Founded 1983, Washington DC

Guaranteed Acceptance forUSA+ Members

SECUREADVANTAGE300

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LimitEd mEdiCAL iNdEmNitY iNSURANCE BENEfitS

Physician/Hospital Benefits

Hospital Room & Board and General Nursing Services $300 per dayThis benefit is payable for up to 31 days per policy year, when a Covered Person is admitted to a hospital due to a covered Injury or Sickness. This benefit is in lieu of the Intensive and Cardiac Care Unit Benefit.

Intensive and Cardiac Care Unit Benefit $1,000 per dayThis benefit is payable up to 31 days per policy year, when as the result of a Covered Injury or Sickness, a Covered Person is confined to a Hospital ICU or CCU unit. This benefit is in lieu of the Hospital Room & Board and General Nursing Services Benefit.

Surgery: (Inpatient/Outpatient) See Surgical ScheduleThis benefit is payable for Covered Expenses due to an Injury or Sickness and pays according to the surgical schedule as set forth in the Certificate of

Coverage. Maximum of one surgery per Covered Person per policy year. The Surgical Schedule can be found on page 10.

Anesthesia: (Inpatient/Outpatient) See Surgical ScheduleThis benefit is payable for Covered Expenses due to an Injury or Sickness and pays according to the surgical schedule as set forth in the Certificate of Coverage. Maximum of one treatment per Covered Person per policy year. The Surgical Schedule can be found on page 10.

Doctor Office Visit:Pays $75 per visit, 5 visits maximum per individual, 10 visits maximum per family per policy year. Benefits are paid if a Covered Person visits a doctor’s office for medically necessary treatment or care of an injury or sickness covered under the policy. No network restrictions, see providers of your choice. This benefit is not subject to a waiting period for pre-existing conditions. PROVIDER LOCATOR

Wellness Exam:Pays $75 per visit, 1 visit maximum per person per policy year at the age intervals listed below. Benefits are paid if a Covered Person visits adoctor’s office for routine wellness care covered under the policy. No network restrictions, see providers of your choice. This benefitis not subject to a waiting period for pre-existing conditions. PROVIDER LOCATOR

• Adult Wellness Visit  (ages 6-64)

• Child Wellness Visit  (ages birth-5)

Diagnostic Tests, X-Rays, and Laboratory:Doctor Office Visit:

Pays $50 per sitting or draw, 1 sitting or draw maximum per Covered Person per policy year. Benefits are paid for a Covered Person when x-rays, laboratory and other diagnostic tests are ordered or performed by a Doctor, coverage is provided for such tests, including the services of a radiologist or radiology group and for services of a pathologist or pathology group for interpretation of diagnostic tests or studies that are Medically Necessary due to an injury and sickness or care of an injury or sickness covered under the policy. This benefit is not subject to a waiting period forpre-existing conditions.

• Sickness or Injury                                         $50 per visit

Emergency Room: $50 per visitWhen Medically Necessary treatment by a Doctor in a Hospital Emergency Room for a Medical Emergency due to an Injury or Sickness, isrequired, coverage is provided for treatment of $50 per Policy Year, 1 visit Maximum per Covered Person. This benefit is not subject to a waiting period for pre-existing conditions.

Ambulance Benefit: $100 per tripWhen as the result of a Covered Injury or Sickness, a Covered Person requires the services of a licensed professional ambulance company fortransportation to or from a Hospital. For Medical Emergencies only. Maximum of one trip per Covered Person per Policy Year. This benefit is not subject to a waiting period for pre-existing conditions.

CLICK HERE for the insurance premium amounts paid to United States Fire Insurance Company out of the association membership fees.

CLICK HERE FoR LImITS and ExCLUSIonS.

The USA+ membership is not an insurance contract. The membership includes insured & non-insured benefits. This is an AssociationMembership offered and administered by United Service Association For Health Care, P.O. Box 200905, Arlington, TX 76006-0905, 800-USA-1187. Not available in all states. Please contact USA+ for state availability.

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ExCESS mEdiCAL ACCidENt ExpENSE BENEfitS

Accident Medical/Dental Expense Benefit: $2,500*When a Covered Person sustains an accidental Injury that requires Medically Necessary care by a Doctor, coverage is provided, less a $200 deductible, up to $2,500, for treatment, services and supplies for such Injury. Maximum of one occurrence per Covered Person per Policy Year.Initial treatment for the Injury must be received within 30 days of the Injury.

*Limited Medical Indemnity benefits are underwritten by United States Fire Insurance Company, rated "A" by AM Best 2010,and are subject to the terms, definitions, conditions, exclusions and limitations of the group policy. Coverage is not provided for loss due to pre-existing conditions for 12 months from the Covered Person’s effective date for Hospital Room & Board,ICU/CCU, Surgery and related Anesthesia benefits only. Coverage is not provided for loss due to sickness for 30 days from theCovered Person’s effective date. Coverage is not provided for members age 65 or over. Coverage will terminate at the end ofthe monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple membershipsincluding United States Fire Insurance Company benefits, is not allowed.

