Critical Assistance

Critical illness insurance

 

Why, Critical Illness Insurance?  Critical Illnesses cause financial devastation to millions of individuals and families, even though they may have adequate coverage for medical expenses. A Critical Illness policy is not designed to be a stand-alone coverage, but to supplement health coverages.  When treating or recovering from a critical illness such as heart attack, stroke, organ transplants, cancer, coronary bypass a critical illness policy provides the much-needed cash to continue to pay for health benefits and out-of-pocket expenses.  In addition, when no income may be coming in, critical illness insurance can provide enough cash to pay the mortgage, car payment, day-to-day expenses, other insurance, car and homeowners, etc.  Its primary purpose is to provide cash to maintain your standard of living while recovering from a critical Illness.

 

 

Category 1

Percentage of Benefit Plan 1
Heart Attack 100% Included
Stroke 100% Included
Heart Transplant Surgery 100% Included
Coronary Bypass Surgery 25% Included
Angioplasty/Stent 5% Included
Category 2 Percentage of Benefit Plan 1
Major Organ Transplant Surgery (excluding heart) 100% Included
End-Stage Renal Failure 100% Included
Burns (3rd degree or 50% coverage) 100% Included
Coma 100% Included
Loss of Sight, Speech, and/or Hearing 100% Included
Miscellaneous Diseases 100% Included
Paralysis Not due to Stroke - all 4 limbs 100% Included
Paralysis Not due to Stroke - less than 4 limbs 50% Included
Alzheimer's Disease 30% Included
Category 3 Percentage of Benefit Plan 1
Invasive Cancer 100% Included
Bone Marrow Transplant 100% Included
Carcinoma in situ 25% Included
Prostate Cancer with TNM Classification of T1 25% Included
Skin Cancer 5% Included
Optional Riders Plan 1
Recurrent Critical Illness Benefit Rider Benefit 25%
Wellness Benefit Rider Annual Benefit $50

Elected Benefit - Employee may purchase a benefit amount based on the premiums as shown in the following pages. Dependent coverage is available for 50% of the employee's Elected Benefit.
Lifetime Maximum Benefit - Total Critical Illness and Recurrent Benefits are limited to 3 times the Elected Benefit.

Age    
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Payment Authorization

You authorize Enrollment123 dba Administration123 to charge the debit card, credit card or ACH bank account as indicated in this authorization on behalf of the Insurance Companies and benefit providers, and their respective plans which you have selected through this enrollment website. Furthermore, you acknowledge and agree that future payments may be charged to the debit card, credit card or ACH bank account you have provided on a recurring monthly basis with your full authorization for the amount associated with the products and services selected above.

Recurring monthly premium payments are billed in advance of the next coverage period, 25 calendar days after your effective date each month. If the recurring payment date falls on a weekend or holiday, you understand that the payment may be executed on the prior or next business day. You understand that this authorization will remain in effect until you cancel it in writing via email or mailed letter. You agree to make any account changes on with your secure online portal or notify Enrollment123 dba Administration123 in writing of any changes in your account information.

You certify that you are an authorized user of this debit card, credit card or bank account and that you will not dispute the scheduled payments with your Credit Card Company or bank provided the transactions correspond to the terms indicated in this authorization form.

Cancellation Policy

You may cancel service at any time. All notices of cancellation must be submitted in writing only, via email or mailed letter. All cancellation notification must be made by the primary account holder. To avoid billing for unwanted services, all cancellation notices must be received no later than fifteen (15) calendar days prior to your next billing date. Upon receipt of your cancellation notice, coverage for the services/products listed will be terminated to the last day of the month of your coverage period. Cancellation notices received less than fifteen (15) days prior to the next billing date will result in cancellation of service postdated to the end of your next coverage period month.

Written notification may be sent via email to support@administration123.com

Refund Policy

You may only receive a refund, if applicable, provided you have submitted a written notice of cancellation.

You may request a refund (refund requests MUST be made in writing) ONLY if you are cancelling your coverage within the first ten (10) calendar days following your product or policy effective date. If you are cancelling coverage for a product or policy and requesting a refund within the first ten (10) days following your effective date service; you are entitled to a full refund of the monthly premium or fee. Administration fees or enrollment fees ARE NOT refundable. You are not eligible for any refund if any claims have been filed by the policy holder or his/her dependents during the initial ten (10) days following the effective date.

