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Why Limited Medical Plans? According to The Commonwealth Fund, 69% of adults who spent time uninsured in 2007 were in families where at least one person was working full-time.* * SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2008 CPS. Limited Medical Plans are an affordable alternative to the high cost of major medical coverage. Many employers find it difficult to offer medical benefits to hourly, part-time and seasonal employees, and major medical coverage can prove to be too costly for many working adults. Fidelity Security Life Insurance Company’s (FSL) Limited Medical Indemnity policy is designed to help employers offer their employees a more affordable alternative to a high cost comprehensive major medical plan. It provides basic medical indemnity benefits to employees and their families either because they are not eligible for major medical coverage (i.e. part-time, hourly, temporary and seasonal employees) or they prefer to purchase limited medical coverage for lower premiums. The standard benefit plan includes: Limited Medical Indemnity Benefits: Daily Hospital Indemnity – Sickness/Injury Outpatient Physician Office Visit Outpatient Testing/Diagnostic (X-Ray & Lab) Surgery (Scheduled) & Anesthesiology

Mental/Nervous (same as any other sickness) Substance Abuse (same as any other sickness)

Employee Term Life/AD&D & Dependent Term Life

Outpatient Generic Only or Generic & Brand Formulary Prescription Drug

Optional Benefits (unless required by state): Hospital Admission Wellness Daily Skilled Nursing Ambulance Daily Intensive Care Emergency Room (Injury & Sickness)

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This policy offers 5 pre-packaged plans that are designed to fit the market. We may also customize benefit plans for groups with 500+ eligible employees.

Medical Indemnity Benefit Options Basic Choice Preferred Premier Platinum

Overall Limited Medical Benefit Per Person Calendar Year Max $100,000 $100,000 $100,000 $100,000 $100,000Pre-Existing Condition Limitation (Standard is 12/6/12) Waived if

10+ Enrolled

Waived if 10+

Enrolled

Waived if 10+

Enrolled

Waived if 10+

Enrolled

Waived if 10+

Enrolled Pregnancy - Covered “same as any other illness” Covered Covered Covered Covered Covered

In-Hospital Indemnity Benefits require a minimum 24-hour stay and are payable from the first day of confinement.

Daily Hospital Confinement Benefit - Pays selected indemnity benefit per day of confinement

Option I – Full Benefit – No per confinement limit Option II – Full Benefit – 30 day limit per confinement

Option II

$100

Option II

$200

Option II

$500

Option I

$800

Option I

$1000

Daily Hospital Confinement Benefit for Mental & Nervous Disorders

Pays % of Daily Hospital Confinement Benefit Covered “same as any other illness”

100%

100%

100%

100%

100%

Daily Hospital Confinement Benefit for Substance Abuse

Pays % of Daily Hospital Confinement Benefit Covered “same as any other illness”

100%

100%

100%

100%

100%

Daily Skilled Nursing Benefit

Pays % of Daily Hospital Confinement Benefit Max Per Skilled Nursing stay is 60 days per person. Skilled Nursing stay must follow a covered Hospital stay of at least 3 days and the person must be less than age 65.

N/A

N/A

N/A

50%

50%

Hospital Admission Benefit

Payable once per person per calendar year. Requires 24 hours stay. Paid in addition to Hospital Confinement.

$100

$200

$500

$800

$1000

Daily In-Hospital Intensive Care Unit Benefit

Paid in addition to Daily Hospital Confinement Benefit.

Option I – 30-day Calendar Year Maximum Option II – 10-day Calendar Year Maximum

Option II

$100

Option II

$200

Option II

$500

Option I

$800

Option I

$1000

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Medical Indemnity Benefit Options Basic Choice Preferred Premier Platinum

Surgical Schedule Benefit Inpatient Schedule Max Outpatient Benefit as % of Inpatient Benefit

Pays the benefit amount on the selected surgical schedule for eligible surgical procedures. Calendar Year Max per person is the selected benefit max.

