Product Reference Guide - Gateway Insurance

Product Reference Guide

Copyright 2006 by Aflac. All rights reserved.

This information is for agent use only. It is not intended for distribution to the general public.

MMC05370 1/06

Table of Contents

Introduction................................................................................................................................... 2

Personal Accident Indemnity (PAI) Plan ................................................................................... 6

Wellness Benefit ....................................................................................................................... 13

Pre-Existing Conditions ............................................................................................................ 18

Waiting Period........................................................................................................................... 25

Personal Accident Indemnity Plan Review............................................................................... 29

Personal Disability Income Protector (PDIP) Plan.................................................................. 32

Pregnancy.................................................................................................................................. 32


Waiting Period........................................................................................................................... 47

Personal Disability Income Protector Plan Review .................................................................. 53

Personal Cancer Indemnity (PCI) Plan .................................................................................... 55


Waiting Period........................................................................................................................... 60

Personal Cancer Indemnity Plan Review.................................................................................. 64

Dental Series A81000 .................................................................................................................. 66


Waiting Period........................................................................................................................... 68

Competitive Replacement Application ..................................................................................... 72

Dental Series A81000 Review .................................................................................................. 75

Personal Sickness Indemnity (PSI) Plan................................................................................... 78

Pregnancy.................................................................................................................................. 78


Waiting Period........................................................................................................................... 93

Physician Visits Benefit .......................................................................................................... 108

Personal Sickness Indemnity Plan Review ............................................................................. 110

Review Answers ........................................................................................................................ 112

Product Reference Guide i

Introduction

Product Reference Guide 1

Introduction

Introduction The purpose of this guide is to serve as a reference to discuss how Aflac’s top five products

pertain to the following areas:

Personal Accident Indemnity Plan: Pregnancy

Wellness Benefit

Pre-Existing Conditions

Waiting Period

Personal Disability Income Protector Plan: Pregnancy


Waiting Period

Personal Cancer Indemnity Plan: Wellness Benefit

Waiting Period

Dental Series A81000: Wellness Benefit

Waiting Period

Competitive Replacement Application

Personal Sickness Indemnity: Pregnancy


Waiting Period

Physician Visits Benefit

Within each product, if state variations apply regarding the discussed topics, a copy of the policy

variation will be shown.

On the following page is a quick-reference sheet that marks states with exceptions.

For each product, a review quiz is included to reinforce learning.



Introduction

3

This guide is intended as a reference piece for Aflac associates only and is not approved for

sales purposes.

This guide is current as of August 2005. For policies that were introduced after this date, it

is your responsibility to check for state variations. Do not assume that because a state is not

listed that there are no state variations.

To determine Aflac’s top five products, the Production Mix Report as of Week 25, 2005, was

used.


PAI AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MOPregnancyWellness BenefitPre-Existing ConditionsWaiting PeriodPDIPPregnancyPre-Existing ConditionsWaiting PeriodPCIWellness BenefitWaiting PeriodDental Series 81000Wellness BenefitWaiting PeriodCompetitive ReplacementPSIPregnancyPre-Existing ConditionsPhysician Visits BenefitWaiting Period

PAI MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WYPregnancyWellness BenefitPre-Existing ConditionsWaiting PeriodPDIPPregnancyPre-Existing ConditionsWaiting PeriodPCIWellness BenefitWaiting PeriodDental Series 81000Wellness BenefitWaiting PeriodCompetitive ReplacementPSIPregnancyPre-Existing ConditionsPhysician Visits BenefitWaiting Period

Aflac's Top Five Products Quick-Reference SpreadsheetStates with exceptions to the standard are marked. Please refer to your specific state introduction packet for complete details. This spreadsheet is current as of August 2005.

Note: States with darkened cells do not sell the product listed.

4

Personal Accident

Indemnity (PAI) Plan


Personal Accident Indemnity (PAI) Plan


(Policy Series A-34000)

Pregnancy

The Personal Accident Indemnity Sickness Disability Rider contains the following provision for

pregnancy and childbirth: Disability as a result of pregnancy and childbirth is payable to the

same extent as a covered sickness. After this policy has been in force ten months, the maximum

benefit period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for

cesarean delivery, less the elimination period chosen, unless the woman furnishes proof that she

remains disabled beyond these time frames.

Aflac treats maternity as a sickness. Before any benefits are payable, the woman must first

satisfy her elimination period. Then the benefit period and the disability benefits begin. Typically

the standard disability length, as set by physicians and the insurance industry, is six weeks for

noncesarean delivery and eight weeks for cesarean delivery. The elimination period is not

subtracted from the benefit period. The elimination period is satisfied first and then benefits are

payable for the remaining time she is considered disabled, up to the benefit period chosen.

Most states have a ten-month maternity exclusion that states, “We will not pay benefits for a

disability that is caused by or occurs as a result of the woman giving birth within the first ten

months of the effective date of the policy as a result of a normal pregnancy, including cesarean

(complications of pregnancy will be covered to the same extent as a sickness).”

Therefore, disability as a result of pregnancy and childbirth is excluded if the birth occurs within

ten months of the effective date of the policy (as a result of a normal pregnancy). Complications

of pregnancy are not excluded for the first ten months. If a woman is totally disabled because of

complications of pregnancy, she would be eligible for disability benefits.

Some states do not have the ten-month maternity exclusion. Please refer to your specific

state introduction packet for complete details. However, all states are subject to the pre-

existing condition limitation provision. (In most states the pre-existing condition limitation



provision is 12 months before and 12 months after the effective date of coverage.) Some

states do not specify the six- or eight-week disability time frame, although Aflac will

continue to administer claims in this manner.




States with exceptions to the standard policy are noted below. The underlined text was added

to the policy and the strikethrough text was deleted.



Connecticut The definition of complications of pregnancy was added for the PAI

policy.

Connecticut The definition of complications of pregnancy was added for the PAI

policy.

F. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; but that do not include false labor, occasional spotting, Physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy; (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible; and (c) conditions requiring medical treatment after the termination of pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy. (This Definition only applies if Optional Sickness Disability Rider Form Series A-34052 is purchased.)

Idaho The definition of complications of pregnancy was added for the PAI

Sickness Rider.

Idaho The definition of complications of pregnancy was added for the PAI

Sickness Rider.


D. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible.

Complications of Pregnancy do not include false labor, occasional spotting, Physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy.

7


The maternity limitation and exclusion is different for the PAI Sickness

Rider.

2. Giving birth within the first ten months of the Effective Date of this rider as a result of a normal pregnancy, including cesarean (complications of pregnancy (Complications of Pregnancy will be covered to the same extent as a Sickness); or

Iowa The maternity limitation and exclusion is different for the PAI Sickness

Rider.

2. Giving birth within the first ten months of the Effective Date of this rider as a result of a normal pregnancy, including cesarean (complications of pregnancy, including non-elective cesarean, will be covered to the same extent as a Sickness); or

Kansas The maternity limitation and exclusion is different for the PAI Sickness

Rider.

2. Giving birth within the first ten months of the Effective Date of this rider as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness); or

The benefits are different for the PAI Sickness Rider regarding maternity.

Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this rider has been in force ten months, the The maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

Michigan The maternity limitation and exclusion is different for the PAI Sickness

Rider.




Montana The maternity limitation and exclusion is different for the PAI Sickness

Rider.



New Jersey The definition of complications of pregnancy was added for the PAI

Sickness Rider.


Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this rider has been in force ten months, the maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

C. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; but that do not include false labor, occasional spotting, physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy; (b) hyperemesis gravidarum and pre-eclampsia requiring hospital confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible; and (c) conditions requiring medical treatment after the termination of pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy.


The maternity limitation and exclusion is different for the PAI Sickness

Rider.

2. Giving birth within the first ten months of the Effective Date of this rider as a result of a normal pregnancy when conception occurs prior to the Effective Date of this rider. Complications of Pregnancy (including non-elective cesarean (complications of pregnancy) will be covered to the same extent as a Sickness); or



North Carolina The maternity limitation and exclusion is different for the PAI Sickness

Rider.






Oklahoma The maternity limitation and exclusion is different for the PAI Sickness

Rider.




South Carolina The maternity limitation and exclusion is different for the PAI Sickness

Rider.

2. Giving birth within the first ten nine months of the Effective Date of this rider as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness); or


Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this rider has been in force ten nine months, the maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

Tennessee The maternity limitation and exclusion is different for the PAI Sickness

Rider.

2. Giving birth within the first ten months of the Effective Date of this rider as a result of a normal pregnancy, including elective cesarean (complications of pregnancy will be covered to the same extent as a Sickness); or



Texas The maternity limitation and exclusion is different for the PAI Sickness

Rider.

1. Giving birth if the pregnancy is a normal pregnancy and the pregnancy began prior to the Effective Date of the rider (complications of pregnancy will be covered to the same extent as a Sickness); or

Vermont The maternity limitation and exclusion is different for the PAI Sickness

Rider.




Wellness Benefit

After the Personal Accident Indemnity policy has been in force for 12 months, Aflac will pay

$60 for the insured or any one family member to undergo a covered routine examination or other

covered preventive testing during the following policy year. This benefit is payable only once

per policy each 12-month period following the policy anniversary date.

The following services will be covered: annual physical examinations, dental exams,

mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, prostate

specific antigen tests (PSAs), ultrasounds, and blood screenings.

The Wellness Benefit is not payable for a procedure performed during the first policy year. Aflac

will mail automated letters to remind policyholders when they are eligible for the Wellness

Benefit.

The Wellness Benefit may vary by state. Please refer to your specific state introduction

packet for complete details.





Connecticut The Wellness Benefit is different for the PAI policy.

Benefit Benefits A is a and B are preventive benefits; the death, Dismemberment, or Injury of a covered person is not required for this benefit these benefits to be payable. A. WELLNESS BENEFIT: After this policy has been in force for 12 months, we

will pay $60 (sixty dollars) if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Services covered are: annual physical examinations, dental exams, mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, prostate-specific antigen tests (PSAs), ultrasounds, and blood screenings. This benefit will become available following each anniversary of the policy's Effective Date for service received during the following policy year and is payable only once per policy each 12-month period following your policy anniversary date. Eligible family members are your spouse and the dependent children of either you or your spouse. Service must be under the supervision of or recommended by a Physician, received while your policy is in force, and a charge must be incurred.

