Wisconsin

Medicare Supplement
Product Forms: MS WI 06 (rev)

Benefits and Features
Coverage Core Plan Optional Core Plan Riders
A B C D E
Part A deductible          
Part A hospital co-payment (61-90 days)          
Part A hospital co-payment (91-150 days)          
Hospitalization beyond 150 days          
Part A blood deductible (3 pints)          
Skilled nursing facility co-payment (21-100 days)          
Inpatient psychiatric care - additional 175 days per lifetime          
Home health care        
Part B deductible        
Part B 20% of eligible expenses          
Part B excess charges        
Part B blood deductible (3 pints)        
Part B policy limits per calendar year No Limit          
Routine physical examinations          
Mammograms, pap smears and breast exams        
Prostate cancer screen        
Inpatient hospital private duty nursing        
Foreign travel          
State mandated benefits          
Exceptions and Limitations

We will NOT pay benefits for any expenses incurred for which a charge normally is not made when there is no insurance or any expense incurred before the policy date. We will not duplicate any benefit paid by Medicare.

Pre-existing Conditions

Our policies do NOT include a pre-existing conditions limitation.
Renewability Provision - Guaranteed Renewable - Premiums Subject to Change

We guarantee to renew your policy each time you send us the premium. It must be paid on or before the date it is due or during the 31 days that follow. Your policy stays in force during this time. We can change your premium only if we do the same to all policies of this form issued to persons of your class in your state.


MSUP3 WI 11-06