Limited Benefit Cancer Indemnity Insurance - Series 9
Cancer Insurance
Limited Benefit Cancer Indemnity Insurance
Wellness Benefit · Benefits Paid Directly to You · Excellent Customer Service · Learn More
Cancer Insurance
A cancer diagnosis can be both a physical and emotional drain. Thanks to advances in medicines and procedures to battle cancer, more
and more people are beating this disease. However, with the arrival of these advances also comes the continuing rise in the cost of
cancer treatment.
The financial impact of a cancer diagnosis can affect anyone’s financial situation. American Fidelity Assurance Company’s Limited
Benefit Cancer Insurance can offer a solution to help you and your family focus on fighting the disease. This plan can assist with the
expenses that may not be covered by medical insurance.
In the U.S., men have slightly less than a 1 in 2 lifetime
risk of developing cancer; for women, the risk is a little
more than 1 in 3.1
American Cancer Society: Cancer Facts and Figures 2013, pg. 1. Cancer/Critical
Illness N.A.
1
38%
62%
Indirect Medical Costs
Direct Medical Costs
1 out of 2 men
1 out of 3 women
62% of all costs for cancer are direct medical
costs, while the remaining 38% of costs are
indirect and generally not covered by major
medical insurance.2
American Cancer Society: Cancer Facts and Figures 2013, pg. 3 Cancer/
Critical Illness N.A.
2
How It Works
This plan is designed to help cover expenses if you are diagnosed with
Cancer. With more than 20 built-in policy benefits, this plan provides
benefits for the treatment of cancer, transportation, hospitalization and
more. In addition, this is a portable plan so you own the policy. You can take
the coverage with you if you choose to leave your current job, and your
premiums will remain the same.
American Fidelity’s Cancer Insurance provides:
• Benefits paid directly to you, to be used however you see fit.
• Policy is guaranteed renewability for as long as premiums are
paid as required.
Wellness Benefit
Receive a benefit for your annual internal
cancer screening test, including but not
limited to Mammogram, PAP, PSA, and
Colonoscopy.
Prevention Care Benefit*
(per calendar year)
$60
• You own the policy and can keep the policy if you change
employers.
* Requires 30 day waiting period before use.
Schedule of Benefits**
Benefit
Prevention Benefits
Prevention Care Benefit
Ambulance, Transportation, & Lodging Benefits
$60
(per calendar year)
Transportation Benefit
$10,000
(per calendar year)
Drug and Medicine Benefit
Inpatient Services
(per calendar year)
Blood, Plasma, and Platelets Benefit
$500
(per day)
$100
(per mile; maximum of 700 miles)
Lodging Expenses
$1,000
Coach fare or .40/
mile by car
$40
(per day; maximum of 21 days)
(per day for the first 75 days)
Benefit is determined on the benefit selected.
Dread Disease
$100, $225,
$300, or $400
$200
(per day after the first 90 days; lifetime max of $100,000)
$500
(per day for the first five days)
$45
( per day after the first five days)
$40
U.S. Government/Charity Hospital or
HMO
(per day - pays in lieu of all other benefits)
Hospital Confinement
Outpatient Services
Lodging
Coach fare or .40/
mile by car
$20
$30
(per day up to 60 days)
Surgical Benefit
$3,000
(per operation)
Anesthesia Benefit
Skin Cancer Surgical Benefit
Reconstructive or Cosmetic Surgery
Benefit
25% of the
scheduled amount
for covered surgery
$240
Continuing Care Benefits
$300
$5,000
(per device with a max of two devices per lifetime)
Extended Care Facility Benefit
$50
(per day for up to the same number of days of paid
Hospital Confinement)
Special Nursing Services Benefit
Hospital Confinement
$75
(per day)
Outpatient
$600
$620
(per operation)
Prosthesis Benefit
(per day for the first 90 days)
Attending Physician
Meals
Coach fare or .40/
mile by car
(per operation)
Hospitalization Benefits
Hospital Confinement Benefit
100%
Surgical Treatment Benefits
(per calendar year)
Travel Expenses
Family Member Transportation, Meals
and Lodging Benefit
Transportation
$250
(per day)
Donor Benefit
Medical Expenses
(up to 700 miles round trip by car or air ambulance)
(up to 700 miles by car per confinement)
(per Hospital Confinement)
Outpatient Drugs and Medicines
Ambulance Benefit
(actual charges)
Treatment Benefits
Radiation Therapy/Chemotherapy
Benefit
Benefit
(per day up to the greater of: 25 days , or the same
number of days of paid Hospital Confinement)
Hospice Care Benefit
$75
$50
(per day)
Medical Equipment Benefit
(per calendar year)
Refer to Plan Benefit Highlights for more complete Benefit Descriptions and limits on the Cancer Insurance Plan.
