TEN AMERICAN INCOME LIFE INSURANCE COMPANY TEN

UNITS Indianapolis, Indiana UNITS

LIMITED BENEFIT INSURANCE COVERAGE

Outline of Coverage

For Policy Form CNM (R82)

1.  READ YOUR POLICY CAREFULLY – This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself 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!

2. LIMITED BENEFIT INSURANCE COVERAGE – Policies of this category are designed to provide, to persons insured, limited or supplemental coverage.

3. BENEFITS: MAXIMUM LIFETIME BENEFIT

HOSPITAL CONFINEMENT $37,100.00

$100.00 per day for twelve days

$50.00 per day thereafter

SURGICAL (diagnostic procedures are not covered) 5,000.00

$45.00 to $750.00 per operation as outlined in schedule of operations

ANESTHESIA 1,000.00

Not to exceed $100.00 per operation

RADIATION THERAPY AND CHEMOTHERAPY BENEFIT 2,000.00

Usual and Customary Charge

PRIVATE NURSING (While hospital confined) 2,000.00

At $40.00 per day when required, for RN or LVN

ATTENDING PHYSICIAN (While hospital confined) 1,000.00

$20.00 per day for physician other than surgeon

BLOOD AND PLASMA 1,000.00

Usual and Customary Charge

AMBULANCE 500.00

Not to exceed $50.00 for each confinement

TRANSPORTATION (Common Carrier) 500.00

Usual and Customary Charge, when required, to hospital

EXTENDED BENEFITS (In lieu of hospital benefits) No Limit

This benefit is payable only when you are hospital confined for 91 straight days or more. The daily hospital confinement benefit is not payable when this benefit is in effect.

$6,000 per month toward charges made by hospital beginning 91st day of continuous hospital confinement (benefits will be prorated for periods of less than 30 days)

GOVERNMENT HOSPITAL CONFINEMENT (In lieu of all other benefits) 18,550.00

This is the only benefit payable for confinement in a government hospital and the treatment

received there.

$50.00 per day for the first twelve days of confinement

$25.00 per day thereafter

4.  EXCLUSIONS AND LIMITATIONS:

You are not eligible for this policy if you have ever had cancer diagnosed. Any family member who has had cancer diagnosed is not eligible. The policy has a 30 day waiting period. If you or any family member has cancer diagnosed within 30 days of the Policy Date, there is no coverage for that person, and we will refund any premium paid on that person.

This policy covers only cancer and its spread or recurrence. It does not cover other sicknesses even if they are caused by cancer or worsened by cancer. Pathological diagnosis (as defined on Page 6) is required to establish a claim. The only exception is when medical judgment prohibits such procedure and other conclusive evidence is given.

Benefits are not payable for treatment received more than 30 days before the required diagnosis is made. However, if cancer is first diagnosed by autopsy, benefits will be payable for treatment received up to 45 days before the date of death.

Diagnostic work to check for the recurrence of cancer is not covered unless it is found that cancer is present at that time. Cosmetic repair by plastic surgery is not covered. The policy does not cover prosthetic devices or their installation.

5.  RENEWABILITY:

If you are eligible for the policy and it is issued, we cannot cancel it as long as you pay the premium. We can change premium rates only by plan, class, and state.


AG-1691 B 10 Units OK