$2,000,000 In Insurance Protection to Help You When Your Basic Health Insurance Plan Limits Your Coverage.

Coverage provisions and availability may vary by state

Catastrophe Major Medical Insurance Can Take Over When Your Basic Health Insurance Runs Short. Today the cost of a serious non-job related sickness or injury may be beyond the benefits provided by the average hospitalization or major medical insurance policy. Extremely large hospital and medical bills can push your expenses far over the limit of your basic insurance or even Medicare.

Any basic major medical or hospitalization insurance policy you may be insured through right now—including Medicare— could still leave you with enormous bills to pay...especially if you are confined to a nursing home for convalescent or custodial care.

Even though your basic health insurance policy probably has a large lifetime maximum benefit, your dollar benefits may be limited per year and may be limited again as to what will and won’t be covered. Convalescent home expenses, convalescent and custodial care, for instance, may be very limited in basic insurance policies.

Purpose of the Plan

• Helps protect you when your basic health insurance plan limits your coverage against extraordinary hospital–medical–surgical–convalescent expenses
• Helps you when the dollar benefits paid by your health insurance are LIMITED PER YEAR and are LIMITED AGAIN as to what will and won’t be covered

PLAN HIGHLIGHTS

• No age limit, no termination age…renew your coverage for life.
• Benefits up to $2,000,000 paid up to five full years*
• Choice of $25,000 or $50,000 deductible
• Eligible expenses that are reasonable and customary can count toward meeting the plan deductible, including those paid for by your basic health insurance or Medicare
• 36 consecutive months to satisfy the deductible
• Includes valuable convalescent care and home healthcare benefits

*Subject to certain inner limits and exclusions.

WHO IS ELIGIBLE?

Required Basic Health Insurance

The required basic plan is a health insurance plan which provides benefits at least as great as the following:

• semi-private room and board for 70 days
• $10,000 for extra services other than room and board
• $25,000 for physicians services
• a lifetime maximum benefit of $1,000,000

In order to be eligible for the ASME Group Catastrophe Major Medical Insurance Plan, you must have a basic health insurance policy providing benefits at least as great as above.

For persons who are not covered under a basic plan at the time of claim, the following charges will not be covered:

• hospital charges incurred during the first 70 days of each confinement
• the first $10,000 of charges for chemotherapy, radiation therapy, physical therapy or speech therapy that would otherwise be covered
• the first $50,000 of charges for physician services that would otherwise be covered
• the first $2,500 of charges for prescription drugs while not hospitalized that would otherwise be covered

All members in good standing who are U.S. residents are eligible to apply for member or spouse coverage, regardless of age, as well as their unmarried dependent children typically those under age 21, age 27 if in school full-time (subject to state variations). All applicants must be covered by a basic major medical plan or by Medicare Parts A and B. (Please refer to the PreExisting Conditions Limitations section.)

Please note: This Plan is not available to members residing outside the United States nor to residents of AZ, KY, MA, NJ, NY, OR, VT, and WA state. New York residents may call the Group Insurance Program Administrator for information about a separate New York Plan.

HOW THE PLAN WORKS

Five Year Benefit Period

The $2,000,000 Catastrophe Major Medical Insurance Plan provides benefits for extraordinary expenses not covered by your basic hospitalization, major medical insurance, HMO, PPO, or Blue Cross/Blue Shield Plan or Medicare. The Plan pays benefits up to five full years from the date your first eligible expense is incurred and used to satisfy the deductible.

Choice of Two Deductibles

The Plan offers the choice of either a $25,000 or $50,000 deductible. All reasonable and customary expenses count toward your deductible in full— even those eligible expenses paid by your basic health plan as well as those paid out of your own pocket. The deductible amount payable is the greater of the deductible amount selected ($25,000 or $50,000) or the benefits provided by your basic health insurance plan (or Medicare).

36 Consecutive Months to Satisfy Your Deductible

Since this deductible is based on the total accumulation of eligible hospital–medical–surgical–convalescent expenses, you may include all eligible expenses regardless of whether or not the claims are related.

In other words, from the time of your first eligible expense, all additional eligible expenses immediately count toward satisfying your deductible— those paid by you as well as those paid by your basic health plan, Medicare, or a Medicare supplement.

WHAT THE PLAN COVERS

Important Convalescent Care Benefit

Anyone at any age can require custodial or convalescent care in a convalescent Home. That’s why this is an extremely important benefit. Should any insured family member become confined as an inpatient in a custodial or convalescent care facility for custodial or convalescent care due to a non-job related sickness or injury, the Plan will pay eligible expenses for room and board, general convalescent care services and supplies up to $500 per week for up to three full years ($78,000 lifetime maximum). Benefits will begin on the seventh day of a convalescent home confinement or provided confinement is prescribed by a licensed physician.

