Product Leadership
Golden Rule’s experience and expertise in the individual health market drive the development of plans that strive to make health coverage more affordable for more Americans. A recognized pioneer -- and one of the nation’s leading providers -- of Health Savings Account plans, Golden Rule continues to seek and embrace new ways to build plans with the benefits you need at prices you can afford.

Claims Satisfaction
At Golden Rule, we recognize the critical importance
of being responsive to the service needs of our customers. That’s why more than 94% of all health insurance claims are processed within 10 working days or less.* With Golden Rule, you can be confident that your claims will be promptly processed.

Preferred Network Discounts
With a Golden Rule insurance plan, you gain access to a quality network of health care professionals and facilities available in your area. Having access to our Preferred Networks can mean substantial discounts in what you pay for your health care. The combined buying power of networks on behalf of large numbers of customers can translate into significant savings for you, including covered out-of-pocket health care expenses incurred before you meet your deductible.

Strength in Numbers
Golden Rule is proud to be a member of the UnitedHealth Group family of businesses. As an innovative leader in the health and well-being industry, UnitedHealth Group currently serves nearly 55 million individuals nationwide, with products and services to help people achieve better health.

* Actual 2005 results

Lower Premiums
With high deductible plans, you’re keeping more of your money and taking responsibility for covering minor or routine health care expenses -- if they come up. The higher the deductible, the lower your premiums.

Saver 80^SM is our lowest premium plan. This plan provides coverage for hospital confinements, surgical procedures in or out of the hospital, and the more costly outpatient expenses, such as CAT scans and MRIs.

Simple to use
Golden Rule’s top-selling high deductible plan -- Plan 100^® -- pays 100% of covered expenses once you meet your calendar-year deductible. Your benefits are not complicated with multiple copays or coinsurance.

Comprehensive Coverage

• Up to $3 million lifetime maximum benefit per covered person
• Up to $500 annually for adult preventive care or childhood immunizations (see chart below for details)
• Add optional benefits to increase coverage (see optional benefits for details)

Preventive Care Benefits Package
(Not available with Copay Select^SM Plan.)

This option is available with our Preferred Network health insurance plans. If elected, this option replaces preventive care benefits otherwise included within the plan. This package waives the deductible and provides 100% for the following covered expenses:

Maternity Benefit
(Not available with HSA Plans; not available in AR, MD, or VA.)

This optional benefit helps cover the costs for routine pregnancy and delivery. You choose the maximum benefit amount -- $2,500 or $4,000. Payment is limited to 50% of the maximum benefit during the first year. After the first year, the plan will pay 100% of the maximum benefit. To be covered, pregnancy must begin while maternity benefits are in effect.

Prescription Drug Card Benefit
(Not available with any Saver or HSA Plans or Copay Select^SM.)

With this benefit, you can purchase:

• Generic prescription drugs for a $20 copay; and
• Name-brand drugs for a $50 copay after a $250 calendar-year, per-person deductible.

IMPORTANT: If generic is available, name-brand drugs will be reimbursed at generic price.

Supplemental Accident Benefit
(Not available with HSA Plans.)

This benefit provides up-front coverage for unexpected injuries and is limited to $500 of first-dollar coverage for treatment of an injury within 90 days of an accident.

Term Life Benefit
You may choose an optional decreasing term life insurance benefit for you and your spouse if your spouse is also a covered person under the health policy. The amount of life insurance protection provided for you and your spouse depends on the primary insured’s attained age at the time of death, as shown in the table.

Attained Age of Primary Insured at Death	Primary Insured Benefit Amount	Covered Spouse Benefit Amount*
49 or less	$30,000	$15,000
50-59	$18,000	$9,000
60-64	$12,000	$6,000

*Equal to the primary insured’s benefit amount for certificates issued to residents of Maryland.

HSA Hospital Indemnity Rider
(See HSA Insert for details.)

HSA Hospital Indemnity Rider is designed to help protect against major hospitalization expenses during the early months of coverage when cash hasn't yet accumulated in your savings account.

