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Cancer Insurance
CANCER ASSIST – NC
How would cancer impact your way of life?
Hopefully, you and your family will never face cancer. If you do, a
financial safety net can help you and your loved ones focus on what
matters most — recovery.
If you were diagnosed with cancer, you could have expenses that
medical insurance doesn’t cover. In addition to your regular, ongoing
bills, you could have indirect treatment and recovery costs, such as
child care and home health care services.
Help when you need it most
Cancer coverage from Colonial Life & Accident Insurance Company
can help protect the lifestyle you’ve worked so hard to build. It provides
benefits you can use to help cover:
Loss of income
Out-of-network treatment
Lodging and meals
Deductibles and co-pays
Paul and Kim were preparing for their second child when they learned Paul had
cancer. They quickly realized their medical insurance wouldn’t cover everything.
Thankfully, Kim’s job enabled her to have a Colonial Life Cancer Insurance policy
on Paul to help them with expenses.
Paul’s wellness benefit helped pay for the
screening that discovered his cancer.
When the couple traveled several hundred miles from
their home to a top cancer hospital, they used the policy’s
lodging and transportation benefits to help with expenses.
The policy’s benefits helped with
deductibles and co-pays related to
Paul’s surgery and hospital stay.
SURGERY SECOND OPINION DOCTOR’S SCREENING
Wellness Benefit Travel Expenses Out-of-pocket Costs
One Family’s Journey
With Colonial Lifes Cancer Insurance:
Coverage options are available for you and
your eligible dependents.
Benefits are paid directly to you, unless you
specify otherwise.
You’re paid regardless of any other insurance
you may have with other companies.
You can take coverage with you, even if you
change jobs or retire.
Cancer Facts & Figures, American Cancer Society, 2013
For illustrative purposes only.
ONLY
of ALL
CANCERS
are
hereditary.
Paul has been cancer-free for more than four years.
His Colonial Life cancer policy provides a benefit for
periodic scans to help ensure the cancer stays in check.
Paul used his plan’s benefits to help pay
for experimental treatments not covered
by his medical insurance.
TREATMENT RECOVERY
Experimental Care Follow-up Evaluations
Colonial Life’s Cancer Insurance oers more than 30 benefits that can help you
with costs that may not be covered by your medical insurance.
Treatment Benefits
(Inpatient or Outpatient)
Radiation/Chemotherapy
Anti-nausea Medication
Medical Imaging Studies
Supportive or Protective Care Drugs
and Colony Stimulating Factors
Second Medical Opinion
Blood/Plasma/Platelets/
Immunoglobulins
Bone Marrow or Peripheral Stem
Cell Donation
Bone Marrow or Peripheral Stem
Cell Transplant
Egg(s) Extraction or Harvesting/
Sperm Collection and Storage
Experimental Treatment
Hair/External Breast/Voice
Box Prosthesis
Home Health Care Services
Hospice (Initial or Daily Care)
Surgery Benefits
Surgical Procedures
Anesthesia
Reconstructive Surgery
Outpatient Surgical Center
Prosthetic Device/Artificial Limb
Travel Benefits
Transportation
Companion Transportation
Lodging
Inpatient Benefits
Hospital Confinement
Private Full-Time Nursing Services
Skilled Nursing Care Facility
Ambulance
Air Ambulance
Additional Benefits
Family Care
Cancer Vaccine
Bone Marrow Donor Screening
Skin Cancer Initial Diagnosis
Waiver of Premium
Cancer Facts & Figures, American Cancer Society, 2013
LIFETIME RISK OF
DEVELOPING CANCER
MEN
1 in 2
WOMEN
1 in 3
Colonial Lifes Cancer Insurance provides benefits to help with
cancer expenses — from diagnosis to recovery.
ColonialLife.com
WAITING PERIOD
The policy and its riders may have a waiting period. Waiting period means the first 30 days
following the policy’s coverage eective date during which no benefits are payable. If your
cancer has a date of diagnosis before the end of the waiting period, coverage for that cancer
will apply only to losses commencing aer the policy has been in force for two years, unless
it is excluded by name or specific description in the policy.
No recovery during the first 12 months of this policy for cancer with a date of diagnosis prior to
30 days aer the eective date of coverage. If a covered person is 65 or older when this policy is
issued, pre-existing conditions for that covered person will include only conditions specifically
eliminated by rider.
EXCLUSIONS
We will not pay benefits for cancer or skin cancer:
If the diagnosis or treatment of cancer is received outside of the territorial limits of the
United States and its possessions; or
For other conditions or diseases, except losses due directly from cancer.
The policy and its riders may have additional exclusions and limitations. For cost and complete
details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state
and may not be available in all states. Applicable to policy forms CanAssist-NC and rider forms
R-CanAssistIndx-NC, R-CanAssistProg-NC and R-CanAssistSpDis-NC.
101481-NC
Optional Riders
For an additional cost, you may have the option of purchasing
additional riders for even more financial protection against cancer.
Talk with your benefits counselor to find out which of these riders
are available for you to purchase.
Initial Diagnosis of Cancer Rider — Pays a one-time, lump-sum benefit
for the initial diagnosis of cancer. You may choose a benefit amount
in $1,000 increments between $1,000 and $10,000. If your dependent
child is diagnosed with cancer, we will pay two and a half times
($2,500 - $25,000) the chosen benefit amount.
Initial Diagnosis of Cancer Progressive Payment Rider — Provides a
lump-sum payment of $50 for each month the rider has been in force
aer the waiting period and before cancer is first diagnosed.
Specified Disease Hospital Confinement Rider — Pays $300 per day if
you or a covered family member is confined to a hospital for treatment
for one of the 34 specified diseases covered under the rider.
If cancer impacts your life, you should be able to focus on
getting better — not on how you’ll pay your bills. Talk with
your Colonial Life benefits counselor about how cancer
insurance can help provide financial security for you and
your family.
©2014 Colonial Life & Accident Insurance Company
Colonial Life products are underwritten by Colonial Life & Accident
Insurance Company, for which Colonial Life is the marketing brand.
3-14
BENEFIT DESCRIPTION BENEFIT AMOUNT
Cancer insurance helps
provide financial protection
through a variety of benefits.
These benefits are not only for
you but also for your covered
family members.
For more information,
talk with your
benefits counselor.
CANCER ASSIST – LEVEL 3
Air ambulance .................................................................................$2,000 per trip
Transportation to or from a hospital or medical facility [max. of two trips per confinement]
Ambulance .....................................................................................$250 per trip
Transportation to or from a hospital or medical facility [max. of two trips per confinement]
Anesthesia
Administered during a surgical procedure for cancer treatment
General anesthesia ......................................................................... 25% of surgical procedures benefit
Local anesthesia ............................................................................$40 per procedure
Anti-nausea medication .....................................................................$50 per day administered or
Doctor-prescribed medication for radiation or chemotherapy [$200 monthly max.] per prescription filled
Blood/plasma/platelets/immunoglobulins .............................................. $175 per day
A transfusion required during cancer treatment [$10,000 calendar year max.]
Bone marrow donor screening .............................................................$50
Testing in connection with being a potential donor [once per lifetime]
Bone marrow or peripheral stem cell donation ......................................... $750
Receiving another person’s bone marrow or stem cells for a transplant [once per lifetime]
Bone marrow or peripheral stem cell transplant .......................................$7,000 per transplant
Transplant you receive in connection with cancer treatment
[max. of two bone marrow transplant benefits per lifetime]
Cancer vaccine .................................................................................$50
An FDA-approved vaccine for the prevention of cancer [once per lifetime]
Companion transportation .................................................................$0.50 per mile
Companion travels by plane, train or bus to accompany a covered cancer patient more
than 50 miles one way for treatment [up to $1,200 per round trip]
Egg(s) extraction or harvesting/sperm collection and storage
Extracted/harvested or collected before chemotherapy or radiation [once per lifetime]
Egg(s) extraction or harvesting/sperm collection .........................................$1,000
Egg(s) or sperm storage (cryopreservation) ...............................................$350
Experimental treatment ..................................................................... $300
per day
Hospital, medical or surgical care for cancer [$15,000 lifetime max.]
