hospital confinement sickness indemnity limited benefit ... · hospital confinement sickness...

Form A-45075-SS RC(8/04)

HOSPITAL CONFINEMENT SICKNESS INDEMNITYLIMITED BENEFIT POLICY

SURGICAL BENEFIT

AFLAC will pay benefits according to the Schedule of Operations when a covered person has a surgicaloperation performed for a covered sickness in a hospital or ambulatory surgical center. Only one benefit ispayable per 24-hour period for surgery even though more than one surgical procedure may be performed.We will pay the highest eligible benefit. Benefits are not payable for cosmetic or elective surgery that is notdue to sickness. Surgical Benefits are not payable for surgery performed in a doctor's or dentist's office,clinic, or other such location. Surgery performed but not listed in the Schedule of Operations will be paidaccording to the amount shown for the surgery most similar in severity and gravity. No lifetime maximum.

SCHEDULE OF OPERATIONS

BONEBone marrow biopsy

or aspiration ............................. $100Arthroscopy.................................... 150Removal of knee cartilage............. 150Total knee replacement................. 500Total hip replacement .................... 750

BRAINBurr holes not followed

by surgery ............................... 300Ventriculoperitoneal shunt............. 500Exploratory craniotomy.................. 700Excision brain tumor ...................... 1,000Hemispherectomy.......................... 2,000

BREASTIncisional biopsy ............................ 100Needle biopsy ................................ 100Breast reduction............................. 300Lumpectomy ................................. 300Stereotactic biopsy ........................ 300Axillary node dissection................. 475Partial mastectomy ........................ 475Breast reconstruction .................... 625Mastectomy

Simple ....................................... 625Radical...................................... 925

DIGESTIVEColonoscopy .................................. 100Esophagoscopy ............................. 100Exploratory laparotomy ................. 100

DIGESTIVE (cont.)Gastroscopy ................................... 100Sigmoidoscopy ............................... 100Appendectomy................................ 200Colostomy....................................... 300ERCP .............................................. 300Vagotomy........................................ 300Partial colectomy ............................ 400Colectomy....................................... 600Colectomy with ileostomy .............. 600Cholecystectomy............................ 625Esophagectomy.............................. 750Gastrectomy

Partial......................................... 750Total........................................... 1,200

EAR/NOSEMyringoscopy ................................. 100Tympanotomy................................. 100Adenoidectomy............................... 150Myringoplasty ................................. 150Mastoidectomy

Simple........................................ 150Radical....................................... 300

Tonsillectomy with or withoutadenoids.................................... 300

EYECataract .......................................... 200Enucleation ..................................... 500Corneal transplant.......................... 750

GYNECOLOGICDilation & curettage (D&C)............ 150Vaginal delivery ............................. 300Cesarean delivery.......................... 400Hysterectomy

Partial ........................................ 400Vaginal ...................................... 450

VulvectomyPartial ........................................ 450Radical...................................... 900

Abdominal hysterectomy with orwithout tubes and ovaries ........ 775

HEARTInsertion of pacemaker.................. 200Angioplasty

One vessel .............................. 500Two vessels ............................ 750

Coronary artery with graft.............. 1,000Replacement of aortic

or mitral valve.......................... 1,000

LARYNXLaryngoscopy with biopsy............. 100Tracheostomy ................................ 200Laryngectomy ............................... 500Laryngectomy with radical

neck dissection ....................... 1,000

LIVERNeedle biopsy ................................ 125Wedge biopsy ................................ 300Resection of liver ........................... 750

LUNGSNeedle biopsy ................................ 200Bronchoscopy with biopsy ............ 250Thoracostomy ................................ 300Thoracotomy .................................. 400Pneumonectomy............................ 750Wedge resection of lung................ 1,200Lobectomy...................................... 1,500

LYMPHATICBiopsy lymph node ........................ 150Splenectomy .................................. 300

MISCELLANEOUSFoot surgery .................................. 150Repair of hernia.............................. 250Carpal tunnel release

(one hand or two)...................... 250Cleft lip repair.................................. 250Club foot repair ............................... 250Partial mandibulectomy

(for TMJ).................................... 250Mandibulectomy ............................. 400Cleft palate repair ........................... 400Organ transplant............................. 2,000

PANCREASJejunostomy ................................... 750Pancreatectomy ............................. 1,000Whipple procedure ......................... 2,000

SPINECordotomy ...................................... 450Laminectomy .................................. 750

THYROIDBiopsy ............................................. 150Thyroidectomy

One lobe.................................... 450Two lobes .................................. 800

URINARYBiopsy prostate............................... 100Hydrocele........................................ 100Cystoscopy ..................................... 125Arteriovenous shunt/fistula ............ 200Cystotomy....................................... 200Orchiectomy

(unilateral, bilateral) .................. 300Biopsy of kidney ............................. 400TUR bladder ................................... 475TUR prostate .................................. 475Prostatectomy, radical.................... 750Cystectomy

Partial......................................... 800Complete ................................... 1,400

Nephrectomy .................................. 1,500

Lymphadenectomy (bilateral)........ 800

Personal SicknessIndemnity PlanHospital Confinement SicknessIndemnity Insurance

Plan Benefits

• Physician Visits

• Initial Hospitalization

• Hospital Confinement

• Major Diagnostic Exams

• Surgical

• Plus ... more

Form A45075B1TX IC(2/08)

American Family Life AssuranceCompany of Columbus (Aflac)

Personal Sickness Indemnity PlanPolicies A-45100-TX, A-45200-TX, and A-45300-TX

� Policy A-45100-TX (Level 1)� Policy A-45200-TX (Level 2)� Policy A-45300-TX (Level 3)

Physician Visits BenefitAflac will pay the amount for the level chosen when a coveredperson incurs a charge for a physician visit. Services must beunder the supervision of a physician. This is a healthmaintenance benefit; the sickness of a covered person is notrequired for this benefit to be payable. No lifetime maximum.

