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Continental Life Insurance Companyof Brentwood, TennesseeAn Aetna Company800 Crescent Centre Dr.Suite 200Franklin, TN 37067800 264.4000aetnaseniorproducts.comOutline of CoverageMedicare Supplement InsuranceBENEFIT PLANS A, B, F, High Deductible F, G, NUnderwritten byAn Aetna CompanyContinental Life Insurance Companyof Brentwood, TennesseeTexasCLIMS01625TX 2016 Aetna Inc.01012016
CONTINENTAL LIFE INSURANCE COMPANY OF BRENTWOOD, TENNESSEEOUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE: Page 1 of 2BENEFIT PLANS AVAILABLE: A, B, F, HIGH DEDUCTIBLE F, G, NThese charts show the benefits included in each of the standard Medicare supplement plans. Every company must make available Plan “A.”Some plans may not be available in your state.Basic Benefits:Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.Medical Expenses: Part B coinsurance (generally 20% of Medicare-Approved expenses) or, co-payments for hospital outpatient services. PlansK, L, and N require insureds to pay a portion of coinsurance or copaymentsBlood: First three pints of blood each year.Hospice-Part A coinsuranceBCDF/F*GKLMNABasic,including100% PartBcoinsuranceBasic,including100% PartBcoinsurancePart ADeductibleBasic,including100% Part BcoinsuranceBasic,including100% Part BcoinsuranceBasic,including100% Part Bcoinsurance*Basic,including100% Part BcoinsuranceSkilledNursingFacilityCoinsurancePart ADeductiblePart BDeductibleSkilledNursingFacilityCoinsurancePart ADeductibleSkilledNursingFacilityCoinsurancePart gencySkilledNursingFacilityCoinsurancePart ADeductiblePart BDeductiblePart andpreventivecare paid at100%; otherbasic benefitspaid at 50%50% SkilledNursingFacilityCoinsurance50% Part ADeductibleHospitalizationandpreventivecare paid at100%; otherbasic benefitspaid at 75%75% SkilledNursingFacilityCoinsurance75% Part ADeductibleBasic,including100% Part BcoinsuranceSkilledNursingFacilityCoinsurance50% Part ADeductibleBasic, including100% Part Bcoinsurance,except up to 20copayment for officevisit, and up to 50copayment for ERSkilled NursingFacility CoinsurancePart A DeductiblePart B it 4960;paid at 100%after limitreachedOut-of-pocketlimit 2480;paid at 100%after limitreachedForeignTravelEmergencyForeign TravelEmergency*Plans F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid acalendar year 2180 deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed 2180. Out-of-pocketexpenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for PartA and Part B, but do not include the plan’s separate foreign travel emergency deductible.CLIMS01625TX01012016
Continental Life Insurance Company of Brentwood, TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: 733, 750-753, 760, 761, 774, 776, 777, 782, 784, 793, 794Female RatesAttainedAgePlan AUnder 09Modal Factors:PreferredPlan BPlan F Plan nnual:Plan ,1592,1722,1842,1982,2092,2230.5200Plan ,9351,9461,9581,9701,9801,994AttainedAgeUnder 8990919293949596979899Quarterly:Plan 82,8162,8322,8492,8662,8822,8990.2650Plan ,9002,9152,9332,9522,9682,987StandardPlan F Plan ,2053,3071,2123,3261,2193,3431,224Monthly:Plan ,3992,4132,4272,4402,4552,4700.0833Plan ,1532,1672,1762,1872,2012,215The above rates do not include the 20 application fee.To calculate a Household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumIf applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.CLIMS01625TX01012016
