Download - CNA - Mark III Employee Benefits · CNA Care Connection insurance coverage is for people who believe in planning for the future. It is a good way to help protect a family's savings

CNA CARE CONNECTION GROUP LONG TERM CARE

City ofWinston-Salem North Carolina

Voluntary Plan

Pays benefits for professional treatment at home or in a nursing home

CNA


CNA

Table of Contents

Thinking Long Term in a Changing World 1

Benefit Exhibit of Your CNA Care Connection Long Term Care Plan 6

Specific Features of Your CNA Care Connection Long Term Care Plan 7

Community Based Care 7

Nursing Home Care 8

Caregiver Benefit 8

Alternate Plan of Care 8

Hospice Care 8

Alternate Care Facility 9

~~~~ 9 Waiver of Premium 9

Emergency Alert System Benefit 9

Caregiver Training 9

Temporary Bed Holding 9

Care Management 9

Portability 10

Discount Programs 10

When You Receive Benefits 10

Exclusions 1 ]

Guaranteed Benefit Option II

Premiums 12

Enrollment is Simple 13

Coverage From a Company You Can Trust 14

Premiums 15

Outline of Coverage A-I

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Thinking Long Term in a Changing World

The need for long term care insurance

Today changes in society and family life longer life spans and the rising cost of health care have combined to make long term care insurance an important part of a sound financial plan More people will require long term care services and paying for those services may be a serious financial burden for them and their families

In fact one in seven men and one in three women who turned 65 in 1990 will spend at least one year in a nursing home

1990

iiiiii iiiiii ii ii ii ii ii

How much does it cost

Again the range is wide A person who provides a few hours of in-home living assistance each day might be paid $5000 to $14000 a year2 On average a one-year stay in a nursing home costs $400003

Who pays for these services

As you can see on the following chart usually the patient pays either with long term care coverage or by drawing on savings or other assets Some people also receive help from their children or other family members either to provide care or help pay for it

Nursing Home Care Financing4

Consumer costs are sometimes reimbursed by private long term care insurance

1The New England Journal ofMedicine February 281991

2Broker World 1991 3Chicago Tribune November 6 1995

4Health Care Financing Administration

Other (3)--- bull Mede 12

Consumer (50)

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Other types of insurance dont pay

Health and disability insurance are important forms of protection but they arent intended to pay for long ternl care

Health insurance plans including Medicare and Medicare supplement policies pay for hospitalization and other medical expenses But even the best private health insurance plans arent designed to cover long term care because thats not their purpose

Disability insurance plans are designed only to replace lost wages if an employed person is unable to work The money from disability insurance will pay for normal living expenses like food and housing but it is not usually enough to pay for the additional cost of long term care

What about government programs

Many are surprised to learn that Medicare does not pay for most long term care expenses even when the care is recommended by a doctor It pays only when skilled care is needed and then under very limited conditions

The only government-funded program that provides extensive benefits for long term care is Medicaid and that is available only to persons who have no other way of paying You cant qualify for Medicaid until most of your other assets have been spent

Protecting your independence

Without long term care insurance savings or other assets must be spent or people have to rely on their families to either provide the care or help pay for it With long term care coverage you know you will be able to pay for care yourself if you need it without depleting your assets or burdening your family thereby preserving your independence

Coverage for then and now

The same long term care protection that will protect you after retirement also will protect you today if you have a serious injury or illness and take a long time to recover In fact the US Government Accounting office estimates that approximately 40 of Americans receiving long term care in either an institution or a home or community-based setting are between the ages of 18 and 645

Some will be accident victims and some will have disabling diseases that strike young adults such as multiple sclerosis In other words long term care insurance deserves an immediate and permanent place in any sound financial plan

5Perspective on Aging What Americans ofAll Ages Dont Know About Long Term Care 1996

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Changes in society have made long term care insurance essential

A number of cultural changes and lifestyle trends have come together in contemporary society to make long term care benefits a necessary element of any sound plan for the future Here are a few of the trends that have made long term care insurance so important

More of us are living longer

Statistics show that the elderly population is growing both in real numbers and in percentage terms Currently more than 29 million people in the United States are 65 years or older That number is expected to reach 35 million by the year 2000 and 68 million in 20406 And as we grow older we are more likely to need long term care services and to benefit from the protection provided by CNA Care Connection Long Term Care

Number ofAmericans Over-65 (in millions)

70

60

50

40

30

20

10

o

The rising cost of health care

Rising cost trends are expected to continue for the foreseeable future Combined with longer life spans they suggest that even a careful plan of pension income savings and investments may not be enough to pay for long term care expenses CNA Care Connection is an excellent way to protect yourself against the high cost of long term care

