mmgap_ga-ppt uai0567 r0108 this is a solicitation for insurance. you may be contacted by an agent...

MMGAP_GA-PPT UAI0567 R0108

www.unitedamerican.com/foundation

This is a solicitation for insurance. You may be contacted by an Agent representing United American Insurance Company.

Policy and Rider Forms: MMGAP, SWL, RT10, R-MMGAP-HO, ABR1, DFR, U4272.

Limited Benefit Hospital Expense Policy

MMGAP_GA-PPT UAI0567 R0108www.unitedamerican.com/foundation

The Foundation Signature Series was designed to help pay hospital inpatient deductibles,

copayments, and coinsurance for individuals with current or pending major medical health coverage or comprehensive health insurance

as their Primary Medical Policy.


Calendar-Year MaximumBenefit Levels

Policy Form: MMGAP


Choose your Calendar-Year Maximum Benefit.

$2,000 $5,000$2,500 $6,000$3,000 $7,500$4,000 $10,000

The calendar year-maximum benefit you select does not have to be the same as your major medical deductible.

The calendar-year maximum benefit starts Jan. 1 and ends Dec. 31. Your benefit amount starts over on Jan. 1.

Policy Form: MMGAP


Foundation Signature SeriesLimited Benefit Hospital Expense Policy

UA will pay up to 100% of your out-of-pocket deductibles, copayments, or coinsurance required by your major medical

policy for hospital inpatient treatment, up to the calendar-year maximum benefit*. Ages 0-63.

Policy Form: MMGAP*Limitations and Exclusions apply. Preexisting Condition Limitation applies.


Policy BenefitsThere is no limit to the number of hospital inpatient confinements

policyholders can have during one year – the policy pays for deductibles, copayments, and coinsurance until the policyholder reaches their calendar-year maximum annual benefit, as long as

the expense is covered by the policyholder’s Primary Medical Policy* as a Hospital Inpatient Expense.

Policyholders can choose to have benefits paid directly to them or assigned to a health service provider.

If the policyholder dies due to an accidental bodily injury while covered under this policy, all premiums will be refunded**.

Policy Form: MMGAP*Limitations and Exclusions apply. Preexisting Condition Limitation applies.**Death must occur while this policy is in force and with 180 days of injury.


How Does A Policyholder File A Claim?

Claims are submitted to United American Insurance Company. The policyholder must submit a copy of the major medical

provider’s Explanation of Benefits (EOB) along with a standard hospital billing form (UB-04).

Policy Form: MMGAP*Limitations and exclusions apply. Preexisting Condition Limitation applies.


Optional Hospital Outpatient Benefit Rider

Policy and Rider Form: MMGAP and R-MMGAP-HO


Optional Hospital Outpatient Benefit Rider

Available at an additional cost

UA will pay 50% of your out-of-pocket deductible, copayment, or coinsurance required by your major medical policy for hospital

outpatient treatment, up to the calendar-year maximum benefit*.

Note: The total deductibles, copayments, and coinsurance covered under the Hospital Inpatient Benefit and the Hospital Outpatient Benefit combined are limited to the maximum annual benefit per calendar year.

Policy and Rider Forms: MMGAP and R-MMGAP-HO*Limitations and Exclusions apply. Preexisting Condition Limitation applies.


Number of Outpatient Hospital Visits/Procedures Covered

There is no limit to the number of outpatient hospital visits/procedures you can have during one calendar year – we

pay your out-of-pocket deductibles, copayments and coinsurance until you reach your calendar-year maximum benefit, as long

as the expense is covered by your major medical policy*.

Note: The total deductibles, copayments, and coinsurance covered under the Hospital Inpatient Benefit and the Hospital Outpatient Benefit combined are limited to the maximum annual benefit per calendar year.

Policy and Rider Forms: MMGAP and R-MMGAP-HO*Limitations and Exclusions apply. Preexisting Condition Limitation applies.


Examples of How the MMGAP Policy Works

The following examples demonstrate how the MMGAP Policy works, what is covers, and what it doesn’t cover.

With the examples where MMGAP policyholders increase their Primary Policy deductible, it should be

mentioned that policyholders can apply their premium savings toward potential out-of-pocket expenses for

which the they are now responsible.


Kate’s StoryExamples for illustrative purposes only.

Rates vary by state.

Charges vary by hospital and major medical provider.


Kate’s StoryKate is a 45-year-old teacher. She has major medical

coverage through her employer. She selected a $5,000 deductible policy for the lower premiums. Kate’s major medical

policy also requires a copayment and 20% coinsurance.

Rates vary by state. Examples for illustrative purposes only. A Foundation Signature Series does not guarantee payment of all charges. There may be expenses for which you will be responsible.


Kate’s StoryKate purchased an MMGAP Hospital Inpatient Expense Policy with a

$7,500 calendar-year maximum benefit to help cover her hospital inpatient deductible, copayment, and coinsurance.