Level 1 Level 2 Level 3A-45100-TX A-45200-TX A-45300-TX

Benefit Amount $15 $20 $25

Number ofVisits per Year:

Individual 3 4 4Family* 6 8 8

Covered physician visits include, but are not limited to, eyeexams, well-baby visits, immunizations, periodic healthexams, and routine physicals.

The following benefits are payable for a covered sickness thatoccurs while coverage is in force. Treatment or confinement in aU.S. government hospital does not require a charge for benefits tobe payable. All of the benefits listed below, except for theHospital Confinement Benefit, are the same for Levels 1, 2, and 3(Policies A-45100-TX, A-45200-TX, and A-45300-TX).

Hospital Confinement BenefitAflac will pay the amount per day for the level chosen when acovered person requires hospital confinement for 14 or morehours for a covered sickness or for rehabilitory care as a resultof sickness and incurs a charge. Benefits are not payable fordays beyond the 180th day in a period of hospitalconfinement.** No lifetime maximum.

Level 1 Level 2 Level 3A-45100-TX A-45200-TX A-45300-TX

Benefit Amount:Days 1–15 $ 50 $ 75 $100Days 16–180 $100 $150 $200

Initial Hospitalization BenefitAflac will pay $250 per period of hospital confinement** whena covered person is confined to a hospital for at least 24 hoursfor a covered sickness. This benefit is limited to one paymentper calendar year, per covered person. No lifetime maximum.

Major Diagnostic ExamsAflac will pay $150 when a covered person requires one of thefollowing exams for a covered sickness:• CT scan• MRI (magnetic resonance imaging)• EEG (electroencephalogram)• Thallium stress test• Myelogram• Angiogram• ArteriogramThese exams must be performed in a hospital, doctor’s office,or ambulatory surgical center, and a charge must be incurred.This benefit is limited to one payment per calendar year, percovered person. No lifetime maximum.

Surgical BenefitAflacwill pay $100–$2,000when a covered person has surgeryperformed for a covered sickness in a hospital or ambulatory surgicalcenter based upon the Schedule of Operations in the policy. Only onebenefit is payable per 24-hour period for surgery even though morethan one surgical procedure may be performed.We will pay thehighest eligible benefit. Benefits are not payable for cosmetic orelective surgery that is not due to sickness. Surgical Benefits are notpayable for surgery performed in a doctor’s or dentist’s office, clinic,or other such location. Surgery performed but not listed in theschedule will be paid according to the amount shown for the surgerymost similar in severity and gravity. No lifetime maximum.

Ambulance BenefitAflac will pay $100 for ground ambulance and $1,000 for airambulance if, because of a covered sickness, a covered personrequires transportation to or from a hospital. A licensedprofessional ambulance company must provide the ambulanceservice. This benefit is limited to two trips per calendar year,per covered person. No lifetime maximum.

Grace PeriodA grace period of 31 days will be granted for the payment ofeach premium falling due after the first premium. During thegrace period, the policy will continue in force.

PremiumsPremiums are subject to change. Risk Class _________

Annual Semiannual Quarterly MonthlyPolicies: A-45100-TX $_______ $_______ $_______ $_______

A-45200-TX $_______ $_______ $_______ $_______A-45300-TX $_______ $_______ $_______ $_______

Optional Rider: Additional Initial Hospitalization BenefitA-45050 $_______ $_______ $_______ $_______

The person to whom the policy is issued is permitted to returnthe policy to Aflac within 30 days of its delivery and to havethe premium paid refunded.

*Family includes two-parent family, one-parent family, and named insured/spouse only.**A period of hospital confinement is the time period of hospital confinement that starts while the policy is in force. If theconfinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless the laterconfinement is the result of an entirely unrelated sickness or the confinements are separated by 30 days or more.

Aflac’s Personal Sickness Indemnity Plan pays cash benefitsdirectly to you, unless assigned, regardless of any other insuranceyou may have.

Continuation of Coverage BenefitAflac will waive all monthly premiums due for the policy andriders for up to two months if you meet all of the followingconditions: (1)Your policy has been in force for at least sixmonths; (2) we have received premiums for at least sixconsecutive months; (3) your premiums have been paid throughpayroll deduction and you leave your employer for any reason;(4) you or your employer notifies us in writing within 30 days ofthe date your premium payments cease because of your leavingemployment; and (5) you re-establish premium payments throughyour new employer’s payroll deduction process or direct paymentto Aflac.You will again become eligible to receive this benefitafter you re-establish your premium payments through payrolldeduction for a period of at least six months and we receivepremiums for at least six consecutive months. Payroll deductionmeans your premiums are remitted to Aflac for you by youremployer through a payroll deduction process.

Guaranteed-RenewableThe policy is guaranteed-renewable for your lifetime, subjectto Aflac’s right to change the applicable table of premiumrates by class upon any renewal date.

Effective DateThe effective date is the date shown in the Policy Schedule, notthe date the application is signed. Payroll rates may be retainedafter one month’s premium payment on payroll deduction.