Medical Expense Benefits

• Daily hospital room-and-board and nursing services at the most common semiprivate rate.
• Charges for intensive care unit.
• Hospital emergency room treatment of an injury or illness (subject to an additional $100 copay each time the emergency room is used for an illness not resulting in confinement -- does not apply to HSA Plans).
• Surgery at an outpatient surgical center.
• Professional fees of doctors and surgeons (but not for standby availability).
• Dressings, sutures, casts, or other necessary medical supplies.
• Professional fees for outpatient services of licensed physical therapists.
• Diagnostic testing using radiologic, ultrasono-graphic, or laboratory services, in or out of the hospital.
• Local ground ambulance service to the nearest hospital for necessary emergency care. Air ambulance, within U.S., if requested by police or medical authorities at the site of emergency.
• Charges for operating, treatment, or recovery room for surgery.
• Dental expenses due to an injury which damages natural teeth if expenses are incurred within six months.
• Surgical treatment of TMJ disorders (see limitations under Provisions That Apply To All Plans).
• Cost and administration of anesthetic, oxygen, and other gases.
• Radiation therapy or chemotherapy.
• Prescription drugs.
• Hemodialysis, processing, and administration of blood and components.
• Mammography, Pap smear, and PSA test fees.
• Artificial eyes, larynx, breast prosthesis, or basic artificial limbs (but not replacements).

Preventive Care Expense Benefits

• See our Health Savings Account Plans, High Deductible Plans, and Copay Plans for coverage details.

For information on additional Plan provisions, including Transplant Expense Benefit, Limited Exclusion for AIDS or HIV-related Disease, Notification Requirements, Preexisting Conditions, General Exclusions, General Limitations, and Other Plan Provisions, read the Provisions That Apply To All Plans.

Inpatient Expense Benefits

• Daily hospital room-and-board and nursing services at the most common semiprivate rate.
• Charges for intensive care unit.
• Drugs, medicines, dressings, sutures, casts, or other necessary medical supplies.
• Artificial limbs, eyes, larynx, or breast prosthesis (but not replacements).
• Professional fees of doctors and surgeons (but not for standby availability).
• Hemodialysis, processing, and administration of blood or components.
• Charges for an operating, treatment, or recovery room for surgery.
• Cost and administration of an anesthetic, oxygen, or other gases.
• Radiation therapy or chemotherapy and diagnostic tests using radiologic, ultrasonographic, or laboratory services.
• Local ground ambulance service to the nearest hospital for necessary emergency care. Air ambulance, within U.S., if requested by police or medical authorities at the site of the emergency.

Outpatient Expense Benefits

• Charges for outpatient surgery, including the fee made by an outpatient surgical facility, the primary surgeon, the assistant surgeon, and/or administration of anesthetic.
• Hemodialysis, radiation, and chemotherapy.
• Prescription drugs to protect against organ rejection in transplant cases.
• Mammography, Pap smear, and PSA test fees.
• Hospital emergency room treatment of an injury or illness (subject to limitations, see our Health Saving Account Plans, High Deductible Plans, and Copay Plans).
• CAT scan and MRI testing.
• Diagnostic testing related to, and performed within, 14 days prior to surgery or inpatient confinement.
• Copay Saver^SM plan includes two doctor office copay visits per year (see Copay Plans).

Important note about Saver Plans:
Premiums for Saver Plans are significantly less because coverage is not provided for most outpatient services. Outpatient expenses not specifically listed in the policy are not covered. Please review the Saver Plans’ inpatient and outpatient expense benefits, exclusions, and limitations for details.

Some outpatient expenses not covered under the Saver Plans include:

• Outpatient doctor office visit fees (limited benefit provided under Copay Saver^SM -- see Copay Plans), diagnostic testing, prescription drugs, and other outpatient medical services not specifically listed under the Inpatient, Outpatient, or Transplant Expense Benefits;
• Outpatient professional fees of licensed physical therapists, durable medical equipment, and medical supplies, except those covered under the Home Health Care Expense Benefits;
• Outpatient expenses incurred for mental or nervous disorders or substance abuse; and
• Preventive care office visits (unless the optional Preventive Care Package is added).

Transplant Expense Benefit
The following types of transplants are eligible for coverage under the Medical Benefits provision:
Cornea transplants, artery or vein grafts, heart valve grafts, and prosthetic tissue replacement, including joint replacements and implantable prosthetic lenses, in connection with cataracts.

Transplants eligible for coverage under the Transplant Expense Benefit are:
Heart, lung, heart and lung, kidney, liver, and bone marrow transplants.

Golden Rule has arranged for certain hospitals around the country (referred to as our “Centers of Excellence”) to perform specified transplant services. If you use one of our “Centers of Excellence,” the specified transplant will be considered the same as any other illness, and will include a transportation and lodging incentive (for a family member) of up to $5,000. Otherwise, the acquisition cost for the organ or bone marrow will not be covered, and covered expenses related to the transplant will be limited to $100,000 and one transplant in a 12-month period.

To qualify as a covered expense under the Transplant Expense Benefit, the covered person must be a good candidate, and the transplant must not be experimental or investigational. In considering these issues, we consult doctors with expertise in the type of transplant proposed.

