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Plan Description

KEY BENEFITS

  • Helps pay expenses not covered by medical insurance
  • Covers a wide range of treatments due to an accident
  • Pays money directly to you, not medical providers
  • Pays an extra 25% of total benefits for injuries during youth organized sports

What Is Accident Insurance?

Accident insurance can help keep your finances on track when an accident happens.

Your medical insurance will cover some of the expenses, but you'll be left to foot the bills for your copays and deductible. Those can add up fast, especially if you're unable to work while you recover. That's where Group Accident insurance comes in: It helps protect your bank account from the out-of-pocket expenses that can come with an injury - whether you're coping with a broken arm or recovering from a serious car accident.

How Does Accident Insurance Work?

In the event of a covered accident, your Accident insurance will pay a benefit directly to you. You can use this money wherever you need it most - whether that's to help with your deductible, copay and other medical bills, or your daily expenses while you recover.

BENEFIT EXAMPLES

Don't Let an Accident Stop Your Financial Plans

Accident insurance is an affordable way to help cover the gap between what your health insurance covers and what you'd owe out of pocket if you or a family member were to get injured. It's protection that's also convenient.

Falling Off a Ladder

While cleaning the gutters, Kang lost his footing and fell off the ladder. He felt a lot of pain, but thought that a little ice would fix him up. The next day, he was in worse shape and visited an urgent care facility where it was determined that he had fractured his arm and dislocated his elbow. He then needed some physical therapy to get back to full strength. His Accident Insurance benefits helped protect his savings from the out-of-pocket costs he incurred.

Kang's insurance paid benefits for:

  • Urgent care
  • X-ray
  • Dislocated elbow
  • Arm fracture
  • Physician follow-up
  • Physical therapy (two sessions)

*Example is for illustrative purposes. Eligibility for benefits and amounts shown in this example may vary from any policy your employer may offer and may vary based upon your individual circumstances, policy definitions, waiting periods, exclusions and limitations.

Mountain Bike Accident

Warren was mountain biking with friends in the hills near his home, and an errant rock caught his front tire. He went over the handlebars and landed badly on his hand and shoulder. His friends managed to help him limp back to the trailhead and called 911. An x-ray at the emergency room showed a wrist and collarbone injury, and he had to stay in the hospital for observation. His Accident Insurance benefit helped cover the expenses he incurred from the injury, including the deductible from his medical insurance.

Warren's insurance paid benefits for:

  • Ground ambulance
  • Emergency room
  • X-ray
  • Dislocated collarbone
  • Wrist fracture
  • Hospital admission
  • One-day hospital stay
  • Physician follow-up

*Example is for illustrative purposes. Eligibility for benefits and amounts shown in this example may vary from any policy your employer may offer and may vary based upon your individual circumstances, policy definitions, waiting periods, exclusions and limitations.

Hit By a Car

Dante was visiting a nearby city and taking a walking tour to see the sights. While crossing the road, he was struck by a car. An ambulance took him to the hospital, where they found multiple fractures. Because of the severity of his injuries, he had to stay in the hospital for five days. The benefits from his Accident Insurance coverage helped him cover his copayments and meet the deductible under his medical insurance plan as well as some of the out-of-pocket expenses related to his family's travel to and from the hospital. He even used part of the benefits for his prescribed physical therapy to help him get back on his feet.

Dante's insurance paid benefits for:

  • Ground ambulance
  • Emergency room
  • CAT scan
  • Hospital admission
  • Five-day hospital stay
  • Leg fracture
  • Kneecap fracture
  • Two physician follow-ups
  • Physical therapy (two sessions)

*Example is for illustrative purposes. Eligibility for benefits and amounts shown in this example may vary from any policy your employer may offer and may vary based upon your individual circumstances, policy definitions, waiting periods, exclusions and limitations.

