New Enrollees Guaranteed Issue Amount
Initial Group Enrollment Annual Group Enrollment
$10,000 $10,000 $10,000 $10,000
Life Status Change
New Hire
Current Insureds Guaranteed Issue Amount
Initial Group Enrollment Annual Group Enrollment
$10,000 $10,000 $10,000
Life Status Change
Benefit Waiting Period:
None
Portability
Maximum Age of Portability
26 as of the date of porting unless at age 26 or more years old, child is primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap Coverage continues to age 26 unless at age 26 or more years old, child is primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap
Portable Period
Amount of Portable Coverage Coverage(s) that may be ported Benefit(s) that may be ported
100% of inforce coverage amount
Dependent Child
All Voluntary Critical Illness Coverage and Optional Benefits
CRITICAL ILLNESS COVERAGE - LIST OF COVERED CONDITIONS
Cancer Conditions
% of Initial Benefit Amount
Recurrence % of Initial Benefit Amount
Invasive Cancer
100%
100%
Carcinoma In Situ
25%
25%
Benefit Amount $250
Skin Cancer
Not Available
Vascular Conditions
% of Initial Benefit Amount
Recurrence % of Initial Benefit Amount
Heart Attack
100%
100%
Stroke
100%
100%
Coronary Artery Disease
25%
25%
Nervous System Conditions
% of Initial Benefit Amount
Recurrence % of Initial Benefit Amount
Advanced Stage Alzheimer's Disease
25%
Not Available
4
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