Family care .....................................................................................$50 per day
Inpatient or outpatient treatment for a covered dependent child
[$2,500 calendar year max.]
Hair/external breast/voice box prosthesis ...............................................$350 per calendar year
Prosthesis needed as a direct result of cancer
Home health care services ..................................................................$100 per day
Examples include physical therapy, occupational therapy, speech therapy and
audiology; prosthesis and orthopedic appliances; rental or purchase of durable
medical equipment [up to 30 days per calendar year or twice the number of days
hospital confined, whichever is greater]
Hospice (initial or daily care)
An initial, one-time benefit and a daily benefit for treatment [$15,000 lifetime max. for both]
Initial hospice care [once per lifetime] .....................................................$1,000
Daily hospice care ..........................................................................$50 per day
Cancer Insurance
Level 3 Benefits
BENEFIT DESCRIPTION BENEFIT AMOUNT
ColonialLife.com
4-15 | 101484-1
©2015 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are
underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.
The policy has limitations and exclusions that may aect benefits payable. Most benefits require that a charge
be incurred. Coverage may vary by state and may not be available in all states. For cost and complete details,
see your benefits counselor.
This chart highlights the benefits of policy form CanAssist (including state abbreviations where used, for example:
CanAssist-TX). This chart is not complete without form number 101481.
Hospital confinement
Hospital stay (including intensive care) required for cancer treatment
30 days or less ..........................................................................................$250 per day
31 days or more ........................................................................................$500 per day
Lodging .....................................................................................................$75 per day
Hotel/motel expenses when being treated for cancer more than 50 miles from home
[70-day calendar year max.]
Medical imaging studies .................................................................................$175 per study
Specific studies for cancer treatment [$350 calendar year max.]
Outpatient surgical center ..............................................................................$300 per day
Surgery at an outpatient center for cancer treatment [$900 calendar year max.]
Private full-time nursing services ......................................................................$125 per day
Services while hospital confined other than those regularly furnished by the hospital
Prosthetic device/artificial limb ........................................................................$2,000 per device or limb
A surgical implant needed because of cancer surgery [payable one per site, $4,000 lifetime max.]
Radiation/chemotherapy
Weekly benefit [max. once per week]
Injected chemotherapy by medical personnel ........................................................$750
Radiation delivered by medical personnel ............................................................$750
Monthly chemotherapy benefit [max. once per month]
Self-injected ............................................................................................$300
Pump ...................................................................................................$300
Topical ..................................................................................................$300
Oral hormonal [1-24 months] ..........................................................................$300
Oral hormonal [25+ months] ...........................................................................$150
Oral non-hormonal ..................................................................................... $300
Reconstructive surgery ..................................................................................$60
per surgical unit
A surgery to reconstruct anatomic defects that result from cancer treatment
[up to $3,000 per procedure, including 25% for general anesthesia]
Second medical opinion .................................................................................$300
A second physician’s opinion on cancer surgery or treatment [once per lifetime]
Skilled nursing care facility .............................................................................$100 per day
Confinement to a covered facility aer hospital release [up to the number of days paid for
hospital confinement]
Skin cancer initial diagnosis ............................................................................$400
A skin cancer diagnosis while the policy is in force [once per lifetime]
Supportive or protective care drugs and colony stimulating factors ...........................$150 per day
Doctor-prescribed drugs to enhance or modify radiation/chemotherapy treatments
[$1,200 calendar year max.]
Surgical procedures ......................................................................................$60 per surgical unit
Inpatient or outpatient surgery for cancer treatment [$5,000 max. per procedure]
Transportation ............................................................................................$0.50 per mile
Travel expenses when being treated for cancer more than 50 miles from home
[up to $1,200 per round trip]
Waiver of premium .......................................................................................Is available
No premiums due if the named insured is disabled longer than 90 consecutive days
CanAssist-O-NC 1 Lvl3-100well 78194
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY
1200 Colonial Life Boulevard, P. O. Box 1365, Columbia, South Carolina 29202
1.800.325.4368 coloniallife.com
A Stock Company
CANCER INSURANCE COVERAGE
OUTLINE OF COVERAGE
(Applicable to Policy Form CanAssist-NC)
THE POLICY PROVIDES LIMITED INDEMNITY BENEFITS
BENEFITS PROVIDED ARE SUPPLEMENTAL AND NOT INTENDED TO COVER
ALL MEDICAL EXPENSES
NO RECOVERY DURING THE FIRST 12 MONTHS OF THIS POLICY FOR CANCER,
IF APPLICABLE, WITH A DATE OF DIAGNOSIS PRIOR TO 30 DAYS AFTER THE
EFFECTIVE DATE OF COVERAGE. IF A COVERED PERSON IS 65 OR OLDER
WHEN THE POLICY IS ISSUED, PRE-EXISTING CONDITIONS FOR THAT COVERED
PERSON WILL INCLUDE ONLY CONDITIONS SPECIFICALLY ELIMINATED BY
RIDER.
