Critical Illness Insurance
A昀氀ac Group Critical Illness INSURANCE – PLAN INCLUDES BENEFITS FOR CANCER AND HEALTH SCREENING We help take care of your expenses while you take care of yourself. ® AG210751 R5 IV (12/19)
G AFLAC GROUP CRITICAL ILLNESS CI A昀氀ac can help ease the 昀椀nancial stress of surviving a critical illness. Chances are you may know someone who’s been diagnosed with a critical illness. You can’t help notice the difference in the person’s life—both physically and emotionally. What’s not so obvious is the impact a critical illness may have on someone’s personal 昀椀nances. That’s because while a major medical plan may pay for a good portion of the costs associated with a critical illness, there are a lot of expenses that may not be covered. And, during recovery, having to worry about out-of-pocket expenses is the last thing anyone needs. That’s the bene昀椀t of an A昀氀ac Group Critical Illness plan. It can help with the treatment costs of covered critical illnesses, such as a heart attack or stroke. More importantly, the plan helps you focus on recuperation instead of the distraction of out-of-pocket costs. With the Critical Illness plan, you receive cash bene昀椀ts directly (unless otherwise assigned)—giving you the 昀氀exibility to help pay bills related to treatment or to help with everyday living expenses. What you need, when you need it. Group critical illness insurance pays cash bene昀椀ts that you can use any way you see 昀椀t. Coverage underwritten by Continental American Insurance Company (CAIC) A proud member of the Aflac family of insurers
G Here’s why the A昀氀ac For more than 60 years, A昀氀ac has been dedicated to helping provide individuals Group Critical Illness and families peace of mind and 昀椀nancial security when they’ve needed it most. plan may be right The A昀氀ac Group Critical Illness plan is just another innovative way to help make for you. sure you’re well protected. CI But it doesn’t stop there. Having group critical illness insurance from A昀氀ac means that you may have added 昀椀nancial resources to help with medical costs or ongoing living expenses. The A昀氀ac Group Critical Illness plan bene昀椀ts include: • Critical Illness Bene昀椀t payable for: – Cancer – Heart Attack (Myocardial Infarction) – Stroke – Kidney Failure (End-Stage Renal Failure) – Major Organ Transplant – Bone Marrow Transplant (Stem Cell Transplant) – Sudden Cardiac Arrest – Coronary Artery Bypass Surgery – Non-Invasive Cancer – Skin Cancer • Health Screening Bene昀椀t Features: • Bene昀椀ts are paid directly to you, unless otherwise assigned. • Coverage is available for you, your spouse, and dependent children. • Coverage may be continued (with certain stipulations). That means you can take it with you if you change jobs or retire. How it works A昀氀ac Group You experience A physician A昀氀ac Group Critical Illness pays Critical Illness chest pains You visit the determines an Initial Diagnosis Bene昀椀t of coverage is and numbness emergency that you have selected. in the left arm. room. suffered a heart attack. $10,000 Amount payable based on $10,000 Initial Diagnosis Bene昀椀t. For more information, ask your insurance agent/producer, call 1.800.433.3036, or visit a昀氀acgroupinsurance.com.
Bene昀椀ts Overview COVERED CRITICAL ILLNESSES: CANCER (Internal or Invasive) 100% HEART ATTACK (Myocardial Infarction) 100% STROKE (Ischemic or Hemorrhagic) 100% KIDNEY FAILURE (End-Stage Renal Failure) 100% BONE MARROW TRANSPLANT (Stem Cell Transplant) 100% SUDDEN CARDIAC ARREST 100% MAJOR ORGAN TRANSPLANT 100% (25% of this bene昀椀t is payable for insureds placed on a transplant list for a major organ transplant) NON-INVASIVE CANCER 25% CORONARY ARTERY BYPASS SURGERY 25% INITIAL DIAGNOSIS We will pay a lump sum bene昀椀t upon initial diagnosis of a covered critical illness when such diagnoses is caused by or solely attributed to an underlying disease. Cancer diagnoses are subject to the cancer diagnosis limitation. Bene昀椀ts will be based on the face amount in effect on the critical illness date of diagnosis. ADDITIONAL DIAGNOSIS We will pay bene昀椀ts for each different critical illness after the 昀椀rst when the two dates of diagnoses are separated by at least 6 consecutive months. Cancer diagnoses are subject to the cancer diagnosis limitation. REOCCURRENCE We will pay bene昀椀ts for the same critical illness after the 昀椀rst when the two dates of diagnoses are separated by at least 6 consecutive months. Cancer diagnoses are subject to the cancer diagnosis limitation. CHILD COVERAGE AT NO ADDITIONAL COST Each dependent child is covered at 50 percent of the primary insured’s bene昀椀t amount at no additional charge. Children-only coverage is not available. SKIN CANCER BENEFIT We will pay $250 for the diagnosis of skin cancer. We will pay this bene昀椀t once per calendar year. WAIVER OF PREMIUM If you become totally disabled due to a covered critical illness prior to age 65, after 90 continuous days of total disability, we will waive premiums for you and any of your covered dependents. As long as you remain totally disabled, premiums will be waived up to 24 months, subject to the terms of the plan. The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.
SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the primary insured’s death, the surviving spouse may elect to continue coverage. Coverage would continue at the existing spouse face amount and would also include any dependent child coverage in force at the time. HEALTH SCREENING BENEFIT (Employee and Spouse only) We will pay $50 for health screening tests performed while an insured’s coverage is in force. We will pay this bene昀椀t once per calendar year. This bene昀椀t is only payable for health screening tests performed as the result of preventive care, including tests and diagnostic procedures ordered in connection with routine examinations. This bene昀椀t is payable for the covered employee and spouse. This bene昀椀t is not paid for dependent children. The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.
All limitations and exclusions that apply to the critical illness plan also TERMS YOU NEED TO KNOW apply to all riders, if applicable, unless amended by the riders. The Bone Marrow Transplant (Stem Cell Transplant) bene昀椀t is not payable if LIMITATIONS AND EXCLUSIONS the transplant results from a covered critical illness for which a bene昀椀t has Cancer Diagnosis Limitation Bene昀椀ts are payable for cancer and/or been paid under this plan. noninvasive cancer as long as the insured: The following are not considered internal or invasive cancers: • Is treatment-free from cancer for at least 12 months before the • Pre-malignant tumors or polyps diagnosis date; and • Carcinomas in Situ • Is in complete remission prior to the date of a subsequent diagnosis, • Any super昀椀cial, non-invasive skin cancers including basal cell and as evidenced by the absence of all clinical, radiological, biological, and squamous cell carcinoma of the skin biochemical proof of the presence of the cancer. EXCLUSIONS • Melanoma in Situ • Melanoma that is diagnosed as We will not pay for loss due to: − Clark’s Level I or II, • Self-In昀氀icted Injuries – injuring or attempting to injure oneself − Breslow depth less than 0.77mm, or intentionally or taking action that causes oneself to become injured; − In Alaska: injuring or attempting to injure oneself intentionally − Stage 1A melanomas under TNM Staging • Suicide – committing or attempting to commit suicide, while sane or Skin cancers are not payable under the Cancer (internal or invasive) Bene昀椀t insane; or the Non-Invasive Cancer Bene昀椀t. The following are considered skin − In Illinois and Minnesota: this exclusion does not apply cancers: • Illegal Acts – participating or attempting to participate in an illegal • Basal cell carcinoma activity, or working at an illegal job: • Squamous cell carcinoma of the skin − In Arizona: participating in or attempting to commit a felony, or • Melanoma in Situ being engaged in an illegal occupation; • Melanoma that is diagnosed as − In Illinois and Pennsylvania: Illegal Occupation - committing or − Clark’s Level I or II, attempting to commit a felony or being engaged in an illegal occupation; − Breslow depth less than 0.77mm, or − In Michigan: Illegal Occupation – the commission of or attempt to − Stage 1A melanomas under TNM Staging commit a felony, or being engaged in an illegal occupation; Critical Illness is a disease or a sickness as de昀椀ned in the plan that 昀椀rst − In Nebraska: being engaged in an illegal occupation, or commission manifests while your coverage is in force. of or attempting to commit a felony; Date of Diagnosis is de昀椀ned as follows: − In Ohio: committing or attempting to commit a felony, or working at • Cancer: The day tissue specimens, blood samples, or titer(s) are an illegal job taken (diagnosis of cancer and/or carcinoma in situ is based on such • Participation in Aggressive Con昀氀ict: specimens). − War (declared or undeclared) or military con昀氀icts; In Oklahoma: • Non-Invasive Cancer: The day tissue specimens, blood samples, or War, or act of war, declared or undeclared when serving in the titer(s) are taken (diagnosis of cancer and/or carcinoma in situ is based military service or an auxiliary unit thereto on such specimens). − Insurrection or riot • Skin Cancer: The date the skin biopsy samples are taken for − Civil commotion or civil state of belligerence microscopic examination. • Illegal Substance Abuse: • Bone Marrow Transplant (Stem Cell Transplant): The date the surgery − Abuse of legally-obtained prescription medication occurs. − Illegal use of non-prescription drugs • Coronary Artery Bypass Surgery: The date the surgery occurs. − In Arizona: Being intoxicated or under the in昀氀uence of any narcotic • Heart Attack (Myocardial Infarction): The date the infarction (death) of a unless administered on the advice of a physician portion of the heart muscle occurs. This is based on the criteria listed under the heart attack (myocardial Infarction) de昀椀nition. − In Michigan, Nevada, and South Dakota: this exclusion does not • Kidney Failure (End-Stage Renal Failure): The date a doctor apply recommends that an insured begin renal dialysis. Diagnosis, treatment, testing, and con昀椀nement must be in the United • Major Organ Transplant: The date the surgery occurs. States or its territories. • Stroke: The date the stroke occurs (based on documented neurological All bene昀椀ts under the plan, including bene昀椀ts for diagnoses, treatment, de昀椀cits and neuroimaging studies). con昀椀nement and covered tests, are payable only while coverage is in • Sudden Cardiac Arrest: The date the pumping action of the heart fails force. (based on the sudden cardiac arrest de昀椀nition).
