Central Choice

Central Choice The Central Choice in Supplemental Health Insurance Benefits

This is a Hospital Indemnity Insurance Policy Underwritten by ManhattanLife Assurance Company of America, The Manhattan Life Insurance Company and Family Life Insurance Company

CC-BR 0720

Central Choice The CentralChoice in Supplemental Health Insurance Benefits

This is a Hospital Indemnity Insurance Policy

CENTRAL CHOICE POLICY HIGHLIGHTS: Individual Renewable - meaning the policy is Guaranteed Renewable providing policyholder security subject to our right to change premium rates. Pre-Existing Conditions - with Central Choice, pre-existing conditions (for covered medical conditions) are covered after the first 12 months. No Ineligible Occupations - no occupational classes are excluded from any of the four plan designs. All Provider plan - You may seek treatment from any doctor and any hospital. Our plans pay directly to the insured. You may benefit from negotiated discounts through the First Health Network. No Utilization Review. No Deductibles, Coinsurance or Lifetime Maximums (individual benefit maximums apply). All Central Choice plans feature a surgical benefit*, which is determined by the state in which the policy is sold. In the states of CO, ID, and NM, Central Choice includes a traditional Surgical Schedule. Surgical procedures in these surgical schedule states are covered the same whether received as inpatient or outpatient treatment. In AL, AR, AZ, CA, DC, DE, GA, IA, IL, IN, KY, LA, MD, MI, MO, MS, NC, NE, NV, OH, OK, PA, SC, SD, TN, TX, VA, WI, WV, and WY, Central Choice features a unique Daily Surgical Benefit, which provides a surgical amount for each day of a consecutive period of hospital confinement in which one or more surgeries take place, up to a maximum of 5 days per period of confinement. The Daily Surgical Benefit is provided for both INPATIENT while hospital confined and as OUTPATIENT at an Ambulatory Surgical Center. The surgical benefit is reduced to 25% of the daily surgical benefit rate when received as outpatient treatment at an Ambulatory Surgical Center. * The Surgical Benefit does not apply in KS.

THE TWO “COSTS” OF HEALTHCARE The first is the premium cost to have health insurance. The second is the cost associated with using it. If it is affordable but unsuitable due to high deductibles, co-insurance, and out-of-network charges then it is really not a manageable plan. Central Choice products include cost effective supplements to fill gaps left open with other products including both qualified major medical as well as limited benefit plans. One of two possibilities will occur for you this year; you will either be hospital confined, or you will not. It is unlikely that many of us will exceed our deductible in a year without a hospital stay. So, in most years we wind up paying our insurance premiums and most or all of the cost of our treatment. But, if and when we are hospital confined, the high cost of treatment will likely have us reach the maximum out-of-pocket threshold of any qualified major medical plan level for even a relatively short confinement. THE IMPORTANCE OF CENTRAL CHOICE AS SUPPLEMENTAL COVERAGE Our Premier Choice and Select Choice package designs each feature a variety of both inpatient as well as outpatient benefits, including surgery. Central Choice benefits can be paid to any hospital or doctor and when First Health Network providers are used additional savings through negotiated discounts may be available. What are now referred to as “qualified plan designs” feature deductible and coinsurance exposure over $6,000 per person per year. This is above the premium cost. Many see the merit of purchasing the “qualified” Bronze plan and using the premium difference between that and more expensive designs to purchase supplemental insurance to “fill the gaps.”

Central Choice Plan Designs

PREMIER CHOICE Is particularly well suited to those aged 50-plus who have pre-existing medical conditions (remember, there is a 12-month wait on pre-existing conditions). SELECT CHOICE Design is suitable for those with limited budget who desire an affordable plan to which they can add additional customized coverage for necessary Critical Illness, Cancer and Accidents. (Available separately) It provides a backbone for a quality portfolio of these additional supplemental policies.

ENHANCED CHOICE A versatile option, this plan can serve as a solid supplement to qualified major medical policy.

