Supplemental Hospital Insurance Plans for Individuals & Families

1 The Burden of Medical Debt: Results from the Kaiser Family Foundation/NY Times Medical Bills

1 The Burden of Medical Debt: Results from the Kaiser Family Foundation/NY Times Medical Bills Survey, Jan. 5, 2016, Pg. 2-3, accessed 9/21/2016. https://www.kff.org/health-costs/report/the-burden-of-medical-debt-results-from-the-kaiser-family-foundationnew-york-times-medical-bills-survey/.

2 HOSPITAL – B40000 SERIES

In Arkansas, Policies B40100AR & B401HAR. In Idaho, Policies B40100ID & B4010HID. In New York, Policies NYB40100 & NYB4010H. In Oklahoma, Policies B40100OK & B4010HOK. In Oregon, Policies B40100OR & B4010HOR. In Pennsylvania, Policies B40100PA & B4010HPA. In Texas, Policies B40100TX& B4010HTX. This is a brief product overview only. Coverage may not be available in all states including but not limited to New Jersey and Virginia. Benefits/premium rates may vary based on plan selected. Optional riders are available at an additional cost. The policy has limitations and exclusions that may affect benefits payable. Refer to the policy for complete details, limitations, and exclusions. For costs and complete details of the coverage, please contact your local Aflac agent.

Limitations & Exclusions for the residents of Arizona:

Aflac will not pay benefits for care or treatment that is: (1) caused by a Pre-existing Condition, unless it begins more than 12 months after the Effective Date of coverage, or (2) received prior to the Effective Date of coverage.

Aflac will not pay benefits whenever coverage provided by the policy is in violation of any U.S. economic or trade sanctions. If the coverage violates U.S. economic or trade sanctions, such coverage shall be null and void.

Aflac will not pay benefits whenever fraud is committed in making a claim under the coverage. If you have received benefits that were not contractually due under the coverage, then Aflac reserves the right to offset any benefits payable under the coverage up to the amount of benefits you received that were not contractually due.

The policy does not cover losses caused by or resulting from:

  1. Giving birth within the first ten months of the Effective Date of coverage; or pregnancy in existence prior to the Effective Date of coverage. Complications of Pregnancy, including nonelective cesarean, are covered to the same extent as a Sickness;
  2. Receiving routine nursing or routine well-baby care for a newborn child;
  3. Using any drug, narcotic, hallucinogen, or chemical substance (unless administered by a Physician and taken according to the Physician’s instructions), or voluntarily taking any type of poison or inhaling any type of gas or fumes;
  4. Participating in, or attempting to participate in, an illegal activity that is defined as a felony (“felony” is as defined by the law of the jurisdiction in which the activity takes place); or being detained in any detention facility or penal institution;
  5. Being intoxicated or under the influence of alcohol, drugs, or any narcotic, unless administered on the advice of a Physician and taken according to the Physician’s instructions (the term “intoxicated” refers to that condition as defined by the law of the jurisdiction in which the cause of the loss occurred);
  6. Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
  7. Having dental treatment, except as a result of Injury;
  8. Having cosmetic surgery that is not Medically Necessary;
  9. Having elective surgery that is not Medically Necessary within the first 12 months of the Effective Date of coverage;
  10. Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Reserve;
  11. Actively participating in a riot, insurrection, or terrorist activity;
  12. Donating an organ within the first 12 months of the Effective Date of coverage; or
  13. Having mental or emotional disorders, including but not limited to the following: bipolar affective disorder (manicdepressive syndrome), delusional (paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders, bereavement, situational depression, depression, stress, or post-partum depression. The policy will pay, however, for covered losses resulting from Alzheimer’s disease, or similar forms of senility or senile dementia, first manifested while coverage is in force.

A “Pre-existing Condition” is an illness, disease, infection, disorder, condition, or injury for which, within the 12-month period before the Effective Date of coverage, prescription medication was taken or medical testing, advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-existing Condition, including deliveries for children conceived prior to the Effective Date of coverage, will not be covered unless it begins more than 12 months after the Effective Date of coverage.

