distributors health bene ts handbook · a word from sozo sozo global, inc. has introduced a...

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This proposal describes both insurance and non-insurance benefits and services. Unless otherwise noted, insurance is underwritten by AXIS Insurance Company. This proposal is not a contract of insurance. This proposal provides only brief descriptions of the coverage available. The policies contain reductions, limitations, exclusions and termination pro- visions. Full details of the coverage are contained in policies that will be issued to you, once we receive your acceptance. If there are any conflicts between this proposal and the policy issued to you, the policy shall govern. The policy is governed by the laws in the state in which it is delivered. Certain terms or provisions may be different if required by the laws of that state. This proposal is valid for 90 days from the date of the proposal. If you accept the terms of this proposal, coverage is subject to the underwriting companies’ determina- tion that trade or economic sanctions or regulations do not prohibit us from binding coverage. Payment of claims under any policy issued shall only be made in full compliance with all United States economic or trade and sanction laws or regulations, including, but not limited to, sanction laws or regulations, including, but not limited to sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control. ETMG, LLC reserves the right to extend or withdraw this proposal at any time by providing written notice to the requestor of this proposal. Not for individual solicitations. Distributors’ Health Benefits Handbook

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Page 1: Distributors Health Bene ts Handbook · A WORD FROM SOZO SOZO Global, Inc. has introduced a breakthrough in the network marketing industry: Group Health Benefits For The Small Business

This proposal describes both insurance and non-insurance benefits and services. Unless otherwise noted, insurance is underwritten by AXIS Insurance Company. This proposal is not a contract of insurance. This proposal provides only brief descriptions of the coverage available. The policies contain reductions, limitations, exclusions and termination pro-visions. Full details of the coverage are contained in policies that will be issued to you, once we receive your acceptance. If there are any conflicts between this proposal and the policy issued to you, the policy shall govern. The policy is governed by the laws in the state in which it is delivered. Certain terms or provisions may be different if required by the laws of that state. This proposal is valid for 90 days from the date of the proposal. If you accept the terms of this proposal, coverage is subject to the underwriting companies’ determina-tion that trade or economic sanctions or regulations do not prohibit us from binding coverage. Payment of claims under any policy issued shall only be made in full compliance with all United States economic or trade and sanction laws or regulations, including, but not limited to, sanction laws or regulations, including, but not limited to sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control. ETMG, LLC reserves the right to extend or withdraw this proposal at any time by providing written notice to the requestor of this proposal. Not for individual solicitations.

Distributors’Health Benefits

Handbook

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A Word from SOZO 3

A Word from ETMG, LLC 4

A Word from Small Business United 5

Important Information 6

Terms of Enrollment 7

Distributor Health Insurance Eligibility Table 8

Distributor Life Insurance Eligibility Table 9

Distributor Enrollment Process 10

Medical Plan Summaries & Rates 11

HealthAssist Plan Summary 12

Ancillary Plan Summaries (Dental and Term Life) 13

Network Summaries 14

Plan Provisions 15

Exclusions and Limitations 16-20

Explanation of How to Pay for Your Premiums 21

How to Enroll 22

“I have enrolled. What now?” 23

Paper Enrollment Forms 24

CONTENTS

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A WORD FROM SOZOSOZO Global, Inc. has introduced a breakthrough in the network marketing industry:

Group Health Benefits For The Small Business Entrepreneur.

“We started SOZO to set a new standard for this industry. We felt that outstanding products and an exceptional compensation plan were just the beginning, and with the clear need for health benefits across the country, SOZO could make a huge difference in the lives of our Distributors.

The program offers several options for a single individual up to a full family, and the higher the Distributor ranks, the lower the out-of-pocket costs. We have gotten such incredibly positive feedback that we are already planning for next year’s enhancements.

MARK ADAMSPresident & CEO

SOZO Global, Inc.

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A WORD FROM ETMG, LLCCongratulations on becoming a Distributor with SOZO! As an eligible Distributor for SOZO, you have access to a guaranteed issue group medical plan underwritten by AXIS Insurance, an A.M. Best A+ Rated company.

ETMG, LLC is here to act as your representative in your dealings with the insurance company. If you have any questions or issues regarding your coverage, contact a Benefit Specialist at ETMG to deal with the insurance company for you.

We are here to help and educate.

Benefit Specialist Hotline 1-888-728-2467

Hours of Operation Monday - Friday, 8:30am - 6:00pm CT

Fax 512-682-8795

SOZO Broker Representative [email protected]

Questions Regarding Plans? [email protected]

Questions After You've Enrolled? [email protected]

Questions Regarding Your Billing Account? [email protected]

Questions or Need Help with Your Claims? [email protected]

The following pages give a brief description of the benefit plans, eligibility requirements, and the specific benefits available to you.

SOZO provides three plans from which a Distributor may choose, based on his or her eligibility.

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A WORD FROM SMALL BUSINESS UNITEDAs a participant in the SOZO benefit program, you will join Small Business United (SBU). SBU is an association chartered in 1992 to be an advocate for small businesses, independent contractors, and associations of any size. SBU seeks out and pulls together helpful resources and services and pools the group purchasing power of its members to make it easier, cheaper, and more efficient for them to do business. SBU is licensed in all 50 states, so our benefits are available nationwide.

The Tools You Need to Succeed

Each participating SOZO Distributor will have access to the benefits defined below in addition to the group medical program through SOZO.

Health BenefitsMembership in SBU provides access to a robust and affordable suite of insurance plan options, underwritten by some of the nation’s largest insurers. Members enjoy group-negotiated rates for several different medical insurance plans. SBU can also facilitate enrollment in individual coverage, traditional group major medical products, and a host of supplemental and ancillary benefits.

