COMMON SENSE PLAN. United American CS1 Guide to Field Underwriting. BASIC HOSPITAL/SURGICAL Expense Plan. General Rules:

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1 United American CS1 Guide to Field Underwriting COMMON SENSE PLAN BASIC HOSPITAL/SURGICAL Expense Plan General Rules: UA'S PRIVACY AND DISCLOSURE INFORMATION UNDERAGE HEALTH SERIES EDITION (FORM UAPDI-UH) Agents are required to carefully review the booklet with the applicant. Complete the detachable HOME OFFICE COPY page and obtain the applicant's signature. The HOME OFFICE COPY page is submitted with the application; the applicant retains the booklet. CONVERSION GUIDELINES Conversions to or from CS1, FLEXGuard, GSP1, HSXC or MMXC are not permitted. There are too many instances that a customer could experience an unintended reduction in benefits. Conversion from SHXC, SMXC, MSXC and SSXC will be permitted if the applicant qualifies based on underwriting. Claims occurring during the waiting period of the new policy (SBR, APR or otherwise) would be processed using the benefit level of the old policy. Conversions from HIXC and HMXC will be permitted if the applicant qualifies based on underwriting or the applicant may keep either of these policies up to $200 Daily Room Benefit and qualify for the CS1, FLEXGuard, GSP1, HSXC or MMXC subject to $600 combined Daily Room Benefit. All conversions are subject to underwriting approval. COVERAGE ON FOREIGN NATIONALS Coverage is not issued to Foreign Nationals unless the applicant verifies in writing (separate note attached to application) that such applicant is a permanent resident of the United States or Canada. HEALTH PLAN COMBINATIONS UA's SMXC or SSXC Supplemental Surgical-Medical plans may be combined with CS1 if the CS1 deductible is at least $2,000. Other plan combinations include (and are limited to) HMXC (up to $100), Critical Illness coverage, Cancer coverage and an Accident Only policy. ISSUE LIMITS Because of the comprehensive nature of the CS Plan of insurance, individuals or family members who have existing hospital, medical or surgical insurance are ineligible for this plan unless they are replacing such coverage. Premium Rates Premium Rates are based on the applicant's resident state. No applications will be accepted if written outside the applicant's resident state. RULES FOR CHILDREN Rates shown are for each child. Children cannot be insured separately. Each application must include at least one adult family member. SIGNATURES All applications must be signed in the Applicant s resident state on the resident state s approved application. STALE DATED APPLICATIONS Applications must be submitted promptly. Any application received in the home office more than 30 days after it is written will be declined as a "stale dated" application. EFFECTIVE DATE OF COVERAGE Policies issued on monthly mode will be dated the date issued in the home office. Policies will be dated and become effective on the date applications are received at the home office, except that requests for special dating not more than 90 days following receipt of the application will be honored.

2 Agent Underwriting Responsibilities: As an Agent of the company, it is your responsibility to select good risks and qualify applicants carefully. Alterations or markouts Changes to the application should be avoided. If a mistake of any kind is made in completing the application a new application should be completed. Application Questions Ask each applicant the questions as they appear on the application. The application must be completed in its entirety and signed by the applicant in order to be processed. Any incomplete application will be returned to the Agent. Answers to questions on the application will be verified with the applicant. Attending Physician Statement Authorization Authorization to Obtain and Disclose Medical Information (form F1224) must be obtained for each application taken. The complete name, address and phone number of the physician where each family member's medical records can be acquired must be obtained before the application will be processed. Every applicant age 18 and over should sign the authorization. Obtain full disclosure of medical history for each proposed insured on the application, not just for the named insured. HIPAA Authorization (F3978) or UA s PRIVACY & DISCLOSURE INFORMATION UNDERAGE HEALTH SERIES EDITION must be reviewed with the applicant. Obtain the Applicant s signature and submit the HOME OFFICE COPY with the Application. The Applicant retains a copy. Consumer Form (3728) Have the applicant read each statement and initial documenting their understanding. The applicant retains the duplicate copy. Policy Explanation At the time of policy delivery, explain the policy benefits, limitations and exclusions, the preexisting conditions limitations and the deductible requirement. PREGNANCY Any applicant who is pregnant at the time of application will not be accepted. Additionally, if any family member is pregnant at the time of application, whether or not they are included on the application, the entire family is ineligible for coverage. Replacement Insurance form Any state requiring a replacement form must have the Replacement Insurance form completed and returned with the application prior to issue. Completion of the Application: COMMON SENSE PLAN (CS1) MALE AND FEMALE MAXIMUM* HEIGHT/WEIGHT CHART HEIGHT MAXIMUM* FEET INCHES WEIGHT and above 311 * Uninsurable if over maximum weight. It is very important that each question on the application be asked and answers recorded correctly to assure full and correct coverage. Where there are multiple conditions in a question, an affirmative response on any one condition means the box must be checked for that applicant. The following must be provided for the application to be processed in the home office: Height and Weight must be completed at the top of the application for each family member. Family members who exceed the weight limits on Height/Weight charts on the CS Plan app/brochure are not eligible for coverage. Questions 3-4: If Question 3 is "Yes", details must be provided and the answer to Question 4 must be answered "Yes" and signed to be eligible for coverage. Replacement form rules apply as required by the state. Questions 5-8: If the answer is "Yes" to any condition listed in Questions 5-8, that family member is ineligible, as noted on the application. Question 9: If the answer to Question 9 is "Yes", company underwriters will review and determine if applicant will be issued coverage. If issued, coverage will be issued standard. Question 10: If any condition listed in Question 10 exists, coverage will be issued with an Exclusion Rider for the condition indicated. No applicant will be issued coverage with more than three (3) Exclusion Riders.