BENEFITS

All three plans include these benefits (View details below on each plan):

  • No limits, no max
  • Hospital pays out anytime hospitalized up to 365 days a year
  • Pays out for every accident
  • No industry exclusions
  • Guaranteedd Issue
Eligibility

Coverage is available for ages 18 - 74

Employees working 20 hours or more per week are eligible

Available for Spouse ages 18-7 4 and Dependent Children (unmarried) ages 0-25

Enrollment Deadline 18th of month Prior to Effective date
Availability Available in ALL States
Issue Age 18 to 74

INPATIENT

  • Archway Accident Gold

    • Daily Hospital Confinement Maximum

      $150 / Day
      365 Days

    • Hospital Admission Per Hospital Confinement

      $1,000

    • Daily Intensive Care Maximum

      $450 / Day
      30 Days

    • Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff

      $750 / Day

    • Anesthesia

      $187.50 /Day

    • Continuous Care(1) Maximum

      $90 / Day
      30 Days

  • Archway Accident Platinum

    • Daily Hospital Confinement Maximum

      $225 / Day
      365 Days

    • Hospital Admission Per Hospital Confinement

      $1,500

    • Daily Intensive Care Maximum

      $475 / Day
      30 Days

    • Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff

      $1,000 / Day

    • Anesthesia

      $250 /Day

    • Continuous Care(1) Maximum

      $135 / Day
      30 Days

  • Archway Accident Diamond

    • Daily Hospital Confinement Maximum

      $250 / Day
      365 Days

    • Hospital Admission Per Hospital Confinement

      $2,000

    • Daily Intensive Care Maximum

      $500 / Day
      30 Days

    • Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff

      $1,500 / Day

    • Anesthesia

      $375 /Day

    • Continuous Care(1) Maximum

      $150 / Day
      30 Days

OUTPATIENT

  • Archway Accident Gold

    • Physician's Office

      $150 / Day
      365 Days

    • Wellness Benefit

      $25 / Day
      1 Per Calendar Year

    • Emergency Room

      $75 / Day
      3 Per Calendar Year

    • Lab, EKG and other Diagnostic Tests

      $20 Per Test Day
      1 Per Calendar Year

    • X-Ray, Echocardiography and Cardiovascular Ultrasound

      $20 Per Test Day
      2 Per Calendar Year

    • Advanced Studies(2)

      $100 / Day
      1 Per Calendar Year

    • Ambulatory Surgical Center

      $25 / Day

    • Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff

      $750 / Day

    • Anesthesia

      $187.50 /Day

    • Ambulance Services Ground

      $120 / Day
      1 Per Calendar Year

    • Ambulance Services Air

      $1,000 / Day
      1 Per calendar Year

    • Lodging Maximum

      $100 I Day
      15 Per calendar Year

    • Prosthesis

      $500

    • Transportation

      $300 / Day
      3 Per Calendar Year

    • Accidental Death

      $20,000

    • Accidental Death on Common earner

      $40,000

    • Dislocation Benefit

      $1,000

    • Fracture Benefit

      $1,000

    • Burn Benefit

      $7,500

    • Coma

      $10,000

    • Dismemberment

      $10,000

    • Paralysis

      $10,000

  • Archway Accident Platinum

    • Physician's Office

      $50 / Day
      365 Days

    • Wellness Benefit

      $25 / Day
      1 Per Calendar Year

    • Emergency Room

      $100 / Day
      3 Per Calendar Year

    • Lab, EKG and other Diagnostic Tests

      $20 Per Test Day
      1 Per Calendar Year

    • X-Ray, Echocardiography and Cardiovascular Ultrasound

      $30 Per Test Day
      2 Per Calendar Year

    • Advanced Studies(2)

