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Sentinel Security Life Insurance Company Administrative Office P.O. Box 16960, Clearwater, FL 33766-6960 (888) 510-0668 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, B, C #, D #, F # and N # Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. Plans E, H, I and J are no longer available for sale. Basic Benefits: Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses), or copayment for hospital outpatient services. Plans K, L and N require insured to pay a portion of Part B coinsurance or copayments. Blood: First three pints of blood each year. Hospice: Part A coinsurance. A B C D F F* G Basic, Basic, Basic, Basic, including including including including 100% Part B 100% Part B 100% Part B 100% Part B Co-Insurance Co-Insurance Co-Insurance Co-Insurance Basic, including 100% Part B Co-Insurance Part A Deductible Skilled Nursing Facility Co-Insurance Part A Deductible Part B Deductible Foreign Travel Emergency Skilled Nursing Facility Co-Insurance Part A Deductible Foreign Travel Emergency Skilled Nursing Facility Co-Insurance Part A Deductible Part B Deductible Part B Excess (100%) Foreign Travel Emergency Basic, including 100% Part B Co-Insurance Skilled Nursing Facility Co-Insurance Part A Deductible Part B Excess (100%) Foreign Travel Emergency # Plans C, D, F and N are also offered as * Plan F also has an option called a high deductible Plan Medicare Supplement Select Plans. If you F. This high deductible plan pays the same benefits as choose a Medicare Select plan, when medical Plan F after one has paid a calendar year $2,070 care is provided in a Participating Hospital, the deductible. Benefits from high deductible Plan F will not Initial Part A Deductible is waived. If medical begin until out-of-pocket expenses exceed $2,070. Outof-pocket care is no provided in a Participating Hospital, expenses for this deductible are expenses that you are responsible for payment of the Initial would ordinarily be paid by the policy. These expenses Part A Deductible. Medicare Supplement include Medicare deductibles for Part A and Part B, but do Select Plans are not available in all states. not include the plan s separate foreign travel emergency deductible. SSLMED-OTLN10-TX Rev 05/10 Page 1 K L M N Basic, Including Basic, 100% Part B Co- Including 100% Insurance; other Part B basic benefits Co-Insurance paid at 75% Basic, Including 100% Part B Co- Insurance; other basic benefits paid at 50% 50% Skilled Nursing Facility Co-Insurance 50% Part A Deductible Out-of-Pocket limit $4640; paid at 100% after limit reached 75% Skilled Nursing Facility Co-Insurance 75% Part A Deductible Out-of-Pocket limit $2320; paid at 100% after limit reached Skilled Nursing Facility Co-Insurance 50% Part A Deductible Foreign Travel Emergency Basic, including 100% Part B Co- Insurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing Facility Co-Insurance Part A Deductible Foreign Travel Emergency

PREMIUM INFORMATION We, Sentinel Security Life Insurance Company, can only raise your premium if (a) We change the premium rates which apply to all policies of this form issued by us and in-force in your state; (b) coverage under Medicare changes; or (c) you move to a different ZIP code location. DISCLOSURES Use this Outline to compare benefits and premiums among policies. This outline shows benefits and premiums of policies sold for effective dates on or after June 1, 2010. Policies sold for effective dates prior to June 1, 2010 have different benefits and premiums. Plans, E, H, I and J are no longer available for sale. READ YOUR POLICY VERY CAREFULLY This is only an Outline, describing your Policy s most important features. The Policy is your insurance contract. You must read the Policy itself to understand all of the rights and duties of both you and Sentinel Security Life Insurance Company. RIGHT TO RETURN POLICY If you find that you are not satisfied with your policy, you may return it to Sentinel Security Life Insurance Company, P.O. Box 16960, Clearwater, FL 33766-6960. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your premiums. POLICY REPLACEMENT If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it. NOTICE This policy may not fully cover all of your medical costs. Neither Sentinel Security Life Insurance Company nor its agents are connected with Medicare. This Outline of Coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details. LIMITATIONS AND EXCLUSIONS Your Medicare Supplement policy will not contain limitations and exclusions that are more restrictive than the limitations and exclusions contained in Medicare. The limitations and exclusions include: (a) expense incurred while your policy is not in force, except as provided in the Extension of Benefits section of the policy; (b) Hospital or skilled nursing facility confinement charges incurred prior to the effective date of coverage of your policy; (c) that portion of any expense incurred which is paid for by Medicare; (d) services for non-medicare Eligible Expenses, including, but not limited to, routine exams, take-home drugs and eye refractions; (e) services for which a charge is not normally made in the absence of insurance; or (f) loss or expense that is payable under any other Medicare supplement insurance policy or certificate. Page 2 Texas Rev. Prem. 10-1-2012

