united american insurance company p.o. box 8080, … sheets v2/library... · n 2162 1081 541 181...

DS-MS2010(37)R 1/19

A* B* C* D* F* F * G**Basic,including 100% Part B coinsurance

Basic,including 100% Part B coinsurance

Basic, including 100% Part B coinsurance




Skilled Nursing Facility Coinsurance




Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

Part A Deductible

Part B Deductible

Part B DeductiblePart B Excess (100%)

Part B Excess (100%)

Foreign Travel Emergency




K L M N*Hospitalization and preventive care paid at 100%; other basic benefits paid at 50%

Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%


Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER

50% Skilled Nursing FacilityCoinsurance

75% Skilled Nursing Facility Coinsurance


Skilled NursingFacilityCoinsurance

50% Part A Deductible

75% Part ADeductible

50% Part A Deductible

Part A Deductible



Out-of-pocket limit $5560; paid at 100% after limit reached

Out-of-pocket limit $2780; paid at 100% after limit reached

* Denotes plans available by United American Insurance Company.

UNITED AMERICAN INSURANCE COMPANYP.O. BOX 8080, MCKINNEY, TEXAS 75070 (972) 529-5085

Administrative Offices: McKinney, Texas

Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010

Benefit Plans A, B, C, D, F, HDF, and N

** Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2300 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2300. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.

This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make available Plans “A & B”. Some plans may not be available in your state.BASIC BENEFITS:Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L and N require insureds to pay a portion of the Part B coinsurance or copayments.Blood: First three pints of blood each year.Hospice: Part A coinsurance.

DS-MS2010(37)R

PREMIUM INFORMATION

We, United American Insurance Company, can only raise your premium if we raise the premium for all policies like yours in this State. If you select an attained age policy, until you are age 81, your premiums will increase on each policy anniversary solely because of your age change. Your premiums may also be increased due to increasing health costs for all policies in your class.

DISCLOSURESUse this outline to compare benefits and premiums among policies.

READ YOUR POLICY VERY CAREFULLY

This is only an Outline describing your policy’s most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and your insurance company.

RIGHT TO RETURN POLICY

If you find that you are not satisfied with your policy, you may return it to United American Insurance Company, P.O. Box 8080, McKinney, Texas 75070. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments.

POLICY REPLACEMENT

If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it.

NOTICE

This policy may not fully cover all your medical costs.

Neither United American Insurance Company nor its agents are connected with Medicare.

This Outline of Coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details.

COMPLETE ANSWERS ARE VERY IMPORTANT

When you fill out the application for the new policy, be sure to answer truthfully and completely all questions about your medical and health history. The Company may cancel your policy and refuse to pay claims if you leave out or falsify important medical information.Review the application carefully before you sign it. Be certain that all information has been properly recorded.

RENEWABILITY

This policy is guaranteed renewable for life. We have the right to change the renewal premiums for this policy in accordance with our table of premium rates applicable to all policies of this form and class. This policy provides a 31-day grace period.

DS-MS2010(37)R

AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

UNDER AGE 65 GUARANTEED ISSUE PERIOD (G/I) *Male

PreferredMQSAAPlan Plan Code Effective Date

1667 834 417 139 5EWA 6/1/20182166 1083 542 181 5F0B 6/1/20133498 1749 875 292 5F4C 9/1/20162920 1460 730 244 5FCF 6/1/2017436 218 109 37 5FGHDF 6/1/2014

Female


1450 725 363 121 5EXA 6/1/20181883 942 471 157 5F1B 6/1/20133042 1521 761 254 5F5C 9/1/20162540 1270 635 212 5FDF 6/1/2017379 190 95 32 5FHHDF 6/1/2014

PCRC-37 PA18 06012018* NOTE: In PENNSYLVANIA, once the policyholder reaches age 65, rates for their policy will change to reflect the rates of the corresponding overage plan.

DS-MS2010(37)R


UNDER AGE 65 DURING OPEN ENROLLMENT (O/E) *Male


1667 834 417 139 5EWA 6/1/20182166 1083 542 181 5F0B 6/1/20133498 1749 875 292 5F4C 9/1/20163320 1660 830 277 5F8D 6/1/20172920 1460 730 244 5FCF 6/1/2017436 218 109 37 5FGHDF 6/1/20142162 1081 541 181 5FWN 6/1/2014

Female


1450 725 363 121 5EXA 6/1/20181883 942 471 157 5F1B 6/1/20133042 1521 761 254 5F5C 9/1/20162887 1444 722 241 5F9D 6/1/20172540 1270 635 212 5FDF 6/1/2017379 190 95 32 5FHHDF 6/1/20141880 940 470 157 5FXN 6/1/2014


DS-MS2010(37)R

AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets




Female




DS-MS2010(37)R





Female




DS-MS2010(37)R

PLAN A - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 6/1/2018 5A4MonthlyQuarterlySemi AnnualAnnualAttained Age

65 1667 834 417 13966 1759 880 440 14767 1848 924 462 15468 1920 960 480 16069 2010 1005 503 16870 2095 1048 524 17571 2166 1083 542 18172 2199 1100 550 18473 2226 1113 557 18674 2240 1120 560 18775 2256 1128 564 18876 2259 1130 565 18977 2259 1130 565 18978 2259 1130 565 18979 2259 1130 565 189

80+ 2259 1130 565 189

Plan Code:Standard Effective Date: 6/1/2018 5A6MonthlyQuarterlySemi AnnualAnnualAttained Age

65 1918 959 480 16066 2024 1012 506 16967 2126 1063 532 17868 2209 1105 553 18569 2313 1157 579 19370 2411 1206 603 20171 2492 1246 623 20872 2530 1265 633 21173 2561 1281 641 21474 2578 1289 645 21575 2597 1299 650 21776 2600 1300 650 21777 2600 1300 650 21778 2600 1300 650 21779 2600 1300 650 217

80+ 2600 1300 650 217

Female


65 1450 725 363 12166 1530 765 383 12867 1607 804 402 13468 1670 835 418 14069 1748 874 437 14670 1822 911 456 15271 1883 942 471 15772 1912 956 478 16073 1936 968 484 16274 1948 974 487 16375 1962 981 491 16476 1964 982 491 16477 1964 982 491 16478 1964 982 491 16479 1964 982 491 164

80+ 1964 982 491 164


65 1667 834 417 13966 1759 880 440 14767 1848 924 462 15468 1920 960 480 16069 2010 1005 503 16870 2095 1048 524 17571 2166 1083 542 18172 2199 1100 550 18473 2226 1113 557 18674 2240 1120 560 18775 2256 1128 564 18876 2259 1130 565 18977 2259 1130 565 18978 2259 1130 565 18979 2259 1130 565 189

