FIRST DIAGNOSIS CANCER POLICY WITH OPTIONAL INCREASING BENEFIT AND CASH VALUE RIDER

Transcription

1 FIRST DIAGNOSIS CANCER POLICY WITH OPTIONAL INCREASING BENEFIT AND CASH VALUE RIDER Underwritten by AmFirst Insurance Company AmFirst Insurance Company herein called the Company, We, or Us, will pay benefits according to the terms of this policy. IMPORTANT NOTICE ABOUT STATEMENTS IN THE APPLICATION. Please read the copy of the application which is a part of the policy. Check to see if any medical history has been omitted. Write to the policy Administrator at Morgan White Administrators International, Inc., 3191 Coral Way, 7 th Floor, Miami, Florida within ten (10) days of your receipt of the policy if any information shown is incorrect or incomplete. The policy is issued on the basis that the answers to all questions are correct and complete. Any omissions or incorrect statements could cause the Company to deny benefits, to endorse, to amend, or to rescind the Insured's coverage. PLEASE READ THIS POLICY CAREFULLY. This policy is a legal contract between the Policyholder and AmFirst Insurance Company. Also, read the copy of your application and the policy Schedule. If there is any error or omission, tell us. We will make any needed change. RIGHT TO EXAMINE. If for any reason You are not satisfied with the policy, You may return it to the Administrator within ten (10) days after You receive it. You must return it to the Administrator by mail or to the broker who sold it to You. The Administrator will then refund any premium paid and the policy will be deemed void, just as though no policy had been issued. If you are diagnosed with Cancer or if Cancer manifests itself during the first ninety (90) days following the Policy Date, all premiums paid will be refunded to you and the policy will be voided from its Policy Date. That will mean your policy was never in force. FIRST DIAGNOSIS CANCER MASTER POLICY Company may change premium rates READ THIS POLICY CAREFULLY AMFIRST INSURANCE COMPANY President 1

2 GUARANTEED RENEWABLE SUBJECT TO PREMIUM CHANGE We guarantee to renew Your Policy, as long as You are an eligible Insured and as long as the premium is paid within the allowable time; provided that the policy shall terminate upon payment of the First Diagnosis benefit. We have the right to change your premium as stated below. Premium Change: We can change your premium only if we do the same to all policies of this form, issued to persons of your class. Class means the factors of age, gender, underwriting class and geographic area of your country of residence that determined your premium rate when coverage was issued. If we make a change, it will not be based on any physical impairment you might have or any claim you have incurred under this policy. If it is necessary to change the premium for your policy, we will notify you 45 days in advance of the change in premium. We will not change your premium more than once in a 12-month period. NOTICE TO INSURED: This policy may not cover all of the costs incurred by the insured during the period of coverage. The insured is advised to carefully review all policy limitations. THIS IS A LIMITED BENEFIT POLICY PLEASE READ IT CAREFULLY. THIS IS A SPECIFIED DISEASE POLICY LIMITED TO CANCER COVERAGE ONLY. NO BENEFITS ARE PAYABLE FOR LOSS FROM ANY OTHER CAUSE. INSURING CLAUSE: We agree to provide the benefits set out in this policy for any insured Loss. This agreement is subject to all of the definitions, provisions, limitations and exclusions of the policy. Contents RIGHT TO EXAMINE... 1 RENEWAL AGREEMENT... 2 DEFINITIONS EXCEPTIONS AND LIMITATIONS... 4 ELIGIBILITY FOR BENEFITS... 4 FIRST DIAGNOSIS CANCER BENEFIT... 5 INCREASING BENEFIT RIDER... 5 CASH VALUE RIDER BENEFIT...5 HOW TO FILE A CLAIM...6 PAYMENT OF CLAIMS... 6 POLICY PROVISIONS

