Aflac Group Hospital Indemnity

IV (12/19)

AG80075L R7

Aﬂac

Group Hospital

Indemnity

INSURANCE

Even a small trip to the hospital can

have a major impact on your ﬁnances.

Here’s a way to help make your visit a

little more affordable.

The plan that can help with

expenses and protect your savings.

Does your major medical insurance cover all of your bills?

Even a minor trip to the hospital can present you with unexpected expenses and medical bills. And even

with major medical insurance, your plan may only pay a portion of your entire stay.

That’s how the Aﬂac Group Hospital Indemnity plan can help.

It provides ﬁnancial assistance to enhance your current coverage. It may help avoid dipping into savings or

having to borrow to address out-of-pocket-expenses major medical insurance was never intended to cover.

Like transportation and meals for family members, help with child care, or time away from

work, for instance.

The Aﬂac Group Hospital Indemnity plan beneﬁts include

the following:

• Hospital Conﬁnement Beneﬁt

• Hospital Admission Beneﬁt

• Hospital Intensive Care Beneﬁt

• Intermediate Intensive Care Step-Down Unit

• Successor Insured Beneﬁt

AFLAC GROUP HOSPITAL INDEMNITY

Policy Series C80000

How it works

The plan has limitations and exclusions that may affect beneﬁts payable. This brochure is for illustrative purposes only. Refer to your

certiﬁcate for complete details, deﬁnitions, limitations, and exclusions.

The

Aﬂac Group

Hospital Indemnity

plan is selected.

The insured

has a high

fever and

goes to the

emergency

room.

The

physician

admits the

insured into

the hospital.

The insured

is released

after two

days.

The Aﬂac Group Hospital Indemnity

plan pays

$700

Amount payable was generated based on beneﬁt amounts for: Hospital Admission ($500), and Hospital Conﬁnement ($100 per day).

BENEFIT AMOUNT

HOSPITAL ADMISSION BENEFIT per conﬁnement (once per covered sickness or accident per calendar year for

each insured)

Payable when an insured is admitted to a hospital and conﬁned as an inpatient because of a covered

accidental injury or covered sickness. We will not pay beneﬁts for conﬁnement to an observation unit, or

for emergency room treatment or outpatient treatment.

We will not pay beneﬁts for admission of a newborn child following his birth; however, we will pay for a

newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is conﬁned as an inpatient

as a result of a covered accidental injury or covered sickness (including congenital defects, birth

abnormalities, and/or premature birth).

$500

HOSPITAL CONFINEMENT per day (maximum of 31 days per conﬁnement for each covered sickness or accident for

each insured)

Payable for each day that an insured is conﬁned to a hospital as an inpatient as the result of a covered

accidental injury or covered sickness. If we pay beneﬁts for conﬁnement and the insured becomes

conﬁned again within six months because of the same or related condition, we will treat this conﬁnement

as the same period of conﬁnement. This beneﬁt is payable for only one hospital conﬁnement at a time

even if caused by more than one covered accidental injury, more than one covered sickness, or a

covered accidental injury and a covered sickness.

$100

HOSPITAL INTENSIVE CARE BENEFIT per day (maximum of 10 days per conﬁnement for each covered sickness

or accident for each insured)

Payable for each day when an insured is conﬁned in a Hospital Intensive Care Unit because of a covered

accidental injury or covered sickness. We will pay beneﬁts for only one conﬁnement in a Hospital's

Intensive Care Unit at a time. Once beneﬁts are paid, if an insured becomes conﬁned to a Hospital's

Intensive Care Unit again within six months because of the same or related condition, we will treat this

conﬁnement as the same period of conﬁnement.

This beneﬁt is payable in addition to the Hospital Conﬁnement Beneﬁt.

$100

INTERMEDIATE INTENSIVE CARE STEP-DOWN UNIT per day (maximum of 10 days per conﬁnement for each

covered sickness or accident for each insured)

Payable for each day when an insured is conﬁned in an Intermediate Intensive Care Step-Down

Unit because of a covered accidental injury or covered sickness. We will pay beneﬁts for only one

conﬁnement in an Intermediate Intensive Care Step-Down Unit at a time.

