Individual Major Medical Insurance - Health Insurance Leads

Individual MajorMedical InsuranceNEW HAMPSHIREThe information in thisbrochure applies to planswith effective datesSeptember 23, 2010,and later.To find the right health insurance solution, you need a company you can rely on. You’ll feel confident in your choice when you depend on Assurant Health’sexpertise and strength.Expertise• 115+ years selling individual and familyhealth plans• More experience in individual healthinsurance than any other companyStrength• Rated A- (Excellent) by highly respectedinsurance rating source A.M. Best*• Part of Assurant, a Fortune 500 company*Source: A.M. Best Ratings and Analysis of Time Insurance Companyand John Alden Life Insurance Company, November 2009.Delivering confidence —every step of the wayTime Insurance CompanyJohn Alden Life Insurance CompanyAssurant Health is the brand name for products underwritten and issued byTime Insurance Company and John Alden Life Insurance Company.

Protectionfor your peace of mindAssurant Health individual major medical plans always have delivered the strong financialprotection you and your family need, and now they provide the benefits set forth in the newPatient Protection and Affordable Care Act (PPACA). Whether you choose a CoreMed SM orOneDeductible plan, you can count on broad major medical coverage with no maximums onhospitalization, emergency care, outpatient care, prescriptions and doctor visits.All CoreMed and OneDeductible plans include the personal assistance you need to make themost of your coverage and other value-added features.• Freedom to choose your own doctors and hospitals, with discounts for using PPOnetwork providers• Immediate coverage for preventive care, even before you meet your deductible• Preferred rates at time of purchase and through renewal 1• Independent advocates provided by Patient Care help you navigate the health caresystem and compare costs among providers 2CoreMedflexible options and great valueIf you’re looking for flexible major medical coverage that will fit your budget,check out CoreMed, Assurant Health’s most popular individual major medical plan.• Customize a plan from CoreMed’s wide array of benefit options• Control your premiums by adjusting benefit levels• Protect yourself from the unexpected and provide for your everydayhealth care needsOneDeductible simplicity and savingsHSAeligibleLook to a OneDeductible major medical plan for simplicity, convenience and tax savings.• Simplify your plan design with one common deductible for all family membersand all covered expenses, even prescriptions• Realize tax advantages with a Health Savings Account (HSA)• Receive broad benefits, including coverage for substance abuseFor reliable temporary (less than six months) insuranceprotection, ask about Assurant Health Short Term Medical plans.Not available in CT, MA, NJ, NM, NY and VT.1 Preferred risk class is subject to approval and is not available in OR.2 Patient Care is an independent advocacy service and may be discontinued at any time.

CoreMed and OneDeductible network plan benefitsCompare benefits to find the plan that best suits your needs. Look for to see richer benefits only availablewith OneDeductble.Make choices to builD YOUR PLANDeductibleCoreMed• Individual: $500; $1,000; $1,500; $2,000;$3,500; $5,000 or $10,000OneDeductibleUnless otherwise noted, all deductibles, maximums and benefit amounts are applied perperson and are reset each January 1.HSAeligible• Individual: $1,200; $1,600; $2,100; $2,850;$3,750 or $5,000• Family: 2x the deductible, met collectivelyby 2 or more people• Family: $2,400; $3,200; $4,200; $5,700;$7,500; or $10,000Benefit Percentage/CoinsuranceCoinsurance Out-of-Pocket Maximum100%/0%, 80%/20%, 70%/30% or 50%/50% 100%/0%, 80%/20% or 50%/50%$0 to $7,500 depending on coinsurance $0 to $2,500 depending on coinsuranceOffice Visit CopayPrescription Drugs• $35 copay• Copay applies to each of 4 network officevisits per person; additional visits covered,subject to deductible and coinsurance• Generic: $15 copay• Brand: $500 deductible/$25 copay + 50%coinsurance; family deductible maximumis $1,000, met collectively by 2 ormore peopleNot availableCovered, subject to plan deductible andcoinsurancePLAN BENEFITS Benefits are subject to the selected deductible and coinsurance unless otherwise noted.Office Visits; Health Care Practitioner Services;Diagnostic Imaging and Laboratory Services;Professional Air and