WIXLIB

MedicareSupplementY0076 PDP 201210R SUP FF BROFILE & USE 100120112012 CY

Is Original Medicare enough to meet your needs?Live life healthy.Live life secure.With Original Medicare you are covered for many hospital and medical expenses,but there are some gaps in that coverage that you may be paying, like deductibles,coinsurance and copays. These costs can add up quickly. For example: Medicare Part A has an upfront deductible of 1,132* for hospitalization —a deductible you pay before your Medicare coverage begins If you stay in the hospital more than 60 days, you begin paying a copayof 283* per day After 90 days in the hospital, your copay increases to 566* per day You pay 20%* coinsurance for most doctors’ services You pay 100% for emergency care received outside the U.S., exceptunder limited circumstancesProtect your health with Alliance Medicare Supplement.With Alliance Medicare Supplement, you can fill the coverage gaps and have peaceof mind knowing that you are protected with a plan from Alliance Health and LifeInsurance Company (Alliance). With Alliance Medicare Supplement, you can receivecare anywhere throughout the U.S. that accepts Medicare and, with some plans,you have emergency care throughout the world. Alliance is a wholly owned subsidiaryof Health Alliance Plan (HAP), a Michigan-based company that has been serving thecommunity for more than 50 years.*These are 2011 amounts. 2012 amounts may be higher.Achieving and maintaining good health starts withhealth insurance coverage that fits your personal needsand budget, and a dependable health insurance partnerdedicated to your personal satisfaction.Alliance Medicare Supplementhelps fill the gapsin Original Medicare.3

Responsive customer service.A plan youcan count on.Freedom and choice.With an Alliance Medicare Supplement plan, you are covered wherever you go. You can use any doctor, specialist or hospital that participates in Medicare,anywhere in the U.S. No referrals are necessary or required to see a specialist Your benefits start on DAY ONE. There is no waiting period for protection to begin* Worldwide emergency coverage** And moreSimple and convenient.When you enroll in an Alliance Medicare Supplement plan: Your health claims are processed quickly by our trained and experienced staff There is virtually no paperwork for you with our automatic claims processing Your benefits through Alliance Medicare Supplement change automaticallywhen Original Medicare deductibles, coinsurance or copays change, so youknow you’re coveredWith Alliance, you have the personal service you want from our team of experiencedservice professionals who are located here in Michigan.As an Alliance plan member, you will have a Personal Service Coordinator for thefirst two years — a person you can call directly who can explain plan details, answerquestions and assist you in working through the specifics of your situation.In the years that follow, you can call any of our knowledgeable Customer ServiceRepresentatives whenever you need extra assistance or information. We are alwaysjust a telephone call away.Member-only discounts.As an Alliance Medicare Supplement member, you are eligible to receive discounts,preferred rates and other special savings through an exclusive program we callHAP Advantage. It’s a free program that helps you save money on a variety of thingsyou may need or enjoy, including exercise programs, weight management programs,massage therapy, personal health items and more.A dependable, Michigan-based partner.Medicare beneficiaries in Michigan have relied on us and our Medicare plans for morethan 20 years. By listening carefully to their needs, we have been able to make ourhealth plans and services more responsive to our members. With Alliance, you enjoythe comfort that comes from knowing you have a partner in Michigan that is dedicatedto your satisfaction. Your coverage renews automatically every year as long as you continueto pay your premiums* If you delay enrollment and have a health problem that is diagnosed before your Medigappolicy starts, the insurance company can refuse to cover that health problem for up to sixmonths. However, you will still be covered under Original Medicare.** Plan C, Plan F and Plan N.5

