Spontaneous.
Fun. Fearless.
Mutual of Omaha Insurance Company
The Facts About Your Plan
Your Mutual of Omaha Medicare supplement
insurance policy helps pay some eligible expenses
not paid for by Medicare Part A and Medicare
Part B. There may be charges above what Medicare
and Mutual of Omaha pay.
Medicare Part A Eligible Expenses for Hospital/
Skilled Nursing Facility Care include expenses for
semiprivate room and board, general nursing, and
miscellaneous services and supplies.
Medicare Part B Eligible Expenses for Medical
Services include expenses for physicians’ services,
hospital outpatient services and supplies, physical
and speech therapy, and ambulance service.
“Medicare Eligible Expenses” means expenses of
the kinds covered by Medicare Parts A and B, to
the extent recognized as reasonable and medically
necessary by Medicare.
A Benefit Period begins the first full day you are
hospitalized and ends when you have not been in a
hospital or skilled nursing facility for 60 days in a row.
Coinsurance is the portion of the eligible expense
not paid by Medicare and paid by Mutual of Omaha.
As Medicare deductibles and coinsurance increase,
your Medicare supplement benefits will automatically
increase. Benefits are not paid for any expense paid
by Medicare.
Benefits are paid to you or to your hospital or doctor.
You have 31 days from your renewal date to pay your
premium. Your policy will stay in force during this
31-day grace period.
Your policy is guaranteed renewable. Your policy
cannot be canceled. It will be renewed as long as the
premiums are paid on time and the information is
correct on the application.
You cannot be singled out for a rate increase, no
matter how many times you receive benefits. Your
premium changes when the same premium change is
made on all in-force Medicare supplement policies of
the same form issued to persons of your classification
in the same geographic area of your state.
2010 Medicare Supplement
Insurance Plans
Whether you’re six or sixtysomething, playing keeps you
young-at-heart. The difference
now, of course, is that you
have adult responsibilities,
including making sound
financial decisions.
You’ll probably enjoy playing,
however you define it, even
more when you feel you’ve got
your bases covered.
You are covered immediately. There is no waiting
period for preexisting conditions. Benefits will be paid
from the time your policy is in force.
A Medicare supplement
insurance policy from
Mutual of Omaha Insurance
Company can help you attain
that secure feeling.
Your Mutual of Omaha Medicare supplement
insurance policy will not pay for:
■ any expense incurred before your Policy Date
■ hospital or skilled nursing facility confinement
incurred during a Medicare Part A benefit period
that begins while this policy is not in force
You can be confident that
your Medicare supplement
benefits will be paid as
promised because Mutual of
Omaha Insurance Company
has been serving people like
you since Medicare began
more than 40 years ago.
And, we’re committed to
continue providing Medicare
supplement benefits amid an
ever-changing political and
economic environment.
■ expense paid for by Medicare
■ services for non-Medicare eligible expenses
■ services for which no charge is made when there is
no insurance
■ loss or expense that is payable under any other
Medicare supplement insurance policy or
certificate
Add our friendly personal
customer service and
affordable premiums and you
have the financial value and
security you seek.
This is a brief description of your coverage. The
outline of coverage must accompany this brochure.
For complete information on benefits, exceptions,
limitations and reductions, please read your outline
of coverage and your policy.
We’ve got you
covered.
This is a solicitation of insurance and an insurance
agent will contact you by telephone.
Go play!
Neither Mutual of Omaha Insurance Company
nor its Medicare supplement insurance policies are
connected with or endorsed by the U.S. government
or the federal Medicare program. Mutual of Omaha
Insurance Company is licensed nationwide.