$500 50%

$1000 50%

$1500 50%

$2000 50%

$3000 60%

Anesthesia Benefit – % of surgical benefit amount paid 20% 20% 20% 20% 20%

Ambulance Benefit

Pays selected indemnity benefit per trip. 3 trip max per person per year – 5 trip lifetime max

N/A

N/A

N/A

$50

$100

Outpatient Testing/Diagnostic X-Ray & Lab Benefit Pays selected indemnity benefit per testing day Calendar Year Max – pays the selected benefit per person per testing day up to the selected dollar max per person per calendar year

$30/day $100 max

$50/day $200 max

$75/day $300 max

$100/day$400 max

$150/day$500 max

Outpatient Physician Office Visit Benefit

Pays selected indemnity benefit per office visit

6 visits per person per calendar year

$30

$65

$75

$85

$100

Wellness Benefit

Pays selected indemnity benefit per wellness visit.

Option I – $150 Per Person Calendar Year Max Option II – $300 Per Person Calendar Year Max

Option I

$50

Option I

$75

Option II

$100

Option II

$125

Option II

$150

Emergency Room Benefit - Accident

Pays selected indemnity benefit per occurrence for injury treatment in Emergency Room if performed within 72 hours of the accident.

$300

$500

$500

$1000

$1000

Emergency Room Benefit - Sickness

Pays indemnity benefit equal to selected Physician Office Visit Benefit amount for treatment in Emergency Room due to Sickness. Benefit counts against Office Visit Max. To include, must first select an Outpatient Physician Office Visit & Emergency Room-Accident Benefit.

N/A

N/A

N/A

Include

Include

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Medical Indemnity Benefit Options Basic Choice Preferred Premier Platinum

Employee Term Life & AD&D Benefit

Benefits reduce by 50% at age 70 & another 50% at age 75 Spouse Benefit = 50% of Employee Term Life Benefit Child(ren) age 6 months to 25 years = 25% of Employee Term Life Benefit Age 14 days to 6 months = 2.5% of Employee Term Life Benefit

$5000

$5000

$5000

$5000

$5000

Outpatient Prescription Drug Benefit

Member pays 100% of discounted price for drugs not on the formulary.

Option I – Generic Formulary Option II – Generic/Brand Formulary $10 Generic Formulary Co-Pay $10 Generic Formulary Co-Pay $15 Formulary Oral Contraceptives Co-Pay $15 Formulary Oral Contraceptives Co-Pay Discounted Brand & Non-Formulary Drugs $50 Brand Formulary Co-Pay Discounted Non-Formulary Drugs

Calendar Year Benefit Maximums: Calendar Year Benefit Maximums: $1500 per person $1500 per person

Option I

Option I

Option I

Option II

Option II

3-TIER Basic Choice Preferred Premier Platinum

Rate Assumptions:

Employee (EE) $44.66 $73.77 $103.18 $145.87 $184.76

These rates are for standard rate states only; rates vary for Florida

EE + 1 $84.42 $141.59 $199.36 $281.39 $357.77

These rates are based on Groups of 10 or more eligible employees. EE + 2 or more $115.61 $195.25 $275.72 $389.32 $495.73

A Group must have a minimum participation of 5 enrolled or 10% of the eligible employees, whichever is greater.

4-TIER Basic Choice Preferred Premier Platinum

$30 monthly billing fee will apply in addition to cost of plan.

Employee (EE) $44.66 $73.77 $103.18 $145.87 $184.76

EE + Spouse $88.40 $146.62 $205.44 $290.82 $368.60

EE + Children $78.99 $133.72 $189.01 $265.52 $338.63

EE + Family $124.05 $207.89 $292.59 $410.72 $522.72

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Eligible employees must work an average of 15 hours per week or more and must be listed on the employer’s regular payroll. Eligible employees do not include independent contractors or self-employed workers (pay for services is reported on IRS form 1099.) Employees and/or their dependents are not eligible if they are covered under any other limited medical plan or hospital indemnity plan made available by the employee’s employer, and if coverage under such a plan begins while covered under this plan, coverage under this plan will cease in accordance with the policy terms.

Employees must be Actively at Work on the coverage effective date for coverage to take effect. Coverage is guaranteed issue for all employees and/or dependents that enroll during the initial enrollment period or during Open Enrollment, and for new employees upon satisfaction of any eligibility waiting period imposed by their employer, subject to the plan’s pre-existing condition limitation, if any.

