Limited Beneit Heart Disease, Heart Attack or Stroke Insurance HD/A/S-2

Transcription

1 Limited Beneit Heart Disease, Heart Attack or Stroke Insurance HD/A/S-2 APSB (TX) APS-1883 Generic-EE

2 Summary of Beneits Beneit Description Daily Hospital Expense Beneit Blood, Plasma or Platelets Beneit Private Duty Nursing Beneit for the Treatment of Heart Disease, Heart Attack or Stroke In-Patient Physician's Expense Beneit In-Hospital Drugs and Medicine Expense Beneit Surgical Expense Beneit Anesthetist Expense Beneit Angioplasty or Heart Catheterization Expense Beneit Electrocardiogram Expense Beneit Oxygen Expense Beneit Physical or Speech Therapy Expense Beneit Skilled Nursing Home/Extended Care Facility Expense Beneit* Ambulance Expense Beneit Transportation Expense Beneit Lodging Expense Beneit Government, Eleemosynary or Charity Hospital Beneits Heart Transplant Expense Beneit Lump Sum Beneit $100, $200, or $300 daily beneit Available Options Actual expenses up to $5000 per calendar year Actual expenses up to $100 per day Actual expenses up to $35 per day Actual charges up to $35 per day Beneits up to $4000 for any one surgical operation Beneits up to 25% of paid Surgical Expense Beneit Actual expenses up to $1150 for Percutaneous Transluminal Coronary Angioplasty; Charges up to $600 for any other Angioplasty; Charges up to $210 for left heart catherization; Charges up to $275 for any other Heart Catherization Actual expenses up to $400 per calendar year Actual expenses up to $400 per calendar year Actual expenses up to $25 per day; up to 30 days per calendar year Actual expenses up to $100 per day of coninement Actual expenses up to $100 per trip; up to 2 one-way trips per coninement Pays actual coach fare or $.35 per mile Actual expenses up to $50 per day; up to 14 days per coninement $100 per day of coninement; paid in lieu of other beneits except Transportation and Lodging Beneits Actual expenses up to $100,000; once per covered person per lifetime Choice of $1000, $2000, $3000, $4000, or $5000 beneit *Coninement must be within 14 days of a covered hospital coninement lasting 7 days and subject to the maximum number of days equal to prior covered hospital coninement.

3 Facts to Consider n Every 40 seconds someone in the United States has a stroke. 1 n 50% of men and 64% of women who died suddenly of CHD had no previous symptoms of this disease. 1 n Heart disease is the leading cause of death in the United States. 1 n In the U.S., someone will suffer a coronary event about every 26 seconds. 1 Policy Beneit Highlights Daily Hospital Expense Beneit Pays a daily hospital expense beneit for charges made by a Hospital while an Insured Person is conined as a resident in-patient as a direct result of Heart Disease, Heart Attack or Stroke. Heart Disease means any functional or structural abnormality of the heart including disease of the Pericardium. It does not mean abnormal blood pressure, hypertension, or hypertensive disorders or conditions. Heart Attack means Myocardial Infarction, which is a gross necrosis of the myocardium as a result of interruption of the blood supply to the area. Stroke means a sudden neurologic impairment due to a cerebrovascular disorder that is caused by intracranial hemorrhage or occlusive cerebrovascular lesions. It does not mean anoxic brain damage or injury. Blood, Plasma or Platelets Beneit Pays a beneit up to the actual expense for an Insured Person for Blood Treatment Expense as the result of Heart Disease, Heart Attack or Stroke. Blood Treatment Expense means the actual charges made to an Insured Person for whole blood, plasma or platelets. It also means the actual charges made to an Insured Person for the procurement, cross-matching, typing and processing of whole blood, plasma or platelets when done in conjunction with the receipt of whole blood, plasma or platelets. It also means the professional fee of a medical practitioner for the act of injecting the whole blood, plasma or platelets into the body of an Insured Person. It does not mean any fees or charges for access to venus circulation. Private Duty Nursing Beneit for the Treatment of Heart Disease, Heart Attack or Stroke Pays a beneit up to the actual expense for the full time, private care and attendance of a Nurse while an Insured Person is conined in a Hospital as a resident in-patient as a direct result of Heart Disease, Heart Attack or Stroke. In-Patient Physician's Expense Beneit Pays a beneit up to the actual expense for the services of a Physician, other than a Surgeon or Anesthesiologist while an Insured Person is conined in a Hospital as a resident in-patient as a direct result of Heart Disease, Heart Attack or Stroke. 1 American Heart Association: 'Heart Disease and Stroke Statistics, 2008 Update at a Glance'.