Note: Convalescent home means a licensed institution that has on its premises organized facilities to care for and treat its patients, a staff of physicians to supervise such care and treatment, and a registered nurse on duty at all times. Convalescent home does not mean a place, or part of one, which is used mainly for the aged, alcoholics, drug addicts, persons with mental, nervous or emotional disorders.

Valuable Home Health Care Benefits

Another benefit not found in many other plans is Home Health Care coverage. The Catastrophe Major Medical Insurance Plan provides this important benefit, and includes up to 100 visits per calendar year for part-time or intermittent home nursing care, or home health aide service, physical therapy, occupational therapy, or speech therapy. The visits must be set up and approved by the insured’s physician and certified home health care agency. Each visit by a member of a home health care team will be considered one home health care visit. Four hours of home health aide services will be considered one home health care visit. Home health care is in lieu of a hospital or skilled nursing facility stay.

Eligible Expenses

After you satisfy your deductible, the Plan pays for up to 100 percent of all reasonable and customary eligible expenses:

• Hospital charges including daily semi-private room & board or intensive care.
• Miscellaneous hospital services and supplies.
• Charges by a currently licensed physician for diagnosis, treatment, and surgery.
• Medically necessary private duty nursing services from a registered LPN or RN private duty nurse while in a hospital or at home–$120 maximum per eight-hour shift ($360 maximum per day) up to a lifetime maximum of $35,000 per insured.
• Dental care, treatment, or surgery if natural teeth are injured by a non-job related injury caused by an accident which occurs while insured.
• X-ray, physiotherapy (by a licensed physiotherapist), or laboratory tests and services for diagnosis and treatment.
• Ambulance service to and from a hospital for treatment prescribed by a licensed physician–up to $2,000 lifetime maximum per insured.
• Anesthetic and its administration.
• Prescription drugs, casts, splints, braces, trusses, and crutches both in and out of the hospital.
• Oxygen and rental of equipment for its administration and rental of other medical equipment, such as wheelchairs or hospital beds.
• Psychiatric, mental, nervous or emotional disorders, alcoholism, or drug addiction treated in a hospital are covered up to a $25,000 lifetime maximum per Insured. A lifetime maximum benefit of $5,000 is provided for outpatient treatment up to a maximum eligible charge of $100 per visit.
• Rental of mechanical equipment for the treatment of respiratory paralysis; rental of other mechanical equipment for medical or surgical treatment.

OTHER IMPORTANT INFORMATION

Preexisting Conditions Limitation

Preexisting conditions will not be covered until 12 continuous months, from the date of the Insured’s coverage under the policy, have passed without incurring charges, receiving medical treatment, consulting a physician, or taking prescribed drugs for such condition; or until the Insured has been covered under the policy for 24 continuous months. Any condition for which the Insured incurred charges, received medical treatment, consulted a physician, or took prescribed drugs during the 12-month period prior to the date his/her insurance went into force is considered a preexisting condition. All covered accidents and sicknesses which originate after the effective date of insurance are covered immediately.

Common Disaster Provision

If more than one insured family member is injured in the same accident—or contracts the same contagious disease within 30 days—only one deductible will be applied and each insured family member will still be eligible for up to $2,000,000 in benefits for up to five years from the date the first expense is incurred against the deductible.

Reasonable and Customary Charges

Reasonable and customary charges are those charges which are not more than the usual charges for medical treatment in the locality where it is received.

Continuation of Coverage

Your coverage cannot be canceled as long as your premiums are paid when due, you remain an eligible ASME member, and the group policy remains in force. Coverage for dependents continues as long as 1) the member’s coverage remains in effect, 2) dependents’ insurance remains in effect under the group policy, 3) with respect to spouses, marriage does not end by divorce or annulment, 4) with respect to children, until the child reaches the limiting age, and 5) premiums are paid when due. If you should die while insured, your insured dependents may continue their coverage, provided the Group Policy remains in force, any required premiums are paid when due, and they continue to remain otherwise eligible.

Recurrent Illnesses

You are eligible for the maximum benefit for covered expenses up to $2,000,000 during any one benefit period. If a period of 12 consecutive months passes with no covered expenses, treatment for the same or related condition will be considered a new illness, with a new deductible and benefit period. Otherwise, the same or related condition will be considered a continuation of the first.

