Aflac
Cancer
Care
classic – caNcER iNDEMNiTY iNsuRaNcE
We’ve been dedicated to helping provide
peace of mind and financial security for
nearly 60 years.
A78375RNDC IC(8/13)
Chances are you know someone who’s been affected, directly or indirectly, by
cancer. You also know the toll it’s taken on them—physically, emotionally, and
financially. That’s why we’ve developed the Aflac Cancer Care insurance policy.
The plan pays a cash benefit upon initial diagnosis of a covered cancer, with a
variety of other benefits payable throughout cancer treatment. You can use these
cash benefits to help pay out-of-pocket medical expenses, the rent or mortgage,
groceries, or utility bills—the choice is yours.
And while you can’t always predict the future, here at Aflac we believe it’s good to
be prepared. The Aflac Cancer Care plan is here to help you and your family better
cope financially—and emotionally—if a positive diagnosis of cancer ever occurs.
That way you can worry less about what may be ahead.
Aflac herein means American Family Life Assurance Company of Columbus.
Added Protection for You and Your Family
aflac caNcER
caRE - classic
coverage is
selected.
Policyholder
suffers from
frequent
infections &
high fevers.
Physician visit
& bone marrow
biopsy reveals
diagnosis of
leukemia.
aflac caNcER
caRE - classic
insurance policy
provides the
following:
how iT woRks
$35,175
ToTal BENEfiTs
The above example is based on a scenario for Aflac Cancer Care – Classic that includes the following benefit conditions: Physician visit (Cancer Wellness Benefit)
of $75, bone marrow biopsy (Surgical/Anesthesia Benefit) of $125, NCI Evaluation/Consultation Benefit of $500, Initial Diagnosis Benefit of $4,000, venous port
(Surgical/Anesthesia Benefit) of $125, Injected Chemotherapy Benefit (10 weeks) of $6,000, Immunotherapy Benefit (3 months) of $1,050,
Antinausea Benefit (3 months) of $300, Hospital Confinement Benefit (10-week hospitalization) of $22,000, Blood/Plasma Benefit (10 transfusions) of $1,000.
1
Cancer Facts & Figures 2012, American Cancer Society.
The policy has limitations and exclusions that may affect benefits payable. For costs and complete details of the coverage, contact your Aflac insurance agent/producer.
This brochure is for illustrative purposes only. Refer to the policy for benefit details, definitions, limitations, and exclusions.
ThE facTs saY You NEED ThE pRoTEcTioN of aflac’s caNcER caRE plaN:
1
-in-
2
1
-in-
3
fact no. 1
fact no. 2
LIFETIME RISK OF DEVELOPING CANCER.
1
LIFETIME RISK OF DEVELOPING CANCER.
1
IN THE UNITED STATES, WOMEN HAVE SLIGHTLY MORE THAN AIN THE UNITED STATES, MEN HAVE SLIGHTLY LESS THAN A
aflac caNcER caRE
caNcER iNDEMNiTY iNsuRaNcE
Policy Series A78000
cc
c
Classic Cancer Care Benefit Overview
BENEFIT NAME BENEFIT AMOUNT
Cancer Wellness Benefit $75 per year, per Covered Person
Cancer Diagnosis Benefits:
Initial Diagnosis Benefit Insured/Spouse: $4,000; Dependent Child: $8,000; payable once per Covered Person
Medical Imaging With Diagnosis Benefit $135; two payments per year, per Covered Person; no lifetime max
NCI Evaluation/Consultation Benefit $500 payable only once per Covered Person
Cancer Treatment Benefits:
Injected Chemotherapy Benefit $600 per week; no lifetime max
Nonhormonal Oral Chemotherapy Benefit $250 per prescription, per month up to $750 max per month for Oral/Topical Benefit
2
Hormonal Oral Chemotherapy Benefit $250 per prescription, per month up to 24 months; after 24 months $75 per month up to $750 max
per month for Oral/Topical Benefit
2
Topical Chemotherapy Benefit $150 per prescription, per month up to $750 max per month for Oral/Topical Benefit
2
Radiation Therapy Benefit $350 per week; no lifetime max
Experimental Treatment Benefit $350 per week if charged; $100 per week if no charge; no lifetime max
Immunotherapy Benefit $350 once per month; $1,750 lifetime max per Covered Person
Antinausea Benefit $100 per month; no lifetime max
Stem Cell Transplantation Benefit $7,000; lifetime max $7,000 per Covered Person
Bone Marrow Transplantation Benefit $7,000; $7,000 lifetime max per Covered Person; $750 to donor
Blood and Plasma Benefit Inpatient: $100 times the number of days paid under the Hospital Confinement Benefit; Outpatient:
$175 per day; no lifetime max
Surgical/Anesthesia Benefit $100–$3,400 (Anesthesia: additional 25% of Surgical Benefit); maximum daily benefit not to
exceed $4,250; no lifetime max on number of operations
Skin Cancer Surgery Benefit $35–$400; no lifetime max on number of operations
Additional Surgical Opinion Benefit $200 per day; no lifetime max
Hospitalization Benefits:
Hospital Confinement Benefit:
• Hospitalization for 30 days or less Insured/Spouse: $200 per day; Dependent Child: $250 per day; no lifetime max
• Hospitalization for Days 31+ Insured/Spouse: $400 per day; Dependent Child: $500 per day; no lifetime max
Outpatient Hospital Surgical Room Charge Benefit $200 (payable in addition to Surgical/Anesthesia Benefit); no lifetime max on number of operations
Continuing Care Benefits:
Extended-Care Facility Benefit $100 a day, limited to 30 days per year, per Covered Person
Home Health Care Benefit $100 per day; limited to 30 days per year, per Covered Person
Hospice Care Benefit $1,000 for the 1st day; $50 per day thereafter; $12,000 lifetime max per Covered Person
Nursing Services Benefit $100 per day; no lifetime max
Surgical Prosthesis Benefit $2,000; lifetime max $4,000 per Covered Person
Nonsurgical Prosthesis Benefit $175 per occurrence; lifetime max $350 per Covered Person
Reconstructive Surgery Benefit $220–$2,000 (Anesthesia: 25% of Reconstructive Surgery Benefit); no lifetime max
on number of operations
Egg Harvesting and Storage (Cryopreservation) Benefit $1,000 to have oocytes extracted; $350 for storage; $1,350 lifetime max per Covered Person
Ambulance, Transportation, Lodging, and Other Benefits:
Ambulance Benefit $250 ground or $2,000 air; no lifetime max
Transportation Benefit $.40 per mile; max $1,200 per round trip; no lifetime max
Lodging Benefit $65 per day; limited to 90 days per year
Bone Marrow Donor Screening Benefit $40; limited to one benefit per Covered Person, per lifetime
REFER TO THE FOLLOWING PAGES FOR BENEFIT DETAILS, DEFINITIONS, LIMITATIONS, AND EXCLUSIONS.
2
Up to three different oral/topical chemotherapy medicines per calendar month.
1
Cancer Facts & Figures 2012, American Cancer Society.
The policy has limitations and exclusions that may affect benefits payable. For costs and complete details of the coverage, contact your Aflac insurance agent/producer.
This brochure is for illustrative purposes only. Refer to the policy for benefit details, definitions, limitations, and exclusions.
American Family Life Assurance Company of Columbus
(herein referred to as Aflac)
The policy described in this document provides supplemental coverage
and will be issued only to supplement insurance already in force.
LIMITED BENEFIT
CaNCEr/SpECIFIED-
DISEaSE INSUraNCE
pOLICY SErIES a78300
Worldwide Headquarters • 1932 Wynnton Road • Columbus, Georgia 31999
Toll-Free 1.800.99.AFLAC (1.800.992.3522)
1. Read Your Policy Carefully: This document provides a very brief
description of some of the important features of your 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 your 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 provided for the benefits outlined in Part (3). The benefits
described in Part (3) may be limited by Part (5).
3. All treatments listed below must be NCI or Food and Drug
Administration approved for the treatment of Cancer or an
Associated Cancerous Condition, as applicable.
A. CANCER WELLNESS BENEFITS:
1. CANCER WELLNESS: Aflac will pay $75 per Calendar Year when
a Covered Person receives one of the following:
• mammogram
• breast ultrasound
• breast MRI
• CA15-3 (blood test for breast
Cancer tumor)
• Pap smear
• ThinPrep
• biopsy
• flexible sigmoidoscopy
• hemoccult stool specimen
(lab confirmed)
• chest X-ray
• CEA (blood test for colon
Cancer)
• CA 125 (blood test for
ovarian Cancer)
• PSA (blood test for prostate
Cancer)
• testicular ultrasound
• thermography
• colonoscopy
• virtual colonoscopy
This benefit is limited to one payment per Calendar Year, per
Covered Person. These tests must be performed to determine
whether Cancer or an Associated Cancerous Condition exists in
a Covered Person and must be administered by licensed medical
personnel. No lifetime maximum.