Small Business Legal PlanRunning a business is expensive. SBU makes small-business-friendly legal services available to its members to alleviate some of that financial pressure. Our legal plan provides access to a nationwide network of pre-qualified attorneys offering free and discounted legal care, from consultation and document review, to assistance with collections and dispute resolution.

Office Supply DiscountsIncrease the efficiency of your small business by utilizing the group purchasing power afforded by membership in SBU. SBU has partnered with some of the nation’s largest office suppliers to bring you deep discounts on office supplies and consumables.

Human Resources SolutionsThe idea of hiring, firing, and maintaining employees can seem daunting, but members of SBU don’t have to go it alone. SBU membership provides access to a Human Resources (HR) service developed specifically for small to mid-sized businesses and delivered via a customized website, phone, and email consultations. This service offers targeted HR content and access to competent administrative and consulting staff so you can run your business confidently and efficiently.

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IMPORTANT INFORMATIONImportant Things to Remember• Although there is no penalty for visiting a doctor who is out-of-network, visiting an in-network doctor allows you

to receive the plan’s deepest discount. To search for a provider please visit firsthealth.coventryhealthcare.com

• This handbook highlights some of the main features of your medical plan, but does not include all plan rules. The terms of your medical plan are governed by legal documents, including an insurance contract. Should there be any inconsistencies between this book and the legal plan documents, the plan documents are the final authority. SOZO reserves the right to change or discontinue its benefit plans at any time.

Cancellation Process• This is a voluntary plan, so you reserve the right to cancel at any time. In order to properly cancel your insurance,

you must submit the cancellation form found on www.sbua.org/SOZO to a Benefit Specialist by the 5th of the effective month. If cancellation is not received by the 5th of the effective month, premium will be collected and will not be refunded. You can also contact a Benefit Specialist at 1-888-728-2467. IF YOU CANCEL YOUR PLAN AT ANYTIME THROUGHOUT THE YEAR, YOU MUST WAIT UNTIL OPEN ENROLLMENT THE FOLLOWING YEAR IN ORDER TO RE-ENROLL.

Associated Fees• ETMG, LLC and Small Business United have teamed up to offer great medical benefits to all qualifying Distributors

of SOZO. In order to maintain the lowest price for medical premiums, Distributors who join the medical plan offered through SOZO are responsible for the following fees:

• One-time $20 application fee

• Payment processing fee of $6 per month

• Small Business United Association Membership fee of $5 per month (see the association membership benefits on page 5 of this handbook)

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TERMS OF ENROLLMENTEnrollment• Each SOZO Distributor becomes eligible for SOZO medical benefits when he or she reaches the ranks defined by

the eligibility table on page 9.

• New Distributors have 30 days to enroll or decline coverage beginning on the exact day they achieve the eligible rank defined by the eligibility table on page 9.

• Individuals may make changes or add dependents without having to provide proof of insurability during the open enrollment period.

• Open enrollment applies to medical coverage.

• The open enrollment period is the only time Distributors may enroll in the medical coverage without the occurrence of a qualifying event (see definition below).

• All Distributors must reach and maintain an autoship of 100 PV to qualify, and to remain qualified, for SOZO Benefits, not withstanding rank qualification PV still applies (i.e. Platinum and above qualified requires autoship of 200PV).

Making Enrollment Changes During the YearIn most cases, your benefit elections will remain in effect for the entire plan year (January – December). During the annual enrollment period, you have the opportunity to review your benefit elections and make changes for the coming year.

You may only make changes to your elections during the year if you have one of the following status changes:• Marriage, divorce or legal separation,

• Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, reaching the dependent child age limit; or

• Significant changes in benefit coverage that affect you or your spouse’s benefit eligibility.

Your benefit change must be consistent with your change in family status.

For enrollment due to a qualifying event defined above, IRS regulations require that change forms be submitted to ETMG, LLC within 30 days of that qualifying event. Please see www.sbua.org/SOZO for these forms.

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HEALTH INSURANCE ELIGIBILITY TABLESOZO will reimburse the Distributor up to the eligible amounts defined below after notification of enrollment is received from ETMG and the necessary qualifications achieved for Monthly Benefits.

RANK HEALTH INSURANCE PLAN HEALTH REIMBURSEMENT

Distributor not available not available

Marketing Director available not available

Senior Marketing Director available not available

Regional Marketing Director available Up to $425

National Marketing Director available Up to $525

International Marketing Director available Up to $725

Global Ambassador available Up to $1,000

SOZO Distributor Health Insurance Reimbursement Table

1. Distributors may cover themselves and their dependents for health insurance.

2. SOZO’s reimbursement is based on monthly paid as rank. If the Distributor falls below a qualifying paid as rank, then he/she will not be reimbursed for premiums 30 days after 30-day grace period.

3. Distributors will only be reimbursed for insurance products which are purchased/enrolled through ETMG.

4. The Health Reimbursement amount counts towards Health, Dental and other supplemental insurance options premiums. There is a seperate reimbursement table on page 9 for Life Insurance reimbursement amounts.

Example: John Doe Distributor has achieved National Marketing Director; SOZO will begin to reimburse up to $525 towards the elected health plans. With that reimbursement the Distributor has chosen to enroll in Health Insurance and Dental for his entire family, the premium for these plans is $701.62 per month. The following month, John's paid as rank for the month is Regional Marketing Director, because SOZO only reimburses up to $425 toward qualifying for Regional Marketing Director, John will be responsible for paying $276.62 for his health insurance premiums. This example works for all qualifying ranks, whether a Distributor moves up or down in rank.

