Medico Insurance Company
Dental, Vision & Hearing insurance
Call Adeeb Barsoum Tel: (480)205-5553

OR FILL THE FOLLOWING
Your name:
Your email address:
Your phone number:
Comments:
Benefits
Once the $100 policy Year Deductible is satisfied, your plan pays for covered expenses, not to
exceed Reasonable and Customary Charges, up to the policy year maximum:

*      60% - First Policy Year
*      70% - Second Policy Year
*      80% - Third Policy Year and thereafter

Applicants can choose:

*    $1,000
*    $1,500
*    $2,000

Policy Year Maximum at the time of application. Some benefits are subject to a three month, a
six month or a one year waiting period.

Covered Immediately
*   Dental X-rays
*   Extractions (other than "full mouth")
*    Examinations
*    Fillings
*    periodontal Services

Deducible
Dental, Vision and Hearing Insurance includes a standard:
*      $100 Policy Year Deductible.

Acceptance
This Policy is issued individually. Premiums are determined according to the age of the
applicant and the benefit selected.

Guaranteed Renewable
Medico doesn't charge a policy fee and although some limitations do apply, your acceptance
in this program is guaranteed. We cannot refuse to renew your policy for any reason if your
premium are paid on time.

Monthly Premium

Age                                    Premium*
18 - 39                               $20
40 - 59                               $23
60 - 69                               $26
70 - 79                               $29
80 - 84                               $30

* premium are subject to change. Premium rates shown above were approved in Arizona on
10/29/2010, based on $1,000 policy Year Maximum.


OTHER IMPORTANT BENEFITS             

30-Day Right To Examine
You have 30 days after you receive the Policy to examine it and return it to Medico or the
producer if you are dissatisfied. Medico will ten refund the premium you paid and void the
policy.

SAVE 10% When you apply with a co-applicant!
(A co-applicant is someone who lives at the same address as you.)


Exceptions and Limitations
Medico will NOT pay benefits for the following items and/or services during the first three
months following the Police Date:
1.        Dental cleanings.

Medico will NOT pay benefits for the following items and/or services during the first six
months following the Policy Date:
1.         Root canals; or
2.         Existing eyeglasses or contact lenses (including the renewal or changing
of                                  prescriptions.)

Medico will NOT pay benefits for the following items and/or services during the first policy
Year.
1.        Bridges, crowns, full dentures or partials, any work relating to replacement of
natural                 teeth which were missing at the time coverage becomes effective, "full
mouth"                             extractions or fluoride treatments;
2.        Hearing aids; or
3.        Outpatient dental surgery prescribed as Medically Necessary.

Medico will NOT pay benefits for:
1.        Any loss resulting from war, declared or undeclared;
2.        Any intentionally self-inflicted injury;
3.        Any loss to which a contributing cause was your commission of or attempt to commit
a              felony or your being engaged in an illegal occupation;
4.        Any expense for which payment is provided under Medicare;
5.        Any Services that are not recommended by a physician, as defined by this policy;
6.        Any Experimental or Investigational Procedure or treatment;
7.        Orthodontic treatment or dental implants;
8.        Any expenses incurred for the diagnosis or treatment of temporomandlar joint
disorder              (TM), unless benefits are otherwise required by your state;
9.        Expenses incurred for surgical procedures (other than outpatient dental
surgery                           following the first policy year) performed on an inpatient or out patient
basis( including              any surgical procedure performed in the treatment  of
cataracts);                                     10.      Changes for radial keratotomy (RK). automated lamellar
keratoplasty (AKL),                                  condductive kerratoplasty (CK) or other cosmetic
procedures.
11.      Prescription drugs;
12.      Charges in excess of Reasonable and Customary Charges;
13.       Treatment  or diagnosis received while outside the territorial limits of the
United                          States.
14.       Services for which you are not liable or for which no charge normally is made in
the                     absence of insurance; and
15.       loss that occurs while this policy is not in force.

Choose Any Provider:
No Network:

Who is Eligible?
anyone age 18-84:

Save 10% when you apply with a
co-applicant,
Co- applicant is someone who lives at the same address as your)