2. BONE MARROW DONOR SCREENING: Aflac will pay $40 when
a Covered Person provides documentation of participation in a
screening test as a potential bone marrow donor. This benefit is
limited to one benefit per Covered Person per lifetime.
B. CANCER DIAGNOSIS BENEFITS:
1. 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 Part 2, Limitations and Exclusions, Section C,
of the policy.
Named Insured or Spouse $4,000
Dependent Child $8,000
This benefit is payable under the policy only once for each
Covered Person. In addition to the Positive Medical Diagnosis, we
may require additional information from the attending Physician
and Hospital.
2. MEDICAL IMAGING WITH DIAGNOSIS BENEFIT: Aflac will
pay $135 when a charge is incurred for a Covered Person who
receives an initial diagnosis or follow-up evaluation of Internal
Cancer or an Associated Cancerous Condition, using one of the
following medical imaging exams: CT scans, MRIs, bone scans,
thyroid scans, multiple gated acquisition (MUGA) scans, positron
emission tomography (PET) scans, transrectal ultrasounds, or
abdominal ultrasounds. This benefit is limited to two payments
per Calendar Year, per Covered Person. No lifetime maximum.
3. NATIONAL CANCER INSTITUTE EVALUATION/CONSULTATION
BENEFIT: Aflac will pay $500 when a Covered Person seeks
evaluation or consultation at an NCI-Designated Cancer Center
as a result of receiving a diagnosis of Internal Cancer or an
Associated Cancerous Condition. The purpose of the evaluation/
consultation must be to determine the appropriate course of
treatment. This benefit is not payable the same day the Additional
Surgical Opinion Benefit is payable. This benefit is also payable at
the Aflac Cancer Center & Blood Disorders Service of Children’s
Healthcare of Atlanta. This benefit is payable only once per
Covered Person.
C. CANCER TREATMENT BENEFITS:
1. DIRECT NONSURGICAL TREATMENT BENEFITS: All benefits
listed below are not payable based on the number,
duration, or frequency of the medication(s), therapy, or
treatment received by the Covered Person (except as
provided in Benefit C1b). Benefits will not be paid under the
Experimental Treatment Benefit or Immunotherapy Benefit
for any medications or treatment paid under the Injected
Chemotherapy Benefit, the Oral/Topical Chemotherapy
Benefits, or the Radiation Therapy Benefit.
a. INJECTED CHEMOTHERAPY BENEFIT: Aflac will pay $600
once per Calendar Week during which a Covered Person
receives and incurs a charge for Physician-prescribed Injected
Chemotherapy. The Surgical/Anesthesia Benefit provides
amounts payable for insertion and removal of a pump. Benefits
will not be paid for each week of continuous infusion of
medications dispensed by a pump, implant, or patch. This
benefit is limited to the Calendar Week in which the charge
for the medication(s) or treatment is incurred. No lifetime
maximum.
b. ORAL/TOPICAL CHEMOTHERAPY BENEFITS:
(1) NONHORMONAL ORAL CHEMOTHERAPY BENEFIT: Aflac
will pay $250 per Calendar Month during which a Covered
Person is prescribed, receives, and incurs a charge for
Nonhormonal Oral Chemotherapy for the treatment of Cancer
or an Associated Cancerous Condition.
6
(2) HORMONAL ORAL CHEMOTHERAPY BENEFIT: Aflac will
pay $250 per Calendar Month for up to 24 months during
which a Covered Person is prescribed, receives, and incurs
a charge for Hormonal Oral Chemotherapy for the treatment
of Cancer or an Associated Cancerous Condition. After 24
months of paid benefits of Hormonal Oral Chemotherapy for
a Covered Person, Aflac will pay $75 per Calendar Month
during which a Covered Person is prescribed, receives, and
incurs a charge for Hormonal Oral Chemotherapy for the
treatment of Cancer or an Associated Cancerous Condition.
Examples of Hormonal Oral Chemotherapy treatments
include but are not limited to Nolvadex, Arimidex, Femara,
and Lupron and their generic versions, such as tamoxifen.
