Group Critical Illness IN

Group Critical Illness / Limited Bene昀椀t Group Critical Illness Group Critical Illness Insurance Limited Benefit Group Critical Illness This brochure highlights important features of the policy. Please refer to your certificate for complete details. This brochure highlights important features of the policy. Please refer to your certificate for complete details. EMPLOYER BENEFIT SOLUTIONS FOR EDUCATION

Group Critical Illness Insurance Critical Illness insurance is here for you. Surviving a critical illness, such as a heart attack or stroke, is becoming increasingly common with new medical technology. However, with advances in technology to treat these diseases, the cost of treatment rises more and more every year. Although many medical plans provide coverage for hospital stays and medical expenses arising from a critical illness, there are still out-of-pocket expenses that can affect anyone’s finances. Co-pays, transportation expenses, and lost income should be the last thing you or your family worries about if a critical illness were to occur. American Fidelity Assurance Company’s Limited Benefit Group Critical Illness Insurance can help cover your out-of-pocket medical expenses and allow your family to focus on recovery. About every 40 seconds, an American will suffer a heart attack.2 American Fidelity’s Group Critical Illness Insurance can help with the rising cost of treatment for a covered Critical Illness such as heart attack or stroke. 17% of total healthcare costs are paid out-of-pocket.1 How It Works If you are diagnosed with a covered Critical Illness, WELLNESS SCREENING BENEFIT such as a heart attack or stroke, this plan is designed This benefit covers several qualified tests, to pay a lump sum benefit amount to help cover including, but not limited to, expenses. In addition, certain specified Critical Illnesses that reoccur will allow for an additional benefit. • Electrocardiogram (EKG) • Stress Test American Fidelity’s Critical Illness Insurance features: • Blood Glucose Testing • Echocardiogram • Benefits paid directly to you, to be used however you see fit. HEALTH SCREENING BENEFIT • No required medical exams as part (per calendar year per of the application process. Covered Employee and Covered Spouse) • Guaranteed Issue benefit amounts may be available $50 for first time eligible employees and spouse. • Extends coverage to dependent children at no additional cost. If you reside in a state other than your employer’s • Compatible with a Health Savings Account. state of domicile, where required by law, policy provisions and benefits may vary. Coverage is available for you and your lawful spouse at determined benefit amounts and for your eligible child(ren), as defined in the policy, at 25% of the employees benefit amount. 1 2017 Milliman Medical Index; May 2017, p.9. 2 American Heart Association: Heart Disease and Stroke Statistics 2017 At-a-Glance, p.2 September 2017.

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.

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

SPECIALIZING IN SUPPLEMENTAL BENEFITS FOR EDUCATION Limited Bene昀椀t Group Critical Illness / Rate Insert Group Critical Illness Insurance Limited Benefit Group Critical Illness Extends coverage to dependent children at no additional cost. EMPLOYEE MONTHLY RATES $10,000 $20,000 $30,000 AGE Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco 18-29 $3.98 $6.30 $6.46 $11.10 $8.94 $15.90 30-39 $6.26 $9.90 $11.02 $18.30 $15.78 $26.70 40-49 $11.38 $17.98 $21.26 $34.46 $31.14 $50.94 50-59 $18.74 $29.66 $35.98 $57.82 $53.22 $85.98 60 & Over $30.66 $48.58 $59.82 $95.66 $88.98 $142.74 SPOUSE MONTHLY RATES $5,000 $10,000 $15,000 AGE Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco 18-29 $2.40 $4.18 $3.30 $6.86 $4.20 $9.54 30-39 $3.76 $6.58 $6.02 $11.66 $8.28 $16.74 40-49 $6.84 $11.96 $12.18 $22.42 $17.52 $32.88 50-59 $11.30 $19.74 $21.10 $37.98 $30.90 $56.22 60-69 $18.50 $32.32 $35.50 $63.14 $52.50 $93.96 9000 Cameron Parkway • Oklahoma City, Oklahoma 73114 800-654-8489 • americanfidelity.com This insert must be used in conjunction with SB-30453(GCI without Cancer) and any state specific deviations thereof. Marketed by American Fidelity Assurance Company G925 Series AFES SB-30454(GCI without Cancer)(Rate Insert)-0318 EMPLOYER BENEFIT SOLUTIONS FOR EDUCATION