Hospital Indemnity Insurance

A昀氀ac Group Hospital Indemnity INSURANCE Even a small trip to the hospital can have a major impact on your 昀椀nances. Here’s a way to help make your visit a little more affordable. ® AG80075H R7 IV (12/19)

AFLAC GROUP HOSPITAL INDEMNITY G Policy Series C80000 HI The plan that can help with expenses and protect your savings. Does your major medical insurance cover all of your bills? Even a minor trip to the hospital can present you with unexpected expenses and medical bills. And even with major medical insurance, your plan may only pay a portion of your entire stay. That’s how the A昀氀ac Group Hospital Indemnity plan can help. It provides 昀椀nancial assistance to enhance your current coverage. It may help avoid dipping into savings or having to borrow to address out-of-pocket-expenses major medical insurance was never intended to cover. Like transportation and meals for family members, help with child care, or time away from work, for instance. The A昀氀ac Group Hospital Indemnity plan bene昀椀ts include the following: • Hospital Con昀椀nement Bene昀椀t • Hospital Admission Bene昀椀t • Hospital Intensive Care Bene昀椀t • Intermediate Intensive Care Step-Down Unit • Successor Insured Bene昀椀t How it works The The insured The The insured The A昀氀ac Group Hospital Indemnity A昀氀ac Group has a high physician is released plan pays Hospital Indemnity fever and admits the after two plan is selected. goes to the insured into days. emergency the hospital. room. $2,400 Amount payable was generated based on bene昀椀t amounts for: Hospital Admission ($2,000), and Hospital Con昀椀nement ($200 per day). The plan has limitations and exclusions that may affect bene昀椀ts payable. This brochure is for illustrative purposes only. Refer to your certi昀椀cate for complete details, de昀椀nitions, limitations, and exclusions.

G Bene昀椀ts Overview BENEFIT AMOUNT HI HOSPITAL ADMISSION BENEFIT per con昀椀nement (once per covered sickness or accident per calendar year for each insured) Payable when an insured is admitted to a hospital and con昀椀ned as an inpatient because of a covered accidental injury or covered sickness. We will not pay bene昀椀ts for con昀椀nement to an observation unit, or for emergency room treatment or outpatient treatment. $2,000 We will not pay bene昀椀ts for admission of a newborn child following his birth; however, we will pay for a newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is con昀椀ned as an inpatient as a result of a covered accidental injury or covered sickness (including congenital defects, birth abnormalities, and/or premature birth). HOSPITAL CONFINEMENT per day (maximum of 31 days per con昀椀nement for each covered sickness or accident for each insured) Payable for each day that an insured is con昀椀ned to a hospital as an inpatient as the result of a covered accidental injury or covered sickness. If we pay bene昀椀ts for con昀椀nement and the insured becomes con昀椀ned $200 again within six months because of the same or related condition, we will treat this con昀椀nement as the same period of con昀椀nement. This bene昀椀t is payable for only one hospital con昀椀nement at a time even if caused by more than one covered accidental injury, more than one covered sickness, or a covered accidental injury and a covered sickness. HOSPITAL INTENSIVE CARE BENEFIT per day (maximum of 10 days per con昀椀nement for each covered sickness or accident for each insured) Payable for each day when an insured is con昀椀ned in a Hospital Intensive Care Unit because of a covered accidental injury or covered sickness. We will pay bene昀椀ts for only one con昀椀nement in a Hospital's Intensive $200 Care Unit at a time. Once bene昀椀ts are paid, if an insured becomes con昀椀ned to a Hospital's Intensive Care Unit again within six months because of the same or related condition, we will treat this con昀椀nement as the same period of con昀椀nement. This bene昀椀t is payable in addition to the Hospital Con昀椀nement Bene昀椀t. INTERMEDIATE INTENSIVE CARE STEP-DOWN UNIT per day (maximum of 10 days per con昀椀nement for each covered sickness or accident for each insured) Payable for each day when an insured is con昀椀ned in an Intermediate Intensive Care Step-Down Unit because of a covered accidental injury or covered sickness. We will pay bene昀椀ts for only one con昀椀nement in an Intermediate Intensive Care Step-Down Unit at a time. $100 Once bene昀椀ts are paid, if an insured becomes con昀椀ned to a Hospital's Intermediate Intensive Care Step- Down Unit again within six months because of the same or related condition, we will treat this con昀椀nement as the same period of con昀椀nement. This bene昀椀t is payable in addition to the Hospital Con昀椀nement Bene昀椀t. SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time. In