(3) TOPICAL CHEMOTHERAPY BENEFIT: Aflac will pay $150
per Calendar Month during 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.
Oral/Topical Chemotherapy benefits are limited to the
Calendar Month in which the charge for the medication(s)
or treatment is incurred. If the prescription is for more
than one month, the benefit is limited to the Calendar
Month in which the charge is incurred. Total benefits
are payable for up to three different Oral/Topical
Chemotherapy medicines per Calendar Month, up to a
maximum of $750 per Calendar Month. Refills of the same
prescription within the same Calendar Month are not
considered a different Chemotherapy medicine. No lifetime
maximum.
c. RADIATION THERAPY BENEFIT: Aflac will pay $350 once
per Calendar Week during which a Covered Person receives
and incurs a charge for Radiation Therapy for the treatment
of Cancer or an Associated Cancerous Condition. This benefit
will not be paid for each week a radium implant or radioisotope
remains in the body. This benefit is limited to the Calendar
Week in which the charge for the therapy is incurred. No
lifetime maximum.
d. EXPERIMENTAL TREATMENT BENEFIT: Aflac will pay $350
once per Calendar Week during which a Covered Person
receives and incurs a charge for Physician-prescribed
experimental Cancer chemotherapy medications. Aflac will
pay $100 once per Calendar Week during which a Covered
Person receives Physician-prescribed experimental Cancer
chemotherapy medications as part of a clinical trial that does
not charge patients for such medications.
Chemotherapy medications must be approved by the NCI as a
viable experimental treatment for Cancer. This benefit does not
pay for laboratory tests, diagnostic X-rays, immunoglobulins,
Immunotherapy, colony-stimulating factors, and therapeutic
devices or other procedures related to these experimental
treatments. Benefits will not be paid for each week of
continuous infusion of medications dispensed by a pump,
implant, or patch. This benefit is limited to the Calendar Week in
which the charge for the chemotherapy medications is incurred.
No lifetime maximum.
Benefits will not be paid under the Experimental Treatment
Benefit for any medications paid under the Immunotherapy
Benefit.
2. INDIRECT/ADDITIONAL THERAPY BENEFITS: The following
benefits are not payable based on the number, duration, or
frequency of Immunotherapy or antinausea drugs received
by the Covered Person.
a. IMMUNOTHERAPY BENEFIT: Aflac will pay $350 per Calendar
Month during which a Covered Person receives and incurs
a charge for Physician-prescribed Immunotherapy as part
of a treatment regimen for Internal Cancer or an Associated
Cancerous Condition. This benefit is payable only once per
Calendar Month. It is limited to the Calendar Month in which
the charge for Immunotherapy is incurred. Lifetime maximum
of $1,750 per Covered Person.
Benefits will not be paid under the Immunotherapy
Benefit for any medications paid under the Experimental
Treatment Benefit.
b. ANTINAUSEA BENEFIT: Aflac will pay $100 per Calendar Month
during which a Covered Person receives and incurs a charge
for antinausea drugs that are prescribed in conjunction with
Radiation Therapy Benefits, Injected Chemotherapy Benefits,
Oral/Topical Chemotherapy Benefits, or Experimental Treatment
Benefits. This benefit is payable only once per Calendar Month
and is limited to the Calendar Month in which the charge for
antinausea drugs is incurred. No lifetime maximum.
c. STEM CELL TRANSPLANTATION BENEFIT: Aflac will pay
$7,000 when a Covered Person receives and incurs a charge
for a peripheral Stem Cell Transplantation for the treatment of
Internal Cancer or an Associated Cancerous Condition. This
benefit is payable once per Covered Person. Lifetime maximum
of $7,000 per Covered Person.
d. BONE MARROW TRANSPLANTATION BENEFIT: (1) Aflac will
pay $7,000 when a Covered Person receives and incurs a
charge for a Bone Marrow Transplantation for the treatment of
Internal Cancer or an Associated Cancerous Condition. (2) Aflac
will pay the Covered Person’s bone marrow donor an indemnity
of $750 for his or her expenses incurred as a result of the
transplantation procedure. Lifetime maximum of $7,000 per
Covered Person.
e. BLOOD AND PLASMA BENEFIT: Aflac will pay $100 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 during a covered
7
Hospital confinement. Aflac will pay $175 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.
