Individual Accident InsuranceAccident Medical Expense BenetFor fracture of bone or bones of:PLAN FEATURES: BENEFITS FOR:Accident Medical Expenses BenefitAccident Hospital IndemnityDislocations and FracturesAccidental Death and DismembermentSkull (except bones of face or nose)Hip, thigh (femur)Pelvis (except coccyx)Arm, between shoulder and elbox (shaft)Shoulder blade (scapula)Leg (tibia and fibula)AnkleKnee cap (patella)Collar bone (clavicle)Forearm (radius or ulna)Foot (except toes)Hand or Wrist (except fingers)Lower jaw (except alveolar process)Two or more ribs, fingers, or toesBones of face or noseOne rib, finger or toeCoccyx$1,900$2,000$2,000$1,100$1,100$1,100$800$800$800$800$700$700$400$300$300$140$140Hip jointKnee joint (except patella)Bone or bones of the foot, other than toesAnkle jointWrist jointElbow jointShoulder jointBone or bones of the hand, other than fingersCollar boneTwo or more fingersTwo or more toesOne finger or one toes$2,000$800$800$800$700$600$400$300$300$140$140$60On and off the job benefitsPays regardless of other coverageWe will pay the actual charges incurred up to $250 per unit if, as a result of injury, a covered person requires medical or surgical treatment.$250Bronze Unit 1Bronze Unit 11For complete dislocation of: Bronze Unit 1$100$100/$200Accident Hospital Indemnity BenetWe will pay each day a covered person is confined during one or more periods of hospital confinement if: a) the confinement is due to injury; or b) the first day of confinement occurs within 90 days after the accident.Individual Accident InsuranceDislocation and Fracture BenetWe will pay for regular ambulance service and for air ambulance if as a result of an injury, a covered person requires ambulance service for transfer; a) to a hospital; or b) from a hospitalPOLICY FORM HIC-ACC-POL 7/09UNDERWRITTEN BY HUMANA COMPANYWe will pay the following amount shown based on your selection of coverageForm Number: HIC-ACC-SB-TXPrimary Insured coverage 100%Spouse Coverage 50%Child coverage 25%BAY BRIDGE ADMINISTRATORSPROOFDocuments released upon approval and payment2Form Number: HIC-ACC-SB-TXBAY BRIDGE ADMINISTRATORSFor loss of:LifeBoth hands or both feet or sight of both eyesBoth arms or both legsOne hand or arm and one foot or legSight of one eye$20,000$20,000$20,000$20,000$10,000One hand or one armOne foot or one legOne or more entire toesOne or more entire fingersBronze Unit 1$10,000$10,000$1,000$800Bronze Unit 1Dislocation and Fracture BenetWe will pay the following amount shown based on your selection of coveragePrimary Insured coverage 100% / Spouse Coverage 50% / Child coverage 25%Loss means with regard to:a. hands and feet-actual severance through or above wrist or ankle joints;b. sight, entire and irrecoverable loss thereofc. toes and fingers-actual severance through or above the metacarpopha-langeal jointsIf loss is sustained by a covered person while riding as a fare-paying passenger on a schedule common carrier, we will pay three times the amount payable under the accidental death and dismemberment benefit.Your coverage terminates on the earliest of:Termination will be without prejudice to a claim that begins before terminationa. the date the policy is terminated;b. the date of your death;c. your attainment of the of the policy age limit;d. failure to pay the required premium, subject to the grace period.Your spouce, if covered under the policy, becomes the new insured upon your death or the date, your coverage terminates because you reached the policy age limit.Coverage for your spouce will terminate on the rst to occura. the termination of this policy;b. the date following your divorce, legal separation or annulment of marraige;c. Your spouces attainment of the of the policy age limit;d. the date of your spouces death; ore. failure to pay the required premium, subject to the grace period.Coverage for your dependent child(ren) will terminate on the rst to occur of:a. the termination of this policy;b. the policy anniversary date after he or she ceases to be a dependent; orc. failure to pay the required premium, subject to the grace period.Loss means with regard to:Family plan coverage may include the following: You, your spouce, your unmarried dependent children under the age of 25 (26 if full-time student); grandchildren dependent on you for income