Aflac Critical Illness Insurance Plan

Transcription

1 Aflac Critical Illness Insurance Plan Aflac Critical Illness Insurance The Aflac cverage described in this bklet is subject t plan limitatins, exclusins, definitins, and prvisins. Fr detailed infrmatin, please see the plan brchure, as this bklet is intended t prvide a general summary f the cverage. This verview is subject t the terms, cnditins, and limitatins f plicy series CI What is Aflac critical illness insurance? Why shuld I cnsider it? Aflac critical illness insurance prvides lump sum benefits upn the diagnsis f each cvered critical illness r event, including the fllwing: Majr Organ Transplant End-Stage Renal Failure Strke Cma Paralysis Burns Lss f Sight Lss f Hearing Lss f Speech Heart Attack Crnary Artery Bypass Surgery Specific Heart Prcedures Any f these diagnses r events wuld be life-changing. While majr medical insurance can help with the csts f treatment, what abut the ut-f-pcket expenses that pile up while yu r a lved ne is ut f wrk as a result f a cvered critical illness? Aflac critical illness insurance benefits are paid directly t yu (unless therwise assigned) t use as yu see fit. Yu can use the benefits t help with mrtgage r rent payments, grceries, car payments hwever yu like. What are sme f the highlights f the Aflac critical illness plan? An annual Health Screening Benefit is included. Spuse cverage is available. Benefit amunts range frm $5000 t $50,000 fr emplyees. The benefit amunt fr spuses range frm $5,000 t $30,000. Each dependent child is cvered at 50% f the primary insured s amunt at n additinal charge. Cverage may be guaranteed-issue (which means yu may qualify fr cverage withut having t answer health questins). Yur premiums are paid thrugh the cnvenience f payrll deductin. Yur plan is prtable (with certain stipulatins). That means yu may be able t take yur cverage with yu if yu leave yur jb. Page 28

2 Underwritten by Cntinental American Insurance Cmpany A prud member f the Aflac family f insurers Am I eligible fr Aflac critical illness cverage? What abut my family? Yu are eligible t apply fr Aflac critical illness cverage if yu: Are between the ages f 18 and 69; Are a full-time, benefit-eligible emplyee; Are wrking at least 40 hurs per week; Have been emplyed fr at least 0 cntinuus days by the enrllment date; and Are nt a seasnal r temprary emplyee. Yur spuse must be between the ages f 18 and 69 t be eligible fr cverage, and dependent children must be yunger than age 26. What cre benefits des the Aflac critical illness plan feature? First Occurrence Benefit After the waiting perid, yu may receive up t 100% f the benefit selected upn the first diagnsis f each cvered critical illness. Additinal Occurrence Benefit After the waiting perid, yu may receive benefits fr each different cvered critical illness. Dates f diagnsis must be separated by at least six mnths. Reccurrence Benefit Yu may receive benefits fr the recurrence f any cvered critical illness. Dates f diagnsis must be separated by at least 12 mnths. Heart Benefit After the waiting perid, yu may receive benefits fr the fllwing cvered heart surgeries and prcedures: Crnary Artery Bypass Surgery (reduces the benefit fr heart attack) Mitral valve replacement r repair Artic valve replacement r repair Surgical treatment f abdminal artic aneurysm AnjiJet clt busting* Balln angiplasty (r balln valvulplasty)* Laser angiplasty* Atherectmy* Stent implantatin* Cardiac catherizatin* Autmatic implantable (r internal) cardiverter defibrillatr (AICD)* Pacemaker insertin* *Benefits fr these prcedures are payable at a percentage f yur maximum benefit and will reduce the benefit amunts payable fr ther cvered heart prcedures. Page 29

