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Supplemental Insurance Protection
Direct Series New Hampshire Portfolio SB NH Portfolio Approval date: 2/15/2013 Code:
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Introduction This is a brief description of the SureBridge® Supplemental Plan portfolio. SureBridge® is a brand name used for insurance products underwritten and administered by The Chesapeake Life Insurance Company®. For plan details, refer to the outlines of coverage and product materials. Premium will be drafted upon submission of the application. The benefits described in this presentation are subject to all provisions, terms, definitions, and limitations and exclusions of the applicable policy. Supplemental plans serve a specific purpose in the insurance market. These plans are not intended as substitutes for accident and sickness health insurance and should not be solicited as such.
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Direct Series Stand-Alone Portfolio
Plan Type Chesapeake Product Cancer CancerWise® Hospital Indemnity Hospital Confinement Direct Disability Income Accident Disability Direct & Income Protection Direct Specified Disease Critical Illness Direct Accident Critical Accident Direct Vision Vision Plan Dental PPO Dental Plan
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Cancer Benefit Policy Form CH-26055-IP (5/07) NH (10/11)
CancerWise® Cancer Benefit Policy Form CH IP (5/07) NH (10/11)
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CancerWise® Benefits Provides a one-time, lump sum amount for benefit selected Benefit Options: Benefit for First Diagnosis of internal Cancer or malignant melanoma only Upon written pathological diagnosis Provided the diagnosis is after the waiting period and while the policy is in force Benefit available for each covered person in family $20,000 $30,000 $40,000 $50,000
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CancerWise® Benefits Benefit can be used for any purpose, such as
Experimental procedures Cosmetic reconstructive surgery Transportation and lodging for relatives Home Care Mortgage Deductibles/coinsurance for other health coverage Provides benefit upon diagnosis, regardless of hospitalization coverage is in addition to any other existing coverage coverage terminates for a covered person once a benefit amount is paid for that person; upon reaching age 65; or becomes eligible for Medicare, whichever occurs first Added or becomes eligible for Medicare, whichever occurs first Global: added or upon reaching age 65 to last sentence
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CancerWise® Waiting Period
Chosen Cancer Benefit Amount is not payable to covered person when cancer diagnosed within the first 30 days after effective date shown in the policy Schedule. If a covered person is First Diagnosed with Cancer during the 30-day waiting period, the maximum payment is $500
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CancerWise® Definitions
Cancer means a disease manifested by the presence of a malignant internal tumor characterized by the uncontrolled growth and spreading of malignant cells and/or the invasion of tissue, a Malignant Melanoma, Leukemia, Hodgkin’s Disease, or cancer in situ that is in the natural or normal place, which is confined to the site of origin and has not invaded neighboring tissue. Cancer does not include pre-malignant conditions, conditions with malignant potential, or all other skin cancer which is not specifically Malignant Melanoma. First Diagnosis or First Diagnosis of Cancer means an insured who has received a Diagnosis, as defined, for the first time while their coverage is in effect under the policy.
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CancerWise® Claim Example
Jane Smith purchased the CancerWise® plan with a $30,000 benefit and only six months later her physician diagnosed her with "invasive ductal carcinoma", or breast cancer. Although Jane had been going for her annual mammograms and one had required additional review by a pathologist, this was her first diagnosis of internal cancer during her lifetime. Chesapeake paid a one-time $30,000 benefit check to Jane and she was able to use the money as she needed. coverage under her CancerWise® plan terminated after this claim was paid.
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CancerWise® Exclusions & Limitations
We will not provide any benefits for loss caused by, resulting from or in connection with: Any services, supplies, care or treatment of Cancer, or any other disease, sickness or incapacity; Any disease, sickness or incapacity which is not included within the definition of Cancer as defined under the policy; All skin cancer which is not diagnosed, by definition, specifically as malignant melanoma; Any diagnosis, as defined which is determined to be caused by war or an act of war; Any diagnosis, as defined which is made by the insured or a member of the insured’s immediate family or household; Any diagnosis, as defined, which is made outside the U.S; or Any diagnosis, as defined, which is made after the date on which coverage under the policy has been terminated.
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CancerWise ® Renewability
The policy is guaranteed renewable to age 65, or Medicare eligibility if earlier, subject to the Company's right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy. Under our business rules, eligible dependents covered under the policy may continue coverage until age 26, subject to the termination provisions of the policy.