6Bureau ofthe Census

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Current 2000 2040

bull bull

The changing American family

Because of modern employment and mobility trends we are less likely than our parents generation to live near our adult children siblings or other relatives who might act as caregivers in a time of need There just are not as many non-working spouses available to care for their spouses or parents in the home

Composition ofAmerican Households7

bull Adults who live alone

Single parent households II

Traditional households it More often people who require long term care services will have to pay for them To know you will be able to pay for long term care you should consider CNA Care Connection insurance

A good financial planning tool

CNA Care Connection insurance coverage is for people who believe in planning for the future It is a good way to help protect a familys savings or other assets to preserve them for the surviving spouse and children Most people who purchase long term care insurance do it so that they will be able to afford care services when needed without risking their familys assets and lifestyle and without depending on anyone else for care


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Coverage for spouses retirees parents and grandparents

A spouse of an employee may also purchase long tenn care coverage through this insurance plan with all the same benefits Retirees parents grandparents and in-laws of employees can be included too (They must be under age 80) Parental coverage is a very valuable feature of this plan because it is estimated that two-thirds of all Americans eventually will have to care for an elderly parent or grandparent

A sound plan for today and tomorrow

Adding CNA Care Connection coverage to your protection plan is a sound way to prepare for the future Our changing world has made this type of protection more important today than ever before and CNA Care Connection coverage has the flexibility you need to feel secure about any future occurrence Help protect your familys assets and your personal independence with the CNA Care Connection Long Tenn Care plan

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Benefit Exhibit of Your CNA Care Connection Plan This section and the next provide a summary of some of the key benefits and features of your CNA Care Connection Long Term Care insurance plan For more details about your benefits and the limitations of your plan see the Outline of Coverage If you have questions you may call 1-800-266-2904 toll-free

PlanA PlanB

Daily Nursing Home Benefit $80 Daily Nursing Home Benefit = $80

Daily Community Based Care Benefit = 60 of Daily Community Based Care Benefit 60 of Daily Nursing Home Benefit Daily Nursing Home Benefit

Lifetime Maximum Benefit = $87600 Lifetime Maximum Benefit $146000 (1095 x $80) (1825 x $80)

PlanA PlanB

Daily Nursing Home Benefit = $120 Daily Nursing Home Benefit = $120



PlanA PlanB

Daily Nursing Home Benefit = $160 Daily Nursing Home Benefit $160

Daily Community Based Care Benefit =60 of Daily Community Based Care Benefit = 60 of Daily Nursing Home Benefit Daily Nursing Home Benefit

Lifetime Maximum Benefit = $175200 Lifetime Maximum Benefit = $292000 (1095 x $160) (1825 x $160)

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Specific Features of Your CNA Care Connection Plan

Getting care thats right for you

Today there are many different institutional and community based care options available for persons who need long term care services Your CNA Care Connection plan is flexible so you can get the care thats right for your situation

Here are some examples of where you may receive covered long term care services

Home health care The variety of health care services available in the home is greater than ever before and includes nursing care help with personal care like dressing and walking and living assistance services like meal preparation and housekeeping available through a home health care agency

Adult day care If a family member provides care at home in the evening but help is needed during the day adult day care may be the right choice Of course there are also other community settings where care can be provided

Nursing home care Of course in some situations a nursing home may be the most appropriate place for you to receive the care you need Nursing homes now offer a wide range of facilities and services matched to the needs of their residents

Community Based Care

Community based care includes Home Health Care Assisted Living Facility Adult Day Care and Adult Foster Care Most long term care takes place at home or in the community In fact almost 80 of older adults who require assistance with activities of daily living receive that assistance in their homes or other community based care settings 8

Every day you receive community based care after the waiting period is over you will be paid actual expenses up to 60 of your daily nursing home benefit amount The same lifetime maximum benefit amount that applies to nursing home care also applies to all choices of community based care

8Perspective on Aging July-September 1996

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Nursing Home Care

Nursing care and custodial care received in a nursing home (licensed by the state in which the facility is located) is covered The nursing home may be a free standing facility or part of a hospital or other institution And if youve been in a nursing home but have to be admitted to a hospital the plan will pay up to 21 days per calendar year to reserve your bed in the nursing home until you return from the hospital

You choose a daily nursing home benefit amount as outlined in the previous Benefit Exhibit You will be paid actual expensesup to your daily nursing home benefit amount for each day you are in a nursing home after the waiting period ends

