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Adventist Health Systems Group Voluntary Cancer Plans
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THE INSURANCE POLICY UNDER WHICH THE CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.
- Cancer insurance from Allstate Benefits pays you benefits that can be used for non-medical cancer-related expenses that health insurance might not cover.
Benefits paid directly to you unless assigned Benefits paid in addition to any other coverage Individual or family coverage
Group Cancer/Specified Disease Insurance From Allstate Benefits
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No one likes to think about getting cancer. But it will still affect 1 in 2 men and 1 in 3 women, according to The American Cancer Society’s Cancer Facts and Figures, 2009. - Cancer may not be preventable, but you can protect yourself from some of the costs. Cancer and specified disease insurance can help you: Manage the high expenses of treatment; Preserve savings; Protect your family from financial hardship; Concentrate on getting well.
Group Voluntary Cancer and Specified Disease benefits are provided by policy from GVCP1, or state variations thereof. This presentation highlights some features of the group coverage but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the policyholder and the insurance company. Allstate Workplace Division is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a wholly-owned subsidiary of The Allstate Corporation. © 2009 Allstate Insurance Company.
Would your finances survive cancer or specified disease treatments?
In addition to cancer, this policy also has benefits for: 1. Muscular Dystrophy 2. Lou Gehrig's Disease 3. Poliomyelitis 4. Multiple Sclerosis 5. Encephalitis 6. Rabies 7. Tetanus 8. Tuberculosis 9. Osteomyelitis 10. Diphtheria 11. Scarlet Fever 12. Cerebrospinal Meningitis (bacterial) 13. Brucellosis 14. Sickle Cell Anemia 15. Thallasemia
16. Rocky Mountain Spotted Fever 17. Legionnaire's Disease 18. Addison's Disease 19. Hansen's Disease 20. Tularemia 21. Hepatitis (Chronic B or Chronic C) 22. Typhoid Fever 23. Myasthenia Gravis 24. Reye's Syndrome 25. Walter Payton's Liver Disease 26. Lyme Disease 27. Systemic Lupus Erythematosus 28. Cystic Fibrosis 29. Primary Biliary Cirrhosis
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Group Cancer/Specified Disease A Case Study
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*The following screens depict an example of how benefits may be paid. Benefits received may vary based upon each covered person’s medical experience.
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According to the American Cancer Society, 1 out of 2 men and 1 out of 3 women will get cancer during their life time.
No Cancer Cancer
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For every $1,000 of costs associated with deadly diseases, an average of $667 are non-medical, according to The American
Cancer Society’s Cancer Facts and Figures, 2009.
Total Medical Costs
$333
$667
Non-Medical Medical
Total Costs
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Examples of Non-Medical Expenses
• Lost income (Employee or spouse)
• Deductibles and co-insurance payments
• Transportation
• Housekeeping
• Child care expenses
• Long distance
telephone calls
• Special diets
• Special clothes and
prostheses
• Meals and lodging
away from home
• Caretaker’s (child)
expenses
Source: Cancer Facts and Figures, American Cancer Society
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Consider our Group Cancer/Specified Disease Plan
• Cancer Screening Benefit: $50 per covered person per calendar year if covered screening test is performed.
Screenings covered:
Bone Marrow Testing
CA15-3
CEA
CA125
Chest X-ray
Colonoscopy
Thermography
PSA
Serum Protein Electrophoresis
Flexible sigmoidoscopy
Hemocult stool analysis
Mammography
Pap Smear
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The Lifecycle of a Possible Cancer Claim
• Susan Smith has enrolled in the Enhanced Cancer plan and has annual mammograms.
–Cancer screening benefit
• Susan has a routine mammogram in 2013. • She is diagnosed with Breast Cancer.
–Cancer screening benefit –Cancer Initial Diagnosis Benefit
Allstate Benefits is notified. Claim Started. Letter from President w/Chicken Soup for the Surviving Soul
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The Lifecycle of a Possible Cancer Claim
• Susan enters the hospital for surgery. – Hospital Confinement – Anesthesia – Surgical Benefit – Many other benefits
Claim checks start arriving
• After the surgery Susan is discharged but must take Chemotherapy at a Outpatient Center 40 miles from her home. – Chemotherapy – Mileage – Family member transportation benefit – Many others
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Case Study Payment Detail with Enhanced Plan Coverage Option* Female Breast Cancer Patient
Benefit Type Benefit Amount Sample Occurrence/ Services Benefit Payment
First Occurrence $3,000.00 Per Covered Person
$3,000.00
Hospital Confinement $300.00 Per Day For First 70 Days
4 Days $1,200.00
At Home Nursing $300.00 Per Day Up To Number Of Days Of Previous Confinement
3 Days Following Inpatient Confinement @ $300.00 Per Day
$900.00
Radiation/Chemotherapy $10,000.00 Per 12 Month Period Beginning With The First Date Of Treatment
35 Radiation Treatments @ $200.00 Per Treatment
$7,000.00
Blood, Plasma and Platelets $10,000.00 Per 12 Month Period Beginning With The First Date Of Treatment
6 Units @ $80.00 Per Unit $480.00
Surgery Paid According To The Procedure Code Up To A Maximum Of $4,500.00
CPT 19240-Inpatient $1,800.00
CPT 19101-Outpatient $675.00
Anesthesia Actual Charge Up To 25% Of The Amount We Paid For The Surgery
CPT 19240-Inpatient $450.00
CPT 19101-Outpatient $168.75
Ambulatory Surgical Center Actual Charge Up To $750.00 Per Day
1 Day @ $3,211.10 $750.00
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*Subject to Pre-Existing Condition Limitation
Case Study Continued - Female Breast Cancer Patient (with Enhanced Plan Coverage Option*)
Benefit Type Benefit Amount Sample Occurrence/ Services Benefit Payment
Second Surgical Opinion Actual Charge Up To $600.00
1 Visit @ $355.00 $355.00
Inpatient Drugs and Medicine
Actual Charge Up To $25.00 Per Day
4 Days $100.00
Inpatient Attending Physician
Actual Charge Up To $50.00 Per Visit
4 Days $200.00
Non-Local Transportation $.40 Per Mile Up To Maximum Of 700 Miles / Roundtrip Must Exceed 70 Miles Or Actual Cost Of Coach Fare On A Common Carrier
30 Trips for Radiation Treatments @ 225 Miles Roundtrip Personal Vehicle Transportation
$2,700.00
2 Trips to Hospital for Surgery @ 225 Miles Roundtrip Personal Vehicle Transportation
$180.00
Outpatient Lodging $50.00 Per Day When Radiation/Chemotherapy Are Received / Maximum of $2,000.00 Per 12 Month Period / Must Exceed 100 Miles One-Way From Home
30 Nights in Hotel @ $100.00 Per Night for Radiation Treatment
$1,500.00
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*Subject to Pre-Existing Condition Limitation
Case Study Continued - Female Breast Cancer Patient (with Enhanced Plan Coverage Option*)
Benefit Type Benefit Amount Sample Occurrences/ Services Benefit Payment
Family Member Lodging Actual Charge Up To $50.00 Per Day While Insured Is Inpatient / Maximum Of 60 Days
4 Nights in Hotel @ $100.00 Per Night for Hospital Confinement
$200.00
Physical or Speech Therapy Actual Charges Up To $50.00 Per Day
4 Days @ $75.00 Per Day $200.00
Surgically Implanted Prosthesis
Actual Charge Up To $2,000.00 Per Amputation
$800.00 Breast Prosthesis $800.00
Comfort Anti-Nausea Drugs Actual Charges Up To $200.00 Per Calendar Year / Outpatient Only
8 Prescriptions Totaling $687.47
$200.00
Cancer Screening $50.00 For Mammogram Mammogram $50.00
TOTAL BENEFIT: $22,908.75
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* Subject to Pre-Existing Condition Limitation
The Lifecycle of a Cancer Claim
Conclusion
• Susan has income to help pay rent, mortgage, day care, credit cards, school tuition, special diet, and out of town family members.
• She may be able to worry less about paying bills and have more time to focus on getting better.
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