Download FIVE UNITS AMERICAN INCOME LIFE INSURANCE COMPANY

FIVE
UNITS
FIVE
UNITS
AMERICAN INCOME LIFE INSURANCE COMPANY
Indianapolis, Indiana
SPECIFIED DISEASE COVERAGE
Outline of Coverage
For Policy Form CNM (R82)
This policy IS NOT A MEDICARE SUPPLEMENT policy.
If you are eligible for Medicare, review the
Medicare Supplement Buyer's Guide available from the company. This is a limited policy.
1. READ YOUR POLICY CAREFULLY - This outline of coverage provides a very brief description 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 your insurance company. It is, therefore
important that you READ YOUR POLICY CAREFULLY!
2. SPECIFIED DISEASE COVERAGE - Policies of this category are designed to provide, to persons insured, restricted
coverage paying benefits ONLY when certain losses occur as a result of specified diseases.
for basic hospital, basic medical-surgical or major medical expenses.
3. BENEFITS:
Coverage is not provided
MAXIMUM LIFETIME BENEFIT
HOSPITAL CONFINEMENT
$50.00 per day for twelve days
$25.00 per day thereafter
SURGICAL (diagnostic procedures are not covered)
$22.50 to $375.00 per operation as outlined in schedule of operations
ANESTHESIA
Not to exceed $50.00 per operation
RADIATION THERAPY AND CHEMOTHERAPY BENEFIT
Usual and Customary Charge
PRIVATE NURSING (While hospital confined)
At $20.00 per day when required, for RN or LVN
$18,550.00
2,500.00
500.00
1,000.00
1,000.00
ATTENDING PHYSICIAN (While hospital confined)
$10.00 per day for physician other than surgeon
500.00
BLOOD AND PLASMA
Usual and Customary Charge
AMBULANCE
Not to exceed $25.00 for each confinement
TRANSPORTATION (Common Carrier)
Usual and Customary Charge, when required, to hospital
500.00
EXTENDED BENEFITS (In lieu of hospital benefits)
This benefit is payable only when you are hospital confined for 91 straight days or more.
The daily hospital confinement benefit is not payable when this benefit is in effect.
$3,000 per month toward charges made by hospital beginning 91st day of continuous
hospital confinement (benefits will be prorated for periods of less than 30 days)
250.00
250.00
No Limit
4. EXCLUSIONS AND LIMITATIONS:
No benefits are provided for loss which begins during the first year of coverage on a Covered Family Member if that
loss results from a condition for which: (1) symptoms existed which would cause an ordinarily prudent person to
seek diagnosis, care or treatment within a one year period preceding the effective date of coverage; or (2) medical
advice or treatment was recommended by or received from a doctor within a five year period preceding the effective
date of coverage.
This policy covers only cancer and its spread or recurrence. It does not cover other sicknesses even if they are
caused by cancer or worsened by cancer. Pathological diagnosis (as defined in the policy) is required to establish a
claim. The only exception is when medical judgment prohibits such procedure and other conclusive evidence is given.
Benefits are not payable for treatment received more than 30 days before the required diagnosis is made. However, if
cancer is first diagnosed by autopsy, benefits will be payable for treatment received up to 45 days before the date of
death.
Diagnostic work to check for the recurrence of cancer is not covered unless it is found that cancer is present at that
time. Cosmetic repair by plastic surgery is not covered, and the policy does not cover prosthetic devices or their
installation, except for reconstructive surgery, prosthesis or physical complications following mastectomies.
AG-1691 (R01) SC
QA6916
5. RENEWABILITY:
We cannot decline to renew. But, premium rates may be increased based on the state in which you live.
increase must be on an overall basis and no individual increases can be made.
6. PREMIUM:
Initial Policy Fee $
Mode Premium
$
Annual Premium $
Premiums are subject to change.
A grace period of 31 days will be granted for the payment of premium.
AG-1691 (R01) SC
PA6916
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