Termination of Benefit Period

Your benefit period will cease at the earlier date of: completion of five years from the day eligible expenses were first incurred and used to satisfy the deductible, the maximum of $2,000,000 has been paid, except as stated for Convalescent Care Benefits, or psychiatric, mental, nervous, or emotional disorders, alcoholism or drug addiction; the end of a period of 12 consecutive months during which no charge is incurred for the injury or sickness; or after 24 months from the date the first covered charge is used to satisfy the deductible, if a period of 90 consecutive days passes without at least $150 of covered charges being incurred.

EXCLUSIONS

The Plan does not cover loss caused by or resulting from any one or more of the following: intentionally self-inflicted injuries; war or act of war; eye examinations to prescribe or fit corrective lenses for eyeglasses, unless they result from a non-job related injury and the injury is caused by an accident which occurs while the person is insured; dental care, treatment, or surgery except to the extent that it is necessary to treat a non-job related injury to natural teeth caused by an accident which occurs while the person is insured; cosmetic treatment or surgery, unless such charges are the result of a non-job related injury or sickness or are necessitated by congenital defects in a dependent child, which have resulted in a functional defect; any treatment given by person’s spouse or his or her spouse’s father, mother, son, daughter, brother or sister or employer or employee of the employer; or treatment that would be free if the person were not insured; treatment which is not essential for the necessary care or treatment of the injury or sickness involved; or treatment for psychiatric mental, emotional, or nervous disorders, alcoholism and drug addiction, except as provided.

The Plan also excludes charges to buy or rent air conditioners, air purifiers, motorized transportation equipment, escalators or elevators in private homes, eye glass frames or lenses, hearing aids, swimming pools or supplies for them, general exercise equipment, charges for a routine physical exam, except charges for preventive mammography and cytologic screening. For persons who are not covered under a basic plan at the time of claim, the following charges will not be covered:

• hospital charges incurred during the first 70 days of each confinement
• the first $10,000 of charges for chemotherapy, radiation therapy, physical therapy or speech therapy that would otherwise be covered
• the first $50,000 of charges for physician services that would otherwise be covered
• the first $2,500 of charges for prescription drugs while not hospitalized that would otherwise be covered

Your Economical Cost

The premium for a member, spouse and children is based on the member’s age and automatically increases on the policy anniversary date on or after the member enters a new age bracket. The Insurance Company reserves the right to change premiums on a class wide basis on any premium due date.

SEMIANNUAL PREMIUMS

You have a choice of three ways to pay your premium—quarterly, semiannually or annually. If you wish to pay quarterly, your premiums are one half of the semiannual premiums. The annual premium is two times the semiannual premium.

EFFECTIVE DATE

Coverage will become effective following approval of the application and receipt of the applicable premium. The effective date of insurance will be delayed if the insured is hospitalized or unable to perform the normal activities of a person of like age and sex, with like occupation or retired status. Insurance will become effective on the date the member is no longer hospitalized and/or resumes such normal activities. Dependents must be able to perform the normal activities of a person of like age and sex, with like occupation or retired status on the day Insurance takes effect. Otherwise, insurance will become effective on the date they resume such normal activities.

HOW TO FILE A CLAIM

To file a claim, call or write the administrator for claim forms.

HOW TO APPLY

1. Refer to the Plan description for benefits and premium cost as you fill out the Application Form.
2. Make a check payable for the total amount of the premium due payable to:
   Administrator, ASME Insurance Program.
3. Mail the completed enrollment form with your check to :
   Administrator, ASME Insurance Program
   P.O. Box 10374
   Des Moines, IA 50306-0374

Consider Your Eligibility

Before you request coverage, you must be a member in good standing of ASME. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, see the ASME home page.

30 Day Free Look

When you become insured you will be sent a Certificate of Insurance summarizing your insurance coverage. If you are not completely satisfied with the terms of your Certificate, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund–no questions asked!

CERTIFICATE OF INSURANCE

This plan is underwritten by The United States Life Insurance Company in the City of New York, NAIC No. 70106, domiciled in the state of New York with a principal place of business of 70 Pine Street, New York, NY 10270. It is currently authorized to transact business in all states plus DC, except PR. This summary is brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy Nos. E–191,206 and E–189,701, Form No. G–19000. Coverage may vary or may not be available in all states.

This underwriting risks, financial obligations and support functions associated with the products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.

This plan is underwritten by The United States Life Insurance Company in the City of New York, NAIC No. 70106, domiciled in the state of New York with a principal place of business of 70 Pine Street New York, NY 10270. It is currently authorized to transact business in all states plus DC except PR. This summary is a brief description of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy Nos. E–191,206 and E–189,701, Form No. G–19000. Coverage may vary or may not be available in all states. The underwriting risks, financial obligations and support functions associated with the products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.

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