Common use of Limits on Amounts of Coverage Clause in Contracts

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx.

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. Blue Cross and Blue Shield of Louisiana HMO Louisiana Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx.

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. Blue Cross and Blue Shield of Louisiana HMO Louisiana Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently diferently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively efectively with us, such as: – Qualified Qualifed sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified Qualifed interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file fle a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx.

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx. Whether Blue Cross or your employer owns your plan, you can file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by mail or phone at: U.S. Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 0-000-000-0000, 000-000-0000 (TDD) Or Electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf. Complaint forms are available at xxxx://xxx.xxx.xxx/ocr/office/file/index.html. 01MK6445 9/16 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company. HMO Louisiana, Inc., and Southern National Life Insurance Company, Inc., are subsidiaries of Blue Cross and Blue Shield of Louisiana. All three companies are independent licensees of the Blue Cross and Blue Shield Association.

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton RougeXxx 00000 Xxxxx Xxxxx, LA 70898XX 00000-9012 0000 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx.

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton RougeXxx 00000 Xxxxx Xxxxx, LA 70898XX 00000-9012 0000 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx. Whether Blue Cross or your employer owns your plan, you can file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by mail or phone at: U.S. Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Xxxx 000X, XXX Xxxxxxxx Xxxxxxxxxx, X.X. 00000 0-000-000-0000, 000-000-0000 (TDD) Or Electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf. Complaint forms are available at xxxx://xxx.xxx.xxx/ocr/office/file/index.html. 01MK6445 9/16 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company. HMO Louisiana, Inc., and Southern National Life Insurance Company, Inc., are subsidiaries of Blue Cross and Blue Shield of Louisiana. All three companies are independent licensees of the Blue Cross and Blue Shield Association.

Limits on Amounts of Coverage. 1. The Louisiana Life and Health Insurance Guaranty Association Law also limits the amount that LLHIGA is obligated to pay out. 2. The benefits for which LLHIGA may become liable shall in no event exceed the lesser of the following: a. LLHIGA cannot pay more than what the insurance company would owe under a policy or contract if it were not an impaired or an insolvent insurer. b. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance. c. For any one insured life, regardless of the number of policies or contracts there are with the same company, LLHIGA will pay a maximum of $500,000 in health insurance benefits, and LLHIGA will pay a maximum of $250,000 in present value of annuities, including net cash surrender and net cash withdrawal values. 3. In no event, regardless of the number of policies and contracts there were with the same company, and no matter how many different types of coverages, LLHIGA shall not be liable to expend more than $500,000 in the aggregate with respect to any one individual. 23XX0534 R08/18 2 Southern National Life Nondiscrimination Notice Discrimination is Against the Law Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., does not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex in its health programs or activities. Blue Cross and Blue Shield of Louisiana and its subsidiaries: • Provide free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (audio, accessible electronic formats) • Provide free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, you can call the Customer Service number on the back of your ID card or email XxxxxxxxxxXxxxxxXxxxxxxxXxxxxxxxxxx@xxxxxx.xxx. If you are hearing impaired call 0-000-000-0000 (TTY 711). If you believe that Blue Cross, one of its subsidiaries or your employer-insured health plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you have the right to take the following steps; 1. If you are fully insured through Blue Cross, file a grievance with Blue Cross by mail, fax, or email. Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 000-000-0000 or 0-000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx 2. If your employer owns your health plan and Blue Cross administers the plan, contact your employer or your company’s Human Resources Department. To determine if your plan is fully insured by Blue Cross or owned by your employer, go to xxx.xxxxxx.xxx/xxxxxxxxxxx.