4 Policy Beneit Highlights continued In-Hospital Drugs and Medicine Expense Beneit Pays a beneit up to the actual charges for prescribed FDA approved drugs and medicine while an Insured Person is conined in a Hospital as a resident in-patient as a direct result of Heart Disease, Heart Attack or Stroke. Surgical Expense Beneit Pays a beneit when an insured cutting Surgical Operation is performed in a Hospital or Ambulatory Surgical Center on an Insured Person as a direct result of Heart Disease, Heart Attack or Stroke. A Coronary Angioplasty By- Pass is insured under this section. The beneit paid shall be determined by: (1) "Procedure Code"; (2) "Relative Value"; and, (3) a "Conversion Factor". Surgical Operations and "Procedure Codes" insured under this Beneit are described as a cutting Surgical Operation in the Current Procedural Terminology published by the American Medical Association. The "Relative Value" for a "Procedure Code" multiplied by the "Conversion Factor" equals the amount We will pay. Anesthetist Expense Beneit Pays a beneit of 25% of the amount payable for the Surgical Expense Beneit for the Professional Fee of an Anesthetist or Anesthesiologist for an Insured Person as a direct result of Heart Disease, Heart Attack or Stroke. An insured expense is one incurred in conjunction with a Surgical Operation for which beneits are payable. Angioplasty or Heart Catheterization Expense Beneit Pays a beneit up to the actual expense for an Angioplasty for an Insured Person conined in a Hospital as a resident in-patient, provided the expense is incurred for the Positive Diagnosis or deinitive treatment of Heart Disease, Heart Attack or Stroke. This beneit will pay charges for a Percutaneous Transluminal Coronary Angioplasty, up to $1, For any other Angioplasty, this beneit will pay charges, up to $ This beneit will pay charges for a left heart catheterization by left ventricular puncture, up to $ For any other Heart Catheterization, this beneit will pay charges up to $ Electrocardiogram Expense Beneit Pays a beneit up to the actual expense for an electrocardiogram (EKG or ECG) for an Insured Person conined in a Hospital as a resident in-patient, for the purpose of Positive Diagnosis or treating, Heart Disease, Heart Attack or Stroke. Oxygen Expense Beneit Pays a beneit up to the actual expense for oxygen and equipment directly associated with the inhalation or exhalation processes for an Insured Person conined in a Hospital as a resident in-patient as a direct result of Heart Disease, Heart Attack or Stroke. Physical or Speech Therapy Expense Beneit Pays a beneit up to the actual expense for Physical Therapy or Speech Therapy that is prescribed by a Physician for an Insured Person as a direct result of Heart Disease, Heart Attack or Stroke. Skilled Nursing Home/Extended Care Facility Expense Beneit Pays a beneit up to the actual expense as a direct result of Heart Disease, Heart Attack or Stroke for coninement in a Skilled Nursing Home or Extended Care Facility when the coninement is by written order of a Physician; and the coninement begins within fourteen (14) days after a Hospital coninement of at least 7 days duration for an Insured Person that was a direct result of Heart Disease, Heart Attack or Stroke. Ambulance Expense Beneit Pays a beneit up to the actual expense for transportation by Ambulance that is provided by a licensed ambulance company; and is for the purpose of taking the Insured Person to a Hospital for admission or home after a Hospital admission; and is medically necessary for an Insured Person as a direct result of Heart Disease, Heart Attack or Stroke. Transportation Expense Beneit Pays a beneit up to the actual expense for transportation to the nearest Hospital that can provide the special Heart Disease, Heart Attack or Stroke treatment for an Insured person when by written order of a Physician, a special treatment for Heart Disease, Heart Attack or Stroke is not available or cannot be obtained locally and requires Hospital coninement. This beneit will pay $.35 per mile for each mile of the most direct route between the Insured Person's home and the Hospital; and will pay to and from the Hospital; provided the Insured Person travels by automobile. If an Insured Person travels to the Hospital by licensed Common Carrier that is an aircraft, a bus or a train, We will pay the charges for coach tickets: on the most direct route to and from the Insured Person's home; for the Insured Person; and one Adult Family Member; provided the Insured Person is conined to the Hospital. Lodging Expense Beneit Pays a beneit up to the actual expense when an Insured Person receives a Transportation Expense Beneit and one adult member of the Insured Person's immediate family incurs a hotel or motel expense on account of accompanying the Insured Person. Government, Eleemosynary or Charity Hospital Beneits Pays a $100 beneit when an Insured Person is conined as a resident in-patient as a direct result of Heart Disease, Heart Attack or Stroke in a United States Government Hospital or any other Hospital that does not make a charge for services it provides. Heart Transplant Expense Beneit Pays a beneit up to the actual expense when an Insured Person receives a Human Heart Transplant as a direct result of Heart Disease. This beneit will be paid based on medically necessary charges in connection with the transplant. s Lump Sum Beneit Pays a lump sum beneit when an Insured Person has a Positive Diagnosis of a Heart Attack or Stroke; or, has a Surgical Operation for which beneits are payable under the Surgical Expense Beneit. This beneit is payable in addition to any other beneits payable under the Policy.