3 Question 11: List any condition not listed in Questions 5-10 for which treatment was received in prior two (2) years. Company underwriters will review and determine if applicant will be issued coverage. If issued, coverage will be issued standard. Question 12: Insured and spouse are eligible for special "Preferred Rates" if the answers to Questions 5-10 are "No" and statements 12(a) - 12(f) are true. Preferred Rates is a one time offer available only at the time of application. This question does not apply to children. If the applicant elects to have premiums paid by Bank Draft, a voided check and signed bank authorization must be attached so renewal payments may be paid by bank draft. Authorization to Obtain and Disclose Medical Information (F1224) signed by each applicant age 18 and over. If, prior to issue an applicant is determined to be ineligible for coverage under the CS Plan, that individual will be declined coverage under this plan and the balance of the family members issued coverage. The declined individual may be eligible for coverage under one of our other plans. If, subsequent to issue an applicant is determined to have been ineligible for coverage at time of application under the CS Plan, that individual will no longer be eligible for coverage of any type with our company. A discussion of all health conditions listed on the application follows; this summary will help you and your customers in properly completing applications. CS Plan Discussion Of Conditions Q5 Q6 (Shown by Question in the same order the conditions appear on the application.) TOTALLY DISABLED: Inability to perform the duties of any occupation for which one is reasonably trained or educated. Anyone who has applied for or is currently receiving workmen's compensation, social security, long term disability or employer/group disability benefits. AIDS, ARC or Immune System Disorders: Any disorder, including AIDS and ARC, that causes an impairment of the body's immune system. CHRONIC ALCOHOL OR DRUG ABUSE: Repeated drinking of alcoholic beverages or taking of drugs to the extent that such interferes with the person's health or social function... any use of illegal drugs. CHRONIC BRAIN SYNDROME: Gradual onset of memory, judgment and thinking deterioration, delusions and irritability. The most frequent cause is cerebral arteriosclerosis, but may also result from brain tumor, infection and/or injury. ADDISON'S DISEASE: Bronzelike pigmentation of the skin, severe prostration, progressive anemia, low blood pressure, diarrhea, and digestive disturbance due to disease of adrenal glands and usually fatal. ALZHEIMER'S: An organic brain disease in which there is a large loss of brain cells resulting in progressively decreasing function loss of memory, impaired speaking, writing, personality changes and loss of control of bodily functions. AMPUTATION DUE TO DISEASE: Surgical removal of an extremity, i.e., arm or foot due to disease such as diabetes, or obstructed circulation which resulted in gangrene. BRAIN TUMOR: All tumors, benign or malignant situated within the cranium (skull) and which may or may not be of the brain substance. CEREBRAL PALSY: Disorders of the central nervous system resulting in paralysis and weakness of extremities, involuntary movements of extremities, exaggerated reflexes, speech difficulties and sometimes mental deficiency. CHRONIC MUSCLE DISORDER: Neuromuscular impairments chronic and progressive muscle weakness and atrophy, muscular dystrophy, muscular atrophy, myasthenia gravis and amyotrophic lateral sclerosis. CHRONIC RENAL (KIDNEY) INSUFFICIENCY: Inability of kidneys to function normally in filtering the blood. CROHN'S DISEASE: A chronic inflammation of the entire gastrointestinal tract, but most commonly the affected areas are the terminal ileum, colon and anorectal area. CYSTIC FIBROSIS: Obstruction of organ passages by the abnormal mucus secretions results in chronic pulmonary disease, pancreatic insufficiency, malnutrition, biliary cirrhosis, intestinal obstruction. DIABETES: A disorder with abnormal glucose metabolism. Some complications are blindness, kidney disease, gangrene, stroke and coronary artery disease. DOWN'S SYNDROME: A congenital condition associated with physical, mental, and chromosomal abnormalities major signs are mental retardation, poor muscle tone, characteristic facial appearance, frequent eye and heart abnormalities and upper respiratory infections. CHRONIC ADRENOCORTICAL INSUFFICIENCY: See Addison's disease.