REFUND OF PREMIUM This policy contains a provision providing for a refund or partial refund of premium upon your death or the surrender of the policy. GRIEVANCE PROCEDURE (MEDICARE SELECT POLICIES ONLY) We have a customer service program which can provide information to you, handle your complaints, and help satisfy your concerns. This grievance procedure is intended to provide an opportunity for you and us to achieve mutual agreement for the settlement of disputes that have not been settled through our customer service program or your desire to have settled by means of a written grievance. The following procedures are aimed at achieving mutual agreement for the settlement of a dispute. 1) Any grievance between you and us or between you and a hospital must be dealt with through this grievance procedure. Out-of hospital grievances will be addressed immediately and resolved as soon as possible. You should write to us within 60 days of the date you are notified of any adverse action with respect to an out-of-hospital grievance. In-hospital grievances relating to ongoing hospital treatment will be addressed immediately on receipt of any written or oral grievance and will be resolved as quickly as possible in a manner which does not interfere with, obstruct or interrupt your continued medical treatment and care. 2) Any written grievance must contain the words THIS IS A GRIEVANCE or other words that clearly state that the intention of the written communication is to serve as a written grievance to be handled according to this procedure. 3) A grievance must be filed by submitting the complete details in writing to Sentinel Security Life Insurance Company, c/o Grievance Review, P.O. Box 16960, Clearwater, FL 33766-6960. 4) Each grievance is processed within a maximum of 60 days after it is received by us. Each level of the grievance process is handled by a person with problem-solving authority. A Physician, other than your primary care physician, must be involved in reviewing any medically related grievances. 5) If a grievance is found to be valid, corrective action will be taken promptly. 6) All concerned parties are to be notified about the result of a grievance. 7) You have the right to appeal to the Department of Insurance after first completing our grievance process. 8) Any meeting with you must be scheduled at a location or in a manner which is convenient and will not necessitate excessive travel or undue hardship. COMPLETE ANSWERS ARE VERY IMPORTANT When you fill out the application for the new Policy, be sure to answer truthfully and completely all questions about your medical and health history. The Company may cancel your Policy and refuse to pay any claims if you leave out or falsify important medical information. Review the application carefully before you sign it. Be certain that all information has been properly recorded. Page 3 Texas Rev. Prem. 10-1-2012

SENTINEL SECURITY LIFE INSURANCE COMPANY - MONTHLY RATES* ZIP CODES: 755-756, 758-760, 762-769, 778-781, 783, 785-792, 795-799 SELECT PLANS - NON-TOBACCO Female Male Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX Attained Age Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX $99.23 $85.15 $103.53 $71.85 65 $114.12 $97.92 $119.06 $82.62 99.23 85.15 103.53 71.85 66 114.12 97.92 119.06 82.62 103.49 88.77 107.97 74.89 67 119.02 102.09 124.17 86.12 106.91 91.70 111.53 77.36 68 122.94 105.45 128.26 88.97 110.44 94.76 115.22 79.96 69 127.01 108.97 132.50 91.96 113.88 97.74 118.80 82.51 70 130.96 112.40 136.62 94.89 117.19 100.63 122.26 84.98 71 134.77 115.72 140.60 97.72 120.38 103.41 125.59 87.36 72 138.44 118.92 144.42 100.47 123.31 105.98 128.64 89.56 73 141.81 121.88 147.94 103.00 126.04 108.38 131.48 91.64 74 144.94 124.64 151.20 105.39 129.78 111.67 135.38 94.48 75 149.24 128.42 155.69 108.65 134.82 116.09 140.64 98.26 76 155.04 133.50 161.73 113.00 137.18 118.19 143.10 100.11 77 157.75 135.92 164.56 115.12 140.76 121.35 146.83 102.83 78 161.87 139.56 168.85 118.26 142.93 123.31 149.10 104.55 79 164.37 141.80 171.46 120.23 145.12 125.27 151.38 106.27 80 166.89 144.06 174.08 122.21 147.25 127.19 153.60 107.95 81 169.34 146.27 176.63 124.15 150.76 130.30 157.25 110.66 82 173.38 149.85 180.84 127.26 152.72 132.08 159.29 112.23 83 175.63 151.89 183.18 129.07 154.65 133.84 161.30 113.80 84 177.85 153.92 185.49 130.87 158.01 136.84 164.80 116.41 85 181.71 157.36 189.51 133.88 159.89 138.56 166.76 117.95 86 183.87 159.35 191.77 135.64 161.84 140.36 168.79 119.55 87 186.12 161.41 194.11 137.49 163.74 142.11 170.76 121.11 88 188.30 163.42 196.38 139.28 165.65 143.91 172.76 122.72 89 190.50 165.49 198.67 141.13 169.23 147.16 176.49 125.58 90 194.62 169.24 202.96 144.41 171.28 149.08 178.62 127.29 91 196.97 171.45 205.41 146.39 173.40 151.08 180.83 129.08 92 199.41 173.74 207.95 148.44 175.59 153.13 183.10 130.91 93 201.93 176.10 210.57 150.54 177.88 155.28 185.49 132.84 94 204.57 178.58 213.32 152.76 181.87 158.92 189.65 136.03 95 209.16 182.76 218.10 156.44 184.19 161.09 192.06 137.99 96 211.81 185.26 220.87 158.68 186.40 163.18 194.36 139.86 97 214.36 187.66 223.51 160.84 188.65 165.31 196.70 141.78 98 216.94 190.10 226.21 163.05 190.96 167.50 199.11 143.75 99 219.60 192.62 228.97 165.32 To obtain annual, semiannual, or quarterly premiums, multiply the Monthly Premium Amount by 12, 6, or 3, respectively. Page 4 Texas Rev. Prem. 10-1-2012

