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TRANSCRIPT
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Comprehensive Rate Book
January, 2016
-
American Retirement Counselors
Comprehensive Rate Book, January 2016
Table of Contents
1. ARC Product Grid
2. Medicare Supplement a. AARP/UnitedHealthcare b. Mutual of Omaha c. Standard Life
3. Supplemental Health
a. Guarantee Trust Life - Advantage Plus - Hospital Indemnity b. Standard Life – Savers Home Health Care c. Kemper Senior Solutions – Home Health Care d. Guarantee Trust Life – Cancer Plans
i. Schedule of Benefits ii. Lump Sum
4. Final Expense/Whole Life
a. Foresters – PlanRight b. Royal Neighbors – Simplified Issue Whole Life c. Standard Life – Advantage Guard d. Lafayette Life – The Protector 15 e. Gerber – Guaranteed Issue Whole Life f. Kemper Senior Solutions – Modified Whole Life g. United of Omaha – Whole Life
i. Living Promise Whole Life ii. Children’s Whole Life
5. Short-Term Care
a. Guarantee Trust Life – Recover Cash b. Standard Life – RecoveryCare II
-
AR
C P
rod
uct
Gri
d
Each
co
mp
any
has
do
wn
load
able
qu
oti
ng
soft
war
e. Y
ou
sh
ou
ld r
egi
ster
wit
h e
ach
co
mp
any
agen
t p
ort
al a
nd
do
wn
load
so
ftw
are
to y
ou
r co
mp
ute
r. W
i-Fi
may
be
req
uir
ed f
or
use
wh
en
ru
nn
ing
soft
war
e. Y
ou
may
be
able
to
uti
lize
you
r p
ho
ne
as
a h
ot
spo
t fo
r in
-ho
me
p
rese
nta
tio
ns.
(C
har
ges
may
ap
ply
ch
eck
wit
h y
ou
r p
ho
ne
serv
ice
com
pan
y).
** M
ob
ile a
pp
s ar
e av
aila
ble
fo
r so
me
com
pan
ies
no
ted
in b
lue.
Yo
u c
an c
hec
k o
n G
oo
gle
Pla
y St
ore
or
Ap
ple
Ap
p S
tore
fo
r m
ore
in
form
atio
n.
Me
dic
are
Su
pp
lem
en
t
Me
dic
are
Ad
van
tage
H
osp
ital
Ind
em
nit
y &
H
om
e H
eal
th C
are
C
ance
r
Fin
al E
xpe
nse
Lif
e
Insu
ran
ce
Sho
rt T
erm
Car
e
AA
RP
P
lan
s A
B C
F K
L N
M
ust
be
a m
emb
er o
f A
AR
P
Ad
ded
ben
efit
s:
Vis
ion
Ben
efit
/Nu
rse
Lin
e/Si
lver
Sn
eake
rs
Un
ited
He
alth
Car
e
AA
RP
(U
HC
) P
PO
/HM
O/S
NP
Gu
aran
tee
Tru
st L
ife
(G
TL)
Ind
em
nit
y P
lus
Gu
aran
tee
Tru
st L
ife
(G
TL)
Sch
ed
ule
of
Be
ne
fits
Tr
eatm
en
t P
lan
s
Fore
ste
rs L
ife
P
lan
Rig
ht
Leve
l/G
rad
ed/M
od
ifie
d
Op
tio
ns
Ava
ilab
le
M
ob
ile A
pp
Fo
rest
ersq
uo
tes.
com
Stan
dar
d L
ife
R
eco
very
Car
e
Pay
s fo
r Fa
cilit
y B
ased
C
are
R
ider
: Ho
me
Car
e
Un
ited
of
Om
aha
P
lan
s A
F G
1
2%
Dis
cou
nt
off
ered
M
ob
ile A
pp
Co
ven
try/
Ae
tna
P
PO
Save
rs A
dva
nta
ge
H
om
e H
ealt
h C
are
Gu
aran
tee
Tru
st L
ife
(G
TL)
Lum
p S
um
Can
cer
Ro
yal N
eig
hb
ors
Si
mp
lifie
d Is
sue
Pla
n
M
emb
er B
en
efit
s
Mo
bile
Ap
p
Gu
aran
tee
Tru
st L
ife
(G
TL)
Re
cove
ry C
ash
Fa
cilit
y C
are
R
ider
: Ho
me
Car
e
Stan
dar
d L
ife
Hig
h D
ed
uct
ible
P
lan
F
Hu
man
a
HM
O/P
PO
/PFF
S
Ke
mp
er
Life
Ho
me
Hea
lth
Car
e
Stan
dar
d L
ife
Si
mp
lifie
d Is
sue
Fo
r yo
un
ger
per
son
w/
hea
lth
issu
es
Age
18
-49
Lafa
yett
e L
ife
Th
e P
rote
cto
r A
cce
pts
10
35
Exc
han
ge
R
egi
on
al A
dv.
