B70125NLA 1 11/17
American Family Life Assurance Company of Columbus
(herein referred to as Aflac)
Worldwide Headquarters • 1932 Wynnton Road • Columbus, Georgia 31999
Toll-Free 1.800.99.AFLAC (1.800.992.3522)
The policy provides supplemental coverage
and will be issued only to supplement insurance already in force.
LIMITED BENEFIT, SPECIFIED DISEASE INSURANCE
Policy Form Series B70100
1. Read Your Policy Carefully: This document provides a very brief
description of some of the important features of the policy. This is not
the insurance contract and only the actual policy provisions will
control. The policy itself sets forth, in detail, the rights and obligations
of both you and Aflac. It is, therefore, important that you READ YOUR
POLICY CAREFULLY.
2. Cancer Insurance Coverage is designed to supplement a Covered
Person’s existing accident and sickness coverage only when certain
losses occur as a result of the disease of Cancer or an Associated
Cancerous Condition. Coverage is not provided for basic hospital,
basic medical-surgical, or major medical expenses.
3. Benefits: Aflac will pay the following benefits, as applicable, while
coverage is in force, subject to all other limitations and exclusions,
conditions, and provisions of the policy, unless indicated otherwise. All
treatments listed below must be National Cancer Institute (NCI) or
Food and Drug Administration (FDA) approved for the treatment of
Cancer or an Associated Cancerous Condition, as applicable.
CANCER SCREENING BENEFIT: Aflac will pay $25 per Calendar
Year when a Covered Person receives one of the following:
mammogram • breast ultrasound • breast MRI • thermography •
CA15-3 (blood test for breast cancer) • CA 125 (blood test for ovarian
cancer) • Pap smear/ThinPrep • PSA (blood test for prostate cancer •
CEA (blood test for colon cancer) • P32 uptake serum protein
electrophoresis (blood test for multiple myeloma) • testicular
ultrasound • transrectal ultrasound • abdominal ultrasound • flexible
sigmoidoscopy • colonoscopy • virtual colonoscopy • cystoscopy •
colposcopy • bronchoscopy • mediastinoscopy • esophagoscopy •
sigmoidoscopy • proctosigmoidoscopy • gastroscopy • laryngoscopy •
chest X-ray • computerized tomography (CT or CAT scan) • magnetic
resonance imaging (MRI) • bone scan • thyroid scan • multiple gated
acquisition (MUGA) scan • positron emission tomography (PET) scan •
biopsy • hemoccult stool specimen (lab confirmed) • Genetic Testing •
bone marrow donor screening • cancer vaccine
This benefit is limited to one $25 payment per Calendar Year, per
Covered Person, with no Positive Medical Diagnosis. If a Covered
Person receives a Positive Medical Diagnosis for Internal Cancer or an
Associated Cancerous Condition, this benefit will pay up to a total of
three $25 payments per Calendar Year for screenings performed on
such Covered Person. Screenings must be administered by licensed
medical personnel. Except for Genetic Testing, bone marrow donor
screening, and cancer vaccine, the screening must be performed for
the purpose of determining whether Cancer or an Associated
Cancerous Condition exists in a Covered Person. No lifetime
maximum.
PROPHYLACTIC SURGERY BENEFIT (DUE TO A POSITIVE GENETIC
TEST RESULT): Aflac will pay $125 when a Covered Person has
surgery due to a positive test result received for a genetic alteration or
mutation associated with a hereditary Cancer syndrome and such
surgery is recommended by a Physician. The Genetic Testing must be
performed while coverage is in force.
This benefit is payable once per Covered Person, per lifetime.
CANCER DIAGNOSIS BENEFITS:
INITIAL DIAGNOSIS BENEFIT:
Aflac
will pay the amount listed below
when a Covered Person is diagnosed as having Internal Cancer or an
Associated Cancerous Condition while the policy is in force, subject to
the Limitations and Exclusions.
Named Insured or Spouse $1,000
Dependent Child $2,000
This benefit is payable once per Covered Person, per lifetime. In
addition to the Positive Medical Diagnosis, we may require additional
information from the attending Physician and Hospital.
ADDITIONAL OPINION BENEFIT: Aflac will pay $150 when a charge
is incurred for an additional surgical opinion from a Physician or an
evaluation or consultation with a Physician for the purpose of
determining the appropriate course of treatment for a covered Internal
Cancer or Associated Cancerous Condition. This benefit is payable
once per Covered Person, per lifetime.