*The association membership fee you will be charged include insurance premiums which are paid to United States Fire InsuranceCompany for limited medical indemnity insurance coverage as well as non-insurance fees for products and services offered byand paid to the Association.

THIS IS NOT BASIC HEALTH INSURANCE OR MAjOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FORBASIC HEALTH INSURANCE OR MAjOR MEDICAL COVERAGE. NOT AVAILABLE IN AK, CT, GA, KS, MD, ME, MI, MT, NC,ND, NH, Nj, NY, OR, RI, VT AND WA.

Accidental Death & Dismemberment (AD&D) Benefit**

Members are insured for Accidental Death & Dismemberment 24 Hours a Day, 365 Days a Year, anywhere in the world. This benefit is paid inaddition to other insurance you may have and; covers accidents in the course of business or pleasure, on or off the job. The benefit amount is$10,000 for each member, $5,000 for each spouse/domestic partner, and $2,500 for each unmarried dependent child.

100% of the Benefit Amount is payable for Accidental: Loss of Life; Loss of Speech and Loss of Hearing; Loss of Speech and one of: Loss of Hand,Foot or Sight of One Eye; Loss of Hearing and one of: Loss of Hand, Foot or Sight of One Eye; Loss of both Hands, both Feet, loss of Sight or anycombination thereof; 50% of the Benefit Amount is payable for Accidental: Loss of Hand, Foot or Sight of One Eye (any one of each); Loss ofSpeech or Loss of Hearing; 25% of the Benefit Amount is payable for Accidental: Loss of Thumb and Index Finger of the same hand. If an InsuredPerson suffers multiple losses as a result of one accident, this benefit only pays the single largest benefit amount applicable to all such losses.

Reduction of Benefit Amount: The benefit amount reduces to 65% at age 70; to 45% at age 75; to 30% at age 80; and to 15% at age 85. The benefit amount cannot be increased after age 70.

Medical Evacuation and Repatriation Benefit**

If accidental bodily injury, disease or illness causes an insured person to require medical evacuation and/or repatriation while on a covered tripmore than 100 miles from home and lasting no more than 180 days, this coverage will pay for covered expenses up to a maximum of $50,000. Themedical evacuation or repatriation must be ordered by a physician and arranged by the Assistance Services Administrator. This benefit will also:a) guarantee payment of the charge made by a hospital prior to and as a condition of an insured person’s admission for emergency medicaltreatment up to $5,000 (Hospital Admission Guaranty); b) $100 per day up to a maximum of 5 days for the costs for temporary lodging and mealsincurred by an immediate family member who travels to be with a hospitalized insured person (Family Travel Expense); c) pay for an accompanyingdependent child to return to his or her residence if the insured person is hospitalized while on a trip (Return of dependent Child).

EXCLUSIONS Applicable to the AD&D and Medical Evacuation and Repatriation Benefit

Insurance does not apply to any Accident, Accidental Bodily Injury or Loss when the United States of America has imposed any trades

sanctions prohibiting the insurance, or there is any other legal prohibition against providing the insurance. In addition no benefits will be

paid for any Accident, Accidental Bodily Injury or Loss caused by or resulting from any of the following: 1) An insured Person being in,entering, or exiting any aircraft:: a) owned, leased or operated by the Sponsoring Organization or on the Sponsoring Organizations’s behalf; or b)operated by an employee of the Sponsoring Organization on the Sponsoring Organization’s behalf. 2) an Insured Person, or exiting any aircraftwhile acting or training as a pilot or crew member. This exclusion does not apply to passengers who temporarily perform pilot or crew functions in alife-threatening emergency. 3) an Insured Person’s emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage,bacterial or viral infection, bodily malfunctions or medical or surgical treatment or diagnosis thereof. This exclusion does not apply to the InsuredPerson’s bacterial infection caused by an Accident or by Accidental consumption of a substance contaminated by bacteria. 4) while the InsuredPerson is incarcerated. 5) an Insured Person participating in military action while in active military service with the armed forces of any country orestablished international authority. However, this exclusion does not apply to the first sixty (60) consecutive days of active military service with thearmed forces of any country or established international authority. 6) an Insured Person traveling or flying on any aircraft engaged in SpecializedAviation Activities. Specialized Aviation Activity means use of a properly certified aircraft for the following: acrobatic or stunt flying, exploration,racing, pipeline inspection, any endurance tests, power line inspection, any flight on a rocket propelled or rocket launched aircraft. livestock herding,bird flock management, crop dusting, aerial photography, crop seeding, banner towing, crop spraying, or any test for experimental purpose.7) an Insured Person’s suicide, attempted suicide or intentionally self-inflicted injury. 8) This insurance does not apply to any Accident, AccidentalBodily Injury, Loss, Covered Loss, or Loss of Property caused by or resulting from, directly or indirectly, a declared or undeclared War.

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**AD&D and Medical Evacuation and Repatriation insurance are underwritten by Federal Insurance Company, a member of theChubb Group of Insurance Companies. This literature is descriptive only. Actual coverage is subject to the language of thepolicies as issued. Exclusions Apply. Chubb, Box 1615, Warren, Nj 07061-1615.

tERm LifE iNSURANCE BENEfitTerm Life InsurancePays the beneficiary $10,000 upon the primary Member’s death. This amount is doubled if the loss of life is due to an accident. Member becomeseligible for this benefit six months after the membership effective date.