Pla
ns
Fors
yth
Co
.- C
ign
a Tr
iad
Co
. - H
TA
Ge
rbe
r Li
fe
Gu
aran
tee
Issu
e
-
AR
C P
rod
uct
Gri
d
Each
co
mp
any
has
do
wn
load
able
qu
oti
ng
soft
war
e. Y
ou
sh
ou
ld r
egi
ster
wit
h e
ach
co
mp
any
agen
t p
ort
al a
nd
do
wn
load
so
ftw
are
to y
ou
r co
mp
ute
r. W
i-Fi
may
be
req
uir
ed f
or
use
wh
en
ru
nn
ing
soft
war
e. Y
ou
may
be
able
to
uti
lize
you
r p
ho
ne
as
a h
ot
spo
t fo
r in
-ho
me
p
rese
nta
tio
ns.
(C
har
ges
may
ap
ply
ch
eck
wit
h y
ou
r p
ho
ne
serv
ice
com
pan
y).
** M
ob
ile a
pp
s ar
e av
aila
ble
fo
r so
me
com
pan
ies
no
ted
in b
lue.
Yo
u c
an c
hec
k o
n G
oo
gle
Pla
y St
ore
or
Ap
ple
Ap
p S
tore
fo
r m
ore
in
form
atio
n.
Lon
g Te
rm C
are
U
niv
ers
al L
ife
an
d
Term
Lif
e
Wh
ole
Lif
e In
sura
nce
(a
nd
Ch
ildre
n P
lan
s)
Fixe
d A
nn
uit
ies
In
de
xed
An
nu
itie
s Li
fe, A
nn
uit
y an
d
Lon
g Te
rm C
are
C
om
bo
Pla
ns
Joh
n H
anco
ck
Cu
sto
m C
are
Full
Co
mp
reh
ensi
ve
Stat
e P
artn
ersh
ip
Ap
pro
ved
No
rth
Am
eri
can
Lif
e
Term
Lif
e
Un
iver
sal L
ife
In
dex
Un
iver
sal L
ife
Li
vin
g B
enef
it R
ider
s
Lafa
yett
e L
ife
H
erit
age
Li
ber
ty
Cen
ten
nia
l
Equ
itru
st
M
YGA
Ser
ies
3yr
,4yr
,5yr
,7yr
,8yr
,10
yr
Gre
at A
me
rica
n
Gro
wth
So
luti
on
Inco
me
Rid
ers
Lega
cy R
ider
s
On
e A
me
rica
A
sset
Car
e I,
II, I
II &
IV
An
nu
ity
Car
e
Un
ited
of
Om
aha
Mu
tual
Plu
s P
lan
Fu
ll C
om
pre
hen
sive
Pro
tect
ive
Lif
e
Term
Lif
e
Un
iver
sal L
ife
In
dex
Un
iver
sal L
ife
Li
vin
g B
enef
it R
ider
s
Ro
yal N
eig
hb
ors
Es
sen
tial
Le
vel P
ay
10
Pay
2
0 P
ay
M
ob
ile A
pp
Ro
yal N
eig
hb
ors
Trad
itio
nal
An
nu
ity
MYG
A
Flex
ible
Pla
n
No
rth
Am
eri
can
Fi
xed
In
dex
ed
Inco
me
Le
gacy
No
rth
Am
eri
can
V
isit
web
site
fo
r p
lan
o
pti
on
s (B
enef
it 1
0 &
14
In
com
e o
pti
on
wit
h
LTC
bo
nu
s o
pti
on
)
Fo
rest
ers
Te
rm L
ife
U
niv
ersa
l Lif
e
Ind
ex U
niv
ersa
l Lif
e
Livi
ng
Ben
efit
Rid
ers
No
n-M
ed
Op
tio
n
Ro
yal N
eig
hb
ors
You
th P
lan
s
Mo
bile
Ap
p
No
rth
Am
eri
can
MYG
A
Tr
adit
ion
al
Equ
itru
st
Inco
me
So
luti
on
Gro
wth
So
luti
on
w
the
Par
tici
pat
ion
O
pti
on
Ath
en
e
Inco
me
so
luti
on
s LT
C b
on
us
op
tio
ns
St
and
ard
Lif
e
Term
Lif
e
Mu
tual
of
Om
aha
C
hild
ren
Pla
ns
Mo
bile
Ap
p
N
ort
h A
me
rica
n
Ind
exed
In
com
e
Lega
cy
-
AR
C P
rod
uct
Gri
d
Each
co
mp
any
has
do
wn
load
able
qu
oti
ng
soft
war
e. Y
ou
sh
ou
ld r
egi
ster
wit
h e
ach
co
mp
any
agen
t p
ort
al a
nd
do
wn
load
so
ftw
are
to y
ou
r co
mp
ute
r. W
i-Fi
may
be
req
uir
ed f
or
use
wh
en
ru
nn
ing
soft
war
e. Y
ou
may
be
able
to
uti
lize
you
r p
ho
ne
as
a h
ot
spo
t fo
r in
-ho
me
p
rese
nta
tio
ns.
(C
har
ges
may
ap
ply
ch
eck
wit
h y
ou
r p
ho
ne
serv
ice
com
pan
y).