Family CoverageFamily coverage includes the insured; spouse; and dependent,unmarried children under age 25. Newborns are automaticallycovered under the terms of the policy from the moment ofbirth. One-parent family coverage includes the insured and allof the insured’s unmarried, dependent children under age 25.

Pre-Existing ConditionsA pre-existing condition is a sickness for which, within the12-month period before the effective date of coverage, medicaladvice, consultation, or treatment was recommended orreceived, or for which symptoms existed that would ordinarilycause a prudent person to seek diagnosis, care, or treatment.Care or treatment caused by a pre-existing condition will notbe covered unless it begins more than six months after theeffective date of coverage.

A sickness is an illness, disease, or disorder diagnosed ortreated 30 days or more after the effective date of coverageand while coverage is in force. It also includes a pregnancywhich starts more than 30 days after your effective date ofcoverage and while coverage is in force. Illnesses, diseases, ordisorders that are diagnosed or treated within the 30-daywaiting period will not be covered for six months from theeffective date of coverage.

Limitations and ExclusionsThe sickness benefits of the policy are subject to a 30-daywaiting period. Any sickness medically treated or diagnosedbefore coverage has been in force 30 days from the effectivedate of coverage will not be covered unless the loss begins morethan six months after the effective date of coverage. Other thanthe Physician Visits Benefit, we will not pay benefits for lossesincurred as a result of an injury. We will not pay benefits for acovered person’s giving birth if the pregnancy is a normalpregnancy and the pregnancy began prior to the effective date ofthe policy (complications of pregnancy* will be covered to thesame extent as a sickness). Exception: Newborn children bornwithin the first ten months of the policy effective date will besubject to a 30-day waiting period.

The policy does not cover losses caused by or resulting from:• receiving dental care or treatment; • intentionally self-inflicting bodily injury or attempting suicide; • participatingin any illegal activity that is classified as a felony (the termfelony is as defined by the law of the jurisdiction in which theactivity takes place); • being exposed to war or any act of war,declared or undeclared, or serving in the armed forces; • havingtreatment for a mental or nervous disorder withoutdemonstrable organic disease, including depression;alcoholism or drug dependency; sustaining or contracting anyloss because of a covered person’s being intoxicated or underthe influence of alcohol, drugs, or any narcotic unlessadministered on the advice of a physician and taken accordingto the physician’s instructions (the term intoxicated refers tothat condition as defined by the law of the jurisdiction inwhich the injury or cause of the loss occurred); • havingcosmetic surgery or elective surgery that is not due tosickness; • obtaining routine nursing or routine well-baby carefor a newborn child (other than provided by the PhysicianVisits Benefit); • donating an organ within the first 12 monthsof the effective date of the policy.

Hospital does not include any institution, or part thereof, used asan ambulatory surgical center; a hospice unit (including any beddesignated as a hospice bed or a swing bed); a convalescenthome; a rest or nursing facility; a psychiatric unit; an extended-care facility; a skilled nursing facility; or a facility primarilyaffording custodial care, educational care, or care or treatmentfor persons suffering from mental disease or disorders, or carefor the aged, drug addicts, or alcoholics.

A physician does not include a member of your immediate family.

An ambulatory surgical center does not include a doctor’s ordentist’s office, clinic, or other such location.

*Complications of pregnancy do not include false labor,occasional spotting, physician-prescribed rest duringpregnancy, morning sickness, and similar conditions associatedwith the management of a difficult pregnancy not constitutinga classifiably distinct complication of pregnancy. Cesareandeliveries are not considered complications of pregnancy.

Refer to the policy, rider, and outline of coverage for complete details, limitations, and exclusions.This brochure is for illustration purposes only.

Your local Aflac insurance agent/producer

American Family Life Assurance Company of Columbus (Aflac) · Worldwide Headquarters · 1932 Wynnton Road · Columbus, Georgia 31999 · aflac.com

1.800.99.AFLAC (1.800.992.3522)

En español:1.800.SI.AFLAC (1.800.742.3522)

Visit our Web site at aflac.com.

Aflac is ...• A Fortune 500 company with nearly $60 billion in assets,insuringmore than 40million people worldwide.

• Rated AA in insurer financial strength by Standard & Poor’s(June 2006), Aa2 (Excellent) in insurer financial strength byMoody’s Investors Service (January 2006), A+ (Superior) byA.M. Best (June 2006), and AA in insurer financial strengthby Fitch, Inc. (June 2006).*

• Named by Fortunemagazine to its list of America’sMostAdmired Companies for the seventh consecutive year inMarch 2007.

• Apremier provider of insurancepolicieswithpremiumspayrolldeducted formore than370,000payroll accounts nationally.

• Outstanding in claims service, withmost claims processedwithin four days.

• Included by Forbesmagazine in its annual list of America’s400 Best Big Companies for the seventh year in January 2007.

• Named by Fortunemagazine to its list of the 100 BestCompanies toWork For in America for the ninth consecutiveyear in January 2007.

*Ratings refer only to the overall financial status of Aflac and are notrecommendations of specific policy provisions, rates, or practices.

Optional Additional Initial Hospitalization Benefit Rider Summary PageRider A-45050

Form A45076BTX RC(2/08)

Riders become part of the policy and are subject to all policyprovisions unless otherwise stated.

