Critical Illness Insurance Benefit Summary
This document outlines critical illness insurance benefits, highlighting coverage conditions and statistics about medical-related bankruptcies.
Page 1 Group name: Peter Corporation Policy number: 027008 Form created: 03/22/2026 Benefit plan and features Class definition: Class 1 – All Active Full Time Employees Employee Spouse Children Benefit Amount $5,000 minimum to a maximum of $30,000 in $5,000 increments $2,500 minimum in $2,500 increments to a maximum of $15,000 Not to exceed 50% of the Employee Benefit 25% of the Employee Elected Benefit Covered Conditions Benefit Percentages Recurrence Benefit Percentages Heart Attack 100% 100% Sudden Cardiac Arrest 100% 100%
Page 2 Covered Conditions Benefit Percentages Recurrence Benefit Percentages Stroke 100% 100% Major Organ Failure 100% 100% End-Stage Heart Failure 100% 100% Bone Marrow Transplant 100% N/A End-Stage Kidney Disease 100% 100% Occupational Infectious Disease 100% N/A Coronary Artery Bypass 25% 25% Angioplasty 5% 5% Invasive Cancer 100% 100% Non-Invasive Cancer 25% 25% Breast Cancer 100% 100% Skin Cancer 5% 5% Benign Brain Tumor 100% 100% Coma 100% 100% Paralysis 100% N/A Severe Burns 100% 100% Advanced Multiple Sclerosis 100% N/A Advanced ALS/Lou Gehrig’s Disease 100% N/A Advanced Alzheimer's Disease 100% N/A Advanced Parkinson's Disease 100% N/A Blindness 100% N/A Complete Loss of Hearing 100% N/A Loss of Speech 100% N/A Hospitalized Infectious Disease 25% 25% Childhood Specific Conditions Autism 100% N/A Sickle Cell Disease 100% N/A Cerebral Palsy 100% N/A Complex Congenital Heart Disease 100% N/A Cystic Fibrosis 100% N/A Type 1 Diabetes Mellitus 100% N/A Muscular Dystrophy 100% N/A Down Syndrome 100% N/A Spina Bifida 100% N/A Cleft Lip/Palate 100% N/A PANDAS 100% N/A Critical Illness features Additional Occurrence Pays a second, unrelated diagnosis. Requires 3 mo. between diagnoses.
Page 3 Recurrence Pays subsequent diagnoses of a previously paid condition. Requires 6 mo. between diagnoses. Enrollment Annual Open Enrollment Portability To age 70 Rate Basis Attained Age Rating Wellness Screening Benefit $50 annually when qualifying exams or screenings are completed.
Page 4 • Annual physical examination • Any medically accepted Cancer screening • Bone density screening • Cardiac exercise stress test • Dental examination • Diabetes tests • Electrocardiogram (ECG)-resting or stress Qualifying exams and screenings for wellness screening benefit There are several exams and screenings that qualify for the annual benefit. Below is an illustration of some of the covered exams and screenings: • Immunizations • Interscholastic Sports Physical Exam • Lipid panel (cholesterol, triglycerides, HDL, LDL) • Mental health screening • Smoking cessation program • Vision examination • Weight reduction program Understanding your benefits Commonly Used Terms Benefit Amount The dollar value of the insurance and the amount able to be claimed. Benefit Percentage The percent of the “Benefit Amount” that is payable for each covered condition. Recurrence Benefit Percentage The percent of the “Benefit Amount” that is payable upon the second and all subsequent claims for a condition for which a claim has previously been paid under this policy. Cancer in Situ A diagnosis referring to cancer that has not spread into surrounding tissue (aka non-invasive cancer). A localized cancer is generally more easily resolved. Attained Age Rating Premium is based on the current age you have attained. Any increases in premium due to entering a new age-band will be administered at the next annual enrollment. Frequently Asked Questions When can I enroll? You can enroll when you are initially eligible for benefits and any subsequent annual enrollment or life status change. Are my dependent children eligible for coverage? Yes, dependent children are eligible up to end of the month they reach age 26. If any dependent children are developmentally disabled, you are able to continue coverage beyond age 26. Do benefits have to be used for medical expenses? You decide how to use your benefit payment: • Out-of-pocket medical costs, including deductibles and co-pays • Rehab costs • Rent or mortgage payments • Groceries • Utility or credit card bills • Childcare • Other financial support What is critical illness insurance? Group critical illness insurance is designed to pay a lump sum cash benefit when an insured is diagnosed with a covered condition (i.e. heart attack, stroke, cancer, etc.). The covered conditions are common and typically are survivable diagnosis. Why should I buy critical illness insurance? Two-thirds of personal bankruptcies are due to medical expenses, even for those with medical insurance. Equitable's critical illness insurance policy covers the most common conditions likely to arise over your lifetime and provides protection from the many expenses stemming from a significant medical condition. • • • • • • • • • • • • • • • • • • • • •
