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.