Accidental Death and Dismemberment Exclusions - ReliaStar Life does not pay benefits for loss directly or indirectly caused by any of the following:

• An accident occurring before the Effective Date of your Covered Class.

• Suicide or intentionally self-inflicted injury, while sane or insane.

• Physical or mental illness

• Bacterial infection or bacterial poisoning. Exception:Infection from a cut or wound caused by an accident.

• Riding in or descending from an aircraft as a pilot or crew member.

• Any armed conflict, whether declared as war or not, involving any country or government.

• Injury suffered while in the military service for any country or government

• Injury which occurs when you commit or attempt to commit a crime.

• Use of any drug, narcotic or hallucinogenic agent, unless prescribed by a doctor or taken as directed by a doctor or the manufacturer.

Coverage provided under a Group Term Life Insurance Policy issued by ReliaStar Insurance Company, a member of the INGUSA Life Group. All benefits are controlled by the terms and conditions of the group Policy. Not available in ID, NH, NC, VT orWV. Coverage is not provided to members age 65 or older or to individuals that are not citizens or legal residents of the UnitedStates, its territories and protectorates.

BENEfitS - mEdiCAL

BridgeHealthMedical - Save 30-80% On Major Surgery Costs With BridgeHealthBridgeHealth, the premier provider of medical travel services, connects you with domestic and international hospitals and doctors to provide you

with excellent quality and pricing that is substantially lower than anything you can find on your own. We provide you with a connection to our pre-

screened network of providers, we schedule the surgery/procedure for you, and provide personal assistance throughout the entire experience -

from the initial contact with the surgeon, to trip planning, updates to friends and family, and follow-up care.

First Health NetworkFirst Health is more than a PPO Network, it is a full service Managed Care Organization offering savings opportunities on a national, directly

contracted basis. It provides broad access in urban, suburban and rural markets to more than 5,000 Hospitals and 550,000 Physicians and health

care professionals nationwide. First Health is committed to patient safety at a high level by exercising care in the selection and evaluation of

providers for our network. Thorough credentialing and recredentialing processes minimize unfavorable risks, which in turn, impacts clinical and cost

outcomes. Network Stability – More than 99% of hospitals, and more than 96% of doctors remain with First Health year after year.

MEDEX PlusMEDEX Plus provides you with Medical Evacuation and Repatriation Services, Travel Assistance Services, and Medical Assistance Services whenyou are 100 or more miles away from home.

Medical Evacuation & Repatriation Services Available

(fully paid service)

• Emergency medical evacuation

• Medically supervised return

• Repatriation of Mortal Remains

• Travel Assistance for dependent children

• Travel Assistance for companion if member is hospitalized when traveling alone

Travel Assistance Services Available

• Emergency Travel Arrangements

• Emergency Transfer of Funds

• Worldwide Legal Referrals

• Translation Services

Medical Assistance Services Available

• Worldwide Medical and Dental Referrals

• Transfer of Insurance Information and Medical Records to Medical Providers

• Dispatch of Doctors and Specialists

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Hospital Bed to Hospital Bed

• Available at no charge to members when a medical situation requires a transfer of 100 air miles or more from a hospital to a specialized hospital

or medical facility. MedEX must be contacted in advance to coordinate the arrangements for a safe and appropriate transfer.

iNSUREd BENEfitS - pRESCRiptiON

Fidelity Security Life RxIS NOT AVAILABLE IN AL ,FL, MA, MD, ME, MN, NH, NY, SD, VT AND WA.

• $200 Annual deductible per family member.*

• $1,500 Annual Maximum.

• $15 co-pay for covered outpatient generic drugs.

• Up to a 30% discount on brand name drugs when prescriptions are filled at participating pharmacies.

This benefit is provided to USA+ Members by a group policy issued to USAHC by Fidelity Security Life, am A- (Excellent) ratedcarrier by A.M.Best. Some provisions, benefits, exclusions or limitation listed herein may vary depending on your state ofresidence.

A brief list of exclusions includes the following: injectables, experimental drugs, vitamins, infertility, cosmetic drugs and brandname drugs. Please contact the Association at 1-800-872-1187 for a complete list of exclusions and limitations. Underwritten by Fidelity Security Life Insurance Company, Kansas City, MO. The plan is governed by M-9031. Policy PD-245.

*NOT APPLICABLE TO RESIDENTS OF CT.

CHECK DRUG PRICING

CareMark Mail Service PharmacyIS NOT AVAILABLE IN AL ,FL, MA, MD, ME, MN, NH, NY, SD, VT AND WA.

Save Time and Money when you use Mail Order. CareMark is an industry leader that provides a high quality, dependable and convenient mail orderprescription program. Certain terms and conditions apply and are subject to the Exclusions and Limitations.