** M
ob
ile a
pp
s ar
e av
aila
ble
fo
r so
me
com
pan
ies
no
ted
in b
lue.
Yo
u c
an c
hec
k o
n G
oo
gle
Pla
y St
ore
or
Ap
ple
Ap
p S
tore
fo
r m
ore
in
form
atio
n.
Un
de
r A
ge H
eal
th
Lim
ite
d B
en
efi
t P
lan
s
Aff
ord
able
He
alth
Car
e
Pla
ns
Ex
chan
ge P
lan
s
U
HC
On
e
Stan
dar
d
H
ealt
h In
sura
nce
H
igh
De
du
ctib
le O
pti
on
s
Hu
man
a U
HC
A
etn
a C
ove
ntr
y
Go
lde
n R
ule
Sh
ort
Ter
m M
edic
al
Insu
ran
ce
-
Group 1 Applies to individuals whose plan effective date will be within three yearsfollowing their 65th birthday or Medicare Part B effective date, if laterAge1 Plan A Plan B Plan C Select C2 Plan F Select F2 Plan K Plan L Plan N
Standard Rates with Enrollment Discount3 for individuals ages 65-74
65 $83.30 $122.50 $157.32 $122.85 $148.05 $123.90 $49.87 $84.35 $100.8066 $86.87 $127.75 $164.06 $128.11 $154.39 $129.21 $52.01 $87.96 $105.1267 $90.44 $133.00 $170.81 $133.38 $160.74 $134.52 $54.15 $91.58 $109.4468 $94.01 $138.25 $177.55 $138.64 $167.08 $139.83 $56.28 $95.19 $113.7669 $97.58 $143.50 $184.29 $143.91 $173.43 $145.14 $58.42 $98.81 $118.0870 $101.15 $148.75 $191.03 $149.17 $179.77 $150.45 $60.56 $102.42 $122.4071 $104.72 $154.00 $197.78 $154.44 $186.12 $155.76 $62.70 $106.04 $126.7272 $108.29 $159.25 $204.52 $159.70 $192.46 $161.07 $64.83 $109.65 $131.0473 $111.86 $164.50 $211.26 $164.97 $198.81 $166.38 $66.97 $113.27 $135.3674 $115.43 $169.75 $218.00 $170.23 $205.15 $171.69 $69.11 $116.88 $139.68
Standard Rates for ages 75 and older
75+ $119.00 $175.00 $224.75 $175.50 $211.50 $177.00 $71.25 $120.50 $144.00
Cover Page - Rates for North CarolinaNon-Tobacco Monthly Plan Rates
AARP® Medicare Supplement Insurance Plans insured by UnitedHealthcare Insurance Company
MRP0036 NC - 1-16
Level 2 Rates with Enrollment Discount3 for individuals ages 68-74 who have one or more of the medicalconditions on the application.4
68 $141.01 $207.37 $266.32 $207.96 $250.62 $209.74 $84.42 $142.79 $170.6469 $146.37 $215.25 $276.43 $215.86 $260.14 $217.71 $87.63 $148.21 $177.1270 $151.72 $223.12 $286.55 $223.76 $269.66 $225.67 $90.83 $153.63 $183.6071 $157.08 $231.00 $296.66 $231.66 $279.18 $233.64 $94.04 $159.06 $190.0872 $162.43 $238.87 $306.77 $239.55 $288.69 $241.60 $97.25 $164.48 $196.5673 $167.79 $246.75 $316.89 $247.45 $298.21 $249.57 $100.45 $169.90 $203.0474 $173.14 $254.62 $327.00 $255.35 $307.73 $257.53 $103.66 $175.32 $209.52
Level 2 Rates for individuals ages 75 and older who have one or more of the medical conditions on theapplication.4
75+ $178.50 $262.50 $337.12 $263.25 $317.25 $265.50 $106.87 $180.75 $216.00
Group 2 Applies to individuals whose plan effective date will be 3 or more yearsfollowing their 65th birthday or Medicare Part B effective date, if laterAge1 Plan A Plan B Plan C Select C2 Plan F Select F2 Plan K Plan L Plan N
Standard Rates with Enrollment Discount3 for individuals ages 68-74 who do not have any of the medicalconditions on the application.4
68 $94.01 $138.25 $177.55 $138.64 $167.08 $139.83 $56.28 $95.19 $113.7669 $97.58 $143.50 $184.29 $143.91 $173.43 $145.14 $58.42 $98.81 $118.0870 $101.15 $148.75 $191.03 $149.17 $179.77 $150.45 $60.56 $102.42 $122.4071 $104.72 $154.00 $197.78 $154.44 $186.12 $155.76 $62.70 $106.04 $126.7272 $108.29 $159.25 $204.52 $159.70 $192.46 $161.07 $64.83 $109.65 $131.0473 $111.86 $164.50 $211.26 $164.97 $198.81 $166.38 $66.97 $113.27 $135.3674 $115.43 $169.75 $218.00 $170.23 $205.15 $171.69 $69.11 $116.88 $139.68
Standard Rates for individuals ages 75 and older who do not have any of the medical conditions on the application.4
75+ $119.00 $175.00 $224.75 $175.50 $211.50 $177.00 $71.25 $120.50 $144.00
The rates above are for plan effective dates from January 2016 - December 2016 and may change.
