Specific Definitions, Benefit Exclusions and Limitations: Coronary Artery Disease, heart disease/angina resulting in a blockage that restricts blood flow to the heart. Advanced Stage Alzheimer’s Disease, progressive degenerative disorder that attacks the brain’s nerve cells resulting in cognitive deficits interfering with independence in completion of instrumental activities of daily living and may also require the inability to perform at least 2 physical activities of daily living. Amyotrophic Lateral Sclerosis (ALS aka Lou Gehrig’s Disease), motor neuron disease resulting in muscular weakness and atrophy. Parkinson’s Disease, progressive, degenerative neurologic disease with indicated signs of the disease. Multiple Sclerosis, disease involving damage to brain and spinal cord cells with signs of motor and sensory deficits confirmed by MRI. Includes Neuromyelitis Optica and Transverse Myelitis. Cerebral Palsy, brain injury or abnormality occurring within 24 hours of birth resulting in developmental brain disorder. Cystic Fibrosis, progressive disorder that affects exocrine glands. Muscular Dystrophy, progressive disorder that interferes with formation of healthy muscles. Poliomyelitis, acute, infectious disease caused by the poliovirus with indicated signs of the disease. Excludes non- paralytic polio or post-polio syndrome. Benign Brain Tumor, non-cancerous abnormal cells in the brain. Blindness, irreversible sight reduction in both eyes; Best corrected single eye visual acuity less than 20/200 (E-Chart) or 6/60 (Metric) or with visual field reduction (both eyes) to 20 degrees or less. May require loss be due to specific illness. Coma, unconscious state lasting at least 96 continuous hours. Excludes any state of unconsciousness intentionally or medically induced from unconsciousness intentionally which the Covered Person is able to be aroused. May require loss be due to specific illness. End-Stage Renal (Kidney) Disease, chronic, irreversible function of both kidneys. Requires hemo or peritoneal dialysis. Major Organ Failure, includes: liver, lung, pancreas, kidney, heart or bone marrow. Happens when transplant is prescribed or recommended and placed on UNOS registry. If the Covered Person has a combination transplant (i.e. heart and lung), a single benefit amount will be payable. Recurrence Benefit not payable for same organ for which a benefit was previously paid. Paralysis, complete, permanent loss of use of two or more limbs due to a disease. Excludes loss due to Stroke and Multiple Sclerosis. May require loss be due to specific illness. No Evidence of Disease, for cancer means recommended treatment has been completed and a physician through a round of bloodwork or special imaging studies confirms there is no evidence of active primary malignant disease. For Heart Attack and Stroke means person discharged from the hospital. ***Benefits-Specific Conditions, Exclusions and Limitations (Additional Benefits): Hospital Indemnity: The Common Exclusions apply to this Additional Benefit. In addition, the following applies: Hospital Pandemic Infectious Disease Admission: Must be admitted inpatient due to a Pandemic Infectious Disease. Excludes: treatment in an emergency room, provided on an outpatient basis. Guaranteed Issue: If you are a new hire you are not required to provide proof of good health if you enroll during your employer's eligibility waiting period and you choose an amount of coverage up to and including the Guaranteed Issue Amount. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. Guaranteed Issue coverage may be available at other specified periods of time. Your employer will notify you when these periods of time are available. Your Spouse must be age 18 or older to apply if evidence of insurability is required. *State Variations For purposes of this brochure, wherever the term Spouse appears, it shall also include Domestic Partner registered under any state which legally recognizes Domestic Partnerships or Civil Unions. Spouse definition includes civil union partners in New Hampshire and Vermont, but excludes civil union partners for Idaho residents. Heart Attack benefits available for residents of AK. Not all shown covered conditions may be available and the Specific Definitions, Benefit Exclusions and Limitations for some of the conditions may vary for residents of ID, MD, MO, NH, OR, RI, UT, WA, WV. Portability in TX and VT is referred to as Continuation due to loss of eligibility. Portability conditions may differ for residents of UT, TX and VT. Exclusions may vary for residents of ID, LA, MN, NC, NH, SC, SD, VT, TX and WA. Wellness Treatment and Preventive Care Benefit is referred to as Health Screening Test or Preventive Care Benefit in WA and Wellness Treatment and Health Screening Test Benefit Rider in OR. Healthy Living Preventive Care Benefits may not be available to NC residents. Wellness Treatment, Health Screening Test or Preventive Care Benefit dental and ophthalmological exam benefits are not available to residents of NH and WA. Hospital Chronic Admission Only benefits are not available to residents of ID. Covid-19 Test and Screening benefits are not available to residents of NH. The coverage effective date will not be deferred for residents of TX if receiving chemotherapy or radiation treatment and deferring due to disability or ADLS only applies to the Spouse. For residents of ID, NH, WA the effective date won’t be deferred due to ability to perform ADLs.
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