Cancer IN

AF™ Limited Bene昀椀t Individual Cancer Insurance Focus on the fight. A Cancer diagnosis may be both a physical and emotional drain. But thanks to advances in medicine and procedures to treat Cancer, more and more people are beating the disease. However, with the arrival of these advances also comes the continuing rise in the cost of Cancer treatment. AF™ Limited Benefit Individual Cancer Insurance offers a solution to help you and your family focus on fighting the disease. Plan Highlights • Helps cover expenses for the treatment of Cancer, transportation, hospitalization, and more. • Benefits paid directly to you to be used however you see fit. ™ • Portable to take with you AF Cancer C11 even if you leave employment. Individual Insurance • Coverage options available for you, your spouse, and your children under age 26. Cancer Insurance Benefits With over 25 benefits specifically designed to help with the financial impact of being diagnosed, Individual Cancer Insurance may help pay for expenses not covered by your major medical insurance. Example Cancer insurance benefits include: Experimental Treatment This benefit may help pay for experimental treatment to give you alternatives in your healing. These treatment types may not be covered by major medical plans. Transportation and Lodging This benefit may help pay for qualified transportation and lodging for the patient and family. + SCREENING BENEFIT Receive a benefit for your annual internal Cancer screening test, including but not limited to mammogram, pap, prostate-specific antigen blood test (PSA), chest x-ray, flexible sigmoidoscopy, thinprep pap test, and colonoscopy. DIAGNOSTIC AND PREVENTION BENEFIT (per calendar year) BASIC ENHANCED ENHANCED PLUS $60 $75 $90 EMPLOYER BENEFIT SOLUTIONS FOR EDUCATION +The premium and amount of benefits provided vary based upon the plan selected.

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

Plan Benefit Highlights + This benefit does not include any drugs/ medicines covered under the drugs MONTHLY PREMIUMS and medicine benefit or the hormone therapy benefit. Actual Charges means BASIC Age 18-40 Age 41-50 Age 51-60 Age 61+ the amount actually paid by or on behalf of the insured person and accepted by the provider for services provided. Individual $16.30 $23.60 $32.60 $44.20 Medical Imaging Benefit Pays the indemnity amount for either an MRI; CT Single Parent Family $24.40 $35.20 $48.70 $65.90 scan; CAT scan; or PET scan when performed at the request of a physician. Family $31.80 $45.70 $63.30 $85.80 Hormone Therapy Benefit Drugs and medicines covered under the drugs and medicine benefit or the radiation/chemotherapy/immunotherapy benefit are not included. This benefit does not cover associated administrative processes. ENHANCED Age 18-40 Age 41-50 Age 51-60 Age 61+ Administrative/Lab Work Benefit Pays when procedures related to radiation therapy/chemotherapy/immunotherapy treatment occur and benefits Individual $21.00 $30.80 $42.40 $57.30 are payable during the same calendar month as the radiation therapy/ Single Parent Family $31.40 $45.80 $63.30 $85.60 chemotherapy/immunotherapy benefit. Benefits for blood, plasma and platelets Blood, Plasma and Platelets Benefit Family $40.80 $59.50 $82.30 $111.30 are only provided under this benefit. Laboratory processes and colony stimulating factors are not covered. ENHANCED PLUS Age 18-40 Age 41-50 Age 51-60 Age 61+ Bone Marrow/Stem Cell Transplant Benefit Harvesting of bone marrow or stem cells from a donor are not covered under Individual $25.80 $38.10 $52.70 $71.00 this benefit. Single Parent Family $38.50 $56.80 $78.60 $106.00 Hospital Confinement Benefit Payable while confined to a Hospital for at least 18 continuous hours. *A Hospital is not an institution, or part thereof, Family $50.10 $73.80 $102.20 $137.90 used as: a hospice unit, including any bed designated as a hospice or swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended care facility; a skilled nursing facility; or a facility primarily affording Plan Benefit Highlights custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. Only loss for Cancer The policy pays only for loss resulting from definitive This benefit is not payable for outpatient treatment. Cancer treatment including direct extension, metastatic spread or Drugs and Medicine Benefit Pays for anti-nausea and pain medication recurrence. Proof must be submitted to support each claim. The policy prescribed by a physician and administered while also receiving radiation also covers other conditions or diseases directly caused by Cancer or the therapy/chemotherapy/immunotherapy, a covered surgery, or a bone marrow/ treatment of Cancer. The policy does not cover any other disease, sickness, stem cell transplant. It does not include associated administrative processes or incapacity, even though after contracting Cancer it may have been