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Hospital Confinement Direct
Hospital Confinement Indemnity policy Form CH IP (01/10) NH
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Hospital Confinement Direct
Provides a daily benefit for hospital confinement due to illness or injury Benefits are subject to Lifetime Maximum, Waiting Period, Daily Benefit Amount, limitations shown in policy Schedule, Exclusions and Limitations and all other provisions of the policy
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Hospital Confinement Direct
Lifetime Maximum (per insured) Waiting Period from effective date of coverage Daily Benefit Amount Options 365 Days Sickness 30 Days Injury 0 Days $500 $750 $1,000
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Hospital Confinement Direct
Hospital Confinement Benefit Intensive Care/Cardiac Care Unit Confinement Benefit Paid in lieu of the Hospital Confinement Benefit Days 1 through 5 100% of the Daily Benefit Amount Days 6 through 10 50% of the Daily Benefit Amount Days 11 and over $100 per day Days 1 through 2 200% of the Daily Benefit Amount Days 3 through 10 100% of the Daily Benefit Amount Days 11 through 30 50% of the Daily Benefit Amount Days 31 and over $100 per day
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Hospital Confinement Direct Example
Lee Parker suddenly became ill and started having severe abdominal pains. Testing at the hospital showed an abdominal tumor. Lee was admitted to the hospital for surgery and was released after a six day hospital stay. Fortunately, before his illness, Lee had purchased the Hospital Confinement Direct and had satisfied the 30 Day Waiting Period for Sickness. Lee had chosen a Daily Benefit amount of $750. Hospital Confinement: Days 1 - 5, 100% of the Daily Benefit: $750 x 5 Days = $3,750 Day 6, 50% of the Daily Benefit: $375 x 1 Day = $ 375 Total Benefit Amount Paid to Lee: $4,125
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Hospital Confinement Direct Exclusions & Limitations
We will not provide any benefits for loss caused by, resulting from or in connection with: Any care or benefits which are not specifically provided for in the policy; Any act of war, declared or undeclared; Active military duty in the service of any country; Participation in a riot, civil commotion or insurrection; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Mental or nervous disorders; Jaw disproportions or malocclusions, or to increase vertical dimension or reconstruct occlusion; Weight loss or modification, or complications arising therefrom, or procedures resulting therefrom, or for surgical treatment of obesity, including wiring of the teeth and all forms of surgery performed for the purpose of weight loss or modification;
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Hospital Confinement Direct Exclusions & Limitations, continued
Breast reduction or augmentation unless necessary in connection with breast reconstructive surgery following a mastectomy performed while insured under the policy; Modification of the physical body in order to improve the psychological mental or emotional well-being of the insured person, such as sex-change surgery; Payment for care for military service connected disabilities for which the insured person is legally entitled to services and for which facilities are reasonably available to the insured person and payment for care for conditions that state or local law requires be treated in a public facility; Experimental or investigational medicine; Any treatment or procedure that either promotes or prevents conception or prevents childbirth, including but not limited to: (a) artificial insemination; (b) in-vitro fertilization or other treatment for infertility; (c) treatment for impotency; (d) sterilization or reversal of sterilization; or (e) abortion (unless the life of the mother would be endangered if the fetus were carried to term) unless otherwise stated in the policy;
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Hospital Confinement Direct Exclusions & Limitations, continued
Cosmetic surgery; Radial keratotomy or any eye surgery when the primary purpose is to correct nearsightedness, farsightedness, astigmatism, or any other refractive error; Operating any motorized passenger vehicle for wage, compensation or profit; Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics unless taken as prescribed by a physician, or hallucinogens, directly or indirectly; Sickness or injury arising from an overdose of drugs, under the influence of hallucinogens, narcotics or other drugs unless taken as prescribed by a physician, directly or indirectly; Committing or trying to commit a felony; Normal pregnancy, except for Complications of Pregnancy while hospital confined; Hospital confinement for routine or normal newborn child care; Mountaineering using ropes and/or other equipment, parachuting, hang gliding, racing any type of vehicle in an organized or unorganized event, sky diving, scuba diving below 50 feet, motorized racing, para-sailing, experimental aviation, ultra-light flying, base jumping, bungee jumping, heli-skiing or heli-snowboarding; and
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Hospital Confinement Direct Exclusions & Limitations, continued
Travel in or descent from any vehicle or device fro aerial navigation, except as a fare paying passenger in an aircraft operated by a commercial airline (other than a charter airline) certified by the U.S. Federal Aviation Administration (FAA), on a regularly scheduled passenger trip. Pre-Existing Condition Limitation: We will not provide benefits for any loss resulting from a Pre-Existing Condition, as defined, unless the loss is incurred at least 9 months after the effective date of coverage for an insured person. A Pre-Existing Condition means a medical condition, sickness or injury not excluded by name or specific description for which: Medical advice, consultation, or treatment was recommended by or received from a medical practitioner acting within the scope of his or her license, within the two year period before the effective date of coverage; or Symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the two year period before the effective date of coverage.
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Hospital Confinement Direct Waiver of Premium
Waiver of Premium: Monthly premiums due for the policy will be waived after the primary insured has been hospital confined for at least 30 consecutive days. Premiums will be waived until the primary insured is no longer receiving a hospital confinement benefit under the policy. Once premiums are resumed, any new hospital confinements will be subject to a 30 day continuous confinement without discharge, before premiums will be waived.
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Hospital Confinement Direct Renewability
The Policy is guaranteed renewable to age 65, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the Policy. Under our business rules, Eligible Dependents covered under the Policy may continue coverage until age 26, subject to the termination provisions of the Policy.
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Accident Disability Direct
Accident-Only Disability Income Insurance policy Form CH IP (01/10) NH
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Accident Disability Direct
The Accident Disability Direct plan provides a Monthly Total Disability benefit if the insured becomes Totally Disabled within 30 days of an Injury while covered under the policy and is Actively at Work Does NOT provide benefits for loss due to sickness Elimination Period Monthly Indemnity Benefit Options Maximum Period Payable Options 14 Days 30 Days $1,000 $1,500 $2,000 $2,500 12 Months 24 Months Benefits may vary by state. See state variations and product materials for more details.
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Accident Disability Direct
Benefits are eligible the first day following the Elimination Period Due to Injury that occurs after the effective date of coverage Must be Actively at Work Total Disability must begin within 30 days after the Accidental Injury Benefit continues through end of Maximum Period payable as long as Total Disability continues Total Disability for a full month provides for the lesser of: The Monthly Indemnity Benefit; or 60% of the insured’s prior monthly income Total Disability for a partial month Partial Month is 1/30 per day of the Monthly Indemnity Benefit
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Accident Disability Direct - Definitions
Actively at Work means: Working on a permanent basis at least 25 hours per week for wage or salary; and Performing the material and substantial duties of a regular job or any other job for which the insured is qualified by reason of education, training or experience. Totally Disabled means that due to Injury, the insured is: Under a legally qualified physician’s care; and Not in fact Actively at Work, as certified by a legally qualified physician upon our request.
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Accident Disability Direct - Definitions
Recurrent Disability means becoming Totally Disabled, ceasing to be Totally Disabled, then becoming Totally Disabled again for the same or related conditions. The latter Total Disability will be considered a Recurrent Disability. New elimination period not required Subject to the Maximum Period Payable that started with the preceding Period of Total Disability If the Maximum Period Payable has ended, no benefits will be payable for a recurrence Concurrent Disability – if Total Disability is caused by more than one injury, benefits are paid as only one injury.
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Accident Disability Direct Waiver of Premium
When an insured has been continuously disabled as defined for 90 days and receiving benefits, future premiums will be waived for the remainder of the disability period Insured must resume premium payments within 31 days when no longer eligible for waiver of premium to keep coverage in force
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Claim Processing The Accident Disability Direct plan does contain a provision for coordination with other compensation. If the insured has other benefits paid for their disability, the monthly benefit under this plan will be reduced. To determine benefits, the company may require additional income information including, but not limited to, pre-tax personal income and income tax returns for periods before and after the start of a period of Total Disability.
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Accident Disability Direct Claims Example
After a long 50 hour week at his diner, Calvin was just finishing the prep work for the next day when he slipped on some grease fracturing his arm and re-injuring his back. He had just returned to work 2 months ago after injuring his back while unloading a delivery. He had been totally disabled for 3 months. Fortunately, Calvin had been issued the Accident Disability plan a year ago with the $2,500 monthly benefit and a maximum period payable of 12 months. For his first disability, the plan paid him $7,500 directly (3 months x $2,500 ). Since Calvin had been actively working for less than 6 months following the end of the preceding disability, then his new disability would not require another elimination period and would be considered a Recurrent Disability. Calvin will be eligible for payments up to the remainder of the 12 month Maximum Period he chose. His fractured arm will be considered part of a Concurrent Injury and benefits will pay as one injury.
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Accident Disability Direct Claims Example
Original Injury Total Disability Insured was permanently and actively at work at least 25 hours Elimination period of 30 Days had passed 3 months Total Disability x Monthly Benefit Chosen 3 x $2,500 = $7,500 Monthly Benefit did not exceed 60% of his gross monthly salary Recurrent Total Disability Returns to work for 2 months and re-injures back Qualifies as a Recurrent Disability since actively at work less than 6 months New elimination period not required Remaining Benefit 12 Month Maximum Period Payable chosen 12 months – 3 months = 9 per month remaining while Total Disability continues
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Accident Disability Direct Exclusions & Limitations
We will not provide any benefits for loss caused by, resulting from or in connection with: Sickness, including but not limited to pregnancy and childbirth Injuries that do not first occur while the policy is in force for the insured person Any act of war, declared or undeclared Active military duty in the service of any country Participation in a riot, civil commotion or insurrection Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane Mental or nervous disorders Having cosmetic surgery Operating any motorized passenger vehicle for wage, compensation or profit Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics, unless taken as prescribed by a physician, or hallucinogens, directly or indirectly
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Accident Disability Direct
Exclusions & Limitations, continued A sickness or injury arising from an overdose of drugs, under the influence of hallucinogens, narcotics or other drugs unleas taken as prescribed by a physician, directly or indirectly Your being incarcerated Committing or trying to commit a felony Mountaineering using ropes and/or other equipment, parachuting, hang gliding, officiating or coaching, racing any type of vehicle in an organized or unorganized event, sky diving, scuba diving below 50 feet, motorized racing, para-sailing, experimental aviation, ultra-light flying, base jumping, bungee jumping, heli-skiing or heli-snowboarding Travel in or descent from any vehicle or device for aerial navigation, except as a fare paying passenger in an aircraft operated by a commercial airline (other than a charter airline) certified by the U.S. Federal Aviation Administration (FAA) on a regularly scheduled passenger trip. 32
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Accident Disability Direct Renewability
The Policy is guaranteed renewable to age 65, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the Policy.
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Disability Income Insurance policy Form CH-26115-IP (01/10) NH
Income Protection Direct Disability Income Insurance policy Form CH IP (01/10) NH
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Income Protection Direct
The Income Protection Direct plan provides a Monthly Total Disability benefit if the insured becomes Totally Disabled within 30 days of sickness onset or occurrence of an injury while covered under the policy and is Actively at Work Elimination Period Monthly Indemnity Benefit Options Maximum Period Payable Options 14 Days 30 Days $1,000 $1,500 $2,000 $2,500 12 Months 24 Months Benefits may vary by state. See state variations and product materials for more details.