CANCER TREATMENT BENEFITS:
NONSURGICAL TREATMENT BENEFITS:
RADIATION THERAPY, CHEMOTHERAPY, IMMUNOTHERAPY, OR
EXPERIMENTAL CHEMOTHERAPY BENEFIT:
SELF-ADMINISTERED:
Aflac will pay $100 once per Calendar Month
for which a Covered Person receives and incurs a charge for self-
administered Physician-prescribed Chemotherapy, Immunotherapy, or
Experimental Chemotherapy as part of a treatment regimen for Cancer
or an Associated Cancerous Condition.
PHYSICIAN-ADMINISTERED: Aflac will pay $600 once per Calendar
Month for which a Covered Person is prescribed, receives, and incurs
a charge for Radiation Therapy, Chemotherapy, Immunotherapy, or
Experimental Chemotherapy administered by a member of the medical
profession in a Medical Facility as part of a treatment regimen for
Cancer or an Associated Cancerous Condition.
This benefit is limited to one self-administered treatment and one
physician-administered treatment per Calendar Month. After this
benefit has been paid for 12 Calendar Months, Aflac will require
annual documentation from the attending Physician certifying that the
Cancer or Associated Cancerous Condition is still detectable and
active in the body and is not in remission in order for this benefit to
continue to be payable.
B70125NLA 2 11/17
HORMONAL THERAPY BENEFIT:
Aflac will pay $15 once per
Calendar Month for which a Covered Person is prescribed, receives,
and incurs a charge for Hormonal Therapy as part of a treatment
regimen for Cancer or an Associated Cancerous Condition.
TOPICAL CHEMOTHERAPY BENEFIT:
Aflac will pay $100 once per
Calendar Month for which a Covered Person is prescribed, receives,
and incurs a charge for a Topical Chemotherapy for the treatment of
Cancer or an Associated Cancerous Condition.
See the Payment of Nonsurgical Treatment Benefits section for
additional information.
INDIRECT/ADDITIONAL THERAPY BENEFITS:
ANTINAUSEA BENEFIT:
Aflac will pay $50 once per Calendar Month
for which a Covered Person receives and incurs a charge for
antinausea drugs that are prescribed in conjunction with Radiation
Therapy, Chemotherapy, Immunotherapy, or Experimental
Chemotherapy. This benefit is payable only once per Calendar Month
and is limited to the Calendar Month in which a person receives
Radiation Therapy, Chemotherapy, Immunotherapy, or Experimental
Chemotherapy, the Calendar Month prior to such treatment, and the
Calendar Month following such treatment.
No lifetime maximum.
STEM CELL AND BONE MARROW TRANSPLANTATION BENEFIT:
Aflac will pay $3,500 when a Covered Person receives and incurs a
charge for a peripheral Stem Cell Transplantation or a Bone Marrow
Transplantation for the treatment of Internal Cancer or an Associated
Cancerous Condition. Lifetime maximum of $3,500 per Covered
Person. In addition, Aflac will pay the Covered Person’s donor an
indemnity amount for his or her expenses as a result of the donation
procedure as follows: $50 for stem cell donation, or $500 for bone
marrow donation. This benefit is payable one time per Covered
Person.
BLOOD AND PLASMA BENEFIT:
Aflac will pay $50 times the
number of days paid under the Hospital Confinement Benefit when a
Covered Person receives and incurs a charge for blood and/or plasma
transfusions for the treatment of Internal Cancer or an Associated
Cancerous Condition during a covered Hospital confinement. Aflac will
pay $140 for each day a Covered Person receives and incurs a charge
for blood and/or plasma transfusions for the treatment of Internal
Cancer or an Associated Cancerous Condition as an outpatient in a
Physician’s office, clinic, Hospital, or Ambulatory Surgical Center. This
benefit does not pay for immunoglobulins, Immunotherapy,
antihemophilia factors, or colony-stimulating factors. No lifetime
maximum.
SURGICAL TREATMENT BENEFITS:
SURGERY/ANESTHESIA BENEFIT:
Aflac will pay according to the
benefits in the Schedule of Operations in the policy when a Covered
Person has a surgical procedure performed for the direct treatment of
a covered Internal Cancer or Associated Cancerous Condition and a
charge is incurred for such surgical procedure.
If any surgical
procedure for the treatment of Internal Cancer or an Associated
Cancerous Condition is performed other than those listed, Aflac will
pay an amount comparable to the amount shown in the Schedule of
Operations for the surgical procedure most nearly similar in severity
and gravity.
EXCEPTIONS: Prophylactic Surgery and procedures payable
under the Cancer Screening Benefit, Skin Cancer Surgery
Benefit, or Reconstructive Surgery Benefit will not be payable
under the Surgery/Anesthesia Benefit.