ESSENTIAL CHOICE A cost effective way to provide a variety of benefits used to “fill the gaps” in qualified major med plans. While the Supplement Plan is sufficient to supply the benefits necessary to reduce or even eliminate the out-of-pocket costs associated with an average period of hospital confinement when used with major medical, it should be supported by additional CI, Accident and Cancer policies whenever possible for the highest levels of protection.

The Smart Choice

ManhattanLife Assurance has a variety of products well-suited for today’s changing environment.

CRITICAL CHOICE Life insurance & Critical Illness, (provided by Family Life Insurance Company) Policy Numbers FGAP02, FGAP03 (including state variations) Critical Protection & Recovery, With or Without Optional Cancer Policy Numbers CI-A, CI-B (including state variations)

CANCER CARE CHOICE Cancer Care Plus, Cancer & Dread Disease Plan Policy Number CP 4000 4/04 (including state variations) Cancer First Occurrence, “Lump Sum” Benefit Policy Numbers FOB98, FOB13 (including state variations)

ACCIDENT CHOICE Personalized Accident Indemnity Delivery (PAID) Policy Numbers HPACC13-24, HPACC13-NOC (including state variations)

This brochure highlights the Central Choice product; please see our other Smart Choice brochure for additional details.

THIS IS A SUPPLEMENT HEALTH INSURANCE POLICY, AND IT IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES.

Central Choice Hospital Indemnity plan designs featuring the Daily Surgical Benefits State usage for Daily Surgical Benefit (C-HPHI-14) - AL, AZ, AR, CA, GA, IA, IL, IN, KY, LA, MD, MO, MS, NC, NE, NV, OH, OK, PA, SC, SD, TN, TX, VA, WI, WV, WY; (FL-HPHI14) - DE, MI; (M-HPHI-14) DC

Premier Choice

Select Choice

Enhanced Choice

Essential Choice

Maximum Benefit/Yr* $182,500

BENEFIT

$500

$400

$100

$50

Daily Room Benefit

RIDERS

Lump Sum Indemnity (CUL-HRLS and CHPHILS14-NC) Paid to an insured upon first hospital confinement each year First Hospital Confinement (CUL-HRFHC (2)) Based on duration of first hospital confinement Intensive Care Unit (CUL-HRICU and CHRICU14-LA) Limited to 20 days per confinement Private Duty Nurse (CUL-HRPN) Limited to 30 days per confinement Surgical Plus (CHPHISP14 and CHPHISP14-LA ) Per day when confined and a covered surgical event takes place. Maximum of 5 days per confinement. Anesthesia Daily benefit amount paid for each day that a surgical benefit is paid for inpatient surgery. Routine Benefits Per calendar year for mammography screening/mammogram, pap smear, or PSA test. Emergency Accident ** (CUL-HREA) Limited to 4 different covered injuries per calendar year per insured Specified Injury Rider (CUL-HRSI) See rider for specific amounts (not available in GA, MD NC and VA)

$1,000

$500

$100

$1,000

$10,000 over 6 days

$5,000 over 6 days

$10,000

$2,500 per day

$2,000 per day

$1,000 per day

$500 per day $250 per day

$50,000

$7,500 per confinement $15,000 per confinement $3,000 per confinement $200 per calendar year

$250 per day

$3,000 per day

$2,000 per day

$1,000 per day

$600 per day

$400 per day

$200 per day

$200 per calendar year

$250 per accident

$1,000

$25 - $2,000 Depending on injury $100 per sickness Limit 4 different sicknesses per year**

$25 - $2,000 Depending on injury $75 per sickness Limit 4 different sicknesses per year**

$25 - $2,000 Depending on injury $50 per sickness Limit 4 different sicknesses per year**

$25 - $2,000 Depending on injury $25 per sickness Limit 4 different sicknesses per year**

To a maximum of $2,000 per injury

Outpatient Sickness ** (CHPHIOS14 and CHPHIOS14-LA)

