HSA-MedEq-BR-TX-FLIC-0710

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B ecause of recent federa l l eg i s la t ion you now have the opportunity to choose a health care plan that offers more affordable coverage and financial savings through a

tax-favored Health Savings Account (HSA). Our MedEquity HSA plan is an HSA-qualified single deductible, health plan that can be used in conjunction with a tax-favored HSA.

A Health Savings Account, or HSA, is a new innovative way to combine a major medical health plan with a separate savings account to pay for health care expenses. You can also use the HSA account to supplement your retirement savings. The HSA plan consists of two components that add up to great savings:

MedEquity HSA

HSA Trust or CustodialSavings Account

Qualified Single DeductibleHealth Insurance Plan +

s You have a single deductible for the entire family.

s You have lower premiums than the traditional PPO plans with lower Calendar Year Deductibles.

s Your taxable income is reduced through contributions to your HSA. Any money deposited to the HSA account is tax deductible, grows tax deferred, and can be withdrawn tax free to pay for insurance deductibles and covered medical expenses.

s Your funds accumulate year to year. Unused health savings account balances grow tax free.

s You have the opportunity to receive the most competitive interest rates available through our strategic alliance with First HSA, Inc.

= Saving money for you and your family!

What are the advantages of the MedEquity HSA Single Deductible Health Plan?

Use your HSA funds to pay for many expenses not covered by most traditional plans!These expenses are referred to as “qualified” expenses. Sample qualified expenses are listed below.s Prescription medicationss Lasik eye surgerys Eyeglasses/contact lensess Dental treatment

s Chiropractic cares Birth control pillss Fertility enhancements Home care

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Health Plan Design Options

O ur HSA qualified health plan offers choices to help you select a tax qualified benefit design. Your choices include a variety of deductibles. Higher deductibles generally allow for larger tax favored deposits into your health savings account. Premium savings can be used to contribute to your health savings account.

MedEquity HSA

Lifetime Certificate Maximum Per Insured $2,000,000 or $5,000,000

Lifetime Transplant Maximum $500,000

Individual Plan

Participating Provider Non-Participating Provider

Calendar Year Single Deductible $2,0001 $2,700 $3,5002 $5,0002 Additional deductible equal to Your

Calendar Year Single Deductible

Coinsurance Options Company Insurance Percentage for Sickness and Injury and Wellness and Screening Benefits

100%80%50%

Insured Coinsurance Percentage for Sickness and Injury and Wellness and Screening Benefits

0%20%50%

Company Insurance Percentage for Sickness and

Injury and Wellness and Screening Benefits

80%60%50%

Insured Coinsurance Percentage for Sickness and Injury and

Wellness and Screening Benefits

20%40%50%

Out-of-Pocket Coinsurance Maximums

100%

80%

50%

Deductible Only

$5,000 (includes Deductible)

$5,000 (includes Deductible)

$10,0003

$10,0003

$10,0003

Family Plan

Participating Provider Non-Participating Provider

Calendar Year Single Deductible $4,0001 $5,400 $7,0002 $10,0002 Additional deductible equal to Your

Calendar Year Single Deductible

Coinsurance Options

Company Insurance Percentage for Sickness and Injury and Wellness and Screening Benefits

100%80%50%

Insured Coinsurance Percentage for Sickness and Injury and Wellness and Screening Benefits

0%20%50%

Company Insurance Percentage for Sickness and

Injury and Wellness and Screening Benefits

80%60%50%

Insured Coinsurance Percentage for Sickness and Injury and

Wellness and Screening Benefits

20%40%50%

Out-of-Pocket Coinsurance Maximums

100%

80%

50%

Deductible Only

$10,000 (includes Deductible)

$10,000 (includes Deductible)

$20,0003

$20,0003

$20,0003

(1) - Only available in 80% and 50% Plan (2) - Only available in 100% Plan (3) - Out-of-Pocket Maximum does not include your Calendar Year Single Deductible, Separate Deductible for Non-Participating Providers (equal to your Calendar Year Single Deductible), and any Failure to

Pre-Authorize Treatment Deductible.

