 12 Months for New Hires Only

Deductibles After the date that 3 members of a family have each satisfied their individual deductible amounts in full, we will waive the entire deductible or any remaining portion of the deductible amount for any other family members for the rest of that plan year.

Late Entrant Employees must enroll during the first 31 days they are eligible for insurance. If an employee fails to enroll within that time frame, he/she will be a Late Entrant. This plan allows coverage for exams, cleanings and fluoride applications for the first 12 months. All other procedures will be denied during this Late Entrant period.

Orthodontia Summary Allowance All Plan Designs: In Network, discounted fee. Out of Network, U&C. Coinsurance No Ortho Coverage for Adults NA NA Lifetime Maximum (per person) Waiting Period NA

50% No $1,000 12 months for New Hires Only

Monthly Rates Employee (EE) EE + Spouse EE + Children EE + Spouse & Children

$17.54 $34.93 $41.65 $65.15

$32.10 $65.45 $70.16 $113.10

Low Plan

High Plan

Type 1

z

Routine Exam (2 per benefit period)

z

Routine Exam (2 per benefit period)

Procedure

z

Bitewing X-rays (1 per benefit period)

z

Bitewing X-rays (1 per benefit period)

(Frequency)

z

Full Mouth/Panoramic X-rays (1 in 5 years)

z

Periapical X-rays

z

Periapical X-rays

z

Cleaning (2 per benefit period)

z

Cleaning (2 per benefit period)

z

Fluoride for Children 13 and under (1 per benefit period)

z

Sealants (age 13 and under)

Full Mouth/Panoramic X-rays (1 in 5 years)

Fluoride for Children 13 and under (1 per benefit period) z

Sealants (age 13 and under)

1

OFG Financial Services Dental Highlight Sheets

Type 2

z

Space Maintainers

z

Space Maintainers

Procedure

z

Restorative Amalgams

z

Restorative Amalgams

(Frequency)

z

Restorative Composites

z

Restorative Composites

z

Periodontics (nonsurgical)

z

Periodontics (nonsurgical)

z

Denture Repair

z

Denture Repair

z

Simple Extractions

z

Simple Extractions

z

None

Type 3

z

Crowns and Onlays (1 in 10 years per tooth)

Procedure

z

Crown Repair

(Frequency)

z

Endodontics (surgical and nonsurgical)

z

Periodontics (surgical)

z

Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 10 years)

Current Dental Terminology © American Dental Association.

z

Complex Extractions and Anesthesia

Dental Rewards® - The High Plan includes a feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns dental rewards by: o Submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. o If a plan member doesn't submit a dental claim during a benefit year, all accumulated rewards are lost. However, he or she can begin earning rewards again the very next year. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. Benefit Threshold $500 Dental benefits received for the year cannot exceed this amount Annual Carryover Amount $250 Dental Rewards amount is added to the following year's maximum Maximum Carryover $1,000 Maximum possible accumulation for Dental Rewards

Ameritas Managed Care Products z

z

Plan members are free to receive care from any dentist they choose. Their out-of-pocket expenses are generally lower when using PPO dentists, who have agreed to provide dental care at contracted fees. Over 83,000 PPO provider access points are available nationwide. PPO network dentists must meet our credentialing and quality assurance evaluation requirements.

U&C We determine the Usual and Customary (U&C) allowance listed on the plan summary page using information including data from Ingenix, a multi-carrier compilation formerly derived by the Health Insurance Association of America (HIAA). Plan members are reimbursed based on the appropriate charges in the dentist's ZIP Code area. We review our U&C allowances annually. z 90th U&C means 9 out of 10 dentists in a specific ZIP Code area charge at or below the plan allowance for a procedure.

Claim Submission Tips z

z z z z z

Ameritas accepts any claim form your provider or you submit. If you’d like to use our claim form visit www.ameritasgoup.com and select Forms New claims can be faxed to 402-467-7336 Electronic claims, pretreatment estimates and attachments can be submitted by your provider using the payer identification number 47009 Claims and pretreatment estimates may also be mailed to: P.O. Box 82520 – Lincoln, NE 68501 Contact us for toll-free benefit questions during your enrollment at 877-573-7749 After your plan effective date contact us toll free at 800-487-5553. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. For plan information any time, access our automated voice response system or visit us online at ameritasgroup.com/member.

2

Dental Rewards

®

Wouldn’t it be great if you could reward your employees for practicing good dental health? You can. With Dental Rewards’ increasing annual maximum feature, employees can “earn” additional money

plan highlights • Available with virtually all of our dental plans • Applies to Type 1, 2, 3 and 4 [Preventive, Basic, Major, and Select] dental procedures • Qualify for rewards by: • Submitting at least one claim per year for a covered procedure • Keeping total paid claims under the plan’s annual threshold limit • Check your Dental Rewards benefit status online. It’s easy!

toward future years’

PPO bonus

annual maximums.

• “Earn” a bonus by making your annual visit to one of our Participating Provider Organization [PPO] providers, who charge reduced rates on covered procedures • PPO and PPO Bonus are available in most states

That way, the money

more information

is available when they need it most.

GR 5743 Rev. 3-09

• Learn how Dental Rewards works and see available plan options on other side

example of how it works Annual maximum for Type 1, 2 & 3 (Preventive, Basic, Major) Annual dental reward (carryover) toward next benefit year Next benefit year’s annual maximum + dental reward

$ 1,500 + $

250

$ 1,750

Please note: Annual benefit threshold limit is $750 (keep paid claims at or below this limit to earn rewards). Annual maximum includes Type 4 (Select) procedures when applicable. Your annual maximum can increase up to $2,500 total in this example.

available plan options Annual Maximum

Annual Benefit Threshold

Annual Dental Reward

$ 500

$ 250

$ 125

550

250

750

Annual PPO Bonus $

Maximum Reward Accumulation

50

$ 500

125

50

500

250

125

50

500

850

250

125

50

500

1,000

500

250

100

1,000

1,200

500

250

100

1,000

1,250

500

250

100

1,000

1,500

500

250

150

1,000

1,500

750

250

150

1,000

1,750

750

400

200

1,200

2,000

750

400

200

1,200

Other annual maximum options may be available.

To learn more, call us at 800.776.9446 or visit ameritasgroup.com.

Ameritas Group is a division of Ameritas Life Insurance Corp. (Ameritas Life), a UNIFI Company, which offers group dental and eye care products nationwide. Certain plan designs may not be available in all areas. Some states require that producers be appointed with Ameritas Life before soliciting its products. To become appointed with Ameritas Life, call 800.659.2223. Ameritas Group’s dental and eye care products (9000 Ed. 01-05) are issued by Ameritas Life. ©2009 Ameritas Life Insurance Corp. Ameritas, the bison symbol, Dental Rewards and “We’re Ameritas. We’re for people.” are registered service marks of Ameritas Life, UNIFI Mutual Holding Company or Ameritas Holding Company.

AMERITAS VISION INSURANCE

John D Webb 600 S. Santa Fe, Suite C Salina, KS 67401 (888)-756-6670 [email protected] www.webbandassociatesfinancial.com

OFG Financial Services, Inc Eye Care Highlight Sheet Focus® Plan Summary

Effective Date: 1/1/2010 Out of Network

VSP Network Deductibles

Annual Eye Exam Lenses (per pair) Single Vision Bifocal Trifocal Lenticular Progressive

$15 Exam $15 Eye Glass Lenses or Frames* Covered in full

$15 Exam $15 Eye Glass Lenses or Frames* Up to $52

Covered in full Covered in full Covered in full Covered in full See lens options

Up to $55 Up to $75 Up to $95 Up to $125 NA

15% discount See Additional Focus Features. Up to $120 Covered in full $120

No benefit Up to $105 Up to $210 Up to $45

12/12/24 Based on date of service

12/12/24 Based on date of service

Contacts Fit & Follow Up Exams Elective Medically Necessary

Frames Frequencies (months) Exam/Lens/Frame

*Deductible applies to a complete pair of glasses or to frames, whichever is selected.

