Employee Critical Illness Option Financial Protection for the Unexpected

Transcription

1 Critical Illess ECIOEmployee Optio Employee Critical Illess Optio Fiacial Protectio for the Uexpected Icludes Cacer Beefit First Occurrece Additioal Occurrece Reoccurrece Spouse Coverage Available Child Coverage at No Additioal Cost Icludes Health Screeig Beefit Protectio for the Uexpected! Approved for use i: AK, AL, AR, AZ, CA, CO, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MI, MO, MS, MT, ND, NE, NJ, NM, NV, OH, OK, OR, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY. Bosto Mutual Life Isurace Compay 120 Royall Street Cato, MA Policy Series - BML2100MP /13 NO TOBACCO/TOBACCO

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3 THE FACTS Accordig to Medical Statistics: Over 1.4 millio ew cacer cases are expected to be diagosed i The Natioal Istitutes of Health estimate the overall costs for cacer i the year 2008 at $228.1 billio: $93.2 billio for direct medical costs ad $134.9 billio for idirect costs. 1 A estimated 785,000 Americas will have a ew coroary attack i 2009 ad about 470,000 will have a recurret attack. 2 It is estimated that a stroke will occur every 40 secods to someoe i the U.S. 2 The estimated direct ad idirect cost of cardiovascular disease is $475.3 billio i Features: Cacer Facts & Figures - America Cacer Society Heart ad Stroke Statistical Update - America Heart Associatio Lump-sum beefits paid directly to the isured followig the diagosis of each covered specified critical illess. Re-occurrece ad additioal occurrece also covered. Spouse coverage available up to $25,000 beefit amout. Each depedet child is covered at 25 percet of the primary isured amout at o additioal charge. Rates caot be idividually icreased due to chage i age, health or idividual claim. Aual health screeig beefits icluded. Simplified uderwritig aswer oly a few health questios. The pla is portable* take your coverage with you if you leave your job. * Certai stipulatios apply to portability. ELIGIBILITY Idividual Eligibility All full-time employees, betwee the ages of workig at least 20 hours or more weekly, are eligible. If a employee is eligible, their spouse ages 18-69, are eligible for coverage ad all childre of the isured who are umarried ad less tha twety-five (25) years of age. Spouse Coverage Available The employee may elect to apply for spouse coverage i amouts of $2,500 to $25,000, ot to exceed 50% of the amout the employee applies for. If the employee does ot meet the uderwritig requiremets, the spouse may still be eligible for coverage. Depedet Childre Coverage at No Additioal Charge Each eligible depedet child is covered at 25 percet of the primary isured amout at o additioal charge. Effective Date of Coverage Coverage is effective o the date the applicatio is siged, provided that the employee is actively at work. This policy also cotais a 30-day waitig period. This meas that o beefits are payable for ay isured before coverage has bee i force for 30 days after the applicatio has bee siged. (refer to limitatios o page 6) Portability The coverage is portable providig your coverage has bee i force for 6 moths after your certificate date ad the group cotract remais i force. Coverage will be cotiued at the same premium ad coverage amouts. 2

4 PLAN BENEFITS First Occurrece Beefit Lump Sum Beefits payable upo iitial diagosis of a covered illess or coditio. Employee beefit amouts available from $5,000 to $50,000. Spouses may apply for up to 1/2 of employee beefit amout. Additioal Occurrece Beefit If a isured collects full beefits for a Critical Illess uder the pla ad later has oe of the remaiig covered illesses/procedures, the we will pay the full beefit amout for each additioal illess. Occurreces must be separated by at least 6 moths. Re-Occurrece Beefit If a isured collects full beefits for a covered coditio ad is later diagosed with the same coditio, we will pay the full beefit agai. The two dates of diagosis must be separated by at least 12 moths or 12 moths treatmet free for cacer. Covered Critical Illesses Cacer 100% Carcioma i SITU 25% Heart Attack (Myocardial Ifarctio) 100% Coroary Artery Bypass Surgery 25% Stroke (Apoplexy or Cerebral Vascular Accidet) 100% Major Orga Trasplat 100% Real Failure (Ed Stage) 100% All covered coditios are subject to the defiitios foud i the employee s certificate. NOTE: If a beefit is paid for carcioma i situ, the iteral cacer beefit will be reduced by 25%. If a beefit is paid for coroary artery bypass surgery, the heart attack beefit will be reduced by 25%. $50 Health Screeig Beefit (employee ad spouse oly) After the Waitig Period, a isured may receive a maximum of $50 for ay oe covered health screeig test per caledar year. We will pay this beefit regardless of the results of the test. There is o limit to the umber of years the isured ca receive the health screeig beefit; it will be paid as log as the certificate remais iforce. This beefit is ot paid for depedet childre.plan BENEFITS Covered Health Screeig Tests Iclude: Mammography Colooscopy Pap smear Breast ultrasoud Chest x-ray PSA (blood test for prostate cacer) Stress test o a bicycle or treadmill Boe marrow testig CA 15-3 (blood test for breast cacer) CA 125 (blood test for ovaria cacer) CEA (blood test for colo cacer) Flexible sigmoidoscopy Hemocult stool aalysis Serum protei electrophoresis (blood test for myeloma) Thermography Fastig blood glucose test, blood test for triglycerides or serum cholesterol test to determie level of HDL ad LDL 3