-
Cover Page - Rates for North Carolina Tobacco Monthly Plan Rates
AARP® Medicare Supplement Insurance Plans insured by UnitedHealthcare Insurance Company
Level 2 Rates with Enrollment Discount3 for individuals ages 68-74 who have one or more of the medicalconditions on the application.4
68 $155.11 $228.11 $292.95 $228.76 $275.68 $230.71 $92.86 $157.06 $187.7069 $161.00 $236.77 $304.08 $237.44 $286.15 $239.48 $96.39 $163.03 $194.8370 $166.89 $245.43 $315.20 $246.13 $296.62 $248.24 $99.91 $168.99 $201.9671 $172.78 $254.10 $326.33 $254.82 $307.09 $257.00 $103.44 $174.96 $209.0872 $178.67 $262.76 $337.45 $263.50 $317.56 $265.76 $106.97 $180.92 $216.2173 $184.56 $271.42 $348.58 $272.19 $328.03 $274.52 $110.49 $186.89 $223.3474 $190.45 $280.08 $359.70 $280.88 $338.50 $283.28 $114.02 $192.85 $230.47
Level 2 Rates for individuals ages 75 and older who have one or more of the medical conditions on the application.4
75+ $196.35 $288.75 $370.83 $289.57 $348.97 $292.05 $117.55 $198.82 $237.60
Group 2 Applies to individuals whose plan effective date will be 3 or more yearsfollowing their 65th birthday or Medicare Part B effective date, if laterAge1 Plan A Plan B Plan C Select C2 Plan F Select F2 Plan K Plan L Plan N
Standard Rates with Enrollment Discount3 for individuals ages 68-74 who do not have any of the medicalconditions on the application.4
68 $103.41 $152.07 $195.30 $152.50 $183.79 $153.81 $61.91 $104.71 $125.1369 $107.33 $157.85 $202.72 $158.30 $190.77 $159.65 $64.26 $108.69 $129.8870 $111.26 $163.62 $210.13 $164.09 $197.75 $165.49 $66.61 $112.66 $134.6471 $115.19 $169.40 $217.55 $169.88 $204.73 $171.33 $68.96 $116.64 $139.3972 $119.11 $175.17 $224.97 $175.67 $211.71 $177.17 $71.31 $120.62 $144.1473 $123.04 $180.95 $232.38 $181.46 $218.69 $183.01 $73.66 $124.59 $148.8974 $126.97 $186.72 $239.80 $187.25 $225.67 $188.85 $76.01 $128.57 $153.64
Standard Rates for individuals ages 75 and older who do not have any of the medical conditions on the application.4
75+ $130.90 $192.50 $247.22 $193.05 $232.65 $194.70 $78.37 $132.55 $158.40
Group 1 Applies to individuals whose plan effective date will be within three yearsfollowing their 65th birthday or Medicare Part B effective date, if laterAge1 Plan A Plan B Plan C Select C2 Plan F Select F2 Plan K Plan L Plan N
Standard Rates with Enrollment Discount3 for individuals ages 65-74
65 $91.63 $134.75 $173.05 $135.13 $162.85 $136.29 $54.85 $92.78 $110.8866 $95.55 $140.52 $180.47 $140.92 $169.83 $142.13 $57.21 $96.76 $115.6367 $99.48 $146.30 $187.88 $146.71 $176.81 $147.97 $59.56 $100.73 $120.3868 $103.41 $152.07 $195.30 $152.50 $183.79 $153.81 $61.91 $104.71 $125.1369 $107.33 $157.85 $202.72 $158.30 $190.77 $159.65 $64.26 $108.69 $129.8870 $111.26 $163.62 $210.13 $164.09 $197.75 $165.49 $66.61 $112.66 $134.6471 $115.19 $169.40 $217.55 $169.88 $204.73 $171.33 $68.96 $116.64 $139.3972 $119.11 $175.17 $224.97 $175.67 $211.71 $177.17 $71.31 $120.62 $144.1473 $123.04 $180.95 $232.38 $181.46 $218.69 $183.01 $73.66 $124.59 $148.8974 $126.97 $186.72 $239.80 $187.25 $225.67 $188.85 $76.01 $128.57 $153.64
75+ $130.90 $192.50 $247.22 $193.05 $232.65 $194.70 $78.37 $132.55 $158.40
MRP0036 NC - 1-16
The rates above are for plan effective dates from January 2016 - December 2016 and may change.
-
Cover Page - Rates for North Carolina Under 65 Monthly Plan Rates
AARP® Medicare Supplement Insurance Plans insured by UnitedHealthcare Insurance Company
The rates above are for plan effective dates from January 2016 - December 2016 and may change.