3. SURGICAL TREATMENT BENEFITS:
a. SURGICAL/ANESTHESIA BENEFIT: When a surgical operation
is performed on a Covered Person for a diagnosed Internal
Cancer or Associated Cancerous Condition, Aflac will pay the
indemnity listed in the Schedule of Operations for the specific
procedure when a charge is incurred. If any operation 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 operation most nearly similar in severity
and gravity.
EXCEPTIONS: Surgery for Skin Cancer will be payable
under Benefit C3b. Reconstructive Surgery will be payable
under Benefit E7.
Two or more surgical procedures performed through the same
incision will be considered one operation, and benefits will be
paid based upon the highest eligible benefit.
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 $4,250. No lifetime
maximum on the number of operations.
b. 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 indemnity listed below when a charge is incurred for
the specific procedure. The indemnity amount listed below
includes anesthesia services. The maximum daily benefit
will not exceed $400. No lifetime maximum on the number
of operations.
Laser or Cryosurgery $ 35
Surgeries OTHER THAN Laser or Cryosurgery:
Biopsy 70
Excision of lesion of skin without flap or graft 170
Flap or graft without excision 250
Excision of lesion of skin with flap or graft 400
c. ADDITIONAL SURGICAL OPINION BENEFIT: Aflac will pay
$200 per day when a charge is incurred for an additional
surgical opinion, by a Physician, concerning surgery for a
diagnosed Cancer or an Associated Cancerous Condition.
This benefit is not payable on the same day the NCI Evaluation/
Consultation Benefit is payable. No lifetime maximum.
D. HOSPITALIZATION BENEFITS:
1. HOSPITAL CONFINEMENT BENEFITS:
a. 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 per day for each day a Covered
Person is charged for a room as an inpatient. No lifetime
maximum.
Named Insured or Spouse $200
Dependent Child $250
b. 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 in
Benefit D1a above for the first 30 days. Beginning with the 31st
day of such continuous Hospital confinement, Aflac will pay the
amount listed below per day for each day a Covered Person is
charged for a room as an inpatient. No lifetime maximum.
Named Insured or Spouse $400
Dependent Child $500
2. 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 $200. 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 Surgical/
Anesthesia Benefit. The maximum daily benefit will not exceed
$200. 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 any
surgery performed in a Physician’s office.
E. CONTINUING CARE BENEFITS:
1. 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 $100 per day when a charge is incurred for such
continued confinement. For each day this benefit is payable,
8
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.
2. 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 $100 per day when a charge is incurred for each such visit,
subject to the following conditions:
a. The home health care or health supportive services must begin
within seven days of release from the Hospital.
b. This benefit is limited to ten days per hospitalization for each
Covered Person.
c. This benefit is limited to 30 days in any Calendar Year for each
Covered Person.
d. 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.
e. 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.
3. 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. This benefit is not payable the same day
the Home Health Care Benefit is payable. Lifetime maximum for
each Covered Person is $12,000.
4. 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 $100 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.
5. SURGICAL PROSTHESIS BENEFIT: Aflac will pay $2,000 when a
charge is incurred for surgically implanted prosthetic devices that
are prescribed as a direct result of surgery for Internal Cancer or
Associated Cancerous Condition treatment. Lifetime maximum of
$4,000 per Covered Person.
The Surgical Prosthesis Benefit does not include coverage
for tissue expanders or a Breast Transverse Rectus
Abdominis Myocutaneous (TRAM) Flap.
6. NONSURGICAL PROSTHESIS BENEFIT: Aflac will pay $175 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 $350 per
Covered Person.
7. RECONSTRUCTIVE SURGERY BENEFIT: Aflac will pay the
specified indemnity 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 treatment of an
Associated Cancerous Condition. The maximum daily benefit will
not exceed $2,000. No lifetime maximum on number
of operations.
Breast Tissue/Muscle Reconstruction Flap Procedures $2,000
Breast Reconstruction (occurring within five years of breast
cancer diagnosis) 500
Breast Symmetry (on the nondiseased breast occurring
within five years of breast reconstruction) 220
Facial Reconstruction 500
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.
9
8. EGG HARVESTING AND STORAGE (CRYOPRESERVATION)
BENEFIT: Aflac will pay $1,000 for a Covered Person to have
oocytes extracted and harvested. In addition, Aflac will pay, one
time per Covered Person, $350 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. Lifetime maximum of $1,350
per Covered Person.
