Page 34 - Prestige

Critical Illness (GVCIP2)

Group Voluntary Critical Illness Insurance PLAN 1
$10,000 Basic Benefit Amount
from Allstate Benefits WEEKLY PREMUIMS
See attached Important Information About Coverage. non-tobacco
AGES EE, EE+CH EE+SP, F
18-29 $2.33 $4.19
30-39 $3.26 $5.58
40-49 $5.04 $8.25
BENEFIT AMOUNTS 50-59 $8.04 $12.75
60-63 $12.34 $19.21
†Covered dependents receive 50% of your benefit amount. 64+ $15.80 $24.38
INITIAL CRITICAL ILLNESS BENEFITS † PLAN 1 PLAN 2 tobacco
Heart Attack (100%) $10,000 $20,000
AGES EE, EE+CH EE+SP, F
Stroke (100%) $10,000 $20,000
18-29 $2.90 $5.05
Major Organ Transplant (100%) $10,000 $20,000 30-39 $4.44 $7.36
End Stage Renal Failure (100%) $10,000 $20,000 40-49 $8.05 $12.76
50-59 $12.79 $19.88
Coronary Artery Bypass Surgery (25%) $2,500 $5,000
60-63 $20.34 $31.20
Waiver of Premium (employee only) Yes Yes 64+ $26.51 $40.45
CANCER CRITICAL ILLNESS BENEFITS † PLAN 1 PLAN 2
PLAN 2
Invasive Cancer (100%) $10,000 $20,000 $20,000 Basic Benefit Amount
Carcinoma in Situ (25%) $2,500 $5,000 WEEKLY PREMUIMS
non-tobacco
SECOND EVENT BENEFITS † PLAN 1 PLAN 2
AGES EE, EE+CH EE+SP, F
Second Event Initial Critical Illness Benefit
(same amount as Initial Critical Illness) Yes Yes 18-29 $3.28 $5.60
30-39 $5.13 $8.39
Second Event Cancer Critical Illness Benefit Yes Yes 40-49 $8.70 $13.73
(same amount as Cancer Critical Illness) 50-59 $14.70 $22.73
60-63 $23.30 $35.64
SUPPLEMENTAL CRITICAL ILLNESS BENEFITS I † PLAN 1 PLAN 2 64+ $30.21 $46.00
Benign Brain Tumor (100%) $10,000 $20,000
tobacco
Coma (100%) $10,000 $20,000
AGES EE, EE+CH EE+SP, F
Complete Blindness (100%) $10,000 $20,000
18-29 $4.43 $7.33
Complete Loss of Hearing (100%) $10,000 $20,000 30-39 $7.50 $11.94
Paralysis (100%) $10,000 $20,000 40-49 $14.71 $22.75
50-59 $24.20 $36.98
Occupational HIV (100%) $10,000 $20,000
60-63 $39.29 $59.63
Advanced Alzheimer’s Disease (25%) $2,500 $5,000 64+ $51.62 $78.12
Advanced Parkinson’s Disease (25%) $2,500 $5,000 EE = Employee; EE+SP = Employee + Spouse;
EE+CH = Employee + Child(ren); F = Family
ADDITIONAL BENEFIT PLAN 1 PLAN 2
Wellness Benefit (per year) $100 $100
ADDITIONAL RIDER PLAN 1 PLAN 2
Second Evaluation Benefit Rider
Second Consultation $1,000 $1,000
Non-Local Transportation¹ Air Fare or $500 $500
(per trip or mile) Personal Vehicle $0.50 $0.50
Outpatient Lodging² (daily) $100 $100
Family Member Lodging² (daily) $100 $100
and Transportation¹ Air Fare or $500 $500
(per trip or mile) Personal Vehicle $0.50 $0.50
¹Limit $5,000/12 mo. period ²Limit $1,000/12 mo. period

68287 For use in enrollments sitused in: MA. This rate insert is part of the approved flyer, form ABJ30427-1; it is not to be used on its own.
This material is valid as long as information remains current, but in no event later than December 03, 2021. Allstate Benefits is
the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The
Allstate Corporation. ©2017 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.