      $150 / Day
      1 Per Calendar Year

    • Ambulatory Surgical Center

      $25 / Day

    • Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff

      $1,000 / Day

    • Anesthesia

      $250 /Day

    • Ambulance Services Ground

      $200 / Day
      1 Per Calendar Year

    • Ambulance Services Air

      $2,000 / Day
      1 Per calendar Year

    • Lodging Maximum

      $125 / Day
      15 Per calendar Year

    • Prosthesis

      $1,000

    • Transportation

      $500 / Day
      3 Per Calendar Year

    • Accidental Death

      $20,000

    • Accidental Death on Common earner

      $40,000

    • Dislocation Benefit

      $1,000

    • Fracture Benefit

      $1,000

    • Burn Benefit

      $10,000

    • Coma

      $15,000

    • Dismemberment

      $15,000

    • Paralysis

      $10,000

  • Archway Accident Diamond

    • Physician's Office

      $50 / Day
      365 Days

    • Wellness Benefit

      $50 / Day
      1 Per Calendar Year

    • Emergency Room

      $125 / Day
      3 Per Calendar Year

    • Lab, EKG and other Diagnostic Tests

      $25 Per Test Day
      1 Per Calendar Year

    • X-Ray, Echocardiography and Cardiovascular Ultrasound

      $40 Per Test Day
      2 Per Calendar Year

    • Advanced Studies(2)

      $200 / Day
      1 Per Calendar Year

    • Ambulatory Surgical Center

      $50 / Day

    • Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff

      $1,500 / Day

    • Anesthesia

      $375 /Day

    • Ambulance Services Ground

      $200 / Day
      1 Per Calendar Year

    • Ambulance Services Air

      $2,000 / Day
      1 Per calendar Year

    • Lodging Maximum

      $150 / Day
      15 Per calendar Year

    • Prosthesis

      $1,500

    • Transportation

      $600 / Day
      3 Per Calendar Year

    • Accidental Death

      $20,000

    • Accidental Death on Common earner

      $40,000

    • Dislocation Benefit

      $1,000

    • Fracture Benefit

      $1,000

    • Burn Benefit

      $10,000

    • Coma

      $20,000

    • Dismemberment

      $20,000

    • Paralysis

      $10,000

(1) Continuous Care means care received in a Skilled Nursing Facility, Rehabilitation Facility, Rehabilitation Un􀀃 or Home Health Care or Hospice. The Continuous Care must begin within 7 days following discharge from a hospital and be necessary to treat the same condition that caused the hospitalization. Benefits are payable for a period equal to the length of the preceding hospital stay not to exceed 30 days.

(2) Advanced studies tests consist of the following: Magnetic Resonance Imaging (MRI); Magnetic Resonance Angiography (MRA); Computed Axial Tomography (CAT Scans); Pos􀀃ron Emission Tomography (PET Scans); and Computed Tomography (CT scans).

(1) Injury facts. (2014). Itasca, IL: National Safety Council.

(2) Moore, B., Levit, K., & Elixhauser, A. (2014, October). Costs for Hospital Stays in the United States, 2012 #181. Retrieved March 02, 2017, from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United- States-2012.jsp

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About Standard Life and Accident Insurance Company

Standard Life and Accident Insurance Company (Standard Life) was founded to provide clients with realistic life and health products that solve their needs for financial security.

Since its inception, more than 70 years ago, the Company's ethic has never changed. "People's needs change from day to day. The shrinking value of the dollar makes insurance protection more important to the individual...We must develop think-ahead programs today which will provide benefits in keeping with the economic changes of tomorrow. While we've grown so fast, it has not been at the expense of the human factor, so vital to this business. Efficiency is emphasized. However, we try never to lose sight of the personal aspects of our relations with policyowners and business clients, as well as our own agents and employees." Leonard H. Savage, President 1948-1973, Standard Life and Accident Insurance Company.

Standard Life and Accident Insurance Company ("Standard Life") has been evaluated and assigned the following ratings by nationally recognized, independent rating agencies. The ratings are current as of November 2018.