Continental Life Insurance Company of Brentwood, TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: 733, 750-753, 760, 761, 774, 776, 777, 782, 784, 793, 794Male RatesAttainedAgePlan AUnder 02Modal Factors:PreferredPlan BPlan FPlan 23,0903,4591,266Semi-Annual:Plan ,4832,4982,5122,5272,5422,5560.5200Plan ,2262,2392,2522,2672,2792,294AttainedAgePlan AUnder 335Quarterly: 0.2650Plan ,3333,3553,3743,3953,4143,435StandardPlan FPlan hly:Plan ,7592,7752,7912,8072,8232,8420.0833Plan ,4742,4872,5022,5172,5332,547The above rates do not include the 20 application fee.To calculate a Household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumIf applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.CLIMS01625TX01012016
Continental Life Insurance Company of Brentwood, TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: 770-773, 775Female RatesAttainedAgePlan AUnder 45Modal Factors:PreferredPlan BPlan F Plan ,157Semi-Annual:Plan ,2712,2862,2982,3122,3242,3390.5200Plan ,0362,0472,0612,0732,0842,098AttainedAgeUnder 8990919293949596979899Quarterly:Plan 42,9632,9802,9973,0153,0323,0500.2650Plan ,0523,0673,0863,1063,1233,142StandardPlan F Plan 4631,2683,4801,2753,4991,2833,5171,287Monthly:Plan ,5242,5392,5532,5682,5832,5990.0833Plan ,2652,2802,2892,3012,3162,330The above rates do not include the 20 application fee.To calculate a Household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumIf applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.CLIMS01625TX01012016
Continental Life Insurance Company of Brentwood, TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: 770-773, 775Male RatesAttainedAgePlan AUnder 58Modal Factors:PreferredPlan BPlan FPlan 1,3273,2513,6401,332Semi-Annual:Plan ,6122,6282,6432,6582,6742,6900.5200Plan ,3432,3562,3692,3852,3982,414AttainedAgeUnder 8990919293949596979899Quarterly:Plan 833,4053,4273,4463,4673,4903,5090.2650Plan ,5073,5303,5503,5723,5923,614StandardPlan FPlan nthly:Plan ,9032,9202,9372,9542,9712,9900.0833Plan ,6032,6172,6332,6492,6662,680The above rates do not include the 20 application fee.To calculate a Household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumIf applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.CLIMS01625TX01012016
Continental Life Insurance Company of Brentwood, TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: Rest of StateFemale RatesAttainedAgePlan AUnder 69Modal Factors:PreferredPlan BPlan F Plan 9532,3352,614956Semi-Annual:Plan ,8771,8891,8991,9111,9211,9330.5200Plan 6921,7031,7131,7221,734AttainedAgeUnder 8990919293949596979899Quarterly:Plan 32,4492,4632,4772,4922,5062,5210.2650Plan ,5222,5352,5502,5672,5812,597StandardPlan F Plan 2,9071,064Monthly:Plan ,0862,0982,1102,1222,1352,1480.0833Plan ,8721,8841,8921,9021,9141,926The above rates do not include the 20 application fee.To calculate a Household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumIf applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.CLIMS01625TX01012016
Continental Life Insurance Company of Brentwood, TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: Rest of StateMale RatesAttainedAgePlan AUnder 10Modal Factors:PreferredPlan BPlan FPlan -Annual:Plan ,1592,1722,1842,1972,2102,2230.5200Plan ,9361,9471,9581,9711,9821,995AttainedAgeUnder 8990919293949596979899Quarterly:Plan 62,8142,8322,8482,8652,8842,9000.2650Plan ,8982,9172,9342,9522,9692,987StandardPlan FPlan ,2043,3071,2103,3241,2173,3411,225Monthly:Plan ,3992,4132,4272,4412,4552,4710.0833Plan ,1512,1632,1762,1892,2032,215The above rates do not include the 20 application fee.To calculate a Household discount:Annual premium x modal factor modal
of Brentwood, Tennessee An Aetna Company 800 Crescent Centre Dr. Suite 200 Franklin, TN 37067 800 264.4000 aetnaseniorproducts.com Continental Life Insurance Company of Brentwood, Tennessee An Aetna Company BENEFIT PLANS A, B, F, High Deductible F, File Size: 1MB