Lens Options (member cost)* Progressive Lenses Std. Polycarbonate High Luster Edge Polish Solid Plastic Dye Plastic Gradient Dye Photochromatic Lenses

VSP Network

Out of Network

$60-$119 Covered in full for dependent children $25 - $35 adults $14 $13 (except Pink I & II) $15 $27-$76

No benefit No benefit

$15-$29 $39-$61 $15 Average discount of 15% off retail. See Additional Focus Features.

No benefit No benefit No benefit No benefit

No benefit No benefit No benefit No benefit

(Glass & Plastic)

Scratch Resistant Coating Anti-Reflective Coating Ultraviolet Coating Lasik or PRK

*Lens Option member costs vary by prescription and option chosen.

Monthly Rates for Active Employees Employee Only (EE) EE + Spouse EE + Children EE + Spouse & Children

$11.73 $23.42 $22.46 $34.82

OFG Financial Services, Inc Eye Care Highlight Sheet

Additional Focus® Features Contact Lenses Elective

Cost of the fitting and evaluation is deducted from the allowance and any amount left is deducted from the material allowance. Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts chosen in lieu of glasses.

Additional Glasses

20% discount off the retail price on additional pairs of prescription glasses (complete pair).

Laser VisionCare

VSP offers an average discount of 15% on LASIK and PRK. The maximum out-of-pocket per eye for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure.

Low Vision

With prior authorization, 75% of approved amount (up to $1,000 is covered every two years).

Eye Care Plan Member Service Focus eye care from Ameritas Group features the money-saving eye care network of VSP. Customer service is available to plan members through VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more. Contact us for toll-free benefit questions during your enrollment at 877-573-7749. After the member is effective, he/she can contact : VSP Call Center: 1-800-877-7195 z Service representative hours: 7 a.m. to 9 p.m. CST Monday through Friday, 8 a.m. to 4:30 p.m. CST Saturday z Interactive Voice Response available 24/7 Locate a VSP provider at: ameritasgroup.com/member View plan benefit information at: vsp.com

Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

American Fidelity Assurance Company Short Term Disability Income Insurance

Lori J. Likes 4606 Sequoia Hutchinson, KS 67502 (800) 450-3506, Ext. #3538 [email protected]

    RELIANCE STANDARD LIFE INSURANCE  COMPANY    GROUP TERM LIFE INSURANCE   

 

John D. Webb  600 S. Santa Fe, Suite C  Salina, Kansas  67401  (888)756‐6670  [email protected]  www.webbandassociatesfinancial.com 

AMERICAN FAMILY LIFE ASSURANCE COMPANY  (AFLAC) 

  CANCER INDEMNITY INSURANCE  HOSPITAL INTENSIVE CARE PROTECTION     

MICHAEL PLETT, AGENT  1616 Avenue H  Ellsworth, Kansas  67439  (785)472‐4980  [email protected] 

Maximum Difference

SM

Cancer Indemnity Insurance Policy Series A76000

American Family Life Assurance Company of Columbus (Aflac) Form A76175KS

IC(7/07)

As long as cancer is in this world, Aflac will innovate to fight it. The fight against cancer has evolved. Aflac’s coverage has as well. In 1958, Aflac introduced its first cancer policy. The goal was to help protect individuals and their families from the damage that cancer can do both physically and financially. By paying cash benefits to its policyholders, unless they designated otherwise, Aflac’s coverage provided a level of freedom that many major medical insurance companies simply could not. Today, millions of individuals and families are still battling cancer, but the fight has changed in many ways. Advances in pharmaceuticals, surgical procedures, and alternative treatments have improved the odds for those diagnosed with the disease. But with improved SM

treatments, increased costs have arrived as well. Aflac’s new Maximum Difference policy addresses these concerns with new benefits that reflect the new directions in which America’s battle against this tenacious foe is headed. SM

The Maximum Difference policy continues Aflac’s goal of providing groundbreaking coverage at affordable rates. One day, cancer will cease to be a threat. Until then, there’s Aflac.

Quick-Reference Chart of Benefits Information Benefits are paid only for Covered Persons who receive Physician-prescribed treatment approved by the National Cancer Institute (NCI) or the Food and Drug Administration for Cancer (unless stated otherwise) or an Associated Cancerous Condition, as applicable. To be payable, the benefits listed below require a charge to be incurred for the applicable treatment or service, except for the Experimental Treatment Benefit (as detailed below), the Hospital Confinement Benefit (when confined in a U.S. government hospital), and the Hospice Care Benefit. Prescription drugs will be covered if the prescription drug is recognized for treatment of the indication in one of the standard reference compendia or in substantially accepted peer-reviewed medical literature. The prescribing Physician will submit to the insurer documentation supporting the proposed off-label use or uses if requested by the insurer.

BENEFIT

BENEFIT AMOUNT

LIFETIME MAX/INSURED

A D D I T I O N A L B E N E F I T I N F O R M AT I O N

D I R E C T N O N S U R G I C A L T R E AT M E N T B E N E F I T S Benefits are payable the calendar week or calendar month, as applicable, during which a Covered Person receives and incurs a charge for the applicable treatment. Benefits will not be paid for each week of continuous infusion of medications dispensed by pump, implant, or patch. Benefits will not be paid for each week a radium implant or radioisotope remains in the body. The Initial Treatment, Injected Chemotherapy, Radiation Therapy, and Experimental Treatment Benefits are not payable based on the number, duration, or frequency of the medication(s), therapy, or treatment received by the Covered Person. Initial Treatment

$3,000

$3,000

Payable the first time Radiation Therapy, Injected Chemotherapy, or Oral Chemotherapy Benefits are received.

Injected Chemotherapy

$900 once per calendar week

None

Limited to the calendar week in which the charge for medication(s) or treatment is incurred.

Nonhormonal

$400 per medication, per calendar month

None

Hormonal

$400 per medication, per calendar month up to 24 months

None

Total benefits (nonhormonal and hormonal) are payable for up to 3 different medications per calendar month, up to a maximum of $1,200 per calendar month. Oral Chemotherapy Benefits are limited to the calendar month in which the charge for the medication(s) or treatment is incurred. Refills within the same calendar month are not considered a different chemotherapy medicine. Examples of hormonal oral chemotherapy are Nolvadex, Arimidex, Femara, and Lupron or generic versions such as Tamoxifen.

Oral Chemotherapy

$100 per medication, per calendar month after 24 months of paid benefits of hormonal oral chemotherapy Radiation Therapy

$500 once per calendar week

None

Benefit is limited to the calendar week in which the charge for the therapy is incurred.

Experimental Treatment

$500 once per calendar week if charge incurred; $125 once per calendar week if no charge incurred for inclusion in a clinical trial

None

Benefit does not pay for laboratory tests, diagnostic X-rays, immunoglobulins, immunotherapy, colony-stimulating factors, and therapeutic devices or other procedures related to these experimental treatments. Benefit is limited to the calendar week in which the charge for the treatment is incurred, if there is a charge.

The policy has limitations that may affect benefits payable. This brochure is for illustrative purposes only. See the policy for complete details, limitations, and exclusions.

BENEFIT

BENEFIT AMOUNT

LIFETIME MAX/INSURED

A D D I T I O N A L B E N E F I T I N F O R M AT I O N

INDIRECT/ADDITIONAL THERAPY BENEFITS The Immunotherapy and Anti-Nausea Benefits are not payable based on the number, duration, or frequency of immunotherapy or anti-nausea drugs received by the Covered Person. The Immunotherapy and Anti-Nausea Benefits are limited to the calendar month in which a Covered Person receives and incurs a charge for the applicable treatment. Immunotherapy

$500 once per calendar month

$2,500

Benefit is payable for an immunotherapy treatment regimen for Internal Cancer or an Associated Cancerous Condition. Not payable for medications paid under the Injected Chemotherapy, Oral Chemotherapy, Radiation Therapy, or Experimental Treatment Benefits.

