Cancer – KBS (Kansas Board Solutions)
PLAN HIGHLIGHTS
• Cancer screening benefit includes coverage for screenings such as biopsy, mammogram, pap smear, PSA for prostate cancer, MRI scans, etc.
PORTANT NOTES
IMPORTANT NOTES
• Cancer means an insured has been diagnosed with a disease manifested by the presence of a malignant tumor characterized by the uncontrolled growth and spread of malignant cells in any part of the body. This includes leukemia, Hodgkin’s disease, lymphoma, sarcoma, malignant tumors and melanoma. Cancer includes carcinomas in-situ (in the natural or normal place, confined to the site of origin, without having invaded neighboring tissue). Pre-malignant conditions or conditions with malignant potential, such as myelodyplastic and myeloproliferative disorders, carcinoid, leukoplakia, hyperplasia, actinic keratosis, polycythemia, and nonmalignant melanoma, moles or similar diseases or lesions will not be considered cancer. Cancer must be diagnosed while insured under the Guardian cancer plan. • Alternative Care – Benefit is paid for palliative care (bio-feedback or hypnosis) or lifestyle benefits such as visits to an accredited practitioner for smoking cessation, yoga, meditation, relaxation techniques and nutritional counseling. • Blood/Plasma/Platelets – Benefit is paid each day you receive blood, plasma and/or platelets for the treatment of internal cancer. • Experimental Treatment – Benefits will be paid for experimental treatment prescribed by a doctor for the purpose of destroying or changing abnormal tissue. All treatment must be NCI listed as viable experimental treatment for Internal Cancer. • Outpatient and Family Member Lodging – Benefit is paid if you stay in a hotel while receiving treatment for internal cancer and treatment cannot be obtained locally. A benefit is also payable if a family member stays in a hotel while you are confined in a hospital for internal cancer treatment. Lodging must be more than 50 miles from your home. • Portability – Portability allows the employee to take the coverage with them if employment has ended. Portability terms at age 70. An insured must port Cancer coverage prior to age 70. • Transportation/Companion Transportation – Benefit is paid if you have to travel more than 50 miles one way to receive treatment for internal cancer. • Waiver of Premium – If you become disabled due to cancer that is diagnosed after the employee’s effective date, and you remain disabled for 90 days, we will waive the premium due after such 90 days for as long as you remain disabled. • Any commercial insurance group policy underwritten and issued by The Guardian Life Insurance Company of America, a New York Domiciled mutual company, is a participating policy. It is not expected, however, that a dividend will be paid on any such group policies. All coverage will be provided as set forth in the policies . • Producer Compensation Disclosure: As is common with Group Insurance, your coverage(s) might involve one or more licensed producers who will receive compensation from Guardian for soliciting, negotiating, securing and/or administering the insurance coverage(s) you have purchased. Compensation to these producers may be paid in the form of base commissions, administrative service commissions and, in some instances, supplemental compensation (e.g.an annual performance bonus). For more detailed information regarding producer compensation relative to your Guardian coverage(s), please contact your local sales consultant or account manager. If commissions are paid based on a percentage, the percentage is calculated monthly on enrolled lives, not eligible lives. Graded commission scales are calculated as a percentage of annual premium and are on a sliding scale. • Public Entity Groups: Released quote is contingent on notification being made to Guardian regarding any political contribution requirements and/ or disclosure requests prior to contract signing. Unless otherwise noted, the benefits listed are payable if the service or treatment is due to the insured’s diagnosis of canc er while covered.
SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS
• Not available for the following SICs: 1011-1241, 1411-1499, 2812-2819, 2879-2892, 2899-2999, 3292, 3312-3399, 3482-3489, 4311, 4952-4959, 7299, 7342, 7360-7363, 7389, 8610-8699, 8811-8999, 9110-9211, 9223-9224, 9311-9999. • In order to be eligible for coverage: Employees must be legally 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. • Subject to state specific variations. • A pre-existing condition includes any condition for which an employee, in the specified time period 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. Other state variations may apply.
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