Dependent means your spouse or your dependent child. Spouse is your caused by or contributed to by a heart attack (myocardial infarction). legal wife, husband, or partner in a legally recognized union. Dependent Treatment does not include maintenance drug therapy or routine follow-up children are your or your spouse’s natural children, step-children, foster visits to verify whether cancer or carcinoma in situ has returned. children, children subject to legal guardianship, legally adopted children, YOU MAY CONTINUE YOUR COVERAGE or children placed for adoption, who are younger than age 26 (In Arizona, on the effective date of coverage). Newborn children are automatically Your coverage may be continued with certain stipulations. See certi昀椀cate covered from the moment of birth. Refer to your certi昀椀cate for details. for details. A doctor does not include you or any of your family members. In Arizona, TERMINATION OF COVERAGE however, a doctor who is your family member may treat you. For the Your insurance may terminate when the plan is terminated; the 31st day purposes of this de昀椀nition, family member includes your spouse as well as after the premium due date if the premium has not been paid; or the date the following members of your immediate family: you no longer belong to an eligible class. If your coverage terminates, we • Son • Father will provide bene昀椀ts for valid claims that arose while your coverage was in • Daughter • Sister force. See certi昀椀cate for details. • Mother • Brother NOTICES This includes step-family members and family-members-in-law. If this coverage will replace any existing individual policy, please be aware Employee is a person who meets eligibility requirements and who is that it may be in your best interest to maintain your individual guaranteed- covered under the plan. The employee is the primary insured under the renewable policy. plan. Diagnosis of a Heart Attack (Myocardial Infarction) must include the following: • New and serial electrocardiographic (ECG) 昀椀ndings consistent with Notice to Consumer: The coverages provided by Continental heart attack (myocardial infarction), and American Insurance Company (CAIC) represent supplemental • Elevation of cardiac enzymes above generally accepted laboratory bene昀椀ts only. They do not constitute comprehensive health insurance levels of normal. (In the case of creatine physphokinase (CPK) a CPK- coverage and do not satisfy the requirement of minimum essential MB measurement must be used.) coverage under the Affordable Care Act. CAIC coverage is not Con昀椀rmatory imaging studies, such as thallium scans, MUGA scans, or intended to replace or be issued in lieu of major medical coverage. It stress echocardiograms may also be used. is designed to supplement a major medical program. Kidney Failure (End-Stage Renal Failure) is covered only under the following conditions: • A doctor advises that regular renal dialysis, hemo-dialysis, or peritoneal dialysis (at least weekly) is necessary to treat the kidney failure (end- stage renal failure); or • The kidney failure (end-stage renal failure) results in kidney transplantation. Maintenance Drug Therapy is meant to decrease the risk of cancer recurrence; it is not meant to treat a cancer that is still present. A Major Organ Transplant bene昀椀t is not payable if the major organ transplant results from a covered critical illness for which a bene昀椀t has been paid. Stroke does not include: • Transient Ischemic Attacks (TIAs) • Head injury • Chronic cerebrovascular insuf昀椀ciency • Reversible ischemic neurological de昀椀cits unless brain tissue damage is con昀椀rmed by neurological imaging Sudden Cardiac Arrest is not a heart attack (myocardial infarction). A sudden cardiac arrest bene昀椀t is not payable if the sudden cardiac arrest is
Continental American Insurance Company (CAIC ), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance Company • Columbia, South Carolina The certificate to which this sales material pertains may be written only in English; the certificate prevails if interpretation of this material varies. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. You’re welcome to request a full copy of the plan certificate through your employer or by reaching out to our Customer Service Center. This brochure is subject to the terms, conditions, and limitations of Policy Series C21000. In Arkansas, C21100AR. In Oklahoma, C21100OK. In Oregon, C21100OR. In Pennsylvania, C21100PA. In Texas, C21100TX.