There is a lifetime maximum benefit amount which is the total amount of benefits you can receive in your lifetime

Caregiver Benefit

Your plan will pay 25 of your chosen daily maximum benefit up to 30 days per year for various types of informal care (ie non-licensed caregivers) This benefit is paid in addition to the Community Based Care benefit

Alternate Plan of Care

The healthcare industry is constantly evolving-treatment that we take for granted today was unknown 20 years ago Your CNA Care Connection plan anticipates these changes by offering an Alternate Plan of Care program that allows CNA to offer non-standard benefits in place of covered services when appropriate This feature lets your CNA Care Connection plan grow as care options grow

Hospice Care

Hospice care refers to the special attention those in the late stages of a terminal illness need This care tries to help the whole person by alleviating physical emotional social and spiritual discomfort The Hospice Care benefit equals either the Long Term Care Benefit payable for Community Based Care or the Long Term Care Benefit payable for Nursing Home Care depending on where Hospice Care is received Benefits however will not be paid for Hospice Care and Nursing Home Care simultaneously Benefits will not be paid for services that would not be billed in the absence of insurance such as a visit by a minister or volunteer social worker or other services that are usually provided free

State-specific regulations may require a variation to this standard definition see the enclosed Outline of Coverage for your states particular definition of this concept

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Alternate Care Facility Often times individuals may need care which is unique and can best be met in a facility other than a nursing home An Alternate Care Facility provides 24-hour care and supervision for those who need long term care services These facilities dont provide the same level of care as a skilled nursing home but can offer an alternative to a nursing home or a specialized part of a nursing home Alzheimers units and dementias units are examples of Alternate Care Facilities that specialize in certain types of long term care needs

Waiting Period

You must satisfy the CNACare Connection plan waiting period of90 calendar days before you start receiving benefits The waiting period is based on days when a qualifying impairment is present It may be satisfied without receipt of paid services

Waiver of Premium

Your premium will be waived while receiving claim benefits Premiums will resume 6 months after long term care services are no longer received

Emergency Alert System Benefit

Your plan will pay 100 of the actual monthly expense up to an amount equal to the community based care daily benefit to rent or lease an emergency alert system for your home

Caregiver Training

Spouses or family members can often help provide the needed care at home if they are properly trained Training could include for example how to administer medication or assist a patient getting into and out of bed Caregiver training of this type is covered up to a total of three times the community based care benefit

Temporary Bed Holding (bed reservation benefit)

An insured receiving formal care in a nursing home may temporarily leave the nursing home for a hospital stay or some other event Your CNA Care Connection plan pays a nursing home benefit up to 21 days per year when a payment is required to hold a nursing home space during a temporary absence

Care Management

In a claim situation your plan offers Care Management services-a voluntary advocacy program designed to evaluate your long term care needs The CNA Care Management program assists claimants and their families in maximizing the long term care benefit These services are provided free-of-charge to the claimant and therefore do not deplete the claimants benefit dollars in any way

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Portability

If an employee leaves the sponsoring organization for any reason CNA will move that person at his or her option to identical coverage on a direct-bill basis

Discount Programs

CNA has negotiated several national contracts which give our policyholders access to discounted services from home health agencies a medical equipment company and a personal emergency response system provider Such discount programs help the claimant to maximize their benefit dollars

When You Receive Benefits

To receive benefit you must be

CHRONICALLY ILL You must be certified by a Licensed Health Care Practitioner as being unable to perform (without substantial assistance from another individual) at least 2 Activities of Daily Living for a period of90 days due to an Activities of Daily Living Impairment or requiring substantial supervision to protect you from threats to health and safety due to a Severe Cognitive Impairment

You will not be considered Chronically III unless within the preceding 12 months a Licensed Health Care Practitioner has certified that the above requirements have been met

ACTIVITIES OF DAILY LIVING Your inability to perform without human assistance or substantial supervision from another person at least two of the Activities of Daily Living bathing continence dressing eating toileting transferring

SEVERE COGNITIVE IMPAIRMENT A loss or deterioration in Your intellectual capacity that is measured by clinical evidence and standardized tests that reliably measures impairment in the following areas

1 Short term or Long term memory

2 Orientation as to people places or time and

3 Deductive or abstract reasoning

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Exclusions

Benefits will not be paid for the following

bull Loss due to or resulting from war or an act of war whether declared or undeclared

bull Long term care to the extent that benefits are paid or payable under Workers Compensation the Occupational Disease Act or Law or a group health plan However the days on which long term care is received will count towards satisfying the waiting period subject to the provisions of the policy