❑ $250

❑ $500

❑ $750

Aflac will pay the Additional Initial Hospitalization Benefitselected above when a covered person is confined to ahospital for at least 24 hours for a covered sickness. We willpay this benefit only once for each covered person percalendar year. We will pay this benefit in conjunction with theInitial Hospitalization Benefit in the policy.

Effective DateThe effective date of the rider is the effective date of thepolicy or the effective date of the rider as stated in the PolicySchedule, if later.

TerminationThe rider will terminate if the policy to which it is attachedterminates or if the premiums for the rider are not paid.

Refer to the policy, rider, and outline of coverage for complete details, limitations, and exclusions.

American Family Life Assurance Company of Columbus (Aflac)Worldwide Headquarters · 1932 Wynnton Road · Columbus, Georgia 31999 · aflac.com

HOSPITAL PROTECTION

American Family Life Assurance Company of Columbus (Aflac) Worldwide Headquarters • Columbus, Georgia 31999

Form A46075SS IC (9/07)

HOSPITAL CONFINEMENT INDEMNITY INSURANCE This insert page is to be used with Policy Series A46000, Plans 2 and 3 only. This page must accompany

the Hospital Confinement Indemnity brochures, Plans 2 and 3 only.

Surgical Benefit Aflac will pay you according to the benefits in the Schedule of Operations when a surgical operation is performed on a covered person for a covered sickness or injury in a hospital or an ambulatory surgical center. Surgical Benefits are not payable for surgery performed in a doctor’s or dentist’s office, clinic, or other such location. Only one benefit is payable per 24-hour period for surgery even though more than one surgical procedure may be performed. The highest eligible benefit will be paid. Exams covered under the Invasive Diagnostic Exams Benefit are not payable under this benefit. Surgical Benefits are not payable for losses caused by or resulting from elective surgery that is not medically necessary within the first 12 months of the effective date of the policy unless the loss begins after 12 months from the effective date of the policy. If any operation for the treatment of the covered sickness or injury is performed other than those listed, Aflac will pay you an amount comparable to the amount shown in the Schedule of Operations for the operation most nearly similar in severity and gravity. No lifetime maximum.

SCHEDULE OF OPERATIONS

BONE Bone marrow biopsy or aspiration ............................ $100 Removal of knee cartilage ............ 150 Total knee replacement................. 500 Total hip replacement ................... 750 BRAIN Burr holes not followed by surgery ................................ 300 Ventriculoperitoneal shunt ........... 500 Exploratory craniotomy................ 700 Excision of brain tumor................ 1,000 Hemispherectomy......................... 1,000 BREAST Incisional biopsy........................... 100 Needle biopsy ............................... 100 Breast reduction............................ 300 Lumpectomy ................................ 200 Stereotactic biopsy ....................... 100 Axillary node dissection............... 150 Partial mastectomy ....................... 300 Breast reconstruction.................... 500 Mastectomy Simple...................................... 300 Radical..................................... 600

DIGESTIVE Exploratory laparotomy................ $300 Appendectomy.............................. 200 Colostomy..................................... 200 ERCP ............................................ 200 Vagotomy ..................................... 300 Partial colectomy .......................... 400 Colectomy..................................... 600 Colectomy with ileostomy............ 600 Cholecystectomy .......................... 600 Esophagectomy............................. 750 Gastrectomy Partial....................................... 500 Total......................................... 1,000 EAR/NOSE Tympanotomy............................... 100 Adenoidectomy............................. 150 Myringoplasty............................... 150 Mastoidectomy Simple...................................... 150 Radical..................................... 300 Tonsillectomy with or without adenoids................................... 150

Refer to the policy for complete details, limitations, and exclusions. Form A46075SS IC (9/07)

EYE Cataract......................................... $200 Enucleation................................... 500 Corneal transplant......................... 750 GYNECOLOGIC Dilation & curettage (D&C)......... 100 Vaginal delivery ........................... 200 Cesarean delivery ......................... 200 Vaginal hysterectomy Partial ...................................... 400 Total ........................................ 750 Abdominal hysterectomy with or without tubes and ovaries .............................. 750 Vulvectomy Partial ...................................... 200 Radical..................................... 300 HEART Insertion of pacemaker ................. 200 Angioplasty One vessel................................ 500 Two vessels ............................. 750 Coronary artery with graft ............ 1,000 Replacement of aortic or mitral valve.......................... 1,000 LARYNX Tracheostomy ............................... 100 Laryngectomy .............................. 500 Laryngectomy with radical neck dissection......................... 1,000 LIVER Needle biopsy ............................... 100 Wedge biopsy ............................... 150 Resection of liver.......................... 750 LUNGS Needle biopsy ............................... 200 Thoracotomy ................................ 400 Pneumonectomy ........................... 750 Wedge resection of lung............... 500 Lobectomy.................................... 750 LYMPHATIC Biopsy lymph node....................... 100 Splenectomy ................................. 300 Lymphadenectomy (bilateral) ...... 500

MISCELLANEOUS Foot surgery ................................. $150 Repair of hernia ............................ 250 Carpal tunnel release (one hand or two) .................... 100 Fractures Open reduction ........................ 250 Mandibulectomy........................... 400 Organ transplant ........................... 1,000 Vasectomy ................................... 150 PANCREAS Jejunostomy.................................. 200 Pancreatectomy............................. 500 Whipple procedure ....................... 1,000 SKIN Biopsy .......................................... 50 Excision of lesion of skin Without flap or graft................ 100 With flap or graft ..................... 300

SPINE Discectomy ................................... 500 Fusions.......................................... 750 Laminectomy................................ 500 THYROID Biopsy........................................... 150 Thyroidectomy One lobe .................................. 200 Two lobes................................. 500 URINARY Biopsy prostate ............................. 100 Hydrocele...................................... 100 Cystotomy..................................... 200 Orchiectomy (unilateral, bilateral) ................ 200 Biopsy of kidney........................... 400 TUR bladder ................................. 300 TUR prostate................................. 300 Prostatectomy, radical .................. 750 Cystectomy (bladder) Partial....................................... 500 Complete ................................. 750 Nephrectomy ................................ 750

Optional Initial Hospitalization Benefit Rider Summary PageRider A46050

Riders become a part of the policy and are subject to all policyprovisions unless otherwise stated.