1 Your age as of your plan effective date.2 You must use a network hospital with Select Plans C and F3 The Enrollment Discount is available to applicants age 65 and over. You may qualify for an Enrollment Discount
based on your age.
Who is eligible
You are eligible for the enrollment discount if you are between the ages of 65 and 74.
How it works
The Enrollment Discount is applied to the current Standard Rate if your plan effective date is either:Within 3 years of your Medicare Part B effective date
OR
After 3 years from your Medicare Part B effective date and you do not have any medical conditionson the application that would qualify you for the Level 2 rate.
The Enrollment Discount is applied to the Level 2 rate if your plan effective date is 3 or more years following your65th birthday or your Medicare Part B effective date and you have one or more of the medical conditions on theapplication.
The Standard Rates usually change each year. The discount you receive in your first year of coverage depends onyour age on your plan effective date. The discount percentage reduces 3% each year on the anniversary date ofyour plan until the discount runs out.
Group 3 Applies to individuals under the age of 65 who are eligible for Medicare by reason of disabilityAge1 Plan A Plan C
50-64 $214.25 $404.50
4 Refer to Section 6 of the application.
MRP0036 NC - 1-16
-
MUTUAL OF OMAHA INSURANCE COMPANY
OUTLINE OF MEDICARE SUPPLEMENT COVERAGE- COVER PAGE BENEFIT PLANS A, F, AND G
This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. Basic Benefits: Hospitalization: Medical Expenses:
Blood: H .
-- ·--~
PlanA Plan B aSIC, Basic,
includ· including in~ 100% 10 % Part B Co-Part B insurance Co· insur· ance
Part A Deductible
Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. Part B coinsurance (generally 20% of Medicare-approved expenses) or co payments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of Part B coinsurance or copayments. First 3 pints of blood each year. PartA .
Plane Plan D PlanG PlanK Plan L Plan M Plan N Basic, Basic, aSIC, aSIC including including including including 100% 100% 100% 100% Part B Co- Part B Co- Part B Co· Part B Co· insurance insurance insurance* insurance
Hospitalization and Hospitalization Basic, Basic, including preventive care and preventive including 100% Part B paid at 1 00%; other care paid at 100% Part Coinsurance, basic benefits paid 100%; other basic B Co- except up to at 50% benefits paid at insurance $20 copayment
75% for office visit, and up to $50 copayment for ER
Skilled Skilled Nursing Nursing Facility Co- racility Co-insurance Insurance
50% Skilled 75% Skilled Skilled Skilled Nursing Nursing Facility Nursing Facility Nursing Facility Coinsurance Coinsurance Facility Co- Coinsurance
insurance
Part A Part A 50% Part A 75% Part A 50% Part A Part A Deductible Deductible Deductible Deductible Deductible Deductible Part B Deductible
Foreign Foreign Foreign Foreign Travel Travel Travel Travel Emergency Emer- Emer- Emergency
Out-of-pocket Out-of-pocket limit limit$4,960; paid $2,480; paid at at 1 00% after limit 1 00% after limit reached reached
*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 $2,180 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy/certificate. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.
NCMOOAGY001 1 NC_MOO_AGY_010116
-
--
FEMALE .. Plan-A- · Plan_:F_. _: ...
:MM2o-·- .· . ·_- . - -- __ MM24_ ·. 361.13 508.63 "95·.79.:. . '134.92: 95.79 134.92 95.79 .. - . ' .. 134.92' ·- .. _ 98.72 139.03 101.95. 143':59 .-105.17 148.14 108.69 153.09 112.21 158.04
--116.02. - . 163.41 119.84 168.78 123.95'·. -174.58 128.05 180.35
--.132.45 186.55' . 136.86 192.74 141.55 ' ' .199.36 146.23 205.96 151.22 212.99 156.20 220.01 161.48 227.45-166.76 234.88 172.63 -~ 243.14 178.78 251.81 .185·.25 -' ;260.91 ~ :..
191.70 269.99 .. 198.44 279.49
205.18 289.00 212.23 298.91-219.26 308.82
-.'-226.59 - 319~15- ," .. : :· --233.93 329.48
·241.27 339.80 ..