bull Long term care which would be provided without charge in the absence of insurance

bull Treatment for neurosis psychoneurosis psychopathy psychosis or mental or emotional disease or disorder which is not of organic origin Alzheimers disease and similar dementi as are covered subject to the provisions of the policy

bull Nursing Home Care received in a hospital or clinic or a rehabilitation hospital except as provided in the definition of Nursing Home or in a facility or section of a facility which operates primarily for the treatment of alcoholics or drug addicts or the mentally ilL

bull Long term care received outside the United States and its possessions

bull Long Term Care to the extent that benefits are payable under Medicare or would be so reimbursable for the application of a deductible or coinsurance amount

Guaranteed Benefit Option


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Premiums

Since your premium is based on a fixed daily benefit and on your age at the time your coverage

begins CNA can predict the appropriate premium to charge you As a result premiums do not need to be adjusted as often as other types of variable benefit insurance policies like your health plan

Because your premium is also based on your age the younger you are when your coverage begins the lower your premiums will be for the duration of your participation in the plan Thats because onee youre in the plan your rates do not increase just because you get older For example a 40 year-old person who enrolls now will pay the same premium amount 20 years from now as a 40 year-old who just enrolled in the plan So it makes sense to buy coverage now when you can set your premiums at the lowest possible rate

Consider the difference in the total premium paid over time if that same person would have waited until he was 60 to enroll in the plan

Total Years ofCoverage Total Premiums Paid Age Entering Plan (to age 75) (PLAN A - $120 Plan)

40 35 $617400

59 16 $1079808

This example illustrates two benefits for enrolling as soon as possible-you save money in the long run and you benefit from more years of important protection

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Enrollment is simple

Ifyou are an employee you can sign up for your companys Group Long Term Care Plan by completing the enclosed ENROLLMENT FORM If you enroll during the initial enrollment period you are guaranteed coverage as long as you are still actively-at-work when your coverage goes into effect If you wait you will have to complete a questionnaire about your health and medical history and meet CNAs good health and other underwriting standards to be accepted into the plan

Your spouse can also apply for coverage by completing the enclosed SHORT FORM APPLICATION and returning it to CNA Please encourage your spouse to consider long term care coverage even ifhe or she has a medical condition Some medical conditions will not necessarily disqualify himher for coverage

Retirees parents parents-in-law grandparents or grandparents-in-Iaw ofan employee can apply for coverage by completing a LONG FORM APPLICATION and returning it to CNA ParentRetiree enrollment kits containing the LONG FORM APPLICATION maybe obtained directly from the CNA Customer Service by calling toll free 1-800-266-2904

These applicants must meet CNAs good health and other underwriting standards to be accepted into the plan Please note that not all medical conditions will disqualify himher for coverage

Easy payroll deduction

For employees once coverage begins your premiums (and those for your spouse) will be deducted from your paycheck automatically

For retirees parents grandparents or in-laws premiums will be paid directly to CNA

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CNA Coverage From a Company You Can Trust CNA value added

CNA Insurance Companies has been meeting customers protection needs for over 100 years A multi-line insurance organization CNA protects a wide range of insureds including individuals businesses of all sizes career professionals and business associations CNA is one of the ten largest insurance organizations in the country

Our long term commitment

With more than 30 years of experience providing long term care protection the Continental Casualty Company the company which underwrites our long term care product has been one of the pioneers of the concept of long term care Since the 1960s CNA has been committed to providing the most responsive and up-to-date coverage possible So you can count on quality service from the time you enroll in your CNA Care Connection Long Term Care plan to the time you have a claim

CNAs experience in providing group employee benefits plans and long term care coverage means that you can be confident you and your family will receive the protection you need when you need it

CNA is a registered service mark ofthe CNA Financial Corporation

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Semi-Monthly Premiums

Plan A -1095x Lifetime l-Iaximum $80 DNB Benefit $120 DNB Benefit $160 DNB Benefit

Age $87600 Lifetime Max $131400 Lifetime Max $175100 Lifetime Max lt25 236 354 471 25 264 396 528 26 266 399 532

The premiums shown 27 27] 407 543 are semi-monthly amounts Premiums are based on the

28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599

individuals age on the 32 3]] 467 623

plan effective date 33 34

326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

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Plan B - 182Sx Lifetime Maximum $80 DNB Benefit $120 DNB Benefit S160 DNB Benefit


The premiums shown are semi-monthly

27 28 29

335 346 357

502 520 535

670 693 713

amounts Premiums are 30 368 552 736 based on the 31 381 572 763

individuals age on the plan effective date

32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

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INFORMATION AND COUNSELING

