Cancer Insurance A Limited Benefit Specified Disease Cancer Expense Insurance Policy

Transcription

1 Limited Benefit Cancer Indemnity Insurance - Series 10 Cancer Insurance A Limited Benefit Specified Disease Cancer Expense Insurance Policy Wellness Benefits Benefits Paid Directly to You Excellent Customer Service Learn More Our Family, Dedicated to Yours.

2 Cancer Insurance A cancer diagnosis can be both a physical and emotional drain. Thanks to advances in medicines and procedures to battle cancer, more and more people are beating this disease. However, with the arrival of these advances also comes the continuing rise in the cost of cancer treatment. The financial impact of a cancer diagnosis can affect anyone s financial situation. American Fidelity Assurance Company s Limited Benefit Cancer Insurance can offer a solution to help you and your family focus on fighting the disease. This plan can assist with the expenses that may not be covered by medical insurance. According to the American Cancer Society, 1 out of 2 men and 1 out of 3 women are diagnosed with cancer in their lifetime. 1 1 American Cancer Society: Cancer Facts and Figures 2010, pg. 1 1 out of 2 men 1 out of 3 women 61% Indirect Medical Costs 39% Direct Medical Costs 39% of all costs for cancer are direct medical costs, while the remaining 61% of costs are indirect and generally not covered by major medical insurance. 2 2 American Cancer Society: Cancer Facts and Figures 2010, pg. 3 How It Works This plan is designed to help cover expenses if you are diagnosed with Cancer. With more than 25 built-in policy benefits, this plan provides benefits for the treatment of cancer, transportation, hospitalization and more. In addition, this is a portable plan so you own the policy. You can take the coverage with you if you choose to leave your current job, and your premiums will remain the same. American Fidelity s Cancer Insurance provides: Benefits paid directly to you, to be used however you see fit. Policy is guaranteed renewability for as long as premiums are paid as required. You own the policy and can keep the policy if you change employers. Wellness Benefit Receive a benefit for your annual internal cancer screening test, including but not limited to Mammogram, PAP, PSA, and Colonoscopy. Cancer Screening Benefit* Basic * Requires 30 day waiting period before use. Enhanced $75

3 Schedule of Benefits * Prevention Benefits Cancer Screening Benefit Cancer Screening Follow-Up Benefit Malignant Growth Prevention Benefit Inpatient (per Hospital Confinement) Outpatient Treatment Benefits Radiation/Chemotherapy/ Immunotherapy Benefit Blood, Plasma, and Platelets Benefit Bone Marrow Transplant Benefit (per lifetime max) Stem Cell Transplant Benefit (no lifetime max) Hospitalization Benefits Hospital Confinement Benefit (per day for the first 60 days) (per day thereafter of Hospital Confinement) Drugs & Medicine Benefit Inpatient (per Hospital Confinement) Outpatient Attending Physician (per day for the first 5 days of Hospital Confinement) (per day thereafter of Hospital Confinement) Basic Enhanced $75 $40 $125 $125 $250 $250 $7,000 $12,000 $1,000 $2,000 $5,000 $10,000 $250 $350 $200 $400 $125 $250 $30 $25 $300 $600 $250 0 $45 $40 U.S. Government/Charity Hospital or HMO Inpatient (per day of confinement; pays in lieu of most benefits) Outpatient $100 $100 $300 $300 (per day; pays in lieu of most benefits) Ambulance, Transportation & Lodging Benefits Ambulance (per admission) $100 $150 Patient Transportation & Lodging Benefit Transportation ($1,500 max round trip; max 12 trips/calendar year) Outpatient Lodging (per day up to 60 days per calendar year) Coach fare or.30/mile $25 Coach fare or.40/mile $30 Basic Ambulance, Transportation & Lodging Benefits Family Member Transportation and Lodging Benefit Transportation (up to 700 miles by car per confinement) Lodging (per day up to 60 days of Hospital Confinement per calendar year) (per day up to 60 days of Outpatient Treatment per calendar year) Coach fare or.30/mile $25 Enhanced Coach fare or.40/mile $30 Surgical Treatment Benefits Surgical Benefit $3,000 $5,000 Anesthesia Benefit Outpatient Hospital or Ambulatory Surgical Cancer Benefit (per day) Second & Third Surgical Opinion Benefit (per diagnosis) Continuing Care Benefits Prosthesis Surgically Implanted & Non- Surgically Implanted Benefit ** Surgical Implantation (per device with one device per site) Non-Surgical Implantation (per device with one device per site) Extended Care Facility Benefit (per day) Hospice Benefit (per day for the first 60 days) (per day thereafter; Basic lifetime maximum of $6,000; Enhanced lifetime maximum of $12,000) Home Health Care Benefit (per day with one session per day for up to 30 days per calendar year) Reconstructive Surgical Benefit Surgeon (per operation) Anesthesia (per operation) Temporary Prosthesis Inpatient Special Nursing Benefit (per day) 25% of the amount paid for covered surgery $100 $200 $150 $200 $1,500 $75 $2,500 $150 $100 $25 $100 $40 $300 $75 $625 $155 $100 $75 $125 Refer to Plan Benefit Highlights for more complete Benefit Descriptions and limits on the Cancer Insurance Plan. ** Except as needed due to growth and development of child.