A.M. Best1: A
Standard & Poor's2: A-

Ratings reflect current independent opinions of the financial capacity of an insurance organization to meet the obligations of its insurance policies and contracts in accordance with their terms. They are based on comprehensive quantitative and qualitative evaluations of the company and its management strategy. The rating agencies do not provide ratings as a recommendation to purchase insurance or annuities. The ratings are not a warranty of an insurer's current or future ability to meet its contractual obligations.

Ratings may be changed, suspended, or withdrawn at any time.

1A.M. Best's active company rating scale is: A++ (Superior), A+ (Superior), A (Excellent), A- (Excellent), B++ (Good), B+ (Good), B (Fair), B- (Fair), C++ (Marginal), C+ (Marginal), C (Weak), C- (Weak) and D (Poor).

2Ratings from 'AA' to 'CCC' may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. For a list of Standard & Poor's active company rating scale visit www.standardandpoors.com


DEFINITIONS – GENERAL
ACTIVELY AT WORK OR ACTIVE SERVICE means an Employee who is present for 20 hours per week at his/her usual place of employment for the Employer or at another location as assigned or directed by the Employer, and is mentally and physically capable of performing the regular duties of the job for which he or she is employed.

On any day that is not an Employee’s regularly scheduled work day (vacation, personal days, and weekends/holidays) the Employee will be considered Actively at Work on such day provided he or she is not absent due to any type of leave and
was Actively at Work on his/her last regularly scheduled work day.
An Employee who usually performs the regular duties of his/her job at their home is considered Actively at Work if they
meet all the above requirements and could work at the Employer’s usual place of employment if required to do so.
AGE means a Covered Person’s Age as of his/her last birthday.
ANGIOPLASTY means the actual undergoing of a percutaneous transluminal angioplasty deemed Medically Necessary
to correct a narrowing or blockage of one or more coronary arteries. A Physician, board-certified as a Cardiologist, must
perform the Procedure. Other surgical or non-surgical techniques such as laser relief or any other intra-arterial procedures
are excluded.
AORTIC SURGERY means the actual undergoing of surgery for disease of the aorta needing excision and surgical
replacement of a portion of the diseased aorta with a graft. The surgery must be deemed Medically Necessary and
performed by a Physician, board-certified as a cardiovascular surgeon, thoracic surgeon, or vascular surgeon. Aorta is
limited to the thoracic and abdominal aorta, but not its branches.
CANCER IN SITU means a Diagnosis of Cancer wherein the tumor cells still lie within the tissue of origin without having
invaded neighboring tissue. Cancer in Situ includes:
1. early prostate cancer Diagnosed as T1N0M0 or equivalent staging; and
2. melanoma not invading the dermis.
Cancer in Situ does not include:
1. other skin malignancies; or
2. pre-malignant lesions (such as intraepithelial neoplasia); or
3. benign tumors or polyps.
Cancer in Situ must be Diagnosed pursuant to a Pathological or Clinical Diagnosis.
CERTIFICATE EFFECTIVE DATE is the date coverage begins for each Covered Person under the Policy. It will be
different for a Covered Person added to the Policy after the original date of issue or when a change in coverage for any
Covered Person occurs. Each Covered Person’s Certificate Effective Date is shown in the Employee’s Certificate of
Coverage Schedule of Benefits.
CLINICAL DIAGNOSIS means a Diagnosis of Invasive Cancer or Cancer In Situ based on the study of symptoms and
Diagnostic test results. We will accept a Clinical Diagnosis of Cancer only if the following conditions are met:
1. a Pathological Diagnosis cannot be made because it is medically inappropriate or life threatening;
2. there is medical evidence to support the Diagnosis; and
3. a Physician is treating the Covered Person for Invasive Cancer and/or Cancer In Situ.
CLOSE RELATIVE means anyone related to a Covered Person by blood, marriage, or adoption; or a court appointed
representative.
COMA means the diagnosis, by a Legally Qualified Physician board-certified as a Neurologist, that a Covered Person is
in a state of unconsciousness:
1. from which he/she cannot be aroused;
2. in which external stimulation will produce no more than primitive avoidance reflexes; and
3. such state has persisted continuously for at least 96 hours.
No benefit is payable for Coma if Coma is the result of a Critical Illness for which benefits are otherwise payable under
this Policy.
 