Anti-Nausea

$150 once per calendar month

None

Anti-nausea drugs must be prescribed while receiving Radiation Therapy Benefits, Injected or Oral Chemotherapy Benefits, or Experimental Treatment Benefits.

Stem Cell Transplantation

$10,000

$10,000

Payable for a peripheral stem cell transplantation for the treatment of Internal Cancer or an Associated Cancerous Condition. Does not include bone marrow transplantations.

$10,000 $ 1,000

$10,000

Payable for a bone marrow transplantation for the treatment of Internal Cancer or an Associated Cancerous Condition. Donor benefit is payable to the Covered Person’s bone marrow donor for expenses incurred as a result of the transplantation procedure. Does not include stem cell transplantations.

$150 times the number of days paid under the Hospital Confinement Benefit

None

Inpatient benefit is payable for blood and/or plasma transfusions during a covered Hospital confinement. Outpatient benefit is payable for blood and/or plasma transfusions for the treatment of Internal Cancer or an Associated Cancerous Condition as an outpatient in a Physician’s office, clinic, Hospital, or Ambulatory Surgical Center. Does not pay for immunoglobulins, immunotherapy, antihemophilia factors, or colony-stimulating factors.

Bone Marrow Transplantation Covered Person Donor

Blood and Plasma Inpatient

Outpatient

$250 per day

S U R G I C A L T R E AT M E N T B E N E F I T S Surgical/Anesthesia

$140–$5,000 (based on Schedule of Operations listed in the policy)

None

The maximum (Surgical/Anesthesia) daily benefit will not exceed $6,250. Payable when a surgical operation is performed for a diagnosed Internal Cancer or an Associated Cancerous Condition. If any operation for the treatment of Internal Cancer or an Associated Cancerous Condition is performed other than those listed, Aflac will pay an amount comparable to the amount shown in the Schedule of Operations for the operation most nearly similar in severity and gravity. Two or more surgical procedures performed through the same incision will be considered one operation, and benefits will be paid based on the highest eligible benefit.

None

Payable when a surgical operation is performed for a diagnosed skin Cancer, including melanoma or Nonmelanoma Skin Cancer. The indemnity amount includes anesthesia services. Maximum daily benefit: $600.

25% of the benefit amount shown in the Schedule of Operations will be paid for the administration of anesthesia during a covered surgical operation.

Skin Cancer Surgery

$50–$600

BENEFIT

BENEFIT AMOUNT

LIFETIME MAX/INSURED

A D D I T I O N A L B E N E F I T I N F O R M AT I O N

H O S P I TA L I Z AT I O N B E N E F I T S Hospital Confinement, Days 1–30 Named Insured/Spouse Dependent Child

$300 per day $375 per day

Hospital Confinement, Days 31+ Named Insured/Spouse Dependent Child

$600 per day $750 per day

Outpatient Hospital Surgical Room Charge

$300 per day

None

For hospitalization of 30 days or less, Aflac will pay benefits for each day a Covered Person is confined to a Hospital for treatment and is charged for a room as an inpatient. During any continuous period of Hospital confinement for 31 days or more, Aflac will pay benefits as described for the first 30 days. Beginning with the 31st day of such continuous Hospital confinement, benefits for Days 31+ will be payable for each day a Covered Person is charged for a room as an inpatient. No charge is required for confinement in a U.S. government Hospital.

None

Payable when a surgical operation is performed for treatment of a diagnosed Internal Cancer or Associated Cancerous Condition. Benefit is not payable for any surgery performed in a Physician’s office. Surgery must be performed on an outpatient basis in a Hospital or an Ambulatory Surgical Center. Benefit is payable once per day and is not payable on the same day as the Hospital Confinement Benefit. Benefit is payable in addition to the Surgical/Anesthesia Benefit. Benefit is also payable for Nonmelanoma Skin Cancer surgery involving a flap or graft. Maximum daily benefit: $300.

CONTINUING CARE BENEFITS Extended-Care Facility

$150 per day

None

Payable when hospitalized and receives Hospital Confinement Benefits and is later confined, within 30 days of the covered Hospital confinement, to an Extended-Care Facility, a skilled nursing facility, a rehabilitation unit or facility, a transitional care unit or any bed designated as a swing bed, or to a section of the Hospital used as such (an Extended-Care Facility). For each day this benefit is payable, Hospital Confinement Benefits are NOT payable. If more than 30 days separates confinements in an Extended-Care Facility, benefits are not payable for the second confinement unless the Covered Person again receives Hospital Confinement Benefits and is confined as an inpatient to the Extended-Care Facility within 30 days of that confinement. Benefits are limited to 30 days per calendar year, per Covered Person.

Home Health Care

$150 per visit (Limit of 10 visits per hospitalization and 30 visits per calendar year for each Covered Person)

None

Payable when hospitalized for the treatment of Internal Cancer or an Associated Cancerous Condition and then has either home health care or health supportive services provided by a licensed, certified, or duly qualified person, other than an immediate family member. Visits must begin within 7 days of release from the Hospital. Benefit will not be payable unless the attending Physician prescribes such services to be performed in the home of the Covered Person and certifies that if these services were not available, the Covered Person would have to be hospitalized to receive the necessary care, treatment, and services. Benefit is not payable the same day the Hospice Care Benefit is payable.

BENEFIT

BENEFIT AMOUNT

LIFETIME MAX/INSURED

A D D I T I O N A L B E N E F I T I N F O R M AT I O N

CONTINUING CARE BENEFITS Hospice Care Day 1 Additional Days

$12,000

Payable when diagnosed with Internal Cancer or an Associated Cancerous Condition and therapeutic intervention directed toward the cure of the disease is medically determined to be no longer appropriate. Medical prognosis must be one in which there is a life expectancy of 6 months or less as the direct result of Internal Cancer or an Associated Cancerous Condition. Benefit is not payable the same day the Home Health Care Benefit is payable.

$1,000 (one-time benefit) $50 per day

Nursing Services

$150 per day

None

Payable while confined in a Hospital and requiring full-time private care and attendance by private nurses (other than an immediate family member) for services other than those regularly furnished by the Hospital. Benefit is limited to the number of days the Hospital Confinement Benefit is payable.

Surgical Prosthesis

$3,000

$6,000

Surgically implanted prosthetic devices must be prescribed as a direct result of surgery for Internal Cancer or Associated Cancerous Condition treatment. Benefit does not include coverage for tissue expanders or a breast transverse rectus abdominis myocutaneous (TRAM) flap.

Prosthesis Nonsurgical

$250 per occurrence

$500

Nonsurgically implanted prosthetic devices (such as voice boxes, hairpieces, and removable breast prostheses) must be prescribed as a direct result of treatment for Internal Cancer or an Associated Cancerous Condition.

Reconstructive Surgery

$350–$3,000 25% of the benefit amount will be paid for administration of anesthesia during a covered reconstructive surgical operation.

None

The specified indemnity listed in the policy is payable when a listed reconstructive surgical operation is performed. If any reconstructive surgery is performed other than those listed, Aflac will pay an amount comparable to the specified indemnity amount for the operation most nearly similar in severity and gravity. Maximum daily benefit: $3,000.

A M B U L A N C E , T R A N S P O R TAT I O N , A N D L O D G I N G B E N E F I T S Ambulance Ground Air

None

Payable for ambulance transportation to or from a Hospital where confined overnight. Limited to 2 trips per confinement. The ambulance service must be performed by a licensed, professional ambulance company.

$ 250 $2,000

Transportation

50 cents per mile, up to $1,500

None

Payable for transportation of the Covered Person requiring treatment and a companion (if applicable), limited to the distance of miles between the Hospital or medical facility and the residence of the Covered Person. Benefit will pay for 2 adults if the Covered Person receiving treatment is a Dependent Child and commercial travel is necessary. Benefit is not payable for transportation to a facility located within a 50-mile radius of the Covered Person’s residence. Does not cover transportation provided by ambulance.