4 Enhance Your Plan * Lump-Sum First Occurrence Rider This rider is designed to pay upon the first occurrence of internal Cancer (not Skin Cancer). Benefits are paid once per lifetime of a Covered Person. Schedule of Benefits Lump-Sum First Occurrence Benefit (once per lifetime) $2,500 Heart Attack and Stroke Rider This rider is designed to pay for each day a Covered Person is Hospital Confined due to a Heart Attack or Stroke as defined in the policy. Benefits are reduced by half upon age 70. Schedule of Benefits Heart Attack and Stroke Benefit (per day for up to 60 days per calendar year) $400 Intensive Care Unit Rider This rider can help provide you financial relief by paying for each day a Covered Person is confined in an Intensive Care Unit (ICU), as defined in the policy. Benefits are reduced by half at age 70. Schedule of Benefits ICU Confinement Benefit (per day up to 30 days) Ambulance Benefit (per admission in an ICU) $600 $100 * Availability of riders may vary by state and employer. Additional riders are subject to our underwriting guidelines and coverage is not guaranteed. Plan Options You can take advantage of the following options to extend coverage to your family: Individual Plan The Insured, age 18 through 70, at the date of policy issue, is the only Covered Person. Single Parent Family Plan The Insured, age 18 through 70, at the date of policy issue, and each Eligible Child under age 21 or under 25, if attending an accredited school full-time, as defined in the policy. Family Plan The Insured and spouse, age 18 through 70, at the date of policy issue, and Eligible Children under age 21 or under 25, if attending an accredited school full-time, as defined in the policy.

