Cancer Expense Insurance Plan Details 

Learn more about Highlights, Eligibility,  Coverage Limits and Rates and Frequently Asked Questions.

           *Lifetime maximum benefit is $250,000.

Use any Doctor and Hospital

You will receive all the benefits for which you are eligible regardless of what physician you see or what hospital you use. There are no restrictions as long as they meet the plan
definitions.

Receive Benefits Regardless of any Other Insurance

There is no coordination of benefits between this plan and any other form of coverage you may have, such as health insurance. This is a supplemental plan that pays regardless of any other insurance you have with other companies.

Use Your Benefits as You Choose

Pay medical bills, the mortgage, buy food—the choice is yours. You can use your benefits any way you wish.

Benefits Paid Directly to You

All benefit checks will be sent directly to you or to anyone you choose.  They will not be sent to your doctor or hospital unless you specifically request it.

How to Apply

1. Refer to the plan description for benefits and premium cost as you fill out the application.
2. Make a check payable for the total amount of the premium due payable to:
3. Affinity Insurance Services, Inc.
Mail the completed application with your check to:

        AIChE Insurance Program Administrator
        159 E. County Line Road
        Hatboro, PA 19040

Effective Date of Coverage

Coverage becomes effective on the date shown on your certificate of insurance provided you have paid your first premium payment, and you or any dependent to be covered is not hospital confined.
 
How to File a Claim

To file a claim, call the administrator at 800-982-4243 for a claim form.

Payment Options

Two payment modes are available to suit your needs and budget: Electronic Fund Transfer (EFT) and direct billing. 

If you choose to have your premiums deducted electronically from your checking or savings account, you can select from monthly, quarterly, semiannual or annual EFT options. 

Bills sent to you directly can be mailed on a quarterly, semiannual or annual basis.

Premiums on the Rate page are shown semiannually.  When paying monthly, divide the semiannual rate by 6; quarterly, divide the semiannual rate by 2; annually, multiply the semiannual rate by 2.

30-Day "Free Look"

When you become insured, you will be sent a certificate of insurance summarizing your insurance coverage. If you are not completely satisfied with the terms of your certificate, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund.

Exclusions

• This insurance plan pays benefits for medical care or treatment resulting from cancer, and recommended and approved or performed by a physician.
• This plan does not cover any expense which results from injury or sickness other than cancer; or treatment or services performed outside the United States.
• A cancer which is diagnosed during the first 30 days of coverage will be considered a pre-existing condition (except in AZ, MN, MO, NH, OK, TX, UT, VT and WI).
• No benefits will be payable unless the covered person incurs expenses after his insurance has been in effect for 12 months.
• A cancer which is diagnosed in the 5 years prior to your effective date is not covered.

This information is only a brief description of the principal provisions and features of the Plan. The complete terms and conditions are set forth in the group policy issued by Monumental Life to the Trustee.

When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the Plan.

The Cancer Expense Insurance Plan Policy Form Number CA 10006 PM.

23199753  

IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance pays a limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions.  It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement Insurance.

This insurance duplicates Medicare benefits when:

• any expenses or services covered by the policy are also covered by Medicare
• It pays the fixed dollar amount stated in the policy and Medicare covers the same event

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

• hospitalization
• physician services 
• hospice 
• other approved items and services.

Before You Buy This Insurance

1. Check the coverage in all health insurance policies you already have.
2. For more information about Medicare and Medicare Supplement Insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
3. For help in understanding your health insurance, contact your state insurance department or state senior insurance counseling program.