order to receive bene昀椀ts for accidental injuries due to a covered accident, an insured must be admitted within six months of the date of the covered accident (in Washington, twelve months). LIMITATIONS AND EXCLUSIONS military, armed forces, or an auxiliary unit thereto. (We will return the prorated EXCLUSIONS premium for any period not covered by the certi昀椀cate when the insured is in We will not pay for loss due to: such service.) War does not include acts of terrorism. • War – voluntarily participating in war, any act of war, or military con昀氀icts, declared or • Suicide – committing or attempting to commit suicide, while sane or insane. undeclared, or voluntarily participating or serving in the military, armed forces, or an − In Missouri, Montana, and Vermont: committing or attempting to commit suicide, auxiliary unit thereto, or contracting with any country or international authority. (We while sane. will return the prorated premium for any period not covered by the certi昀椀cate when − In Minnesota: this exclusion does not apply. the insured is in such service.) War also includes voluntary participation (In North • Self-In昀氀icted Injuries – injuring or attempting to injure oneself intentionally. Carolina, active participation) in an insurrection, riot, civil commotion or civil state of − In Missouri: injuring or attempting to injure oneself intentionally which is belligerence. War does not include acts of terrorism (except in Illinois). obviously not an attempted suicide. − In Connecticut: a riot is not excluded. − In Vermont: injuring or attempting to injure oneself intentionally, while sane. − In Oklahoma: War, or any act of war, declared or undeclared, when serving in the

• Racing – riding in or driving any motor-driven vehicle in a race, stunt show or speed Doctor is a person who is duly quali昀椀ed as a practitioner of the healing arts acting within test in a professional or semi-professional capacity. the scope of his license, and: is licensed to practice medicine; prescribe and administer • Illegal Occupation – voluntarily participating in, committing, or attempting to commit drugs; or to perform surgery, or is a duly quali昀椀ed medical practitioner according to the a felony or illegal act or activity, or voluntarily working at, or being engaged in, an laws and regulations in the state in which treatment is made. illegal occupation or job. In Montana: For purposes of treatment, the insured has full freedom of choice in the − In Connecticut: voluntarily participating in, committing, or attempting to commit selection of any licensed physician, physician assistant, dentist, osteopath, chiropractor, a felony. optometrist, podiatrist, licensed social worker, psychologist, licensed professional − In Illinois: committing or attempting to commit a felony or being engaged in an counselor, acupuncturist, naturopathic physician, physical therapist, or advanced illegal occupation. practice registered nurse. − In Nebraska and Tennessee: voluntarily participating in, committing, or A Doctor does not include you or any of your Family Members. For the purposes of attempting to commit a felony or voluntarily working at, or being engaged in, an this de昀椀nition, Family Member includes your spouse as well as the following members illegal occupation or job. of your immediate family: son, daughter, mother, father, sister, or brother. In Arizona, − In Pennsylvania: committing or attempting to commit a felony, or being engaged however, a doctor who is your family member may treat you. In South Dakota, however, in an illegal occupation. a doctor who is your family member may treat you if that doctor is the only doctor in the − In South Dakota: voluntarily committing a felony. area and acts within the scope of his or her practice. • Sports – participating in any organized sport in a professional or semi-professional A Hospital is not a nursing home; an extended care facility; a skilled nursing facility; capacity. a rest home or home for the aged; a rehabilitation facility; a facility for the treatment of alcoholism or drug addiction (except in Vermont); an assisted living facility; or any • Custodial Care – this is non-medical care that helps individuals with the basic tasks facility not meeting the de昀椀nition of a Hospital as de昀椀ned in the certi昀椀cate. of everyday life, the preparation of special diets, and the self-administration of A Hospital Intensive Care Unit is not any of the following step-down units: a progressive medication which does not require the constant attention of medical personnel. care unit; a sub-acute intensive care unit; an intermediate care unit; a private monitored • Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any