United World Life Insurance Company
A Mutual of Omaha Company
The Facts About Your Plan
Your United World 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 United
World 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 United World.
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.
You cannot be singled out for a rate increase, no
matter how many times you receive benefits. Your
premium changes: (a) each year on the renewal
date coinciding with or following the anniversary
of your Policy Date until you reach age 90; or
(b) 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.
2009 Medicare Supplement
Insurance Plans
Medicare supplement insurance is underwritten by
United World Life Insurance Company
A Mutual of Omaha Company
Mutual of Omaha Plaza
Omaha, NE 68175
mutualofomaha.com
You are covered immediately. There is no waiting
period for preexisting conditions. Benefits will be
paid from the time your policy is in force.
Your United World Medicare supplement insurance
policy will not pay for:
■ any expense incurred before your Policy Date
■ ervices for which no charge is made when
s
there is no insurance
■ expense paid for by Medicare
This is a brief description of your coverage. The
outline of coverage must accompany this brochure.
For complete information on benefits, exceptions,
reductions and limitations, please read your outline
of coverage and your policy.
Neither United World Life Insurance Company nor its
Medicare supplement insurance policies are connected
with or endorsed by the U.S. government or the federal
Medicare program. United World Life Insurance
Company is licensed nationwide except in CT and NY.
This is a solicitation of insurance and an agent will
contact you by telephone.
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 your application.
Policy Form WM1-21214 – Plan A
Policy Form WM2-21215 – Plan B
Policy Form WM3-21413 – Plan F
Policy Form WM4-21414 – Plan G
Policy Form WM8-21216 – Plan C
Policy Form WM12-21217 – Plan D
WC6843_PA_0109
Pennsylvania
Policy Forms WM1-21214, WM2-21215, WM3-21413,
WM4-21414, WM8-21216, WM12-21217
Spontaneous. Fun. Fearless.
Whether you’re six or sixty-something, 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.
A Medicare supplement insurance policy from United World
Life Insurance Company can help you attain that secure feeling.
A Mutual of Omaha company since 1983, United World Life
Insurance Company offers specialty life insurance plans and
Medicare supplement plans. When you own a United World
Medicare supplement, you get the reputation, stability and
power of Mutual of Omaha and its affiliates, which have been
providing quality products and services for 100 years.
Add our friendly personal customer service and affordable
premiums and you have the financial value and security
you seek.
We’ve got you covered.
Go play!
Choose the Medicare Supplement Plan That Meets Your Needs
Your Medicare Supplement Benefits
Medicare
Medicare
Medicare
Medicare
Medicare
Medicare
Services and Supplies
Supplement Supplement
Supplement
Supplement
Supplement Supplement
Medicare
Plan A
Plan B
Plan C
Plan D
Plan F
Plan G
Medicare Part A_ ______________________ Pays__________ Pays__________ Pays_ _________ Pays_ ________ Pays__________ Pays_ ________ Pays
_
Hospital Coverage
Deductible___________________________ Nothing ____________________ $1,068 ________ $1,068_ ______ $1,068_ _______ $1,068_ ______ $1,068
First 60 days___________________________ 100%_ ______________________________________________________________________________
Coinsurance_ ________________________ All but_________$267_ ________ $267 __________ $267_________ $267__________ $267_________ $267
_
61-90 days
$267
a day
a day
a day
a day
a day
a day
a day
Coinsurance_ ________________________ All but________ $534_ ________ $534 __________ $534_________ $534__________ $534_________ $534
91-150 days (Lifetime Reserve)
$534
a day
a day
a day
a day
a day
a day
a day
Extended Hospital Coverage_____________ Nothing ______ Eligible_ ______ Eligible_______ Eligible_______ Eligible _ ______ Eligible_______ Eligible
(up to an additional 365 days
Expenses
Expenses
Expenses
Expenses
Expenses
Expenses
in your lifetime)
Benefit for Blood______________________ All but______ Three pints_____Three pints____ Three pints____ Three pints_ ___ Three pints____ Three pints
three
pints
Skilled Nursing Facility Care
First 20 days___________________________ 100%_ ______________________________________________________________________________
Coinsurance_ ________________________ All but___________________________________ Up to_________Up to_________ Up to________ Up to
$133.50
$133.50
$133.50
$133.50
$133.50
21-100 days
a day
a day
a day
a day
a day
Medicare Part B Physician’s
Services and Supplies
Deductible___________________________ Nothing ___________________________________ $135_ ______________________ $135____________
Coinsurance_ _________________________ 80%_________ 20%_________ 20%_________ 20%_________ 20% _________ 20%_ ________ 20%
Excess Benefits_____________________________________________________________________________________________100%_________ 80%
up to
up to
Medicare’s
Medicare’s
limit
limit
Benefit for Blood______________________ All but______ Three pints____ Three pints____ Three pints____ Three pints_ ___ Three pints_ __ Three pints
_
three
pints
Additional Benefits*
80% to
80% to
80% to
80% to
lifetime max of lifetime max of lifetime max of lifetime max of
Emergency Care Received________________________________________________________$50,000_ ______ $50,000________$50,000_______ $50,000
Outside the U.S.
