Group Critical Illness Insurance Schedule of Benefits Knowing everyone’s financial situation is different, American Fidelity offers multiple lump sum benefit amounts. Depending on the plan selected by your employer, the following Benefit Amounts may be available. The Employee Benefit Amounts can range from $10,000, $20,000 or $30,000. If elected, Spousal Benefit Amounts will be 50% of the Employee Benefit Amount. Critical Illness Benefits Pays once per Covered Person for each Critical Illness shown below. Benefit Percentage Recurrent Diagnosis Benefit Heart Attack Benefit 100% 50% Pays full lump sum benefit amount. Coronary Artery Bypass Surgery Pays 25% of benefit amount. Payment will reduce the Heart Attack 25% - Benefit. Stroke Benefit (Permanent damage due to a Stroke) 100% 50% Pays full lump sum benefit amount. Paralysis Benefit (Permanent due to a Covered Accident) 100% Pays full lump sum benefit amount. - Major Organ Failure Benefit 100% 50% Pays full lump sum benefit amount. End Stage Renal Failure Benefit 100% Pays full lump sum benefit amount. - Plan Benefit Highlights Coronary Artery Bypass Surgery Wellness Screening Benefit Pays following open heart surgery performed by a Physician to Pays $50 when a Covered Employee or Covered Spouse receives a correct Coronary Artery Disease with bypass grafts. Coronary covered Health Screening Test. This benefit covers several qualified Artery Bypass Surgery does not include balloon angioplasty, tests, including, but not limited to: Blood test for triglycerides, Doppler laser angioplasty, stenting, valve replacement surgery, or ultrasound, Echocardiogram, Electrocardiogram (EKG), Fasting procedures other than Coronary Artery Bypass Surgery. blood glucose test, Serum cholesterol test to determine HDL and Stroke (Permanent Damage Due To A Stroke) LDL levels, Exercise or Pharmacologic stress test, and Neuroimaging Pays following permanent neurological damage to the brain due studies. This policy pays for one test per Covered Employee and to a Stroke which results from an acute or sub-acute interruption of one test per Covered Spouse per Calendar Year regardless of the blood flow to brain tissue as defined in the policy. Permanent Damage number of tests received during the Calendar Year. This benefit due to a Stroke does not include Transient Ischemic Attacks (TIA). is available without a diagnosis of a Critical Illness. This benefit does not reduce the Critical Illness lump sum benefit amount. Paralysis (Permanent Due To A Covered Accident) Critical Illness Benefit Injuries to the spinal cord due to a Covered Accident, which result in the loss of use of two or more limbs. Paralysis must Pays once per Covered Person for each Critical Illness. be diagnosed as permanent, total, and irreversible. Each Critical Illness must be separated by at least 90 days following the first Critical Illness Occurrence Date. Major Organ Failure Heart Attack Pays following the date the Covered Person is placed on the United Network for Organ Sharing (UNOS) list for a Pays following a Heart Attack due to Coronary Artery Disease. transplant of the heart, liver, lung, or entire pancreas. Any previous amounts paid for a Coronary Artery Bypass Surgery will be deducted from the amount payable under this benefit. End Stage Renal Failure A Heart Attack is not congestive heart failure, atherosclerotic Pays following the Occurrence Date of End Stage Renal Failure heart disease, angina, cardiac arrest, or any other disease resulting in irreversible failure of both kidneys to function and which or injury involving the cardiovascular system. requires regular dialysis or renal transplantation to sustain life.