The following drugs are excluded: Cosmetic Injectable, Immune Globulins, Multiple Sclerosis/Immune Response Modifiers, RSVAgent (Respiratory Syncytial Virus), Nutritional Supplements and Oncology medications.

CHECK DRUG PRICING

APS PRESCRIPTION PROGRAM

IS ONLY AVAILABLE IN AL, FL, MA, MD, ME, MN, NH, NY, SD, VT AND WA.

APS has established a network of community pharmacies to provide a combination of convenience and cost effectiveness for the delivery of acute

medication. This plan is designed to save you money on your prescription drug costs. Your Prescription Plan is recognized at most pharmacies in the

United States.

• Tier 1 - $10.00 or less

• Tier 2 - $20.00 or less

• Tier 3 - $40.00 or less

• Tier 4 - The USA+ contracted rate

APS MAIL SERVICE PHARMACyIS ONLY AVAILABLE IN AL, FL, MA, MD, ME, MN, NH, NY, SD, VT AND WA.

APS is an industry leader that provides a high quality, dependable and convenient mail order prescription program

Order long term medications through APS and save time and money. Due to the time required for mail order shipments, this program is not suitablefor one-time prescriptions needed for emergencies or temporary conditions. Certain terms and conditions apply and are subject to theExclusions and Limitations.

The following drugs are excluded: Cosmetic Injectable, Immune Globulins, Multiple Sclerosis/Immune Response Modifiers, RSVAgent (Respiratory Syncytial Virus), Nutritional Supplements and Oncology medications.

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NON-iNSUREd BENEfitS - mEdiCAL

Karis Group - Patient AdvocacyThe Karis flagship Patient Advocacy service could be the most cost effective and valuable health benefit we provide to take care of your self-paybalances. Karis mediators work directly with patients and providers to resolve bills, allowing patients to focus on their health while Karis focuses onthe most cost effective solutions. WATCH THE INTRODUCTORy VIDEO TO LEARN MORE

Facts and figures say a lot about what Karis does. Stories about the people that Karis helps everyday say even more. Below you will find personalstories describing what Karis does for patients, and how their knowledgeable and attentive staff has impacted their lives.

John owned his company and medical insurance was unfortunately low on the priority list. When a symptom-free aneurysm burst and caused a stroke,John had to be airlifted to his local care hospital where it was decided that he needed more extensive care at a regional center. Four weeks later thetotal bills – including the flight, two hospitals and rehab – exceeded $46,000. John did not qualify for Medicaid and lacked the funds to pay bills of thissize. After much negotiation, we reached a settlement with all of the parties involved, averting financial ruin for John. Savings: Over $42,000.

Brandon cut and dislocated his finger playing hockey. He drove himself to the emergency room where he waited for two hours before a doctor saw him.The doctor put his finger back in place and stitched up the cut. The whole procedure took less than thirty minutes. Two weeks later Brandon received abill for $5,500. We contacted the doctor who agreed to reduce the bill to $2,500 and accept monthly payments to pay off the balance. Savings: $3,000.

Hannah broke her hip following a nasty fall a year ago. The hip had to be replaced, resulting in medical bills of $44,000. We managed to obtain a 50%discount off the hospital bill. The doctor’s bill of $6,500 was reduced by 25%. Hannah now needs to have her other hip replaced. Both the hospitaland the doctor have agreed to give her the same discounts as before. Savings: $47,250 plus ongoing savings.

To maintain patient privacy, names and other sensitive information has been changed or removed.

DirectLabsAn annual Comprehensive Wellness Exam (CWP™), at no charge!

A simple inexpensive blood test could save your life. Serious Medical Conditions such as heart disease, prostate cancer, diabetes, thyroid disease, andmore, can go undetected for up to two years - without noticeable symptoms.

The earlier a problem is detected, the easier and more likely it is to be treatable. A Comprehensive Wellness Exam (CWP™), is not a physical, butincludes a Complete Blood Count, Liver Profile, Kidney Panel, Thyroid Panel, Lipid Profile, Bone and Minerals, Fluids & Electrolytes and Diabetes, costsover $500. Direct Labs provides direct access to major clinical labs across the USA for these important blood tests one time annually at no charge foreach enrolled member and the member’s spouse, if enrolled.

This benefit is NOT available in Maryland and Massachusetts. Nebraska and North Dakota Residents: DirectLabs’ services arelimited to Specialty Lab testing ONLY. Special conditions apply.

Comprehensive Wellness Profile (CWP™) with 50+ results includes CBC’s, lipids, kidney, liver, glucose, electrolytes, bones andminerals.This benefit is not available until the 61st day following effective date.

CallMDThis benefit will save you time and money that might otherwise have been spent in a physician's waiting room or office. With this service, youcan use a toll-free number that connects you with a nurse and ultimately with a physician, who will discuss symptoms with you and whereallowed by law, may write a prescription for non-narcotic or non controlled medications at any time day or night.

Optum® NurselineWhen you or your child are ill in the middle of the night, or at any time, it is now at your fingertips to get professional help. Speak with a caring staff of

registered nurses toll-free, 24 hours a day, 7 days a week.

