Personal Sickness Indemnity Plan - hosspeople.com

1 Personal SicknessIndemnity PlanHospital Confinement Sickness IndemnityLimited Benefit InsurancePlan Benefits Physician Visits Initial Hospitalization Hospital Confinement Major Diagnostic Exams Surgical Plus .. moreForm A45075B1 PAIC(2/08) Personal Sickness Indemnity PlanPolicies A-45100-PA, A-45200-PA, and A-45300-PA Policy A-45100-PA (Level 1) Policy A-45200-PA (Level 2) Policy A-45300-PA (Level 3) Physician Visits BenefitAflac will pay the amount for the level chosenwhen a coveredperson incurs a charge for a physician visit. Services must beunder the supervision of a physician. This is a healthmaintenance benefit; the Sickness of a covered person is notrequired for this benefit to be payable. No lifetime 1 Level 2 Level 3A-45100-PAA-45200-PAA-45300-PABenefit Amount$15$20$25 Number of Visits per Year:Individual344 Family*688 Covered physician visits include, but are not limited to, eyeexams, well-baby visits, immunizations, periodic healthexams, and routine physicals.

2 The following benefits are payable for a covered Sickness thatoccurs while coverage is in force. Treatment or confinement in government hospital does not require a charge for benefits tobe payable. All of the benefits listed below, except for theHospital Confinement Benefit, are the same for Levels 1, 2, and 3 (Policies A-45100-PA, A-45200-PA, and A-45300-PA).Hospital Confinement BenefitAflac will pay the amount per dayfor the level chosen when acovered person requires hospital confinement for 14 or morehours for a covered Sickness or for rehabilitory care as a resultof Sickness and incurs a charge. Benefits are not payable fordays beyond the 180th day in a period of hospitalconfinement.** No lifetime 1 Level 2 Level 3A-45100-PAA-45200-PAA-45300-PABenefit Amount:Days 1 15$ 50$ 75$ 100 Days 16 180$100$150$200 Initial Hospitalization BenefitAflac will pay $250per period of hospital confinement** whena covered person is confined to a hospital for at least 24 hoursfor a covered Sickness .

3 This benefit is limited to one paymentper calendar year, per covered person. No lifetime Diagnostic ExamsAflac will pay $150when a covered person requires one of thefollowing exams for a covered Sickness : CT scan MRI (magnetic resonance imaging) EEG (electroencephalogram) Thallium stress test Myelogram Angiogram ArteriogramThese exams must be performed in a hospital, doctor s office,or ambulatory surgical center, and a charge must be benefit is limited to one payment per calendar year, percovered person. No lifetime BenefitAflac will pay $100 $2,000when a covered person has surgeryperformed for a covered Sickness in a hospital or ambulatorysurgical center based upon the Schedule of Operations in thepolicy. Only one benefit is payable per 24-hour period forsurgery even though more than one surgical procedure may beperformed.

4 We will pay the highest eligible benefit. Benefitsare not payable for cosmetic or elective surgery that is not dueto Sickness . Surgical Benefits are not payable for surgeryperformed in a doctor s or dentist s office, clinic, or other suchlocation. Surgery performed but not listed in the schedule willbe paid according to the amount shown for the surgery mostsimilar in severity and gravity. No lifetime BenefitAflac will pay $100 for ground ambulance and $1,000 for airambulanceif, because of a covered Sickness , a covered personrequires transportation to or from a hospital. A licensedprofessional ambulance company must provide the ambulanceservice. This benefit is limited to two trips per calendar year,per covered person. No lifetime maximum.* Family includes two-parent family, one-parent family, and named insured/spouse only.**A period of hospital confinement is the time period of hospital confinement that starts while the policy is in force.

5 If the confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless the later confinement is the result of an entirely unrelated Sickness or the confinements are separated by 30 days or Family Life Assurance Company of Columbus ( aflac ) aflac s Personal Sickness Indemnity Plan pays cash benefitsdirectly to you, unless assigned, regardless of any other insuranceyou may of Coverage BenefitAflac will waive all monthly premiums due for the policy andriders for up to two months if you meet all of the followingconditions: (1) Your policy has been in force for at least sixmonths; (2) we have received premiums for at least sixconsecutive months; (3) your premiums have been paidthrough payroll deduction and you leave your employer forany reason; (4) you or your employer notifies us in writingwithin 30 days of the date your premium payments ceasebecause of your leaving employment; and (5) you re-establishpremium payments through your new employer s payrolldeduction process or direct payment to aflac .