Kentucky North CarolinaCalifornia

The North Carolina Seniors Health The Kentucky Benefits CounselingThe Health Insurance Counseling and Insurance Information program Program provides information andAdvocacy Program (HICAP) provides provides information and counseling service for persons age 60 long term care insurance counseling to counseling to North Carolina senior or olderCalifornia Senior Citizens Please call citizens For Information on this

their tOil-free number at 1-800-434-0222 To schedule an appointment with a program please contact or assessing the Department of benefit specialist contact the KentuckyInsurances web site at Division of Aging Services at 1-502-564shy(wwwinsurancecagov) 6930 North Carolina Seniors Health

Insurance Information Program Delaware co North Carolina

Department of Insurance Louisiana

ELDERinfo provides long term care The Louisiana Senior Health Insurance PO Box 26387 counseling to Delaware senior citizens Program (SHIIP) provides information Raleigh NC 27611 For information on ELDERinfo call and counseling to Louisiana senior 1-800-443-9354 1-800-336-9500 or write to citizens For information on SHIIP

contact Ohio State of Delaware Department of

Insurance

Becky Gates

Louisiana Department of Insurance The state of Ohio provides free PO Box 94214 841 Silver Lake Boulevard insurance counseling for senior

Baton Rouge LA 70804-92141shyDover DE 19901 citizens 800-259-5301

Illinois Please contact the Ohio DepartmentMaine

of Insurance at 1-800-686-1578 for The Illinois Senior Health Insurance more informationThe Maine Bureau of InsuranceProgram provides information and

provides assistance or informationcounseling to Illinois senior citizens Virginiaabout Long Term Care insurance to For information on the Illinois Seniors Maine residents Health Insurance Program contact The Virginia Insurance Counseling

Senior Health Insurance Program and Assistance Program is available 320 West Washington for residents of Virginia For more Springfield IL 62767 information please contact

1-800-548-9034 You may contact the Maine Bureau of Insurance at 1-800-300-5000

Virginia Dept for the Aging Kansas You may also contact them by mail at 1600 Forest Avenue

the following address or you can visit Suite 102 The Kansas Department on Aging and the their website at Richmond VA 23229 Kansas Department of Insurance have maineinsuranceregorg senior programs available to Kansas senior

or call the Aging Services Hotline atcitizens For information on these

1-800-552-3402programs contact Maine Bureau of Insurance

Wyoming34 State House Station

915 SW Harrison Kansas Department on Aging

Augusta ME 04333-0034 The Wyoming State Health Room 122 South Insurance Assistance Program

MissouriTopeka KS 66612 (WSHIIP) offers information 1-785-296-4986 counseling and assistance on long

The state of Missouri provides free 1-800-432-3535 term care medicare supplement and insurance counseling for senior or other insurance issues for senior citizens Please contact CLAIM Kansas Dept of Insurance citizens (Community Leaders Assisting the

Topeka KS 66612 420 SW 9th St

insureds of Missouri) at 1-800-390shyYou may contact WSHIIP at

3330 1-800-856-4398 for more information

CNA

Important Notice To Persons On Medicare This Insurance Duplicates Some Medicare Benefits

This is not Medicare Supplement Insurance

Federal law requires us to inform you that this insurance duplicates Medicare benefits in some situations

bull This is long term care insurance that provides benefits for covered nursing home and home care services

bull In some situations Medicare pays for short periods of skilled nursing home care limited home health services and hospice care

bull This insurance does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance

Neither Medicare nor Medicare Supplement insurance provides benefits for most long term care expenses

Before You Buy This Insurance

j Check the coverage in all health insurance policies you already have

v For more information about long term care insurance review the Shoppers Guide to Long Term Care Insurance available from the insurance company

j For more information about Medicare and Medicare Supplement insurance review the Guide to Health Insurance for People with Medicare available from the insurance company

j For help in understanding your health insurance contact your state insurance department or state senior insurance counseling program

CNA is a registered service mark trade name and domain name ofCNA Financial Corporation underwritten by Continental Casualty Company Coverages features product availability andor undernriting company may vary by state This is for illustrative purposes only and is not a contract Only the insurance policy can give actual terms coverage amounts conditions and exclusions copy 2004 CNA Financial Corporation

AGmiddot139706middotB 29 102004 Printed in USACNA

Continental Casualty Company CNA CNA Plaza A Stock Company Chicago Illinois 60685

LONG TERM CARE INSURANCE

OUTLINE OF COVERAGE

THIS OUTLINE OF COVERAGE IS A QUALIFIED LONG TERM CARE INSURANCE PLAN UNDER THE FEDERAL TAX CODE

Continental Casualty Company PO Box 946760

Maitland FL 32794-6760 1-(800)-266-2904

In this outline of coverage the Continental Casualty Company is referred to as we our or us The insured is referred to as you or your

Caution If you complete an application to obtain this coverage please be advised that issuance of coverage is based upon your responses to the questions in that application If your answers are incorrect or untrue we have the right to deny benefits or rescind your coverage

If your age has been misstated the benefit will be in an amount that the premiums paid would have purchased at your true age If coverage would not have been issued we will refund the premium paid

A copy of the application or the enrollment form as applicable is attached to your certificate The best time to clear up any questions is now before a claim arisesI If for any reason any of your answers are incorrect contact us at Continental Casualty Company PO Box 946760 Maitland FL 32794-6760