Lodging

$80 per day

None

Payable for lodging, in a room in a motel, hotel, or other commercial accommodation, for you or any one adult family member when a Covered Person receives treatment. Limited to 90 days per calendar year. Hospital or medical facility where treatment is received must be more than 50 miles from the Covered Person’s residence. Benefit is not payable for lodging occurring more than 24 hours prior to treatment or more than 24 hours after treatment.

Policy benefits continue on back panel.

Understanding the Risk Despite the best efforts of doctors, researchers, and countless organizations, cancer remains a concern for many individuals and

Advances in treatment also mean that Americans diagnosed with cancer are living longer than ever. The five-year relative survival rate for all cancers combined between 1996 and 2002 is 66%, up from 50% in 1975–77.*

According to the American Cancer Society:*

Although major medical insurance can help with the costs of cancer treatment, you still may have to cover deductibles and copayments on your own. Additionally, cancer treatment can necessitate out-of-pocket expenses that aren’t covered by major medical insurance, including travel, food, lodging, long-distance calls, child care, and household help.

• In the United States, 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.

Meanwhile, living expenses such as car payments, mortgages or rent, and utility bills continue, whether or not you are able to work. If a family member has to stop working to take care of you, the loss of income may be doubled.

families. People from all walks of life are at risk regardless of age, sex, or ethnic background. Here are a few statistics to help you understand the role cancer plays in America’s overall health.

• About 1,444,920 new cancer cases are expected to be diagnosed in 2007. • An estimated 10,400 new cases are expected to occur among children ages 0–14 in 2007.

By paying cash benefits directly to you, unless you choose otherwise, Aflac’s Maximum Difference policy allows you the freedom to use those funds as you see fit, helping you with the financial consequences of cancer that may not be covered by major medical insurance. SM

*Cancer Facts and Figures 2007

Cancer

Basic Plan

Policy Summaries, For Illustration Purposes Only BENEFIT HIGHLIGHTS

BENEFIT AMOUNTS

Initial Treatment of Radiation, Injected Chemo, or Oral Chemo (Lifetime $3,000/insured) . . . . . . . . . . . . . . . Injected Chemotherapy (Per calendar week) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . Oral Chemotherapy Nonhormonal (No Lifetime Max.) (Max. $1,200/calendar month) . . . . . . . . . . . . . . . Oral Chemotherapy Hormonal (No Lifetime Max.) (Per calendar month up to 24 months) . . . . . . . . . . . Radiation Therapy (Per calendar week) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . Experimental Treatment (No Lifetime Max.) . . . . . . . . . . . . Per calendar week if charge incurred . . . . . . Immunotherapy (Per calendar month) (Lifetime $2,500/insured). . . . . . . . . . . . . . . . . . . . . . . . . Anti-Nausea Prescriptions (Per calendar month) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . Stem Cell Transplant (Lifetime $10,000/insured) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bone Marrow Transplant (Lifetime $10,000/insured) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inpatient Blood and Plasma (Times number of days paid under Hospital Confinement Benefit) (No Lifetime Max.) . . . . Outpatient Blood and Plasma (Per Day) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . Surgical/Anesthesia (Based on Schedule of Operations in the Policy) (No Lifetime Max.) . . . . . . . . . . . . . . Skin Cancer Surgery (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospital Confinement (No Lifetime Max.) . . . . . . . . Days 1-30 Named Insured/Spouse (Per Day) . . . . . . . For Continuous period of Hospital confinement Days 1-30 Dependent Child (Per Day) . . . Days 30+ Named Insured/Spouse (Per Day) . . . . . Days 30+ Dependent Child (Per Day) . . . . Outpatient Hospital Surgical Room Charge (Per Day) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . Extended-Care Facility (Per Day) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . Home Health Care (Per Day) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospice Care (Lifetime Max. $12,000/insured). . . . . . . . . . . . . . . . . . . . Day 1 (one time benefit) . . Additional Days . . Nursing Services (Per Day) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surgical Prosthesis (Lifetime Max. $6,000). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prosthesis Nonsurgical (Lifetime Max. $500) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reconstructive Surgery (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ambulance (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ground Air Transportation (No Lifetime Max.) (Per Mile over 50 miles from residence, $1,500 Max. per trip) . . . . . . . . . . Lodging (Per Day) (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Base Plan Monthly Premium (Premium does not Increase when you move into older age)

Individual: 1 Parent Family: 2 Parent Family: Insured & Spouse:

Age 18-35 $16.12 $16.12 $29.90 $29.90

Age 36-45 $23.40 $23.40 $4212 $42.12

Age 46-55 $33.02 $33.02 $61.75 $61.75

$3,000 $900 $400 $400 $500 $500 $500 $150 $10,000 $10,000 $150 $250 $140 - $5,000 $50 - $600 $300 $375 $600 $750 $300 $150 $150 $1,000 $50 $150 $3,000 $250 $350 - $3,000 $250 $2,000 $. 50 $80

Age 56-70 $43.55 $43.55 $85.67 $85.67

Optional Riders Available Initial Diagnosis Benefit

Cancer Screening and Annual Care Benefit

Specified Disease Benefit

Return of Premium Benefit

____________________________________________________________________________________________________________________________________________

Intensive Care

Level 1

Policy Summaries, For Illustration Purposes Only BENEFIT HIGHLIGHTS

BENEFIT AMOUNTS

Hospital Intensive Care Unit Benefit (No Lifetime Max.) . . . . . . . . . Days 1-7 For Sickness (Per Day) . . Confinement in a Hospital Intensive Care Unit Days 8-15 For Sickness (Per Day) . . Days 1-7 For Injury (Per Day) . . Days 8-15 For Injury (Per Day) . . Days 16-30 For Sickness or Injury (Per Day) . . Step-Down Intensive Care Unit Benefit (For Sickness or Injury Days 1-15) (No Lifetime Max.) . . . . . . . . . Progressive Benefit for HIC Unit /Step Down ICU (Accumulate each Month). . . . . . . . . . . . . . Ambulance (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ground . Air . Major Human Organ Transplant Benefit (No Lifetime Max.) . . . . . . . . . . . . . . . . . . . . For Kidney, Liver, Heart, Lung, or Pancreas Monthly Premium (Premium does not Increase when you move into older age)

Individual: 1 Parent Family: 2 Parent Family: Insured & Spouse:

Age 18-35 $10.40 $20.41 $24.57 $20.80

Age 36-45 $11.31 $20.41 $24.57 $20.80

Age 46-55 $13.65 $22.36 $27.43 $25.35

. . . . . . . . . .

. . . . . . . . . .

. $700 . .$1,200 . $800 . $1,300 . $350 . $350 . $2.00 . $250 . $2,000 . $25,000 Age 56-70 $15.47 $28.86 $34.06 $30.94

This is a brief summary of coverage; please read both the policy and brochure carefully.

