| Show ADVERTISEMENT SUPPLEMENT VerIlpfM1' vWeSrtnis 7p to 41 1 7 SU Vk L 0 '40 t ikr ti N 4 'Ne s - niuranciti k1i --i-i----- 14 i eiv Illar NI 0 rZ US 0 F Se‘ FAN' ft c‘-'C-- aI 0® ‘c - t' sl '' 1411 li ea nher3' (2'ommerciat Zile RGQ1( ‘' 16' t Z it N ' !ITC s -- Z! 4 - - t I ik -- '''' o )" ct N l'As - 4 09 - LEGAL RESERVE STU -- N - 0111IIN '' l' icI -- -ti ) (11 1 f: A pta'n - --- e mpany--r 1 — - I G -- e 4- -- 1 0 SOF cSg 5720 LB1 Freeway Suite 200 Dallas Texas 75240 "mow 1 1 Ft - cNftNPAYI014911- t - t - omotrootto' ftc - MEDICAL AND) SURGICAL POLICY PAYS ON ALL OF THE FOLLOWING IN OR OUT OF HOSPITAL: 1- IN IN IN IN CALLS CALLS CALLS CALLS DR DR DR DR an OUTLINE OF COVERAGE for your review and examination They both are written in understandable language The law requires we send you the OUTLINE OF COVERAGE as it is a brief description of some of the important features of the policy including the benefits limitations and exclusions of the policy The OUTLINE OF COVERAGE is not the insurance contract but it will help you understand the policy The POLICY itself sets forth in detail the rights and obligations of both you and the Company IT IS THEREFORE IMPORTANT THAT YOU READ THE POLICY CAREFULLY You will have the POLICY and OUTLINE OF COVERAGE in your possession approximately 15 days before we mail you a premium notice Show the policy to someone you trust If you are satisfied with it you may put the policy in force by paying the premium after you receive your premium notice If you are not satisfied with it just throw it away DO NOT SEND ANY MONEY UNLESS YOU ARE 1000o SATISFIED WITH THE POLICY SURGERY BENEFITS DENTAL SERVICE EYEGLASSES PRESCRIPTIONS CHIROPRACTIC SERVICES OFFICE CLINIC HOSPITAL HOME ALSO PAYS ON THE FOLLOWING IN OR OUT OF THE HOSPITAL: Electrocardio(excluding Dental gram Pyelogram Encephalogram or Metabolism Test — — — Laboratory Service — Emergency or Operating Room Anesthesia — Casts IT i X-ra- t or Splints and Tetanus Anti-Toxi- s) n ALSO I PAYS ON MEDICINES DRUGS AND I 1 111 I t PRESCRIPTIONS (OUT OF HOSPITAL) recognize Doctors of Medicine Osteopathy Podiatry Chiropractic or any other physician or surgeon licensed and legally authorized to practice their respective professions by the State in which they perform such functions or services as specifically We provided for in policy ltt This policy pays full policy benefits in addition to Medicare Work1 men's Compensation or other Private or Group Insurance It does not reduce or prorate to old age Regardless of your age it pays the same full policy benefits t benefits due II on all covered persons as provided for in the policy ri All benefits payable are paid as per the provisions of the policy It is therefore imi ti portant that you READ THE POLICY CAREFULLY VERY IMPORTANT: I t THE FOLLOWING IS ALL THAT YOU DO: JUST t FILL OUT AND MAIL THE POSTAGE FREE r1 i CARD BELOW We will MAIL you a POLICY and THIS LIMITED SUPPLEMENTARY - WHATSOEVER YOU ARE UNDER NO OBLIGATION oost IMIACCERTANCEIrall EE A i' 11111S—ENDDICT:0 O'iCt OR OUT OF HOSPITAL MEDICAL AND SURGICAL POLICY THIS IS A TRUE IN fit" ( su i ht YOU ARE UNDER NO OBLIGATION 1 WHATSOEVER JUST FILL OUT AND MAIL THE POSTAGE FREE CARD BELOW ! 1 COMPLETE AND MAIL THIS POSTAGE FREE DO I HAVE TO GO TO THE HOSPITAL PRINT I TO BE COVERED? ABSOLUTELY NOT - THIS IS A TRUE IN OR OUT OF : DOCTOR'S OFFICE - CLINIC - HOME - 4 kV?'' i Day Year List Above All Persons Interested — List Adults First Use Separate Sheet Of Paper If Necessary Mail Policy And All I Correspondence To: Address: Name State City Home Phone Business Phone Please List Name Of Newspaper Taken From: Zip Please MAIL me the MS-3Medical and Surgical Policy and Outline Of Coverage (required by law) for my review and examination with the understanding I AM UNDER NO OBLIGATION WHATSOEVER J 4 I THE POSTAGE FREE CARD understand that this policy is designed to supplement Medical and Surgical expenses and is not to replace an existing policy of hospital and other insurance MS-3- WOR1D All rights reserved Age ((45)) JUST FILL OUT AND MAIL ADV Mo (3) DRUGS AND PRESCRIPTIONS (OUT OF HOSPITAL) ia-1- Present Date of Birth Sex (2) PAYS ON MEDICINES r":Z":prr7rt4r 70RIPt LIST BELOW ALL PERSONS INTERESTED PLEASE LIST ADULTS FIRST II MMSD I - AND OF COURSE IN HOSPITAL PLUS CARD —SEND NO MONEY (1) HOSPITAL MEDICAL AND SURGICAL POLICY THAT PAYS IN MS-3- 4 Bankers Commercial Lite inStillne Company 1987: Copyright Reproduction in whole or in part without written permission W strictly prohibited Ut-- 43 SLCT Signed By For and in behalf of the above-name- d to person(s) IN or OUT |
