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HCCUA member programsmanaged and supported byCCT-ULI-040114 Insurance Benefits OverviewAmerica’s Choice Today 1.0Limited Benefit Health Insurance Plan Overview

INSURANCE BENEFITS CHARTAmerica's Choice Today 1.0 Plans123 50 75 75224 50 50 75444 50 50 75444 100 100 100111 300 350 50011120% of surgical benefit20% of surgical benefit20% of surgical benefit111 100 125 150123 200 500 1,000101010Benefits Payable per DayN/A 250 500Maximum Number of Days Payable per Covered Person per Benefit YearN/A33 750 1,000 1,50011120% of surgical benefit20% of surgical benefit20% of surgical benefit111 100 200 3005510 200 200 200111 1,000 1,500 2,000111Outpatient BenefitsPrimary / Specialist - Doctor's Office VisitsBenefits Payable per DayMaximum Number of Days Payable per Covered Person per Benefit YearOutpatient Diagnosis BenefitsBenefits Payable per Day of testingMaximum Number of Days Payable per Covered Person per Benefit YearOutpatient Diagnostic Advanced Studies BenefitsBenefits Payable per Day of testingMaximum Number of Days Payable per Covered Person per Benefit YearOutpatient Surgical Facility BenefitBenefits Payable per DayMaximum Number of Days Payable per Covered Person per Benefit YearOutpatient Surgical BenefitBenefits Payable per Day of SurgeryMaximum Number of Days Payable per Covered Person per Benefit YearOutpatient AnesthesiaBenefits Payable per DayMaximum Number of Days Payable per Covered Person per Benefit YearEmergency Room BenenfitBenefits Payable per DayMaximum Number of Days Payable per Covered Person per Benefit YearInpatient BenefitsInpatient HospitalizationBenefits Payable per DayMaximum Number of Days Payable per Covered Person per Benefit YearDaily Hospital ICUInpatient SurgeryBenefits Payable per Day of inpatient SurgeryMaximum Number of Days Payable per Covered Person per Benefit YearInpatient AnesthesiaBenefits Payable per Day of AnesthesiaMaximum Number of Days Payable per Covered Person per Benefit YearSkilled Nursing FacilityBenefits Payable per DayMaximum Number of Days Payable per Covered Person per Benefit YearSupplemental Accident BenefitBenefits Payable per Day per AccidentMaximum Number of Days Payable per Covered Person per Benefit YearCritical Illness BenefitPer OccuranceUpon the First Ever Diagnosis by a Physician2

866-227-5400INSURANCE BENEFITS OVERVIEWMEMBER S ER VIC ESPLEASE NOTE: THE FOLLOWING IS AN OVERVIEW OF INSURANCE BENEFITSPROVIDED ONLY TO AMERICA’S CHOICE TODAY CLASS MEMBERS. IF YOUARE AN AMERICA’S CHOICE TODAY CLASS MEMBER, YOU WILL RECEIVECERTIFICATES OF COVERAGE SEPARATE FROM THIS HANDBOOK. TO THEEXTENT THAT ANY OF THE AMERICA’S CHOICE CLASS BENEFITS IN THEOVERVIEW DIFFER FROM THE BENEFITS AS DESCRIBED IN THE CERTIFICATESOF COVERAGE, THE CERTIFICATE OF COVERAGE SHALL CONTROL.LIMITED BENEFIT HEALTH INSURANCE PLANThis limited benefit health insurance plan is underwritten by Unified Life InsuranceCompany. America’s Choice Plans do not satisfy the requirement to enroll in healthinsurance under the Affordable Care Act.PROVIDED BY:The following information is a brief description of important features of thisinsurance coverage. It is not a contract of insurance. The benefits, terms, conditions,limitations, and exclusions of coverage are as set forth in the insurance policies andshown in the certificate of coverage and schedule of benefits delivered to you withthis Member Handbook.This plan provides important coverage for the treatment of illness and nonoccupational injuries as well as lab tests and preventive care. Benefits under theplan are limited to specified maximum amounts shown in your schedule of benefitsand certificate for your plan.Preferred Provider Network access is provided by PHCS.Limited Benefit PlanELIGIBLE PROVIDERS Doctors and Physicians Hospitals and Outpatient Surgical Centers Clinics and Specialty Centers Laboratories and Imaging CentersSEE ANY DOCTORYou are free to see any doctor you choose but your coverage goes further if youselect a participating Preferred Network Provider and take full advantage of the prenegotiated network rates to reduce your medical bills before the insurance benefitis applied. Even if you elect to see a Non-Network Provider, the full insured benefitamount will still be applied to the bill for covered charges, but without the networkrate reduction.ASSIGNMENT OF BENEFITSWhen you need to visit a doctor or go to the hospital, there is no need for you to filea claim for in-network providers because your benefits are fully assignable and canbe paid directly to your provider. Any daily hospital benefits will be paid directlyto your Provider and all other benefits are assignable at your discretion. In order toassign benefits you sign a document allowing your doctor or your hospital to collectyour health insurance benefits directly from the carrier. By assigning benefits you willnot have to file a claim with the insurance carrier to be reimbursed. If you choose,you may pay your provider at the time of service and submit the claim yourself forreimbursement. You may obtain a claim form at www.HCCUA.org.3Insurance Benefits Overviewwww.HCCUA.org