248.89 350.55 ·-•256~51 . ·- 361.28' --·~
264.14 372.02 --212.05~. 383.-17 . :
·-
.-
-_,
MONTHLY NON-TOBACCO PREMIUMS* ZIP CODES: 270 - 289
PlanG Attained PlanA -. MM25. Ao-e ·_ MM20
Thru 64 408.04 95.05·. ' 65 l08.24· 95.05 66 108.24
': -- . .95.05 . - 67 108.24 . -97.95 68 111.54
"10L16 69 115.20 104.36 70 118.85 107.85 71 122.81 111.34 72 126.80 115.12 73 131.11 118.90 74 135.41
. 122.99 75 .140.05 127.06 76 144.69 131.42 77 149.66 135.78 78 154.63 140.44 79 159.93 145.09 80 165.24 150.04 81 170.87 154.99 82 176.50 160.24 83 182.47 165.47 84 188.44 171.28 . - 85 195.06 177.40 86 202.03 183.80 87 209.31 190.21 88 216.60 196.89 89 224.23 203.60 90 231.85 210.58 91 239.80 217.55 92 247.76 224.83 :93 256.04 232.11 94 264.33 239.39 .95 272.62 246.95 96 281.23
- . ' . . 2'54~52 97. 289.85 262.09 98 298.46 '269.94 . 99+ 307.41
MALE PlanF PlanG MM24 MM25 574.72 152.45 107AO 152.45 107.40 152.45 107.40 157.11 110.69 162.25 114.30 167.38 117.92 172.97 121.86 178.59 125.81 184.66 130.09 190.72 134.36 197.25 138.96 203.78 143.57 210.78 148.50 217.79 153.43 225.26 158.69 232.73 163.95 240.66 169.55 248.59 175.13 257.00 181.05 265.40 186.97 274.73 193.54 284.54 200.45 294.81 207.68 305.07 214.92 315.81 222.49 326.55 230.05 337.75 237.94 348.95 245.83
.. 360.62 254.04 372.29 262.27 383.95 270.49 396.10 279.04 408.24 287.60 420.36 296.13 432.2_7~ 305.02
To obtain annual, semiannual, and quarterly premiums, multiply the above-quoted premiums by 12, 6, and 3, respectively. *See PREMIUM INFORMATION regarding Risk Class and Household Premium Discount rating.
NC MOO AGY 001 2 NC_MOO_AGY _ 010116
i
-
Mutual of Omaha Insurance Company North Carolina Plans A, F & 0
Life Expectancy* at Issuance and Increase** In Monthly Premium after 1 0 Policy Years
Female Non-Tobacco Male Non-Tobacco Age at Life Age at Life Issue Expectancy PlanA PlanF PlanO Issue Expectancy PlanA Plan F PlanO
65 20.55 28.16 39.66 27.94 65 17.39 31.81 44.80 31.56 66 19.70 32.26 45.43 32.01 66 16.58 36.45 51.33 36.17 67 18.87 36.66 51.63 36.37 67 15.79 41.42 58.33 41.10 68 18.05 38.14 53.71 37.83 68 15.02 43.09 60.68 42.74 69 17.26 39.60 55.77 39.28 69 14.27 44.73 63.01 44.39 70 16.92 41.06 57.82 40.73 70 13.96 46.39 65.35 46.03 71 16.10 42.53 59.90 42.19 71 13.21 48.06 67.69 47.69 72 15.30 43.99 61.97 43.65 72 12.49 49.70 70.00 49.32 73 14.53 45.46 64.04 45.12 73 11.78 51.36 72.34 50.96 74 13.77 46.92 66.10 46.57 74 11.10 53.03 74.68 52.61 75 13.05 48.68 68.56 48.29 75 10.45 55.01 77.48 54.58 76 12.30 50.73 71.46 50.34 76 9.78 57.34 80.76 56.88 77 11.97 52.80 74.36 52.38 77 9.51 59.65 84.03 59.18 78 11.26 54.84 77.25 54.43 78 8.88 61.97 87.28 61.49 79 10.58 56.89 80.13 56.45 79 8.28 64.30 90.55 63.80 80 9.92 58.95 83.04 58.51 80 7.70 66.61 93.82 66.10 81 9.27 61.01 85.92 60.54 81 7.13 68.93 97.09 68.39 82 9.01 63.06 88.81 62.56 82 6.91 71.26 100.36 70.70 83 8.39 65.11 91.70 64.59 83 6.38 73.57 103.62 72.99 84 7.81 67.17 94.60 66.64 84 5.88 75.89 106.89 75.30 85 7.59 68.64 96.66 68.11 85 5.70 77.56 109.22 76.95 86 7.02 70.11 98.74 69.55 86 5.21 79.20 111.56 78.59 87 6.48 71.26 100.37 70.72 87 4.76 80.54 113.43 79.92 88 5.97 72.44 102.03 71.88 88 4.33 81.86 115.29 81.21 89 5.48 73.61 103.68 73.05 89 3.93 83.18 117.16 82.53
90+ 5.01 66.87 94.17 66.34 90+ 3.56 75.56 106.42 74.97
*Life expectancy includes only mortality **Increase in premium is based on rates at the time of Issue. Increase is subject to premium change provisions.