room; a surgical recovery room; an observation unit; or any facility not meeting the related procedures, including any resulting complications. de昀椀nition of a Hospital Intensive Care Unit as de昀椀ned in the certi昀椀cate • Services performed by a family member. Sickness means an illness, infection, disease, or any other abnormal physical condition − In Arizona: this exclusion does not apply. or pregnancy that is not caused solely by, or the result of, any injury (In Maine, illness or − In South Dakota: this exclusion does not apply. disease of an insured). A Covered Sickness is one that is not excluded by name, speci昀椀c • Services related to sex or gender change, sterilization, in vitro fertilization, vasectomy description, or any other provision in this plan. For a bene昀椀t to be payable, loss arising or reversal of a vasectomy, or tubal ligation. from the covered sickness must occur while the applicable insured’s coverage is in − In Washington D.C. and Washington: Services related to sterilization, in vitro force (except in Montana). fertilization, vasectomy or reversal of a vasectomy, or tubal ligation. Treatment is the consultation, care, or services provided by a doctor. This includes • Elective Abortion – an abortion for any reason other than to preserve the life of the receiving any diagnostic measures and taking prescribed drugs and medicines. person upon whom the abortion is performed. Treatment does not include telemedicine services (except in Kansas). − In Tennessee, or if the pregnancy was the result of rape or incest, or if You May Continue Your Coverage the fetus is non-viable. Your coverage may be continued with certain stipulations. See certi昀椀cate for details. • Dental Services or Treatment. Termination of Coverage • Cosmetic Surgery, except when due to: Your insurance may terminate when the plan is terminated; the 31st day after the − Reconstructive surgery, when the service is related to or follows surgery premium due date if the premium has not been paid; or the date you no longer belong resulting from a Covered Accidental Injury or a Covered Sickness, or is related to to an eligible class. If your coverage terminates, we will provide bene昀椀ts for valid claims or results from a congenital disease or anomaly of a covered dependent child. that arose while your coverage was in force. See certi昀椀cate for details. − Congenital defects in newborns. NOTICES If this coverage will replace any existing individual policy, please be aware that TERMS YOU NEED TO KNOW it may be in your best interest to maintain your individual guaranteed-renewable A Covered Accident is an accident that occurs on or after an insured’s effective date policy. while coverage is in force, and that is not speci昀椀cally excluded by the plan. Notice to Consumer: The coverages provided by Continental American Dependent means your spouse or dependent children, as de昀椀ned in the applicable rider, Insurance Company (CAIC) represent supplemental bene昀椀ts only. They do not who have been accepted for coverage. Spouse is your legal wife, husband, or partner in constitute comprehensive health insurance coverage and do not satisfy the a legally recognized union. Refer to your certi昀椀cate for details. requirement of minimum essential coverage under the Affordable Care Act. Dependent Children are your or your spouse’s natural children, step-children, CAIC coverage is not intended to replace or be issued in lieu of major medical grandchildren who are in your legal custody and residing with you, foster children, coverage. It is designed to supplement a major medical program. children subject to legal guardianship, legally adopted children (in Texas, adopted For more information, ask your insurance agent/producer, call 1.800.433.3036, children), or children placed for adoption. (In Florida, coverage may be provided for the or visit a昀氀acgroupinsurance.com. children of custodial and non-custodial parents.) Newborn children are automatically covered from the moment of birth for 60 days. Newly adopted children (and foster children in North Carolina) are automatically covered for 60 days also. See certi昀椀cate for details. Dependent children must be younger than age 26 (In Arizona, on the ef昀椀ctive date of coverage and in Louisiana and Illinois, unmarried). See certi昀椀cate for details. 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. 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. Benefits, terms, and conditions may vary by state. This brochure is subject to the terms, conditions, and limitations of Policy Series C80000. In Arkansas, C80100AR. In Oklahoma, C80100OK. In Oregon, C80100OR. In Pennsylvania, C80100PA. In Texas, C80100TX. In Virginia, C80100VA.