INSURANCE BENEFITS OVERVIEWPHCS NETWORK ACCESSYou now have access to medical providers in the PHCS network. Currently,PHCS contracts with nearly 900,000 practitioners, 3,800 hospitals and more than66,000 ancillary care facilities nationwide - making it the largest independentprimary PPO in the country1. PHCS has been the national leader in health carecost containment for more than 20 years, and continually strives to recruit themost respected hospitals, physicians and other healthcare professionals so youwill receive the quality of care you expect and deserve. The providers in thePHCS network encompass virtually every specialty and you do not need a referralfrom your primary care physician to get an appointment with the specialist youmay need. The PHCS Network consistently achieves 40% average inpatient andphysician savings, by negotiating fixed fee arrangements.If your Physician is not a PHCS Network participant, you can easily nominatehim or her by going to www.multiplan.com - select Providers then Nominate aProvider. You can nominate your provider through the Online Provider ReferralSystem or download a Provider Referral Letter to present to your provider. Yourprovider can then contact the network to obtain an application packet.ACCESSING THE NETWORKThe process differs slightly for Network and Non-Network visits, so please read thefollowing carefully:1. You may locate a Network Provider in two ways:Call Member Services at 1-888-866-7919, or Go to www.hccua.org à Under“Provider Search,” select “PHCS/Multiplan” à Enter the Search Criteria tofind your list of Network Providers à If it is your first visit to that Provider asa member, please call the Provider to verify that the Provider is stillparticipating in the Network at least 24 hours prior to scheduling anappointment. If the Provider is not part of the Network, you may access theProvider of your choice but will not receive the Network rate reduction.2. Schedule an appointment with the Provider of your choice.3. Present your America’s Choice Membership Card upon arrival. Ifyour doctor’s office has any questions about your coverage they can callMember Services for assistance.4. After your visit, your Network Provider, not you will submit a claim to theinsurance company for re-pricing and payment. NOTE: If Provider is not partof the Network, no re-pricing applies and you, as the member, must submitthe claim to the insurance company for payment.5. In about 45 days, you should receive an EOB (Explanation of Benefits). It willshow you the amount of the Provider bill, the Network reduction, theamount paid by the insurance company, and, if there is a balance, theamount for which you, the patient, will be responsible.6. If you have chosen not to assign your benefits, you need to call MemberServices to obtain a claim form.1http://www.multiplan.com/aboutus4

866-227-5400EXCLUSIONS AND LIMITATIONSMEMBER S ER VIC ESwww.HCCUA.orgLIMITATIONS AND EXCLUSIONSWe will not pay benefits for treatment, services or supplies which: Are not Medically Necessary; Are not prescribed by a Doctor as necessary to treat Sickness or injury; Are experimental/investigational in nature, except as required by law; Are received without charge or legal obligation to pay; or Is provided by an immediate family member.ADDITIONAL LIMITATIONS AND EXCLUSIONSExcept as specifically provided for in this Policy or any attached Riders, We will not pay benefits for Sickness or injuries that arecaused by:Dental Procedures – Dental care or treatment except for such care or treatment due to accidental injury to sound natural teethwithin 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly.Elective Procedures and Cosmetic Surgery – Cosmetic surgery, except that cosmetic surgery shall not include reconstructivesurgery when such service is incidental to or follows surgery resulting from trauma, infection or other disease of the involvedpart and reconstructive surgery because of congenital disease or anomaly of a covered Dependent Child which has resulted in afunctional defect.Felony or Illegal Occupation – Commission of or attempt to commit a felony or to which a contributing cause was the insured’sbeing engaged in an illegal occupation.Manipulations of the Musculoskeletal System – Care in connection with the detection and correction by manual or mechanicalmeans of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference andthe effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation or of or in thevertebral column.Suicide or Injuries Which Any Covered Person Intentionally Does to Himself – Suicide, attempted suicide or intentionally selfinflicted injury.War or Act of War – War or act of war (whether declared or undeclared; participation in a felony, riot or insurrection; service inthe Armed Forces or units auxiliary thereto. Losses as a result of acts of terrorism committed by individuals or groups will not beexcluded from coverage unless the Covered Person who suffered the loss committed the act of terrorism.Work-related Injury or Sickness – Work-related injury or Sickness, whether or not benefits are payable under any state orfederal Workers’ Compensation, employer’s liability or occupational disease law or similar law.PRE-EXISTING CONDITION & PREGNANCY EXCLUSIONSThere is no coverage for a pre-existing condition for a continuous period of 12 months following the effective date of coverageunder this Policy.This limitation does not apply to: genetic information in the absence of a diagnosis of the condition related to such information; and a newborn child who is enrolled in the plan within 31 days after birth; nor to a child who is adopted or placed for adoptionbefore attaining 18 years of age; and as of the last day of the 31-day period beginning on the date of birth, adoption orplacement for adoption, is covered under creditable coverage.5

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866-227-5400NOTESMEMBER S ER VIC ESwww.HCCUA.org7