WPS Medicare supplement insurance plansYou’re never alone—we’re committed to helping you with your health careRates effective January 1, 2021

Choose the right Medicare supplement insurance plan with complete customer support!Visit mywpsmedicare.com

Plans A, G, K, L, and N

TX_MSS_1908

Underwritten by:

The EPIC Life Insurance CompanyA WPS Company

TX

Neither Wisconsin Physicians Service Insurance Corporation, nor The EPIC Life Insurance Company, nor their products, nor agents are connected with or endorsed by the United States government or the federal Medicare program. WPS Health Insurance Medicare supplement insurance plans are underwritten by The EPIC Life Insurance Company.

2 | mywpsmedicare.com | 1-800-236-8809

ContentsMedicare alone is not enough ...............................................................2

Committed to our customers .................................................................2

Medicare supplement insurance plans are a great choice ............3

Top reasons to choose our Medicare supplement insurance plans ..........................................................................................3

Our Medicare supplement insurance plans have five smart options ............................................................................4

Choose from convenient payment options .........................................4

Enrollment timeline ....................................................................................5

Premium rates ...................................................................................... 6–9

Parts of Medicare ................................................................................... 10

Limitations and exclusions ............................................................. 10-11

Valuable programs included with your plan ............................. 12–16

Medicare alone is not enough Medicare is a valuable benefit, but it doesn’t pay everything. Deductibles and coinsurance can add up. If you have Medicare alone, there’s a chance a serious illness or injury could exhaust your savings. Our Medicare supplement insurance plans help protect your health and retirement savings.

Committed to our customersFor more than 70 years, our top priority has been providing our customers the highest quality service and support. We are driven to make our products easy to use and understand.Of our Medicare supplement customers, 95% say they would recommend WPS1, and 95% choose to stay with WPS year after year1.

“I felt like I had a home at WPS. Someone to take care of me and someone I can turn to.”

—Jewel Customer since 2005

Eliminate the worry“ “

Personal service ensures you get the kind of attention you need when you have questions. We know your concerns and are equipped to help you get the answers you need to your Medicare supplement questions. We have your back! Judy is a customer service

rep who helps seniors get the most from their Medicare supplement plans.

1WPS customer support survey, 2019.

1-800-236-8809 | mywpsmedicare.com | 3

“Medicare supplement insurance plans are a great choiceMedicare supplement insurance plans give you the freedom to choose your own doctors and hospitals that accept Medicare anywhere in the U.S. This means you can keep your doctor or select a new doctor at any time. You have complete freedom to choose! And if you move, your coverage moves with you—anywhere in the U.S.

Plus, you always can keep your plan as long as you pay your premium. Your policy will never be canceled because of your health. As long as you pay your premium on time, your plan is guaranteed renewable for life.

Also, there is less paperwork and fewer worries. Automatic claims service means you don’t have to worry about filing claims or dealing with medical bills. Medicare sends us your claims electronically, so we handle them while you enjoy almost no paperwork.

Top reasons to choose our Medicare supplement insurance plans• Save money with our discounts

We offer a 7% discount when you and a second household member are enrolled in our Medicare supplement insurance plan.1 You also can get a 2% discount when you choose automatic bank withdrawal.

• You get treated like family When you call us, you reach our highly trained, caring, Midwest-based Customer Support team who answer your questions promptly and accurately.

• Strong commitment to ethics In 2019, Wisconsin Physicians Service Insurance Corporation (The EPIC Life Insurance Company’s parent company and administrator of our Medicare supplement insurance plans) was named one of the World’s Most Ethical Companies® for the 10th year in a row by the international Ethisphere® Institute.2

• You deserve to live your life Health care and health insurance are important, but honestly, you’ve got better things to do than worry about all of it. Let us help handle your medical bills while you handle all the activities you enjoy.

1Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex. 22010-2019 World’s Most Ethical Companies®, Ethisphere® Institute, worldsmostethicalcompanies.ethisphere.com. “World’s Most Ethical Companies” and “Ethisphere” names and marks are registered trademarks of Ethisphere LLC.