SENTINEL SECURITY LIFE INSURANCE COMPANY - MONTHLY RATES* ZIP CODES: 755-756, 758-760, 762-769, 778-781, 783, 785-792, 795-799 SELECT PLANS - TOBACCO Female Male Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX Attained Age Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX $113.55 $97.43 $118.46 $82.62 65 $130.58 $112.05 $136.23 $95.02 113.55 97.43 118.46 82.62 66 130.58 112.05 136.23 95.02 118.42 101.58 123.55 86.13 67 136.19 116.82 142.08 99.04 122.33 104.93 127.63 88.97 68 140.68 120.67 146.77 102.31 126.37 108.43 131.84 91.96 69 145.33 124.69 151.62 105.75 130.31 111.84 135.94 94.89 70 149.85 128.62 156.33 109.12 134.10 115.14 139.90 97.72 71 154.21 132.42 160.88 112.38 137.75 118.33 143.71 100.47 72 158.41 136.08 165.26 115.54 141.10 121.27 147.20 103.00 73 162.27 139.46 169.28 118.45 144.22 124.02 150.45 105.39 74 165.85 142.62 173.02 121.20 148.50 127.78 154.91 108.65 75 170.78 146.95 178.15 124.94 154.27 132.84 160.93 113.00 76 177.41 152.76 185.07 129.95 156.97 135.25 163.74 115.12 77 180.51 155.54 188.30 132.39 161.07 138.86 168.01 118.26 78 185.23 159.69 193.21 136.00 163.56 141.10 170.61 120.23 79 188.09 162.26 196.20 138.26 166.06 143.34 173.22 122.21 80 190.97 164.85 199.20 140.54 168.50 145.54 175.76 124.15 81 193.78 167.37 202.12 142.77 172.51 149.11 179.94 127.26 82 198.39 171.47 206.93 146.35 174.75 151.14 182.27 129.07 83 200.97 173.81 209.61 148.43 176.96 153.15 184.57 130.87 84 203.50 176.12 212.25 150.50 180.80 156.58 188.57 133.88 85 207.92 180.07 216.86 153.96 182.96 158.55 190.82 135.64 86 210.40 182.34 219.44 155.99 185.20 160.61 193.15 137.49 87 212.98 184.70 222.12 158.11 187.36 162.61 195.40 139.28 88 215.46 187.00 224.71 160.17 189.55 164.67 197.68 141.13 89 217.99 189.37 227.33 162.30 193.65 168.39 201.95 144.41 90 222.70 193.65 232.24 166.07 195.99 170.59 204.39 146.39 91 225.39 196.18 235.04 168.35 198.42 172.88 206.92 148.44 92 228.19 198.81 237.96 170.70 200.92 175.22 209.52 150.54 93 231.06 201.51 240.95 173.12 203.55 177.69 212.26 152.76 94 234.08 204.34 244.09 175.68 208.11 181.85 217.01 156.44 95 239.33 209.12 249.56 179.90 210.76 184.34 219.77 158.68 96 242.38 211.99 252.73 182.49 213.29 186.73 222.40 160.85 97 245.29 214.74 255.76 184.97 215.86 189.16 225.08 163.05 98 248.24 217.53 258.84 187.51 218.51 191.66 227.83 165.32 99 251.29 220.41 262.01 190.12 To obtain annual, semiannual, or quarterly premiums, multiply the Monthly Premium Amount by 12, 6, or 3, respectively. Page 5 Texas Rev. Prem. 10-1-2012

SENTINEL SECURITY LIFE INSURANCE COMPANY - MONTHLY RATES* ZIP CODES: 750-751, 753-754, 757, 761, 784 SELECT PLANS - NON-TOBACCO Female Male Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX Attained Age Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX $111.14 $95.36 $115.95 $80.47 65 $127.81 $109.67 $133.34 $92.54 111.14 95.36 115.95 80.47 66 127.81 109.67 133.34 92.54 115.91 99.42 120.93 83.88 67 133.30 114.34 139.07 96.46 119.74 102.70 124.92 86.65 68 137.70 118.11 143.66 99.64 123.69 106.13 129.05 89.56 69 142.25 122.05 148.40 102.99 127.54 109.47 133.06 92.41 70 146.67 125.89 153.02 106.27 131.25 112.70 136.93 95.17 71 150.94 129.61 157.47 109.45 134.83 115.82 140.66 97.85 72 155.05 133.19 161.75 112.52 138.11 118.70 144.08 100.31 73 158.83 136.50 165.69 115.36 141.16 121.39 147.26 102.64 74 162.34 139.59 169.35 118.04 145.35 125.07 151.63 105.81 75 167.15 143.83 174.37 121.69 151.00 130.02 157.51 110.06 76 173.65 149.52 181.14 126.56 153.64 132.38 160.27 112.12 77 176.68 152.24 184.31 128.94 157.65 135.92 164.45 115.17 78 181.30 156.31 189.11 132.45 160.09 138.10 166.99 117.09 79 184.10 158.82 192.03 134.66 162.54 140.30 169.54 119.02 80 186.92 161.35 194.97 136.87 164.93 142.45 172.03 120.91 81 189.66 163.82 197.83 139.05 168.85 145.94 176.12 123.94 82 194.18 167.83 202.54 142.53 171.05 147.93 178.40 125.70 83 196.70 170.12 205.16 144.56 173.21 149.90 180.65 127.45 84 199.19 172.39 207.75 146.57 176.97 153.26 184.57 130.38 85 203.51 176.25 212.26 149.94 179.08 155.19 186.77 132.11 86 205.94 178.47 214.78 151.92 181.27 157.20 189.05 133.90 87 208.46 180.78 217.40 153.99 183.38 159.16 191.25 135.65 88 210.89 183.03 219.94 155.99 185.53 161.18 193.49 137.45 89 213.36 185.35 222.51 158.07 189.54 164.82 197.66 140.64 90 217.97 189.55 227.31 161.74 191.83 166.97 200.05 142.57 91 220.60 192.02 230.06 163.95 194.21 169.21 202.53 144.57 92 223.34 194.59 232.91 166.25 196.66 171.50 205.07 146.62 93 226.16 197.23 235.84 168.61 199.23 173.92 207.75 148.78 94 229.11 200.00 238.91 171.09 203.70 177.99 212.41 152.36 95 234.25 204.69 244.27 175.21 206.29 180.43 215.10 154.54 96 237.23 207.49 247.37 177.73 208.77 182.76 217.68 156.65 97 240.08 210.18 250.34 180.14 211.28 185.15 220.30 158.80 98 242.98 212.92 253.35 182.61 213.87 187.59 223.00 161.01 99 245.96 215.74 256.45 185.16 To obtain annual, semiannual, or quarterly premiums, multiply the Monthly Premium Amount by 12, 6, or 3, respectively. Page 6 Texas Rev. Prem. 10-1-2012

