Page 1 © 2014 AmeriPlan® Corporation. All rights reserved. DVPC.07.14

DISCLOSURES TO CONSUMERS:These discount medical plans are NOThealth insurance or a MediCare PrescriptionDrug Plan. Membership in these programsentitles you to discounts for certain medicalservices and prescription drugs by providerswho have agreed to participate in these dis-count programs. These programs do NOTmake payments directly to the providers ofmedical services and prescription drugs. Theprograms’ members are obligated to pay for allhealthcare services, but will receive a discountfrom those healthcare providers who havecontracted with these discount programs. Thename, address and specialty of the discountmedical and prescription drug programproviders in your service area are availablebefore purchase and upon request by loggingon to www.ameriplanusaprovidersearch.comor call the AmeriPlan® Consumer InformationCenter at 1-800-647-8421.

AmeriPlan® Corporation 5700 Democracy Drive Plano, Texas 75024

A Discount Medical Plan Organization

The average savings on the most utilized provider proceduresstated in this brochure are only a sample from the discount feeschedule that each AmeriPlan® provider has agreed to honor formembers. The discounts represent a reduction on a treatment orpercentage basis of the usual and customary fees charged by theproviders for a specific treatment.AmeriPlan® confirms that its medical, dental, vision, chiropracticand pharmacy providers are professionally licensed in your state,but does not guarantee the quality of the services or products.Quality of care complaints should be addressed to the appropriatelicensing agency in your state. If you are not sure whom to callregarding quality of care complaints, contact the ConsumerInformation Center at 1-800-647-8421.If you have health insurance, this discount medical plan may beduplicative of your health insurance.

For more information, contact AmeriPlan® IBO:

Exams

D0150 - Initial Oral Exam $120 $32 73%D0120 - Periodic Oral Exam $ 68 $13 81%

X-RaysD0210 - Intraoral Complete Series $167 $50 70%

CleaningD1110 - Regular Teeth Cleaning $117 $46 61%(Light Scaling & Polishing)

FillingsAmalgam Filling (Silver Colored)D2140 - 1 Surface $182 $45 75%Composite Filling (Tooth Colored)D2330 - 1 Anterior Surface $ 209 $70 67%

Root Canal (Excluding Final Restoration)D3310 - Anterior $933 $375 60%

D2750 - Porcelain Crown $1,408 $ 550 61%(w/High Noble Metal)

Orthodontic Treatment (Braces*)by General Dentist

D8080 - Child (under age 19) $6,205 $2,250 64%D8090 - Adult (age 19 and over) $6,518 $2,400 63%

Example of savings on the most utilized dental procedures:

Sample General Dental Office AmeriPlan® AmeriPlan®Dentist Procedures* Fees** up to Fees Savings

Up To

* Current Dental Terminology © 2011 American Dental Association, All Rights Reserved**National Dental Advisory Service 2011

Different fees may apply in different areas of your state For the appropriate fees for your area, go to

www.ameriplanusaprovidersearch.com or call 1-800-647-8421

• Nationwide Network• Over 75,000 Dentists• No Paperwork• No Waiting• No Limits On Visits Or Services• No Age Restrictions• Ongoing Dental Problems Accepted• Can Change Dentists Anytime• Oral Exams• X-Rays• Teeth Cleaning• Filings and Crowns• Orthodontics (braces) • Cosmetic Dentistry included• Specialists included, (where available)

Dental:

~ MORE THAN 7,500 PARTICIPATING DOCTORS.~ FREE INITIAL CONSULTATION.~ 50% SAVINGS on all diagnostic services & required x-rays.~ 30% SAVINGS on treatment and most other services.~ NO LIMIT on number of visits.

~ MORE THAN 56,000 PARTICIPATING RETAIL ANDINDEPENDENT PHARMACY LOCATIONS NATIONWIDE*

~ Save 10% - 85% on most brand name and genericprescription drugs**

~ Save on over the counter medications, smoking cessation aids and diabetes supplies

~ Mail order pharmacy option available

Prescription:

Chiropractic:

~ MORE THAN 12,000 OPTICAL PROVIDERS NATIONWIDE.~ SAVE FROM 20% TO 60% on all frames, lenses, tints, scratch-

resistant coatings and ultra-violet protection.~ SAVE FROM 10% TO 50% on ophthalmology eye exams, and

LASIK surgery with certain providers in selected markets.~ SAVE FROM 10% TO 20% ON CONTACT LENSES (excluding

disposables) at participating retail locations.~ SPECIAL SAVINGS FROM 10% TO 40% ON REPLACEMENT

CONTACT LENSES. Including daily wear, extended wear, dis-posable, tinted, bifocals and gas permeable.*

~ ADDITIONAL DISCOUNTS on designer non-prescription sun-glasses with the world’s largest online optical store.**

~ 30-DAY UNCONDITIONAL money-back guarantee on allmerchandise.

* Available through mail order program only. ** Available through Internet program only.

Vision:

Pharmacy discounts are NOT insurance services or a

MediCare Prescription Drug Plan

and are NOT intended as a substitute for insurance.

* Discounts are available only at participating pharmacies.** You may not receive a savings on some high-volume or

maintenance type drug since these medications may have already been reduced at the pharmacy level.

Example of savings on most Generic and Name Brand Prescriptions

Naproxen 375 MG 10 $330.90 $11.10 97%Tramadol HCL 50 MG 30 $71.30 $4.60 94% Pantoprazole 40 MG 30 $119.90 $8.10 93%Sodium

Diazepam 5 MG 30 $67.70 $5.09 92%Ranitidine HCL 300 MG 30 $337.10 $32.60 90%

Ofloxacin .3% Ear 7 $74.50 $10.10 86%

Prednisone 5 MG 30 $25.90 $3.90 85%Drops

Lisinopril 30 MG 30 $91.70 $19.10 79%

Oxycodone- 5-325 8 $30.90 $7.20 77%Acetaminophen

Armour 60 MG 30 $28.50 $7.80 73%Thyroid

Nitrostat .4 MG 20 $33.30 $12.30 63%

Atorvastatin 20 MG 30 $157.90 $62.80 60%Calcium

Fexofenadine 60 MG 90 $210.80 $94.1 55%HCL

Drug Name Dosage Days Supply Retail AmeriPlan AmeriPlanCost Cost Savings