ManhattanLife Assurance Medicare Supplement

Deductible ~ Medicare Supplement Plans B, C, D, F, G and N all pay the $[XXXX] inpatient hospital deductible for each benefit period. Plan M pays 50% of the Part A Deductible.

First 60 Days ~ After the Part A deductible, Medicare pays all eligible expenses for services from your first through 60th day of hospital confinement. Services include semiprivate room and board, general nursing and miscellaneous hospital services and supplies.

Coinsurance ~ All Medicare Supplement Plans pay up to $[XXX] a day when you're hospitalized from the 61st through the 90th day. And when you're in the hospital from the 91st through 150th day, Medicare Supplement Plans pay you up to $[XXX] a day for each Lifetime Reserve day used.

Extended Hospital Coverage ~ When you're in the hospital longer than 150 days during a Benefit Period, and you've exhausted your 60 Medicare Lifetime Reserve days, all Medicare Supplement Plans pay the Part A Medicare eligible expenses for hospitalization, paid at the Prospective Payment System (PPS) rate or other appropriate standard of payment, subject to a lifetime maximum benefit of an additional 365 days.

Benefit for Blood ~ Medicare has one calendar-year deductible for blood that is the cost of the first three pints needed. All Medicare Supplement Plans pay this deductible.

Skilled Nursing Facility Care
First 20 Days ~ Medicare pays all eligible expenses.
Coinsurance ~ Medicare Supplement Plans C, D, F, G, M and N pay up to $[XXX] a day from the 21st through the 100th day during which you receive skilled nursing care. You must enter a Medicare certified skilled nursing facility within 30 days of being hospitalized for at least three days.

Hospice Care ~ After you meet Medicare's requirements, including a doctor's certification of terminal illness, Medicare pays all but very limited co-payment or coinsurance for outpatient drugs and inpatient respite care. Medicare Supplement Plans pay the Medicare co-payment or coinsurance.

Deductible ~ Medicare Supplement Plans C and F pay the $[XXX] calendar year deductible.

Coinsurance ~ After the Part B deductible, All Medicare Supplement Plans generally pay 20% of Medicare Eligible Expenses for physician's services, hospital outpatient services and supplies, physical and speech therapy, and ambulance service. Plan N requires the insured to pay a portion of Part B coinsurance or co-payments: up to $[XX] copayment for each covered office visit, including specialists, and up to $[XX] copayment for each covered Emergency Room visit. Emergency Room co-payment will be waived if admitted to any Hospital and the ER visit is covered as a Part A Expense.

Excess Benefits ~ Your bill for Part B services and supplies may exceed the Medicare Eligible Expense. When that occurs, Medicare Supplement Plans F and G pay 100% of the difference, up to the charge limitation established by Medicare.

Benefit for Blood ~ Medicare has one calendar year deductible for blood that is the cost of the first three pints needed. All Medicare Supplement Plans pay this deductible.

Additional Benefits
Emergency Care Received Outside the U.S. ~ After you pay a $[XXX] calendar-year deductible, Medicare Supplement Plans C, D, F, G, M and N pay you 80% of eligible expenses incurred during the first 60 days for emergency care received outside the U.S. up to a lifetime maximum of $50,000. Benefits are payable for emergency health care you need immediately because of a covered injury or illness of sudden and unexpected onset.

Medicare Supplements help pay some eligible expenses not paid for by Medicare Part A and Medicare Part B. There may be charges above what Medicare and your Medicare Supplement pay.

Medicare Part A Eligible Expenses for Hospital/Skilled Nursing Facility Care include expenses for semiprivate room and board, general nursing, miscellaneous services and supplies.

Medicare Part B Eligible Expenses for Medical Services include expenses for physician's services, hospital outpatient services and supplies, physical and speech therapy, and ambulance service.

"Medicare Eligible Expenses" means expenses of the kinds covered by Medicare, to the extent recognized as reasonable and medically necessary by Medicare.

A Benefit Period begins the first full day you are hospitalized and ends when you have not been in a hospital or skilled nursing facility for 60 days in a row.

Coinsurance is the portion of the Medicare Eligible Expense you have to pay. It does not include Part A and B deductible amounts not paid by Medicare.

As Medicare deductibles and coinsurance increase, your Manhattan Life benefits will automatically increase. Manhattan Life benefits will not duplicate benefits paid by Medicare.

Benefits are paid to you or to your hospital or doctor.

You have 31 days from your renewal date to pay your premium. Your policy will stay in force during this 31 day grace period.

Your policy is guaranteed renewable. Your policy cannot be cancelled. It will be renewed as long as the premiums are paid on time.

You're covered immediately. There is no waiting period for pre-existing conditions. Benefits will be paid from the time your policy is in force.

Not connected with or endorsed by the United States government or the Federal Medicare program.

If, for any reason, you are not satisfied, you may return your policy to us within thirty days after receiving it. If returned, the policy will be void from its beginning and any premium paid will be refunded, less any claims paid.

Rates are based on your age and your premiums will increase automatically on each policy anniversary date, based on the age you attain. Premium rate adjustments may also be made based on current health care cost experience for benefits paid. Manhattan Life reserves the right to establish new premium rates for all insureds based on a class basis, but only after giving you advance notice. However, we will not increase premiums based on your own claims.

Manhattan Life Medicare Supplements will not pay for:

- Expenses incurred while the policy is not in force except as provided in the Extension of Benefits section;

- Hospital or Skilled Nursing Facility confinement incurred during a Medicare Part A Benefit Period that begins while the policy is not in force;

-That portion of any expense incurred which is paid for by Medicare;

- Services for non-Medicare Eligible Expenses unless specifically covered in the policy, including, but not limited to, routine exams, take-home drugs and eye refractions;

-Services for which a charge is not normally made in the absence of insurance; or

-Loss or expense that is payable under any other Medicare Supplement insurance policy or certificate.

THIS IS A BRIEF DESCRIPTION of your coverage. For complete information on benefits, exceptions and limitations, PLEASE READ YOUR ACCOMPANYING OUTLINE OF COVERAGE.

Neither Manhattan Life nor its agents are connected in any way with the Federal or state Government or Medicare.

You cannot be denied any Medicare Supplement plan, sold by Manhattan Life Insurance Company, if your application is submitted during the six-month open enrollment period. Open enrollment is the 6 month period beginning on the first day of the month in which you are enrolled in Medicare Part B. If you are on Medicare under age 65, you will also have a 6 month open enrollment period when you reach age 65. Standard Medicare Supplement Plan A will be made available to qualifying individuals, under age 65.

Benefits and premiums under the policy may be suspended for up to 24 months if you become entitled to benefits under Medicaid. You must request that your policy be suspended within 90 days of becoming entitled to Medicaid. If you lose (are no longer entitled to) benefits from Medicaid, this policy can be reinstated if you request reinstatement within 90 days of the loss of such benefits and pay the required premium.