PROTECTION solutions Benefit coverage for HSP2 12.4 million people alive today have a history of heart attack, angina pectoris (chest pains) or both. 1 1 2009 Heart and Stroke Statistical Update, American Heart Association. Heart/stroke INSURANCE the right coverage your future great choice ABJ22682X www.pierceins.com For additional information or to enroll by phone, please contact us at the above phone number or web address. Page 1 of 6
HeartCare Plus heart/stroke insurance HeartCare Plus insurance pays you benefits that can be used for non-medical expenses that health insurance might not cover. Benefits are paid as they are incurred and correspond with specific treatments and expenses as they happen. And they can help protect your financial resources, should you or a member of your family need expensive treatment for coronary artery disease or stroke. i meeting your needs Our coverage can meet the needs of you, your spouse, and your child(ren). We know you will agree what we offer will provide peace of mind for a secure future. Here are some of the features: Guaranteed renewable for life, subject to change in premiums by class Benefits are paid directly to you, unless assigned Benefits are paid in addition to any other coverage you may have No reduction in benefits at age 65 or retirement Pays in addition to your Workers Compensation We have made it easy to protect your family and help secure your financial future. EASY on you & your savings Ask me how. benefit coverage highlights HOSPITALIZATION AND RELATED BENEFITS Hospital Confinement - Pays daily for you or each covered family member admitted to and confined as an inpatient in a hospital due to Heart Attack, Heart Disease or Stroke. Physician s Attendance - Pays daily for the services of a physician during a covered hospital confinement. Payable only for the number of days the hospital confinement benefit is payable. Inpatient Drugs and Medicine - Pays daily for drugs or medicine required during a covered hospital confinement. Payable only for the number of days the hospital confinement benefit is payable. Private Duty Nursing Services - Pays daily for private nursing care and attendance by a nurse during a covered hospital confinement.* Must be required and authorized by attending physician. Physiotherapy - Pays daily for physiotherapy performed by a licensed physical therapist during a covered hospital confinement.* Oxygen - Pays for the use of oxygen equipment during a covered hospital confinement.** Cardiograms - Pays for an electrocardiogram, echocardiogram, phonocardiogram or vectorcardiogram required during a covered hospital confinement.** Cerebral or Carotid Angiogram - Pays for a cerebral or carotid angiogram required during a covered hospital confinement.** SURGERY AND RELATED BENEFITS Blood, Plasma and Platelets - Pays for the administration of blood, plasma, or platelets during a covered hospital confinement.** * Subject to a maximum of 60 days per continuous hospital confinement **Subject to a maximum of 1 payment per continuous hospital confinement Page 2 of 6 ABJ22682X
Cardiac Catheterization - Pays for a cardiac catheterization procedure. Pacemaker Insertion - Pays for the initial insertion of a permanent pacemaker. Thromboendarterectomy - Pays for a thromboendarterectomy operation. Heart Transplant - Pays for the implantation of a natural human heart. This benefit is only payable once per covered person. Coronary Angioplasty - Pays for a coronary angioplasty procedure, regardless of the number of blood vessels repaired during the procedure. Coronary Artery By-Pass Graft Operation - Pays for a coronary artery by-pass graft operation, regardless of the number of grafts performed during the operation. Second Surgical Opinion - Pays for a second opinion obtained after a positive diagnosis that results in the physician recommending surgery for a covered illness. Surgery and Anesthesia - (1) Surgery - Pays for a surgery performed in a hospital or ambulatory surgical center. For a surgical procedure not listed in the surgical schedule, we pay $34 per unit of coverage multiplied by the California Relative Value Schedule (C.R.V.S.), up to a maximum of amount shown. If the surgical procedure has no unit value or is not shown in the 1964 C.R.V.S., we pay an amount we reasonably determine based upon relative difficulty and payment amounts for other procedures, up to a maximum of amount shown. (2) Anesthesia - Pays an additional 25% of the amount paid for surgery benefit described in 1 above for anesthesia received during the surgery. (3) Ambulatory Surgical Center - Pays when surgery benefit described in 1 is paid for a surgery performed at an ambulatory surgical center. These benefits do not pay for surgeries covered by other benefits in the policy. TRANSPORTATION AND LODGING BENEFITS Ambulance - Pays for transfer by air and non-air ambulance to a hospital or emergency room for the treatment of a covered condition. Non-Local Transportation - Pays for a covered hospital confinement which is obtained more than 100 miles from the covered person s home because the prescribed treatment cannot be obtained locally.** Family Member Lodging and Transportation - (1) Lodging - Pays daily when a family member stays in a motel, hotel, or any other accommodation acceptable to us, in order to be near the covered person.* (2) Transportation - Pays when the Non-Local Transportation benefit is paid and a family member travels more than 100 miles from their home to be near the covered person for a portion of their continuous hospital confinement.** OPTIONAL RIDER BENEFITS Wellness Benefit Rider (WBR5) - Pays per calendar year per covered person for one of the following wellness tests: Biopsy for skin cancer; Blood test for triglycerides; Bone Marrow Testing; CA15-3 (blood test for breast cancer); CA125 (blood test for ovarian cancer); CEA (blood test for colon cancer); Chest X-ray; Colonoscopy; Doppler screening for peripheral vascular disease; Echocardiogram; EKG (Electrocardiogram); Flexible sigmoidoscopy; Hemocult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Pap smear, including ThinPrep Pap Test; PSA (blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; or Ultrasound screening of the abdominal aorta for abdominal aortic aneurysms. This benefit is paid regardless of the result of the test. There is no limit to the number of years a covered person can receive a wellness benefit. Hospital Intensive Care (ICR90) - Pays when you receive care in an intensive-care unit (ICU) and ambulance transportation to the covered hospital is required. POLICY SPECIFICATIONS Renewability - The policy is guaranteed renewable for life, subject to change in premiums by class. A notice will be mailed in advance of any change. Eligibility/Termination - Family coverage may include you, your spouse and children as defined in the policy. If the insured s spouse is a covered person, the spouse s coverage ends upon valid decree of divorce. Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. Policy and Rider(s) Exclusions and Limitations - The policy does not cover any other sickness or incapacity caused, complicated or otherwise affected by Heart Attack, Heart Disease or Stroke. If a covered confinement is due to more * Subject to a maximum of 60 days per continuous hospital confinement **Subject to a maximum of 1 payment per continuous hospital confinement ABJ22682X Page 3 of 6
than one covered condition, benefits will be payable as though the confinement were due to one condition. If a confinement due to a covered disease is also due to a condition that is not covered, benefits will be payable only for the part of the confinement attributable to the covered condition. Exclusions and limitations to the policy also apply to the rider. Policy and Rider(s) Pre-Existing Condition Limitation - If a covered person has a pre-existing condition as defined, we do not pay benefits for such conditions under the policy during the 12-month period beginning on the date that person became a covered person. If the loss is not due to a pre-existing condition, then the pre-existing condition limitation does not apply. A pre-existing condition is defined as a condition not revealed in the application for which: symptoms existed within a 1-year period before the effective date of coverage; and medical advice or treatment was recommended by or received from a physician within the 1-year period before the effective date of coverage. All losses are subject to the Time Limit on Certain Defenses provision. Intensive Care Rider (ICR90) Exclusions and Limitations - We do not pay for intensive care confinement if you are admitted because of: a pre-existing condition as defined in the policy; or an attempted suicide or intentional self-inflicted injury; or any loss sustained or contracted in consequence of the insured s being intoxicated or being under the influence of any narcotic unless administered on the advice of a physician; or alcoholism or drug addiction. We do not pay for confinements in any care unit that does not qualify as a hospital intensive care unit. The following do not qualify as Hospital Intensive Care Units : progressive care units; or sub-acute intensive care units; or intermediate care units; or private room with monitoring; or step-down units; or any other lesser care treatment units. The policy is a Limited Benefit Policy with riders. ABJ22682X Page 4 of 6
This material is valid as long as information remains current, but in no event later than December 15, 2014. Heart Stroke insurance benefits provided by policy HSP2 or state variations thereof. Wellness Benefit Rider provided by rider WBR5, or state variations thereof. Intensive Care Rider provided by rider ICR90 or state variations thereof. The policy is underwritten by American Heritage Life Insurance Company. The policy is not a Medicare Supplement Policy. The policy provides supplemental, limited benefit insurance. This brochure highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. For costs and complete details, contact your Insurance Agent, or, contact Allstate Benefits at: 1-800-521-3535 or, go to allstateatwork.com. Underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). This brochure is for use in NC. Page 5 of 6 ABJ22682X
Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. 2011 Allstate Insurance Company. www.allstate.com or allstateatwork.com. Page 6 of 6 ABJ22682X
PROTECTION solutions Benefit coverage for PLAN A premiums detailed Basic - 0.5 unit of HSP2 + 4 units of WBR5 Enhanced - 1 unit of HSP2 + 4 units of WBR5 Semi-Monthly Insured Basic Enhanced EE $5.97 $10.46 Family $11.06 $19.72 PLAN B Basic - 0.5 unit of HSP2 + 4 units of WBR5 + 3 units of ICR90 Enhanced - 1 unit of HSP2 + 4 units of WBR5 + 6 units of ICR90 Semi-Monthly Insured Basic Enhanced EE $7.62 $13.76 Family $14.36 $26.32 Issue Ages: 18-64 HSP2 HEART/STROKE INSURANCE the right coverage your future great choice ABJ22682X - Insert - ECU www.pierceins.com For additional information or to enroll by phone, please contact us at the above phone number or web address. Page 2a
policy benefits The listing below describes the benefit amounts associated with each benefit described in the brochure. HOSPITALIZATION AND RELATED BENEFITS Basic Enhanced Hospital Confinement $200/day $400/day Physician s Attendance $25/day $50/day Inpatient Drugs and Medicine $25/day $50/day Private Duty Nursing Services $100/day $200/day Physiotherapy $50/day $100/day Oxygen $200 $400 Cardiograms $100 $200 Cerebral or Carotid Angiogram $150 $300 SURGERY AND RELATED BENEFITS Blood, Plasma and Platelets $200 $400 Cardiac Catheterization $500 $1,000 Pacemaker Insertion $1,000 $2,000 Thromboendarterectomy $2,500 $5,000 Heart Transplant $100,000 $200,000 Coronary Angioplasty $750 $1,500 Coronary Artery By-pass Graft Operation $2,500 $5,000 Second Surgical Opinion $100 $200 Surgery and Anesthesia 1. Surgery 1.$5,000 max. 1. $10,000 max. 2. Anesthesia 2.25% 2. 25% 3. Ambulatory Surgical Center 3. $250 3. $500 TRANSPORTATION AND LODGING BENEFITS Ambulance Non-Air Ambulance $200 $400 Air Ambulance $400 $800 Non-Local Transportation $200 $400 Family Member Lodging $50/day $100/day Family Member Transportation $200 $400 OPTIONAL RIDER BENEFITS Basic Enhanced Wellness Benefit Rider $100 $100 Hospital Intensive Care Rider Hospital Intensive Care Confinement Benefit $300/day 1 $600/day 1 Ambulance Benefit actual charges actual charges 1 At age 70, benefit reduces to $50/unit This insert is for use in: NC This insert is part of brochure ABJ22682X and is not to be used on its own. This material is valid as long as information remains current, but in no event later than December 15, 2014. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. 2011 Allstate Insurance Company. www.allstate.com or allstateatwork.com. ABJ22682X - Insert - ECU Page 2b