tax purposes; and children required to be insured under a medical support order by a court. Incapaci-tated children are covered in accordance with the incapacitated child continuation provision in the policy.Pre-existing condition limitationIf a covered person has a pre-existing condition, we will not pay benefits for such condition during the 2-year period beginning on the policy date.Pre-existing condition means a condition [a] which manifested itself prior to the effective date of coverage; or [b] for which medical advice or treatmentwas recommended by or received from a physician in the 5 years prior to the effective date of coverage.Right to examine policyWe urge you to examine this policy closely. If you are not satisfied, you may return to us or to the agent from whom it was purchased within 30 days after that event; we will consider it void from the policy date and any premium paid will be returned.RenewabilityYour policy is guarenteed renewable until age 70, by payment of premiums as they become due. This policy will terminate on the last day of the period for which premium is paid unless continued in force during a grace period.Termination of covered persons:This policy does not cover and loss resulting from:a. intentionally self-inflicted injury;b. suicide or attempted suicide, whether sane or insane;c. injury incurred prior to the effective date of coverage;d. war or act of war, whether declared or undeclared;e. injury sustained while in the armed forces of any country or international authority;f. injury sustained while riding on any aircraft except a civil or public aircraft, or military transport aitcraft;g. injury sustained while riding on any aircraft except as a fare-paying passenger in an aircraft provided by a licensed common carrierh. injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription, including sedatives, narcotics, barbiturates, amphetimines, or hallucinagens, unless the drug is taken as prescribed or administered by a licensed physician;i. injury sustained while committing or attempting to commit a felony;j. injury sustained while the covered person is operating any moto vehicle while legally intoxicated from the use of alcoholk.hernia, including complications due to hernial. driving in any organized or scheduled race or speed test or while testing an automobile or any vehicle on any racetrack or speedway;m. volunatrily taking poison;n. asphyxiation from voluntarily inhaling gas or fumes.Exclusions and Other LimitationsPROOFDocuments released upon approval and payment3Form Number: HIC-ACC-ABR-TX-7/09BAY BRIDGE ADMINISTRATORSBenet ScheduleAdditional Benets RiderHIC-ACC-ABR-TX-7/09Abdominal or Thoracic Surgery BenetAppliance BenetWe will pay $2,000 if a covered person undergoes abdominal or thoracic surgery to repair internal injuries as a result of a covered injury. the surgery must be performed within 3 days of the covered accident. For exploratory surgery done with no surgical repair, we will pay $200.In consideration of an additional premium, we will pay the benefits listed below. Coverage for primary insured, spouce and child(ren) based on your selection of coverage.We will pay $250 for prescribed medical appliances that aid in personal mobility including wheelchair, crutches or walker. Use of these devices must begin within 90 days after a covered accident and the benefit is payable only once per covered accident and is payableonly once per covered person per covered accident.Blood and Plasma BenetWe will pay $600 for blood or plasma for a transfusion required for a covered accident. The transfusion must be within 3 days of the covered accident and is payable only once per covered person per accident.Brain Injury Diagnosis BenetWe will pay $300 for the first diagnosis of the following traumatic brain injuries: cerebral contusion, cerebral laceration, concussion, or inter cranial hemorrhage. The covered person must be treated within 3 days of a covered accident, and diagnosis made by computed tomography (CT) scan, electroencephalogram (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET) scan or X-ray must occur within 30 days of the accident. The benefit is payable only once per covered person.Burn BenetWe will pay $200 if burnscover less than 15% of the body surface and $500 if burns cover more than 