5 WEEKLY RATES - EMPLOYEE No-Tobacco Ages $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $0.85 $1.29 $1.73 $2.17 $2.61 $3.04 $3.48 $3.92 $4.36 $ $1.21 $2.01 $2.80 $3.60 $4.39 $5.19 $5.99 $6.78 $7.58 $ $2.04 $3.67 $5.29 $6.92 $8.55 $10.18 $11.80 $13.43 $15.06 $ $3.34 $6.28 $9.21 $12.14 $15.07 $18.00 $20.93 $23.86 $26.79 $ $5.12 $9.83 $14.54 $19.25 $23.95 $28.66 $33.37 $38.08 $42.79 $47.49 Tobacco Ages $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $1.14 $1.87 $2.59 $3.32 $4.05 $4.77 $5.50 $6.23 $6.96 $ $1.79 $3.16 $4.53 $5.91 $7.28 $8.65 $10.03 $11.40 $12.77 $ $3.83 $7.24 $10.66 $14.08 $17.49 $20.91 $24.32 $27.74 $31.15 $ $6.30 $12.18 $18.07 $23.95 $29.84 $35.72 $41.61 $47.49 $53.38 $ $9.83 $19.25 $28.66 $38.08 $47.49 $56.91 $66.33 $75.74 $85.16 $94.57 WEEKLY RATES - SPOUSE No-Tobacco Ages $2,500 $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $0.63 $0.85 $1.07 $1.29 $1.51 $1.73 $1.95 $2.17 $2.39 $ $0.81 $1.21 $1.61 $2.01 $2.40 $2.80 $3.20 $3.60 $4.00 $ $1.23 $2.04 $2.85 $3.67 $4.48 $5.29 $6.11 $6.92 $7.74 $ $1.88 $3.34 $4.81 $6.28 $7.74 $9.21 $10.67 $12.14 $13.60 $ $2.77 $5.12 $7.48 $9.83 $12.18 $14.54 $16.89 $19.25 $21.60 $23.95 Tobacco Ages $2,500 $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $0.78 $1.14 $1.50 $1.87 $2.23 $2.59 $2.96 $3.32 $3.69 $ $1.10 $1.79 $2.47 $3.16 $3.85 $4.53 $5.22 $5.91 $6.59 $ $2.12 $3.83 $5.54 $7.24 $8.95 $10.66 $12.37 $14.08 $15.78 $ $3.36 $6.30 $9.24 $12.18 $15.13 $18.07 $21.01 $23.95 $26.90 $ $5.12 $9.83 $14.54 $19.25 $23.95 $28.66 $33.37 $38.08 $42.79 $47.49 Rates iclude beefits for Critical Illess icludig Cacer, Additioal Occurrece, Re-occurrece ad Health Screeig. 4

