Critical Illness insurance provides an extra layer of protection that can make a big difference in your ability to pay out-of-pocket expenses associated with a serious illness. It pays a lump-sum benefit directly to you upon diagnosis of a covered illness, regardless of your treatment costs or what's covered by your medical insurance.
|Plan Availability||All States|
|Enrollment Deadline||18th of month Prior to Effective date|
|Eligibility||Must meet the following criteria to be eligible for coverage:|
|Although improved medical treatment and survival rates are a good thing, that's only half the story.
Even if you have primary health insurance, there are many expenses that may not be covered.
Pays in addition to any other insurance you may have
Pays a cash lump sum upon diagnosis of a critical illness
Benefits can be used to pay:
Coinsurance and deductibles from other insurance plans, Necessities like mortgage, rent, car payments, Specialist fees and experimental treatment, Day-to-day living expenses like additional childcare, Special equipment OR Home modifications necessary for recovery, Treatment-related travel expenses like parking, food, gas, hotel stays and pet boardin and the list foes on.
- Invasive Cancer (100%)
- Invasive Cancer -diagnosis prior to 90 days of in force coverage (10%)*
- Cancer In Situ (25%)
- Cancer In Situ -diagnosis prior to 90 days of in force coverage (2.5%)*
- Heart Attack (100%)
- Heart Transplant (100%)
- Stroke (100%)
- Angioplasty (25%)
- Aortic Surgery (25%)
- Coronary Artery Bypass Surgery (25%)
- Heart Valve Replacement/Repair Surgery (25%)
- Coma (100%)
- End-Stage Renal Failure (100%)
-- Major Organ Transplant, other than heart (100%)
- Paralysis (100%)
*No additional benefits will be paid if diagnosis or treatment in first 90 days (30 days for Employer Group).
THIS POLICY PROVIDES LIMITED BENEFITS. Policy Form Series SLA-CI11/SLA-CI11-GEP and Mortgage Protection Benefit Rider SLA-CIMP11/SLA-CIMPGE is not available in all states and benefits may vary. The policy has specific terms and conditions relating to coverage, including limitations and exclusions. For costs and complete details of the coverage, please call or write the company or your insurance professional.
|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
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.
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 Employees 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 Employers usual place of employment if required to do so.
AGE means a Covered Persons 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
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 Persons Certificate Effective Date is shown in the Employees 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
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
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
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 Employees 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 Persons
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 Persons medical records. For a procedure, it is the date the Covered
Person undergoes the procedure.
DEPENDENT means an Employees 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 Employees legal Domestic Partner.
DIAGNOSIS means the definitive establishment by a Physician of the Critical Illness through the use of clinical and/or
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 Employers 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 Persons 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 Employees 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 Persons 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
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.
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:
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
Invasive Cancer must be Diagnosed by a Physician, board-certified as a pathologist pursuant to a Pathological or Clinical
MAJOR ORGAN means a Covered Persons 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
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)
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 Persons 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 Persons 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
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 Persons Certificate Effective Date; or
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
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.
SCHEDULE OF BENEFITS
CLASSES OF ELIGIBLE PERSONS TO BE COVERED UNDER THIS POLICY:
Employees and dependents who meet the eligibility requirements as set forth under this Policy.
Class 1: All full time Employees of the Employer working a minimum of 20 hours per week.
EMPLOYER WAITING PERIOD:
Initial Employees: None
New Employees: None
BENEFIT AMOUNTS AVAILABLE UNDER THIS POLICY ARE CHOSEN BY THE EMPLOYEE IN THE ENROLLMENT FORM AND SHOWN IN THE EMPLOYEE'S CERTIFICATE OF COVERAGE.
BENEFITS OTHERWISE PAYABLE ARE REDUCED 50% ON THE LATER OF A COVERED PERSON'S AGE 70 OR HIS/HER 5TH CERTIFICATE EFFECTIVE DATE ANNIVERSARY.
Initial Benefit Amount - $10,000 - $30,000
Maximum Benefit Amount - 3 TIMES THE INITIAL BENEFIT AMOUNT
EMPLOYEE'S SPOUSE -
Initial Benefit Amount - $20.000
Maximum Benefit Amount - 3 TIMES THE INITIAL BENEFIT AMOUNT
CATEGORY 1 CRITICAL ILLNESSES - BENEFIT PERCENTAGE
- Invasive Cancer 100%
(Diagnosis more than 90 days after the Certificate Effective Date)
- Invasive Cancer 10%
(Diagnosis during the first 90 days after the Certificate Effective Date)
- Cancer In Situ 25%
(Diagnosis more than 90 days after the Certificate Effective Date)
- Cancer In Situ 2.5%
(Diagnosis during the first 90 days after the Certificate Effective Date)
CATEGORY 2 CRITICAL ILLNESSES -
- Heart Attack 100%
- Stroke 100%
- Heart Transplant or Combination Heart and Other Major Organ Transplant 100%
- Coronary Artery Bypass Surgery 25%
- Angioplasty 25%
- Aortic Surgery 25%
- Heart Valve Replacement/Repair Surgery 25%
CATEGORY 3 CRITICAL ILLNESSES -
- Major Organ Transplant, not covered in Category 2 100%
- Coma 100%
- Paralysis 100%
- End-Stage Renal Failure 100%
OPTIONAL BENEFITS: None
Premium rates are shown in the Employee's Certificate Schedule of Benefits.
Benefits otherwise payable under the Policy are reduced 50% on the later of a Covered Persons Age 70 or his/her 5th
Certificate Effective Date anniversary.
Unless the Covered Persons 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
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;
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 Physicians 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
2. the Covered Persons 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.