15% of the body surface for one or more second or third-degree burns other than sunburn. Treatment must be done within 3 days of the covered accident and the benefit is payable only once per covered person per covered person.Coma BenetWe will ay $30,000 if a covered person is in a coma as definied in this rider which lasts 5 or more consecutive days as a result of a covered accident. This benefit is payable only once per covered person.Eye Injury BenetWe will pay $200 for the surgery or the removal of a foreign object from the eye. Treatment must be performed by a physician and occur within 90 days of the accident. An examination without anesthesia is not considered a surgery. This benefit is payable only once per covered person per covered accident.Family Member Lodging BenetWe will pay $200 per day for lodging of one adult member of a covered persons family when a covered person is confined in a non-local hospital or specialty free standing treatment center while undergoing treatment for a covered accident. This benefit is payable for 30 days for each covered accident. The benefit is payable only if the non-local transportation benefit is payable under the covered accident. The benefit will not be paid if the family member lives within 60 miles of the treatment facility.Hospital Intensive Care Connement BenetWe will pay $800 per day that a covered person is confined to a hospital intensive care unit. Confinement must begin within 3 days after a covered accident and is payable for up to 60 days of continuous confinement in the intensive care unit. For a partial day confinement, the daily benefit will be pro-rates based on the number of hours confined divided by 24 hours.Immediate Hospitalization BenetWe will pay $2,000 upon the first confinement to a hospital during a calendar year for a covered accident providing that a benefit is payable under the hospital during a calendar year for a covered accident providing that a benefit is payable under the hospital confinement benefit of the policy. The covered person ,ust be confined to the hospital within 3 days of a covered accident an is payable only once per covered person per hospital confined and only once per calendar year.Accident Follow-up Treatment BenetWe will pay $100 per day a covered person receives a follow-up treatment provided that a benefit has been paid under the medical expense benefit or the policy. This benefit is limited to 2 treatments per covered accident per covered person. Treatments must be administered by a physician in the physicians office or a hospital on an outpatient basis. Follow-up treatments must begin within 90 days of the covered accident and not take place longer than 6 months after the covered accident. The benefit is not payable at the same time a benefit is payable under the physical therapy benefit.PROOFDocuments released upon approval and payment4Form Number: HIC-ACC-SB-TXBAY BRIDGE ADMINISTRATORSAdditional Benets RiderHIC-ACC-ABR-TX-7/09Laceration BenetWe will pay $100 for lacerations or cuts treated by a physician within 3 days of a covered accident. This benefit is only payable once per covered person per calendar year.Non Local Transportation BenetWe will pay $600 per trip for non-local treatment at a hospital or specialty free-standing treatment center nearest the covered persons home. Treatment must be prescribed by a physician and the same treatment or care cannot be obtained locally. Non-local is treatment that is 60 miles or more one way from the covered persons home. We do not pay for visits to a physicians office or clinic or for service other than actual treatment. Benefit is payable 3 times per covered accident. The benefit does not cover ground or air ambulance.Paralysis BenetWe will pay $20,000 for paraplegia and $40,000 for quadriplegia if a covered person receives a spinal cord injury resulting in complete and permanent loss of use of two or more limbs. An attending physician must confirm the paralysis within 3 days of a covered accident and the parlysis must past for at least 90 consecutive days. This benefit is payable once per covered person.Physical Therapy BenetWe will pay $60 per day a covered person receives physical therapy treatment. This benefit is only payable if a benefit has been paid under the medical expense benefit of the policy. We