80+ 2259 1130 565 189

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN B - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 6/1/2013 5AMMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2166 1083 542 18166 2299 1150 575 19267 2421 1211 606 20268 2531 1266 633 21169 2659 1330 665 22270 2782 1391 696 23271 2892 1446 723 24172 2959 1480 740 24773 3014 1507 754 25274 3055 1528 764 25575 3096 1548 774 25876 3120 1560 780 26077 3120 1560 780 26078 3120 1560 780 26079 3121 1561 781 261

80+ 3121 1561 781 261

Plan Code:Standard Effective Date: 6/1/2013 5AOMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2492 1246 623 20866 2646 1323 662 22167 2786 1393 697 23368 2912 1456 728 24369 3060 1530 765 25570 3202 1601 801 26771 3328 1664 832 27872 3406 1703 852 28473 3468 1734 867 28974 3516 1758 879 29375 3564 1782 891 29776 3591 1796 898 30077 3591 1796 898 30078 3591 1796 898 30079 3592 1796 898 300

80+ 3592 1796 898 300

Female

Plan Code:Preferred Effective Date: 6/1/2013 5ANMonthlyQuarterlySemi AnnualAnnualAttained Age

65 1883 942 471 15766 1999 1000 500 16767 2105 1053 527 17668 2201 1101 551 18469 2313 1157 579 19370 2420 1210 605 20271 2515 1258 629 21072 2574 1287 644 21573 2621 1311 656 21974 2657 1329 665 22275 2693 1347 674 22576 2713 1357 679 22777 2713 1357 679 22778 2713 1357 679 22779 2714 1357 679 227

80+ 2714 1357 679 227

Plan Code:Standard Effective Date: 6/1/2013 5APMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2166 1083 542 18166 2299 1150 575 19267 2421 1211 606 20268 2531 1266 633 21169 2659 1330 665 22270 2782 1391 696 23271 2892 1446 723 24172 2959 1480 740 24773 3014 1507 754 25274 3055 1528 764 25575 3096 1548 774 25876 3120 1560 780 26077 3120 1560 780 26078 3120 1560 780 26079 3121 1561 781 261

80+ 3121 1561 781 261

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN C - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 9/1/2016 5B4MonthlyQuarterlySemi AnnualAnnualAttained Age

65 3498 1749 875 29266 3710 1855 928 31067 3907 1954 977 32668 4095 2048 1024 34269 4322 2161 1081 36170 4544 2272 1136 37971 4749 2375 1188 39672 4898 2449 1225 40973 5026 2513 1257 41974 5124 2562 1281 42775 5228 2614 1307 43676 5307 2654 1327 44377 5388 2694 1347 44978 5471 2736 1368 45679 5555 2778 1389 463

80+ 5661 2831 1416 472

Plan Code:Standard Effective Date: 9/1/2016 5B6MonthlyQuarterlySemi AnnualAnnualAttained Age

65 4026 2013 1007 33666 4269 2135 1068 35667 4496 2248 1124 37568 4712 2356 1178 39369 4973 2487 1244 41570 5229 2615 1308 43671 5466 2733 1367 45672 5637 2819 1410 47073 5784 2892 1446 48274 5897 2949 1475 49275 6016 3008 1504 50276 6107 3054 1527 50977 6201 3101 1551 51778 6296 3148 1574 52579 6393 3197 1599 533

80+ 6515 3258 1629 543

Female


65 3042 1521 761 25466 3226 1613 807 26967 3398 1699 850 28468 3561 1781 891 29769 3758 1879 940 31470 3951 1976 988 33071 4130 2065 1033 34572 4260 2130 1065 35573 4371 2186 1093 36574 4456 2228 1114 37275 4546 2273 1137 37976 4615 2308 1154 38577 4686 2343 1172 39178 4758 2379 1190 39779 4831 2416 1208 403

80+ 4923 2462 1231 411


65 3498 1749 875 29266 3710 1855 928 31067 3907 1954 977 32668 4095 2048 1024 34269 4322 2161 1081 36170 4544 2272 1136 37971 4749 2375 1188 39672 4898 2449 1225 40973 5026 2513 1257 41974 5124 2562 1281 42775 5228 2614 1307 43676 5307 2654 1327 44377 5388 2694 1347 44978 5471 2736 1368 45679 5555 2778 1389 463

80+ 5661 2831 1416 472

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN D - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 6/1/2017 5BMMonthlyQuarterlySemi AnnualAnnualAttained Age

65 3320 1660 830 27766 3538 1769 885 29567 3740 1870 935 31268 3933 1967 984 32869 4164 2082 1041 34770 4390 2195 1098 36671 4603 2302 1151 38472 4753 2377 1189 39773 4889 2445 1223 40874 4990 2495 1248 41675 5094 2547 1274 42576 5173 2587 1294 43277 5260 2630 1315 43978 5343 2672 1336 44679 5426 2713 1357 453

80+ 5540 2770 1385 462

Plan Code:Standard Effective Date: 6/1/2017 5BOMonthlyQuarterlySemi AnnualAnnualAttained Age

65 3820 1910 955 31966 4072 2036 1018 34067 4304 2152 1076 35968 4526 2263 1132 37869 4793 2397 1199 40070 5052 2526 1263 42171 5297 2649 1325 44272 5470 2735 1368 45673 5626 2813 1407 46974 5743 2872 1436 47975 5863 2932 1466 48976 5954 2977 1489 49777 6053 3027 1514 50578 6149 3075 1538 51379 6245 3123 1562 521

80+ 6375 3188 1594 532

Female

Plan Code:Preferred Effective Date: 6/1/2017 5BNMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2887 1444 722 24166 3077 1539 770 25767 3253 1627 814 27268 3420 1710 855 28569 3622 1811 906 30270 3818 1909 955 31971 4003 2002 1001 33472 4133 2067 1034 34573 4251 2126 1063 35574 4340 2170 1085 36275 4430 2215 1108 37076 4499 2250 1125 37577 4574 2287 1144 38278 4647 2324 1162 38879 4719 2360 1180 394

80+ 4817 2409 1205 402

Plan Code:Standard Effective Date: 6/1/2017 5BPMonthlyQuarterlySemi AnnualAnnualAttained Age

65 3320 1660 830 27766 3538 1769 885 29567 3740 1870 935 31268 3933 1967 984 32869 4164 2082 1041 34770 4390 2195 1098 36671 4603 2302 1151 38472 4753 2377 1189 39773 4889 2445 1223 40874 4990 2495 1248 41675 5094 2547 1274 42576 5173 2587 1294 43277 5260 2630 1315 43978 5343 2672 1336 44679 5426 2713 1357 453

80+ 5540 2770 1385 462

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN F - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 6/1/2017 5C4MonthlyQuarterlySemi AnnualAnnualAttained Age

