Group Critical Illness / Limited Bene昀椀t Group Critical Illness Plan Benefit Highlights, continued Effective Date A Heart Attack is an acute Myocardial Infarction due to Coronary Certificates will become effective on the requested effective Artery Disease resulting in death of a portion of the heart muscle. date following the date we approve the application, providing Diagnosis must be supported by onset of new symptoms and any you are on Active Employment and premium has been paid. of the following: EKG changes, elevation of biochemical markers, Eligibility or imaging studies, consistent with an acute myocardial infarction. All permanent employees in the subscribing group In the event of death, an autopsy, medical examiner’s confirmation working 20 hours or more per week. or death certificate identifying Heart Attack will be acceptable. Recurrent Diagnosis Benefit Heart attack does not include congestive heart failure, Upon a second Occurrence of certain specified Critical Illnesses, this atherosclerotic heart disease, angina, cardiac arrest, or any benefit pays 50% of the amount previously paid under the policy. other disease or injury involving the cardiovascular system. Covered Critical Illness events include Heart Attack, Permanent Exclusions Damage Due To a Stroke, and Major Organ Failure. The second We will not pay benefits for any Critical Illness resulting from or Occurrence Date must be separated by at least 180 days following caused, whether directly or indirectly, by: (a) An intentionally self- the first Occurrence Date of that same Critical Illness. Once a inflicted Accident or Sickness. (b) Suicide or attempted suicide, while Recurrent Diagnosis Benefit has been paid for a Critical Illness, no sane or insane. (c) Participating in a riot, insurrection, rebellion, civil further benefits for that same Critical Illness will be payable. commotion, civil disobedience, or unlawful assembly. This does not Portability include a loss which occurs while acting in a lawful manner within the Upon becoming no longer eligible for coverage, you will have 30 days scope of authority. (d) Being intoxicated or under the influence of any to request continuation of coverage. Providing you pay premiums narcotic unless administered by a Physician or taken according to the when due, you may continue your coverage provided in this certificate Physician’s instructions. Intoxication means that which is determined upon leaving employment until the earliest of these dates: a) your and defined by the laws and jurisdiction of the geographical area in 75th birthday, b) 10 years from the portability effective date, c) the which the event that caused the Critical Illness occurred. (e) Committing, date the policy is terminated, or d) the date you fail to pay the required or attempting to commit a felony. (f) Being incarcerated in any type premium. You must have been continuously covered for 12 consecutive of penal institution. (g) Alcoholism or drug addiction. (h) A diagnosis months prior to the date your coverage under the Policy ends. received outside the United States, or its territories, that cannot be confirmed by a Physician licensed and practicing in the United States. Limitations and Exclusions Your coverage may be continued for up to 1 year during a leave Pre-Existing Condition Limitation of absence approved in writing by your employer. Coverage will continue as long as the group policy remains in force, the premiums No Critical Illness Benefit will be payable for a Critical Illness which is are paid and you remain eligible for the coverage under the policy. caused by or resulting from a Pre-Existing Condition when the Critical Your coverage will end when you no longer qualify as an insured, Illness Occurrence Date occurs before a Covered Person has been you retire, you are not on active employment, or your employment continuously covered under the Policy for 12 consecutive months. terminates. Your coverage can be terminated or premiums may be Pre-Existing Condition means a disease, Accident, Sickness, physical increased on any premium due date with 31 days advance notice. condition or mental illness for which a Covered Person has experienced This product is only offered on an after-tax basis. This product is any of the following: (a) received treatment; or (b) received a diagnosis inappropriate for people who are eligible for Medicaid coverage. or advice from a Physician, during the 12-month period immediately before the Covered Person’s Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Accident, Sickness, physical condition or mental illness. View and print your policies or file a claim at americanfidelity.com American Fidelity’s Online Service Center provides you convenient, secure access to manage your account. 9000 Cameron Parkway Oklahoma City, Oklahoma 73114 800-654-8489 americanfidelity.com SB-30453(IN)(GCI without Cancer)-0318 CG925 Series AFES