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pROtECtiON BENEfitSHelicopter Emergency BenefitIn the event that an eligible member suffers from a “certified injury” that requires emergency medical transportation by helicopter in accordance withEMS protocols, the program will reimburse the participant up to a maximum of $7,000.00 per occurrence. Reimbursement includes expensesincurred from the cost of “Medically Necessary” or “Life Threatening” helicopter transportation from the scene of an accident to the nearest medicalfacility capable of treating the injuries or from one medical facility to another medical facility. Claims for “Medically Necessary” transports from onemedical facility to another medical facility are subject to review by Lifeguard’s Medical Officer.

Provisions include:• One benefit will be paid per occurrence. • Benefit in excess of all other valid collectable insurance.• Coverage is worldwide. •Transportation by helicopter only.

This benefit is provided to USA+ members by Lifeguard Emergency Travel, Inc. Certain terms and conditions apply and benefitsare subject to the Limitations and Exclusions. See your Membership Handbook for the details.

LIMITATIONS AND EXCLUSIONSThe following conditions represent coverage exclusions:1. Suicide or attempted suicide;2. Intentionally self-inflicted injuries;3. War, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;4. Participation in any military maneuver or training exercise;5. Mental or emotional disorders, unless hospitalized;6. Being under the influence of drugs or intoxicants, unless prescribed by a Physician;7. Commission or the attempt to commit a criminal act;8. Participation as a professional in athletics;9. Pregnancy and childbirth (except for complications of pregnancy);10. Bodily injury or sickness which can be treated locally

NON-iNSUREd pROtECtiON BENEfitS

USA+ Benefits ProtectorMany individuals lose their job due to a company re-location, company downsizing or as the result of natural disasters. For most individuals, loss ofemployment also means a monetary loss.

The Benefits Protector program helps cushion the impact of economic downturns that occur. Should you lose your job through no fault of your own,we will be there for you. Your membership dues will be waived and your membership benefits will continue for three (3) months.(Certain Terms and Conditions Apply).

dENtAL/ViSiON BENEfitS

Ameritas Group Dental Benefits*You receive the following benefits: NO Deductible for Type 1 Preventive Services, $50 Deductible for Type 2 Basic Services, No more than 3deductibles per calendar year, Maximum Benefit – $2,500 annually Per Family Member, Benefits Are Paid Based On Schedule of Eligible Expenses,No waiting period on preventive and basic services, Choose any dentist nationwide or select from one of nearly 65,000 provider access locations.

Dental Rewards - Rewards insureds that care for their teeth and use only a portion of their annual maximum benefit in a year. With its increasingmaximum feature, each insured member and dependent earns additional money toward his or her next year’s annual maximum.

To get the maximum carryover for the next year, you must meet the following requirements:

1) Visit your Dentist between Jan. 1st and Dec. 31st.2) Submit claim for payment prior to April 1st of the next year. 3) Total benefits paid for current year visits must be less than $500.• If you meet all 3 requirements you will have an additional $250 available in annual maximum for the next year.

• In future years if you have benefits paid of less than $500, additional amounts of $250 will be added to the carryover.However, the most you can accumulate in the maximum carryover is $3,500.

• Your annual maximum will be $3,500 in four years if you continue to visit the dentist once each year!

LimitEd iNdEmNitY iNSURANCE BENEfitS ExCLUSiONS

LimitAtiONS ANd ExCLUSiONS (May Vary by State)

Benefits will not be paid for charges or loss caused by, or resulting from, any of the following:

(1) Suicide or any intentionally self-inflicted Injury;

(2) Any drug, narcotic, gas or fumes, or chemical substance voluntarily taken, administered, absorbed or inhaled unless prescribed by, and taken according to the directions of, a Doctor (accidental ingestion of a poisonous substance is not excluded.);

(3) Commission, or attempt to commit, a felony;

(4) Participation in a riot or insurrection;

(5) Driving under the influence of a controlled substance, unless administered on the advice of a Doctor;

(6) Driving while Intoxicated. "Intoxicated" will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs.

(7) Declared or undeclared war or act of war;

(8) Nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 180-days of the initial incident and:(1) The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear

energy; and(2) The Covered Person was within a 25-mile radius of the site of the release either:

(a) At the time of the release; or(b) Within 24-hours of the start of the release; or(c) Occurs while he is in the issue state of this Certificate;

(9) Routine health checkups or immunizations for Covered Person aged 6 and older; expenses for allergies, allergy serum or allergy testing, unless specifically provided for in this Certificate;

(10) Surgery to correct vision or hearing; eyeglasses, contact lenses and hearing aids, braces, appliances, or examinations orprescriptions therefore;

(11) Dental care, x-rays, or treatment other than Injury to sound, natural teeth and gums resulting from an accidental Injury and rendered within 6-months of the Injury;

(12) Spinal manipulations and manual manipulative treatment or therapy;

(13) Weight loss or modification and complications arising therefrom, including surgery and any other form of treatment for the purpose of weight loss or modification;

(14) Rest cures or custodial care, or treatment of sleep disorders;

(15) Treatment, services or supplies received outside of the U.S. except for acute Sickness or Injury sustained during the first 30-days of travel outside the U.S.;