Medicare supplement insurance
is underwritten by
Mutual of Omaha
Insurance Company
Mutual of Omaha Plaza
Omaha, NE 68175
mutualofomaha.com
Mutual of Omaha Insurance Representative
___________________________________________
License No.__________________________________
MC34168_FL
Florida
Policy Form M267-Plan A
Policy Form M268-Plan C
Policy Form M279-Plan D
Policy Form M269-Plan F
Choose the Medicare Supplement Plan That Meets Your Needs
Services and Supplies
Medicare Part A
Hospital Coverage
Deductible
First 60 days
Coinsurance
61-90 days
Coinsurance
91-150 days (Lifetime Reserve)
Extended Hospital Coverage
(up to an additional 365 days
in your lifetime)
Benefit for Blood
Skilled Nursing
Facility Care
First 20 days
Coinsurance
21-100 days
Medicare Part B
Physician’s
Services and Supplies
Deductible
Coinsurance
Medicare
Pays
Nothing
100%
All but
$275
a day
All but
$550
a day
Nothing
All but
three
pints
Medicare
Supplement
Plan A
Pays
Medicare
Supplement
Plan C
Pays
Medicare
Supplement
Plan D
Pays
Medicare
Supplement
Plan F
Pays
$1,100
$1,100
$1,100
$275
a day
$275
a day
$275
a day
$275
a day
$550
a day
$550
a day
$550
a day
$550
a day
Eligible
Expenses
Eligible
Expenses
Eligible
Expenses
Eligible
Expenses
Three pints
Three pints
Three pints
Three pints
100%
All but
$137.50
a day
Nothing
80%
Up to
$137.50
a day
Generally
20%
$155
Generally
20%
Up to
$137.50
a day
Generally
20%
Excess Benefits
Benefit for Blood
All but
three
pints
$155
Generally
20%
100%
up to
Medicare’s
limit
Three pints
Three pints
80% to
lifetime max
of $50,000
80% to
lifetime max
of $50,000
$1,600
80% to
lifetime max
of $50,000
Your Premium
Your Premium
Your Premium
$ __________
$ __________
$ __________
$ __________
Nothing
At-home Recovery Visits
Three pints
Your Premium
Additional Benefits*
Emergency Care Received
Outside the U.S.
Three pints
Up to
$137.50
a day
Nothing
* Refer to the next page and your outline
of coverage for more information.
Your Medicare Supplement Benefits
Medicare Part A Hospital Coverage Medicare Part B Physician’s
Services and Supplies
Deductible – Plans C, D and F pay the $1,100
inpatient hospital deductible for each benefit period.
First 60 Days – After the Medicare Part A deductible,
Medicare pays all eligible expenses for services from
your first through 60th day of hospital confinement.
Services include semiprivate room and board,
general nursing, and miscellaneous hospital services
and supplies.
Coinsurance – Plans A, C, D and F pay $275 a day
when you are hospitalized from the 61st through the
90th day. And, when you are in the hospital from the
91st day through the 150th day, you receive $550 a
day for each Lifetime Reserve day used.
Extended Hospital Coverage – When you are in
the hospital longer than 150 days during a benefit
period, and you have exhausted your 60 days of
Medicare Lifetime Reserve, Plans A, C, D and
F pay the Medicare Part A eligible expenses for
hospitalization, paid at the Diagnostic Related Group
(DRG) day outlier per diem or other appropriate
standard of payment, subject to a lifetime maximum
benefit of an additional 365 days.
Benefit for Blood – Medicare has one calendaryear deductible for blood that is the cost of the
first three pints needed. Plans A, C, D and F pay
this deductible.
Skilled Nursing Facility Care
First 20 Days – Medicare pays all eligible expenses.
Coinsurance – Plans C, D and F pay up to $137.50
a day from the 21st through the 100th day during
which you receive skilled nursing care. You must enter
a Medicare-certified skilled nursing facility within
30 days of being hospitalized for at least three days.
Deductible – Plans C and F pay the $155 calendaryear deductible.
Coinsurance – After the Medicare Part B deductible,
Plans A, C, D and F pay generally 20% of eligible
expenses for physician’s services and supplies,
physical and speech therapy, and ambulance service.
For hospital outpatient services, the copayment
amount will be paid under a prospective payment
system. If this system is not used, then generally 20%
of eligible expenses will be paid.
Excess Benefits – Your bill for Medicare Part B
services and supplies may exceed the Medicare
eligible expense. When that occurs, Plans F pays
100% of the difference, up to the charge limitation
established by Medicare.
Benefit for Blood – Medicare has one calendaryear deductible for blood that is the cost of the
first three pints needed. Plans A, C, D and F
pay this deductible.
Additional Benefits
Emergency Care Received Outside the U.S. – After
you pay a $250 calendar-year deductible, Plans C,
D and F pay you 80% of eligible expenses incurred
during the first 60 days of a trip up to a lifetime
maximum of $50,000. Benefits are payable for health
care you need because of a covered injury or illness.
At-home Recovery Visits – Plan D pays for seven
visits a week, up to $40 a visit up to a maximum of
$1,600 a year for assistance with activities of daily
living. Benefits are payable for services necessary
for your continuing recovery from an illness, injury
or surgery.