Billing Questions

Any questions regarding billing should be directed to support@administration123.com

Policy / Benefit Notification

You authorize Enrollment123 dba Administration123 to contact you via email and/or sms (text messaging) with regards to the policy(s) or benefit(s) which you have enrolled and updates regarding related products and services. You agree to provide Enrollment123 dba Administration123 with any updates/changes to your email address or phone number through the "Member Portal" or via email at support@administration123.com with these updates.

This authorization shall remain in effect until revoked by you in writing. You understand and agree that this authorization, an updated email address and phone number is required to receive important updates regarding your enrolled benefits and insurance coverage; and that revoking this authorization will result in missing important notification(s) that may adversely affect your coverage, including termination of benefits. Enrollment123 dba Administration123 shall not be held responsible or liable for any missed notifications due to incorrect contact mailing address, email address or phone number that results in a change to or loss of coverage or benefits.

Critical Illness Benefit

CriticalAssistance Advance pays a lump sum benefit equal to the Elected Benefit multiplied by the applicable percentage shown above upon the first occurrence of a covered critical illness within each category. First occurrence means a critical illness that is diagnosed on or after the effective date.

If the total benefit paid in a category is less than 100% of the Elected Benefit, we will pay upon the diagnosis of a different type of critical illness within the same category. The lump sum benefit is equal to the Elected Benefit multiplied by the applicable percentage shown above, not to exceed the remaining Elected Benefit for the category. Cumulative benefits

paid within each category will not exceed 100% of the Elected Benefit.

Cancer Benefit Rider (Rider Form Series CRCAN400)

If included in your plan, this rider adds Category 3 to the list of covered Critical Illnesses.

Recurrent Critical Illness Benefit Rider (Rider Form Series CRRCI400)

If included in your plan, we will pay a lump sum Recurrent Benefit equal to the selected percentage multiplied by the Elected Benefit multiplied by the applicable percentage upon the diagnosis of a Recurrent Critical Illness. Recurrent Critical Illness means a covered critical illness that is not eligible for payment under the Critical Illness Benefit as a First Occurrence. Diagnosis must be made after the effective date and while coverage is in force. Total Recurrent Benefits paid within each category will not exceed the selected percentage of the Elected Benefit. Recurrent Benefits are subject to the

Lifetime Maximum Benefit.

 

Wellness Benefit Rider (Rider Form Series CRWEL400)

If included in your plan, we will pay the selected amount per calendar year for each covered person when a charge is incurred for one of the following cancer screening tests: biopsy, blood test for triglycerides, bone marrow testing, breast ultrasound, CA 125 (blood test for ovarian cancer), CA 15-3 (blood test for breast cancer), CEA (blood test for colon cancer), chest x-ray, colonoscopy, fasting blood glucose test, flexible sigmoidoscopy, hemoccult stool specimen, mammogram, Pap test, PSA (prostate-specific antigen tests), serum cholesterol test to determine HDL/LDL level, serum protein electrophoresis (blood test for myeloma), stress test on a bicycle or treadmill, or thermography.

This benefit is limited to one payment per calendar year per covered person (not subject to the Lifetime Maximum Benefit).

Product Details

We do not cover losses caused by, or as a result of, the following:

Conditions other than those due to a covered Critical Illness.

The covered person participating or attempting to participate in an illegal activity. The covered person intentionally causing self-inflicted injury.

The covered person committing or attempting to commit suicide, whether sane or insane. The covered person's involvement in any period of armed conflict.

Surgeries performed outside the United States or its Territories.

Under no condition will we pay any benefits for losses or medical expenses incurred prior to the effective date.

We may reduce or deny a claim or void coverage for loss incurred by a covered person during the first 2 years from the effective date of such coverage for any misstatements in the application which would have materially affected our acceptance of the risk or at any time for fraudulent misstatements in the application.

Heart Attack - Diagnosis must be supported by 3 or more of the following indicators: typical chest pain suggestive of heart attack; new EKG changes indicative of myocardial infarction; diagnostic increase of specific cardiac markers typical for heart attack; or, confirmatory imaging studies.

Stroke - Diagnosis must be based on documented neurological deficits and confirmatory neuroimaging studies. Stroke does not include cerebral symptoms due to Transient Ischemic Attack (TIA), Reversible neurological deficit, migraine, cerebral injury resulting from trauma or hypoxia, or vascular disease affecting the eye, optic nerve or vestibular functions.

