Page 32 - E. Cohen & Co. Allstate Benefits Flipbook

Admitted to the Surgery is A doctor visits You get paid
hospital performed you daily cash benefits*

*Subject to policy and rider coverage and specifications.

Outpatient Physician's Benefit - Pays a benefit for physician Supplemental Health Exclusions and Other Limitations -
treatment outside a hospital. Maximum of 2 visits each year We do not pay benefits for: (a) any act of war or participation
per person and 4 visits per family. in a riot, insurrection or rebellion; or (b) attempted suicide
or intentional self-inflicted injury; or (c) intoxication or
At Home Nursing Benefit - Pays a benefit for nursing care being under the influence of drugs not prescribed or
authorized by the attending physician, within 60 days after recommended by a physician; or (d) alcoholism or drug
hospital confinement. Pays for one visit each day for up addiction; or (e) nervous or mental disorders; or (f) dental or
to 30 visits. plastic surgery for cosmetic purposes, except when required
due to an injury or for correction of disorders of normal
Transportation bodily functions; or (g) a newborn child's routine nursing or
Ambulance Services - Pays a benefit for transport to an well-baby care; or (h) childbirth within the first 10 months
emergency treatment center or hospital by a licensed or
hospital-owned ambulance. Maximum of 2 trips each year of the effective date (complications of pregnancy are covered
the same as sickness); or (i) hospitalization beginning
per person.
before the effective date; or (j) benefits that duplicate
Non-Local Transportation - Pays a benefit for transportation benefits paid by Medicare; or (k) any care unit that does
when hospital confinement for treatment is not available not qualify as a hospital intensive-care unit, as defined.
locally. Maximum of 2 trips each year per person.
STATE VARIAT IONS
POLICY AND RIDER SPECIFICATIONS Maryland (changes affect page 3) - In the Eligibility/
Renewability - The policy and riders are guaranteed Termination paragraph, item (a) is replaced with: Coverage
renewable to age 65, subject to change in premiums may include you, your spouse or domestic partner, and
by class. children; item (c) is replaced with: Spouse/domestic partner
coverage ends upon the earliest of his or her 65th birthday,
Eligibility/Termination - (a) Coverage may include you, valid decree of divorce/termination of domestic partnership,
your spouse and children. (b) Coverage under the policy or your death. In the Supplemental Health Exclusions and
ends on the date the policy is canceled or the last day Other Limitations paragraph, item (c) is replaced with:
premium payments were made. (c) Spouse coverage ends from being intoxicated or under the influence of alcohol or
upon the earliest of his or her 65th birthday, valid decree any other controlled substance or drug unless administered
of divorce, or your death. (d) Coverage for children ends upon the advice of a physician; item (d) is deleted.
when each child reaches age 26, unless he or she continues
to meet the requirements of an eligible dependent. Tennessee (changes affect page 3) - In the Supplemental
Health Exclusions and Other Limitations paragraph,
LIMITATIONS AND EXCLUSIONS item (c) is replaced with: from being intoxicated or under
Hospital Intensive Care Exclusion - We do not pay the the influence of any narcotic unless administered on the
hospital intensive-care unit benefit for confinement in advice of a physician.
any care unit that does not qualify as a hospital intensive­ Virginia (changes affect pages 2 and 3) - In the At Home
care unit. Progressive care, sub-acute intensive care, Nursing rider benefit, the second sentence is replaced with:
intermediate care or step down units, private rooms with Pays for one visit each day for up to 45 visits. Under the
monitoring or any other lesser care treatment units do Transportation rider, the second sentence of the Ambulance
not qualify. Services benefit is replaced with: Maximum of 3 trips each
Pre-Existing Condition - We do not pay benefits due to a year per person; and the second sentence of the Non-Local
pre-existing condition during the first 12 months of coverage. Transportation benefit is replaced with: Maximum of 3 trips
A pre-existing condition is a condition not revealed in the each year per person. In the Pre-Existing Condition paragraph,
application for which: symptoms existed within the 1-year the second sentence is replaced with: A pre-existing condition
period prior to the effective date, or medical advice or is a condition not revealed in the application for which
treatment was recommended or received from a physician symptoms existed which would cause a prudent person
within the 1-year period before the application date. to seek diagnosis, care, or treatment within 1 year before
the effective date.

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