Choose the Medicare Supplement Plan That Meets Your Needs
Services and Supplies
Medicare Part A
Hospital Coverage
Deductible
First 60 days
Coinsurance
61-90 days
Coinsurance
91-150 days (Lifetime Reserve)
Extended Hospital Coverage
(up to an additional 365 days
in your lifetime)
Benefit for Blood
Skilled Nursing
Facility Care
First 20 days
Coinsurance
21-100 days
Medicare Part B
Physician’s
Services and Supplies
Deductible
Coinsurance
Medicare
Pays
Nothing
100%
All but
$275
a day
All but
$550
a day
Nothing
All but
three
pints
Medicare
Supplement
Plan A
Pays
Medicare
Supplement
Plan C
Pays
Medicare
Supplement
Plan D
Pays
Medicare
Supplement
Plan F
Pays
$1,100
$1,100
$1,100
$275
a day
$275
a day
$275
a day
$275
a day
$550
a day
$550
a day
$550
a day
$550
a day
Eligible
Expenses
Eligible
Expenses
Eligible
Expenses
Eligible
Expenses
Three pints
Three pints
Three pints
Three pints
100%
All but
$137.50
a day
Nothing
80%
Up to
$137.50
a day
Generally
20%
$155
Generally
20%
Up to
$137.50
a day
Generally
20%
Excess Benefits
Benefit for Blood
All but
three
pints
$155
Generally
20%
100%
up to
Medicare’s
limit
Three pints
Three pints
80% to
lifetime max
of $50,000
80% to
lifetime max
of $50,000
$1,600
80% to
lifetime max
of $50,000
Your Premium
Your Premium
Your Premium
$ __________
$ __________
$ __________
$ __________
Nothing
At-home Recovery Visits
Three pints
Your Premium
Additional Benefits*
Emergency Care Received
Outside the U.S.
Three pints
Up to
$137.50
a day
Nothing
* Refer to the next page and your outline
of coverage for more information.
Your Medicare Supplement Benefits
Medicare Part A Hospital Coverage Medicare Part B Physician’s
Services and Supplies
Deductible – Plans C, D and F pay the $1,100
inpatient hospital deductible for each benefit period.
First 60 Days – After the Medicare Part A deductible,
Medicare pays all eligible expenses for services from
your first through 60th day of hospital confinement.
Services include semiprivate room and board,
general nursing, and miscellaneous hospital services
and supplies.
Coinsurance – Plans A, C, D and F pay $275 a day
when you are hospitalized from the 61st through the
90th day. And, when you are in the hospital from the
91st day through the 150th day, you receive $550 a
day for each Lifetime Reserve day used.
Extended Hospital Coverage – When you are in
the hospital longer than 150 days during a benefit
period, and you have exhausted your 60 days of
Medicare Lifetime Reserve, Plans A, C, D and
F pay the Medicare Part A eligible expenses for
hospitalization, paid at the Diagnostic Related Group
(DRG) day outlier per diem or other appropriate
standard of payment, subject to a lifetime maximum
benefit of an additional 365 days.
Benefit for Blood – Medicare has one calendaryear deductible for blood that is the cost of the
first three pints needed. Plans A, C, D and F pay
this deductible.
Skilled Nursing Facility Care
First 20 Days – Medicare pays all eligible expenses.
Coinsurance – Plans C, D and F pay up to $137.50
a day from the 21st through the 100th day during
which you receive skilled nursing care. You must enter
a Medicare-certified skilled nursing facility within
30 days of being hospitalized for at least three days.
Deductible – Plans C and F pay the $155 calendaryear deductible.
Coinsurance – After the Medicare Part B deductible,
Plans A, C, D and F pay generally 20% of eligible
expenses for physician’s services and supplies,
physical and speech therapy, and ambulance service.
For hospital outpatient services, the copayment
amount will be paid under a prospective payment
system. If this system is not used, then generally 20%
of eligible expenses will be paid.
Excess Benefits – Your bill for Medicare Part B
services and supplies may exceed the Medicare
eligible expense. When that occurs, Plans F pays
100% of the difference, up to the charge limitation
established by Medicare.
Benefit for Blood – Medicare has one calendaryear deductible for blood that is the cost of the
first three pints needed. Plans A, C, D and F
pay this deductible.