6 DEFINITIONS Treatmet: Meas cosultatio, care or services provided by a physicia icludig diagostic measures ad takig prescribed drugs ad medicies. Major Orga Trasplat: Meas udergoig surgery as a recipiet of a trasplat of a huma heart, lug, liver, kidey, or pacreas. Myocardial Ifarctio: (Heart Attack) Meas the death of a portio of the heart muscle (myocardium) resultig from a blockage of oe or more coroary arteries. Heart attack does ot iclude ay other disease or ijury ivolvig the cardiovascular system. Cardiac Arrest ot caused by a myocardial ifarctio is ot a heart attack. The diagosis must iclude all of the followig criteria: 1. New ad serial Electrocardiographic (EKG) fidig cosistet with Myocardial Ifarctio; ad 2. Elevatio of cardiac ezymes above geerally accepted laboratory levels of ormal [i case of creatie physphokiase (CPK), a CPK-MB measuremet must be used]. 3. Cofirmatory imagig studies such as thallium scas, MUGA scas, or stress echocardiograms. 4. Chest Pai. Stroke: Meas Apoplexy (due to rupture or acute occlusio of a cerebral artery), or a cerebral vascular accidet or icidet, which is first maifested o or after the policy date. Stroke does ot iclude Trasiet Ischemic Attacks ad attacks of Verterbrobasilar Ischemia. We will pay a beefit for Stroke which produces permaet cliical eurological sequela persistig for at least 30 days followig a iitial diagosis made after ay applicable Waitig Period. We must receive evidece of the permaet eurological damage provided from Computed Axial Tomography (CAT sca) or Magetic Resoace Imagig (MRI). Stroke does ot mea head ijury, trasiet ischemic attack or chroic cerebrovascular isufficiecy. Cacer: Meas a maligat tumor characterized by the ucotrolled growth ad spread of maligat cells ad the ivasio of distat tissue. Cacer icludes leukemia. Excluded are Cacers such as 1. Pre-maligat tumors or polyps; 2. Carcioma i Situ (o-ivasio); 3. Ay ski cacers except melaomas; 4. Stage 1 Hodgki s Disease; 5. Stage A Prostate Cacer; 6. Melaoma that is diagosed as Clark s Level I ad II or Breslow less tha.77 mm; 7. Basal cell carcioma ad squamous cell carcioma of the ski. Carcioma i situ: Meas Cacer that is i the atural or ormal place, cofied to the site without havig ivaded eighborig tissue. Cacer ad/or carcioma i situ must be diagosed i oe of two ways: 1. Pathological Diagosis A pathological diagosis of cacer or carcioma i situ is based o a microscopic study of fixed tissue or preparatios from the hemic (blood) system. This type of diagosis must be doe by a certified pathologist whose diagosis of maligacy is i keepig with the stadards set by the America Board of Pathology. 2. Cliical Diagosis A cliical diagosis of cacer or carcioma i situ is based o the study of symptoms. We will pay beefits for a cliical diagosis oly if: a. A pathological diagosis caot be made because it is medically iappropriate or life threateig; b. There is medical evidece to support the diagosis; ad c. A doctor is treatig the isured for cacer ad/or carcioma i situ. Real Failure: (Kidey Failure) Meas the ed stage real failure presetig as a chroic, irreversible failure of both of your kideys to fuctio. The Kidey failure must ecessitate regular real dialysis, hemo-dialysis or peritoeal dialysis (at least weekly); or which results i kidey trasplatatio. Real failure is covered, provided it is ot caused by a traumatic evet, icludig surgical traumas. Coroary Artery Bypass Surgery: Meas udergoig ope heart surgery to correct arrowig or blockage of oe or more coroary arteries with bypass grafts, but excludig procedures such as, but ot limited to balloo agioplasty, laser relief, stits or other o-surgical procedures. 5

7 LIMITATIONS & EXCLUSIONS If a diagosis occurs after the age of 70, half of the beefit is payable. This Certificate cotais a 30-day Waitig Period. This meas o beefits are payable for ay Isured who has bee diagosed before coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule. If a Isured is first diagosed durig the Waitig Period, beefits for treatmet of that Critical Illess or Specified Procedure will apply oly to loss commecig after 12 moths from the Effective Date of their coverage; or, at your optio, you may elect to void the Certificate from the begiig ad receive a full refud of premium. The applicable beefit amout will be paid if: the date of diagosis is after the waitig period; the date of diagosis occurs while the certificate is i force; ad the cause of the illess is ot excluded by ame or specific descriptio. Beefits will ot be paid for loss due to: 1. Itetioally self-iflicted ijury or actio; 2. Suicide or attempted suicide while sae or isae; 3. Illegal activities or participatio i a illegal occupatio; 4. War, whether declared or udeclared or military coflicts; participatio i a isurrectio or riot, civil commotio or state of belligerece; 5. Substace abuse; or 6. Pre-existig coditios (except as stated below). Pre-existig Coditio Limitatio: Pre-existig Coditio meas a sickess or physical coditio which, withi the 12-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiary prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 12 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 12 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 12 cosecutive moths startig ad edig after the effective date. Uderwritte by: For Claims Call Toll Free: ext. 368 For Customer Service Call Toll Free: This brochure provides a geeral descriptio of the importat features of the policy/certificate. This brochure is ot the isurace cotract ad oly the actual policy/certificate provisios will cotrol. The policy may ot be available i all states ad state variatios may apply. See certificate for detail regardig exclusios. Exclusios may vary by state. 6