** The premium and amount of benefits provided vary dependent upon the plan selected.
$250
Enhance Your Plan*
Radiation Therapy and
Chemotherapy Rider
Summary of Radiation Therapy and
Chemotherapy Rider Benefits:
This rider is designed to increase the amount payable under the
Radiation Therapy and Chemotherapy benefit in the policy.
Schedule of Benefits
Radiation Therapy and Chemotherapy
Benefit
$10,000
• Pays when actual charges for coverage provided under the
Radiation Therapy and Chemotherapy benefit in the policy
exceed $10,000 in one calendar year. This benefit will pay for
the covered excess actual charges up to an additional $10,000
for that same calendar year.
(per calendar year)
Hospital Intensive Care Unit Rider
This rider can provide you financial relief by paying for each day
a Covered Person is confined in an Intensive Care Unit (ICU), as
defined in this rider.
Schedule of Benefits
ICU Confinement Benefit
$600
(per day up to 30 days)
Ambulance Benefit
(per admission in an ICU)
$100
Summary of Hospital ICU Rider Benefits:
• Confinement must be due to accident or sickness and begin
after the effective date of coverage under this rider.
• Under age 70, pays $600 per day from the first day of
confinement up to 30 days for each confinement in an ICU, or
age 70 or older, $300 per day for up to 30 days.
• Under age 70, pays $100 per admission for ambulance charges,
or age 70 or older, $50 for transportation to a Hospital where
they are admitted to an ICU within 24 hours of arrival.
• All ICU amounts reduce by 50% at age 70.
• Benefits will be provided after the first two years of the rider
for Intensive Care Unit confinement caused by any heart
condition when any heart condition was diagnosed or treated
prior to the 30th day following the Covered Person’s Effective
Date of this rider.
* Availability of Riders may vary by state and employer. Additional Riders are subject to our general underwriting guidelines and coverage is not guaranteed.
Plan Options
You can take advantage of the following options to extend coverage to your family:
• Individual Plan
The Insured, age 18 through 70, at the date of policy issue, is the only Covered Person.
• Single Parent Family Plan
The Insured, age 18 through 70, at the date of policy issue, and each Eligible Child, as defined in the policy.
• Family Plan
The Insured and spouse, age 18 through 70, at the date of policy issue, and Eligible Children, as defined in the policy.
Plan Benefit Highlights
Preventive Care Benefit
We will pay for each Covered Person who has one or more routine screening
procedures for a Specified Disease including mammograms and pap smears,
when ordered or provided by a Physician in accordance with the standard
practice of medicine. Benefits will only be payable for tests performed after the
30-day period following the Covered Person’s Effective Date of coverage. This
benefit is available without a diagnosis of cancer. We will pay up to $60 with No
Lifetime Maximum each Calendar Year.
Radiation Therapy/Chemotherapy Benefit
We will pay benefits for the following: teleradiotherapy, using either natural or
artificially propagated radiation; surgical chemotherapy implants; anti-nausea
medication; interstitial or intracavity application of radium or radioisotopes
in sealed sources; application of radium or radioisotopic plaques or molds;
or the administration internally, interstitially or intracavitarially of radium or
radioisotopes in nonsealed sources; and cancerocidal chemical substances.
This therapy must be used for the purpose of modification or destruction of
abnormal tissue and not for diagnosis. Benefits will be reduced by any amount
paid under the Drugs and Medicine Benefit. Pays benefits up to $10,000 per
Calendar Year with No Lifetime Maximum.
Drugs & Medicine Benefit
We will pay for drugs and medicines administered to a Covered Person for
treatment of cancer. We will pay actual charges up to $250 per confinement for
inpatient services and up to $500 per Calendar Year for outpatient drugs and
medicines with No Lifetime Maximum.
Blood, Plasma and Platelets Benefit
We will pay for the following: blood, plasma, and platelets; transfusion service;
procurement fees, including blood donor expenses; and administration,
processing, typing and crossmatching. This does not include any laboratory
expenses except those specifically listed. Benefits for blood, plasma and
platelets are ONLY provided under this provision of the Policy. We will pay
benefits up to $100 per day used with No Lifetime Maximum.