At-home Recovery Visits_______________________________________________________________________$1,600_____________________ $1,600
Medicare Part A Hospital Coverage
Your Premium Your Premium Your Premium Your Premium Your Premium Your Premium
* Refer to the next page and your outline
of coverage for more information.
$ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________
Deductible — Plans B, C, D, F and G pay the $1,068
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, B, C, D, F and G pay $267 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 $534
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, B, C, D, F
and G pay the Medicare Part A eligible expenses for
hospitalization, paid at the Prospective Payment
System (PPS) rate or other appropriate standard of
payment, subject to a lifetime maximum benefit of
an additional 365 days.
Benefit for Blood — Medicare has one calendar-year
deductible for blood that is the cost of the first three
pints needed. Plans A, B, C, D, F and G pay this
deductible.
Medicare Part B Physician’s Services
and Supplies
Deductible — Plans C and F pay the $135 calendaryear deductible.
Coinsurance — After the Medicare Part B deductible,
Plans A, B, C, D, F and G pay 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 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, Plan F pays 100%
and Plan G pays 80% 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, B, C, D, F and G pay this
deductible.
Additional Benefits
First 20 Days — Medicare pays all eligible expenses.
Emergency Care Received Outside the U.S. — After
you pay a $250 calendar-year deductible, Plans C, D,
F and G 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.
Coinsurance — Plans F and G pay up to $133.50
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.
At-home Recovery Visits — Plans D and G pay
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.
Skilled Nursing Facility Care
Spontaneous. Fun. Fearless.
Whether you’re six or sixty-something, 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.
A Medicare supplement insurance policy from United World
Life Insurance Company can help you attain that secure feeling.
A Mutual of Omaha company since 1983, United World Life
Insurance Company offers specialty life insurance plans and
Medicare supplement plans. When you own a United World
Medicare supplement, you get the reputation, stability and
power of Mutual of Omaha and its affiliates, which have been
providing quality products and services for 100 years.
Add our friendly personal customer service and affordable
premiums and you have the financial value and security
you seek.
We’ve got you covered.
Go play!