65 2920 1460 730 24466 3095 1548 774 25867 3258 1629 815 27268 3417 1709 855 28569 3603 1802 901 30170 3789 1895 948 31671 3959 1980 990 33072 4081 2041 1021 34173 4186 2093 1047 34974 4270 2135 1068 35675 4355 2178 1089 36376 4421 2211 1106 36977 4486 2243 1122 37478 4557 2279 1140 38079 4626 2313 1157 386

80+ 4714 2357 1179 393

Plan Code:Standard Effective Date: 6/1/2017 5C6MonthlyQuarterlySemi AnnualAnnualAttained Age

65 3361 1681 841 28166 3562 1781 891 29767 3750 1875 938 31368 3932 1966 983 32869 4147 2074 1037 34670 4360 2180 1090 36471 4556 2278 1139 38072 4696 2348 1174 39273 4817 2409 1205 40274 4914 2457 1229 41075 5011 2506 1253 41876 5088 2544 1272 42477 5162 2581 1291 43178 5244 2622 1311 43779 5324 2662 1331 444

80+ 5425 2713 1357 453

Female


65 2540 1270 635 21266 2692 1346 673 22567 2834 1417 709 23768 2971 1486 743 24869 3134 1567 784 26270 3295 1648 824 27571 3443 1722 861 28772 3549 1775 888 29673 3640 1820 910 30474 3713 1857 929 31075 3787 1894 947 31676 3845 1923 962 32177 3901 1951 976 32678 3963 1982 991 33179 4023 2012 1006 336

80+ 4099 2050 1025 342


65 2920 1460 730 24466 3095 1548 774 25867 3258 1629 815 27268 3417 1709 855 28569 3603 1802 901 30170 3789 1895 948 31671 3959 1980 990 33072 4081 2041 1021 34173 4186 2093 1047 34974 4270 2135 1068 35675 4355 2178 1089 36376 4421 2211 1106 36977 4486 2243 1122 37478 4557 2279 1140 38079 4626 2313 1157 386

80+ 4714 2357 1179 393

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN HDF - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 6/1/2014 5CMMonthlyQuarterlySemi AnnualAnnualAttained Age

65 436 218 109 3766 473 237 119 4067 512 256 128 4368 538 269 135 4569 567 284 142 4870 594 297 149 5071 623 312 156 5272 658 329 165 5573 692 346 173 5874 723 362 181 6175 755 378 189 6376 783 392 196 6677 815 408 204 6878 847 424 212 7179 880 440 220 74

80+ 923 462 231 77

Plan Code:Standard Effective Date: 6/1/2014 5COMonthlyQuarterlySemi AnnualAnnualAttained Age

65 502 251 126 4266 544 272 136 4667 589 295 148 5068 619 310 155 5269 653 327 164 5570 684 342 171 5771 717 359 180 6072 757 379 190 6473 797 399 200 6774 832 416 208 7075 869 435 218 7376 901 451 226 7677 938 469 235 7978 975 488 244 8279 1013 507 254 85

80+ 1062 531 266 89

Female

Plan Code:Preferred Effective Date: 6/1/2014 5CNMonthlyQuarterlySemi AnnualAnnualAttained Age

65 379 190 95 3266 411 206 103 3567 445 223 112 3868 467 234 117 3969 493 247 124 4270 517 259 130 4471 541 271 136 4672 572 286 143 4873 602 301 151 5174 629 315 158 5375 657 329 165 5576 681 341 171 5777 709 355 178 6078 737 369 185 6279 765 383 192 64

80+ 802 401 201 67

Plan Code:Standard Effective Date: 6/1/2014 5CPMonthlyQuarterlySemi AnnualAnnualAttained Age

65 436 218 109 3766 473 237 119 4067 512 256 128 4368 538 269 135 4569 567 284 142 4870 594 297 149 5071 623 312 156 5272 658 329 165 5573 692 346 173 5874 723 362 181 6175 755 378 189 6376 783 392 196 6677 815 408 204 6878 847 424 212 7179 880 440 220 74

80+ 923 462 231 77

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN N - AREA 1 (ZIP 150-154; 189-194)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male

Plan Code:Preferred Effective Date: 6/1/2014 5DMMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2162 1081 541 18166 2304 1152 576 19267 2436 1218 609 20368 2567 1284 642 21469 2721 1361 681 22770 2876 1438 719 24071 3013 1507 754 25272 3120 1560 780 26073 3211 1606 803 26874 3283 1642 821 27475 3356 1678 839 28076 3413 1707 854 28577 3478 1739 870 29078 3543 1772 886 29679 3606 1803 902 301

80+ 3703 1852 926 309

Plan Code:Standard Effective Date: 6/1/2014 5DOMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2488 1244 622 20866 2651 1326 663 22167 2803 1402 701 23468 2954 1477 739 24769 3131 1566 783 26170 3309 1655 828 27671 3467 1734 867 28972 3591 1796 898 30073 3695 1848 924 30874 3778 1889 945 31575 3863 1932 966 32276 3928 1964 982 32877 4003 2002 1001 33478 4077 2039 1020 34079 4149 2075 1038 346

80+ 4261 2131 1066 356

Female

Plan Code:Preferred Effective Date: 6/1/2014 5DNMonthlyQuarterlySemi AnnualAnnualAttained Age

65 1880 940 470 15766 2003 1002 501 16767 2118 1059 530 17768 2233 1117 559 18769 2366 1183 592 19870 2501 1251 626 20971 2620 1310 655 21972 2713 1357 679 22773 2792 1396 698 23374 2855 1428 714 23875 2919 1460 730 24476 2968 1484 742 24877 3025 1513 757 25378 3081 1541 771 25779 3136 1568 784 262

80+ 3220 1610 805 269

Plan Code:Standard Effective Date: 6/1/2014 5DPMonthlyQuarterlySemi AnnualAnnualAttained Age

65 2162 1081 541 18166 2304 1152 576 19267 2436 1218 609 20368 2567 1284 642 21469 2721 1361 681 22770 2876 1438 719 24071 3013 1507 754 25272 3120 1560 780 26073 3211 1606 803 26874 3283 1642 821 27475 3356 1678 839 28076 3413 1707 854 28577 3478 1739 870 29078 3543 1772 886 29679 3606 1803 902 301

80+ 3703 1852 926 309

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN A - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 1667 834 417 13966 1759 880 440 14767 1848 924 462 15468 1920 960 480 16069 2010 1005 503 16870 2095 1048 524 17571 2166 1083 542 18172 2199 1100 550 18473 2226 1113 557 18674 2240 1120 560 18775 2256 1128 564 18876 2259 1130 565 18977 2259 1130 565 18978 2259 1130 565 18979 2259 1130 565 189