The Surgery/Anesthesia Benefit is only payable one time per 24-
hour period, even though more than one surgical procedure may
be performed. The highest eligible benefit will be paid.
Aflac will pay an indemnity benefit equal to 25% of the amount shown
in the Schedule of Operations for the administration of anesthesia
during a covered surgical operation.
The maximum daily benefit will not exceed $2,125. No lifetime
maximum on the number of operations.
SKIN CANCER SURGERY BENEFIT:
When a surgical operation is
performed on a Covered Person for a diagnosed skin Cancer,
including melanoma or Nonmelanoma Skin Cancer, Aflac will pay the
amount listed below when a charge is incurred for the specific
procedure. The amount listed below includes anesthesia services. The
maximum daily benefit will not exceed $200. No lifetime maximum on
the number of operations.
Laser or Cryosurgery $ 20
Surgeries OTHER THAN Laser or Cryosurgery:
Excision of lesion of skin without flap or graft 85
Flap or graft without excision 125
Excision of lesion of skin with flap or graft 200
PROPHYLACTIC SURGERY BENEFIT (WITH CORRELATING
INTERNAL CANCER DIAGNOSIS):
Aflac will pay $125 when, as
recommended by a Physician due to a covered diagnosis of Internal
Cancer or an Associated Cancerous Condition, one of the Prophylactic
Surgeries shown below is performed on a Covered Person:
1. mastectomy due to a covered diagnosis of Internal Cancer
other than breast Cancer;
2. oophorectomy due to a covered diagnosis of Internal Cancer
other than ovarian Cancer; or
3. orchiectomy due to a covered diagnosis of Internal Cancer
other than testicular Cancer.
This benefit is payable once per Covered Person, per lifetime.
HOSPITALIZATION BENEFITS:
HOSPITAL CONFINEMENT BENEFITS:
HOSPITALIZATION FOR 30 DAYS OR LESS:
When a Covered Person
is confined to
a Hospital for treatment of Cancer or an Associated
Cancerous Condition for 30 days or less, Aflac will pay the amount
listed below for each day the Covered Person is charged for a room as
an inpatient. No lifetime maximum.
Named Insured or Spouse $100
Dependent Child $125
HOSPITALIZATION FOR 31 DAYS OR MORE: During any continuous
period of Hospital confinement of a Covered Person for treatment of
Cancer or an Associated Cancerous Condition for 31 days or more,
Aflac will pay benefits as described above for the first 30 days.
Beginning with the 31st day of such continuous Hospital confinement,
B70125NLA 3 11/17
Aflac will pay the amount listed below for each day the Covered
Person is charged for a room
as an inpatient. No lifetime maximum.
Named Insured or Spouse $200
Dependent Child $250
OUTPATIENT HOSPITAL SURGICAL ROOM CHARGE BENEFIT:
When a surgical operation is performed on a Covered Person for
treatment of a diagnosed Internal Cancer or Associated Cancerous
Condition, and a surgical room charge is incurred, Aflac will pay
$100. For this benefit to be paid, surgeries must be performed on an
outpatient basis in a Hospital or an Ambulatory Surgical Center. This
benefit is payable once per day and is not payable on the same day
the Hospital Confinement Benefit is payable. This benefit is payable in
addition to the Surgery/Anesthesia Benefit. The maximum daily benefit
will not exceed $100. No lifetime maximum on number of operations.
This benefit is also payable for Nonmelanoma Skin Cancer
surgery involving a flap or graft. It is not payable for the
procedures listed in the Cancer Screening Benefit or any surgery
performed in a Physician’s office.
CONTINUING CARE BENEFITS:
EXTENDED-CARE FACILITY BENEFIT:
When a Covered Person is
hospitalized and receives Hospital Confinement Benefits and is later
confined, within 30 days of the covered Hospital confinement, to an
extended-care facility, a skilled nursing facility, a rehabilitation unit or
facility, a transitional care unit or any bed designated as a swing bed,
or to a section of the Hospital used as such, (collectively referred to as
“Extended-Care Facility”), Aflac will pay $75 per day when a charge is
incurred for such continued confinement. For each day this benefit is
payable, Hospital Confinement Benefits are NOT payable. Benefits are
limited to 30 days in each Calendar Year per Covered Person.
If more than 30 days separates confinements in an Extended-Care
Facility, benefits are not payable for the second confinement unless
the Covered Person again receives Hospital Confinement Benefits and
is confined as an inpatient to the Extended-Care Facility within 30
days of that confinement.