4 | mywpsmedicare.com | 1-800-236-8809

Choose from convenient payment options

Coverage of Plan A Plan G Plan K Plan L Plan N

Basic benefits √ √ √1 √2 √

Part B coinsurance √ √ √1 √2 √3

Part A deductible √ 50% 75% √

Skilled nursing facility coinsurance

√ 50% 75% √

Foreign travel emergency

√ √

Part B excess charges

√

1After deductible, hospitalization and preventive care paid at 100%; other basic benefits paid at 50%. Out-of-pocket limit set by CMS; pays at 100% after limit reached.2After deductible, hospitalization and preventive care paid at 100%; other basic benefits paid at 75%. Out-of-pocket limit set by CMS; pays at 100% after limit reached.3After deductible, requires up to $20 copayment for office visits; up to $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible.

Foreign travel coverage for emergency care that is not covered by Medicare is subject to a $250 calendar year deductible. Benefits are payable at 80% to a lifetime maximum benefit of $50,000 for services beginning during the first 60 days of each trip outside the USA.

The level of benefits available under the plan directly corresponds to the premium amount.

Our Medicare supplement insurance plans have five smart options

• Automatic bank withdrawal (includes 2% discount!)• Credit/debit card payment• Direct billing

Please see our Medicare supplement insurance plan enrollment application for additional instructions for selecting a payment option.

If you were eligible for Medicare prior to Jan. 1, 2020, please call us at 1-800-236-8809 for more plan options available to you.

1-800-236-8809 | mywpsmedicare.com | 5

Our Medicare supplement insurance plans have five smart options

Turn

65!Turn

65!

If you apply during your one-time open enrollment period, you won’t need to answer any health questions; simply submit a policy enrollment application.

One-time open enrollment

period ends

You cansubmit an application

or enroll in Part B

66Months

AfterMonths

After

33Months Before

Months Before

Enrollment timeline when you turn 65

Our Medicare supplement insurance plan monthly premium ratesEffective January 1, 2021Determine your rate area:

Area 1=Dallas, Houston, and Lubbock areas 750_ _ : All ZIPs that begin with these 3 numbers751_ _ : All ZIPs that begin with these 3 numbers752_ _ : All ZIPs that begin with these 3 numbers753_ _ : All ZIPs that begin with these 3 numbers760_ _ : All ZIPs that begin with these 3 numbers761_ _ : All ZIPs that begin with these 3 numbers762_ _ : All ZIPs that begin with these 3 numbers770_ _-777_ _: All ZIPs that begin with these 3 numbers793_ _ : All ZIPs that begin with these 3 numbers794_ _ : All ZIPs that begin with these 3 numbers

Area 2=All other Texas ZIP codes

RelocationIf, in the future, you permanently relocate to another state, Area 1 rates will apply. If you relocate to another Texas ZIP code, you will pay the rates for the area to which you move.

Have other coverage that’s terminating or changing?If so, you may be eligible for guaranteed acceptance of this policy. Contact your agent or call our sales representatives at 1-800-236-8809 for information.

Enroll anytime after you turn 65Already passed the 65-year milestone?You can switch Medicare supplement insurance plans at any time throughout the year. You don’t have to wait for an annual enrollment period like you do with Medicare Advantage plans. If you can answer “No” to simple health questions or if you qualify for guaranteed issue, it’s easy to make the switch! Just contact your agent or call our sales representatives at 1-800-236-8809.

Coverage begins on the first of the month that you turn 65 and/or enroll in Medicare Part B, or on the effective date you request up to three months in the future.

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10 | mywpsmedicare.com | 1-800-236-8809

Parts of Medicare

The Medicare program has several different parts, which can be confusing if you’re unfamiliar with them. A Medicare supplement insurance plan works with your Medicare Part A and Part B coverage.

Part A Part B Part D

• Hospital care• Skilled nursing

facility care• Nursing home care• Hospice• Home health services

• Medically necessary outpatient services to diagnose or treat your medical condition

• Most preventive outpatient services, including an annual wellness exam

• Stand-alone prescription drug plans (PDP) help pay for medications

• Mail order options and access to retail pharmacies nationwide

Limitations and exclusionsNo insurance policy covers everything. Here’s a list of things this Medicare supplement doesn’t cover:

• Expenses you incur while your policy is not in force, except as provided in the EXTENSION OF BENEFITS Section.

• That portion of any expense you incur which is paid for by Medicare.• Non-Medicare-eligible expenses, including, but not limited to, routine exams, take-home drugs, and eye

refractions.

• Services for which a charge is not normally made in the absence of insurance.

