| USE ANY DOCTOR OR HOSPITAL |
 |
| ▪ No Deductible of Co-pays |
| ▪ No PPO and No HMO |
| ▪ Guaranteed Renewable to Age 65 |
| Benefits Are Paid Directly To You, In Addition To Any Other Insurance You May Have. |
| SICKNESS AND ACCIDENT MEDICAL BENEFITS SCHEDULE |
DOCTOR'S OFFICE CALLS
With Any Licensed Provider |
$75.00 per visit
10 per Calendar Year |
OUTPATIENT BENEFIT
Doctor's Treatment, Medical Suppolies, X-Rays, Lab & More |
up to $250.00 per visit |
| AMBULANCE BENEFIT |
$200.00
Per Sickness or Accident |
| HOSPITAL BENEFIT |
$200.00 Daily
After 3 Days |
|
| Offered To United First Universal Members Exclusively. |
| Pre-Existing Condition Limitation |
| Pre-existing conditions are those medical conditions disclosed or not disclosed on the application which were diagnosed or for which medical advice or treatment was recommended or received from a Doctor within a 12 month period (6 months in ID) immediately preceding the Effective Date of a Covered Person's coverage. |
| Any loss due to a pre-existing condition is not covered unless the loss begins more than 12 months after the Effective Date of a Covered Person's coverage. |
| Exceptions and Limitations |
| We won't pay for charges incurred: |
| 1. due to war or act of war whether declared or not; |
| 2. due to intentionally self-inflicted injury; |
| 3. due to Mental Illness or nervous disorders without demonstrable organic disease (Loss due to Parkinson's Disease or senile dementia is covered); |
| 4. for normal pregnancy and child birth. Complications of pregnancy are covered as a Sickness; |
| 5. for treatment of an injury that results from the Covered Person's commission of, or attempt to commit a felony, or from the Covered Person being engaged in an illegal activity; |
| 6. for cosmetic surgery. But "cosmetic surgery" does not include reconstructive surgery that is incidental because of previous surgery due to trauma, infection, or other disease of the involved part; |
| 7. for confinement in a Hospital located or care received outside of the territorial limits of the United States of America, its commonwealth partners, or the countries of Canada and Mexico; or |
| 8. for the Covered Person being intoxicated or under the influence of alcohol or a narcotic; unless administered on the advice of a Physician. |
| 9. Doctor's Office Calls are limited to one call per week, except Maryland. |
| 10. Outpatient Benefit maximum is $1,000.00 per calendar year. |
| Stable Premiums |
| Your premiums cannot be changed due to declining health. Your premiums can only be changed if we change the premiums of all like policies in your state. You will be notified before any changes are made. |
Issue Age Unisex Rates
Rates Stay As Of Issue Age |
| Issue Ages |
Monthly |
18 ~ 49
50 ~ 59
60 ~ 64 |
$31.00
$49.00
$70.00 |
|
Underwritten by:
United National Life Insurance Company of America |
Underwritten by:
Guarantee Trust Life Insurance Company |
| in AR, ID, IL, KS, MO, NE, NV, NM, ND, OK, SD, TX. |
in All Other States Except NY. |
| Group Policy #UP2005. |
Group Policy #GP2005. |
|