Coverage is terminated when:

The Group policy terminates The premiums remain unpaid (subject to a 31-day grace period) The Insured Person is no longer an eligible employee, dependent spouse, or dependent child.

Commercial Fishing Mining Oil and Gas Extraction Logging and Wood Products Processing Taxicabs Junk and Scrap Dealers Car Washes Farming Explosives, Bombs, Pyrotechnics Asbestos Products Fire Arms & Ammunition

Sports Teams Members of Credit Unions Multiple Employer Welfare Arrangements (MEWAs) Independent Contractors or Self-Employed Workers

(issued 1099s) Taft Hartley or Unions Affinity Groups Associations Professional Employer Organizations (PEOs) Leasing Companies

Temporary Staffing Agencies Casinos

Franchises Religious Organizations

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DAILY HOSPITAL CONFINEMENT INDEMNITY BENEFIT FOR BODILY SICKNESS AND INJURY

Pays a Daily Indemnity Benefit for hospital confinement. Requires a 24-hour hospital stay, but benefits are payable from the 1st day of confinement.

Option I – Full Benefit with no specific calendar year or per confinement limit. Option II - Full Benefit -30 consecutive days per confinement.

MENTAL & NERVOUS BENEFIT Mental or Nervous Disorders are treated the same as any other Sickness. Note: The definition of Sickness in the Definitions section of the Policy is amended to include Mental or Nervous disorders; the Daily Hospital Confinement Benefit is amended to include Confinement in a Qualified Treatment Facility for Mental and Nervous Disorders; and Mental and Nervous Disorders is removed from the Policy Exclusions.

SUBSTANCE ABUSE BENEFIT Substance Abuse (including alcoholism) is treated the same as any other Sickness. Note: The definition of Sickness in the Definitions section of the Policy is amended to include alcoholism and Substance Abuse; the Daily Hospital Confinement Benefit is amended to include treatment received in any facility for the treatment of abuse of alcohol or drugs that is certified by the Bureau of Alcohol and Drug Abuse in the Rehabilitation of the Department of Human Resources or Hospital or other facility licensed by the Health Division of the Department of Employment, Training and Rehabilitation, accredited by the Joint Commission on Accreditation of Hospitals and provides a program for the treatment of abuse of alcohol or drugs as part of its accredited services for; and alcoholism and Substance Abuse is removed from the Policy Exclusions.

DAILY SKILLED NURSING BENEFIT Pays a Daily Indemnity Benefit that is a percentage of the Daily Hospital Confinement Indemnity Benefit up to a maximum of 60 days per person per stay in a Skilled Nursing Facility. Each Skilled Nursing stay must follow a covered hospital stay of at least 3 days and the Insured Person must be less than age 65. A 3 consecutive day Hospital stay is not necessary if the Insured Person is readmitted to a Skilled Nursing Facility within 14 days.

DAILY INTENSIVE CARE CONFINEMENT INDEMNITY BENEFIT This benefit is paid in addition to the Daily Hospital Confinement Indemnity Benefit. Pays a Daily Indemnity Benefit that is a percent of the Daily Hospital Confinement Indemnity Benefit up to a maximum of number of days per person per calendar year for each day of an Insured Person’s Intensive Care Confinement due to Injury or Sickness.

Option I – 30 day calendar year maximum Option II – 10 day calendar year maximum

HOSPITAL ADMISSION INDEMNITY BENEFIT Pays a lump sum benefit after a 24-hour stay in the hospital for Injury or Sickness. This benefit is payable once per person per calendar year and is paid in addition to any other benefits provided.

SURGICAL SCHEDULE INDEMNITY BENEFIT Inpatient: Pays the Benefit Amount shown in the surgical schedule for Inpatient surgical procedures up to the Inpatient Calendar Year Maximum per covered person per Calendar Year. Outpatient: Pays the selected percentage of the Benefit Amount shown in the surgical schedule for Outpatient surgical procedures up to the Outpatient Calendar Year Maximum per covered person per Calendar Year.

ANESTHESIOLOGY INDEMNITY BENEFIT Pays 20% of the Surgical Schedule Benefit paid.