Additional notations• Rates shown are illustrative only;• Please do not send money to us in response to this advertisement;• You cannot obtain coverage under a WPS Health Insurance Medicare supplement insurance plan until you

have completed an application for coverage; and

• As noted above, there are benefit exclusions and limitations that may apply to the WPS Health Insurance Medicare supplement insurance plans.

• Coverage under our Medicare supplement plans is not effective unless, and/or until, you are enrolled in Medicare Part B.

1-800-236-8809 | mywpsmedicare.com | 11

Open enrollment and creditable coverage There is an open enrollment period for Medicare supplement plans that is a six-month period during which you may buy any Medicare supplement plan offered in Texas. During this time, we must sell you a policy, even if you have health problems. The open enrollment period is a six-month period that begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. If you are on Medicare under age 65, you will have a six-month open enrollment period beginning the month you turn age 65. If you have any questions or would like additional information, please contact us at 1-800-236-8809.

Although we must sell you a policy during your open enrollment period, we may require a waiting period of up to six months before covering your pre-existing conditions. You are not covered for pre-existing conditions until after a six-month waiting period. However, you will not have a waiting period if on the day preceding your effective date under one of our Medicare supplement policies you had continuous creditable coverage of at least six months. If your continuous period of creditable coverage was less than six months, we will shorten the six-month waiting period by the time served under the prior coverage.

If you lost or are losing other health insurance coverage and received notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement policy or that you had certain rights to buy such a policy, you may be eligible for guaranteed acceptance in one of our Medicare supplement plans. There are other scenarios that you may qualify for guaranteed acceptance. You may find a full list of qualifying scenarios in Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare, available at medicare.gov if you did not receive a copy with this book. If you have any questions whether you qualify for guaranteed acceptance into a Medicare supplement plan, please contact us or speak with your agent.

Pre-existing conditions limitationYou are not covered for pre-existing conditions until after a six-month waiting period. A pre-existing condition is a condition for which: (1) medical advice was given from a physician within six months prior to your effective date; or (2) treatment was recommended or received from a physician within six months prior to your effective date.

However, you will not have a waiting period for pre-existing conditions if on the day preceding your effective date under this policy, you had a continuous period of creditable coverage of at least six months. If your continuous period of creditable coverage was less than six months, we will shorten the six-month waiting period by the time served under the prior coverage.

Suspension of benefits and premiumsBenefits and premiums under the policy may be suspended for up to 24 months if you become entitled to benefits under Medicaid. You must request that your policy be suspended within 90 days of becoming entitled to Medicaid. If you lose, or are no longer entitled to, benefits from Medicaid, your policy can be reinstated if you request reinstatement within 90 days of the loss of such benefits and pay the required premium.

Right to return policyIf you purchase a WPS Health Insurance Medicare supplement insurance plan and find that you are not satisfied with your plan, you may return it to us at: WPS, P.O. Box 8190, Madison, WI 53708-8190. 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.

12 | mywpsmedicare.com | 1-800-236-8809

The Silver&Fit® Exercise and Healthy Aging Program1When you choose Plan A, G, or N (not available with cost-sharing Plans K and L), you also get this great perk! At no extra cost, the Silver&Fit program gives you fitness center or select YMCA exercise center membership.

The Silver&Fit network includes Texas locations of national fitness chains as well as dozens of regional and local gyms.2

1The Silver&Fit® program is provided by American Specialty Health Fitness, Inc. The ChooseHealthy® program is provided by ChooseHealthy, Inc. Both are subsidiaries of American Specialty Health Incorporated (ASH), a national provider of fitness, health education, musculoskeletal provider networks, and health management programs. Silver&Fit and ChooseHealthy are registered trademarks of ASH and used with permission herein. Services that require an additional cost are not included in the Silver&Fit program. Please note that these programs are not insurance. You should check any insurance benefits you have before using this program, as those benefits may result in lower costs to you than using this program. The program provides for discounts from participating specialty health care providers. You are obligated to pay for all services, but you will receive a discount from those providers who have contracted with the program. The program does not make any payments directly to the participating providers. The program has no liability for providing or guaranteeing services and assumes no liability for the quality of services rendered. Discounts on products available through the ChooseHealthy program are subject to change; please consult the website for current availability. Fitness programs are not part of the insurance policy and are offered at no additional charge. Enrollment in these programs is subject to contract renewal and can be changed or discontinued at any time. The Silver&Fit and ChooseHealthy programs are not included with Medicare supplement cost-sharing plans (Plans K and L). ²The fitness centers listed are participating in the Silver&Fit network as of July 2020. For the most current fitness center locations, please check the online directory at silverandfit.com.