5 Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company's insurability requirements. Persons not meeting APL's insurability requirements will be excluded from coverage by an endorsement attached to the policy. Base Policy No beneit will be payable under this Policy: for any disease, sickness or inirmity other than Heart Disease, Heart Attack or Stroke; for loss due to a Pre-Existing Condition unless the loss occurs after premiums have been paid for twenty-four (24) consecutive months (or six months for those age 65 or older) on behalf of the Insured Person sustaining the loss; or, for charges incurred outside the United States if the Insured traveled to the location for the purpose of receiving such treatment. Beneits payable are restricted and limited to those listed by name or speciic description in the Schedules of Beneits for Heart Disease, Heart Attack or Stroke or any attached Beneit Endorsement or Rider. Ancillary procedures, treatments or services are not covered under this Policy. Beneits are payable only when an event, for which a beneit is payable, occurs while the Insured Person is insured under this policy. Positive Diagnosis is required. Loss due to Pre-Existing Conditions speciically named, or described as excluded in any part of the Policy are never covered. Pre-Existing Condition means any condition, that is diagnosed as Heart Disease, Heart Attack or Stroke subsequent to the Effective Date, which exhibited the existence of symptoms which would cause an ordinarily prudent person to seek medical diagnosis or treatment during the Five year period before the Insured Person became insured; or any condition, that is diagnosed as Heart Disease, Heart Attack or Stroke for which medical advice or treatment was recommended by or received from a Physician or Surgeon during the Five year period before the Insured Person became insured hereunder. Daily Hospital Expense Beneit This beneit represents our only payment for: Hospital room and board; normal nursing care; radiological procedures or services; operating room; recovery room; treatment room; laboratory and diagnostic procedures or services; anesthesia; luids; tubing; ports; pumps; intravenous set-ups; venipuncture; clamps; dressings; bandages; use of Hospital equipment; and, any other medically necessary procedure supply or service not covered elsewhere under the Policy, a Beneit Endorsement, or Rider. A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless you are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward. Blood, Plasma or Platelets Beneit This beneit will pay actual expenses up to $5, per Calendar Year. Private Duty Nursing Beneit for the Treatment of Heart Disease, Heart Attack or Stroke We will pay a Private Duty Nursing Beneit, provided: the nursing service is not customarily provided by the Hospital; the nursing service is required and ordered by a Physician. This beneit will pay actual expenses up to $ per 24 hour period, proportionally. In-Patient Physician's Expense Beneit This beneit will pay actual expenses up to $35.00 per 24 hour period. In-Hospital Drugs and Medicine Expense Beneit This beneit will pay actual charges up to $35.00 per day. Surgical Expense Beneit Any Procedure Code that is diagnostic in nature is not insured under this beneit. Angioplasty and Catheterization are not insured under this beneit. Our payment shall not be less than $66.67 nor more than $4,000.00, as a result of any one Surgical Operation. If more than one Surgical Operation is performed during a single operative session in the same operative ield, We will pay a Beneit for only one Surgical Operation. We will pay a beneit for the Surgical Operation calling for the largest payment. Our payment includes pre-operative and post-operative attendance of the Surgeon. The Schedule of Operations, included in your policy, lists examples of Our Payments under this Beneit. Our payment for any insured Surgical Operation, not listed in the Schedule of Operations, shall be calculated using the method described in Your policy. Anesthetist Expense Beneit This beneit will pay the charges of the Anesthetist or Anesthesiologist, up to 25% of the amount payable for the Surgical Expense Beneit. Angioplasty or Heart Catheterization Expense Beneit We will not pay actual expenses for a Coronary Angioplasty By-Pass (endarterectomy with or without gas, arterial implantation or anastomosis) or Heart Catheterization under this beneit. When an Insured Person undergoes both an Angioplasty and Heart Catheterization during the same period of Hospital coninement, We will pay the applicable beneit for the Angioplasty. We will pay no beneit, in that instance, for Heart Catheterization. If the Angioplasty or Heart Catheterization does not provide a Positive Diagnosis of or treat Heart Disease, Heart Attack or Stroke, no beneit is payable under this beneit. Electrocardiogram Expense Beneit This beneit will pay actual expenses up to $ per calendar year. If the Electrocardiogram does not provide a Positive Diagnosis of or treat Heart Disease, Heart Attack or Stroke, no beneit is payable. Oxygen Expense Beneit This beneit will pay actual expenses up to $ per calendar year. Physical or Speech Therapy Expense Beneit This beneit will pay actual expenses up to $25.00 per therapy session; up to $ per Calendar Year for all Physical or Speech therapy sessions combined. Physical Therapy must be given by a licensed Physical Therapist. Speech Therapy must be given by a licensed Speech Therapist or Speech Pathologist. Skilled Nursing Home/Extended Care Facility Expense Beneit This beneit will pay actual expenses up to $ per day; up to the number of days of prior Hospital coninement. Ambulance Expense Beneit This beneit will pay actual expenses up to $ per trip; up to two oneway trips per Hospital admission.