Notice to Buyer The Policy may not cover all the costs associated with Long Term Care incurred by the buyer during the period of coverage The buyer is advised to review carefully all Policy limitations SKS1CA-TQ

1 The policy is a group policy issued to the City of Winston-Salem in the state of North Carolina

2 PURPOSE OF OUTLINE OF COVERAGE This outline of coverage provides a very brief description of the important features of your coverage This is not the insurance contract Only the actual policy provisions will control The policy itself sets forth in detail both your rights and obligations and ours It is therefore important that you READ YOUR CERTIFICATE CAREFULLY

3 TERMS UNDER WHICH THE CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED

A-1

You have the right to return your certificate within 30 days (In Washington this period is 60 days) for a refund of the initial premium if you are not satisfied with the coverage

4 THIS IS NOT MEDICARE SUPPLEMENT COVERAGE If you are eligible for Medicare review the Medicare Supplement Buyers Guide available from us

Neither we nor our agents represent Medicare the federal government or any state government

5 LONG TERM CARE COVERAGE Policies of this type are designed to provide coverage for one or more diagnostic preventive therapeutic rehabilitative maintenance or personal care services received in a setting other than an acute care unit of a hospital such as in a nursing home in the community or in the home Your benefits are described in the Benefits Provided by the Policy provision They may be limited as provided in the Limitations and Exclusions provisions SKS2AA

6 BENEFITS PROVIDED BY THE POLICY Benefits are payable for Long Term Care services received as part of a plan of care if you are Chronically III SKNH1AC-TQ

LONG TERM CARE BENEFIT FOR NURSING HOME CARE The benefit payable for nursing home care is stated in the attached Benefit Exhibit Nursing home care consists of nursing care and custodial care It must be received in a nursing home licensed by the state in which it is located and which meets the other requirements stated in the policy a nursing home may be a domiciliary facility a free standing facility or a ward wing unit or swing bed of a hospital or other institution SKNH2AA-32

LONG TERM CARE BENEFIT FOR COMMUNITY BASED CARE The benefit payable for community based care is stated in the attached Benefit Exhibit Community based care consists of home health care adult day care assisted living care and adult foster care It must be received from a provider which is licensed or certified by the state in which it is located and which meets the other requirements stated in the certificate We will waive the licensing and certification requirement for adult day care centers in states which do not regulate these facilities providing they are certified by a recognized accrediting agency SKNH3AA

LONG TERM CARE BENEFIT FOR HOSPICE CARE The benefit payable for hospice care is stated in the attached Benefit Exhibit Hospice Care can be received in a Hospice Care Facility or at your home In order to receive benefits it must be certified by a phYSician that you are expected to live less than 6 months If care is in a facility it must be a stand-alone facility or wardwing of a Nursing Home that specializes in hospice care and is licensed by the state in which it is located If care is received at your home It must be received from a provider which is licensed or certified by the state in which it is located and which meets the other requirements stated in the certificate SKHC1AB

ALTERNATE CARE FACILITY CARE T he benefit payable for care in an alternate care facility is stated in the attached Benefit Exhibit This facility provides 24 hour care and qualified long term care services sufficient to support your needs if you are chronically ill The facility must be licensed or accredited by the appropriate agency to provide such care if such licensing or accreditation is required by the state in which care is received and which meets the other requirements stated in the certificate SKNH14AA

A-2

LIFETIME MAXIMUM BENEFIT We will pay the lifetime maximum benefit shown in the attached Benefit Exhibit All amounts paid under any benefit provision in or attached to your certificate including any payments under the Alternate Plan of Care provision count towards this maximum SKNH4AA

CHRONICALLY ILL You must be certified by a Licensed Health Care Practitioner as being unable to perform (without substantial assistance from another individual) at least 2 Activities of Daily Living for a period of 90 days due to an Activities of Daily Living Impairment or requiring substantial supervision to protect you from threats to health and safety due to a Severe Cognitive Impairment

You will not be considered Chronically III unless within the preceding 12 months a Licensed Health Care Practitioner has certified that the above requirements have been met SKNHBBA-TQ

ACTIVITIES OF DAILY LIVING Your inability to perform without human assistance or substantial supervision from another person at least two of the Activities of Daily Living listed and defined below SKNH9AA-TQ

Bathing Washing oneself by sponge bath or in either a tub or shower including the task of getting into or out of the tub or shower SKNH5CA-9

Continence The ability to maintain control of bowel and bladder function or when unable to maintain control of bowel or bladder function the ability to perform associated personal hygiene including caring for a catheter or colostomy bag SKNH5BAmiddot6

Dressing Putting on and taking off all items of clothing and any necessary braces fasteners or artificial limbs SKNH5BAmiddot2

Eating Feeding oneself by getting food into the body from a receptacle (such as a plate cup or table) or by a feeding tube or intravenously SKNH5BA-1