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Income Protection Direct
Benefits are eligible the first day following the Elimination Period Due to sickness or injury that occurs after the effective date of coverage Must be Actively at Work Total Disability must begin within 30 days after the sickness begins or injury occurs Benefit continues through end of Maximum Period payable as long as Total Disability continues Total Disability for a full month provides for the lesser of: The Monthly Indemnity Benefit; or 60% of the insured’s prior monthly income Total Disability for a partial month Partial Month is 1/30 per day of the Monthly Indemnity Benefit
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Income Protection Direct - Definitions
Actively at Work means: Working on a permanent basis at least 25 hours per week for wage or salary; and Performing the material and substantial duties of a regular job or any other job for which the insured is qualified by reason of education, training or experience. Concurrent Disability If Total Disability is caused by more than on injury or sickness, or both, benefits are paid as only one sickness or injury. Pre-Existing Condition means a sickness not excluded by name or specific description for which: Medical advice, consultation or treatment was recommended by or received from a medical practitioner acting within the scope of his or her license, within the two year period before the effective date of coverage; or Symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the two year period before the effective date of coverage.
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Income Protection Direct Definitions, continued
Recurrent Disability will be deemed when the insured is disabled after a Period of Total Disability and has not been actively at work for at least 6 months following the end of the preceding disability New elimination period not required Subject to the Maximum Period Payable that stared with the preceding Period of Total Disability If the Maximum Period Payable has ended, no benefits will be payable for a recurrence Totally Disabled means that due to sickness or injury, the insured is: Under a legally qualified physician’s care; and Not in fact Actively at Work, as certified by a legally qualified physician upon our request.
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Income Protection Direct Waiver of Premium
When an insured has been totally disabled as defined for 90 consecutive days and receiving benefits, future premiums will be waived for the remainder of the disability period Insured must resume premium payments within 31 days when no longer eligible for waiver of premium to keep coverage in force
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Claim Processing The Income Protection Direct plan does contain a provision for coordination with other compensation. If the insured has other benefits paid for their disability, the monthly benefit under this plan will be reduced. To determine benefits, the company may require additional income information including, but not limited to, pre-tax personal income and income tax returns for periods before and after the start of a period of Total Disability.
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Income Protection Direct Claims Example
Bill Green purchased the Income Protection Direct plan with a monthly benefit of $2,000, the 30 day elimination period, and a maximum benefit period of 24 months. Unfortunately, later that year Bill was diagnosed with Multiple Sclerosis and over time the disease resulted in a total disability confirmed by his physician. After the 30 day elimination period expired, Bill was eligible to receive a monthly benefit of $2,000 from Chesapeake that would continue for the next 23 months. Having this monthly benefit in place was a big help as his family adapted to their new lifestyle of not having Bill as the breadwinner in the family.
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Income Protection Direct Claims Example
Original Injury Total Disability Insured was permanently and actively at work at least 25 hours Elimination period of 30 Days had passed 3 months Total Disability x Monthly Benefit Chosen 3 x $2,500 = $7,500 Monthly Benefit did not exceed 60% of his gross monthly salary Recurrent Total Disability Returns to work for 2 months and re-injures back Qualifies as a Recurrent Disability since actively at work less than 6 months New elimination period not required Remaining Benefit 12 Month Maximum Period Payable chosen 12 months – 3 months = 9 per month remaining while Total Disability continues
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Income Protection Direct Exclusions & Limitations
We will not provide any benefits for loss caused by, resulting from or in connection with: Injuries that do not first occur while the policy is in force for the insured person; Any act of war, declared or undeclared; Active military duty in the service of any country; Participation in a riot, civil commotion or insurrection; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Mental or Nervous Disorders; Having cosmetic surgery; Experimental or investigational medicine; Operating any motorized passenger vehicle for wage, compensation or profit;
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Income Protection Direct Exclusions & Limitations, continued
Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics unless taken as prescribed by a physician, or hallucinogens, directly or indirectly; Sickness or injury arising from an overdose of drugs, under the influence of hallucinogens, narcotics or other drugs unless taken as prescribed by a physician, directly or indirectly; Your being incarcerated; Committing or trying to commit a felony; Pregnancy and Childbirth; Mountaineering using ropes and/or other equipment, parachuting, hang gliding, officiating or coaching, racing any type of vehicle in an organized or unorganized event, sky diving, scuba diving below 50 feet, motorized racing, para-sailing, experimental aviation, ultra-light flying, base jumping, bungee jumping, heli-skiing or heli-snowboarding;
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Income Protection Direct Exclusions & Limitations, continued
Travel in or descent from any vehicle or device for aerial navigation, except as a fare paying passenger in an aircraft operated by a commercial airline (other than a charter airline) certified by the U. S. Federal Aviation Administration (FAA), on a regularly scheduled passenger trip. Pre-Existing Condition Limitation: We will not provide benefits for any loss resulting from a Pre-Existing Condition, as defined, unless the loss is incurred at least 9 months after the insured’s effective date of coverage.