B. MAMMOGRAPHY BENEFIT: We will pay $70 (seventy dollars) per calendar

year for each covered person when a charge is incurred for an annual screening, prescribed by a Physician, by low dose mammography for the presence of occult breast cancer.

Massachusetts There is no Wellness Benefit for the PAI policy.

Montana The Wellness Benefit is different for the PAI policy.

A. WELLNESS BENEFIT: After this policy has been in force for 12 months, we will pay $60 (sixty dollars) if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Services covered are: annual physical examinations, dental exams, mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, prostate-specific antigen tests (PSAs), ultrasounds, and blood screenings. This benefit will become available following each anniversary of the policy's Effective Date for service received during the following policy year and is payable only once per policy each 12-month period following your policy anniversary date. Eligible family members are your spouse and the dependent children of either you or your spouse. Service must be under the supervision of or recommended by a Physician, received while your policy is in force, and a charge must be incurred.

B. MAMMOGRAPHY BENEFIT: We will pay actual charges up to $70 for an

annual screening, prescribed by a Physician, by low dose mammography.



New Jersey The Wellness Benefit is different for the PAI policy.


A. WELLNESS BENEFIT: After this policy has been in force for 12 months, we We will pay $60 (sixty dollars) if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Services covered are: annual physical examinations, dental exams, mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, prostate-specific antigen tests (PSAs), ultrasounds, and blood screenings. This benefit will become available following each anniversary of the policy’s Effective Date for service received during the following policy year and is payable only once per policy each 12-month period following your policy anniversary date. Eligible family members are your spouse and the dependent children of either you or your spouse. Service must be under the supervision of or recommended by a Physician, received while your policy is in force, and a charge must be incurred.

We will pay the following benefits as applicable if a covered person’s death, Dismemberment, or Injury is caused by a covered accident that occurs on or off the job. Death, Dismemberment, or Injury must be independent of disease or bodily infirmity, or of any cause other than a covered accident. A covered accident must also occur while coverage is in force and is subject to the limitations and exclusions.

New York There is no Wellness Benefit for the PAI policy.


Pennsylvania The Wellness Benefit is different for the PAI policy.

Benefit A is a preventive benefit; the death, Dismemberment, or Injury of a covered person is not required for this benefit to be payable. A. WELLNESS BENEFIT: After this policy has been in force for 12 months, we

will pay $60 (sixty dollars) if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Services covered are: annual physical examinations, dental exams, mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, prostate-specific antigen tests (PSAs), ultrasounds, and blood screenings. This benefit will become available following each anniversary of the policy's Effective Date for service received during the following policy year and is payable only once per policy each 12-month period following your policy anniversary date. Eligible family members are your spouse and the dependent children of either you or your spouse. Service must be under the supervision of or medically recommended by a Physician, received while your policy is in force, and a charge must be incurred.

We will pay the following benefits as applicable if a covered person’s death, Dismemberment, or Injury is caused by a covered accident that occurs on or off the job. Death, Dismemberment, or Injury must be independent of disease or bodily infirmity, or of any cause other than a covered accident. A covered accident must also occur while coverage is in force and is subject to the limitations and exclusions.




A pre-existing condition is a sickness (including pregnancy) or an injury for which, within the

12-month period before the effective date of coverage, medical advice, consultation, or treatment

was recommended or received, or for which symptoms existed that would ordinarily cause a

prudent person to seek diagnosis, care, or treatment.

Under the Personal Accident Indemnity Disability Riders, disability caused by a pre-existing

condition or injuries to a pre-existing condition will not be covered unless it begins more than 12

months after the effective date of coverage.

The Personal Accident Indemnity Sickness Disability Rider is also subject to a pre-existing

condition provision. The pre-existing condition provision states, “Disability or hospitalization

caused by a pre-existing condition will not be covered unless it begins more than 12 months after

the effective date of coverage.”

The pre-existing conditions provision may vary by state. Please refer to your specific state

introduction packet for complete details.



Alaska The definition of pre-existing condition is different for the PAI Sickness

Rider.

Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.



Connecticut The definition of pre-existing condition is different for the PAI Sickness

Rider, Off-the-Job Rider, On-the-Job Rider, and Spouse Rider.


D.C. The definition of pre-existing condition is different for the PAI Sickness


Florida T

R

Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended by or received from a Physician, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. If you are replacing another disability policy that was in force within 60 days of the effective date of this rider, we will credit this provision with the period of time the previous coverage was in force.

Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.

19

he definition of pre-existing condition is different for the PAI Sickness

ider, Off-the-Job Rider, On-the-Job Rider, and Spouse Rider.

Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care, or treatment member of the medical profession.


Georgia The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than during the first 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.

Idaho The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-six month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care, or treatment Physician. This rider does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this rider.

Illinois The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, is an Injury or Sickness which was diagnosed by, or for which medical advice, consultation, or treatment was recommended or received from a legally qualified Physician, or in the opinion of a Physician, symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.

Maryland The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. A Pre-Existing Condition does not include a condition admitted in the application which was not excluded by a signed waiver rider.



Montana The definition of pre-existing condition is different for the PAI Sickness



North Carolina The definition of pre-existing condition is different for the PAI Sickness



Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care, or treatment Physician. This rider has a 30-day waiting period for Sickness. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 30 days after the Effective Date of coverage.

North Dakota The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received. or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.


New Jersey The definition of pre-existing condition is different for the PAI Sickness

Rider, Accident Rider, and Spouse Rider.

Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 during the first 24 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness either misrepresented or not revealed on the application and for which, within the 12-month period before the symptoms existed prior to the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would cause an ordinarily cause a prudent person to seek diagnosis, care, or treatment or for which medical advice or treatment was recommended by or received from a Physician. If you are replacing another disability policy that was in force within 60 days of the Effective Date of this rider, we will credit this provision with the period of time the previous coverage was in force.

New Mexico The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness condition for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, provider of health care, or treatment services within six months preceding the Effective Date of coverage of an Insured person.

New York The definition of pre-existing condition was removed from the PAI

Accident Rider and Spouse Rider.

Pennsylvania The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was medically recommended by a Physician or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment from a Physician within the 12-month period before the Effective Date of coverage.



South Carolina The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before condition misrepresented or not revealed in the application and which symptoms existed prior to the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would cause an ordinarily cause a prudent person to seek diagnosis, care, or treatment or for which medical advice or treatment was recommended by or received from a Physician. This policy does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this policy.

Vermont The definition of pre-existing condition is different for the PAI Sickness

Rider.

Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. This policy does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this policy.

Virginia The definition of pre-existing condition is different for the PAI Sickness





Wisconsin The definition of pre-existing condition is different for the PAI Sickness


Disability or hospitalization caused by a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Any Pre-Existing Condition admitted in the application is covered from the Effective Date of the policy unless excluded by specific name and description.



Waiting Period

The waiting period is defined as the period after the effective date of coverage for which benefits

are not payable. The Personal Accident Indemnity Sickness Disability Rider has a 30-day

waiting period. If the disease or disorder is first manifested or treated within the first 30 days

after the effective date of coverage, any resulting disability will not be covered unless it begins

more than 12 months after the effective date of coverage.

Some states do not have the 30-day waiting period. Please refer to your specific state




Arizona There is no 30-day waiting period for the PAI policy.

Idaho There is no 30-day waiting period for the PAI policy.

Kansas There is no 30-day waiting period for the PAI policy.

Louisiana There is no 30-day waiting period for the PAI policy.

Maine There is no 30-day waiting period for the PAI policy.



Michigan There is no 30-day waiting period for the PAI policy.

The definition of sickness is different for the PAI policy.

W. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If you purchase Sickness only applies if the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage issued.

Missouri There is no 30-day waiting period for the PAI policy.

Montana There is no 30-day waiting period for the PAI policy.

The definition of sickness is different for the PAI policy.


New Hampshire There is no 30-day waiting period for the PAI policy.

New Jersey The definition of sickness is different for the PAI policy.

W. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested diagnosed or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If you purchase the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage. Sickness also includes a pregnancy which starts after your Effective Date of coverage and while coverage is in force.

W. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated results in loss commencing more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If This definition only applies if you purchase the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.


Oklahoma The definition of sickness is different for the PAI policy.

W.

Pennsylvania The de


New Mexico The de

W.

W.

South Dakota There

SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If you purchase the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability resulting from Sickness will not be covered unless it begins for losses incurred more than 12 months 30 days after the your Effective Date of coverage.

finition of sickness is different for the PAI policy.

27

finition of sickness is different for the PAI policy.

SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or medically treated or medically diagnosed more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If you purchase the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.

SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If you purchase the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 six months after the Effective Date of coverage.

is no 30-day waiting period for the PAI policy.


Virginia The definition of sickness is different for the PAI policy.

Y.


SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated morethan 30 days or more after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If you purchase the Optional Sickness Disability Rider Series A-34052, and the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability resulting from Sickness will not be covered unless it begins for losses incurred 30 days or more than 12 months after the your Effective Date of coverage.

28


Personal Accident Indemnity Plan Review

1. True or False. Before any benefits are payable on the Personal Accident Indemnity

Sickness Disability Rider, the insured must first satisfy his or her elimination period.

2. Fill in the Blank. Most states have a _______-month maternity exclusion that excludes

giving birth within the first _______ months of the effective date of the policy as a result of

a normal pregnancy, including cesarean.

3. Fill in the Blank. In most states the pre-existing condition provision is _______ months

before and _______ months after the effective date of coverage.

4. True or False. Under the Personal Accident Indemnity plan, the Wellness Benefit is

payable for dental exams.

5. Multiple Choice. The Personal Accident Indemnity plan has a __________ Wellness

Benefit.

a. $40

b. $50

c. $60

d. None of the above

6. True or False. The Wellness Benefit is payable for the insured and each family member

covered by the Personal Accident Indemnity plan.



7. Multiple Choice. After coverage has been in force for ______ months, the Personal

Accident Indemnity plan will pay a Wellness Benefit.

a. 6

b. 9

c. 12


8. True or False. Under the Personal Accident Indemnity policy, the Wellness Benefit is not

payable for treatment received during the first year after the policy effective date.