SENTINEL SECURITY LIFE INSURANCE COMPANY - MONTHLY RATES* ZIP CODES: 750-751, 753-754, 757, 761, 784 SELECT PLANS - TOBACCO Female Male Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX Attained Age Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX $127.18 $109.12 $132.68 $92.54 65 $146.26 $125.49 $152.58 $106.42 127.18 109.12 132.68 92.54 66 146.26 125.49 152.58 106.42 132.63 113.77 138.37 96.46 67 152.53 130.84 159.13 110.93 137.01 117.52 142.94 99.64 68 157.56 135.15 164.38 114.59 141.54 121.44 147.66 102.99 69 162.77 139.66 169.81 118.44 145.94 125.26 152.25 106.27 70 167.83 144.05 175.09 122.21 150.19 128.96 156.69 109.45 71 172.72 148.31 180.19 125.87 154.28 132.53 160.95 112.52 72 177.42 152.41 185.09 129.40 158.04 135.82 164.87 115.36 73 181.74 156.19 189.60 132.66 161.53 138.90 168.50 118.03 74 185.76 159.74 193.78 135.74 166.32 143.12 173.50 121.69 75 191.27 164.58 199.53 139.94 172.78 148.77 180.24 126.56 76 198.70 171.09 207.27 145.55 175.81 151.48 183.39 128.94 77 202.18 174.20 210.90 148.28 180.40 155.53 188.17 132.45 78 207.45 178.86 216.40 152.32 183.18 158.03 191.08 134.66 79 210.66 181.73 219.74 154.85 185.99 160.55 194.00 136.87 80 213.89 184.63 223.10 157.40 188.72 163.01 196.85 139.05 81 217.03 187.46 226.37 159.90 193.21 167.00 201.53 142.53 82 222.20 192.05 231.76 163.91 195.72 169.27 204.14 144.56 83 225.08 194.67 234.76 166.24 198.20 171.53 206.72 146.57 84 227.92 197.26 237.72 168.56 202.50 175.37 211.20 149.94 85 232.87 201.67 242.88 172.43 204.91 177.58 213.71 151.92 86 235.65 204.22 245.77 174.71 207.42 179.88 216.32 153.99 87 238.53 206.86 248.77 177.08 209.84 182.12 218.85 155.99 88 241.32 209.44 251.67 179.39 212.30 184.43 221.40 158.07 89 244.14 212.10 254.61 181.78 216.88 188.60 226.18 161.74 90 249.42 216.89 260.11 186.00 219.51 191.07 228.91 163.95 91 252.43 219.72 263.25 188.55 222.23 193.62 231.75 166.25 92 255.57 222.67 266.51 191.19 225.03 196.25 234.66 168.61 93 258.79 225.68 269.86 193.90 227.97 199.01 237.73 171.09 94 262.17 228.86 273.39 196.76 233.09 203.67 243.05 175.21 95 268.05 234.22 279.51 201.49 236.05 206.46 246.14 177.73 96 271.46 237.43 283.06 204.38 238.89 209.13 249.09 180.15 97 274.72 240.50 286.45 207.17 241.77 211.86 252.09 182.61 98 278.03 243.64 289.90 210.01 244.73 214.66 255.17 185.16 99 281.44 246.86 293.45 212.93 To obtain annual, semiannual, or quarterly premiums, multiply the Monthly Premium Amount by 12, 6, or 3, respectively. Page 7 Texas Rev. Prem. 10-1-2012

