Cancer Income Protection Policy

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1 Cancer Income Protection Policy The Insurance Company of Scott & White offers peace of mind when the financial burden associated with cancer arises.

2 Cancer Income Protection Policy Fighting cancer takes more than strength and determination. It takes a financial strategy as well. Everyday living expenses don t stop when you get sick, so ICSW s cancer income protection plan can help you beat the financial difficulties you can face when dealing with medical expenses and lost income. This policy pays in addition to any other insurance you have in force. Enjoy peace of mind knowing that you can have access to a benefit of up to $5,000 in cash paid to you upon the initial diagnosis of cancer, and additional benefits. How the policy works First occurrence benefit: $5,000 lump sum benefit upon diagnosis of cancer Hospitalization benefit: $300/day for first 30 days, $600/day for days 31+ Radiation/chemotherapy: Surgical benefit: $300 a day Pays scheduled amounts based upon type of surgery See policy provisions for complete listing of benefits Additional cash benefits are payable for hospital confinement, radiation and chemotherapy, surgery and anesthesia, transportation and lodging, home health and hospice services. See the cancer income policy provisions for more details. Use the cash for anything you choose: Replacing any loss of income like unpaid leave Deductibles, coinsurance and co-payment under your major medical plan Everyday living expenses: mortgage, car payments, utility bills, child care, groceries, and credit card bills Experimental treatments Transportation and lodging expenses to and from treatment facilities Applying for coverage is easy just answer a few health questions. No medical exam is required. For more information go to or call us at

3 First-Occurrence Benefits Hospital Confinement Benefit Continuous confinement resulting from treatment of cancer. Radiation and Chemotherapy Benefit Not payable the same day that the Experimental Treatment Benefit is paid; limited to $300 per day. Anti-Nausea Benefit Policy Provisions $5,000 when diagnosed as having internal cancer. Includes melanomas classified as Clark s Level III and higher. Days 1-30 $300/day Days 31 or more $600/day Extended Care Facility $100/day Inpatient private nursing services $100/day Inpatient or Outpatient $300/day Self-injected or pump administered $300/script Oral Chemotherapy $1,200/month $100/month Anti nausea drugs prescribed while receiving radiation or chemotherapy treatments. Surgical/Anesthesia Benefit ICSW will pay the amount listed in the Schedule of Operations for the specific procedure completed. ICSW will pay 25% of the amount shown in the Schedule of Operations for the administration of anesthesia during a covered surgical operation. Maximum combined benefit of $6,250 per operation. Skin Cancer Surgery Benefit Biopsy $100 Excision of lesion of skin w/o flap or graft $250 Flap or graft without excision $375 Excision of lesion of skin with flap or graft $600 Reconstructive Surgery Benefit Prosthesis Benefit (Lifetime max) Surgically implanted $3,000 Non-surgical $200 Blood and Plasma Benefit Transportation/Lodging Benefits Covered person requiring special cancer treatment 100 miles or more away from Hospital or medical facility. Bone Marrow Transplantation Not payable for the same procedure as the Stem Cell Transplantation Benefit. Lifetime maximum of $10,000 per covered person. Hospice Benefits Not payable the same day as the Home Health Care Benefit. Home Health Care Benefit Experimental Treatment Not payable on the same day that the Radiation and Chemotherapy Benefit is paid. Surgery for breast reconstruction usual/customary following mastectomy Inpatient $100/day Outpatient $250/day Mileage reimbursement $0.50 per mile Commercial reimbursement $1,500/round trip Lodging (60 days/calendar year) $60/day Ambulance (round trip within 100 miles of hospital or medical facility) National Cancer Institute Evaluation: Transportation $250 Inpatient $10,000 Outpatient $5,000 Donor Expenses $1,000 Days 1-60 $100/day Days 61 and over $50/day Lifetime Maximum $12,000 Each visit $50/day. Limited to 10 visits per hospitalization and 30 visits per calendar year. Not payable the same day as the hospice benefit. $300/day Second Surgical Opinion $250 Stem Cell Transplantation $2,500 lifetime National Cancer Institute Evaluation $500 (not payable in conjunction with bone marrow transplantation) This summary attempts to summarize the principal benefits of Insurance Company of Scott and White and is not a contract. Details of benefits are subject to the terms, conditions, and limitations of the Required Outline of Coverage. See the Exclusions and Limitations section of the Insurance Company of Scott and White Required Outline of Coverage.

4 Monthly Premium Age Male Female <23 $2.03 $ $1.74 $ $2.40 $ $2.98 $ $4.00 $ $6.35 $ $11.77 $ $23.39 $ $40.67 $ $63.60 $ $95.78 $ $ $ $ $ $ $ $ $ $ $ $99.36 $64.30 FAQs: Answers to common questions about our cancer income protection policy. How is a cancer income protection policy different from a traditional medical plan? Medical insurance reimburses the insured, or provider, for covered and approved medical services, procedures, equipment, and prescription drugs. The cancer income protection plan pays an immediate one-time, lump-sum payment directly to the insured upon initial diagnosis of a covered cancer. Additional cash benefits are also available when you receive services related to the treatment of cancer. The cancer income policy benefit can be used for any purpose you choose. Do I have to be employed to enroll in the cancer income policy? No. Enrollment isn t dependent on current or future employment. As long as you pay your premiums on time, coverage will continue. How is the benefit paid? When first diagnosed with invasive cancer or melanoma, you submit a claim form with the required diagnosis information. Once we receive all required information, we issue a check to you. This check is a one-time, lump-sum payment. The benefit can be used for any purpose you choose. Am I eligible for a cancer income policy if I ve had cancer in the past? You may qualify for coverage if you have been medically diagnosed as having or been treated by a doctor for internal cancer. We may request further documentation during the underwriting process if you have been diagnosed with cancer in the past. Are benefits coordinated with other insurance, if any? No. Benefits for this cancer insurance policy are paid to the policyholder separate from any other insurance. Do benefit amounts differ for family members? No. The cancer insurance policy provides the full benefits for all covered family members.