4 HEMOPHILIA: A blood disorder characterized by a life-long tendency to hemorrhage. It is an inherited deficiency in clotting which delays coagulation and hence prolongs hemorrhage. HODGKIN'S DISEASE: A malignant condition characterized by painless, progressive enlargement of the lymph nodes, spleen and general lymphoid tissue. HUNTINGTON'S CHOREA: Rare hereditary disease characterized by jerky movements, and mental deterioration terminating in dementia. HYDROCEPHALUS: Abnormal accumulation of fluid in the cranial vault, enlargement of the head, atrophy of brain, mental deterioration and convulsions. LIVER CIRRHOSIS: Diseases of the liver characterized by loss of normal liver function. MENTAL RETARDATION: Significantly below average general functioning intellectually, which results in impairment in adaptive behavior. MULTIPLE MYELOMA: Malignant neoplasm of plasma cells usually arising in the bone marrow and manifested by skeletal destruction, fractures, and bone pain. MULTIPLE SCLEROSIS: Chronic disease affecting the brain and/or spinal cord causing disturbance of vision, muscle weakness and incoordination and partial or complete paralysis. MUSCULAR DYSTROPHY: Weakness and atrophy of muscles without involvement of the nervous system. ORGAN TRANSPLANT OTHER THAN CORNEA: Pertains to transplant of internal organs such as heart, liver or kidney. PAGET'S DISEASE: Results in both abnormal bone destruction and bone repair usually involves the long bones (softening and bowing) spine and pelvis (abnormal curvature and gait) and skull (large head). PANCREATITIS: Inflammation of the pancreas. PARAPLEGIA: Paralysis of the lower extremities. PARKINSON'S DISEASE: A group of neurological disorders characterized by tremor and muscular rigidity. POLYCYSTIC RENAL (KIDNEY) DISEASE: Cysts, hereditary and congenital origin, are multiple and involve the kidneys. As they increase in size and number, functioning kidney tissue is gradually destroyed. QUADRIPLEGIA: Complete paralysis of both arms and both legs. Q7 RENAL (KIDNEY) FAILURE: Non-functioning kidney not filtering the blood failure to excrete the endproducts of body metabolism in the form of urine. SCLERODERMA: Connective tissue diseases, chronic, where connective tissue proliferates in the skin and many internal organs progressive, with cardiac or renal involvement, death usually occurs in one to three years. SICKLE CELL ANEMIA: A hereditary anemia, characterized by arthralgia, acute attacks of abdominal pain, ulcerations of lower extremities. APLASTIC ANEMIA: An anemia generally unresponsive to therapy the bone marrow fails to produce adequate number of peripheral blood elements. SPINA BIFIDA: Congenital failure of closure of the vertebral arch in one or several adjacent vertebrae-varying degrees of paralysis, sphincter disturbances and gait defects. SYSTEMIC LUPUS ERYTHEMATOSUS: A connective tissue disorder, progressive inflammatory disease involving the skin and variably the muscles, joints, vessels, internal organs and central nervous system. THROMBOCYTOPENIA: Decrease in the number of blood platelets. DISCOID LUPUS: Skin disease where superficial localized areas of inflammation develop and persist. ELEVATED CHOLESTEROL COUNT: If High Cholestrol is treated and under control, with no other complications, the applicant can be considered using standard rates. HEART OR CARDIOVASCULAR DISEASE: Heart attack, congestive heart failure, coronary thrombosis, arteriosclerotic heart disease, congenital heart defects. INTERNAL CANCER, MALIGNANT MELANOMA, LEUKEMIA: Any type of malignancy that is internal including leukemia as well as malignant melanoma which is a highly invasive form of skin cancer with a marked tendency to metastasis or spread and become internal malignancy. PERIPHERAL BLOOD VESSEL DISEASE: Disease of the arteries and veins of the upper and lower extremities with the lower extremities more frequently involved. POLYCYTHEMIA: An increase in the total red cell mass of the blood.

5 Q9 CHRONIC OBSTRUCTIVE LUNG DISEASE: Generalized airways obstruction associated with varying degrees of chronic bronchitis, emphysema and sometimes bronchial asthma, bronchiectasis and fibrotic changes in the lungs. COMPLICATIONS OF PREGNANCY OR CHILDBIRTH: Any complication or abnormality related to pregnancy or childbirth. CONVULSIONS: Violent involuntary contraction or series of contractions of the involuntary muscles, includes epilepsy and seizures. HEPATITIS: Inflammation of the liver. NERVOUS OR MENTAL DISORDER: Schizophrenia, psychosis, insanity, dementia, depression or anxieties. REPRODUCTIVE ORGAN, BREAST OR PROSTATE DISORDER: Disorders involving female and male reproductive organs, also breast disorders except fibrocystic disease of breast. Urinary tract DISORDERS: Bladder or kidney infections or disorders, kidney stones, cystitis. Back bone or joint DISORDERS: Conditions q10 involving the spine, bones or joints such as, degenerative disc, osteoarthritis, osteomyelitis, osteoporosis, joint replacement. Chronic Ear DISORDER: Otitis media (middle ear disease), Menieres disease (inner ear disease). Eye DISORDER: Cataracts, glaucoma, not intended to include use of corrective lenses. Gallbladder Disorder (unoperated): An existing gallbladder infection or stones. COLITIS: Inflammation of the colon. DIVERTICULITIS: A sac protruding from the intestine with accompanying inflammation. DIVERTICULOSIS: Presence of diverticula, particularly of intestinal diverticula. Post Office Box 8080 McKinney, Texas CS1 UG 5 of 5