Donor Benefit
We will pay expenses incurred by a donor on behalf of a Covered Person for a
covered surgery. If surgery is performed more than 50 miles from the donor’s
place of residence, benefits will be paid for the donor’s transportation and
lodging in a single room in a motel or hotel for a period of time beginning 24
hours before and ending 24 hours after the donor’s presence is required. We
will pay benefits up to $1,000 in medical expenses; for non-local treatment we
will pay 21 days of lodging at $40 per day, and round trip coach fare or $.40 per
mile for up to 700 miles with No Lifetime Maximum.
Hospital Confinement Benefit
We will pay the benefit option amount you choose for each period of Hospital
Confinement of a Covered Person for treatment of cancer. This benefit covers
charges made by the Hospital for: room and board; services of regular hospital
attendants, including Nurses; laboratory tests; and Hospital supplies and
equipment used in the treatment of cancer. A Hospital is not, other than in a
minor way, a place for: rest or the aged; convalescence; custodial or educational
care. Benefit options are $100, $225, $300, or $400 per day for the first 75 days
of confinement, and actual charges thereafter, with No Lifetime Maximum.
Dread Disease Benefit
We will pay benefits for each period of Hospital Confinement of a Covered
Person for the treatment of the following Dread Diseases: Addison’s Disease,
Amyotrophic Lateral Sclerosis (ALS), Diphtheria, Encephalitis, Grand Mal
Epilepsy, Legionnaire’s Disease, Meningitis, Multiple Sclerosis, Muscular
Dystrophy, Myasthenia Gravis, Niemann-Pick Disease, Osteomyelitis,
Poliomyelitis, Reye’s Syndrome, Rheumatic Fever, Rocky Mountain Spotted
Fever, Sickle Cell Anemia, Systemic Lupus Erythematosus, Tay-Sachs Disease,
Tetanus, Toxic Epidermal Necrolysis, Toxic Shock Syndrome, Tuberculosis,
Tularemia, Typhoid Fever and Whipple’s Disease. Benefits for Dread Disease are
ONLY provided under this provision of the policy. We will pay benefits up to
$200 per day for the first 90 days of a hospital stay, $500 per day thereafter, up
to a maximum of $100,000 for the lifetime of a Covered Person.
Attending Physician Benefit
We will pay for visits by an attending Physician, other than a surgeon, while
a Covered Person is hospitalized for treatment of cancer (Maximum one
Physician’s visit per day). We will pay benefits up to $45 per day for the first five
days and $40 per day thereafter with No Lifetime Maximum.
U.S. Government or Charity Hospital Benefit, or H.M.O.
Benefit
If an itemized list of charges is not available because a Covered Person is
confined in a U.S. Government or Charity Hospital, or covered under a Health
Maintenance Organization or Diagnostic Related Group, this benefit pays
in lieu of all other benefits previously described. We will pay $600 per day of
Hospital Confinement in lieu of benefits previously listed with No Lifetime
Maximum. We will pay $300 per day of Outpatient Services received in lieu of
benefits previously listed with No Lifetime Maximum.
Ambulance Benefit
We will pay 100% of actual charges for transportation of a Covered Person
to and from a Hospital by ground ambulance, or from one medical facility
to another where the Covered Person is admitted as an inpatient for the
treatment of cancer. Air ambulance service does not qualify for this benefit.
Benefits for air ambulance are paid as stated in the Transportation Benefit. We
will pay actual charges with No Lifetime Maximum.
Transportation Benefit
We will pay for transportation of a Covered Person who has been diagnosed as
having cancer, to receive treatment in a Hospital that is at least 50 miles away,
using the most direct route. Such Hospital must be prescribed by a Physician.
Travel must be by scheduled bus, plane, train, or by car or air ambulance. We
will pay for transportation of a Covered Person for round trip coach fare or $.40
per mile up to 700 miles round trip by car or air ambulance with No Lifetime
Maximum.
Family Member Transportation, Meals, and Lodging
Benefit
Expenses are covered for one adult family member to be near the Covered
Person when the Covered Person is confined in a non-local Hospital for
specialized treatment. Non-local means the Hospital is at least 50 miles away,
using the most direct route. Benefits will be reduced by any amount paid for
the family member under the Donor Benefit. We will pay lodging up to $30
per day for up to 60 days and $20 per day for meals and actual charges for one
round trip coach fare or $.40 per mile, up to 700 miles round trip by car per
confinement with No Lifetime Maximum.