4 MedEquity HSACovered Expenses Provided under the Certificate are expressly subject to the definitions, terms, conditions, limitations, and exclusions contained in the actual Certificate and Group Policy. A brief description of some of the coverages and other features afforded by the Group Policy and Certificates of coverage issued in Your state under the Group Policy are summarized in this brochure. These Benefits are subject to any coverage limits, Calendar Year Single Deductible, Separate Deductible for Non-Participating Providers, Failure to Pre-Authorize Treatment Deductible, if any, and the Insured maximum coinsurance payment per Calendar Year.

Sickness and Injury BenefitsInpatient Hospital Care Semi-private room; Intensive Care Unit; Inpatient miscellaneous medications, Prescription

Drugs, including formulas to treat PKU (phenylketonuria) or other heritable diseases, services and supplies; and one Provider visit per Provider per day to a maximum of 60 Provider visits per Hospital Confinement.

Inpatient or Outpatient Surgery Services Provided by a Hospital or Ambulatory Surgical Center; primary surgeon; assistant surgeon; surgical assistant; anesthesiologist or nurse anesthetist; pathologist; and second surgical opinion up to $250.

Inpatient Therapy Chemotherapy; Occupational Therapy; Radiation Therapy; Rehabilitation Therapy; and Physical Therapy. Physical Therapy is limited to 25 treatments or $2,000 per Insured per Calendar Year.

Inpatient Laboratory and Diagnostic Tests

Benefits include expenses charged by a Hospital and fees charged by a Provider for performance and interpretation of laboratory and diagnostic testing.

Emergency Room Services Emergency room services and supplies; Provider services for surgery; services of registered nurse; X-ray and lab exams; Prescription Drugs; surgical dressing, casts, splints, trusses, braces, and crutches.

Outpatient Treatment of Accidental Injury

Benefits include fees charged by the emergency room of a Hospital, an Emergency Care Facility, and fees charged by a Provider for Outpatient treatment of an Injury.

Emergency Transportation by Ambulance

Services Provided for transportation by ground or air ambulance to the nearest Hospital that is equipped for the Emergency.

Outpatient Provider Office Visits Professional services for a Medically Necessary visit for the purpose of evaluation, diagnosis, and treatment of an Injury or Sickness.

Outpatient Laboratory and Diagnostic Tests

Benefits include expenses charged by a Hospital or other medical facility and fees charged by the Provider for performance and interpretation of laboratory and diagnostic testing.

Outpatient Therapy Chemotherapy; Occupational Therapy; Radiation Therapy; Rehabilitation Therapy; and Physical Therapy. Physical Therapy is limited to 25 treatments or $2,000 per Insured per Calendar Year.

Outpatient Prescriptions Prescriptions filled by a Participating Pharmacy not to exceed the amount of the cost of the least expensive drug, medicine or Prescription Drug. Prescription Drugs purchased at a Non-Participating Pharmacy will be limited to the amount of Covered Expenses that would have been incurred at a Participating Pharmacy.

Breast Reconstruction Hospital and Provider charges incurred for Breast Reconstruction incident to a Mastectomy.

Mastectomy Benefits include Covered Expenses incurred for Confinement for a minimum of forty-eight (48) hours following a Mastectomy and twenty-four (24) hours following a lymph node dissection for the treatment of breast cancer.

Home Health Care 120 days in a 12 month period, subject to daily maximum of 50% of the semi-private room rate, must be for the same or related Injury or Sickness as the Hospital or Skilled Nursing Home Confinement and must begin within 30 days after discharge from a Hospital or Skilled Nursing Home.

Hospice Care Limited to 6 continuous months.

5MedEquity HSA

Sickness and Injury Benefits cont’dSkilled Nursing Home 120 days in a 12 month period if the Insured has first been in a Hospital for 3 consecutive days;

stay must begin within 30 days of discharge from the Hospital; the Injury or Sickness must be related to the Hospital Confinement and the Provider must certify the need for Skilled Nursing Home Confinement, except if the Confinement is the result of the treatment of diabetes.

Medical Equipment Rental (not to exceed the purchase price) of a wheelchair, hospital bed, or other durable, portable medical equipment used for therapeutic treatment.

Diabetes Supplies and Services Diabetes Equipment, Diabetes Supplies, Diabetes Self-Management Training, and immunizations for influenza and pneumococcus.