P R E M I U M WA I V E R A N D R E L AT E D B E N E F I T S Waiver of Premium If you, due to having Cancer or an Associated Cancerous Condition, are completely unable to perform all of the usual and customary duties of your occupation [or if not employed: are unable to perform 2 or more activities of daily living (ADLs) without the assistance of another person] for a period of 90 continuous days, Aflac will waive, from month to month, any premiums falling due during your continued inability. For premiums to be waived, Aflac will require an employer’s statement (if applicable) and a Physician’s statement of your inability to perform said duties or activities and may each month thereafter require a Physician’s statement that total inability continues. Aflac may ask for and use an independent consultant to determine whether you can perform an ADL while this benefit is in force. Aflac will also waive, from month to month, any premiums falling due while you are receiving Hospice Benefits. Continuation of Coverage Aflac will waive all monthly premiums due for the policy and riders for 2 months if you meet all of the following conditions: your policy has been in force for at least 6 months; we have received premiums for at least 6 consecutive months; your premiums have been paid through payroll deduction; you or your employer has notified us in writing within 30 days of the date your premium payments ceased due to your leaving employment; and you re-establish premium payments with Aflac. You will again become eligible to receive this benefit after you re-establish your premium payments through payroll deduction for a period of at least 6 months, and we receive premiums for at least 6 consecutive months. Limitations and Exclusions: We pay only for treatment of Cancer and Associated Cancerous Conditions diagnosed on or after the Effective Date of coverage, including direct extension, metastatic spread, or recurrence. Benefits are not provided for premalignant conditions or conditions with malignant potential (unless specifically covered); complications of either Cancer or an Associated Cancerous Condition; or any other disease, sickness, or incapacity. Guaranteed-Renewable: The policy is guaranteed-renewable for your lifetime, subject to Aflac’s right to change premiums by class upon any renewal date. Effective Date: The Effective Date is the date coverage begins, as shown in the Policy Schedule. It is not the date you signed the application for coverage. Covered Person: A Covered Person is any person covered under individual (named insured listed in the Policy Schedule), named insured/Spouse only (named insured and Spouse), one-parent family (named insured and Dependent Children), or two-parent family (named insured, Spouse, and Dependent Children) coverage as applied for by you on the application. Spouse is defined as the person to whom you are legally married and who is listed on your application. Newborn children are automatically insured from the moment of birth. If coverage is for individual or named insured/Spouse only, and you desire uninterrupted coverage, you must notify Aflac in writing within 31 days of the birth of your child, and Aflac will convert the policy to one-parent family or two-parent family coverage and advise you of the additional premium due. Coverage will include any other unmarried Dependent Child, regardless of age, who is incapable of self-sustaining employment by reason of mental retardation or physical handicap and who became so incapacitated prior to age 25 and while covered under the policy. Dependent Children are your natural children, stepchildren, or legally adopted children who are unmarried, under age 25, and legal dependents for federal tax exemption purposes. A Dependent Child (including persons incapable of self-sustaining employment by reason of mental retardation or physical handicap) must be under age 25 at the time of application to be eligible for coverage. Cancer: Cancer is a disease manifested by the presence of a malignant tumor and characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Cancer also includes, but is not limited to, leukemia, Hodgkin’s disease, and melanoma. Cancer must receive a positive medical diagnosis. 1. Internal Cancer includes all Cancers other than Nonmelanoma Skin Cancer (see definition of Nonmelanoma Skin Cancer). 2. Nonmelanoma Skin Cancer is a Cancer other than a melanoma that begins in the upper part of the skin (epidermis). Associated Cancerous Conditions, premalignant conditions, or conditions with malignant potential will not be considered Cancer. Associated Cancerous Condition: An Associated Cancerous Condition is a myelodysplastic blood disorder, myeloproliferative blood disorder, or carcinoma in situ (in the natural or normal place, confined to the site of origin without having invaded neighboring tissue). An Associated Cancerous Condition must receive a positive medical diagnosis. Premalignant conditions or conditions with malignant potential, other than those specifically named above, are not considered Associated Cancerous Conditions. Hospital: Hospital does not include any institution or part thereof used as an emergency room; an observation unit; a rehabilitation unit; a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a psychiatric unit; an Extended-Care Facility; a skilled nursing facility; or a facility primarily affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for the aged, or care for persons addicted to drugs or alcohol. Ambulatory Surgical Center: An Ambulatory Surgical Center does not include a doctor’s or dentist’s office, clinic, or other such location. Physician: A Physician is a person legally qualified to practice medicine, other than a member of your immediate family, who is licensed as a Physician by the state where treatment is received to treat the type of condition for which a claim is made.

1932 Wynnton Road • Columbus, GA 31999 Phone: 706.323.3431 • Toll-free: 1.800.992.3522 aflac.com

Plan 1

Hospital Intensive Care Protection Hospital Intensive Care Unit Insurance

Plan Benefits • Hospital Intensive Care Unit Benefit • Step-Down Intensive Care Unit Benefit • Major Human Organ Transplant Benefit • Progressive Benefit

Form A18475AKS

IC(8/06)

Hospital Intensive Care Protection Insurance Policy Series A18400

Hospital Intensive Care Unit Benefit Aflac will pay the following benefits when a covered person incurs a charge for confinement in a hospital intensive care unit or a step-down intensive care unit for a covered sickness or injury: Confinement in a Hospital Intensive Care Unit: Sickness Injury Days 1–7 $ 700 per day $ 800 per day Days 8–15 $1,200 per day $1,300 per day This benefit is limited to 15 days per period of confinement. No lifetime maximum. Confinement in a Step-Down Intensive Care Unit: Aflac will pay benefits for confinement in a step-down intensive care unit after exhaustion of benefits paid for confinement in a hospital intensive care unit or for Days 1–15 of a step-down intensive care unit confinement. This benefit is limited to 15 days per period of confinement. Sickness Injury Days 1–15 (Step-Down Intensive Care Unit) $350 per day $350 per day or Days 16–30 (Hospital Intensive Care Unit) $350 per day $350 per day Benefits payable for confinement in a hospital intensive care unit or for confinement in a step-down intensive care unit are not payable on the same day. If a covered person is charged for both on the same day, only the highest eligible benefit will be paid. Treatment or confinement in a U.S. government hospital does not require a charge for benefits to be payable. Benefits reduce by one-half for losses incurred on or after the policy anniversary date following the 70th birthday of a covered person. No lifetime maximum. Progressive Benefit for Hospital Intensive Care Unit/StepDown Intensive Care Unit Confinement A $2 indemnity will accumulate for the named insured and the covered spouse for each calendar month the policy remains in force after the effective date. This accumulated indemnity, if any, will be paid in addition to any benefits paid under the Hospital Intensive Care Unit Benefit. This progressive benefit will cease to build on the policy anniversary date following the 65th birthday of a covered person. Any amount accrued at the time this benefit ceases to build for a covered person will continue to be added to the benefit amount for all hospital intensive care unit/step-down intensive care unit confinements commencing prior to the policy anniversary date following the 70th birthday of a covered person. This accumulated benefit reduces at age 70. This accumulated benefit will be reduced by one-half for hospital intensive care unit/step-down intensive care unit confinements commencing on or after the policy

anniversary date following the 70th birthday of a covered person. This benefit is not applicable and will not accrue to any covered person who has attained age 65 prior to the effective date of the policy. The named insured and covered spouse, if any, are the only persons eligible for this benefit. Dependent children do not qualify for this benefit. When a spouse is added to an existing policy, this benefit will begin to accrue from the endorsement date adding such spouse, provided the spouse has not yet attained age 65. Ambulance Benefit Aflac will pay $250 for ground ambulance transportation of a covered person to and from a hospital where the covered person is confined in a hospital intensive care unit or step-down intensive care unit. Aflac will pay $2,000 if air ambulance transportation of a covered person is required to and from a hospital where the covered person is confined in a hospital intensive care unit or step-down intensive care unit. The ambulance service must be performed by a licensed professional or licensed volunteer ambulance company. This benefit is limited to two trips per confinement. No lifetime maximum. Major Human Organ Transplant Benefit Aflac will pay $25,000 as a result of a human organ transplant procedure when a covered person is confined in a hospital and receives one or more of the following human organs: • Kidney • Liver • Heart • Lung • Pancreas Transplant procedures involving more than one organ will be considered one organ transplant procedure. This benefit is not payable for transplants involving mechanical or nonhuman organs and is limited to one procedure per 180-day period. No lifetime maximum. Continuation of Coverage Benefit Aflac will waive all monthly premiums due for the policy and riders, if applicable, for two months if you meet all of the following conditions: (1) your policy has been in force for at least six months; (2) we have received premiums for at least six consecutive months; (3) your premiums have been paid through payroll deduction; (4) you or your employer has notified us in writing within 30 days of the date your premium payments ceased due to your leaving employment; and (5) you re-establish your premium payments through your new employer’s payroll deduction process or direct payment to Aflac. You will again become eligible to receive this benefit after you re-establish your premium payments through payroll deduction for a period of at least six months and we receive premiums for at least six consecutive months. Payroll deduction means your premium is remitted to Aflac for you by your employer through a payroll deduction process.

