Protection when faced with a critical illness diagnosis and you need treatment Critical Illness Insurance No one is ever really prepared for a life altering critical illness diagnosis. The whirlwind of appointments, tests, treatments and medications can add to your stress levels. The treatment to recovery is vital, but it can also be expensive. Your medical coverage may only cover some of the costs associated with treatment, but you re still responsible for deductibles and coinsurance. If treatment keeps you out of work, the financial worries can grow quickly and stress levels may rise. Critical Illness coverage helps provide financial support if you are diagnosed with a covered critical illness. With the expense of treatment often high, seeking the treatment you need could seem like a financial burden. When a diagnosis occurs, you need to be focused on getting better and taking control of your health, not stressing over financial worries. Here s How It Works You choose the benefit coverage amount you want to protect yourself and any family members if diagnosed with a critical illness. Then, if diagnosed with a covered critical illness, you will receive a cash benefit based on the percentage payable for the condition. Meeting Your Needs Guaranteed Issue, meaning no medical questions to answer at enrollment Coverage available for employee, spouse and child(ren) Covered dependents receive 50% of your Basic-Benefit Amount Benefits paid regardless of any other medical or disability plan coverage Premiums are affordable, with convenient payroll deductions available Coverage may be continued under the Portability Privilege provision With Allstate Benefits, you can make treatment decisions without putting your finances at risk. Are you in Good Hands? You can be. * http://tinyurl.com/z7uwyfc DID YOU KNOW? Every 34 seconds, an American will suffer a heart attack* Every 40 seconds, someone in the U.S. has a stroke* The School District of Lee County ABJ33216X Page 1
Meet Ashley Ashley is like any single parent who has been diagnosed with a critical illness. She s worried about her future, her children and how they will cope with her treatments. Most importantly, she worries about how she will pay for it all. Here is what weighs heavily on her mind: Major medical only pays a portion of the expenses associated with my treatment I have copays I am responsible for until I meet my deductible If I am not working due to my treatments, I must cover my bills, rent/mortgage, groceries and my children s education If the right treatment is not available locally, I will have to travel to get the treatment I need Ashley s story of diagnosis and treatment turned into a happy ending; she had supplemental Critical Illness Insurance to help with expenses. CHOOSE Ashley chooses the Critical Illness Plan benefits to help protect her and her children, if they are diagnosed with a critical illness. Page 2 USE During Ashley s annual mammogram a suspicious area was discovered. She went through rounds of tests, a biopsy, outpatient surgery and doctor visits. Here s Ashley s treatment path: Ashley has her annual mammogram screening A suspicious area is found, a biopsy is performed and she is diagnosed with invasive breast cancer After visits with doctors, surgeons, radiologists, and anesthesiologists, Ashley undergoes surgery Surgery is performed to remove a Stage II tumor. She is visited by her doctor and released She undergoes three-week intervals of chemotherapy and medications for three months Two years later, Ashley s cancer returns. She has surgery and is treated with radiation Followed-up with doctor visits Ashley would go online after each treatment to file claims. The cash benefits were direct deposited into her bank account. Ashley is a fighter and is determined to beat cancer. CLAIM Ashley s Critical Illness claim paid her cash benefits for the following: Wellness Benefit Invasive Cancer Second Event (cancer diagnosis) For a listing of benefits and benefit amounts, see rate listing (page 4).
Using your cash benefits Cash benefits provide you with options, because you decide how to use them. Finances Can help protect HSAs, savings, retirement plans and 401(k)s from being depleted. Travel Can help pay for expenses while receiving treatment in another city. Home Can help pay the mortgage, continue rental payments, or perform needed home repairs for after care. Expenses Can help pay your family s living expenses such as bills, electricity, and gas. Benefits (subject to maximums as listed on page 4) Benefit paid upon diagnosis of the following conditions. Diagnosis of each condition must be separated by 90 days. INITIAL CRITICAL ILLNESS BENEFITS Heart Attack - the death of a portion of the heart muscle due to inadequate blood supply. Established (old) myocardial infarction not covered. A cardiac arrest is not a heart attack and is not covered by this benefit Stroke - The death of a portion of the brain producing neurological sequelae including infarction