HOME HEALTH CARE BENEFIT:
When a Covered Person is
hospitalized for the treatment of Internal Cancer or an Associated
Cancerous Condition and then has either home health care or health
supportive services provided on his or her behalf, Aflac will pay $50
per day when a charge is incurred for each such visit, subject to the
following conditions:
1. The home health care or health supportive services must
begin within seven days of release from the Hospital.
2. This benefit is limited to ten days per hospitalization for
each Covered Person.
3. This benefit is limited to 30 days in any Calendar Year for
each Covered Person.
4. This benefit will not be payable unless the attending
Physician prescribes such services to be performed in the
home of the Covered Person and certifies that if these
services were not available, the Covered Person would have
to be hospitalized to receive the necessary care, treatment,
and services.
5. Home health care and health supportive services must be
performed by a person, other than a member of your
Immediate Family, who is licensed, certified, or otherwise
duly qualified to perform such services on the same basis
as if the services had been performed in a health care
facility.
This benefit is not payable the same day the Hospice Care
Benefit is payable.
HOSPICE CARE BENEFIT:
When a Covered Person is diagnosed with
Internal Cancer or an Associated Cancerous Condition and therapeutic
intervention directed toward the cure of the disease is medically
determined to be no longer appropriate, and if the Covered Person’s
medical prognosis is one in which there is a life expectancy of six
months or less as the direct result of Internal Cancer or an Associated
Cancerous Condition (hereinafter referred to as “Terminally Ill”), Aflac
will pay a one-time benefit of $1,000 for the first day the Covered
Person receives Hospice care and $50 per day thereafter for Hospice
care. For this benefit to be payable, Aflac must be furnished: (1) a
written statement from the attending Physician that the Covered
Person is Terminally Ill, and (2) a written statement from the Hospice
certifying the days services were provided. Lifetime maximum for each
Covered Person is $12,000.
This benefit is not payable the same day the Home Health Care
Benefit is payable.
NURSING SERVICES BENEFIT:
While confined in a Hospital for the
treatment of Cancer or an Associated Cancerous Condition, if a
Covered Person requires and is charged for private nurses and their
services other than those regularly furnished by the Hospital, Aflac will
pay $50 per day for full-time private care and attendance provided by
such nurses (registered graduate nurses, licensed practical nurses, or
licensed vocational nurses). These services must be required and
authorized by the attending Physician. This benefit is not payable for
private nurses who are members of your Immediate Family. This
benefit is payable for only the number of days the Hospital
Confinement Benefit is payable. No lifetime maximum.
SURGICAL PROSTHESIS BENEFIT:
Aflac will pay $1,000 when a
charge is incurred for surgically implanted prosthetic devices that are
prescribed as a direct result of surgery for Internal Cancer or an
Associated Cancerous Condition treatment. Lifetime maximum of
$2,000 per Covered Person.
The Surgical Prosthesis Benefit does not include coverage for
tissue expanders or a Breast Transverse Rectus Abdominis
Myocutaneous (TRAM) Flap.
NONSURGICAL PROSTHESIS BENEFIT: Aflac will pay $90 per
occurrence, per Covered Person when a charge is incurred for
nonsurgically implanted prosthetic devices that are prescribed as a
direct result of treatment for Internal Cancer or an Associated
Cancerous Condition. Examples of nonsurgically implanted prosthetic
devices include voice boxes, hair pieces, and removable breast
prostheses. Lifetime maximum of $180 per Covered Person.
RECONSTRUCTIVE SURGERY BENEFIT:
BREAST RECONSTRUCTION:
Aflac will pay the amount listed below
when a charge is incurred for a reconstructive surgical operation that
is performed on a Covered Person as a result of treatment of Cancer
or an Associated Cancerous Condition. The maximum daily benefit will
not exceed $1,000.
Breast Tissue/Muscle Reconstruction
Flap Procedures $1,000
B70125NLA 4 11/17
Breast Reconstruction (occurring within five
years of breast Cancer diagnosis) 250
Breast Symmetry (on the nondiseased breast
occurring within five years of breast
reconstruction) 110
Permanent Areola Repigmentation 50
OTHER RECONSTRUCTIVE SURGERY:
Aflac will pay the amount
listed below when a charge is incurred for a reconstructive surgical
operation that is performed on a Covered Person as a result of
treatment of Cancer or an Associated Cancerous Condition. The
maximum daily benefit will not exceed $250.
Facial Reconstruction $ 250
Aflac will pay an indemnity benefit equal to 25% of the amount shown
above for the administration of anesthesia during a covered
reconstructive surgical operation.