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Income Protection Direct Renewability
The policy is guaranteed renewable to age 65, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy.
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Critical Illness Direct
Specified Disease/Condition & Major Organ Transplant Plan Form CH IP (01/10) NH IN and CA have Critical Care, not Critical Care Plus
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Critical Illness Direct
Designed to provide a lump-sum benefit ONLY when certain losses First Occur due to a Qualifying Event NO coverage for basic hospital, basic medical-surgical, or major medical expenses or loss from injury or accident If there is a Qualifying Event First Occur within 30 days following the effective date of coverage, the plan will pay no more than $500 of the Lifetime Maximum Benefit Amount. Lifetime Maximum Benefit Amount Options Primary / Dependent Spouse (Applicants can choose different benefit options but dependent children must choose the same amount) $10,000 $15,000 $20,000 $30,000 $40,000 $50,000 $60,000
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Critical Illness Direct
Qualifying Event First Occurrence Benefit Percentage* Benign Brain Tumor 25% of Lifetime Maximum Benefit Amount Cancer In Situ Coronary By-pass Advanced Alzheimer’s 100% of Lifetime Maximum Benefit Amount Amyotrophic Lateral Sclerosis (ALS) End Stage Renal Failure Heart Attack Illness Induced Coma Cancer Major Organ Transplant Severe Stroke If a customer suffers a qualifying event paying a 25% benefit, they will retain coverage and the remaining 75% of the benefit amount for future First Occurrences of Qualifying Events *Percentage reduced by ½ on date insured reaches age 70
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Critical Illness Direct - Definitions
First Occurs, First Occurred or First Occurrence means any diagnosis, treatment, surgery or advice by a legally qualified physician having initially occurred for the first time in the insured person’s lifetime and while the policy is in force for the insured person. Cancer means only those types of cancer manifested by the presence of a malignant neoplasm characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Leukemia and Hodgkin’s Disease are considered Cancer. Cancer in Situ includes a diagnosis of cancer wherein the tumor cells still lie within the tissue of origin without having invaded neighboring tissue. State 0 transitional carcinoma of urinary bladder and early prostate cancer requiring medical treatment is considered Cancer in Situ. Cancer in Situ does not include premalignant lesions, tumor or polyps; benign tumors or polyps; or skin cancer
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Critical Illness Direct - Definitions
Illness Induced Coma means loss of consciousness due to illness for a continuous 96 hour period in which external stimulation produces only primitive avoidance refluxes. Illness Induced Coma does not include: deliberately induced Comas for medical reasons or comas resulting from injury. Major Organ (for a Major Organ Transplant) includes only the following organs: heart; lung or lungs; liver; kidney; pancreas; heart/lung combined; or bone marrow. Please refer to the policy for additional definitions of all Qualifying Events.
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Critical Illness Direct Claim Example
Don Brown purchased a Critical Illness Direct plan with a $20,000 benefit amount. 45 days after the effective date of coverage, he went to the hospital with severe chest pains. Don was admitted to the hospital where he was required to undergo a coronary bypass operation. Because Don had passed the 30 day waiting period from his effective date, and this was a first occurrence, he was eligible for 25% of his $20,000 benefit amount. Chesapeake processed the claim and mailed a check for $5,000 to Don Brown to use for anything he chose. Don's Critical Illness Direct plan remained in effect because he still has $15,000 remaining in the event that he has a first diagnosis of any other qualifying event covered under the plan.
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Critical Illness Direct Claim Example
Critical Illness Benefit First Occurrence Coronary Bypass Remaining Benefits $20,000 $5,000 (25%) $15,000* *The policy will remain in-force and remaining benefits can be used towards the first diagnosis of other qualifying events on the plan.
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Critical Illness Direct Exclusions & Limitations
We will not provide any benefits for any loss caused by, resulting from or in connection with: An injury or accident; Any care or benefits which are not specifically provided for in the policy; Any act of war, declared or undeclared; Active military duty in the service of any country; Participation in a riot, civil commotion or insurrection; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Payment for care for military service connected disabilities for which the insured person is legally entitled to services and for which facilities are reasonably available to the insured person and payment for care for conditions that state or local law requires be treated in a public facility; Experimental or investigational medicine;
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Critical Illness Direct Exclusions & Limitations , continued
Intentionally medically induced Qualifying Event, except in the case of Major Organ Transplant; Cosmetic surgery; Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics unless taken as prescribed by a physician, or hallucinogens, directly or indirectly; Sickness or injury arising from an overdose of drugs, under the influence of hallucinogens, narcotics or other drugs unless taken as prescribed by a physician, directly or indirectly; Committing or trying to commit a felony; or Premalignant lesions, tumors or polyps; benign tumors or polyps; or any skin cancer other than invasive malignant melanoma in the dermis or deeper, or skin malignancies that have become cancers.
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Critical Illness Direct Exclusions & Limitations, continued
Qualifying Events Benefits will not be payable for: A Qualifying Event, which First Occurs prior to an insured person's effective date of coverage as specified in the policy; Any Qualifying Event caused directly or indirectly by Acquired Immune Deficiency Syndrome (AIDS) or AIDS related complex; Any condition that is not diagnosed as a Qualifying Event as defined in the policy; Loss resulting from any other disease, sickness or incapacity, other than loss resulting from a Qualifying Event, as defined in the policy. This includes any other disease or incapacity which may have been complicated or directly or indirectly affected or caused by a Qualifying Event or as a result of treatment of a Qualifying Event; or Any amounts in excess of the lifetime benefit amount.