$400

* For the Premier Choice Plan, per calendar year per insured person, unless otherwise specified. ** Insured categories are the insured person, the insured person’s spouse (in NV, spouse/domestic partner), and/or all of the insured person’s dependent children. Maximum total of 4 different sicknesses per year for all dependent children, not per child. Daily Surgical Benefits Premiums State usage for Daily Surgical Benefits Premium - AL, AZ, AR, DC, DE, IA, IL, IN, KY, LA, MD, MI, MS, NE, NV, OH, OK, SC, TN, TX, WI, WV, WY (Specified Injury Rider is not available in MD) Monthly Rates Premier Choice Select Choice Enhanced Choice Essential Choice Single $189.00 $158.35 $70.90 $49.15 Single w/Spouse (in NV, Spouse/Domestic Partner) $371.25 $309.95 $135.05 $91.55 Single w/Children $306.55 $255.00 $115.40 $78.70 Family $488.80 $406.60 $179.55 $120.70

Central Choice State Specific Plan Variations for Daily Surgical Benefit States State Variation Georgia & Virginia The Specified Injury Rider is not available. Missouri The Outpatient Sickness Rider and Surgery Plus is not available. Instead, the Surgery (CHPISS14) is used. North Carolina The Specified Injury Rider is not available. Pennsylvania The Surgery Plus is not available. Instead, the Surgery (CHPISS14-PA) is used.

California and South Dakota

The benefits are the same as the generic states, but are priced differently. The rates for these states are listed below

Premier Choice

Select Choice Enhanced Choice Essential Choice

$210.65 $394.30 $333.93 $517.58

$180.28 $333.56 $278.19 $431.47

$91.01 $166.02 $144.40 $219.41

$66.69 $117.38 $98.61 $149.30

Single

Single w/Spouse Single/Children

Family

GA & VA

Premier Choice

Select Choice Enhanced Choice Essential Choice

$185.50 $366.00 $301.30 $481.80

$154.85 $304.70 $249.75 $399.60

$67.40 $129.80 $110.15 $172.55

$45.65 $86.30 $73.05 $113.70

Single

Single w/Spouse Single/Children

MO Single Family

Premier Choice

Select Choice Enhanced Choice Essential Choice

$165.40 $324.05 $258.95 $417.60

$141.40 $276.05 $220.03 $354.70

$60.60 $114.45 $93.10 $146.95

$42.50 $78.25 $65.65 $101.40

Single w/Spouse Single/Children

Family

Premier Choice

Select Choice Enhanced Choice Essential Choice

$185.50 $366.00 $301.30 $481.80

$154.85 $304.70 $249.75 $399.60

$67.40 $129.80 $110.15 $172.55

$45.65 $86.30 $73.05 $113.70

Single

Single w/Spouse Single/Children

Family

Premier Choice

Select Choice Enhanced Choice Essential Choice

$180.00 $353.25 $297.55 $470.80

$152.35 $297.95 $249.00 $394.60

$67.90 $129.05 $112.40 $173.55

$46.15 $85.55 $75.30 $114.70

Single

Single w/Spouse Single/Children

Family

Premier Choice

Select Choice Enhanced Choice Essential Choice

$186.50 $366.25 $302.55 $482.30

$156.35 $305.95 $251.80 $401.40

$70.40 $134.05 $114.60 $178.25

$48.90 $91.05 $77.90 $120.05

Single

Single w/Spouse Single/Children

Family

Central Choice Hospital Indemnity plan designs Featuring the Surgical Schedule

State Usage for Surgery Schedule (CUL-HPHI2010) - CO, KS, NM; (C-HPHI-11) - ID

Premier Choice

Select Choice

Enhanced Choice

Essential Choice

Maximum Benefit/Yr* $182,500

BENEFIT

$500

$400

$100

$50

Daily Room Benefit

RIDERS

Lump Sum Indemnity (CUL- HRLS) Paid to an insured upon first hospital confinement each year First Hospital Confinement (CUL-HRFHC) Based on duration of first hospital confinement Intensive Care Unit (CUL-HRICU) Limited to 20 days per confinement Private Duty Nurse (CUL-HRPN) Limited to 30 days per confinement Surgical (CUL-HRSUR and CHPHISS) (Does not apply in KS) Details may vary, see Surgical Schedule Anesthesia Benefit Emergency Accident ** (CUL-HREA) (Does not apply in KS) Limited to 4 different covered injuries per calendar year per insured

