Cancer Insurance Plus Insurance Program Maximum Lifetime Benefits

Schedule of Benefits per Plan:

Plan B

Hospital Confinement Daily Benefit
Daily Benefit per Illness Period:
4th through day 365 of Confinement:                          $16.50 per day

Blood and Plasma Benefit
Maximum Benefit per Illness Period:                           $16.50**
**There is no Illness Period maximum for leukemia.

Cancer Intensive Indemnity Care Benefit
Daily Benefit:                                                                      $16.50
Maximum Benefit:                                                              7 days

Surgical Benefit
(with Pathologist’s Diagnosis)
Maximum Benefit per Operative Session:                    100% of actual charges up to $16.50
Lifetime Maximum Amount For This Benefit:                $500.00

Radiology and Chemotherapy Benefit
Daily Benefit:                                                                       $ 50.00
Maximum Benefit Amount per Year:                               $100.00

Private Duty Nurse Benefit
Daily Benefit:                                                                        $50.00
Maximum Benefit Amount per Year:                                $50.00

Skin Cancer Benefit
Maximum Benefit Amount per Year:                                $33.00
Lifetime Maximum for this Benefit:                                  $500.00

Anesthesia Benefit
Maximum Benefit Amount per Year:                                 $33.00
Lifetime Maximum for this Benefit:                                   $500.00

Overall Lifetime Maximum Amount
For All Of The Above Benefit(s):                                        $25,000.00

PLAN C

Hospital Confinement Daily Benefit
Daily Benefit per Illness Period:
1st through day 365 of Confinement:                               $16.50 per day

Blood and Plasma Benefit
Maximum Benefit per Illness Period:                               $16.50**
**There is no Illness Period maximum for leukemia.

Cancer Intensive Indemnity Care Benefit
Daily Benefit:                                                                         $16.50
Maximum Benefit:                                                                7 days

Surgical Benefit
(with Pathologist’s Diagnosis)
  Maximum Benefit per Operative Session:                    100% of actual charges up to $16.50
  Lifetime Maximum Amount For This Benefit:               $500.00

Radiology and Chemotherapy Benefit
Daily Benefit:                                                                         $ 50.00
Maximum Benefit Amount per Year:                                 $100.00

Private Duty Nurse Benefit
Daily Benefit:                                                                         $50.00
Maximum Benefit Amount per Year:                                 $50.00

Skin Cancer Benefit
Maximum Benefit Amount per Year:                                $33.00
Lifetime Maximum for this Benefit:                                  $500.00

Anesthesia Benefit
Maximum Benefit Amount per Year:                                $33.00
Lifetime Maximum for this Benefit:                                  $500.00

Overall Lifetime Maximum Amount
For All Of The Above Benefit(s):                                      $25,000.00

PLAN D

Hospital Confinement Daily Benefit
Daily Benefit per Illness Period:
1st through day 365 of Confinement:                              $22.50 per day

Blood and Plasma Benefit
Maximum Benefit Per Illness Period:                              $22.50**
**There is no Illness Period maximum for leukemia.

Cancer Intensive Indemnity Care Benefit
Daily Benefit:                                                                         $22.50
Maximum Benefit:                                                                 7 days

Surgical Benefit
(with Pathologist’s Diagnosis)
Maximum Benefit per Operative Session:                       100% of actual charges up to $22.50
Lifetime Maximum Amount For This Benefit:                   $500.00

Radiology and Chemotherapy Benefit
Daily Benefit:                                                                           $ 50.00
Maximum Benefit Amount per Year:                                   $100.00

Private Duty Nurse Benefit
Daily Benefit:                                                                            $50.00
Maximum Benefit Amount per Year:                                    $50.00

Skin Cancer Benefit
Maximum Benefit Amount per Year:                                    $45.00
Lifetime Maximum for this Benefit:                                      $500.00

Anesthesia Benefit
Maximum Benefit Amount per Year:                                     $45.00
Lifetime Maximum for this Benefit:                                       $500.00

Overall Lifetime Maximum Amount
For All Of The Above enefit(s):                                          $25,000.00

PLAN E

Hospital Confinement Daily Benefit
Daily Benefit per Illness Period:
1st through day 365 of Confinement:                              $30.00 per day

Blood and Plasma Benefit
Maximum Benefit per Illness Period:                              $30.00**
**There is no Illness Period maximum for leukemia.

