Non-Tobacco Rates Tobacco Rates Issue Age Employee Spouse Child Issue Age Employee Spouse Child VALUE PLAN 1: $15,000 VALUE PLAN 1: $15,000 <26 $7.62 $4.54 $1.00 <26 $8.52 $6.06 $1.00 26-30 $8.22 $5.70 26-30 $9.66 $8.24 31-35 $9.48 $8.00 31-35 $12.14 $12.42 36-40 $11.46 $10.72 36-40 $15.62 $17.48 41-45 $14.02 $14.24 41-45 $20.12 $23.92 46-50 $17.02 $18.24 46-50 $25.28 $31.24 51-55 $20.36 $22.24 51-55 $30.94 $38.58 56-60 $24.90 $27.24 56-60 $38.90 $47.54 61-65 $31.24 $33.84 61-65 $49.94 $59.28 66-70 $40.30 $41.88 66-70 $66.06 $73.30 70+ $78.66 $78.66 70+ $141.21 $141.21 ADVANTAGE PLAN 2: $20,000 ADVANTAGE PLAN 2: $20,000 <26 $8.26 $5.48 1.26 <26 $9.46 $7.48 $1.26 26-30 $9.10 $6.98 26-30 $11.00 $10.44 31-35 $10.86 $10.00 31-35 $14.40 $15.84 36-40 $13.48 $13.56 36-40 $19.00 $22.46 41-45 $16.84 $18.14 41-45 $24.88 $30.94 46-50 $20.80 $23.38 46-50 $31.70 $40.60 51-55 $25.12 $28.72 51-55 $39.16 $50.28 56-60 $31.08 $35.30 56-60 $49.62 $62.14 61-65 $39.28 $44.10 61-65 $64.12 $77.62 66-70 $51.18 $54.88 66-70 $85.44 $96.36 70+ $104.56 $104.56 70+ $187.96 $187.96 PREMIER PLAN 3: $25,000 PREMIER PLAN 3: $25,000 <26 $8.90 $6.42 $1.52 <26 $10.40 $8.90 $1.52 26-30 $9.98 $8.26 26-30 $12.34 $12.64 31-35 $12.24 $12.00 31-35 $16.66 $19.26 36-40 $15.50 $16.40 36-40 $22.38 $27.44 41-45 $19.66 $22.04 41-45 $29.64 $37.96 46-50 $24.58 $28.52 46-50 $38.12 $49.96 51-55 $29.88 $35.20 51-55 $47.38 $61.98 56-60 $37.26 $43.36 56-60 $60.34 $76.74 61-65 $47.32 $54.36 61-65 $78.30 $95.96 66-70 $62.06 $67.88 66-70 $104.82 $119.42 70+ $130.46 $130.46 70+ $234.71 $234.71
CRITICAL ILLNESS INSURANCE
Covered Conditions
First Occurrence
Second Occurrence
Vascular
Heart Attack
100% 100% 100%
50% 50% 50%
Stroke
Heart Failure Coronary Arteriosclerosis Organ Failure & Kidney Failure Loss of Speech, Sight or Hearing
30%
0%
Other
100%
50%
100%
0%
Severe Burns
100%
0%
ALS (Lou Gehrig’s Disease) & Parkinson’s Disease Addison’s Disease, Huntington’s Disease, & Multiple Sclerosis
100%
0%
30%
0%
Alzheimer’s Disease
50%
0%
Coma
100%
0%
Permanent Paralysis for 1 Limb
50%
0%
Permanent Paralysis for 2 Limbs
100%
0%
Dependent Age Limits
Child birth to 26 years
12 month look back period, 12 month exclusion period, continuity of coverage
Pre-Existing Condition Limitation
*The services, exclusions, and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. This document is a summary of the major features of the referenced insurance coverage. It is intended for illustrative purposes only and does not constitute a contract. The insurance plan documents, including the policy and certificate, comprise the contract for coverage. The full plan description, including the benefits and all terms, limitations and exclusions that apply will be contained in your insurance certificate. Coverage terms may vary by state and employer-sponsored plan. The premium amounts reflected in this summary are an approximation; if there is a discrepancy between this amount and the premium deducted from your paycheck, the latter prevails.
The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. There are limitations & special requirements for each condition. See the certificate of coverage or contact your sales representative for full details. • We will not pay benefits for the First Occurrence of a Critical Illness if it occurs less than 3 months after the First Occurrence of a related Critical Illness for which this Plan paid benefits. By related we mean either: (a) both Critical Illnesses are contained within the Cancer Related Conditions category; or (b) both Critical Illnesses are contained within the Vascular Conditions category. • We will not pay benefits for a second occurrence (recurrence) of a Critical Illness unless the Covered Person has not exhibited symptoms or received care or treatment for that Critical Illness for at least 12 months in a row prior to the recurrence. For purposes of this exclusion, care or treatment does not include: (1) preventive medications in the absence of disease; and (2) routine scheduled follow-up visits to a Doctor. • We do not pay for a third or later occurrence of a critical illness. • First & second occurrence refers to the first & second time an insured experiences or is diagnosed with a covered critical illness while covered under Guardian Critical Illness insurance. • A pre -existing condition includes any condition for which an employee, in the specified period of time prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs. Please refer to the plan documents for specific time periods. • If the plan is new (not transferred): During the exclusion period, this critical illness plan does not pay charges relating to a preexisting condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian’s pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply. • We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces), committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane, or insane. • In order to be eligible for coverage: Employees must be le gally working: (a) in the United States or (b) outside the United States, for a US based employer, in a country or region approved by Guardian. • Employees must be work ingfull-time on the effective date of coverage; otherwise, coverage becomes effective after the completion of the specific waiting period. • Evidence of Insurab ility is required for all late enrollees. Benefit increases may require underwriting. • This coverage will not be effective until approved by a Guardian underwriter. T his proposal is subject to satisfactory financial evaluation. Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.
082020
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