Managing Your Healthcare Costs Limited Benefit Hospital Expense Policy This is a solicitation for insurance. You may be contacted by an Agent representing United American Insurance Company. Policy and Rider Forms: MMGAP, SWL, RT10, R-MMGAP-HO, ABR1, DFR, U4272. www.unitedamerican.com/foundation

The Foundation Signature Series was designed to help pay deductibles, copayments, and coinsurance for individuals with current or pending major medical health coverage.

Calendar-Year Maximum Benefit Levels Policy Form: MMGAP

Choose your Calendar-Year Maximum Benefit. $1,000 $4,000 $1,500 $5,000 $2,000 $6,000 $2,500 $7,500 $3,000 $10,000 The calendar year-maximum benefit you select does not have to be the same as your major medical deductible. The calendar-year maximum benefit starts Jan. 1 and ends Dec. 31. Your benefit amount starts over on Jan. 1. Policy Form: MMGAP

Foundation Signature Series Limited Benefit Hospital Expense Policy UA will pay up to 100% of your out-of-pocket deductibles, copayments, or coinsurance required by your major medical policy for hospital inpatient treatment, up to the calendar-year maximum benefit*. Ages 0-63. Policy Form: MMGAP *Limitations and Exclusions apply. Preexisting Condition Limitation applies.

Policy Benefits There is no limit to the number of inpatient hospital confinements you can have during one year – we pay until you reach your calendar-year maximum benefit, as long as the expense is covered by your major medical policy*. You can choose to have benefits paid directly to you or assigned to your health service provider. If you die due to an accidental bodily injury while covered under this policy, all premiums will be refunded**. Policy Form: MMGAP *Limitations and Exclusions apply. Preexisting Condition Limitation applies. **Death must occur while this policy is in force and with 180 days of injury.

How To File A Claim Send in a copy of your major medical provider’s Explanation of Benefits along with your standard hospital billing form (UB-04) Policy Form: MMGAP *Limitations and exclusions apply. Preexisting Condition Limitation applies.

Optional Hospital Outpatient Benefit Rider Policy and Rider Form: MMGAP and R-MMGAP-HO

Optional Hospital Outpatient Benefit Rider Available at an additional cost UA will pay 50% of your out-of-pocket deductible, copayment, or coinsurance required by your major medical policy for hospital outpatient treatment, up to the calendar-year maximum benefit*. Note: The total deductibles, copayments, and coinsurance covered under the Hospital Inpatient Benefit and the Hospital Outpatient Benefit combined are limited to the maximum annual benefit per calendar year. Policy and Rider Forms: MMGAP and R-MMGAP-HO *Limitations and Exclusions apply. Preexisting Condition Limitation applies.

Number of Outpatient Hospital Visits/Procedures Covered There is no limit to the number of outpatient hospital visits/procedures you can have during one calendar year – we pay your out-of-pocket deductibles, copayments and coinsurance until you reach your calendar-year maximum benefit, as long as the expense is covered by your major medical policy*. Note: The total deductibles, copayments, and coinsurance covered under the Hospital Inpatient Benefit and the Hospital Outpatient Benefit combined are limited to the maximum annual benefit per calendar year. Policy and Rider Forms: MMGAP and R-MMGAP-HO *Limitations and Exclusions apply. Preexisting Condition Limitation applies.

Kate’s Story Kate is a 45-year-old teacher. She has major medical coverage through her employer. She selected a $5,000 deductible policy for the lower premiums. Kate’s major medical policy also requires a copayment and 20% coinsurance. Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Kate’s Story Unexpectedly, Kate developed pneumonia and spent two nights in the hospital. Fortunately, she purchased a $7,500 Foundation Signature Series to help cover her deductible, copayment, and coinsurance. Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Kate’s Story Total Hospital Expenses Billed to Major Medical Policy for Inpatient Hospital Charges: $15,100 Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Kate’s Story Kate’s Major Medical Explanation of Benefits Foundation Paid Deductible $5,000 Foundation Paid Hospital Admission Copayment $ 100 Foundation Paid 20% Coinsurance $2,000 Total Kate Owed $7,100 Foundation Paid $7,100 Amount Kate Paid $0 Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Her Healthcare Expenses How Kate Managed Her Healthcare Expenses Annual Foundation Premium $605 – vs.– Potential Hospital Expenses $7,100 Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Another Example

Robert’s Story Robert is a 33-year-old single father. He has a major medical policy with a $1,500 deductible. Robert’s policy requires a copayment and 20% coinsurance. Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Robert’s Story He also purchased a $2,000 Foundation Signature Series to help cover his deductible, copayment, and coinsurance. Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Robert’s Story Robert had a motorcycle accident that resulted in a one-night hospital stay. Total Hospital Expenses Billed to Major Medical Policy for Inpatient Hospital Charges: $3,050 Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Robert’s Story Robert’s Major Medical Explanation of Benefits Foundation Paid Deductible $1,500 Foundation Paid Hospital Admission Copayment $ 50 Foundation Paid 20% Coinsurance $ 300 Total Robert Owed $1,850 Foundation Paid $1,850 Amount Robert Paid $0 Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

His Healthcare Expenses How Robert Managed His Healthcare Expenses Annual Foundation Premium $88 – vs.– Potential Hospital Expenses $1,850 Robert has $150 remaining in his calendar-year maximum benefit. Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

Another Example

The Lopez Family’s Story Maria and Jose Lopez, both 38 years old, are married with two teenagers. They have a major medical policy with a $1,000 annual deductible. Their policy also requires a copayment and coinsurance. Their monthly major medical premium for their family is $877. Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.

