ELIGIBILITY - You and your covered spouse must
be ages 18 through 69 to apply for coverage. Unmarried, dependent children under
the age of 21 (in NM and TX, age 25 regardless of student status) may be covered.
Unmarried children under the age of 25 may also be covered if enrolled as a full-time
student in an accredited college or university, or marriage, whichever occurs first.
When the child reaches the limiting age, the child may “convert” to
an individual policy without evidence of insurability, subject to the “Conversion”
provision in the base policy.
LIMITATIONS 30-Day Waiting Period. If a
Covered Person has a Positive Diagnosis for Cancer or a Dread Disease during the
first thirty days after the Effective Date of this Policy, coverage for such Cancer
or Dread Disease will only apply to loss commencing after two years (in NH, six
months; in NC, twelve months) from the Effective Date of this Policy; or, at Your
option, You may elect to void this Policy from the beginning and receive a full
refund of premium. In AZ and MO, we will pay a reduced benefit of $40 for loss covered
by or resulting from such Positive Diagnosis during the first two years from the
Effective Date of this Policy; in MN, we will pay a reduced benefit of $40 for loss
covered by or resulting from any Cancer or Dread Disease during the first two years
from the Effective Date of this Policy.
WAIVER OF PREMIUM -If the Named Insured becomes
Totally Disabled for 60 days as a result of a Positive Diagnosis of Cancer or a
Dread Disease while this Policy is in force, We will waive the premiums that fall
due while he or she is Totally Disabled. The Total Disability must begin before
the policy anniversary following that person’s attainment of age 60. To be
eligible for this benefit, premiums must continue to be paid for 60 days after the
commencement of Total Disability. Upon approval of this benefit, waiver of premiums
will begin on the premium due date next following 60 days of continuous Total Disability.
This provision does not apply to Total Disability of the Insured Spouse or Insured
GUARANTEED RENEWABLE FOR LIFE - Your policy
cannot be cancelled regardless of changes in health, the number of times benefits
are received or advancing age. The only way the policy can be cancelled is for failure
to pay premiums. The Company reserves the right to change the rates on all policies
of this class in the entire state.
10 DAY RIGHT TO EXAMINE POLICY - You have ten
(10) days to examine the policy. If you are not satisfied, you may return it to
us and have your premiums refunded.
EXCLUSIONS - Subject to the Time Limit on Certain
Defenses provision, We will not pay benefits for: 1.
Anything caused by or resulting from Injury;
2. Anything other than Cancer or a Dread Disease;
3. any sickness, illness, bodily infirmity or
incapacity that has been caused, complicated, worsened, or affected by Cancer or
a Dread Disease or as a result of Cancer or a Dread Disease treatment including
side effects from Cancer or a Dread Disease treatment except as specifically covered;
4. anything due to Cancer or a Dread Disease
for which a Positive Diagnosis was made, or treatment was received, (in NE, five
years; in NC, twelve months) prior to the Effective Date. In NC, a Pre-Existing
Condition for Insured Persons age 65 or older shall include only conditions excluded
by rider. In MT, any Cancer or Dread Disease during the first twelve months following
the Effective Date due to Cancer or a Dread Disease for which a Positive Diagnosis
was made, or treatment was received, 3 years prior to the Effective Date will not
5. anything for which no charge was incurred
by the Covered Person (except as expressly provided herein);
6. (except in WI) any treatment, procedure,
or service which is not grounded in current, generally accepted medical practices,
except as specifically provided in the Experimental Treatment benefit or Bone Marrow
Transplant benefit (benefits for Experimental Treatment are limited to a lifetime
maximum of $10,000 and benefits for Bone Marrow Transplants are limited to a lifetime
maximum of $10,000);
7. any care and/or treatment received outside
the U.S. or its territories unless the Covered Person has traveled outside the United
States and/or its territories and treatment is received due to an Emergency Situation;
8.< (except in MO) any care, confinement and/or
treatment in a government or charity hospital except as specifically provided in
the Government or Charity Hospital benefit;
9. (except in AZ, MN, MO and MT) any Cancer
or Dread Disease during the first two years (in NH, six months; in NC, twelve months)
following the Effective Date in connection with a loss that was incurred during
the Waiting Period; 10. planning, clinical treatment
planning, clinical treatment management, medical radiation physics, dosimetry, blocks,
molds, treatment devices, special services, and similar services ancillary or related
to Teleradiotherapy or Radio-Active Isotopes Therapy; 11.side-effect
medications or treatments, supplies, saline or similar fluids, administration charges,
and other services or treatments ancillary or related to Chemotherapy (except as
expressly provided in the Chemotherapy Enhancer Drug benefit and Anti-Nausea benefit
provisions); or 12. side-effect medications
or treatments, supplies, saline or similar fluids, administration charges, and other
services or treatments ancillary or related to Chemotherapy Enhancer Drug, Anti-Nausea
medication, or Immunotherapy.
In MD, we will not pay any benefits otherwise covered under this Policy that are
in connection with or resulting from a Prohibited Referral.
We will reimburse you for the actual charges for the services provided. Actual charges
are the amounts paid by you or on your behalf and accepted by the provider for the
The following limitations apply to the Critical Care Benefit
Rider and Intensive Care Unit Rider:
LIMITATIONS - Pre-Existing Conditions. These Riders
do not provide benefits for loss or losses due to Pre-Existing Conditions that are
incurred during the 12 months (in NM, 6 months) immediately prior to the Rider Date.
In addition, a loss caused by a Pre-Existing Condition will not be covered if: 1. (except in MD) the Pre-Existing
Condition was revealed in the application; or 2.
we have specifically excluded the Pre-Existing Condition by name or specific description.
However, a claim for a Pre-Existing Condition incurred after 2 years (in NM, 6 months;
in CA, 12 months) from the date these Riders become effective will be covered, unless
that condition is excluded by name or specific description effective on the date
The benefits as specified in these Riders are payable in addition to all other indemnities
set forth in the Policy and/or attached Riders, if any.