American Family Life Assurance Company of Columbus (Aflac)

Guaranteed-Renewable The policy is guaranteed-renewable for your lifetime with benefits reduced at age 70, subject to Aflac’s right to change premiums by class upon any renewal date. Family Coverage Family coverage includes the insured; spouse; and dependent, unmarried children to age 25. Newborn children are automatically covered under the terms of the policy from the moment of birth. Effective Date The effective date is the date shown in the Policy Schedule, not the date you signed the application for coverage. The payroll rate may be retained after one month’s premium payment on payroll deduction. Limitations and Exclusions Benefits payable under the policy will be reduced by one-half for losses that begin on or after the policy anniversary date following the 70th birthday of a covered person. Benefits are not payable for losses or confinements that occur or begin before the policy effective date or after termination of the policy. The policy does not cover losses caused by or resulting from: • Intentionally self-inflicting bodily injury or attempting suicide; • Participating in or attempting to participate in any illegal activity that is classified as a felony, whether charged or not (the term felony is as defined by the law of the jurisdiction in which the activity takes place); • Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve; • Having treatment for a mental or nervous disorder or disease; alcoholism or drug dependency; any loss sustained or contracted due, directly or indirectly, to a covered person’s being intoxicated or under the influence of alcohol, drugs, or any narcotic unless administered on the advice of a physician and taken according to the physician’s instructions (the term intoxicated refers to that condition as defined by the law of the jurisdiction in which the injury or cause of the loss occurred); • Confinement in units such as telemetry or surgical recovery rooms; postanesthesia care units; progressive care units; intermediate care units; private monitored rooms; observation units located in emergency rooms or outpatient surgery units; beds, wards, or private or semiprivate rooms with or without telemetry monitoring equipment; emergency rooms; labor or delivery rooms; or other facilities that do not meet the standards for a hospital intensive care unit or step-down intensive care unit.

A hospital does not include any institution, or part thereof, used as an emergency room; a rehabilitation unit; a hospice unit, including any bed designated as a hospice bed or a swing bed; a transitional care unit; a convalescent home; a rest or nursing facility; a psychiatric unit; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for the aged, or care for persons addicted to drugs or alcohol. A physician does not include a member of your immediate family. A hospital intensive care unit does not include telemetry or surgical recovery rooms, postanesthesia care units, progressive care units, intermediate care units, private monitored rooms, observation units located in emergency rooms or outpatient surgery units, step-down intensive care units, or other facilities that do not meet the standards for a hospital intensive care unit. A step-down intensive care unit does not include telemetry or surgical recovery rooms; observation units located in emergency rooms or outpatient surgery units; postanesthesia care units; beds, wards, or private or semiprivate rooms with or without telemetry monitoring equipment; emergency rooms; or labor or delivery rooms. The policy to which this sales material pertains is written only in English; the policy prevails if interpretation of this material varies.

Refer to the policy for complete details, limitations, and exclusions. This brochure is for illustration purposes only.

Aflac is ... • A Fortune 500 company insuring more than 40 million people worldwide. • Rated AA in insurer financial strength by Standard & Poor’s (April 2004), Aa2 (Excellent) in insurer financial strength by Moody’s Investors Service (January 2006), A+ (Superior) by A.M. Best (June 2005), and AA in insurer financial strength by Fitch, Inc. (April 2005).* • Named by Fortune magazine to its list of America’s Most Admired Companies for the sixth consecutive year in March 2006. • A premier provider of insurance policies with premiums payroll deducted for more than 350,000 payroll accounts nationally. • Outstanding in claims service, with most claims processed within four days. • Included by Forbes magazine in its annual Platinum 400 List of America’s Best Big Companies for the sixth year in January 2006. • Named by Fortune magazine to its list of the 100 Best Companies to Work For in America for the eighth consecutive year in January 2006. *Ratings refer only to the overall financial status of Aflac and are not recommendations of specific policy provisions, rates, or practices.

1.800.99.AFLAC (1.800.992.3522) En español: 1.800.SI.AFLAC (1.800.742.3522) Visit our Web site at aflac.com. Your local Aflac insurance agent/producer

American Family Life Assurance Company of Columbus (Aflac) · Worldwide Headquarters · 1932 Wynnton Road · Columbus, Georgia 31999 · aflac.com

 

     

CANCER & SPECIFIED DISEASE INSURANCE  WITH OPTIONAL INTENSIVE CARE RIDER    Underwritten by Humana Insurance Company    John D. Webb  600 S. Santa Fe, Suite C  Salina, Kansas 67401  (888)756‐6670  [email protected]  www.webbandassociatesfinancial.com 

Cancer & Specified Disease Insurance With Optional Intensive Care Rider

WHEN CANCER STRIKES... Ý Ý

Expenses increase... travel & lodging to and from treatment, medication, co-payments, special diets, and treatment not covered by health insurance, etc.



Income decreases... missed work for both you and your spouse (will you be able to afford to have your spouse with you when you have to go to treatment? Direct medical cost represents about 40% of the cost when you are stricken with Cancer Source: The American Cancer Society’s Cancer Facts & Figures, 2008

HOW CAN YOU PROTECT YOUR FINANCIAL RESOURCES? RELATIVES

 LOANS

SAVINGS

LIQUIDATION OF ASSETS CANCER PLAN BENEFITS 

- Major medical pays the doctor and hospital - This Plan pays money directly to you or a person designated by you - You can use the money any way you want

* Pays regardless of other coverage * In and out of hospital benefits * Covers certain transportation and lodging * Many benefits have no lifetime maximum * Wellness Benefits * Portable (take it with you) * Donor Benefits * Renewable for life * Premiums for this policy are calculated at age at issue class as of the effective date of the policy. You lock in your age class for the life of the policy. The premium for this policy and rider if selected may change but will not change because you attain the next premium rate age classification.

Security For You and Your Family Underwritten by Humana Insurance Company Cancer & Specified Disease Policy Form HIC-CAN-POL-KS -5/09 BBAC 01, 15-KS Form Number: HIC-SB-TX

  

   

  

   

Wellness Benefit. For Cancer screening tests such as mammogram, flexible sigmoidoscopy, pap smear, chest X-ray, hemocult stool specimen, or prostate screen. No Lifetime Maximum

Up to $50 per calendar year

Up to $100 per calendar year

Positive Diagnosis Test. Payable for a test that leads to positive diagnosis of Cancer or Specified Disease within 90 days. This benefit is not payable if the same Cancer or Specified Disease recurs.

Up to $300 per calendar year

Up to$300 per calendar year

$2,500

$7,500

Actual Charge

Actual Charge

 1

2

3

4

First Diagnosis Benefit. One-time benefit payable when a covered person is first diagnosed with Cancer (other than Skin Cancer) or a specified disease. Must occur after the policy effective date. Second and Third Surgical Opinions. Covers written opinions received after a positive diagnosis and before surgery. No Lifetime Maximum

5

Non-Local Transportation. Payable for transportation to a hospital, clinic or treatment center which is more than 60 miles and less than 700 miles from a Covered Person’s home. No Lifetime Maximum

Actual charges by a common carrier or 50 cents per mile if a personal vehicle is used.

Actual charges by a common carrier or 50 cents per mile if a personal vehicle is used

6

Adult Companion Lodging and Transportation. Payable for one adult companion to stay with a Covered Person who is confined in a hospital that is more than 60 miles and less than 700 miles from his or her home. Covered expenses include a single room in a motel or hotel up to 60 days per confinement; and the actual charge of round trip coach fare by a common carrier or a mileage allowance for the use of a personal vehicle. This benefit is not payable for lodging expense incurred more than 24 hours before the treatment nor for lodging expense incurred more than 24 hours following treatment. No Lifetime Maximum

Up to $75 per day for lodging. 50 cents per mile if a personal vehicle is used.