SENTINEL SECURITY LIFE INSURANCE COMPANY - MONTHLY RATES* ZIP CODES: 752, 770-777, 782, 793-794 SELECT NON-TOBACCO Female Male Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX Attained Age Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX $123.05 $105.58 $128.37 $89.09 65 $141.51 $121.42 $147.63 $102.45 123.05 105.58 128.37 89.09 66 141.51 121.42 147.63 102.45 128.33 110.08 133.88 92.87 67 147.58 126.59 153.97 106.79 132.57 113.71 138.30 95.93 68 152.45 130.76 159.05 110.32 136.95 117.50 142.87 99.16 69 157.49 135.12 164.30 114.03 141.20 121.20 147.31 102.31 70 162.39 139.38 169.41 117.66 145.32 124.78 151.60 105.37 71 167.11 143.49 174.34 121.17 149.27 128.23 155.73 108.33 72 171.66 147.47 179.09 124.58 152.91 131.41 159.52 111.06 73 175.84 151.12 183.44 127.72 156.29 134.39 163.03 113.63 74 179.73 154.55 187.49 130.68 160.93 138.47 167.87 117.15 75 185.06 159.24 193.06 134.72 167.17 143.95 174.39 121.85 76 192.25 165.54 200.55 140.12 170.10 146.56 177.44 124.13 77 195.61 168.55 204.05 142.75 174.54 150.48 182.07 127.51 78 200.72 173.05 209.38 146.64 177.24 152.90 184.88 129.64 79 203.82 175.84 212.61 149.08 179.95 155.34 187.71 131.77 80 206.95 178.64 215.86 151.54 182.60 157.72 190.46 133.86 81 209.99 181.37 219.03 153.94 186.94 161.58 194.99 137.22 82 214.99 185.82 224.24 157.80 189.37 163.78 197.52 139.17 83 217.78 188.35 227.15 160.05 191.76 165.96 200.01 141.11 84 220.53 190.86 230.01 162.28 195.93 169.68 204.35 144.35 85 225.32 195.13 235.00 166.01 198.26 171.82 206.78 146.26 86 228.00 197.59 237.79 168.20 200.69 174.04 209.30 148.25 87 230.79 200.15 240.70 170.48 203.03 176.21 211.74 150.18 88 233.49 202.64 243.51 172.71 205.41 178.45 214.22 152.17 89 236.22 205.21 246.35 175.00 209.85 182.48 218.84 155.71 90 241.33 209.85 251.67 179.07 212.38 184.86 221.48 157.85 91 244.24 212.59 254.70 181.52 215.02 187.34 224.23 160.06 92 247.27 215.44 257.86 184.06 217.73 189.88 227.05 162.32 93 250.39 218.36 261.10 186.67 220.58 192.55 230.01 164.72 94 253.66 221.43 264.51 189.42 225.52 197.06 235.17 168.68 95 259.35 226.62 270.44 193.98 228.39 199.76 238.15 171.10 96 262.65 229.72 273.87 196.77 231.13 202.35 241.01 173.43 97 265.80 232.70 277.16 199.45 233.92 204.98 243.91 175.81 98 269.01 235.73 280.49 202.18 236.79 207.69 246.89 178.26 99 272.31 238.85 283.93 204.99 To obtain annual, semiannual, or quarterly premiums, multiply the Monthly Premium Amount by 12, 6, or 3, respectively. Page 8 Texas Rev. Prem. 10-1-2012

SENTINEL SECURITY LIFE INSURANCE COMPANY - MONTHLY RATES* ZIP CODES: 752, 770-777, 782, 793-794 SELECT TOBACCO Female Male Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX Attained Age Select Plan C SSLC10SL-TX Select Plan D SSLD10SL-TX Select Plan F SSLF10SL-TX Select Plan N SSLN10SL-TX $140.80 $120.82 $146.90 $102.45 65 $161.93 $138.94 $168.93 $117.82 140.80 120.82 146.90 102.45 66 161.93 138.94 168.93 117.82 146.85 125.96 153.20 106.80 67 168.87 144.85 176.18 122.81 151.69 130.11 158.26 110.32 68 174.45 149.63 181.99 126.87 156.70 134.45 163.48 114.03 69 180.21 154.62 188.01 131.13 161.58 138.68 168.57 117.66 70 185.81 159.49 193.85 135.31 166.28 142.78 173.47 121.17 71 191.22 164.20 199.49 139.35 170.81 146.73 178.19 124.58 72 196.43 168.74 204.92 143.27 174.97 150.37 182.53 127.72 73 201.22 172.93 209.91 146.88 178.83 153.78 186.56 130.68 74 205.66 176.85 214.54 150.28 184.14 158.45 192.09 134.72 75 211.77 182.22 220.91 154.93 191.29 164.71 199.55 140.12 76 219.99 189.42 229.48 161.14 194.64 167.71 203.04 142.75 77 223.84 192.86 233.49 164.16 199.72 172.19 208.33 146.64 78 229.68 198.02 239.58 168.64 202.81 174.96 211.55 149.08 79 233.23 201.20 243.28 171.45 205.92 177.75 214.79 151.54 80 236.80 204.41 247.01 174.27 208.94 180.47 217.94 153.94 81 240.28 207.54 250.63 177.03 213.92 184.89 223.12 157.80 82 246.00 212.62 256.59 181.47 216.69 187.41 226.02 160.05 83 249.20 215.52 259.92 184.05 219.43 189.91 228.86 162.28 84 252.34 218.39 263.19 186.62 224.20 194.16 233.83 166.01 85 257.82 223.28 268.90 190.91 226.87 196.61 236.61 168.20 86 260.90 226.10 272.10 193.43 229.64 199.15 239.50 170.48 87 264.09 229.03 275.43 196.05 232.33 201.64 242.30 172.71 88 267.17 231.88 278.64 198.62 235.05 204.19 245.13 175.00 89 270.30 234.82 281.89 201.25 240.12 208.81 250.42 179.07 90 276.14 240.13 287.98 205.93 243.03 211.54 253.44 181.52 91 279.48 243.27 291.45 208.75 246.04 214.37 256.58 184.06 92 282.95 246.52 295.07 211.67 249.14 217.28 259.81 186.67 93 286.51 249.87 298.78 214.67 252.40 220.33 263.20 189.42 94 290.26 253.38 302.68 217.84 258.06 225.49 269.09 193.98 95 296.77 259.31 309.46 223.08 261.34 228.58 272.51 196.77 96 300.54 262.86 313.39 226.28 264.48 231.54 275.78 199.45 97 304.15 266.27 317.15 229.36 267.67 234.56 279.10 202.18 98 307.82 269.74 320.96 232.51 270.95 237.66 282.51 204.99 99 311.60 273.31 324.89 235.74 To obtain annual, semiannual, or quarterly premiums, multiply the Monthly Premium Amount by 12, 6, or 3, respectively. Page 9 Texas Rev. Prem. 10-1-2012