Alliance Medicare SupplementSub1: 24 pt. / 27pt. LeadingYourchoiceSunplans.ofRegularReversed OutWith Alliance Medicare Supplement, you havea choice of plans — Plan A, Plan C, Plan F andPlan N. The benefits of each of these plans arestandardized by the federal government.Plan A provides basic benefits. Plans C, F and Nprovide coverage in addition to the basicbenefits. You choose the plan that best meetsyour needs. (See pages 8 and 9 for moreinformation about each plan.)Plan APlan CPlan FPlan NPlan A is the mostbasic Medigapplan. It helps fillsome of the gaps inMedicare’s coverage.Plan C provides moreextensive coveragethan Plan A. It maybe the right plan foryou if most of yourdoctors acceptMedicare.Plan F may be a goodchoice if some ofyour doctors do notaccept Medicare’sapproved amount aspayment in full.Plan N* has a lowmonthly premiumand copays for visitsto the doctor’soffice and theemergency room.Plan A covers:Plan C covers:Plan F covers:Plan N covers:All four plans offer the basic benefits.The basic benefits include: Hospitalization: Coverage for Medicare(Part A) daily copays, plus 365 additionaldays (lifetime) after Medicare benefits end Medical expenses: Coverage for MedicarePart B coinsurance (20% of Medicareapproved costs) or copays for doctors’services, hospital outpatient servicesand other medical services Blood: First three pints of blood each year Hospice: Coinsurance for inpatient respitecare and copays for hospice outpatientprescription drugsNote: Plans do not include Medicare Part Dprescription drug benefits. For Part D coverage,you might want to consider our AllianceMedicare Rx (pdp) plan. Basic benefits(see the listat the left) Basic benefits,plus: Basic benefits,plus: Basic benefits,plus: Skilled nursingfacility copay Skilled nursingfacility copay Skilled nursingfacility copay Part A deductible Part A deductible Part A deductible Part B deductible Part B deductible Worldwideemergencycoverage** Worldwideemergencycoverage** Worldwideemergencycoverage** Part B excesscharges (theamount a doctorcharges in excessof the Medicareapprovedamount)* Plan N pays 100% of Part B services except the 162 (in 2011) deductible. Member pays up to 20copay for doctor’s office visits and up to 50 for emergency room visits.** 250 deductible each year. Lifetime maximum of 50,000. Subscriber pays all amounts over 50,000.7

MedicareWhat benefits aremost importantto you?Alliance Medicare Supplement plan isnot connected with or endorsed by theUnited States Government or the FederalMedicare program. Neither Alliance MedicareSupplement nor its agents are connectedwith Medicare.This outline of coverage does not give all thedetails of Medicare coverage.This policy may not fully cover all of yourmedical costs.Contact your local Social Security officeor consult the booklet “Medicare and You”for more details.* A benefit period begins the day you go into thehospital and ends when you have been out ofthe hospital for 60 days in a row. If you go intothe hospital again after 60 days have passed, youbegin a new benefit period.** You must meet Medicare’s requirements, includinghaving been in a hospital for at least three days,and enter a Medicare-approved facility within 30days after leaving the hospital.†Subscriber pays all amounts over 50,000.‡ These are 2011 amounts. 2012 amounts maybe higher.Alliance MedicareSupplement AAlliance MedicareSupplement CAlliance MedicareSupplement FAlliance MedicareSupplement NMedicare othing 1,132‡ 1,132‡Nothing 1,132‡Nothing 1,132‡NothingCopay (61-90 days)All but 283‡ a day 283‡ a dayNothing 283‡ a dayNothing 283‡ a dayNothing 283‡ a dayNothingCopay (91-150 days)All but 566‡ a day 566‡ a dayNothing 566‡ a dayNothing 566‡ a dayNothing 566‡ a dayNothingNothing100% ofMedicareeligibleexpensesNothing100% ofMedicareeligibleexpensesNothing100% ofMedicareeligibleexpensesNothing100% ofMedicareeligibleexpensesNothingAll but first 3 pints3 pintsNothing3 pintsNothing3 pintsNothing3 gNothingNothingNothingNothingUp to 141.50‡a dayUp to 141.50‡a dayNothingUp to 141.50‡a dayNothingUp to 141.50‡a dayNothingNothingNothing 162‡ 162‡Nothing 162‡NothingNothing 162‡80%20%Nothing20%Nothing20%Nothing20% 20 MD/ 50 ERNothingNothingAll costsup to 15%aboveMedicareapprovedamountNothingAll costsup to 15%aboveMedicareapprovedamountAll costsup to 15%aboveMedicareapprovedamountNothingNothingAll costsup to 15%aboveMedicareapprovedamountAll but first 3 pints3 pintsNothing3 pintsNothing3 pintsNothing3 pintsNothing80% toa lifetimemaximumof 50,000† 250deductible.20% toa lifetimemaximumof 50,000†80% toa lifetimemaximumof 50,000† 250deductible.20% toa lifetimemaximumof 50,000†80% toa lifetimemaximumof 50,000† 250deductible.20% toa lifetimemaximumof 50,000†Medicare Part A Hospital CoverageUpfront deductible( 1,132‡ per benefit period*)Extended hospital coverage(up to an additional 365 days inyour lifetime)Benefit for bloodin total out-of-pocket costsSkilled Nursing Facility**First 20 daysCoinsurance 21-100 daysAll but 141.50‡ a dayMedicare Part B Physician’s Services and SuppliesUpfront deductible( 162‡ per year)Coinsurance/copayExcess benefits(the amount a doctor chargesin excess of the Medicareapproved amount)Benefit for bloodin total out-of-pocket costsAdditional BenefitsEmergency care receivedoutside of the U.S.Nothing(except underlimitedcircumstances)NothingAll9