American Fidelity Assurance Company s AF Critical Choice Limited Benefit Critical Illness Insurance Financial Protection is a Choice
Critical Illness Surviving a critical illness can come at a high price. Have you thought what would happen if you or a family member suffered from a critical illness such as a heart attack or stroke? Consider the Facts 1 in 3 Americans have one or more types of cardiovascular disease. 1 Every 40 seconds someone in the United States has a stroke. 2 Rising Medical Costs Can Be Overwhelming Of all Americans who file bankruptcy this year, 60% will be due to medical bills. 1 Your medical bills plus your routine expenses can start adding up quickly after you have suffered a Critical Illness and are unable to work. These may include: AF Critical Choice, American Fidelity s Limited Benefit Critical Illness Insurance Policy, may be able to help provide some financial protection so you can focus on your recovery. AF Critical Choice Is Here For You Non-Medical Expenses Loss of income House payments Car payments Groceries Childcare Travel to specialized care Lodging Choose your Critical Illness benefit amount: Q $15,000, $20,000 or $25,000 Out-of-Pocket Medical Expenses High deductibles Co-pays Prescription drugs Out-of-network charges Alternative treatments Rehabilitation therapy Home modifications Use your benefit for any expense you wish. Maximize your benefits with optional riders. A plan compatible with your High Deductible Health Plan and Health Savings Account. Portable so you can keep it even if you change employers.
AF Critical Choice We will pay the percentage shown of the Critical Illness benefit amount you have chosen at the time of application: $15,000, $20,000 or $25,000 for each Critical Illness listed. The Recurrent Diagnosis Benefit provides an additional 50% of the Critical Illness benefit amount after the second Occurrence Date of the specified Critical Illness. Critical Illness BENEFIT AF Critical Choice Benefits BENEFIT AMOUNT Recurrent Diagnosis Benefit amount Heart Attack 100% 50% Coronary Artery Bypass Surgery Recommendation* 25% * Coronary Angioplasty Recommendation* $500 Indemnity Amount* Permanent Damage Due To A Stroke Coverage is available for you and your lawful spouse at 100% of the benefit amount and for your eligible child(ren), up to age 26 as defined in the policy, at 25% of the benefit amount. 100% 50% Major Organ Failure 100% 50% End Stage Renal Failure 100% Coma Due To A Covered Accident 100% 50% Permanent Paralysis Due To A Covered Accident 100% 50% Major Burns 100% 50% Occupational HIV or Occupational Hepatitis B, C, or D Health Screening Benefit Optional Hospital Confinement Benefit Rider Optional Sudden Death Due To Cardiac Arrest Rider *Partial payments reduce the Heart Attack benefit. 100% $50 Indemnity Amount $100 per day Indemnity Amount 100% Eight benefits, nine critical illness events. Focus On Your Recovery.
Financial protection when you need it most. Critical illness BENEFIT Each Critical Illness must be separated by at least 180 days following the first Critical Illness Occurrence Date. Heart Attack Pays following a Heart Attack due to Coronary Artery Disease. Any previous amounts paid for a Coronary Artery Bypass Surgery Recommendation and/or a Coronary Angioplasty Recommendation will be deducted from the amount payable under this benefit. A Heart Attack is not congestive heart failure, atherosclerotic heart disease, angina, cardiac arrest, or any other dysfunction of the cardiovascular system. Cardiac arrest is only payable under the optional rider for Sudden Death Due To Cardiac Arrest. Coronary Artery Bypass Surgery Recommendation Pays following a Physician s recommendation for such surgery to occur within 60 days immediately following the date of the recommendation due to Coronary Artery Disease. This benefit is payable only once per Covered Person per lifetime. Coronary Angioplasty Recommendation Pays following a Physician s recommendation for such surgery to occur within 60 days due to Coronary Artery Disease. This benefit is payable only once per Covered Person per lifetime. For all heart related benefits combined, we will not pay more than 100% of the Critical Illness benefit amount. Permanent Damage Due To A Stroke Permanent Damage must be due to a stroke and persist for a minimum of 30 consecutive days before this benefit is payable. Major Organ Failure Pays following the date the Covered Person is placed on the United Network for Organ Sharing (UNOS) list for a transplant of the heart, liver, lung or entire pancreas. End Stage Renal Failure Pays following a Physician s diagnosis of End Stage Renal Failure. Failure of one kidney is not End Stage Renal Failure, unless the Covered Person has only one kidney. End Stage Renal Failure does not include renal failure caused by any surgical accidents. Coma Due To A Covered Accident The Coma must be due to a Covered Accident and persist for a minimum of 14 consecutive days before this benefit is payable. Coma does not include a coma induced by, or at the request of a Physician, or a coma resulting from causes other than a Covered Accident. Permanent Paralysis Due To A Covered Accident Injuries to the spinal cord due to a Covered Accident, which result in paraplegia or quadriplegia must be diagnosed by a Physician and persist for a minimum of 90 consecutive days before this benefit is payable. Major Burns Pays following the date the third or fourth-degree burns occurred. Such burns must cover at least 50% of the total body surface. First or second-degree burns are not payable under this policy. Occupational HIV or Occupational Hepatitis B, C, or D Pays following the date of a positive antibody test for HIV or Hepatitis B, C, or D, due to an occupational accidental exposure to HIV or Hepatitis B, C, or D. Only one Critical Illness benefit amount for either Occupational HIV or Occupational Hepatitis B, C, or D is payable. Recurrent Diagnosis Benefit Pays 50% of the Critical Illness benefit amount following the second Occurrence Date for a Heart Attack, Permanent Damage Due To A Stroke, Major Organ Failure, Coma Due To A Covered Accident, Permanent Paralysis Due To A Covered Accident, or Major Burns for which a Critical Illness benefit amount was previously paid under this policy. A second Occurrence Date must be separated by at least 180 days following the first Occurrence Date of that same Critical Illness and occur while the policy is in force before benefits will be payable. Once a Recurrent Diagnosis Benefit has been paid for a Critical Illness, no further benefits for that same Critical Illness will be payable.
Health Screening Benefit Pays $50 when a Covered Person receives one of the following Health Screening Tests: Blood test for triglycerides Doppler ultrasound Echocardiogram Electrocardiogram (EKG) Fasting blood glucose test Serum cholesterol test to determine HDL and LDL levels Exercise or Pharmacologic stress test Neuroimaging studies This policy pays for one test per Covered Person per Calendar Year regardless of the number of tests a Covered Person receives during the Calendar Year. This benefit is available without a diagnosis of a Critical Illness. This benefit does not reduce the Critical Illness benefit amount. GUARANTEED RENEWABLE The policy and riders are guaranteed renewable until the Primary Insured reaches age 75 as long as you pay premiums when due or within the premium grace period. We have the right to change premiums by class. If your spouse is a Covered Person under this policy and under age 75 on the date of the Primary Insured s 75th birthday, the policy may be continued by the spouse upon written notification to us within 60 days. In such case, the spouse will then become the Primary Insured. Hospital Confinement Benefit Rider Pays an indemnity amount of $100 per day of confinement in a Hospital for at least 18 consecutive hours, up to 30 days per Covered Person. Successive Hospital stays will be considered as one confinement if they are: 1) due to the same or related Sickness or bodily injury; and 2) separated by less than 30 days. This benefit will not be paid for outpatient treatment or a stay in an Emergency Room, or Hospital Confinements due to pregnancy, including Cesarean delivery, any post-partum or routine services rendered to mother and child after birth. Complications of Pregnancy will be covered as any other Sickness. A Hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial care, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or for drug or alcohol addiction. Sudden Death Due To Cardiac Arrest Benefit Rider Pays following the date of Sudden Death Due To Cardiac Arrest at 100% of the Critical Illness benefit amount. Sudden Death Due To Cardiac Arrest is death resulting from a sudden, unexpected loss of heart function due to Sickness or a Covered Accident, in which the heart, abruptly and without warning, stops working as a result of an internal electrical system malfunction of the heart. Cardiac arrest is not a Heart Attack.
AF Critical Choice Monthly Premiums Age Non-nicotine Family Age Nicotine Family $15,000 $15,000 18-25 $ 7.62 $12.16 $ 8.62 $13.16 18-25 $ 8.52 $ 14.58 $ 9.52 $ 15.58 26-30 8.22 13.92 9.22 14.92 26-30 9.66 17.90 10.66 18.90 31-35 9.48 17.48 10.48 18.48 31-35 12.14 24.56 13.14 25.56 36-40 11.46 22.18 12.46 23.18 36-40 15.62 33.10 16.62 34.10 41-45 14.02 28.26 15.02 29.26 41-45 20.12 44.04 21.12 45.04 46-50 17.02 35.26 18.02 36.26 46-50 25.28 56.52 26.28 57.52 51-55 20.36 42.60 21.36 43.60 51-55 30.94 69.52 31.94 70.52 56-60 24.90 52.14 25.90 53.14 56-60 38.90 86.44 39.90 87.44 61-65 31.24 65.08 32.24 66.08 61-65 49.94 109.22 50.94 110.22 66-70 40.30 82.18 41.30 83.18 66-70 66.06 139.36 67.06 140.36 $20,000 $20,000 18-25 $ 8.26 $13.74 $ 9.52 $ 15.00 18-25 $ 9.46 $ 16.94 $10.72 $ 18.20 26-30 9.10 16.08 10.36 17.34 26-30 11.00 21.44 12.26 22.70 31-35 10.86 20.86 12.12 22.12 31-35 14.40 30.24 15.66 31.50 36-40 13.48 27.04 14.74 28.30 36-40 19.00 41.46 20.26 42.72 41-45 16.84 34.98 18.10 36.24 41-45 24.88 55.82 26.14 57.08 46-50 20.80 44.18 22.06 45.44 46-50 31.70 72.30 32.96 73.56 51-55 25.12 53.84 26.38 55.10 51-55 39.16 89.44 40.42 90.70 56-60 31.08 66.38 32.34 67.64 56-60 49.62 111.76 50.88 113.02 61-65 39.28 83.38 40.54 84.64 61-65 64.12 141.74 65.38 143.00 66-70 51.18 106.06 52.44 107.32 66-70 85.44 181.80 86.70 183.06 $25,000 $25,000 18-25 $ 8.92 $15.32 $10.42 $ 16.82 18-25 $ 10.40 $ 19.30 $ 11.90 $ 20.80 26-30 9.98 18.24 11.48 19.74 26-30 12.36 24.98 13.86 26.48 31-35 12.26 24.22 13.76 25.72 31-35 16.64 35.90 18.14 37.40 36-40 15.50 31.88 17.00 33.38 36-40 22.36 49.84 23.86 51.34 41-45 19.66 41.68 21.16 43.18 41-45 29.68 67.62 31.18 69.12 46-50 24.56 53.10 26.06 54.60 46-50 38.14 88.08 39.64 89.58 51-55 29.92 65.08 31.42 66.58 51-55 47.38 109.38 48.88 110.88 56-60 37.26 80.62 38.76 82.12 56-60 60.34 137.06 61.84 138.56 61-65 47.46 101.70 48.96 103.20 61-65 78.32 174.30 79.82 175.80 66-70 62.06 129.78 63.56 131.28 66-70 104.74 223.94 106.24 225.44
Hospital Confinement Benefit Rider Non-nicotine Nicotine Age Family Age Family 18-25 $ 1.94 $ 3.32 $ 4.04 $ 5.26 18-25 $ 2.06 $ 3.48 $ 5.14 $ 6.36 26-30 2.04 3.36 4.92 6.22 26-30 2.66 4.48 6.28 7.98 31-35 2.98 5.34 6.02 8.48 31-35 3.82 7.20 7.94 11.16 36-40 3.78 6.94 7.00 10.12 36-40 5.42 10.94 9.32 14.72 41-45 4.90 9.10 8.10 12.26 41-45 7.10 14.62 10.76 18.72 46-50 5.70 11.78 9.18 14.68 46-50 9.22 19.54 13.32 23.48 51-55 7.12 15.16 10.30 18.38 51-55 12.00 26.12 16.08 30.46 56-60 9.56 19.70 12.32 22.84 56-60 15.80 34.84 19.64 38.32 61-65 11.96 24.22 14.86 27.64 61-65 19.76 42.66 23.74 46.70 66-70 13.26 29.18 15.78 30.68 66-70 21.96 46.34 28.42 49.80 Sudden Death Due To Cardiac Arrest Benefit Rider Age Non-nicotine Family Age Nicotine Family $15,000 $15,000 18-25 $ 1.34 $ 2.90 $ 1.34 $ 2.90 18-25 $ 2.30 $ 5.30 $ 2.30 $ 5.30 26-30 2.14 4.88 2.14 4.88 26-30 3.90 9.20 3.90 9.20 31-35 3.58 8.04 3.58 8.04 31-35 6.78 15.56 6.78 15.56 36-40 5.32 11.82 5.32 11.82 36-40 10.26 23.24 10.26 23.24 41-45 7.44 16.34 7.44 16.34 41-45 14.42 32.44 14.42 32.44 46-50 9.94 21.60 9.94 21.60 46-50 19.30 42.96 19.30 42.96 51-55 12.54 26.84 12.54 26.84 51-55 24.32 53.30 24.32 53.30 56-60 15.70 33.00 15.70 33.00 56-60 30.60 65.52 30.60 65.52 61-65 19.74 40.52 19.74 40.52 61-65 38.60 80.36 38.60 80.36 66-70 24.50 49.36 24.50 49.36 66-70 48.30 98.02 48.30 98.02 $20,000 $20,000 18-25 $ 1.78 $ 3.88 $ 1.78 $ 3.88 18-25 $ 3.06 $ 7.06 $ 3.06 $ 7.06 26-30 2.86 6.50 2.86 6.50 26-30 5.20 12.28 5.20 12.28 31-35 4.78 10.70 4.78 10.70 31-35 9.02 20.76 9.02 20.76 36-40 7.10 15.74 7.10 15.74 36-40 13.66 31.00 13.66 31.00 41-45 9.90 21.78 9.90 21.78 41-45 19.24 43.26 19.24 43.26 46-50 13.26 28.80 13.26 28.80 46-50 25.74 57.26 25.74 57.26 51-55 16.70 35.80 16.70 35.80 51-55 32.42 71.08 32.42 71.08 56-60 20.94 44.00 20.94 44.00 56-60 40.78 87.34 40.78 87.34 61-65 26.32 54.04 26.32 54.04 61-65 51.48 107.16 51.48 107.16 66-70 32.66 65.82 32.66 65.82 66-70 64.40 130.70 64.40 130.70 $25,000 $25,000 18-25 $ 2.22 $ 4.84 $ 2.22 $ 4.84 18-25 $ 3.82 $ 8.82 $ 3.82 $ 8.82 26-30 3.56 8.12 3.56 8.12 26-30 6.50 15.34 6.50 15.34 31-35 5.96 13.38 5.96 13.38 31-35 11.28 25.94 11.28 25.94 36-40 8.86 19.68 8.86 19.68 36-40 17.08 38.74 17.08 38.74 41-45 12.38 27.22 12.38 27.22 41-45 24.04 54.06 24.04 54.06 46-50 16.56 36.00 16.56 36.00 46-50 32.16 71.58 32.16 71.58 51-55 20.88 44.74 20.88 44.74 51-55 40.52 88.84 40.52 88.84 56-60 26.16 55.00 26.16 55.00 56-60 50.98 109.18 50.98 109.18 61-65 32.90 67.54 32.90 67.54 61-65 64.34 133.94 64.34 133.94 66-70 40.82 82.26 40.82 82.26 66-70 80.50 163.36 80.50 163.36 Rider Premiums
Limitations and Exclusions Base Policy A Heart Attack is an acute myocardial infarction due to Coronary Artery Disease resulting in the ischemic death of a portion of the heart muscle. A Physician must make the diagnosis within 72 hours of the onset of symptoms. A positive diagnosis must be supported by three or more of the following criteria: the sudden onset of symptoms consistent with an acute myocardial infarction; EKG changes indicative of an acute myocardial infarction; elevation of biochemical markers of myocardial necrosis; and/ or confirmatory imaging studies. A Heart Attack is not Congestive Heart Failure, Atherosclerotic Heart Disease, Angina, Cardiac Arrest, or any other Dysfunction of the Cardiovascular System. The Critical Illness benefit amount is payable once per Covered Person for each Critical Illness shown on the Schedule of Benefits. After the Occurrence Date of the first Critical Illness payable under this policy or any attached rider, a benefit for each subsequent Critical Illness will only be payable if the Occurrence Date is for a Critical Illness for which a Critical Illness benefit amount has not been previously paid. The subsequent Critical Illness must be separated by more than 180 days following the last Critical Illness Occurrence Date, and occurs while the Covered Person is insured under the policy or rider. No benefits are payable for any Critical Illness with an Occurrence Date during the first 12 months of the Covered Person s coverage under this policy if the Critical Illness is the result of a Pre-Existing Condition. Pre-Existing Condition means a condition for which, within 12 months prior to the Covered Person s Effective Date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession. No benefits will be paid for any Critical Illness resulting from or caused, whether directly or indirectly, by: 1) war or any act caused by war, whether declared or undeclared, or active service in the armed forces; 2) an intentionally self-inflicted injury; 3) suicide or attempted suicide, while sane or insane; 4) participating in a riot, insurrection, or rebellion; 5) being intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician s instructions (intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the Critical Illness occurred); 6) committing, or attempting to commit, an illegal act that is defined as a felony ( felony is as defined by the law of the jurisdiction in which the act takes place); 7) being incarcerated in any type of penal institution; 8) alcoholism or drug addiction; 9) a diagnosis received outside the United States, or its territories, that cannot be confirmed by a Physician licensed and practicing in the United States. Optional Sudden Death Due To Cardiac Arrest Benefit Rider No benefits are payable for any Sudden Death Due To Cardiac Arrest with an Occurrence Date during the first 12 months of the Covered Person s coverage under this rider if the Sudden Death Due To Cardiac Arrest is the result of a Pre-Existing Condition. Optional Hospital Confinement Benefit Rider No benefits are payable for any Hospital Confinements during the first 12 months of the Covered Person s coverage under this rider if the Hospital Confinement is the result of a Pre-Existing Condition. Pre-Existing Condition means a condition for which, within 12 months prior to the Covered Person s Effective Date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession. For the purpose of this rider, no benefits will be provided for loss incurred for Sickness, or injuries received in an Accident, that is caused, whether directly or indirectly, by or occurs as a result of: 1) an intentionally selfinflicted injury; 2) suicide or attempted suicide, whether sane or insane; 3) war or any act caused by war, whether declared or undeclared, or active service in the armed forces; 4) participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician s instructions (intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss was incurred); 5) participating in a riot, insurrection, or rebellion; 6) committing, or attempting to commit, an illegal act that is defined as a felony ( felony is as defined by the law of the jurisdiction in which the act takes place); 7) alcoholism or drug addiction; 8) dental care or dental procedures, unless due to a Covered Accident; 9) routine newborn care, including routine nursery confinements; 10) pregnancy, including Cesarean delivery, any post-partum or routine services rendered to mother and child after birth (Complications of Pregnancy will be covered as any other Sickness.); 11) a neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind; 12) cosmetic surgery, including complications of cosmetic surgery (Correction of congenital birth defects or anomalies of a child, or reconstructive surgery related to a covered Sickness or injury will be covered as any other Sickness or injury.); 13) elective surgery, including complications of elective surgery; 14) medical treatment received outside the United States or its territories; 15) services rendered by a member of the Covered Person s Immediate Family, as defined in the policy; 16) participation in any sport as a professional; 17) participation in any contest of speed in a power driven vehicle as a professional. Rider benefits are subject to the benefit amounts, limits, separation periods, and calendar year maximums of the base policy. This is a brief description of the coverage and does not constitute the actual policy. For actual benefits, limitations, exclusions 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. Additional riders are subject to our general underwriting guidelines and coverage is not guaranteed. Rider availability may vary by state. 1 The Real Risk That You ll Have A Critical Illness. American Association for Critical Illness Insurance. http://www.criticalillnessinsuranceinfo.org/learning-center/ critical-illness-coverage-facts.php, 5 Apr. 2011. 2 American Heart Association: Heart Disease and Stroke Statistics 2012 Update, p.e3. December 2011. Sign up for online secured access to view and print your policies at americanfidelity.com. American Fidelity s Online Service Center provides you convenient, secure 24/7 access to your detailed policy information. We understand your privacy is important so we will not use your e-mail address for solicitation purposes. SB-24706-1212 2000 N. Classen Boulevard Oklahoma City, Oklahoma 73106 (800) 654-8489 www.americanfidelity.com CRIT11 Series