Transplants The Lifetime Transplant Maximum is $500,000. Covered Expenses include any Solid Organ Transplant, Bone Marrow Transplant and/or Stem Cell Transplant. Professional fees and facility fees for harvesting of applicable donor organs or donor bone marrow is limited to $10,000 per transplant. Benefits are reduced by 50% if transplantation evaluation, testing or donor search are not previously reviewed by Us prior to transplantation.

Inherited Metabolic Disorder Benefits include Covered Expenses for Medical Foods prescribed or ordered by a Provider for the therapeutic treatment of an Inherited Metabolic Disorder. Benefits are limited to a maximum of $5,000 in a 12-month period.

Temporomandibular Joint Disorder and Craniomandibular Disorder

Benefits include Covered Expenses for the diagnosis and surgical treatment of Temporomandibular Joint Disorder and Craniomandibular Disorder if the condition is a result of an accident; trauma; a congenital defect; a developmental defect; or a pathology.

Serious Mental Illness Benefits include Covered Expenses incurred for the treatment of Serious Mental Illness Inpatient treatment up to forty-five (45) days per Calendar Year per Insured; and Outpatient treatment up to sixty (60) visits per Calendar Year per Insured.Benefits include Covered Expenses incurred when an Insured receives Medically Necessary care and treatment for such disorders in a Psychiatric Day Treatment Facility which is accredited by the Program for Psychiatric Facilities, its successor, or the Joint Commission on Accreditation of Hospitals provided, however that: treatment not to exceed 8 hours in a 24 hour period; each full day of treatment in such facility shall be considered equal to one-half day of Hospital Confinement; and the attending Provider certifies that such treatment is in lieu of Hospital Confinement.Benefits also include Covered Expenses incurred for treatment rendered in a Crisis Stabilization Unit, or a Residential Treatment Center for Children and Adolescents, for child and adolescent Insureds. For purposes of Benefit payment, two days of treatment in a Crisis Stabilization Unit or Residential Treatment Center for Children and Adolescents will equal one (1) day of treatment in a Hospital.Medication management visits covered the same as Outpatient visits for treatment of any other Sickness will not be counted against the Outpatient maximums.

Acquired Brain Injuries Benefits include Covered Expenses incurred by an Insured for the Medically Necessary treatment of an Acquired Brain Injury. Treatments include Cognitive Communication Therapy, Cognitive Rehabilitation Therapy, Community Reintegration Services, Neurobehavioral Testing, Neurobehavioral Treatment, Neurocognitive Rehabilitation, Neurocognitive Therapy, Neurofeedback Therapy, Neurophysiological Testing, Neurophysiological Treatment, Neuropsychological Testing, Neuropsychological Treatment, Post-acute Transition Services, Psychophysiological Testing, Psychophysiological Treatment, and Remediation.

Craniofacial Abnormalities Covered Expenses incurred as a result of reconstructive surgery for craniofacial abnormalities to improve the function of, or to attempt to create a normal appearance of, an abnormal structure caused by congenital defects, developmental deformities, trauma, tumors, infections, or disease for an Insured child who is younger than 18 years of age.

Chemical Dependency Benefits for Covered Expenses incurred for the treatment of Chemical Dependency, to a lifetime maximum of three (3) separate Series of Treatments per Insured.

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Optional RidersWAIVER OF PREMIUM UPON TOTAL DISABILITY OF PRIMARY INSUREDIn addition to any Benefits that might be payable under the Certificate, upon receipt of a claim for waiver of premium and proper proof of loss that the Primary Insured became Totally Disabled after the Issue Date with the Disability Period commencing during the First Renewal Premium Guarantee Period and extending beyond the Elimination Period, We will waive all Renewal Premium that becomes due during the First Renewal Premium Guarantee Period and while the Primary Insured is Totally Disabled. For every Disability Period that extends beyond the Elimination Period and during the First Renewal Premium Guarantee Period, We will refund the amount of Renewal Premium paid during the Elimination Period.We may require at Our expense a physical or mental examination by a Provider of Our choice in order that We may verify the nature, commencement and extent of any disability claim wherein the Primary Insured seeks waiver of Renewal Premium under this rider.

