Common use of COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE Clause in Contracts

COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE. Agreements of this category are designed to provide, to persons covered under the Agreement, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, out-of-hospital care, prosthetic appliances and durable medical equipment, preventive services, emergency services and transplant services. Outpatient prescription drug coverage is provided for prescription drugs when purchased at a participating pharmacy provider. Coverage is provided at network and out-of-network benefit levels with cost-sharing options such as deductibles, coinsurance, and annual and lifetime maximums. Benefits are subject to the Health Care Management Services Provision with possible loss of benefits for non- compliance. Benefits for emergency care are provided at the network benefit level. A gatekeeper is not required to access benefits from providers. Except for a newborn child of a member, enrollment under the Agreement is subject to medical underwriting. BSMUHDHP1200-O 23081 (6/05) III. A BRIEF DESCRIPTION OF THE BENEFITS CONTAINED IN THE AGREEMENT IS AS FOLLOWS:

COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE. Agreements of this category are designed to provide, to persons covered under the Agreement, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, out-of-hospital care, prosthetic appliances and durable medical equipment, preventive services, emergency services and transplant services. Outpatient prescription drug coverage is provided for prescription drugs when purchased at a participating pharmacy provider. Coverage is provided at network and out-of-network benefit levels with cost-sharing options such as deductibles, coinsurance, and annual and lifetime maximums. Benefits are subject to the Health Care Management Services Provision with possible loss of benefits for non- compliance. Benefits for emergency care are provided at the network benefit level. A gatekeeper is not required to access benefits from providers. Except for a newborn child of a member, enrollment under the Agreement is subject to medical underwriting. BSMUHDHP1200BSMUHDHP3500-O 23081 23083 (6/05) III. A BRIEF DESCRIPTION OF THE BENEFITS CONTAINED IN THE AGREEMENT IS AS FOLLOWS:

COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE. Agreements of this category are designed to provide, to persons covered under the Agreement, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, out-of-hospital care, prosthetic appliances and durable medical equipment, preventive services, emergency services and transplant services. Outpatient prescription drug coverage is provided for prescription drugs when purchased at a participating pharmacy provider. Coverage is provided at network and out-of-network benefit levels with cost-sharing options such as deductibles, coinsurance, and annual and lifetime maximums. Benefits are subject to the Health Care Management Services Provision with possible loss of benefits for non- compliance. Benefits for emergency care are provided at the network benefit level. A gatekeeper is not required to access benefits from providers. Except for a newborn child of a member, enrollment under the Agreement is subject to medical underwriting. BSMUHDHP12002/MUHDHP1200-O 23081 23019 (6/052/06) III. A BRIEF DESCRIPTION OF THE BENEFITS CONTAINED IN THE AGREEMENT IS AS FOLLOWS:

COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE. Agreements of this category are designed to provide, to persons covered under the Agreement, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, out-of-hospital care, prosthetic appliances and durable medical equipment, preventive services, emergency services and transplant services. Outpatient prescription drug coverage is provided for prescription drugs when purchased at a participating pharmacy provider. Coverage is provided at network and out-of-network benefit levels with cost-sharing options such as deductibles, coinsurance, and annual and lifetime maximums. Benefits are subject to the Health Care Management Services Provision with possible loss of benefits for non- compliance. Benefits for emergency care are provided at the network benefit level. A gatekeeper is not required to access benefits from providers. Except for a newborn child of a member, enrollment under the Agreement is subject to medical underwriting. BSMUHDHP1200BSMUHDHP2600-O 23081 23082 (6/05) III. A BRIEF DESCRIPTION OF THE BENEFITS CONTAINED IN THE AGREEMENT IS AS FOLLOWS:

COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE. Agreements of this category are designed to provide, to persons covered under the Agreement, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, out-of-hospital care, prosthetic appliances and durable medical equipment, preventive services, emergency services and transplant services. Outpatient prescription drug coverage is provided for prescription drugs when purchased at a participating pharmacy provider. Coverage is provided at network and out-of-network benefit levels with cost-sharing options such as deductibles, coinsurance, and annual and lifetime maximums. Benefits are subject to the Health Care Management Services Provision with possible loss of benefits for non- compliance. Benefits for emergency care are provided at the network benefit level. A gatekeeper is not required to access benefits from providers. Except for a newborn child of a member, enrollment under the Agreement is subject to medical underwriting. BSMUHDHP12002/MUHDHP2600-O 23081 23020 (6/052/06) III. A BRIEF DESCRIPTION OF THE BENEFITS CONTAINED IN THE AGREEMENT IS AS FOLLOWS:

COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE. Agreements of this category are designed to provide, to persons covered under the Agreement, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, out-of-hospital care, prosthetic appliances and durable medical equipment, preventive services, emergency services and transplant services. Outpatient prescription drug coverage is provided for prescription drugs when purchased at a participating pharmacy provider. Coverage is provided at network and out-of-network benefit levels with cost-sharing options such as deductibles, coinsurance, and annual and lifetime maximums. Benefits are subject to the Health Care Management Services Provision with possible loss of benefits for non- compliance. Benefits for emergency care are provided at the network benefit level. A gatekeeper is not required to access benefits from providers. Except for a newborn child of a member, enrollment under the Agreement is subject to medical underwriting. BSMUHDHP12002/MUHDHP3500-O 23081 23021 (6/052/06) III. A BRIEF DESCRIPTION OF THE BENEFITS CONTAINED IN THE AGREEMENT IS AS FOLLOWS: