Page 104 - Benefits Summary 2018-2019

Critical Illness Insurance (GVCIP4) Offered to the employees of:
Hercules Living
from Allstate Benefits
BENEFIT AMOUNTS ISSUE AGE PREMIUMS
Percentages below are based on the Basic Benefit Amount chosen by your EE/EE+CH EE+SP/F EE/EE+CH EE+SP/F
employer. PLAN 1 AGE Non-Tobacco Tobacco
SEMI- 18-29 $2.56 $4.20 $3.29 $5.29
†Covered dependents receive 50% of your benefit amount.
MONTHLY 30-39 $4.92 $7.80 $6.82 $10.64
INITIAL CRITICAL ILLNESS BENEFITS † PLAN 1 PLAN 2 40-49 $9.41 $14.63 $14.08 $21.64
Heart Attack (100%) $10,000 $20,000 50-59 $16.25 $25.03 $24.92 $38.05
$33.58
$51.13
60-64
$22.01
$33.77
Stroke (100%) $10,000 $20,000 65+ $35.16 $53.66 $52.84 $80.18
End Stage Renal Failure (100%) $10,000 $20,000 EE + CH = Employee + Child(ren); and F = Family
Major Organ Transplant (100%) $10,000 $20,000 EE/EE+CH EE+SP/F EE/EE+CH EE+SP/F
EE/EE+CH EE+SP/F EE/EE+CH EE+SP/F
Non-Tobacco
PLAN 1
Coronary Artery Bypass Surgery (25%) $2,500 $5,000 PLAN 2 AGE Non-Tobacco Tobacco
AGE
Tobacco
#N/A
#N/A
18-29
$6.98
Waiver of Premium (employee only) Yes Yes SEMI- 30-39 $4.43 #N/A #N/A #N/A
$9.19
18-29
$5.89
#N/A
#N/A
#N/A
#N/A
#N/A
30-39
CANCER CRITICAL ILLNESS BENEFITS † PLAN 1 PLAN 2 MONTHLY 40-49 $9.02 $13.92 $12.82 $19.63
40-49
#N/A
#N/A
#N/A
#N/A
$27.17
$41.19
$27.12
Invasive Cancer (100%) $10,000 $20,000 50-59 $17.77 $47.42 $48.51 $73.44
#N/A
#N/A
#N/A
#N/A
50-59
$31.18
#N/A
60-64
#N/A
#N/A
Carcinoma in Situ (25%) $2,500 $5,000 60-64 $42.49 $64.49 $65.63 $99.21
#N/A
65+
#N/A
#N/A
#N/A
#N/A
REOCCURRENCE OF CRITICAL ILLNESS BENEFITS † PLAN 1 PLAN 2 65+ $68.46 $103.61 $103.82 $156.65
Initial Critical Illness EE + CH = Employee + Child(ren); and F = Family
EE/EE+CH EE+SP/F EE/EE+CH EE+SP/F
(same amount as Initial Critical Illness Benefit) Yes Yes PLAN 1 AGE EE/EE+CH EE+SP/F EE/EE+CH EE+SP/F
Tobacco
Non-Tobacco
Tobacco
Non-Tobacco
AGE
Cancer Critical Illness Yes Yes PLAN 2 18-29 #N/A #N/A #N/A #N/A
#N/A
18-29
(same amount as Cancer Critical Illness Benefit) #N/A 30-39 #N/A #N/A #N/A #N/A
#N/A
#N/A
#N/A
#N/A
#N/A
30-39
RIDER BENEFITS PLAN 1 PLAN 2 #N/A 40-49 #N/A #N/A #N/A #N/A
#N/A
#N/A
40-49
#N/A
#N/A
#N/A
#N/A
#N/A
#N/A
#N/A
Skin Cancer Rider $250 $250 50-59 #N/A #N/A #N/A #N/A
50-59
#N/A
#N/A
#N/A
60-64
#N/A
#N/A
Cardiopulmonary Enhancement Rider † 60-64 #N/A #N/A #N/A #N/A
#N/A
#N/A
65+
#N/A
#N/A
#N/A
#N/A
Sudden Cardiac Arrest (25%) $2,500 $5,000 65+ #N/A #N/A #N/A #N/A
Pulmonary Embolism (25%) $2,500 $5,000 EE/EE+CH EE+SP/F EE/EE+CH EE+SP/F
Pulmonary Fibrosis (25%) $2,500 $5,000 PLAN 1 AGE Non-Tobacco Tobacco
†
Specified Chronic Illness Rider (50%) $5,000 $10,000 #N/A 18-29 #N/A #N/A #N/A #N/A
†
Specified Chronic Illness Or Injury Rider Illness (50%) $5,000 $10,000 #N/A 30-39 #N/A #N/A #N/A #N/A
40-49
Specified Chronic Illness Or Injury Rider Injury (100%) $10,000 $20,000 50-59 #N/A #N/A #N/A #N/A
#N/A
#N/A
#N/A
#N/A
Supplemental Critical Illness Rider † 60-64 #N/A #N/A #N/A #N/A
Advanced Alzheimer’s Disease (100%) $10,000 $20,000 65+ #N/A #N/A #N/A #N/A
Advanced Parkinson’s Disease (100%) $10,000 $20,000
Benign Brain Tumor (100%) $10,000 $20,000
Coma (100%) $10,000 $20,000
Complete Loss of Hearing (100%) $10,000 $20,000
Complete Loss of Sight (100%) $10,000 $20,000
Complete Loss of Speech (100%) $10,000 $20,000
Paralysis (100%) $10,000 $20,000
Fixed Wellness Rider (per year) $50 $50
For use in enrollments sitused in: VA. This rate insert is part of the approved brochure for Hercules Living; 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 September 11, 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.
GVCIP4-Insert-34722 www.allstate.com or allstatebenefits.com.