of brain tissue, hemorrhage and embolization from an extra-cranial source. Transient ischemic attacks (TIAs), head injury, chronic cerebrovascular insufficiency or reversible ischemic neurological deficits are not covered End Stage Renal Failure - irreversible failure of both kidneys, resulting in peritoneal dialysis or hemodialysis to help them function. Renal failure caused by traumatic events, including surgical trauma are not covered Major Organ Transplant - Surgical transplantation of heart, lung, liver, pancreas or kidneys. Transplanted organ must come from a human donor Coronary Artery Bypass Surgery - to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Abdominal aortic bypass, balloon angioplasty, laser embolectomy, atherectomy, stent placement, or other non-surgical procedures are not covered Waiver of Premium (Employee only) - premiums waived if disabled for 90 consecutive days due to a critical illness CANCER CRITICAL ILLNESS BENEFITS Carcinoma In Situ - non-invasive cancer, including early prostate cancer (stages A, I, II) and melanoma that has not invaded the dermis. Other skin malignancies, pre-malignant lesions (such as intraepithelial neoplasia), or benign tumors or polyps are not included Invasive Cancer - malignant tumor with uncontrolled growth and spread of malignant cells and the invasion of tissue, including Leukemia and Lymphoma. Carcinoma in situ, tumors related to HIV, non-invasive or metastasized skin cancer, or early prostate cancer are not included MyBenefits: 24/7 Access allstatebenefits.com/mybenefits An easy-to-use website that offers 24/7 access to important information about your benefits. Plus, you can submit and check your claims (including claim history), request your cash benefit to be direct deposited, make changes to personal information, and more. SECOND EVENT CRITICAL ILLNESS BENEFITS Initial Critical Illness - second diagnosis more than 12 months after the first date of diagnosis for which an Initial Critical Illness benefit was paid. Only payable once for each Critical Illness Cancer Critical Illness - second diagnosis more than 12 months after the last date treatment was received, for which a Cancer Critical Illness benefit was paid. Not payable if treatment is received during the 12-month period. Treatment does not include maintenance drug therapy or routine follow-up visits. Can only receive once for each Cancer Critical Illness SUPPLEMENTAL CRITICAL ILLNESS BENEFIT II Advanced Alzheimer s Disease - must exhibit impaired memory and judgment and be certified unable to perform at least two or more daily activities 1 without adult assistance Advanced Parkinson s Disease - must exhibit two or more of the following: muscle rigidity, tremor, or bradykinesia (slowness in movement, sluggishness of physical and mental responses); and be certified unable to perform at least three daily activities 1 without adult assistance Benign Brain Tumor - a non-cancerous tumor limited to the brain. Tumors of the skull, pituitary adenomas, or germinomas are not covered Coma - unconscious 14 or more consecutive days due to a sickness or traumatic brain injury. A medically induced coma is not included Complete Loss of Hearing - permanent loss of hearing in both ears that cannot be corrected by use of hearing aids or devices Complete Blindness - irreversible reduction of sight in both eyes Paralysis - total and permanent loss of voluntary movement or motor function of two or more limbs WELLNESS BENEFIT Per covered person, once per year. 23 exams include: Biopsy for skin cancer; Blood tests for triglycerides, CA15-3 (breast cancer), CA125 (ovarian cancer), CEA (colon cancer), and PSA (prostate cancer); Bone Marrow Testing; Chest X-ray; Colonoscopy; Doppler screening for carotids or peripheral vascular disease; Echocardiogram; EKG; Flexible sigmoidoscopy; Hemoccult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Pap Smear, including ThinPrep Pap Test; Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening for abdominal aortic aneurysms 1 Daily activities include: bathing, dressing, toileting, bladder and bowel continence, transferring and eating. 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BENEFIT AMOUNTS Percentages below are based on the PLAN 1 benefit amount of $10,000, and PLAN 2 benefit amount of $20,000 chosen by your employer. Covered dependents receive 50% of your basic-benefit amount. INITIAL CRITICAL ILLNESS BENEFITS PLAN 1 PLAN 2 Heart Attack (100%) $10,000 $20,000 Stroke (100%) $10,000 $20,000 End Stage Renal Failure (100%) $10,000 $20,000 Major Organ Transplant (100%) $10,000 $20,000 Coronary Artery Bypass Surgery (25%) $2,500 $5,000 Waiver of Premium (Employee only) Yes Yes CANCER CRITICAL ILLNESS BENEFITS PLAN 1 PLAN 2 Carcinoma In Situ (25%) $2,500 $5,000 Invasive Cancer (100%) $10,000 $20,000 SECOND EVENT CRITICAL ILLNESS BENEFITS PLAN 1 PLAN 2 Initial Critical Illness Yes Yes (same amount as Initial Critical Illness Benefit) Cancer Critical Illness Yes Yes (same amount as Cancer Critical Illness Benefit) SUPPLEMENTAL CRITICAL ILLNESS BENEFITS II PLAN 1 PLAN 2 Advanced Alzheimer s Disease (25%) $2,500 $5,000 Advanced Parkinson s Disease (25%) $2,500 $5,000 Benign Brain Tumor (100%) $10,000 $20,000 Coma (100%) $10,000 $20,000 Complete Loss of Hearing (100%) $10,000 $20,000 Complete Blindness (100%) $10,000 $20,000 Paralysis (100%) $10,000 $20,000 ADDITONAL BENEFIT PLAN 1 PLAN 2 Wellness (per year) $50 $50 Page 4