Cancer Intensive Indemnity Care Benefit
Daily Benefit:                                                                         $30.00
Maximum Benefit:                                                                 7 days

Surgical Benefit
(with Pathologist’s Diagnosis)
  Maximum Benefit per Operative Session:                      100% of actual charges up to $30.00
  Lifetime Maximum Amount For This Benefit:                 $500.00

Radiology and Chemotherapy Benefit
Daily Benefit:                                                                           $ 50.00
Maximum Benefit Amount per Year:                                   $100.00

Private Duty Nurse Benefit
Daily Benefit:                                                                           $50.00
Maximum Benefit Amount per Year:                                   $50.00

Skin Cancer Benefit
Maximum Benefit Amount per Year:                                    $60.00
Lifetime Maximum for this Benefit:                                      $500.00

Anesthesia Benefit
Maximum Benefit Amount per Year:                                     $60.00
Lifetime Maximum for this Benefit:                                       $500.00

Overall Lifetime Maximum Amount
For All Of The Above Benefit(s):                                           $25,000.00
 

PLAN F

Hospital Confinement Daily Benefit
Daily Benefit per Illness Period:
1st through day 365 of Confinement:                                   $37.50 per day

Blood and Plasma Benefit
Maximum Benefit per Illness Period:                                   $37.50**
**There is no Illness Period maximum for leukemia.

Cancer Intensive Indemnity Care Benefit
Daily Benefit:                                                                              $37.50
Maximum Benefit:                                                                      7 days

Surgical Benefit
(with Pathologist’s Diagnosis)
  Maximum Benefit per Operative Session:                           100% of actual charges up to $37.50
  Lifetime Maximum Amount For This Benefit:                       $500.00

Radiology and Chemotherapy Benefit
Daily Benefit:                                                                                 $ 50.00
Maximum Benefit Amount per Year:                                          $100.00

Private Duty Nurse Benefit
Daily Benefit:                                                                                  $50.00
Maximum Benefit Amount per Year:                                          $50.00

Skin Cancer Benefit
Maximum Benefit Amount per Year:                                          $75.00
Lifetime Maximum for this Benefit:                                            $500.00

Anesthesia Benefit
Maximum Benefit Amount per Year:                                           $75.00
Lifetime Maximum for this Benefit:                                             $500.00

Overall Lifetime Maximum Amount
For All Of The Above Benefit(s):                                                $25,000.00
 

PLAN G

Hospital Confinement Daily Benefit
Daily Benefit per Illness Period
1st through day 365 of Confinement:                                         $45.00 per day

Blood and Plasma Benefit
Maximum Benefit per Illness Period:                                         $45.00**
**There is no Illness Period maximum for leukemia.

Cancer Intensive Indemnity Care Benefit
Daily Benefit:                                                                                   $45.00
Maximum Benefit:                                                                           7 days

Surgical Benefit
(with Pathologist’s Diagnosis)
  Maximum Benefit per Operative Session:                                100% of actual charges up to $45.00
  Lifetime Maximum Amount For This Benefit:                            $500.00

Radiology and Chemotherapy Benefit
Daily Benefit:                                                                                      $ 50.00
Maximum Benefit Amount per Year:                                              $100.00

Private Duty Nurse Benefit
Daily Benefit:                                                                                      $50.00
Maximum Benefit Amount per Year:                                               $50.00

Skin Cancer Benefit
Maximum Benefit Amount per Year:                                               $90.00
Lifetime Maximum for this Benefit:                                                 $500.00

Anesthesia Benefit
Maximum Benefit Amount per Year:                                               $90.00
Lifetime Maximum for this Benefit:                                                 $500.00

Overall Lifetime Maximum Amount
For All Of The Above Benefit(s):                                                     $25,000.00