(16) Normal pregnancy or childbirth, except for Complications of Pregnancy;

(17) Any drug, treatment, or procedure that either promotes or prevents conception or childbirth regardless of what the drug,treatment, or procedure was originally prescribed or intended for;

(18) Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood;

(19) Treatment of temporomandibular joint (TMj) disorders involving the installation of crowns, pontics, bridges or abutments, or theinstallation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy;

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(20) Cosmetic surgery. This Exclusion does not apply to reconstructive surgery:(a) On an injured part of the body following trauma, infection or other disease of the involved part; (b) Of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or(c) On a non-diseased breast to restore and achieve symmetry between two breasts following a covered Mastectomy;

(21) The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; dentures, partial dentures, braces or fixed or removable bridges;

(22) Treatment or removal of warts, moles, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain;

(23) Personal items such as television, telephone, lotions, shampoos, extra beds, meals for guests, take home items, or other items for comfort and convenience;

(24) Treatment of Mental or Nervous Disorders, or alcohol or substance abuse, unless specifically provided for under this Certificate;

(25) Prescription medicines, unless specifically provided for under this Certificate;

(26) Any Injury that is caused by flight or travel in, or upon:(a) An aircraft or other, craft designed for navigation above or beyond the earth's atmosphere except as a fare paying

passenger;(b) An ultra light, hang-gliding, parachuting or bungi-cord jumping;(c) A snowmobile;(d) Any two or three wheeled motor vehicle;(e) Any off-road motorized vehicle not requiring licensing as a motor vehicle;(f) Any watercraft or other craft designed for water use above or beneath the water, except as a fare-paying passenger;

(27) Any accidental Injury where the Covered Person is the operator of a motor vehicle and does not possess a current and validmotor vehicle operator's license;

(28) Services, treatment or loss:(a) Rendered in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;(b) Payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited);(c) Which a Covered Person would not have to pay if he did not have insurance;(d) Provided by a Doctor, Nurse or any other person who is employed or retained by a Covered Person or who is a

member of a Covered Person’s Immediate Family;(e) Covered by state or federal worker's compensation, employers liability, occupational disease law, or similar laws;(f) Injury or Sickness sustained while on active duty in the armed forces of any country. This does not include Reserve or

National Guard duty for training. Upon receipt of proof of service, we will refund, any unearned premium paid on apro rata basis;

(29) Hemorrhoids, tonsils, adenoids, middle ear disorders, any disease or disorder of the reproductive organs unless the loss is incurred at least 6-months after the Covered Person becomes insured under this Certificate;

(30) Elective treatment or surgery and treatment, procedures, products or services that are experimental or investigative. “Experimental or Investigative” means a drug, device or medical treatment or procedure that:(a) Cannot lawfully be marketed without approval of the United States Food and Drug Administration and approval for

marketing has not been given at the time of being furnished;(b) Has Reliable Evidence indicating it is the subject of ongoing clinical trials or is under study to determine its maximum

tolerated dose, toxicity, safety, efficacy, or its efficacy as compared with the standard means of treatments or diagnosis; or

(c) Has Reliable Evidence indicating that the consensus of opinion among experts is that further studies or clinical trials arenecessary to determine its maximum tolerated dose, toxicity, efficacy, or its efficacy as compared with the standard means of treatment or diagnosis.

“Reliable Evidence” means (i) published reports and articles in authoritative medical and scientific literature; (ii) the written protocol(s) of the treating facility or the protocols of another facility studying substantially the same drug, device, medical treatment or procedure; or (iii) the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, or medical treatment or procedure.

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UNitEd StAtES fiRE iNSURANCE COmpANY SURgiCAL REimBURSEmENt SChEdULE

if A Cpt COdE CAN NOt BE LOCAtEd ON thiS LiSt, YOU NEEd tO CONtACt thE

AdmiNiStRAtOR tO dEtERmiNE thE AppROpRiAtE dOLLAR REimBURSEmENt.