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RANK LIFE INSURANCE AMOUNT

Senior Marketing Director $25,000 (Guaranteed Issue)

Regional Marketing Director $25,000 (Guaranteed Issue)

National Marketing Director $100,000 (Subject to Insurability)

International Marketing Director $350,000 (Subject to Insurability)

Global Ambassador $500,000 (Subject to Insurability)

1. Life Insurance for ranks Marketing Director thru Regional Marketing Director will be underwritten by Minnesota Life and will be for the Distributors only, no spouse or child coverage.

2. Life insurance for National Marketing Director will be underwritten on a simplified issue basis.

3. Life insurance for ranks International Marketing Director and Global Ambassador will be fully individually underwritten by a suite of carriers that ETMG represents.

4. All amounts above $25,000 will be issued based on Health Status.

5. After notification of enrollment is received from ETMG, Senior Marketing Director and Regional Marketing Director can be eligible to be reimbursed up to $25.00 per month. Reimbursement for the remaining ranks as follows: National Marketing Director is up to $200.00, International Marketing Director is up to $500.00 and Global Ambassador is up to $1,000.00 per month. Reimbursement amounts are paid to the Distributor by SOZO on the 15th of the following month.

6. If, for any reason, you leave SOZO or become an inactive Distributor, SOZO will discontinue paying premiums, and the Distributor will have the repsonsibility to cancel thier policy, but may continue coverage on an individual basis at their discrection.

7. Distributors who do not maintain their monthly qualifying paid as rank for 30 days may continue coverage but will be responsible for payment of premiums.

8. Marketing Directors are eligible to enroll in life insurance but SOZO does not reimburse at this level.

LIFE INSURANCE ELIGIBILITY TABLE

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DISTRIBUTOR ENROLLMENT PROCESS

Distributor reaches qualifying rank.SoZo begins reimbursingSenior Marketing Director.

(see pg 6 for amounts)

Following e�ective date all medicalpolicies and cards will be mailed

directly to the Distributor

SoZo will contact Distributorby email that he/she has

quali�ed for bene�ts.

Once the Distributor is enrolled,ETMG will process all information

with the insurance carrier and SoZoreimburses the Distributor based

on reimbursement schedule on pg 6by the 15th of the month following

the e�ective date.

Distributorcontacts ETMG

to enroll at1.888.728.2467

• SOZO reimburses a monthly dollar amount towards a qualifying Distributors health plan (see page 8). Distributors will pay 100% of the premium for the products that he/she has enrolled into. SOZO will reimburse all qualifying Distributors up to the amount defined on page 8.

• If the Distributor does not maintain rank beyond the 30 day grace period, he/she will be responsible for 100% of the premiums which will be paid by the payment information on file with ETMG, LLC. (If the Distributor decides to cancel coverage, he/she will not be eligible to enroll until the open enrollment period.)

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LIMITED MEDICAL PLAN SUMMARIES & RATESHealthSelect is a fixed indemnity medical plan which provides limited coverage for accidents, illness, and specified disease to help cover basic, minor-medical expenses.

(1)The Fixed Indemnity, Outpatient Accidental-Only, Critical Illness and AD&D Benefit Plans are underwritten by AXIS Insurance Company. (2)The office visit pre-pay is a service through the First Health PPO Network. (3)The prescription copay is underwritten by Companion Life Insurance Company. (4)These services are not insurance and are not provided by the underwriting companies shown here. *Benefit amounts listed are for Distributor/Spouse/Child(ren)

INPATIENT(1) Max PlanGold Level & Above

Hospital Confinement• Day 1 benefit amount• Days 2+ benefit amount per day

Surgery benefit amount (incl. maternity) per surgeryAnesthesia benefit amount - per surgery

$1,500 per day x 1 day$1,000 thereafter30 days per year

$3,000 x 1 surgery25% surgical amount

Potential Maximum Benefit Total $35,250

OUTPATIENT(1)

Physician Office Visit Pre-pay(2)

• Benefit amount per visit• Wellness benefit amount per visit• Well child care (up to age 4) benefit amount per visit

Accident maximum benefit amount per year up to:• Benefit % payable

Deductible per AccidentSurgery benefit amount per surgery

• Anesthesia benefit amount - per surgeryDiagnostic, X-ray, Lab - benefit amount per test:

• Class I: Laboratory - Blood work, CMP, Lipid Panel• Class II: X-ray, ECG, Pap/PSA test, all other diagnostic• Class III: Ultrasound, Mammogram• Class IV: CT, PET, MRI

$10$85 x 5 visits$150 x 1 visit$150 x 4 visits

$10,000 per year80 percentile U&C

$0$2,000 x 1 surgery

%25 surgical amount

$35 x 2 tests$75 x 2 tests$75 x 2 tests$200 x 1 test

Potential Maximum Benefit Total $13,945

PRESCRIPTION(3)

• Retail - Generic RX copay• Retail - Preferred Brand RX copay• Mail Order - Generic RX copay• Mail Order - Preferred Brand RX copay

Monthly benefit maximum - INDIVIDUALMonthly benefit maximum - FAMILY

$10$30$30$90

$200$400

VISION / CRITICAL ILLNESS / AD&DVision Benefit $35 exam benefit / yr

$75 materials every 2 yrs

Critical Illness(1) benefit amount payable for 10 conditionsAccidental Death & Dismemberment(1) benefit amount*

$20,000$25,000 / 5,000 / 1,000

OTHER SERVICES(4)

Consult a Doctor: Telephonic Doctor Office Visits - $38SupportLinc: Employee Assistance Program: EAPFirstHealth PPO Discounts

yesyesyes

Monthly RatesDistributor Only

Distributor + SpouseDistributor + Child(ren)

Family

$193.38$451.27$380.96$612.22

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MEDICAL PLAN SUMMARIES & RATESHealthAssist provides supplemental insurance coverage for employees with high deductible plans. HealthAssist focuses on the unexpected by offering outpatient accident, medical, hospitalization and critical illness coverage at a price members can afford.