Family Security Rider

Wellness and Screening BenefitsAdult Wellness and Preventive Care

Benefits for You and Your Spouse for necessary Adult Wellness Preventive Care by a Participating Provider once every twelve months limited to a maximum payment of $50 for the first Calendar Year following the Insured’s effective date and $250 per person per Calendar Year after the first Calendar Year. Benefits for You and Your Spouse for necessary Adult Wellness Preventive Care by a Non-Participating Provider once every twelve months limited to a maximum payment of $35 for the first Calendar Year and $150 per person per Calendar Year after the first Calendar Year.

Mammography Benefits include annual screening by low dose Mammogram to detect the presence of occult breast cancer for female Insureds age 35 and over.

Pap Smear An annual conventional Pap Smear or a screening using liquid based cytology methods, alone or in combination with a test for the detection of the human papillomavirus Provided to female Insureds, including the examination by a Provider, the laboratory fee, and the Provider’s interpretation of the laboratory results.

Prostate Cancer Screening An annual physical examination for the detection of prostate cancer including a prostate-specific antigen blood test.

Childhood Wellness and Preventive Care

Benefits for each Insured under the age of 25 for necessary Child Wellness and Preventive Care not more than once every twelve months up to a maximum of $250 for services Provided by a Participating Provider and $150 for services Provided by a Non-Participating Provider per Insured per Calendar Year.

Colorectal Cancer Screening Benefits include Covered Expenses for colorectal cancer screening incurred by an Insured who is fifty (50) years of age or older and at normal risk for developing colon cancer.

Osteoporosis Screening Benefits include Covered Expenses incurred by an Insured for osteoporosis detection for a Qualified Individual, including a medically accepted bone mass measurement for the detection of low bone mass and to determine the Insured’s risk of osteoporosis and fractures associated with osteoporosis.

Screening Tests for Hearing Loss Benefits include Covered Expenses incurred by an Insured for screening tests for hearing loss from birth through age thirty (30) days for a child Insured, as well as necessary diagnostic follow-up care from birth through age twenty-four (24) months for such child Insured, when the diagnostic follow-up care is related to the screening test. The screening test and diagnostic follow-up care are not subject to the Calendar Year Single Deductible, the Separate Deductible For Non-Participating Providers, or the Failure to Pre-Authorize Treatment Deductible.

Miscellaneous BenefitsMiscellaneous Benefits are not subject to either the Calendar Year Single Deductible or the Insured Coinsurance Percentage. However, these Benefits are expressly subject to the definitions, terms, conditions, limitations and exclusions contained in the actual Certificate and Group Policy.

Childhood Immunizations Benefits for the following routine childhood immunizations provided to each Insured under the age of 6: poliomyelitis, rubella, measles, mumps, tetanus, pertussis, diphtheria, hepatitis B, Haemophilus influenza type b (Hib), varicella, and any other immunization that is required for the child by law.

7MedEquity HSA

Premium Rate Guarantee PeriodYour rate will automatically be locked in for the first 12 months of coverage. Ask Your agent how to lock in a rate for up to 36 months with Our fixed rate health insurance. Premium Rate Guarantee Period does not apply to any rate change due to: change of address; Benefits; or calculations of premiums mandated by law.

Premium Rate AdjustmentsWe will not raise Your premium rates on an individual basis due to Your personal claims experience. We may raise Your premium rates on Your Renewal Premium Class for all Certificates in Your state. Renewal Premiums are calculated based on a variety of factors some of which are plan of coverage, age, sex and/or place of residence, number of dependents past claims experience of Your Renewal Premium Class, inflationary trends, anticipated advances in medical diagnosis, delivery and treatment and other reasons permitted by state law. Rates for individuals of the same sex and age may vary by Issue Date. Insureds are always free to request and apply for new underwritten coverage on this or other available plans.

Coordination of BenefitsThe Certificate contains a Coordination of Benefits provision which describes how Benefits will be payable. Benefits payable under the Certificate will be proportionately reduced by other valid coverage as outlined in the Certificate. In the event an Insured has coverage under Medicare, and/or its amendments, Benefits will be limited to the excess of the usual and customary charges for Covered Expenses under the Certificate that are not payable by Medicare and/or its amendments.