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Critical Illness Direct Renewability
The policy is guaranteed renewable to age 75, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy. Under our business rules, eligible dependents covered under the policy may continue coverage until age 26, subject to the termination provisions of the policy.
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Critical Accident Direct
Critical Accidental Injury Insurance Policy Form CH IP (04/11) NH
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Critical Accident Direct
Provides a one time, lump-sum benefit for a Qualifying Injury ONLY when certain losses are a direct result of an Accidental Injury Qualifying Injury must occur within 60 days of the accident Does not provide benefits for loss due to sickness Does not provide benefits for injuries that occur prior to the effective date of coverage Lifetime Maximum Benefit Amount Options Per insured person Primary / Dependent Spouse / Dependent Children (Applicants can choose different benefit options but dependent children must choose the same amount) $10,000 $15,000 $20,000 $30,000 $40,000 $50,000 $60,000
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Critical Accident Direct
Qualifying Injury Quadriplegia – Total Paralysis of Both Upper and Lower Limbs Paraplegia – Total Paralysis of Lower Limbs Hemiplegia – Total Paralysis of Upper and Lower Limbs on One Side of the Body Second-Degree Burn to at least 20% of the Body Third-Degree Burn to at least 10% of the Body Coma (lasting 7 or more continuous days) Loss of Sight in Both Eyes Loss of Hearing in Both Ears Only one benefit amount will be paid per insured, per lifetime Coverage ends on the date the Qualifying Injury occurs and benefit is paid Hemiplegia, Paraplegia, and Quadriplegia must result in defined loss of not less than 30 continuous days
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Critical Accident Direct Claim Example
Betty was in a serious automobile accident and suffered a severe spinal cord injury that resulted in quadriplegia, or the complete and total loss of use of her upper and lower limbs. Fortunately, Betty had been issued Chesapeake's Critical Accident Direct plan five months before with a benefit amount of $30,000. When Chesapeake received proof of her diagnosed permanent condition, Betty was mailed a check for her full benefit of $30,000 and her coverage under the plan was terminated and the family premium was reduced by her premium amount. This money allowed her to remodel her home to accommodate her new lifestyle in an electric wheelchair and the remodeling was not something that was covered under her health insurance.
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Critical Accident Direct Exclusions & Limitations
We will not provide any benefits for any loss caused by, resulting from or in connection with: A Sickness; Any care or benefits which are not specifically provided for in the policy; Any act of war, declared or undeclared; Active military duty in the service of any country; Participation in a riot, civil commotion or insurrection; Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; Payment for care for military service connected disabilities for which the insured person is legally entitled to services and for which facilities are reasonably available to the insured person and payment for care for conditions that state or local law requires be treated in a public facility;
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Critical Accident Direct Exclusions & Limitations, continued
Experimental or investigational medicine; Intentionally medically induced Qualifying Injury; Cosmetic surgery; Drug abuse or addiction including alcoholism, or overdose of drugs, narcotics unless taken as prescribed by a legally qualified physician, or hallucinogens, directly or indirectly; Sickness or injury arising from an overdose of drugs, under the influence of hallucinogens, narcotics or other drugs unless taken as prescribed by a physician, directly or indirectly; Committing or trying to commit a felony; Sunburn.
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Critical Accident Direct Exclusions & Limitations, continued
Benefits will not be payable for: A Qualifying injury that occurred prior to an insured person’s Effective date of coverage; Any condition that is not a Qualifying Injury; Loss resulting from any other condition or incapacity, other than loss resulting from a Qualifying Injury. This includes any other condition or incapacity which may have been complicated or directly or indirectly affected or caused by a Qualifying Injury or as a result of treatment of a Qualifying Injury; or Any amounts in excess of the Benefit Amount.
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Critical Accident Direct Renewability
The policy is guaranteed renewable to age 75, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy. Under our business rules, eligible dependents covered under the policy may continue coverage until age 26, subject to the termination provisions of the policy.
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Vision Insurance Policy CH-26023-IP (5/07) NH (01/12)
Vision Plan Vision Insurance Policy CH IP (5/07) NH (01/12)
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Vision Plan-Exams Provides one eye exam per year from last date of service, per insured Network exams covered at 100%; Non-Network exams are paid at 100% of the network negotiated rate Includes dilation Covered expenses do not include frames, contact lens fittings or follow-up visits
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Corrective Spectacle Lenses Corrective Contact Lenses
Vision Plan-Lenses Corrective Spectacle Lenses One purchase every 12 months from last date of service per insured person 100% for standard single, bifocal or trifocal plastic lenses Corrective Contact Lenses One purchase evrey 12 months from last date of service per insured person 100% for non-disposable, disposable, Therapeutic-not covered In-network only Out-of-network not covered or
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Vision Plan Exclusions and Limitations
Benefits will not be provided under this policy for expenses associated with the following: orthoptic or vision training and any associated supplemental testing; plano lenses; lens coating; two pair of glasses, in lieu of bifocals or trifocals; medical or surgical treatment of the eyes; any type of corrective vision surgery, including LASIK surgery; any eye examination, or any corrective eyewear, required by an employer as a condition of employment; any services or supplies when paid under any Worker’s Compensation or similar law; No-line bifocal or progressive lenses; photochromic, transition, or polycarbonate lenses; lenticular lenses;
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Vision Plan Exclusions and Limitations, continued
sub-normal vision aids or non-prescription lenses; services rendered or supplies purchased outside the U.S. or Canada, unless the insured person resides in the U.S. or Canada and the charges are incurred while on a business or pleasure trip; eyeglasses when the change in prescription is less than .5 Diopter; experimental or investigational or non-conventional treatment or device; eyeglass lens treatments, including “add-ons”, UV coating, anti-reflective coating, scratch resistant coating, tinting, or edge polishing; oversized lenses; high index lenses of any material type; fitting for contact lenses; follow-up visits; frames for corrective spectacle lenses; therapeutic contact lenses; or charges incurred after this policy has terminated or coverage has ended.
