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Continental Life Insurance Company of Brentwood, Tennessee

Outline of CoverageMedicare Supplement InsuranceUnderwritten by Continental life Insurance Company of brentwood , Tennessee An Aetna Company 800 Crescent Centre 200 Franklin, TN 37067800 life Insurance Companyof brentwood , Tennessee An Aetna CompanyBENEFIT PLANS A, B, F, High Deductible F, G, NTexasCLIMS01625TX 2016 Aetna 01012016 Continental life Insurance Company OF brentwood , Tennessee OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE: Page 1 of 2 BENEFIT PLANS AVAILABLE: A, B, F, HIGH DEDUCTIBLE F, G, N These charts show the benefits included in each of the standard Medicare supplement plans. Every Company must make available Plan A. Some plans may not be available in your state.

Outline of Coverage Medicare Supplement Insurance Underwritten by Continental Life Insurance Company of Brentwood, Tennessee An Aetna Company 800 Crescent Centre Dr.

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Transcription of Continental Life Insurance Company of Brentwood, Tennessee

1 Outline of CoverageMedicare Supplement InsuranceUnderwritten by Continental life Insurance Company of brentwood , Tennessee An Aetna Company 800 Crescent Centre 200 Franklin, TN 37067800 life Insurance Companyof brentwood , Tennessee An Aetna CompanyBENEFIT PLANS A, B, F, High Deductible F, G, NTexasCLIMS01625TX 2016 Aetna 01012016 Continental life Insurance Company OF brentwood , Tennessee OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE: Page 1 of 2 BENEFIT PLANS AVAILABLE: A, B, F, HIGH DEDUCTIBLE F, G, N These charts show the benefits included in each of the standard Medicare supplement plans. Every Company must make available Plan A. Some plans may not be available in your state.

2 Basic Benefits: Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. Medical Expenses: 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 coinsurance or copayments Blood: First three pints of blood each year. Hospice-Part A coinsurance A B C D F/F* G K L M N Basic, including 100% Part B coinsurance Basic, including 100% Part B coinsurance Basic, including 100% Part B coinsurance Basic, including 100% Part B coinsurance Basic, including 100% Part B coinsurance* Basic, including 100% Part B coinsurance Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Hospitalization and preventive care paid at 100%.

3 Other basic benefits paid at 75% Basic, including 100% Part B coinsurance Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance 50% Skilled Nursing Facility Coinsurance 75% Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible 50% Part A Deductible 75% Part A Deductible 50% Part A Deductible Part A Deductible Part B Deductible Part B Deductible Part B Excess (100%) Part B Excess (100%)

4 Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Out-of-pocket limit $4960; paid at 100% after limit reached Out-of-pocket limit $2480; paid at 100% after limit reached *Plans 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 $2180 deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed $2180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy.

5 These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan s separate foreign travel emergency deductible. CLIMS01625TX 01012016 AttainedPreferredAttainedStandard AgePlan APlan BPlan FPlan HFPlan GPlan NAgePlan APlan BPlan FPlan HFPlan GPlan NUnder 657,828 n/an/an/an/an/aUnder 658,697 n/an/an/an/an/a 651,498 1,542 1,829 669 1,275 1,142 651,663 1,711 2,032 743 1,417 1,270 661,498 1,542 1,829 669 1,275 1,142 661,663 1,711 2,032 743 1,417 1,270 671,498 1,542 1,829 669 1,275 1,142 671,663 1,711 2,032 743 1,417 1,270 681,569 1,618 1,921 703 1,337 1,199 681,745 1.

6 796 2,132 782 1,487 1,334 691,641 1,688 1,994 729 1,398 1,254 691,823 1,876 2,218 813 1,555 1,394 701,708 1,758 2,067 758 1,454 1,303 701,895 1,953 2,298 840 1,612 1,449 711,771 1,824 2,140 783 1,509 1,352 711,969 2,026 2,377 869 1,676 1,503 721,832 1,885 2,206 806 1,561 1,401 722,037 2,096 2,451 898 1,734 1,556 731,891 1,947 2,268 830 1,609 1,443 732,100 2,162 2,519 922 1,791 1,604 741,945 2,002 2,322 851 1,657 1,486 742,160 2,225 2,582 946 1,840 1,651 751,994 2,054 2,377 869 1,699 1,524 752,215 2,282 2,642 966 1,888 1,691 762,039 2,100 2,423 888 1,737 1,558 762,268 2,333 2,691 986 1,930 1,731 772,082 2,145 2,463 902 1,774 1,593 772,314 2,382 2,738 1,003 1,972 1,771 782,125 2,187 2,502 917 1,809 1,623 782,359 2,429 2,782 1,019 2,010 1.