5 Plan Benefit Highlights Cancer Screening Benefit We will pay for each Covered Person who has one of the following tests each Calendar Year: mammogram; breast ultrasound; breast thermography; colon cancer blood test (CEA); prostate-specific antigen blood test (PSA); flexible sigmoidoscopy; colonoscopy; ovarian cancer blood test (CA- 125); pap smear; chest x-ray or hemocult stool specimen. The Cancer Screening Benefit will only be paid for tests performed after the 30-day period following the Covered Person s Effective Date of coverage. Cancer Screening Follow Up Benefit We will pay for a Covered Person to receive one invasive follow-up test needed due to an abnormal covered Cancer Screening result. Diagnostic surgeries which result in a positive diagnosis of Cancer will be paid under the Surgical Benefit. The Cancer Screening Benefit will only be paid for tests performed after the 30-day period following the Covered person s effective date of coverage. Malignant Growth Prevention Benefit We will pay for a Covered Person s drugs and medicines used as therapy specifically to prevent the growth of malignant cells. (This benefit covers the costs of drugs/medicines only-does not cover associated administrative charges. This benefit does not cover drugs/medicines covered under the Drugs and Medicine Benefit.) Radiation/Chemotherapy/Immunotherapy Benefit We will pay for a Covered Person s Inpatient or Outpatient therapy for the purpose of modification or destruction of abnormal tissue. (Chemotherapy and Immunotherapy covers cost of drugs/medicines only and does not cover other related procedures.) This benefit does not include drugs/medicines covered under the Drugs & Medicines Benefit or Malignant Growth Prevention Benefit. Blood, Plasma and Platelets Benefit We will pay for blood, plasma and platelets; transfusion service; procurement fees, including blood donor fees; administration, processing, blood-typing and cross-matching. Benefits for Blood, Plasma and Platelets are ONLY provided under this benefit. Bone Marrow Benefit We will pay for the surgeon s and anesthesiologist s fees for a Covered Person s bone marrow transplant. Stem Cell Transplant Benefit We will pay up to the amount shown for a Covered Person s stem cell transplant as treatment for a diagnosed Cancer. Amount shown is per Collection; up to three Collections are allowed per diagnosis with for One Reinfusion per diagnosis. This benefit does not include charges incurred by a donor for the harvest of stem cells. Hospital Confinement Benefit We will pay for each day room and board charges are incurred for a Covered Person while confined to a Hospital for the treatment of Cancer. A hospital is not, other than in a minor way, a place for: rest or the aged; convalescence; custodial or educational care. Drugs & Medicine Benefit We will pay for drugs and medicines prescribed by a Physician for a Covered Person for treatment of Cancer. This benefit does not cover associated administrative charges. This benefit does not include drugs/medicines covered under the Malignant Growth Prevention Benefit. Attending Physician Benefit We will pay for one attending Physician visit, other than a surgeon, per day the Covered Person is Hospital Confined for the treatment of Cancer. U.S. Government or Charity Hospital Benefit, or H.M.O. Benefit If a Covered Person is: confined in a charity Hospital or U.S. Government owned Hospital; or covered under a Health Maintenance Organization (H.M.O.) or Diagnostic Related Group (D.R.G.) where no charges are made to the Covered Person, benefits under the policy may be converted to pay the indemnity amount shown. Ambulance Benefit We will pay for the transportation of a Covered Person in an air or ground ambulance to a Hospital or from one medical facility to another where the Covered Person is admitted as an Inpatient and confined for at least 18 consecutive hours for treatment of Cancer. Patient Transportation and Lodging Benefit We will pay for the transportation of a Covered Person when diagnosed with Cancer and cannot receive treatment locally. The Hospital must be at least 50 miles away from the Covered Person s residence, using the most direct route. Such Hospital must be prescribed by a Physician and be the nearest Hospital which offers the specialized treatment. Benefits will be provided for only one mode of transportation per round trip. Travel must be within the United States or its Territories. Transportation benefits will be paid once per Hospital Confinement. If treatment is received on an outpatient basis, we will also pay the amount shown for the Covered Person s lodging in a single room in a motel, hotel or other accommodation acceptable to the Company. Benefits for lodging will only be paid on those days the Covered Person received outpatient treatment. Family Member Transportation and Lodging Benefit Expenses are covered for one adult family member to be near the Covered Person when the Covered Person is confined in a non-local Hospital for specialized treatment. Non-local means the Hospital is at least 50 miles away, using the most direct route. Benefits will be reduced by any amount paid for the family member under the Donor Benefit. If treatment is received on an outpatient basis, benefits for lodging will be paid only on those days the Covered Person received outpatient treatment. If the family member is also a donor, expenses for travel and lodging will be covered under this benefit only. Surgical Benefit We will pay up to the amount shown in the Schedule of Operations for surgeon s fees for a covered surgery of a diagnosed Cancer on a Covered Person. Fees charged for co-surgeons or assistants are not covered. Two or more surgical procedures performed through the same incision will be considered one operation and benefits will be limited to the most expensive procedure. Diagnostic surgeries which result in a negative diagnosis of Cancer are not covered under this benefit.