F. AMBULANCE, TRANSPORTATION, AND LODGING BENEFITS:
1. 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
of 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.
2. TRANSPORTATION BENEFIT: Aflac will pay 40 cents per mile
for transportation, up to a combined maximum of $1,200, if a
Covered Person requires treatment that has been prescribed by
the attending Physician for Cancer or an Associated Cancerous
Condition. This benefit includes:
a. 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.
b. 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 $1,200 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.
3. LODGING BENEFIT: Aflac will pay $65 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.
G. PREMIUM WAIVER AND RELATED BENEFITS:
1. 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.
2. 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:
a. Your policy has been in force for at least six months;
b. We have received premiums for at least six consecutive
months;
c. Your premiums have been paid through payroll deduction, and
you leave your employer for any reason;
d. You or your employer notifies us in writing within 30 days of the
date your premium payments ceased because of your leaving
employment; and
e. You re-establish premium payments through:
(1) your new employer’s payroll deduction process, or
(2) direct payment to Aflac.
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You will again become eligible to receive this benefit after:
a. You re-establish your premium payments through payroll
deduction for a period of at least six months, and
b. 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 A78000)
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. All amounts cited in the rider are for one unit of coverage.
If more than one unit has been purchased, the amounts listed
must be multiplied by the number of units in force. The number
of units you purchased is shown in both the Policy Schedule and the
attached application.
The INITIAL DIAGNOSIS BENEFIT, as shown in the policy, will be
increased by $100 for each unit purchased on each rider anniversary
date while the rider 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 the rider, 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 the Initial Diagnosis
Building Benefit Rider:
The rider contains a 30-day waiting period. If a Covered Person has
Internal Cancer or an Associated Cancerous Condition diagnosed
before coverage has been in force 30 days from the Effective Date,
you may, at your option, elect to void the rider from its beginning and
receive a full refund of premium.
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 the rider and the subsequent
recurrence, extension, or metastatic spread of such Internal Cancer
or Associated Cancerous Condition; (2) Internal Cancer or Associated
Cancerous Conditions diagnosed during the rider’s 30-day waiting
period; or (3) 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 78000)
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 the Dependent Child
Rider:
The rider contains a 30-day waiting period. If a covered Dependent
Child has Internal Cancer or an Associated Cancerous Condition
diagnosed before coverage has been in force 30 days from the
Effective Date you may, at your option, elect to void the rider from its
beginning and receive a full refund of premium.
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; (2) Internal Cancer or Associated
Cancerous Conditions diagnosed during the rider’s 30-day waiting
period; or (3) 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 A78000)
Applied for: Yes No
The rider is issued on the basis that the information shown on the
application is correct and complete. If answers on your application
for the rider are incorrect or incomplete, then the rider may be
voided or claims may be denied. If voided, any premiums for the
rider, less any claims paid, will be refunded to you.
SPECIFIED-DISEASE INITIAL BENEFIT: While coverage is in force,
if a Covered Person is first diagnosed, after the Effective Date of
the rider, with any of the covered Specified Diseases, Aflac will pay
a benefit of $1,000. This benefit is payable only once per covered
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disease per Covered Person. NO OTHER BENEFITS ARE PAYABLE
FOR ANY COVERED SPECIFIED DISEASE NOT PROVIDED FOR IN
THE RIDER.
A. HOSPITAL CONFINEMENT BENEFITS:
1. HOSPITALIZATION FOR 30 DAYS OR LESS: When a Covered
Person is confined to a Hospital for 30 days or less, for a
covered Specified Disease, Aflac will pay $200 per day.
2. 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 in Section A1 above for the first 30 days, and
beginning with the 31st day of such continuous Hospital
confinement, Aflac will pay $500 per day.
“Specified Disease,” as used under this benefit, means one or
more of the diseases listed below. These diseases must be first
diagnosed by a Physician 30 days following the Effective Date
of the rider for benefits to be paid. The diagnosis must be made
by and upon a tissue specimen, culture(s), and/or titer(s). If any
of these diseases are diagnosed prior to the rider’s being in
effect for 30 days, benefits for that disease(s) will be paid only
for loss incurred after the rider has been in force two years.
