Frequently Asked Questions – Specified Disease Rider Eligibility & Underwriting If the Rider is declined, will the base coverage remain active? Yes, the base policy stays active. The only exception is if underwriting uncovers undisclosed information on the original application. Is the Rider available for children? The Rider is not available for child-only coverage. However, dependents can be covered until age 26 if included under a parent’s policy. What health conditions make a Specified Disease applicant uninsurable? Applications should not be submitted if the applicant has been diagnosed, treated or tested abnormally for any of the conditions listed in the Uninsurable Health Conditions section for the last 10 years. What about uninsurable procedures or surgeries? Applicants with procedures such as angioplasty, coronary bypass, dialysis or stent placement are uninsurable. What additional rules apply to the Specified Disease Rider underwriting? Certain musculoskeletal, joint and autoimmune diseases are ineligible (e.g., rheumatoid arthritis, ankylosing spondylitis). Conditions like asthma, diabetes and high blood pressure have specific control and medication requirements. Can an applicant who is currently pregnant apply? No. Applications will be declined if the applicant, or any of the applicants’ dependents (spouse or child(ren) under the age of 26), whether applying for coverage or not, is currently pregnant or in the process of adopting a child. How does the network discount work with the Specified Disease Rider? The network discount applies to the Affordable Choice base policy. This means the discount is applied to services considered under the AFC policy, regardless of whether they are covered. ManhattanLife does not apply the discount to the rider itself, as the rider pays benefits that are already accounted for under the base policy. In other words, the network discount has effectively already been factored in. Deductible How are expenses/benefits handled if the deductible has not been met? The insured will pay the deductible to the provider until the full deductible is met. In an instance where the claim is more than the deductible, the insured will fulfill the deductible and ManhattanLife will pay the remaining to the provider (deductible payment from insured is not required for ManhattanLife to pay). Example #1: If an insured has a $50,000 deductible and a $35,000 Specified Disease claim, the full $35,000 is owed to the provider from the insured, and no benefits are paid from ManhattanLife. Example #2: If an insured has a $50,000 deductible and an $80,000 Specified Disease claim, the client would pay the $50,000 deductible and ManhattanLife would pay the remaining $30,000 of the claim to the provider.
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