6 Plan Benefit Highlights, cont d Anesthesia Benefit We will pay up to the amount shown for anesthesiologist s fees incurred as a result of a covered surgery. Outpatient Hospital or Ambulatory Surgical Center Benefit We will pay up to the amount shown towards the facility fee of an Ambulatory Surgical Center or Hospital charges for a surgical procedure of a diagnosed Cancer as an outpatient. Surgical procedures for Skin Cancer are not covered under this benefit. Second and Third Surgical Opinion Benefit We will pay for a Covered Person s second surgical opinion when the attending Physician recommends surgery for the treatment of Cancer. If the second opinion disagrees with the first, this benefit pays for a third opinion. This benefit is payable once per diagnosis. Surgical opinions for reconstructive, skin cancer or prosthesis surgeries are not covered. Prosthesis Surgically Implanted and Non-Surgically Implanted Benefit We will pay for Surgically Implanted and Non-Surgically Implanted Devices. Coverage is only available if the prosthesis is prescribed by a Physician as a direct result of surgery for Cancer. This benefit does not cover anesthesia or prosthetic related supplies. Extended Care Facility Benefit We will pay for each day room and board charges are incurred while a Covered Person is confined in an Extended Care Facility. Confinement must be at the direction of a Physician, and begin within 14 days after a Hospital Confinement. This benefit will be paid for up to the same number of days benefits were paid for a Covered Person s Hospital Confinement. Hospice Care Benefit We will pay benefits when a Covered Person has been diagnosed as terminally ill due to Cancer and requires Hospice Care. Treatment must be directed by a licensed Hospice organization in the persons home or in a Hospice facility. This benefit does not include well baby care; volunteer services; meals; housekeeping services; or family support after the death of the Covered Person. We will pay benefits up to a day for each day care is received with No Lifetime Maximum. Home Health Care Benefit We will pay for a Covered Person s Home Health Care, as described in the Policy, required due to Cancer when prescribed by a Physician in lieu of Hospital Confinement. This benefit does not include: nutrition counseling; medical social services; medical supplies; prosthesis or orthopedic appliances; rental or purchase of durable medical equipment; drugs or medicines; child care; meals or housekeeping services. The caregiver may not be a family member. Reconstructive Surgery Benefit We will pay up to the amount shown for a surgeon s and anesthesiologist s fees incurred for reconstructive surgery needed as a result of Cancer or the treatment of Cancer. Fees for co-surgeons and assistants are not covered. Two or more surgical procedures performed through the same incision will be considered one operation and benefits will be limited to the most expensive procedure. Surgeries required to implant a permanent prosthetic device are covered under the Prosthesis Benefit. Surgical benefits for reconstructive Inpatient or Outpatient surgery are ONLY provided under this benefit. Inpatient Special Nursing Benefit We will pay for full-time special nursing care (other than that regularly furnished by a Hospital) while a Covered Person is confined to a Hospital. Full-time means at least eight consecutive hours during a 24 hour period. Care must be provided by a Nurse, as defined by the Policy, be prescribed by a Physician and be medically necessary for the treatment of Cancer. Donor Benefit We will pay expenses incurred by a donor on the behalf of a Covered Person for a covered surgery. If surgery is performed more than 50 miles from the donor s place of residence, benefits will be paid for the donor s transportation and lodging in a single room in a motel or hotel for a period of time beginning 24 hours before and ending 24 hours after the donor s presence is required. If the donor is also a family member who would qualify for benefits under the Family Member Transportation and Lodging Benefit, expenses for travel and lodging will be covered under that benefit only. Charges for blood donor expenses will be paid under the Blood, Plasma and Platelets Benefit only. Basic Plan: We will pay benefits up to $1000 in medical expenses; for non-local treatment we will pay 21 days of lodging at $25 per day, and round trip coach fare or $.30 per mile for up to 700 miles with No Lifetime Maximum. Enhanced Plan: We will pay benefits up to $1000 in medical expenses; for non-local treatment we will pay 21 days of lodging at $30 per day, and round trip coach fare or $.40 per mile for up to 700 miles with No Lifetime Maximum. Medical Equipment Benefit We will pay for the rental of a respirator or similar mechanical apparatus, braces, crutches, oxygen and wheelchairs when prescribed by a Physician for the treatment of Cancer. Basic Plan: up to $150 per Calendar Year with No Lifetime Maximum. Enhanced Plan: up to $250 per Calendar Year with No Lifetime Maximum. Dread Disease Benefit We will pay an indemnity amount for each period of Hospital Confinement for treatment of a Dread Disease defined in the policy. Benefits for Dread Disease are ONLY provided under this benefit. Basic Plan: up to $100 per day for the first 90 days per Confinement and up to $250 per day thereafter with a,000 Lifetime Maximum. Enhanced Plan: up to $200 per day for the first 90 days per Confinement and up to 0 per day thereafter with a $100,000 Lifetime Maximum. Waiver of Premium Benefit If the Primary Insured becomes disabled due to Cancer and remains so for more than 90 days, we pay all premiums due after the 90th day so long as the Primary Insured remains disabled. Total disability means the Primary Insured s inability because of Cancer: to work at any job for which (s)he is qualified by education, training or experience; not working at any job for pay or benefits; and under the care of a Physician for the treatment of Cancer. This policy must be in force at the time of disability and the Primary Insured must be under 65. Experimental Treatment Benefit We will pay up to the amount shown for a Covered Person s Experimental Treatment in or out of the hospital. This benefit does not provide coverage for treatments received outside the United States or its Territories. Basic and Enhanced Plans: paid as any non-experimental benefit for Inpatient or Outpatient with No Lifetime Maximum.