3 Health Screening Benefit After the waiting perid, yu may receive a maximum f $100 fr any ne cvered screening test per calendar year (regardless f the test results). This benefit is payable fr yu (the emplyee) and yur cvered spuse, nt fr dependent children. Cvered screening tests include the fllwing: Stress test n a bicycle r treadmill Fasting bld glucse test, bld test fr triglycerides r serum chlesterl test t determine level f HDL and LDL Bne marrw testing Breast ultrasund CA 15-3 (bld test fr breast cancer) CA 125 (bld test fr varian cancer) CEA (bld test fr cln cancer) Chest X-ray Clnscpy Flexible sigmidscpy Hemcult stl analysis Mammgraphy Pap smear PSA (bld test fr prstate cancer) Serum prtein electrphresis (bld test fr myelma) Thermgraph What else d I need t knw abut the Aflac critical illness plan? Yu shuld knw that the plan includes: A 30-day waiting perid. This means that n benefits are payable fr any insured befre cverage has been in frce 30 days frm yur effective date f cverage. A pre-existing cnditin limitatin. A pre-existing cnditin is a sickness r physical cnditin that, within the 12 mnth perid befre yur plan s effective date, resulted in the insured s receiving medical advice r treatment. N benefits are payable fr any cnditin r illness starting within 12 mnths f an insured s effective date that is caused by, cntributed t, r resulting frm a pre-existing cnditin. Certain exclusins. N benefits are payable fr lss resulting frm: Intentinally self-inflicted injury r actin; Suicide r attempted suicide while sane r insane; Illegal activities r participatin in an illegal ccupatin; War-participating in war r any act f war, declared r nt, r participating in the armed frces f r cntracting with any cuntry r internatinal authrity. This exclusin des nt include acts f terrrism. We will return the prrated premium fr any perid nt cvered by this certificate when yu are in such service. Substance abuse; r Diagnsis and/r treatment received utside the United States. Page 30

4 Mark III - Semimnthly (24pp./yr.) NONTOBACCO - Emplyee AGES $ 5,000 $ 10,000 $ 15,000 $20,000 $25,000 $ 30,000 $ 35,000 $ 40,000 $ 45,000 $ 50, $ 2.76 $ 3.77 $ 4.78 $ 5.79 $ 6.80 $ 7.81 $ 8.82 $ 9.82 $ $ $ 3.44 $ 5.14 $ 6.83 $ 8.52 $ $ $ $ $ $ $ 5.22 $ 8.69 $ $ $ $ $ $ $ $ $ 7.60 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ NONTOBACCO - Spuse AGES $ 5,000 $ 7,500 $ 10,000 $ 12,500 $ 15,000 $17,500 $20,000 $22,500 $25,000 $30, $ 2.76 $ 3.26 $ 3.77 $ 4.27 $ 4.78 $ 5.28 $ 5.79 $ 6.29 $ 6.80 $ $ 3.44 $ 4.29 $ 5.14 $ 5.98 $ 6.83 $ 7.68 $ 8.52 $ 9.37 $ $ $ 5.22 $ 6.96 $ 8.69 $ $ $ $ $ $ $ $ 7.60 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOBACCO - Emplyee AGES $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $ 3.30 $ 4.86 $ 6.41 $ 7.97 $ 9.52 $ $ $ $ $ $ 4.42 $ 7.10 $ 9.77 $ $ $ $ $ $ $ $ 8.60 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOBACCO - Spuse AGES $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000 $30, $ 3.30 $ 4.08 $ 4.86 $ 5.64 $ 6.41 $ 7.19 $ 7.97 $ 8.74 $ 9.52 $ $ 4.42 $ 5.76 $ 7.10 $ 8.44 $ 9.77 $ $ $ $ $ $ 8.60 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Rates d nt include cancer benefit. Rates include: $100 Health Screening Benefit, Additinal Benefits Rider, Heart Rider, and n additinal riders. Guaranteed Issue Amunt = $10,000 EE / $5,000 Spuse N benefit reductin at age 70. Please Nte: Premiums shwn are accurate as f publicatin. They are subject t change. Published: Mar-14 NC-CI-24PP-WOC-100HSB-CBP-SSH-HRT-70BENERED+9-TNT Page 39 Page 31