Plan Benefit Highlights, cont’d
Surgical Benefit
When a surgical operation is performed on a Covered Person for a diagnosed
cancer, we will pay the surgeon’s fee for the operation up to the amount
shown for such operation in the Schedule of Operations. Two or more surgical
procedures performed through the same incision will be considered one
operation and benefits will be limited to the most expensive procedure.
Benefits are not to exceed $3,000 per operation with No Lifetime Maximum.
Anesthesia Benefit
We will pay for the services of an anesthesiologist. Hospital Confinement is not
required to receive this benefit. We will pay benefits up to 25% of the scheduled
amount for the surgical procedures performed with No Lifetime Maximum.
Skin Cancer Surgical Benefit
We will pay benefits for charges incurred for the surgeon’s fee for surgical
procedures for skin cancer, as shown in the Schedule of Operations. Melanoma
is considered internal cancer and will be covered as such under other provisions
of the policy. Benefits for surgery for skin cancer are ONLY provided under this
provision of the policy. We will pay benefits up to $240 per operation with No
Lifetime Maximum.
Reconstructive or Cosmetic Surgery Benefit
When reconstructive or cosmetic surgery is performed on a Covered Person for
a diagnosed cancer, we will pay for the surgeon’s fee for the operation. We will
pay benefits up to $620 per operation with No Lifetime Maximum.
Prosthesis Benefit
We will pay benefits for a prosthetic device and, if surgery is required, its
surgical implantation when prescribed by a Physician and needed as a direct
result of surgery for cancer. We will pay benefits up to $5,000 per device with a
maximum of two devices per lifetime of each Covered Person.
Extended Care Facility Benefit
We will pay charges when the Covered Person is confined to an Extended Care
Facility. Such confinement must be at the direction of a Physician and begin
within 14 days after a Hospital Confinement. We will pay benefits up to $50
a day for up to the same number of days benefits were paid for a Covered
Person’s Hospital Confinement with No Lifetime Maximum.
Special Nursing Services Benefit
We will pay for full-time special nursing care (other than that regularly furnished
by a Hospital) while a Covered Person is confined in a Hospital. This benefit
will be extended to cover private duty nursing at the Covered Person’s home
immediately following a Hospital Confinement. Benefits are also available for
outpatient private duty nursing at the Covered Person’s home when there is no
Hospital Confinement. Such care must be provided by a Nurse or Home Health
Nurse’s Aide, as explained in the policy; be prescribed by a Physician; and be
Medically Necessary for the treatment of cancer. We will pay benefits up to $75
per day while Hospital confined with No Lifetime Maximum. For outpatient
private duty nursing at the Covered Person’s home, we will pay benefits up
to $75 per day up to the greater of: 25 days, or the same number of days this
benefit was paid while the Covered Person was hospitalized, with No Lifetime
Maximum.
Hospice Care Benefit
We will pay benefits when a Covered Person has been diagnosed as terminally
ill and requires Hospice Care. We will pay benefits up to $50 a day for each day
care is received with No Lifetime Maximum.
Medical Equipment Benefit
We will pay benefits for the rental of a respirator or similar mechanical
apparatus, braces, crutches and wheelchairs when prescribed by a Physician
for the treatment of cancer. We will pay benefits up to $250 per Calendar Year
with No Lifetime Maximum.
Waiver of Premium Benefit
If, while this policy is in force, and prior to age 65, you become disabled due to
cancer and remain so for 90 days, we will pay premiums as long as you remain
disabled. Cancer must be diagnosed 30 or more days after the Effective Date of
this policy. Premiums will only be paid for premiums due after you have been
disabled for a 90 day period. Disabled means that you are unable to work at
any job for which you are qualified by education, training, or experience; not
working at any job for pay or benefits; and under the care of a Physician for the
treatment of cancer. This benefit does not apply if your spouse or Eligible Child
becomes disabled. This benefit includes the premium for any riders attached
to the policy. Premiums are waived after 90 days of disability.
Ambulatory Surgical Center Benefit
We will pay for any Covered Person to receive health care treatment or services
rendered by an Ambulatory Surgical Center the same as we provide coverage
for the same treatment or services rendered by a Hospital. These benefits
are paid in the same manner and up to the same maximums as the same
treatment or service provided by a Hospital with No Lifetime Maximum.