READ POLICY PROVISIONS CAREFULLY.
THE POLICY IS NOT MEDICARE SUPPLEMENT COVERAGE.
If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare
available from the company.
Please Read the Policy Carefully
This outline provides a very brief description of the important features of your policy. This is not an insurance contract and only the
actual policy provisions will control. The policy sets forth in detail the rights and obligations of both you and us. It is, therefore,
important that you READ YOUR POLICY CAREFULLY.
Renewability
The policy is guaranteed renewable as long as you pay the premiums when they are due or within the grace period. Your premium
can be changed only if we change it on all policies of this kind in force in the state where the policy was issued.
Coverage Provided by the Policy
The policy is designed to provide coverage ONLY for losses due to cancer and for specified wellness procedures, subject to any
limitations in your policy. The policy does not provide coverage for basic hospital, basic medical-surgical or major medical
expenses.
The policy provides benefits for cancer, including skin cancer where applicable, if the date of diagnosis, treatment of cancer or skin
cancer, or the performance of wellness procedures occur: after the waiting period has been satisfied; while your policy is in force;
and if the cancer or treatment is not excluded by name or specific description in the policy. Drugs received for the treatment of
cancer must be approved by the United States Food and Drug Administration (FDA). Any procedures for Wellness Benefits
performed before the end of the waiting period will not be covered. If the date of diagnosis of cancer is before the end of the waiting
period, coverage for that cancer will apply only to loss commencing after the policy has been in force 12 months. Benefits will be
provided for unrelated cancers diagnosed after the effective date of the policy. Cancer must be pathologically or clinically
diagnosed. If cancer is not diagnosed until after you die, we will only pay benefits for the treatment of cancer performed during the
45-day period before your death.
BENEFITS FOR CANCER
Air Ambulance $2,000 per trip
Benefit payable if a charge is incurred and a licensed professional air ambulance company transports by air any covered
person to or from a hospital or between medical facilities while he is confined as an inpatient for the treatment of cancer. No
lifetime limit other than two trips each time he is confined as an inpatient for the treatment of cancer.
CanAssist-O-NC 2 Lvl3-100well 78194
Ambulance $250 per trip
Benefit payable if a charge is incurred and a licensed medical professional ambulance company transports any covered
person by ground transportation to or from a hospital or between medical facilities, while he is confined as an inpatient for the
treatment for cancer. No lifetime limit other than two trips each time he is confined as an inpatient for the treatment of cancer.
Anesthesia
General Anesthesia 25%of Surgical Procedures Benefit
Local Anesthesia $40 per procedure
Benefit payable if any covered person incurs a charge and receives general anesthesia administered by an anesthesiologist or a
Certified Registered Nurse Anesthetist during a surgical procedure that is performed for the treatment of cancer and for which a
benefit is payable.
If a covered person incurs a charges and receives local anesthesia during a surgical procedure performed for the treatment of
cancer for which a benefit is payable, we will pay the amount indicated above.
If a covered person has more than one surgical procedure performed at the same time, we will pay only one Anesthesia benefit.
We will pay the Anesthesia benefit for the surgical procedure performed that has the highest dollar value. The benefit is payable
for skin cancer. No lifetime limit.