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Vision Plan Renewability
The policy is guaranteed renewable, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy. Under our business rules, eligible dependents covered under the policy may continue coverage until age 26, subject to the termination provisions of the policy.
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PPO Dental Plan Premier and Basic Plan Options
Dental Insurance Policy Form CH IP (01/12) (P) NH Form CH IP (01/12) (B) NH
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Dental Plan Overview Two dental plan options available –Premiere and Basic Both plans provide benefits for covered expenses through Network Providers and Non-Network Providers Insured can go anywhere, but will maximize benefits by using Careington’s Maximum Care Network providers Includes access to the Maximum Care Network providers for covered and non-covered services Participating providers can be found by going to or by calling Benefits are payable up to the scheduled maximum per calendar year, per insured or per family, based on the plan Charges exceeding maximums are the insured’s responsibility
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Premiere & Basic PPO Dental Plan
TYPE I COVERED EXPENSES Premiere Plan & Basic Plan No deductible No waiting period, 100% Co-Insurance with Network Providers, 80% Coinsurance with Non-Network Providers TYPE I COVERED EXPENSES: PREVENTIVE: Prophylaxis, once every 6 months Topical fluoride, once every 12 months, up to age 16 Sealants, once every 36 months, up to age 16 DIAGNOSTIC: Oral evaluations, once every 6 months Bitewing x-rays, once every 12 months Vertical bitewings, once every 36 months Diagnostic casts
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Premiere & Basic PPO Dental Plan
TYPE II COVERED EXPENSES Premiere Plan 6 month waiting period $50 Deductible 80% Coinsurance for Network Providers 60% for Coinsurance Non-Network Providers Basic Plan $100 Deductible 50% Coinsurance for Network and Non-Network Providers TYPE II COVERED EXPENSES: PREVENTIVE: Space maintainers, up to age 6 DIAGNOSTIC: Intraoral films, extraoral films, and panoramic film, once every 36 months RESTORATIVE: Amalgam, primary or permanent and resin- based composite ADJUNCTIVE SERVICES: Includes services such as: Palliative (emergency) treatment of pain Fixed partial denture sectioning Local anesthesia Analgesia, up to age 13 Inhalation of nitrous oxide Occlusion analysis and occlusion adjustment
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Premiere & Basic PPO Dental Plan
Type III Covered Expenses Premiere Plan 12 month waiting period $50 Deductible 60% Coinsurance for Network Providers 50% Coinsurance Non-Network Providers Basic Plan Type III Covered Expenses are Not Included with this plan TYPE III COVERED EXPENSES: PREMIERE PLAN ONLY RESTORATIVE: Includes services such as: Inlays and onlays (and recementing, once every 12 months) Crowns; cast posts and core buildups Pin retention in addition to restoration, up to 2 procedures every 12 months Sedative fillings ENDODONTICS: Includes services such as: Pulp caps; therapeutic pulpotomy; pulpal therapy Root canal or endodontic therapy
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Premier & Basic PPO Dental Plan TYPE III COVERED EXPENSES (continued)
PERIODONTICS: Includes services such as: Gingivectomy/gingivoplasty, once every 36 months Gingival flap procedure and osseous surgery, each limited to once every 36 months Soft tissue graft procedures Periodontal scaling and root planning, limited to 4 separate quadrants every 2 years Full-mouth debridement to enable evaluation and diagnosis, once every 36 months PROSTHODONTICS: Includes services such as: Complete dentures ( limited to once every 5 years ), including adjustment Resin-base partial dentures, including adjustment Repair of broken complete denture base ORAL SURGERY: Includes services such as: Extraction of erupted tooth; removal of impacted tooth Tooth transplantation Alveoloplasty Removal of benign cyst/tumor Incision and drainage of abscess
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Dental Plan Comparison
Benefits Premiere Basic Calendar Year Deductible Family Limited to 3 per family Calendar Year Benefit Maximum $1,200 per insured $6,000 per family $1,000 per insured $5,000 per family Type I Covered Expenses Deductible: 0 Waiting Period: 0 months Coinsurance Network: 100% Coinsurance Non-Network: 80% Type II Covered Expenses Deductible: $50 per insured Waiting Period: 6 months Coinsurance Network: 80% Coinsurance Non-Network: 60% Deductible: $100 Coinsurance Network: 50% Coinsurance Non-Network: 50% Type III Covered Expenses Deductible: $50 per insured Waiting Period: 12 months Coinsurance Network: 60% Coinsurance Non-Network: 50% Not Included Orthodontics
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Premier PPO Dental Plan Exclusions and Limitations
We will not provide any benefits for charges arising directly or indirectly, in whole or in part, from: Treatment, care, services or supplies for which benefits are not specifically provided for in this policy; Charges exceeding the Maximum Benefit Amount, if any; Attempted suicide or any intentionally self-inflicted injury; Treatment or disturbances of the temporomandibular joint (TMJ); A service not furnished by a Dentist, UNLESS by a dental hygienist under the Dentist’s supervision and x-rays are ordered by the Dentist; Cosmetic procedures, UNLESS due to an injury or for congenital / developmental malformation. Facing on crowns, or pontics, posterior to the second bicuspid is considered cosmetic; The replacement of full and partial dentures, bridges, inlays, onlays or crowns that can be repaired or restored to normal function; Implants; replacement of lost or stolen appliances; replacement of orthodontic retainers; athletic mouthguards; precision or semi-precision attachments; denture duplication; or splinting;