Once beneﬁts are paid, if an insured becomes conﬁned to a Hospital's Intermediate Intensive Care

Step-Down Unit again within six months because of the same or related condition, we will treat this

conﬁnement as the same period of conﬁnement.

This beneﬁt is payable in addition to the Hospital Conﬁnement Beneﬁt.

$50

SUCCESSOR INSURED BENEFIT

If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage

would continue according to the existing plan and would also include any dependent child coverage in force at the time.

Beneﬁts Overview

LIMITATIONS AND EXCLUSIONS

EXCLUSIONS

We will not pay for loss due to:

• War – voluntarily participating in war, any act of war, or military conﬂicts, declared or

undeclared, or voluntarily participating or serving in the military, armed forces, or an

auxiliary unit thereto, or contracting with any country or international authority. (We

will return the prorated premium for any period not covered by the certiﬁcate when

the insured is in such service.) War also includes voluntary participation (In North

Carolina, active participation) in an insurrection, riot, civil commotion or civil state of

belligerence. War does not include acts of terrorism (except in Illinois).

− In Connecticut: a riot is not excluded.

− In Oklahoma: War, or any act of war, declared or undeclared, when serving in the

military, armed forces, or an auxiliary unit thereto. (We will return the prorated

premium for any period not covered by the certiﬁcate when the insured is in

such service.) War does not include acts of terrorism.

• Suicide – committing or attempting to commit suicide, while sane or insane.

− In Missouri, Montana, and Vermont: committing or attempting to commit suicide,

while sane.

− In Minnesota: this exclusion does not apply.

• Self-Inﬂicted Injuries – injuring or attempting to injure oneself intentionally.

− In Missouri: injuring or attempting to injure oneself intentionally which is

obviously not an attempted suicide.

In order to receive beneﬁts for accidental injuries due to a covered accident, an insured must be admitted within six months of the date of

the covered accident (in Washington, twelve months).

Continental American Insurance Company (CAIC ), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of

Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the

Virgin Islands.

Continental American Insurance Company • Columbia, South Carolina

The certificate to which this sales material pertains may be written only in English; the certificate prevails if interpretation of this

material varies. Read your certificate carefully for exact terms and conditions. You’re welcome to request a full copy of the plan

certificate through your employer or by reaching out to our Customer Service Center. Benefits, terms, and conditions may vary by

state.

This brochure is subject to the terms, conditions, and limitations of Policy Series C80000. In Arkansas, C80100AR. In Oklahoma,

C80100OK. In Oregon, C80100OR. In Pennsylvania, C80100PA. In Texas, C80100TX. In Virginia, C80100VA.

− In Vermont: injuring or attempting to injure oneself intentionally, while sane.

• Racing – riding in or driving any motor-driven vehicle in a race, stunt show or speed

test in a professional or semi-professional capacity.

• Illegal Occupation – voluntarily participating in, committing, or attempting to commit

a felony or illegal act or activity, or voluntarily working at, or being engaged in, an

illegal occupation or job.

− In Connecticut: voluntarily participating in, committing, or attempting to commit

a felony.

− In Illinois: committing or attempting to commit a felony or being engaged in an

illegal occupation.

− In Nebraska and Tennessee: voluntarily participating in, committing, or

attempting to commit a felony or voluntarily working at, or being engaged in, an

illegal occupation or job.

− In Pennsylvania: committing or attempting to commit a felony, or being engaged

in an illegal occupation.

− In South Dakota: voluntarily committing a felony.

• Sports – participating in any organized sport in a professional or semi-professional

capacity.

• Custodial Care – this is non-medical care that helps individuals with the basic tasks

of everyday life, the preparation of special diets, and the self-administration of

medication which does not require the constant attention of medical personnel.

• Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any

related procedures, including any resulting complications.

• Services performed by a family member.

− In Arizona: this exclusion does not apply.