Choose the Medicare Supplement Plan That Meets Your Needs
Your Medicare Supplement Benefits
Medicare
Medicare
Medicare
Medicare
Medicare
Medicare
Services and Supplies
Supplement Supplement
Supplement
Supplement
Supplement Supplement
Medicare
Plan A
Plan B
Plan C
Plan D
Plan F
Plan G
Medicare Part A_ ______________________ Pays__________ Pays__________ Pays_ _________ Pays_ ________ Pays__________ Pays_ ________ Pays
_
Hospital Coverage
Deductible___________________________ Nothing ____________________ $1,068 ________ $1,068_ ______ $1,068_ _______ $1,068_ ______ $1,068
First 60 days___________________________ 100%_ ______________________________________________________________________________
Coinsurance_ ________________________ All but_________$267_ ________ $267 __________ $267_________ $267__________ $267_________ $267
_
61-90 days
$267
a day
a day
a day
a day
a day
a day
a day
Coinsurance_ ________________________ All but________ $534_ ________ $534 __________ $534_________ $534__________ $534_________ $534
91-150 days (Lifetime Reserve)
$534
a day
a day
a day
a day
a day
a day
a day
Extended Hospital Coverage_____________ Nothing ______ Eligible_ ______ Eligible_______ Eligible_______ Eligible _ ______ Eligible_______ Eligible
(up to an additional 365 days
Expenses
Expenses
Expenses
Expenses
Expenses
Expenses
in your lifetime)
Benefit for Blood______________________ All but______ Three pints_____Three pints____ Three pints____ Three pints_ ___ Three pints____ Three pints
three
pints
Skilled Nursing Facility Care
First 20 days___________________________ 100%_ ______________________________________________________________________________
Coinsurance_ ________________________ All but___________________________________ Up to_________Up to_________ Up to________ Up to
$133.50
$133.50
$133.50
$133.50
$133.50
21-100 days
a day
a day
a day
a day
a day
Medicare Part B Physician’s
Services and Supplies
Deductible___________________________ Nothing ___________________________________ $135_ ______________________ $135____________
Coinsurance_ _________________________ 80%_________ 20%_________ 20%_________ 20%_________ 20% _________ 20%_ ________ 20%
Excess Benefits_____________________________________________________________________________________________100%_________ 80%
up to
up to
Medicare’s
Medicare’s
limit
limit
Benefit for Blood______________________ All but______ Three pints____ Three pints____ Three pints____ Three pints_ ___ Three pints_ __ Three pints
_
three
pints
Additional Benefits*
80% to
80% to
80% to
80% to
lifetime max of lifetime max of lifetime max of lifetime max of
Emergency Care Received________________________________________________________$50,000_ ______ $50,000________$50,000_______ $50,000
Outside the U.S.
At-home Recovery Visits_______________________________________________________________________$1,600_____________________ $1,600
Medicare Part A Hospital Coverage
Your Premium Your Premium Your Premium Your Premium Your Premium Your Premium
* Refer to the next page and your outline
of coverage for more information.
$ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________
Deductible — Plans B, C, D, F and G pay the $1,068
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, B, C, D, F and G pay $267 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 $534
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, B, C, D, F
and G pay the Medicare Part A eligible expenses for
hospitalization, paid at the Prospective Payment
System (PPS) rate or other appropriate standard of
payment, subject to a lifetime maximum benefit of
an additional 365 days.
Benefit for Blood — Medicare has one calendar-year
deductible for blood that is the cost of the first three
pints needed. Plans A, B, C, D, F and G pay this
deductible.
Medicare Part B Physician’s Services
and Supplies
Deductible — Plans C and F pay the $135 calendaryear deductible.
Coinsurance — After the Medicare Part B deductible,
Plans A, B, C, D, F and G pay 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 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, Plan F pays 100%
and Plan G pays 80% 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, B, C, D, F and G pay this
deductible.
Additional Benefits
First 20 Days — Medicare pays all eligible expenses.
Emergency Care Received Outside the U.S. — After
you pay a $250 calendar-year deductible, Plans C, D,
F and G 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.
Coinsurance — Plans F and G pay up to $133.50
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.
At-home Recovery Visits — Plans D and G pay
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.
Skilled Nursing Facility Care
Spontaneous. Fun. Fearless.
Whether you’re six or sixty-something, 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.
A Medicare supplement insurance policy from United World
Life Insurance Company can help you attain that secure feeling.
A Mutual of Omaha company since 1983, United World Life
Insurance Company offers specialty life insurance plans and
Medicare supplement plans. When you own a United World
Medicare supplement, you get the reputation, stability and
power of Mutual of Omaha and its affiliates, which have been
providing quality products and services for 100 years.