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE G Policy Series C80000 HI BUILDING BENEFIT RIDER SUMMARY 10% increase to Hospital Confinement, Hospital Intensive Care and Intermediate Intensive Care Step-Down Unit Benefits Hospital Confinement, Hospital Intensive Care and Intermediate Intensive Care Step-Down Unit Benefits increase by 10% each year for the first 5 years of coverage. This increase is automatic and requires no medical evidence of insurability. Premiums do not increase each year as the benefit increases. For a complete list of limitations and exclusions please refer to the brochure. Continental American Insurance Company (CAIC), a proud member of the A昀氀ac family of insurers, is a wholly-owned subsidiary of A昀氀ac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AG80075BBR R1 IV (2/16)

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE G Policy Series C80000 HI INPATIENT AND OUTPATIENT SURGICAL BENEFITS BENEFIT AMOUNT INPATIENT SURGERY AND ANESTHESIA (performed in hospital or ambulatory surgical center) Payable for each day that, due to a covered accidental injury or sickness, an insured has an inpatient $750 surgical procedure performed by a doctor. The surgery must be performed while the insured is con昀椀ned to a hospital as an inpatient. OUTPATIENT SURGERY AND ANESTHESIA (performed in hospital or ambulatory surgical center) Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient $500 surgical procedure performed by a doctor in a hospital on an outpatient basis or ambulatory surgical center. FACILITIES FEE FOR OUTPATIENT SURGERY (performed in hospital or ambulatory surgical center) Payable if due to a covered accidental injury or sickness: · An insured has an outpatient surgical procedure performed in an ambulatory surgical center or in a $100 hospital on an outpatient basis, and · The insured receives an Outpatient Surgery and Anesthesia Benefit under this plan. OUTPATIENT SURGERY AND ANESTHESIA (performed in a doctor’s of昀椀ce, urgent care facility or emergency room; maximum of 4 procedures per calendar year for each insured) $50 Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient surgical procedure performed by a doctor in a doctor’s of昀椀ce or urgent care facility. Residents of Massachusetts are not eligible for these bene昀椀ts. TERMS YOU NEED TO KNOW Ambulatory Surgical Center is defined as a licensed surgical center consisting of an operating room; facilities for the administration of general anesthesia; and a post-surgery recovery room in which the patient is admitted and discharged within a period of less than 24 hours. Urgent Care is a walk-in clinic that delivers ambulatory, outpatient care in a dedicated medical facility for illnesses or injuries that require immediate care but that are not serious enough to require a visit to an emergency room. For a complete list of limitations and exclusions please refer to the brochure. Continental American Insurance Company (CAIC), a proud member of the A昀氀ac family of insurers, is a wholly-owned subsidiary of A昀氀ac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AG80075IOPH R1 IV (2/16)

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE G Policy Series C80000 HI BENEFIT TREATMENT BENEFITS AMOUNT OUTPATIENT DOCTOR’S OFFICE VISIT (maximum of 6 visits per calendar year for each insured) We will pay the amount shown for each day that an insured visits a doctor’s of昀椀ce. This bene昀椀t is not payable for visits to $50 a chiropractor’s of昀椀ce. TELEMEDICINE SERVICES (maximum of 6 per calendar year for each insured) We will pay the bene昀椀t amount shown for each day that, because of a covered accidental injury or covered sickness, an $20 insured seeks medical advice from a doctor via telemedicine services. The telemedicine services must be provided in lieu of an outpatient doctor’s of昀椀ce visit. CHIROPRACTOR VISIT (maximum of 4 visits per calendar year for each insured) We will pay the amount shown for each day that an insured receives services from a chiropractor for treatment of a $30 covered accidental injury or because of a covered sickness. Visits to a chiropractor’s of昀椀ce are not payable under the outpatient doctor’s of昀椀ce visit bene昀椀t. MAJOR DIAGNOSTIC EXAMS (once per covered sickness or accident per calendar year) We will pay the amount shown for each day that, due to a covered accidental injury or covered sickness, an insured requires one of the