− In South Dakota: this exclusion does not apply.

• Services related to sex or gender change, sterilization, in vitro fertilization, vasectomy

or reversal of a vasectomy, or tubal ligation.

− In Washington D.C. and Washington: Services related to sterilization, in vitro

fertilization, vasectomy or reversal of a vasectomy, or tubal ligation.

• Elective Abortion – an abortion for any reason other than to preserve the life of the

person upon whom the abortion is performed.

− In Tennessee, or if the pregnancy was the result of rape or incest, or if

the fetus is non-viable.

• Dental Services or Treatment.

• Cosmetic Surgery, except when due to:

− Reconstructive surgery, when the service is related to or follows surgery

resulting from a Covered Accidental Injury or a Covered Sickness, or is related to

or results from a congenital disease or anomaly of a covered dependent child.

− Congenital defects in newborns.

TERMS YOU NEED TO KNOW

A Covered Accident is an accident that occurs on or after an insured’s effective date

while coverage is in force, and that is not speciﬁcally excluded by the plan.

Dependent means your spouse or dependent children, as deﬁned in the applicable rider,

who have been accepted for coverage. Spouse is your legal wife, husband, or partner in

a legally recognized union. Refer to your certiﬁcate for details.

Dependent Children are your or your spouse’s natural children, step-children,

grandchildren who are in your legal custody and residing with you, foster children,

children subject to legal guardianship, legally adopted children (in Texas, adopted

children), or children placed for adoption. (In Florida, coverage may be provided for the

children of custodial and non-custodial parents.) Newborn children are automatically

covered from the moment of birth for 60 days. Newly adopted children (and foster

children in North Carolina) are automatically covered for 60 days also. See certiﬁcate

for details. Dependent children must be younger than age 26 (In Arizona, on the efﬁctive

date of coverage and in Louisiana and Illinois, unmarried). See certiﬁcate for details.

Doctor is a person who is duly qualiﬁed as a practitioner of the healing arts acting within

the scope of his license, and: is licensed to practice medicine; prescribe and administer

drugs; or to perform surgery, or is a duly qualiﬁed medical practitioner according to the

laws and regulations in the state in which treatment is made.

In Montana: For purposes of treatment, the insured has full freedom of choice in the

selection of any licensed physician, physician assistant, dentist, osteopath, chiropractor,

optometrist, podiatrist, licensed social worker, psychologist, licensed professional

counselor, acupuncturist, naturopathic physician, physical therapist, or advanced

practice registered nurse.

A Doctor does not include you or any of your Family Members. For the purposes of

this deﬁnition, Family Member includes your spouse as well as the following members

of your immediate family: son, daughter, mother, father, sister, or brother. In Arizona,

however, a doctor who is your family member may treat you. In South Dakota, however,

a doctor who is your family member may treat you if that doctor is the only doctor in the

area and acts within the scope of his or her practice.

A Hospital is not a nursing home; an extended care facility; a skilled nursing facility;

a rest home or home for the aged; a rehabilitation facility; a facility for the treatment

of alcoholism or drug addiction (except in Vermont); an assisted living facility; or any

facility not meeting the deﬁnition of a Hospital as deﬁned in the certiﬁcate.

A Hospital Intensive Care Unit is not any of the following step-down units: a progressive

care unit; a sub-acute intensive care unit; an intermediate care unit; a private monitored

room; a surgical recovery room; an observation unit; or any facility not meeting the

deﬁnition of a Hospital Intensive Care Unit as deﬁned in the certiﬁcate

Sickness means an illness, infection, disease, or any other abnormal physical condition

or pregnancy that is not caused solely by, or the result of, any injury (In Maine, illness or

disease of an insured). A Covered Sickness is one that is not excluded by name, speciﬁc

description, or any other provision in this plan. For a beneﬁt to be payable, loss arising

from the covered sickness must occur while the applicable insured’s coverage is in

force (except in Montana).

Treatment is the consultation, care, or services provided by a doctor. This includes

receiving any diagnostic measures and taking prescribed drugs and medicines.

