Supplemental Medical Expense (Gap) Insurance Policy

Beazley's Supplemental Medical Expense (Gap) insurance policy is a supplemental benefit plan that reimburses eligible out-of-pocket medical expenses (deductibles, co-pays and co-insurance). Brokers can customize benefit options and plan amounts to meet a group’s distinct needs. The plan is suited to groups that have high deductible health plans but no Health Savings Accounts (HSAs). Like our other supplemental benefit solutions, Supplemental Medical is offered guaranteed issue (no medical questions) with optional dependent coverage.

Note: Supplemental Medical does NOT replace health insurance. It is only available if an employer has a major medical plan in place.

of U.S. adults say they couldn’t cover the 60% cost of a $1,000 emergency room visit using savings.1 How Supplemental Medical can help meet your group’s needs

Supplemental Medical can address the needs of your groups and their employees in several ways.

SUPPLEMENT A MAJOR MEDICAL PLAN How Gap Works Our philosophy is to align Supplemental Medical with the underlying major Claim: $7,540 Gap plan benefits medical plan. It is designed to cover out-of-pocket expenses for non-elective • Hospital: $7,105 • Inpatient: $5,000 • Office visit: $435 • Outpatient: $3,000 treatments that are already eligible under the major medical plan. • Note: it doesn’t cover elective treatments, which are often prone to excess utilization. (not eligible for Gap)

PROVIDE AN EQUITABLE BENEFIT Without With While HSAs are popular, average wage earners may not have the means to pre- GAP GAP fund an HSA or anticipate the cost of unforeseen medical needs. Supplemental Deductible Medical can provide an insured option for all workers from the first day of the $1,200 $1,200 plan year. Co-insurance $1,902 $1,902 SIMPLIFY ADMINISTRATION AND USE Supplemental Medical is easy for employers to administer and for employees Major medical to use. At time of service, insureds present an ID card and assign benefits to out-of-pocket cost $3,537 $3,537 (paid by insured) the providers, so itemized bills can be submitted on their behalf.

DELIVER MEANINGFUL BENEFITS Gap reimburses eligible out-of-pockets Supplemental Medical provides a benefit for hospitalization due to an illness $0 $3,102 or an accident, routine nursery care during an OB admission, and treatment in select outpatient facilities. Net out-of-pocket cost (paid by insured) $3,537 $ 435

1 Bankrate Financial Security Index, 2021

*Insurance is underwritten by Beazley Insurance Company, Inc., 30 Batterson Park Road, Farmington, Supplemental Medical Expense – Plan Design Options

Plan design Range of options

Funding options May offer employer-paid, or employee-paid (voluntary), or a combination

Benefit options Benefit amounts

Inpatient hospital benefit Reimbursement levels Reimburses deductibles, co-pays and co-insurance incurred during inpatient Per insured: $500-$7,000 per benefit year hospitalization, such as hospital room and board and other inpatient Per family: 2-3 times benefit year maximum per insured hospital expenses.

Outpatient hospital benefit Reimburses eligible out-of-pocket expenses incurred in select outpatient facilities (each option is selected and rated at the case level):

• Treatment in a hospital ER (not admitted). Reimbursement levels • Surgery and other surgical procedures in outpatient hospital or surgery center (or in Per insured: 10-70% of inpatient benefit per benefit year Physician’s Office or Urgent Care facility - optional). Per family: 2-3 times benefit year maximum • Radiological diagnostic testing in an outpatient hospital or MRI facility (or in Physician’s Office or Urgent Care facility - optional). • Chemotherapy or radiation therapy performed in a licensed facility (optional). Note: Optional benefits for Durable Medical Equipment and Treatment in an Urgent Care facility are available in some states

Ambulance benefit Reimbursement levels Reimburses eligible out-of-pocket expenses for transportation provided by a licensed Per insured: $150-$350

Physician’s office/urgent care indemnity benefit Covers services rendered by a physician at the physician’s office or urgent Indemnity coverage levels care facility. Per insured: $15-$125, 3-6 visits per benefit year Note: Includes visits for Mental & Nervous Disorders

Indemnity coverage levels Prescription drug benefit Per insured: $5-$25 per prescription, 5-12 prescriptions per Covers prescription drug charges. benefit year

Participation requirements (for voluntary plans) • Groups with 10-19 eligible employees require a minimum of 8 covered employees. • Groups with 20-49 eligible employees require a minimum of 12 covered employees. • Groups with 50-99 eligible employees require a minimum of 15 covered employees. • Groups with 100+ eligible employees require a minimum of 15% participation.

Insurance is underwritten by Beazley Insurance Company, Inc., 30 Batterson Park Road, Farmington, Connecticut, 06032. Beazley is rated A by A.M. Best. Beazley is licensed in all 50 states and the District of Columbia. The Supplemental Medical Expense (out-of-pocket) plan is not a major medical plan. The product is designed to reimburse certain covered expenses, and is only available if an employer has a major medical plan in place. Out-of-pocket expenses submitted for reimbursement must be eligible under the major medical plan, and must meet the coverage definitions under our policy (may not include full reimbursement, if annual plan limits have been met). Riders for outpatient services performed in a physician’s office/urgent care, or for outpatient chemotherapy/radiation performed in a licensed facility, may not be available in all states. Coverage is not available in all states. Benefits may vary by state. Premium will vary based on the plan chosen. A waiting period for late entrants may apply. This policy is renewable at the option of Beazley. See the Master Policy and Certificate for all terms, conditions, exclusions and limitations. Beazley uses the services of third party administrators