OUTPATIENT TESTING/DIAGNOSTIC PROCEDURE INDEMNITY BENEFIT Benefits are payable for diagnostic X-ray, lab exams, tests and procedures performed on an Insured Person. This includes services provided by a Physician to interpret the results. These tests must be Medically Necessary for the Insured Person’s Injury or Sickness and ordered by the Insured Person’s attending Physician. Pays an indemnity benefit per person per testing day up to the selected maximum payable per person per calendar year.

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Option I - $ Calendar Year Max - pays the selected benefit per person per testing day up to the selected dollar max per person per calendar year Option II - # days Calendar Year Max - pays the selected benefit per person per testing day with a maximum of 3 testing days per person per calendar year.

OUTPATIENT PHYSICIAN OFFICE VISIT INDEMNITY BENEFIT Indemnity benefits are payable for Outpatient Physician Office Visits in which Confinement is not required and treatment for Injury or Sickness is performed in the Physician's Office. The maximum payable per person per calendar year may be:

Option I - 6 visits per person per calendar year Option II - $500 per person per calendar year

The Medical Emergency Option for Sickness includes benefits for medical emergency treatment in an emergency room for Sickness. The benefit equals the Outpatient Physician Office Visit Benefit and counts against the Outpatient Physician Office Visit Benefit Calendar Year Maximum (see Medical Emergency Benefit).

MEDICAL EMERGENCY BENEFIT (EMERGENCY ROOM) An indemnity benefit is payable for Physician’s services, medical treatment and supplies if an Insured Person requires treatment in a Hospital Emergency room due to a covered Sickness or Accident/Injury. Any emergency treatment must be performed within 72 hours of the Accident.

Accident/Injury: A benefit equal to the selected indemnity amount is payable per visit. Sickness: A benefit equal to the Outpatient Physician Office Visit Benefit indemnity amount is payable. The benefit paid will count against the Outpatient Physician Office Visit Benefit Calendar Year Maximum.

WELLNESS INDEMNITY BENEFIT Pays an indemnity benefit per visit for routine physical exams, Prostate Cancer Screening services, mammography, routine pap smears and related laboratory charges, and well-child care including immunizations for children up to age 6. The maximum payable per person per calendar year may be:

Option I - $150 Per Person Calendar Year Max Option II - $300 Per Person Calendar Year Max

AMBULANCE INDEMNITY BENEFIT Pays an indemnity benefit per run. Benefits are payable for professional transportation furnished by a duly licensed ambulance service to the nearest facility equipped to treat an Insured Person’s Injury or Sickness. This does not include transportation solely to the Insured Person’s personal Physician, or to secure treatment from a Physician, or a facility of greater renown. Air transportation is payable only if Medically Necessary and to the nearest facility equipped to handle the Insured Person’s Injury or Sickness. Benefits are limited to 3 times the benefit amount per person per calendar year with a per person lifetime maximum of 5 times the benefit amount.

OUTPATIENT PRESCRIPTION DRUG BENEFIT This benefit is automatically included in each Limited Medical Indemnity Plan. Member pays 100% of discounted price for drugs not on the formulary. Members receive up to a 40% discount off of brand and non-formulary drugs. Calendar Year Benefit Maximum: $1500 per person

Option 1: $10 Generic Formulary Co-pay $15 Co-pay for Generic Oral Formulary Contraceptives Option 2: $10 Generic Formulary Co-pay with $50 Brand Formulary Co-pay $15 Co-pay for Oral Formulary Contraceptives

EMPLOYEE TERM LIFE & AD&D BENEFIT This benefit is automatically included in each Limited Medical Indemnity Plan. The Employer may choose to include either $5,000, $10,000, $15,000, or $20,000 of Life and AD&D coverage for each covered employee. Benefits reduce by 50% at age 70 and another 50% at age 75.

DEPENDENT TERM LIFE BENEFIT This benefit is automatically included for dependents who are insured under the Limited Medical policy. Spouse coverage equals 50% of the employee’s term life insurance amount; child coverage equals 25% of the employee’s term life insurance amount if age 6 months and up

and 2.5% for infants who are ages 14 days to 6 months. Dependent life coverage terminates when base medical coverage eligibility ceases.

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The Overall Calendar Year Maximum Benefit payable for all medical benefits combined, regardless of plan is $100,000. This does not include Life/AD&D or Outpatient Prescription Drug benefits.

