SB-33171(IN)(GCI without Cancer)-0421 CG925 Series This product may contain limitations, exclusions, and waiting periods. This product is inappropriate for people who are eligible for Medicaid coverage. This brochure highlights important features of the policy. Please refer to your certificate for complete details. Pre-Existing Condition Limitation No critical illness benefit will be payable for a critical illness which is caused by or resulting from a Pre-Existing Condition when the critical illness occurrence date occurs before a covered person has been continuously covered under the policy for 12 consecutive months. Pre-Existing Condition means a disease, accident, sickness, physical condition or mental illness for which a covered person has experienced any of the following: recieved treatment or received a diagnosis 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. A Heart Attack is an acute myocardial infarction due to coronary artery disease resulting in death of a portion of the heart muscle. Diagnosis must be supported by onset of new symptoms and any of the following: EKG changes, elevation of biochemical markers, or imaging studies, consistent with an acute myocardial infarction. In the event of death, an autopsy, medical examiner’s confirmation or death certificate identifying Heart Attack will be acceptable. Heart attack does not include congestive heart failure, atherosclerotic heart disease, angina, cardiac arrest, or any other disease or injury involving the cardiovascular system. Exclusions We will not pay benefits for any critical illness resulting from or Limitations and Exclusions caused, whether directly or indirectly, by: (a) An intentionally self-inflicted accident or sickness. (b) Suicide or attempted suicide, while sane or insane. (c) Participating in a riot, insurrection, rebellion, civil commotion, civil disobedience, or unlawful assembly. This does not include a loss which occurs while acting in a lawful manner within the scope of authority. (d) Being Intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions. Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the critical illness occurred. (e) Committing, or attempting to commit a felony. (f) Being incarcerated in any type of penal institution. (g) Alcoholism or drug addiction. (h) A diagnosis received outside the United States, or its territories, that cannot be confirmed by a physician licensed and practicing in the United States. Your coverage may be continued for up to 1 year during a leave of absence approved in writing by your employer. Coverage will continue as long as the group policy remains in force, the premiums are paid and you remain eligible for the coverage under the policy. Your coverage will end when you no longer qualify as an insured, you retire, you are not on active employment, or your employment terminates. Your coverage can be terminated or premiums may be increased on any premium due date with 31 days advance notice. Group Critical Illness Insurance American Fidelity Assurance Company 800-662-1113 • americanfidelity.com