5 Nte: If this cverage will replace any existing individual plicy, please be aware that it may be in yur best interest t maintain yur individual guaranteed-renewable plicy. Cntinental American Insurance Cmpany (CAIC), a prud member f the Aflac family f insurers, is a whllywned subsidiary f Aflac Incrprated and underwrites grup cverage. CAIC is nt licensed t slicit business in New Yrk, Guam, Puert Ric, r the Virgin Islands. Cntinental American Insurance Cmpany 2801 Devine Street Clumbia, Suth Carlina Cntinental American Insurance Cmpany is nt aware f whether yu receive benefits frm Medicare, Medicaid, r a state variatin. If yu r a dependent are subject t Medicare, Medicaid, r a state variatin, any and all benefits under this plan culd be assigned. This means that yu may nt receive any f the benefits in the plan. As a result, please check t the cverage in all health insurance plicies yu already have r may have befre yu buy this insurance t verify the absence f any assignments r liens. Ntice t Cnsumer: The cverages prvided by Cntinental American Insurance Cmpany (CAIC) represent supplemental benefits nly. They d nt cnstitute cmprehensive health insurance cverage and d nt satisfy the requirement f minimum essential cverage under the Affrdable Care Act. CAIC cverage is nt intended t replace r be issued in lieu f majr medical cverage. It is designed t supplement a majr medical prgram aflacgrupinsurance.cm Page 32

6 Aflac Hspital Indemnity Plan Effective Date: September 1, 2015 Plan Features Benefits are available fr spuse and/r dependent children. Premiums are paid by cnvenient payrll deductin. The plan cvers injuries and sickness. Admissin and per-day hspital cnfinement benefits are included. Wellness benefit is included. Surgery and anesthesia benefits are included. High r Lw Plan Optins- Emplyee may nly chse ne ptin. Issue Ages Emplyee: Spuse: Children: under age 26 Full-time, benefit-eligible emplyees wrking at least 40 hurs per week are eligible t apply. Emplyees must be actively at wrk n the date f applicatin and the effective date f cverage. Seasnal and temprary emplyees are nt eligible. Class I All full-time and part-time benefit-eligible emplyees are eligible fr Class I cverage. That eligibility extends t their spuses and children under age 26. Class II A Class I primary insured is eligible fr Class II cverage if he: Was previusly insured under Class I; and Is n lnger emplyed by the plicyhlder. The emplyee must elect Class II cverage under the Prtability Privilege within 31 days after the date fr which his Class I eligibility wuld therwise terminate. Only dependents cvered under Class I cverage are eligible fr cntinued cverage under Class II. Class II insureds cannt cntinue cverage thrugh the emplyer s payrll deductin prcess. They must remit premiums directly t the cmpany. The emplyee may purchase supplemental hspital indemnity cverage fr his spuse and/r dependent children. The spuse and dependent children cannt participate if the emplyee is nt eligible fr cverage r elects nt t participate. A spuse is the persn married t the emplyee n the effective date f this cverage. A spuse means the legal spuse wh is between the ages f 18 and 64. A spuse must nt be hspitalized r unable t perfrm his r her nrmal duties r activities n the date f applicatin and the effective date f cverage. Dependent child means natural children, stepchildren, fster children, legally adpted children, r children placed fr adptin wh are under age 26. Guaranteed-Issue During the initial enrllment and fr newly eligible emplyees, cverage is guaranteed-issue, prvided the applicants are eligible fr cverage. Enrllments take place nce each 12- mnth perid. Late enrllees cannt enrll utside f an annual enrllment perid and will be underwritten. Page 33

7 Prtability When cverage is effective and wuld therwise terminate because the emplyee ends emplyment with the emplyer, cverage may be cntinued. He may exercise the Prtability Privilege when there is a change t his cverage class. The emplyee and any cvered dependents will cntinue the cverage that is in-frce n the date emplyment ends. The cntinued cverage will be prvided under Class II. The premium rate fr prtability cverage may change fr the class f cvered persns n prtability n any premium due date. Written ntice will be given at least 31 days befre any change is t take effect. The emplyee may cntinue the cverage until the earlier f: The date he fails t pay the required premium; r The date the class f cverage is terminated. Cverage may nt be cntinued: If the emplyee fails t pay any required premium; r If the cmpany receives ntice f Class I plan terminatin. Benefits Hspital Cnfinement (per day) High Optin Lw Optin $150 $100 We will pay the amunt shwn when an insured is cnfined t a hspital as a resident bed patient as the result f injuries received in a cvered injury r because f a cvered sickness. T receive this benefit fr injuries received in an injury, the insured must be cnfined t a hspital within six mnths f the date f the cvered accident. The maximum perid fr which a cvered persn can cllect benefits fr hspital cnfinements resulting frm cvered sickness r frm injuries received in the same cvered accident is 180 days. This benefit is payable fr nly ne hspital cnfinement at a time even if the cnfinement is a result f mre than ne cvered accident, mre than ne cvered sickness, r a cvered accident and a cvered sickness. Hspital Admissin (per cnfinement) High Optin Lw Optin $1,500 $500 We will pay the amunt shwn when an insured is admitted t a hspital and cnfined as a resident bed patient because f an injury r because f a cvered sickness. T receive this benefit fr injuries received in a cvered accident, an insured must be admitted t a hspital within six mnths f the date f the cvered accident. We will nt pay benefits fr cnfinement t an bservatin unit, fr emergency rm treatment, r fr utpatient treatment. We will pay this benefit nly nce fr each cvered accident r cvered sickness. If an insured is cnfined t the hspital because f the same r related injury r sickness, we will nt pay this benefit again. This benefit ptin will be based n the insured s current majr medical plan s deductible t assist the insured in meeting the ut-f-pcket liability. Page 34