Up to $75 per day for lodging. 50 cents per mile if a personal vehicle is used

Ambulance. For ambulance service if the Covered Person is taken to a hospital and admitted as an inpatient. No Lifetime Maximum

Actual Charge

Actual Charge

Up to $1,500. Outpatient surgery at 150% of the schedule not to exceed the actual surgeon’s fees

Up to $4,500. Outpatient surgery at 150% of the schedule not to exceed the actual surgeon’s fees

$200 per day Actual charges

$400 per day Actual charges

50 cents per mile

50 cents per mile

Actual charges up to $50 per day.

Actual charges up to $50 per day.

7

8

Surgery. Covers actual surgeon’s fee for an operation up to the amount listed on the schedule in the policy. No Lifetime Maximum

9

Donor-Benefit Bone Marrow and Stem Cell Transplant. We will pay expenses incurred by the covered person and his or her live donor. Medical Expense Allowance Round trip Coach Fare for Common Carrier to the city where the transplant is performed; or Personal Automobile expense measured from the home of the Donor or Covered Person. No to exceed 700 miles per hospital stay. Lodging and meals expense for donor to remain near hospital.

10

Bone Marrow and Stem Cell Transplant. We will pay Actual Charges per Covered Person for surgical and anesthetic charges associated with bone marrow transplant and/or peripheral stem cell transplant

11

Anesthesia. For services of an anesthesiologist during a Covered Person’s surgery. No Lifetime Maximum

Actual charges to a combined lifetime maximum of $15,000 Up to 25% of surgical benefit paid. Skin Cancer $100

Actual charges to a combined lifetime maximum of $15,000 Up to 25% of surgical benefit paid. Skin Cancer $100

 12

Ambulatory Surgical Center. We will pay the expense incurred at an Ambulatory Surgical Center. No Lifetime Maximum

  

   

  

   

$250 Per Day

$250 Per Day

13

Drugs and Medicines. Payable for drugs and medicine received while the Covered Person is hospital confined. No Lifetime Maximum

Up to $25 per day, $600 per calendar year

Up to $25 per day, $600 per calendar year

14

Outpatient Anti-Nausea Drugs. Payable for drugs prescribed by a physician to suppress nausea due to Cancer or Specified Disease. No Lifetime Maximum

Up to $250 per calendar year

Up to $250 per calendar year

15

Radiation, Radioactive Isotopes Therapy, Chemotherapy, or Immunotherapy. Covers treatment administered by a Radiologist, Chemotherapist or Oncologist on an inpatient or outpatient basis. No Lifetime Maximum

Actual charges up to $1,000 per day

Actual charges up to $10,000 per month

Miscellaneous Therapy Charges. Covers charges for physical exams, lab work or x-rays in connection with radiation and chemotherapy treatment. Service must be performed while receiving treatment(s) in Item 15 or within 30 days following a covered treatment.

Actual charges up to a lifetime maximum of $10,000

Actual charges up to a lifetime maximum of $10,000

Self-Administered Drugs. We will pay the actual expenses incurred for self-administered chemotherapy, including hormone therapy, or immunotherapy agents. This benefit is not payable for planning, monitoring, or other agents used to treat or prevent side effects, or other procedures related to this therapy treatment. No Lifetime Maximum

Actual charges up to $4,000 per month

Actual charges up to $4,000 per month

Colony Stimulating Factors. We will pay expenses incurred for expenses incurred for: [a] cost of the chemical substances and [b] their administration to stimulate the production of blood cells. Treatment must be administered by an Oncologist or Chemotherapist. No Lifetime Maximum

Actual charges up to $500 per month

Actual charges up to $1,000 per month

19

Blood, Plasma and Platelets. For blood, plasma and platelets, and transfusions: including administration. No Lifetime Maximum

Actual charges up to $200 per day

Actual charges up to $200 per day

20

Physician's Attendance. For one visit per day while hospital confined. No Lifetime Maximum

Up to $35 per day

Up to $35 per day

21

Private Duty Nursing Service. For private nursing services ordered by the physician while hospital confined. No Lifetime Maximum

Up to $100 per day

Up to $100 per day

22

National Cancer Institute Designated Comprehensive Cancer Treatment Center Evaluation/Consultation Benefit. We will pay the expense incurred if an Insured Person is diagnosed with Internal Cancer and seeks evaluation or consultation from a National Cancer Institute designated Comprehensive Cancer Treatment Center. If the Comprehensive Cancer Treatment Center is located more than 30 miles from the Insured Person’s place of residence, We will also pay the transportation and lodging expenses incurred. This benefit is not payable on the same day a Second or Third Surgical Opinion Benefit is payable and is in lieu of the Non-Local Transportation Benefits of the policy.

Expenses incurred limited to a lifetime maximum up to $750 for evaluation

Expenses incurred limited to a lifetime maximum up to $750 for evaluation

Expenses incurred limited to a lifetime maximum up to $350 for transportation and lodging

Expenses incurred limited to a lifetime maximum up to $350 for transportation and lodging

Actual charge

Actual charge

16

17

18

23

Breast Prosthesis. Covers the prosthesis and its implantation if it is required due to breast cancer. No Lifetime Maximum

  

   

  

   

$1,500 lifetime maximum per amputation.

$1,500 lifetime maximum per amputation.

Up to $35 per session

Up to $35 per session

$300 per day

$600 per day

Extended Care Facility. Limited to number of days of prior hospital confinement. Must begin within 14 days after hospital confinement, and be at the direction of the attending physician. No Lifetime Maximum

Up to $50 per day

Up to $50 per day

At Home Nursing. Limited to number of days of prior hospital confinement. Must begin immediately following a hospital confinement, and be authorized by the attending physician. No Lifetime Maximum

Up to $100 per day

Up to $100 per day

New or Experimental Treatment. We will pay the expenses incurred by a Covered Person for New or Experimental Treatment judged necessary by the attending physician and received in the United States or in its territories. No Lifetime Maximum

Up to $7,500 per calendar year

Up to $7,500 per calendar year

Hospice Care. If a Covered Person elects to receive hospice care, we will pay the expenses incurred for care received in a Free Standing Hospice Care Center. No Lifetime Maximum

Up to $50 per day

Up to $50 per day

$200 per day

$200 per day

Actual charge up to a lifetime maximum of $150

Actual charge up to a lifetime maximum of $150

Actual charges up to $1,500 per calendar year

Actual charges up to $1,500 per calendar year

Waiver of Premium. After 60 continuous days of disability due to Cancer or Specified Disease, we will waive premiums starting on the first day of policy renewal.

After 60 days

After 60 days

Hospital Confinement. Payable for each day a Covered Person is charged the daily room rate by a Hospital, for up to 60 days of continuous stay. The benefit for covered children under age 21 is two times the Covered Person’s daily benefit. No Lifetime Maximum

$100 per day

$200 per day

 24

Artificial Limb or Prosthesis. Covers implantation of an artificial limb or prosthesis when an amputation is performed.

25

Physical or Speech Therapy. Payable when therapy is needed to restore normal bodily function. No Lifetime Maximum

26

Extended Benefits. If a Covered Person is confined in a Hospital for 60 continuous days we will pay a Hospital Confinement Benefit beginning on the 61st day for Hospital Confinement. This benefit is payable in place of the Hospital Confinement Benefit. No Lifetime Maximum

27

28

29

30

31

Government or Charity Hospital. Payable if the Covered Person is confined in a U. S. Government Hospital or a hospital that does not charge for its services. Paid in place of all other benefits under the policy. No Lifetime Maximum

32

Hairpiece. We will pay the actual expense incurred per Covered Person for a hairpiece when hair loss is a result of Cancer Treatment.

