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Critical illness brochure
- 1. CRITICAL ILLNESS CRISISCRISIS RECOVERYRECOVERY Protection when you need it most to help you cope with the high cost of recovering from a Medical Crisis INSURANCE PLAN POLICY FORM H-0186 Introducing CRISISCRISIS RECOVERYRECOVERY Thanks to medical advances, more and more American are surviving major medical crises– cancer, strokes, heart attacks and kidney failure. We all realize that many individuals who have been diagnosed with what at one time were considered fatal illnesses are now overcoming the odds and surviving. Unfortunately, it places a tremendous emotional strain on the family and many times accompanied by an overwhelming financial burden. Your financial security is most threatened when you are told by a physician that you have suffered a heart attack or stroke or that the tissue taken during a biopsy is, in fact malignant. Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon the diagnosis of a covered illness. Use your Crisis Recovery benefits any way you wish. It’s your money the choice is up to you Non-medical expenses resulting from your condition. Deductibles, co-pays, prescriptions, experimental treatments and out of network expenses. Extended convalescence services or for rehabilitation Treatments that are not covered by or limited by your existing medical insurance. Your mortgage, auto loans and credit card payments. Home or automobile alterations for special needs. Expenses for child and/or nursing care Your income and your spouse’s lost wages while he or she cares for you. Or any other bills you may have. Definitions (Continued) Organ Transplant (kidney) The actual undergoing, as a recipient, of a transplant due to failure of the kidney. End Stage Renal Failure Diagnosis by a Legally Qualified Physician who is a board certified Nephrologist, of End Stage Renal disease which: (1) results in chronic irreversible failure of both kidneys to function; and (2) requires an insured person to undergo regular renal dialysis at least weekly. Exclusions and Limitations Benefits will not be payable for any such loss resulting from or in connection with: (1) suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; (2) war or any act of war (whether declared or undeclared) or participating in a riot or felony; (3) being intoxicated (as determined by the laws governing the operation of motor vehicles in the jurisdiction where the loss or cause of loss occurs) or under the influence of an illegal substance or a narcotic (except for narcotics used as prescribed to an insured person by a physician); (4) the insured person’s commission or attempt to commit a felony or to which a contributing cause was the insured person’s being en- gaged in an illegal occupation; (5) loss that begins prior to the effective date of coverage. PRE-EXISTING SICKNESS OR INJURY PROVISION: The benefits of the policy will not be payable during the first 12 months that coverage is in force with respect to an insured person for a loss caused by a Pre-Existing Sick- ness or Injury disclosed or not disclosed in the application. This 12 month period is measured from the effective date of coverage for each insured person. A Pre-Existing Sick- ness or Injury means a Sickness or Injury which is Diag- nosed by a legally qualified physician or for which medical advice or treatment was recommended or received from a legally qualified physician within 12 months prior to the effective date of coverage for each insured person. Underwritten By: Philadelphia American Life Insurance Company P.O. Box 4884 Houston, TX 77210-4884
- 2. Select the amount that’s right for you. You may apply for up to $50,000 of valuable critical illness protection. Children may apply for $10,000. Select a Benefit level to fit your needs. $10,000 $20,000 $30,000 $40,000 $50,000 Dependent Children’s Benefit $10,000 CATEGORY ONE BENEFITS CATEGORY TWO BENEFITS Conditions Percent Paid Cancer (Internal Cancer)* Non-Invasive Carcinoma In-Situ 100% 25% Heart Attack Stroke Coronary Artery Bypass** Angioplasty Pacemaker Implant -single chambered Pacemaker Implant -double chambered End Stage Renal Failure Organ Transplant (kidney) Organ Transplant (heart, lung, liver and pancreas) 100% 100% 25% 10% 30% 40% 100% 50% 100% Conditions Percent Paid If you collect a benefit for the first diagnosed illness or procedure under this policy in one category of benefits and then have a second diagnosis of a condition or procedure in another category under this policy we will pay the maximum benefit to you again. If a partial benefit is paid (25%) the remainder of the benefit will be payable upon the diagnosis of another covered condition. During the first 90 days after the Effective Date of coverage, Reinstatement date or for a second date of occurrence resulting in a Diagnosis or procedure in a Multiple Condition instance, We will pay 25% of the Percentage Benefit Payable listed in the Policy Schedule. Reduced Benefits Reduction of Benefits Due To Age Any benefits remaining at age 65 or older will reduce 50%. Guaranteed Renewable This Policy is guaranteed renewable to age 75 by the timely payment of premiums. It must be paid on or before its due date, or within the 31 days that follow. When an Insured’s coverage terminates at age 75, coverage for other Insured persons, if any, shall continue under this Policy. After the first 12 months, We reserve the right, subject to 30 days (45 or 60 days depending on state) prior written notice to You at Your last known address, to establish a new schedule of premium