Pre-existing Condition Limitation“Pre-existing Condition” means a condition, whether physical or mental, and regardless of the cause of the condition for which medical advice or treatment was received by the Insured during the twelve (12) month period immediately preceding the effective date of coverage under the Certificate for the Insured incurring the expense.

The Certificate provides coverage as of the Issue Date for Pre-existing Conditions disclosed on the application provided they are not otherwise limited or excluded by the Certificate or any riders, amendments, or endorsements attached to the Certificate.

The Certificate does not provide coverage for Pre-existing Conditions, that are not disclosed on the application, unless the expenses are incurred more than twelve (12) months after the Insured’s coverage has been in effect, and provided such expenses are not otherwise limited or excluded by the Certificate or any riders, amendments, or endorsements attached to the Certificate.

Failure to Pre-Authorize Treatment PenaltyCertain procedures that You or Your Provider do not Pre-Authorize with Us are subject to the $1,000 Failure to Pre-Authorize Treatment Deductible.

Annual Increase in Lifetime MaximumYou will receive a $250,000 increase in the amount of the Lifetime Certificate Maximum Per Insured on each anniversary of the Issue Date when the amount of billed charges submitted to Us in the prior year for all Insureds is less than the amount of Your Calendar Year Single Deductible, and a $125,000 increase in the Lifetime Certificate Maximum Per Insured if the amount of the billed charges submitted is less than twice the amount of the Calendar Year Single Deductible.

The total amount of good health plan benefit increases in the Lifetime Certificate Maximum Per Insured is $2 million.

Plan Features

Optional Riders cont’dWAIVER OF PREMIUM UPON DEATH OF PRIMARY INSUREDIn addition to any Benefits that might be payable under the Certificate, upon receipt of a claim for waiver of premium and proper proof of loss that the Primary Insured died prior to the expiration of the First Renewal Premium Guarantee Period, We will waive all Renewal Premium that are or were otherwise due for the remainder of the First Renewal Premium Guarantee Period for coverage of the remaining Insureds who were covered under the Certificate on the date of death of the Primary Insured. In the event that We received Renewal Premium prior to receiving and evaluating such proper proof of loss, We will refund the amount of any such Renewal Premium collected after the death of such Primary Insured and prior to the expiration of the First Renewal Premium Guarantee Period.

Limitations, Exclusions and Non-Waiver

Coverage under the Certificate is limited as provided by the definitions, limitations, exclusions, and terms contained in each and every Section of the Certificate, as well as the following limitations and waiting periods: Any loss or expense incurred as a result of an Insured’s Pre-existing Condition not disclosed on the application is not covered under the Certificate unless such loss or expense constitutes Covered Expenses incurred by such Insured more than twelve (12) months after the Issue Date, and are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate; s Covered Expenses incurred by the Primary Insured and/or any Other Insureds before the expiration of six (6) months from the Issue Date which results from hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, tonsils and/or adenoids, or otitis media shall be limited to a maximum total Benefit payment by Us under this Certificate during such period to the amount of $100, provided that coverage for any such Sicknesses is not excluded by this Certificate or any riders, endorsements, or amendments attached to this Certificate and such Sicknesses are not Pre-existing Conditions. Benefit payments by Us for Covered Expenses Incurred by the Primary Insured and/or Other Insureds after the expiration of six (6) months from the Issue Date which results from hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, otitis media, tonsils and/or adenoids shall be the same as Benefit payments for any other Sickness, provided that coverage for such Sicknesses is not excluded by any rider, endorsement, or amendment attached to this Certificate, and such Sicknesses are not Pre-existing Conditions; s Insureds have the right to obtain Prescriptions from the pharmacy of their choice. However, if an Insured: (i) uses a Non-Participating Pharmacy to fill a Prescription; or (ii) does not present his/her correct ID card when the Prescription is filled at a Participating Pharmacy, then such Insured must pay the applicable pharmacy in full and file a claim form with the Company for reimbursement. In either event, the Insured will be reimbursed by the Company at the discounted or negotiated rate for such Prescription that would have been paid to a Participating Pharmacy by the Company under the Certificate if the Insured had used a Participating Pharmacy and properly presented the correct ID card at the time the Prescription was filled; s Pre-authorization may be required by the Company prior to the time that Prescriptions for certain Prescription Drugs are filled; s If as the result of an Emergency Sickness or an Emergency Injury services are rendered for an Insured by a Non-Participating Provider when a Participating Provider was not reasonably available in connection with either (i) on an Outpatient basis in the emergency room of a Hospital or (ii) an Emergency Inpatient admission to a Hospital, then the Covered Expenses incurred will be reimbursed by Us as if such Non-Participating Provider were a Participating Provider up to the point when the Insured can be safely transferred to a Participating Provider. If the Insured refuses or is unwilling to be transferred to the care of a Participating Provider after such Insured can be safely transferred, then reimbursement shall thereafter be reduced to the Company’s Insurance Percentage for Non-Participating Providers; s Because the Calendar Year Single Deductible under the Certificate is calculated on the basis of Covered Expenses, it is possible that every dollar an Insured pays for Prescription Drugs at a Participating Pharmacy may not apply toward meeting the Calendar Year Single Deductible; s Sickness and Injury Benefits and Wellness and Screening Benefits under the Certificate for any Insured who has coverage under Medicare, and/or amendments thereto, regardless of whether such Insured is enrolled in Medicare, shall be limited to only the usual and customary charges for services, supplies, care or treatment covered under the Certificate that are not or would not have been payable or reimbursable by Medicare and/or its

