Table of Contents

Important Notice  PAGEREF _Toc13838857 \h 2

Policy/Certificate Description  4

Included Riders  5

Accidental Death and Dismemberment Rider (Form No. R G1712C) (HSA compatible) 5

Optional Riders  5

Accident-Only Disability Income Rider (Form No. R G1709C) (HSA compatible) 5

Outpatient Care Rider (Form No. R G1710C) 5

Hospital Sickness Rider (Form No. R G1711C) 6

Benefits  6

Optional Rider Benefits  15

Definitions  16

General Policy/Certificate Terms  19

Pre-Issue Guidelines  21

Pre-Approval of Field-Produced Marketing Material 21

Ordering Supplies  22

Enrollment Arrangement Checklist 22

Criteria for Eligible Employers  22

Association/Affinity/Union Groups  22

Criteria for Eligible Employees  22

Eligible Dependents  23

Enrollment Guidelines  23

Enrolling the Account – Completing the Paper Application  23

Submitting the Accounting  24

Policy/Certificate Issue Practices  24

Billing and Follow-Up  25

Underwriting Guidelines  25

Claims Guidelines  25

Claims Support 25

Claims Administration  25

Premium Rates  26

Proposals/Rate Sheets  26

State Specific Information  26

Revisions to this Product Guide  26

About Assurity  27

Connect with us! 27

Why Assurity?  27