80+ 2259 1130 565 189


65 1918 959 480 16066 2024 1012 506 16967 2126 1063 532 17868 2209 1105 553 18569 2313 1157 579 19370 2411 1206 603 20171 2492 1246 623 20872 2530 1265 633 21173 2561 1281 641 21474 2578 1289 645 21575 2597 1299 650 21776 2600 1300 650 21777 2600 1300 650 21778 2600 1300 650 21779 2600 1300 650 217

80+ 2600 1300 650 217

Female


65 1450 725 363 12166 1530 765 383 12867 1607 804 402 13468 1670 835 418 14069 1748 874 437 14670 1822 911 456 15271 1883 942 471 15772 1912 956 478 16073 1936 968 484 16274 1948 974 487 16375 1962 981 491 16476 1964 982 491 16477 1964 982 491 16478 1964 982 491 16479 1964 982 491 164

80+ 1964 982 491 164


65 1667 834 417 13966 1759 880 440 14767 1848 924 462 15468 1920 960 480 16069 2010 1005 503 16870 2095 1048 524 17571 2166 1083 542 18172 2199 1100 550 18473 2226 1113 557 18674 2240 1120 560 18775 2256 1128 564 18876 2259 1130 565 18977 2259 1130 565 18978 2259 1130 565 18979 2259 1130 565 189

80+ 2259 1130 565 189

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN B - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 2166 1083 542 18166 2299 1150 575 19267 2421 1211 606 20268 2531 1266 633 21169 2659 1330 665 22270 2782 1391 696 23271 2892 1446 723 24172 2959 1480 740 24773 3014 1507 754 25274 3055 1528 764 25575 3096 1548 774 25876 3120 1560 780 26077 3120 1560 780 26078 3120 1560 780 26079 3121 1561 781 261

80+ 3121 1561 781 261


65 2492 1246 623 20866 2646 1323 662 22167 2786 1393 697 23368 2912 1456 728 24369 3060 1530 765 25570 3202 1601 801 26771 3328 1664 832 27872 3406 1703 852 28473 3468 1734 867 28974 3516 1758 879 29375 3564 1782 891 29776 3591 1796 898 30077 3591 1796 898 30078 3591 1796 898 30079 3592 1796 898 300

80+ 3592 1796 898 300

Female


65 1883 942 471 15766 1999 1000 500 16767 2105 1053 527 17668 2201 1101 551 18469 2313 1157 579 19370 2420 1210 605 20271 2515 1258 629 21072 2574 1287 644 21573 2621 1311 656 21974 2657 1329 665 22275 2693 1347 674 22576 2713 1357 679 22777 2713 1357 679 22778 2713 1357 679 22779 2714 1357 679 227

80+ 2714 1357 679 227


65 2166 1083 542 18166 2299 1150 575 19267 2421 1211 606 20268 2531 1266 633 21169 2659 1330 665 22270 2782 1391 696 23271 2892 1446 723 24172 2959 1480 740 24773 3014 1507 754 25274 3055 1528 764 25575 3096 1548 774 25876 3120 1560 780 26077 3120 1560 780 26078 3120 1560 780 26079 3121 1561 781 261

80+ 3121 1561 781 261

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN C - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 3498 1749 875 29266 3710 1855 928 31067 3907 1954 977 32668 4095 2048 1024 34269 4322 2161 1081 36170 4544 2272 1136 37971 4749 2375 1188 39672 4898 2449 1225 40973 5026 2513 1257 41974 5124 2562 1281 42775 5228 2614 1307 43676 5307 2654 1327 44377 5388 2694 1347 44978 5471 2736 1368 45679 5555 2778 1389 463

80+ 5661 2831 1416 472


65 4026 2013 1007 33666 4269 2135 1068 35667 4496 2248 1124 37568 4712 2356 1178 39369 4973 2487 1244 41570 5229 2615 1308 43671 5466 2733 1367 45672 5637 2819 1410 47073 5784 2892 1446 48274 5897 2949 1475 49275 6016 3008 1504 50276 6107 3054 1527 50977 6201 3101 1551 51778 6296 3148 1574 52579 6393 3197 1599 533

80+ 6515 3258 1629 543

Female


65 3042 1521 761 25466 3226 1613 807 26967 3398 1699 850 28468 3561 1781 891 29769 3758 1879 940 31470 3951 1976 988 33071 4130 2065 1033 34572 4260 2130 1065 35573 4371 2186 1093 36574 4456 2228 1114 37275 4546 2273 1137 37976 4615 2308 1154 38577 4686 2343 1172 39178 4758 2379 1190 39779 4831 2416 1208 403

80+ 4923 2462 1231 411


65 3498 1749 875 29266 3710 1855 928 31067 3907 1954 977 32668 4095 2048 1024 34269 4322 2161 1081 36170 4544 2272 1136 37971 4749 2375 1188 39672 4898 2449 1225 40973 5026 2513 1257 41974 5124 2562 1281 42775 5228 2614 1307 43676 5307 2654 1327 44377 5388 2694 1347 44978 5471 2736 1368 45679 5555 2778 1389 463

80+ 5661 2831 1416 472

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN D - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 3320 1660 830 27766 3538 1769 885 29567 3740 1870 935 31268 3933 1967 984 32869 4164 2082 1041 34770 4390 2195 1098 36671 4603 2302 1151 38472 4753 2377 1189 39773 4889 2445 1223 40874 4990 2495 1248 41675 5094 2547 1274 42576 5173 2587 1294 43277 5260 2630 1315 43978 5343 2672 1336 44679 5426 2713 1357 453

80+ 5540 2770 1385 462


65 3820 1910 955 31966 4072 2036 1018 34067 4304 2152 1076 35968 4526 2263 1132 37869 4793 2397 1199 40070 5052 2526 1263 42171 5297 2649 1325 44272 5470 2735 1368 45673 5626 2813 1407 46974 5743 2872 1436 47975 5863 2932 1466 48976 5954 2977 1489 49777 6053 3027 1514 50578 6149 3075 1538 51379 6245 3123 1562 521

80+ 6375 3188 1594 532

Female


65 2887 1444 722 24166 3077 1539 770 25767 3253 1627 814 27268 3420 1710 855 28569 3622 1811 906 30270 3818 1909 955 31971 4003 2002 1001 33472 4133 2067 1034 34573 4251 2126 1063 35574 4340 2170 1085 36275 4430 2215 1108 37076 4499 2250 1125 37577 4574 2287 1144 38278 4647 2324 1162 38879 4719 2360 1180 394