5 What payment arrangements are available? The following payment arrangements are available when paying premium directly to ICSW: Monthly Bank Draft (your bank account will be drafted on the 1st of the month) Semi-annual Bank Draft (your bank account will be drafted for 50% of the annual premium amount upon approval, and 50% of annual premium 6 months later) Pay the Annual Premium upon approval (we will draft your account for the full annual premium upon notification of acceptance) Exclusions Coverage only for treatment of cancer including direct extension, metastatic spread or recurrence. No coverage for premalignant conditions, conditions with malignant potential, complications of any other disease, sickness or incapacity. This policy contains a 30-day waiting period. Benefits are not payable for any covered person who has cancer diagnosed before coverage has been in force 30 days from the Effective Date shown in the Policy Schedule. If a covered person has cancer diagnosed during the waiting period, benefits for treatment of that cancer will apply only to treatment occurring after two years from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium. Exception: If a covered person age 65 or over has cancer diagnosed during the waiting period, benefits for treatment of that cancer will apply only to treatment occurring after six (6) months from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium. Benefits will not be paid under Part 6, C through J of the Outline of Coverage, for treatment in a U.S. government hospital unless the covered person is actually charged for such treatment and is legally required to pay such charge. No benefits are payable for immunoglobulins or colony-stimulating factors. The First-Occurrence Benefit is not payable for (1) any internal cancer diagnosed or treated before the effective date of this policy or subsequent recurrence, extension or metastatic spread of such internal cancer that is diagnosed or treated after the effective date of this policy; (2) cancer diagnosed during this policy s 30-day waiting period; (3) the diagnosis of skin cancer or melanomas classified as Clark s Level I and II. Any covered person who has a previous diagnosis of cancer will NOT be eligible for a First-Occurrence benefit under this policy for a recurrence, extension, or metastatic spread of that same cancer.

6 Schedule of Operations ABDOMEN KIDNEY THROAT Paracentesis $100 Nephrectomy $2,100 Laryngoscopy $300 Exploratory laparotomy $525 Radical $3,600 Tracheostomy $300 Cholecystectomy $700 LIVER Laryngectomy (w/o neck $900 BLADDER Needle biopsy $140 dissection) Cystoscopy $140 Wedge biopsy $350 Laryngectomy (w/neck $1,800 TUR bladder tumors $525 Resection of liver $1,000 dissection) Cystectomy (partial) $900 LYMPHATIC THYROID Cystectomy (complete) $1,800 Excision of lymph node $175 Partial thyroidectomy (1 lobe) $525 Cystectomy (w/ureteroileal conduit) $600 Splenectomy $700 Total thyroidectomy (2 lobes) $700 BRAIN Axillary node dissecti $700 VULVA Burr holes not followed by surgery $700 Lymphadenectomy (unilateral) $700 Vulvectomy (partial) $525 Ventriculoperitoneal shunt $700 Lymphadenectomy (bilateral) $900 Vulvectomy (radical) $1,050 Exploratory craniotomy $1,500 MANDIBLE Excision brain tumor $3,500 Mandibulectomy $1,400 Hemispherectomy $5,000 MISCELLANEOUS BREAST Bone marrow biopsy or aspiration $140 Needle biopsy $140 Venous catheters/venous port for $280 Cutting operation biopsy $280 chemotherapy Lumpectomy $350 Pathological hip fracture $875 Mastectomy (partial) $525 MOUTH Mastectomy (simple) $700 Hemiglossectomy $350 Mastectomy (radical) $1,050 Tonsil/mucous membrane $525 CERVIX Glossectomy $700 D&C $175 Resection of palate $700 Colposcopy $175 PANCREAS Vaginal hysterectomy (uterus only) $525 Jejunostomy $900 Oophorectomy $525 Whipple procedure $3,600 Abdominal hysterectomy (uterus only) $900 Whipple procedure $3,600 Uterus, tubes & ovaries $1,750 PENIS Uterus, tubes & ovaries w/exenteration $5,000 Amputation (partial) $350 CHEST Amputation (complete) $700 Thoracentesis $140 Amputation (radical) $900 Bronchoscopy $300 PROSTATE Mediastinoscopy $300 Needle biopsy $140 Thoracostomy $300 Cystoscopy $140 Thoracotomy $700 TUR prostate $525 Wedge resection $1,200 Radical prostatectom $1,400 Lobectomy $1,500 RADIUM IMPLANTS Pneumonectomy $2,100 Insertion $1,000 ESOPHAGUS Removal $500 Esophagoscopy $280 SALIVARY GLANDS Esophagogastrectomy $1,500 Biopsy $350 Resection of esophagus $2,000 Parotidectomy $700 EYE Radical neck dissection $1,800 P32 uptake $250 SPINE Enucleation $500 Cordotomy $525 INTESTINES Laminectomy $900 Sigmoidoscopy $140 STOMACH Proctosigmoidoscopy $140 Gastroscopy $300 Colonoscopy $280 Gastrojejunostomy $900 Cutting operation on rectum for biopsy $280 Partial gastrectomy $900 Colostomy or revision of $350 Gastrectomy $1,400 ERCP $350 TESTIS Ileostomy $350 Orchiectomy (unilateral) $350 Colectomy $900 Orchiectomy (bilateral) $490 Resection small intestine $2,100 Abdominal-perineal approach for $2,500 removal of cancer of sigmoid colon or rectum

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