Supplemental — DUO^® Hospital Indemnity Insurance

THIS PRODUCT PROVIDES LIMITED BENEFITS. DUO HOSPITAL INDEMNITY INSURANCE IS GROUP HOSPITAL INDEMNITY-ONLY COVERAGE. THIS COVERAGE IS SUPPLEMENTAL AND IS NOT A SUBSTITUTE OR REPLACEMENT FOR COMPREHENSIVE HEALTH INSURANCE COVERAGE. IT IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES.

This document provides a brief description of USAble Life’s DUO Hospital Indemnity insurance. This is not an insurance policy. Limitations and exclusions apply, and coverage may be reduced or terminated due to lack of eligibility. Please read the insurance policy carefully.

Please consult your policy, certificate, and any attached riders, if applicable, for specific information about the benefits available, the benefit amounts payable, and the requirements that describe qualifying for payment of the benefits.

Renewability
The policy is renewable at the option of the policyholder, subject to the terms and conditions of the policy. The acceptance of a renewal premium is optional with the company. An employee’s coverage is contingent upon continued employment or membership in the group.

Change of Premium
Premiums are subject to change. Rates are guaranteed for two years from the policy effective date. The company reserves the right to change the premium rate at the end of any rate guarantee period.

Cancelability and Modification
The policy may be canceled at any time by the policyholder. We may cancel or modify the policy with at least 31 days’ notice, subject to the policy provisions.

Termination
Coverage will end when an employee is no longer actively at work, no longer eligible for insurance, when due premium is not paid, or when the policy is terminated by us or the policyholder, subject to the policy provisions.

We will not pay benefits for a loss that is caused by, contributed to by, or occurs as a result of any of the following:

1. Receiving treatment for any mental, nervous or emotional disorder or receiving treatment in a psychiatric facility.
2. Receiving treatment for drug or alcohol abuse or receiving treatment in a substance abuse treatment facility.
3. Intentionally self-inflicting bodily injury or attempting suicide, while sane or insane.
4. Being exposed to any act of war, declared or undeclared, or serving in any of the armed forces.
5. Participating in, or attempting to participate in commission of a felony; actively participating in a riot or insurrection; or being incarcerated in any type of penal institution.
6. Being under the influence of alcohol or any narcotic, unless administered upon the advice of a physician.
7. Having cosmetic surgery or other elective procedures that are not a) required to treat an illness or injury; or b) to correct a disorder of normal bodily function.
8. Receiving eye glasses, hearing aids, or the fitting thereof.
9. Receiving reversal of a tubal ligation or vasectomy.
10. Receiving artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications or physician services.
11. Participating in any form of flight aviation other than as a fare-paying passenger in a fully licensed/passenger-carrying aircraft.
12. Engaging in bungee jumping, sail gliding, parachuting, parasailing, parakiting, hang gliding, mountain climbing, or jumping from any aircraft.
13. Participating in any organized sport in a professional or semi-professional capacity.
14. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
15. Being placed into a medically induced coma.

We will not pay benefits for medical care or receiving healthcare treatment, services, transportation, or for a hospital stay in any medical facility outside the United States of America or Canada.

Based on the plan selected, hospital admission benefits are limited to a maximum of up to two admissions per calendar year, and hospital confinement benefits are limited to a maximum of 365 days per calendar year. Plan specific benefit amounts and maximums are included in your certificate and any attached riders, if applicable.

Observation Treatment benefit requires a minimum of 18 hours of monitoring in a designated hospital unit before the benefit is payable.

Benefits
At the group policyholder’s option, your certificate may also include benefits for any of the following: hospital admission, hospital confinement, intensive care unit admission, intensive care unit confinement, observation treatment, hospice care, mental health treatment, rehabilitation, skilled nursing at home treatment, skilled nursing facility treatment, substance abuse treatment, ambulance, diagnostic exam — advanced, diagnostic exam — major, emergency treatment, follow-up physician treatment, medical equipment, physical therapy, physician office and urgent care treatment, prescription drug, surgery, telemedicine, lodging, transportation, preventative care rider.

For complete details of coverage, please refer to the group policy forms: GHI-POL (9-20), GHI-CRT (9-20), GRP-SUPP-PC-RDR (9-20)

We will not pay benefits for a loss that is caused by, contributed to by, or occurs as a result of any of the following:

1. Receiving treatment for any mental, nervous or emotional disorder or receiving treatment in a psychiatric facility.
2. Receiving treatment for drug or alcohol abuse or receiving treatment in a substance abuse treatment facility.
3. Intentionally self-inflicting bodily injury or attempting suicide, while sane or insane.
4. Being exposed to any act of war, declared or undeclared, or serving in any of the armed forces.
5. Participating in, or attempting to participate in commission of a felony; actively participating in a riot or insurrection; or being incarcerated in any type of penal institution.
6. Being intoxicated as defined by the laws of the jurisdiction in which the loss occurred, unless taking narcotics as prescribed by a physician.
7. Having cosmetic surgery or other elective procedures that are not a) required to treat an illness or injury; or b) to correct a disorder of normal bodily function.
8. Receiving eye glasses, hearing aids, or the fitting thereof.
9. Receiving reversal of a tubal ligation or vasectomy.
10. Receiving artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications or physician services.
11. Participating in any form of flight aviation other than as a fare-paying passenger in a fully licensed/passenger-carrying aircraft.
12. Engaging in bungee jumping, sail gliding, parachuting, parasailing, parakiting, hang gliding, mountain climbing, or jumping from any aircraft.
13. Participating in any organized sport in a professional or semi-professional capacity.
14. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
15. Being placed into a medically induced coma.

We will not pay benefits for medical care or receiving healthcare treatment, services, transportation, or for a hospital stay in any medical facility outside the United States of America or Canada.

Based on the plan selected, hospital admission benefits are limited to a maximum of up to two admissions per calendar year, and hospital confinement benefits are limited to a maximum of 365 days per calendar year. Plan specific benefit amounts and maximums are included in your certificate and any attached riders, if applicable.

Observation Treatment benefit requires a minimum of 18 hours of monitoring in a designated hospital unit before the benefit is payable.

Benefits
At the group policyholder’s option, your certificate may also include benefits for any of the following: hospital admission, hospital confinement, intensive care unit admission, intensive care unit confinement, observation treatment, hospice care, mental health treatment, rehabilitation, skilled nursing at home treatment, skilled nursing facility treatment, substance abuse treatment, ambulance, diagnostic exam — advanced, diagnostic exam — major, emergency treatment, follow-up physician treatment, medical equipment, physical therapy, physician office and urgent care treatment, prescription drug, surgery, telemedicine, lodging, transportation, preventative care rider.

For complete details of coverage, please refer to the group policy forms: GHI-POL (9-20), GHI-CRT (9-20), GRP-SUPP-PC-RDR (9-20).

We will not pay benefits for a loss that is caused by, contributed to by, or occurs as a result of any of the following:

1. Receiving treatment for any mental, nervous or emotional disorder or receiving treatment in a psychiatric facility.
2. Receiving treatment for drug or alcohol abuse or receiving treatment in a substance abuse treatment facility.
3. Intentionally self-inflicting bodily injury or attempting suicide, while sane or insane.
4. Being exposed to any act of war, declared or undeclared, or serving in any of the armed forces.
5. Participating in, or attempting to participate in commission of a felony; actively participating in a riot or insurrection; or being incarcerated in any type of penal institution.
6. Being under the influence of alcohol or any narcotic, unless administered upon the advice of a physician.
7. Having cosmetic surgery or other elective procedures that are not a) required to treat an illness or injury; or b) to correct a disorder of normal bodily function.
8. Receiving eye glasses, hearing aids, or the fitting thereof.
9. Receiving reversal of a tubal ligation or vasectomy.
10. Receiving artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications or physician services.
11. Participating in any form of flight aviation other than as a fare-paying passenger in a fully licensed/passenger-carrying aircraft.
12. Engaging in bungee jumping, sail gliding, parachuting, parasailing, parakiting, hang gliding, mountain climbing, or jumping from any aircraft.
13. Participating in any organized sport in a professional or semi-professional capacity.
14. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
15. Being placed into a medically induced coma.

We will not pay benefits for medical care or receiving healthcare treatment, services, transportation, or for a hospital stay in any medical facility outside the United States of America or Canada.

Based on the plan selected, hospital admission benefits are limited to a maximum of up to two admissions per calendar year, and hospital confinement benefits are limited to a maximum of 365 days per calendar year. Plan specific benefit amounts and maximums are included in your certificate and any attached riders, if applicable.

Observation Treatment benefit requires a minimum of 18 hours of monitoring in a designated hospital unit before the benefit is payable.

Benefits

At the group policyholder’s option, your certificate may also include benefits for any of the following: hospital admission, hospital confinement, intensive care unit admission, intensive care unit confinement, observation treatment, hospice care, mental health treatment, rehabilitation, skilled nursing at home treatment, skilled nursing facility treatment, substance abuse treatment, ambulance, diagnostic exam — advanced, diagnostic exam — major, emergency treatment, follow-up physician treatment, medical equipment, physical therapy, physician office and urgent care treatment, prescription drug, surgery, telemedicine, lodging, transportation, preventative care rider.

For complete details of coverage, please refer to the group policy forms: GHI-POL (9-20), GHI-POL-51 (9-20), GHI-CRT (9-20), GHI-CRT-51 (9-20), GRP-SUPP-PC-RDR (9-20).

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