Toileting Getting to and from the tOilet getting on and off the toilet and performing associated personal hygiene SKNH5BAmiddot3

Transferring Moving into or out of a bed chair or wheelchair SKNH5BA-8


1 Short term or Long term memory 2 Orientation as to people places or time and 3 Deductive or abstract reasoning SKNH10BAmiddotTQ

PLAN OF CARE This is a program of treatment or care which is initiated and approved in writing by a Licensed Health Care Practitioner SKNH11AAmiddotTQ

A-3

7 LIMITATIONS AND EXCLUSIONS SKL1M

WAITING PERIOD To receive the long term care benefit you must first complete the waiting period stated in the attached Benefit Exhibit SKL2M

EXCLUSIONS We will not pay benefits for the following SKL3M

(a) Loss due to or resulting from war or an act of war whether declared or undeclared SKL3M-1

(b) Long term care to the extent that benefits are paid or payable under Workers Compensation the Occupational Disease Act or Law or a group health plan However the days on which long term care is received will count towards satisfying the waiting period subject to the provisions of the policy SKL3CA-2-TQ-32

(c) Long term care which would be provided without charge in the absence of insurance SKL3M-3

(d) Treatment for neurosis psychoneurosis psychopathy psychosis or mental or emotional disease or disorder which is not of organic origin Alzheimers disease and similar dementias are covered subject to the provisions of the policy SKL3M-4

(e) Nursing Home Care received in a hospital or clinic or a rehabilitation hospital except as provided in the definition of Nursing Home or in a facility or section of a facility which operates primarily for the treatment of alcoholics or drug addicts or the mentally ill SKL3C8-5

(f) Long term care received outside the United States and its possessions SKL3M-6

(g) Long Term Care to the extent that benefits are payable under Medicare 0 r would be so reimbursable for the application of a deductible or coinsurance amount SKL3M-7-TQ

OTHER LIMITATIONS SKL5AA

THE POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONG TERM CARE NEEDS SKL6AA

8 RELATIONSHIP OF COST OF CARE AND BENEFITS Because the costs of long term care will likely increase over time you should consider whether and how the benefits of this plan may be adjusted The benefit level is not guaranteed to increase over time unless an automatic benefit increase option or other inflation benefit is elected SKS3M

9 TERMS UNDER WHICH YOUR COVERAGE MAY BE CONTINUED IN FORCE OR DISCONTINUED

A-4

OUR RIGHT TO CHANGE THE PREMIUM Your premium is based on your age on your coverage effective date Your premium will not increase as you grow older It will remain the same unless the rates are increased for everyone in your age group you cannot be singled out for a rate increase for any reason SKS4AA

NON-RENEWAL The holder may elect not to renew the policy at any time by written notice to us We guarantee to renew the policy at the end of each renewal period unless the holder fails without good and sufficient cause to duly perform in good faith any obligation pertaining to the policy or the number of eligible persons insured is less than we require Coverage may be continued as provided below if the policy is not renewed SKS5BA

CONTINUATION OF COVERAGE You become eligible to elect continuation of coverage on the date your coverage under the policy terminates Coverage will be continued under the continuation of coverage policy with the same benefits and provisions as under your old policy If you elect continuation of coverage your coverage under the new policy is effective as of the date your coverage under the old policy terminates You may not continue coverage if termination is due to nonpayment of premium or to the lifetime maximum benefit being reached SKS6AA

CONTINUATION OF COVERAGE DUE TO DEATH OR DIVORCE OF SPOUSE If you are no longer eligible for coverage due to the death of or divorce from your spouse your coverage will continue i nforce under the policy subject to its provisions SKS7AA

WAIVER OF PREMIUM We will waive premiums starting with the first premium due after you complete the waiting period stated in the attached Benefit Exhibit We will continue to waive premiums until no benefits have been paid for 6 months SKS8BA

10 ALZHEIMERS DISEASE AND SIMILAR DEMENTIAS Loss due to Alzheimers Disease and similar dementias are covered subject to the provisions of the policy SKS9AA

11 PREMIUM Premium rates are shown in the attached Benefit Exhibit SKS10AA

12 ADDITIONAL FEATURES SKE1AA

UNDERWRITING Employees as defined in the master application will not be subject to underwriting if they enroll during the enrollment period stated in the master application All other eligible classes may obtain coverage subject to our approval of evidence of insurability SKE2BA

INTERRUPTION IN CARE If you have completed the waiting period we will consider the long term care for the same or for a related condition to be continuing without interruption until 6 months pass during which you receive no long term care due to such condition When long term care for the same 0 r f or a related condition recurs you must complete the full waiting period before benefits again become payable and premiums are again waived for long term care due to such condition SKE3BA

A-5

ALTERNATE PLAN OF CARE If you require long term care we may pay for alternate services devices or types of care under a written alternate plan of care It will be developed by or with health care professionals The plan must be mutually agreeable to you your physician and us It must be a medically acceptable option SKE4AA

TEMPORARY BED HOLDING BENEFIT We will pay the temporary bed holding benefit stated in the Benefit Exhibit if you are temporarily absent from the nursing home due to hospitalization or other event and continue to incur a charge for a bed in the nursing home This benefit is payable for up to 21 days per calendar year SKE10AA