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Limitations - Waiting Periods

Termination and RenewabilityCoverage is guaranteed renewable except when:s You are no longer an eligible individual; s the Group Policy is terminated by the Group Policyholder; s premium was due and not paid; s You terminate coverage by notifying Us of the date You desire coverage to terminate and specify the Insured whose coverage is to terminate; s We are required by the order of an appropriate regulatory authority to non-renew or cancel the Certificate or Group Policy; s We cease offering and renewing coverage of the same form of coverage as the Certificate in Your state upon a minimum of ninety (90) days prior written notice mailed to Your last known address with an opportunity for You to select a similar medical expense policy or certificate that We are then actively marketing and offering to new applicants in Your state; s We elect to discontinue offering all similar types of coverage under any association group in Your state and to terminate all such certificates of coverage in Your state, including Your form of coverage, in which case the commissioner of insurance for Your state, the Group Policyholder and You will be given a minimum of one hundred eighty (180) days prior written notice of the termination, mailed to Your last known address; s the total amount of any Benefit payments made by Us are equal to the Lifetime Certificate Maximum Per Insured; or s the date We receive due proof that fraud or intentional misrepresentation of material fact existed in applying for the Certificate or in filing a claim for Benefits under the Certificate.Except for claims involving fraud or intentional misrepresentation of material fact, any termination will be without prejudice to any Covered Expenses incurred by an Insured for Sickness and Injury Benefits, Wellness and Screening Benefits or Miscellaneous Benefits prior to the date of termination. If coverage is terminated, unearned premium will be computed pro rata and any unearned premium will be refunded to You.

amendments (assuming such enrollment), subject to all provisions, limitations, exclusions, reductions and maximum benefits set forth in the Certificate; s Two million dollars ($2,000,000) is the maximum total amount of all applicable annual increases in the Lifetime Certificate Maximum Per Insured that can be conditionally received after the Issue Date pursuant to Section VIII. INCREASE IN THE LIFETIME CERTIFICATE MAXIMUM of the Certificate; and s Except as contained and specifically set forth in the INCREASE IN THE LIFETIME CERTIFICATE MAXIMUM Section of the Certificate, there shall be no increase in the amount of the Lifetime Certificate Maximum Per Insured.

9MedEquity HSA

Limitations, Exclusions and Non-Waiver

ExclusionsCoverage under the Certificate is limited as provided by the definitions, limitations, exclusions, and terms contained in each and every Section of the Certificate. In addition, the Certificate does not provide coverage for expenses charged to an Insured or any payment obligation for Us under the Certificate for any of the following, all of which are excluded from coverage:

s the amount of any professional fees or other medical expenses or charges for treatments, care, procedures, services or supplies which do not constitute Covered Expenses; s Covered Expenses which exceed the Lifetime Certificate Maximum Per Insured; s Covered Expenses which exceed the amount of the Lifetime Transplant Maximum for all Solid Organ Transplants, Bone Marrow Transplants, and Stem Cell Transplants, received by each Insured, including any applicable Covered Expenses for professional fees and facility fees incurred in connection with harvesting the applicable donor organ or donor bone marrow for the purposes of such transplantation; s Prescription Drugs that are immunosuppressants; s the amount of any professional fees or other medical expenses contained on a billing statement to a Insured which exceed the amount of the Maximum Allowable Charge; s any professional fees or other medical expenses for treatments, care, procedures, services or supplies which are not specifically enumerated in the Sickness and Injury Benefits, Wellness and Screening Benefits, or Miscellaneous Benefits Sections of the Certificate and any optional coverage rider attached hereto; s treatment of the teeth, the surrounding tissue or structure, including the gums and tooth sockets. This exclusion does not apply to treatment: (a) due to Injury to natural teeth; (b) for malignant tumors; or (c) for TMJ (Temporomandibular Joint Disorder) or CMD (Craniomandibular Disorder), when caused by an accident, trauma, congenital defect, developmental defect or pathology; s Injury or Sickness due to any act of war (whether declared or undeclared); s services provided by any state or Federal government agency, including the Veterans Administration unless, by law, an Insured must pay for such services; s charges that are payable or reimbursable by either: a) a plan or program of any governmental agency (except Medicaid) provided the coverage was purchased prior to the Insured becoming eligible for Medicare, or b) Medicare Part A, Part B and/or Part D (If the applicable Insured does not enroll in Medicare, We will estimate the charges that would have been paid if such enrollment had occurred); s drugs or medication not used for a Food and Drug Administration (“FDA”) approved use or indication; s administration of experimental drugs or substances or investigational use or experimental use of Prescription Drugs except for any Prescription Drug prescribed to treat a covered chronic, disabling, life-threatening Sickness or Injury, but only if the investigational or experimental drug in question: a) has been approved by the FDA for at least one indication; b) is recognized for treatment of the indication for which the drug is prescribed in: 1) a standard drug reference compendia; or 2) substantially accepted peer-reviewed medical literature; and c) drugs labeled “Caution – limited by Federal law to investigational use”, s any Injury or Sickness covered by any Workers’ Compensation insurance coverage, or similar coverage underwritten in connection with any Occupational Disease Law, or