9. True or False. Disability caused by a pre-existing condition or injuries to a pre-existing

condition will not be covered unless it begins more than 12 months after the effective date of

coverage.

10. Multiple Choice. The Personal Accident Indemnity Sickness Disability Rider has a

_______-day waiting period.

a. 30

b. 60

c. 90


Review answers can be found at the end of this guide.

For additional information regarding the Personal Accident Indemnity plan, refer to the field

sales guide, M1044B, and your state’s administrative guidelines.


Personal Disability

Income Protector

(PDIP) Plan


Personal Disability Income Protector (PDIP) Plan


(Policy Series A-57400)

Pregnancy

The Personal Disability Income Protector Plan contains the following provision for pregnancy

and childbirth: Disability as a result of pregnancy and childbirth is payable to the same extent as

a covered sickness. After this policy has been in force ten months, the maximum benefit period

allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean

delivery, less the elimination period chosen, unless the woman furnishes proof that she remains

disabled beyond these time frames.

Aflac treats maternity as a sickness. Before any benefits are payable, the woman must first

satisfy her elimination period. Then the benefit period and the disability benefits begin. Typically

the standard disability length, as set by physicians and the insurance industry, is six weeks for

noncesarean delivery and eight weeks for cesarean delivery. The elimination period is not

subtracted from the benefit period. The elimination period is satisfied first and then benefits are

payable for the remaining time she is considered disabled, up to the benefit period chosen.

Most states have a ten-month maternity exclusion that states: We will not pay benefits for a

disability that is caused by or occurs as a result of the woman’s giving birth within the first ten

months of the effective date of the policy as a result of a normal pregnancy, including cesarean

(complications of pregnancy will be covered to the same extent as a sickness).

Therefore, disability as a result of pregnancy and childbirth is excluded if the birth occurs within

ten months of the effective date of the policy (as a result of a normal pregnancy). Complications

of pregnancy are not excluded for the first ten months. If a woman is totally disabled as a result

of complications of pregnancy, she would be eligible for disability benefits.



existing condition limitation provision. (In most states, the pre-existing condition limitation








Arkansas The maternity limitation and exclusion is different for the PDIP policy.

1.

Arizona The maternity limitation and exclusion is different for the PDIP policy.

1. Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy, including nonelective cesarean, will be covered to the same extent as a Sickness);

Connecticut The definition for complications of pregnancy was added for the PDIP

policy.

C.


COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; but that do not include false labor, occasional spotting, Physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy; (b) hyperemesis gravidarum and pre-eclampsia requiring hospital confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible; and (c) conditions requiring medical treatment after the termination of pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy.

Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including an elective cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

33


Idaho The definition for complications of pregnancy was added for the PDIP

policy.

D. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible.

Complications of Pregnancy do not include false labor, occasional spotting, Physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy.

The maternity limitation and exclusion is different for the PDIP policy.

1.

Iowa The m


Kansas The m

1.

1.

Giving birth within the first ten months of the Effective Date of this policy as aresult of a normal pregnancy, including cesarean (Complications of pregnancywill be covered to the same extent as a Sickness).

aternity limitation and exclusion is different for the PDIP policy.


Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy, including non-elective cesarean, will be covered to the same extent as a Sickness);

34


Michigan The maternity limitation and exclusion is different for the PDIP policy.

1.

Montana The m


The be

New Hampshire The m

1.

DisabSicknallowdeliveas def

1.

The be

Giving birth within the first ten months of the Effective Date of this policy as aresult of a normal pregnancy, including cesarean (complications of pregnancy willbe covered to the same extent as a Sickness);


Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

nefits are different for the PDIP policy regarding maternity.


ility due to pregnancy and childbirth is payable to the same extent as a covered ess. After this policy has been in force ten months, the maximum Benefit Period ed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean ry, less the Elimination Period, unless you furnish proof that you remain disabled, ined above, beyond these time frames.

Giving birth within the first ten nine months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

nefits are different for the PDIP policy regarding maternity.

Disability due to pregnancy and childbirth is payable to the same extent as a coveredSickness. After this policy has been in force ten nine months, the maximum BenefitPeriod allowed for childbirth is six weeks for noncesarean delivery and eight weeks forcesarean delivery, less the Elimination Period, unless you furnish proof that you remaindisabled, as defined above, beyond these time frames.

35


New Jersey The definition of complications of pregnancy was added for the PDIP

policy.

C. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; but that do not include false labor, occasional spotting, Physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy; (b) hyperemesis gravidarum and pre-eclampsia, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible; and (c) conditions requiring medical treatment after the termination of pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy.


1. Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy when conception occurs prior to the Effective Date of this policy. Complications of Pregnancy (including non-elective cesarean (complications of pregnancy) will be covered to the same extent as a Sickness.

New York The definition of complications of pregnancy was added for the PDIP

policy.

COMPLICATIONS OF PREGNANCY: (1) conditions requiring hospital stays (when the pregnancy is not terminated) whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity, and shall not include false labor, occasional spotting, Physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct Complication of Pregnancy; and (2) nonelective caesarean section, ectopic pregnancy which is terminated and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.




1. Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including elective cesarean (complications section (Complications of pregnancy will be covered to the same extent as a Sickness);

The benefits are different for the PDIP policy regarding maternity.


North Carolina The maternity limitation and exclusion is different for the PDIP policy.


Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this policy has been in force ten months, the maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

1. Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this policy has been in force ten months, the The maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

North Dakota The maternity limitation and exclusion is different for the PDIP policy.

1. Giving birth within the first ten nine months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);



Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this policy has been in force ten nine months, the maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

Oklahoma The maternity limitation and exclusion is different for the PDIP policy.

T

South Carolina T

T


B. We will not pay benefits for a disability that is caused by or occurs as a result of your:

1. Giving birth within the first ten months of the Effective Date of this policy

as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness) Alcoholism and drug addiction;

he benefits are different for the PDIP policy regarding maternity.

Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this policy has been in force ten months, the The maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remaindisabled, as defined above, beyond these time frames.

he maternity limitation and exclusion is different for the PDIP policy.

1. Giving birth within the first ten nine months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

he benefits are different for the PDIP policy regarding maternity.

Disability due to pregnancy and childbirth is payable to the same extent as a covered Sickness. After this policy has been in force ten nine months, the maximum Benefit Period allowed for childbirth is six weeks for noncesarean delivery and eight weeks for cesarean delivery, less the Elimination Period, unless you furnish proof that you remain disabled, as defined above, beyond these time frames.

38


Tennessee The maternity limitation and exclusion is different for the PDIP policy.


Texas The definition of sickness is different regarding pregnancy for the PDIP

policy.

The m

Vermont The m

J.

1.

1.

1. Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including elective cesarean (complications of pregnancy will be covered to the same extent as a Sickness);

SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. It also includes a pregnancy which starts more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.



Giving birth within if the first ten months of pregnancy is a normal pregnancy and the pregnancy began prior to the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of. Complications of such pregnancy will be covered to the same extent as a Sickness.
Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy willbe covered to the same extent as a Sickness);
39


Washington The maternity limitation and exclusion is different for the PDIP policy.

1. Giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (complications of pregnancy will be covered to the same extent as a Sickness);







prudent person to seek diagnosis, care, or treatment. Disability caused by a pre-existing

condition or reinjuries to a pre-existing condition will not be covered unless it begins more than

12 months after the effective date of coverage.

All waiting periods for pre-existing conditions, sickness, etc., start over as of the conversion. If

claims are not payable under the converted policy, they will be reviewed under the previous

coverage.





Connecticut The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended by or received from a Physician, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. If you are replacing another disability policy that was in force within 60 days of the effective date of this policy, we will credit this provision with the period of time the previous coverage was in force.



D.C. The definition of pre-existing condition is different for the PDIP policy.


Georgia The definition of pre-existing condition is different for the PDIP policy.

Idaho The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than during the first 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12- six month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care, or treatment Physician. This policy does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this policy.

Illinois The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, is an Injury or Sickness which was diagnosed by, or for which medical advice, consultation, or treatment was recommended or received from a legally qualified Physician, or in the opinion of a Physician, symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment.


Indiana The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. This policy has a 30-day waiting period for Sickness. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.

Maryland The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or re-injuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Conditions disclosed on the application are not considered Pre-Existing Conditions and are therefore covered unless they are specifically excluded by an endorsement attached to the policy. However, if you do not tell us about any condition about which we inquire on the application, or if you have materially misrepresented any answer in the application, we may rescind coverage for that condition. The right to rescind coverage is subject to the Time Limit on Certain Defenses Provision in Part 3B.

Massachusetts The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. If you are replacing another disability policy that was in force within 60 days of the Effective Date of this policy, we will credit this provision with the period of time the previous coverage was in force.



Montana The definition of pre-existing condition is different for the PDIP policy.


New Jersey The definition of pre-existing condition is different for the PDIP policy.

New Mexico The definition of pre-existing condition is different for the PDIP policy.


Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 during the first 24 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury either misrepresented or not revealed on the application and for which, within the 12-month period before the symptoms existed prior to the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would cause an ordinarily cause a prudent person to seek diagnosis, care, or treatment or for which medical advice or treatment was recommended by or received from a Physician. If you are replacing another disability policy that was in force within 60 days of the Effective Date of this policy, we will credit this provision with the period of time the previous coverage was in force.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 six months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury condition for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, provider of health care, or treatment services within six months preceding the Effective Date of coverage of an Insured person.


New York The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Conditionwill not be covered unless it begins occurs more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended by a Physician, or received from a Physician, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. If you are replacing another disability insurance policy that was in force within 60 days of the Effective Date of this policy, we will credit the Pre-Existing Condition waiting period with the period of time the previous coverage was in force.

North Carolina The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care, or treatment Physician. This policy has a 30 day waiting period for Sickness. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 30 days after the Effective Date of coverage.

North Dakota The definition of pre-existing condition is different for the PDIP policy.


Pennsylvania The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was medically recommended by a Physician or received, or symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care, or treatment Physician within the 12-month period before the Effective Date of coverage.



South Carolina The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness condition misrepresented or an Injury for which, with not revealed in the 12-month period before application and which symptoms existed prior to the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would cause an ordinarily cause a prudent person to seek diagnosis, care, or treatment or for which medical advice or treatment was recommended by or received from a Physician. This policy does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this policy.