Anti-Nausea Medication $50 per day administered in doctor’s
office, clinic or hospital or per
prescription filled
Maximum Benefit Amount of $200 per covered person per calendar month
Benefit payable if any covered person incurs a charge for medication for nausea as a result of radiation or chemotherapy
treatments prescribed by a doctor during the treatment of cancer. We will only pay one Anti-Nausea Medication benefit per
day regardless of the number of anti-nausea medications a covered person receives on the same day. No lifetime limit.
Blood/Plasma/Platelets/Immunoglobulins $175 per day
Maximum Benefit Amount of $10,000 per covered person per calendar year
Benefit payable for actual charges incurred, subject to the daily benefit amount if any covered person receives a transfusion
of blood/plasma/platelets/ immunoglobulins, including fees for administering them, during the treatment of cancer. No lifetime
limit.
Bone Marrow or Peripheral Stem Cell Donation $750 per donation
Maximum of one per covered person per lifetime
Benefit payable if any covered person incurs a charge for receiving another person’s bone marrow or stem cells in connection
with a covered transplant procedure for the treatment of cancer. We will pay the benefit only once per covered person per
lifetime.
Bone Marrow or Peripheral Stem Cell Transplant
Bone Marrow Stem Cell Transplant $7,000 per transplant
Peripheral Stem Cell Transplant $7,000 per transplant
Maximum of two transplant benefits per covered person per lifetime
Benefit payable if any covered person incurs a charge and receives a bone marrow or peripheral stem cell transplant for the
treatment of cancer. We will pay for no more than two transplants per covered person per lifetime.
Companion Transportation $ .50 per mile
Maximum Benefit Amount of $1,200 per covered person per round trip
Benefit payable if a charge is incurred for one companion to accompany a covered person to another city (more than 50 miles
one way from the city where he lives) where he is receiving treatment for cancer on the advice of a doctor. The benefit is
payable when charges are incurred for commercial travel (i.e., plane, train or bus) to and from the covered person’s
destination. Benefits for air ambulance and ambulance are only available under the Air Ambulance and Ambulance benefits.
There is no limit to the number of times a covered person receives benefits for Companion Transportation, subject to the
Maximum Benefit Amount shown above.
CanAssist-O-NC 3 Lvl3-100well 78194
Egg(s) Extraction or Harvesting/Sperm Collection and Storage (Cryopreservation)
Egg(s) Extraction or Harvesting or Sperm Collection $1,000 maximum of one per covered
person per lifetime
Egg(s) or Sperm Storage $350 maximum of one per covered
person per lifetime
Benefit payable if any covered person incurs a charge to have eggs extracted and harvested or sperm collected. An additional
benefit is payable if a covered person incurs a charge for the storage of eggs or sperm with a licensed reproductive tissue bank or
a similar licensed storage facility. The extraction, harvesting, collection and storage must occur prior to chemotherapy or radiation
treatment that has been prescribed by a doctor for the covered person’s treatment of cancer. We will pay these benefits only once
per covered person per lifetime.
Experimental Treatment $300 per day
Maximum Benefit Amount of $15,000 per covered person per lifetime
Benefit payable each day any covered person incurs a charge for receiving hospital, medical or surgical care in connection
with experimental treatment of cancer. These treatments must be prescribed by a physician and must be received in an
experimental cancer treatment program. Payment of the Experimental Treatment benefit is in place of payment of any other
benefit for the same covered treatments.
Family Care $50 per day
Maximum Benefit Amount of $2,500 per covered person per calendar year
Benefit payable each day an insured dependent child incurs charges for receiving treatment for cancer on an inpatient or
outpatient basis by a licensed medical practitioner. The Family Care benefit is paid in addition to any other applicable
benefits. Self-administered treatment or treatment within the home is excluded. No lifetime limit.
Hair/External Breast/Voice Box Prosthesis $350 per covered person per
calendar year
Benefit payable if any covered person incurs charges and receives a hair prosthesis, external breast prosthesis or voice box
prosthesis needed as a direct result of cancer. No lifetime limit.
Home Health Care Services $100 per covered person per day
Benefit payable if any covered person incurs a charge for receiving services provided by a home health agency when required
by your doctor instead of confinement in a hospital. We will pay the greater of: 1) 30 days per calendar year; or 2) twice the
number of days the covered person was confined to a hospital during a calendar year for the treatment of cancer. We will not
pay the benefit for housekeeping services, childcare or food services other than dietary counseling. No lifetime limit.