6 You will againbecome eligible to receive this benefit after you re-establishyour premium payments through payroll deduction for aperiod of at least six months and we receive premiums for atleast six consecutive months. Payroll deduction means yourpremiums are remitted to aflac for you by your employerthrough a payroll deduction policy is guaranteed-renewable for your lifetime, subjectto aflac s right to change the applicable table of premiumrates by class upon any renewal DateThe effective date is the date shown in the Policy Schedule, notthe date the application is signed. Payroll rates may be retainedafter one month s premium payment on payroll CoverageFamily coverage includes the insured; spouse; and dependent,unmarried children under age 19 (or 23 if they are enrolled asfull-time students). Newborns are automatically covered underthe terms of the policy from the moment of birth.

7 One-parentfamily coverage includes the insured and all of the insured sunmarried, dependent children under age 19 (or 23 if they areenrolled as full-time students). A dependent child must be underthe age of 19 at the time of application to be eligible forcoverage. Please refer to the policy regarding eligibility forcoverage for a full-time student who is called or ordered toactive duty as a member of the Pennsylvania National Guard ora Reserve Component of the Armed Forces of the United States. Pre-Existing ConditionsA pre-existing condition is a Sickness for which, within the12-month period before the effective date of coverage, medicaladvice or treatment was medically recommended by orreceived from a physician. Care or treatment caused by a pre-existing condition will not be covered unless it beginsmore than six months after the effective date of Sickness is an illness, disease, or disorder medically diagnosedor treated 30 days or more after the effective date of coverageand while coverage is in force.

8 Illnesses, diseases, or disordersthat are medically diagnosed or treated within the 30-daywaiting period will not be covered for six months from theeffective date of and ExclusionsThe Sickness benefits of the policy are subject to a 30-daywaiting period. Any Sickness medically treated or diagnosedbefore coverage has been in force 30 days from the effectivedate of coverage will not be covered unless the loss begins morethan six months after the effective date of coverage. Other thanthe Physician Visits Benefit, we will not pay benefits for lossesincurred as a result of an injury. We will not pay benefits for acovered person s giving birth within the first ten months of theeffective date of the policy as a result of a normal pregnancy,including cesarean (complications of pregnancy* will be coveredto the same extent as a Sickness ). Exception: Newborn childrenborn within the first ten months of the policy effective date willbe subject to a 30-day waiting policy does not cover losses caused by or resulting from: receiving dental care or treatment; suicide or intentionallyself-inflicted bodily injuries; committing or attempting tocommit a felony, or engaging in any illegal occupation; losssustained or expenses incurred while a member of the armedforces of any nation, or losses sustained or expenses incurredas a result of enemy action or act of war, whether declared orundeclared; having treatment for a mental or nervousdisorder or disease, alcoholism, drug dependency, or any losssustained or contracted due to a covered person's beingintoxicated or under the influence of any narcotic unlessadministered on the advice of a physician.

9 Having cosmeticsurgery or elective surgery that is not due to Sickness ; obtaining routine well-baby care for a newborn child (otherthan provided by the Physician Visits Benefit). Care ortreatment caused by a Sickness , including medically diagnosedcongenital defects, birth abnormalities, prematurity, androutine nursery care will be does not include an ambulatory surgical center; ahospice unit, including any beds designated as a hospice; aswing bed; a convalescent home; a convalescent rest or nursingfacility; or facilities used primarily for the aged, or drug oralcohol rehabilitation, and those primarily affording custodial oreducational care. A physician does not include a member of your immediatefamily. An ambulatory surgical center does not include a doctor s ordentist s office, clinic, or other such location.* Complications of pregnancy do not include false labor,occasional spotting, physician-prescribed rest during theperiod of pregnancy, morning Sickness , and similarconditions associated with the management of a difficultpregnancy not constituting a classifiably distinctcomplication of to the policy for complete details, limitations, and exclusions.

10 This brochure is for illustration purposes local aflac insurance agent/producerAmerican Family Life Assurance Company of Columbus ( aflac ) Worldwide Headquarters 1932 Wynnton Road Columbus, Georgia 31999 ( )En espa ( )Visit our Web site at is .. A Fortune 500 company with nearly $60 billion in assets,insuring more than 40 million people worldwide. Rated AA in insurer financial strength by Standard & Poor s(June 2006), Aa2 (Excellent) in insurer financial strength byMoody s Investors Service (January 2006), A+ (Superior) Best (June 2006), and AA in insurer financial strengthby Fitch, Inc. (June 2006).* Named by Fortune magazine to its list of America s MostAdmired Companies for the seventh consecutive year in March 2007. A premier provider of insurance policies with premiums payrolldeducted for more than 370,000 payroll accounts nationally.