33

Rental or Purchase of Durable Goods. We will pay the actual expenses incurred for the rental or purchase of the following pieces of durable medical equipment: a respirator or similar mechanical device, brace, crutches, hospital bed, or wheelchair. No Lifetime Maximum

34

35

OPTION TO ADD ADDITIONAL BENEFITS HOSPITAL INTENSIVE CARE INSURANCE RIDER [FORM NUMBER HIC-ICR-KS 5/09] This coverage will provide you with benefits if you go into a Hospital Intensive Care Unit (ICU). Benefits. Your benefits start the first day you go into ICU. The benefit is payable for up to 45 days per ICU stay. Hospital Intensive Care Confinement Benefit. You may choose a benefit of $325, $625, $725 or $825 per day. It is reduced by one-half at age 75. Double Benefits. We will double the daily benefits for each day you are in an ICU as a result of Cancer or a Specified Disease. We will also double the benefit for an injury that results from: being struck by an automobile, bus, truck, motorcycle, train, or airplane; or being involved in an accident in which the named insured was the operator or was a passenger in such vehicle. ICU confinement must occur within 48 hours of the accident. Emergency Hospitalization and Subsequent Transfer to an ICU. We will pay the benefit selected by you for the highest level of care in a hospital that does not have an ICU, if you are admitted on an emergency basis, and you are transferred within 48 hours to the ICU of another hospital. Step Down Unit. We will pay a benefit equal to one half the chosen daily benefit for confinement in a Step Down Unit. Exceptions and Other Limitations. Except as provided in Step Down Unit and Emergency Hospitalization and Subsequent Transfer to an ICU, coverage does not provide benefits for: surgical recovery rooms; progressive care; intermediate care; private monitored rooms; observation units; telemetry units; or other facilities which do not meet the standards for a Hospital Intensive Care Unit. Benefits are not payable: if you go into an ICU before the policy "Effective Date"; if you go into an ICU for intentionally self-inflicted bodily injury or suicide attempts; if you go into an ICU due to being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on the advice of a physician and taken according to the physician’s instructions. The term “intoxicated” refers to that condition as defined by law in the jurisdiction where the accident or cause of loss occurred. RENEWABILITY. As long as premiums are paid on time, you have the right to renew your policy and riders. PREMIUMS. The premium for the policy and riders may change at any time. The change in premium will apply to all policies and riders of this form number issued in your State of residence. A grace period of 31 days will be granted for the payment of each premium after the first. Your policy remains in force during the grace period. Premiums for this policy are calculated at age at issue class as of the effective date of the policy. You lock in your age class for the life of the policy. The premium for this policy and rider if selected may change but will not change because you attain the next premium rate age classification. PAYMENT OF BENEFITS. We will pay the benefits for the necessary treatment of a Covered Person’s Cancer or Specified Disease provided he or she is covered under this Policy and this Policy remains in force. Payment will be made in accordance with all applicable Policy provisions. Benefits are payable for a Positive Diagnosis that begins after the effective date of this Policy and while this policy has remained in force. The Positive Diagnosis must be for Cancer or Specified Disease, as they are defined in the Policy. All benefits are subject to the terms of the Policy. If Cancer or a Specified Disease is diagnosed while You or any Covered Person is confined in the Hospital, benefits will begin on the day of admission or 10 days prior to the Date of Diagnosis if this is more favorable to You. Admission to the Hospital must begin after the effective date of this Policy. If a Positive Diagnosis is made for Cancer or Specified Disease within 12 months after a Tentative Diagnosis, benefits will be paid from the date of the Tentative Diagnosis after the Policy Effective Date. If the Positive Diagnosis of Cancer or Specified Disease can only be confirmed post-mortem, then we will pay benefits beginning on the first day of confinement for the terminal admission for up to 45 days. (a) With respect to the Wellness Benefit, on the date the expense is incurred. (b)

Subject to the Maximum Benefit Amount stated across from each Benefit.

OTHER DISEASES COVERED: Addison’s Disease Amyotrophic Lateral Sclerosis Cystic Fibrosis Diphtheria Encephalitis Epilepsy Hansen’s Disease Legionnaire’s Disease Lupus Erythematosus Lyme Disease Malaria

Meningitis (epidemic cerebrospinal) Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Niemann-Pick Disease Osteomyelitis Poliomyelitis Rabies Reye’s Syndrome Rheumatic Fever Rocky Mountain Spotted Fever

Scarlet Fever Sickle Cell Anemia Tay-Sachs Disease Tetanus Toxic Epidermal Necrolysis Tuberculosis Tularemia Typhoid Fever Undulant Fever Whipple’s Disease

EXCEPTIONS AND LIMITATIONS. Benefits will not be paid for the following: Cancer or Specified Disease diagnosed before the policy effective date; or losses not directly due to Cancer or Specified Disease. Claims may be reduced, limited or denied during the first 24 months after the policy effective date if you made a fraudulent misstatement in the application for the policy. A claim may be denied or the policy may be voided at any time if you make any material misstatements in the application for the policy. EXCEPTIONS AND OTHER LIMITATIONS. The Policy pays benefits only for diagnosis resulting from Cancer or Specified Diseases, as defined in the Policy. It does not cover: (1) any other disease or sickness; (2) injuries; (3) any disease, condition, or incapacity that has been caused, complicated, worsened, or affected by: (a) Specified Disease or Specified Disease treatment; or (b) Cancer or Cancer treatment, or unless otherwise defined in the Policy (4) care and treatment received outside the United States or its territories; (5) treatment not approved by a Physician as medically necessary; (6) Experimental Treatment by any program that does not qualify as Experimental Treatment as defined in the Policy. PRE-EXISTING CONDITION LIMITATION. During the first 12 months of a Covered Person's insurance, losses incurred for PreExisting Conditions are not covered. During the first 12 months following the date a Covered Person makes a change in coverage that increases his or her benefits, the increase will not be paid for Pre-Existing Conditions. After this 12 month period, however, benefits for such conditions will be payable unless specifically excluded from coverage. This 12 month period is measured from the effective date of coverage for each Covered Person. A Pre-Existing Condition means Cancer or a Specified Disease, for which a Covered Person has received medical consultation, treatment, care, services, or for which diagnosis test(s) have been recommended or for which medication has been prescribed during the 12 months immediately preceding the effective date of coverage. If this Policy replaces a prior specified disease policy or is in addition to another specified disease policy already in force, months or days used towards satisfaction of the other policy's pre-existing conditions limitation will count as time used toward satisfaction of this policy's pre-existing conditions limitation. ADDITIONAL INFORMATION. Family Plan Coverage may include the following: you; your spouse who is not legally separated or divorced from you; your unmarried child, including a natural child from the moment of birth, stepchild, foster or legally adopted child, or child in the process of adoption (including a child while you are a party to a proceeding in which the adoption of such child by you is sought); a child for whom you are required by a court order to provide medical support, and grandchildren who are dependent on you for federal income tax purposes at the time of application, who is: (a) not yet age 21; or (b) is not yet age 25 if a full time student at an accredited school. Coverage is subject to each applicant submitting evidence of insurabilty on themselves and their dependents (if applying) which is acceptable to Humana Insurance Company. No coverage will be issued until your application is approved. If approved, your effective date of coverage will be indicated in the policy that is issued to you. This Sales Brochure is not a contract. It is intended only as a brief description of the policy provisions in the planning of your program. The benefits are determined by the terms and conditions of the policy alone. IN ALL CASES, CONSULT YOUR POLICY FOR FULL DETAILS. CLAIM PROVISIONS Notice of Claim. Written notice of claim must be given to Us within 90 days after an Covered Person's loss, or as soon thereafter as reasonably possible. Written notice given by or on behalf of the claimant to Us with information sufficient to identify the Covered Person, is deemed notice to Us. Upon receipt of your policy, please review it and your application. If any information is incorrect, please contact the Administrator at 1-800-845-7519.

This is not a Medicare Supplement Policy. If you are eligible for Medicare, see the Medicare Supplement Buyer’s Guide available from the Company. THE POLICY ONLY COVERS CANCER AND THE DISEASES SPECIFIED ABOVE, UNLESS THE HOSPITAL INTENSIVE CARE RIDER IS SELECTED. Underwritten By: Humana Insurance Company Administered By: Bay Bridge Administrators, LLC P.O. Box 161690 Austin, TX 78716