Coordination of Benefits does not apply to this product; benefits are not limited by amounts paid under other insurance plans.

Pre-Existing Conditions Limitation: For groups with less than 10 enrolled lives, a Pre-Existing Conditions Limitation will apply. A Pre-Existing Condition is an Injury or Sickness for which medical treatment or advice was rendered or recommended by a Physician within 12 months prior to the Effective Date of the Insured Person’s coverage. The Injury or Sickness will no longer be considered Pre-Existing after the earlier of the following occurrences: 1) the expiration of 6 consecutive months commencing on and ending after the Effective Date of the Insured Person’s coverage during which period there has been no medical treatment or advice rendered or recommended for such Injury or Sickness; or 2) the expiration of 12 consecutive months from the Effective Date of the Insured Person’s coverage.

THIS IS NOT BASIC HEALTH INSURANCE OR COMPREHENSIVE MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR COMPREHENSIVE MAJOR MEDICAL INSURANCE.

Notwithstanding any provision in the Policy to the contrary, the Policy does not provide any Benefits for the following charges, services or supplies: 1. suicide or any attempt of suicide, while sane or insane (while sane in Colorado or Missouri); 2. any intentionally self-inflicted Injury or Sickness or any attempt thereat (while sane in Colorado or Missouri); 3. participation in a riot, insurrection, rebellion, civil commotion, civil disobedience, or unlawful assembly. For purposes of this exclusion, “participation” means to take an active part in common with others; “riot” means any use or threat to use force or violence or disturbance by three or more persons without authority of law. This does not include a loss, which occurs while acting in a lawful manner within the scope of authority; 4. committing, attempting to commit, or taking part in a felony, battery, assault, or engaging in an illegal occupation; 5. participation in a contest of speed in power driven vehicles, parachuting, parasailing, bungee jumping, scuba diving, stunt driving, rock climbing, flying ultra-light aircraft, skydiving, or hang gliding or any hazardous sports activity for exhibition purposes; 6. flying as a pilot, crew member, or a passenger in any aircraft, except as a fare-paying passenger in any regularly scheduled commercial aircraft flying between established airports on a regularly scheduled route. 7. any Accident occurring while the Insured Person is intoxicated (where the blood alcohol content meets the legal presumption of intoxication under the law of the state where the Accident took place); 8. declared or undeclared war or acts thereof; 9. Accident or Sickness arising out of or in the course of any occupation for compensation, wage or profit or Benefits which the Insured Person is entitled to under any Workers’ Compensation Law, Occupational Disease Law or similar law, whether or not application for such Benefits have been made; 10. accidental bodily Injury occurring while serving on full-time active duty in any Armed Forces of any country or international authority (any premium paid will be returned by the Company pro-rata for any period of active duty); 11. charges for the treatment of: a) codependency; b) social, occupational or religious maladjustment; c) compulsive gambling; d) chronic marital or family problems when not related to the primary focus of treatment which must be a diagnosable mental disorder; (Note: Exclusion #11 is expanded to exclude Mental & Nervous Disorders, alcoholism and substance abuse if the policy is issued without such coverage.) 12. unless specifically provided for in the Policy, charges for the treatment of: a) Mental or Nervous Disorder; b) alcoholism; c) the voluntary taking of any poison or inhalation of gas, or voluntary taking of any drug, sedative or narcotic, unless prescribed by a Physician and taken according to the prescribed dosage; d) substance abuse; 13. unless specifically provided for in the Policy, rest care or rehabilitative care and treatment; 14. cosmetic surgery or care or treatment solely for cosmetic purposes or complications from such surgery, care or treatment. This includes but is not limited to: reconstructive surgery and prosthetic devices, unless due to an Accident and performed within one year from the Accident or to repair a congenital or abnormal defect of a newborn child, while covered under the Policy; 15. unless specifically provided for in the Policy, immunization shots and routine examinations such as: health exams, periodic check-ups, pre-marital exams, and routine physicals, unless they are necessary for the diagnosis and treatment of a Sickness;