If any reconstructive surgery is performed other than those listed,
Aflac will pay an amount comparable to the amount shown above for
the operation most nearly similar in severity and gravity. No lifetime
maximum on number of operations.
EGG HARVESTING, STORAGE (CRYOPRESERVATION), AND
IMPLANTATION BENEFIT: Aflac will pay $500 for a Covered Person
to have oocytes extracted and harvested due to a positive diagnosis of
Internal Cancer or an Associated Cancerous Condition. In addition,
Aflac will pay, one time per Covered Person, $100 for the storage of a
Covered Person’s oocyte(s) or sperm when a charge is incurred to
store with a licensed reproductive tissue bank or similarly licensed
facility. Any such extraction, harvesting, or storage must occur prior to
Chemotherapy or radiation treatment that has been prescribed for the
Covered Person’s treatment of Cancer or an Associated Cancerous
Condition. Aflac will also pay $100 for embryo transfer resulting from
such stored oocyte(s) or sperm of a Covered Person. Lifetime
maximum of $700 per Covered Person.
ANNUAL CARE BENEFIT:
Aflac will pay $100 on the anniversary
date of a Covered Person’s diagnosis of a covered Internal Cancer or
Associated Cancerous Condition for care other than the direct
treatment of Cancer or an Associated Cancerous Condition to meet
the Covered Person’s physical, emotional, spiritual, or social needs.
Lifetime maximum of five annual $100 payments per Covered Person.
AMBULANCE, TRANSPORTATION, AND LODGING BENEFITS:
AMBULANCE BENEFIT: Aflac will pay $250 when a charge is
incurred for ambulance transportation of a Covered Person to or from
a Hospital where the Covered Person receives treatment for Cancer or
an Associated Cancerous Condition. Aflac will pay $2,000 when a
charge is incurred for air ambulance transportation of a Covered
Person to or from a Hospital where the Covered Person receives
treatment for Cancer or an Associated Cancerous Condition. This
benefit is limited to two trips per confinement. The ambulance service
must be performed by a licensed professional ambulance company.
No lifetime maximum.
TRANSPORTATION BENEFIT:
Aflac will pay 35 cents per mile for
transportation, up to a combined maximum of $1,050, if a Covered
Person requires treatment that has been prescribed by the attending
Physician for Cancer or an Associated Cancerous Condition.
This benefit includes:
1. Personal vehicle transportation of the Covered Person
limited to the distance of miles between the Hospital or
Medical Facility and the residence of the Covered Person.
2. Commercial transportation (in a vehicle licensed to carry
passengers for a fee) of the Covered Person and no more
than one additional adult to travel with the Covered Person.
If the treatment is for a covered Dependent Child and
commercial transportation is necessary, Aflac will pay for up
to two adults to travel with the covered Dependent Child.
This benefit is limited to the distance of miles between the
Hospital or Medical Facility and the residence of the
Covered Person.
This benefit is payable up to a maximum of $1,050 per round trip for
all travelers and modes of transportation combined. No lifetime
maximum.
THIS BENEFIT IS NOT PAYABLE FOR TRANSPORTATION TO ANY
HOSPITAL/FACILITY LOCATED WITHIN A 50-MILE RADIUS OF THE
RESIDENCE OF THE COVERED PERSON OR FOR
TRANSPORTATION BY AMBULANCE TO OR FROM ANY HOSPITAL.
LODGING BENEFIT: Aflac will pay $50 per day when a charge is
incurred for lodging, in a room in a motel, hotel, or other commercial
accommodation, for you or any one adult family member when a
Covered Person receives treatment for Cancer or an Associated
Cancerous Condition at a Hospital or Medical Facility more than 50
miles from the Covered Person’s residence. This benefit is not payable
for lodging occurring more than 24 hours prior to treatment or for
lodging occurring more than 24 hours following treatment. This
benefit is limited to 90 days per Calendar Year.
PREMIUM WAIVER AND RELATED BENEFITS:
WAIVER OF PREMIUM BENEFIT:
If you, due to having Cancer or an
Associated Cancerous Condition, are completely unable to perform all
of the usual and customary duties of your occupation [if you are not
employed: are completely unable to perform two or more Activities of
Daily Living (ADLs) without the assistance of another person] for a
period of 90 continuous days, Aflac will waive, from month to month,
any premiums falling due during your continued inability. For
premiums to be waived, Aflac will require an employer’s statement (if
applicable) and a Physician’s statement of your inability to perform
said duties or activities, and may each month thereafter require a
Physician’s statement that total inability continues.
