OPTIONAL RIDERS These riders are optional and have an additional cost.
Intensive Care Unit Rider - (Form Number ICUR 4000) Benefits Reduce to ½ at age 70
Benefit for Intensive Care Unit. If a Covered Person is confined in an Intensive Care Unit of a Hospital, we will pay the ICU Daily Benefit Amount for each day of such confinement, not to exceed 30 days during any one period of confinement Benefit for Step-Down Unit. If a Covered Person is confined in a Step-Down Unit of a Hospital, we will pay for each day of such confinement, not to exceed 30 days during any one period of confinement Critical Care Benefit Rider - (Form Number CCBR 4000) Benefit for Heart Disease - A Heart Disease benefit will be paid for the actual charges incurred by a Covered Person for the following due to Heart Disease: 1 pacemaker insertion; 2 angioplasty; and 3 heart catheterization This benefit is limited to a lifetime maximum Benefit for Heart Attack/Stroke - A Heart Attack/Stroke benefit will be paid for the actual charges incurred by a Covered Person
Pays $600 per day
Pays $300 per day step down unit
Pays Actual charges to lifetime max $2,500
Pays Actual charges to lifetime max $5,000
The following limitations apply to the Critical Care Benefit Rider and Intensive Care Unit Rider: LIMITATIONS
Pre-Existing Conditions These Riders do not provide benefits for loss or losses due to Pre-Existing Conditions that are incurred during the 12 months (in NM, 6 months) immediately prior to the Rider Date In addition, a loss caused by a Pre-Existing Condition will not be covered if: 1 (except in MD) the Pre-Existing Condition was revealed in the application; or 2 we have specifically excluded the Pre-Existing Condition by name or specific description However, a claim for a Pre- Existing Condition incurred after 2 years (in NM, 6 months; in CA, 12 months) from the date these Riders become effective will be covered, unless that condition is excluded by name or specific description effective on the date of loss The benefits as specified in these Riders are payable in addition to all other indemnities set forth in the Policy and/or attached Riders, if any
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FOR AGENT USE ONLY
AGT-CP4000 0216
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