Ground Ambulance;Inpatient Hospital; Outpatient Hospital,Surgical Center and Urgent Care; OutpatientPhysical MedicinePreventive ServicesEmergency RoomCoveredImmediate coverage paid at 100% for preventive services mandated by the Patient Protectionand Affordable Care Act (see ahrq.gov/clinic/uspstfix.htm for more information); additionalpreventive services paid subject to deductible and coinsuranceCoveredHome Health CareInpatient Rehabilitation Facility, SubacuteRehabilitation and Skilled Nursing FacilitiesTransplants (see page 5 for more information)Up to 160 hoursUp to 90 daysCoveredBehavioral HealthCovered, subject to plan deductible and 50%coinsuranceCovered, subject to integrateddeductible and 50% coinsurance;includes coverage for substance abuseThe amount of benefits depends upon the plan design components selected, and the premium varies with the amount of benefits. Plan design components are notavailable in all combinations. Additional provisions may apply. OneDeductible is also available without a PPO network.3

CoreMed and OneDeductible network informationand plan provisionsNetwork ServicesWhen you use network providers, covered chargesare discounted and never exceed the maximumallowable amount.Out-of-Network ServicesEmergencies: Covered services are always paidat the network benefit percentage –– even if youare out of network –– subject to the maximumallowable amount.Non-emergencies: Covered services are subjectto the out-of-network deductible, the maximumallowable amount provision, a benefit percentagereduction and the increased out-of-networkcoinsurance out-of-pocket maximum. See the chartbelow for details.Medically Necessary CareTreatment must be medically necessary to becovered. Medically necessary services or suppliesmust be:• Appropriate and consistent with the diagnosis• Commonly accepted as proper treatment• Reasonably expected to result in improvementof the condition• Provided in the least intensive setting withoutaffecting the quality of medical care providedMaximum Allowable AmountThe maximum allowable amount is the most theplan pays for covered services. If you have a non-PPO plan or you have a PPO plan and usean out-of-network provider, you are responsiblefor any balance in excess of the maximumallowable amount.Utilization ReviewAuthorization is required before receiving inpatienttreatment and certain types of outpatient treatment.Unauthorized services will result in a penalty of25% of the charge (up to $1,000). Unauthorizedtransplants are not covered.Pre-Existing ConditionsA pre-existing condition is a sickness or an injuryand related complications for which medicaladvice, consultation, diagnosis, care or treatmentwas sought, received or recommended from aprovider or prescription drugs were prescribedduring the 3-month period immediately prior tothe covered person's effective date, regardlessof whether the condition was diagnosed,misdiagnosed or not diagnosed; or that producedsign or symptoms during the 3-month periodimmediately prior to the covered person's effectivedate. Benefits are not paid for charges incurreddue to a pre-existing condition until you have beencontinuously insured under the plan for 3 months,unless the condition was fully disclosed on theapplication. After the 3-month period, benefitsare paid for a pre-existing condition, unless thecondition is specifically excluded from coverage.Enrollees under the age of 19 are not subject to thepre-existing condition limitation.TransplantsKidney, cornea, skin, bone marrow, heart, liverand lung transplants are covered as any otherservice. All transplants include the following:• Up to $10,000 toward travel expenses• Up to $10,000 toward donor expensesOUT-OF-NETWORK COSTSOut-of-network DeductibleOut-of-networkCoinsuranceOut-of-PocketMaximumOut-of-networkBenefit PercentageIndividual Family Individual FamilyCoreMedSelecteddeductible + $1,0002x individual out-of-networkdeductible, met collectivelyby 2 or more people$10,000 $20,000For 100% and 80%benefit percentages:selected benefitpercentage less 20%For 50% and 70% benefitpercentages: 50%OneDeductible PPOSelected individual plandeductible + $500Selected family plandeductible + $1,000$1,000 to$3,000$2,000 to$6,000For 100% and 80% benefitpercentages: selectedbenefit percentage less 20%For 50% benefitpercentage: 50%5