80+ 4817 2409 1205 402


65 3320 1660 830 27766 3538 1769 885 29567 3740 1870 935 31268 3933 1967 984 32869 4164 2082 1041 34770 4390 2195 1098 36671 4603 2302 1151 38472 4753 2377 1189 39773 4889 2445 1223 40874 4990 2495 1248 41675 5094 2547 1274 42576 5173 2587 1294 43277 5260 2630 1315 43978 5343 2672 1336 44679 5426 2713 1357 453

80+ 5540 2770 1385 462

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN F - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 2920 1460 730 24466 3095 1548 774 25867 3258 1629 815 27268 3417 1709 855 28569 3603 1802 901 30170 3789 1895 948 31671 3959 1980 990 33072 4081 2041 1021 34173 4186 2093 1047 34974 4270 2135 1068 35675 4355 2178 1089 36376 4421 2211 1106 36977 4486 2243 1122 37478 4557 2279 1140 38079 4626 2313 1157 386

80+ 4714 2357 1179 393


65 3361 1681 841 28166 3562 1781 891 29767 3750 1875 938 31368 3932 1966 983 32869 4147 2074 1037 34670 4360 2180 1090 36471 4556 2278 1139 38072 4696 2348 1174 39273 4817 2409 1205 40274 4914 2457 1229 41075 5011 2506 1253 41876 5088 2544 1272 42477 5162 2581 1291 43178 5244 2622 1311 43779 5324 2662 1331 444

80+ 5425 2713 1357 453

Female


65 2540 1270 635 21266 2692 1346 673 22567 2834 1417 709 23768 2971 1486 743 24869 3134 1567 784 26270 3295 1648 824 27571 3443 1722 861 28772 3549 1775 888 29673 3640 1820 910 30474 3713 1857 929 31075 3787 1894 947 31676 3845 1923 962 32177 3901 1951 976 32678 3963 1982 991 33179 4023 2012 1006 336

80+ 4099 2050 1025 342


65 2920 1460 730 24466 3095 1548 774 25867 3258 1629 815 27268 3417 1709 855 28569 3603 1802 901 30170 3789 1895 948 31671 3959 1980 990 33072 4081 2041 1021 34173 4186 2093 1047 34974 4270 2135 1068 35675 4355 2178 1089 36376 4421 2211 1106 36977 4486 2243 1122 37478 4557 2279 1140 38079 4626 2313 1157 386

80+ 4714 2357 1179 393

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN HDF - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 436 218 109 3766 473 237 119 4067 512 256 128 4368 538 269 135 4569 567 284 142 4870 594 297 149 5071 623 312 156 5272 658 329 165 5573 692 346 173 5874 723 362 181 6175 755 378 189 6376 783 392 196 6677 815 408 204 6878 847 424 212 7179 880 440 220 74

80+ 923 462 231 77


65 502 251 126 4266 544 272 136 4667 589 295 148 5068 619 310 155 5269 653 327 164 5570 684 342 171 5771 717 359 180 6072 757 379 190 6473 797 399 200 6774 832 416 208 7075 869 435 218 7376 901 451 226 7677 938 469 235 7978 975 488 244 8279 1013 507 254 85

80+ 1062 531 266 89

Female


65 379 190 95 3266 411 206 103 3567 445 223 112 3868 467 234 117 3969 493 247 124 4270 517 259 130 4471 541 271 136 4672 572 286 143 4873 602 301 151 5174 629 315 158 5375 657 329 165 5576 681 341 171 5777 709 355 178 6078 737 369 185 6279 765 383 192 64

80+ 802 401 201 67


65 436 218 109 3766 473 237 119 4067 512 256 128 4368 538 269 135 4569 567 284 142 4870 594 297 149 5071 623 312 156 5272 658 329 165 5573 692 346 173 5874 723 362 181 6175 755 378 189 6376 783 392 196 6677 815 408 204 6878 847 424 212 7179 880 440 220 74

80+ 923 462 231 77

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN N - AREA 2 (ZIP 155-167)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 2162 1081 541 18166 2304 1152 576 19267 2436 1218 609 20368 2567 1284 642 21469 2721 1361 681 22770 2876 1438 719 24071 3013 1507 754 25272 3120 1560 780 26073 3211 1606 803 26874 3283 1642 821 27475 3356 1678 839 28076 3413 1707 854 28577 3478 1739 870 29078 3543 1772 886 29679 3606 1803 902 301

80+ 3703 1852 926 309


65 2488 1244 622 20866 2651 1326 663 22167 2803 1402 701 23468 2954 1477 739 24769 3131 1566 783 26170 3309 1655 828 27671 3467 1734 867 28972 3591 1796 898 30073 3695 1848 924 30874 3778 1889 945 31575 3863 1932 966 32276 3928 1964 982 32877 4003 2002 1001 33478 4077 2039 1020 34079 4149 2075 1038 346

80+ 4261 2131 1066 356

Female


65 1880 940 470 15766 2003 1002 501 16767 2118 1059 530 17768 2233 1117 559 18769 2366 1183 592 19870 2501 1251 626 20971 2620 1310 655 21972 2713 1357 679 22773 2792 1396 698 23374 2855 1428 714 23875 2919 1460 730 24476 2968 1484 742 24877 3025 1513 757 25378 3081 1541 771 25779 3136 1568 784 262

80+ 3220 1610 805 269


65 2162 1081 541 18166 2304 1152 576 19267 2436 1218 609 20368 2567 1284 642 21469 2721 1361 681 22770 2876 1438 719 24071 3013 1507 754 25272 3120 1560 780 26073 3211 1606 803 26874 3283 1642 821 27475 3356 1678 839 28076 3413 1707 854 28577 3478 1739 870 29078 3543 1772 886 29679 3606 1803 902 301

80+ 3703 1852 926 309

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN A - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 1440 720 360 12066 1519 760 380 12767 1596 798 399 13368 1658 829 415 13969 1736 868 434 14570 1809 905 453 15171 1870 935 468 15672 1899 950 475 15973 1922 961 481 16174 1934 967 484 16275 1949 975 488 16376 1951 976 488 16377 1951 976 488 16378 1951 976 488 16379 1951 976 488 163

80+ 1951 976 488 163


65 1657 829 415 13966 1748 874 437 14667 1836 918 459 15368 1908 954 477 15969 1997 999 500 16770 2082 1041 521 17471 2152 1076 538 18072 2185 1093 547 18373 2212 1106 553 18574 2226 1113 557 18675 2243 1122 561 18776 2245 1123 562 18877 2245 1123 562 18878 2245 1123 562 18879 2245 1123 562 188

80+ 2245 1123 562 188

Female


65 1252 626 313 10566 1321 661 331 11167 1388 694 347 11668 1442 721 361 12169 1509 755 378 12670 1573 787 394 13271 1626 813 407 13672 1651 826 413 13873 1672 836 418 14074 1682 841 421 14175 1695 848 424 14276 1697 849 425 14277 1697 849 425 14278 1697 849 425 14279 1697 849 425 142