will pay for a maximum of one treatment per day with a maximum of 6 treatments per covered accidents per covered person. This benefit is only payable for injuries resulting from a covered accident. This benefit is payable only once per covered person per covered accident.Prosthesis BenetWe will pay $500 for one device and $1,000 for 2 or more devices for a prosthetic hand, foot, or eye that is prescribed by a physician. This benefit is payable f a benefit is paid for the loss of hand, foot, or eye under the accidental dismemberment benefit of the policy. The device or devices must be received within 180 days of a covered accident. This benefit is payable only once per covered person per covered accident.Ruptured Disc BenetWe will pay $500 for a ruptured disc of the spine. the ruptured disc must be diagnosed as a result of a covered accident and surigcally repaired by a physician within 180 days of the date of the covered accident.Skin Graft BenetWe will pay 50% of the burn benefit under this rider if a covered person receives a skin graft for a burn for which a benefit is paid under the burn benefit. The skin graft must be performed by a physician to treat a covered burn within 90 days of the covered accident. this benefit is payable only once per covered person per covered accident.Tendon, Ligament, Rotator Cuff or Knee Cartilage BenetWe will pay $500 per injury for an injured tendon, ligament, rotator cuff or knee cartilage. The injury site must be torn, ruptured, or severed and surgically repaired by a physician within 180 days of a covered accident. If exploratory surgery, using arthroscopy is done and no surgical repair is done, with will pay $150 for the exploratory surgery. This benefit is not paid if a benefit is paid under the ruptured disc benefit of the rider for the same covered accident. The benefits under this rider are subject to the pre-existing condition limitation of the policy. All general provisions of the policy to which this rider is attached apply to this rider..Rider Renewal ProvisionThis rider is renewable in the same manner as the policy to which it is attached.TerminationThis rider terminates:a. when coverage terminates under the policy to which this rider is attached;b. when the premium for this rider is not paid before the end of the grace period; orc. when the insured person gives us written notice to terminate this rider.PROOFDocuments released upon approval and payment5Form Number: HIC-ACC-SB-TXCorporate Benets Solutions702 S Denton Tap Rd., Suite 100, Coppell, TX 75019(972) 393-8686Individual Accident InsuranceIndividualIndividual + SpouceIndividual + Child(ren)Family$15.97$29.97$32.17$46.18Coverage TierMarketed by:Administered by:Underwritten by:AmountPROOFDocuments released upon approval and paymentChemotherapy 2 days per month for 9 months - then 1 day per month for 4 months=22 days of chemotherapy, all outpatient basisColony Stimulation Injections3 Case StudiesBased onrst-hand experience.1Actual Treatment for Follicular Lymphoma (2011)13 month protocol; Standard for most types of cancerChemotherapy 1 day per month for 12 months. ($8,800 per day)All performed on an outpatient basis. Possible additional protocol based on tests.Colony Stimulation InjectionsAlfac 78400All StateColonial LifeAssurantTrans AmericaCBS Plan (PAID)$8,600$18,000$8,600$17,000$15,000$81,1502Actual Treatment for Ovarian Cancer9 month protocolMasectomy followed by Radiation treatment 1 session per day, 20 per month for 2 months, 11 days month 3 plus 2 days of chemotherapy at $3,700 EOB charge per day. Then CAT SCAN and evaluation for treatment needs. Outpatient basis. Breast ReconstructionColony Stimulation Injections3Actual Treatment for Breast Cancer3 month protocol; StandardPROOFDocuments released upon approval and payment1Form Number: HIC-GP-CAN-AGTBAY BRIDGE ADMINISTRATORSHumana Group Cancer ProductPOLICY FORM HIC-GP-CAN-AGTBenetLowHigh *Wellness BenetUp to $100 per calendar yearUp to $100 per calendar year Positive Diagnosis Up to $300 per calendar yearUp to $300 per calendar year *First Diagnosis Benet$2,500.00 $5,000.00Second & Third Surgical Opinion Actual ChargesActual Charges Non-Local Transportation Actual charges by a common carrier or 50 cents per mile if a personal vehicle is used. Actual charges by a common carrier or 50 cents per mile if a personal vehicle is used. Adult Companion Lodging & Transpor- tation Up to $75 per day for lodging. 