Page 5 What conditions are covered as a Critical Illness? Only the conditions listed above are covered by this policy. Any condition that is not listed above is not a covered condition and therefore is not a payable claim. What is a Wellness Benefit? Insureds are eligible to receive an annual benefit amount (default is $50) when they undergo any eligible exam or screening from the covered list. How do I learn more about my benefits Go to www.equitable.com/employeebenefits and log on to EB360® to view your account details. If I have additional questions, who can I talk too? Please don’t hesitate to contact us at phone number 1-866-274-9887. nasdaq.com/articles/medical-bankruptcy-is-killing-the-american-middleclass-2019-02-14. 1
Page 6 nasdaq.com/articles/medical-bankruptcy-is-killing-the-american-middleclass-2019-02-14. 1 cdc.gov/heartdisease. 2 cdc.gov/stroke/facts.htm. 3 Important Information The following is a summary. A complete Limitations and exclusions: list of applicable exclusions and limitations are included in the policy and certificate. State variations may apply. We may not pay a benefit for any that is due to or results from: services Critical Illness or treatment for which an Insured is not charged, unless facility is a United States government facility; treatment or complications of treatment not related to a ; an autologous bone Critical Illness marrow transplant; intentionally self-inflicted injuries or committing or attempting to commit suicide; elective plastic or cosmetic surgery; active military duty, or war or any act of war (excluding terrorism); your active participation in a riot, rebellion or insurrection; committing or attempting to commit an assault, felony or other criminal act or incarceration; your engagement in dangerous conduct or hazardous activity where there is a likelihood of death or serious Injury; being legally intoxicated or under the influence of any narcotic unless taken on the advice of a physician and taken as prescribed; or illegal use of inhalants or huffing. In some states, critical illness This policy provides limited benefits: insurance is referred to as specified disease insurance. Critical insurance is a limited benefit policy. It does NOT provide Illness basic hospital, basic medical or major medical insurance, and does not satisfy the requirement for minimum essential coverage under the Affordable Care Act. THIS POLICY IS NOT A MEDICARE SUPPLEMENT PLAN. The certificate has exclusions and limitations for certain conditions that may affect any benefits payable. Benefits payable are subject to all terms and conditions of the certificate. For costs and complete details of the coverage, please see the actual policy or contact your insurance broker. Policy form AXEBP19 CI; MOEBP19 CI and state variations. Availability is subject to state approvals. NY: This policy provides limited benefits health insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. The expected benefit ratio for this policy is 70 percent. This ratio is the portion of future premiums that the company expects to return as benefits, when averaged over all people with this policy. Equitable is the brand name of the retirement Legal disclosures: and protection subsidiaries of Equitable Holdings, Inc., including Equitable Financial Life Insurance Company (Equitable Financial) (NY, NY), Equitable Financial Life Insurance Company of America (Equitable America), an AZ stock company with an administrative office located in Charlotte, NC, and Equitable Distributors, LLC. Equitable Advisors is the brand name of Equitable Advisors, LLC (member FINRA, SIPC) (Equitable Financial Advisors in MI and TN). All group insurance products are issued either by Equitable Financial or Equitable America, which have sole responsibility for their respective insurance and backed solely by their claims-paying obligations. Some products are not available in all states. ©2023 Equitable Holdings, Inc. All rights reserved. (6/23) | EB360® is a registered mark of Equitable Holdings, Inc., NY, NY.