PLAN CODE(s): US058799

MAXIMUM INDEMNITY BENEFIT: $ 4,000 $ 1,000

Surgical Anesthesia

CPT CODE Surgical Procedure Reimbursement Reimbursement

ABDOMEN

44950 Appendectomy $ 1,000 $ 250

47600 Removal of gallbladder $ 2,000 $ 500

43620 Total Gastrectomy $ 3,400 $ 850

43500 Gastrotomy $ 1,000 $ 250

20102 Laparotomy, exploratory $ 1,000 $ 250

AMPUTATION

24920 Amputation of upper arm $ 1,000 $ 250

26951 Amputation of finger/thumb $ 1,000 $ 250

27295 Amputation of leg at hip $ 2,000 $ 500

27880 Amputation of lower leg $ 2,000 $ 500

28820 Amputation of toe $ 1,000 $ 250

BREAST

19182 Removal of breast $ 1,000 $ 250

19120 Removal of breast lesion $ 1,000 $ 250

19350 Breast reconstruction $ 2,000 $ 500

CHEST

32100 Exploratory Thoracotomy $ 2,000 $ 500

31641 Bronchoscopy (esophagoscopy) $ 400 $ 100

43124 Esophagectomy $ 3,400 $ 850

32520 Lung, removal of or portion of (Lobectomy) $ 2,000 $ 500

33471 Valvotomy or commissurotomy, closed $ 2,000 $ 500

33403 Aortic, Mitral, or Tricuspid Valvuloplasty, open with bypass $ 3,400 $ 850

33697 Tetralogy of Fallot with Bypass $ 3,400 $ 850

33400 Double valve procedure replacement and or repair $ 3,400 $ 850

DISLOCATION, REDUCTION OF

27840 Treat ankle dislocation $ 400 $ 100

23520 Treat clavicle dislocation $ 400 $ 100

24640 Treat elbow dislocation $ 400 $ 100

27256 Treat hip dislocation $ 400 $ 100 21485 Reset dislocated jaw $ 1,000 $ 250

23655 Treat shoulder dislocation $ 400 $ 100

25660 Treat wrist dislocation $ 1,000 $ 250

27557 Treat knee dislocation $ 2,000 $ 500

11

ARTHROTOMY

29895 Ankle arthroscopy/surgery $ 1,000 $ 250 29838 Elbow arthroscopy/surgery $ 1,000 $ 250 29863 Hip arthroscopy/surgery $ 1,000 $ 250 29883 Knee arthroscopy/surgery $ 2,000 $ 500 29807 Shoulder arthroscopy/surgery $ 2,000 $ 500

EAR, NOSE, THROAT

69840 Fenestration $ 2,000 $ 500 69502 Mastoidectomy-single $ 2,000 $ 500 69511 Extensive mastoid surgery $ 2,000 $ 500 42835 Adenoidectomy (independent procedure) $ 400 $ 100 31070 Sinusotomy, frontal, external simple (Trephine) $ 1,000 $ 250 58560 Submucous resection of nasal septum (septectomy) $ 1,000 $ 250 31585 Laryngectomy, without neck dissection $ 1,000 $ 250 42825 Tonsillectomy, with or without adenoidectomy-under age 18 $ 400 $ 100 42826 Tonsillectomy, with or without adenoidectomy-18 and over $ 400 $ 100 31500 Tracheotomy (independent procedure) $ 400 $ 100

EYE

66982 Cataract, operation for intracapsular, extracapsular unilateral $ 2,000 $ 500 67107 Repair detached retina $ 2,000 $ 500 65110 Removal of eye $ 2,000 $ 500

FRACTURE, TREATMENT OF

28430 Treatment of ankle fracture $ 400 $ 100 26720 Treat finger fracture, each $ 400 $ 100 21315 Treatment of nose fracture $ 400 $ 100 25560 Treat fracture radius & ulna $ 400 $ 100 27781 Treatment of fibula fracture $ 1,000 $ 250

GENITO_URINARY TRACT

57530 Cervix amputation (cervicectomy) $ 400 $ 100 54150 Circumcision Newborn Clamp $ 400 $ 100 58120 Dilation & Curettage (non-Puerperal) $ 400 $ 100 58180 Partial hysterectomy $ 2,000 $ 500 58150 Total hysterectomy $ 2,000 $ 500 58260 Vaginal hysterectomy $ 2,000 $ 500 50065 Kidney -Nephropexy $ 2,000 $ 500 50360 Kidney transplant, unilateral or bilateral, recipient with nephrectomy $ 3,400 $ 850 50978 Ureterotomy $ 1,000 $ 250 51065 Cystotomy $ 1,000 $ 250 52601 Prostate, removal of (Prostatectomy) $ 1,000 $ 250 55860 Surgical exposure, prostate $ 2,000 $ 500 55810 Extensive prostate surgery $ 2,000 $ 500 54860 Removal of epididymis $ 1,000 $ 250 57260 Cyctocele, operation for anterior colporrhaphy $ 1,000 $ 250 57250 Rectocele operation for posterior colporrhaphy $ 400 $ 100 45560 Rectocele and cystocele A&P colporrhaphy $ 1,000 $ 250

12

GOITRE

60210 Adenoma or benign tumor of thyroid exsection $ 1,000 $ 250

60240 Thyroidectomy $ 2,000 $ 500

HERNIA

49500 Repair Inguinal- unilateral $ 400 $ 100

49582 Repair Umbilical-under age 5 $ 1,000 $ 250

49587 Repair Umbilical-over age 5 $ 1,000 $ 250

49560 Repair Ventral (incisional $ 1,000 $ 250

49555 Repair Femoral $ 1,000 $ 250

49570 Repair Epigastric $ 400 $ 100

LIGAMENTS AND TENDONS

27686 Revise lower leg tendons $ 1,000 $ 250

26410 Repair hand tendon $ 1,000 $ 250

26350 Repair finger/hand tendon $ 2,000 $ 500

26480 Transplant hand tendon $ 2,000 $ 500

OBSTETRICAL

59410Removal of placenta and/or immediate or early repair ofperineum and/or cervix $ 2,000 $ 500