$1,000

$500

$100

$1,000

$10,000 over 6 days

$5,000 over 6 days

$10,000

$2,500 per day

$2,000 per day

$1,000 per day

$500 per day $250 per day

$50,000

$250 per day

$7,500 Per confinement

X X

$10,000 $2,500 $250 per accident

$5,000 $1,250

$10,000 UNLIMITED times

$250 per accident

$1,000

Specified Injury (CUL-HRSI) (Does not apply in KS) See rider for specific amounts

To a maximum of $2,000 per injury

$25 - $2,000 Depending on injury

$100 per sickness

$75 per sickness

$50 per sickness

$25 per sickness

Outpatient Sickness ** (CUL-HROS) (Does not apply in KS)

$400

Limit 4 different sicknesses per year**

* For the Premier Choice Plan, per calendar year per insured person, unless otherwise specified. ** Insured categories are the insured person, the insured person’s spouse, and/or all of the insured person’s dependent children. Maximum total of 4 different sicknesses per year for all dependent children, not per child. *** Lesser amounts apply for Spouse and Child

Sample Central Choice Surgical Schedule Premiums

Monthly Rates

Premier Choice Select Choice Enhanced Choice Essential Choice

$197.70 $388.65 $330.05 $521.00

$159.15 $311.55 $261.50 $413.90

$66.80

$45.05 $83.35 $73.30 $111.60

Single

$126.85 $111.40 $170.45

Single w/Spouse Single w/Children

Family

Central Choice State Specific Plan Variations for Surgical Schedule States State Variation Colorado The benefits are the same as the generic states, but are priced differently. The rates for these states are listed below Idaho and New Mexico The benefits are the same as the generic states, but are priced differently. The rates are listed below Kansas The Emergency Accident Rider, Out Patient Sickness Rider, Specified Injury Rider Surgery and Surgery Plus Riders is not available.

Premier Choice

Select Choice Enhanced Choice Essential Choice

$179.77 $352.94 $301.98 $475.15

$144.93 $283.26 $239.45 $377.78

$71.91 $137.22 $121.44 $186.75

$38.77 $70.94 $62.56 $94.73

Single

Single w/Spouse Single/Children

Family

ID & NM

Premier Choice

Select Choice Enhanced Choice Essential Choice

$197.70 $388.65 $330.05 $521.00

$159.15 $311.55 $261.50 $413.90

$78.80 $150.85 $132.40 $204.45

$42.05 $77.35 $67.80 $103.10

Single

Single w/Spouse Single/Children

Family

Premier Choice

Select Choice Enhanced Choice Essential Choice

$146.75 $288.50 $225.50 $367.25

$126.85 $248.70 $194.10 $315.95

$50.15 $95.30 $74.65 $119.80

$32.05 $59.10 $47.20 $74.25

Single

Single w/Spouse Single/Children

Family

A SmartChoice Claim Example Featuring the Daily Surgical Benefits

Making a smart choice, this 52-year-old male purchased a Central Choice Premier Choice Plan (Defined Benefit coverage) along with Critical Choice (Critical Protection and Recovery). He has heart bypass surgery with a 7-day hospital confinement, three of those in the Intensive Care unit. He also owns an Accident policy.

Daily Room Benefit $500/day X 7 days hospital confinement

Central Choice Premier Choice Policy Design:

$3,500

Indemnity Rider first hospital confinement of any given year of $1,000 First Hospital Confinement Rider over first 6 days of “first hospital confinement” of the year Surgical Rider $3,000 per day of a continuous confinement in which one or more surgeries takes place, maximum of 5 days per confinement. Anesthesia $600/day for each day that a surgical benefit is paid.

