American Heritage Life Insurance Company A …

1 Allstate Workplace Division is the marketing name for American Heritage life Insurance Company ,a wholly-owned subsidiary of the Allstate Corporation, Home Office: Northbrook, Illinois. Allproducts are underwritten by American Heritage life Insurance Company . Home Office:Jacksonville, Florida. This illustration highlights some features of the policy and riders, but is notthe Insurance contract. Only the actual policy and rider provisions control. The policy and riders setforth, in detail, the rights and obligations of both the insured and the Insurance Company .

2 2003 American Heritage life Insurance 1 of 6 pagesAmerican Heritage life Insurance CompanyA Cancer and Specified Disease Insurance IllustrationName:Sample F ClientAge:54 Application Signature State:ArkansasCase Name:Agent Name:Earl WebbPolicy:Cancer/Specified Disease(CP10AR)Type of Coverage:FamilyBenefit Level:Option BOptional Riders:Cancer/Specified Disease Enhancement Rider(CER1)2 unitsIntensive care Rider (ICR2)3 unitsPremium Payment Mode:MonthlyPremium by Policy and Rider:Cancer/Specified Disease$ Disease Enhancement Rider$ care Rider$ Modal Premium.

3 $ 2 of 6 pagesAmerican Heritage life Insurance CompanyPolicy CP10 ARIn addition to cancer, this policy also covers Muscular Dystrophy, Poliomyelitis, MultipleSclerosis, Encephalitis, Rabies, Tetanus, Typhoid Fever, Tuberculosis, Osteomyelitis,Diphtheria, Scarlet Fever, Epidemic Cerebrospinal Meningitis, Undulant Fever, Sickle CellAnemia, Rocky Mountain Spotted Fever, Smallpox, Addison's Disease, Hansen's Disease,Tularemia, Bubonic Plague. BenefitsMaximumBenefitPayableHospital ConfinementEach day a covered person is admitted to and confined as an inpatient in a 70 days per each period of continuous confinement.

4 $200/daySurgerySurgeon's fee not to exceed amount shown in the Schedule of Operations in the surgery is paid at 150% of surgical benefit.$3,000/maximumdepends onsurgerySecond Surgical OpinionActual charges up to $200. Must be incurred after diagnosis and before surgery.$200 AnesthesiaActual charges up to 25% of the amount paid for surgery when surgery is performed. Themaximum benefit paid for skin cancer is $ of surgical or$100 if SkinCancerAmbulatory Surgical CenterActual charges up to $250/day, when surgery is performed at an ambulatory surgical center.

5 $250/dayRadiation Therapy, Radio-Active Isotopes Therapy, Chemotherapy, or ImmunotherapyActual charges up to maximum shown per 12 month period beginning with the first day ofbenefit under this provision.$10,000/12 or Experimental TreatmentActual charges when the attending physician judges such treatment necessary and no othergenerally accepted treatment produces superior results in the opinion of the attendingphysician. Maximum shown per 12 month period beginning the first day of treatment underthis provision.$10,000/12 Drugs and MedicineActual in-hospital charges up to $10/day.

6 $10/dayBlood, Plasma and PlateletsActual charges up to maximum shown per 12 month period beginning with the first day ofbenefits under this provision for blood, plasma, platelets and transfusions (includingadministration charges); processing and procurement costs; cross matching. Blood replacedby donors is not covered.$10,000/12 's AttendanceActual charges up to maximum shown while hospital confined. Limited to one visit/day byone doctor.$30/dayPrivate Duty nursing ServiceActual charges up to $100/day while hospital confined.

7 $100/dayPage 3 of 6 pagesAmerican Heritage life Insurance CompanyPolicy CP10 ARMaximumBenefitPayableHome NursingActual charges up to $100/day for private nursing care and attendance by a nurse at be required and authorized by the attending physician and must begin within 14 daysafter confinement as an inpatient in a hospital. Limited to the number of days that theHospital Confinement benefit is paid.$100/daySkin CancerActual charges for removal of skin cancer up to maximum shown when a physician who isnot a pathologist diagnoses it.

8 If more than one skin cancer is removed at the same time,the maximum benefit payable is the amount shown for each additional skin cancer cancers diagnosed by a pathologist are eligible for other policy benefits.$120 for firstremoval/$60 eachadditionalremovalProsthesisActual charges up to maximum shown per prosthetic device requiring surgical to $2,000 per covered person, per amputation.$2,000 AmbulanceActual charges up to maximum shown per continuous confinement for transportation by alicensed ambulance service or hospital owned ambulance.

9 $200 Hospice care (Freestanding Hospice care Center or Home care )One of the following is paid if a covered person has been diagnosed by a physician asterminally ill and the attending physician has approved services. Payable only if services oradmission occurs within 14 days after a period of inpatient hospital Actual charges up to $100/day for confinement in a licensed free standing hospice carecenter. Benefits payable for hospice centers that are designated areas of hospitals will bepaid the same as inpatient hospital $100/day2.

10 Actual charges up to $100/visit, limited to 1 visit/day, for home care services by ahospice care team. Home care services are hospice services provided in the patient'shome. Food services or meals other than dietary counseling, services related to well-babycare, services provided by volunteers or support for the family after the death of the coveredperson are not or Charity Hospital$100/day in lieu of all other benefits in the policy when confined to a hospital operated bythe Government or a hospital that does not charge for the services it provides.