6 Limitations and Exclusions continued Transportation Expense Beneit This beneit will not pay actual expenses if the treatment is available or may be obtained at a Hospital that is within 100 miles, one way, of the Insured Person's home. Lodging Expense Beneit This beneit will pay actual expenses up to $50.00 per day; not to exceed the period of that Hospital coninement of the Insured Person or 14 days, whichever is less. Government, Eleemosynary or Charity Hospital Beneits This beneit will be paid in lieu of all other beneits except the Transportation Expense Beneit and the Lodging Expense Beneit. Heart Transplant Expense Beneit This beneit is subject to all the following conditions and limitations: (1) The transplant is recommended by two or more Physicians with a medical specialty in Cardiology. (2) The transplant is indicated for treatment of the particular type of Heart Disease by the United States Food and Drug Administration. (3) The maximum We will pay during the entire lifetime of the Insured Person is $100, (4) No insurance is provided for experimental treatments. (5) No beneits are payable under any other Section of this policy subsequent to the date the Insured Person is admitted to the Hospital for the purpose of the transplant. (6) Human Heart means a donor heart from another human being. It does not mean a mechanical heart, any man-made device or the heart of an animal. (7) No insurance is provided for expenses incurred for extraction of the heart from the donor. (8) No insurance is provided for medical or other expenses incurred by the donor. Lump Sum Beneit You must select this optional beneit in Your Application and have paid the required premium to qualify for this beneit. This beneit is payable one time during the entire lifetime of the Insured Person. Guaranteed Renewable This Policy is Guaranteed Renewable for Life and may be renewed by the timely payment of premiums. We have the right to change premium rates by class. Family Coverage You can take advantage of several options to extend coverage to your family: n Family Plan You and your spouse and any Eligible Child* under age 21. n Single Parent Family You and any Eligible Child* under age 21. *Please consult the policy for the deinition of Eligible Child and full-time student eligibility.

7 The Company Behind Your Plan American Public Life Insurance Company (APL) has an A.M. Best Rating of A- (Excellent)*. Founded in 1945 with an executive ofice located in Jackson, MS, we are licensed to transact business in 49 states and the District of Columbia. For many years, APL has focused on the worksite market providing a broad portfolio of Voluntary Supplemental Insurance products. Our products are distributed through an Agent/Broker network that is supported by our experienced sales and marketing staff. We take great pride in our support and service to our Agent/Broker partners and their clients. We work hard everyday to live up to our slogan, EZ2doBizWith. We hope that you will give us the opportunity to show you what our product portfolio and services can mean to you. Available Products offered by American Public Life n Dental n Accident n Intensive Care n Medical Supplement n Hospital Indemnity n Cancer n Whole Life n Term Life n Disability Income n Heart Disease/Heart Attack/Stroke All products not available in all states. *Best Insurance Reports: Life and Health, 2007 Edition (A- is 4 out of 16 with one being the highest).

8 Limited Beneit Heart Disease, Heart Attack or Stroke Insurance HD/A/S-2 Monthly Premiums Payroll Deduction (Ages 64 and below) Beneit Individual Single Parent Family 2 Parent Family $100 Daily Hospital Beneit $200 Daily Hospital Beneit $300 Daily Hospital Beneit Lump Sum Beneit (per $1,000 unit) Bank Draft (Ages 17-49) Beneit Individual Single Parent Family 2 Parent Family $100 Daily Hospital Beneit $200 Daily Hospital Beneit $300 Daily Hospital Beneit Lump Sum Beneit (per $1,000 unit) Bank Draft (Ages 50-64) Beneit Individual Single Parent Family 2 Parent Family $100 Daily Hospital Beneit $200 Daily Hospital Beneit $300 Daily Hospital Beneit Lump Sum Beneit (per $1,000 unit) Selected Beneits Heart Disease, Heart Attack, Stroke Plan Payroll Deduction Bank Draft Daily Hospital Beneit $100 $200 $300 Optional Lump Sum Beneit $1,000 $2,000 $3,000 $4,000 $5,000 Beneit Selected Underwritten by: Individual Single Family 2 Parent Family Total $ per pay period The premium and beneit may vary dependent upon plan selected at time of application. This is a brief description of coverage. For actual beneits and other provisions, please refer to the policy. This coverage does not replace Worker's Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. n Policy Form HD/A/S (06/08) Texas n Limited Beneit Heart Disease, Heart Attack or Stroke Insurance n Employee Brochure.