A stay in the intensive care unit can be financially overwhelming

BASE 1

STANDARD 2

Intensive Care Unit Benet — No Lifetime Limits

PREFERRED 4 ELITE 8

$200

$100

$400

$200

For each day, up to 30 days, of hospitalization in an Intensive Care Unit for any reason, we will pay...

You or your spouse ........................................................................................................................................

Your covered child .........................................................................................................................................

An Intensive Care Unit (ICU, CCU, PICU or NICU) is a specically designated facility of the hospital which:

• Provides the highest level care (as determined based on the billing rate charged by the hospital);

• Is restricted to those patients who are critically ill or injured;

• Is separate and apart from other hospital areas;

• Is permanently equipped with special life-saving equipment for the care of the critically ill or injured; and

• Is listed as an Intensive Care Unit in the current edition of the American Hospital Association Guide or be

eligible to be listed therein.

$800

$400

$1,600

$800

BASE 1

STANDARD 2

Vehicular Accident — No Lifetime Limits

PREFERRED 4 ELITE 8

$200

$100

$400

$200

For each day, up to 30 days, of hospitalization in an ICU, due to a vehicular accident,

we will pay an additional...

You or your spouse ........................................................................................................................................

Your covered child .........................................................................................................................................

This benet is not payable for hospitalizations in a Step Down Unit.

$800

$400

$1,600

$800

BASE 1

STANDARD 2

Step Down Unit Benet — No Lifetime Limits

PREFERRED 4 ELITE 8

$150

$75

$300

$150

For each day, up to 30 days, of hospitalization in a Step Down Unit for any reason, we will pay...

You or your spouse ........................................................................................................................................

Your covered child .........................................................................................................................................

A Step Down Unit is part of an ICU, CCU, PICU or NICU where the patient is charged less than the highest

level care. A Step Down Unit may also be referred to as a progressive care unit, an intermediate care unit,

or a sub-acute care unit.

$600

$300

$1,200

$600

BASE 1

STANDARD 2

Ambulance Benets — No Lifetime Limits

PREFERRED 4 ELITE 8

$100

$250

$200

$500

For Ambulance transportation per hospitalization in an ICU or Step Down Unit, we will pay...

Surface Ambulance .......................................................................................................................................

Air Ambulance ...............................................................................................................................................

$400

$1,000

$800

$2,000

BASE 1

STANDARD 2

Accidental Death Benet

PREFERRED 4 ELITE 8

$2,500

$1,250

$5,000

$2,500

If you are injured in an accident and the injury causes death within 90 days of the accident, we will pay...

You or your spouse ........................................................................................................................................

Your covered child .........................................................................................................................................

$10,000

$5,000

$20,000

$10,000

FORM I12LV-SC

A stay in the intensive care unit can be nancially overwhelming ...

Limitations and Exclusions

• Persons with a previously diagnosed or treated stroke or heart condition:

ū Will not be paid benets for a heart/stroke related hospitalization.

ū Will be paid benets for up to 7 days for hospitalizations resulting from any other sickness, disease or accident.

• Benets will not be paid for loss incurred during the 12 month period following the coverage eective date for any accident or sickness contributed

to, caused by or resulting from a pre-existing condition. A pre-existing condition is any sickness, illness, disease, injury or condition (including those

diagnosed before birth) which was diagnosed by a physician or for which you received treatment or consulted a physician within the 12 month period

prior to your eective date.

• This plan does not pay benets for any accident or sickness contributed to, caused by or resulting from:

ū A hospitalization or loss which began before your eective date.

ū Injuring or attempting to injure yourself, or a covered spouse or child intentionally, regardless of mental capacity.

ū Committing or attempting to commit suicide, regardless of mental capacity.

ū Committing or attempting to commit a felony, or being engaged in an illegal occupation.

ū Being intoxicated or under the inuence of any narcotic, unless taken on the advice of a physician and according to the physician’s instructions.

• Children born within 10 months of the policy eective date will not be covered for any period of ICU or Step Down Unit hospitalization that occurs or

begins during the rst 30 days of that child’s life.

• The Vehicular Accident Benet covers accidents resulting from riding in, operating or being struck by an automobile, bus, truck, train or commercial

airplane. This benet does not include accidents resulting from riding in, operating or being struck by an all-terrain vehicle (ATV), motorcycle, tractor,

or other farm equipment, construction equipment, boat or other water conveyance, private airplane or glider.

The benets described in this brochure are contained in policy series I12POL-SC

NO CLAIM SMALL CLAIM LARGE CLAIM

PREMIUMS PAID $25,000 $25,000 $25,000

LESS CLAIMS PAID - 0 - - 5,000 - 65,000

RETURN $25,000 $20,000 - 0 -

Three examples of what can happen...

Return of Premium Benet

• You are paid if you have claims or if you stay well!

• We RETURN YOUR PREMIUMS, less any claims paid, after

twenty ve years!

• If all covered adults pass away for any reason before 25 years,

we immediately RETURN YOUR PREMIUM, less any claims

paid!

Issue Age 66 to 75

Issue Age 65 & Under

Survivor Benet

• If all covered adults pass away for any reason while the policy is in force, we immediately RETURN YOUR PREMIUM*, less any

claims paid!

• * up to $16,000 for Elite 8 - $8,000 for Preferred 4 - $4,000 for Standard 2 - $2,000 for Base 1

Our committments to you...

• Your benets are paid DIRECTLY TO YOU, unless you instruct us

otherwise.

• Your benets are paid IN ADDITION to any other insurance you have.

• Your coverage is GUARANTEED RENEWABLE for life - only you can

cancel.

• Your benets BEGIN IMMEDIATELY on your eective date.

Our program makes sense even if you never le a claim!

Family Heritage Life Insurance

Company of America

P.O. Box 470608

Cleveland, Ohio 44147

(440) 922-5222 phone

(440) 922-5223 fax