The Silver&Fit network is continually growing, including the additions of fitness centers nominated by our customers. Visit silverandfit.com for a complete list of participating locations.

National Fitness Chains with Texas Locations

LA Fitness Gold’s Gym Anytime Fitness Planet Fitness

Curves Snap Fitness YMCA Jazzercise

San Antonio area

» Global Fitness Center

» HealthLink Fitness and Wellness Center

» S.A. Fitness

» Davis Scott Family YMCA

Austin area

» North Austin YMCA

» Springwoods Municipal Pool

Houston area

» Houston Gym

» Alief Family YMCA

» Fitness Connection

» Sundance Yoga StudioDallas area

» YouFit Health Club

» The Branch Connection

» Elzie Odom Athletic Center

» Life Time Fitness

» Carpenter Park Recreation Center

Plus, additional fitness centers throughout Texas!

Valuable programs included with your planWe strive to provide the greatest value possible to our customers. Our Medicare supplement insurance plans include an impressive collection of added benefits that, unlike in other plans, are available at no extra cost for customers. The programs are not insurance and are not part of the insurance policy.

The Silver&Fit program also offers: » Fitness clubs with group classes for older

adults, where available, such as:• Signature Series• Senior Dance• Senior Yoga• Aqua• Cardio• Strength• And more

Or, if you would prefer to work out at home, home fitness kits are available which can include:

• Stay fit kits• DVDs• Pedometer• Quick starts guides• And more

» Fitness challenges and rewards

» And more

The ChooseHealthy® program1

All our Medicare supplement insurance plan options, except cost-sharing Plans K and L, also include access to the ChooseHealthy program at no additional cost for membership. You can save more on wellness products and services and be empowered with health improvement tools to help you live better every day. The program allows you to:

» Save 25% on services from 80,000 specialty health care practitioners

» Learn from evidence-based, online health classes and articles offered at no extra cost

» Get discounts up to 55% on popular health and fitness brands including: • Garmin®

• Vitamix®

• PRO Compression®

• Fitbit®

1-800-236-8809 | mywpsmedicare.com | 13

14 | mywpsmedicare.com | 1-800-236-8809

Hear In America, Inc. programThe Hear In America program, available to all our Medicare supplement insurance plan customers, makes you eligible to receive:

» Free hearing screenings

» A three-year warranty on new hearing aids

» Free office services (including retests, cleanings, and adjustments) for three years

» A 45-day trial period for your hearing aid

» Discounts from 35 to 70% off of manufacturer’s suggested retail price (MSRP) for hearing aids from all nine major manufacturers including:

Sample SavingsMSRP or

Average PriceYou Pay* Savings % Saved

FREE annual hearing screening $0 100%

Three-year repair warranty, three-year loss and damage warranty

$500 $0 $500 100%

Three years of hearing aid batteries $315 $0 $315 100%

Three years of office service $600 $0 $600 100%

12 months financing (to those who qualify)$0 service charges

and interestUp to

$1,160

Basic digital hearing aid $1,450 $995 $455 31%

Mid-level hearing aid $3,995 $1,475 $2,520 63%

Premium digital hearing aid $5,996 $2,540 $3,456 58%

Examples of how you can save

• Phonak• Starkey• ReSound• Rexton• Signia• Sonic Innovations• Oticon• Unitron• Widex

*These are savings examples only. May be used in conjunction with your existing insurance coverage. Hearing programs are not part of the insurance policy and are offered at no additional charge. Enrollment in these programs is subject to contract renewal and can be changed or discontinued by us at any time.

Call us toll-free at 1-800-236-8809

EyeMed Vision Care, LLC programAll our Medicare supplement insurance plan customers receive access to the EyeMed Vision Care program at no additional cost.1 EyeMed offers substantial savings on eye care and eyewear at thousands of provider locations nationwide.

Our Medicare supplement insurance plan customers receive a discount simply by showing their Medicare supplement ID card at participating EyeMed providers.

EyeMed’s provider network includes many familiar optical retailers, including:

Does your vision provider accept EyeMed? We would be happy to explain how this valuable program works and help you find a provider.