Virginia The definition of pre-existing condition is different for the PDIP policy.


Vermont The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. This policy does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this policy.

Washington The definition of pre-existing condition is different for the PDIP policy.

Disability caused by a Pre-Existing Condition or reinjuries to a Pre-Existing Condition will not be covered unless it begins more than 12 months after the Effective Date of coverage. A Pre-Existing Condition is a Sickness or an Injury for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Any Pre-Existing Condition admitted in the application is covered from the Effective Date of the policy unless excluded by specific name and description.



Waiting Period

The Personal Disability Income Protector Plan has a 30-day waiting period for sickness after the

effective date of coverage.

The waiting period may vary by state. Please refer to your specific state introduction




Arizona There is no 30-day waiting period for the PDIP policy.

Georgia The definition of sickness is different for the PDIP policy.

M. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than during the first 12 months after the Effective Date of coverage.

Idaho There is no 30-day waiting period for the PDIP policy.

Kansas There is no 30-day waiting period for the PDIP policy.

Louisiana There is no 30-day waiting period for the PDIP policy.



Maine There is no 30-day waiting period for the PDIP policy.

The definition of sickness is different for the PDIP policy.

M. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. “Sickness” includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.

Maryland There is no 30-day waiting period for the PDIP policy.


J. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury and that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. If the Sickness includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within manifests itself before the Effective Date of coverage, it will be covered if the first 30 days after your Effective Date of coverage, any resulting loss is incurred or disability will not be covered unless it begins more than 12 months after 12 months from the Effective Date of coverage.

Massachusetts There is no 30-day waiting period for the PDIP policy.

Michigan There is no 30-day waiting period for the PDIP policy.

Missouri There is no 30-day waiting period for the PDIP policy.



Montana There is no 30-day waiting period for the PDIP policy.


M. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days Sickness also includes a pregnancy which starts after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of and while coverage is in force.

New Hampshire There is no 30-day waiting period for the PDIP policy.


K.

North Carolina The de

M.


SICKNESS: a disease, disorder, infection, or any other abnormal physicalcondition that is not caused by an Injury that is first manifested or treated morethan 30 days after your Effective Date of coverage and while coverage is in force."Sickness" includes diseases or conditions resulting from insect bites orinfestations by microorganisms. If the disease or disorder is first manifested ortreated within the first 30 days after your Effective Date of coverage, any resultingdisability will not be covered unless it begins more than 12 months after theEffective Date of coverage.

finition of sickness is different for the PDIP policy.

SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months 30 days after the Effective Date of coverage.

49


North Dakota There is no 30-day waiting period for the PDIP policy.


K. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days Sickness also includes a pregnancy which starts after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of and while coverage is in force.

New Jersey There is no 30-day waiting period for the PDIP policy.



New Mexico The definition of sickness is different for the PDIP policy.

J. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated results in loss commencing more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.

M. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 six months after the Effective Date of coverage.


New York There is no 30-day waiting period for the PDIP policy.


L. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested diagnosed or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.

Oklahoma The definition of sickness is different for the PDIP policy.

M. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Any disability resulting from Sickness will be covered for losses incurred more than 30 days after your Effective Date of coverage.

Pennsylvania The definition of sickness is different for the PDIP policy.

N. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or medically treated or medically diagnosed more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or medically treated or medically diagnosed within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage.



South Carolina The definition of sickness is different for the PDIP policy.


South Dakota There is no 30-day waiting period for the PDIP policy.

Virginia The definition of sickness is different for the PDIP policy.

M. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Effective Date of coverage. Any disability resulting from Sickness will be covered for losses incurred more than 30 days after your Effective Date of coverage.

N. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition that is not caused by an Injury that is first manifested or treated more than 30 days or more after your Effective Date of coverage and while coverage is in force. "Sickness" includes diseases or conditions resulting from insect bites or infestations by microorganisms. If the disease or disorder is first manifested or treated within the first 30 days after your Effective Date of coverage, any resulting disability will not be covered unless it begins more than 12 months after the Any disability resulting from Sickness will be covered for losses incurred 30 days or more after your Effective Date of coverage.


Personal Disability Income Protector Plan Review

1. True or False. Assuming all waiting periods (ten-month exclusion, pre-existing conditions,

etc.) have been met, if a policyholder receives disability benefits for complications of

pregnancy, then gets better and returns to work for two months, she will have to again meet

her elimination period before receiving disability benefits for giving birth.

2. True or False. Tammi purchases a PDIP policy in a state that doesn’t allow the ten-month

maternity exclusion, but has a 12-month pre-existing condition provision. At the time she

purchases the policy, Tammi is two months pregnant. If she delivers during the eighth

month of disability coverage, Tammi will receive disability benefits for giving birth.

3. Multiple Choice. In most states, a sickness that begins during the first ______ day(s) of

coverage is considered a pre-existing condition.

a. 10

b. 1

c. 15

d. 30

4. True or False. Disability caused by a pre-existing condition or reinjuries to a pre-existing

condition will not be covered unless it begins more than 12 months after the effective date of

coverage.

5. Fill in the Blank. PSTD has a _______-day waiting period after the effective date of

coverage.


For additional information regarding the Personal Disability Income Protector plan, refer to the

field sales guide, M1045B, and your state’s administrative guidelines.


Personal Cancer

Indemnity (PCI) Plan



Personal Cancer Indemnity (PCI) Plan (Policy Series A-75000)

Wellness Benefit

For the Personal Cancer Indemnity Plan, Aflac will pay a Wellness Benefit when a charge is

incurred for one of the following tests performed to determine whether cancer exists in a covered

person:

• Mammogram

• Chest X-ray

• Breast ultrasound

• CEA (blood test for colon cancer)

• Pap smear

• CA 125 (blood test for ovarian

cancer)

• ThinPrep

• PSA (blood test for prostate cancer)

• Biopsy

• Thermography

• Flexible sigmoidoscopy

• Colonoscopy

• Hemocult stool specimen

• Virtual colonoscopy

Per covered person, per calendar year, Level 1 pays $40, and Levels 2 and 3 pay $75.

This benefit is limited to one payment per covered person, per calendar year. Although the

Wellness Benefit is payable immediately, remember that the policy has a 30-day waiting period

before cancer benefits are payable. If cancer is detected through a wellness exam during the first

30 days, only the Wellness Benefit will be paid.




Personal Cancer Indemnity (PCI) Plan



California The Wellness Benefit is different for the Level 1 PCI policy.

A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $40 (forty dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

B. MAMMOGRAPHY AND PAP SMEAR BENEFIT: Aflac will pay $100 (one

hundred dollars) per calendar year when a charge is incurred for an annual screening by low dose mammography for the presence of occult breast cancer and Aflac will pay $30 (thirty dollars) per calendar year when a charge is incurred for a ThinPrep or an annual Pap smear. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

The Wellness Benefit is different for the Level 2 and Level 3 PCI policies.

A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $75 (seventy-five dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

B. MAMMOGRAPHY AND PAP SMEAR BENEFIT: Aflac will pay $100 (one

hundred dollars) per calendar year when a charge is incurred for an annual screening by low dose mammography for the presence of occult breast cancer and Aflac will pay $30 (thirty dollars) per calendar year when a charge is incurred for a ThinPrep or an annual Pap smear. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.



Kansas The Wellness Benefit is different for the Level 1 PCI policy.

A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $40 (forty 30 (thirty dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

B. MAMMOGRAPHY BENEFIT: Aflac will pay $70 (seventy dollars) per calendar

year when a charge is incurred for a mammogram. No lifetime maximum.


A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $75 (seventy-five 50 (fifty dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.


year when a charge is incurred for a mammogram. No lifetime maximum.



Montana The Wellness Benefit is different for the Level 1 PCI policy.

T

Tennessee T


A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $40 (forty dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit islimited to one payment per calendar year, per covered person. No lifetime maximum.

B. MAMMOGRAPHY BENEFIT: Aflac will pay $70 (seventy dollars) for an

annual screening, prescribed by a Physician, by low dose mammography, per covered person per year, when a charge is incurred. No lifetime maximum.

he Wellness Benefit is different for the Level 2 and Level 3 PCI policies.

A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $75 (seventy-five dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

B. MAMMOGRAPHY BENEFIT: Aflac will pay $70 (seventy dollars) for an

annual screening, prescribed by a Physician, by low dose mammography, per covered person per year, when a charge is incurred. No lifetime maximum.

he Wellness Benefit is different for the Level 1 PCI policy.

A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $40 (forty 30 (thirty dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.


year when charges are incurred for an annual screening by low dose mammography for the presence of occult breast Cancer. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

58



A. CANCER SCREENING WELLNESS BENEFIT: Aflac will pay $75 (seventy-five 50 (fifty dollars) per calendar year when a charge is incurred for one of the following: mammogram, breast ultrasound, Pap smear, ThinPrep, biopsy, flexible sigmoidoscopy, hemocult stool specimen, chest X-ray, CEA (blood test for colon Cancer), CA 125 (blood test for ovarian Cancer), PSA (blood test for prostate Cancer), thermography, colonoscopy or virtual colonoscopy. These tests must be performed to determine whether Cancer exists in a covered person. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.


year when charges are incurred for an annual screening by low dose mammography for the presence of occult breast Cancer. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.



Waiting Period


are not payable. The Personal Cancer Indemnity policy contains a 30-day waiting period. If a

covered person has cancer diagnosed before coverage has been in force 30 days from the

effective date of coverage shown in the Policy Schedule, benefits for treatment of cancer will

apply only to treatment occurring after two years from the effective date of the policy or, at your

option, you may elect to void the policy from its beginning and receive a full refund of premium.

The waiting period may vary by state. Please refer to your specific state introduction


States with variations to the 30-day waiting period are listed below. The underlined text was

added to the policy and the strikethrough text was deleted.

Arizona There is no 30-day waiting period for the PCI policy.

Connecticut The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years one year from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium.

Idaho The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years 12 months from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium.

Illinois There is no 30-day waiting period for the PCI policy.



Indiana The waiting period is different for the PCI policy.

THIS POLICY HAS A 30-DAY WAITING PERIOD. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium.

Kansas There is no 30-day waiting period for the PCI policy.

Louisiana There is no 30-day waiting period for the PCI policy.

Massachusetts The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years six months from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium.

Minnesota There is no 30-day waiting period for the PCI policy.

Montana There is no 30-day waiting period for the PCI policy.

New Hampshire The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years six months from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium.



North Carolina The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years one year from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium.

Oklahoma There is no 30-day waiting period for the PCI policy.

Pennsylvania The waiting period is different for the PCI policy.


South Carolina The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer medically diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium. EXCEPTION: If skin Cancer is medically diagnosed during hospitalization, benefits shall be limited to the day(s) the covered person actually received treatment for skin Cancer.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium. EXCEPTION: Persons age 65 and over will be covered for loss commencing after six months from the Effective Date of the policy.

South Dakota There is no 30-day waiting period for the PCI policy.


Texas The waiting period is different for the PCI policy.

B. This policy contains a 30-day waiting period. If a covered person has Cancer diagnosed before coverage has been in force 30 days from the Effective Date of coverage shown in the Policy Schedule, benefits for treatment of that Cancer will apply only to treatment occurring after two years from the Effective Date of the policy or, at your option, you may elect to void the policy from its beginning and receive a full refund of premium. Exception: Insureds age 65 and over will be covered six (6) months from the Effective Date.

Utah There is no 30-day waiting period for the PCI policy.

Virginia There is no 30-day waiting period for the PCI policy.



Personal Cancer Indemnity Plan Review

1. True or False. The Wellness Benefit for the Personal Cancer Indemnity plan pays for each

covered person per calendar year.

2. Multiple Choice. The Personal Cancer Indemnity plan has a __________ Wellness Benefit

for Levels 2 and 3.

a. $40

b. $65

c. $75


3. Multiple Choice. If cancer is detected through a wellness exam during the first 30 days of

the policy’s effective date, only the _______ would be payable.

a. Wellness Benefit

b. First-Occurrence Benefit

c. Wellness and First-Occurrence Benefits


4. Multiple Choice. The Personal Cancer Indemnity plan has a _______-day waiting period.

a. 30

b. 60

c. 90



For additional information regarding the Personal Cancer Indemnity plan, refer to the field sales

guide, M1071B, and your state’s administrative guidelines.


Dental Series A81000




Wellness Benefit

For the Dental Series A81000 plan, the Wellness Benefit is payable for any covered person for

one listed treatment per visit. The benefit is payable once per visit, regardless of the number of

treatments received. Visits must be separated by 150 days or more. The Wellness Benefit is

payable twice per policy year, per covered person.

Wellness Benefits provide payment for preventive dental procedures with no waiting period.

They also do not apply toward annual maximums.

Below are the coverage options and the Wellness Benefit associated with each:

• Basic is a basic tier of coverage with a $25 Wellness Benefit and the lowest benefit schedule.

Basic is the only plan available when supplementing existing dental insurance.

• Standard features a midrange benefit schedule and a $50 Wellness Benefit. We anticipate

that Standard’s solid benefits will make it the most commonly sold plan.

• Premier, also with a $50 Wellness Benefit, uses a higher tier of benefits for those desiring

more coverage. This option may be helpful in major metropolitan areas with higher costs.

• Premier Plus, with a $75 Wellness Benefit, allows a second high-end option for people in

states with significantly higher dental treatment costs. Premier Plus is available only in

Alaska, California, Connecticut, Florida, Hawaii, Massachusetts, New Jersey, New York,

Oregon, and Washington.





The state with a variation to the Wellness Benefit is listed below. The underlined text was

added to the policy and the strikethrough text was deleted.

Oregon The Dental Wellness Benefit is different for the Dental Series A81000 policy.

A. DENTAL WELLNESS BENEFIT

This benefit is payable for you or any covered person for any one treatment listed below per visit. This benefit is payable once per visit, regardless of the number of treatments received. To be payable, dental wellness visits must be separated by 150 days or more. This benefit is payable twice per Policy Year per covered person. The treatment must be performed by a Dentist, Dental Hygienist or Licensed Denturist acting within the scope of his license.



Waiting Period


are not payable. For the Dental Series A81000, the waiting period includes the following:

• If a policy is reinstated, new waiting periods begin on the date of reinstatement.

• If a dependent is added to the policy by endorsement, the waiting periods for that person

begin on the effective date of the addition.

• If a policy is converted to a higher level and waiting periods were met under the original

policy, the new waiting periods apply only to the increased benefit amounts.

• If a policy is converted to a lower level, the waiting periods run from the effective date of the

original policy.

The Dental Series A81000 policy contains the following waiting periods:

Benefit Category Waiting Period

Dental Wellness Benefits None

X-Ray Benefit None

Other Preventive Benefits 6 months

Other Diagnostic Benefits 3 months

Fillings and Other Basic Restorative Benefits 3 months

Crowns and Other Major Restorative Benefits 12 months

Root Canals and Other Endodontic Benefits 12 months

Gum Treatments/Periodontic Benefits 6 months

Dentures and Other Prosthetic Benefits 24 months

Repairs and Adjustments to Prosthetics Benefits 6 months

Extractions and Other Oral Surgery Benefits 6 months

Pain Relief and Other Adjunctive Services Benefits 3 months

Optional Riders:

Orthodontic Benefit Rider 24 months

Cosmetic Benefit Rider 24 months



Some states have different waiting periods. Please refer to your specific state introduction




Maryland The waiting period is different for the Dental Series A81000 policy.


Benefit Categories Waiting Periods A. Dental Wellness Benefit [0, 0 months] B. X-Ray Benefit [0, 0 months] C. Other Preventive Benefits [0, 6 months] D. Other Diagnostic Benefits [0, 3 months] E. Fillings and Other Basic Restorative Benefits [0, 3 months] F. Crowns and Other Major Restorative Benefits [3, 12 months] G. Root Canals and Other Endodontic Benefits [3, 12 months] H. Gum Treatments/Periodontic Benefits [3, 6 months] I. Dentures and Other Prosthetic Benefits [6, 24 12 months] J. Repairs and Adjustments to Prosthetic Benefits [3, 6 months] K. Extractions and Other Oral Surgery Benefits [3, 6 months] L. Pain Relief and Adjunctive Services Benefits [3, 3 months] Optional Benefits Waiting PeriodsOrthodontic Benefit Rider 24 months Cosmetic Benefit Rider 24 months

69


New Jersey The waiting period is different for the Dental Series A81000 policy.


Oregon T

Benefit Categories Waiting Periods A. Dental Wellness Benefit [0, 0 months] B. X-Ray Benefit [0, 0 months] C. Other Preventive Benefits [0, 6 months] D. Other Diagnostic Benefits [0, 3 months] E. Fillings and Other Basic Restorative Benefits [0, 3 months] F. Crowns and Other Major Restorative Benefits [3, 12 months] G. Root Canals and Other Endodontic Benefits [3, 12 months] H. Gum Treatments/Periodontic Benefits [3, 6 months] I. Dentures and Other Prosthetic Benefits [6, 24 12 months] J. Repairs and Adjustments to Prosthetic Benefits [3, 6 months] K. Extractions and Other Oral Surgery Benefits [3, 6 months] L. Pain Relief and Adjunctive Services Benefits [3, 3 months] Optional Benefits Waiting Periods Orthodontic Benefit Rider 24 months Cosmetic Benefit Rider 24 months

he waiting period is different for the Dental Series A81000 policy.

Benefit Categories Waiting Periods A. Dental Wellness Benefit [0, 0 months] B. X-Ray Benefit [0, 0 months] C. Other Preventive Benefits [0, 6 months] D. Other Diagnostic Benefits [0, 3 months] E. Fillings and Other Basic Restorative Benefits [0, 3 months] F. Crowns and Other Major Restorative Benefits [3, 12 months] G. Root Canals and Other Endodontic Benefits [3, 12 months] H. Gum Treatments/Periodontic Benefits [3, 6 months] I. Dentures and Other Prosthetic Benefits [6, 24 12 months] J. Repairs and Adjustments to Prosthetic Benefits [3, 6 months] K. Extractions and Other Oral Surgery Benefits [3, 6 months] L. Pain Relief and Adjunctive Services Benefits [3, 3 months] Optional Benefits Waiting PeriodsOrthodontic Benefit Rider 24 months Cosmetic Benefit Rider 24 months

70


South Carolina The waiting period is different for the Dental Series A81000 policy.

Benefit Categories Waiting Periods A. Dental Wellness Benefit [0, 0 months] B. X-Ray Benefit [0, 0 months] C. Other Preventive Benefits [0, 6 months] D. Other Diagnostic Benefits [0, 3 months] E. Fillings and Other Basic Restorative Benefits [0, 3 months] F. Crowns and Other Major Restorative Benefits [3, 12 months] G. Root Canals and Other Endodontic Benefits [3, 12 months] H. Gum Treatments/Periodontic Benefits [3, 6 months] I. Dentures and Other Prosthetic Benefits [6, 24 months] J. Repairs and Adjustments to Prosthetic Benefits [3, 6 months] K. Extractions and Other Oral Surgery Benefits [3, 6 months] L. Pain Relief and Adjunctive Services Benefits [3, 3 months] M. Cleft Palate Orthodontia Benefits [24 months]

Tennessee The definition of waiting period is different for the Dental Series A81000

policy.

F. WAITING PERIOD: the period after the effective date of coverage for which benefits are not payable. If the policy is reinstated, all covered persons will be subject to new Waiting Periods beginning with, if any, not completed prior to the effective date lapse of reinstatement. your policy. If a dependent is added by endorsement, the Waiting Period for such dependent will begin from the effective date of the addition. The Waiting Period will vary based on the benefit category (see the Policy Schedule).



Competitive Replacement Application

For the Dental Series A81000 policy, the competitive replacement (takeover) process allows

reduced waiting periods for groups that are replacing existing group dental insurance with our

dental plan. All other policy benefits remain the same; only the waiting periods are reduced.

The following requirements must be met before an account can be considered for reduced

waiting periods:

• Fifty or more eligible employees

• A group dental plan that has been in place for at least one year

• At least 70 percent participation in Aflac Dental

Conversions of existing Aflac dental policies do not count toward the participation requirements.

To request reduced waiting periods for a competitive replacement, submit Dental Competitive

Replacement Checksheet M0978B to New Account Set-Up.

If approved, competitive replacement policies will receive the following waiting periods:

Benefit Category Waiting Period Dental Wellness Benefits None X-Ray Benefit None Other Preventive Benefits None Other Diagnostic Benefits None Fillings and Other Basic Restorative Benefits None Crowns and Other Major Restorative Benefits 3 months Root Canals and Other Endodontic Benefits 3 months Gum Treatments/Periodontic Benefits 3 months Dentures and Other Prosthetic Benefits 6 months Repairs and Adjustments to Prosthetics Benefits 3 months Extractions and Other Oral Surgery Benefits 3 months Pain Relief and Other Adjunctive Services Benefits 3 months Optional Riders: Orthodontic Benefit Rider 24 months Cosmetic Benefit Rider 24 months



Reduced waiting periods are available only during the initial enrollment period. Any employees

applying after the initial enrollment, including new employees, will receive standard waiting

periods. Family members added to the policy are eligible for reduced waiting periods. The

waiting periods begin with the effective date of the addition.

Use Application A8101T for competitive replacements. Policies will be issued with reduced

waiting periods only if the account meets the competitive replacement requirements. If the

requirements are not met, policies may still be issued with standard waiting periods. The

applicant must indicate whether this is acceptable by completing the following portion of the

application:

PLEASE NOTE: This policy has standard Waiting Periods ranging from 0 to 24 months.

Where specific Aflac requirements are met, these Waiting Periods will be reduced. Upon

receipt of your policy, please see your Policy Schedule for a list of Waiting Periods.

.I agree to have this policy issued with either standard or reduced Waiting Periods ڤ

________ Applicant’s Initials

.Do not issue this policy with standard Waiting Periods ڤ

________ Applicant’s Initials

Applications will be held in New Business until the account meets the requirements for reduced

waiting periods or until the enrollment dates have passed, whichever comes first. If reduced

waiting periods are not possible and the applicant indicated that standard waiting periods are

acceptable, the policy will issue with standard waiting periods. If reduced waiting periods are not

possible and the applicant advised that standard waiting periods are not acceptable, the

application will close. Aflac will also send a letter to the applicant advising that no policy was

issued. If the applicant later decides that standard waiting periods are acceptable, a standard

application must be completed.

The Competitive Replacement Application may vary by state. Please refer to your specific

state introduction packet for complete details.



The state that does not allow for a Competitive Replacement Application is listed below.

New Jersey This state does not allow for competitive replacements.



Dental Series A81000 Review

1. Multiple Choice. The Standard policy has a Wellness Benefit of _______.

a. $25

b. $50

c. $75

d. $100

2. True or False. The Premier policy has a $75 Wellness Benefit.

3. True or False. For the Dental Series A81000 policy, the Wellness Benefit does not count

toward the policy year maximum.

4. True or False. X-rays are covered under the Wellness Benefit with the Dental Series

A81000 plan.

5. Multiple Choice. The Basic policy has a Wellness Benefit of _____.

a. $25

b. $50

c. $75

d. $100

6. Multiple Choice. With the Dental Series A81000 policy, wellness visits must be separated

by _____ days or more.

a. 90

b. 150

c. 180

d. 365

7. True or False. With the Dental Series A81000 policy, crowns may have different waiting

periods depending on where the crowns are placed.



8. True or False. If dental benefits are downgraded to a lower level, waiting periods start over

on the date of conversion.

9. True or False. With the Dental Series A81000 policy, waiting periods start over on the date

of reinstatement.

10. Multiple Choice. With the Dental Series A81000 policy, the waiting period for Fillings and

Other Basic Restorative Benefits is:

a. None

b. 3 months

c. 6 months

d. 12 months

11. True or False. To receive reduced waiting periods for a competitive replacement, at least

50 percent participation in Aflac Dental is required.

12. True or False. If a dental policy is converted to a higher level, waiting periods start over

for the entire benefit amount.

13. Multiple Choice. With the Dental Series A81000 policy, competitive replacements require

at least _____ eligible employees.

a. 10

b. 25

c. 50

d. 100


For additional information regarding the Dental Series A81000 plan, refer to the field sales

guide, M1106B, and your state’s administrative guidelines.


Personal Sickness

Indemnity (PSI) Plan


Personal Sickness Indemnity (PSI) Plan

Personal Sickness Indemnity (PSI) Plan Policy Series (A-45000)

Pregnancy

The Personal Sickness Indemnity policy defines complications of pregnancy as: (a) conditions

requiring medical treatment prior to or subsequent to the termination of a pregnancy whose

diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by

pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease

of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical

conditions of comparable severity; (b) hyperemesis gravidarum and pre-eclampsia requiring

hospital confinement; ectopic pregnancy that is terminated; and spontaneous termination of

pregnancy that occurs during a period of gestation in which a viable birth is not possible.

Complications of pregnancy do not include false labor, occasional spotting, physician-prescribed

rest during pregnancy, morning sickness, and similar conditions associated with the management

of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy.

Cesarean deliveries are not considered complications of pregnancy.

Aflac will not pay benefits for a covered person’s giving birth within the first months of the

effective date of this policy as a result of a normal pregnancy, including cesarean (complications

of pregnancy will be covered to the same extent as a sickness).

Therefore, sickness as a result of pregnancy and childbirth is excluded if the birth occurs within

ten months of the effective date of the policy (as a result of a normal pregnancy).



existing condition limitation provision. (In most states the pre-existing condition provision

is 12 months before and six months after the effective date of coverage.) States with

exceptions to the standard policy are noted below. The underlined text was added to the

policy and the strikethrough text was deleted.



Arkansas The definition of complications of pregnancy is different for the PSI

policy.

COMPLICATIONS OF PREGNANCY: (1) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; and (2)(a) non-elective cesarean section, (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, (c) ectopic pregnancy which is terminated, and (d) spontaneous termination of pregnancy which occurs during a period of gestation in which a viable birth is not possible.

The maternity limitation and exclusion is different regarding pregnancy

for the PSI policy.

C. We will not pay benefits for a covered person’s giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including an elective cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

Arizona The maternity limitation and exclusion is different regarding pregnancy

for the PSI policy.

B. We will not pay benefits for a covered person’s giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy, including nonelective cesarean, will be covered to the same extent as a Sickness).

Iowa The definition of complications of pregnancy is different for the PSI

policy.

Complications of Pregnancy do not include false labor, occasional spotting, Physician-prescribed rest during pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy. Cesarean deliveries are not considered Complications of Pregnancy.



The definition of sickness is different regarding pregnancy for the PSI

policy.

J.

The m

for the


Idaho The de

pregna

The m

for the

C.

Compprescwith tcompPregn

B.

SICKNESS: an illness, disease or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. Illnesses, diseases or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage. Complications of pregnancy (including non-elective cesarean) will be covered to the same extent as a Sickness.

aternity limitation and exclusion is different regarding pregnancy

PSI policy.

80

finition of complications of pregnancy is different regarding

ncy for the PSI policy.

aternity limitation and exclusion is different regarding pregnancy

PSI policy.

We will not pay benefits for a covered person’s giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

lications of Pregnancy do not include false labor, occasional spotting, Physician-ribed rest during pregnancy, morning sickness and similar conditions associated he management of a difficult pregnancy not constituting a classifiably distinct lication of pregnancy. Cesarean deliveries are not considered Complications of ancy.

We will not pay benefits for a covered person's giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).


Michigan The definition of complications of pregnancy is different regarding

pregnancy for the PSI policy.



for the PSI policy.


B. We will not pay benefits for a covered person’s giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

Minnesota The maternity limitation and exclusion is different regarding pregnancy

for the PSI policy.

C. We will not pay benefits for a covered person’s giving birth within if the first ten months of the pregnancy began prior to the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

New Hampshire The maternity limitation and exclusion is different regarding pregnancy

for the PSI policy.

C. We will not pay benefits for a covered person’s giving birth within the first ten nine months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).


New York The definition of complications of pregnancy is different for the

PSI policy.


Oklahoma The definition of complications of pregnancy is different for the PSI

policy.

B. COMPLICATIONS OF PREGNANCY: (a (1) conditions requiring medical treatment prior to or subsequent to hospital stays (when the termination of a pregnancy is not terminated) whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; (b) hyperemesis gravidarum, and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible.

Complications of Pregnancy do shall not include false labor, occasional spotting, Physician physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, pre-eclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy. Cesarean deliveries are not considered Complications of Pregnancy; and (2) nonelective cesarean section, ectopic pregnancy which is terminated and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.

B. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment (when the pregnancy is not terminated) whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; and similar medical and surgical conditions of comparable severity; (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible.




for the PSI policy.


Pennsylvania The definition of complications of pregnancy is different for the PSI

policy.

B. Benefits B through H are not payable for losses incurred as a result of an Injury. C. We will not pay benefits for a covered person’s giving birth within the first ten

months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

B. COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion, disease of the vascular, hemopoietic, nervous, or endocrine systems, and similar medical and surgical conditions of comparable severity; (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible. Complications of Pregnancy do but will not include false labor, occasional spotting, Physician prescribed rest during the period of pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiably distinct complication of pregnancy. Cesarean deliveries are not considered Complications of Pregnancy; and (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible; (c) conditions requiring medical treatment after the termination of pregnancy whose diagnoses are distinct from pregnancy but which are adversely affected by pregnancy or caused by pregnancy.


Tennessee The definition of complications of pregnancy is different for the

PSI policy.


The maternity limitation and exclusion are different regarding pregnancy

for the PSI policy.

COMPLICATIONS OF PREGNANCY: (a) conditions requiring medical treatment prior to or subsequent to the termination of a pregnancy whose diagnoses are distinct from pregnancy but that are adversely affected by pregnancy or caused by pregnancy, such as acute nephritis; nephrosis; cardiac decompensation; missed abortion; disease of the vascular, hemopoietic, nervous, or endocrine systems; miscarriage; non-elective cesarean; non-elective abortion; and similar medical and surgical conditions of comparable severity; (b) hyperemesis gravidarum and pre-eclampsia requiring Hospital Confinement, ectopic pregnancy that is terminated, and spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible.


C. We will not pay benefits for a covered person’s giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including elective cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

Texas The definition of sickness is different regarding pregnancy for the PSI

policy.

SICKNESS: an illness, disease, or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. It also includes a pregnancy which starts more than 30 days after your Effective Date of coverage and while coverage is in force. Illnesses, diseases or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage.

84



for the PSI policy.

‘C. We will not pay benefits for a covered person’s giving birth within if the first ten months of pregnancy is a normal pregnancy and the pregnancy began prior to the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

Vermont The maternity limitation and exclusion is different regarding pregnancy

for the PSI policy.

We will not pay benefits for a covered person’s giving birth within the first ten months of the Effective Date of this policy as a result of a normal pregnancy, including cesarean (Complications of Pregnancy will be covered to the same extent as a Sickness).

Obtaining routine nursing or routine well-baby care for a newborn child (other than provided by the Physician Visits Benefit);







prudent person to seek diagnosis, care, or treatment.

For the Personal Sickness Indemnity policy, the pre-existing conditions provision and 30-day

sickness waiting period do not apply to the Physician Visits Benefit.

Newborn children born within the first ten months of the policy effective date will be subject to a

30-day waiting period. Any other person(s) who wishes to become insured after the effective

date of the policy must be added by endorsement. The added person(s) will be subject to a pre-

existing conditions provision and a 30-day waiting period for Sickness, which will begin on the

effective date of the endorsement.

For conversions, the pre-existing conditions provision in the new policy will run from the

original policy’s effective date for the benefits provided under the original policy.







Alaska The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage.

Georgia The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered during the first six months after the Effective Date of coverage.



Idaho The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the six-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.

Indiana The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage. COVERAGE FOR SICKNESS BEGINS 30 DAYS AFTER THE EFFECTIVE DATE.

Maryland The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. A Pre-Existing Condition does not include a condition admitted in the application which was not excluded by a signed waiver rider. However, if you do not tell us about any condition about which we inquired on the application, or if you have materially misrepresented any answer in the application, we may rescind coverage for that condition. The right to rescind coverage is subject to the Time Limit on Certain Defenses provision. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than during the first six months after the Effective Date of coverage.

The uniform provision for pre-existing condition is different for the PSI

policy.

(2) Pre-Existing Conditions: No claim for loss incurred after two years six months from the Effective Date of coverage will be reduced or denied on the grounds that a disease or physical condition, not excluded from coverage by name or specific description, had existed prior to such Effective Date.



Minnesota The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins the loss is incurred more than six months after the Effective Date of coverage.

Montana The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.

The uniform provisions for pre-existing condition are different for the PSI

policy.

B. TIME LIMIT ON CERTAIN DEFENSES: (1) After two years from the Effective Date of coverage, no misstatements, except fraudulent misstatements, made by the applicant in the application will be used to void the coverage or to deny a claim for loss incurred after the expiration of such two-year period. (2) No claim for loss incurred after two years from the Effective Date of coverage will be reduced or denied on the grounds that a disease or physical condition, not excluded from coverage by name or specific description, had existed prior to such Effective Date. (2) This policy contains a provision limiting coverage for Pre-Existing Conditions. Pre-Existing Conditions are covered under this policy if care or treatment begins six months after the Effective Date of coverage.



New Mexico The definition of pre-existing condition is different for the PSI

policy.

A Pre-Existing Condition is a Sickness condition for which, within the 12-month period before the Effective Date of coverage, medical advice consultation or treatment was recommended or received, or for which symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, provider of health care or treatment. services within six months preceding the Effective Date of coverage of an insured person. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.

New York The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice consultation or treatment was recommended by a Physician or received from a Physician, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months or more after the Effective Date of coverage.

North Dakota The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation or treatment was recommended or received or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.

Pennsylvania The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice consultation or treatment was medically recommended or received or for which symptoms existed that would ordinarily cause from a prudent person to seek diagnosis, care or treatment. Physician. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.



The uniform provisions for pre-existing condition are different for the PSI

policy.

B. TIME LIMIT ON CERTAIN DEFENSES: (1) After two years from the Effective Date of coverage, no misstatements, except fraudulent misstatements, made by the applicant in the application will be used to void the coverage or to deny a claim for loss incurred after the expiration of such two-year period. (2) No claim for loss incurred after two years from the Effective Date of coverage will be reduced or denied on the grounds that a disease or physical condition, not excluded from coverage by name or specific description, had existed prior to such Effective Date. (2) This policy contains a provision limiting coverage for Pre-Existing Conditions. Pre-Existing Conditions are covered under this policy if care or treatment begins six months after the Effective Date of coverage.

South Carolina The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before condition misrepresented or not revealed in the application and for which symptoms existed prior to the Effective Date of coverage, that would cause an ordinarily prudent person to seek diagnosis, care, or treatment or for which medical advice consultation or treatment was recommended by or received or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care or treatment. Care or treatment from a physician. Confinement caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.

South Dakota The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received. or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.



Vermont The definition of pre-existing condition is different for the PSI

policy.

A Pre-Existing Condition is a Sickness for which, within the 12-month period before the Effective Date of coverage, medical advice, consultation or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage.

This policy does not cover losses caused by or resulting from donating an organ within the first 12 months of the Effective Date of this policy.

Wisconsin The definition of pre-existing condition is different for the PSI policy.

A Pre-Existing Condition is a Sickness for which, within the 12-six-month period before the Effective Date of coverage, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-Existing Condition will not be covered unless it begins more than six months after the Effective Date of coverage. Any Pre-Existing Condition admitted in the application is covered from the Effective Date of the policy unless excluded by specific name and description.

The definition of sickness is different regarding pre-existing conditions for

the PSI policy.

A. The Sickness benefits of this policy are subject to a 30-day waiting period. Any

Sickness medically treated or diagnosed before coverage has been in force 30 days from the Effective Date of coverage will not be covered unless the loss begins more than six months after the Effective Date of coverage. Any Sickness deemed to be a Pre-Existing Condition will be covered six months after the Effective Date of coverage.



Waiting Period


are not payable. The sickness benefits of the Personal Sickness Indemnity policy are subject to a

30-day waiting period. Any sickness medically treated or diagnosed before coverage has been in

force 30 days from the effective date of coverage will not be covered unless the loss begins more

than six months after the effective date of coverage.

Newborn children born within the first ten months of the policy effective date will be subject to a

30-day waiting period. Any other person(s) who wishes to become insured after the effective

date of the policy must be added by endorsement. The added person(s) will be subject to a pre-

existing conditions provision and a 30-day waiting period for sickness, which will begin on the

effective date of the endorsement.

Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period

will not be covered for six months from the effective date of coverage.

Some states do not have the 30-day waiting period. Please refer to your specific state




Arkansas The definition of type of coverage is different regarding the waiting period

for newborn children for the PSI policy.


Upon notification, Aflac will convert this policy to One-Parent Family or Two-Parent Family coverage and advise you of the additional premium due. If One-Parent Family or Two-Parent Family coverage is in force, you do not need to notify Aflac of the birth of your child or the date the petition for adoption is filed, and we will not require an additional premium payment. Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement.

93


Arizona There is no 30-day waiting period for the PSI policy.

The definition of type of coverage is different regarding the waiting period


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California T

T

p


Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement.

he limitations and exclusions are different regarding the 30-day waiting

eriod for the PSI policy.

A. The Sickness benefits of this policy are subject to a 30-day waiting period. Any Sickness medically treated or diagnosed before coverage has been in force 30 days from the Effective Date of coverage will not be covered unless the loss begins more than six months after the Effective Date of coverage.

B. Benefits B through H are not payable for losses incurred as a result of an Injury.

here is no 30-day waiting period for the PSI policy.



A. The Sickness benefits of this policy are subject to a 30-day waiting period. Any not payable for any Sickness medically treated or diagnosed before coverage has been in force 30 days from or treated prior to the Effective Date of coverage will not be covered unless the loss begins more than six months after the Effective Date of coverage this policy. See the Pre-Existing Conditions provision on the policy face page.

94




Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement.

The definition of sickness is different regarding the 30-day waiting period

for the PSI policy.


The added person(s) will be subject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement.

95


Florida The definition of type of coverage is different regarding the waiting period




In the event of your death, your spouse, if covered, will become the Named Insured. COVERAGE FOR NEWBORN CHILDREN AND ADOPTED CHILDREN: All health insurance benefits applicable for newborn children, with respect to a child born to you or your eligible dependents after the Effective Date and while coverage is in force, will be covered from the moment of birth. However, with respect to a newborn child of a covered dependent other than your spouse, the coverage terminates 18 months after the birth of the newborn child. You must notify us, in writing, of the birth of a child within 30 days after the birth. If timely notice is given, we will not charge an additional premium for coverage of the newborn child for the duration of the notice period. If timely notice is not given, we will charge the applicable additional premium from the date of birth. We will not deny coverage for a child due to your failure to notify us within the 30-day period. All health insurance benefits applicable for children shall be payable with respect to your adopted child or your foster child or other child in court-ordered custody, which child is placed in compliance with Chapter 63. Except in the case of a foster child, we will not exclude coverage for any pre-existing condition of the child. In the case of a foster child, we will not exclude coverage for any pre-existing condition of the child. In the case of a newborn child, coverage shall begin from the moment of birth if you have entered into an agreement to adopt such a child prior to the birth of the child, whether or not such agreement is enforceable. An adopted child is covered from the moment of placement in the residence. However, coverage for such child shall not be required in the event the child is not ultimately placed in your residence. Newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their sickness or injury, including congenital anomaly. Any other person(s) who wishes to become insured after the effective date of the policy must be added by endorsement after you make application, subject to the Pre-Existing Conditions provision and 30-day waiting period for sicknesses. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement.

96


Iowa The definition of type of coverage is different regarding the waiting period


If One-Parent Family or Two-Parent Family coverage is in force, you do not need to notify Aflac of the birth of your child or the date of petition for adoption, and we will not require an additional premium payment. Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement.

Idaho There is no 30-day waiting period for the PSI policy.



Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to the Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement.

The limitations and exclusions are different regarding the 30-day waiting

period for the PSI policy.

A. The Sickness benefits of this policy are subject to a 30-day waiting period. Any Sickness medically treated or diagnosed before coverage has been Benefits B through G, located in Part 5, force 30 days from the Effective Date of coverage will not be covered unless the loss begins more than six months after the Effective Date of coverage. are not payable for losses incurred as a result of an Injury.



Kentucky There is no 30-day waiting period for the PSI policy.



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Maryland T

f


Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will besubject to the Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement





he definition of sickness is different regarding the 30-day waiting period

or the PSI policy.

SICKNESS: an illness, disease, or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. SICKNESS: a disease, disorder, infection, or any other abnormal physical condition not caused by an Injury that first manifested itself while coverage is in force. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage. If the Sickness first manifests itself 12 months before the policy Effective Date, it will be covered under the policy if the loss is incurred after six months from the policy Effective Date.

98


Michigan There is no 30-day waiting period for the PSI policy.







Minnesota There is no 30-day waiting period for the PSI policy.




Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement.




A. The Sickness benefits of this policy are subject to a 30-day waiting period. Any Sickness medically treated or diagnosed before coverage has been in force 30 days from prior to the Effective Date of coverage will not be covered unless the loss begins is incurred more than six months after the Effective Date of coverage.


Missouri There is no 30-day waiting period for the PSI policy.







B. Benefits B through G are not payable for losses incurred as a result of an Injury.



Montana The definition of sickness is different regarding the 30-day waiting


SICKNESS: an illness, disease, or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the losses incurred more than 30 days after your Effective Date of coverage.




The limitations and exclusion are different for the PSI policy.

The Sickness benefits of this policy are subject to a 30-day waiting period. Any Sickness medically treated or diagnosed before coverage has been in force 30 days from the Effective Date of coverage will not be covered unless the loss begins more than six months 30 days after the Effective Date of coverage.

New Hampshire There is no 30-day waiting period for the PSI policy.



Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required.





New York T

f


T

f



or the PSI policy.

102

he definition of type of coverage is different regarding the waiting period

or newborn children for the PSI policy.

SICKNESS: an illness, disease, or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage.

If One-Parent Family or Two-Parent Family coverage is in force, you do not need it is not necessary for you to notify Aflac New York of the birth of your child or the date of petition for adoption, and we will not require an additional premium payment. Other than provided by the Physician Visits Benefit, newborn will not be required. Newborn children will not be covered for routine nursing or routine well baby care, but we will pay the policy benefits because of their Sickness or Injury, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement.



period or the PSI policy.


B. Benefits B through H E are not payable for losses incurred as a result of an Injury.

Oklahoma There is no 30-day waiting period for the PSI policy.



Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s), other than a newborn or adopted child, will be subject to a Pre-Existing Conditions Limitations provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement.

The limitations and exclusions are different for the PSI policy.



Oregon The definition of type of coverage is different regarding the waiting period





Rhode Island The definition of type of coverage is different regarding the

waiting period for newborn children for the PSI policy.

Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement.

South Carolina The definition of sickness is different regarding the 30-day waiting period

for the PSI policy.




J. SICKNESS: an illness, disease or disorder diagnosed or treated first manifested more than 30 days or more after the your Effective Date of coverage and while coverage is in force. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage.

Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will be subject to a Pre-Existing Conditions Limitations provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement.


South Dakota There is no 30-day waiting period for the PSI policy.



Texas T

f

Utah T

f


Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement. The added person(s) will besubject to a Pre-Existing Conditions provision and a 30-day waiting period for Sickness, which will begin on the Effective Date of the endorsement. If Two-Parent Family coverage is already in force, an additional premium will not be required. Insurance for persons added by endorsement becomes effective on the date specified on the endorsement.


or the PSI policy.

SICKNESS: an illness, disease, or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. It also includes a pregnancy which starts more than 30 days after your Effective Date of coverage and while coverage is in force. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage.

he definition of type of coverage is different regarding the waiting period

or newborn children for the PSI policy.


105


Vermont The definition of type of coverage is different regarding the waiting

period for newborn children for the PSI policy.

If One-Parent Family or Two-Parent Family coverage is in force, you do not need to notify Aflac of the birth of your child or the date of petition for adoption, and we will not require an additional premium payment. Other than provided by the Physician Visits Benefit, newborn children will not be covered for routine nursing or routine well-baby care, but we will pay the policy benefits because of their Sickness, including congenital anomaly. EXCEPTION: Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period. Newborn children born within the first ten months of the policy Effective Date will be subject to a 30-day waiting period for Sickness. Any other person(s) who wishes to become insured after the Effective Date of the policy must be added by endorsement.

Virginia The definition of sickness is different regarding the 30-day waiting period

for the PSI policy.

J. SICKNESS: an illness, disease, or disorder diagnosed or treated 30 days or more after the Effective Date of coverage and while coverage is in force. Illnesses, diseases, or disorders that are diagnosed or treated within the 30-day waiting period will not be covered for six months from the Effective Date of coverage, except for newborn children born within ten months of the Effective Date of coverage. Newborn children born within ten months of the Effective Date of coverage that are diagnosed or treated for illnesses, diseases or disorders within the 30-day waiting period, will be covered on the 31st day.

Washington The definition of type of coverage is different regarding the waiting period





Wisconsin The definition of type of coverage is different regarding newborn

children for the PSI policy.




Physician Visits Benefit

For the Personal Sickness Indemnity policy, covered physician visits include, but are not limited

to, eye exams, well-baby visits, immunizations, periodic health exams, and routine physicals.

Some states do not have a Physician Visits Benefit. Please refer to your specific state




Arkansas The limitations and exclusions are different regarding the Physician Visits

Benefit for the PSI policy.

6. having cosmetic surgery or elective surgery that is not due to Sickness;

7. obtaining routine nursing or routine well-baby care for a newborn child (other

than provided by the Physician Visits Benefit); 8. donating an organ within the first 12 months of the Effective Date of this policy.

California The Physician Visits Benefit is different for the PSI policy.


A. PHYSICIAN VISITS BENEFIT: We will pay $25 (twenty-five dollars) for you or any covered family member when a charge is incurred for Physician visits. Services must be under the supervision of a Physician. If the Type of Coverage for this policy is Individual, the benefit is limited to four visits per calendar year. If the Type of Coverage is Named Insured/Spouse Only, One-Parent Family or Two-Parent Family, the benefit is limited to a total of eight visits per calendar year for this policy.

Covered Physician visits include, but are not limited to, eye exams, well-baby visits, immunizations, periodic health exams, and routine physicals.

Benefits B and C are preventive benefits; hospitalization of a covered person is not required for these benefits to be payable. B. MAMMOGRAPHY BENEFIT: We will pay $70 (seventy dollars) per calendar

year for each covered person when a charge is incurred for a mammogram. No lifetime maximum.

C. PAP SMEAR BENEFIT: We will pay $30 (thirty dollars) per calendar year for each covered person when a charge is incurred for a Pap smear. No lifetime maximum.

108


Maryland The Physician Visits Benefit is different for the PSI policy.

A. PHYSICIAN VISITS BENEFIT: We will pay $25 (twenty-five dollars) for you or any covered family member when a charge is incurred for Physician visits on or after the Effective Date of the coverage. Services must be under the supervision of a Physician.

Montana The Physician Visits Benefit is different for the PSI policy.

Covered Physician visits include, but are not limited to, eye exams, well-baby visits, immunizations, periodic health exams and , routine physicals, mammograms, Pap smears and prostate-specific antigen (PSA) tests.



Personal Sickness Indemnity Plan Review

1. True or False. The Personal Sickness Indemnity policy does not pay benefits for a covered

person’s giving birth within the first ten months of the effective date of the policy as a result

of a normal pregnancy, including cesarean.

2. True or False. For the Personal Sickness Indemnity policy, the pre-existing conditions

provision and 30-day sickness waiting period apply to the Physician Visits Benefit.

3. Multiple Choice. The Personal Sickness Indemnity policy has a Wellness Benefit of

_______.

a. $25

b. $60

c. $75


4. True or False. Newborn children born within the first ten months of the effective date are

subject to a 30-day waiting period.

5. Multiple Choice. Ann Smith is issued a Personal Sickness Indemnity policy. Two weeks

after the effective date of the policy, Ms. Smith felt ill and went to see her physician. The

physician diagnosed Ms. Smith with the flu and told her to rest and drink plenty of fluids.

What would the PSI plan pay?

a. Wellness Benefit

b. Physician Visits Benefit

c. Pre-Existing Conditions Benefit


6. Short Answer. What would the Personal Sickness Indemnity plan pay if, two weeks after

the effective date of the policy, the physician diagnosed acute appendicitis and Ms. Smith

was promptly admitted to the hospital for an emergency appendectomy?



7. True or False. For the Personal Sickness Indemnity policy, the pre-existing conditions

provision does not apply to conversions.


For additional information regarding the Personal Sickness Indemnity plan, refer to the field

sales guide, M1031B, and your state’s administrative guidelines.


Review Answers

Review Answers

Personal Accident Indemnity Plan Review

1. True

2. 10, 10

3. 12, 12

4. True

5. c

6. False. The policy is payable for one policy per year.

7. c

8. True

9. True

10. a

Personal Disability Income Protector Plan Review

1. False. Successive periods of disability due to related conditions are considered one

disability, unless they are separated by returning to work for 180 days or more.

2. False. Pregnancy is treated as a sickness and still subject to the pre-existing condition

provision.

3. d

4. True

5. 30

Personal Cancer Indemnity Plan Review

1. True

2. c

3. a

4. a


Review Answers

Dental Series A81000 Review

1. b

2. False. The benefit is $50.

3. True

4. False. There is a separate X-ray benefit.

5. a

6. b

7. True

8. False. Waiting periods do not start over for downgrades.

9. True

10. b

11. False. Seventy percent participation is required.

12. False. Waiting periods apply only to the increased benefit amount.

13. c

Personal Sickness Indemnity Plan Review

1. True

2. False

3. d

4. True

5. b

6. The PSI would pay the Physician Visits Benefit only. If Ms. Smith started feeling ill after

the 30-day waiting period and then the appendicitis was diagnosed, Ms. Smith would be

eligible for all other applicable PSI benefits, such as the Initial Hospitalization Benefit,

Hospital Confinement Benefit, and Surgical Benefit.

7. False


Documents

Product Reference Guide - Gateway Insurance