NC MOO AGY 001 3 NC_MOO_AGY_ 010116
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MONTHLY TOBACCO PREMIUMS* ZIP CODES: 270 - 289
~~--~----~------FE-. -MAL---.-.E-•... -----------. ------~~ ~~--------------~MAL~~E~--------------~1
· · ·.Plan: A
-
Mutual of Omaha Insurance Company North Carolina Plans A, F & G
Life Expectancy* at Issuance and Increase** In Monthly Premium after I 0 Policy Years
Female Tobacco Male Tobacco Age at Life Age at Life Issue Expectancy PlanA Plan F PlanG Issue Expectancy PlanA PlanF Plan G
65 I8.04 30.44 42.87 30.20 65 I5.36 34.38 48.44 34.I2 66 I7.22 34.88 49.12 34.60 66 14.59 39.40 55.50 39.IO 67 I6.43 39.63 55.82 39.3I 67 13.84 44.77 63.06 44.43 68 15.65 41.22 58.06 40.90 68 13.12 46.58 65.60 46.21 69 I4.90 42.81 60.28 42.47 69 I2.43 48.36 68.I3 47.99 70 I4.56 44.39 62.5I 44.04 70 I2.11 50.I6 70.65 49.77 7I I3.79 45.98 64.76 45.61 7I 11.42 51.96 73.18 51.55 72 I3.04 47.55 66.99 47.19 72 I0.76 53.74 75.68 53.32 73 12.32 49.15 69.23 48.77 73 IO.I2 55.53 78.21 55.10 74 11.63 50.72 71.45 50.34 74 9.50 57.33 80.74 56.88 75 10.96 52.63 74.12 52.21 75 8.91 59.48 83.76 59.01 76 10.27 54.84 77.25 54.42 76 8.32 61.99 87.30 61.49 77 9.95 57.08 80.38 56.64 77 8.04 64.49 90.84 63.98 78 9.31 59.29 83.51 58.84 78 7.49 67.00 94.36 66.48 79 8.70 61.51 86.63 61.03 79 6.96 69.51 97.89 68.97 80 8.11 63.73 89.77 63.24 80 6.47 72.01 101.43 71.45 81 7.54 65.95 92.89 65.45 81 5.98 74.52 104.96 73.95 82 7.28 68.18 96.0I 67.63 82 5.76 77.03 I08.49 76.43 83 6.75 70.39 99.I3 69.83 83 5.31 79.53 II2.02 78.91 84 6.25 72.61 102.27 72.05 84 4.89 82.04 II5.55 8I.40 85 6.02 74.20 104.50 73.63 85 4.70 83.84 1I8.07 83.I9 86 5.54 75.79 I06.74 75.20 86 4.30 85.62 120.60 84.97 87 5.09 77.04 108.52 76.44 87 3.93 87.07 122.63 86.40 88 4.67 78.32 11 0.3I 77.71 88 3.58 88.49 I24.64 87.80 89 4.28 79.58 112.09 78.97 89 3.26 89.92 126.66 89.22
90+ 3.91 72.29 I 01.81 71.73 90+ 2.97 81.68 115.05 81.05
*Life expectancy includes only mortality **Increase in premium is based on rates at the time of Issue. Increase is subject to premium change provisions.
NC MOO AGY 001 5 NC_MOO_AGY_ 010116
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pjsclosyres Use this outline to compare benefits and premiums among policies.
premjym lnformatjon We, Mutual of Omaha, can only raise your premium if we raise the premium for all the policies like yours in the same geographic area of the state where you live. Until you are age 90, your premium may change each year. This change will only be made on the first renewal date that coincides with or follows each anniversary of the policy date. Schedules of rates may vary depending upon your policy date.
Premiums are based on attained age rating which means premiums increase as your age increases. Premiums that are based on issue age do not increase as your age increases. Policies on an issue age basis should be compared to policies on an attained age basis.
Rjsk Class Ratjng If, according to our underwriting standards, you are overweight or underweight for your height, you will be considered to be a greater insurable risk. In such a case, your premium will be priced either as Class I - 1 0°/o or Class II- 20o/o higher than the rates illustrated, based on your Body Mass Index (BMI) reading. Risk class rating will not be applicable when you apply for coverage during an open enrollment or guaranteed issue period.
Hoysebold Premjym Qjscount You are eligible for a household premium discount if for the past year you have resided with at least one, but no more than three adults who are age 60 or older. The discounted premium will be priced 12% lower than the rates illustrated.
NC MOO AGY 001 6
The policy's household premium discount will be removed if the other adult no longer resides with you (other than in the case of his or her death).
Read voyr policv Verv 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.
Rjght to Retyrn policcy If you find that you are not satisfied with your policy, you may return it us at Mutual of Omaha Plaza, Omaha, NE 68175. 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.
Notjce The policy may not fully cover all of your medical costs. Neither Mutual of Omaha 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 & You" for more details.
Complete Answers Are Verv 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 any 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.
NC_MOO_AGY_ 010116
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PLANA 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 hosoital and have not received skilled care in anv other facilitv for 60 d ·
I - - - - - - " " Services Medicare Pays Plan A Pays You Pay
HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies
First 60 days All but $1,288 $0 $1,288 (Part A deductible)
61 51 through 9Qlh day All but $322 a day $322 a dav $0 91 st day and after:
While using 60 lifetime reserve days All but $644 a day $644 a dav $0 Once lifetime reserve days are used:
Additional 365 days $0 100% of Medicare- $0** eligible expenses
Beyond the additional 365 days $0 $0 All costs SKILLED 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 21 51 through 100th day All but $161.00 a day $0
Up to $161.00 a day 101 51 day and after $0 $0 All costs
BLOOD First 3 R_ints $0 3 pints $0 Additional amounts 100% $0 $0
HOSPICE CARE All but very limited Medicare copayment/ $0 You must meet Medicare's requirements, including a docto~s certification of copayment/coinsurance coinsurance terminal illness. for outpatient drugs and
-- --in~atient respite care
--
**NOTICE: When your Medicare Part A hospital benefits are exhausted, we stand in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy's/certificate's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
NC MOO AGY 001 7 NC_MOO_AGY _ 010116
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PLANA MEDICARE (PART B) -MEDICAL SERVICES -PER CALENDAR YEAR
*Once you have been billed $166 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.