rates; such schedule of rates will be effective on the following renewal date for all or any class of Insured’s covered by this Policy. Premiums are scheduled to change annually based upon each Insured’s attained age. Attained age means the age of the Insured on the Policy Effective Date of coverage and subsequent Policy anniversary. Attained Age Pricing Issue Age Pricing 0 5 YRS 10YRS Benefit Definitions Cancer (Internal Cancer) A disease that is identified by the uncontrolled and abnormal growth of malignant cells. This includes Hodgkin’s Disease, leukemia, lymphoma, carcinoma, sarcoma, malignant melanoma that is Diagnosed as Clark’s Level IIIor above or Breslow greater than .75mm and malignant tumors. Diagnosis must be made by a Pathologist based on a microscopic examination of fixed tissue or preparations from the hemic system. For purposes of the policy, the following are not considered Cancer (Internal Cancer): pre-malignant conditions or conditions with malignant potential, cervical intraepithelial neoplasia (CIN) stages I and II, Carcinoma in Situ, Non-Invasive Carcinoma In-Situ, Leukoplakia, hyperplasia, polycythemia, moles, lesions, Skin Cancer. Non-Invasive Carcinoma In-Situ A localized malignant tumor, which contains one or several cells that have the potential to invade or metastasize but have not yet done so. This excludes Skin Cancer. Diagnosis must be made by a licensed Pathologist. Heart Attack The death (infarction) of a portion of the heart muscle as a result of inadequate blood supply. Diagnosis of a Heart Attack must be made by a Legally Qualified Physician who is a board certified Cardiologist. Diagnosis of a Heart Attack must be based on all of the following criteria: (1) associated new EKG changes consistent with Injury; (2) elevation of cardiac enzymes above generally accepted la- boratory levels of normal (a diagnostic elevation of Troponin I or in the case of CPK, a CPK-MB measurement must be used) and (3) confirmatory imaging studies such as thallium scans, MUGA scans or stress echocardiograms. The following are not considered a Heart Attack: an EKG change consistent with transient ischemic change, angina, or chance finding of EKG changes suggestive of a previous Heart Attack, or death of the heart muscle coincident with death of an insured from other causes. In the event of death, an autopsy confirmation and death certificate identifying Heart Attack as the cause of death will be accepted. * Excludes pre-malignant conditions or conditions with malignant potential; cervical intraepithelial neoplasia (CIN) stage I and II; Carcinoma in Situ and Skin Cancer. ** Payable for one Coronary Artery Bypass Surgery only. Waiting Period The benefits of this Policy are payable for loss that begins more than 90 days after the Effective Date of coverage for each Insured person. If the Diagnosis is made within the first 90 days, we will pay 25% of the benefit payable as listed in Category One and Two of the policy. Stroke A cerebrovascular event resulting in permanent neurological damage, including infarction of, hemorrhage of, or emboliza- tion to brain tissue from an extracranial source. Diagnosis of Stroke must be made by a Legally Qualified Physician who is a board certified Neurologist. Diagnosis of a Stroke must be based on the following criteria: (1) documented neurological impairment or deficits; and (2) confirming neuroimaging studies. Stroke does not mean a cerebrovascular event resulting from a head Injury, transient ischemic attack, chronic cerebrovas- cular insufficiency and reversible ischemic neurological deficits. Coronary Artery Bypass Surgery (surgical treatment) The first ever heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts, performed by a Legally Qualified Physician who is a board certified Cardiothoracic Surgeon. Payable for one Coronary Artery Bypass Surgery per insured person. Angioplasty The undergoing of angioplasty, atherectomy or laser treat- ment for coronary artery disease,whichcannot be adequately controlled by medical therapy, following a recommendation by a cardiologist. Angiographic evidence of the underlying disease must be provided. Pacemaker Implant The procedure to insert an artificial pacemaker. A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles). A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy. Organ Transplant (heart, lung, liver, pancreas) The actual undergoing, as a recipient, of a transplant due to failure of one of the following organs: heart, lung, liver or pancreas. 0 5 YRS 10 YRS Issue Age PricingAttained Age Pricing Total Costs of Insurance PALIC PALIC Competition Competition Attained Age Pricing In order to make this plan as affordable as possible, we used a pricing method that is called Attained Age Pricing. By using this method the cost of the plan is lower at the beginning and takes small incremental increases each year there after. This is in contrasts to a method called Issue Age Pricing where the premium starts out much higher but remains at the same level for several years or the life of the policy. Which method is better? We believe that Attained Age Pricing is better for the consumer since it’s more affordable up front and allows you to purchase the amount you need by paying less when your income is lower and as your income continues to grow you will be able to pay a little higher premium. In comparing this method to other insurance carriers that prices their product using Issue Age Pricing, we find that our method can save you as much as 20% to 30% (see graph) in the first 10 Years depending on your age.