FOR
U.S. Citizens Or U.S. Residents Awaiting Medicare Eligibility

OR
U.S. Citizens Or U.S. Residents Without Medicare Part A Or Part B

An Individual Major Medical Plan For People Awaiting Medicare Eligibility

The Bridge Plan is a major medical expense insurance plan intended for persons age 60-95 who are awaiting acceptance as a participant in the U.S. Medicare System. Foreign Nationals are eligible to participate in U.S. Medicare five years after becoming a U.S. Resident. Certain U.S. citizens not covered by both parts of Medicare A and B may also apply for coverage under this plan. The Bridge Plan pays medically necessary expenses incurred. The expenses eligible for payment under this plan are subject to the deductible, coinsurance and limitations as outlined in the policy.

The Bridge Plan pays like this…

Deductible

• A choice of $1,000, $1,500, $2,500, $5,000, or $10,000 per policy year.

Coinsurance

• The plan pays 80% of the eligible expenses that exceed the deductible amount, up to the next $10,000.

Thereafter

• After the deductible and coinsurance amounts are satisfied, 100% of eligible expenses are paid on the basis of usual, customary and reasonable charges, up to the lifetime maximum benefit of:
  • $250,000 ages 60-74
  • $100,000 ages 75-79
  • $50,000 ages 80-89
  • $25,000 ages 90-95

Additional Information

1. The deductible and coinsurance are on a per policy period basis.
2. The lifetime maximum benefit, limitations and pre-existing conditions begin from the inception date of the first policy.
3. The plan may include coverage for Part A, Part B or both.

Covered Expenses

• Part A: These benefits include Hospitalization, Hospice Facilities, Skilled Nursing Facilities, and Home Health care services, based on medical necessity.
• Part B: These benefits include the costs of Physicians and Surgeons on either an in-patient or out-patient basis, supplies, therapy and ambulance services, based on medical necessity.

Plan Highlights

• Any Doctor and Any Hospital.
• Guaranteed to renew annually for up to five years without medical underwriting on renewals.
• Benefits paid based on usual, customary and reasonable charges and not on diagnostic related groups. (DRG is what Medicare uses as it has a much lower fee schedule.)

Pre-Existing Conditions

• A pre-existing condition means any condition which originated and which would have caused an ordinarily prudent person to seek medical diagnosis or treatment or was treated or diagnosed prior to the coverage effective date. A pre-existing condition shall not be covered until a period of 24 months, treatment free, has elapsed after inception of the first policy. The Bridge Plan, like Medicare, pays a large part of health care expenses, but it does not pay all of them. There are limits as to the amounts payable.

Part A: Hospitalization

Hospitalization Benefits
Covered expenses include semi-private room and board charges, general nursing, miscellaneous hospital services and supplies, drugs, x-rays, laboratory tests and operating rooms.

Hospice Facilities Benefits
Such costs are covered, including medically necessary out-patient treatment. A physician must certify the need of such care.

Skilled Nursing Facility Benefits
Such costs are covered following a necessary hospital confinement of three days or longer and begins within thirty days following the hospital confinement.

Home Health Care Services Benefits
Skilled care at home is covered if such care is deemed to be medically necessary.

Part B: Physicians and Surgeons

Physicians and Surgeons Benefits
The costs of physicians and surgeons are covered on either an in-patient or out-patient basis. Supplies, therapy and ambulance services are covered if prescribed as medically necessary.

Conditions:

1. Benefits are paid directly to you to reimburse you for eligible medical expenses which have been paid by you, unless we agree to pay the provider directly. Unless and until we agree, this is a reimbursement plan.
2. The policy is issued on the basis of information given in the Application. A copy of the Application becomes a part of the policy of Insurance.
3. Material misstatement or concealment of health information made by or on behalf of you may render the insurance null and void.
4. Notice of claim is to be given at the earliest possible date.
5. Benefits shall be paid for all eligible expenses which are necessarily incurred due to an illness manifesting itself or an accidental bodily injury occurring during the period of insurance.
6. These benefits are available only if there is no other source of funding available through any government insurance or private programs.

Limitations and Exclusions
Expenses which have limitations include:

• Alzheimer’s disease is limited to a lifetime maximum benefit of $25,000.
• Cardiac and/or Cancer related conditions are limited to a maximum benefit of $25,000 the first 180 days after inception of the first Policy. After 180 days, benefits will be paid as any other condition.
• Cataract surgery and procedures are limited to a maximum benefit of $2,000.

Expenses which are not covered include: Any expense which you are not legally obligated to pay; services which are not medically necessary or are not furnished by and under supervision of a Physician; any type of expense for which payment was made by Medicare or any other private or public program; expenses incurred in excess of usual, customary, and reasonable charges in your home area; outpatient drugs; self-inflicted injuries while sane; treatment of alcoholism, drug addiction, allergies, and nervous or mental disorders; rest cures, quarantine or isolation; cosmetic and plastic surgery unless necessitated by an accidental injury; dental exam, dental x-rays and general dental care except as the result of an accidental injury; eye glasses; hearing aids; general or routine exams; coverage outside the boundaries of the United States; injuries due to war or any act of war, whether declared or undeclared; or while committing a criminal or felonious act; or expenses for or resulting from subjective pain. Injuries sustained from participation in hazardous sport (mountaineering, hang gliding, scuba diving, etc.); This policy will automatically cease upon eligibility of the insured into the United States Medicare System. It is your responsibility to enroll in Medicare when you are first eligible.