Experimental Treatment Benefit
We will pay benefits for experimental drugs or chemical substances approved
by the National Cancer Institute the same as we provide coverage for any
treatment covered under this policy. This benefit does not provide coverage
for treatments received outside of the United States or its Territories. These
benefits are paid in the same manner and up to the same maximums as any
other treatment in the Schedule of Benefits with No Lifetime Maximum.
Limitations and Exclusions
Eligibility
The policy, Radiation & Chemotherapy Rider, and First Occurrence Benefit
Rider will not be issued to anyone who has ever been diagnosed or treated
for cancer. The Intensive Care Unit Rider will not cover heart conditions for a
period of two years following the Effective Date of coverage for anyone who
has been diagnosed or treated for any heart related condition prior to the 30th
day following Covered Person’s Effective Date of coverage.
Cancer Policy
This policy pays only for loss resulting from definitive cancer treatment,
including direct extension, metastatic spread, or recurrence. This policy also
covers other conditions or diseases directly caused by cancer or the treatment
of cancer. This policy does not cover any other disease, sickness, or incapacity,
which existed prior to the diagnosis of Cancer, even though after contracting
Cancer it may have been complicated, aggravated or affected by Cancer or
the treatment of Cancer except as specifically provided in the Dread Disease
Benefit. All cancer, except skin cancer, must be diagnosed by a pathologist.
Clinical diagnosis will be accepted only if a pathological diagnosis is medically
inadvisable. No benefits will be paid for two years for any Pre-Existing cancer.
No benefits will be paid for one year for any Pre-Existing Dread Disease. PreExisting Condition means any cancer or Dread Disease that is diagnosed prior
to the Covered Person’s Effective Date. Pre-Existing Conditions specifically
named or described as excluded in any part of this contract are never covered.
Cancer means a disease which is manifested by autonomous growth
(malignancy) in which there is uncontrolled growth, function, or spread (local
or distant) of cells in any part of the body. This includes Cancer in situ and
malignant tumors. This includes Diethylstibestrol (DES) related conditions. It
does not include other conditions which may be considered pre-cancerous
or having malignant potential such as: leukoplakia; hyperplasia; carcinoid;
acquired immune deficiency syndrome (AIDS); polycythemia; non-malignant
melanoma; moles or similar lesions.
Radiation Therapy and Chemotherapy Rider
No benefits will be paid for two years for any cancer diagnosed or treated prior
to the Covered Person’s effective date of this rider.
Hospital Intensive Care Rider
No benefits will be provided during the first two years of the rider for Intensive
Care Unit confinement caused by any heart condition when any heart condition
was diagnosed or treated prior to the 30th day following the Covered Person’s
Effective Date of this rider (the heart condition causing the Confinement need
not be the same condition diagnosed or treated prior to the Effective Date). No
benefits will be provided if the loss results from: attempted suicide, whether
sane or insane; intentional self-injury; alcoholism or drug addiction; any act of
war, declared or undeclared, or any act related to war; or military service for
any country at war. No benefits will be paid for confinements in units such
as: Surgical Recovery Rooms, Progressive Care, Burn Units, Intermediate Care,
Private Monitored Rooms, Observation Units, Telemetry Units or Psychiatric
Units not involving intensive medical care; or other facilities which do not
meet the standards for Intensive Care Unit as defined in the policy. Benefits are
reduced by half at age 70.
Cancer Insurance Premiums
Base Plan Monthly Premiums*
Daily Hospital Benefit
Individual
Single Parent Family
Family
$100
$18.72
$22.80
$27.84
$225
$21.12
$25.68
$31.44
$300
$22.20
$27.00
$33.00
$400
$24.48
$29.88
$36.36
Optional Benefit Rider Monthly Premiums
Radiation Therapy & Chemotherapy Benefit Rider
Individual
Single Parent Family
Family
Monthly Premium
$7.00
$9.00
$11.00
Hospital Intensive Care Unit Rider
Individual
Single Parent Family
Family
Monthly Premium
$6.00
$8.00
$11.00
Guaranteed Renewable
You are guaranteed the right to renew your base policy during your lifetime as long as you pay premiums when due or within the premium
grace period. We have the right to increase premiums by class.
* The premium and amount of benefits provided vary based upon the plan selected.
This is a brief description of the coverage. For actual benefits and other provisions, please refer to the policy. This coverage does
not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid Coverage.
800-437-1011 • www.americanfidelity.com • 2000 N. Classen Boulevard • Oklahoma City, Oklahoma 73106
Policy Form: C-9 (MN)
SB-7348(MN)-1113