Cancer

APL

ABOUT CANCER

Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd

THIS IS ONLY A SUMMARY OF BENEFITS. PLEASE REFER TO THE CERTIFICATE OF COVERAGE FOR LIMITATIONS AND EXCLUSIONS TO DETERMINE ACTUAL COVERAGES. GO TO WWW.MYBENEFITSHUB.COM/PROSPERISD UNDER THE CANCER SECTION FOR COMPLETE DETAILS.

EMPLOYEE BENEFITS

Cancer Monthly Premium Employee $21.88 Employee + Spouse $35.50 Employee + Child(ren) $27.24 Family $37.96

Summary of Benefits Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12-month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime Internal Cancer First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Hospital Intensive Care Unit Rider Benefits Intensive Care Unit Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit Plan 1 Level 4 $20,000 $50 per treatment paid in same manner and under the same maximums as any other benefit Level 1 $30 unit dollar amount Max $3,000 per operation 25% of amount paid for covered surgery $6,000 $600 $1,000 / $100 Level 2 $5,000

$7,500

$600 per day $300 per day