Additional Benefits
Emergency Care Received Outside the U.S. – After
you pay a $250 calendar-year deductible, Plans C,
D and F pay you 80% of eligible expenses incurred
during the first 60 days of a trip up to a lifetime
maximum of $50,000. Benefits are payable for health
care you need because of a covered injury or illness.
At-home Recovery Visits – Plan D pays for seven
visits a week, up to $40 a visit up to a maximum of
$1,600 a year for assistance with activities of daily
living. Benefits are payable for services necessary
for your continuing recovery from an illness, injury
or surgery.
Spontaneous.
Fun. Fearless.
Mutual of Omaha Insurance Company
The Facts About Your Plan
Your Mutual of Omaha Medicare supplement
insurance policy helps pay some eligible expenses
not paid for by Medicare Part A and Medicare
Part B. There may be charges above what Medicare
and Mutual of Omaha pay.
Medicare Part A Eligible Expenses for Hospital/
Skilled Nursing Facility Care include expenses for
semiprivate room and board, general nursing, and
miscellaneous services and supplies.
Medicare Part B Eligible Expenses for Medical
Services include expenses for physicians’ services,
hospital outpatient services and supplies, physical
and speech therapy, and ambulance service.
“Medicare Eligible Expenses” means expenses of
the kinds covered by Medicare Parts A and B, to
the extent recognized as reasonable and medically
necessary by Medicare.
A Benefit Period begins the first full day you are
hospitalized and ends when you have not been in a
hospital or skilled nursing facility for 60 days in a row.
Coinsurance is the portion of the eligible expense
not paid by Medicare and paid by Mutual of Omaha.
As Medicare deductibles and coinsurance increase,
your Medicare supplement benefits will automatically
increase. Benefits are not paid for any expense paid
by Medicare.
Benefits are paid to you or to your hospital or doctor.
You have 31 days from your renewal date to pay your
premium. Your policy will stay in force during this
31-day grace period.
Your policy is guaranteed renewable. Your policy
cannot be canceled. It will be renewed as long as the
premiums are paid on time and the information is
correct on the application.
You cannot be singled out for a rate increase, no
matter how many times you receive benefits. Your
premium changes when the same premium change is
made on all in-force Medicare supplement policies of
the same form issued to persons of your classification
in the same geographic area of your state.
2010 Medicare Supplement
Insurance Plans
Whether you’re six or sixtysomething, playing keeps you
young-at-heart. The difference
now, of course, is that you
have adult responsibilities,
including making sound
financial decisions.
You’ll probably enjoy playing,
however you define it, even
more when you feel you’ve got
your bases covered.
You are covered immediately. There is no waiting
period for preexisting conditions. Benefits will be paid
from the time your policy is in force.
A Medicare supplement
insurance policy from
Mutual of Omaha Insurance
Company can help you attain
that secure feeling.
Your Mutual of Omaha Medicare supplement
insurance policy will not pay for:
■ any expense incurred before your Policy Date
■ hospital or skilled nursing facility confinement
incurred during a Medicare Part A benefit period
that begins while this policy is not in force
You can be confident that
your Medicare supplement
benefits will be paid as
promised because Mutual of
Omaha Insurance Company
has been serving people like
you since Medicare began
more than 40 years ago.
And, we’re committed to
continue providing Medicare
supplement benefits amid an
ever-changing political and
economic environment.
■ expense paid for by Medicare
■ services for non-Medicare eligible expenses
■ services for which no charge is made when there is
no insurance
■ loss or expense that is payable under any other
Medicare supplement insurance policy or
certificate
Add our friendly personal
customer service and
affordable premiums and you
have the financial value and
security you seek.
This is a brief description of your coverage. The
outline of coverage must accompany this brochure.
For complete information on benefits, exceptions,
limitations and reductions, please read your outline
of coverage and your policy.
We’ve got you
covered.
This is a solicitation of insurance and an insurance
agent will contact you by telephone.
Go play!
Neither Mutual of Omaha Insurance Company
nor its Medicare supplement insurance policies are
connected with or endorsed by the U.S. government
or the federal Medicare program. Mutual of Omaha
Insurance Company is licensed nationwide.
Medicare supplement insurance
is underwritten by
Mutual of Omaha
Insurance Company
Mutual of Omaha Plaza
Omaha, NE 68175
mutualofomaha.com
Mutual of Omaha Insurance Representative
___________________________________________
License No.__________________________________
MC34168_FL
Florida
Policy Form M267-Plan A
Policy Form M268-Plan C
Policy Form M279-Plan D
Policy Form M269-Plan F
