CANCER INDEMNITY INSURANCE

Monumental Life Insurance Company

Benefits:



Table of Monthly Premium Rates
Member: $9.95
Family: $14.95
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Hospital Confinement Daily Benefit
Benefits: Amounts and Limits:
Daily Benefit per Illness Period
1st through 90th day of Confinement
$75 per day
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Miscellaneous Hospital Expense Benefit
Benefits: Amounts and Limits:
Maximum Benefit per Illness Period
Lifetime Maximum for this Benefit
$750
$1,000

We will pay the Hospital charges for expenses other than the room under the Miscellaneous Hospital Expense Benefit. Such charges include but are not limited to drugs, use of the operating room, medical supplies, oxygen and other items medically necessary for the treatment of cancer.
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Attending Physician Benefit for Covered Persons
while under the Hospital Confinement Daily Benefit
Benefits: Amounts and Limits:
Daily Benefit
Maximum Benefit per Illness Period
$30 per day
$600
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Private Duty Nurse Benefit
Benefits: Amounts and Limits:
Daily Benefit
Maximum Benefit per Illness Period
Lifetime Maximum for this Benefit
$25 per day
$900
$1,000

A Private Duty Nurse is a Nurse whose services are contracted for while the covered person is hospital confined and who is not employed by the Hospital if a Covered Person is Confined. The services of the Private Duty Nurse must be recommended by a Physician.
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Blood and Plasma Benefit while Hospital Confined,
as an Outpatient or in a Free-Standing Facility
Benefits: Amounts and Limits:
Maximum Benefit per Illness Period
**There is no maximum benefit for leukemia
$500**
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Radiology and Chemotherapy Benefit
Benefits: Amounts and Limits:
Maximum Benefit per Illness Period
Lifetime Maximum Amount for this Benefit
$1,000
$1,500

Upon receipt of due proof that the Covered Person incurred expenses for the cost of x-ray, radium, cobalt or chemotherapy treatments, we will pay a benefit for these expenses not to exceed the Maximum Benefit. The expense of x-ray, radium, cobalt and chemotherapy treatments incurred while Hospital Confined, as an outpatient or in a free standing facility is eligible for this benefit.
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Ambulance Benefit for Transporting a Covered Person
to or from a Hospital or Skilled Nursing Facility

Benefits: Amounts and Limits:
Maximum Benefit per one way trip
Maximum Benefit per Illness Period
$75
$500
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Surgical and Anesthesia Benefit (with Pathologist's Diagnosis)
Benefits: Amounts and Limits:
Maximum Benefit per Operative Session
Lifetime Maximum Amount for this Benefit
Skin Cancer Maximum Benefit per initial incision
Skin Cancer Maximum Benefit per additional incision
Skin Cancer Lifetime Maximum
20% of actual charges up to $1,000
$1,500
$100
$50
$1,500
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Anesthesia
Benefits: Amounts and Limits:
Maximum Benefit per Operative Session
Maximum Benefit for Skin Cancer per Operative Session
20% of actual charges up to $100
$30
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Extended Hospital Expense Benefit
Benefits: Amounts and Limits:
Maximum Benefit per Illness Period 100% of Hospital charges in lieu of all other benefits up to $5,000 per month

91st day and beyond. The Covered person must be in the Hospital for a total of 90 days during any Illness Period. The benefit cannot exceed the Maximum Benefit shown on the Schedule. This benefit will be paid as long as the Covered person is Hospital Confined or until the Maximum Lifetime Benefit is reached.
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Skin Cancer Benefit (without Pathologist's Diagnosis)
Benefits: Amounts and Limits:
Maximum Benefit per initial incision
Maximum Benefit per any additional incision
Lifetime Maximum amount for this Benefit
Anesthesia Maximum Benefit per removal session
$100
$50
$1,500
$30

Upon receipt of due proof that a Covered Person incurred expenses for treatment of Skin Cancer, we will pay the expense for its removal. The diagnosis may be made by a Physician other than a legally qualified Pathologist. This benefit will not exceed the amounts shown on the Schedule of Benefits per Skin Cancer removal session. The benefit is subject to the Lifetime Maximum amount.
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Hospice Care Benefit
Benefits: Amounts and Limits:
Daily Benefit
Maximum Benefit Period
$25 per day following confinement of at least 3 consecutive days
100 days

Upon receipt of due proof that a Covered Person, following a Covered Hospital Confinement which lasted at least 3 consecutive days, incurs expenses for treatment in a Hospice, we will pay the amount shown on the Schedule.
  1. Hospice means a facility that:
    • provides a Hospice Care Program,
    • is separated from any other facility, and
    • fulfills any licensing requirements of the state or locality in which it operates.