Add our friendly personal customer service and affordable
premiums and you have the financial value and security
you seek.
We’ve got you covered.
Go play!
Choose the Medicare Supplement Plan That Meets Your Needs
Your Medicare Supplement Benefits
Medicare
Medicare
Medicare
Medicare
Medicare
Medicare
Services and Supplies
Supplement Supplement
Supplement
Supplement
Supplement Supplement
Medicare
Plan A
Plan B
Plan C
Plan D
Plan F
Plan G
Medicare Part A_ ______________________ Pays__________ Pays__________ Pays_ _________ Pays_ ________ Pays__________ Pays_ ________ Pays
_
Hospital Coverage
Deductible___________________________ Nothing ____________________ $1,068 ________ $1,068_ ______ $1,068_ _______ $1,068_ ______ $1,068
First 60 days___________________________ 100%_ ______________________________________________________________________________
Coinsurance_ ________________________ All but_________$267_ ________ $267 __________ $267_________ $267__________ $267_________ $267
_
61-90 days
$267
a day
a day
a day
a day
a day
a day
a day
Coinsurance_ ________________________ All but________ $534_ ________ $534 __________ $534_________ $534__________ $534_________ $534
91-150 days (Lifetime Reserve)
$534
a day
a day
a day
a day
a day
a day
a day
Extended Hospital Coverage_____________ Nothing ______ Eligible_ ______ Eligible_______ Eligible_______ Eligible _ ______ Eligible_______ Eligible
(up to an additional 365 days
Expenses
Expenses
Expenses
Expenses
Expenses
Expenses
in your lifetime)
Benefit for Blood______________________ All but______ Three pints_____Three pints____ Three pints____ Three pints_ ___ Three pints____ Three pints
three
pints
Skilled Nursing Facility Care
First 20 days___________________________ 100%_ ______________________________________________________________________________
Coinsurance_ ________________________ All but___________________________________ Up to_________Up to_________ Up to________ Up to
$133.50
$133.50
$133.50
$133.50
$133.50
21-100 days
a day
a day
a day
a day
a day
Medicare Part B Physician’s
Services and Supplies
Deductible___________________________ Nothing ___________________________________ $135_ ______________________ $135____________
Coinsurance_ _________________________ 80%_________ 20%_________ 20%_________ 20%_________ 20% _________ 20%_ ________ 20%
Excess Benefits_____________________________________________________________________________________________100%_________ 80%
up to
up to
Medicare’s
Medicare’s
limit
limit
Benefit for Blood______________________ All but______ Three pints____ Three pints____ Three pints____ Three pints_ ___ Three pints_ __ Three pints
_
three
pints
Additional Benefits*
80% to
80% to
80% to
80% to
lifetime max of lifetime max of lifetime max of lifetime max of
Emergency Care Received________________________________________________________$50,000_ ______ $50,000________$50,000_______ $50,000
Outside the U.S.
At-home Recovery Visits_______________________________________________________________________$1,600_____________________ $1,600
Medicare Part A Hospital Coverage
Your Premium Your Premium Your Premium Your Premium Your Premium Your Premium
* Refer to the next page and your outline
of coverage for more information.
$ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________
Deductible — Plans B, C, D, F and G pay the $1,068
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, B, C, D, F and G pay $267 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 $534
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, B, C, D, F
and G pay the Medicare Part A eligible expenses for
hospitalization, paid at the Prospective Payment
System (PPS) rate or other appropriate standard of
payment, subject to a lifetime maximum benefit of
an additional 365 days.
Benefit for Blood — Medicare has one calendar-year
deductible for blood that is the cost of the first three
pints needed. Plans A, B, C, D, F and G pay this
deductible.
Medicare Part B Physician’s Services
and Supplies
Deductible — Plans C and F pay the $135 calendaryear deductible.
Coinsurance — After the Medicare Part B deductible,
Plans A, B, C, D, F and G pay 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 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, Plan F pays 100%
and Plan G pays 80% 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, B, C, D, F and G pay this
deductible.