CORONARY BYPASS SURGERY means the actual undergoing of coronary artery bypass surgery using either a
saphenous vein or internal mammary artery graft for the treatment of coronary heart disease deemed Medically
Necessary to correct a narrowing or blockage of one or more coronary arteries. The Procedure must be performed by a
SLA-CI11-GEC 5
Physician, board-certified as a cardiovascular surgeon or thoracic surgeon. Other surgical or non-surgical techniques
such as laser relief or any other intra-arterial procedures are excluded.
COVERED PERSON means an Employee, an Employee’s spouse or Dependent children, listed as a Covered Person in
the Certificate Schedule of Benefits and for whom premium has been paid.
CRITICAL ILLNESS means any of the medical conditions or procedures, shown in the Certificate Schedule of Benefits,
that is first Diagnosed or first performed as the result of a Diagnosis, each made after the respective Covered Person’s
Certificate Effective Date.
DATE OF DIAGNOSIS means the date the Diagnosis is established by a Physician, through the use of clinical and/or
laboratory findings as supported by the Covered Person’s medical records. For a procedure, it is the date the Covered
Person undergoes the procedure.
DEPENDENT means an Employee’s family as follows:
1. The lawful Spouse*, if not legally separated or divorced;
2. Unmarried children (whether natural, adopted or stepchildren) under the limiting age of 26; or
3. Unmarried children for whom the Employee is required to provide insurance under a medical support order or an
order enforceable by a court.
*The term “Spouse” as used throughout the Policy will also mean the Employee’s legal Domestic Partner.
DIAGNOSIS means the definitive establishment by a Physician of the Critical Illness through the use of clinical and/or
laboratory findings.
DOMESTIC PARTNER means an opposite or same sex person with whom an Employee maintains a committed
relationship and shares a familial relationship characterized by mutual caring and the sharing of a mutual residence and
who has registered under the state law as domestic partners. Each partner must:
1. Be at least 18 years old and competent to contract;
2. Be the sole domestic partner of the other person; and
3. Not be married.
EMPLOYEE means the Employee designated in the Enrollment Form who is Actively at Work and listed in an eligible
class of Employees in the Employer’s application. The Employee must be listed as a Covered Person in the Certificate
Schedule of Benefits and appropriate premium paid in order to be covered under the Policy.
EMPLOYER means the plan sponsor to whom the Group Policy is issued and shall include any affiliated entities or
subsidiaries approved by the Company.
END-STAGE RENAL FAILURE means the chronic and irreversible failure of both of a Covered Person’s kidneys, which
requires the Covered Person to undergo periodic and ongoing dialysis. The Diagnosis must be made by a Physician.
ENROLLMENT FORM means the form(s) that the Employee (and Employee’s spouse, if any) signed to apply for
coverage under the Policy. It also includes any other document approved by the Company that the Employee uses to
apply for or change coverage under the Policy.
FIRST OCCUR(S)/FIRST OCCURRING/FIRST OCCURRENCE means the occurrence, Diagnosis, or procedure is the
first time ever in the Covered Person’s lifetime that he/she has experienced such Critical Illness, been Diagnosed with
that specific condition included as a Critical Illness, or undergone a specific procedure included as a Critical Illness.
HEART ATTACK means an Acute Myocardial Infarction resulting in:
1. the death of a portion of the heart muscle (myocardium) due to a blockage of one or more coronary arteries; and
2. resulting in the loss of the normal function of the heart.
The Diagnosis must be made by a Physician and based on both:
1. new clinical presentation and electrocardiographic changes consistent with an evolving heart attack; and
2. serial measurement of cardiac biomarkers showing a pattern and to a level consistent with a Diagnosis of Heart
Attack.
Established (old) Myocardial Infarction is excluded.
HEART VALVE REPLACEMENT/REPAIR SURGERY means the actual undergoing of open heart surgery to replace or
repair one or more valves. The surgery must be deemed Medically Necessary and performed by a Physician,
board-certified as a cardiovascular surgeon or thoracic surgeon.
SLA-CI11-GEC 6
INVASIVE CANCER means a malignant neoplasm, which is characterized by the uncontrolled growth and spread of
malignant cells and the invasion of tissue through the basement membrane or capsule. “Invasive Cancer” includes, but
shall not be limited to any form of:
1. Leukemia;
2. Lymphoma; or
3. Multiple Myeloma.
The following are not “Invasive Cancer”:
1. pre-malignant lesions (such as intraepithelial neoplasia); or
2. benign tumors or polyps; or
3. early prostate cancer Diagnosed as T1N0M0 or equivalent staging; or
4. Cancer in Situ; or
5. any skin cancer (other than invasive malignant melanoma in the dermis or deeper or skin malignancies that have
become metastatic).
Invasive Cancer must be Diagnosed by a Physician, board-certified as a pathologist pursuant to a Pathological or Clinical
Diagnosis.
MAJOR ORGAN means a Covered Person’s entire liver, kidney, lung, heart, small intestine, pancreas, pancreas-kidney,
bone marrow, or stem-cells. No other organ or system is included.
MAJOR ORGAN TRANSPLANT means the placement of an entire Major Organ in a Covered Person, where such Major
Organ:
1. originates in a person other than such Covered Person;
2. is somewhat independent from all other parts of the human body; and
3. performs a special or unique function.
 