8 Surgical Benefit (per prcedure) High Optin Lw Optin Up t $1,500 Up t $750 If an insured has surgery perfrmed by a physician due t an injury r because f a cvered sickness, we will pay the apprpriate surgical benefit amunt shwn in the Schedule f Operatins. The surgical benefit paid will never exceed the maximum surgical benefit designated in the plan. The surgery can be perfrmed in a hspital (n an inpatient r utpatient basis), in an ambulatry surgical center, r in a physician s ffice. If an peratin is nt listed in the Schedule f Operatins, we will pay an amunt cmparable t that which wuld be payable fr the peratin listed in the Schedule f Operatins (the peratin that is nearest in severity and cmplexity). If tw r mre surgical prcedures are perfrmed at the same time thrugh the same r different incisins, nly ne benefit the largest will be prvided. Anesthesia Benefits High Optin Lw Optin Up t $375 Up t $188 When an insured receives benefits fr a surgical prcedure cvered under the Surgical Benefit, we will pay the apprpriate benefit amunt shwn in the Schedule f Operatins fr anesthesia administered by a physician in cnnectin with such prcedure. Hwever, the Anesthesia Benefit paid will nt exceed 25 percent f the amunt paid under Surgical Benefit. Wellness Benefit High Optin Lw Optin $50 $50 We will pay the amunt shwn when an insured visits a dctr and he is neither injured nr sick. This benefit is payable nce per calendar year per insured. Pre-Existing Cnditin Limitatin A pre-existing cnditin means, within the 12-mnth perid prir t the insured s effective date, cnditins fr which medical advice r treatment was received r recmmended. We will nt pay benefits fr any lss r injury that is caused by, cntributed t by, r resulting frm a pre-existing cnditin fr 12 mnths after the insured s effective date r fr 12 mnths frm the date medical care, treatment, r supplies were received fr the pre-existing cnditin whichever is less. A claim fr benefits fr lss starting after 12 mnths frm the effective date f the insured s certificate will nt be reduced r denied n the grunds that it is caused by a pre-existing cnditin. Pregnancy is cnsidered a pre-existing cnditin if cnceptin was befre the cverage effective date. If the certificate is issued as a replacement fr a certificate previusly issued under this plan, then the pre-existing cnditin limitatin prvisin f the new certificate applies nly t any increase in benefits ver the prir certificate. Any remaining pre-existing cnditin limitatin perid f the prir certificate cntinues t apply t the prir level f benefits. Page 35