If you die and your Spouse becomes the new Named Insured,
premiums will resume and be payable on the first premium due date
after the change. The new Named Insured will then be eligible for this
benefit if the need arises.
Aflac may ask for and use an independent consultant to determine
whether you can perform an ADL when this benefit is in force.
Aflac will also waive, from month to month, any premiums falling due
while you are receiving Hospice Benefits.
B70125NLA 5 11/17
CONTINUATION OF COVERAGE BENEFIT:
Aflac will waive all
monthly premiums due for the policy and riders for up to two months
if you meet all of the following conditions:
1. Your policy has been in force for at least six months;
2. We have received premiums for at least six consecutive
months;
3. Your premiums have been paid through payroll deduction,
and you leave your employer for any reason;
4. You or your employer notifies us in writing within 30 days of
the date your premium payments ceased because of your
leaving employment; and
5. You re-establish premium payments through:
(1) your new employer’s payroll deduction process, or
(2) direct payment to Aflac.
You will again become eligible to receive this benefit after:
1. You re-establish your premium payments through payroll
deduction for a period of at least six months, and
2. We receive premiums for at least six consecutive months.
“Payroll deduction” means your premium is remitted to Aflac for
you by your employer through a payroll deduction process or any
other method agreed to by Aflac and the employer.
4. Optional Benefits:
INITIAL DIAGNOSIS BUILDING BENEFIT RIDER:
(SERIES B70050) Applied for Yes No
INITIAL DIAGNOSIS BUILDING BENEFIT:
This benefit can be
purchased in units of $100 each, up to a maximum of five units or
$500. If more than one unit has been purchased, the number of
units purchased must be multiplied by $100.
The number of units
you purchased is shown in both the Policy Schedule and the attached
application.
The INITIAL DIAGNOSIS BUILDING BENEFIT
will increase the amount
of your Initial Diagnosis Benefit, as shown in the policy, by $100 for
each unit purchased for each Covered Person on the anniversary date
of their coverage, while coverage remains in force. (The amount of the
monthly increase will be determined on a pro rata basis.) This benefit
will be paid under the same terms as the Initial Diagnosis Benefit in
the policy to which the rider is attached. This benefit will cease to
build for each Covered Person on the anniversary date of the rider
following the Covered Person's 65th birthday or at the time Internal
Cancer or an Associated Cancerous Condition is diagnosed for that
Covered Person, whichever occurs first. However, regardless of the
age of the Covered Person on the Effective Date of coverage, this
benefit will accrue for a period of at least five years, unless Internal
Cancer or an Associated Cancerous Condition is diagnosed prior to the
fifth year of coverage.
Exceptions, Reductions, and Limitations of Rider Series B70050:
The Initial Diagnosis Building Benefit is not payable for: (1) any Internal
Cancer or Associated Cancerous Condition diagnosed or treated
before the Effective Date of coverage under the rider and the
subsequent recurrence, extension, or metastatic spread of such
Internal Cancer or Associated Cancerous Condition; or (2) the
diagnosis of Nonmelanoma Skin Cancer. Any Covered Person who
has had a previous diagnosis of Internal Cancer or an Associated
Cancerous Condition will NOT be eligible for an Initial Diagnosis
Building Benefit under the rider for a recurrence, extension, or
metastatic spread of that same Internal Cancer or Associated
Cancerous Condition.
DEPENDENT CHILD RIDER: (SERIES B70051)
Applied for Yes No
DEPENDENT CHILD BENEFIT:
Aflac
will pay $10,000 when a
covered Dependent Child is diagnosed as having Internal Cancer or an
Associated Cancerous Condition while the rider is in force.
This benefit is payable under the rider only once for each covered
Dependent Child. In addition to the Positive Medical Diagnosis, we
may require additional information from the attending Physician and
Hospital.
Exceptions, Reductions, and Limitations of Rider Series B70051:
The Dependent Child Benefit is not payable for: (1) any Internal Cancer
or Associated Cancerous Condition diagnosed or treated before the
Effective Date of the rider and the subsequent recurrence, extension,
or metastatic spread of such Internal Cancer or Associated Cancerous
Condition; or (2) the diagnosis of Nonmelanoma Skin Cancer. Any
Dependent Child who has had a previous diagnosis of Internal
Cancer or an Associated Cancerous Condition will NOT be
eligible for any benefit under the rider for a recurrence,
extension, or metastatic spread of that same Internal Cancer or
Associated Cancerous Condition.