❑ $250 Initial Hospitalization Benefit



❑ $1,000 Initial Hospitalization Benefit

Aflac will pay the Initial Hospitalization Benefit selectedabove when a covered person requires hospital confinementfor a covered sickness or injury, for each period of hospitalconfinement. This benefit is limited to one payment percalendar year, per covered person.

TerminationThe rider will terminate if the policy to which it is attachedterminates or if the premiums for the rider are not paid.

Effective DateThe effective date of the rider is the effective date of thepolicy or the effective date of the rider as stated in the PolicySchedule, if later.

The rider to which this sales material pertains is written onlyin English; the rider prevails if interpretation of this materialvaries.

Form A46076RTX IC(5/08)

Refer to the policy and rider for complete details, limitations, and exclusions.

American Family Life Assurance Company of Columbus (Aflac)Worldwide Headquarters · 1932 Wynnton Road · Columbus, Georgia 31999 · aflac.com

Plan 1

Designed specifically for

hospital stays

Form A46175TX RC(4/07)

HospitalProtectionHospital Confinement Indemnity Insurance …

what you need, when you need it.


Hospital ProtectionPolicy A46100TX

Annual Hospitalization Confinement BenefitAflac will pay the amount listed below for the first five daysof hospitalization when a covered person requires hospitalconfinement* for a covered sickness or injury, or forrehabilitory care as a result of sickness or injury, and a chargeis incurred.

Sickness $400 per dayInjury $500 per day

Benefits for the Annual Hospitalization Confinement Benefitare limited to a total benefit payment of five days per calendaryear, per policy. Confinements not separated by 30 days ormore, or hospitalization that begins prior to the end of onecalendar year and continues into the next calendar year, willbe considered one confinement.

Daily Hospital Confinement BenefitAflac will pay $100 per day for the period of hospitalconfinement* when a covered person requires hospitalconfinement for a covered sickness or injury, or forrehabilitory care as a result of sickness or injury. This benefitis payable in addition to the Annual HospitalizationConfinement Benefit. The maximum benefit period for anyone period of hospital confinement is 365 days. No lifetimemaximum.

*Hospital confinement does not include emergency rooms.Treatment or confinement in a U.S. government hospital doesnot require a charge for benefits to be payable.

Waiver of Premium BenefitAflac will waive from month to month, for the named insuredonly, any premium(s) falling due during the named insured’scontinued hospital confinement. This benefit will begin afterthe named insured has received Daily Hospital ConfinementBenefits from the policy for 30 consecutive days. When DailyHospital Confinement Benefits are no longer being paid,premium payments must be resumed. Once premiumpayments are resumed, any new confinements must againsatisfy the 30-day continued confinement for premiums to bewaived. If you die and your spouse becomes the new namedinsured, premiums will start again at the appropriate rate andwill be due on the first premium due date after the change.The new named insured will then be eligible for this benefit ifthe need arises.


PremiumsPremiums are subject to change. Risk Class: ________

Annual Semiannual Quarterly MonthlyPolicy A46100TX: $_______ $_______ $_______ $_______

Optional Rider: Initial Hospitalization Benefit

A46050: $_______ $_______ $_______ $_______


Guaranteed-RenewableThe policy is guaranteed-renewable for your lifetime,subject to Aflac’s right to change premiums by class uponany renewal date.

Family CoverageFamily coverage includes the insured; spouse; and dependent,unmarried children under age 25. Newborn children areautomatically insured from the moment of birth. One-parentfamily coverage includes the insured and dependent,unmarried children under age 25. A dependent child must beunder age 25 at the time of application to be eligible forcoverage.

Effective DateThe effective date is the date shown in the Policy Schedule,not the date the application is signed. Payroll rates may beretained after one month’s premium payment on payrolldeduction.

Pre-Existing ConditionsA pre-existing condition is an illness, disease, or disorder forwhich, within the 12-month period before the effective date ofcoverage, medical advice, consultation, or treatment wasrecommended or received, or for which symptoms existed thatwould ordinarily cause a prudent person to seek diagnosis,care, or treatment. Care or treatment caused by a pre-existingcondition will not be covered unless it begins more than sixmonths after the effective date of coverage. A sickness is anillness, disease, or disorder, independent of injury, diagnosedor treated more than 30 days after the effective date ofcoverage and while coverage is in force.

Limitations and ExclusionsAny illness, disease, or disorder diagnosed by a physician ormedically treated during the 12 months prior to the effectivedate of the policy will not be covered, unless the loss beginsmore than six months after the effective date of the policy.Benefits are not payable for any illness, disease, or disorderthat is diagnosed by a physician or medically treated beforecoverage has been in force 30 days from the effective dateshown in the Policy Schedule, unless the loss begins morethan six months after the effective date of the policy. Benefitsfor a covered sickness for all persons added to the policy(including newborns) are subject to a 30-day waiting period.Aflac will waive the waiting period for newborns added afterthe policy has been in force for ten full months.

