American Medical Access Group Insurance Plan

ALL INSURANCE OPTIONS

Tuesday, April 13, 2004

Choose from three great medical plans at prices you can afford!

Instructions for Applying

Employer Participation Agreement

Employee Application

Waiver of Pre-Existing for Groups over 100 Lives

AMERICAN MEDICAL ACCESS GROUP INSURANCE PLAN

Guaranteed Acceptance

No deductibles Affordable Premiums

*Benefits*	*Option 1*	*Option 2*	*Option 3*
*Doctor Visits*	$50 per visit 5 Visits per year	$50 per visit 5 Visits per year	$75 per visit 7 Visits per year
*Lab & X-Ray*	None	$100 per day 3 days per year	$100 per day 5 days per year
*Accident*	100% $500 per accident	100% $1,000 per accident	100% $1,000 per accident
*Daily Hospital*	$250 per day 30 days maximum	$500 per day 30 days maximum	$1,000 per day 30 days maximum
*Surgical*	Surgical Schedule $1,200 maximum	Surgical Schedule $1,800 maximum	Surgical Schedule $2,400 maximum
*Anesthesia*	20% of Surgical Benefit	20% of Surgical Benefit	20% of Surgical Benefit
*Prescription Drugs*	None	$20 per prescription 10 prescriptions per year ($200) max	$20 per prescription 15 prescriptions per year ($300) max
*Term Life Insurance*	Insured - $10,000 Spouse - $2,500 Child - $1,000	Insured - $10,000 Spouse - $2,500 Child - $1,000	Insured - $10,000 Spouse - $2,500 Child - $1,000

	Fully Insured – Companion Life Insurance Company (A+ rated)
	Voluntary – Minimum 20% participation required
	Guaranteed Issue (except if family member is pregnant)
	Pre-Existing Condition Limitations apply – can not waive –No Pre-Existing for Doctor Visits
	No Doctor or Hospital Networks
	Life Insurance – Age 65 or older principle sum is 65% of the amount shown above

*Monthly Premium*	*Option 1*	*Option 2*	*Option 3*
*Member*	$ 51.17	$ 90.36	$127.02
*Member + 1*	$ 90.89	$164.06	$232.35
*Member + 2 or more*	$129.27	$235.38	$334.43

	Rates above include a $1.15 monthly COBRA Administration fee
	Rates above do not include a $30 group monthly billing/administration fee

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