following exams: · Computerized Tomography (CT/CAT scan) $200 · Magnetic Resonance Imaging (MRI) · Electroencephalography (EEG) OUT OF HOSPITAL PRESCRIPTION DRUG (maximum of $100 per calendar year for each insured) We will pay the amount shown for each day an insured has a prescription 昀椀lled. Prescription drugs must meet three criteria: (1) be ordered by a doctor; (2) be dispensed by a licensed pharmacist; and (3) be medically necessary for the care and treatment of the insured. $20 This bene昀椀t does not include bene昀椀ts for: (a) therapeutic devices or appliances; (b) experimental drugs; (c) drugs, medicines or insulin used by or administered to a person while he is con昀椀ned to a hospital, rest home, extended-care facility, convalescent home, nursing home or similar institution; (d) immunization agents, biological sera, blood or blood plasma; or (e) contraceptive materials, devices or medications or infertility medication, except where required by law. HOSPITAL EMERGENCY ROOM VISIT (maximum of 5 visits per calendar year for each insured) We will pay the amount shown for each day that an insured visits a hospital emergency room due to a covered accidental $125 injury or for treatment due to a covered sickness. EMERGENCY ROOM OBSERVATION (1 visit for each covered sickness or accident per calendar year, maximum of 5 total visits per calendar year $150 for each insured) Each 24 hour We will pay the amount shown for each period of observation that, because of a covered accidental injury or covered period sickness, an insured: $75 · Receives treatment in a hospital emergency room, and Less than 24 · Is held in a hospital for observation without being admitted as an inpatient. hours, but at least 4 hours REHABILITATION FACILITY per day (maximum of 15 days per con昀椀nement, no more than 30 days total per calendar year for each insured) We will pay the amount shown for each day that, due to a covered accidental injury or a covered sickness, an insured receives treatment as an inpatient at a rehabilitation facility. For this bene昀椀t to be payable, the insured must be transferred $100 to the rehabilitation facility for treatment following an inpatient hospital con昀椀nement. We will not pay the rehabilitation facility bene昀椀t for the same days that the hospital con昀椀nement bene昀椀t is paid. AG80075TH R2 IV (1/19)

Residents of Massachusetts are not eligible for these bene昀椀ts. TERMS YOU NEED TO KNOW Chiropractor means a person, other than the insured or the insured’s family member, who • Is licensed as a chiropractor in the state in which treatment is received, and • While working under the scope of his license, uses manual or mechanical means to detect or correct disorders of structural imbalance, distortion, or subluxation of the musculoskeletal system and the nervous system for the purpose of removing nerve interference and related effects. The interference must result from or relate to distortion, misalignment, or subluxation of or in the vertebral column. Rehabilitation Facility is a unit or facility providing coordinated multidisciplinary physical restorative services. These services must be provided to inpatients under a doctor’s direction. The doctor must be knowledgeable and experienced in rehabilitative medicine. Beds must be set up in a unit or facility specifically designated and staffed for this service. This is not a facility for the treatment of alcoholism or drug addiction (except in Vermont). Telemedicine Service means a medical inquiry with a doctor via audio or video communication that assists with a patient’s assessment, diagnosis, and consultation. Observation Unit means a unit in which observation services are given through hospital outpatient services to help the doctor decide if the patient needs to be admitted as an inpatient or can be discharged. Observation services may be given in the emergency department or another area of the hospital. For a complete list of limitations and exclusions please refer to the brochure. Continental American Insurance Company (CAIC), a proud member of the A昀氀ac family of insurers, is a wholly-owned subsidiary of A昀氀ac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. This piece is intended to be used in conjunction with the product brochure for Policy Series C80000 and is subject to the terms, conditions, and limitations of the plan. Continental American Insurance Company • Columbia, South Carolina