Limitations and Exclusions for residents of Idaho:

Aflac will not pay benefits for care or treatment that is: (1) caused by a Pre-existing Condition, unless it begins more than 12 months after the Effective Date of coverage, or (2) received prior to the Effective Date of coverage. Aflac will pay benefits for elective surgery that is not Medically Necessary after the first 12 months of the Effective Date of coverage. The policy does not cover losses caused by or resulting from:

  1. Pregnancy in existence on the Effective Date of coverage, including giving birth or maternal-fetal intervention procedure. Involuntary Complications of Pregnancy are covered to the same extent as a Sickness;
  2. Elective abortions (an elective abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed);
  3. Alcoholism or drug addiction;
  4. Receiving routine nursing or routine well-baby care for a newborn child; Policy benefits will be paid for a newborn’s Sickness or Injury, including Congenital Anomaly;
  5. Participating in a felony, whether charged or not (“felony” is as defined by the law of the jurisdiction in which the activity takes place);
  6. Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
  7. Having dental treatment, except as a result of Injury;
  8. Having cosmetic surgery that is not Medically Necessary, except that “cosmetic surgery” shall not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part and reconstructive surgery because of Congenital Anomaly or disease of the covered Dependent Child;
  9. Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Reserve;
  10. Actively participating in a riot or an insurrection; or
  11. Having mental or emotional disorders.

PRE-EXISTING CONDITION LIMITATIONS: A “Pre-existing Condition” is an illness, disease, infection, disorder, condition, or injury for which, within the six-month period before the Effective Date of coverage, prescription medication was taken or medical testing, advice, consultation, or treatment was recommended or received from a Physician. Pre-existing Conditions, including pregnancies in existence on the Effective Date of coverage, will not be covered during the first 12 months after the Effective Date of coverage.

3 Diagnosis & Treatment: Asthma Attack Diagnosis & Treatment., Mayo Clinic Staff. Last Updated August 02, 2019.
http://www.mayoclinic.org/diseases-conditions/asthma-attack/diagnosis-treatment/treatment/txc-20257835.

Asthma costs the US economy more than $80 billion per year, American Thoracic Society. Published January 12, 2018.
https://www.sciencedaily.com/releases/2018/01/180112091212.htm.

Costs of diagnosis and treatment(s) are based on:

4 The information provided in the Benefits Estimator is illustrative only. Plans may not be available in all states, and benefits may vary by state, coverage, and plan level selected. Policies have limitations and exclusions that may affect benefits payable. The Aflac payout values do not guarantee an amount to be paid for the listed conditions. Benefits paid by Aflac (if any) will depend on the severity of the accident or illness, the physician diagnosis, and the treatment received. The “Aflac Pays You” data is an average of historical payments made to Aflac policyholders/certificateholders who qualified for benefits under their specific plans and does not reflect instances when benefits were not paid for a particular claim. Whether benefits are payable will be determined when a claim is processed. You must be 18 or older to apply for Aflac insurance. Availability varies by product; see your local Aflac agent for details. The out-of-pocket expenses displayed are estimated at 40% of the total medical cost, assuming that average major medical plans cover approximately 60% of the expense. Your major medical coverage may be more or less, and if an individual or family incurs expenses for non-covered benefits, these out-of-pocket expenses may increase potential unexpected costs. You will also need to pay for any limits or exclusions on your benefits which may include the number of refills for certain drugs, visits to certain specialists, or days covered for certain benefits. View Data Sources to see our underlying sources.

5 Assumes the average cost of a greeting card is $3.49**, and the average cost of postage to mail is $0.49***. Comparison is based on the average weekly premium for Nebraska Payroll Premium rates for industry Class A; Aflac Hospital Choice Series B40100 – $500 Confinement Amount – Individual Age 18-49. Premiums may vary by coverage type, account, state of issue, and the election of additional/optional benefits.
**Source: Hallmark.com, 2017.
***Source: U.S. Postal Service, April 2017.

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