The following conditions are eligible for bone marrow transplant coverage:
Allogenic bone marrow transplants (BMT) for treatment of: Hodgkin’s lymphoma or non-Hodgkin’s lymphoma, severe aplastic anemia, acute lymphocytic and nonlymphocytic leukemia, chronic myelogenous leukemia, severe combined immunodeficiency, Stage III or IV neuroblastoma, myelodysplastic syndrome, Wiskott-Aldrich syndrome, thalassemia major, multiple myeloma, Fanconi’s anemia, malignant histiocytic disorders, and juvenile myelomonocytic leukemia.

Autologous bone marrow transplants (ABMT) for treatment of: Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, acute lymphocytic and nonlymphocyctic leukemia, multiple myeloma, testicular cancer, Stage III or IV neuroblastoma, pediatric Ewing’s sarcoma and related primitive neuroecto-dermal tumors, Wilms’ tumor, rhabdomyosarcoma, medulloblastoma, astrocytoma, and glioma.

Home Health Care
To qualify for benefits, home health care must be:

• Provided in lieu of medically necessary inpatient care in a hospital or hospice; and
• Provided through a licensed home health care agency.

Covered expenses for home health aide services will be limited to seven visits per week, and a lifetime maximum of 365 visits. Registered nurse services will be limited to a lifetime maximum of 1,000 hours.

Hospice Care
To qualify for benefits, a Hospice Care program for a terminally ill covered person must be licensed by the state in which it operates. Benefits for inpatient care in a hospice will be limited to 180 days in a covered person’s lifetime. Covered expenses for room and board are limited to the most common semiprivate room rate of the hospital or nursing home with which the hospice is associated.

Notification Requirements
You must notify us by phone on or before the day a covered person:

• Begins the fourth day of an inpatient hospitalization; or
• Is evaluated for an organ or tissue transplant.

Failure to comply with Notification Requirements will result in a 20 percent reduction in benefits, to a maximum of $1,000.

If it is impossible for you to notify us due to emergency inpatient hospital admission, you must contact us as soon as reasonably possible.

Our receipt of notification does not guarantee either payment of benefits or the amount of benefits. Eligibility for, and payment of, benefits are subject to all terms and conditions of the policy. You may contact Golden Rule for further review if coverage for a health care service is denied, reduced, or terminated.

Preexisting Conditions
Preexisting conditions will not be covered during the first 12 months after an individual becomes a covered person. This exclusion will not apply to conditions which are both: (a) fully disclosed to Golden Rule in the individual’s application; and (b) not excluded or limited by our underwriters.

A preexisting condition is an injury or illness: (a) for which a covered person received medical advice or treatment within 24 months prior to the applicable effective date for coverage of the illness or injury; or (b) which manifested symptoms which would cause an ordinarily prudent person to seek diagnosis or treatment within 12 months prior to the applicable effective date for coverage of the illness or injury.

Limited Exclusion for AIDS or HIV-Related Disease
AIDS or HIV-related disease are treated the same as any other illness unless the onset of AIDS or HIV-related disease is: (a) diagnosed before the coverage has been in force for one year; or (b) first manifested before the coverage has been in force for one year. If diagnosed or first manifested before coverage has been in force for one year, AIDS or HIV-related disease claims will never be covered. Details of this limited exclusion are set forth in the policy and certificates.

General Exclusions
No benefits are payable for expenses which:

• Are due to pregnancy (except for complications of pregnancy) or routine newborn care (unless optional coverage is selected).
• Are for routine or preventive care unless provided for in the policy.
• Are incurred while confined primarily for custodial, rehabilitative, or educational care or nursing services.
• Result from employment-related injury or illness if the covered person is insured or is required to be insured, by Workers’ Compensation insurance under applicable state or federal law.
• Are in relation to, or incurred in conjunction with, investigational treatment.
• Are for dental expenses or oral surgery, eyeglasses, contacts, eye refraction, hearing aids, or any examination or fitting related to these.
• Are for modification of the physical body, including breast reduction or augmentation.
• Are incurred for cosmetic or aesthetic reasons, such as weight modification or surgical treatment of obesity.
• Would not have been charged in the absence of insurance.
• Are for eye surgery to correct nearsightedness, farsightedness, or astigmatism.
• Result from war, intentionally self-inflicted bodily harm (whether sane or insane), or participation in a felony (whether or not charged).
• Are for treatment of temporomandibular joint disorders, except as may be provided for under covered expenses.
• Are incurred for animal-to-human organ transplants, artificial or mechanical organs, procurement or transportation of the organ or tissue, or the cost of keeping a donor alive.
• Are incurred for marriage, family, or child counseling.
• Are for recreational or vocational therapy or rehabilitation.
• Are incurred for services performed by an immediate family member.
• Are not specifically provided for in the policy or incurred while your certificate is not in force.
• Are for any drug treatment or procedure that promotes conception.
• Are for any procedure that prevents conception or childbirth.