A Major Organ Transplant does not include the placement of a mechanical or man-made device or substance which is
intended to serve as a substitute for or aid in the performance of the failed Major Organ; nor does it include Major Organ
parts such as valves, ducts, arteries, and any other part of a Major Organ, which in and of itself provides no life sustaining
purpose. For purposes of this definition, a Major Organ Transplant is considered to have occurred on the date a Covered
Person is added to the United Network of Organ Sharing (UNOS) or the National Marrow Donor Program (NMDP)
transplant list.
MAXIMUM BENEFIT AMOUNT means the eligible total of Benefit Payments for all Critical Illnesses as stated in the
Certificate Schedule of Benefits.
MEDICALLY NECESSARY means that, based on generally accepted current medical practice, a service is necessary
and appropriate for the Diagnosis or treatment of a Critical Illness. We do not consider a service Medically Necessary if:
1. It is provided only as a convenience to the Covered Person or provider; or
2. It is not appropriate treatment for the Covered Person’s Diagnosis or symptoms;
3. It exceeds (in scope, duration, or intensity) that level of care that is needed to provide safe, adequate, and
appropriate diagnosis or treatment.
PATHOLOGICAL DIAGNOSIS means Diagnosis based on a microscopic study of fixed tissue or preparations from the
hemic (blood) system. This type of Diagnosis must be done by a Physician who is a board certified pathologist and
whose Diagnosis of malignancy conforms to the standards set by the American College of Pathology.
PARALYSIS means a Covered Person’s complete and permanent loss of use, not including amputation, of two or more
limbs through neurological injury for a continuous period of at least 180 days, confirmed by a Legally Qualified Physician
board-certified as a Neurologist. No benefit is payable for Paralysis if Paralysis is the result of a Critical Illness for which
benefits are otherwise payable under the Policy.
PHYSICIAN means a person, other than You, a Close Relative, or a business or professional partner who is:
1. duly licensed to practice medicine in the jurisdiction where the Diagnosis is made, or the procedure performed where
such jurisdiction is a continuing member of the United States of America or a territory within the jurisdiction of the
United States of America (embassies, military zones, and similarly designated non-domestic extensions of the United
States government are not included); and
2. acting within the scope of his/her license.
PRE-EXISTING CONDITION means a medical condition relating to a Critical Illness, not otherwise excluded by name or
specific description:
1. for which medical advice, testing, care, treatment or medication was given or was recommended by, or received from,
a Physician within 12 months before the Covered Person’s Certificate Effective Date; or
SLA-CI11-GEC 7
2. that would have caused a reasonably prudent person to seek medical Diagnosis or treatment within 12 months before
his/her Certificate Effective Date.
Critical Illness related to such a medical condition is not covered within 12 months of a Covered Person's Certificate
Effective Date.
STROKE means any acute cerebrovascular accident producing neurological impairment and resulting in paralysis or
other measurable objective neurological deficit persisting for at least 96 hours and expected to be permanent. Transient
ischemic attack (mini-stroke), head injury, chronic cerebrovascular insufficiency and reversible ischemic neurological
deficits are excluded. The Diagnosis must be made by a Physician.
YOU, YOUR OR YOURS means the Employee named on the Certificate Schedule of Benefits.