9 Exclusins We will nt pay benefits fr lss cntributed t by, caused by, r resulting frm: 1. War Participating in war r any act f war, declared r nt, r participating in the armed frces f r cntracting with any cuntry r internatinal authrity. This exclusin des nt include acts f terrrism. We will return the prrated premium fr any perid nt cvered by this certificate when the insured is in such service. 2. Suicide Cmmitting r attempting t cmmit suicide, while sane r insane. 3. Self Inflicted Injuries Injuring r attempting t injure yurself intentinally. 4. Traveling Traveling mre than 40 miles utside the territrial limits f the United States, Canada, Mexic, Puert Ric, the Bahamas, Virgin Islands, Bermuda, and Jamaica. 5. Racing Riding in r driving any mtr driven vehicle in a race, stunt shw r speed test. 6. Aviatin Operating, learning t perate, serving as a crew member n, r jumping r falling frm any aircraft, including thse, which are nt mtr driven. 7. Intxicatin Being legally intxicated, r being under the influence f any narctic, unless such is taken under the directin f a physician. 8. Illegal Acts Participating r attempting t participate in an illegal activity, r wrking at an illegal jb. 9. Sprts Participating in any rganized sprt: prfessinal r semi prfessinal. 10. Rutine physical exams and rest cures. 11. Custdial care. This is care meant simply t help peple wh cannt take care f themselves. 12. Treatment fr being verweight, gastric bypass r stapling, intestinal bypass, and any related prcedures, including cmplicatins. 13. Services perfrmed by a relative. 14. Services related t sex change, sterilizatin, in vitr fertilizatin, reversal f a vasectmy r tubal ligatin. 15. A service r a supply furnished by r n behalf f any gvernment agency unless payment f the charge is required in the absence f insurance. 16. Elective abrtin. 17. Treatment, services, r supplies received utside the United States and its pssessins r Canada. 18. Injury r sickness fr which benefits are paid r payable by Wrker s Cmpensatin. 19. Dental services r treatment. 20. Csmetic surgery, except when due t medically necessary recnstructive plastic surgery. 21. Mental r emtinal disrders withut demnstrable rganic disease. 22. Alchlism, drug addictin, r chemical dependency. Terminatins An emplyee s insurance will terminate n the earliest f the fllwing: 1. The date the plan is terminated, fr Class I insureds; 2. The 31st day after the premium due date if the required premium has nt been paid; 3. The date he ceases t meet the definitin f an emplyee as defined in the plan, fr Class I insureds; r 4. The date he is n lnger a member f the Class eligible fr cverage. Insurance fr dependents will terminate n the earliest f the fllwing: 1. The date the Plan is terminated, fr dependents f Class I insureds; 2. The 31st day after the premium due date, if the required premium has nt been paid; 3. The date the spuse r dependent child ceases t be a dependent; r 4. The premium due date fllwing the date we receive the emplyee s written request t terminate cverage fr his spuse and/r all dependent children. Terminatin f the insurance n any Insured will nt prejudice his rights regarding any claim arising prir t terminatin. Page 36

10 Semi-Mnthly Premium Rates High Optin Lw Optin Emplyee $14.72 $6.93 Emplyee and Spuse $30.21 $14.22 Emplyee and Dependent Child(ren) $25.91 $12.04 Emplyee and Family $41.40 $19.33 Nte: If this cverage will replace any existing individual plicy, please be aware that it may be in yur emplyees best interest t maintain their individual guaranteed-renewable plicy. Cntinental American Insurance Cmpany (Aflac), a prud member f the Aflac family f insurers, is a whllywned subsidiary f Aflac Incrprated and underwrites grup cverage. Aflac is nt licensed t slicit business in New Yrk, Guam, Puert Ric, r the Virgin Islands. Cntinental American Insurance Cmpany 2801 Devine Street Clumbia, Suth Carlina Ntice t Cnsumer: The cverages prvided by Cntinental American Insurance Cmpany (CAIC) represent supplemental benefits nly. They d nt cnstitute cmprehensive health insurance cverage and d nt satisfy the requirement f minimum essential cverage under the Affrdable Care Act. CAIC cverage is nt intended t replace r be issued in lieu f majr medical cverage. It is designed t supplement a majr medical prgram. Cntinental American Insurance Cmpany is nt aware f whether yu receive benefits frm Medicare, Medicaid, r a state variatin. If yu r a dependent are subject t Medicare, Medicaid, r a state variatin, any and all benefits under this plan culd be assigned. This means that yu may nt receive any f the benefits in the plan. As a result, please check t the cverage in all health insurance plicies yu already have r may have befre yu buy this insurance t verify the absence f any assignments r liens. Custmer Service This brchure is a brief descriptin f cverage and is nt a cntract. Read yur certificate carefully fr exact terms and cnditins. This brchure is subject t the terms, cnditins, and limitatins f Plicy Series CA8500-MP(VA). Page 37