Hospice
Initial hospice care $1,000 maximum of one per lifetime
Daily hospice care $50 per day
Maximum Benefit Amount of $15,000 for initial and daily hospice care per covered person per lifetime
Benefit payable each day any covered person incurs a charge and receives hospice care, as the result of cancer, consisting
of one or more of the following services received by a covered person for whom a doctor determines that cancer treatments
are no longer of benefit and that he is expected to live for only six months or less: a visit from a representative of a hospice
care team at home; the services of a hospital on an outpatient basis under the direction of a hospice; a visit to a hospice on
an outpatient basis for treatment or services; and confinement to a hospice care facility. We will pay the initial hospice care
benefit shown above for the first day a covered person receives hospice care. Initial hospice care is payable once per covered
person per lifetime regardless of the number of times a covered person receives hospice care. There is no limit to the number
of days a covered person receives a benefit for Hospice, subject to the Maximum Benefit Amount shown above.
Hospital Confinement
30 days or less $250 per covered person per day
31 days or more $500 per covered person per day
Benefit payable each day any covered person incurs charges for confinement to a hospital (including intensive care) for the
treatment of cancer. If less than 30 days separate a period of confinement, we will treat the confinement as a continuation of
the prior confinement. If more than 30 days separate a period of confinement, we will treat the confinement as a new
confinement. No lifetime limit.
CanAssist-O-NC 4 Lvl3-100well 78194
Lodging $75 per day
Maximum of 70 days per covered person per calendar year
Benefit payable each day any covered person or any one adult companion or family member incurs a charge for lodging
required while the covered person is being treated for cancer more than 50 miles from the covered person’s residence. No
lifetime limit.
Medical Imaging Studies $175 per study
Maximum Benefit Amount of $350 per covered person per calendar year
Benefit payable if any covered person incurs a charge for having a covered medical image study performed that was
prescribed by a doctor for the treatment or follow-up evaluation of cancer and performed after the initial diagnosis of cancer.
No lifetime limit.
Outpatient Surgical Center $300 per day
Maximum Benefit Amount of $900 per covered person per calendar year
Benefit payable each day any covered person incurs a charge for having surgery performed at an outpatient surgical center
for the treatment of cancer. This does not include surgery received in the emergency room or while confined to the hospital.
No lifetime limit.
Private Full-time Nursing Services $125 per covered person per day
Benefit payable each day any covered person incurs a charge for private full-time nursing services (other than those regularly
furnished by the hospital), required and authorized by a doctor and performed by a registered, a licensed practical or a
licensed vocational nurse while confined to a hospital for the treatment of cancer. No lifetime limit.
Prosthetic Device/Artificial Limb $2,000 per device or limb
Maximum of $4,000 per covered person per lifetime
Benefit payable if any covered person incurs a charge and receives a surgically implanted prosthetic device or artificial limb
prescribed a doctor as a direct result of cancer surgery. The benefit does not include coverage for tissue expanders or a
Breast Transverse Rectus Abdominis Myocutaneous (TRAM) Flap. We will pay for no more than one of the same type of
prosthetic device or artificial limb per site.
Radiation/Chemotherapy
Weekly Benefit
Injected chemotherapy by medical personnel $750 maximum of one per covered
person per calendar week
Radiation delivered by medical personnel $750 maximum of one per covered
person per calendar week
Chemotherapy
Monthly Benefit
Self-Injected $300 maximum of one per covered
person per calendar month
Pump $300 maximum of one per covered
person per calendar month
Topical $300 maximum of one per covered
person per calendar month
Oral Hormonal (1-24 months) $300 maximum of one per covered
person per calendar month
Oral Hormonal (25+ months) $150 maximum of one per covered
person per calendar month
Oral Non-Hormonal $300 maximum of one per covered
person per calendar month
Benefit payable if any covered person incurs a charge and receives one or more of the covered treatments listed below during the
treatment of cancer.