$1,000

= $10,000

5 X $3,000 = $15,000

$600 X 5 days =

$3,000

Intensive Care $2,500 per day in ICU, up to 20 consecutive days.3 X $2,500 =

$7,500

TOTAL CENTRAL CHOICE PREMIER CHOICE BENEFITS PAID

$40,000

Critical Protection and Recovery Critical Illness Policy

First Occurrence Benefit

= $10,000

Monthly Income Benefit 10% of FOB above ( $1,000 ) X 12 months

= $12,000

Hospital Confinement Benefit $300 per day confined for treatment for a covered incident, X 7 = $2,100 (Could also include benefits for Transportation, Lodging, and Air or Ground Ambulance) Monthly Income Benefit 10% of FOB above ( $1,000 ) X 12 months = $12,000 TOTAL CPR BENEFITS PAID $24,100

PAID Accident Plan

No benefits payable for this condition TOTAL BENEFITS FOR PROCEDURE

= $64,100

*The examples shown are hypothetical and may vary depending on plan(s) selected.

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Health Advocacy offers you expert assistance with a wide range of healthcare and insurance-related issues

Support for every type of medical condition • Explain health conditions, diagnoses and treatments, research treatment options • Answer questions so you can make the right choices for your care Coordinate medical care and additional services • Facilitate any necessary pre-authorizations and coordinate benefits • Provide in-hospital support and arrange post- discharge services and care • Research and locate eldercare services Research and arrange second opinions and tests • Identify and connect you with leading specialists and Centers of Excellence • Arrange for the transfer of medical records, lab results and X-rays Take the hassle out of healthcare • Find the right in-network doctors and make appointments • Review medical bills to find errors or duplicate charges; resolve claims and billing issues Medical Bill Saver It can be overwhelming to receive a large bill for medical or dental care. Health Advocate’s Medical Bill Saver service can help. Our skilled negotiators can help lower your out- of-pocket costs on bills that are not covered by insurance. • Send us your medical or dental bill of $400 or more and we’ll contact the provider on your behalf to negotiate a discount on the amount due* RX Shopper Rx Shopper can reduce your prescription costs by helping you find the lowest prices for your medications. • Download and print your card, then bring it with you when filling your prescription to save up to 85% We support the whole family Health Advocate services are available to you as the primary policy holder, your spouse/partner, dependents, parents and parents-in-law. Quickly reach us by phone, email and secure messaging By phone: 866.969.3435 Email: Answers@healthadvocate.com Web: www.healthadvocate.com/members

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*Health Advocate will attempt to negotiate with providers on claim balances where allowed by states. Best attempts to reduce balances are made but specific percentage results are not guaranteed. Listed above are two added sponsored benefits that are not part of the policy. There is a $5.00 monthly administration fee for these two services included in the premium. (Not included in Child Only Policy)

Underwritten by: ManhattanLife Assurance Company of America

Manhattan Life Insurance Company and Family LIfe Insurance Company Administrative Office: 10777 Northwest Freeway, Houston, TX 77092 Toll Free Telephone: 800-669-9030

State Usage for Surgery Schedule (CUL-HPHI2010) - CO, KS*, NM,: (C-HPHI-11) - ID STATE USAGE FOR DAILY SURGICAL BENEFIT (C-HPHI-14) - AL, AZ, AR, CA, GA, IA, IL, IN, KY, LA, MD, MO, MS, NC, NE, NV, OH, PA, OK, SC, SD, TN, TX, VA, WI, WV, WY; (FL-HPHI14) - DE, MI; (M-HPHI-14) - DC *The Surgery Schedule does not apply to KS. Benefits and riders may vary by state and may not be available in all states. This is not a complete disclosure of plan qualifications and limitations. Please access our website to obtain a completed list for the Central Choice product at disclosure.manhattanlife. com. Please review this information before applying for coverage. The amounts of benefits provided depend on the plan selected. Premiums will vary according to the selection made. THIS POLICY PROVIDES LIMITED BENEFITS. This product does not constitute comprehensive health insurance coverage (often referred to as, “major medical coverage”). Therefore, this product does not satisfy the requirement of Minimum Essential Coverage under the Federal Patient Protection and Affordable Care Act. For additional information, you can contact us, refer the official federal website at www.healthcare.gov, or call their toll-free number at 800-318-2596.

For additional information about this or any of the other quality products from ManhattanLife Assurance, please contact your Central Choice Marketing Director.

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