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16. routine newborn care such as Hospital and Physician services during Hospital Confinement immediately following birth. Payment for routine Physician’s services will be limited to one routine Inpatient examination of the well newborn child performed by a Physician other than the Physician who delivered the baby or administered anesthesia during delivery; 17. voluntary abortion, except with respect to the Eligible Employee or covered Dependent spouse: a) where such person’s life would be endangered if the fetus were carried to term; or b) where medical complications have arisen from an abortion; 18. the reversal of tubal ligation and vasectomies; 19. charges for treatment of male or female infertility; artificial insemination, in vitro or in vivo fertilization, including any related testing, medications or Physician’s services; 20. Dependent child maternity; 21. sex changes; 22. treatment of obesity, weight reduction or dietetic control; except morbid obesity or disease etiology; 23. charges for Outpatient food, food supplements or vitamins; 24. charges for services in the nature of educational or vocational testing or training; 25. charges related to smoking cessation; 26. Pre-Existing Conditions, except as described in the Schedule of Benefits 27. unless specifically provided for in the Policy, air, water or ground ambulance service; 28. charges for treatment or services for temporomandibular joint dysfunction or TMJ pain syndrome, orofacial, or myofacial syndrome whether medical or dental in scope; 29. with regard to any Outpatient benefit, visits made, examinations given, or x-rays or laboratory tests performed as an in-patient while Confined to a Hospital; 30. unless specifically provided for in the Policy, prescription drugs; 31. routine eye examinations, refractions, eyeglasses, or their fitting; 32. any procedure intended to enhance an Insured Person’s quality of vision that is not essential to the treatment of a Sickness or Injury; 33. hearing aids or their fitting; 34. dental examinations, dental care or oral surgery other than expenses resulting from accidental Injury; 35. experimental or investigational treatments or surgery; 36. unless specifically provided for in the Policy, diagnostic and surgical procedures, including but not limited to, diagnostic laboratory and pathology procedures, diagnostic radiology, nuclear medicine and ultra sound procedures; 37. charges for stand-by surgeons, pediatricians, anesthesiologists, anesthetists, or other doctor as defined by the plan, or stand-by supplies, equipment, rooms, or any other service, supply or treatment not actually used in the care or treatment of an Accident or Sickness; 38. charges made by, durable equipment recommended by, or drugs dispensed by; a physician, surgeon, nurse or other doctor who: a) normally lives with the Insured Person; b) is a member of the Insured Person’s family; c) is the Insured Person’s plan sponsor; 39. charges for services provided outside the scope of the license of the institution or practitioner rendering service; 40. any charge for which there is no legal obligation to pay; no charge is made; or in the absence of coverage, no charge would be made; 41. charges incurred prior to the Insured Person’s Effective Date of coverage or after termination of coverage; 42. charges for care or services furnished by any agency or program funded by federal, state or local government. This does not apply to Medicaid or where prohibited by law; 43. charges which are not Medically Necessary for treatment of an Accident or Sickness; 44. charges for services which are not related to and consistent with the treatment of any Accident or Sickness of the Insured Person; 45. charges for medical care, services or supplies which are not furnished or prescribed by a Physician; 46. charges for care, treatment, services or supplies that are not approved or accepted for the treatment of an Injury, Accident or Sickness by any of the following: a) The American Medical Association; b) The U.S. Surgeon General; c) The U.S. Department of Public Health; and d) The National Institutes of Health; 47. charges in excess of the plan maximums as shown in the Schedule of Benefits; 48. any charge for a service or supply not specifically covered in the Schedule of Benefits; 49. unless specifically provided for in the Policy, charges for Intensive Care.

No Benefit will be payable for any Accidental Death or Dismemberment Loss caused by or contributed to by: 1. Sickness, bodily or mental health or diagnostic medical or surgical treatment;