SPECIFIED-DISEASE BENEFIT RIDER: (SERIES B70052)
Applied for Yes No
SPECIFIED-DISEASE INITIAL BENEFIT: While coverage is in force, if
a Covered Person is first diagnosed, after the Effective Date of
coverage under the rider, with any of the covered Specified Diseases,
Aflac will pay a benefit of $2,000. This benefit is payable only once
per Specified Disease per Covered Person. NO OTHER BENEFITS
ARE PAYABLE FOR ANY COVERED SPECIFIED DISEASE NOT
PROVIDED FOR IN THE RIDER.
HOSPITAL CONFINEMENT BENEFITS:
HOSPITALIZATION FOR 30 DAYS OR LESS:
When a Covered
Person is confined to
a Hospital for a covered Specified Disease
for 30 days or less, Aflac will pay $400 for each day the Covered
Person is charged for a room as an inpatient.
HOSPITALIZATION FOR 31 DAYS OR MORE:
During any
continuous period of Hospital confinement of 31 days or more for
a covered Specified Disease, Aflac will pay benefits as described
above for the first 30 days, and beginning with the 31st day of
such continuous Hospital confinement, Aflac will pay $800 for
each day the Covered Person is charged for a room as an
inpatient.
Exceptions, Reductions, and Limitations of Rider Series B70052:
Specified diseases must be first diagnosed by a Physician on or after
the Effective Date of coverage under the rider for benefits to be paid.
The diagnosis must be made by and upon a tissue specimen,
culture(s), and/or titer(s).
5. Payment of Nonsurgical Treatment Benefits:
If an initial prescription of Hormonal Therapy, Chemotherapy,
Immunotherapy, or Experimental Chemotherapy medication instructs a
B70125NLA 6 11/17
Covered Person to take the medication orally for a period of thirty days
or less, then the payment under the applicable Nonsurgical Treatment
Benefit is limited to the Calendar Month in which the medication was
prescribed, received, and the Covered Person incurred a charge.
If a prescription of Hormonal Therapy, Chemotherapy,
Immunotherapy, or Experimental Chemotherapy medication which
instructs a Covered Person to take the medication orally for a period of
thirty days or less is refilled during a Calendar Month in which the
stated amount under the applicable Nonsurgical Treatment Benefit
has previously been paid, then we will pay the stated amount under
the applicable Nonsurgical Treatment Benefit in advance for one
additional Calendar Month for which it has not previously been paid
without requiring proof a Covered Person incurred a charge for the
medication during that additional Calendar Month. Otherwise, if the
prescription is refilled during a Calendar Month in which the stated
amount under the applicable Nonsurgical Treatment Benefit has not
been previously paid, then the benefit is limited to the Calendar Month
in which the medication was prescribed, received, and the Covered
Person incurred a charge.
If an initial prescription of Hormonal Therapy, Chemotherapy,
Immunotherapy, or Experimental Chemotherapy medication instructs a
Covered Person to take the medication orally for a period of more than
thirty days but less than 61 days, then we will pay the stated amount
under the applicable Nonsurgical Treatment Benefit in advance for
one additional, consecutive Calendar Month without requiring proof a
Covered Person incurred a charge for the medication during the
additional, consecutive Calendar Month.
If an initial prescription of Hormonal Therapy, Chemotherapy,
Immunotherapy, or Experimental Chemotherapy medication instructs a
Covered Person to take the medication orally for a period of more than
sixty days but less than 91 days, then we will pay the stated amount
under the applicable Nonsurgical Treatment Benefit in advance for two
additional, consecutive Calendar Months without requiring proof a
Covered Person incurred a charge for the medication during the
additional, consecutive Calendar Months.
If a prescription of Hormonal Therapy, Chemotherapy,
Immunotherapy, or Experimental Chemotherapy medication which
instructs a Covered Person to take the medication orally for a period of
more than thirty days is refilled during a Calendar Month in which the
payment under the applicable Nonsurgical Treatment Benefit has
previously been paid, then we will pay the stated amount under the
applicable Nonsurgical Treatment Benefit in advance for up to three
additional, consecutive Calendar Months for which it has not
previously been paid without requiring proof a Covered Person
incurred a charge for the medication during the three additional,
consecutive Calendar Months. Otherwise, if the prescription is refilled
during a Calendar Month in which the payment under the applicable
Nonsurgical Treatment Benefit has not been previously paid, then, so
long as the Covered Person incurred a charge during the first
Calendar Month of the prescription, for refills instructing a Covered
Person to take the medication orally for a period of more than thirty
days but less than 61 days, we will pay the stated amount under the
applicable Nonsurgical Treatment Benefit in advance for one
additional, consecutive Calendar Month without requiring proof a
Covered Person incurred a charge for the medication during the
additional, consecutive Calendar Month, and for refills instructing a
Covered Person to take the medication orally for a period of more than
sixty days but less than 91 days, we will pay the stated amount under
the applicable Nonsurgical Treatment Benefit in advance for two
additional, consecutive Calendar Months without requiring proof a
Covered Person incurred a charge for the medication during the
additional, consecutive Calendar Months.