CAREGIVER TRAINING BENEFIT We will pay the caregiver training benefit stated in the attached Benefit Exhibit for training necessary for the informal caregiver to care for you in your residence SKEBAA

EMERGENCY ALERT SYSTEM BENEFIT We will pay the emergency alert system benefit stated in the attached Benefit Exhibit for the rental or lease of an emergency alert system for your residence while you are receiving benefits for community based care This is a communication system located in your residence which is used to summon medical attention in care of a medical emergency SKE9AA

GUARANTEED BENEFIT INCREASE We will offer you an increase in the maximum Nursing Home Care benefit on each third anniversary of the master policy as indicated in the attached Benefit Exhibit Premiums for the increased amount will be based on your attained age Premiums for your initial benefit amount will always be based on your age when you entered the plan SKE14AA

CAREGIVER BENEFIT We will pay the Caregiver Benefit stated in the attached Benefit Exhibit for informal care provided by an informal caregiver SKE21AA

A-6


CNA

Table of Contents





Nursing Home Care 8

Caregiver Benefit 8


Hospice Care 8






Care Management 9

Portability 10



Exclusions 1 ]


Premiums 12



Premiums 15


CNA





1990












Consumer (50)

CNA














2

CNA






70

60

50

40

30

20

10

o




3

CNA

Current 2000 2040

bull bull










4

718

CNA





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

Table of Contents





Nursing Home Care 8

Caregiver Benefit 8


Hospice Care 8






Care Management 9

Portability 10



Exclusions 1 ]


Premiums 12



Premiums 15


CNA





1990












Consumer (50)

CNA














2

CNA






70

60

50

40

30

20

10

o




3

CNA

Current 2000 2040

bull bull










4

718

CNA





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6





1990












Consumer (50)

CNA














2

CNA






70

60

50

40

30

20

10

o




3

CNA

Current 2000 2040

bull bull










4

718

CNA





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6














2

CNA






70

60

50

40

30

20

10

o




3

CNA

Current 2000 2040

bull bull










4

718

CNA





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6






70

60

50

40

30

20

10

o




3

CNA

Current 2000 2040

bull bull










4

718

CNA





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

bull bull










4

718

CNA





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6





5

CNA


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6


PlanA PlanB




PlanA PlanB




PlanA PlanB




6

CNA












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6












7

CNA

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

Nursing Home Care




Caregiver Benefit




Hospice Care



8

CNA


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6


Waiting Period


Waiver of Premium




Caregiver Training




Care Management


9

CNA

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

Portability


Discount Programs











10

CNA

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

Exclusions











11

CNA

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

Premiums






40 35 $617400

59 16 $1079808


12

CNA









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6









13

CNA







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6







14

CNA





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6





28 29 30 31

278 285 29] 300

4]7 427 436 450

556 569 581 599



326 345

489 5]7

652 690

35 365 548 730 36 389 583 778 37 412 619 825 38 437 655 873 39 463 695 926 40 490 735 980 41 5]9 779 1038 42 549 824 1099 43 580 870 1l60 44 612 918 ]224 45 645 968 1291 46 682 ]023 1364 47 725 1087 ]449 48 770 1155 1540 49 817 1225 1634 50 870 1305 ]739 51 932 1397 ]863 52 1007 1510 2013 53 ]096 1643 2191 54 1197 1795 2393 55 1307 1960 2613 56 1428 2142 2855 57 1561 2341 3122 58 1711 2567 3423 59 1875 2812 3749 60 2049 3074 4099 6] 2229 3344 4458 62 2408 3612 4816 63 2576 3864 5152 64 2735 4102 5470 65 2904 4356 5807 66 3100 4650 6200 67 3349 5023 6698 68 3632 5449 7265 69 3938 5908 7877 70 4288 6432 8577 71 4705 7057 9409 72 5209 7813 10417 73 5806 8708 11611 74 6482 9723 12963 75 7227 10841 14454 76 8039 12059 16078 77 8893 13340 17787 78 9791 14686 ]9581 79 10737 16106 2]474

15CNA





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6





27 28 29

335 346 357

502 520 535

670 693 713



32 33 34

399 421 447

598 631 671

798 842 894

35 477 715 953 36 509 764 1019 37 544 815 1087 38 578 867 1156 39 616 924 1231 40 654 981 1308 41 696 1043 1391 42 738 Il08 1477 43 781 1172 1562 44 825 1238 165] 45 872 1308 ]744 46 924 1386 1847 47 983 1474 1965 48 1045 1568 2091 49 IIIO 1665 2220 50 1184 1776 2368 5] 1269 1903 2537 52 1371 2057 2743 53 1491 2237 2982 54 1627 2440 3254 55 1776 2664 3552 56 ]940 2909 3879 57 2121 3182 4242 58 2327 3490 4654 59 2551 3826 5102 60 2791 4187 5583 61 3038 4557 6076 62 3282 4923 6564 63 3509 5264 7018 64 3721 5582 7443 65 3949 5923 7897 66 4214 6321 8428 67 4556 6834 9112 68 4951 7426 9901 69 5380 8070 10760 70 5871 8806 11741 7] 6451 9676 12902 72 7149 10723 14297 73 7972 11958 15944 74 8902 13354 ]7805 75 9927 14890 19853 76 II 042 16563 22084 77 12216 18323 24431 78 13449 20173 26897 79 14749 22124 29499

16CNA









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6









Insurance

Becky Gates




















CNA

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







A-6

















OUTLINE OF COVERAGE



Maitland FL 32794-6760 1-(800)-266-2904









A-1










A-2














A-3















A-4











A-5







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Download - CNA - Mark III Employee Benefits · CNA Care Connection insurance coverage is for people who believe in planning for the future. It is a good way to help protect a family's savings

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