• adrenal hypofunction
(Addison’s disease)
• amyotrophic lateral
sclerosis
(ALS or Lou Gehrig’s
disease)
• botulism
• bubonic plague
• cerebral palsy
• cholera
• cystic fibrosis
• diphtheria
• encephalitis
(including encephalitis
contracted from West Nile
virus)
• Huntington’s chorea
• Lyme disease
• malaria
• meningitis (bacterial)
• multiple sclerosis
• muscular dystrophy
• myasthenia gravis
• necrotizing fasciitis
• osteomyelitis
• polio
• rabies
• Reye’s syndrome
• scleroderma
• sickle cell anemia
• systemic lupus
• tetanus
• toxic shock syndrome
• tuberculosis
• tularemia
• typhoid fever
• variant Creutzfeldt-Jakob
disease
(mad cow disease)
• yellow fever
RETURN OF PREMIUM BENEFIT: (Series A78000)
Applied for: Yes No
Aflac will pay you a cash value based upon the annualized
premium paid for the rider, the policy, and any other attached
benefit riders (premium paid for the policy and other
attached benefit riders will be calculated at the original
premium in effect on the rider Effective Date and will not
include premium increases that may occur for the policy
or other such riders). All Return of Premium Benefits/cash
values paid will be less any claims paid. If you surrender the
rider for its cash value after Cancer or an Associated Cancerous
Condition is diagnosed but before claims are submitted, we will
reduce subsequent claim payment(s) by the amount of the cash
value paid. Both the policy and the rider must remain in force
for 20 consecutive years for you to obtain a maximum refund of
premiums paid. If the rider is added to the policy after the policy
has been issued, only the premium paid for the policy after the
Effective Date of the rider will be returned. When the rider is
issued after the Effective Date of the policy, the 20-year period
begins for both the policy and the rider on the rider Effective
Date.
The cash value for premium paid for the policy and rider begins
on the fifth rider anniversary date.
Your cash value is based upon annualized premium of $ .
If you surrender the rider after its fifth anniversary and such
surrender occurs between rider anniversaries, a prorated
amount for the partial year will be paid. The proration will be
calculated by taking the cash value difference between the last
and next anniversary dates, dividing by 12, and multiplying by
the number of months that premiums were earned in the partial
year at the time of surrender. This proration will then be added
to the cash value on the last rider anniversary date, and this will
be the cash value paid.
IMPORTANT! READ CAREFULLY: The rider will terminate on
the earlier of: its 20th anniversary date and payment of the
cash value; your surrender of it for its cash value between the
fifth and 20th anniversary dates; your death prior to its 20th
anniversary date, in which case the cash value (if any) will be
paid to your estate; your failure to pay the premium for the rider,
in which case any cash values due will be paid; the policy’s
termination, in which case any cash values due will be paid; or
the time that claims paid equal or exceed the cash value that
would be paid on the 20th policy anniversary. When the rider
terminates (is no longer in force), no further premium will be
charged for it.
12
5. Exceptions, Reductions, and Limitations of the Policy (This is
not a daily hospital expense plan.):
A. We pay only for treatment of Cancer and 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.
B. The policy contains a 30-day waiting period. If a Covered Person
has Cancer or an Associated Cancerous Condition diagnosed
before his or her coverage has been in force 30 days, benefits
for treatment of that Cancer or Associated Cancerous Condition
will apply only to treatment occurring after two years from the
Effective Date of such person’s coverage. At your option, you may
elect to void the coverage and receive a full refund of premium.
C. 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; (2) Internal Cancer or
an Associated Cancerous Condition diagnosed during the policy’s
30-day waiting period; or (3) 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.
D. 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.
E. Aflac will not pay benefits whenever fraud is committed in making
a claim under this coverage or any prior claim under any other
Aflac coverage for which you received benefits that were not
lawfully due and that fraudulently induced payment.
6. Renewability: The policy is guaranteed-renewable for life by
payment of the premium in effect at the beginning of each renewal
period. Premium rates may change only if changed on all policies of
the same form number and class in force in your state.
The policy has limitations that may affect benefits payable.
This brochure is for illustration purposes only.
Refer to the policy and riders for complete definitions, details,
limitations, and exclusions.
