Group Critical Illness
As approved, some state insurance departments may require modifications to policy application, contract language, benefits, rates and other features. Please refer to the individual contracts specific to each state as the ultimate authority.
This applies to policy/certificate Form Nos. G H1715/G H1715C. This information is for agent use only. It is not for use with consumers.
The following chart represents some of those key differences from the standard contract language, benefits, rates and features:
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State Specific Information for Group Critical Illness Policy and Riders | |
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California |
•State law requires that the proposed insured is covered by an individual or group contract that arranges or provides comprehensive health insurance or an HMO plan, including medical, hospital and surgical coverage to be eligible to purchase this coverage. •Tier 2 plans have state-specific rates (included in proposals). •Employee benefit amount must be at least $20,000. •Dependent children benefit amount automatically 50% of employee benefit amount. •Policy’s Loss of Independent Living benefit is not available. •Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date and for six months after the issue date. •Additional Critical Illness Rider’s Advanced ALS benefits is not available. •Additional Critical Illness Rider’s Occupational HIV benefits is not available. •Increasing Benefit Rider not available. |
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Connecticut |
•Prime Benefits plan not available. •Benefits amounts are only available in increments of $10,000. •Dependent •Policy and riders have state-specific rates (included in proposals). •Benefit amount is not reduced by 50% at age 70. •Policy’s Loss of Independent Living benefit is not available. •Additional Critical Illness Rider’s Advanced ALS benefits is not available. •Genetic Screening Test Rider not available. |
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District of Columbia |
•Policy pays a $25 benefit for either ground or air ambulance transportation to or from a hospital for a critical illness. •Policy pays a $25 benefit for emergency medical services in an emergency room for a critical illness. |
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Florida |
•Attained Age rates not available. •Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date. |
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Idaho |
•Tier 1 plan not available. •Policy benefits amounts are only issued in increments of $10,000. •Policy child benefit amount is automatically 20% of the employee benefit amount. •Policy has state-specific rates (included in proposals). •Policy’s Coronary Artery Bypass Surgery, Angioplasty, Major Organ Transplant and Loss of Independent Living benefits not available. •For diagnosis of cancer during the policy waiting period, the Primary Insured Person may opt to have coverage voided and premiums returned. •Additional Critical Illness Rider’s Coma, Paralysis, Loss of Sight, Loss of Speech, Loss of Hearing, Advanced ALS, Severe Burns and Bone Marrow Transplant benefits not available. •Cardiopulmonary Rider’s cardiac conditions not available; replaced with Pulmonary Rider only covering pulmonary conditions. •Genetic Screening Test Rider not available. •Health Screening Rider not available. |
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Maine |
•Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date and for six months after the issue date. |
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Maryland |
•Policy has state-specific rates (included in proposals). •Policy’s Loss of Independent Living benefit is not available. |
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Michigan |
•Genetic Screening Test Rider not available. •Health Screening Rider not available. |
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Minnesota |
•Policy and riders have state-specific rates (included in proposals). •Health Screening Rider not available. |
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Missouri |
•Policy’s Loss of Independent Living benefit, Invasive Cancer benefit, Non-Invasive Cancer benefit and Skin Cancer benefit pay 10 percent of the benefit amount during the 30-day waiting period. |
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Montana |
•Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date. |
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Nevada |
•Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date. |
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•State law requires that all proposed insureds applying under this policy must have other coverage providing benefits for hospital and medical services and supplies. •Policy and riders have state-specific rates (included in proposals). •Benefit amount is not reduced by 50% at age 70. •Policy’s and applicable riders’ Additional Diagnosis Benefit and Reoccurrence Diagnosis Benefit do not require that the date of diagnosis of a new critical illness be separated from the prior diagnosis by any time period. •Policy’s Return of Premium upon Death of Primary Insured benefit not available. •Policy’s Waiver of Premium Benefit not available. •Policy’s Coronary Artery Bypass Surgery, Sudden Cardiac Arrest, Angioplasty, Kidney (Renal) Failure, Loss of Independent Living, Major Organ Transplant and Skin Cancer benefits not available. •Invasive Cancer and Non-Invasive Cancer benefits do not have the 30-day waiting period. •Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date and for six months after the issue date. •Additional Critical Illness Rider’s Coma benefit does not require that the condition persist for at least 96 hours. •Additional Critical Illness Rider’s Paralysis benefit does not require that the condition persist for at least 180 days. •Cardiopulmonary Rider not available. •Genetic Screening Test Rider not available. | |
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New Mexico |
•Policy and riders have state-specific rates (included in proposals). •Age-banded rates not available. •Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date. |
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Pennsylvania |
•Tier 3 plan not available. •Policy’s Return of Premium upon Death of Primary Insured Person benefit not available. •Policy’s pre-existing condition limitation applies to conditions 90 days prior to the issue date. •Specified Disease Rider not available. |
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South Dakota |
•Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date. |
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Tennessee |
•Policy’s waiting period for the Loss of Independent Living benefit does not apply to diagnosis due to accidental causes. |
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Texas |
•Policy and Additional CI Rider have state-specific rates (included in proposals). •Policy’s Loss of Independent Living benefit not available. •Policy’s and applicable riders’ Additional Diagnosis Benefit does not require that the date of diagnosis of a new critical illness be separated from the prior, different diagnosis by any time period. •Additional Critical Illness Rider’s Advanced ALS and Occupational HIV benefits are not available. |
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Utah |
•Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date and for six months after the issue date. •There is no elimination period for the policy’s Loss of Independent Living benefit. •Paralysis must be for a continuous period of 30 days relative to the Additional Critical Illness Rider’s benefit. |
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Wyoming |
•Policy’s pre-existing condition limitation applies to conditions six months prior to the issue date. |