Supplemental products expand the coverage of yourCoreMed or OneDeductible planDental InsuranceThis fee-for-service coverage pays cash benefits thatoffset the cost of routine, basic and, depending on theplan, major dental services. With Assurant HealthDental Insurance, you:• Choose a plan –– Basic or Plus• Visit any dentist• Receive quick cash benefits sent directly to youor to the provider• Can retain the coverage even if you discontinueyour individual medical coverageNot available in MN and VA. Dental Insurance is a separate contract.BASICPLUSPreventive ServicesTwo visits per person each policy year. $75/visit $100/visit• Exams, x-rays, cleaningsBasic Services*Payments are 50% of the listed benefitin the first policy year.• Deep sedation/general anesthesia –first 30 minutes$ 50 $ 100• Amalgam filling – three surfaces $ 40 $ 90• Extraction – erupted tooth orexposed root$ 20 $ 60• Reline complete denture(laboratory)$ 50 $ 145Major Services*Payments are 20% of the listed benefitin the first policy year and 50% in thesecond year.• Inlay — metallic — two surfaces $ 125 $ 330• Crown — resin $ 125 $ 450• Retreatment of previous root canaltherapy — bicuspid$ 105 $ 250• Clinical crown lengthening — hardtissue$ 150 $ 300Life InsuranceTerm life insurance is available to everyone on yourindividual medical plan. The options are: primaryinsured only, spouse only, primary insured andspouse only, dependents and primary insuredand/or spouse.Life insurance face amount options are:• $50,000; $75,000 or $100,000 for primary insuredor spouse• $10,000 for dependents age one yearto eighteen years• $2,000 for dependents age two months to one yearAn accidental death benefit equal to two times theface amount is included. And an accelerated benefitequal to 50% of the face amount of the policy is paidif a covered person is diagnosed with a terminalillness and has a life expectancy of 12 months or less.Life insurance is not available in FL, GA, KS and MN.Accident Medical Expense BenefitThis benefit pays first in the event of an injury —before any copay, access fee, deductible orcoinsurance. You select the benefit amount:$500; $1,000 or $2,500.Supplemental products are available at an additional cost. Accident MedicalExpense Benefit—Riders 4014 and 4017. Additional provisions may apply.Office Visit Copay (optional feature)With an office visit copay, you have theconvenience of knowing what you’ll spend whenyou visit a network doctor. Your copay is your onlycost for an eligible network office visit, includingimmunizations and allergy shots.The office visit copay is not available with OneDeductible plans.• Complete denture $ 135 $ 375• Crown $ 125 $ 375• Maxillary sinusotomy $ 335 $ 825Temporomandibular Joint (TMJ)ServicesA lifetime benefit of up to $500 isavailable for each person beginning inthe third policy year.• Temporomandibular jointarthrogram$ 90 $ 275* Combined annual benefitThe maximum calendar yearbenefit for Basic and Major Servicescombined is:$ 1,000 $ 1,5006

Widen your protection with Assurant Health’s supplemental products, which help you pay expensesnot covered by other insurance. It’s easy and convenient to obtain both an individual medical planand supplemental coverage.• Easy –– No additional application or underwriting is required• Convenient –– One bill covers your total premiumSuiteSolutions ®Available through membership in Health Advocates Alliance, SuiteSolutions provides cash benefits that canprotect you financially if sudden, serious medical needs bring significant medical bills.Choose from two membership levels — SecureSolution or SelectSolution. With both, you:• Select a benefit option that covers some or all of your deductible or total out-of-pocket amount• Receive cash benefits sent directly to you• Get the same full benefit with any doctor or hospital• Can retain the coverage even if you discontinue your individual medical coverageLEVEL 1SecureSolutionBenefits for accidentsSecureSolution can cover the amount you wouldotherwise pay out-of-pocket toward injuryexpenses and provide additional accident benefits.Accident Medical Expense Benefit• Benefit options: $2,500; $5,000 or $10,000 perinsured per accident• $250 deductible per insured per accidentAccidental Death and Dismemberment BenefitUp to $10,000 for the primary insured and up to$1,000 for the spouse and each child.Weekly Accident Indemnity Benefit70% of basic weekly salary to a maximum of$250 per week, for up to 52 weeks for the primaryinsured only.LEVEL 2SelectSolutionBenefits for accidents, critical illnesses and moreSelectSolution includes all the benefits ofSecureSolution, plus