means you are prevented from engaging in substantially all of the normal activities of a person of like age and sex who is in good health, solely because of an injury or illness or disease. Three things must be true for benefits to continue: • The reason for your total disability was an illness, injury, or physical disability that occurred while this coverage was in effect. • On the date coverage would otherwise end, you are incurring a “continuous loss.” “Continuous loss" means you are continuously confined in a medical facility and admission occurred while your coverage was in force; or you are under a written plan of treatment prescribed by a physician which commenced while your coverage was in force, and you are receiving covered services in said plan one or more times per week. Your receipt of Medicare Part D benefits will not be considered in determining a continuous loss. When the above three things are true, contract benefits will remain available solely for the above continuous loss and only until the first of the following occurs: • You are no longer confined in an inpatient facility. • You are no longer totally disabled. • You cease to experience the continuous loss. • The maximum benefits of this plan have been provided. • Six months of extended benefits have been provided. • You become covered for the disabling condition under another Medicare supplement plan. Within 90 days after coverage under this plan ends, you must certify your total disability and continuous loss in writing by providing us with a statement of disability and a plan of treatment from your physician. Furthermore, we reserve the right to require you or your physician to provide any medical records or documents which are necessary to verify your total disability and continuous loss. YOUR CLAIMS FOR BENEFITS How To File A Claim Before your claims are filed with us, they should first be filed with and processed by Medicare. In most cases, federal law requires your provider of care to file your claim for you. However, in the event you must file the claim yourself, here are the items you must send us: • A copy of your Medicare Summary Notice; • A completed claim form obtained from us or a copy of the itemized bill. The bill must contain at least the following information: • Your name • Your subscriber identification number • Name, address, and I.R.S. tax identification number of the provider 9 Group Plan G/Age