PLAN A MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61 st thru 90 th day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital. First 20 days 21 st thru 100 th day 101 st day and after BLOOD First 3 pints Additional amounts All but $1,156 All but $289 a day All but $578 a day All approved amounts All but $144.50 a day 100% $289 a day $578 a day 100% of Medicare Eligible Expenses 3 pints $1,156 (Part A Deductible) ** Up to $144.50 a day HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance **NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid. Page 10

PLAN A MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once You have been billed $140 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $140 of Medicare-approved amounts* Generally 80% Generally 20% Part B Excess Charges (Above Medicare-approved amounts) All costs BLOOD First 3 pints Next $140 of Medicare-approved amounts* 80% 20% CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% PARTS A & B HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies Durable medical equipment First $140 of Medicare-approved amounts* 100% 80% 20% Page 11

PLAN B MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61 st thru 90 th day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital. First 20 days 21 st thru 100 th day 101 st day and after BLOOD First 3 pints Additional amounts HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but $1,156 All but $289 a day All but $578 a day All approved amounts All but $144.50 a day 100% All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care $1,156 (Part A Deductible) $289 a day $578 a day 100% of Medicare Eligible Expenses 3 pints Medicare copayment/ coinsurance ** Up to $144.50 a day **NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid. Page 12

PLAN B MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once You have been billed $140 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $140 of Medicare-approved amounts* Generally 80% Generally 20% Part B Excess Charges (Above Medicare-approved amounts) BLOOD First 3 pints Next $140 of Medicare-approved amounts* 80% 20% CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% PARTS A & B HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies Durable medical equipment First $140 of Medicare-approved amounts* 100% 80% 20% Page 13

PLAN C# MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. # For Medicare Select Plans, if you do not utilize a network provider, you are responsible for all charges. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61 st thru 90 th day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital. First 20 days 21 st thru 100 th day 101 st day and after BLOOD First 3 pints Additional amounts HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but $1,156 All but $289 a day All but $578 a day All approved amounts All but $144.50 a day 100% All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Page 14 $1,156 (Part A Deductible) $289 a day $578 a day 100% of Medicare Eligible Expenses Up to $144.50 a day 3 pints Medicare copayment/ coinsurance ** **NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the Policy s Core Benefits. During this time the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN C MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once You have been billed $140 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $140 of Medicare-approved amounts* Generally 80% Generally 20% Part B Excess Charges (Above Medicare-approved amounts) BLOOD First 3 pints Next $140 of Medicare-approved amounts* 80% 20% CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies Durable medical equipment First $140 of Medicare-approved amounts* 100% 80% PARTS A & B 20% OTHER BENEFITS NOT COVERED BY MEDICARE FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges 80% to a lifetime maximum benefit of $50,000 $250 20% and amounts over the $50,000 lifetime maximum Page 15

PLAN D# MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. # For Medicare Select Plans, if you do not utilize a network provider, you are responsible for all charges. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61 st thru 90 th day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital. First 20 days 21 st thru 100 th day 101 st day and after BLOOD First 3 pints Additional amounts HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but $1,156 All but $289 a day All but $578 a day All approved amounts All but $144.50 a day 100% All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Page 16 $1,156 (Part A Deductible) $289 a day $578 a day 100% of Medicare Eligible Expenses Up to $144.50 a day 3 pints Medicare copayment/ coinsurance ** **NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN D MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once You have been billed $140 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $140 of Medicare-approved amounts* Generally 80% Generally 20% Part B Excess Charges (Above Medicare-approved amounts) BLOOD First 3 pints Next $140 of Medicare-approved amounts* 80% 20% CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% PARTS A & B HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies Durable medical equipment First $140 of Medicare-approved amounts* 100% 80% 20% Page 17

PLAN D OTHER BENEFITS NOT COVERED BY MEDICARE FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges 80% to a lifetime maximum benefit of $50,000 $250 20% and amounts over the $50,000 lifetime maximum Page 18

PLAN F# MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. # For Medicare Select Plans, if you do not utilize a network provider, you are responsible for all charges. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61 st thru 90 th day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital. First 20 days 21 st thru 100 th day 101 st day and after BLOOD First 3 pints Additional amounts HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but $1,156 All but $289 a day All but $578 a day All approved amounts All but $144.50 a day 100% All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Page 19 $1,156 (Part A Deductible) $289 a day $578 a day 100% of Medicare Eligible Expenses Up to $144.50 a day 3 pints Medicare copayment/ coinsurance ** **NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN F MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once You have been billed $140 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $140 of Medicare-approved amounts* Generally 80% Generally 20% Part B Excess Charges (Above Medicare-approved amounts) 100% BLOOD First 3 pints Next $140 of Medicare-approved amounts* 80% 20% CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies Durable medical equipment First $140 of Medicare-approved amounts* 100% 80% PARTS A & B 20% OTHER BENEFITS NOT COVERED BY MEDICARE FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges 80% to a lifetime maximum benefit of $50,000 $250 20% and amounts over the $50,000 lifetime maximum Page 20