$10,000

MONTHLY RATES Max Plan

Distributor OnlyDistributor + SpouseDistributor + Child(ren)Distributor + Family

$59.98$142.16$118.17$191.95

OUTPATIENT ACCIDENT COVERAGE• Deductible per Accident• Paid at

$0100%

INPATIENT BENEFIT• Day 1 cash benefit• Day 2+ cash benefit per day

$1,000$1,000 x 9 days

CRITICAL ILLNESS• Payable for 10 conditions: Cancer, Heart Attack, Renal Failure, Stroke, Major Organ Transplant, Multiple Sclerosis,

Coronary Artery Bypass Surgery, Alzheimer’s, ALS, Terminal Illness. $10,000

ACCIDENTAL DEATH & DISMEMBERMENTDistributorSpouseChild(ren)

$15,000$5,000$1,000

SUPPLEMENTAL ASSIST PACKAGE(1)

Consult a Doctor - Telephonic & Email Doctor VisitsNew Directions - Telephonic Counselor Visits / No Cost Face-to-Face VisitsRX Discount Card

UnlimitedUnlimited / 3 visits per yr

22-50% savings

(1)These services are not insurance and are not provided by AXIS Insurance Company.(2)Prescription benefits are underwritten by Companion Life Insurance Company.Plan is underwritten by AXIS Insurance Company. HealthAssist is a limited medical plan. It is not considered creditable coverage under HIPAA, is not major medical insurance, and is NOT designed to replace, provide, or modify major medical insurance. This information is a brief description of the important features of the insurance plan. It is not a contract of insurance. The terms and conditions of the coverage are set forth in the policy issued in the state in which the policy is delivered. The policy is subject to the laws of the state in which it is issued. Coverage may not be available in all states or certain terms may be different if required by state law. This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims.

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DENTAL PLAN: No deductibles; Reimburses 100% of usual amounts listed. Company may offer Dental Plan as a standalone option.

Maximum Plan Year LimitPeriodontics Lifetime MaximumOrthodontics Lifetime Maximum

$1,000$500$500

Type 1: Preventive & Diagnostic• Oral exams, including prophylaxis• Bitewings, per film• X-ray, panoramic or cephalometric• Sealants / topical fluoride• Space maintainers

$36$5

$36$11

$108

Type 2: Major Restorative• Crowns, bridges & dentures• Pre-fabricated crowns• Crown build-up procedures

$180$60$48

Type 3: Minor Restorative• Filings• Crown repair, bridge repair & denture repair• Relining or rebasing dentures

$42$24$60

Type 4: Endodontics• Root canals, apicoectomies• Root amputation• Therapeutic pulptomy, retrograde, filings, apexification, hemisection

$192$96$48

Type 5: PeriodonticsLifetime Maximum

• Tissue grafts or bone surgery• Gingivectomy (per quadrant)• Gingivectomy (per tooth)• Periodontal scaling, periodontal splinting, root planning, gingival curettage (per quadrant)

$500$96$60$36$24

Type 6: Oral Surgery• Surgeries Level 1 (example: removal of exostosis)• Surgeries Level 2 (example: removal of impacted tooth)• Surgeries Level 3 (example: simple extraction)

$120$66$36

Type 7: General Anesthesia and IV• IV, first half hour general, each additional 1/4 hour general $72

Type 8: Orthodontia• Per course of treatment (Lifetime Maximum) $500

Type 1 through 7: Subject to annual premium $1,000

Types 2, 5, 6, 8: Subject to a 12 month waiting periodMonthly Rates

Distributor OnlyDistributor + Spouse

Distributor + Child(ren)Family

$24.50$58.07$48.27$78.40

TERM LIFE INSURANCE* NOTE: Term Life coverage is employer paid (merit earned basis) by schedule

• Benefits reduced to 50% at age 70

Monthly RatesEligible Distributor Only

$25,000$9.38

*Term Life is underwritten by Minnesota Life.

ANCILLARY PLAN SUMMARIES

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VALUE ADDED BENEFITS

FIRST HEALTH PPO MEDICAL NETWORKAccess to Network discounts at over 5,000 hospitals and 590,000 physicians and health care professionals. Service provides members affordable access to physicians by allowing them to pay a $10 Office Visit Pre-pay before insurance benefits are applied.

PHARMACY NETWORKWith RxEDO, members can use their card for prescription fills and refills at over 56,000 participating pharmacies for co-pay benefits that will be processed in real-time at the point-of-purchase at the pharmacy.

CONSULT A DOCTOR™Offers convenient 24/7 access to physicians for phone and secure e-mail medical consultations.

Its proprietary nationwide cross-coverage network of U.S. licensed primary care physicians and specialists provide specific answers to medical questions and advice regarding non-emergency, routine medical conditions. Consult A Doctor’s physicians discuss symptoms, recommend treatment options, diagnose many common conditions, and prescribe medication when appropriate.

Consult A Doctor™ physicians are experts, with an average of 10 years’ experience. They are also progressive, with extensive training in telemedicine. All are board certified and state licensed, and are based in the U.S., so they are available at any time.

SupportLinc Employee AssistanceThe SupportLinc Assistant Program (EAP) helps you deal with life's challenges and the demands that come with balancing home and work. SupportLinc provides confidential, professional referrals and up to three (3) face-to-face counseling sessions for a wide array of personal and work-related concerns.

DENTEMAXWith DenteMax, members have access to network discounts averaging 20 - 40% below normal costs. In addition, members have access to over 137,000 providers in all 50 states.

*These services are not insurance and are not provided by the underwriting companies shown.