Services Medicare Pays Plan A Pays You Pay MEDICAL EXPENSES-IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment
First $166 of Medicare-approved amounts* $0 $0 $166 (Part 8 deductible) Remainder of Medicare-approved amounts Generally 80% Generally 20% $0
Part B Excess Charges (above Medicare-approved amounts) $0 $0 All costs BLOOD
First 3 pints $0 All costs $0 Next $166 of Medicare-approved amounts* $0 $0 $166 (Part 8 deductible)
Remainder of Medicare-approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES-TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0
----- - ----
PARTS A AND B
HOME HEALTH CARE-MEDICARE-APPROVED SERVICES Medical! necessa skilled care services and medical su lies 100% $0 $0 Durable medical equipment
First $166 of Medicare-a roved amounts $0 $0 Remainder of Medicare-a roved amounts 80% 20%
NC MOO AGY 001 8 NC_MOO_AGY_ 010116
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PLANS FAND G 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 hosoital and have not received skilled care in anv other facilitv for 60 d ·
"' "' "' Services Medicare Pays Plan F Pays You Pay Plan G Pays You Pay
HOSPITALIZATION* Semiprivate room and board, general nursing, and miscellaneous services and supplies
First 60 days All but $1 ,288 $1 ,288 (Part A $0 $1 ,288 (Part A $0 deductible) deductible)
61 51 through 90th day All but $322 a day $322 a dav $0 $322 a day $0 91 51 day and after:
$644 a day $0 While using 60 lifetime reserve days All but $644 a day $0 $644 a day Once lifetime reserve days are used:
100% of Medicare-Additional 365 days $0 $0** 1 00% of Medicare- $0** eligible expenses eligible expenses
Beyond the additional 365 days $0 $0 All costs $0 All costs SKILLED 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 $0 $0 21st through 1 QQth day All but $161.00 a day Up to $161.00 a day $0 Up to $161.00 a day $0 101 51 day and after $0 $0 All costs $0 All costs
BLOOD First 3 pints $0 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 $0 $0
HOSPICE CARE All but very limited Medicare copayment/ $0 Medicare copayment/ $0 You must meet Medicare's requirements, copayment/ coinsurance coinsurance including a docto~s certification of terminal coinsurance for illness. outpatient drugs and
inpatient respite care ~- -
**NOTICE: When your Medicare Part A hospital benefits are exhausted, we stand in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy's/certificate's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
NC MOO AGY 001 9 NC_MOO_AGY _ 010116
I
-
PLANS FAND G MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR
*Once you have been billed $166 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.
Services Medicare Pays Plan F Pays You Pay Plan G Pays You Pay MEDICAL EXPENSES-IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment
First $166 of Medicare-approved amounts* $0 $166 (Part 8 $0 $0 $166 (Part 8 deductible) deductible)
Remainder of Medicare-approved amounts Generally 80% Generally 20% $0 Generally 20% $0 Part B Excess Charges (above Medicare-approved amounts) $0 100% $0 100% $0
BLOOD First 3 pints $0 All costs $0 All costs $0
I
Next $166 of Medicare-approved amounts* $0 $166 (Part 8 $0 $0 $166 (Part 8 deductible) deductible)
Remainder of Medicare-approved amounts 80% 20% $0 20% $0 CLINICAL LABORATORY SERVICES-TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 $0 $0
PARTS A AND B
HOME HEALTH CARE-MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies 100% $0 $0 $0 $0 Durable medical equipment
First $166 of Medicare-approved amounts* $0 $166 (Part 8 $0 $0 $166 (Part 8 deductible) deductible)
Remainder of Medicare-approved amounts 80% 20% $0 20% $0
NC MOO AGY 001 10 NC_MOO_AGY_ 010116
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PLANS FAND G MEDICARE (PART B) -MEDICAL SERVICES -PER CALENDAR YEAR
OTHER BENEFITS - NOT COVERED BY MEDICARE Services Medicare Pays Plan F Pays You Pay Plan G Pays You Pay
FOREIGN TRAVEL-NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA
First $250 each calendar year $0 $0 $250 $0 $250 Remainder of charges $0 80% to a lifetime 20% and amounts 80% to a lifetime 20% and amounts
maximum benefit over the $50,000 maximum benefit of over the $50,000 of$50,000 lifetime maximum $50,000 lifetime maximum
benefit benefit --- ---
NC MOO AGY 001 11 NC _MOO _AGY _ 010116
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Page 2
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-
Page 3
NO
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