Treatment does not include telemedicine services (except in Kansas).

You May Continue Your Coverage

Your coverage may be continued with certain stipulations. See certiﬁcate for details.

Termination of Coverage

Your insurance may terminate when the plan is terminated; the 31st day after the

premium due date if the premium has not been paid; or the date you no longer belong

to an eligible class. If your coverage terminates, we will provide beneﬁts for valid claims

that arose while your coverage was in force. See certiﬁcate for details.

NOTICES

If this coverage will replace any existing individual policy, please be aware that

it may be in your best interest to maintain your individual guaranteed-renewable

policy.

Notice to Consumer: The coverages provided by Continental American

Insurance Company (CAIC) represent supplemental beneﬁts only. They do not

constitute comprehensive health insurance coverage and do not satisfy the

requirement of minimum essential coverage under the Affordable Care Act.

CAIC coverage is not intended to replace or be issued in lieu of major medical

coverage. It is designed to supplement a major medical program.

For more information, ask your insurance agent/producer, call 1.800.433.3036,

or visit aﬂacgroupinsurance.com.

TREATMENT BENEFITS

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE

Policy Series C80000

AG80075TL R2 IV (1/19)

BENEFIT

AMOUNT

OUTPATIENT DOCTOR’S OFFICE VISIT (maximum of 6 visits per calendar year for each insured)

We will pay the amount shown for each day that an insured visits a doctor’s ofﬁce. This beneﬁt is not payable for visits to

a chiropractor’s ofﬁce.

$25

TELEMEDICINE SERVICES (maximum of 6 per calendar year for each insured)

We will pay the beneﬁt amount shown for each day that, because of a covered accidental injury or covered sickness, an

insured seeks medical advice from a doctor via telemedicine services. The telemedicine services must be provided in lieu

of an outpatient doctor’s ofﬁce visit.

$10

CHIROPRACTOR VISIT

(maximum of 4 visits per calendar year for each insured)

We will pay the amount shown for each day that an insured receives services from a chiropractor for treatment of a

covered accidental injury or because of a covered sickness. Visits to a chiropractor’s ofﬁce are not payable under the

outpatient doctor’s ofﬁce visit beneﬁt.

$10

MAJOR DIAGNOSTIC EXAMS

(once per covered sickness or accident per calendar year)

We will pay the amount shown for each day that, due to a covered accidental injury or covered sickness, an insured

requires one of the following exams:

· Computerized Tomography (CT/CAT scan)

· Magnetic Resonance Imaging (MRI)

· Electroencephalography (EEG)

$100

OUT OF HOSPITAL PRESCRIPTION DRUG

(maximum of $100 per calendar year for each insured)

We will pay the amount shown for each day an insured has a prescription ﬁlled. Prescription drugs must meet three

criteria: (1) be ordered by a doctor; (2) be dispensed by a licensed pharmacist; and (3) be medically necessary for the

care and treatment of the insured.

This beneﬁt does not include beneﬁts for: (a) therapeutic devices or appliances; (b) experimental drugs; (c) drugs,

medicines or insulin used by or administered to a person while he is conﬁned to a hospital, rest home, extended-care

facility, convalescent home, nursing home or similar institution; (d) immunization agents, biological sera, blood or blood

plasma; or (e) contraceptive materials, devices or medications or infertility medication, except where required by law.

$20

HOSPITAL EMERGENCY ROOM VISIT (maximum of 5 visits per calendar year for each insured)

We will pay the amount shown for each day that an insured visits a hospital emergency room due to a covered accidental

injury or for treatment due to a covered sickness.

$75

EMERGENCY ROOM OBSERVATION (1 visit for each covered sickness or accident per calendar year, maximum of 5 total visits per calendar year

for each insured)

We will pay the amount shown for each period of observation that, because of a covered accidental injury or covered

sickness, an insured:

· Receives treatment in a hospital emergency room, and

· Is held in a hospital for observation without being admitted as an inpatient.

$50

Each 24 hour

period

$25

Less than 24

hours, but at

least 4 hours

REHABILITATION FACILITY per day (maximum of 15 days per conﬁnement, no more than 30 days total per calendar year for each insured)

We will pay the amount shown for each day that, due to a covered accidental injury or a covered sickness, an insured

receives treatment as an inpatient at a rehabilitation facility. For this beneﬁt to be payable, the insured must be transferred

to the rehabilitation facility for treatment following an inpatient hospital conﬁnement. We will not pay the rehabilitation

facility beneﬁt for the same days that the hospital conﬁnement beneﬁt is paid.

$50

Residents of Massachusetts are not eligible for these beneﬁts.

TERMS YOU NEED TO KNOW

Chiropractor means a person, other than the insured or the insured’s family member, who

• Is licensed as a chiropractor in the state in which treatment is received, and

• While working under the scope of his license, uses manual or mechanical means to detect or correct disorders of structural

imbalance, distortion, or subluxation of the musculoskeletal system and the nervous system for the purpose of removing nerve

interference and related effects. The interference must result from or relate to distortion, misalignment, or subluxation of or in the

vertebral column.

Rehabilitation Facility is a unit or facility providing coordinated multidisciplinary physical restorative services. These services must

be provided to inpatients under a doctor’s direction. The doctor must be knowledgeable and experienced in rehabilitative medicine.

Beds must be set up in a unit or facility specifically designated and staffed for this service. This is not a facility for the treatment of

alcoholism or drug addiction (except in Vermont).

Telemedicine Service means a medical inquiry with a doctor via audio or video communication that assists with a patient’s

assessment, diagnosis, and consultation.

Observation Unit means a unit in which observation services are given through hospital outpatient services to help the doctor

decide if the patient needs to be admitted as an inpatient or can be discharged. Observation services may be given in the

emergency department or another area of the hospital.

For a complete list of limitations and exclusions please refer to the brochure.

Continental American Insurance Company (CAIC), a proud member of the Aﬂac

family of insurers, is a wholly-owned subsidiary of Aﬂac Incorporated and underwrites

group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico,

or the Virgin Islands.

This piece is intended to be used in conjunction with the product brochure for Policy Series C80000 and

is subject to the terms, conditions, and limitations of the plan.

Continental American Insurance Company • Columbia, South Carolina

INPATIENT AND OUTPATIENT SURGICAL BENEFITS

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE

Policy Series C80000

AG80075IOPL R1 IV (2/16)

For a complete list of limitations and exclusions please refer to the brochure.

Continental American Insurance Company (CAIC), a proud member of the Aﬂac

family of insurers, is a wholly-owned subsidiary of Aﬂac Incorporated and underwrites

group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico,

or the Virgin Islands.

BENEFIT

AMOUNT

INPATIENT SURGERY AND ANESTHESIA (performed in hospital or ambulatory surgical center)

Payable for each day that, due to a covered accidental injury or sickness, an insured has an inpatient

surgical procedure performed by a doctor. The surgery must be performed while the insured is conﬁned to

a hospital as an inpatient.

$250

OUTPATIENT SURGERY AND ANESTHESIA (performed in hospital or ambulatory surgical center)

Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient

surgical procedure performed by a doctor in a hospital on an outpatient basis or ambulatory surgical

center.

$125

FACILITIES FEE FOR OUTPATIENT SURGERY (performed in hospital or ambulatory surgical center)

Payable if due to a covered accidental injury or sickness:

· An insured has an outpatient surgical procedure performed in an ambulatory surgical center or in a

hospital on an outpatient basis, and

· The insured receives an Outpatient Surgery and Anesthesia Benefit under this plan.

$50

OUTPATIENT SURGERY AND ANESTHESIA (performed in a doctor’s ofﬁce, urgent care facility or emergency room; maximum

of 4 procedures per calendar year for each insured)

Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient

surgical procedure performed by a doctor in a doctor’s ofﬁce or urgent care facility.

$50

Residents of Massachusetts are not eligible for these beneﬁts.