Benefits otherwise payable under the Policy are reduced 50% on the later of a Covered Person’s Age 70 or his/her 5th
Certificate Effective Date anniversary.
Unless the Covered Person’s Critical Illness First Occurs or is Diagnosed while coverage is in force under the Policy, no
benefit will be payable.
No benefit is payable for Coma or Paralysis if Coma or Paralysis is the result of a Critical Illness for which benefits are
otherwise payable under the Policy.
With the exception of benefits that may be paid on behalf of a Covered Person in accordance with the Recurrence
Benefit:
1. The sum of benefits paid for a Covered Person under each Category shall not exceed 100% of the Initial Benefit
Amount for each Category; and
2. The sum of all benefits payable for a Covered Person under the Policy shall not exceed the Maximum Benefit Amount
shown in the Certificate Schedule of Benefits.
Benefits will not be paid for Critical Illnesses in more than a single Category during any 180-day period. However, this
does not apply to multiple benefit payments for Critical Illnesses within the same category, unless the Initial Benefit
Amount has been paid.
In the event benefits for a Covered Person are paid for a Critical Illness and within 180 days the Covered Person is
Diagnosed with a Critical Illness from another Category with no benefit paid, any recurrence of the latter Critical Illness
will be treated as an original Diagnosis with benefits paid accordingly.
If two or more Critical Illnesses are Diagnosed at the same proximate time, the benefit paid will be based upon the
Diagnosed Critical Illness providing the largest benefit.
The Company will NOT pay benefits for a Critical Illness, if it is caused by or results from:
1. intentional self-inflicted injuries;
2. suicide, or any attempt at suicide, while sane or insane;
3. service in the armed forces or any auxiliary unit of the armed forces;
SLA-CI11-GEC 12
4. participation in the commission or attempted commission of a felony;
5. participation in a riot or insurrection;
6. alcoholism or drug addiction; or
7. being intoxicated or under the influence of alcohol, drugs, or any narcotic (including overdose) unless
administered on the advice of a Physician and taken according to the Physician’s instructions. The term
“intoxicated” refers to that condition as defined by law and decisions of the jurisdiction in which the accident,
cause of loss, or loss occurred.
The Company will NOT pay any benefit for a Critical Illness if:
1. A Critical Illness is Diagnosed outside the United States or a covered procedure is performed outside the United
States; or
2. the Covered Person’s date of birth, age or sex was misstated in the Enrollment Form and at the correct date of
birth, age or sex the coverage would not have become effective or would have terminated.
PREEXISTING CONDITION LIMITATION. Critical Illness caused by or relating to a Preexisting Condition is not covered
for the first 12 months after the Certificate Effective Date of each Covered Person.





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