living with a critical illness Group Voluntary Critical Illness Provides lump-sum cash benefits that can help with daily expenses What can
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1 What can living with a critical illness mean to you? FOR SALE mortgage doctor prescriptions Daily out-of-pocket expenses for fighting the disease while still paying your bills! Group Voluntary Critical Illness Provides lump-sum cash benefits that can help with daily expenses Allstate Life Insurance Company of New York ABJ23779NY Page 1 of 6 (D, E, F)
2 group voluntary critical illness Allstate Benefits (AB) group voluntary critical illness coverage provides a lump-sum cash benefit to help you cover the out-of-pocket expenses associated with a critical illness. No one knows what lies ahead on the road through life. Will you be diagnosed with Coronary Artery Disease or have to undergo a Major Organ Transplant? Will you suffer a stroke or a heart attack? The signs pointing to a critical illness are not always clear and may not be preventable, but our coverage can help offer financial support in the event you are diagnosed. Critical illness coverage can help offer peace of mind when a critical illness diagnosis occurs. Below is an example of how benefits might be paid.* John chooses coverage from the plan benefits his employer is offering John is at home working in the yard and he suffers a mild heart attack. He is rushed to the hospital, treated and released 18 mos. later - John is at work, suffers a second heart attack. 3 mos. later he is rushed to the hospital, examined, and moved to surgery Our critical illness insurance coverage would provide John the following: Heart Attack $ 10,000 Second Event (Heart Attack) $ 10,000 Coronary Artery Disease $02,500 Total cash benefits $ 22,500 Prognosis is good and he is expected to make a full recovery i meeting your needs Our coverage can help meet the needs of you and your family by offering financial support when it is needed most: Benefits and coverage amounts have been selected by your employer to make it easy to choose a plan that meets your needs** Covered dependents receive 50% of your basic-benefit amount Benefits paid directly to you Coverage supplements any existing medical benefits Premiums are affordable Portable your benefit coverage A percentage of the basic-benefit amount is payable for the Initial Critical Illness benefits, Cancer Critical Illness benefits and Second Event Initial Critical Illness benefit. Coverage also includes an annual Wellness benefits. Benefit amounts are shown on pages 2a and/or 2b. See pages 3 and 4 for conditions and requirements. INITIAL CRITICAL ILLNESS BENEFITS Heart Attack (100%) - Pays when you have a heart attack. Stroke (100%) - Pays when you have a stroke. Coronary Artery Disease (25%) - Pays when you have coronary artery narrowing or blockage. Major Organ Transplant (100%) - Pays when you have a heart, lung, liver, pancreas or kidney transplant (from a human donor). End Stage Renal Failure (100%) - Pays when you have peritoneal dialysis or hemodialysis. Waiver of Premium (Employee only) - Pays your premium if you are disabled for 90 days in a row, due to a covered critical illness, as long as the disability lasts, up to 2 years. Page 2 of 6 ABJ23779NY *The example shown may vary from the plan your employer is offering. Your individual experience may also vary. **Amounts over the guaranteed issue amount or enrolling after your initial enrollment period requires evidence of insurability.
3 CANCER CRITICAL ILLNESS BENEFITS Invasive Cancer (100%) - Pays when you have an invasive cancer (includes Leukemia and Lymphoma). Carcinoma in Situ (25%) - Pays when you have cancer in situ. Other Cancer - Pays one time only when you have basal cell or squamous cell skin cancer, or other cancers not covered above. CRITICAL ILLNESS ADDITIONAL BENEFIT Second Event Initial Critical Illness - Pays when you are diagnosed a second time with a critical illness we paid a benefit for in the Initial Critical Illness benefits. ADDITIONAL BENEFIT Wellness - Pays each year for one of the following: Biopsy for skin cancer Blood test for triglycerides Bone Marrow Testing CA15-3, CA125 and CEA (blood tests for breast, ovarian and colon cancer) Chest X-ray Colonoscopy Doppler screenings for carotids and peripheral vascular disease Echocardiogram EKG (Electrocardiogram) Flexible sigmoidoscopy Hemocult stool analysis HPV Vaccination (Human Papillomavirus) Lipid panel (total cholesterol count) Mammography, including Breast Ultrasound Pap Smear, including ThinPrep Pap Test PSA (prostate specific antigen blood test for prostate cancer) Serum Protein Electrophoresis (test for myeloma) Stress test on bike or treadmill Thermography Ultrasound (screening for abdominal aortic aneurysms) CERTIFICATE SPECIFICATIONS Your Eligibility - Your employer decides who is eligible for your group (such as length of service and hours worked each week). Issue ages are 18 and over. Dependent Eligibility/Termination - (a) Family members eligible for coverage are your spouse (or domestic partner) and children. (b) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. (c) Spouse coverage ends upon divorce or annulment. (d) Domestic partner coverage ends when the domestic partnership ends or your death. Medical Insurance Requirement - Coverage can only be issued to persons covered by either major medical insurance, or basic hospital and basic medical insurance. We will send you a letter asking if covered persons have this insurance. If you respond that insurance is not in force on the effective date, coverage for that person will not be provided and any premiums paid will be refunded. Suspended Coverage During Military Service - If you are a member of a reserve armed forces of the United States, you may request to suspend this coverage during active duty for up to 5 years. Coverage will not be in force while suspended, and you will not be required to pay premiums. Portability Privilege - Coverage may be continued under the Portability Provision when coverage under the policy ends. Termination of Coverage - Your coverage under the policy ends when: the policy is canceled; you stop paying your premium; your active employment ends; you are no longer eligible; a fraudulent or materially misrepresented claim is filed; or all critical illness benefits have been paid. BENEFIT CONDITIONS All critical illnesses must meet the definitions and dates of diagnoses stated in the policy and be diagnosed by a physician while coverage is in effect. Emergency situations while you are outside the U.S., its territories, Canada or Mexico will be considered when you return. The date of diagnosis for each illness must be separated by 90 days. ABJ23779NY Page 3 of 6
4 Pre-Existing Condition Limitation - (a) We do not pay benefits for a critical illness from a pre-existing condition when the date of diagnosis is within 6 months after the effective date. (b) A pre-existing condition is a condition for which, during the 6 months just prior to the effective date, medical advice or treatment was recommended by or received from a health care provider. Exclusions - We do not pay benefits for: (a) war, participation in a riot, insurrection or rebellion; (b) intentionally self-inflicted injury or action; (c) illegal activities or participation in an illegal occupation; (d) suicide while sane, or self-destruction while insane, or any attempt at either; (e) substance abuse, including alcohol, alcoholism, drug addiction, or dependence upon any controlled substance. Heart Attack Exclusions - Does not include an established (old) myocardial infarction. Stroke Exclusions - Does not include: Transient ischemic attacks (TIAs), head injury, chronic cerebrovascular insufficiency and reversible ischemic neurological deficits. Coronary Artery Disease Exclusions - Does not include: abdominal aortic bypass, balloon angioplasty; laser embolectomy; atherectomy; stent placement; or other non-surgical procedures. Invasive Cancer Exclusions - Does not include: carcinoma in situ; tumors related to HIV; non-invasive or nonmetastasized skin cancer; or early prostate cancer. Carcinoma in Situ Exclusions - Does not include: other skin malignancies; or premalignant lesions (such as intraepithelial neoplasia); or benign tumors or polyps. Second Event Initial Critical Illness Benefit Conditions - There must be at least 12 months between each diagnosis. A Second Event Critical Illness Benefit is paid only once for each initial critical illness. Page 4 of 6 ABJ23779NY
5 Don t Wait for A Sign There are different signs that doctors look for when diagnosing critical illnesses. Being diagnosed with a critical illness can be one of the most frightening experiences anyone has to face, especially if you are unprepared. Don t wait for a sign to start thinking about the future or your finances. You can rely on our Critical Illness Insurance to help give you peace of mind, so you can focus on the challenges of treatment. Budget friendly Sometimes, undergoing expensive treatments for a critical illness is difficult if your money is tight. That s where we can help. Our supplemental benefit coverage pays in addition to your major medical insurance to help provide additional dollars that may be used to cover your out-of-pocket expenses. vs. According to the first National Critical Illness Risk Assessment Study published by the American Association for Critical Illness Insurance in 2010, 17 percent of non-smoking men and 36 percent of male smokers who reach the age of 55 without having a critical illness will be diagnosed with one prior to turning age 65. For women who reach age 55, some 12 percent of nonsmokers and 23 percent of smokers will face a critical illness before reaching age 65. Page 5 of 6 ABJ23779NY
6 Coverage is provided by supplemental, limited benefit health insurance. This material is valid as long as information remains current, but in no event later than August 15, Group Critical Illness benefits provided by policy form GVCIP2NY, which provides stated benefits for specified illnesses. The policy does not provide benefits for any other sickness or condition. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer s Guide available from Allstate Benefits. This brochure highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the policyholder (employer) and the insurance company. Policy issued by Allstate Life Insurance Company of New York. For complete details of the insurance, including exclusions, restrictions and other provisions included in the certificates issued, contact your Insurance Agent, or call Allstate Life Insurance Company of New York at: or, go to allstate.com. This brochure is for use in enrollments sitused in New York Allstate Benefits is a marketing name for Allstate Life Insurance Company of New York (Home Office, Hauppauge, NY) Allstate Insurance Company. Page 6 of 6 ABJ23779NY
7 Allstate Life Insurance Company of New York group voluntary critical illness (with pre-ex) benefit amounts INITIAL CRITICAL ILLNESS BENEFITS Low High Heart Attack (100%) $10,000 $20,000 Stroke (100%) $10,000 $20,000 Coronary Artery Disease (25%) $2,500 $5,000 Major Organ Transplant (100%) $10,000 $20,000 End Stage Renal Failure (100%) $10,000 $20,000 Waiver of Premium (Employee only) Yes Yes cancer critical ILLNESS BENEFITS Invasive Cancer (100%) $10,000 $20,000 Carcinoma in-situ (25%) $2,500 $5,000 Other Cancer (one-time payment) $250 $250 critical ILLNESS ADDITIONAL BENEFIT Second Event Initial Critical Illness Benefit 1 Yes Yes ADDITIONAL BENEFIT Wellness Benefit (per year) $100 $100 1 Pays same amount as Initial Critical Illness Benefit weekly premiums LOW PLAN - $10,000 BASIC BENEFIT AMOUNT non-tobacco tobacco AGES EE EE + SP EE + CH F AGES EE EE + SP EE + CH F $2.41 $4.03 $2.41 $ $3.24 $5.49 $3.24 $ $4.83 $7.75 $4.83 $ $7.97 $12.78 $7.97 $ $8.06 $13.06 $8.06 $ $15.31 $24.13 $15.31 $ $10.92 $17.88 $10.92 $ $21.98 $34.38 $21.98 $ $13.12 $21.62 $13.12 $ $26.75 $41.81 $26.75 $41.81 EE = Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Children; F = Family. Issue Ages: 18 and over if Actively at Work Additional premiums on reverse Allstate Life Insurance Company of New York ABJ23779NY-Insert-F Page 2a (F)
8 weekly premiums HIGH PLAN - $20,000 BASIC BENEFIT AMOUNT non-tobacco tobacco AGES EE EE + SP EE + CH F AGES EE EE + SP EE + CH F $3.93 $6.23 $3.93 $ $5.59 $9.13 $5.59 $ $8.78 $13.66 $8.78 $ $15.05 $23.72 $15.05 $ $15.24 $24.27 $15.24 $ $29.73 $46.43 $29.73 $ $20.96 $33.92 $20.96 $ $43.07 $66.92 $43.07 $ $25.35 $41.39 $25.35 $ $52.62 $81.78 $52.62 $81.78 monthly premiums LOW PLAN - $10,000 BASIC BENEFIT AMOUNT non-tobacco tobacco AGES EE EE + SP EE + CH F AGES EE EE + SP EE + CH F $10.42 $17.46 $10.42 $ $14.02 $23.76 $14.02 $ $20.92 $33.56 $20.92 $ $34.52 $55.36 $34.52 $ $34.92 $56.56 $34.92 $ $66.32 $ $66.32 $ $47.32 $77.46 $47.32 $ $95.22 $ $95.22 $ $56.82 $93.66 $56.82 $ $ $ $ $ HIGH PLAN - $20,000 BASIC BENEFIT AMOUNT non-tobacco tobacco AGES EE EE + SP EE + CH F AGES EE EE + SP EE + CH F $17.02 $26.96 $17.02 $ $24.22 $39.56 $24.22 $ $38.02 $59.16 $38.02 $ $65.22 $ $65.22 $ $66.02 $ $66.02 $ $ $ $ $ $90.82 $ $90.82 $ $ $ $ $ $ $ $ $ $ $ $ $ EE = Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Children; F = Family. Issue Ages: 18 and over if Actively at Work This insert is for use in: New York This insert is part of brochure ABJ23779NY 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 August 15, Allstate Benefits is the marketing name used by Allstate Life Insurance Company of New York (Home Office, Hauppauge, NY) Allstate Insurance Company. ABJ23779NY-Insert-F Page 2b (F)
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