Benefits will not be paid for services or supplies that are not medically necessary to the diagnosis or treatment of an illness or injury, as defined in the policy.

General Limitations

• Expenses incurred by a covered person for treatment of tonsils, adenoids, middle ear disorders, hemorrhoids, hernia, or any disorders of the reproductive organs, will not be covered during the covered person’s first six months of coverage under the policy. This provision will not apply if treatment is provided on an “emergency” basis. “Emergency” means a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing a person’s life or limb in danger if medical attention is not provided within 24 hours.
• Covered expenses will not include more than what was determined to be the reasonable and customary charge for a service or supply.
• Transplants eligible for coverage under the Transplant Expense Benefit are limited to two transplants in a ten-year period.
• Charges for an assistant surgeon are limited to 20 percent of the primary surgeon’s covered fee.
• Covered expenses for surgical treatment of TMJ, excluding tooth extractions, will be limited to $10,000 per covered person.
• All diagnoses or treatments of mental disorders, as defined in the policy, including substance abuse, will be limited to a lifetime maximum benefit of $3,000 (not covered in Saver Plans, subject to state variations). Covered expenses for outpatient diagnosis or treatment of mental disorders will be further limited to $50 per visit. As with any other illness or injury, inpatient care which is primarily for educational or rehabilitative care will not be covered.
• Covered outpatient expenses relating to diagnosis or treatment of any spine or back disorders will be limited to a maximum of $2,000 per calendar year. CAT scan and MRI tests are not subject to this limitation.
• Covered expenses will be limited to no more than a 34-day supply for any one outpatient prescription drug order or refill.

Effective Date
For injuries, the effective date for a mailed application will be the later of: (a) the requested effective date, if any, shown on the application; or (b) the date upon which the original application is actually received by Golden Rule at its Home Office.

For an application sent by any electronic method, the effective date for injuries will be the later of: (a) the requested effective date, if any, shown on the application; or (b) the day after the date upon which the application is actually received by Golden Rule at its Home Office.

The effective date for illnesses will be the same as for injuries if you are replacing prior coverage within 62 days of application for this coverage and disclose replacement information on the initial application for insurance. If replacement information is not disclosed on the initial application for insurance, the effective date for illnesses will be the 15th day after the effective date for injuries. Illnesses that begin prior to that 15th day will be treated as a preexisting condition and will not be covered until the individual has been a covered person for 12 months.

Premium
We may adjust the premium rates from time to time. Premium rates are set by class, and you will not be singled out for a premium change regardless of your health. The policy plan, age and sex of covered persons, type and level of benefits, time the certificate has been in force, and your place of residence are factors that may be used in setting rate classes. Premiums will increase the longer you are insured.

Dependents
For purposes of this coverage, eligible dependents are your lawful spouse and eligible children. Eligible children must be unmarried, living with and financially dependent on you, and under 19 years of age, or under 23 years of age if attending an accredited college or vocational school on a full-time basis.

Termination of a Covered Person
A covered person’s coverage will terminate on the date that person no longer meets the eligibility requirements, or if the covered person commits fraud or intentional misrepresentation.

Continued Eligibility Requirements
A covered person’s eligibility will cease on the earlier of the date a covered person:

• Ceases to be a dependent; or
• Becomes insured under an individual plan providing medical or hospital, surgical, or medical services or benefits. (This does not apply to stand-alone cancer, ICU, or accident-only policies.)

Renewability
You may renew coverage by paying the premium as it comes due. We may decline renewal only:

• For failure to pay premium; or
• If we decline to renew all certificates just like yours issued to everyone in the state where you are then living.

Underwriting
Coverage will not be issued as a supplement to other health plans that you may have at the time of application.

Conditions Prior to Legal Action
To help resolve disputes before litigation, the policy requires that you provide us with written notice of intent to sue as a condition prior to legal action. This notice must identify the source of the disagreement, including all relevant facts and information supporting your position. Unless prohibited by law, any action for extra-contractual or punitive damages is waived if the contract claims at issue are paid or the disagreement is resolved or corrected within 30 days of the written notice.

Group -- COB
If, after coverage is issued, a covered person becomes insured under a group plan, benefits will be determined under the Coordination of Benefits (COB) clause. COB allows two or more plans to work together so that the total amount of all benefits will never be more than 100 percent of covered expenses. COB also takes into account medical coverage under auto insurance contracts.

