BENEFIT PACKAGES
BENEFIT PACKAGE
DESCRIPTION
PLAN A
PLAN B
PLAN C
PLAN D
Pays a one‐time monetary benefit when a Covered Person is diagnosed for the first time as having Cancer (other than skin cancer) as defined in the policy Not available for ages 65 and above For Cancer and Dread Disease, pays a monetary benefit for each day of Hospital Confinement, to a maximum of 70 days per Confinement For Cancer and Dread Disease, pays monetary benefits for Teleradiotherapy, Radio‐Active Isotopes Therapy, Chemotherapy, Chemotherapy Enhancer Drug, Anti‐Nausea and Immunotherapy treatments, as defined in the policy For Cancer and Dread Disease, pays monetary benefits for covered surgeries in or out of the hospital based on a percentage of the maximum amount, according to the schedule shown in the policy Payable for one annual cancer screening test, including but not limited to mammography screening, pap smear (test only); CA125 (blood test for ovarian Cancer); PSA (blood test for prostate Cancer); hemocult stool specimen; flexible sigmoidoscopy; CEA (blood test for colon Cancer); colonoscopy; chest X-ray; thermography; or serum protein electrophoresis Payment based on benefit amount selected Not payable if received through any free-testing program or for any other cancer screening test for which a charge is not made
First Occurrence Benefit Rider
$1,000
$2,500
$5,000
$10,000
Hospital Confinement
$100 per day
$150 per day
$300 per day
$150 per day
Radiation, Chemotherapy, and other Treatments
Actual Charges to a maximum of $2,500 per month
Actual Charges to a maximum of $5,000 per month
Actual Charges to a maximum of $7,500 per month
Actual Charges to a maximum of $5,000 per month
Maximum per Surgery $2,500
Maximum per Surgery $3,000
Maximum per Surgery $4,000
Maximum per Surgery $4,000
Surgical Benefit
Pays your choice of $50 or $100 per calendar year (MT only, $100 per calendar year)
Pays $50 per calendar year (MT only, $100 per calendar year)
Cancer Screening Test
Pays $100 per calendar year
Pays $100 per calendar year
7
FOR AGENT USE ONLY
AGT-CP4000 0216
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