AF™ Limited Bene昀椀t Individual Cancer Insurance Riders Critical Illness Rider Hospital Intensive Care Unit Rider Limitations and Exclusions Benefits will only be paid for a Limitations and Exclusions No benefits will be provided during Covered Critical Illness as shown on the Policy Schedule page in the first two years of the rider for Hospital Intensive Care Unit the policy. No benefits will be provided for any loss caused by or confinement caused by any heart condition when any heart resulting from: intentionally self-inflicted bodily injury, suicide condition was diagnosed or treated prior to the Covered Person’s or attempted suicide, whether sane or insane; or intentional self- Effective Date of the rider (The heart condition causing the injury; or alcoholism or drug addiction; or any act of war, declared confinement need not be the same condition diagnosed or or undeclared or any act related to war; or military service for any treated prior to the Effective Date.). No benefits will be provided country at war; or a Pre-Existing Condition during the 12 month if the loss results from: attempted suicide whether sane or period following the Covered Person’s Effective Date under the insane; intentional self–injury; alcoholism or drug addiction; rider; or participation in any activity or event while intoxicated or any act of war, declared or undeclared, or any act related to or under the influence of any narcotic unless administered by a war; or military service for any country at war. No benefits will Physician or taken according to the Physician’s instructions; or be paid for confinements in units such as: Surgical Recovery participation in, or attempting to participate in, a felony, riot or Rooms, Progressive Care, Burn Units, Intermediate Care, Private insurrection (A felony is as defined by the law of the jurisdiction in Monitored Rooms, Observation Units, Telemetry Units or which the activity takes place.) All Critical Illness amounts reduce Psychiatric Units not involving intensive medical care; or other by 50% at age 70. facilities which do not meet the standards for Intensive Care Unit Pre-Existing Condition As defined in this rider means any as defined in the Rider. All ICU and Ambulance amounts reduce sickness or condition for which, within 12 months prior to the by 50% at age 70. Effective Date of coverage under this rider, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession.) Internal Cancer does not include: other conditions that may be considered pre–cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non–malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non–malignant monoclonal gamopathy; or pre–malignant lesions, benign tumors or polyps; or Leukoplakia; or Hyperplasia; or Carcinoid; or Polycythemia; or cancer in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper.. Heart Attack does not include congestive heart failure, atherosclerotic heart disease, angina, including unstable angina, coronary disease or any other dysfunction of the cardiovascular system. Stroke does not mean a head injury, transient ischemic attack, multi-infarct dementia, or chronic cerebrovascular insufficiency. Termination Each Covered Person’s coverage will terminate when the maximum benefit amount for the Covered Critical Illness(es) has been paid for him/her. This insert must be used in conjunction with SB-30641 and any state specific deviations thereof. This is a brief description of the coverage. For complete benefits American Fidelity Assurance Company and other provisions, please refer to the policy and riders. This 9000 Cameron Parkway, Oklahoma City, Oklahoma 73114 coverage does not replace Workers’ Compensation Insurance. These products are inappropriate for people who are 800-662-1113 • americanfidelity.com eligible for Medicaid Coverage. SB-32507(IN)(AFES)-1019 Policy Form Series AMDI239 and AMDI240 Plan Code 013-776, 013-777, and 013-769