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PLAN PROVISIONSPre-existing Condition Limitation HealthSelect:

• 6-month treatment period / 12-month - limitation period

HealthAssist:

• 6-month treatment period / 12-month - limitation period

Critical Illness benefit on all plans, except on states noted below:

• Treatment period - 24 months / limitation period - 24 months

Critical Illness Benefit waiting period - 90 days

Survival period - 30 days

(state variations may apply)

Continuation of Coverage When Employment Ends

Continuation of coverage provision in policy

Issue Ages Employee / Spouse: 18+

Dependent Child: to 26

For critical illness benefit, covered person must be under age 65

Benefit Reductions AD&D

• At age 70-74, benefit reduces to 65% of the original face amount

• At age 75-79, benefit reduces to 40% of the original face amount

• At age 80+, benefit reduces to 20% of the original face amount

Term Life benefit

• At age 65-69, benefit reduces to 65% of the $25,000.00

• At age 70-74, benefit reduces to 50% of the $25,000.00

• At age 75 or older the benefit becomes 25% of the $25,000.00

Coordination of Benefits None

Rate Guarantee 1 Year

Per Member Monthly Billing Fee $6.00 per month (added to quoted premium rates at time of enrollment)

Situs State Policy will be issued in the situs state of Texas

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EXCLUSIONS AND LIMITATIONSFor HealthSelect and HealthAssist - We will not pay benefits for any loss, injury or sickness that is caused by, or results from:

For Hospital Indemnity:

• - 6-Month Treatment Period / 12-Month Limitation Period

HealthAssist: • - 6-Month Treatment Period / 12-Month Limitation Period

Critical Illness benefit on all plans: [TX Treatment Period 24 months / TX Limitation Period 24 months]

• Intentionally self-inflicted injury, suicide or any attempt while sane or insane;

• Commission or attempt to commit a felony or an assault;

• Commission of or active participation in a riot or insurrection;

• Declared or undeclared war or act of war;

• Release, whether or not accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release;

• An injury or sickness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, the Company will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;

• Travel or activity outside the United States, Canada or Mexico, except for a Medical Emergency;

• Flight in, boarding or alighting from an Aircraft except as:

• A fare-paying passenger on a regularly scheduled commercial or charter airline;

• A passenger in a non-scheduled, private Aircraft used for pleasure purposes with no commercial intent during the flight;

• Travel in any Aircraft owned, leased or controlled by the Policyholder, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be “controlled” by the Policyholder, if the Aircraft may be used as the Policyholder wishes for more than 10 straight days, or more than 15 days in any year;

• Bungee-cord jumping, parachuting, skydiving, parasailing, hang-gliding;

• Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;

• The Insured Person’s intoxication. The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the locale in which the accident occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he is in fact operating a motor vehicle, when the injury occurs. An autopsy report from a licensed medical examiner, law enforcement officer’s report, or similar items will be considered proof of the Insured Person’s intoxication;

• An Accident if the Insured Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator’s license, unless: (a) the Insured Person holds a valid learners permit and (b) the Insured Person is receiving instruction from a driver’s education instructor;

• Alcoholism, drug addiction or the use of any drug or narcotic except as prescribed by a Physician unless specifically provided herein;

• Repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental

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EXCLUSIONS AND LIMITATIONSrestoration;

• Repair, replacement, examinations for prescriptions or the fitting of eyeglasses or contact lenses;

• Elective Abortion. Elective Abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed;

• Mental and nervous disorders;

• Elective surgery or cosmetic surgery, except for reconstructive surgery needed as the result of a Covered Injury or Covered Sickness;

• Experimental or Investigational drugs, services, supplies. For the purposes of this exclusion, “Experimental or Investigational” means medical services, supplies or treatments provided or performed in a special setting for research purposes, under a treatment protocol or as part of a clinical trial (Phase I, II or III). The covered service will also be considered Experimental or Investigational if the Insured Person is required to sign a consent form that indicates the proposed treatment or procedure is part of a scientific study or medical research to determine its effectiveness or safety. Medical treatment, that is not considered standard treatment by the majority of the medical community or by Medicare, Medicaid or any other government financed programs or the National Cancer Institute regarding malignancies, will be considered Experimental or investigational. A drug, device or biological product is considered Experimental or Investigational if it does not have FDA approval or approval under an interim step in the FDA process, i.e., an investigational device exemption or an investigational new drug exemption;

• Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications;

• Sexual reassignment surgery, sexual transformation surgery, sexual transgendering surgery;

• Services related to sterilization, reversal of a vasectomy or tubal ligation; in vitro fertilization and diagnostic treatment of infertility or other problems related to the inability to conceive a child, unless such infertility is a result of a Covered Injury or Covered Sickness;

• Treatment or services provided by a private duty nurse;

• Organ or tissue transplants and related services;

• Personal comfort or convenience items;

• Rest or custodial cures;

• Hearing aids.

• In addition, benefits will not be paid for services or treatment rendered by any person who is:

1. Employed or retained by the Policyholder; Subscriber;

2. Living in the Insured Person’s household;

3. An Immediate Family Member of either the Insured Person or the Insured Person’s Spouse;

4. The Insured Person.

For Outpatient Accident and Accidental Death & Dismemberment:We will not pay benefits for any loss or Injury that is caused by, results from, or is contributed to by:

1. Intentionally self-inflicted injury, suicide or any attempt while sane or insane;

2. Commission or attempt to commit a felony or an assault;

3. Commission of or active participation in a riot or insurrection;

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EXCLUSIONS AND LIMITATIONS4. Declared or undeclared war or act of war;

5. An injury or sickness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, the Company will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;

6. Flight in, boarding or alighting from an Aircraft except as a fare-paying passenger on a regularly scheduled commercial or charter airline;

7. Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;

