Hospital Indemnity Insurance Policy - GTL

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A DV A NT A G E PL U S H OSPITA L INDEM N ITY IN SUR AN CE P OLIC YHELP PAY FOR OUT-OF-POCKETEXPENSES ASSOCIATED WITH: DAILY HOSPITAL CONFINEMENT AMBULANCE TRIPS CANCER DENTAL/VISION SHORT DURATION HOSPITAL STAYS OUTPATIENT SURGERY SKILLED NURSING FACILITY CRITICAL ACCIDENTSAccess toonline symptomassessment service. Hospital Indemnity Insurance PolicyUNDERWRITTEN BY:Guarantee Trust Life Insurance CompanyGAD255-18GUARANTEE TRUST LIFE INSURANCE COMPANY (GTL)1275 Milwaukee Avenue, Glenview, IL 60025www.gtlic.com 800.338.7452(Rev. 10/18) 15B473

YOUR HEALTHINSURANCECOVERAGE MAYLEAVE YOU WITHSUBSTANTIALOUT-OF-POCKETEXPENSESHere’s a simple and moreaffordable solution to helpcover these costs!ADVANTAGE PLUS WILL PAY YOU* BENEFITS FOR:Hospital ConfinementObservation Stay CoveredThe base plan benefit will pay you a daily benefit shouldyou be confined to a hospital. Choose the base planand a daily hospital confinement benefit amount thatworks best for you. Whichever base plan you select, itwill restore fully and for an unlimited amount of times,after 60 days of no hospital confinement.Base Plan Choices:Daily Benefit Amount1-Day3-Day6-Day10-Day21-Day 1,000 to 2,500 350 to 750 250 to 750 100 to 750 100 to 750People are surprised when a hospital codes a hospitalstay as “under observation” after a hospital confinement.This simple change in a hospital status can impact yourhealth insurance benefits. Rest assured that GuaranteeTrust Life’s Advantage Plus base plan will pay full dailybenefits if your 24-hour hospital stay is coded as aninpatient or as “under observation”.Emergency Room BenefitsThis benefit will pay you 150 if you are admitted toa hospital within 24 hours following an emergencyroom visit due to accident or injury (not available in GA).Mental Health BenefitsCoverage benefits for short duration hospital staysof 12 to 24 hours are included in both the 3-Day and6-Day benefit base plans. The 1-Day benefit base planincludes a 25% short duration hospital stay benefit for12 to 24 hour stays.ALSO AVAILABLE: Add the Short Duration HospitalStay rider to your 10-Day or 21-Day base plan in orderto receive benefits for Short Duration Hospital Stays of12 to 24 hours.Your policy will pay 175 per day for up to seven days ifyou are confined to a hospital for a mental or nervousdisorder. This benefit is in lieu of the hospital confinementbenefit for sickness or injury, not in addition.Benefits are paid directly toyou so you* can use the fundsany way you choose.*We will pay you or your assigned benefit designee. Guaranteed Issue for Ages 64 ½ to 65 ½and simple yes or no application for others. Guaranteed renewable for lifeas long as your premiums are paid on time.