7 Limitations and Exclusions Eligibility This policy will be issued only to those persons who meet American Fidelity Assurance Company s insurability requirements. This product is inappropriate for those people who are eligible for Medicaid. The policy will not be issued to anyone who has been diagnosed or treated for Cancer in the previous ten years. The First Occurrence Benefit Rider will not be issued to anyone who has ever been diagnosed or treated for Cancer. The Heart Attack/Stroke Rider will not be issued to anyone who has been diagnosed or treated for any heart or stroke related conditions. The Intensive Care Unit Rider will not cover heart conditions for a period of two years following the Effective Date of coverage for anyone who has been diagnosed or treated for any heart related condition prior to the 30th day following Covered Person s Effective Date of coverage. Cancer means a disease which is manifested by autonomous growth (malignancy) in which there is uncontrolled growth, function, or spread (local or distant) of cells in any part of the body. This includes Cancer in situ and malignant tumors. It does not include other conditions which may be considered precancerous or having malignant potential such as: leukoplakia; hyperplasia; acquired immune deficiency syndrome (AIDS); polycythemia; actinic keratosis; myelodysplastic and myeloproliferative disorders; aplastic anemia; atypia; monoclonal gammopathy; moles or similar lesions. Cancer Policy All diagnosis of Cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This policy also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. This policy does not cover any other disease, sickness or incapacity even though after contracting cancer it may have been aggravated or affected by Cancer or the treatment of Cancer except for conditions specifically stated in the Dread Disease Benefit. No benefits are payable for any Covered Person for any loss incurred during the first two years of this policy as a result of a Pre-Existing cancer as defined in the policy. No benefits are payable for any loss incurred during the first year of the policy as a result of a Pre-Existing Dread Disease, as defined in this policy. A Pre-Existing Condition is a Specified Disease, not revealed in the application, for which symptoms existed or medical advice or treatment was recommended or received from a Physician within the two-year period prior to the Effective Date of a Covered Person s coverage under this policy. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered. This policy contains a 30 day waiting period during which no benefits will be paid under this policy. No benefits will be paid for two years for any cancer diagnosed or treated within the 30-day period following the Covered Person s Effective Date of coverage, or one year for any Dread Disease diagnosed or treated within the 30-day period following the Covered Person s Effective Date of coverage. However, if this policy replaces cancer expense coverage from any other company that terminates within 30 days of the Issue Date of the policy, the 30-day waiting period will be waived for any person insured under the prior coverage. (However, the Pre-Existing Condition limitation will still apply.) All benefits payable only to amount listed in the Schedule of Benefits. First Occurrence Benefit Rider No benefits will be provided for Cancer diagnosed prior to the 30th day following the Effective Date of this rider. Heart Attack/Stroke Rider No benefits will be provided during the first two years of the Heart Attack/ Stroke Rider when any heart condition or Stroke was diagnosed or treated prior to the Covered Person s Effective Date of coverage under the rider. No benefits will be provided for any loss resulting from: attempted suicide, whether sane or insane; intentional self-injury; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war; or military service for any country at war. Intensive Care Unit Rider No benefits will be provided during the first two years of this rider for Intensive Care Unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the Covered Person s Effective Date of this rider (the heart condition causing the confinement need not be the same condition diagnosed or treated prior to the Effective Date). No benefits will be provided if the loss results from: attempted suicide whether sane or insane; intentional self-injury; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war; or military service for any country at war. No benefits will be paid for confinements in units such as: Surgical Recovery Rooms, Progressive Care, Burn Units, Intermediate Care, Private Monitored Rooms, Observation Units, Telemetry Units or Psychiatric Units not involving intensive medical care; or other facilities which do not meet the standards for Intensive Care Unit as defined in the Rider.

8 Cancer Insurance Premiums Base Plan Monthly Premiums * Basic Enhanced Individual $17.80 $27.20 Single Parent Family $21.80 $33.30 Family $26.70 $40.80 Optional Benefit Rider Monthly Premiums Lump-Sum First Occurrence Benefit Rider Monthly Premium Individual $3.50 Single Parent Family $4.00 Family $5.70 Heart Attack and Stroke Benefit Rider Monthly Premium Individual $3.20 Single Parent Family $3.50 Family $5.30 Intensive Care Unit Rider Monthly Premium Individual $6.00 Single Parent Family $8.00 Family $11.00 Guaranteed Renewable You are guaranteed the right to renew your base policy during your lifetime as long as you pay premiums when due or within the premium grace period. We have the right to increase premiums by class. * The premium and amount of benefits provided vary based upon the plan selected. This is a brief description of the coverage. For actual benefits and other provisions, please refer to the policy. This coverage does not replace Workers Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid Coverage. Our Family, Dedicated to Yours. Toll-free N. Classen Boulevard Oklahoma City, Oklahoma Policy Form: C10-98 Series (FL) SB-6008(FL)-1011