50 cents per mile if a personal vehicle is used. Up to $75 per day for lodging. 50 cents per mile if a personal vehicle is used. AmbulanceActual ChargesActual Charges *Surgery Up to $3,000. Outpatient surgery at 150% of the schedule not to exceed the actual surgeons fees. Up to $4,500. Outpatient surgery at 150% of the schedule not to exceed the actual surgeons fees. Donor Benet- Bone Marrow & Stem Cell Transplant (a) $200 per day (b) Actual charges for round trip coach fare; or personal automobile expense of 50 cents per mile. (c) Actual charges up to $50 per day (a) $200 per day (b) Actual charges for round trip coach fare; or personal automobile expense of 50 cents per mile. (c) Actual charges up to $50 per day Bone Marrow & Stem Cell Transplant Actual charges to a combined lifetime maximum of $15,000Actual charges to a combined lifetime maximum of $15,000 Anesthesia Up to 25% of surgical benet paid. $100 maximum per Covered Person Up to 25% of surgical benet paid. $100 maximum per Covered Person Ambulatory Surgical Center $250 Per Day$250 Per Day Drugs and MedicineUp to $25 per day, $600 per calendar yearUp to $25 per day, $600 per calendar year Outpatient Anti-Nausea Drugs Up to $250 per calendar yearUp to $250 per calendar year *Radiation, Radioactive Isotopes Therapy, Chemotherapy or Immunotherapy Actual charges up to $500 per dayActual charges up to $5,000 per month Miscellaneous Therapy Charges Actual charges up to a lifetime maximum of $10,000 Actual charges up to a lifetime maximum of $10,000 Self Administered DrugsActual charges up to $4,000 per monthActual charges up to $4,000 per month *Colony Stimulating Factors Actual charges up to $500 per monthActual charges up to $1,000 per month PROOFDocuments released upon approval and payment2Form Number: HIC-GP-CAN-AGT BAY BRIDGE ADMINISTRATORSHumana Group Cancer ProductPOLICY FORM HIC-GP-CAN-AGTBenetLowHigh Blood, Plasma & PlateletsActual charges up to $200 per dayActual charges up to $200 per day Physicians AttendanceUp to $35 per dayUp to $35 per day Private Duty Nursing ServiceUp to $100 per dayUp to $100 per day National Cancer Institute Designated Comprehensive Cancer Treatment Center Evaluation/Consultation Benet Expenses incurred limited to a lifetime maximum up to $750 for evaluation. Expenses incurred limited to a lifetime maximum up to $350 for transportation and lodging Expenses incurred limited to a lifetime maximum up to $750 for evaluation. Expenses incurred limited to a lifetime maximum up to $350 for transportation and lodging Breast ProsthesisActual Charges Actual ChargesArticial Limb or Prosthesis $1,500 lifetime maximum per amputation.$1,500 lifetime maximum per amputation. Physical or Speech Therapy Up to $35 per sessionUp to $35 per session Extended Benets$300 per day$300 per day Extended Care FacilityUp to $50 per dayUp to $50 per day At Home NursingUp to $100 per dayUp to $100 per day New or Experimental Treatment Up to $7,500 per calendar yearUp to $7,500 per calendar year Hospice CareUp to $50 per dayUp to $50 per day Govt or Charity Hospital$200 per day$200 per day Hair Piece Actual charge up to a lifetime maximum of $150 Actual charge up to a lifetime maximum of $150 Rental or Purchase of Durable Goods Actual charges up to $1,500 per calendar yearActual charges up to $1,500 per calendar year Waiver of PremiumAfter 60 daysAfter 60 days *Hospital Connement$100 per day$200 per day Waiting PeriodNoneNone Addisons Disease Amyotrophic Lateral Sclerosis Cystic FibrosisDiphtheriaEncephalitisEpilepsyHansens Disease Legionnaires DiseaseLupus ErythematosusMalariaRocky Mountain Spotted FeverScarlet FeverMultiple SclerosisMuscular DystrophyMyasthenia GravisNiemann-Pick Disease OsteomyelitisPoliomyelitisRabiesReyes SyndromeRheumatic FeverMeningitis (epidemic cerebrospinal)Sickle Cell Anemia Tay-Sachs DiseaseTetanusToxic Epidermal Necrolysis Lyme Disease TuberculosisTularemia Typhoid Fever Undulant Fever Whipples DiseaseOther Specied Diseases CoveredPROOFDocuments released upon approval and paymentExpedite and simplify the benet enrollment processIncrease operational efciencyLower administrative costAutomate transmission of eligiblity changes to carriersThe BeneBridge