or drugs or medicines covered under the radiation therapy/chemotherapy/ aggravated or affected by Cancer or the treatment of Cancer except for immunotherapy benefit or the hormone therapy benefit. conditions specifically provided in the dread disease benefit. Attending Physician Benefit Pays for one physician’s visit per day when the Cancer means a disease of autonomous growth (malignancy) in which services of a physician, other than a surgeon, are required while confined in a there is uncontrolled growth, function, or spread (local or distant) of Hospital. cells in any part of the body. This includes Cancer in situ and malignant U.S. Government/Charity Hospital /HMO Benefit Payable when an itemized melanoma. It does not include other conditions which may be considered list of services is not available due to confinement in a charity Hospital or a precancerous or having malignant potential such as: leukoplakia; Hospital owned or operated by the U.S. government or covered under an hyperplasia; acquired immune deficiency syndrome (AIDS); polycythemia; HMO or diagnostic related group where no charges are made for treatment actinic keratosis; myelodysplastic and non–malignant myeloproliferative of Cancer or a covered dread disease. This benefit will be paid in lieu of most disorders; aplastic anemia; atypia; non–malignant monoclonal benefits covered under this policy. gammopathy; carcinoid; or pre–malignant lesions, benign tumors or polyps. Ambulance Benefit If air and ground ambulance services are both required All diagnosis of Cancer must be positively diagnosed by a legally licensed on the same day, we will only pay the higher benefit amount. The covered doctor of medicine certified by the American Board of Pathology or person must be admitted as an inpatient and Hospital confined for at least 18 American Board of Osteopathic Pathology. Benefits under this policy pays consecutive hours. the benefit amount shown per covered person due to a covered Cancer Transportation and Lodging Benefits Pays a benefit for transportation by unless otherwise specified. scheduled bus, plane or train, or by car and outpatient lodging to receive Diagnostic, Prevention and Cancer Screening Benefit Pays for a generally radiation therapy, chemotherapy, or immunotherapy treatment, bone marrow medically recognized internal Cancer screening test when a charge is or stem cell transplant, or surgery in a Hospital not available locally and at least incurred for the test. Tests include but are not limited to mammogram, 50 miles from the covered person’s residence. Payable for the covered person thinprep pap test, prostate-specific antigen blood test (PSA), colonoscopy, and one adult family member. If traveling in the same car or lodging in the and chest x–ray. Refer to the policy for more examples. Screening tests same room, the benefit is payable only for the covered person. Travel must be payable under this benefit will ONLY be paid under this benefit and does within the United States or its Territories. not include any test payable under the medical imaging benefit. This Surgical Benefit Payable when a surgical operation is performed for covered benefit is available without a diagnosis of Cancer. diagnosed Cancer, skin Cancer, or reconstructive surgery due to Cancer. Cancer Screening Follow-Up Benefit Payable for one invasive follow–up Benefits are calculated up to a maximum benefit by multiplying the surgical screening test needed due to an abnormal result from a covered screening unit value assigned to the procedure, as shown in the most current physician’s test. Diagnostic surgeries which result in a positive diagnosis of Cancer will relative value table, by the unit dollar amount shown in the policy. Two be paid under the surgical benefit. or more surgical procedures performed through the same incision will be Pays the Actual considered one operation and benefits will be limited to the most expensive Radiation/Chemotherapy/Immunotherapy Benefit procedure. Diagnostic surgeries that result in a negative diagnosis of Cancer Charges up to the maximum amount shown when radiation therapy, are not covered under this benefit. Bone marrow surgeries, surgeries to chemotherapy, or immunotherapy is received as defined in the policy, per implant a permanent prosthetic device, are not covered under this benefit. 12-month period. The 12-month period begins on the first day the covered This benefit is payable for reconstructive breast surgery performed on a radiation therapy, chemotherapy, or immunotherapy is received. This benefit nondiseased breast to establish symmetry with a diseased breast when does not cover other procedures related to radiation/ chemotherapy/ reconstructive surgery on the diseased breast is performed while covered immunotherapy. under this policy, in the manner determined by the Physician and the Covered Person to be appropriate.

AF™ Limited Bene昀椀t Individual Cancer Insurance Plan Benefit Highlights (cont.) Anesthesia Benefit Services of an anesthesiologist for bone marrow Dread Disease Benefit Covered dread diseases are: addison’s disease; transplants, skin Cancer or surgical prosthesis implantation are not amyotrophic lateral sclerosis; cystic fibrosis; diphtheria; encephalitis; grand covered. mal epilepsy; legionnaire’s disease; meningitis; multiple sclerosis; muscular Outpatient Hospital or Ambulatory Surgical Center Benefit Surgical dystrophy; myasthenia gravis; niemann-pick disease; osteomyelitis; procedures for skin Cancer are not covered. poliomyelitis; reye’s syndrome; rheumatic fever; rocky mountain spotted fever; sickle cell anemia; systemic lupus erythematosus; tay-sach’s disease; Second and Third Surgical Opinion Benefit Payable once per diagnosis tetanus; toxic epidermal; toxic shock syndrome; tuberculosis; tularemia; of Cancer for a second surgical opinion, and a third if the second disagrees typhoid fever; whipple’s disease. with the first. Surgical opinions for reconstructive, skin Cancer, or Inpatient Special Nursing Services Benefit Pays when Hospital confined prosthesis surgeries are not covered. and receiving physician authorized special nursing care (other than that Prosthesis Benefit Payable for a prosthetic device and, if surgery required, regularly furnished by a Hospital) of at least 8 consecutive hours during a its surgical implantation. Prosthetic related supplies such as special bras 24 hour period. or ostomy pouches and supplies are not covered. Hair Prosthesis Benefit See your policy for more information regarding the benefits listed above. is payable once per covered person per lifetime when a hair prosthesis is needed. Eligibility The policy/rider(s) will be issued only to those persons who meet Extended Care Facility Benefit Pays for physician authorized confinement American Fidelity’s insurability requirements, which includes satisfactory that begins within 14 days after a Hospital confinement. responses to medical questions. You, your lawful spouse and each natural, Physical or Speech Therapy Benefit Therapy must be provided by a adopted or step child who is under 26 years of age are eligible to apply for caregiver licensed in physical or speech therapy. coverage. Hospice Care Benefit Payable when a physician determines terminal Limitations and Exclusions The policy does not cover any other disease, illness with life expectancy of 6 months or less and approves hospice care sickness or incapacity even though after contracting Cancer it may have at home or in a hospice facility. This benefit does not include well baby been aggravated or affected by Cancer or the treatment of Cancer except care, volunteer services, meals, housekeeping services, or family support for conditions specifically stated in the dread disease benefit. after the death. Pre-Existing Condition A Pre-Existing Condition is a Cancer or dread Home Health Care Benefit Pays for physician authorized private nursing disease for which, within 12 months prior to the effective date of care that begins within 14 days of a hospital confinement. This benefit coverage, medical advice, consultation or treatment, including prescribed does not include nutrition counseling, medical social services, medical medications, was recommended by or received from a member of supplies, prosthesis or orthopedic appliances, rental or purchase of durable the medical profession. Pre–Existing Conditions specifically named or medical equipment, drugs or medicines, child care, meals or housekeeping described as excluded in any part of the policy are never covered. No services, or physical or speech therapy. The service must be provided by a benefits are payable for any covered person for any loss incurred during nurse or home health nurse’s aid and can not be a family member. the first year of the policy as a result of a Pre–Existing Condition. Waiver of Premium Benefit If the primary insured becomes disabled due Termination of Insurance Policy/rider(s) will terminate and coverage will to Cancer and remains so for more than 90 continuous days, we will pay end on the earliest of: the end of the grace period if the premium remains all premiums for policy and rider(s) due after the 90th day so long as the unpaid; or the end of the policy/rider(s) month in which we receive a primary insured remains disabled. “Disabled” means the primary insured’s written request from you to terminate the policy/rider(s); or the date of inability because of Cancer: to work at any job for which (s)he is qualified your death, if this is an Individual Plan. If the plan is other than individual by education, training or experience; not working at any job for pay or the remaining covered persons may have the right to continue or convert benefits; and under the care of a physician for the treatment of Cancer. their coverage. Coverage will terminate when they no longer meet the The policy must be in force at the time disability begins and the primary eligibility requirements. insured must be under age 65. For the spouse, policy/rider(s) will terminate and coverage will end on the Experimental Treatment Benefit Benefits for experimental treatment earliest of: The end of the policy/rider(s) month in which we receive a prescribed by a physician for treatment of Cancer will be provided the same as written request from you to delete the spouse from the policy/rider(s); the non-experimental treatment. Coverage for treatments received outside of the end of the premium term in which a divorce, annulment, legal separation United States or its territories is not provided. is obtained; or upon their death. Donor Benefit Pays if a donor incurs expenses on behalf of a covered For the child(ren), policy/rider(s) will terminate and coverage will end the person for a covered surgery due to organ transplant or a bone marrow/ earliest of: The end of the policy/rider(s) month in which we receive a stem cell transplant. Blood donor expenses are not covered under this written request from you to delete the child(ren) from the policy/rider(s); benefit. or upon their death. Guaranteed Renewable You are guaranteed the right to renew your policy/rider(s) during your lifetime as long as you pay premiums when due or within the premium grace period. We have the right to increase premiums by class. This product may contain limitations and exclusions. This American Fidelity Assurance Company product is inappropriate for people who are eligible for 9000 Cameron Parkway, Oklahoma City, Oklahoma 73114 Medicaid coverage. 800-662-1113 • americanfidelity.com Policy Form Series C11 SB-30641(IN)(AFES)-1019 Plan Codes 013-746, 013-747, 013-748

AF™ Limited Bene昀椀t Individual Cancer Insurance Riders EMPLOYER BENEFIT SOLUTIONS FOR EDUCATION Enhance Your Plan+,++ Critical Illness Rider Hospital Intensive Care Unit Rider SCHEDULE OF BENEFITS SCHEDULE OF BENEFITS Cancer Benefit $2,500 ICU Confinement Benefit $600 per unit - maximum $10,000 per day up to 30 days per confinement Heart Attack/Stroke Benefit $2,500 Ambulance Benefit $100 per unit - maximum $10,000 per admission in an ICU Summary of Critical Illness Rider Benefits: Summary of Hospital ICU Rider Benefits: • Pays when diagnosed by a Physician after the covered persons • Confinement must be due to an accident or sickness and effective date of coverage with Internal Cancer or Heart begin after the effective date of coverage under this rider. Attack/Stroke, depending upon the Critical Illness coverage • A day is defined as a 24-hour period. elected at time of application. • Pays the specified Maximum Benefit Amount per Covered • If confined to an ICU for a portion of a day, a pro rata share of Critical Illness, as defined under this rider. the daily benefit will be paid. • Each benefit is a one-time paid benefit. • For ambulance charges, $100 for transportation to a Hospital • All Critical Illness amounts reduce by 50% at age 70. where the Covered Person is admitted to an ICU within 24 hours of arrival. • All ICU and Ambulance amounts reduce by 50% at age 70. ++ Optional Benefit Rider Monthly Premiums Critical Illness Rider Monthly Premiums $2,500 $5,000 $7,500 $10,000 CANCER ONLY Ind 1 Parent 2 Parent Ind 1 Parent 2 Parent Ind 1 Parent 2 Parent Ind 1 Parent 2 Parent Family Family Family Family Family Family Family Family Age 18-40 $1.50 $2.20 $2.90 $3.00 $4.40 $5.80 $4.50 $6.60 $8.70 $6.00 $8.80 $11.60 Age 41-50 $3.00 $4.50 $5.80 $6.00 $9.00 $11.60 $9.00 $13.50 $17.40 $12.00 $18.00 $23.20 Age 51-60 $4.90 $7.30 $9.40 $9.80 $14.60 $18.80 $14.70 $21.90 $28.20 $19.60 $29.20 $37.60 Age 61+ $7.10 $10.60 $13.80 $14.20 $21.20 $27.60 $21.30 $31.80 $41.40 $28.40 $42.40 $55.20 HEART $2,500 $5,000 $7,500 $10,000 ATTACK/ Ind 1 Parent 2 Parent Ind 1 Parent 2 Parent Ind 1 Parent 2 Parent Ind 1 Parent 2 Parent STROKE ONLY Family Family Family Family Family Family Family Family Age 18-40 $0.80 $1.20 $1.50 $1.60 $2.40 $3.00 $2.40 $3.60 $4.50 $3.20 $4.80 $6.00 Age 41-50 $2.10 $3.10 $4.10 $4.20 $6.20 $8.20 $6.30 $9.30 $12.30 $8.40 $12.40 $16.40 Age 51-60 $3.10 $4.60 $6.00 $6.20 $9.20 $12.00 $9.30 $13.80 $18.00 $12.40 $18.40 $24.00 Age 61+ $4.60 $6.90 $8.90 $9.20 $13.80 $17.80 $13.80 $20.70 $26.70 $18.40 $27.60 $35.60 Hospital Intensive Care Unit Rider Monthly Premiums HOSPITAL INTENSIVE CARE Age 18–40 Age 41–50 Age 51–60 Age 61+ UNIT RIDER Individual $3.40 $4.20 $5.50 $7.10 Single Parent Family $5.10 $6.30 $8.20 $10.60 Family $6.60 $8.20 $10.70 $13.80 +Availability of riders may vary by state and employer. Optional benefit riders are subject to our general underwriting guidelines and coverage is not guaranteed. ++The premium and amount of benefits provided vary based upon the plan selected.

AF™ Limited Bene昀椀t Individual Cancer Insurance Riders Critical Illness Rider Hospital Intensive Care Unit Rider Limitations and Exclusions Benefits will only be paid for a Limitations and Exclusions No benefits will be provided during Covered Critical Illness as shown on the Policy Schedule page in the first two years of the rider for Hospital Intensive Care Unit the policy. No benefits will be provided for any loss caused by or confinement caused by any heart condition when any heart resulting from: intentionally self-inflicted bodily injury, suicide condition was diagnosed or treated prior to the Covered Person’s or attempted suicide, whether sane or insane; or intentional self- Effective Date of the rider (The heart condition causing the injury; or alcoholism or drug addiction; or any act of war, declared confinement need not be the same condition diagnosed or or undeclared or any act related to war; or military service for any treated prior to the Effective Date.). No benefits will be provided country at war; or a Pre-Existing Condition during the 12 month if the loss results from: attempted suicide whether sane or period following the Covered Person’s Effective Date under the insane; intentional self–injury; alcoholism or drug addiction; rider; or participation in any activity or event while intoxicated or any act of war, declared or undeclared, or any act related to or under the influence of any narcotic unless administered by a war; or military service for any country at war. No benefits will Physician or taken according to the Physician’s instructions; or be paid for confinements in units such as: Surgical Recovery participation in, or attempting to participate in, a felony, riot or Rooms, Progressive Care, Burn Units, Intermediate Care, Private insurrection (A felony is as defined by the law of the jurisdiction in Monitored Rooms, Observation Units, Telemetry Units or which the activity takes place.) All Critical Illness amounts reduce Psychiatric Units not involving intensive medical care; or other by 50% at age 70. facilities which do not meet the standards for Intensive Care Unit Pre-Existing Condition As defined in this rider means any as defined in the Rider. All ICU and Ambulance amounts reduce sickness or condition for which, within 12 months prior to the by 50% at age 70. Effective Date of coverage under this rider, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession.) Internal Cancer does not include: other conditions that may be considered pre–cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non–malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non–malignant monoclonal gamopathy; or pre–malignant lesions, benign tumors or polyps; or Leukoplakia; or Hyperplasia; or Carcinoid; or Polycythemia; or cancer in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper.. Heart Attack does not include congestive heart failure, atherosclerotic heart disease, angina, including unstable angina, coronary disease or any other dysfunction of the cardiovascular system. Stroke does not mean a head injury, transient ischemic attack, multi-infarct dementia, or chronic cerebrovascular insufficiency. Termination Each Covered Person’s coverage will terminate when the maximum benefit amount for the Covered Critical Illness(es) has been paid for him/her. This insert must be used in conjunction with SB-30641 and any state specific deviations thereof. This is a brief description of the coverage. For complete benefits American Fidelity Assurance Company and other provisions, please refer to the policy and riders. This 9000 Cameron Parkway, Oklahoma City, Oklahoma 73114 coverage does not replace Workers’ Compensation Insurance. These products are inappropriate for people who are 800-662-1113 • americanfidelity.com eligible for Medicaid Coverage. SB-32507(IN)(AFES)-1019 Policy Form Series AMDI239 and AMDI240 Plan Code 013-776, 013-777, and 013-769