Heart Transplant Surgery - Being placed on the transplant list or undergoing surgery to receive a transplant of a human heart.

Coronary Bypass Surgery - Angiographic evidence to support the necessity for this surgery will be required. This benefit does not include balloon angioplasty, laser embolectomy, atherectomy, stent placement, or other non-surgical procedures.

Angioplasty/Stent - Coronary angioplasty must be performed by a physician who is also a board-certified cardiologist. This benefit is confined to the heart; therefore, angioplasty/stenting of renal arteries or other peripheral arteries are excluded from this benefit.

Major Organ Transplant - Being placed on the transplant list or undergoing surgery to receive a transplant of a human heart, lung, liver, kidney or pancreas.

End Stage Renal Failure - Chronic irreversible failure of both kidneys that requires treatment by renal dialysis or kidney transplant.

Paralysis - Quadriplegia, paraplegia, or hemiplegia that is expected to last for a continuous 12-month period or longer from the date of diagnosis to determine if paralysis is permanent. A benefit will not be paid for paralysis that results from a stroke or psychiatric related causes.

Burns - A full-thickness or third-degree burn covering at least 50% of the body surface.

Coma - Lasting for 30 consecutive days with no reaction to external stimuli, no reaction to internal needs and the use of life support systems. Diagnosis must indicate that permanent neurological deficit is present.

Loss of Sight, Speech, or Hearing - Total loss of sight in both eyes, total and permanent loss of speech, or total and irreversible loss of hearing in both ears that cannot be corrected by the use of a hearing aid or device.

Miscellaneous Diseases - Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Encephalitis/Meningitis, Rocky Mountain Spotted Fever, Typhoid Fever, Anthrax, Cholera, Primary Sclerosing Cholangitis (Walter Payton's Disease), or Tuberculosis.

Alzheimer's Disease - Requires the inability to independently perform 2 or more of the following activities: bathing, dressing, eating, toileting, transferring, or incontinence.

 

Cancer Benefit Rider

We will only pay for loss as a direct result of cancer or bone marrow transplant. We will not pay for any disease or incapacity that has been caused, complicated, worsened, or affected by, or as a result of cancer or its treatment.

Invasive Cancer - Evidenced by a malignant tumor and the invasion of tissue. Invasive cancer does not include

pre-malignant conditions or conditions with malignant potential, prostatic cancers which are histologically described as TNM Classification T1 (including T1(a) or T1(b), or of other equivalent or lesser classification), and any malignancy associated with the diagnosis of HIV.

Carcinoma In Situ - Cancer that is in the normal place, confined to the site without having invaded neighboring tissue.

Prostate Cancer with TNM Classification of T1 - Microscopic tumors of the prostate that are neither palpable nor visible on transrectal ultrasonography.

Skin Cancer - Basal cell epithelioma or squamous cell carcinoma. Skin cancer does not include malignant melanoma or mycosis fungoides, which are not considered skin cancers.

Recurrent Critical Illness Benefit Rider

A recurrence of the same type of critical illness is not considered a Recurrent Critical Illness unless the diagnosis for the prior occurrence was at least 12 months from the most recent diagnosis and the person has been Treatment Free for at least 12 months. Treatment Free means the person is no longer receiving care from a physician, nor regular office visits, or being prescribed medication for a critical illness, other than routine checkups or maintenance medication for that critical illness.

Termination of Insurance

Employee insurance will terminate on the earliest of: The date of the employee's death;

The date on which the employee ceases to be eligible for insurance; The last date for which premium payment has been made to us;  The last date on which employment terminates;

The date the group master policy terminates; or

The date the employee sends us a written notice to cancel insurance.

Dependent insurance will terminate on the earliest of: The date the employee's insurance terminates;

The last date for which premium payment has been made to us;

The date the dependent no longer meets the definition of dependent;

The date the group master policy is modified so as to exclude dependent insurance; or The date the employee sends us a written notice to cancel dependent insurance.

 

We will have the right to terminate the insurance of any covered person who submits a fraudulent claim under the policy.

Portability Option

If an employee loses eligibility for this insurance for any reason other than nonpayment of premiums, insurance can be continued by paying the premiums directly to us within 31 days after termination. We will bill the employee directly once we receive notification to continue your insurance.

Standard 1-5 business days $7.95
Two Day 2 business days $15
Next Day 1 business day $30
* Free on orders of $50 or more


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