Solution1 BAY BRIDGE ADMINISTRATORSOur proprietary web-based system streamlines the benefit enrollment and administration process byconsolidatingemployeebenefitdataintooneeasy-to-useplatformthatsimplifiesbenefit management tasks.Eliminate the time-intensive task of contacting each carrier individually when employee eligibility information changes. With as little as one transaction in BeneBridge, our EDI feeds automatically notify carriers of changes through the secure and seamless transfer of data files.Please note that EDI feeds are heavily dependent on specific carrier requirements. For instance, some carriers will not accept feeds for groups of less than 100 employees.Bay Bridge Administrators offers employersatotalsolutionto benefitadministration.Our innovativelineofservices transforms benefit administration andmanagementintoone seamlessprocessthatreduces thetime,cost,andresources associatedwithbenefit administration.Bystreamlining andautomatingourprocesses, and through fees paid by carriers toreducetheiradministration cost,wecanofferthispackage absolutelyfreeofchargewhen twoormoreofourproprietary Humanaproductsareincluded intheoffering.Nopermember permonthcharge,noreduction inbrokercommissions.Simply Free.Savetimewithourpaperlessapplicationprocess. Allapplications are completed online and signed with a secured PIN.Paperless EnrollmentAccelerated Application ProcessElectronic Payroll UpdatesDefined ContributionReal-time, Around the Clock AccessCustomizable ReportsIntuitive User ExperienceFill out demographic and eligibility information just once and use it for every benefit you enroll in.Generate customizable payroll files to import into your organizations existing payroll system.Benefitdescriptions,contactnumbers,andclaimformsare examples of information that can be available to employees 24/7.Generateon-the-fly,highlycustomizablereportsbasedonbenefit, employee, and dependent information.User-friendly system interface makes for a short learning curve and easy implementation.Real-time, Around the Clock AccessCustomizable ReportsIntuitive User ExperienceBenefitdescriptions,contactnumbers,andclaimformsare examples of information that can be available to employees 24/7.Generateon-the-fly,highlycustomizablereportsbasedonbenefit, employee, and dependent information.User-friendly system interface makes for a short learning curve and easy implementation.Employers may contribute a specific dollar amount and prioritize the benefits it can be used to purchase. As employees choose benefits, thebalanceisreducedsothatemployeesknowhowmuchofthe contribution remains to be used.Web-based Benets Enrollment and AdministrationEDI FeedsOverviewEmployers are no longer required to reconcile invoices from each carrier. Instead, we will send one invoicetotheEmployerforalloftheactivebenefitsinBeneBridge.Employerswillmakeone payment to us and we will remit payments to each carrier.Consolidated BillingWeb-based Invoicing and ReconciliationPROOFDocuments released upon approval and payment2Ourproprietaryweb-basedsystemstreamlinesthebenefitenrollmentand administration process by consolidating employee benefit data into one easy-to-use platform that simplifies benefit management tasks.Guarenteesreceiptoftheinvoice(NoLost Invoices!),canbeprintedatanytime,reduces turnaround time.As you make changes online, the amount due is automatically adjusted so you know exactly how much to remit.Paperless Invoicing Immediate ReconciliationSaves time by eliminating manual balancing and saves postage because there is no need to mail a large packet of paperwork.Speedsupreconciliationbyallowingsearches of partial names and social security numbers.Reduce Expenses Search Feature24 hours a day, 365 days a year. You may require a higher level of authorization to submit the invoice.Available When You Need It Supports Dual ControlGuarenteesreceiptoftheinvoice(NoLost Invoices!),canbeprintedatanytime,reduces turnaround time.Appliestoboth403(b)andsupplemental products invoices.User Friendly Available for All InvoicesWebsite is secured by GeoTRUST using up to 256 bit encryption.Changelistandsummariesbyproductareat your fingertips.Secure Website ReportsCorporate Benets Solutions702 S Denton Tap Rd., Suite 100, Coppell, TX 75019(972) 393-8686Balance BridgePROOFDocuments released upon approval and payment