3 DEFINITIONS Certain words have been capitalized throughout this policy to indicate that they have the specific meanings set out below. When we use the following words in this policy, this is what we mean: Anniversary Date: The same day and month as the Policy Date in each later year. Cancer: A disease which expresses itself as: (a) a malignant tumor characterized by the uncontrolled growth and spread of malignant cells; (b) the invasion of body tissues by such malignant cells; (c) leukemia; or (d) Hodgkin's disease. For the purposes of this policy, Cancer does not include skin cancer (other than malignant melanoma), premalignant conditions or conditions with malignant potential. Cancer does not include any malignant tumors, cells or any leukemia that manifest itself as a result of HIV or Aids. First Diagnosis/First Diagnosed: The first time in which the earliest of the following takes place: 1. You are diagnosed on the basis of pathological proof as having Cancer. A pathological diagnosis of Cancer is made from the results of a microscopic study of fixed tissue or blood samples, or from a cytology report. This type of diagnosis must be made by a Pathologist whose diagnosis of malignancy is in keeping with the standards adopted by the American or Osteopathic Boards of Pathology. A pathological diagnosis of Cancer can be made before or after death; or 2. You are diagnosed as having Cancer on the basis of a clinical diagnosis from a Physician. A clinical diagnosis of Cancer will only be accepted as a First Diagnosis when it is not medically possible to attempt a pathological diagnosis. Proof that it is not medically possible to attempt a pathological diagnosis must be satisfactory to us. We reserve the right to request additional information, an additional Physician s statement and/or an examination by a Physician of our choice at our expense. 3. Cancer must be first manifested and First Diagnosed after the 90-day Waiting Period and while this policy is in force. The diagnosis will not be considered a First Diagnosis if you have had a diagnosis of Cancer within the 10-year period prior to the Policy Date; or if you have received medical advice, care or treatment of any kind; or a clinical or pathological diagnosis of Cancer prior to or within the 90-day Waiting Period. Cancer will not be a covered condition if tissue extracted during the 90-day Waiting Period leads to a diagnosis of Cancer. Immediate Family: Your spouse, parent, child, brother or sister or any person living with you. Licensed Health Care Practitioner: Any Physician, registered professional Nurse, licensed social worker or other individual who meets requirements prescribed by the country in which they practice, other than a member of your Immediate Family. Loss: Your First Diagnosis of internal Cancer or malignant melanoma following the Waiting Period and while the policy is in force. Nurse: A person duly licensed as a Registered Nurse (R.N.), Licensed Practical Nurse (L.P.N.) or Licensed Vocational Nurse (L.V.N.), other than a member of your Immediate Family. 3

4 Pathologist: A doctor licensed to practice medicine and certified by the American or Osteopathic Boards of Pathology or similar board of pathology in the country in which they practice pathological anatomy, other than a member of your Immediate Family. Physician: A doctor licensed to practice medicine and who is engaged in the active practice of medicine in the country in which services or treatment are performed for or on the insured, other than a member of your Immediate Family. Policy Date: The date on which this policy first became effective. That date is shown on the Schedule. Policy Renewal Date: The month and day your policy s premium is due. The frequency of the Policy Renewal Date can vary depending on the premium payment option you selected. This is shown on the Schedule. Schedule: Is attached to and is a part of this policy. Waiting Period: Means the 90-day period beginning on the Policy Date, during which there is no benefit. We, Us or Our: Means AmFirst Insurance Company. You or Your: Means the person named in the Schedule as the Insured. EXCEPTIONS AND LIMITATIONS This policy pays only for First Diagnosis of internal Cancer or malignant melanoma. We will NOT pay benefits for: 1. skin cancer, other than malignant melanoma; 2. any disease, sickness or incapacity, other than internal Cancer or malignant melanoma; 3. more than one First Diagnosis benefit; 4. loss that occurs while this policy is not in force; and 5. Cancer First Diagnosed during the 90-day Waiting Period. Cancer will not be a covered condition: a. when any medical advice, care, treatment or clinical diagnosis received within the Waiting Period leads to a First Diagnosis of Cancer; b. if tissue extracted during the Waiting Period leads to a First Diagnosis of Cancer; or c. if Cancer manifests itself before the policy has been in force for at least 90 days following the Policy Date. Cancer is manifested when symptoms exist. d. if you are diagnosed with Cancer or if Cancer manifests itself during the first 90 days following the Policy Date, all premiums paid will be refunded to you and the policy will be voided from its Policy Date. ELIGIBILITY FOR BENEFITS Eligibility: To be eligible for coverage under this policy, you must meet all of the conditions listed. 1. You must be less than 75 years old to enter the Policy. 2. You must not have attained the age of 85. This Policy terminates at age 85 for any Insured. 4

5 3. Your Cancer must be First Diagnosed more than 90 days after the Policy Date; 4. Your Cancer must be First Diagnosed while this policy is in force; 5. Your Loss must not be excluded by name or specific description in this policy. 6. Your Policy must be in force and not terminated. You must be diagnosed on the basis of pathological proof as having Cancer. This type of diagnosis must be made by a Pathologist whose diagnosis of malignancy is in keeping with the standards adopted by the American or Osteopathic Boards of Pathology. A clinical diagnosis of Cancer will only be accepted when it is not medically possible to attempt a pathological diagnosis. FIRST DIAGNOSIS CANCER BENEFIT Subject to the terms of this policy, we will pay the benefit amount shown in the Schedule, or the benefit amount in effect at the time of your Loss, when you are First Diagnosed as having internal Cancer or malignant melanoma. No benefit is payable if the Cancer first manifests itself before the end of the 90-day Waiting Period. You are limited to one benefit payment while this policy is in force. Your coverage terminates upon payment of the benefit. INCREASING BENEFIT RIDER The policy Schedule shows the rider benefit amount. As long as the policy remains in force, the rider benefit amount will automatically increase on each fifth (5th) policy Anniversary Date by ten percent (10%) of the benefit amount shown on the Schedule. The maximum increase that any policy may increase is fifty percent (50%) during the life of the policy. CASH VALUE RIDER - PAYMENT OF RIDER BENEFIT The Cash Value Rider Benefit will be paid if any of the following conditions are met: 1. You surrender the policy after the Tenth Anniversary Date. 2. You die after the Tenth Anniversary Date. 3. You fail to pay premium required to keep this policy in force after the Tenth Anniversary Date. 4. The policy terminates after the Tenth Anniversary Date. The Cash Value Rider cannot be sold to any insured over 64 years old. The Cash Value Rider Benefit is only available if the First Diagnosis Cancer Benefit is not paid and will be paid in accordance with the below Cash Value Rider Benefit Table: Certificate Year Percentage of premium return 10 th Year 40% 11 th Year 44% 12 th Year 48% 13 th Year 52% 14 th Year 56% 15 th Year 60% 16 th Year 64% 17 th Year 68% 18 th Year 72% 19 th Year 76% 20 th Year 80% 21 st Year 84% 22 nd Year 88% 23 rd Year 92% 24 th Year 96% 25 th Year 100% 5

6 HOW TO FILE A CLAIM 1. Notice of Claim: You must give us written notice of a claim within 30 days after a Loss starts. You may give the notice or you may have someone do it for you. The notice should give your name and policy number. Notice should be mailed to our Administrative Office in Miami, Florida. The address is listed at the end of this Policy. 2. Claim Forms: When we receive your notice, we will send you a form for filing proof of Loss. If these forms are not sent to you in 30 days, you will have met the proof of Loss rule below if you gave us a written statement within 180 days after the Loss began. 3. Proof of Loss: You must give us written proof of the Loss within 180 days after the Loss begins, except in the absence of legal capacity. PAYMENT OF CLAIMS 1. Time of Payment of Claims: All benefits will be paid immediately upon receipt of your proof of Loss and the Company s determination that the Loss is covered by the terms of this Policy. 2. Payment of Claims: Benefits will be paid to you. Benefits unpaid at your death will be paid to your beneficiary or your estate. 3. Claim Review and Appeal Procedure: In the event of any claim denial with which you do not agree, you have the right to submit a written request to us at our Administrative Office asking for a review of the denial of benefits. That request may include documents from your Physician or care provider that support your basis for the requested review. Within 30 days after we receive that written request, we will notify you or your representative of the results of the review. 6

7 POLICY PROVISIONS 1. Entire Contract; Changes: This policy, with any attachments (and the copy of your application), is the entire contract of insurance. No producer may make contracts, determine insurability or change the application or policy in any way. Only an executive officer of ours can approve a change. That change must be shown in the policy. 2. Time Limit on Certain Defenses: For a policy that has been in force for less than six months, we may rescind the policy or deny an otherwise valid claim upon a showing of misrepresentation that is material to the acceptance for coverage. For a policy that has been in force for at least six months, but less than two years, we may rescind the policy or deny an otherwise valid claim upon a showing of misrepresentation that: a. is material to the acceptance for coverage; and b. pertains to the condition for which benefits are sought. After a policy has been in force for two years, no misrepresentation may be used to rescind the policy or deny any claim for Loss incurred after the two-year period. 3. Grace Period: Your premium must be paid on or before the date it is due or during the thirty one (31) day grace period that follows. Your policy stays in force during your grace period. 4. Reinstatement: Your policy will lapse if you do not pay your premium before the end of the grace period. If You desire to reinstate Your Policy after the end of the Grace Period, We will require an application for reinstatement and, this policy will be put back in force only when we approve it. If we fail to notify you of disapproval of Your application for reinstatement within forty five (45) days of the date of application, your policy will be put back in force on that 45th day. Your reinstated policy will cover only Loss due to Cancer that is First Diagnosed more than fifteen (15) days after the date the policy was put back in force. In all other respects, you and we will have the same rights under this policy that we had before it lapsed, unless there are special conditions that apply to the reinstatement. If there are special conditions, they will be endorsed on or attached to the policy. The premium we accept to reinstate this policy may be used for a period for which premiums had not been paid, but it will not be used for any period more than sixty (60) days before the reinstatement date. 5. Physical Examination and Autopsy: We, at our expense, can have you examined as often as reasonably needed while a claim is pending. In case of death, we, at our expense, may require an autopsy where it is not forbidden by law. 6. Legal Action: You can't bring a legal action to recover under your policy for at least sixty (60) days after you have given us written proof of Loss. You cannot start such an action more than three years after the date written proof of Loss is required. The parties hereon agree that any and all disputes, claims, or controversies arising out of or relating to this certificate, shall be submitted to final and binding arbitration. Such arbitration shall be conducted in the City of Miami, Florida, in accordance with Commercial Arbitration Rules of the American Arbitration Association, and judgment on any award rendered in such arbitration may be entered in any state or federal court in such City. 7

8 Such arbitration shall be the sole remedy for any disputes, claims or controversies on this certificate. Notices in connection with such arbitration and process in any judicial proceeding in connection herewith may be served by personal delivery or registered mail or via courier to The Company at the address of its Administrator and to the Insured at the most current address appearing on the records of The Company, with the same effect as if personally served, sent by registered mail or via courier in such city. The Insured must file the request for arbitration to The Company within one hundred and eighty (180) days of the event which brought about the dispute, claim or controversy between the parties hereon. Failure of the Insured to give such notice to The Company within the one hundred and eighty (180) day period will relieve The Company of any and all liability for the dispute, claim or controversy. The Company liability in any such arbitration shall be limited to such amounts that are specified under this certificate, with such interest thereon and such costs of the arbitration proceeding, if any, as the arbitrators may direct. In no event shall The Company be liable for any extra-contractual damages, whether characterized, without limitation, as consequential, exemplary, punitive or tort damages, for any disputes, claims or controversies arising out of or relating to this certificate. 7. Governing Law: Any matters relating to the interpretation of this Policy including any matters relating to the representations of the Insured in connection with the application for coverage or issuance of this Policy shall be resolved in accordance with the laws of Florida. 8. Change of Beneficiary; Assignment: Only you have the right to change the beneficiary. This right is yours unless you make a beneficiary designation that may not be changed. Consent of the beneficiary is not required to make a change in this policy. Also, such consent is not required to surrender this policy or to assign the benefits. 9. Misstatement of Age: If your age has been misstated, an adjustment in premiums, coverage or both will be made, based on your true age. No misstatement of age will continue insurance otherwise validly terminated, or terminate insurance otherwise validly in force. 10. Refund of Unearned Premium: In the event of your death or cancellation of the policy, we will promptly return the unearned portion of any premium paid beyond the end of the policy month in which death or cancellation occurred. 11. Other Insurance with Us: You may have only one policy like this one with us at any one time. If you have more than one such policy, the one you, your beneficiary or your estate selects will remain in force. We will return all premiums paid for all other such policies. 12. Termination of Coverage: Your coverage starts on the Policy Date at 12:01 a.m. standard time where you live. It ends at 12:01 a.m. on the same standard time on the first renewal date. If not terminated by you due to non-payment of the premium, this policy will terminate at 12:01 am standard time where you live on the date you become 85 years old. 8

9 Our [President and Secretary] sign this policy on our behalf. [President] [Secretary] AMFIRST INSURANCE COMPANY. ADMINISTRATOR: Morgan White Administrators International, Inc Coral Way, 7 th Floor Miami, Florida Phone: Cancer.Insurance@morganwhiteintl.com 9