PLAN N# MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD * A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. # For Medicare Select Plans, if you do not utilize a network provider, you are responsible for all charges. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61 st thru 90 th day 91 st day and after: While using 60 lifetime reserve days Once lifetime reserve days are used: - Additional 365 days - Beyond the additional 365 days SKILLED NURSING FACILITY CARE* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital. First 20 days 21 st thru 100 th day 101 st day and after BLOOD First 3 pints Additional amounts HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but $1,156 All but $289 a day All but $578 a day All approved amounts All but $144.50 a day 100% All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Page 21 $1,156 (Part A Deductible) $289 a day $578 a day 100% of Medicare Eligible Expenses Up to $144.50 a day 3 pints Medicare copayment/ coinsurance ** **NOTICE: When Your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN N MEDICARE (PART B) MEDICAL SERVICES PER CALENDAR YEAR * Once You have been billed $140 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $140 of Medicare-approved amounts* Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Part B Excess Charges (Above Medicare-approved amounts) Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. BLOOD First 3 pints Next $140 of Medicare-approved amounts* 80% 20% CLINICAL LABORATORY SERVICES TESTS FOR DIAGNOSTIC SERVICES 100% Page 22

PLAN N PARTS A & B HOME HEALTH CARE MEDICARE-APPROVED SERVICES Medically necessary skilled care services and medical supplies Durable medical equipment First $140 of Medicare-approved amounts* 100% 80% 20% OTHER BENEFITS NOT COVERED BY MEDICARE FOREIGN TRAVEL NOT COVERED BY MEDICARE Medically necessary emergency care services during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges 80% to a lifetime maximum benefit of $50,000 $250 20% and amounts over the $50,000 lifetime maximum Sentinel Security Life Insurance Company Administrative Office P.O. Box 16960 Clearwater, FL 33766-6960 Toll-free 888-510-0668 Fax 855-808-0946 www.sentinellife.org Page 23

Sentinel Security Life Insurance Company Medicare Select Hospital Network / /2011

WELCOME Welcome to the individual Medicare SELECT Medicare supplement program from Sentinel Security Life Insurance Company. We are pleased to offer these hospitals to our policyholders. Medicare SELECT has a participating hospital network that is serving the medical needs of your community by containing costs while maintaining quality health care. For information on hospitals located in a specific area, please refer to the provider listings on the following pages. IMPORTANT DIRECTORY INFORMATION With Medicare SELECT Medicare supplement coverage, you have the freedom to choose any participating network hospital in your area. If you need emergency care, your policy pays the Medicare Part A deductible no matter what hospital you use. For non-emergency care, you must use a participating network hospital for the Medicare Part A deductible to be covered. IDENTIFICATION CARD (ID) PARTICIPATING HOSPITALS Please understand that this directory lists participating hospitals as of the publication date. From time to time, hospitals may be added or removed from the participating hospital network. Before receiving care from a hospital, ask the hospital if it s still participating in our Medicare SELECT network. For current information on participating hospitals call (888) 510-0668. IF YOU HAVE QUESTIONS Our Customer Service staff will be glad to help with your questions or concerns about your coverage, participating hospitals or the care you receive. Please call Customer Service whenever you have a question, (888) 510-0668. For details about your coverage, please read your policy. Sentinel Security Life Insurance Company does not supervise, control or guarantee the health care services of any hospital, including those participating in its Medicare SELECT hospital network. When you re issued your Medicare SELECT policy, you will receive an ID card. Please present your card whenever you receive medical services. TABLE OF CONTENTS Hospitals 1-9

by State and County Medicare Select Provider Network ARIZONA Pima El Dorado Hospital 1400 N Wilmot Tucson AZ 85712 Northwest Medical 6200 North La Cholla Blvd Tucson AZ 85741 Northwest Medical Ina Urgent Care 2945 W Ina Rd Tucson AZ 85741 Northwest Medical Outpatient Therapy 2945 W Ina Rd Tucson AZ 85741 Northwest Medical Rancho Vistoso Urgent Care 13101 N Oracle Rd Tucson AZ 85737 Northwest Rancho Vistoso Imaging Services 13101 N Oracle Rd Tucson AZ 85737 CALIFORNIA Alameda City Of Alameda Health Care District 2070 Clinton Ave Alameda CA 94501 Eden Medical 20103 Lake Chabot Rd Castro Valley CA 94546 Laurel Grove Hospital 19933 Lake Chabot Rd Castro Valley CA 94546 San Leandro Hospital 13855 E 14th St San Leandro CA 94578 Colusa Colusa Regional Medical 199 Webster St Colusa CA 95932 Fresno Coalinga Regional Medical 1191 Phelps Ave Coalinga CA 93210 Kingsburg District Hospital 1200 Smith St Kingsburg CA 93631 Sanger General Hospital 2558 Jensen Ave Sanger CA 93657 Imperial Palo Verde Hospital 250 N 1st St Blythe CA 92225 Kern Bakersfield Memorial Hospital 420 34th St Bakersfield CA 93301 Good Samaritan Hospital 901 Olive Dr Bakersfield CA 93308 Los Angeles Beverly Hospital 309 W Beverly Blvd Montebello CA 90640 Brotman Medical 3828 Delmas Ter Culver City CA 90232 Coast Plaza Doctors Hospital 13100 Studebaker Rd Norwalk CA 90650 Page 1 of 9 Sentinel Medicare Select Provider Network 12/19/2011