The Lopez Family’s Story Current Healthcare Situation Annual Major Medical Deductible $1,000 Monthly Major Medical Premium – $877 For illustrative purposes only.

The Lopez Family’s Story Managing Healthcare Expenses Maria and Jose increased their major medical deductible from $1,000 to $5,000, which reduced their major medical monthly premium to $453. Then they selected a $7,500 United American Foundation Signature Series for $136 in monthly premium. Previous Monthly Major Medical Premium – $877 New Monthly Major Medical Premium – $453 Foundation Monthly Premium – $136 For illustrative purposes only.

The Lopez Family’s Story As a result, the Lopez family reduced its monthly premium from $877 ($1,000 annual major medical deductible) to $589 ($5,000 annual major medical deductible + $7,500 Foundation policy). Previous Monthly Major Medical Premium – $877 New Monthly Major Medical Premium Plus Foundation Monthly Premium – $589 For illustrative purposes only.

How the Lopez Family Managed Its Healthcare Expenses The Lopez family saved $288 per month For illustrative purposes only.

Hospital Outpatient Benefit Rider For $187 additional monthly premium, the Lopez family could add the Hospital Outpatient Benefit Rider to its Foundation Signature Series. Their total monthly premium would be $776, which would still be a monthly savings of $101. For illustrative purposes only.

$101 per month! How the Lopez Family Managed Its Healthcare Expenses The Lopez family has a major medical policy, a Foundation Hospital Expense Policy, plus the optional Hospital Outpatient Rider, and still managed to save $101 per month! For illustrative purposes only.

Optional Life Policy Policy Forms: SWL or RT10

Optional Life Policy Available at an additional cost Whole Life Insurance Policy or 10-Year Renewable Term Life Insurance Policy Choose a face amount from $1,000 to $20,000 Whole Life: Level benefit for the life of the insured. Premiums never increase. Builds cash and loan value which you may use in many ways: Surrender your policy for cash, and spend however you wish. Convert your policy to life insurance where no premiums are ever due (such as reduced benefit paid-up insurance, or extended term insurance). Take a loan from your policy’s value. 10-Year Renewable Term Life: Level benefit term policy with premiums that stay the same for 10 years. The policy renews and premiums increase every 10 years. Renewable to age 121. Policy and Rider Forms: SWL or RT10; ABR1 *May vary by state.

Optional Life Insurance Riders Policy and Rider Forms: SWL or RT10; U4272; DFR

Available at an additional cost Optional Riders Available at an additional cost Deposit Fund Rider Available only on 10-Year Renewable Term Life insurance policy. Earn a guaranteed minimum of 3% interest on deposits made with premium payments. Minimum deposit amount is $5. Maximum account balance is limited to two times the policy face amount. Child Term Life Rider Available with the purchase of an adult whole life or term life policy. Choose $5,000 or $10,000 of coverage for children ages 0–23. Policy and Rider Forms: SWL or RT10; U4272; DFR. May vary by state.

Automatic Benefit Terminal Illness Accelerated Death Benefit – Automatically added to either life policy at no additional charge*. We will pay you 50% of your life policy benefit if you are diagnosed with a qualifying terminal illness while your policy is in force. (If the policy owner is diagnosed with a terminal illness that will result in death within one year, we will pay 50% of the death benefit upon our receipt of due proof of terminal illness. This benefit is payable only once. Not approved in all states.) Policy and Rider Forms: SWL or RT10; U4272; DFR. May vary by state.

UA Partners® Receive discounts on: Our optional non-insurance discount health services program is also available for a $6.95 monthly fee. Receive discounts on: Chiropractic — 20% to 40% Dental — 10% to 50% Eye Care — 20% to 60% Hearing Aids — 10% to 20% Prescriptions — Average of 20% Mail Order Pharmacy — Save More $$ DISCLOSURE: This is NOT a health insurance policy. The plan provides discounts at certain health care providers of medical services. The plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. This plan is administered by Best Benefits, Inc., (a discount medical plan organization) at 8420 W. Bryn Mawr, Suite 700, Chicago, IL 60631, 1-800-308-0374. You have the right to cancel and receive a full refund within 30 days. Plans may vary by state. Not available in Kansas, New York, or Vermont.

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