The policy does not cover losses caused by or resulting fromintentionally self-inflicting bodily injury or attemptingsuicide; participating in any illegal activity that is classified asa felony (the term felony is as defined by the law of thejurisdiction in which the activity takes place); being exposedto war or any act of war, declared or undeclared, or activelyserving in any of the armed forces or units auxiliary thereto,including the National Guard or Reserve; having treatment fora mental or nervous disorder without demonstrable organicdisease; alcoholism or drug dependency; any loss sustained orcontracted due to a covered person’s being intoxicated orunder the influence of alcohol, drugs, or any narcotic unlessadministered on the advice of a physician and taken accordingto the physician’s instructions (the term intoxicated refers tothat condition as defined by the law of the jurisdiction inwhich the injury or cause of the loss occurred); havingcosmetic surgery that is not medically necessary; havingelective surgery that is not medically necessary within thefirst 12 months of the effective date of the policy; pregnancyor childbirth for a covered person, if the pregnancy is anormal pregnancy and the pregnancy began prior to theeffective date of the policy (complications of pregnancy willbe covered to the same extent as a sickness); routine nursingor well-baby care for a newborn child; being hospitalizedbefore the effective date of coverage; or donating an organwithin the first 12 months of the effective date of the policy.

If the period of hospital confinement follows a previouslycovered confinement, it will be deemed a continuation of thefirst confinement unless the later confinement is the result ofan entirely unrelated sickness or injury, or the confinementsare separated by 30 days or more during which the coveredperson is not confined in any institution or facility.

A physician does not include a member of your immediatefamily.

Hospital does not include any institution or part thereof usedas an emergency room; a hospice unit, including any beddesignated as a hospice or a swing bed; a convalescent home;a rest or nursing facility; a psychiatric unit; an extended-carefacility; a skilled nursing facility; or a facility primarilyaffording custodial or educational care, care or treatment forpersons suffering from mental disease or disorders, care forthe aged, or care for persons addicted to drugs or alcohol.

Complications of pregnancy do not include prematuredelivery without incidence, false labor, occasional spotting,prescribed rest during pregnancy, morning sickness, andsimilar conditions associated with the management of adifficult pregnancy not constituting a classifiably distinctcomplication of pregnancy. Cesarean deliveries are notconsidered complications of pregnancy.

The policy to which this sales material pertains is written onlyin English; the policy prevails if interpretation of this materialvaries.

This is a brief summary of coverage. Refer to the policy, rider, and outline of coveragefor complete details, limitations, and exclusions.



1.800.99.AFLAC (1.800.992.3522)



Aflac is ...• A Fortune 500 company (Fortune magazine, April 2006)

with nearly $60 billion (company statistics, December2005), in assets, insuring more than 40 million peopleworldwide (company statistics, May 2005).


• Named by Fortune magazine to its list of America’s MostAdmired Companies for the seventh consecutive year inMarch 2007.

• A premier provider of insurance policies with premiums payrolldeducted for more than 370,000 payroll accounts nationally(company statistics, November 2006).

• Included by Forbes magazine in its annual list of America’s400 Best Big Companies for the seventh year in January 2007.

• Named by Fortune magazine to its list of the 100 BestCompanies to Work For in America for the ninth consecutiveyear in January 2007.


Plan 2

Hospital ProtectionHospital Confinement Indemnity Insurance …


Plan Benefits

• Annual Hospitalization

Confinement

• Daily Hospital Confinement

• Invasive Diagnostic Exams

• Plus … more









Invasive Diagnostic Exams BenefitAflac will pay $100 when a covered person requires one of thefollowing exams and a charge is incurred: arthroscopy,bronchoscopy, colonoscopy, cystoscopy, gastroscopy,laryngoscopy, sigmoidoscopy, esophagoscopy, ormyringoscopy. These exams must be performed in a hospitalor an ambulatory surgical center. Only one benefit is payableper 24-hour period, per covered person. When an invasivediagnostic exam and a surgical benefit are performed on thesame day, only one benefit is payable per 24-hour period. Thehighest eligible benefit will be paid. No lifetime maximum.

Surgical BenefitAflac will pay $50–$1,000 when a surgical operation isperformed, including a vaginal or cesarean delivery, on acovered person for a covered sickness or injury in a hospitalor an ambulatory surgical center. If any operation for thetreatment of the covered sickness or injury is performed otherthan those listed, Aflac will pay an amount comparable to theamount shown in the Schedule of Operations for the operationmost nearly similar in severity and gravity. Only one benefit ispayable per 24-hour period for surgery, even though more

than one surgical procedure may be performed. The highesteligible benefit will be paid. Exams covered under theInvasive Diagnostic Exams Benefit are not payable under thisbenefit. No lifetime maximum.

Surgical Benefits are not payable for surgery performed in adoctor’s or dentist’s office, clinic, or other such location.Surgical Benefits are not payable for losses caused by orresulting from elective surgery that is not medically necessarywithin the first 12 months of the effective date of the policyunless the loss begins after 12 months from the effective dateof the policy.

Outpatient Surgical Room Charge BenefitAflac will pay the amount listed below when a covered personhas a surgical operation or an invasive diagnostic examperformed on an outpatient basis in a hospital, including anambulatory surgical center. This benefit is not payable on thesame day as the Hospital Confinement Benefit. No lifetimemaximum on the number of operations.