by State and County Medicare Select Provider Network Covina Valley Community Hospital 845 N Lark Ellen Ave West Covina CA 91791 Doctors Hospital Of West Covina 725 S Orange Ave West Covina CA 91790 Miracle Mile Medical 6000 San Vicente Blvd Los Angeles CA 90036 Pacifica Hospital Of The Valley 9449 San Fernando Rd Sun Valley CA 91352 Silver Lake Medical 1711 W Temple St Los Angeles CA 90026 St Johns Hospital & Health Care 1328 22nd St Santa Monica CA 90404 Temple Community Hospital 235 N Hoover St Los Angeles CA 90004 USC University Hospital 1500 San Pablo St Los Angeles CA 90033 Orange Western Medical Anaheim 1025 S Anaheim Blvd Anaheim CA 92805 Western Medical Santa Ana 1001 N Tustin Ave Santa Ana CA 92705 Riverside San Gorgonio Memorial Hospital 600 N Highland Springs Ave Banning CA 92220 San Bernardino Doctors Hospital 5000 San Bernardino St Montclair CA 91763 Mountains Community Hospital 29101 Hospital Rd Lake Arrowhead CA 92352 San Diego Fallbrook Hospital 624 E Elder St Fallbrook CA 92028 San Francisco UCSF Medical 505 Parnassus Ave San Francisco CA 94143 Santa Clara Stanford Medical 300 Pasteur Dr Stanford CA 94305 Stanislaus Oak Valley District Hospital 350 S Oak Ave Oakdale CA 95361 COLORADO Alamosa San Luis Valley Regional Medical 106 Blanca Ave Alamosa CO 81101 IDAHO Ada Complex Care Hospital Of Idaho 2131 S Bonito Way Meridian ID 83642 Page 2 of 9 Sentinel Medicare Select Provider Network 12/19/2011

by State and County Medicare Select Provider Network IOWA Delaware Regional Medical Of Ne Ia And Del 709 W Main St Manchester IA 52057 Polk Broadlawns Medical 1801 Hickman Rd Des Moines IA 50314 Pottawattamie Jennie Edmundson Memorial Hospital 933 E Pierce St Council Bluffs IA 51503 Scott Trinity At Terrace Park 4500 Utica Ridge Rd Bettendorf IA 52722 Story Story County Hospital 630 6th St Nevada IA 50201 KANSAS Greenwood Greenwood County Hospital 100 W 16th St Eureka KS 67045 Johnson Heartland Spine and Specialty Hospital 10720 Nall Ave Overland Park KS 66211 Sedgwick Kansas Surgery and Recovery 2770 N Webb Rd Wichita KS 67226 Shawnee St Francis Hospital and Medical 1700 SW 7th St Topeka KS 66606 LOUISIANA Acadia American Legion Hospital 1305 Crowley Rayne Hwy Crowley LA 70526 Bossier CHRISTUS Schumpert Bossier 2105 Airline Drive Bossier City LA 71111 Caddo CHRISTUS Schumpert - St Mary Place One St Mary Place Shreveport LA 71101 CHRISTUS Schumpert Highland 1453 E Bert Kouns Shreveport LA 71105 Calcasieu CHRISTUS St Patrick Hospital 524 S Ryan St Lake Charles LA 70601 Evangeline Parish Savoy Medical 801 Poinciana Ave Mamou LA 70554 Jefferson Doctors Hospital of Jefferson 4320 Houma Blvd Metairie LA 70006 Page 3 of 9 Sentinel Medicare Select Provider Network 12/19/2011

by State and County Medicare Select Provider Network Kenner Regional Medical 180 W Esplanade Ave Kenner LA 70065 Meadowcrest Hospital 2500 Belle Chasse Hwy Gretna LA 70056 Lafayette Lafayette General Medical 1214 Coolidge St Lafayette LA 70503 Lafayette General Surgical 1000 West Pinhook Rd Lafayette LA 70503 Rehabilitation Hospital of Acadiana 310 Youngsville Highway Lafayette LA 70508 Lincoln Green Clinic Surgical Hospital 1118 S Farmerville St Ruston LA 71270 Orleans Memorial Medical - Baptist 2700 Napoleon Ave New Orleans LA 70115 Memorial Medical - Mercy 301 N Jefferson Davis Pkwy New Orleans LA 70119 Methodist Hospital 5620 Read Blvd New Orleans LA 70127 Ouachita P & S Surgical Hospital 312 Grammont St Monroe LA 71201 St Francis Medical 309 Jackson St Monroe LA 71210 St Francis North Hospital 3421 Medical Park Dr Monroe LA 71203 Rapides CHRISTUS St Frances Cabrini Hospital 3330 Masonic Dr Alexandria LA 71301 Red River CHRISTUS Coushatta Health Care 1635 Marvelle St Coushatta LA 71019 Saint Landry Opelousas General Hospital 539 E Prudhomme St Opelousas LA 70570 St John The Baptist River Parishes Hospital 500 Rue De Sante La Place LA 70068 St Martin St Martin Hospital 210 Champagne Blvd Breaux Bridge LA 70517 St Tammany Parish Oschner Medical - North Shore 100 Medical Dr Slidell LA 70461 Terrebonne Terrebonne General Medical 8166 Main St Houma LA 70360 Page 4 of 9 Sentinel Medicare Select Provider Network 12/19/2011

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