What is Secondary Health Insurance? (2024)

FOR ALL APPLICABLE POLICIES AND RIDERS:
PRE-EXISTING CONDITION(S): A condition/conditions diagnosed or for which medical advice or treatment was recommended by or received from a physician within the six months prior to the policy or rider effective date. The benefits of the policy and any attached rider will not be payable during the first 12 months that coverage is in force with respect to an insured person for any loss caused by pre-existing condition(s). This 12-month period is measured from the policy and rider effective date for each insured person.
(Pre-existing conditions(s) do not apply to the Catastrophic Accidental Injury Benefit Rider, Vehicular Accidental Injury Cash Benefit Rider, Parent Benefit Rider, Declining Deductible Benefit Rider, Individual Whole Life Insurance Policy, Terminal Illness Accelerated Benefit Rider and Accidental Death Benefit to Age 100 Rider)

LUMP SUM CANCER POLICY/RIDER AND CANCER RECURRENCE BENEFIT RIDER

If you happen to be diagnosed within the first 30 days following the effective date of the policy and/or rider, the benefit amount payable will be reduced to 10% of the selected benefit amount, and your coverage will be terminated. (not applicable on Cancer Recurrence Benefit Rider)

In addition to any benefit-specific conditions, limitations, or exclusions, no benefits will be payable under this policy and rider for:

  1. any disease, Sickness or incapacity other than Cancer as defined; this is so even though such disease, Sickness or incapacity may have been complicated, affected (directly or indirectly) or caused by Cancer;
  2. loss that begins prior to the policy and/or rider effective date;
  3. Diagnosis received outside the United States or its territories, unless otherwise specified in this policy and/or rider; or
  4. any illness specifically excluded from the definition of Cancer or Carcinoma in Situ.

LUMP SUM HEART ATTACK AND STROKE POLICY/RIDER AND HEART ATTACK & STROKE RESTORATION BENEFIT RIDER

If you happen to be diagnosed with two or more qualifying events on the same day or have two or more surgical treatments at the same time (through a common incision or entry point are considered one operation), we will pay only one benefit amount for the diagnosis and one benefit amount for the surgical treatment, the larger of the qualifying event benefits.

In addition to any benefit-specific conditions, limitations, or exclusions, no benefits will be payable under this policy and rider for:

  1. any disease, Sickness or incapacity other than Qualifying Events as defined; this is so even though such disease, Sickness or incapacity may have been complicated, affected (directly or indirectly) or caused by a Qualifying Event;
  2. loss that begins prior to the policy and/or rider effective date;
  3. Diagnosis received outside the United States or its territories, unless otherwise specified in this policy and/or rider;
  4. intentionally self-inflicted Injury, suicide or any attempt while sane or insane;
  5. voluntary self-administration of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; or
  6. any illness specifically excluded from the definition of Qualifying Events listed in this policy and/or rider.

CANCER TREATMENT POLICY

In addition to any benefit-specific conditions, limitations, or exclusions, no benefits will be payable under this policy for:

  1. any disease, Sickness or incapacity other than Cancer as defined; this is so even though such disease, Sickness or incapacity may have been complicated, affected (directly or indirectly) or caused by Cancer;
  2. loss that begins prior to the expiration of the Waiting Period;
  3. Diagnosis received outside the United States or its' territories, unless otherwise specified in this policy; or
  4. any illness specifically excluded from the definition of Cancer or Carcinoma in Situ.

WAITING PERIOD:If you are diagnosed with cancer within the first 30 days after the effective date of the Cancer Treatment policy, no benefits will be paid until such waiting period has expired.

HOSPITAL AND INTENSIVE CARE UNIT INDEMNITY BENEFIT RIDER AND INTENSIVE CARE UNIT INDEMNITY BENEFIT RIDER

Benefits are only payable for the first 30 days for any one period of confinement.
Once you reach age 65, coverage will be reduced by 50%.

These Riders are subject to the following Exclusions and Limitations, in addition to those outlined in the policy.

In addition to any benefit-specific conditions, limitations, or exclusions, no benefits will be payable under these Riders for Confinement or loss caused directly or indirectly by:

  1. Suicide (while sane or insane), attempted suicide or intentionally self-inflicted Injury;
  2. War or act of war (whether declared or undeclared);
  3. Commission or attempt to commit an illegal activity or a felony;
  4. Commission of or active participation in a riot, insurrection, rebellion or police action;
  5. Voluntary self-administration of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;
  6. Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant. "Under the influence of alcohol", for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Injury occurred;
  7. Mental or emotional disorders, alcoholism and drug addiction;
  8. Treatment outside the United States except for emergency care for acute onset of Sickness or accidental Injury sustained while traveling for business or pleasure;
  9. Travel or activity outside the United States;
  10. Participation in any motorized race or contest of speed on sea, land or air;
  11. Travel in or on any off-road motorized vehicle not requiring licensing as a motor vehicle;
  12. Participation in any high risk activities such as bungee jumping, parachuting, skydiving, parasailing, hang-gliding, deep-sea scuba diving, parkour, free running, sail gliding, parakiting or any similar activity;
  13. Flight in, boarding, or alighting from an aircraft or any craft designed to fly above the Earth's surface, except as a fare-paying passenger on a regular-scheduled commercial or charter airline;
  14. Practicing for or participating in any semiprofessional or professional competitive athletic contest for which such Insured Person receives any compensation or remuneration;
  15. Operating a motor vehicle without a valid motor vehicle operator's license, except while participating in a driver's education program;
  16. The following conditions if they are diagnosed within six (6) months after the Rider Effective Date unless Confinement is on an emergency basis: a hernia, adenoids, tonsils, varicose veins, hemorrhoids, disorder of the reproductive organs, or elective sterilization;
  17. Routine pregnancy; however, Complications of Pregnancy will be considered the same as any other Sickness;
  18. An elective abortion;
  19. Dental treatment of the teeth, gums or structures directly supporting the teeth, including dental x-rays, examinations, repairs, orthodontics, periodontics, casts, splints and services for dental malocclusion, for any condition are not covered, except if provided for or in connection with an Injury to sound natural teeth and a continuous course of dental treatment is started within six (6) months of the Injury. Sound natural teeth are defined as natural teeth that are free of active clinical decay, have at least 50% bony support and are functional in the arch; or
  20. Cosmetic care, except when the Hospital Confinement is due to medically necessary reconstructive plastic surgery. Medically necessary reconstructive surgery is defined as:
    1. surgery as the result an Injury; or
    2. surgery to restore a normal bodily function; or
    3. surgery to improve functional impairment by anatomic alteration made necessary as a result of a congenital birth defect; or
    4. breast reconstruction following mastectomy.

Also, no benefits will be payable under these Riders for:

  1. Loss that begins prior to the Rider Effective Date;
  2. Treatment for which no charges are made by the provider of same;
  3. Services which are primarily for rest care, convalescent care or for rehabilitation; or
  4. Any Injury or Sickness paid for under any state or federal Worker's Compensation, Employer's Liability Law or similar law.

Catastrophic Accidental Injury Benefit Rider
In addition to the policy exclusions and limitations, no benefits will be payable for:

  1. a Covered Loss that is not sustained throughout the Catastrophic Accident Waiting Period, as shown on the policy schedule page. Vehicular Accidental Injury Cash Benefit Rider In addition to the policy exclusions and limitations, no benefits will be payable:

Vehicular Accidental Injury Cash Benefit
Rider In addition to the policy exclusions and limitations, no benefits will be payable:

  1. if the Insured Person was the driver, operator or passenger and was not wearing a helmet, as required by the laws of the state in which the Covered Vehicular Accident occurred.
  2. if the Insured Person was the driver, operator or passenger and was not wearing a seatbelt, as required by the laws of the state in which the Covered Vehicular Accident occurred.
  3. for a Covered Vehicular Accident that occurs during the Vehicular Accidental Injury Cash Benefit Waiting Period, as shown on the Policy Schedule Page.
  4. for no more than one Vehicular Accidental Injury Cash Benefit Amount will be paid per the lifetime of each Insured Person.

Parent Benefit Rider and Declining Deductible Benefit Rider
The exclusions and limitations that apply to these riders are the same as the exclusions and limitations of the policy.

INDIVIDUAL WHOLE LIFE INSURANCE POLICY

Suicide
If the insured dies by Suicide, while sane or insane, within two years from the policy effective date, our liability under this policy is limited to the premiums paid.

Incontestability
Except for non-payment of premiums or for fraud if permitted in the state where the policy is delivered or issued for delivery, this policy will be incontestable after in force for two years from the policy effective date. This provision does not apply to any rider that contains its own Incontestability clause.

Terminal Illness Accelerated Benefit Rider
If the Insured dies after the claim is presented for a Terminal Illness Accelerated Benefit, but before any such benefits are received, the request is cancelled and the Death Benefit will be paid pursuant to the policy. We will not pay a benefit amount for any condition that is not diagnosed as a Terminal Illness. The diagnosis of a Terminal Illness must be confirmed by a physician practicing within the United States or its territories.

Accidental Death Benefit To Age 100 Rider
No Accidental Death Benefit will be payable if the Insured's death results within 180 days directly or indirectly from any of these causes:

  1. Suicide: while the Insured is sane or insane.
  2. War: declared or undeclared, or any act of war. War is defined as armed conflict between nations, or between factions in the same nation.
  3. Military Service: in the military forces of any country at war or in any civilian noncombatant unit serving with those forces.
  4. Natural Causes: Bodily or mental illness, disease or infirmity of any kind, or medical or surgical treatment for any of these.
  5. Death caused or materially contributed to by voluntary intake or use by any means of any drug, unless prescribed or administered by a physician and taken in accordance with the physician's instructions.
  6. Speed contest: Fatal Injury which is incurred as the result of taking part in any speed contest.
  7. Blood Alcohol: Death while the Insured is operating a motor vehicle and is determined to have a blood alcohol level exceeding the legal limit as defined by state law.
  8. Felony: Injury received while committing a felony or incarcerated.
  9. Participation in a riot, civil commotion, terrorist activity or rising against civil or governmental authority.
What is Secondary Health Insurance? (2024)
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