8. Medical or surgical treatment, diagnostic procedure, administration of anesthesia, or medical mishap or negligence, including malpractice;

9. The Insured Person’s intoxication. The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the locale in which the accident occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he is in fact operating a motor vehicle, when the injury occurs. An autopsy report from a licensed medical examiner, law enforcement officers report, or similar items will be considered proof of the Insured Person’s intoxication;

10. Aggravation or re-injury of a prior injury the Insured Person suffered prior to His Coverage Effective Date, unless the Company receives a written medical release from the Insured Person’s Physician;

11. Sickness, disease or any bacterial infection, except one that results from an Accidental cut or wound, or pyogenic infections that result from Accidental ingestion of contaminated substances;

12. Release, whether or not accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release;

13. Travel in any Aircraft owned, leased or controlled by the policyholder, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be “controlled” by the policyholder if the Aircraft may be used as the policyholder wishes for more than 10 straight days, or more than 15 days in any year.

In addition, benefits will not be paid for services or treatment rendered by any person who is:1. Employed or retained by the Policyholder;

2. Living in the Insured Person’s household;

3. An Immediate Family Member of either the Insured Person or the Insured Person’s spouse;

4. The Insured Person.

Excluded ExpensesIn addition to Common Exclusions, the Company will not pay Outpatient Accident Medical Expense Benefits for any Covered Medical Expense, treatment or services resulting from or contributed by:

• Treatment by persons employed or retained by the Policyholder, or by any Immediate Family or member of the Covered Person’s household.

• Treatment of sickness, disease or infections except pyogenic infections or bacterial infections that result from the accidental ingestion of contaminated substances;

• Treatment of hernia, Osgood-Schlatter’s Disease, osteochondritis, appendicitis;

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EXCLUSIONS AND LIMITATIONS• Osteomyelitis, cardiac disease or conditions, pathological fractures, congenital weakness;

• Detached retina unless caused by a Covered Accident;

• Mental disorder or psychological or psychiatric care or treatment whether or not caused by a Covered Accident;

• Pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions;

• Mental and nervous disorders.

• Damage to or loss of dentures or bridges, or damage to existing orthodontic equipment;

• Expenses incurred for treatment of temporomandibular or craniomandibular joint dysfunction and associated myofacial disorders;

• Injury covered by Workers’ Compensation, Employer’s Liability Laws or similar occupational benefits, including any insurance policy that provides benefits to the Insured Person for injuries resulting from an occupational accident, or while engaging in activity for monetary gain from sources other than the Policyholder;

• All surgery, including cosmetic and elective surgery;

• Any elective treatment, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed by us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States;

• Eyeglasses, contact lenses, hearing aids, examinations or prescriptions for them, or repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices;

• Expenses payable by any automobile insurance policy without regard to fault;

• Conditions that are not caused by a Covered Accident; or

• Any treatment, service or supply not specifically covered by the Policy;

• Injuries paid under medical payment coverage or no-fault coverage contained in an automobile insurance policy or liability insurance policy.

In addition, Critical Illness Benefits will not be paid for:• The Insured Person’s suicide or intentional self inflicted injury or Sickness, while sane or insane;

• The Insured Person’s being under the influence of an excitant, depressant, hallucinogen, narcotic, and other drug, or intoxicant including those taken as prescribed by a Physician;

• The Insured Person’s commission of or attempt to commit an assault or felony;

• The Insured Person’s engaging in an illegal activity or occupation;

• The Insured Person’s voluntary participation in a riot;

• Any illness, loss or condition specifically excluded from the definition of any Critical Illness;

• A Critical Illness that was initially Diagnosed before the Coverage Effective Date;

• War, whether declared or not;

• Balloon angioplasty, laser relief of an obstruction, and/or other intra-arterial procedure unless covered under this Certificate; or

• Any injury or Sickness covered under any state or federal Worker’s Compensation, Employer’s Liability law or similar law.

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EXCLUSIONS AND LIMITATIONSNo Prescription Drug Benefits will be paid for:• All over-the-counter products and medications, including, but not limited to, electrolyte replacement, infant formulas,

miscellaneous nutritional supplements and all other over-the-counter products and medications;

• Blood glucose meters; insulin injecting devices;

• Depo-Provera; condoms, contraceptive sponges, and spermicides; sexual dysfunction drugs;

• Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS injectables; immunizations; and all other injectables unless shown in the definition of Prescription Drug;

• Medical supplies and durable medical equipment unless shown in the definition of Prescription Drug;

• Liquid nutritional supplements; pediatric Legend Drug vitamins; prescribed versions of Vitamins A, D, K, B12, Folic Acid, and Niacin – used in treatment verses as a dietary supplement; and all other Legend Drug vitamins and nutritional supplements;

• Anorexiants; any cosmetic drugs including, but not limited to, Renova and skin pigmentation preps; any drugs or products used for the treatment of baldness; and topical dental fluorides;

• Refills in excess of that specified by the prescribing Doctor, or refills dispensed after one year from the original date of the prescription;

• Any drug labeled “Caution – limited by Federal Law for Investigational Use” or experimental drugs;

• All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new FDA approved indication for a period of one year from such FDA approval for its intended indication;

• Drugs needed due to conditions caused, directly or indirectly, by a covered person taking part in a riot or other civil disorder; or the covered person taking part in the commission of a felony;

• Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or any act of war; or drugs dispensed to a covered person while on active duty service in any armed forces;

• Any expenses related to the administration of any drug;

• Drugs or medicines taken while in or administered by a Hospital or any other health care facility or office;

• Drugs covered under Worker’s Compensation, Medicare, Medicaid or other governmental program;

• Drugs, medicines or products which are not medically necessary;

• Diaphragms; erectile dysfunction Legend Drugs; and infertility Legend Drugs;

• Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; and Imitrex-auto injection;

• Smoking deterrents, Legend or over-the-counter drugs;

• Replacement of stolen medication (except under circumstances approved by us), or lost, spilled, broken or dropped Prescription Drugs;

• Vacation supplies of Prescription Drugs (except under circumstances approved by us).

