Group Voluntary Supplemental Health Options Plan
 
My Lifeline

When you think about your family have any of them experienced a heart attack, stroke, kidney failure, or life-threatening cancer? If you answered yes, then you understand the emotional and financial impact a critical illness can have on your hard-earned savings.

Today, advancements in medical technology can mean an increase in the chances of surviving a critical illness or living with a critical illness for months, perhaps even years. Are you or your family financially prepared in the event you survive a critical illness?

Just think about the chances of becoming critically ill or living with a critical illness and consider these statistics:

  • Stroke is the leading cause of serious, long-term disability in the United States.1
  • At age 40, the lifetime risk of developing Heart Failure for both men and women is one in five.1
  • 13,200,000 victims of angina, heart attack, and other forms of coronary heart disease are still living.2
  • About 76% of all cancers are diagnosed in persons 55 and older.3
  • 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 3.3

The good news is that Allstate Workplace Division’s Group Voluntary Critical Illness product pays a lump sum benefit to each covered person at the time of diagnosis. This benefit can be used to help meet expenses which are not normally covered under traditional health insurance. Which means you and your family can concentrate on getting well without worrying about having enough money to cover the bills.

If you were diagnosed with a critical illness today, would your finances be there for tomorrow?

1. Heart Disease and Stroke Statistics Update, American Heart Association, 2006.
2. American Heart Association Website, www.americanheart.org.
3. Cancer Facts & Figures, American Cancer Society, 2007.

Offered to the employees of:
Brandsource

 


 

Group Voluntary Critical Illness Benefits

What You Get

  • Your choice of a $10,000 or $20,000 basic benefit amount.
  • The maximum amount payable by AWD for Categories 1, 2, and 3 is 100% of the basic benefit amount.
  • Benefits paid directly to you unless you assign them to someone else.
  • Individual, spouse, and child(ren) coverage is available. Spouse and child(ren) basic benefit amount is 50% of the primary insured.
  • Portable coverage. If you leave the company or employment is terminated, you can continue coverage as long as premiums are paid to Allstate Workplace Division.
  • Coverage that does not replace your other group medical benefits. Instead, it is designed to supplement.

Group critical illness coverage only provides benefits as defined, or other optional benefits described in your certificate. The amount paid for each illness listed in Categories 1, 2, and 3 (except Coronary Artery By-Pass Surgery, Alzheimer’s Disease, and Carcinoma in Situ) is at 100% of the basic benefit amount. Coronary Artery By-Pass Surgery, Alzheimer’s Disease, and Carcinoma in Situ are at 25% of the basic benefit amount. No more than $10,000 is payable in each category for the Low Option and $20,000 for the High Option.
 

Benefit Category 1 - Group Critical Illness Coverage  Low Option High Option
Heart Attack - The death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. Diagnosis must be based on both new electrocardiographic changes; and elevation of cardiac enzymes or biochemical markers showing a pattern and to a level consistent with a diagnosis of heart attack. $10,000 $20,000
Heart Transplant - The surgical transplantation of the heart from a patient who died and whose heart was intact and capable of functioning in the recipient. The transplanted organ must come from a human donor. $10,000 $20,000
Stroke - Death of a portion of the brain producing neurological sequelae including infarction of brain tissue, hemorrhage and embolization from an extra-cranial source. There must be evidence of permanent neurological deficit. Transient ischemic attacks (TIA’s), head injury, chronic cerebrovascular insufficiency and reversible ischemic neurological deficits are excluded. $10,000 $20,000
Coronary Artery By-Pass Surgery - Undergoing a surgical operation to correct narrowing or blockage of one or more coronary arteries with bypass grafts on the advice of a cardiologist registered in the United States. Angiographic evidence to support the necessity for bypass surgery will be required. The following procedures are not considered by-pass surgery: balloon angioplasty; laser embolectomy; atherectomy; stent placement; or other non-surgical procedures. $2,500 $5,000
Benefit Category 2 - Group Critical Illness Coverage  Low Option High Option
Major Organ Transplant (other than heart) - The surgical transplantation of a lung, liver, pancreas, or kidney. The transplanted organ must come from a human donor. $10,000 $20,000
End Stage Renal Failure - Failure of both kidneys to perform their essential functions, with the covered person undergoing peritoneal dialysis or hemodialysis or a renal transplant. $10,000 $20,000
Paralysis (not as a result of a stroke) - Complete and permanent loss of use of two or more limbs. Paralysis as a result of stroke is excluded. $10,000 $20,000
Alzheimer’s Disease - A clinically established diagnosis of the disease by a psychiatrist or neurologist, resulting in the inability to perform, independently, 3 or more of the following activities of daily living: bathing; or dressing; or toileting; or eating; or taking medication. $2,500 $5,000
 
Benefit Category 3 - Optional/Additional Critical Illness Cancer Coverage Low Option High Option
Invasive Cancer - AWD pays this benefit if a covered person is diagnosed with a new form or type of invasive cancer, which means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This includes Leukemia and Lymphoma. This is subject to all of the following: clear and definitive diagnosis by either a pathological or clinical method; and the date of diagnosis is after the effective date of coverage; and the date of diagnosis is while this optional benefit is in force; and the illness is not excluded by name or specific description in the certificate. $10,000 $20,000
Carcinoma in Situ - AWD pays this benefit if a covered person is diagnosed with a new form or type of cancer wherein the tumor cells still lie within the tissue of origin without having invaded neighboring tissue. Cancer in Situ includes: early prostate cancer diagnosed as stage A or equivalent staging; and melanoma not invading the dermis. Carcinoma in Situ does not include: other skin malignancies; or pre-malignant lesions (such as intraepithelial neoplasia); or benign tumors or polyps. This is subject to all of the following: clear and definitive diagnosis by either a pathological or clinical method; and the date of diagnosis is after the effective date of coverage; and the date of diagnosis is while this optional benefit is in force; and the illness is not excluded by name or specific description in the certificate. $2,500 $5,000
Optional/Additional Benefits Low Option High Option
Wellness Benefit (Cancer Screenings and Heart Screenings) - AWD pays $25 for each unit of coverage, up to a maximum of 4 units, each calendar year per covered person, for one of the following cancer screening tests or heart screening tests performed while not hospital confined: Bone Marrow Testing; CA15-3 (blood test for breast cancer); CA125 (blood test for ovarian cancer); CEA (blood test for colon cancer); chest X-ray; colonoscopy; flexible sigmoidoscopy; hemocult stool analysis; mammography, including breast ultrasound; Pap Smear, including ThinPrep Pap Test; PSA (blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); biopsy for skin cancer; stress test on bike or treadmill; electrocardiogram (EKG); carotid doppler; echocardiogram; lipid panel (total cholesterol count); and blood test for triglycerides. There is no limit to the number of years a covered person can receive cancer screening tests. This benefit is paid regardless of the result of the test(s) and is limited to one test per calendar year per covered person. $100
4 units
$100
4 units
Recurrence Benefit - AWD pays this benefit if a covered person is diagnosed more than once with the same specified critical illness listed in category 1 or 2 for which a benefit was previously paid if: there is more than 18 months between each diagnosis; and treatment was not received during that 18 month period (for purposes of the preceding statement, treatment does not include medications and follow-up visits to your physician); and the subsequent date of diagnosis is while coverage is in force; and the specified critical illness is not excluded by name or specific description in the certificate. • AWD will pay an amount equal to 25% of the specified critical illness basic benefit amount previously paid for that specified critical illness. AWD will pay no more than one recurrence benefit per previously paid specified critical illness under category 1 and 2. 25% of
previously
paid
Category
1 or 2
benefits
25% of
previously
paid
Category
1 or 2
benefits
 
Example of how benefits are paid under the $10,000 Low Option
Benefit
If you have
Amount Payable After 100% of the basic benefit amount of the certificate has been paid within a category (Category 1, Category 2, or Category 3), AWD does not pay any more benefits for any illness associated with that category. Once the covered person has exhausted all basic benefit maximums in Category 1, 2, and 3 and the Optional/ Additional Recurrence Benefit, coverage is terminated.
Coronary Artery By-Pass
Surgery then -
Coronary Artery By-Pass
Surgery at 25% = $2,500
a Heart Attack then - Heart Attack at 75% = $7,500
(Since By-Pass Surgery paid)
Alzheimer’s Disease then - Alzheimer’s at 25% = $2,500
a Cancer Screening Test then - CEA (blood test for colon
cancer) = $100 (4 units)
Invasive Cancer then - Invasive Cancer at 100% = $10,000
a second Heart Attack 2 years later Heart Attack covered under Optional
Recurrence Benefit at 25% = $1,875
Total Category 1, Category 2, Category 3, Wellness Benefits and Recurrence Benefit paid = $24,475
The covered person is still eligible for up to $7,500 under Category 2 benefits.
 
Low Option and High Option Premiums Weekly

Issue Age: 18-35

The Low Option package and premiums consist of:
Category 1 and Category 2 Group Voluntary Critical Illness benefits; Optional/Additional Category 3 Critical Illness Cancer Coverage; Optional/Additional Wellness Benefit (4 units); and Optional/Additional Recurrence Benefit.
Non-Tobacco
Employee Only
Employee and Spouse
Employee and Child(ren)
Family
Low Option
$2.15
$3.31
$2.27
$3.45
High Option
$3.37
$5.11
$3.60
$5.39
The High Option package and premiums consist of:
Category 1 and Category 2 Group Voluntary Critical Illness benefits; Optional/Additional Category 3 Critical Illness Cancer Coverage; Optional/Additional Wellness Benefit (4 units), and Optional/Additional Recurrence Benefit.
Tobacco
Employee Only
Employee and Spouse
Employee and Child(ren)
Family
Low Option
$3.17
$4.81
$3.28
$4.95
High Option
$5.40
$8.11
$5.63
$8.39
Issue ages: 18 and over      
 
Weekly Issue Age: 36-49 Issue Age: 50-59 Issue Age: 60-64 Issue Age: 65-69 Issue Age: 70+
Non-
Tobacco

Emp Only
Emp & Spouse
Emp & Child(ren)
Family
Low
Option

$4.32
$6.54
$4.46
$6.65
High
Option

$7.71
$11.57
$7.99
$11.80
Low
Option

$8.61
$12.86
$8.73
$13.00
High
Option

$16.30
$24.22
$16.53
$24.49
Low
Option

$13.13
$19.58
$13.27
$19.69
High
Option

$25.34
$37.65
$25.62
$37.88
Low
Option

$16.23
$24.17
$16.37
$24.31
High
Option

$31.53
$46.83
$31.80
$47.11
Low
Option

$18.97
$28.19
$19.09
$28.32
High
Option

$37.02
$54.86
$37.25
$55.14
Tobacco

Emp Only
Emp & Spouse
Emp & Child(ren)
Family
Low
Option

$7.62
$11.41
$7.73
$11.52
High
Option

$14.31
$21.31
$14.54
$21.54
Low
Option

$15.90
$23.69
$16.04
$23.80
High
Option

$30.88
$45.86
$31.16
$46.09
Low
Option

$21.65
$32.18
$21.77
$32.29
High
Option

$42.37
$62.85
$42.60
$63.08
Low
Option

$24.23
$35.99
$24.35
$36.10
High
Option

$47.54
$70.46
$47.77
$70.69
Low
Option

$26.27
$39.01
$26.40
$39.15
High
Option

$51.60
$76.51
$51.88
$76.79

Eligibility - Your employer determines the criteria for eligibility (such as length of service and hours worked each week). Issue ages are 18 and over if actively at work for the number of hours determined by your employer. You cannot be covered under both the Individual and Group Voluntary Critical Illness Insurance Plans with Allstate Workplace Division (AWD).

