PAYS DAILY BENEFITS
You can choose daily benefits from $30 to $250 through age 64 and from $30 to $125 beginning at age 65 for each day you are hospitalized as the result of a covered injury or illness for confinement that begins prior to age 65, the earlier of 500 days, or to age 65 or for confinement that begins on or after age 65, 365 days.

DOUBLE BENEFITS
Two times your daily benefit amount will be paid to you for each day you are hospitalized for pathologically diagnosed cancer or for intensive care treatment, including coronary care units.

CONVALESCENT HOME FACILITY CARE
This plan pays up to 50 percent of your daily benefit each day you are confined in a licensed skilled nursing facility for up to 120 days for each separate accident or illness when you are admitted within seven days following a hospital stay of at least three days.

OUTPATIENT SURGERY
Three times your daily benefit amount will be paid each time you have surgery in the outpatient department of a hospital or an ambulatory surgical center.

HOME HEALTH CARE
Up to 50 percent of your daily benefit amount will be paid for visits by a home health care professional, up to 60 visits per year, with a limit of one visit per day. Benefits begin on the first day following a hospitalization of three days or longer, and on the eighth day if no hospitalization, or one of less than three days.

EMERGENCY ROOM
Your daily benefit amount will be paid each time you have emergency care in a hospital emergency room.

HOSPICE CARE
One full day of your daily benefit amount will be paid for each day in a licensed hospice up to 90 days, when you are admitted within seven days following a hospital stay of at least three days.

CANCER SCREENING
Mammogram
The plan pays for one exam between ages 35 and 40, one exam every two years between ages 40 and 50, and one exam each year for ages 50 and over. It pays the lesser of two times your daily benefit, the actual charge of the procedure, or $150.

Proctoscopy or Sigmoidoscopy
The plan pays for one exam every two years for age 50 and over. It pays the lesser of two times your daily benefit, the actual charge of the procedure, or $150.

PRE-ADMISSION TESTING
One full day of your daily benefit amount will be paid for pre-admission testing done within ten days of the ultimate hospitalization.

RECUPERATION
As a recuperation benefit, you will receive $10 for each day you were confined in the hospital. This benefit is payable whether you recuperate at home or in a nursing facility, convalescent center, or anywhere else you choose to recuperate after your hospitalization.

AMBULANCE
You will receive up to two times your daily benefit amount, not to exceed the actual cost, for the use of an ambulance. Ambulance usage must be for an emergency or ordered by a physician.

PRE-EXISTING CONDITIONS
Pre-existing conditions are those diagnosed, treated, or for which treatment was recommended during 12 months before your certificate's effective date. Coverage for pre-existing conditions begins 12 consecutive months after the effective date of your insurance.

PROMPT, SIMPLE CLAIM HANDLING
A simple, one-page claim form is sent with your certificate.

COVERAGE
Coverage can be continued to age 65 as long as the plan remains in force and your premiums are paid. When you reach age 65, you will be able to continue your coverage with daily benefits up to $125, until the group policy ends or premium is not paid when due.

FAMILY MEMBERS ARE ELIGIBLE
The following family members, as long as they reside in the same household as you, are eligible to be covered: husband and unmarried dependent children.

EXCLUSIONS
Exclusions are suicide or intentionally self-inflicted injury; war; pre-existing conditions as defined previously; injury or illness covered by Workers' Compensation; active military duty; treatment in a government hospital; custodial care; confinement for more than 365 days for a nervous or mental disorder.

Hospital Plus Plan Daily Benefits and Monthly Premiums (Electronic Funds Transfer see Payment Information page)
Ages 1-49
	Daily Benefit	Society Members	Male Dependents	Female Dependents
	$50	$9.42	$6.50	$9.42
	$100	$18.58	$12.75	$18.58
	$150	$27.75	$19.00	$27.75
	$200	$37.05	$25.45	$37.05
	$250	$46.25	$31.75	$46.25
Ages 50-64
	Daily Benefit	Society Members	Male Dependents	Female Dependents
	$50	$14.00	$14.83	$16.08
	$100	$27.75	$29.42	$31.92
	$150	$41.50	$44.00	$47.75
	$200	$55.45	$58.85	$63.85
	$250	$69.25	$73.50	$79.75
	Ages 65+
	Daily Benefit	Society Members	Male Dependents	Female Dependents
	$50	$23.88	$29.42	$29.42
	$75	$35.69	$44.00	$44.00
	$100	$47.80	$58.85	$58.85
	$125	$59.70	$73.50	$73.50
	$.25 monthly billing fee, $.50 quarterly and semi-annual billing fee included.
Monthly premiums are payable only by Electronic Funds Transfer.

 QUESTIONS AND ANSWERS
Will I still receive benefits from any of these plans if I have other insurance?
Yes. Benefits are payable in addition to any other coverage, including Medicare. Benefits are paid directly to you unless you authorize us to pay directly to a doctor or hospital.

Is it simple to file a claim?
Yes. Normally, you and your doctor simply complete and sign the one-page form you'll receive with your insurance certificate.

Could my family members continue their coverage in the event of my death?
Yes. Your insured family members may continue their coverage upon request even though they are not members of Delta Kappa Gamma.

When do benefits begin?
Benefits are paid beginning with the very first day in the hospital.

1-800-252-9653, ext.7116 or 512-454-2681, ext.7126 • Fax: 512-459-1552 • E-mail: deltakappagamma@boonchapman.com • P.O. Box 9201, Austin, Texas 78766-9201