59514 Cesarean Section, complete procedure including delivery $ 2,000 $ 500

59525 Cesarean Section and Hysterectomy, total or subtotal $ 1,000 $ 250

59136 Ectopic (tubal, extra-uterine) pregnancy $ 2,000 $ 500

59812 Miscarriage, including dilation and curettage $ 400 $ 100

PILONIDAL CYST OR SINUS

11770 Removal of pilonidal lesion $ 400 $ 100

10080 Drainage of pilonidal cyst $ 400 $ 100

RECTUM

46942Fissure (Fissurectomy) cutting operation for (IndependentProcedure) $ 400 $ 100

46083 Incise external hemorrhoid $ 400 $ 100

46936 Destruction of hemorrhoids $ 400 $ 100

46262 Hemorrhoidectomy and Fistulotomy or Fistulectomy $ 1,000 $ 250

46220 Papillectomy, single tag (independent procedure) $ 400 $ 100

SKULL

61322 Osteoplastic craniotomy (other than operation for brain tumor) $ 3,400 $ 850

61250 Trephine $ 1,000 $ 250

61543 Hemispherectomy $ 3,400 $ 850

SPINE OR SPINAL CORD

63295 Laminectomy $ 400 $ 100

63278 Spinal cord tumor operation $ 2,000 $ 500

TUMOR

24077 Remove tumor of arm/elbow $ 2,000 $ 500

21557 Remove tumor, neck/chest $ 1,000 $ 250

13

The monthly association membership fees you will be charged include insurance premiums which are paid to United States FireCompany for limited medical indemnity insurance coverage as well as non-insurance fees for products and services offered by and paid to the Association. The monthly insurance premiums paid to United States Fire Insurance Company out of the monthlyassociation membership fees are as follows:

Secure Advantage 300

The above Insurance Premium reflects only the coverage underwritten by United States Fire Insurance Company. It does Notinclude the association’s costs for other coverages, programs and services; including but not limited to member discount andsavings related programs and services; administration and maintenance of association information and benefits, websites,enrollment, fulfillment, and any other costs related to the administration of association membership. Monthly AssociationMembership dues can be found on the next page.

Member only$78.25

Member/Spouse$162.87

Member/Child$147.61

Member/Family$224.73

In the States of CO and UT, the following rates apply:

Member only$72.12

Member/Spouse$150.09

Member/Child$136.03

Member/Family$207.10

In the States of DE, MN and NV, the following rates apply:

Member only$68.20

Member/Spouse$141.94

Member/Child$128.65

Member/Family$195.86

VARICOSE VEINS37780 Revision of leg vein $ 400 $ 100

TRANSPLANT & PARTIAL ORGAN REMOVAL32851 Lung Transplant $ 4,000 $ 1,000 32852 Lung Transplant with bypass $ 4,000 $ 1,000 33935 Heart and Lung Transplant $ 4,000 $ 1,000 47136 Liver Transplant $ 4,000 $ 1,000 47120 Liver - partial removal $ 4,000 $ 1,000 48140 Pancreas - partial removal $ 4,000 $ 1,000

*For surgical procedures not listed, the benefit amount will be determined based on a percentage of a fixed relative valuescale. The percentage used will be the same percentage as used in determining the benefit amount for the listed procedures.

ADMINISTRATIVE OFFICES1901 North Highway 360 • Grand Prairie, TX 75050

800-USA-1187 • www.usateamcorp.com

10 Day GuaranteeYou have 10 days from the date youreceive your membership materials(or such longer period as may berequired by state law) to review andevaluate the USA+ membership. Ifyou wish to cancel your membershipand receive a refund, you may do soby submitting a written request toUSA+ at the address listed below.

United Service Association For Health Care Foundation

USA+ Foundation Founder andChairman of the Board, DodyWood, with two special patients.

• American Diabetes Association

• Cystic Fibrosis Foundation

• Habitat for Humanity

• Juvenile Diabetes Research Foundation

• Muscular Dystrophy Association

• St. Jude Children’s Research Hospital®

The USA+ Foundation was created twenty years ago to help fund charities that assistthose who suffer needlessly, giving them hope for the future.

So far, the USA+ Foundation has awarded over 6 million dollars to worthy charitablegroups. As a USA+ member, you will assist worthwhile charities, community programs,and national research programs by helping us reach our goal of giving $1,000,000 amonth to charity.

Here are a few of the organizations that receive funding from the USA+ Foundation tohelp improve the quality of life for those facing unknown challenges:

$100

SA300_B • 07.26.12

14USAHC - US032407

Membership Receipt____________________________________________________________________Applicant’s Name Date

Membership Selected:

Secure Advantage 300 . . . . . . . . . . . . . . . . . $244 (Member)$400 (Member+Spouse)$376 (Member+Child(ren))$513 (Family)

Monthly Membership Dues: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Setup Fees: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Total Remitted: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Method of Payment: Check Credit Card

Mode of Payment: Monthly Bank Draft (EFT) Quarterly Direct Billing

Monthly Credit Card Semi-Annual Direct Billing

Annual Direct Billing

Recurring Monthly Dues: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

REPRESENTATivE SigNATuRE