THIS PRODUCT PROVIDES LIMITED BENEFITS. USAble Life’s CRITICAL ILLNESS INSURANCE PROVIDES BENEFITS FOR SPECIFIED ILLNESSES ONLY. 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 CRITICAL ILLNESS insurance. This is not an insurance policy. Limitations and exclusions may apply, and coverage may be reduced or terminated due to lack of eligibility. Please read the insurance policy carefully.
Please consult your policy, 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 and continuation
The policy is guaranteed renewable during the covered person’s lifetime. USAble Life may change the premium rate, but only if the rate is changed for all policies in the covered person’s state. The policy will not be issued to anyone 65 years of age or over on the initial effective date. If you purchase the policy prior to your 65th birthday, you may continue coverage after age 65 as long as you continue to pay the premium rate by the due date or during the 31 days that follow. Children born while the policy is in force will be covered immediately from the moment of birth under the Individual and Family plans. If you wish to continue coverage on newborn children under the Individual or Individual/Spouse Plan, you must apply within 90 days of the child’s birth date. A covered person’s spouse’s coverage will terminate on the first renewal date following the covered persons death or at the time of divorce. A covered dependent who no longer meets eligibility requirements may convert to an individual policy without evidence of insurability.
Pre-existing conditions
The benefits of the policy will not be payable for any loss caused by a pre-existing condition during the first 24 months the policy is in force. After this 24-month period, however, loss due to such conditions will be payable unless specifically excluded from coverage. This 24-month period is measured from the effective date of coverage for each covered person. A pre-existing condition means a specified critical illness that is diagnosed or for which treatment is received within 24 months prior to the effective date of coverage for each covered person. “Treatment” means consultation, care, or services provided by a physician including diagnostic measures and taking prescription drugs and medicines. If the issuance of a covered person’s coverage was based on the medical history disclosed on the application, such conditions which were fully disclosed and not excluded or limited by us are not considered pre-existing conditions.
Exceptions and limitations
The policy pays only for loss resulting from specified critical illnesses or surgeries as defined in the policy. We will not pay benefits for a specified critical illness or surgery that occurs as a result of the following:
Conditions other than the specified critical illnesses or surgeries defined in the policy, unless directly caused or aggravated by said specified critical illness or surgery.
The insured person being diagnosed with a specified critical illness during the waiting period.
The covered person voluntarily participating or attempting to participate in an illegal activity.
The covered person intentionally causing a self-inflicted injury.
The covered person committing or attempting to commit suicide, whether sane or insane.
The covered person’s voluntary involvement in any period of armed conflict, even if it is not declared.
Surgeries performed outside of the United States or its Territories.
Other Exclusions: We will not pay the Specified Critical Illness Benefit for the following:
a. Cerebral symptoms due to transient ischemic attack (TIA), migraine, cerebral
injury resulting from trauma or hypoxia, and vascular disease affecting the
eye, optic nerve, or vestibular functions.
b. Leukemia, other than chronic lymphocytic leukemia, if there is no generalized
dissemination of leukemia cells in the blood-forming bone marrow.
c. All skin cancers, unless there is evidence of metastasis or the tumor is a malignant melanoma of greater than 1.5 mm maximum thickness as determined by histological examination using the Breslow method.
d. All tumors which are histologically described as pre-malignant or noninvasive (including cervical dysplasia CIN-1, CIN-2, CIN-3), except carcinoma in situ.
e. Non life-threatening cancers, such as prostate cancers which are histologically described as TNM Classification T1(a), or T1(b), or are of another equivalent or lesser classification.
f. Papillary micro-carcinoma of the thyroid.
g. Non-invasive papillary cancer of the bladder histologically described as TaNOMO or a lesser classification.
h. Chronic lymphocytic leukemia less than RAI stage I or Binet Stage A-I.
For complete details of coverage, please refer to individual policy forms: CIP2-WC (7-07).
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