80+ 1697 849 425 142


65 1440 720 360 12066 1519 760 380 12767 1596 798 399 13368 1658 829 415 13969 1736 868 434 14570 1809 905 453 15171 1870 935 468 15672 1899 950 475 15973 1922 961 481 16174 1934 967 484 16275 1949 975 488 16376 1951 976 488 16377 1951 976 488 16378 1951 976 488 16379 1951 976 488 163

80+ 1951 976 488 163

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN B - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 1870 935 468 15666 1986 993 497 16667 2091 1046 523 17568 2185 1093 547 18369 2297 1149 575 19270 2403 1202 601 20171 2498 1249 625 20972 2556 1278 639 21373 2603 1302 651 21774 2638 1319 660 22075 2674 1337 669 22376 2695 1348 674 22577 2695 1348 674 22578 2695 1348 674 22579 2696 1348 674 225

80+ 2696 1348 674 225


65 2152 1076 538 18066 2285 1143 572 19167 2406 1203 602 20168 2515 1258 629 21069 2643 1322 661 22170 2765 1383 692 23171 2874 1437 719 24072 2941 1471 736 24673 2995 1498 749 25074 3036 1518 759 25375 3078 1539 770 25776 3101 1551 776 25977 3101 1551 776 25978 3101 1551 776 25979 3102 1551 776 259

80+ 3102 1551 776 259

Female


65 1626 813 407 13666 1727 864 432 14467 1818 909 455 15268 1901 951 476 15969 1997 999 500 16770 2090 1045 523 17571 2172 1086 543 18172 2223 1112 556 18673 2264 1132 566 18974 2295 1148 574 19275 2326 1163 582 19476 2343 1172 586 19677 2343 1172 586 19678 2343 1172 586 19679 2344 1172 586 196

80+ 2344 1172 586 196


65 1870 935 468 15666 1986 993 497 16667 2091 1046 523 17568 2185 1093 547 18369 2297 1149 575 19270 2403 1202 601 20171 2498 1249 625 20972 2556 1278 639 21373 2603 1302 651 21774 2638 1319 660 22075 2674 1337 669 22376 2695 1348 674 22577 2695 1348 674 22578 2695 1348 674 22579 2696 1348 674 225

80+ 2696 1348 674 225

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN C - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 3021 1511 756 25266 3204 1602 801 26767 3374 1687 844 28268 3536 1768 884 29569 3732 1866 933 31170 3924 1962 981 32771 4102 2051 1026 34272 4230 2115 1058 35373 4340 2170 1085 36274 4425 2213 1107 36975 4515 2258 1129 37776 4583 2292 1146 38277 4654 2327 1164 38878 4725 2363 1182 39479 4797 2399 1200 400

80+ 4889 2445 1223 408


65 3477 1739 870 29066 3687 1844 922 30867 3883 1942 971 32468 4070 2035 1018 34069 4295 2148 1074 35870 4516 2258 1129 37771 4720 2360 1180 39472 4868 2434 1217 40673 4995 2498 1249 41774 5093 2547 1274 42575 5196 2598 1299 43376 5275 2638 1319 44077 5356 2678 1339 44778 5438 2719 1360 45479 5521 2761 1381 461

80+ 5627 2814 1407 469

Female


65 2627 1314 657 21966 2786 1393 697 23367 2934 1467 734 24568 3075 1538 769 25769 3246 1623 812 27170 3413 1707 854 28571 3567 1784 892 29872 3679 1840 920 30773 3775 1888 944 31574 3848 1924 962 32175 3926 1963 982 32876 3986 1993 997 33377 4047 2024 1012 33878 4109 2055 1028 34379 4172 2086 1043 348

80+ 4252 2126 1063 355


65 3021 1511 756 25266 3204 1602 801 26767 3374 1687 844 28268 3536 1768 884 29569 3732 1866 933 31170 3924 1962 981 32771 4102 2051 1026 34272 4230 2115 1058 35373 4340 2170 1085 36274 4425 2213 1107 36975 4515 2258 1129 37776 4583 2292 1146 38277 4654 2327 1164 38878 4725 2363 1182 39479 4797 2399 1200 400

80+ 4889 2445 1223 408

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN D - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 2867 1434 717 23966 3056 1528 764 25567 3230 1615 808 27068 3397 1699 850 28469 3597 1799 900 30070 3791 1896 948 31671 3975 1988 994 33272 4105 2053 1027 34373 4222 2111 1056 35274 4310 2155 1078 36075 4400 2200 1100 36776 4468 2234 1117 37377 4542 2271 1136 37978 4615 2308 1154 38579 4686 2343 1172 391

80+ 4784 2392 1196 399


65 3300 1650 825 27566 3517 1759 880 29467 3718 1859 930 31068 3909 1955 978 32669 4139 2070 1035 34570 4363 2182 1091 36471 4575 2288 1144 38272 4724 2362 1181 39473 4859 2430 1215 40574 4960 2480 1240 41475 5063 2532 1266 42276 5142 2571 1286 42977 5228 2614 1307 43678 5311 2656 1328 44379 5393 2697 1349 450

80+ 5506 2753 1377 459

Female


65 2493 1247 624 20866 2657 1329 665 22267 2809 1405 703 23568 2954 1477 739 24769 3128 1564 782 26170 3297 1649 825 27571 3457 1729 865 28972 3570 1785 893 29873 3672 1836 918 30674 3748 1874 937 31375 3826 1913 957 31976 3885 1943 972 32477 3950 1975 988 33078 4013 2007 1004 33579 4075 2038 1019 340

80+ 4161 2081 1041 347


65 2867 1434 717 23966 3056 1528 764 25567 3230 1615 808 27068 3397 1699 850 28469 3597 1799 900 30070 3791 1896 948 31671 3975 1988 994 33272 4105 2053 1027 34373 4222 2111 1056 35274 4310 2155 1078 36075 4400 2200 1100 36776 4468 2234 1117 37377 4542 2271 1136 37978 4615 2308 1154 38579 4686 2343 1172 391

80+ 4784 2392 1196 399

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN F - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 2522 1261 631 21166 2673 1337 669 22367 2814 1407 704 23568 2951 1476 738 24669 3112 1556 778 26070 3272 1636 818 27371 3419 1710 855 28572 3524 1762 881 29473 3615 1808 904 30274 3687 1844 922 30875 3761 1881 941 31476 3818 1909 955 31977 3874 1937 969 32378 3935 1968 984 32879 3995 1998 999 333

