Disclosures for Critical Illness ’01 contract


Pre-Existing Condition limitation

Benefits for pre-existing condition (defined as a sickness or physical condition for which within 12 months before the coverage effective date symptoms existed that would cause a person to seek treatment or; the insured individual was treated, received medical advice from a physician, or had taken medicine) will not be paid during the first 12 months the policy is inforce.


Reduction of benefits

The benefit amount for the employee and spouse benefits reduces by 50% on the first policy anniversary after the covered individual’s 70th birthday, or five years after the policy date, whichever is later. Premiums for the policy will not be reduced.


Date of diagnosis

  • for heart attack (myocardial infarction), the date that the ischemic death of a portion of the heart muscle occurred based on the criteria listed under the heart attack (myocardial infarction) definition;
  • for stroke, the date a stroke occurred based on permanent neurological deficits and neuroimaging studies
  • for end stage renal (kidney) failure, the date that your Physician recommends that you begin renal dialysis;
  • for major organ transplant surgery or coronary artery bypass surgery, the date the surgery occurs for covered transplants or covered coronary artery bypass surgery occurs; or
  • for permanent paralysis (due to a covered accident), the date the physician confirms the permanent paralysis continued for a period of 180 consecutive days.

Date of diagnosis for the cancer rider is the date the tissue specimen, blood samples and/or titer(s) are taken on which the first diagnosis of cancer or carcinoma in situ is based.


Medicare requirements

Those age 65 or older or disabled purchasing this coverage must be advised that this is not a Medicare supplement. They are required to sign the Medicare Certification Form, which certifies that they have received the “Guide to Health Insurance for People with Medicare” and “Important Notice to Persons on Medicare” at the point of sale. There may also be additional forms for various states.


Exclusions

We will not pay benefits for a specified critical illness that occurs as a result of:

  • transient ischemic attacks;
  • balloon angioplasty;
  • laser relief or other like procedures;
  • your participating or attempting to participate in an illegal activity;
  • your committing or attempting to commit suicide or injuring yourself intentionally, whether you are sane or not;
  • your practicing for or participating in any semi-professional or professional competitive athletic contest for which any type of compensation or remuneration is received;
  • or your involvement in any period of armed conflict, even if it is not declared.

Cancer Rider exclusions:

We will not pay benefits described in the rider for any of the following:

  • diagnosis of cancer or carcinoma in situ during the waiting period;
  • pre-malignant condition or conditions with malignant potential;
  • basal cell carcinoma and squamous cell carcinoma of the skin; or melanoma that is diagnosed as Clark’s Level I or II or Breslow less than .75mm.

Termination of the policy

The policy will terminate on the earliest of the following:

  • written request by you to terminate the policy;
  • failure to pay the premiums for the policy, subject to the grace period allowed;
  • payment of the available Face Amount as defined in the policy or in any other attached supplementary benefit;
  • your death.

Right to convert

Coverage for dependent children can be converted if:

  • the policy terminates other than for nonpayment of premiums;
  • the primary insured individual and the spouse are legally divorced;
  • the primary insured individual dies; or
  • a dependent child reaches age 25 or becomes married.

Disclosures for Critical Illness ’05 contract


Pre-existing condition limitation

Benefits for a pre-existing condition (defined as a sickness or physical condition for which within 12 months before the coverage effective date symptoms existed that would cause a person to seek treatment or; the insured was treated, received medical advice from a physician or had taken medicine) will not be paid during the first 12 months the policy is inforce.


Reduction of benefits

The benefit amount for you and your spouse (if applicable) will reduce by 50% on the first policy anniversary of your 70th birthday, or five years after the policy effective date, whichever is later. Premiums for the policy will not reduce.


Date of diagnosis

  • for heart attack (myocardial infarction), the date that the ischemic death of a portion of the heart muscle occurred based on the criteria listed under the heart attack (myocardial infarction) definition;
  • for stroke, the date a stroke occurred based on neuroimaging consistent with the acute or subacute abnormality or other neurodiagnostic study and presence of neurological deficits persisting for a period of 30 days or greater;
  • for end stage renal (kidney) failure, the date that regular hemodialysis or peritoneal dialysis begins;
  • for major organ transplant surgery or coronary artery bypass surgery, the date the major organ transplants surgery or coronary artery bypass surgery occurs; or
  • for permanent paralysis (due to a covered accident), the date the physician confirms the permanent paralysis continued for a period of 180 consecutive days.
  • Date of diagnosis for additional specified critical illness is the date the tissue specimen, blood samples and/or titer(s) are taken on which the diagnosis of cancer or carcinoma in situ is based.

Date of diagnosis for the cancer rider is the date the tissue specimen, blood samples and/or titer(s) are taken on which the first diagnosis of cancer or carcinoma in situ is based.


Exclusions

We will not pay benefits for a specified critical illness or additional specified critical illness that is caused by or occurs as a result of:

  • participating or attempting to participate in an illegal activity;
  • committing or trying to commit suicide or injuring oneself intentionally, whether sane or not;
  • practicing for or participating in any semiprofessional or professional competitive athletic contest for which you receive any type of compensation or remuneration;
  • war or act of war, whether declared or undeclared; or
  • having a pre-existing condition as defined and limited in this policy/rider.

No benefits are payable for the following:

  • any condition or procedure other than the specified critical illness or additional specified critical illness covered by this policy;
  • specified critical illness or additional specified critical illness if you were diagnosed with or sought treatment for the same specified critical illness or additional specified critical illness within the ten-year period prior to the coverage effective date;
  • transient ischemic attacks; or
  • percutaneous coronary intervention (balloon angioplasy, stent implantation or related procedures to increase the flow of blood through the coronary arteries). Policy with additional specified critical illnesses benefit also excludes:
  • premalignant conditions or conditions with malignant potential;
  • basal cell carcinoma and squamous cell carcinoma of the skin, unless metastatic disease develops; or
  • melanoma that is diagnosed as Clark’s Level I or II, or Breslow less than .75mm.

Termination Provision

This policy will terminate on the earliest of the following:

  • written request by you to terminate this policy;
  • failure to pay the premiums for this policy, subject to the grace period allowed;
  • payment of the available specified critical illness benefit amount and additional specified critical illness benefit amount (if applicable); or
  • your death.

Disclosures for Group Critical Illness contract


Pre-Existing Condition limitation

Unum will not pay benefits for a claim that is caused by, contributed to or occurs as a result of a pre-existing condition. Please refer to information provided in your certificate or consult with your benefit counselor to determine what would be considered pre-existing condition. A pre-existing condition is a condition for which symptoms existed within 12 months before your coverage effective date that would cause a person to seek treatment from a physician or for which a person was treated or received medical advice from a physician, or took prescribed medicine. The determination on whether your condition qualifies as pre-existing will be based on the date of disability and not the date you notify Unum.


Reduction of Benefits

  • The benefit amount for the employee and spouse reduces by 50% on the first policy anniversary date after the insured individual’s 70th birthday.
  • Premiums will not be reduced.
  • For coverage purchased after age 70, benefit amounts will not be reduced.

Exclusions

Unum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of:

  • participating or attempting to participate in a felony or being engaged in an illegal occupation;
  • committing or trying to commit suicide or injuring oneself intentionally, whether sane or not;
  • participating in war or any act of war, whether declared or undeclared;
  • committing acts of terrorism;
  • being under the influence of or addicted to intoxicants or narcotics. This would not include physician-prescribed medication, taken in the prescribed dosage;
  • having a date of diagnosis during the benefit waiting period.

Termination

If you choose to cancel your coverage under the policy, your coverage ends at 12:00 midnight on the first of the month following the date you provide notification to your employer. Otherwise, your coverage under the policy ends on the earliest of the:

  • date this policy is cancelled;
  • date you are no longer in an eligible group;
  • date your eligible group is no longer covered;
  • date of your death;
  • last day of the period for which you made any required contributions; or
  • last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness. Coverage on your dependent children ends on the earliest of the date your coverage under the policy ends or the date a dependent child no longer meets the definition of dependent children. Unum will provide coverage for a payable claim which occurs while you are covered under this policy.

NS13-137