CONTINENTAL LIFE INSURANCE COMPANY

1 CONTINENTAL life INSURANCE COMPANY OF BRENTWOOD, TENNESSEE 101 CONTINENTAL Place, Brentwood, Tennessee 37027 Toll Free 1-800-264-4000 LIMITED BENEFIT POLICY HOSPITAL AND SKILLED NURSING FACILITY CONFINEMENT INDEMNITY THIS IS NOT A MEDICARE SUPPLEMENT POLICY If you are eligible for Medicare, review the Guide to Health INSURANCE for People with Medicare available from the COMPANY . OUTLINE OF COVERAGE FOR POLICY FORM HIS-96 RETAIN THIS OUTLINE FOR YOUR RECORDS READ YOUR POLICY CAREFULLY: This outline of coverage provides a very brief description of the important features of your policy.

2 This is not the INSURANCE contract. Only the actual policy provisions will control. The policy sets forth in detail the rights and obligations of both you and your INSURANCE COMPANY . It is therefore important that you READ YOUR POLICY CAREFULLY! Limited Benefit Coverage: Policies of this type are designed to provide, to persons insured, limited or supplemental coverage. This policy does not provide any benefits other than the coverage described below. BENEFITS: A. Hospital Indemnity $_____ for the first day of confinement in each Period of Care.

3 B. Private Hospital Room Indemnity An additional $ for each day of confinement in a private hospital room subject to a maximum of 90 days per Period of Care. C. Private Nurse In-Hospital, Skilled Nursing Facility or In-Home) Indemnity $30 per shift, maximum of two shifts per day, not to exceed 30 days per Period of Care for medically necessary services of a Private Nurse during hospital confinement. D. Skilled Nursing Facility (SNF) Indemnity After a _____day elimination period, $_____ per day for each day of confinement in a Skilled Nursing Facility, subject to a maximum of 90 days for each Period of Care.

4 E. Daily Hospital Indemnity $_____ per day for each day of confinement subject to a maximum of 90 days for each Period of Care. F. Waiver of Premium After 8 continuous weeks of hospital confinement during which benefits are paid under this policy, monthly premiums will be waived during further confinement. OC/HIS-96 (OK) (OVER) LMK1798B Page 2 EXCLUSIONS AND LIMITATIONS: We will not pay for losses resulting from or expenses of: 1.

5 Injuries or Sicknesses caused by or contributed to by war or any act of war (whether declared or undeclared) or service in the armed forces of any country; 2. Mental or emotional disorders (such as neurosis, psychoneurosis, psychopathy, psychosis,or personality disorder) without demonstrable organic disease.(Alzheimer's disease is not excluded); 3. Alcoholism or drug addiction, except where administered by a Physician; 4. Suicide or any suicide attempt while sane or insane or any intentionally self-inflicted injury; 5. Care received outside the territorial limits of the United States or its possessions; 6.

6 Service rendered by any agency of the Federal or State government (except Medicaid) unless You are legally obligated to pay for such service (Medicare is not excluded); 7. Dental operations or dental treatment, except expenses otherwise covered due to injury to sound natural teeth; 8. Normal pregnancy; or 9. Eyeglasses and hearing aids (and examinations for them), ordinary dental care and dentures, orthopedic shoes, cosmetic plastic surgery, except for reconstructive surgery which is incidental to or follows surgery.

7 10. Pre-existing conditions are not covered unless the loss begins more than three (3) months after the Effective Date. RENEWABILITY: We guarantee to renew this policy during your lifetime as long as you pay the renewal premiums on time, either in advance or during the grace period. We may change the premium rates. A premium change must affect all policies of the same form number of the state in which you live, and minimum of 30 days notice will be given. A change will apply on the next due date after we notify you. Each premium will be computed by the sex and age shown in the application.

8 PREMIUM: Annual - $_____ Semi-Annual - $_____ Quarterly - $_____ Monthly - $_____ There is a one time only policy fee of $_____ Premiums are subject to change. There is a 31 day grace period during which you can pay the premium. The policy stays in force during the grace period.