MORE GREAT BENEFITS TO CHOOSE FROM:Cancer Lump Sum Benefit Rider*The Lump Sum Cancer Rider will pay you your chosencash benefit of 2,500, 5,000, 6,700, 10,000, 15,000 or 20,000 should you be diagnosed withcancer. It includes a 25% benefit for Cancer In Situand a 500 payment for Basal cell/Squamous cellskin carcinoma (Recurrence benefit also available;not available in GA.)Critical Accident Benefit RiderAfter an Emergency Room visit, this rider will pay a lumpsum benefit for the following types of accident injuries:Covered Event 5,000 Plan 10,000 PlanAccidental Death 5,000 10,000Hip or Skull Fracture 1,250 2,500Hip Dislocation 1,000 2,000Knee Dislocation orKnee Ligament Tear 500 1,000Fracture, Other 250 500(The Cancer Lump Sum Benefit and Critical AccidentBenefit Riders have a 30-day waiting period.)Skilled Nursing Facility Benefit Rider**– Choose from 2 optionsOPTION 1: This rider will pay 100, 150 or 200per day for days 1 through 50 if you are confined toa skilled nursing facility. This benefit applies if youare admitted to a skilled nursing facility after havingbeen confined to a hospital for three consecutivedays. We will pay benefits as long as confinementoccurs within 30 days of hospitalization. See policyfor exclusions and limitations.OROPTION 2: This rider will pay 120 per day fordays 21-100 if you are confined to a skilled nursingfacility. This benefit applies if you are admitted to askilled nursing facility after having been confined toa hospital for three consecutive days. We will paybenefits as long as confinement occurs within 30days of hospitalization.** Both benefit options restore after 60 days of noconfinement in a hospital or skilled nursing facility.(Riders not available in MS; Option 1 not available in KY; Option 2 notavailable in LA; in IA, Skilled Nursing refers to Nursing Facility Benefit; inWI, not available if eligible for Medicare).*EXCLUSIONS: You will be eligible for benefits under the cancer rider if all of the following conditions are met: cancer is first diagnosed and treated while insured under this rider; loss due to firstdiagnosed cancer is incurred while insured under this rider and not excluded from coverage under the policy’s pre-existing condition provision; and loss is the result of cancer covered under this rider.Please consult your policy for definitions. This rider is not available in all states. Please refer to your outline of coverage for exclusions and limitations (in GA, Cancer Rider is “First Diagnosis Lump SumCancer Rider”; in MS and SD, no “First Diagnosis” cancer language).Definition of Cancer: Cancer means an internal disease that is identified by the presence of a malignant tumor characterized by the uncontrolled growth and spread of malignant cells andthe invasion of body tissue by such malignant cells. Cancer includes, but is not limited to, leukemia, Hodgkin’s disease or malignant melanoma. Excluded are pre-malignant tumors or polyps. Limitedbenefits are available for Cancer In Situ and Skin Cancer. Cancer In Situ is an early stage Cancer that involves only the site of origin and which has not spread beyond the organ or tissue in which itoriginated. Skin Cancer means a squamous cell or basal cell skin carcinoma.

Ambulance Benefit RiderShort Duration Hospital Stay Benefit RiderThis rider will pay a chosen benefit of 50 to 400 perambulance ride to or from a hospital. It is payableonce per day, up to four times per year and subjectto a lifetime maximum of 12 trips. No hospitalconfinement is required.This rider is available for those with a 10 or 21-Daybenefit period. It is included in the 1, 3 or 6-Daybenefit period plans. It pays for a short hospital stayof 12 to 24 hours if you are admitted to a hospital fora covered sickness or injury. This includes time spentin a hospital as an inpatient, under observation or asan outpatient in the emergency room. The Short StayBenefit Rider will pay 25% of the 1-Day benefit periodamount selected (not available in SD.)Dental and Vision Benefit RiderThe Dental/Vision Rider will pay you an annual benefitof up to 400, 800 or 1,200 for services performedby a licensed dentist, ophthalmologist or optometristafter the first year, including 200 for prescriptioneye glasses or contact lenses (not available in GA,NM, ND, TN).(The Dental/Vision Rider has a 3 month waitingperiod.)Outpatient Surgical Benefit RiderThis rider will pay 250, 500, 750 or 1,000 fora surgical procedure performed in an ambulatorysurgical center or outpatient hospital facility. Thissurgical indemnity is payable no more than two timesper year (not available in AZ, IA).BENEFITS NEEDS ESTIMATORYOUR HEALTH PLAN OUT-OF-POCKET COSTSGTL BENEFITHospital Confinement Daily Co-Pay x days GTL PREMIUMAmbulance Service Co-PayRadiation/Chemotherapy Max. Out-of-pocketSkilled Nursing Facility Daily Co-Pay x days Outpatient Surgical Co-PayDental/Vision Average Monthly CostsPotential Out-of-Pocket Costs GTL PremiumGUARANTEE TRUST LIFE INSURANCE COMPANYExperience You Can Trust - With more than 80 years of experience in the insurance industry, GuaranteeTrust Life Insurance Company has a proud heritage of providing excellent service and superior insuranceproducts. Guarantee Trust Life is a mutual legal reserve company located in Glenview, Illinois and licensed toconduct business in 49 states and the District of Columbia.