24-PAY* Plan 1 - $10,000 Basic Benefit Amount 18-24 $1.18 $2.02 $1.61 $2.68 25-29 $1.51 $2.53 $2.17 $3.51 30-34 $1.99 $3.24 $2.93 $4.66 35-39 $2.47 $3.97 $3.70 $5.81 40-44 $3.38 $5.33 $5.28 $8.18 45-49 $4.62 $7.20 $7.41 $11.37 50-54 $6.06 $9.35 $9.78 $14.93 55-59 $8.41 $12.88 $13.70 $20.82 60-64 $12.97 $19.73 $21.50 $32.52 65-69 $19.42 $29.39 $32.58 $49.13 70-74 $23.19 $35.06 $39.12 $58.94 75-79 $27.23 $41.11 $46.10 $69.41 80+ $34.35 $51.77 $56.33 $84.75 20-PAY* Plan 1 - $10,000 Basic Benefit Amount 18-24 $1.42 $2.42 $1.93 $3.22 25-29 $1.81 $3.04 $2.60 $4.21 30-34 $2.39 $3.89 $3.52 $5.59 35-39 $2.96 $4.76 $4.44 $6.97 40-44 $4.06 $6.40 $6.34 $9.82 45-49 $5.54 $8.64 $8.89 $13.64 50-54 $7.27 $11.22 $11.74 $17.92 55-59 $10.09 $15.46 $16.44 $24.98 60-64 $15.56 $23.68 $25.80 $39.02 65-69 $23.30 $35.27 $39.10 $58.96 70-74 $27.83 $42.07 $46.94 $70.73 75-79 $32.68 $49.33 $55.32 $83.29 80+ $41.22 $62.12 $67.60 $101.70 24-PAY* Plan 2 - $20,000 Basic Benefit Amount 18-24 $1.83 $3.00 $2.70 $4.31 25-29 $2.49 $4.00 $3.80 $5.97 30-34 $3.44 $5.43 $5.34 $8.27 35-39 $4.41 $6.88 $6.87 $10.57 40-44 $6.24 $9.62 $10.03 $15.31 45-49 $8.72 $13.34 $14.29 $21.70 50-54 $11.59 $17.65 $19.02 $28.80 55-59 $16.29 $24.69 $26.88 $40.58 60-64 $25.42 $38.39 $42.47 $63.97 65-69 $38.31 $57.73 $64.62 $97.20 70-74 $45.86 $69.05 $77.71 $116.83 75-79 $53.93 $81.16 $91.65 $137.75 80+ $68.16 $102.50 $112.12 $168.45 20-PAY* Plan 2 - $20,000 Basic Benefit Amount 18-24 $2.20 $3.60 $3.24 $5.17 25-29 $2.99 $4.80 $4.56 $7.16 30-34 $4.13 $6.52 $6.41 $9.92 35-39 $5.29 $8.26 $8.24 $12.68 40-44 $7.49 $11.54 $12.04 $18.37 45-49 $10.46 $16.01 $17.15 $26.04 50-54 $13.91 $21.18 $22.82 $34.56 55-59 $19.55 $29.63 $32.26 $48.70 60-64 $30.50 $46.07 $50.96 $76.76 65-69 $45.97 $69.28 $77.54 $116.64 70-74 $55.03 $82.86 $93.25 $140.20 75-79 $64.72 $97.39 $109.98 $165.30 80+ $81.79 $123.00 $134.54 $202.14 EE & EE+CH = Employee & Employee + Child(ren) EE+SP & F = Employee + Spouse & Family Employee Issue Ages are 18 and over *24-Pay refers to Semi-Monthly payroll deductions and 20-Pay refers to 20thly payroll deductions Page 5
SPECIFICATIONS Conditions and Limits Benefits are not payable for any critical illness diagnosed prior to the effective date. 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. The date of diagnosis for each illness must be separated by 90 days. Emergency situations while you are outside the U.S. will be considered when you return to the U.S. Eligibility All employees in a regular position working at least 20 or more hours per week. Termination of Coverage The date the Group Policy ends; the end of the period for which the last premium has been paid. Coverage for your child will end at the end of the calendar year during which the child reaches age 26; or otherwise does not meet the requirements of an eligible dependent. Continuing Your Coverage You may be able to continue coverage under the Portability Privilege provision when coverage under the policy ends. Refer to your Certificate of Insurance for details. Recurrence of Cancer Cancer critical illness benefits are payable for a diagnosis of a recurrence of cancer, as long as you are diagnosed after the effective date of coverage, and have been free of any symptoms and treatment of cancer for 12 consecutive months immediately preceding the effective date of coverage, or any 12 consecutive months thereafter. EXCLUSIONS AND LIMITATIONS Benefits are not paid for: war, participation in a riot, insurrection or rebellion; intentionally self-inflicted injury or action; illegal activities or occupations; suicide while sane, or self-destruction while insane, or any attempt at either; substance abuse, including alcohol, alcoholism, drug addiction, or dependence upon any controlled substance. This brochure is for use in enrollments sitused in Florida. This material is valid as long as information remains current, but in no event later than November 1, 2019. Critical Illness benefits provided by policy form GVCIP2. Coverage is provided by Limited Benefit Supplemental Critical Illness Insurance. 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 information highlights some features of the policy but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions, and other provisions are included in the certificates issued. The coverage does not constitute comprehensive health insurance coverage (often referred to as major medical coverage ) and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. 2016 Allstate Insurance Company. www.allstate.com or allstatebenefits.com Page 6