it can cover the amountyou would otherwise pay out-of-pockettoward critical illness expenses, and itprovides additional services and discounts.Critical Illness Expense BenefitBenefit options: $2,500; $5,000 or $10,000 for theprimary insured and spouse. Covers life-threateningcancer, heart attack, stroke, renal failure, coma,major organ transplant, loss of sight/speech/hearing and paralysis — as each is defined inthe insurance certificate.Selected benefit option must be the same as Accident Medical Expense.Additional Benefits• Identity network child safety services• Financial relief for identity fraud• Travel assistance• Discounts on hearing aids and moreSelectSolution is not available in IN or OR.Supplemental products are available at an additional cost. Dental insurance is a separate contract. Additional provisions may apply.SuiteSolutions accident medical expense benefits are reduced by benefits payable under any other insurance plan. Accident and critical illness benefits areunderwritten by National Union Fire Insurance Company of Pittsburgh, PA, a subsidiary of Chartis Insurance Company. Supplemental products are available atan additional cost. SuiteSolutions plans are separate contracts. Discount programs are not insurance. Additional provisions may apply.Health Advocates Alliance is an association dedicated to the health and well-being of its members. Membership includes access to a 24-hour nurse helpline,a scholarship program for qualified students studying in a health-related field and a number of additional benefits as well as discounts.Fees paid for membership in Health Advocates Alliance are used for benefits, marketing, distribution and administrative expenses. Assurant Health also mayrealize some benefit from these fees.This brochure provides summary information. For a complete listing of benefits, exclusions and limitations, please refer to the certificate of insurance.In the event there are discrepancies with the information in this brochure, the terms and conditions of the coverage documents will govern.7

Exclusions summaryNo benefits are provided for the following, except where statemandates apply:• For policyholders age 19 and older, charges incurred due to apre-existing condition until you have been continuously insuredfor 3 months unless the condition was fully disclosed on theapplication• Illness or injury caused by war, commission of a felony, attemptedsuicide, influence of an illegal substance, or a hazardous activity forwhich compensation is received• Routine hearing care, routine vision care, vision therapy, surgery tocorrect vision, routine foot care, or foot orthotics• Cosmetic services including chemical peels, plastic surgery andmedications• Charges by a health care practitioner or medical provider who isan immediate family member. Immediate family members are you,your spouse, your children, brothers, sisters, parents, their spousesand anyone with whom legal guardianship has been established• Custodial care• Charges reimbursable by Medicare, Workers’ Compensation orautomobile insurance carriers• Growth hormone stimulation treatment to promote ordelay growth• Routine dental care, unless you choose the dental insurance option• Non-surgical treatment for TMJ or CMJ other than that describedin the contract, or any related surgical treatment that is notpreauthorized• Any correction of malocclusion, protrusion, hypoplasia orhyperplasia of the jaws• Charges for educational testing or training, vocational or workhardening programs, transitional living, or services providedthrough a school system• Diagnosis and treatment of infertility• Maternity and routine nursery charges• Pregnancy, maternity and other expenses related to surrogatepregnancy• Storage of umbilical cord stem cells or other blood components inthe absence of sickness or injury• Genetic testing, counseling and services• Charges for sex transformation, treatment of sexual dysfunction orinadequacy, or to restore or enhance sexual performance or desire• Over-the-counter products• Contraceptive drugs or devices• Drugs not approved by the FDA• Drugs obtained from sources outside the United States• The difference in cost between a generic and brand name drugwhen the generic is available• Treatment of “quality of life” or “lifestyle” concerns, including, butnot limited to: smoking cessation; obesity; hair loss; sexual function,dysfunction, inadequacy or desire; or cognitive enhancement• Treatment