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SERVICES NOT COVERED: No benefits will be paid for the following:

• For services and supplies not listed in the Schedule of Benefits or not recognized as essential for the treatment of the condition according to accepted standards of practice or considered experimental;

• For cosmetic procedures, including but not limited to veneers and bleaching of teeth and procedures performed primarily for cosmetic reasons;

• For services related to, performed in conjunction with, or resulting from a non-covered procedure;

• For charges in excess of the Usual and Customary rate;

• For any treatment program which began prior to the date the Insured Person is covered under the Policy;

• For crowns, inlays and onlays on teeth that can be restored by direct placement materials;

• For the replacement of crowns, bridges, dentures, inlays or onlays that can be restored to normal function;

• For the replacement of crowns, bridges, inlays, onlays or prosthetic appliance within 5 years from the date of last placement;

• For service or supplies payable under any medical expense potion of an auto or no-fault plan;

• For any condition paid under any Worker’s Compensation Act or similar law;

• For services applied without cost by any municipality, county or other political subdivision or for which there would be no charge in the absence or insurance;

• During any Waiting Period the Company requires. When the Insured Person voluntarily ends this insurance without a qualifying event and re-enrolls at a later date, the Waiting Period is 2 years and begins on the date coverage first ended;

• For services that are applied toward the satisfaction of a Deductible, if any;

• For services subject to a Waiting Period that were incurred during the Waiting Period;

• For charges resulting from changing from one provider to another while receiving treatment, or from receiving treatment from more than one provider for one dental procedure to the extent that the total charges billed exceed the amount incurred if one provider had performed all services;

• For Hospital facility charges for any dental procedure, including but not limited to: emergency room charges, surgical facility charges, Hospital confinement;

• For drugs or the dispensing of drugs;

• For oral hygiene instruction; plaque control; acid etch; prescription or take-home fluoride; broken appointments; completion of a claim form; OSHA/Sterilization fees (Occupational Safety & Health Agency); or diagnostic photographs (except for orthodontic purposes);

• For implants; myofunctional therapy; athletic mouth guards; precision or semi-precision attachments; treatment of fractures, cysts, tumors, or lesions; maxillofacial prosthesis; orthognathic surgery; TMJ dysfunction; cleft palate; or anodontia;

• For orthodontia, unless included within the Schedule of Benefits;

• For services to replace teeth that were missing (extracted or congenitally) prior to the effective date of coverage on Our Plan. This limitation ends after 36 months of continuous coverage on the Plan. Abutment teeth will be reviewed for eligibility of prosthetic benefits;

• For composite, resin, or white fillings on posterior primary teeth. Benefits will be reduced to that of an amalgam or silver filling;

• For the replacement of a filling within 24 months of placement, unless for specific health reasons;

• For the replacement of retainers;

• For sealants not applied to permanent bicuspid or molar; applied at age 15 or older; applied 3 years from a previous sealant application; applied to a decayed tooth;

• For lab fees for higher metals or porcelain crowns, bridges, inlays, or onlays.

EXCLUSIONS AND LIMITATIONS

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EXCLUSIONS AND LIMITATIONSThe following applies to the Group Term Life Insurance benefit:• SUICIDE EXCLUSION: We will not pay a death benefit if an insured person dies by suicide, while sane or insane, within two

years of the date his/her insurance starts. If You or Your spouse dies by suicide, We will refund the premiums paid for Your insurance. If any death benefit is increased, this suicide exclusion starts anew, but will apply only to the amount of the increase.

The insurance coverage provided herein may be considered a welfare benefit plan pursuant to the Employee Retirement Income Security Act of 1974 (“ ERISA”). If ERISA applies the plan sponsor has certain responsibilities. Please consult with your legal or tax counsel for guidance as to whether ERISA would apply to this coverage and the responsibilities of a plan sponsor.

Coverage may not be available in all U.S. states and jurisdictions. Product availability and plan design features, including eligibility requirements, descriptions of benefits, exclusions or limitations may vary depending on state laws.

This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit AXIS Insurance Company from providing insurance, including, but not limited to, the payment of claims.

Payment of claims under any insurance policy issued shall only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“”OFAC”).

NOTICE

Insurance policies providing certain health insurance coverage issued or renewed on or after September 23, 2010 are required to comply with all applicable requirements of the Patient Protection and Affordable Care Act (PPACA). However, there are a number of insurance coverages that are specifically exempt from the requirements of the PPACA.

Based on our understanding of the current law and regulations, it is our belief that the accident and health benefits provided under this program are exempt from the relevant provisions of the PPACA. Similarly, we do not believe that the accident and health coverage qualifies as minimum essential benefits as set forth in the PPACA.

AXIS Insurance Company continues to monitor PPACA laws and regulations and guidelines to determine any impact on its products. Should there be any change that requires modification of this plan, we reserve the right to change the policy and rates accordingly.

Please understand that this is not intended as legal advice. For legal advice on the PPACA, please consult with your own legal counsel or tax advisor directly.

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PAYING FOR YOUR MEDICAL PREMIUMS• ETMG, LLC is a licensed Premium Collection Agency and will be responsible for collecting all

medical premiums along with any associated fees.

• All premiums will generally be drafted (due to holidays and weekends) between the 20th and last day of each month; all premium payments will pre-pay for the upcoming month of coverage.

• If your premium payment is not honored by your financial institution, for any reason, a Returned Payment Fee of $30.00 will be due along with your insurance premium, and may be billed separately.