ACCESS TO ASK MAYO CLINIC ONLINE!With Ask Mayo Clinic online,you will have access to answersthat are time-saving, costsaving and potentially lifesaving – right at your fingertips!HOW IT WORKSAsk Mayo Clinic’s on-demand,private and secure web-based tool provides aneasy assessment of over 300 common symptoms.Instead of spending hours searching theinternet for answers to your health-relatedquestions, policyholders have 24/7 access to AskMayo Clinic online for answers to important healthquestions - anytime, anywhere!Ask Mayo Clinic is a service provided to GuaranteeTrust Life Insurance Company by Mayo Clinic at nocost to the consumer.Mayo Clinic and the triple-shield Mayo Clinic logo aretrademarks of Mayo Foundation for Medical Educationand Research. Mayo Clinic does not endorse any thirdparty products advertised. Availability of Ask Mayo Clinicis subject to change without prior notice. Ask MayoClinic does not diagnose medical conditions and is nota substitute for consulting with your own healthcareprovider for the diagnosis and treatment of personalhealth and medical conditions.RECEIVE CAREGUIDANCE

NOTE: THIS IS A SUPPLEMENT TO HEALTH INSURANCEAND IS NOT A SUBSTITUTE FOR MAJOR MEDICALCOVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OROTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULTIN AN ADDITIONAL PAYMENT WITH YOUR TAXES.Policy series G0553 is a limited benefit healthinsurance policy. It is not a Medicare Supplementpolicy or certificate, and does not fully supplementany federal Medicare health insurance. If you areeligible for Medicare, you may review the Guide toHealth Insurance for People with Medicare availablefrom GTL.PRE-EXISTING CONDITION:A Pre-existing Condition is a sickness or injury,disclosed or not disclosed on the application, forwhich medical care, treatment, diagnosis or advice wasreceived or recommended within the six month periodimmediately prior to your effective date of coverageunder this policy; or the existence of symptoms whichwould cause an ordinarily prudent person to seekdiagnosis, care or treatment within the six monthsprior to your effective date of coverage under thispolicy. Treatment includes the taking of prescriptiondrugs or medicines. Pre-existing conditions are notcovered unless the loss begins more than six monthsafter your effective date of coverage. The Pre-existingCondition period may differ in some states. Pleaseread the Outline of Coverage carefully (in NC, no preexisting condition limitation).PREMIUMS:The Advantage Plus policy is guaranteed renewable forlife. Premiums are subject to change only if changed forall policies of this type in your state and on a class basis.BASIC EXCLUSIONSWe will not pay benefits for:1. Treatment, services or supplies which: Are not Medically Necessary; Are not prescribed by a Doctor as necessary totreat a Sickness or Injury; Are determined to be Experimental/Investigationalin nature by Us; Are received from any Family Member; or Are received outside the United States.2. Expenses incurred as a result of loss due to war, orany action of war, declared or undeclared; servicein the armed forces of any country.3. Expenses incurred as a result of committing orattempting to commit an assault or felony orparticipating in a riot or civil commotion.4. Expenses incurred as a result of suicide orintentionally self inflicted Injury while sane orinsane.5. Injury or Sickness arising out of or in the course ofemployment or which is compensable under anyWorkers’ Compensation or Occupational DiseaseAct or Law.6. Cosmetic surgery other than: Reconstructive surgery incidental to or followingsurgery resulting from trauma, infection, or otherdiseases of the involved part; or Reconstructive surgery because of a congenitaldisease or anomaly.7. Injury due to being legally intoxicated, as defined bythe jurisdiction in which an Accident occurs.8.Loss due to voluntarily using any drug, narcotic orcontrolled substance, unless as prescribed by adoctor.For optional benefit rider limitations and exclusions,please refer to the Outline of Coverage. Optionalbenefit riders are offered for an additional premium.This brochure is a summary, not a contract.Advantage Plus , Limited Benefit Policy, providingHospital Confinement Indemnity Benefits, is issuedon Form Series G0553 and Rider Form Series RG15CLS,RG15CLSR, RG15SDH, RG05SNF, RG13SNF, RG18ASB,RG07OPS(A), RG12DV, RG15CA, by Guarantee TrustLife Insurance Company. This product, its features, andriders are subject to state availability and may vary bystate. Certain exclusions and limitations may apply. Forcost and complete details of coverage, please refer tothe outline of coverage. Are received without charge or legal obligationto pay; Would not routinely be paid in the absence ofinsurance;1275 Milwaukee Avenue, Glenview, IL 60025www.gtlic.com 800-338-7452

Guarantee Trust Life Insurance Company GAD255-18 ADVANTAGE PLUS HOSPITAL INDEMNITY INSURANCE POLICY GUARANTEE TRUST LIFE INSURANCE COMPANY (GTL) 1275 Milwaukee Avenue, Glenview, IL 60025 www.gtlic.com 800.338.7452 (Rev. 10/18) 15B473 HELP PAY FOR OUT-OF-POCKET EXPENSES ASSOCIATED WITH:

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