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2. infection, except pyogenic infections resulting from an Accidental Bodily Injury or resulting from the accidental ingestion of a contaminated substance; 3. attempted suicide or intentional self-inflicted Injury or Sickness while sane or insane (while sane in Colorado or Missouri); 4. declared or undeclared war or acts thereof; 5. military service for any country or organization, including service with military forces as a civilian whose duties do not include combat; war or any act of war whether declared or undeclared. Upon notice to the Company of entering the Armed Forces, the Company will return to the Insured, pro rata any premium paid, less any Benefits paid, for any period during which the Insured is in such service; 6. Participation in a Riot or insurrection. “Participation” means taking an active part in common with others. “Riot” means any use or threat to use force or violence by three or more persons without authority of law; 7. Insured’s commission or attempted commission of a felony, assault or illegal action; 8. voluntary taking of any poison, drug, sedative or narcotic, or inhalation of any kind of gas unless prescribed by a Physician and taken according to the prescribed dosage; 9. legal intoxication where the blood alcohol content of the Insured exceeds the legal limit of the state in which the Accident took place; 10. an on-the-job Injury that is covered by Workers’ Compensation; or 11. participation in any non-occupational activity in which the Insured purposely exposes the Insured to an increase in Accidental Bodily Injury. These activities include, but are not limited to: a) belaying and repelling rock climbing; b) flying ultra-light aircraft; c) hang-gliding, skydiving, scuba diving, para-sailing; d) motorized vehicle stunt driving, racing, jumping, drag racing and demolition; e) bungee jumping; f) any hazardous activity for exhibition purposes; or g) flying as a pilot, crew member or passenger in any aircraft, except as a fare-paying passenger in any regularly scheduled commercial aircraft flying between established airports on a regularly scheduled route.

Prescription Drug benefits are not payable for the following items except as set forth above: 1. all over-the-counter products and medications unless shown under the definition of Prescription Drug. This includes, but is not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements and all other over-the-counter products and medications; 2. blood glucose meters; insulin injecting devices; 3. Depo-Provera; levonorgestrel; condoms, contraceptive sponges and spermicides; sexual dysfunction drugs; 4. biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS injectables; immunizations; all other injectables unless shown under the definition of Prescription Drug; 5. Aerochamber, Aerochamber with Mask; Peak Flow Meter; all other medical supplies and durable medical equipment unless shown under the definition of Prescription Drug; 6. liquid nutritional supplements; pediatric Legend Drug vitamins; prenatal Legend Drug vitamins; prescribed versions of Vitamins A, D, K, B12, Folic Acid and Niacin used in treatment versus as a dietary supplement; all other Legend Drug vitamins and nutritional supplements; 7. Anorexiants; any cosmetic drugs including, but not limited to, Renova, skin pigmentation preps; any drugs or products used for the treatment of baldness; topical dental fluorides; 8. refills in excess of that specified by the prescribing Physician; or refills dispensed after one year from the original date of the prescription; 9. any drug labeled “Caution - Limited by Federal Law for Investigational Use” or experimental drugs; 10. any drug that the FDA has determined to be contraindicated for the specific treatment; 11. drugs needed due to conditions caused, directly or indirectly, by an Insured Person taking part in a riot or other civil disorder; or the Insured Person taking part in the commission of a felony; 12. drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or an act of war; or drugs dispensed to an Insured Person while on active duty in any Armed Forces; 13. any expenses related to the administration of any drug; 14. needles or syringes unless shown under the definition of Prescription Drug; 15. drugs or medicines taken while in or administered by a hospital or any other health care facility or office; 16. drugs covered under Workers’ Compensation, Medicare, Medicaid or other Governmental program; 17. drugs, medicines or products that are not Medically Necessary; 18. Brand Name Prescription Drugs; 19. Diaphragms; Erectile dysfunction Legend Drugs, unless specifically listed in the definition of Prescription Drug; Infertility Legend Drugs; 20. Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; Imitrex-auto injection; or smoking deterrents, Legend or over-the-counter.

129/2011

This brochure contains a brief description of the plans of insurance offered to qualified employers. The exact provisions governing the insurance are contained in the master policy issued to each group on policy no. LM-120, LM-121; form no. M-6005. Not available in all states. Some benefits, provisions, exclusions, or limitations listed may vary depending on your state of residence.

UNDERWRITTEN BY:

FIDELITY SECURITY LIFE INSURANCE COMPANY Kansas City, Missouri

Rated A– Excellent, based on an analysis of financial position and operating performance, by A.M. Best Company, an

independent analyst of the insurance industry.

ARRANGED/ADMINISTERED BY:

Special Insurance Services, Inc. 2740 Dallas Pkwy, Suite 100

Plano, Texas 75093 (972) 788-0699 Phone

(972) 960-0377 Fax marketing@specialinc.com www.specialinc.com

MARKETED BY: