Cancer 1000 PRP. Cancer Product Reference Pamphlet

Transcription

1 Cancer 1000 PRP Cancer 1000 Product Reference Pamphlet

2 The information contained in this product reference pamphlet is intended for the training and education of Colonial Life & Accident Insurance Company employees and benefit counselors (insurance producers in WA) only. Colonial Life has not authorized any other use of this information. Do not give or show it to prospective insureds, employers of prospective insureds, or anyone else not employed by or contracted with Colonial Life & Accident Insurance Company or other Unum Group business units. This pamphlet contains highlights of the actual product benefits. Please see the policy for your state for complete details.

3 Contents General Need for Cancer Insurance...1 Quick Product Summary...3 Key Benefit Differences Between Cancer 1000 and Cancer Security SM...7 Product Positioning Within the Marketplace...10 Target Markets...10 Competitive Advantages...10 Product Positioning Within Colonial's Product Portfolio...12 Sales Opportunities...12 Support Materials Field Supplies...12 Support Materials ProducerNet...13 Market Conduct Issues...15 Sales Practice Reminders...17 Important Policy Definitions...18 Waiting Period and Pre-existing Conditions Limitation...19 Standard Base Plan Benefits...20 Wellness Benefit...20 Part 1: Cancer Screening Wellness Benefit...20 Part II: Additional Cancer Screening Wellness Benefit...21 Inpatient Benefits...21 Hospital Confinement...21 Hospital Confinement in a U.S. Government Hospital...22 Ambulance...22 Air Ambulance...23 Private Full-time Nursing Services...23 Treatment Benefits (In or Outpatient)...23 Radiation/Chemotherapy...23 Anti-Nausea Medication...25 Blood/Plasma/Platelets/Immunoglobulins...25 Experimental Treatment...26 Hair Prosthesis/External Breast/Voice Box Prosthesis...26 Supportive or Protective Care Drugs and Colony Stimulating Factors...27 Medical Imaging Studies...27 Bone Marrow Stem Cell Transplant...28 Peripheral Stem Cell Transplant...28 Contents

4 Transportation/Lodging Benefits...29 Transportation...29 Companion Transportation...29 Lodging...30 Surgical Benefits...30 Surgical Procedures...30 Anesthesia...31 Second Medical Opinion...31 Reconstructive Surgery...32 Prosthesis/Artificial Limb...32 Outpatient Surgical Center...33 Extended Care Benefits...33 Skilled Nursing Care Facility...33 Family Care...34 Hospice...34 Home Health Care Services...34 Waiver of Premium...35 Initial Diagnosis of Skin Cancer Benefit...35 Optional Riders...36 Specified Disease Rider Hospital Confinement...36 Initial Diagnosis of Cancer Rider...38 Progressive Payment Rider...39 Policy Exclusions...40 Skin Cancer Exclusion Rider...40 Eligibility Guidelines...41 Accounts...41 Employees...41 Spouses/Dependents Spouses Dependents...43 Riders...44 Underwriting Guidelines...45 Composite Rate Structure...45 Sample Premiums...45 AccHlth Application...45 Cancer History Form...49 Underwriting Authorization (HIPAA)...49 Frequently Asked Underwriting Questions...51 Sales Automation Tips...52 Simple Application System (SAS) Tips...53 Contents

5 Service Guidelines...54 Service for Individual Policies...54 Handling Transfers...54 Transfer Limitations...55 Transfer Exclusions...56 Stacking Coverage...56 Reinstating Lapsed Coverage...56 Porting Coverage...57 Adding Family Members to an Existing Cancer 1000 Policy...57 Service for Claims...57 Filing Procedures...58 Calling in Cancer Screening/Wellness Claims...58 Faxing the Claim Form...58 Taxability of Claim Payments...59 Benefits Paid Without Regard to Incurred Expenses...59 Benefits Paid With Regard to Incurred Expenses...60 Index...61 Contents

6 About This Pamphlet The Cancer 1000 Product Reference Pamphlet provides comprehensive product and sales-related information for sales representatives interested in selling cancer insurance coverage. In addition, we strongly recommend that you review a sample policy for your state, along with the appropriate product brochure, outline of coverage, and other support materials.

7 General Need for Cancer Insurance Cancer is a dreaded disease, but not one without hope. First, early detection and prompt treatment are keys to recovery. Second, improved technology has dramatically improved cancer survival rates. But technological advancements also mean higher costs for cancer treatment. Consider these statistics from the American Cancer Society.* In the U.S., men have slightly less than a 1 in 2 lifetime risk of developing cancer. For women, the risk is a little more than 1 in 3. About 1,444,920 new cancer cases are expected to be diagnosed in This estimate does not include carcinoma in situ (noninvasive cancer) of any site except urinary bladder, and does not include basal and squamous cell skin cancers. More than 1 million cases of basal and squamous cell skin cancers are expected to be diagnosed this year. The American Cancer Society reports that cancer costs Americans more than $206.3 billion annually. Of that, only $78.2 billion (38 percent) goes towards direct medical costs, which typically includes the types of costs listed below. Over half of direct medical costs are attributed to treatment of breast, lung, and prostate cancers.* 38% Direct costs, which most major medical plans cover at least a portion of: Hospital charges Surgeon fees Physician fees Medication and drug costs Radiological fees Nursing costs The remaining 62 percent of cancer costs involve indirect costs.* *Cancer Facts and Figures, American Cancer Society, General Need For Cancer Insurance 1

8 62% Indirect costs, which most major medical plans do not cover: Deductibles and coinsurance Loss of wages/salary Travel expenses to and from treatment centers Lodging and meals Child care Special diets Health insurance does not usually cover these indirect costs, which can weigh heavily on cancer victims and their families. Such costs may be financially debilitating. Colonial s Cancer 1000 policy provides insureds with additional benefits to help ease the financial obligations that may result from the treatment of cancer. General Need For Cancer Insurance

9 Quick Product Summary The following chart lists a few characteristics of the Cancer 1000 policy. The chart is not state specific. Refer to the policy and outline of coverage for your state for exact product details. Simple Product Design Cancer Screening/ Wellness Benefit Standard Plan Benefits (Levels 1 4) Four benefit levels (Levels 1-4) with benefits increasing at each level. Wellness Part I, Hospital Confinement in a U.S. Government Hospital, Skin Cancer Initial Diagnosis and the Initial Diagnosis and Progressive Payment Riders are indemnity benefits that do not require an expense to be incurred. All other benefits pay indemnity amounts, but they require that an expense be incurred. Part 1 pays for 17 cancer screening tests. May vary by state. Part 2 pays a benefit for an additional invasive test or procedure when abnormal results are produced in a Part 1 wellness test. Inpatient benefits: - Hospital confinement - Hospital confinement in U.S. Government hospital - Ambulance - Air ambulance - Private full-time nursing services Quick Product Summary 3

10 Standard Plan Benefits (Levels 1 4) cont. Three Optional Riders Treatment benefits: - Radiation/chemotherapy - Anti-nausea medication - Blood/plasma/platelets/immunoglobulins - Experimental treatments - Hair prosthesis/external breast/voice box prosthesis - Supportive or protective care drugs and colony stimulating factors - Medical imaging studies - Bone marrow stem cell transplant - Peripheral stem cell transplant Transportation/Lodging benefits: - Transportation - Companion transportation - Lodging Surgical procedures benefits: - Surgical procedures - Anesthesia - Second medical opinion - Reconstructive surgery - Prosthesis/artificial limb - Outpatient surgical center Extended care benefits: - Skilled nursing care facility - Family care - Hospice - Home health care services Skin cancer initial diagnosis Specified Disease Initial Diagnosis of Cancer Progressive Payment 4 Quick Product Summary

11 Payment Method Rate Structure Employee Eligibility Available to both payroll-deduction and individual-pay group (IPG) accounts, following normal payment method guidelines. Nonpayroll sales are available in some states and are an extremely small part of overall sales. Payroll premiums are not age-rated or agebanded. (Because producers sometimes have occasion to offer Cancer 1000 on a non-payroll basis, non-payroll rates are provided on your state s rate sheet if they are available. Nonpayroll sales are an extremely small part of total sales. Non-payroll rates are age-banded.) Full-time (20 hours per week minimum). Meet issue age requirements (17 69 in most states). Answer no to the internal cancer question on the AccHlth Application. If the skin cancer question is answered yes, coverage will be issued with a skin cancer rider. Have never been diagnosed with AIDS or an AIDS-related condition. Spouse Eligibility Meet issue age requirements (17 69 in most states). Answer no to the internal cancer question on the AccHlth Application. If the skin cancer question is answered yes, coverage will be issued with a skin cancer rider. Have never been diagnosed with AIDS or an AIDS-related condition. Quick Product Summary

12 Dependent Child Eligibility Application Process Non-payroll Sales Portability Transfers/Stacking Renewability Waiver of Premium Meet the definition of dependent child (varies by state and appears in the Outline of Coverage under definitions). Answer no to the internal cancer question on the AccHlth Application. If the skin cancer question is answered yes, coverage will be issued with a skin cancer rider. Have never been diagnosed with AIDS or an AIDS-related condition. AccHlth Application (most states) Producers sometimes have occasion to offer Cancer 1000 on a non-payroll basis. Therefore, non-payroll sales are available in some states using Base Plan Levels 1-3 and the Progressive Payment Rider. Non-payroll sales require special plan codes and age-banded premiums. Refer to the Cancer 1000 Rate Sheet for rates, plan codes, and to verify non-payroll availability in your state. Non-payroll sales are an extremely small part of this product s and Colonial s overall sales. Coverage is portable. Transfers are allowed, but stacking (owning multiple policies) is not. Policy is guaranteed renewable. Premiums can be changed only if Colonial changes premiums on all policies of this kind in force in the state where the policy is issued. Premium payment waived if named insured is disabled due to cancer for longer than 90 continuous days. 6 Quick Product Summary

13 Key Benefit Differences Between Cancer 1000 and Cancer Security SM Several new benefits appear in Cancer 1000 that did not appear in Cancer Security SM : A benefit for Immunoglobulins was added to the Blood and Plasma Benefit. A benefit for Colony Stimulating Factors was added to the Supportive or Protective Care Drugs Benefit. A benefit for Voice Box was added to the Hair/External Breast Prosthesis Benefit. Based on recent treatment trends, a number of benefit amounts have increased and a few have decreased compared with Cancer Security SM. Cancer 1000 Plan Design Four levels Three riders (no Death Due to Cancer Rider) Benefit Structure Most benefits are indemnity-based, payable if a charge is incurred. On those benefits, a Form 1099 is not generated. See Taxability of Benefits section for full details. Cancer Security SM Four levels plus Value Plan Four riders Benefits are expense-based in most states. Some states are indemnitybased (regardless of charge), which means a Form 1099 is generated if premiums are paid with pre-tax dollars. Key Benefit Differences Between Cancer 1000 and Cancer Security sm

14 Key Benefit Differences Hospital Confinement Cancer 1000 Benefit amount increases once insured is confined for 31 days Cancer Security SM Benefit amount increases once insured is confined for 71 days Surgery Maximum of $5,000 on level 3 and $6,000 on Level 4 Maximum of $4,000 on level 3 and $5,000 on Level 4 Ambulance $200 per trip $150 per trip Air Ambulance No distance requirement Reconstructive Surgery Prosthesis/ Artificial Limb Benefit Higher maximum on all levels (based on PRV) $3,000 per device with a $6,000 lifetime limit (one per site) Distance requirement $2,400 highest per procedure maximum $2,000 per device (one per site) Second Medical Opinion Initial Diagnosis Rider $300 per malignant condition On family coverage, benefit for dependent children will be 1.5 times amount for named insured $200 per malignant condition Adults and children (if covered) receive same rider amount 8 Key Benefit Differences Between Cancer 1000 and Cancer Security sm

15 Skin Cancer Initial Diagnosis $300 one time payment Health Screenings 17 screenings -added virtual colonoscopy Specified Disease Rider Part II Wellness Matches Part I amount Anti-nausea Level 3 $50 per day Level 4 $60 per day Monthly maximum on all levels Radiation/ Chemotherapy Cancer Security SM $200 one time payment 16 screenings 34 diseases covered 22 diseases covered Monthly limits on various delivery methods outside of a doctor s office Level 4 daily amount reduced to $300 Part II amount higher than Part I Level 3 $60 per day Level 4 $80 per day Monthly limit only on oral delivery method. Level 4 daily amount $400 Medical Imaging $500 annual limit $1,000 annual limit Family Care $60 per day $100 per day Supportive or Protective Care Drug & Colony Stimulating Factors Cancer 1000 One calendar year maximum; ranges from $400-$1,600 depending on level of coverage purchased. Calendar year maximums range from $500-$2,000, depending on level of coverage purchased. Key Benefit Differences Between Cancer 1000 and Cancer Security sm

16 Product Positioning Within the Marketplace Target Markets Cancer 1000 is available to all accounts except those listed as prohibited in the New Account Manual (form 8690). It is especially appealing to accounts as a complement to major medical insurance. The product is desirable to employers who offer major medical insurance that is reduced for out-of-network care because Cancer 1000 can help fill financial gaps when employees choose to go out of network. As one of Colonial s supplemental health products, Cancer 1000 helps employees deal with the out-of-pocket expenses commonly associated with cancer. Competitive Advantages Cancer 1000 offers the following competitive advantages within the marketplace. Family coverage options Innovative benefits Benefits paid to the insured Variety of coverage options available: - Employee - Employee and dependent children - Employee, spouse and dependent children The spouse may be listed as the primary insured on a Cancer 1000 policy if the employee is not eligible for coverage. Cancer 1000 offers benefits to help address current treatment costs for the care of cancer. Immunoglobulins and Colony Stimulating Factors are payable under this policy. Benefits are paid directly to the insured, unless we receive a written authorization to pay them elsewhere or we are legally required to pay them elsewhere. 10 Product Positioning

17 Benefits paid regardless of any other insurance the insured may have with another insurance company Composite premiums Portable coverage Lifetime guaranteed renewable Colonial pays the benefits regardless of any other insurance the insured may have with another insurance company, including Workers Compensation, group hospitalization and Social Security. Insureds can use these benefits to help offset the many indirect expenses associated with cancer. All eligible applicants in an account have the same premium, regardless of risk class or age. Coverage can continue with no increase in premium if the insured changes jobs or retires. This coverage goes anywhere the insured goes. Policies cannot be cancelled just because the insured gets older, and premiums will not increase as the insured gets older (unless premiums for all like policies in the insured s state of issue are increased.) Product Positioning11

18 Product Positioning Within Colonial s Portfolio Sales Opportunities Cancer 1000 is a flexible insurance product that offers many levels of coverage and three optional riders to meet broker, decision maker and employee goals giving you a marketplace advantage. The flexibility of Cancer 1000 may increase your sales opportunities. For example, you may choose to: Offer different benefit levels and/or riders for accounts that have various classes of employees or for employers who offer several coverage options. Offer Cancer 1000 and Critical Illness insurance (without the cancer option) as a way to provide coverage for additional serious illnesses. Support Materials Field Supplies The following sales support materials are available from Field Supply, extension These form numbers may vary by state. For numbers not listed, click on the Support Materials link on the ProducerNet cancer product page. Cancer 1000 Brochure (Form number varies by state.) This brochure is for use with the appropriate outline of coverage that corresponds with the level of coverage selected. Cancer 1000 Level 1 Outline of Coverage (Form number varies by state.) Cancer 1000 Level 2 Outline of Coverage (Form number varies by state.) Cancer 1000 Level 3 Outline of Coverage (Form number varies by state.) Cancer 1000 Level 4 Outline of Coverage (Form number varies by state.) Progressive Payment Rider Flier (Form number varies by state.) Outline of coverage on reverse. Initial Diagnosis of Cancer Rider Flier (Form number varies by state.) Outline of coverage on reverse. Specified Disease Rider Flier (Form number varies by state.) Outline of coverage on reverse. 12 Product Positioning

19 Rate (Plan Card) Sheet (Form number varies by state.) AccHlth Application (Form number varies by state.) Cancer Pre-approach Flier (form 48959) Summary of Benefits of Cancer 1000 (Form number varies by state.) Reflects benefit amounts for all four levels. For training use only. May be distributed to brokers and employers, but not to employees. Taxability of Benefits Flier (form 48951, -5 or later version) 0 Distribute only written materials that have been approved by Colonial s home office. The materials listed have met that approval. According to your contract with Colonial, any other advertising requires written approval from the home office prior to use. Materials should be submitted to the Marketing Communications Department for approval. This requirement applies to any written document you prepare, no matter how brief, that describes Colonial business or products. Support Materials ProducerNet Following is a list of support tools available for download from ProducerNet ( Product Overview Product Proposals Product Availability Product Bulletins Underwriting Overview Underwriting Guidelines Underwriting Frequently Asked Questions Underwriting Bulletins Product Positioning13

20 To access these tools on ProducerNet, click on Product, then Supplemental Health and select Cancer from the drop-down menu. 14 Product Positioning

21 Market Conduct Issues Remember the following market conduct guidelines when you sell Cancer 1000 coverage. Use only current advertising material provided by Colonial. Do not create your own advertising and do not change any advertising materials provided to you. Always disclose the full name of the carrier(s) represented on any printed materials and/or any presentations associated with a sale. Do not directly or indirectly use a method to market without disclosing the purpose is to solicit insurance and that a contact will be made by the agent or the insurance company. Avoid using any method of marketing to recommend the purchase of insurance through force, fright, threat, or other undue pressure. Misrepresentation or incomplete or fraudulent comparisons of any insurance coverage or carrier should not be used to influence or attempt to influence a customer. Accurately communicate the coverage according to terms of the policy. Avoid using synonymous terms to refer to any disease that may imply broader coverage. Do not comment on the legal or tax implications of coverage without the appropriate training, qualifications or license. Distribute the appropriate outline of coverage with the product brochure at the point-of-sale in all states. Ask all the questions on the application and carefully record the applicant s answers. Explain all benefits, exclusions, and limitations on the base policy including the 30-day waiting period and the pre-existing condition limitation, if any, in your state. Explain all benefits, limitations, and exclusions associated with the optional riders. If an insured transfers from an existing Colonial cancer plan to Cancer 1000, we will waive the 30-day waiting period or pre-existing condition limitation, if applicable. Product Positioning15

22 Inform applicants that any provision of this policy that, on the effective date, does not agree with state laws where the policy was issued will be amended to conform to the minimum requirements of those laws. Always explain the assignment for Cancer 1000 benefits during the sales process. Assignment of benefits is an important decision that insureds must make before filing a claim. Taking time to explain these options fully will help potential insureds make an informed decision regarding payment of benefits. This clarification also helps to avoid misunderstanding and disappointment during a stressful period of illness and treatment. When taking an application on a person age 65 or older, complete the forms for the over 65 applicants (discussed in the Underwriting Guidelines section of this pamphlet). Do not respond to hypothetical (or perhaps real) cancer situations that applicants may bring up only a benefits person with the actual facts surrounding the particular illness can provide answers for these situations. Simply limit all comments to what the contract says. If the proposed insured answers the replacement question with a yes, then the applicable replacement forms for that state must be completed and submitted with the application. Be sure to provide any other underwriting or disclosure forms required at the point-of-sale, such as the Cancer Buyer s Guide. If you are a California licensee, you must adhere to an advertising requirement that became effective January 1, According to the requirement, all print advertising must have the word insurance displayed in a type size no smaller than the largest telephone number, address or fax number. Print advertisements include business cards, written price quotations for insurance products, stationery, product brochures, and any other printed sales piece. Anything that you distribute to applicants must comply with this requirement. Any person in violation of this regulation will be subject to a fine levied by the commissioner in the amount of $200 for the first offense, $500 for the second offense, and $1,000 for any subsequent offense. A separate penalty will not be imposed for each piece of printed material that fails to conform to the requirements of this section. 16 Product Positioning

23 Cancer 1000 is available for sale in Massachusetts only by representatives who have met the state s stringent training requirements. A score of 85 percent or higher on the online test allows reps to order state-specific sales materials from Field Supplies and to sell the product in Massachusetts. You may NOT provide Massachusetts sales material to anyone who has not successfully completed this product reference pamphlet and accompanying online mastery test. Failure to follow these training requirements will be For additional information on general market conduct issues, refer to the Market Conduct Issues Training Manual & Test (form 48606). Your Colonial contract and the Sales Organization General Policies and Guidelines Manual also address market conduct behavior and issues. (To view or download the Sales Organization General Policies and Guidelines Manual, visit ProducerNet at Resources + Forms > Support Materials > Tutorials & Manuals > Policy & Guidelines Manual Colonial.) Sales Practice Reminders Advertising Do not create your own advertising materials and do not change any advertising materials Colonial provides you. Refer to the Market Conduct Issues Training Manual (#48606) and the Advertising topic on ProducerNet for more information. You should avoid directly or indirectly marketing or advertising specified disease coverage without clearly disclosing that it is an insurance solicitation and an agent or the company will be contacting the prospect. Be sure to use current home-office-generated advertising and sales materials. Twisting-Churning Do not use misrepresentations or incomplete comparisons of any insurance coverage or carrier to influence an insured s decision to replace coverage. Pressure Avoid directly or indirectly using high pressure sales tactics to influence a potential insured s decision to purchase coverage. Product Positioning17

24 Important Policy Definitions Before you proceed, review the following important policy definitions. These definitions may vary by state. Cancer Cancer means a disease that is identified by the presence of malignant cells or a malignant tumor characterized by the uncontrolled and abnormal growth and spread of invasive malignant cells. Pre-malignant conditions or conditions with malignant potential are not to be construed as cancer for the purposes of this policy. Date of Diagnosis Date of diagnosis is the day the tissue specimen, blood samples, and/or titer(s) are taken, on which the first diagnosis of cancer is based. Doctor or Physician Doctor or physician means a person, other than the insured or family member, who is licensed by the state to practice a healing art, performs services for the insured which is allowed by his/her license, and performs services for which benefits are provided by the policy. Home Health Care Agency A home health care agency means an agency that is certified by the insured s state government. Its main purpose is to arrange and provide nursing services, home health aide services, and other related services. Hospice A hospice is an organization that provides care for the terminally ill, mainly in the home, and that is licensed by a governmental agency, or is accredited by the Joint Commission on Accreditation of Hospitals, or is qualified to receive benefit payments from Medicare or Medicaid. The organization must have on its staff at least one doctor and one registered nurse and must complete medical records for each patient. Hospital A hospital is a place that is run according to law on a full-time basis, provides overnight care of injured and sick people, is supervised by a doctor, has full-time nurses supervised by a registered nurse; and has at its locations, or uses on a pre-arranged basis, X-ray equipment, a laboratory, and an operating room where surgical operations take place. A hospital does not include a nursing home, an extended care facility, a skilled nursing care facility, a rest home, a home for the aged, an assisted living center, a hospice care facility, a rehabilitation center, or a place for alcoholics or drug addicts. 18 Important Policy Definitions

25 Skin Cancer Skin cancer means melanoma of Clark s level I or II (Breslow less than.75 mm), basal cell carcinoma, or squamous cell carcinoma of the skin. Waiting Period and Pre-existing Conditions Limitation Most states have a waiting period as defined below. In most states that do not allow a waiting period, we have a pre-existing conditions limitation. The waiting period and pre-existing conditions limitation, if any, are defined in the outline of coverage for the customer at the point of sale. Waiting Period (may vary by state) Waiting period means the first 30 days following each insured person s coverage effective date during which no benefits are payable. Pre-existing Condition (may vary by state) A pre-existing condition means a condition for which the insured received medical advice, was given treatment, or treatment was recommended by or received from a doctor within six months immediately preceding the effective date of the policy, and which is not excluded by name or specific description in the policy. Pre-existing Condition Limitation Colonial does not cover cancer that is a pre-existing condition during the first six months after the effective date of coverage. For example: A Cancer 1000 applicant has a mammogram within six months before the effective date of her policy and a lump is found (which would be a pre-existing condition), but the individual is not diagnosed with cancer prior to purchasing our policy. This individual then has a biopsy within the first six months after the effective date of the policy that confirms a diagnosis of cancer. The pre-existing condition limitation would affect claims for this individual in the following manner: Policy Benefits Colonial would not pay benefits for this individual s cancer under the policy during the first six months after the policy effective date. Diagnosis Rider Benefits Colonial would never pay the Initial Diagnosis or Progressive Payment Rider benefits for this individual s cancer because the diagnosis occurred during the first six months after the effective date and the cancer was a pre-existing condition. Important Policy Definitions19

26 Standard Base Plan Benefits (Levels 1-4) Because of state regulations, certain product benefits vary. For exact details on product provisions, refer to the policy, outline of coverage, and product brochures for your state. Wellness Benefit Colonial pays benefits for cancer screening tests performed after the waiting period, while the policy is in force. Part I: Cancer Screening Wellness Benefit In most states, Colonial pays this benefit for the following cancer screening tests: Biopsy for skin cancer Hemoccult stool analysis Bone marrow aspiration biopsy Mammography Breast ultrasound Pap smear CA 15-3 blood test PSA blood test CA 125 blood test Serum protein electrophoresis CEA blood test Thermography Chest X-ray Thinprep pap test Colonoscopy Virtual colonoscopy Flexible sigmoidoscopy Colonial will pay this benefit once per calendar year for each insured who has a covered cancer screening test performed. We will pay this benefit regardless of the results of the test. There is no lifetime limit and Colonial does not require proof that a charge was incurred to pay this benefit. Cancer Screening Wellness Benefit Part I Pays $ per calendar year. Level 1 Level 2 Level 3 Level 4 $25 $75 $100 $ Base Plan Benefits

27 Part II: Additional Cancer Screening Wellness Benefit Colonial will pay this benefit for each insured who incurs charges for and has an additional invasive diagnostic procedure performed as the result of an abnormal cancer screening test as shown in Part I. Invasive diagnostic means a diagnostic test that requires an incision or an instrument into the body. We will pay this benefit regardless of the outcome of tests in Part II. There is no lifetime limit on this benefit. Cancer Screening/ Wellness Benefit Part II Pay $ per calendar year. Inpatient Benefits Hospital Confinement Level 1 Level 2 Level 3 Level 4 $25 $75 $100 $125 Colonial will pay this benefit if an insured incurs charges for confinement to a hospital (including intensive care) for the treatment of cancer. There is no lifetime limit for this benefit. Hospital Confinement Level 1 Level 2 Level 3 Level 4 First 30 continuous days: $100 $200 $300 $400 Pays $ per day. Beginning with the 31 st day: Pays $ per day. $200 $400 $600 $800 Both the Hospital Confinement benefit and the Confinement in a U.S. Government Hospital benefit (see the next section) share the following characteristics: An insured can collect benefits on only one Cancer 1000 hospital confinement benefit for the treatment of cancer. For example, if the insured is confined to a U.S. government hospital, Colonial pays the Confinement in a U.S. Government Hospital benefit instead of the Hospital Confinement benefit not both. Base Plan Benefits 21

28 Benefit amounts are listed in two groups: - Length of confinement 1 to 30 days. - Length of confinement 31 days or more. If insureds are confined to a hospital for the same condition within 30 days of discharge, Colonial considers it a continuation of the prior confinement. If more than 30 days have passed between the periods of hospital confinement, Colonial treats it as a new confinement. Hospital Confinement in a U.S. Government Hospital Colonial will pay this benefit if an insured is confined to a U.S. Government Hospital (including intensive care) for the treatment of cancer. This benefit is payable in place of all benefits except: Cancer Screening, Air Ambulance, Ambulance, Companion Transportation, Family Care, Hair Prosthesis/External Breast Prosthesis/Voice Box Prosthesis, Lodging, Skilled Nursing Care Facility, Skin Cancer Initial Diagnosis, Transportation, and Waiver of Premium. If less than 30 days separates periods of confinement, we will consider second and subsequent periods to be continuations of the prior period. There is no lifetime limit on this benefit. U.S. Government Hospital Confinement First 30 continuous days: Pays $ per day. Beginning with the 31 st day: Pays $ per day. Level 1 Level 2 Level 3 Level 4 $100 $200 $300 $400 $200 $400 $600 $800 Ambulance Colonial will pay this benefit if an insured incurs charges for and is transported by a professional ambulance service to or from a hospital where the insured is confined as an inpatient for the treatment of cancer. There is no lifetime limit but the benefit does have a limit of two trips each time the insured is confined as an inpatient for the treatment of cancer. Ambulance Level 1 Level 2 Level 3 Level 4 Pays $ per trip. $200 $200 $200 $ Base Plan Benefits

29 Air Ambulance Colonial will pay this benefit if an insured incurs charges for a professional air ambulance to transport the insured on the advice of a doctor to or from a hospital where he/she is confined as an inpatient for the treatment of cancer. There is no lifetime limit but the benefit does have a limit of two trips each time the insured is confined as an inpatient for the treatment of cancer. Air Ambulance Level 1 Level 2 Level 3 Level 4 Pays $ per trip. $1000 $1000 $1000 $1000 Private Full-Time Nursing Services Colonial will pay this benefit if an insured uses and incurs charges for private full-time nursing services (at least eight consecutive hours during any 24-hour period) required and authorized by his/her doctor and performed by a registered, licensed practical or licensed vocational nurse while he/she is confined to the hospital for the treatment of cancer. There is no lifetime limit for this benefit. Private Full-Time Level 1 Level 2 Level 3 Level 4 Nursing Services Pays $ per day. $150 $150 $150 $150 Treatment Benefits (In or Outpatient) Radiation/Chemotherapy Colonial will pay the amount indicated below if an insured incurs charges for and receives covered radioactive or chemical treatments which are approved for destruction of malignant cells during the treatment of internal (not skin) cancer by the United States Food and Drug Administration, and prescribed by the insured s doctor for the treatment of cancer. There is no lifetime limit for this benefit. For chemotherapy injected by medical personnel in a doctor s office, clinic or hospital, or radiation delivered by medical personnel in a doctor s office, clinic or hospital, there is no monthly limit. Base Plan Benefits 23

30 Other methods of delivery have monthly maximums as shown below. In the oral, topical, and pump delivery methods, benefits will be payable for the day the prescription or the pump is filled. Radiation/ Chemotherapy Pays $ per day. Some delivery methods subject to monthly maximums as listed below.* Level 1 Level 2 Level 3 Level 4 $100 $200 $300 $300 Monthly maximums Level 1 Level 2 Level 3 Level 4 based on delivery methods* Oral chemotherapy $400 $800 $1,200 $1,200 Topical chemotherapy $400 $800 $1,200 $1,200 Self-injected (not by $800 $1,600 $2,400 $2,400 medical personnel) Pump $400 $800 $1,200 $1,200 Any other method not listed above $400 $800 $1,200 $1,200 *Chemotherapy injected by medical personnel or radiation delivered by medical personnel do not have a monthly maximum. 24 Base Plan Benefits

31 Anti-nausea Medication Colonial will pay this benefit if an insured incurs charges for medication that is prescribed by a doctor for nausea as a result of radiation and/or chemotherapy treatments. We will only pay one anti-nausea medication benefit per day, regardless of the number of medications the insured receives in the same day. There is no lifetime limit for this benefit. Anti-nausea Medication Level 1 Level 2 Level 3 Level 4 Pays $ per day. $20 $40 $50 $60 Maximum per month. $80 $160 $200 $240 Blood/Plasma/Platelets/Immunoglobulins Colonial will pay this benefit for each day an insured incurs charges for and receives a transfusion of blood/plasma/platelets/immunoglobulins during the treatment of cancer. Immunoglobulins are antibodies in the blood. There is no lifetime limit for this benefit. Blood/Plasma/ Platelets/ Immunoglobulins Pays $ per day. Level 1 Level 2 Level 3 Level 4 $200 $200 $200 $200 Calendar year maximum. $10,000 $10,000 $10,000 $10,000 Base Plan Benefits 25

32 Experimental Treatment Colonial will pay this benefit if an insured incurs charges for hospital, medical or surgical care in connection with the experimental treatment of internal (not skin) cancer prescribed by a physician. Treatment must be received in an experimental cancer treatment program within the United States. Payment of this benefit is in place of any other benefit for the same covered treatments. Experimental Treatment Pays $ per day. Level 1 Level 2 Level 3 Level 4 $300 $300 $300 $300 Lifetime maximum: $10,000 $10,000 $10,000 $10,000 Hair Prosthesis/External Breast/Voice Box Prosthesis Colonial will pay this benefit if an insured incurs charges for receiving a hair, external breast, or voice box prosthesis needed as a direct result of cancer. There is no lifetime limit for this benefit. Hair Prosthesis/ External Breast/ Voice Box Prosthesis Pays $ per calendar year. Level 1 Level 2 Level 3 Level 4 $200 $200 $200 $ Base Plan Benefits

33 Supportive or Protective Care Drugs and Colony Stimulating Factors Colonial will pay this benefit if an insured incurs charges for and receives supportive or protective drugs and/or colony stimulating factors prescribed by his/her doctor for the treatment of cancer. Bone marrow colony stimulating factors are substances that stimulate the production of bone marrow cells, which include red and white blood cells and platelets. There is no lifetime limit for this benefit. Supportive or Protective Care Drugs & Colony Stimulating Factors Pays $ per day. Calendar year maximum: Level 1 Level 2 Level 3 Level 4 $50 $400 $100 $800 $150 $1,200 $200 $1,600 Medical Imaging Studies Colonial will pay this benefit if an insured incurs charges for having a covered medical image study performed that was prescribed by his/her doctor for the treatments of cancer and after the initial diagnosis of cancer. There is no lifetime limit for this benefit. Covered images are: Computed Tomography (CT) Computed Axial Tomography Imaging. (CAT Scan). Magnetic Resonance (MR). Magnetic Resonance Imaging (MRI). Positron Emission Tomography Ultrasound (US) Imaging. (PET or Bone Scan). Medical Imaging Studies Pays $ per image. Calendar year maximum: Level 1 Level 2 Level 3 Level 4 $250 $250 $250 $250 $500 $500 $500 $500 Base Plan Benefits 27

34 Bone Marrow Stem Cell Transplant Colonial will pay these benefits only once per lifetime for each insured if a charge is incurred for receiving a bone marrow stem cell transplant. A bone marrow stem cell transplant is the harvesting, storage, and reinfusion of bone marrow stem cells from the insured or a matched donor, performed under general anesthesia or IV sedation. Benefits for a peripheral stem cell transplant are only available under the Peripheral Stem Cell Transplant benefit. Bone Marrow Stem Cell Transplant Bone Marrow Stem Cell Transplant lifetime maximum: Level 1 Level 2 Level 3 Level 4 $10,000 $10,000 $10,000 $10,000 Bone Marrow Stem Cell Donation: $1,000 $1,000 $1,000 $ 1,000 Peripheral Stem Cell Transplant Colonial will pay this benefit if an insured incurs charges for receiving a peripheral stem cell transplant for the treatment of cancer. We will pay this benefit only once per lifetime for each person covered under the policy. A peripheral stem cell transplant is the harvesting, storage, and infusion of stem cells taken from the insured or a matched donor. Peripheral Stem Cell Transplant Pays $5,000 lifetime maximum. Level 1 Level 2 Level 3 Level 4 $5,000 $5,000 $5,000 $5, Base Plan Benefits

35 Transportation/Lodging Benefits Transportation Colonial will pay this benefit if an insured incurs charges for travel to another city (more than 50 miles one way from the city where he/she lives) to receive treatment for cancer on the advice of his/her doctor. We will pay this for travel to and from the insured s destination for commercial travel (train, plane, or bus) or for noncommercial travel (use of personal car). Use of a personal car will be considered an incurred charge. There is no lifetime limit for this benefit. Transportation Level 1 Level 2 Level 3 Level 4 $ per mile for personal car mileage or commercial travel ($1,500 per round trip limit) Companion Transportation Colonial will pay this benefit for one companion to accompany an insured to another city (more than 50 miles one way from the city where he/she lives) where the insured is receiving treatment for internal cancer on the advice of a doctor. We will pay this benefit if the insured s companion incurs charges for commercial travel (train, plane, or bus) to and from this destination or for non-commercial travel (use of personal car). If the Air Ambulance or Transportation benefit is paid, the Companion Transportation benefit will not exceed the greater of the other two benefits paid. If the insured and his/her companion travel together in a personal car, we will only pay the Transportation benefit or the Companion Transportation benefit not both. Use of a personal car will be considered an incurred charge. There is no lifetime limit for this benefit. Companion Transportation $ per mile for personal car mileage or commercial travel ($1,500 per round trip limit). Level 1 Level 2 Level 3 Level Base Plan Benefits 29

36 Lodging Colonial will pay this benefit for each day that an insured and his/her adult companion incurs charges for lodging while the insured is being treated for cancer more than 50 miles from his/her residence. There is no lifetime limit for this benefit. Lodging Level 1 Level 2 Level 3 Level 4 Pays $ per day for up to 70 days per calendar year. $75 $75 $75 $75 Surgical Benefits Surgical Procedures Colonial will pay this benefit if an insured incurs charges and receives surgical procedures performed for the treatment of cancer. If the insured has more than one surgical procedure performed at the same time and through the same incision, we will consider them to be one procedure and pay the benefit that has the highest dollar value. If an insured has more than one surgical procedure performed at the same time but through different incisions, we will pay for each one. There is no lifetime limit for this benefit. We will use the most current Physician s Relative Value table and the Current Procedural Terminology (CPT) Code to determine the surgical unit value assigned to each procedure. To calculate the benefit, multiply the dollar amount per unit times the surgical unit value up to the maximum per procedure. Surgical Procedures Level 1 Level 2 Level 3 Level 4 Pays: $ per unit: $40 $50 $60 $70 $ maximum per procedure: $2,500 $3,000 $5,000 $6, Base Plan Benefits

37 Anesthesia Colonial will pay 25 percent of the amount of the surgery benefit paid if an insured incurs charges for and receives general anesthesia administered by an anesthesiologist or Certified Registered Nurse Anesthetist during a surgical procedure performed for the treatment of cancer. If an insured receives and incurs charges for local anesthesia during a surgical procedure performed for the treatment of cancer, we will pay the amount indicated below. If an insured has more than one surgical procedure performed at the same time, we will pay the benefit for the procedure performed which has the highest dollar value. There is no lifetime limit for this benefit. Anesthesia/Local Anesthesia Anesthesia Pays percent of surgical benefit paid. Local Anesthesia Pays $ per procedure. Level 1 Level 2 Level 3 Level 4 25% 25% 25% 25% $25 $30 $40 $50 Second Medical Opinion Colonial will pay this benefit if an insured chooses to obtain and incur charges for the opinion of a second physician recommended cancer surgery or treatment following the positive diagnosis of internal (not skin) cancer. We will pay this benefit only once for each cancerous condition. This benefit is not payable for skin cancer treatment or reconstructive surgery. Second Medical Opinion Pays $ per malignant condition. Level 1 Level 2 Level 3 Level 4 $300 $300 $300 $300 Base Plan Benefits 31

38 Reconstructive Surgery Colonial will pay this benefit if an insured incurs charges for a reconstructive surgical procedure that requires an incision, is performed by a doctor for the treatment of cancer, and is due to internal (not skin) cancer. We will pay up to 25 percent of the Reconstructive Surgery benefit if an insured has general anesthesia during a reconstructive surgical procedure. We will pay no more than the maximum amount indicated below per procedure for Reconstructive Surgery and anesthesia combined, and we will pay no more than two procedures per site. There is no lifetime limit for this benefit. Reconstructive Surgery Reconstructive Surgery per unit value: Level 1 Level 2 Level 3 Level 4 $40 $40 $60 $60 $ maximum per procedure, including anesthesia. $2,500 $2,500 $3,000 $3,000 Prosthesis/Artificial Limb Colonial will pay this benefit if an insured incurs charges for a surgically implanted device or artificial limb received as a direct result of cancer surgery. We will pay for no more than one of the same type of prosthetic device or artificial limb per site. Prosthesis/ Artificial limb Pays $ per device or limb Level 1 Level 2 Level 3 Level 4 $3,000 $3,000 $3,000 $3,000 Lifetime maximum of $6,000. (limit 1 per site) $6,000 $6,000 $6,000 $6, Base Plan Benefits

39 Outpatient Surgical Center Colonial will pay this benefit if an insured incurs charges for having surgery performed at an outpatient surgical center for the treatment of internal (not skin) cancer. This does not include surgery in the emergency room or while confined to the hospital. There is no lifetime limit for this benefit. Outpatient Surgery Level 1 Level 2 Level 3 Level 4 Pays $ per day for treatment of internal cancer. $200 $200 $300 $400 Calendar year maximum: $600 Extended Care Benefits Skilled Nursing Care Facility $600 $900 $1,200 Colonial will pay this benefit for each day an insured is confined and incurs charges for a skilled nursing care facility if your confinement begins within 14 days after he/she is released from a hospital. We will pay this benefit for no more than the number of days we paid the insured the Hospital Confinement or Hospital Confinement in a U.S. Government Hospital benefit for his/her most recent confinement. There is no lifetime limit for this benefit. Skilled Nursing Care Facility Pays $ per day (up to number of days confined to hospital.) Level 1 Level 2 Level 3 Level 4 $100 $100 $100 $100 Base Plan Benefits 33

40 Family Care Colonial will pay this benefit for each day an insured child incurs charges for receiving treatment for internal (not skin) cancer on an inpatient or outpatient basis from a licensed medical practitioner. This benefit is paid in addition to any other applicable benefits. Self-administered treatment or treatment within the home is excluded. No lifetime limit. Family Care Level 1 Level 2 Level 3 Level 4 Pays $ per day. $60 $60 $60 $60 Hospice Colonial will pay this benefit for each day an insured incurs charges for and receives covered care provided by a hospice as the result of cancer. We will pay this benefit if a doctor determines that cancer treatments are no longer of benefit to the insured, and the insured is expected to live six months or less. We will not pay this benefit if an insured is confined to a hospital, a U.S. Government Hospital, or to a skilled nursing care facility. It is also not payable for days that the Home Health Care Services benefit is payable. There is no lifetime limit for this benefit. Hospice Level 1 Level 2 Level 3 Level 4 Pays $ $70 $70 $70 $70 per day. Home Health Care Services Colonial will pay this benefit if an insured incurs charges for and receives covered services provided by a home health agency when required by a doctor instead of confinement in a hospital. We will pay the greater of: 1) 30 days per calendar year; or 2) twice the number of days the insured was confined to a hospital during a calendar year for the treatment of cancer. This benefit does not pay for housekeeping services, childcare, or food services other than dietary counseling. There is no lifetime limit for this benefit. 34 Base Plan Benefits

41 Home Health Care Services Pays $ per day (up to 30 days per year or twice the number of days confined to hospital whichever is greater). Level 1 Level 2 Level 3 Level 4 $75 $75 $75 $75 Waiver of Premium Colonial will waive the premium payment if the named insured is disabled due to cancer for longer than 90 continuous days and the first date of diagnosis is after the waiting period and while the policy is in force. Disabled means unable to work at any job for which an insured is qualified by reason of education, training or experience; the insured is not, in fact, working at any job for pay or benefits, and are under the care of a doctor for the treatment of cancer. If the insured does not have a job when cancer is diagnosed, Colonial will not require premium payment for as long as the insured is kept at home because of cancer and under the care of a doctor. This benefit is available only for the named insured. Initial Diagnosis of Skin Cancer Benefit Colonial will pay this benefit when an insured is diagnosed for the first time as having skin cancer. We will pay this benefit only once per lifetime for each person insured. This benefit does not require that a charge be incurred. Benefits are also payable as applicable for skin cancer under the Surgery and Anesthesia benefits. Skin Cancer means: Melanoma of Clark s Level I or II (Breslow less than.75mm); or Basil Cell Carcinoma; or Squamous cell carcinoma of the skin. Skin Cancer Initial Diagnosis Pays $ per lifetime. Level 1 Level 2 Level 3 Level 4 $300 $300 $300 $300 Base Plan Benefits 35