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Premier PPO Dental Plan Exclusions and Limitations, continued
Plaque control; completion of claim forms; broken appointments; prescription or take-home fluoride; or diagnostic photographs; Replacement of any prosthetic appliance, crown, inlay, or onlay restoration, or fixed bridge within 5 years of the date of the last replacement, UNLESS due to an injury; Oral/facial images, including intra- and extra-oral images; Pulp vitality tests; Post removals UNLESS in conjunction with endodontic therapy; Chairside, labial veneers (laminates); Intentional re-implantation, including necessary splinting; Surgical procedure for isolation of tooth with rubber dam; Canal preparation and fitting of performed dowel or post; Regional block anesthesia; Hospital, house, or extended care facility calls; Office visits for the purpose of observation, during or after regularly scheduled hours;
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Premier PPO Dental Plan Exclusions and Limitations, continued
Office visits outside of regularly scheduled hours; Enamel microabrasions; An initial placement of a partial or full removable denture or fixed bridgework if it involves the replacement of one or more natural teeth lost before coverage was effective under this policy. This limitation does not apply if replacement includes a natural tooth extracted while covered under the policy; Services not completed by the end of the month in which coverage terminates; Procedures that are begun, but not completed; Those services for which there would be no charge in the absence of insurance or for any service or treatment provided without charge; Services in connection with war or any act of war, whether declared or undeclared, or condition contracted or accident occurring while on full-time active duty in the armed forces of any country or combination of countries; Care or treatment of a condition for which benefits are payable under any Workers’ Compensation Act or similar law;
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Premier PPO Dental Plan Exclusions and Limitations, continued
Orthodontic procedures; Covered Expenses for which an insured person is not legally obligated to pay; or Experimental/Investigational treatment.
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Basic PPO Dental Plan Exclusions and Limitations
We will not provide any benefits for charges arising directly or indirectly, in whole or in part, from: Treatment, care, services or supplies for which benefits are not specifically provided for in this policy; Charges exceeding the Maximum Benefit Amount, if any; Attempted suicide or any intentionally self-inflicted injury; Treatment or disturbances of the temporomandibular joint (TMJ); A service not furnished by a Dentist, UNLESS by a dental hygienist under the Dentist’s supervision and x-rays are ordered by the Dentist; Cosmetic procedures; Plaque control; completion of claim forms; broken appointments; prescription or take-home fluoride; or diagnostic photographs; Oral/facial images, including intra- and extra-oral images; Pulp vitality tests; Chairside, labial veneers (laminates); Regional block anesthesia; Hospital, house, or extended care facility calls;
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Basic PPO Dental Plan Exclusions and Limitations, continued
Office visits for the purpose of observation, during or after regularly scheduled hours Office visits outside of regularly scheduled hours; Enamel microabrasions; Services not completed by the end of the month in which coverage terminates; Procedures that are begun, but not completed; Those services for which there would be no charge in the absence of insurance or for any service or treatment provided without charge; Services in connection with war or any act of war, whether declared or undeclared, or condition contracted or accident occurring while on full-time active duty in the armed forces of any country or combination of countries; Care or treatment of a condition for which benefits are payable under any Workers’ Compensation Act or similar law; Orthodontic procedures; Covered Expenses for which an insured person is not legally obligated to pay; or Experimental/Investigational treatment.
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Premier & Basic PPO Dental Plan Renewability
The policy is guaranteed renewable, subject to the Company’s right to discontinue or terminate the coverage as provided in the TERMINATION OF COVERAGE section of the policy. Under our business rules, eligible dependents covered under the policy may continue coverage until age 26, subject to the termination provisions of the policy.
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Premier & Basic PPO Dental Plan Business Rules
All members must select the same option Issuable to ages 0-63
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Reminders This presentation is not inclusive of all policy provisions
See product materials for complete details and any additional state variations regarding Termination of coverage, Renewability, Premium Changes, Eligible Dependents, and policy Definitions The claims examples used in this presentation is for training purposes only and is not approved for any other use This material cannot be copied or used in any way for advertising or presentation purposes
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