Let’s take a look at a year in Kate’s life and what expenses MMGAP Policy will and will not cover.



Kate’s StoryIn January, Kate begins having sinus congestion and sinus

headaches. She visits her general practitioner and is diagnosed with a sinus infection. Kate incurs these charges:

• $200 for the doctor’s visit1, including a $15 copay• $4 in charges for a prescription drug (Penicillin2) from the retail pharmacy3

The MMGAP Policy does not pay for doctor’s visit copayments, charges, or lab work, or prescription drugs.

Remaining MMGAP Policy calendar-year maximum benefit: $7,500

1 The Washington Post, Oct. 22, 2006 2 Most Patients Get Antibiotic for Sinus Infection, American Society of Health-System Pharmacists, March 19, 20073 Wal-Mart $4 Prescription Program, Oct. 23, 2007



Kate’s StoryOccurrence: General Practitioner Doctor’s Visit


Expense Billed Charges Major Medical Paid MMGAP Paid Kate Paid

Doctor’s Visit $200 $185 $0 $15

Prescription Drugs $4 $0 $0 $4

Total $204 $185 $0 $19



Kate’s StoryIn March, Kate developed pneumonia and spent

two nights in the hospital. Fortunately, she purchased a $7,500 Foundation Signature Series to help

cover her deductible, copayment, and coinsurance.



Kate’s StoryTotal Hospital Expenses Billed to Major Medical Policy for Inpatient Hospital Charges: $15,100



Kate’s StoryKate’s Major Medical Explanation of Benefits MMGAP Paid Deductible $5,000MMGAP Paid Hospital Admission

Copayment $ 100MMGAP Paid 20% Coinsurance $2,000

Total Kate Owed $7,100

Foundation Paid $7,100Amount Kate Paid $0



Annual Foundation Premium $759*– vs.–

Potential Hospital Expenses $7,100

Kate has $400 remaining in her calendar-year maximum benefit.

*Kate was also responsible for $19 in out-of-pocket expenses associated with her General Practitioner Doctor’s visit.



Robert’s Story

Examples for illustrative purposes only.

Rates vary by state.



Robert’s StoryRobert is a 33-year-old single father.

He has a major medical policy with a $2,500 deductible. Robert’s policy requires a copayment and 20% coinsurance with a $5,000 stop loss.



Robert’s StoryHe purchased an MMGAP Hospital Inpatient Expense Policy with a $4,000 calendar-year maximum benefit to help cover his hospital

inpatient deductible, copayment, and coinsurance.

Let’s take a look at a year in Robert’s life and what expenses the MMGAP Policy will and will not cover.




Robert’s StoryIn February, Robert begins coughing. When the

coughing persists for more than two weeks, he visits his general practitioner. The doctor has a radiologist perform an X-ray of Robert’s

chest during the office visit. Robert incurs multiple charges:

• $200 for the doctor’s visit1, including a $10 copay• $86 for chest X-ray2 • $63.60 in charges for a prescription drug (Ipratropium Bromide3) from the retail pharmacy4

The MMGAP Policy does not pay for doctor’s visit copayments, charges, or lab work, or prescription drugs.


1 The Washington Post, Oct. 22, 2006 2 www.bsbsnc.com/apps/cost-estimator/doctors-visits.jsp, March 27, 2008 3 Chronic cough, Mayo Clinic, May 8, 20074 MedStore International, March 27, 2008



Robert’s StoryOccurrence: General Practitioner Doctor’s Visit

Expense Billed Charges Major Medical Paid MMGAP Paid Robert Paid

Doctor’s Visit $200 $190 $0 $10

Doctor’s Lab Work $86 $0 $0 $86*

Prescription Drugs $63.60 $0 $0 $63.60

Total $349.60 $190 $0 $159.60

*Applied to major medical annual deductible.



Robert’s StoryIn November, Robert had a motorcycle accident that

resulted in a one-night hospital stay.

Total Hospital Expenses Billed to Major Medical Policy for Inpatient Hospital Charges: $10,800




Robert’s StoryRobert’s Major Medical Explanation of BenefitsMMGAP Paid Deductible $2,416MMGAP Paid Hospital Inpatient

Copayment $ 100MMGAP Paid 20% Coinsurance $1,000

Total Robert Owed $3,516

MMGAP Paid $3,516 Amount Robert Paid $0


Annual Foundation Premium $176*– vs.–

Potential Hospital Expenses $3,516

Robert has $484 remaining in his calendar-year maximum benefit.

*Robert was also responsible for $159.60 in out-of-pocket expenses associated with his General Practitioner Doctor’s visit.



Jose & Maria’s Story

Examples for illustrative purposes only. Rates vary by state.




Jose and Maria, both 38 years old, are married with two teenagers. They have a major medical policy

with a $500 annual deductible. Their policy also requires a copayment and coinsurance.

