Catastrophic Plan Benefits
$2,000, $3,000, $5,000 or $10,000 Deductible

Plan Name	Assurant Catastrophic
PCY = per calendar year	Participating Provider	Non-Participating Provider
Lifetime Maximum	$3 million per individual ($6 million available at additional cost)
Annual Deductible Per individual PCY (family limit = 2x individual deductible) the deductible applies to all expenses unless otherwise noted	Choose one of the deductibles shown below $2,000 $3,000 $5,000 $10,000	2x Participating Provider annual deductible
Coinsurance Benefit paid by Assurant Health unless otherwise noted	Choose one of the coinsurance percentages shown below 75% or 50%	50%
Annual Coinsurance Maximum Per individual PCY (family limit = 2x individual coinsurance maximum)	Choose one of the coinsurance maximums shown below $2,500 $5,000 $10,000 $20,000 ($20,000 is available only with the $2,000 deductible)	2x Participating Provider annual coinsurance maximum
Annual Out-of-Pocket Maximum Per individual PCY (family limit = 2x individual out-of-pocket maximum); includes annual deductible and coinsurance maximum; once the out-of-pocket maximum is met, providers are covered in full	$4,500 to $22,000 depending on annual deductible and coinsurance maximum chosen	2x Participating Provider annual out-of-pocket maximum
Preventive Exam Routine exam, well child care
	100% no deductible	50%
Preventive Screening Includes Pap smear, prostate cancer screening, colorectal cancer screening, cholesterol screening, urinalysis	100% no deductible	50%
Mammography No deductible	75% or 50%	50%
Immunization	100% no deductible	50%
Plan Name	Assurant Catastrophic
PCY = per calendar year	Participating Provider	Non-Participating Provider
Office Visit	First 4 visits per calendar year no deductible & paid at 100% after $35 copay per visit After first 4 visits paid at 75% or 50% after annual deductible	50%
Naturopathy	75% or 50%	50%
Spinal (Chiropractic) Manipulation 10 visits limit per calendar year	75% or 50%	50%
Acupuncture 10 visits limit per calendar year	75% or 50%	50%
Mental Health Outpatient Office Visit	75% or 50%	50%
Outpatient Diagnostic Imaging (X-Ray) and Lab Services	75% or 50%	50%
Other Outpatient & Inpatient Professional Services	75% or 50%	50%
Inpatient & Outpatient Facility Care	75% or 50%	50%
Maternity (Complications)	75% or 50%	50%
Maternity (Routine)	100% after separate $20,000 deductible	50%
Mental Health Inpatient Facility Care	75% or 50%	50%
Pharmacy - Retail up to 30 day supply per copay No deductible	Pharmacy is an optional benefit available for an additional cost per month You pay up to the copay shown below* Two plans are available Basic 500: $15 / $25 + 50% Select 5000: $15 / $25 + 25%
Pharmacy - Mail Service up to 90 day supply per copay No deductible	You pay up to the copay shown below* Basic 500: $30 / $50 + 50% Select 5000: $30 / $50 + 25%
* copay for generic / formulary brand-name drugs. Non-formulary brand-name drugs are not covered. Basic 500: maximum benefit for all drugs is limited to $500 per person, per calendar year. Select 5000: maximum benefit for formulary brand-name drugs is limited to $5,000 per person, per calendar year. There is no limit for generic drugs.
Plan Name	Assurant Catastrophic
PCY = per calendar year	Participating Provider	Non-Participating Provider
Vision - Routine Exam	Not covered (Dental-Vision Discount Plan available for an additional $9.95 per month per family)
Vision Hardware Frames, lenses and contact lenses	Not covered (Dental-Vision Discount Plan available for an additional $9.95 per month per family)
Emergency Room Care $75 copay per emergency room visit; copay waived if admitted	75% or 50%
Ambulance Transportation	75% or 50%	50%
Skilled Nursing Facility 45 days limit per calendar year	75% or 50%	50%
Durable Medical Equipment and Prosthetics $500 lifetime maximum benefit	75% or 50%	50%
Home Health Care 130 visits limit per calendar year	75% or 50%	50%
Hospice Care Inpatient: 10 days PCY Respite: 240 hours limit PCY	75% or 50%	50%
Rehabilitation Includes physical, occupational, massage and speech therapy; cardiac & pulmonary rehabilitation Inpatient: 10 days limit PCY Outpatient: 20 visits limit PCY	75% or 50%	50%
Transplants (Kidney, Cornea and Skin) 12-month waiting period	75% or 50%	50%
Transplants (Bone Marrow, Heart, Liver and Lung) 12-month waiting period $250,000 lifetime maximum $500,000 lifetime maximum when performed by a designated transplant provider Up to an additional $10,000 benefit toward travel expenses when using a designated transplant provider	75% or 50%	Not covered
Occupational Injury or Disease	Covered as for any other condition (limited to partners, proprietors or corporate officers who are not covered by a Workers' Compensation Act or other similar law)
Pre-Existing Conditions	A pre-existing condition is a sickness, pregnancy or injury, and related complications for which, during the six-month period immediately prior to the effective date of your health insurance coverage: a) You sought, received or were recommended medical advice, consultation, diagnosis, care, or treatment. b) Prescription drugs were prescribed. c) Symptoms were produced, or diagnosis was possible.   No benefits are paid for charges incurred due to a pre-existing condition until you have been continuously insured under the plan for nine months. After the nine-month period, benefits are paid for a pre-existing condition. In some cases, Assurant Health will apply credit for pre-existing conditions if the person enrolling has been covered by a prior group or individual health benefit plan that is considered "creditable" coverage at any time during the 63 (sixty-three) day period immediately preceding the receipt date of the application.
Benefit Waiting Period for Certain Treatment	In addition to the transplant and pre-existing condition waiting periods shown above, benefits for certain types of treatment are payable after a 6-month waiting period for the services shown below: Durable and personal medical equipment ($500 lifetime maximum) Face and jaw dysfunction services ($600 lifetime maximum) Surgical treatment of bunions, hemorrhoids, inguinal hernia, varicose veins Surgical treatment of tonsils/adenoids

Office Visit Copay: With this benefit, a copay is your only cost for an eligible network office visit. Any associated imaging and laboratory services, such as x-rays and blood tests, are covered subject to deductible and coinsurance, but are not eligible for benefits under the office visit copay.

Immunizations administered during an office visit are covered under the preventive services benefit.

Other services that are subject to deductible and coinsurance, but not eligible for benefits under the office visit copay are: office visits with non-participating providers, surgical procedures and allergy tests.

Medically Necessary Care: Treatment must be medically necessary to be covered. Medically necessary services or supplies must be:

• Appropriate and consistent with the diagnosis.

• Commonly accepted as proper treatment.

• Reasonably expected to result in improvement of the condition.

• Provided in the least intensive setting without affecting the quality of medical care provided.

Maximum Allowable Amount: The maximum allowable amount is the most the plan pays for covered services. If you use an out-of-network provider, you are responsible for any balance in excess of the maximum allowable amount.

Network Services: When you use network providers, covered charges are eligible for discounts and never exceed the maximum allowable amount.

Out-of-Network Services:

• Emergencies: Covered services are always paid at the network benefit percentage - even if you are out of network - subject to the maximum allowable amount.

• Non-emergencies: Covered services are subject to the out-of-network deductible, the maximum allowable amount provision, the out-of-network coinsurance, and the increased out-of-network coinsurance out-of-pocket maximum.

Utilization Review: Authorization is required before receiving inpatient treatment and certain types of outpatient procedures. Unauthorized services will result in a penalty. Unauthorized transplants are not covered.