Medicare -- Carve-Out
Covered persons who reach the age of Medicare eligibility and obtain Medicare coverage will be provided an alternative health insurance benefit called “Carve-out.” Basically, “Carve-out” pays the difference between what Golden Rule benefits normally would pay and what is paid by Medicare.

Alaska

• Copay Plans are not available in this state.
• Formulas necessary for the treatment of phenylketonuria are covered the same as any other illness.

Arizona

• The references to 24 and 12 months in the definition of a preexisting condition are both changed to 6 months.
• Dependent children do not have to live with you to meet the definition of eligible children.
• The limited exclusion for AIDS does not apply.
• Portability plans (guarantee issue without preexisting conditions exclusions) are available to eligible applicants. Review the application for insurance for details.

Arkansas

• The exclusion for TMJ disorders does not apply.
• Limited coverage is provided for children’s preventive health care services.
• Childhood immunizations are not subject to the deductible.

Colorado

• The limitation on expenses incurred during the first six months for treatment of tonsils, adenoids, middle ear disorders, hemor-rhoids, hernia, or any disorders of the reproductive organs does not apply.
• The 14-day waiting period for the coverage of illnesses does not apply.
• The preexisting conditions limitation is reduced from 24 to 6 months.
• The limited exclusion for AIDS does not apply.
• Limited routine newborn care.
• Expenses for mammography exams, prostate screening, and child health services are not subject to the deductible.
• Mental or nervous disorders: The exclusion under the Saver Plans and the $3,000 lifetime limit under other plans are removed. Instead, you will receive certain limited benefits mandated by Colorado.
• Certain types of biologically based mental illnesses will be covered, subject to all the terms and conditions of the certificate.
• The age limit for a dependent is increased from 23 to 24, and can include a dependent medically certified as disabled.
• No benefits will be paid for treatment of intractable pain as defined in the certificate.
• Notification requirements do not apply.

CoverColorado Notice Form
You and/or your dependents may qualify for health insurance from CoverColorado as Eligible Individuals, as defined under the federal “Health Insurance Portability and Accountability Act of 1996.”

Generally, you are eligible if you:

• Have had 18 months of continuous prior health insurance coverage;
• Were most recently covered under a group health plan;*
• Have elected and exhausted COBRA or state continuation of benefits coverage;
• Are not eligible for any other group health coverage, Medicare, or Medicaid; and
• Do not have other health insurance.

*Group health plan = coverage existing in connection with employment.

You also may be eligible for participation in the plan, without first requiring application to a carrier for health coverage, if a licensed physician has diagnosed you with a medical condition that is on the list of presumptive medical conditions established by the CoverColorado Board of Directors.

Other eligibility requirements, exclusions, and limitations may apply.

You may apply to CoverColorado for a determination of your eligibility for insurance on application forms available from CoverColorado. A premium will be charged for this insurance if your application is accepted.

For more information regarding CoverColorado, including benefits and exclusions, please contact:

Plan Representative
CoverColorado
425 South Cherry Street, Suite 160
Glendale, CO 80246
(877) 461-3811
(800) 259-2656 (TDD)

Florida

• Covered child health supervision services (well child care services) are not subject to the deductible.
• Portability plans (guarantee issue without preexisting conditions exclusions) are available to eligible applicants. Review the application for insurance for details.

Indiana

• The limited exclusion for AIDS does not apply.

Iowa

• The spine and back limitation does not apply.
• The preexisting conditions 12-month waiting period may be reduced for persons covered by qualifying prior coverage.
• The limited exclusion for AIDS does not apply.
• The maternity expense benefits rider does not cover maternity expenses until 300 days after the rider effective date.

World of FACT Value
FACT makes it possible for members to pick and choose from a full menu of important benefits:

• Dental Discounts -- you can save up to 50% on general dental, x-rays and orthodontics
• Vision discounts -- typical savings of 20-60% for eye exams, eyeglasses, contact lenses, and LASIK correction surgery
• Prescription drug discounts
• Van line discounts
• Health insurance plans
• Consumer library
• Consumer hotline referral service
• Amusement park discounts
• Travel service and savings
• Informative newsletter

Plus …

• You may apply for: FACT scholarships, classroom grants, and community project grants
• You are eligible to request: Financial assistance in the event of a natural disaster
• You are kept aware of matters of importance through: FACT’s Eye-On-Washington Reports

Benefits and suppliers change from time to time. For the most current information: Visit FACT’s Web site at www.fact-org.org or call toll-free at 1-800-USA-FACT.