For injected treatment, the stated amount under the applicable
Radiation Therapy, Chemotherapy, Immunotherapy, Or Experimental
Chemotherapy Benefit is payable one time per prescribed injection,
but not more than one time per Calendar Month. The
Surgical/Anesthesia Benefit provides amounts payable for insertion
and removal of a pump. Benefits will not be paid for each month of
continuous infusion of medications dispensed by a pump, implant, or
patch.
If only Experimental Chemotherapy is payable during any Calendar
Month, the benefit amount will be reduced 50% for Experimental
Chemotherapy for which no charge is incurred. If a Covered Person
received the stated amount under the applicable Radiation Therapy,
Chemotherapy, Immunotherapy, Or Experimental Chemotherapy
Benefit at the reduced 50% amount and, later in the same Calendar
Month, receives Radiation Therapy, Chemotherapy, Immunotherapy,
or Experimental Chemotherapy where a charge is incurred, we will pay
the difference between the 50% previously received and the Radiation
Therapy, Chemotherapy, Immunotherapy, or Experimental Therapy
Benefit.
6. Exceptions, Reductions, and Limitations of the Policy (policy is
not a daily hospital expense plan):
Except as specifically provided in the Benefits section of the policy,
Aflac will pay only for treatment of Cancer or Associated Cancerous
Conditions, including direct extension, metastatic spread, or
recurrence. Benefits are not provided for premalignant conditions or
conditions with malignant potential (unless specifically covered);
complications of either Cancer or an Associated Cancerous Condition;
or any other disease, sickness, or incapacity.
If a Covered Person has Cancer or an Associated Cancerous Condition
diagnosed after the date the application for coverage was signed but
before the Effective Date of coverage, benefits for treatment of that
Cancer or Associated Cancerous Condition, or any recurrence,
extension, or metastatic spread of that same Cancer or Associated
Cancerous Condition will apply only to treatment occurring after two
years from the Effective Date of such person’s coverage. You may, at
your option, elect to void the coverage and receive a full refund of
premium.
The Initial Diagnosis Benefit is not payable for: (1) any Internal Cancer
or Associated Cancerous Condition diagnosed or treated before the
Effective Date of the policy and the subsequent recurrence, extension,
or metastatic spread of such Internal Cancer or Associated Cancerous
Condition; or (2) the diagnosis of Nonmelanoma Skin Cancer. Any
Covered Person who has had a previous diagnosis of Internal
Cancer or an Associated Cancerous Condition will NOT be
eligible for an Initial Diagnosis Benefit under the policy for a
recurrence, extension, or metastatic spread of that same Internal
Cancer or Associated Cancerous Condition.
Aflac will not pay benefits whenever coverage provided by the policy is
in violation of any U.S. economic or trade sanctions. If the coverage
violates U.S. economic or trade sanctions, such coverage shall be null
and void.
Aflac will not pay benefits for any loss that is diagnosed or treated
outside the territorial limits of the United States or its possessions.
B70125NLA 7 11/17
Aflac may void the policy and will not pay benefits whenever: (1)
material facts or circumstances have been concealed or
misrepresented in making a claim under the policy; or (2) fraud is
committed or attempted in connection with any matter relating to the
policy. If you have received benefits that were not contractually due
under the policy, then Aflac reserves the right to offset any benefits
payable under the policy up to the amount of benefits you received
that were not contractually due.
7. Renewability: The policy is guaranteed renewable for your lifetime
as long as you pay the premiums when they are due or within the
grace period. We may discontinue or terminate the policy if you have
performed an act or practice that constitutes fraud, or have made an
intentional misrepresentation of material fact, relating in any way to
the policy, including claims for benefits under the policy. We may
change the premium we charge, but not specific to any one person.
Any premium change will be made for all policies of the same form
number and premium classification in the state where the policy was
issued that are then in force.
RETAIN FOR YOUR RECORDS.
THIS IS ONLY A BRIEF SUMMARY OF THE COVERAGE PROVIDED.
REFER TO THE POLICY AND RIDER(S) FOR COMPLETE DEFINITIONS, DETAILS, LIMITATIONS AND EXCLUSIONS.
