Understanding Critical Illness Insurance
This document provides an overview of critical illness insurance, detailing its purpose, coverage for various serious illnesses, and the financial benefits it offers to supplement existing health insurance plans.
Critical illness insurance Critical illness insurance may help you cover expenses not covered by your health insurance. It’s a cash payment you receive if you ever experience a serious illness like cancer, a heart attack, or a stroke, giving you the financial support to focus on recovery. Who is it for? Criticalillnessinsuranceisasupplementalpolicyforpeoplewhoalready havehealthinsurance.Itprovidesyouwithanadditionalpaymentto coverexpenseslikedeductibles,treatments,andlivingcosts. What does it cover? Critical illnesses include strokes, heart attacks, Parkinson’s disease and cancer. Our policies can cover over 30 major illnesses, helping you stay financially stable by paying you a lump sum if you’re diagnosed with one of them. Why should I consider it? Health coverage is becoming more expensive, with higher co-pays, premiums, and deductibles. Critical illness insurance is an affordable way to supplement and pay for additional expenses that your health insurance doesn’t cover. Our policies typically provide payments for the first and second time you’re diagnosed with a covered illness. Plus, critical illness insurance is portable and payments are made directly to you. Watch our video How critical illness insurance helps cover the costs of treatment. You willreceive these benefits ifyou meetthe conditions listedin the policy. Critical costs John is hospitalizedafteraheart attack, andhas tocoverthe cost of five days as an inpatient. Average heart attack hospitalization expense: $53,000 Average Major Medical deductible: $1,500 MajorMedicalcovers 80%ofthecost after the deductibleis met, butJohn’s stillresponsiblefor 20%: $10,300. Totalout-of-pocketamountforJohn (deductible + coinsurance): $11,800. John has a $10,000 Guardian Critical Illness policy, which covers the majority of these out-of-pocket expenses. This example is for illustrative purposes only. Your plan’s coverage mayvary. See yourplan’s information on the following pages for specific amounts and details. GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America AesopIntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 2020-104305 (07/22) 25
Your critical illness coverage GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Aesop IntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 CRITICAL ILLNESS Benefit Amount(s) Employee may choose a lump sum benefit up to $10,000. Please see your cost illustration for a full list of available benefit amounts. CONDITIONS Cancer 1st OCCURRENCE 2nd OCCURRENCE Invasive Cancer 100% 100% Carcinoma In Situ 30% 0% Benign Brain Tumor 75% 0% Skin Cancer $250 per lifetime Not Covered Vascular Heart Attack 100% 100% Stroke 100% 100% Heart Failure 100% 100% Coronary Arteriosclerosis 30% 0% Other Organ Failure 100% 100% Kidney Failure 100% 100% ADDITIONAL CONDITIONS 1st OCCURRENCE ONLY Addison's Disease 30% ALS (Lou Gehrig's Disease) 100% Alzheimer's Disease 50% Coma 100% Huntington's Disease 30% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Multiple Sclerosis 30% Parkinson's Disease 100% Permanent Paralysis 50% for 1 limb, 100% for 2 limbs Severe Burns 100% Childhood Conditions 1st OCCURRENCE ONLY Cerebral Palsy 100% Cleft Lip/Palate 100% Club Foot 100% Cystic Fibrosis 100% Down's Syndrome 100% Muscular Dystrophy 100% Spina Bifida 100% Type 1 Diabetes 100% 26
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Aesop IntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 Your critical illness coverage CRITICAL ILLNESS Spouse Benefit 50% of employee's lump sum benefit Child Benefit- children age Birth to 26 years 50% of employee's lump sum benefit Guarantee Issue: The ‘guarantee’ means you are not required to answer health questions to qualify for coverage up to and including the specified amount, when you sign up for coverage during the initial enrollment period or the annual open enrollment period. We Guarantee Issue up to: $10,000 For a spouse: $5,000 For a child: All Amounts Health questions are required if the elected amount exceeds the Guarantee Issue. Portability: Allows you to take your Critical Illness coverage with you if you terminate employment. Included Pre-Existing Condition Limitation: A pre-existing condition includes any condition for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Not Applicable WELLNESS BENEFIT Employee Per Year Limit $50 Spouse Per Year Limit $50 Child Per Year Limit $50 Condition Definitions • Stroke: Stroke must be severe enough to cause neurological deficits at least 30 days after the event. • Heart Failure: An insured must be placed on an organ transplant list in order to be eligible for the Heart failure benefits. • Coronary Arteriosclerosis: Coronary Arteriosclerosis must be severe enough to require a coronary artery bypass graft. • Organ Failure: Organ failure includes both lungs, liver, pancreas or bone marrow and requires the insured to be placed on an organ transplant list. • Kidney Failure: An insured must be placed on an organ transplant list in order to be eligible for the Kidney failure benefits. 27
GUARDIAN® is a registered trademark of The Guardian Life Insurance Company of America Aesop IntermediateLLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 Critical Illness Cost Illustration To determine the most appropriate level of coverage, you should consider your current basic monthly expenses and expected financial needs during a Critical Illness. Spouse coverage premium is based on Employee age Child cost is included with employee election. Monthly Premiums Displayed Election Cost Per Age Bracket < 30 30-39 40-49 50-59 60-69 70+ $10,000 Benefit Amount Employee $10,000 Spouse $5,000 Non-tobacco Tobacco Non-tobacco Tobacco $3.90 $5.80 $1.95 $2.90 $6.20 $10.30 $3.10 $5.15 $11.20 $22.30 $5.60 $11.15 $21.80 $50.90 $10.90 $25.45 $37.90 $99.40 $18.95 $49.70 $63.80 $167.50 $31.90 $83.75 EXCLUSIONS AND LIMITATIONS A SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS FOR CRITICAL ILLNESS: We will not pay benefits for the First Occurrence of a Critical Illness if it occurs less than 3 months after the First Occurrence of a related Critical Illness for which this Plan paid benefits. By related we mean either: (a) both Critical Illnesses are contained within the Cancer Related Conditions category; or (b) both Critical Illnesses are contained within the Vascular Conditions category. We will not pay benefits for a Second occurrence (recurrence) of a Critical Illness unless the Covered Person has not exhibited symptoms or received care or treatment for that Critical Illness for at least 12 months in a row prior to the recurrence. For purposes of this exclusion, care or treatment does not include: (1) preventive medications in the absence of disease; and (2) routine scheduled follow-up visits to a Doctor. We do not pay benefits for claims relating to a covered person: taking part in any war or act of war (including service in the armed forces) committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane or insane. Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding 1 year; or (b) in an area under travel warning by the US Department of State, subject to state specific variations. Guardian’s Critical Illness plan does not provide comprehensive medical coverage. It is a basic or limited benefit and is not intended to cover all medical expenses. It does not provide “basic hospital,” “basic medical,” or “ medical” insurance as defined by the New York State Insurance Department. Health questions are required on late enrollees. This coverage will not be effective until approved by a Guardian underwriter. This policy will not pay for a diagnosis of a listed critical illness that is made before the insured’s Critical Illness effective date with Guardian. The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. See your certificate booklet for a full listing of exclusions & limitations.. If Critical Illness insurance premium is paid for on a pre tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding the tax treatment of your policy benefits.. Contract # GP-1-CI-14 Guardian’s Critical Illness Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. This policy provides limited benefits health insurance only. It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. Policy Form # GP-1-LAH-12R; GP-1-CI-14 28