CanAssist-O-NC 5 Lvl3-100well 78194
Covered Treatments consist of the following:
Chemotherapy, consisting of one or more of the following:
ο chemotherapy treatments injected by medical personnel in a doctor’s office, clinic or hospital;
ο chemotherapy treatments injected by yourself or anyone other than personnel in a doctor’s office, clinic or hospital;
ο a pump for chemotherapy initially filled or refilled;
ο a prescription for topical chemotherapy;
ο a prescription for oral-hormonal chemotherapy; or
ο a prescription for oral-non-hormonal chemotherapy.
Radiation, consisting of radioactive treatments delivered by medical personnel in a doctor’s office, clinic, or hospital.
Covered Treatments injected or delivered by medical personnel in a doctor’s office, clinic or hospital are payable each week and
are limited to the calendar week in which the covered person incurs a charge for the treatment of cancer.
Covered Treatments delivered by any other method, as listed above, are payable each month and are limited to the calendar month
in which the covered person incurs a charge for the treatment of cancer. Payment of the benefit is not based on the number,
duration or frequency of the covered treatment.
If a covered person receives a prescription for chemotherapy that is for more than one month, the benefit is limited to the calendar
month in which the charge is incurred. Refills of the same prescription within the same calendar month are not considered a
different chemotherapy medicine. Radioactive treatments delivered by medical personnel are not payable each week a radium
implant or radioisotope remains in the body. No lifetime limit.
Reconstructive Surgery $60 per surgical unit
Maximum Benefit Amount of $3,000 per covered person per procedure, including 25%for general anesthesia
Benefit payable if any covered person incurs a charge for a reconstructive surgery that requires an incision; is performed by a
doctor for treatment of cancer; and is due to cancer. We will pay up to 25% of the Reconstructive Surgery benefit if a covered
person incurs charges and has general anesthesia administered during reconstructive surgery. We will pay no more than the
Maximum Benefit Amount indicated above per procedure. We will pay for no more than two procedures per site. If a covered
person has more than one reconstructive surgery performed at the same time and through the same incision, we will consider
them to be one procedure and pay the benefit that has the highest dollar value. If a covered person has more than one
reconstructive surgery performed at the same time but through different incisions, we will pay for each one. No lifetime limit.
Second Medical Opinion $300 per lifetime
Maximum of one per covered person per lifetime
Benefit payable if any covered person incurs a charge for the opinion of a second physician on recommended surgery or
treatment following the positive diagnosis of cancer. The benefit is not payable for reconstructive surgery. We will pay the
benefit only once per covered person per lifetime.
Skilled Nursing Care Facility $100 per covered person per day up
to the number of days for hospital
confinement
Benefit payable each day any covered person incurs a charge for a skilled nursing care facility if confinement begins within
14 days after release from a hospital. We will pay the benefit for no more than the number of days we paid the Hospital
Confinement benefit for the most recent confinement. No lifetime limit.
Skin Cancer Initial Diagnosis $400 per lifetime
Maximum of one per covered person per lifetime
Benefit payable if any covered person incurs a charge and is diagnosed with skin cancer if the date of diagnosis is while the
policy is in force, the skin cancer is diagnosed after the waiting period and the skin cancer is not excluded by name or
specific description in the policy. We will pay the benefit only once per covered person per lifetime.
CanAssist-O-NC 6 Lvl3-100well 78194
Supportive or Protective
Care Drugs and Colony Stimulating Factors
$150 per day
Maximum Benefit Amount of $1,200 per covered person per calendar year
Benefit payable each day any covered person incurs a charge and receives supportive or protective care drugs and/or colony
stimulating factors for the treatment of cancer. Benefits for supportive or protective care drugs and/or colony stimulating factors
will only be payable for the day a covered person has the prescription filled. We will only pay one benefit per day regardless of the
number of supportive or protective care drugs and/or colony stimulating factors a covered person receives on the same day. If a
covered person receives a prescription for supportive or protective care drugs and/or colony stimulating factors that is for more
than one month, this benefit is limited to the calendar month in which the charge is incurred. Refills of the same prescription within
the same calendar month are not considered a different supportive or protective care drug and/or colony stimulating factor
medicine. No lifetime limit.
