Benefits from this Surgical Assistance Plan are paid whether or not you are confined to a hospital. Since outpatient surgery has become much more common, payment for these expenses is an especially valuable feature of the plan.

Benefits are paid according to a schedule of 100 surgical procedures most commonly performed. These benefits range from $24 for removal of a foreign object from the eye to $2,400 for plastic heart valve surgery, and benefits are paid directly to you, regardless of any other insurance you may have, unless you tell us to pay a doctor or hospital directly.

Other examples of benefits from the schedule of procedures include: hysterectomy, $720; appendectomy, $480; cataract removal, $1,200; radical mastectomy, $840; tonsillectomy, $240.

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

EXCLUSIONS
Any act of war; attempted suicide or self-inflicted injury; treatment in a government hospital; custodial care; injury or illness covered by Workers' Compensation; full-time military service; a mental or nervous disorder, except for the first 365 days of confinement; any condition requiring dental care or dental treatment, except a fractured jaw or accidental injury to sound teeth; elective abortion; any expense for administration of anesthesia. A complete list of exclusions is contained in the certificate of insurance.

Surgical Plan Monthly Premium Rates (Electronic Funds Transfer see Payment Information page)
	Age	Female	Male	Child
	Under 50	$14.76	$9.92	$5.42
	50-64	$19.59	$19.59
	65+	$21.21	$29.27
	$.25 monthly billing fee, $.50 quarterly and semi-annual billing fee included. Monthly premiums are payable only by Electronic Funds Transfer.

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