Additional Benefits
First 20 Days — Medicare pays all eligible expenses.
Emergency Care Received Outside the U.S. — After
you pay a $250 calendar-year deductible, Plans C, D,
F and G 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.
Coinsurance — Plans F and G pay up to $133.50
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.
At-home Recovery Visits — Plans D and G pay
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.
Skilled Nursing Facility Care
United World Life Insurance Company
A Mutual of Omaha Company
The Facts About Your Plan
Your United World 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 United
World 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 United World.
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.
You cannot be singled out for a rate increase, no
matter how many times you receive benefits. Your
premium changes: (a) each year on the renewal
date coinciding with or following the anniversary
of your Policy Date until you reach age 90; or
(b) 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.
2009 Medicare Supplement
Insurance Plans
Medicare supplement insurance is underwritten by
United World Life Insurance Company
A Mutual of Omaha Company
Mutual of Omaha Plaza
Omaha, NE 68175
mutualofomaha.com
You are covered immediately. There is no waiting
period for preexisting conditions. Benefits will be
paid from the time your policy is in force.
Your United World Medicare supplement insurance
policy will not pay for:
■ any expense incurred before your Policy Date
■ ervices for which no charge is made when
s
there is no insurance
■ expense paid for by Medicare
This is a brief description of your coverage. The
outline of coverage must accompany this brochure.
For complete information on benefits, exceptions,
reductions and limitations, please read your outline
of coverage and your policy.
Neither United World Life Insurance Company nor its
Medicare supplement insurance policies are connected
with or endorsed by the U.S. government or the federal
Medicare program. United World Life Insurance
Company is licensed nationwide except in CT and NY.
This is a solicitation of insurance and an agent will
contact you by telephone.
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 your application.
Policy Form WM1-21214 – Plan A
Policy Form WM2-21215 – Plan B
Policy Form WM3-21413 – Plan F
Policy Form WM4-21414 – Plan G
Policy Form WM8-21216 – Plan C
Policy Form WM12-21217 – Plan D
WC6843_PA_0109
Pennsylvania
Policy Forms WM1-21214, WM2-21215, WM3-21413,
WM4-21414, WM8-21216, WM12-21217
United World Life Insurance Company
A Mutual of Omaha Company
The Facts About Your Plan
Your United World 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 United
World 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 United World.
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.
You cannot be singled out for a rate increase, no
matter how many times you receive benefits. Your
premium changes: (a) each year on the renewal
date coinciding with or following the anniversary
of your Policy Date until you reach age 90; or
(b) 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.
2009 Medicare Supplement
Insurance Plans
Medicare supplement insurance is underwritten by
United World Life Insurance Company
A Mutual of Omaha Company
Mutual of Omaha Plaza
Omaha, NE 68175
mutualofomaha.com
You are covered immediately. There is no waiting
period for preexisting conditions. Benefits will be
paid from the time your policy is in force.
Your United World Medicare supplement insurance
policy will not pay for:
■ any expense incurred before your Policy Date
■ ervices for which no charge is made when
s
there is no insurance
■ expense paid for by Medicare
This is a brief description of your coverage. The
outline of coverage must accompany this brochure.
For complete information on benefits, exceptions,
reductions and limitations, please read your outline
of coverage and your policy.
Neither United World Life Insurance Company nor its
Medicare supplement insurance policies are connected
with or endorsed by the U.S. government or the federal
Medicare program. United World Life Insurance
Company is licensed nationwide except in CT and NY.
This is a solicitation of insurance and an agent will
contact you by telephone.
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 your application.
Policy Form WM1-21214 – Plan A
Policy Form WM2-21215 – Plan B
Policy Form WM3-21413 – Plan F
Policy Form WM4-21414 – Plan G
Policy Form WM8-21216 – Plan C
Policy Form WM12-21217 – Plan D
WC6843_PA_0109
Pennsylvania
Policy Forms WM1-21214, WM2-21215, WM3-21413,
WM4-21414, WM8-21216, WM12-21217