Allstate CI Terms and Conditions

• Guaranteed issue coverage, subject to exclusions and limitations
• Coverage available for individual and child(ren) or family
• Covered dependents receive 50% of your basic-benefit amount
• Benefits paid regardless of any other medical or disability plan coverage
• Premiums are conveniently payroll deducted

• Heart Attack -the death of a portion of the heart muscle due to inadequate blood supply. Established (old) myocardial infraction in cardiac arrest are not covered
• Stroke – the death of a portion of the brain producing neurological sequelae including in fraction of the brain tissue, hemorrhage, and embolization from an extra cranial source. Transient ischemic attacks (TIAs), head injury, chronic cerebrovascular insufficiency’s in reversible ischemic neurological deficits are not covered
• End Stage Renal Failure – irreversible failure of both kidneys, resulting in potential dialysis or hemodialysis. renal failure caused by traumatic events, including surgical trauma, are not covered
• Major Organ Transplant – pays either candidate benefit and placed on national transplant list, or surgery benefit for transplant of heart, lungs, liver, pancreas, or kidneys. Lungs and kidneys are each considered one major organ, regardless of whether one or both lungs or kidneys are transplanted. Surgery benefit not paid if candidate benefit paid; also not paid for mechanical or non-human organs
• Coronary Artery Bypass Surgery – to correct narrowing or blockage of one or more coronary arteries with bypass graft. Abnormal Aortic bypass, balloon angioplasty, laser embolectomy, atherectomy, stent placement in nonsurgical procedures are not covered
• Waiver of Premium (employee only) – premiums waived if disabled for 90 consecutive days due to critical illness or specified disease

• Invasive cancer- malignant tumor with uncontrolled growth, including Leukemia and Lymphoma. Carcinoma in situ, non-invasive or metastasized skin cancer in early prostate cancer or not covered
• Carcinoma In Situ – non-invasive cancer, including early prostate cancer (stages A, I, II) and Melanoma that has not invaded the dermis. Other skin malignancies, pre-malignant lesions (such as intraepithelial neoplasia), benign tumors and polyps are not covered

• Initial critical illness- second diagnosis more than six months after the first date of diagnosis for which an initial critical illness benefit was paid
• Cancer critical illness- second diagnosis more than six months after the last date treatment was received for which a cancer critical illness benefit was paid

• Skin cancer rider – includes diagnosis of basal cell carcinoma and squamous cell carcinoma. Must not have been paid within 365 days. Malignant Melanoma and precancerous conditions such as leukoplakia; carcinoid; hyperplasia; polycythemia; non-malignant melanoma; moles; and similar diseases or lesions are not covered
• Fixed Wellness rider- 24 exams. Once per person per calendar year, See list for list of Wellness services in test
  *benefit paid once per covered person. When all benefits have been used, the coverage terminates

Eligibility

Your employer decides who is eligible for your group (such as a length of service and hours worked each week). Issue ages are 18 and over.

Dependent eligibility/ termination

Family members eligible for coverage or your spouse or domestic partner and children. Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. Spouse coverage ends upon valid degree of divorce or your death. Domestic partner coverage ends when the domestic partner ends or your death.

When coverage ends

You may be eligible to continue coverage when coverage under the policy ends refer to your certificate of insurance for details

Conditions and limits

A diagnosis occurring before your coverage begins is not payable; However, a diagnosis of any covered critical illness or specified disease after your effective date will be payable. Benefits are subject to all limitations and exclusions. All critical illness must meet the definitions and dates of diagnosis started in the policy and be diagnosed by a physician while coverage is in effect. The basic benefit amount paid for all critical illness combined will never exceed $250,000 for each covered person. If the first diagnosis of cancer occurs before the effective date of coverage, benefits are paid for a subsequent diagnosis of cancer after the effective date, subject to the terms and conditions in the certificate.

Exclusions

Benefits are not for: intentionally self-inflicted injury or action; Illegal activities or occupations; suicide while sane, or self-destruction while insane, or any attempt at either; substance abuse, including alcohol, alcoholism, abusive legally obtained prescription medicines, or illegal use of non-prescribed drugs or narcotics; being under the influence of alcohol, drugs or narcotics, and less administered and taken as prescribed by physician; or hospital confinement due to mental illness