GENERAL INFORMATION CP4000 is a Limited Cancer and Dread Disease Policy Coverage is not provided for any expenses due to sickness Use only in the states of AR, AZ, CO, IA, IL, IN, KY, LA, MO, NC, ND, NE, NM, OH, SD,SC, TX, TN and VA BENEFIT PACKAGES CP4000 has four plan offerings, A, B, C or D *The First Occurrence Benefit Rider is not available for age band 65 and above and is not included in the premium for employee, spouse, and children **Cancer Screening Benefit Plan A‐$50, Plan B‐$50 or $100, Plan C and D ‐$100 RENEWABILITY Guaranteed renewable for life Subject to the company’s right to change premiums ACTUAL CHARGES The amount(s) actually paid by or on behalf of the Covered Person and accepted by the provider as full payment for the covered services provided We will pay monetary benefits representing the actual charges for the covered services provided Actual Charges means the amount(s) actually paid by or on behalf of the covered person and accepted by the provider as full payment for the covered services provided If this Policy is the covered person’s only form of insurance coverage, the amount the covered person is required to pay, the provider for the covered services is the Actual Charge OPTIONAL RIDERS These riders are optional and have an additional cost • Intensive Care Unit Rider • Critical Care Benefit Rider ISSUE AGES AND PREMIUM AGES • The Insured and spouse must be between ages 18 through 69 to apply for individual coverage Between the ages of 18 and 64 for payroll group rates Eligibility for coverage is determined by each adult age • Family Coverage is available for unmarried, dependent children under the age of 21( in NM and TX, age 25 regardless of student status) Unmarried children under the age of 25 may also be covered if enrolled as a full‐time student in an accredited college or university When the child reaches the limiting age, the child may “convert” to an individual policy without evidence of insurability, subject to the “Conversion” provision in the base policy • ManhattanLife uses the Employee’s current age on the policy issue date for payroll premium determination Use the oldest participant age when determining the premium for two parent non‐payroll rates • The Individual rates for the base plan must be used for the 65‐69 age band even on payroll deduction (Those rates do not include the FOB Rider, which is not available for ages 65+) UNDERWRITING AND EFFECTIVE DATES • Our underwriting guidelines preclude individuals with multiple indemnity cancer policies ManhattanLife will not issue a second indemnity Cancer plan to a proposed insured that already has an existing cancer policy Proof of replacement is required • Only ONE Cancer Screening Benefit is allowed for each individual policyholder You cannot offer the Cancer Screening Benefit with any cancer plan if the insured has an existing Cancer Screening Benefit on any other Policy (MIAC or other Associated Company) Exception: if the total of all existing benefits is $50 annually or less, the cancer screening benefit rider will be allowed • Coverage is not guaranteed • The “Effective Date” of a policy will be the policy date stated on the policy schedule page It is not the date the application is signed • With the exception of Hodgkin’s disease, leukemia, and melanoma, applicants who have not been diagnosed with or been treated for cancer, or any malignancy within the last ten years will be considered for cancer coverage (excluding the First Occurrence Benefit Rider) • Persons who have a previous history of Hodgkin’s disease, leukemia or melanoma are not eligible • Applicants who have been diagnosed with or been treated with skin cancer, at anytime, will be considered for cancer coverage; however, skin cancer will be excluded from coverage for the life of the policy
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FOR AGENT USE ONLY
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