Surgical operation or invasive diagnostic exam with general anesthesia $300

Surgical operation or invasive diagnostic exam without general anesthesia $100

Waiver of Premium BenefitAflac will waive from month to month, for the named insuredonly, any premium(s) falling due during the named insured’scontinued hospital confinement. This benefit will begin afterthe named insured has received Daily Hospital ConfinementBenefits from the policy for 30 consecutive days. When DailyHospital Confinement Benefits are no longer being paid,premium payments must be resumed. Once premiumpayments are resumed, any new confinements must againsatisfy the 30-day continued confinement for premiums to bewaived. If you die and your spouse becomes the new namedinsured, premiums will start again at the appropriate rate andwill be due on the first premium due date after the change.The new named insured will then be eligible for this benefit ifthe need arises.



Annual Semiannual Quarterly MonthlyPolicy A46200TX: $_______ $_______ $_______ $_______Optional Rider: Initial Hospitalization BenefitA46050: $_______ $_______ $_______ $_______


Guaranteed-RenewableThe policy is guaranteed-renewable for your lifetime, subjectto Aflac’s right to change premiums by class upon anyrenewal date.

Family CoverageFamily coverage includes the insured; spouse; and dependent,unmarried children under age 25. Newborn children areautomatically insured from the moment of birth. One-parentfamily coverage includes the insured and dependent, unmarriedchildren under age 25. A dependent child must be under age 25at the time of application to be eligible for coverage.



Limitations and ExclusionsAny illness, disease, or disorder diagnosed by a physician ormedically treated during the 12 months prior to the effectivedate of the policy will not be covered, unless the loss beginsmore than six months after the effective date of the policy.Benefits are not payable for any illness, disease, or disorderthat is diagnosed by a physician or medically treated beforecoverage has been in force 30 days from the effective dateshown in the Policy Schedule, unless the loss begins morethan six months after the effective date of the policy. Benefitsfor a covered sickness for all persons added to the policy

(including newborns) are subject to a 30-day waiting period.Aflac will waive the waiting period for newborns added afterthe policy has been in force for ten full months.

The policy does not cover losses caused by or resulting fromintentionally self-inflicting bodily injury or attemptingsuicide; participating in any illegal activity that is classified asa felony (the term felony is as defined by the law of thejurisdiction in which the activity takes place); being exposedto war or any act of war, declared or undeclared, or activelyserving in any of the armed forces or units auxiliary thereto,including the National Guard or Reserve; having treatment fora mental or nervous disorder without demonstrable organicdisease; alcoholism or drug dependency; any loss sustained orcontracted due to a covered person’s being intoxicated orunder the influence of alcohol, drugs, or any narcotic unlessadministered on the advice of a physician and taken accordingto the physician’s instructions (the term intoxicated refers tothat condition as defined by the law of the jurisdiction inwhich the injury or cause of the loss occurred); havingcosmetic surgery that is not medically necessary; havingelective surgery that is not medically necessary within thefirst 12 months of the effective date of the policy; pregnancyor childbirth for a covered person, if the pregnancy is anormal pregnancy and the pregnancy began prior to theeffective date of the policy (complications of pregnancy willbe covered to the same extent as a sickness); routine nursingor well-baby care for a newborn child; being hospitalizedbefore the effective date of coverage; or donating an organwithin the first 12 months of the effective date of the policy.








1.800.99.AFLAC (1.800.992.3522)






• Named by Fortune magazine to its list of America’s MostAdmired Companies for the seventh consecutive year in March 2007.





Plan 3

HospitalProtectionHospital Confinement Indemnity Insurance …


Plan Benefits

• Annual Hospitalization

Confinement

• Daily Hospital Confinement

• Invasive Diagnostic Exams

• Wellness

• Plus … more









Invasive Diagnostic Exams BenefitAflac will pay $100when a covered person requires one of thefollowing exams and a charge is incurred: arthroscopy,bronchoscopy, colonoscopy, cystoscopy, gastroscopy,laryngoscopy, sigmoidoscopy, esophagoscopy, ormyringoscopy. These exams must be performed in a hospitalor an ambulatory surgical center. Only one benefit is payableper 24-hour period, per covered person. When an invasivediagnostic exam and a surgical benefit are performed on thesame day, only one benefit is payable per 24-hour period. Thehighest eligible benefit will be paid. No lifetime maximum.

Surgical BenefitAflac will pay $50–$1,000when a surgical operation isperformed, including a vaginal or cesarean delivery, on acovered person for a covered sickness or injury in a hospitalor an ambulatory surgical center. If any operation for thetreatment of the covered sickness or injury is performed otherthan those listed, Aflac will pay an amount comparable to theamount shown in the Schedule of Operations for the operationmost nearly similar in severity and gravity. Only one benefit ispayable per 24-hour period for surgery even though more thanone surgical procedure may be performed. The highesteligible benefit will be paid. Exams covered under theInvasive Diagnostic Exams Benefit are not payable under thisbenefit. No lifetime maximum.

Surgical Benefits are not payable for surgery performed in adoctor’s or dentist’s office, clinic, or other such location.Surgical Benefits are not payable for losses caused by orresulting from elective surgery that is not medically necessary

within the first 12 months of the effective date of the policyunless the loss begins after 12 months from the effective dateof the policy.