• If your premium payment is not received by the last day of the month by close of business, your policy may not go into effect.

• After your initial payment is made, you will continue to be charged between the 20th and the last day of the month. If payment is not received in full by the 5th of the following month, your policy will be cancelled retroactive to the first day of the month for which payment is in default.

• The insurance carrier will not honor payment for any provider services after the date of retroactive cancellation and any payment made by the carrier to a provider after the date of retroactive cancellation will be reversed by the insurance company. You will be personally liable to the service provider(s) for any charges you incur after the retroactive date of cancellation.

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HOW TO ENROLLETMG, LLC is a licensed Third Party Administrator and therefore will be handling all enrollments on behalf of SOZO. We at ETMG know that as a self-employed business owner, your time is very valuable. That is why ETMG has created three ways to enroll in SOZO’s medical benefit program.

Online Self-Enrollment

By visiting www.SOZO.myternian.com, each Distributor will have access to our online enrollment system powered by Ternian. Upon arrival to the enrollment site, there will be a section in which it asks you to enter your SOZO I.D. number. Your I.D. number must be an exact match to what is pre-loaded in the enrollment system in order to access enrollment.

All I.D. numbers will be uploaded into the Ternian system, which will have the ability to recognize exactly what plan you are eligible for based on your rank.

Benefit Specialist Hotline Enrollment

ETMG, LLC provides access to ETMG-employed licensed Benefit Specialist. You can reach a Benefit Specialist by calling 1.888.728.2467. Benefit Specialists are available to assist, educate, and enroll all eligible Distributors Monday – Friday from 8:30am to 6:00pm Central Standard Time.

Downloadable Paper Application Enrollment

“I’ve Enrolled. What Now?”

ETMG has created a website specifically for SOZO’s medical benefits program at www.sbua.org/SOZO. Medical enrollment forms can be downloaded on the right side under “Forms”. Application instructions will precede the actual application form. Once you have filled out your form, please fax it to 512.682.8795.

Now that you have made your decision to enroll in SOZO’s group medical coverage, what can you expect? You will go through the same steps whether you enrolled by telephone with a Benefit Specialist, used online self-enrollment, or filled out a paper application. The following steps will guide you through your expectations.1. You will receive an email confirming your enrollment.2. In that email, there will be a link that directs you to create an account. For assistance setting up your account, visit

www.sbua.org/SOZO and watch the “Set Up Your Account” instructional video.3. The checking or savings account that you provided at the time of enrollment will be debited between the 20th

and the last day of the month by ETMG, LLC.4. Your I.D. cards will arrive the first week of your effective coverage month.5. If you have any questions or concerns about your coverage, please contact a Benefit Specialist at 1-888-728-2467.

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Step 1: SOZO Distributor ID Number: ______________________________

Step 2: Select Coverage Type:

HealthSelect

o Distributor Only o Distributor & Spouse o Distributor & Child(ren) o Distributor & Family

HealthAssist and Coverage Type

o $2,500 o $5,000 o $10,000

o Distributor Only o Distributor & Spouse o Distributor & Child(ren) o Distributor & Family

Dental and Coverage Type

o Enroll o Decline

o Distributor Only o Distributor & Spouse o Distributor & Child(ren) o Distributor & Family

Distributor Only Term Life - $25,000

o Enroll o Decline

Step 3: Provide the information that we need in order to enroll you and/or your family members.

First Name: ___________________ M.I.: ______ Last Name: ________________________Gender (M/F): __ D.O.B. (mm / dd / yyyy)____

Social Security Number: ___ / __ / ____ Hire Date: __ / __ / ____

Street Address: ______________________________________________________________________ City: ____________________________ State: ____ Zip: ________

Email Address: ______________________________________________________________________ Primary Phone: (_____) _____ - ________ o Home o Work o Cell

Dependent Information (If Any): For more than three dependents, attach additional sheet

First Name: ___________________ M.I.: ______ Last Name: ________________________Gender (M/F): __ D.O.B. (mm / dd / yyyy)____ Relationship to you: ___________

First Name: ___________________ M.I.: ______ Last Name: ________________________Gender (M/F): __ D.O.B. (mm / dd / yyyy)____ Relationship to you: ___________

Warning: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and / or fines. In addition, the insurer may deny insurance benefits if false information materially related to a claim provided by the applicant.

Signature Date Signed:

_______________________________________________________________ _______________________________________________________________

I have read the AXIS Insurance Company enrollment brochure, including the exclusions and limitations, and accept the terms and conditions of the coverages outlined in it. I understand fixed indemnity insurance plans are not considered creditable coverage under HIPAA and do not provide Major Medical or Comprehensive Medical coverage. I have read the enrollment brochure and understand my coverage is subject to the terms and conditions of the policy issued to SOZO. I understand my coverage will go into effect on the date stated in the brochure only if I am active on that date. If I am not in Qualified Production on that date, my coverage will go into effect on the date I return to active service. If I have elected coverage for my dependents, their coverage will

not go into effect prior to my effective date. I authorize ETMG, LLC to deduct the required premium for the plan I have elected. To the best of my knowledge and belief, all information i have provided is true and complete. I understand my information is protected by privacy laws and will be released only in accordance with these laws. The only people who have access to this information are employees of the Insurance Company who service my policy or claim and other third parties authorized by the Insurance Company. Information may be disclosed to those who have an insurance-related regulatory or legal need for the information. In other situations, the Insurance Company will ask me for written authorization to disclose information about me.

Fax or Email Completed Form To:512.682.8795 | [email protected]

Questions? Call 1.888.728.2467If needed, request for coverage forms are available at www.sbua.org/SOZO

AXIS Insurance CompanySOZO Distributor Enrollment Form