Limitations - Waiting Periods cont’d

Employer’s Liability Law, regardless of whether you file a claim for benefits thereunder; s experimental procedures or treatment methods not approved by the American Medical Association or other appropriate medical society; s eye refractions, eyeglasses, contact lenses, radial keratotomy, lasik surgery, hearing aids, and exams for their prescription or fitting; s Cochlear implants; s any professional fees or other medical expenses incurred by an Insured which were caused or contributed to by such Insured’s being intoxicated or under the influence of any drug, narcotic or hallucinogens unless administered on the advice of a Provider, and taken in accordance with the limits of such advice; s intentionally self inflicted Injury, suicide or any suicide attempt while sane or insane; s serving in one of the branches of the armed forces of any foreign country or any international authority; s voluntary abortions, abortificants or any other drug or device that terminates a pregnancy; s services Provided by You or a Provider who is a member of an Insured’s Family; s any medical condition excluded by name or specific description by either the Certificate or any riders, endorsements, or amendments attached to the Certificate; s any loss to which a contributing cause was the Insured’s being engaged in an illegal occupation or illegal activity; s participation in aviation, except as fare-paying passenger traveling on a regular scheduled commercial airline flight; s cosmetic surgery, except for Medically Necessary cosmetic surgery performed under the following circumstances: (i) where such cosmetic surgery is incidental to or following surgery resulting from trauma or infection to correct a normal bodily function or congenital deformity, (ii) such cosmetic surgery constitutes Breast Reconstruction that is incident to a Mastectomy, or (iii) reconstructive surgery under the Craniofacial Abnormalities Benefit; s Prescription Drugs or other medicines and products used for cosmetic purposes or indications; s voluntary sterilization, reversal or attempted reversal of a previous elective attempt to induce or facilitate sterilization; s fertility hormone therapy and/or fertility devices for any type fertility therapy, artificial insemination or any other direct conception; s any operation or treatment performed, prescription or medication prescribed in connection with sex transformations or any type of sexual or erectile dysfunction, including complications arising from any such operation or treatment; s Appetite suppressants, including but not limited to, anorectics or any other drugs used for the purpose of weight control, or services, treatments, or surgical procedures rendered or performed in connection with an overweight condition or a condition of obesity or related conditions; s Prescriptions, treatment or services for behavioral or learning disorders, Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), except as stated in the Serious Mental Illness provision; s any professional fees, or other medical expenses incurred for the diagnosis, care or treatment of Mental and Emotional Disorders, Alcoholism, and drug addiction/abuse, except as stated in the Serious Mental Illness and Chemical Dependency provisions; s Covered Expenses for Serious Mental Illness for treatment of an addiction to a Controlled Substance or marijuana that is used in violation of the law; or mental illness resulting from the use of a Controlled Substance or marijuana in violation of the law; s Prescription Drugs that are classified as psychotherapeutic drugs, including antidepressants; s routine maternity or any other expenses related to childbirth except Complications of Pregnancy, including routine nursery charges; s Outpatient Prescription Drugs that are dispensed by a Provider, Hospital or other state-licensed facility; s Prescription Drugs produced from blood, blood plasma and blood products, derivatives, Hemofil M, Factor VIII, and synthetic blood products, or immunization agents, biological or allergy sera, hematinics, blood or blood products administered on an Outpatient basis; s level one controlled substances; s Prescription Drugs used to treat or cure hair loss or baldness; s Prescription Drugs that are classified as anabolic steroids or growth hormones; s compounded Prescription Drugs; s fluoride products; s allergy kits intended for future emergency treatment of possible future allergic reactions; replacement of a prior filled prescription for Prescription Drugs that was covered and is replaced because the original prescription was lost, stolen or damaged; s Prescription Drugs, which have an over the counter equivalent that may be obtained without a Prescription, even though such Prescription Drugs were prescribed by a Provider; s any intentional misuse or abuse of Prescription Drugs, including Prescription Drugs purchased by an Insured for consumption by someone other than such Insured; s Prescription Drugs that are classified as anti-fungal medication used for treatment of onychomycosis; s fees or expenses charged for spinal manipulations; s Prescription Drugs that are classified as tobacco cessation products; and s drugs prescribed for the treatment of any disease, illness or condition that has been excluded from coverage under the Certificate by exclusionary rider, limitation or exclusion.

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Limitations, Exclusions and Non-WaiverExclusions cont’d

MedEquity HSA

Billed charges for medical care and treatment received by all Insureds during a Calendar Year that are considered and applied 1) by Us under Section VIII. INCREASE IN LIFETIME CERTIFICATE MAXIMUM, does not mean We have any liability for coverage or the payment of any Sickness and Injury Benefits under the Certificate for the illness, injury or condition that resulted in such expenses, and any such mistake and error by Us shall not constitute a waiver of or modification to any of the conditions, terms, definitions, limitations or exclusions contained in either the Certificate or any exclusionary rider attached to the Certificate;

Expenses charged to an Insured for Prescription Drugs that are mistakenly applied by Us to the Calendar Year Single Deductible 2) or erroneously paid by Us under the OUTPATIENT PRESCRIPTION DRUG BENEFIT Section shall not: a) constitute a waiver of or modification to any conditions, terms, definitions or limitations contained in the Certificate, specifically including, but not by way of limitation, the definitions of Sickness and Injury, the limitation of coverage under the Certificate for Pre-existing Conditions, as well as any exclusion, limitation and/or exclusionary riders which may be attached to the Certificate, or otherwise operate to alter, amend, affect, abridge or modify the Certificate to which it is attached; b) create or establish coverage of any medical condition illness, disease or injury under the Certificate or under any exclusion, limitation and/or exclusionary riders which may be attached to the Certificate; or c) affect, alter, amend, abridge, constitute or act as a waiver of the Company’s ability to rely upon, assert and apply such terms, definitions, limitations or exclusions of the Certificate or any amendments thereto.

11MedEquity HSA

Limitations, Exclusions and Non-WaiverNon-Waiver

Note: The information shown here and in any accompanying literature does not provide full details of the Certificate. Different plan provisions may apply in certain states. This brochure is only a brief description of Benefits available. The complete terms of the coverage, including limitations and exclusions, and any state required provisions are in the Certificate.

GRP-P-06-FLIC