Today, serious sickness or injury can result in medical expenses that are too high for the average health insurance policy to handle. To cover these excess expenses, the Society sponsors two Excess Major Medical plans. Let's refer to them as the OLD Excess Major Medical Plan and the NEW Catastrophic Excess Major Medical Plan. These plans have been designed to help compensate for medical expenses that go beyond those covered by your present health insurance. The cost is economical because of Delta Kappa Gamma's mass buying power and because of the plans' deductible.

Old Excess Major Medical Plan
Underwritten by the United States Life Insurance Company in the City of New York
The OLD plan has been in effect for more than 30 years. Several thousand members are covered under it, and the covered members have received millions of dollars of benefits from it. However, the insurance company is not accepting new applications for this plan. The following information about the OLD plan is included here as a convenience to those members who are covered by the plan. Complete information is contained in their certificate of insurance.

BENEFITS
SOME COVERED EXPENSES
Coverage will be continued, regardless of age, as long as the plan remains in force and you pay your premiums.

The benefits of the program include:
• $500,000 maximum lifetime benefit for each insured person.
• 100 Percent Payment After the $15,000 deductible has been met, the Excess Major Medical Plan takes over and pays up to 100 percent of the covered expenses for the rest of that calendar year. The covered expense for all accidents and illnesses will be added together to meet the calendar-year deductible of $15,000.
• Worldwide Coverage Protection is 24 hours a day, anywhere in the world, whether you are traveling, at home, or at work.

• Treatment by a licensed physician, surgeon, or physiotherapist; surgical expenses; private-duty nursing in or out of the hospital, when ordered by your physician (RN or LPN only); daily hospital semi-private room and board; and intensive care treatment.
• Blood and blood plasma, artificial limbs and eyes, casts, splints, surgical dressings, braces, trusses, crutches, and oxygen.
• Dental treatment for fractured jaw or injury to natural teeth.
• Drugs and other medications and rental equipment prescribed by a physician.
• Professional ambulance service; anesthetic; radiation treatment, X-ray, and laboratory examination; treatment in a skilled nursing home within seven days following a hospital stay of at least three consecutive days (This does not have to be a Medicare-approved facility); up to lifetime maximum of $10,000 per person for treatment of mental disorders; hospice care.

Coordination of benefits avoids duplicate payment of benefits, which otherwise would make the plan expensive. The Excess Major Medical Plan will not pay benefits again if they have already been paid by other insurance, including Medicare and the Delta Kappa Gamma Cancer and Medicare Supplement plans.

Exclusions include treatment in any government hospital, custodial care, military service, suicide or intentionally self-inflected injury, vision appliance, dental care, or mental disorders in excess of a $10,000 lifetime maximum.

New Catastrophic Excess Major Medical Insurance Plan
Underwritten by the United States Life Insurance Company in the City of New York

• $1,000,000 MAXIMUM
  $25,000 CALENDAR-YEAR DEDUCTIBLE
  
  Whatever your age, you will want to consider this coverage. The cost of a serious illness or injury is often far beyond the benefits provided by the average health insurance policy. Rising hospital and nursing home costs, escalating doctor's fees, expensive medicines, home healthcare costs, specialized surgical procedures, and new equipment can push your expenses far over the limit of your basic insurance. This plan has been designed as supplemental coverage when your basic coverage (including Medicare) runs short. All members and/or spouses and unmarried dependent children from birth to 19 years of age (25 if attending school full time) are eligible to apply.

The plan pays up to 100 percent of all reasonable and customary eligible expenses after the deductible is met. This includes:

• Hospital charges including daily, semi-private room, and board - up to $400 per day. Services of a physician for medical treatment whether at home, in the hospital, or in the office. Anesthetics and the administration thereof. Blood and plasma, artificial limbs or eyes, surgical dressings, casts, splints, trusses, braces or crutches, oxygen and rental of equipment to administer oxygen, rental of a wheelchair or hospital-type bed, rental of an iron lung or other mechanical equipment for the treatment of respiratory paralysis, rental of other mechanical equipment for medical or surgical treatment. Treatment to natural teeth injured by a non-job related accident. Drugs and medicines requiring written prescription. Ambulance service up to $2,000 per calendar year. Mental, nervous, or emotional disorders and alcoholism or drug addiction treated in a hospital are covered, but not to exceed $25,000 while insured. Private-duty nursing services up to $300 per day, $30,000 per calendar year.
• Convalescent Home Benefits Anyone, at any age, may require long-term convalescent or custodial care in a nursing home. That's why this is an important benefit for you. If an insured person becomes confined as an inpatient in a convalescent home facility, the plan pays $300 per week for room, board, general nursing care services, and supplies, to a maximum of $46,800 while insured. An attending physician must prescribe confinement within 14 days of hospitalization.
• Home Healthcare Benefits The plan will pay the reasonable and customary charges for covered home health care treatment up to 100 visits in any one calendar year. These services must be approved by a physician and provided by a certified home health care agency. Each visit by a member of a home health care team will be considered as one home health care visit. Four hours of such home health aide visits will be considered one visit.

Hospice Care The plan also pays for up to 210 consecutive days of confinement in a hospice and the charges for five bereavement counseling visits to the family of the terminally ill person.

Your Deductible The annual deductible for each insured person is $25,000 or the amount paid by your basic health insurance, whichever is higher. This is an important feature in keeping your cost as economical as possible. Once this deductible is reached, the plan covers up to 100 percent of the plan's eligible expenses during the calendar year, up to a maximum of $1,000,000 in benefits while insured.

Survivor's Coverage Coverage continues for dependents of a deceased member as long as the dependents meet the normal eligibility requirements, premiums continue to be paid at the adjusted rates depending on the survivor's age, and the group policy remains in force.

Coordination of Benefits This plan will coordinate benefits with plans providing similar benefits that are not considered a basic plan as defined by the group policy.

Common Disaster Provision If more than one insured family member is injured in the same accident, only one deductible needs to be satisfied.

Pre-existing Conditions LimitationAll covered accidents and sicknesses that originate after the effective date of insurance are covered immediately. Pre-existing conditions are not covered until 12 consecutive months from the insured's effective date have passed without treatment or medical advice for such a condition, or the insured has been covered under the group policy for two years. A pre-existing condition is any condition for which medical advice or treatment has been received during the past 12-month period prior to the day the insurance went into force.

What's Not Covered Benefits are not paid for loss caused by or resulting from any one or more of the following: intentionally self-inflicted injuries; hearing aids; dental treatment; eye examinations or glasses, or the fitting thereof, except to the extent that any of them are necessary for the repair or alleviation of damages caused solely by an accident covered under the group policy, or necessitated by congenital defects; any treatment or service furnished by a member of the insured's family, employer, or employee of such employer; results from a war or act of war. A complete list of exclusions is contained in the certificate of insurance.

1-800-252-9653, ext.7116 or 512-454-2681, ext.7116 • Fax: 512-459-1552 • E-mail: deltakappagamma@boonchapman.com • P.O. Box 9201, Austin, Texas 78766-9201