Surgical Procedures $60 per surgical unit
Maximum Benefit Amount of $5,000 per covered person per procedure
Benefit payable if any covered person incurs a charge for a surgical procedure performed by a doctor for the treatment of
cancer. If a covered person has more than one surgical procedure performed at the same time and through the same
incision, we will consider them to be one procedure and pay the benefit that has the highest dollar value. If a covered person
has more than one surgical procedure performed at the same time but through different incisions, we will pay for each one.
Surgery performed laparoscopically with more than one incision will be considered one surgical procedure regardless of the
number of incisions. We will pay the benefit that has the highest dollar value. The benefit is payable for skin cancer. No
lifetime limit.
Transportation $ .50 per mile
Maximum Benefit Amount of $1,200 per covered person per round trip
Benefit payable if any covered person receiving treatment incurs a charge and must travel from their residence to another city
(more than 50 miles one way from the city where he lives) to receive a diagnosis or treatment of cancer on the advice of a
doctor and not available locally.
We will pay the benefit for travel to and from your destination for commercial travel (i.e., plane, train or bus); or
non-commercial travel (i.e., use of a personal car). No lifetime limit.
Waiver of Premium
If the named insured becomes disabled because of cancer for longer than 90 consecutive days, and the date of diagnosis is after
the waiting period and while the policy is in force, you will not be required to pay premiums to keep your policy in force as long as
you are disabled. Disabled means you are unable to perform the material and substantial duties of your job; not, in fact, working at
any job for pay or benefits; and are under the regular and appropriate care of a doctor because of cancer. If you do not have a job,
we will not require you to pay premiums only as long as you are under the regular and appropriate care of a doctor because of
cancer. If you do have a job, we will require an employer’s statement of your inability to perform the material and substantial duties
of your job. No lifetime limit.
WELLNESS BENEFITS
Bone Marrow Donor Screening $50 per lifetime
Maximum of one per covered person per lifetime
Benefit payable if any covered person provides documentation of participation in a screening test as a potential bone marrow
donor. Participation must occur after the waiting period and while the policy is in force. We will pay the benefit only once per
covered person per lifetime.
Cancer Vaccine $50 per lifetime
Maximum of one per covered person per lifetime
Benefit payable if any covered person incurs a charge and receives any cancer vaccine that is FDA approved for the
prevention of cancer after the waiting period and while the policy is in force. The vaccine must be administered by licensed
medical personnel while the policy is in force. We will pay the benefit only once per covered person per lifetime.
Part 1: Cancer Wellness/Health Screening $100 per calendar year
Maximum of one per covered person per calendar year
Benefit payable once per calendar year if any covered person incurs a charge and has one of the following tests listed below
performed after the waiting period and while the policy is in force. We will pay the benefit regardless of the results of the test.
No lifetime limit. The covered tests include:
CanAssist-O-NC 7 Lvl3-100well 78194
Cancer Wellness tests
Bone marrow testing
Breast ultrasound
CA 15-3 (blood test for breast cancer)
CA 125 (blood test for ovarian cancer)
CEA (blood test for colon cancer)
Chest x-ray
Colonoscopy
Flexible sigmoidoscopy
Hemoccult stool analysis
Mammography
Pap smear
PSA (blood test for prostate cancer)
Serum protein electrophoresis(blood test for myeloma)
Skin biopsy
Thermography
ThinPrep pap test
Virtual colonoscopy
Health Screening tests
Blood test for triglycerides
Carotid Doppler
Echocardiogram (ECHO)
Electrocardiogram (EKG, ECG)
Fasting blood glucose test
Serum cholesterol test to determine level of HDL and LDL
Stress test on a bicycle or treadmill
Part 2: Cancer Wellness - Additional Invasive Diagnostic Test or
Surgical Procedure
$100 per calendar year
Maximum of one per covered person per calendar year
Benefit payable if any covered person incurs a charge for an additional invasive diagnostic test or surgical procedure
performed by a physician as the result of an abnormal result from one of the covered Cancer Wellness tests shown in Part 1.
We will pay the benefit regardless of the outcome of test(s) in Part 2. No lifetime limit.
WHAT IS NOT COVERED BY THE POLICY
We will not pay Benefits for Cancer or skin cancer:
if the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions;
or
for other conditions or diseases, except losses due directly from cancer.