80+ 4071 2036 1018 340


65 2903 1452 726 24266 3076 1538 769 25767 3238 1619 810 27068 3396 1698 849 28369 3581 1791 896 29970 3766 1883 942 31471 3935 1968 984 32872 4056 2028 1014 33873 4160 2080 1040 34774 4244 2122 1061 35475 4328 2164 1082 36176 4394 2197 1099 36777 4458 2229 1115 37278 4529 2265 1133 37879 4598 2299 1150 384

80+ 4685 2343 1172 391

Female


65 2193 1097 549 18366 2325 1163 582 19467 2447 1224 612 20468 2566 1283 642 21469 2706 1353 677 22670 2846 1423 712 23871 2973 1487 744 24872 3065 1533 767 25673 3144 1572 786 26274 3207 1604 802 26875 3271 1636 818 27376 3320 1660 830 27777 3369 1685 843 28178 3422 1711 856 28679 3475 1738 869 290

80+ 3540 1770 885 295


65 2522 1261 631 21166 2673 1337 669 22367 2814 1407 704 23568 2951 1476 738 24669 3112 1556 778 26070 3272 1636 818 27371 3419 1710 855 28572 3524 1762 881 29473 3615 1808 904 30274 3687 1844 922 30875 3761 1881 941 31476 3818 1909 955 31977 3874 1937 969 32378 3935 1968 984 32879 3995 1998 999 333

80+ 4071 2036 1018 340

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN HDF - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 376 188 94 3266 408 204 102 3467 442 221 111 3768 464 232 116 3969 490 245 123 4170 513 257 129 4371 538 269 135 4572 568 284 142 4873 598 299 150 5074 624 312 156 5275 652 326 163 5576 676 338 169 5777 704 352 176 5978 732 366 183 6179 760 380 190 64

80+ 797 399 200 67


65 433 217 109 3766 470 235 118 4067 508 254 127 4368 534 267 134 4569 564 282 141 4770 591 296 148 5071 619 310 155 5272 654 327 164 5573 688 344 172 5874 719 360 180 6075 750 375 188 6376 778 389 195 6577 810 405 203 6878 842 421 211 7179 875 438 219 73

80+ 917 459 230 77

Female


65 327 164 82 2866 355 178 89 3067 384 192 96 3268 404 202 101 3469 426 213 107 3670 446 223 112 3871 468 234 117 3972 494 247 124 4273 520 260 130 4474 543 272 136 4675 567 284 142 4876 588 294 147 4977 612 306 153 5178 636 318 159 5379 661 331 166 56

80+ 693 347 174 58


65 376 188 94 3266 408 204 102 3467 442 221 111 3768 464 232 116 3969 490 245 123 4170 513 257 129 4371 538 269 135 4572 568 284 142 4873 598 299 150 5074 624 312 156 5275 652 326 163 5576 676 338 169 5777 704 352 176 5978 732 366 183 6179 760 380 190 64

80+ 797 399 200 67

PCRC-37 PA18 06012018

DS-MS2010(37)R

PLAN N - AREA 3 (ZIP 168-188; 195-196)PENNSYLVANIA 2018 United American Insurance Company - ProCare® Rate Sheets

Male


65 1867 934 467 15666 1990 995 498 16667 2104 1052 526 17668 2217 1109 555 18569 2350 1175 588 19670 2483 1242 621 20771 2602 1301 651 21772 2695 1348 674 22573 2773 1387 694 23274 2835 1418 709 23775 2899 1450 725 24276 2948 1474 737 24677 3004 1502 751 25178 3060 1530 765 25579 3114 1557 779 260

80+ 3198 1599 800 267


65 2149 1075 538 18066 2290 1145 573 19167 2421 1211 606 20268 2552 1276 638 21369 2704 1352 676 22670 2858 1429 715 23971 2994 1497 749 25072 3101 1551 776 25973 3191 1596 798 26674 3263 1632 816 27275 3336 1668 834 27876 3392 1696 848 28377 3457 1729 865 28978 3521 1761 881 29479 3584 1792 896 299

80+ 3680 1840 920 307

Female


65 1624 812 406 13666 1730 865 433 14567 1830 915 458 15368 1928 964 482 16169 2043 1022 511 17170 2160 1080 540 18071 2263 1132 566 18972 2343 1172 586 19673 2412 1206 603 20174 2466 1233 617 20675 2521 1261 631 21176 2563 1282 641 21477 2612 1306 653 21878 2661 1331 666 22279 2708 1354 677 226

80+ 2781 1391 696 232


65 1867 934 467 15666 1990 995 498 16667 2104 1052 526 17668 2217 1109 555 18569 2350 1175 588 19670 2483 1242 621 20771 2602 1301 651 21772 2695 1348 674 22573 2773 1387 694 23274 2835 1418 709 23775 2899 1450 725 24276 2948 1474 737 24677 3004 1502 751 25178 3060 1530 765 25579 3114 1557 779 260

80+ 3198 1599 800 267

PCRC-37 PA18 06012018

DS-MS2010(37)R

SERVICES MEDICARE PAYS PLAN PAYS YOU PAYHOSPITALIZATION *Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1364 $0 $1364 (Part A Deductible) 61st thru 90th day All but $341 a day $341 a day $0 91st day and after: – While using 60 lifetime reserve days All but $682 a day $682 a day $0 Once lifetime reserve days are used: – Additional 365 days $0 100% of Medicare Eligible

Expenses$0 **

– Beyond the Additional 365 days $0 $0 All CostsSKILLED NURSING FACILITY CARE *You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day $0 Up to $170.50 a day 101st day and after $0 $0 All CostsBLOODFirst 3 pints $0 3 pints $0Additional Amounts 100% $0 $0HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness

All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care

Medicare copayment/coinsurance

$0

PLAN AMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you the balance based on any difference between its billed charges and the amount Medicare would have paid.

DS-MS2010(37)R

SERVICES MEDICARE PAYS PLAN PAYS YOU PAYMEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such asPhysician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $185 of Medicare Approved Amounts* $0 $0 $185 (Part B Deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0

Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All CostsBLOOD First 3 pints $0 All Costs $0 Next $185 of Medicare Approved Amounts* $0 $0 $185 (Part B Deductible) Remainder of Medicare Approved Amounts 80% 20% $0CLINICAL LABORATORY SERVICES – TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0

PARTS A & BHOME HEALTH CARE MEDICARE APPROVED SERVICES – Medically necessary skilled care services and medical supplies 100% $0 $0 – Durable medical equipment First $185 of Medicare Approved Amounts* $0 $0 $185 (Part B Deductible) Remainder of Medicare Approved Amounts 80% 20% $0

PLAN AMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

* Once you have been billed $185 of Medicare-Approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year.