TERMS YOU NEED TO KNOW

Ambulatory Surgical Center is defined as a licensed surgical center consisting of an operating room; facilities for the administration

of general anesthesia; and a post-surgery recovery room in which the patient is admitted and discharged within a period of less

than 24 hours.

Urgent Care is a walk-in clinic that delivers ambulatory, outpatient care in a dedicated medical facility for illnesses or injuries that

require immediate care but that are not serious enough to require a visit to an emergency room.

DEPENDENT CHILD NEONATAL AND PEDIATRIC HOSPITAL INTENSIVE

CARE UNIT RIDER

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE

Policy Series C80000

AG80075NP IV (1/19)

For a complete list of limitations and exclusions please refer to the brochure.

Continental American Insurance Company (CAIC), a proud member of the Aﬂac

family of insurers, is a wholly-owned subsidiary of Aﬂac Incorporated and underwrites

group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico,

or the Virgin Islands. For groups sitused in California, group coverage is underwritten by

Continental American Life Insurance Company.

This piece is intended to be used in conjunction with the product brochure for Policy Series

C80000 and is subject to the terms, conditions, and limitations of the plan.

Continental American Insurance Company • Columbia, South Carolina

BENEFIT

AMOUNT

Maximum of 31 days per conﬁnement for each covered sickness or accident for dependent child.

We will pay the amount shown for each day a dependent child is conﬁned to a Neonatal or Pediatric

Hospital Intensive Care Unit because of a covered accidental injury or because of a covered sickness.

In order to receive this beneﬁt for accidental injuries received in a covered accident, an insured must

be admitted to a Neonatal or Pediatric Hospital Intensive Care Unit within six months of the date of the

covered accident (in Washington, twelve months).

We will pay beneﬁts for only one conﬁnement in a Hospital’s Neonatal or Pediatric Intensive Care Unit at a

time, even if it is caused by more than one covered accidental injury, more than one covered sickness or a

covered accidental injury and a covered sickness.

If we pay beneﬁts for conﬁnement in a Hospital’s Neonatal or Pediatric Intensive Care Unit and an insured

becomes conﬁned to a Hospital’s Intensive Care Unit again within six months because of the same or

related condition, we will treat this conﬁnement as the same period of conﬁnement.

$300

per day

This beneﬁt is payable in addition to the Hospital Conﬁnement Beneﬁt and Hospital Intensive Care Beneﬁt.

DEFINITIONS

The term Neonatal Hospital Intensive Care Unit specifically excludes any type of facility not meeting the definition of Neonatal

Hospital Intensive Care Unit as defined in the plan, including but not limited to private monitored rooms, surgical recovery rooms,

observation units, and the following step-down units:

• A progressive care unit,

• A sub-acute intensive care unit, or

• An intermediate care unit.

The term Pediatric Hospital Intensive Care Unit specifically excludes any type of facility not meeting the definition of Pediatric

Hospital Intensive Care Unit as defined in the plan, including but not limited to private monitored rooms, surgical recovery rooms,

observation units, and the following step-down units:

• A progressive care unit,

• A sub-acute intensive care unit, or

• An intermediate care unit.

In New Jersey, insured means covered person.

IV (2/16)

AG80075BBR R1

10% increase to Hospital Confinement, Hospital Intensive Care and Intermediate Intensive

Care Step-Down Unit Benefits

Hospital Confinement, Hospital Intensive Care and Intermediate Intensive Care Step-Down Unit

Benefits increase by 10% each year for the first 5 years of coverage. This increase is automatic

and requires no medical evidence of insurability. Premiums do not increase each year as the

benefit increases.

BUILDING BENEFIT RIDER SUMMARY

AFLAC GROUP HOSPITAL INDEMNITY INSURANCE

Policy Series C80000

For a complete list of limitations and exclusions please refer to the brochure.

Continental American Insurance Company (CAIC), a proud member of the Aﬂac

family of insurers, is a wholly-owned subsidiary of Aﬂac Incorporated and underwrites

group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico,

or the Virgin Islands.