Dependent Coverage - Family members who are eligible for coverage are: your spouse (or domestic partner); your unmarried children including adopted children, step children (child(ren) of domestic partner), or legal ward who is under 22 years of age, or under 26 years of age and full-time students at an educational institution of higher learning beyond high school. Children must be dependent on you for support or reside with you over 50% of the time in a regular parent-child relationship and be named on the enrollment or evidence of insurability form. Children born to you or your spouse while Individual and Child(ren) coverage or Family coverage is in force will be eligible for coverage. Coverage begins at the moment of birth.

Portability Privilege - AWD will provide Group Voluntary Critical Illness insurance portability coverage, subject to the following provisions. Coverage will not be available to an employee or member unless: coverage under the policy terminates as stated in the “Termination of Coverage” provision; and we receive a written request and payment of the first premiums for the portability coverage no later than 30 days after such termination; and the request is made on a form we furnish or approve for that purpose. Specific criteria for coverage, premiums, grace period and termination of insurance provisions are included with this privilege; refer to the policy or certificate for complete details. This option is not available to an employee or member if they failed to make the required monthly premium payments.

Continuation of Coverage (COBRA) - The coverage provided under the policy is subject to the federal COBRA continuation requirements. In general, this allows you to continue insurance under the policy for 18 months after your employment terminates. If your dependent should lose coverage due to your death, divorce, or attainment of the limiting age for eligibility of dependents, the coverage may be continued for up to 36 months. If the policy is terminated by your employer before the end of the COBRA continuation period, you are entitled to continue coverage under the Portability Provision.

Termination of Coverage - Coverage under the policy ends on the earliest of: the date the policy is canceled; or the last day of the period for which any required premium payments were made; or the last day you are in active employment or membership, except as provided under the “Temporary Layoff, Leave of Absence, or Family and Medical Leave of Absence” provision; or the date you are no longer in an eligible class; or the date your class is no longer eligible; or the date you have received the maximum total percentage of the basic benefit amount for each critical illness category, including the Optional Recurrence Benefit, if applicable.

Pre-Existing Condition Limitation - AWD does not pay for any loss due to a pre-existing condition, as defined, during the 12 month period beginning on the date you became an insured. A pre-existing condition means a disease or physical condition for which medical advice or treatment has been received by an insured within 90 days immediately prior to becoming covered under this policy. The condition shall be covered after an individual has been insured for more than 12 months under this policy.

Exclusions & Limitations - AWD does not pay benefits for an illness due to, or resulting from, (directly or indirectly): any act of war, whether or not declared, participation in a riot, insurrection or rebellion; or intentionally self-inflicted injuries; or injury incurred while engaging in an illegal occupation or committing or attempting to commit a felony; or attempted suicide, while sane or insane; or any loss sustained or contracted as a consequence of intoxication or being under the influence of narcotics or any other controlled substance or drug, unless administered on the advice of a physician; or participation in any form of aeronautics except as a fare paying passenger in a licensed aircraft provided by a common carrier and operating between definitely established airports; or alcohol abuse or alcoholism, drug addiction or dependence upon any controlled substance. State variations exist.

This information is for use in the Brandsource enrollment which is sitused in Pennsylvania.

This material is valid as long as information remains current, but in no event later than March 1, 2012. Group Voluntary Critical Illness benefits provided by policy form GVCIP1, or state variations thereof. This guide highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the policyholder (employer) and the insurance company. This is a limited benefit Critical Illness Policy with optional benefits, which provides stated benefits for specified illnesses or other benefits that may be added. The policy does not provide benefits for any other sickness or condition. The policy and optional benefits are not a Medicare Supplement Policy. Subject to COBRA continuation of coverage. Underwritten by American Heritage Life Insurance Company. Allstate Workplace Division is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a wholly-owned subsidiary of The Allstate Corporation. ©2009 Allstate Insurance Company. The Workplace Marketer®. www.allstate.com or allstateatwork.com

 

©2009 ExpertCARE+
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