DS-MS2010(37)R

SERVICES MEDICARE PAYS PLAN PAYS YOU PAYHOSPITALIZATION *Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1364 $1364 (Part A Deductible) $0 61st thru 90th day All but $341 a day $341 a day $0 91st day and after: – While using 60 lifetime reserve days All but $682 a day $682 a day $0 Once lifetime reserve days are used: – Additional 365 days $0 100% of Medicare Eligible

Expenses$0 **

– Beyond the Additional 365 days $0 $0 All CostsSKILLED NURSING FACILITY CARE *You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day $0 Up to $170.50 a day 101st day and after $0 $0 All CostsBLOODFirst 3 pints $0 3 pints $0Additional Amounts 100% $0 $0HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness


Medicare copayment/coinsurance $0

PLAN BMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD



DS-MS2010(37)R




PLAN BMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


DS-MS2010(37)R


Expenses$0 **

– Beyond the Additional 365 days $0 $0 All CostsSKILLED NURSING FACILITY CARE *You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day Up to $170.50 a day $0 101st day and after $0 $0 All CostsBLOODFirst 3 pints $0 3 pints $0Additional Amounts 100% $0 $0HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

All but very limited copayment, coinsurance for outpatient drugs and inpatient respite care




PLAN CMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

DS-MS2010(37)R

SERVICES MEDICARE PAYS PLAN PAYS YOU PAYMEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such asPhysician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $185 of Medicare Approved Amounts* $0 $185 (Part B Deductible) $0 Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0

Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All CostsBLOOD First 3 pints $0 All Costs $0 Next $185 of Medicare Approved Amounts* $0 $185 (Part B Deductible) $0 Remainder of Medicare Approved Amounts 80% 20% $0CLINICAL LABORATORY SERVICES – TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0

PARTS A & BHOME HEALTH CARE MEDICARE APPROVED SERVICES – Medically necessary skilled care services and medical supplies 100% $0 $0 – Durable medical equipment First $185 of Medicare Approved Amounts* $0 $185 (Part B Deductible) $0 Remainder of Medicare Approved Amounts 80% 20% $0

OTHER BENEFITS – NOT COVERED BY MEDICAREFOREIGN TRAVEL – NOT COVERED BY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of Charges $0 80% to a lifetime maximum

benefit of $50,00020% and amounts over the $50,000 lifetime maximum

PLAN CMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


DS-MS2010(37)R


Expenses$0 **

– Beyond the Additional 365 days $0 $0 All CostsSKILLED NURSING FACILITY CARE *You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day Up to $170.50 a day $0 101st day and after $0 $0 All CostsBLOODFirst 3 pints $0 3 pints $0Additional Amounts 100% $0 $0HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

All but very limited copayment, coinsurance for outpatient drugs and inpatient respite care


PLAN DMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD



DS-MS2010(37)R






PLAN DMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


DS-MS2010(37)R

SERVICES MEDICARE PAYSAFTER YOU PAY $2300

DEDUCTIBLE, ** PLAN PAYS

IN ADDITION TO $2300 DEDUCTIBLE, **

YOU PAYHOSPITALIZATION *Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1364 $1364 (Part A Deductible) $0 61st thru 90th day All but $341 a day $341 a day $0 91st day and after: – While using 60 lifetime reserve days All but $682 a day $682 a day $0 Once lifetime reserve days are used: – Additional 365 days $0 100% of Medicare Eligible

Expenses$0 ***

– Beyond the Additional 365 days $0 $0 All CostsSKILLED NURSING FACILITY CARE *You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day Up to $170.50 a day $0 101st day and after $0 $0 All CostsBLOODFirst 3 pints $0 3 pints $0Additional Amounts 100% $0 $0HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness



PLAN F or HIGH DEDUCTIBLE PLAN FMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD


** This high deductible plan pays the same benefits as standard Plan F after one has paid a calendar year $2300 deductible. Benefits from the high deductible plan F will not begin until out-of-pocket expenses are $2300. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible. The $2300 high deductible Plan F deductible does not apply to standard Plan F.

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you the balance based on any difference between its billed charges and the amount Medicare would have paid.

DS-MS2010(37)R

SERVICES MEDICARE PAYSAFTER YOU PAY $2300

DEDUCTIBLE, ** PLAN PAYS

IN ADDITION TO $2300 DEDUCTIBLE, **

YOU PAYMEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such asPhysician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $185 of Medicare Approved Amounts* $0 $185 (Part B Deductible) $0 Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0

Part B Excess Charges (Above Medicare Approved Amounts) $0 100% $0BLOOD First 3 pints $0 All Costs $0 Next $185 of Medicare Approved Amounts* $0 $185 (Part B Deductible) $0 Remainder of Medicare Approved Amounts 80% 20% $0CLINICAL LABORATORY SERVICES – TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0

PARTS A & BHOME HEALTH CARE MEDICARE APPROVED SERVICES – Medically necessary skilled care services and medical supplies 100% $0 $0 – Durable medical equipment First $185 of Medicare Approved Amounts* $0 $185 (Part B Deductible) $0 Remainder of Medicare Approved Amounts 80% 20% $0



PLAN F or HIGH DEDUCTIBLE PLAN FMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


** This high deductible plan pays the same benefits as standard Plan F after one has paid a calendar year $2300 deductible. Benefits from the high deductible plan F will not begin until out-of-pocket expenses are $2300. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible. The $2300 high deductible Plan F deductible does not apply to standard Plan F.

DS-MS2010(37)R

SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION *Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1364 $1364 ( Part A Deductible) $0 61st thru 90th day All but $341 a day $341 a day $0 91st day and after: – While using 60 lifetime reserve days All but $682 a day $682 a day $0 Once lifetime reserve days are used: – Additional 365 days $0 100% of Medicare Eligible Expenses $0 ** – Beyond the Additional 365 days $0 $0 All CostsSKILLED NURSING FACILITY CARE *You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day Up to $170.50 a day $0 101st day and after $0 $0 All CostsBLOODFirst 3 pints $0 3 pints $0Additional Amounts 100% $0 $0HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness



PLAN N

MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and

have not received skilled care in any other facility for 60 days in a row.


DS-MS2010(37)R

SERVICES MEDICARE PAYS PLAN PAYS YOU PAYMEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such asPhysician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $185 of Medicare Approved Amounts* $0 $0 $185 (Part B Deductible) Remainder of Medicare Approved Amounts Generally 80% Balance, other than up to $20

per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costsBLOOD First 3 pints $0 All Costs $0 Next $185 of Medicare Approved Amounts* $0 $0 $185 (Part B Deductible) Remainder of Medicare Approved Amounts 80% 20% $0CLINICAL LABORATORY SERVICES – TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0


OTHER BENEFITS – NOT COVERED BY MEDICAREFOREIGN TRAVEL – NOT COVERED BY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of Charges $0 80% to a lifetime maximum benefit

of $50,00020% and amounts over the $50,000 lifetime maximum

PLAN NMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


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