Senior age people desire coverage under the Social Security Medicare program. There are some people who, either by residency status or other reasons, may not be currently eligible for Medicare. All permanent residents and citizens of the United States are eligible for Medicare at some point in time. There are three conditions for which The Bridge Plan plan is used as a substitute.

Medicare Restriction #1:
Medicare will accept people who have been a permanent resident of the United States for at least five years. This does not require citizenship or any payment into Social Security prior to eligibility. The only requirement is that they must pay a premium to have both Part A and Part B.

Petersen’s Solution #1:
The Bridge Plan is available to persons who have become permanent residents of the United States and who are within the five year waiting period for Medicare eligibility.

Medicare Restriction #2:
Some people may be eligible for Medicare due to age and qualifications, but have failed to enroll. Enrollment is not automatic. Social Security does not remind people to enroll. If they miss their enrollment period they must wait o enroll at a later date. This may be as much as 18 months later!

Petersen’s Solution #2:
The Bridge Plan will cover them with benefits similar to Medicare until the next enrollment opportunity.

Medicare Restriction #3:
Some people, for various reasons, have only Part A or Part B. They may be able to get the additional part through Medicare, but at a later date.

Petersen’s Solution #3:
The Bridge Plan may be sold with both Part A and Part B, just Part A, or just Part B.

Medical Underwriting:

• Please allow approximately 3-4 weeks for Underwriters to process the applications.
• Underwriters will either order medical records from your primary care physician or they will schedule a medical exam including a blood test, a urine test, and a resting EKG at the expense of Underwriters.

Application Submission

• Please submit the two page application along with the medical release form.
• Underwriters will accept a faxed copy, a scanned email copy, or the original application for underwriting.
• Please do NOT send premium with the application.

Question #1:	If I have a claim under the first policy will the condition be considered a pre existing condition on the renewal?
Answer #1:	The condition will not be considered a pre existing condition on the renewal as long as there has not been a lapse in coverage. This plan is only medically underwritten the first year.
Question #2:	If I have a chronic pre existing condition such as diabetes necessitating regular treatment, will the policy provide coverage for medical expenses related to diabetes?
Answer #2:	The policy will not provide coverage for expenses related to diabetes or any chronic conditions. The policy wording has an exclusion which requires 24 months, treatment free, before being covered.
Question #3:	I had a heart attack 5 years ago, will this still be considered a pre existing condition?
Answer #3:	Due to the cardiac event underwriters will most likely place a permanent exclusion for the entire cardiovascular system including heart attack and stroke.
Question #4:	How will my premiums be determined on the renewals?
Answer #4:	Premiums will adjust each renewal year by age and any other underwriting ratings at that time.
Question #5:	Will my prescription medications be covered under this plan?
Answer #5:	Prescriptions will be covered during a hospitalization only. Maintenance medication is typically covered by a Medicare supplement under Medicare Part D and is not covered under the Bridge Plan.
Question #6:	Do I need to pay the premium when I apply for the coverage?
Answer #6:	No, the premium is not due until the coverage has been approved by underwriters. If the payment is set up to be automated on a monthly basis the payment will be drafted the day of the month the coverage became effective.
Question #7:	Is there a list of doctors that I am restricted to?
Answer #7:	No, with the Bridge Plan you can see any doctor and go to any hospital. The policy does not require that the insured go to a specific network of doctors and hospitals.

Monthly Premium Rates

Age	$1,000 Deductible	$1,500 Deductible	$2,500 Deductible	$5,000 Deductible	$10,000 Deductible
60	$379	$345	$287	$192	$137
61	$387	$352	$293	$196	$140
62	$394	$359	$299	$199	$143
63	$402	$365	$305	$203	$145
64	$410	$373	$311	$207	$148
65	$431	$392	$327	$218	$156
66	$445	$404	$337	$225	$161
67	$459	$418	$348	$232	$166
68	$474	$431	$360	$240	$171
69	$490	$445	$371	$248	$177
70	$525	$478	$398	$266	$190
71	$543	$494	$411	$274	$196
72	$561	$510	$425	$284	$203
73	$580	$528	$440	$293	$210
74	$600	$546	$455	$303	$217
75	-	$599	$499	$333	$238
76	-	$620	$516	$344	$246
77	-	$641	$535	$357	$255
78	-	$664	$553	$369	$264
79	-	$688	$573	$382	$273
80	-	-	$591	$394	$282
81	-	-	$655	$437	$312
82	-	-	$726	$484	$346
83	-	-	$805	$537	$384
84	-	-	$894	$596	$426
85	-	-	-	$647	$462
86	-	-	-	$695	$497
87	-	-	-	$748	$534
88	-	-	-	$804	$574
89	-	-	-	$865	$618
90	-	-	-	-	$653
91	-	-	-	-	$703
92	-	-	-	-	$757
93	-	-	-	-	$815
94	-	-	-	-	$878
95	-	-	-	-	$945

Additional Calculations:

• Annual Premium = Monthly x 11.60
• Semi Annual Premium = Monthly x 6.40
• Quarterly Premium = Monthly x 3.33
• For Part A coverage only = above rates x .60
• For Part B coverage only = above rates x .60

This plan is Administered by

Petersen International Underwriters
Lloyd’s Coverholder
23929 Valencia Boulevard
Suite 215
Valencia, California 91355-2186

It is Underwritten by Certain Underwriters at Lloyd's that is rated A "excellent" by A.M. Best.

This is not intended to be a complete outline of coverage. Actual wording may change without notice. Underwriters reserve the right to modify terms and benefits at time of underwriting.

08/01/2010