Outpatient Surgical Room Charge BenefitAflac will pay the amount listed below when a covered personhas a surgical operation or an invasive diagnostic examperformed on an outpatient basis in a hospital, to include anambulatory surgical center. This benefit is not payable on thesame day as the Hospital Confinement Benefit. No lifetimemaximum on the number of operations.

Surgical operation or invasive diagnostic examwith general anesthesia $300

Surgical operation or invasive diagnostic examwithout general anesthesia $100

Medical Diagnostic and Imaging BenefitAflac will pay $150 per calendar year for each covered personwhen a covered person requires one of the following examsand a charge is incurred: CT scan, MRI (magnetic resonanceimaging), EEG (electroencephalogram), thallium stress test,myelogram, angiogram, or arteriogram. These exams must beperformed in a hospital, an ambulatory surgical center, or adoctor’s office. This benefit is limited to one payment percalendar year, per covered person. No lifetime maximum.

Ambulance BenefitAflac will pay $100 if, due to a covered sickness or injury, acovered person requires ground ambulance transportation toor from a hospital and a charge is incurred. If air ambulancetransportation is required due to a covered sickness or injuryand a charge is incurred, Aflac will pay $1,000. A licensedprofessional ambulance company must provide the ambulanceservice. This benefit is limited to two trips per calendar year,per covered person. No lifetime maximum.

Wellness BenefitAfter the policy has been in force for 12 months, Aflac will pay$50 if you or any one family member undergoes routineexaminations or other preventive testing during the followingpolicy year. Services covered are annual physicalexaminations, dental exams, mammograms, Pap smears, eyeexaminations, immunizations, prostate-specific antigen tests,ultrasounds, and blood screenings. This benefit will becomeavailable following each anniversary of the policy’s effectivedate for service received during the following policy year andis payable only once per policy each 12-month periodfollowing your policy anniversary date. Eligible familymembers are your spouse and the dependent children of eitheryou or your spouse. Service must be under the supervision ofor recommended by a physician, received while your policy isin force, and a charge must be incurred.

Waiver of Premium BenefitAflac will waive from month to month, for the named insuredonly, any premium(s) falling due during the named insured’scontinued hospital confinement. This benefit will begin afterthe named insured has received Daily Hospital ConfinementBenefits from the policy for 30 consecutive days. When Daily


Hospital Confinement Benefits are no longer being paid,premium payments must be resumed. Once premiumpayments are resumed, any new confinements must againsatisfy the 30-day continued confinement for premiums to bewaived. If you die and your spouse becomes the new namedinsured, premiums will start again at the appropriate rate andwill be due on the first premium due date after the change.The new named insured will then be eligible for this benefit ifthe need arises.



Annual Semiannual Quarterly MonthlyPolicy A46300TX: $_______ $_______ $_______ $_______Optional Rider: Initial Hospitalization BenefitA46050: $_______ $_______ $_______ $_______


Guaranteed-RenewableThe policy is guaranteed-renewable for your lifetime, subjectto Aflac’s right to change premiums by class upon anyrenewal date.

Family CoverageFamily coverage includes the insured; spouse; and dependent,unmarried children under age 25. Newborn children areautomatically insured from the moment of birth. One-parentfamily coverage includes the insured and dependent, unmarriedchildren under age 25. A dependent child must be under age25 at the time of application to be eligible for coverage.


Limitations and ExclusionsAny illness, disease, or disorder diagnosed by a physician ormedically treated during the 12 months prior to the effectivedate of the policy will not be covered, unless the loss beginsmore than six months after the effective date of the policy.Benefits are not payable for any illness, disease, or disorderthat is diagnosed by a physician or medically treated beforecoverage has been in force 30 days from the effective dateshown in the Policy Schedule, unless the loss begins morethan six months after the effective date of the policy. Benefits

for a covered sickness for all persons added to the policy(including newborns) are subject to a 30-day waiting period.Aflac will waive the waiting period for newborns added afterthe policy has been in force for ten full months.

The policy does not cover losses caused by or resulting fromintentionally self-inflicting bodily injury or attemptingsuicide; participating in any illegal activity that is classified asa felony (the term felony is as defined by the law of thejurisdiction in which the activity takes place); being exposedto war or any act of war, declared or undeclared, or activelyserving in any of the armed forces or units auxiliary thereto,including the National Guard or Reserve; having treatment fora mental or nervous disorder without demonstrable organicdisease; alcoholism or drug dependency; any loss sustained orcontracted due to a covered person’s being intoxicated orunder the influence of alcohol, drugs, or any narcotic unlessadministered on the advice of a physician and taken accordingto the physician’s instructions (the term intoxicated refers tothat condition as defined by the law of the jurisdiction inwhich the injury or cause of the loss occurred); havingcosmetic surgery that is not medically necessary; havingelective surgery that is not medically necessary within thefirst 12 months of the effective date of the policy; pregnancyor childbirth for a covered person, if the pregnancy is anormal pregnancy and the pregnancy began prior to theeffective date of the policy (complications of pregnancy willbe covered to the same extent as a sickness); routine nursingor well-baby care for a newborn child; being hospitalized beforethe effective date of coverage; or donating an organ within thefirst 12 months of the effective date of the policy.








1.800.99.AFLAC (1.800.992.3522)






• Named by Fortune magazine to its list of America’s MostAdmired Companies for the seventh consecutive year inMarch 2007.





hospital confinement sickness indemnity limited benefit ... · hospital confinement sickness...

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