13
TERMS YOU NEED TO KNOW
ACTIVITIES OF DAILY LIVING (ADLs): BATHING: washing oneself by
sponge bath or in either a tub or shower, including the task of getting
into or out of the tub or shower; MAINTAINING CONTINENCE: controlling
urination and bowel movements, including your ability to use ostomy
supplies or other devices such as catheters; TRANSFERRING: moving
between a bed and a chair, or a bed and a wheelchair; DRESSING:
putting on and taking off all necessary items of clothing; TOILETING:
getting to and from a toilet, getting on and off a toilet, and performing
associated personal hygiene; EATING: performing all major tasks of
getting food into your body.
ASSOCIATED CANCEROUS CONDITION: Myelodysplastic blood
disorder, myeloproliferative blood disorder, or internal carcinoma in situ
(in the natural or normal place, confined to the site of origin without
having invaded neighboring tissue). An Associated Cancerous Condition
must receive a Positive Medical Diagnosis. Premalignant conditions or
conditions with malignant potential, other than those specifically
named above, are not considered Associated Cancerous
Conditions.
CANCER: Disease manifested by the presence of a malignant tumor
and characterized by the uncontrolled growth and spread of malignant
cells, and the invasion of tissue. Cancer also includes but is not limited
to leukemia, Hodgkin’s disease, and melanoma. Cancer must receive a
Positive Medical Diagnosis.
1. INTERNAL CANCER: All Cancers other than Nonmelanoma Skin
Cancer (see definition of “Nonmelanoma Skin Cancer”).
2. NONMELANOMA SKIN CANCER: A Cancer other than a
melanoma that begins in the outer part of the skin (epidermis).
Associated Cancerous Conditions, premalignant conditions, or
conditions with malignant potential will not be considered Cancer.
COVERED PERSON: Any person insured under the coverage type you
applied for: individual (named insured listed in the Policy Schedule),
named insured/Spouse only (named insured and Spouse), one-parent
family (named insured and Dependent Children), or two-parent family
(named insured, Spouse, and Dependent Children). “Spouse” is defined
as the person to whom you are legally married and who is listed on your
application. “Domestic Partner” is an unmarried same or opposite sex
adult who resides with the Covered Person and has registered in a state
or local domestic partner registry with a Covered Person. A “Civil Union”
is a relationship similar to marriage that is recognized by law. Wherever
the terms “Spouse”, “immediate family”, or any other term that denotes
the spousal relationship are used or defined in this policy, the definitions
of civil union and domestic partner are included. Newborn children
are automatically insured from the moment of birth. If coverage is for
individual or named insured/Spouse only and you desire uninterrupted
coverage for a newborn child, you must notify Aflac in writing within
31 days of the birth of your child, and Aflac will convert the policy to
one-parent family or two-parent family coverage and advise you of the
additional premium due. Coverage will include any other Dependent
Child, regardless of age, who is incapable of self-sustaining employment
by reason of mental retardation or physical handicap and who became
so incapacitated prior to age 26 and while covered under the policy.
“Dependent Children” are your natural children, stepchildren, or legally
adopted children who are under age 26.
EFFECTIVE DATE: The date coverage begins, as shown in the Policy
Schedule. The Effective Date is not the date you signed the application
for coverage.
PHYSICIAN: A person legally qualified to practice medicine, other
than you or a member of your immediate family, who is licensed as a
Physician by the state where treatment is received to treat the type of
condition for which a claim is made.
ADDITIONAL INFORMATION
An Ambulatory Surgical Center does not include a doctor’s or dentist’s
office, clinic, or other such location.
The term “Hospital” does not include any institution or part thereof
used as an emergency room; an observation unit; a rehabilitation unit;
a hospice unit, including any bed designated as a hospice or a swing
bed; a convalescent home; a rest or nursing facility; a psychiatric unit;
an extended-care facility; a skilled nursing facility; or a facility primarily
affording custodial or educational care, care or treatment for persons
suffering from mental disease or disorders, care for the aged, or care
for persons addicted to drugs or alcohol.
A Bone Marrow Transplantation does not include Stem Cell
Transplantations.
A Stem Cell Transplantation does not include Bone Marrow
Transplantations.
If Nonmelanoma Skin Cancer is diagnosed during hospitalization,
benefits will be limited to the day(s) the Covered Person actually
received treatment for Nonmelanoma Skin Cancer.
If treatment for Cancer or an Associated Cancerous Condition is
received in a U.S. government Hospital, the benefits listed in the policy
will not require a charge for them to be payable.
Underwritten by:
American Family Life Assurance Company of Columbus
Worldwide Headquarters | 1932 Wynnton Road | Columbus, Georgia 31999
