Medicare Supplement Insurance

Nassau Life Insurance Company of Kansas
Medicare Supplement Insurance

POLICY DISCLOSURES, EXCLUSIONS & LIMITATIONS BY STATE

GENERAL DISCLOSURE

Policy benefits will not duplicate benefits paid by Medicare. The combined benefits of Medicare and a Medicare Supplement Insurance Policy will not exceed 100% of Medicare eligible expenses. Coverage will remain in force as long as premiums are paid on a timely basis according to the policy. Nassau Life Insurance Company of Kansas reserves the right to change premiums on a class basis.

Nassau Medicare Supplement Insurance Policies are insured by Nassau Life Insurance Company of Kansas. The information provided on this page is a summary only. It is not a contract. View the policy for complete terms and conditions.

Company Location and Contact Information
Home Office: Overland Park, Kansas
Administrative Office: PO Box 19018, Greenville, SC 29602-9018
Phone: (800) 999-2224

Medicare Supplement Policy Form Number:
Plan A: NKS MS19-PLAN A GN
Plan F: NKS MS19-PLAN F GN
Plan G: NKS MS19-PLAN G GN
Plan N: NKS MS19-PLAN N GN

ALABAMA, DELAWARE, ILLINOIS, INDIANA, IOWA, KENTUCKY, MARYLAND, MISSISSIPPI, MONTANA, NEVADA, NEW MEXICO, NORTH DAKOTA, OHIO, OKLAHOMA, SOUTH CAROLINA, SOUTH DAKOTA, UTAH

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

COLORADO
Policy form numbers:
Plan A: NKS MS19-PLAN A CO
Plan F: NKS MS19-PLAN F CO
Plan G: NKS MS19-PLAN G CO
Plan N: NKS MS19-PLAN N CO


Important Notice: In Colorado, all Medicare Supplement plans are available to persons eligible for Medicare because of disability.


Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

KANSAS
Plan A: NKS MS19-PLAN A KS
Plan F: NKS MS19-PLAN F KS
Plan G: NKS MS19-PLAN G KS
Plan N: NKS MS10-PLAN N KS

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare; or
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected).

LOUISIANA

Nassau Life Insurance Company of Kansas is not connected with or endorsed by the United States Government or the federal Medicare program.

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

MICHIGAN
Policy form numbers:
Plan A: NKS MS19-PLAN A MI
Plan F: NKS MS19-PLAN F MI
Plan G: NKS MS19-PLAN G MI
Plan N: NKS MS19-PLAN N MI

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

NEBRASKA

This is a solicitation of insurance and an agent may contact you. Nassau Life Insurance Company of Kansas is not connected with or endorsed by the United States Government or the federal Medicare program.

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage.Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

NORTH CAROLINA
Policy form numbers:
Plan A: NKS MS19-PLAN A NC
Plan F: NKS MS19-PLAN F NC
Plan G: NKS MS19-PLAN G NC
Plan N: NKS MS10-PLAN N NC

After two years from the issue date, omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

PENNSYLVANIA
Policy form numbers:
Plan A: NKS MS19-PLAN A PA
Plan B: NKS MS19-PLAN B PA
Plan F: NKS MS19-PLAN F PA
Plan G: NKS MS19-PLAN G PA
Plan N: NKS MS19-PLAN N PA

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

TENNESSEE
Policy form numbers:
Plan A: NKS MS19-PLAN A TN
Plan F: NKS MS19-PLAN F TN
Plan G: NKS MS19-PLAN G TN
Plan N: NKS MS19-PLAN N TN

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Confinement that begins or expenses incurred while your policy is not in force.

Limitations: The policy does NOT cover Pre-existing Conditions for the first 6 months following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months (for prior coverage less than 6 months, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

TEXAS
Policy form numbers:
Plan A: NKS MS19-PLAN A TX
Plan F: NKS MS19-PLAN F TX
Plan G: NKS MS19-PLAN G TX
Plan N: NKS MS19-PLAN N TX

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

EXCLUSIONS

What We Will Not Pay For
This policy does not pay for expenses of the kind not covered by Medicare.

PRE-EXISTING CONDITION LIMITATIONS

Pre-Existing Conditions Are Not Covered For 6 Months
Pre-existing Conditions are covered after this policy has been in force for 6 months. "Pre-Existing Condition" means a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

If, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 6 months, we will not exclude benefits based on a pre-existing condition. If, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for less than 6 months, we will reduce the period of the preexisting condition limitation by the time covered under such prior coverage.

We will waive any pre-existing condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status.

WYOMING
Policy form numbers:
Plan A: NKS MS19-PLAN A WY
Plan B: NKS MS19-PLAN F WY
Plan C: NKS MS19-PLAN G WY
Plan D: NKS MS10-PLAN N WY

Omissions or material misstatements in the application for insurance could cause an otherwise valid claim to be denied and your policy rescinded.

Exclusions and Limitations: This policy will not pay benefits for the following:
1. Any expenses not included as a covered benefit in the policy;
2. Expenses of the kind not covered by Medicare, including but not limited to expenses not recognized as reasonable or medically necessary by Medicare;
3. Any deductible, coinsurance, or copayment not covered by Medicare, unless included as a covered benefit in the policy (view the policy, as benefits vary by the type of plan selected); or
4. Pre-Existing Conditions: the policy does NOT cover Pre-existing Conditions for the first 90 days following the effective date of coverage. Benefits will not be excluded if, as of the date of application, you had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least 90 days (for prior coverage less than 90 days, we will reduce the period of the Pre-existing Condition limitation by the time covered under such prior coverage). We will waive any Pre-existing Condition limitation if you applied for and were issued this policy under a qualified guaranteed issue status. A Pre-existing Condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 90 days before the effective date of coverage.

40266
09/2020