7 802 792,160 2,225 2,538 929 1,840 1,650 792,400 2,473 2,820 1,032 2,045 1,832 802,194 2,259 2,568 942 1,870 1,677 802,439 2,512 2,855 1,045 2,079 1,865 812,225 2,292 2,602 953 1,896 1,702 812,475 2,547 2,892 1,059 2,108 1,891 822,256 2,324 2,637 965 1,923 1,725 822,507 2,583 2,929 1,074 2,137 1,917 832,284 2,354 2,667 978 1,946 1,747 832,540 2,617 2,965 1,086 2,164 1,940 842,314 2,382 2,698 988 1,971 1,771 842,569 2,647 2,998 1,096 2,192 1,964 852,343 2,410 2,729 999 1,995 1,789 852,601 2,678 3,034 1,110 2,216 1,987 862,369 2,438 2,758 1,009 2,017 1,809 862,632 2,709 3,065 1,121 2,243 2,010 872,392 2,463 2,785 1,020 2,038 1,827 872,658 2,737 3,095 1,133 2,264 2,031 882,415 2,487 2,812 1,029 2,060 1,847 882,684 2,765 3,121 1,143 2,289 2,050 892,439 2,512 2,832 1,037 2,079 1,865 892.

8 709 2,790 3,149 1,153 2,308 2,070 902,460 2,533 2,858 1,047 2,096 1,881 902,736 2,815 3,174 1,162 2,330 2,088 912,481 2,555 2,881 1,055 2,115 1,896 912,757 2,837 3,197 1,171 2,349 2,106 922,501 2,576 2,898 1,061 2,130 1,910 922,778 2,861 3,223 1,180 2,367 2,123 932,519 2,593 2,918 1,067 2,144 1,923 932,798 2,881 3,242 1,187 2,384 2,138 942,535 2,609 2,933 1,074 2,159 1,935 942,816 2,900 3,258 1,194 2,399 2,153 952,547 2,623 2,946 1,080 2,172 1,946 952,832 2,915 3,274 1,198 2,413 2,167 962,565 2,639 2,964 1,086 2,184 1,958 962,849 2,933 3,291 1,205 2,427 2,176 972,579 2,654 2,977 1,093 2,198 1,970 972,866 2,952 3,307 1,212 2,440 2,187 982,594 2,671 2,993 1,096 2,209 1,980 982,882 2,968 3,326 1,219 2,455 2,201 992,609 2,685 3,006 1,099 2,223 1,994 992,899 2,987 3,343 1,224 2,470 2,215 Modal Factors.

9 Semi- above rates do not include the $20 application fee. To calculate a Household discount: Annual premium x modal factor = modal premium (round to nearest whole cent) Modal premium x .95 = discounted premium If applying during Open Enrollment or Guaranteed Issue Period, use Preferred RatesContinental life Insurance Company of brentwood , TennesseeAnnual Attained Age PremiumsFor Use in ZIP Codes: 733, 750-753, 760, 761, 774, 776, 777, 782, 784, 793, 794 CLIMS01625TX 01012016 AttainedPreferredAttainedStandard AgePlan APlan BPlan FPlan HFPlan GPlan NAgePlan APlan BPlan FPlan HFPlan GPlan NUnder 659,003 n/an/an/an/an/aUnder 6510,007 n/an/an/an/an/a 651,720 1,772 2,105 771 1,466 1,313 651,910 1,967 2,338 856 1,628 1,461 661,720 1,772 2,105 771 1,466 1,313 661,910 1,967 2,338 856 1,628 1,461 671,720 1,772 2,105 771 1,466 1,313 671,910 1,967 2.

10 338 856 1,628 1,461 681,807 1,860 2,206 806 1,536 1,380 682,007 2,067 2,454 898 1,709 1,533 691,888 1,944 2,294 841 1,608 1,441 692,095 2,157 2,548 933 1,786 1,602 701,962 2,021 2,378 871 1,671 1,500 702,179 2,245 2,642 966 1,857 1,666 712,037 2,096 2,460 900 1,734 1,556 712,260 2,329 2,735 1,001 1,927 1,728 722,106 2,170 2,538 929 1,795 1,610 722,343 2,410 2,820 1,032 1,994 1,789 732,172 2,236 2,605 953 1,853 1,661 732,414 2,486 2,896 1,060 2,057 1,845 742,236 2,302 2,676 980 1,906 1,708 742,484 2,558 2,969 1,088 2,116 1,900 752,292 2,360 2,735 1,001 1,954 1,753 752,547 2,623 3,038 1,112 2,169 1,945 762,345 2,414 2,785 1.


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