  2. Hospice Care Program means: a coordinated, inderdisciplinary program for meeting the special needs of dying individuals and their families, by providing palliative and supportive medical, nursing and other health services during the illness and bereavement:
    • to individuals who have no reasonable prospect of cure; and as estimated by a physician to have a life expectancy of less than six months; and
    • to the families of those individuals.

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Intensive Care Benefit*

Benefits: Amounts and Limits:
Daily Benefit
Maximum Benefit Period
$75 per day
15 days

Intensive Care Benefit for covered persons is subject to the following conditions:
  1. The Covered Person is Hospital Confined.
  2. The Confinement must be caused by Cancer.
  3. The Confinement begins while insurance under the Certificate and Rider are in force for the Covered Person.
The benefits payable is paid in addition to the Hospital Confinement Daily Benefit. This benefit is subject to the maximum number of days shown on the Schedule. Intensive Care Unit means a facility in a Hospital other than the patient's bedroom or an operating or a recovery room. It must be designated by the Hospital as a department providing the highest level of Intensive Care.
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Overall Lifetime Maximum Amount for all of the Above Benefits

Benefits: Amounts and Limits:
Overall Lifetime Maximum Amount for all of the Above Benefits
$250,000
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Eligibility
All new Members and Dependents, who have not been medically treated for or advised of Cancer within the 5 years prior to the Effective Date of Coverage are eligible for this Cancer insurance.

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Effective Date of Insurance
Issuance of a certificate is not a waiver of any of the following conditions. Each eligible Member and his Dependent will become insured under this Policy at the beginning of the Policy Month following acceptance by us of his application and the first premium. Any required premium for newborn Dependents must be paid within 31 days to continue coverage beyond 31 days. The Effective Date of Coverage will be shown on the certificate. If a Covered Person is Confined for any condition in a Hospital or an institution which provides medical care and treatment on the date his insurance would otherwise become effective, he will be insured the day following normal discharge from the Hospital or institution.

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Cancer Insurance Benefit
Except as provided under Exclusions, we will pay benefits according to the Schedule of Benefits for Cancer that manifests itself while the Covered Person is insured under this Policy and any attached Riders. These benefit payments will begin for covered expenses incurred up to 90 days before the date the first pathological diagnosis is made. If the Covered Person receives treatment for Cancer but positive diagnosis is not made during his lifetime, we will make payment if positive diagnosis is made after death. This payment will begin for covered expenses incurred up to 90 days before the date of diagnosis by a Certified Pathologist.

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Hospital Confinement Daily Benefit
We will pay the following benefit for Cancer treatment provided the Covered Person is Hospital Confined. We will pay the benefit for 90 days during any one Illness Period. Upon receipt of due proof that a Covered Person is Hospital Confined for the treatment of Cancer, we will pay the benefit shown on the Schedule for each day of Confinement. The benefit is subject to the Overall Lifetime Maximum Benefit Amount.

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Exclusions
Benefits will not be paid under this Policy and any attached Rider for any expenses which result from:
(1) injury or sickness other than Cancer;
(2) expenses the Covered Person is not legally obligated to pay or those charged only because the Covered Person has insurance;
(3) treatment or services performed outside of the United States.

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Pre-Existing Condition Limitation
No benefits will be payable for the Covered Person's Pre-Existing Conditions. They are defined as a Cancer that was positively diagnosed within five years prior to the Covered Person's Effective Date of Coverage under this Policy, or a Cancer for which treatment has been received before the Covered Person has been insured for 30 days from his Effective Date of Coverage. We will, however, pay benefits for Cancer diagnosed and treated within the first 30 days the Covered Person has been insured. Expenses for such treatment are payable only if incurred after coverage has been in force for 12 consecutive months from the Effective Date.
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About the Insurance Company
Monumental Life Insurance Company is rated A+ (Superior) for financial condition by A.M. Best Company and is rated AA+ (Very Strong) for claims paying ability by Standard and Poors, independent analysts of the insurance industry.
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Coverage is not available in all states.

CA1000GPM, CA1000GCM, CA1000GCM.FL, CA1000GCM.MN, CA1000GCM.MD, CA1000GCM.NH, CA1000GCM.TX, CA1000GCM.WI, CA1000GCM.WY