8 STATE VARIATIONS This brochure reflects the stadard beefits, rates ad policy provisios. The followig state variatios apply: CALIFORNIA: All full-time employees, betwee the ages of workig at least 20 hours or more weekly, are eligible. If a employee is eligible, his/her spouse (age 18-64), is eligible for coverage. Mammography ad Pap Smear are ot icluded i the Health Screeig Beefit. For Mammography, pays actual charges up to $100 per isured per caledar year. For Pap Smear, pays actual charges up to $100 per isured per caledar year. Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiarily prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 6 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 6 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 6 cosecutive moths startig ad edig after the effective date. NOTE: You must have a Health Care Pla to purchase this isurace. COLORADO: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to a Isured s Effective Date resulted i the Isured receivig advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 12 moths of a Isured s Effective Date which is caused by, cotributed to, or resultig from a Pre-existig Coditio. A claim for beefits for loss startig after 12 moths from a Isured s Effective Date will ot be reduced or deied o the grouds that it is caused by a Pre-existig Coditio. A coditio will o loger be cosidered Pre-existig at the ed of 12 cosecutive moths startig ad edig after a Isured s Effective Date. DISTRICT OF COLUMBIA: IDAHO: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to a Isured s Effective Date resulted i the Isured receivig advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 12 moths of a Isured s Effective Date which is caused by, cotributed to, or resultig from a Pre-existig Coditio. A claim for beefits for loss startig after 12 moths from a Isured s Effective Date will ot be reduced or deied o the grouds that it is caused by a Pre-existig Coditio. A coditio will o loger be cosidered Pre-existig at the ed of 12 cosecutive moths startig ad edig after a Isured s Effective Date. The Waitig Period is special. It reads: This Certificate cotais a 30-day Waitig Period. This meas a 25% beefit is payable for ay Isured who has bee diagosed before coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule. Pre-existig Coditio Limitatio is special. It reads: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiarily prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 12 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 12 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 12 cosecutive moths startig ad edig after the effective date. 7

9 STATE VARIATIONS... cot. This brochure reflects the stadard beefits, rates ad policy provisios. The followig state variatios apply: ILLINOIS: The Waitig Period is special. It reads: This Pla cotais a 30-day Waitig Period. This meas a 25% beefit is payable for ay isured perso who has bee diagosed with a specified critical illess before their coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule; or at their optio, they may elect to void their coverage ad receive a full refud of premium. INDIANA: The Pre-Existig Coditio Limitatio does ot apply. The 30-day Waitig Period does ot apply. MASSACHUSETTS: There is o Re-occurrece Beefit. The Additioal Occurrece beefit is special. It reads: If a isured collects full beefits for a Critical Illess uder the pla ad later has oe of the remaiig covered illesses/procedures, the we will pay a 25% beefit amout for each additioal illess, if the date of diagosis is separated by less tha 6 moths. If the date of diagosis is separated by 6 moths or more, we will provide a 100% beefit amout. This Certificate cotais a 30-day Waitig Period. This meas o beefits are payable for ay Isured who has bee diagosed before coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule. If a Isured is first diagosed durig the Waitig Period, beefits for treatmet of that Critical Illess or Specified Procedure will apply oly to loss commecig after 6 moths from the Effective Date of their coverage; or, at your optio, you may elect to void the Certificate from the begiig ad receive a full refud of premium. Exclusios are special. It reads: Beefits will ot be paid for loss due to: 1. Itetioally self-iflicted ijury or actio; 2. Suicide or attempted suicide; 3. Participatio i a feloy, riot or isurrectio; 4. War, declared or udeclared; 5. Services provided for alcohol ad drug detoxificatio. Pre-existig Coditio Limitatio is special. It reads: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiarily prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 6 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 6 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 6 cosecutive moths startig ad edig after the effective date. NOTE: You must have a Health Care Pla to purchase this isurace. MISSOURI: Exclusio #2: Suicide or attempted suicide while sae. Exclusio #5: Substace abuse, uless these drugs are take as prescribed by a physicia. Waitig Period is special. It reads: This Pla cotais a 30-day Waitig Period. This meas a 25% beefit is payable for ay isured perso who has bee diagosed with a specified critical illess before their coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule; or at their optio, they may elect to void their coverage ad receive a full refud of premium. 8