used to improve memory or to slow the normal processof aging• Testing related to the diagnosis of behavioral conduct ordevelopmental problems• Chelation therapy• Prophylactic treatment• Cranial orthotic devices, except following cranial surgery• Telemedicine (including but not limited to treatmentrendered through the use of interactive audio, video orother electronic media)• Experimental or investigational services• Charges in excess of any benefit maximum• Charges for non-medical items• Charges for alternative medicine including acupunctureand naturopathic medicine• Charges related to health care practitioner-assisted suicideExclusions for CoreMed only:• Charges for the treatment of substance abuse• Charges for drugs used for inpatient or outpatient treatment ofsubstance abuseIndividual Medical markets ratingand renewal provisionsYour rates are guaranteedWe offer a twelve-month, first year rate guarantee to all newindividual policies.Your rates may be subject to change duringthis period if any one of the following situations occur:• The policyholder moves to another ZIP code• There is a change in benefits• Dependents are added or deletedWhat factors are considered in the calculation of my premium?Our rating procedures are designed to treat you fairly and consistentlywith policies similar to yours. We comply with the guidelines set forthby your state to set the levels of renewal rate increases. The premiumrate charged to your policy depends primarily on the specific benefitplans you have selected and your case characteristics.Case characteristics include:• Age and gender of covered individuals and dependents• Geographic location of residence• Underwriting class of covered individuals and dependents• Number of lives on the policy with medical coverage• Any applicable administration feeRenewability of health coverageWe can refuse to renew a policy if one of the following situations occur:• If we receive a request from you in writing to terminate coverage• If no further premium is received• If there is fraud or intentional misrepresentation made by or withthe knowledge of any insured applying for coverage or filing a claimfor benefits• If all policies with the same form number or class are non-renewedor cancelled in the state in which your policy was issued or the statein which you presently reside• If we terminate or non-renew health insurance coverage in theindividual market in the state in which this your policy was issuedor the state in which you presently reside• If you move to a state where we do not provide individual medicalinsurance coverage• If you move outside of the service area if you have a PPO plan• If you become eligible for Medicare, if allowed by federal law• If you cease to be a covered dependentRates and practices are in compliance with New Hampshire law.About Assurant HealthAssurant Health has been in business since 1892 and is the brand name for products underwritten and issued by Time Insurance Company, John Alden LifeInsurance Company and Union Security Insurance Company. Together, these three underwriting companies provide health insurance coverage to peoplenationwide. Each underwriting company is financially responsible for its own insurance products. Primary products include individual medical, small groupand short-term health insurance products, as well as non-insurance products and consumer-choice products such as Health Savings Accounts and HealthReimbursement Arrangements. Assurant Health is headquartered in Milwaukee, Wisconsin, with operations offices in Minnesota, Idaho and Florida,as well as sales offices across the country. The Assurant Health Web site is www.assuranthealth.com.Assurant Health is part of Assurant, a premier provider of specialized insurance products and related services in North America and select worldwide markets.Its four key businesses — Assurant Employee Benefits, Assurant Health, Assurant Solutions and Assurant Specialty Property — have partnered with clientswho are leaders in their industries and have built leadership positions in a number of specialty insurance market segments worldwide.The information in this brochure applies to plans with effective dates September 23, 2010, and later. Product forms TIM.POL.NH and JIM.POL.NHAssurant Health is the brand name for products underwritten and issued by Time Insurance Company and John Alden Life Insurance Company.Form 29233-NH (Rev. 6/2010) © 2010 Assurant, Inc. All rights reserved.