Page 78 - Aflac Flipbook 2023

American Family Life Assurance Company of Columbus
(herein referred to as Aflac)
Worldwide Headquarters • 1932 Wynnton Road • Columbus, Georgia 31999
Toll-Free 1.800.99.AFLAC (1.800.992.3522)

The policy provides supplemental coverage
and will be issued only to supplement insurance already in force.
LIMITED BENEFIT, SPECIFIED DISEASE INSURANCE
Policy Form Series B70300

1. Read Your Policy Carefully: This document provides a very brief products. Aflac will pay $20 up to two times per Calendar Year when
description of some of the important features of the policy. This is not a Covered Person is prescribed, receives, and incurs a charge for a
the insurance contract and only the actual policy provisions will 90-day course of nicotine replacement therapy as an aid for the
control. The policy itself sets forth, in detail, the rights and obligations cessation of the use of tobacco products. The medication and therapy
of both you and Aflac. It is, therefore, important that you READ YOUR must be approved by the FDA for such use and must not be available
POLICY CAREFULLY. without a prescription. This benefit has a maximum of $40 per
Calendar Year. No lifetime maximum.
2. Cancer Insurance Coverage is designed to supplement a Covered
Person’s existing accident and sickness coverage only when certain PROPHYLACTIC SURGERY BENEFIT (DUE TO A POSITIVE GENETIC
losses occur as a result of the disease of Cancer or an Associated TEST RESULT): Aflac will pay $350 when a Covered Person has
Cancerous Condition. Coverage is not provided for basic hospital, surgery due to a positive test result received for a genetic alteration or
basic medical-surgical, or major medical expenses. mutation associated with a hereditary Cancer syndrome and such
surgery is recommended by a Physician. The Genetic Testing must be
3. Benefits: Aflac will pay the following benefits, as applicable, while performed while coverage is in force.
coverage is in force, subject to all other limitations and exclusions,
conditions, and provisions of the policy, unless indicated otherwise. This benefit is payable once per Covered Person, per lifetime.
All treatments listed below must be National Cancer Institute (NCI) or
Food and Drug Administration (FDA) approved for the treatment of CANCER DIAGNOSIS BENEFITS:
Cancer or an Associated Cancerous Condition, as applicable. INITIAL DIAGNOSIS BENEFIT: Aflac will pay the amount listed below
CANCER SCREENING BENEFIT: Aflac will pay $100 per Calendar when a Covered Person is diagnosed as having Internal Cancer or an
Year when a Covered Person receives one of the following: Associated Cancerous Condition while the policy is in force, subject to
the Limitations and Exclusions.
mammogram • breast ultrasound • breast MRI • thermography •
CA15-3 (blood test for breast cancer) • CA 125 (blood test for ovarian Named Insured or Spouse $ 6,000
cancer) • Pap smear/ThinPrep • PSA (blood test for prostate cancer • Dependent Child $12,000
CEA (blood test for colon cancer) • P32 uptake serum protein
electrophoresis (blood test for multiple myeloma) • testicular This benefit is payable once per Covered Person, per lifetime. In
ultrasound • transrectal ultrasound • abdominal ultrasound • flexible addition to the Positive Medical Diagnosis, we may require additional
sigmoidoscopy • colonoscopy • virtual colonoscopy • cystoscopy • information from the attending Physician and Hospital.
colposcopy • bronchoscopy • mediastinoscopy • esophagoscopy • ADDITIONAL OPINION BENEFIT: Aflac will pay $400 when a charge
sigmoidoscopy • proctosigmoidoscopy • gastroscopy • laryngoscopy • is incurred for an additional surgical opinion from a Physician or an
chest X-ray • computerized tomography (CT or CAT scan) • magnetic evaluation or consultation with a Physician for the purpose of
resonance imaging (MRI) • bone scan • thyroid scan • multiple gated determining the appropriate course of treatment for a covered Internal
acquisition (MUGA) scan • positron emission tomography (PET) scan • Cancer or Associated Cancerous Condition. This benefit is payable
biopsy • hemoccult stool specimen (lab confirmed) • Genetic Testing once per Covered Person, per lifetime.
• bone marrow donor screening • cancer vaccine
CANCER TREATMENT BENEFITS:
This benefit is limited to one $100 payment per Calendar Year, per
Covered Person, with no Positive Medical Diagnosis. If a Covered NONSURGICAL TREATMENT BENEFITS:
Person receives a Positive Medical Diagnosis for Internal Cancer or an
Associated Cancerous Condition, this benefit will pay up to a total of RADIATION THERAPY, CHEMOTHERAPY, IMMUNOTHERAPY, OR
three $100 payments per Calendar Year for screenings performed on EXPERIMENTAL CHEMOTHERAPY BENEFIT:
such Covered Person. Screenings must be administered by licensed SELF-ADMINISTERED: Aflac will pay $400 once per Calendar
medical personnel. Except for Genetic Testing, bone marrow donor Month for which a Covered Person receives and incurs a charge for
screening, and cancer vaccine, the screening must be performed for self-administered Physician-prescribed Chemotherapy,
the purpose of determining whether Cancer or an Associated Immunotherapy, or Experimental Chemotherapy as part of a treatment
Cancerous Condition exists in a Covered Person. No lifetime regimen for Cancer or an Associated Cancerous Condition.
maximum.
PHYSICIAN-ADMINISTERED: Aflac will pay $1,500 once per
SMOKING CESSATION BENEFIT: Aflac will pay $20 when a Covered Calendar Month for which a Covered Person is prescribed, receives,
Person is prescribed, receives, and incurs a charge for medication and incurs a charge for Radiation Therapy, Chemotherapy,
that is used as an aid for the cessation of the use of tobacco
B70325NMD 1 4/19