10 STATE VARIATIONS... cot. This brochure reflects the stadard beefits, rates ad policy provisios. The followig state variatios apply: NEVADA: Pre-existig Coditio Limitatio is special. It reads: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiarily prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 12 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 12 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 12 cosecutive moths startig ad edig after the effective date. Exclusio #5 regardig substace abuse does ot apply. NORTH DAKOTA: Umarried depedet childre who are full-time studets ad uder the age of 26 are eligible. OKLAHOMA: OREGON: Waitig Period is special. It reads: This Pla cotais a 30-day Waitig Period. This meas a 25% beefit is payable for ay isured perso who has bee diagosed with a specified critical illess before their coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule; or at their optio, they may elect to void their coverage ad receive a full refud of premium. Exclusio #4: War or act of war, declared or udeclared while servig i the military service or ay auxiliary uit attached thereto. Exclusio #5 is special. It reads: Itoxicats ad Narcotics - beig legally itoxicated, or beig uder the ifluece of ay drug or arcotic, uless such is take uder the directio of a physicia. (Itoxicatio meas that which is determied ad defied by the laws ad jurisdictio of the geographic area i which the loss or cause is icurred.) SOUTH CAROLINA: The 30-day Waitig Period does ot apply. SOUTH DAKOTA: The 30-day Waitig Period does ot apply. For the diagosis of Myocardial Ifarctio, oly oe of the criteria (ot all ) must be met. Chest pai was deleted from the criteria list. TENNESSEE: TEXAS: The 30-day Waitig Period is waived for kidey failure or orga trasplat that occurs due to a accidet. The 30-day Waitig Period does ot apply. 9

11 STATE VARIATIONS... cot. This brochure reflects the stadard beefits, rates ad policy provisios. The followig state variatios apply: UTAH: Pre-existig Coditio Limitatio is special. It reads: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiarily prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 6 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 6 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 6 cosecutive moths startig ad edig after the effective date. Waitig Period is special. It reads: This Certificate cotais a 30-day Waitig Period. This meas o beefits are payable for ay Isured who has bee diagosed before coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule. If a Isured is first diagosed durig the Waitig Period, beefits for treatmet of that Critical Illess or Specified Procedure will apply oly to loss commecig after 6 moths from the Effective Date of their coverage; or, at your optio, you may elect to void the Certificate from the begiig ad receive a full refud of premium. VERMONT: All employees betwee the ages of workig at least 17.5 hours or more weekly are eligible. Waitig Period is special. It reads: This Certificate cotais a 30-day Waitig Period. This meas o beefits are payable for ay Isured who has bee diagosed before coverage has bee i force 30 days from the Effective Date show i the Certificate Schedule. If a Isured is first diagosed durig the Waitig Period, beefits for treatmet of that Critical Illess or Specified Procedure will apply oly to loss commecig after 6 moths from the Effective Date of their coverage; or, at your optio, you may elect to void the Certificate from the begiig ad receive a full refud of premium. VIRGINIA: Waitig Period is special. It reads: If a Isured is first diagosed durig the Waitig Period, beefits for treatmet of that Critical Illess or Specified Procedure will apply oly to loss commecig after 2 years from the Effective Date of their coverage; or, at your optio, you may elect to void the Certificate from the begiig ad receive a full refud of premium. WISCONSIN: Exclusio #3 is chaged to: Covictio of a feloy. WYOMING: Pre-existig Coditio Limitatio is special. It reads: Pre-existig Coditio meas a sickess or physical coditio which, withi the 6-moth period prior to the effective date of the certificate, either: 1. Resulted i a isured perso s receivig medical advice or treatmet; or 2. Caused symptoms for which a ordiarily prudet perso would seek medical advice or treatmet. We will ot pay beefits for ay coditio or illess startig withi 12 moths of the effective date which is caused by, cotributed to, or resultig from a pre-existig coditio. A claim for beefits for loss startig after 12 moths from the effective date will ot be reduced or deied o the grouds that it is caused by a pre-existig coditio. A coditio will o loger be cosidered pre-existig at the ed of 12 cosecutive moths startig ad edig after the effective date. 10

12 BOSTON MUTUAL LIFE INSURANCE COMPANY 120 Royall Street Cato, Massachusetts Policy Series BML2100MP /13 NO TOBACCO/TOBACCO