Call us toll-free at 1-800-236-8809

1Vision discount program is not insurance, nor is it part of the insurance policy, and is offered at no additional charge. Enrollment in this program is subject to contract renewal. 2Frame, lens, and lens option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, customers receive 20% off the retail price. Benefits may not be combined with any discount, promotional offering, or other group benefit plans, except as indicated. Discount plan is effective Oct. 1, 2019, through Sept. 3, 2021.

1-800-236-8809 | mywpsmedicare.com | 15

» America’s Best Contacts & Eyeglasses

» EyeTx Vision Centers » First Eye Care » Freedom Eye Care » LensCrafters » Mann Eye Institute » Pearle Vision » Target Optical » Texan Eye » Vision Source Castle Hills » And many more!

Vision Care Services Customer Benefits

Eye exam (with dilation, as necessary)

$5 off routine exam$5 off contact lens exam

Complete Pair Eyeglass Purchase2

Frames

Any available frame at provider location 35% off retail price

Standard Plastic Lenses

Single vision $50 patient responsibility

Bifocal $70 patient responsibility

Trifocal $105 patient responsibility

Lens Options

UV coating $15 patient responsibility

Tint (solid and gradient) $15 patient responsibility

Standard scratch-resistant coating $15 patient responsibility

Standard polycarbonate $40 patient responsibility

Standard anti-reflective coating $45 patient responsibility

Standard progressive (add-on to bifocal) $65 patient responsibility

Other add-ons and services 20% off retail price

Contact Lenses (discount applies to materials only)

Conventional 15% off retail price

Laser Vision Correction

LASIK or PRK from U.S. Laser Network

15% off retail price5% off promotional price

Frequency of use for examination, frames, lenses, or contact lenses unlimited

eyemedvisioncare.com, Access Network

16 | mywpsmedicare.com | 1-800-236-880916 | mywpsmedicare.com | 1-800-236-8809

Ameritas Life Insurance Corp. optional dental coverage

Research shows that good dental health is essential to your overall health. Protecting your smile starts with regular visits to the dentist and a good dental plan.

When you take advantage of Ameritas dental coverage, you can choose a plan from one of the largest nationwide networks with more than 483,000 access points and 115,000 providers. Or, choose a plan that allows you and your family members to receive care from any licensed dental provider, regardless of whether they are in or out of network.

If you would like to find out more about these affordable plans, please call 1-800-236-8809. We can walk you through all your options and give you an immediate quote.

Call 1-800-236-8809 today!

Underwritten by Ameritas Life Insurance Corp. | P.O. Box 82520 | Lincoln, NE 68501-2520

Ameritas Life Insurance Corp. has sole financial responsibility for its own products. This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Group dental, vision, and hearing care products 9000 Rev. 03-16, (may vary by state) and individual dental and vision products Indiv. 9000 Rev. 07-16, (may vary by state) are issued by Ameritas Life. Some plan designs are not available in all areas. In Texas, our dental network and plans are referred to as the Ameritas Dental Network. Some states require that producers be appointed with Ameritas Life before soliciting its products.

Ameritas, the bison design, “fulfilling life,” and product names designated with SM or ® are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company, or Ameritas Mutual Holding Company. All other brands are property of their respective owners. ©2019 Ameritas Mutual Holding Company.

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Medicare supplement insurance plans give you peace of mindOriginal Medicare covers a lot—about 80% of your approved health care costs. But covering even just the 20% that Medicare leaves behind can be a real burden and hassle. Our Medicare supplement insurance plans help reduce these out-of-pocket costs when you need medical care.

Join our Medicare supplement insurance plan family today and get worry-free peace of mind you’ll enjoy for years to come!

In some states, all Medicare supplement standardized insurance plans are offered to qualified individuals under the age of 65 and/or to Medicare qualified individuals due to disability.

Ready to take the next step?Contact your local agent or call us today at 1-800-236-8809.

©2021 All rights reserved. JO20078 31323-100-2103

The purpose of this marketing is solicitation of insurance. Contact will be made by an insurance agent or insurance company. Medicare supplement policy forms in Texas include: EPIC_TX_PlanA_1710, EPIC_TX_PlanC_1710, EPIC_TX_PlanF_1710, EPIC_TX_PlanG_1710, EPIC_TX_PlanK_1710, EPIC_TX_PlanL_1710, and EPIC_TX_PlanN_1710. This plan summary provides only a general description of benefits and limitations. A detailed description of coverage is in the applicable policy. If there is ever a discrepancy between the policy and this document, the policy has final authority.

The EPIC Life Insurance CompanyA WPS Company