SURGICAL TREATMENT Surgical Benefit unit dollar amount (per surgical unit) maximum per operation $30 $3,000 $40 $4,000 $50 $5,000 Anesthesia Benefit 25% of the amount paid for covered surgery Outpatient Hospital or Ambulatory Surgical Center Benefit (per day) $400 $600 $800 Second & Third Surgical Opinion Benefit (per diagnosis) $300 $300 $300 CONTINUING CARE Prosthesis Benefit Non-Surgical (per device - 1 per site, lifetime max of 3) Surgical Implantation (per device, includes surgical fee - 1 per site, lifetime max of 2) Hair Prosthesis (once per life) $150 $1,500 $150 $200 $2,000 $200 $250 $2,500 $250 Extended Care Facility Benefit (per day for up to the same number of days of paid Hospital confinement) $75 $100 $125 Physical or Speech Therapy Benefit (per visit up to 4 per calendar month - lifetime max of $1,000) $25 $25 $25 Hospice Care Benefit (per day - $13,500 lifetime max for basic; $18,000 lifetime max for enhanced; $22,500 lifetime max for enhanced plus) $75 $100 $125 Home Health Care Benefit (per day for up to the same number of days of paid Hospital confinement) $75 $100 $125 Waiver of Premium (as long as the primary insured remains disabled) pays 90 continuous days BENEFITS+ BASIC ENHANCED ENHANCED PLUS +The premium and amount of benefits provided vary based upon the plan selected. Refer to Plan Benefit Highlights for more complete benefit descriptions and limits on the Individual Cancer insurance plan. Benefits TREATMENT Radiation Therapy/Chemotherapy/ Immunotherapy Benefit (per 12-month period) (Actual Charges) up to $15,000 up to $20,000 up to $25,000 Medical Imaging Benefit (per image - max 2 per calendar year) $200 $300 $400 Hormone Therapy Benefit (per treatment - max 12 treatments/ calendar year) $50 $50 $50 Administrative/Lab Work Benefit (per calendar month) $75 $100 $125 Blood, Plasma, and Platelets Benefit (per day) (per calendar year max) $150 $7,500 $200 $10,000 $250 $12,500 Experimental Treatment Benefit Paid as any non- experimental benefit Bone Marrow/Stem Cell Transplant Benefit Autologous (patient provided) (per calendar year) Non-autologous (donor provided) (per calendar year) $1,000 $3,000 $1,500 $4,500 $2,000 $6,000 Donor Benefit $1,000 per donation Inpatient Special Nursing Services Benefit (per day) $150 $150 $150 Dread Disease Benefit (per day for the first 30 days per Hospital confinement) (per day thereafter) $200 $400 $300 $600 $400 $800 HOSPITALIZATION Hospital Confinement Benefit* (per day for the first 30 days) (per day thereafter) $200 $400 $300 $600 $400 $800 Drugs & Medicine Benefit Hospital Confinement (per confinement) Outpatient (per prescription - $100 monthly max for basic; $150 for enhanced; $200 for enhanced plus per calendar month) $200 $50 $300 $50 $400 $50 Attending Physician Benefit (per day) $40 $50 $60 U.S. Government/Charity Hospital or HMO Benefit (per day in lieu of most benefits) Hospital Confinement Outpatient Services $200 $200 $300 $300 $400 $400 BENEFITS+ BASIC ENHANCED ENHANCED PLUS SCREENING Diagnostic and Prevention Benefit (one per calendar year) $60 $75 $90 Cancer Screening Follow-Up Benefit (one per calendar year) $60 $75 $90 AMBULANCE, TRANSPORTATION, & LODGING Ambulance Benefit (per trip - max 2 trips any combination per confinement) Ground Air $200 $2,000 $200 $2,000 $200 $2,000 Transportation & Lodging Benefit (Patient and/or Family) Transportation ($1,500 max per round trip; max 12 trips/calendar year) Outpatient Lodging (per day up to 90 days per calendar year) Coach fare or $.50/mile by car $60 $80 $100