Their monthly major medical premium for their family is $1,104.



For illustrative purposes only.

Jose & Maria’s StoryCurrent Insurance Premium Situation

Annual Deductible Monthly Premium

Major Medical $500 $1,104


Jose & Maria’s StoryMaria and Jose increased their major medical deductible from

$500 to $5,000, which reduced their major medical monthly premium to $507. Then they purchases an MMGAP Hospital Inpatient Expense Policy with a $7,500 calendar-year maximum benefit for $150

in monthly premium.

Previous Monthly Major Medical Premium – $1,104

New Monthly Major Medical Premium – $507

Foundation Monthly Premium – $150





Current Insurance Premium SituationAnnual Deductible Monthly Premium


Foundation Signature SeriesAnnual Deductible Monthly Premium

Major Medical $5,000 $507

Foundation Signature Series

$0 $150

New Total Monthly Premium $657


Jose & Maria Saved $447 per month

in premium



Hospital Outpatient Benefit Rider

For $187 additional monthly premium, Jose & Maria added the Hospital Outpatient Benefit Rider to their

MMGAP Policy. Their total monthly premium would be $844, which would still be a monthly premium savings of $260.




Current Insurance Premium SituationAnnual Deductible Monthly Premium



Foundation Signature SeriesAnnual Deductible Monthly Premium

Major Medical $5,000 $507

Foundation Signature Series

$0 $150

New Total Monthly Premium $657

Outpatient Rider $0 $187

New Total Monthly Premium with Optional Outpatient Rider

$844


How Jose & Maria Managed Their Expenses

Jose & Maria have a major medical policy,

a Foundation Hospital Expense Policy, plus the optional Hospital Outpatient Rider,

and still managed to save

$260 per month in premium!For illustrative purposes only.


Optional Life Policy

Policy Forms: SWL or RT10


Optional Life PolicyAvailable at an additional cost

Whole Life Insurance Policy or 10-Year Renewable Term Life Insurance Policy

Choose a face amount from $1,000 to $20,000

Whole Life: Level benefit for the life of the insured. Premiums never increase. Builds cash and loan value which you may use in many ways: Surrender your policy for cash, and spend however you wish. Convert your policy to life insurance where no premiums are ever due (such as reduced benefit paid-up insurance, or extended term insurance). Take a loan from your policy’s value.

10-Year Renewable Term Life: Level benefit term policy with premiums that stay the same for 10 years. The policy renews and premiums increase every 10 years. Renewable to age 121.

Policy and Rider Forms: SWL or RT10; ABR1*May vary by state.


Optional Life Insurance Riders

Policy and Rider Forms: SWL or RT10; U4272; DFR


Optional RidersAvailable at an additional cost

Deposit Fund Rider-Available only on 10-Year Renewable Term Life insurance policy.-Earn a guaranteed minimum of 3% interest on deposits made with premium payments. -Minimum deposit amount is $5.-Maximum account balance is limited to two times the policy face amount.

Child Term Life Rider-Available with the purchase of an adult whole life or term life policy.-Choose $5,000 or $10,000 of coverage for children ages 0–23.

Policy and Rider Forms: SWL or RT10; U4272; DFR.May vary by state.


Policy and Rider Forms: SWL or RT10; U4272; DFR.May vary by state.

Automatic Benefit Terminal Illness Accelerated Death Benefit – Automatically added to either life policy

at no additional charge*. We will pay you 50% of your life policy benefit if you are diagnosed with a qualifying terminal illness while your policy is in force. (If the policy owner is diagnosed with a terminal illness that will result in death within one year, we will pay 50% of the death benefit upon our receipt of due proof of terminal illness. This benefit is payable only once. Not approved in all states.)


UA Partners®

Our optional non-insurance discount health services program is also available for a $6.95 monthly fee.

Receive discounts on:• Chiropractic — 20% to 40%• Dental — 10% to 50%• Eye Care — 20% to 60%• Hearing Aids — 10% to 20%• Prescriptions — Average of 20%• Mail Order Pharmacy — Save More $$

DISCLOSURE: This is NOT a health insurance policy. The plan provides discounts at certain health care providers of medical services. The plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. This plan is administered by Best Benefits, Inc., (a discount medical plan organization) at 8420 W. Bryn Mawr, Suite 700, Chicago, IL 60631, 1-800-308-0374.

You have the right to cancel and receive a full refund within 30 days.

Plans may vary by state. Not available in Kansas, New York, or Vermont.


Thank You

mmgap_ga-ppt uai0567 r0108 this is a solicitation for insurance. you may be contacted by an agent...

Documents

mmgap slide

mmgap policy works

mmgap policyholders

hospital inpatient benefit

gappt uai0567 r0108

major medical policy

calendar yearmaximum

policy benefits