Critical Illness Exclusions and Disclosures
Critical Illness Exclusions
Benefits for pre-existing condition (defined as a sickness or physical condition for which within 12 months before the coverage effective date symptoms existed that would cause a person to seek treatment or; the insured individual was treated, received medical advice from a physician, or had taken medicine) will not be paid during the first 12 months the policy in in force.
Reduction of benefits
The benefit amount for the employee and spouse benefits reduces by 50% on the first policy anniversary after the covered individual's 70th birthday, or five years after the policy date, whichever is later. Premiums for the policy will not be reduced.
Date of diagnoses
- for heart attack (myocardial infarction), the date that the ischemic death of a portion of the heart muscle occurred based on the criteria listed under the heart attack (myocardial infarction) definition;
- for stroke, the date a stroke occurred based on permanent neurological deficits and neuroimaging studies.
- for end stage renal (kidney) failure, the date that your Physician recommends that you begin renal dialysis;
- for major organ transplant surgery or coronary artery bypass surgery, the date the surgery occurs for covered transplants or covered coronary artery bypass surgery occurs; or
- for permanent paralysis (due to a covered accident), the date the physician confirms the permanent paralysis continued for a period of 180 consecutive days.
Date of diagnosis for the cancer rider is the date the tissue specimen, blood samples and/or titer(s) are taken on which the first diagnosis of cancer of carcinoma in situ is based.
Those age 65 or older or disabled purchasing this coverage must be advised that this is not a Medicare supplement. They are required to sign the Medicare Certification Form, which certifies that they have received the "Guide to Health Insurance for People with Medicare" and "Important Notice to Persons on Medicare" at the point of sale. there may also be additional forms for various states.
We will not pay benefits for a specified critical illness that occurs as a result of:
- transient ischemic attacks;
- balloon angioplasty;
- laser relief or other like procedures;
- your participating or attempting to participate in an illegal activity;
- your committing or attempting to commit suicide or injuring yourself intentionally, whether you are sane or not;
- your practicing for or participating in any semi-professional or professional competitive athletic contest for which any type of compensation or remuneration is received;
- or your involvement in any period of armed conflict, even if it is not declared.
Cancer Rider exclusions
We will not pay benefits described in the rider for any of the following:
- diagnosis of cancer of carcinoma in situ during the waiting period;
- pre-malignant condition or conditions with malignant potential;
- basal cell carcinoma and squamous cell carcinoma of the skin; or melanoma that is diagnosed as Clark's Level I or II or Breslow less than .75mm.
Termination of the policy
The policy will terminate on the earliest of the following:
- written request by you to terminate the policy
- failure to pay the premiums for the policy, subject to the grace period allowed;
- payment of the available Face Amount as defined in the policy or in any other attached supplementary benefit;
- your death.
Right to convert
Coverage for dependent children can be converted if:
- the policy terminates other than for nonpayment of premiums;
- the primary insured individual and the spouse are legally divorced;
- the primary insured individual dies; or
- a dependent child reaches age 25 or becomes married.