Experimental Treatment – pays the actual charges up to $25,000 per calendar year for such treatment received in the United States or its territories, except for experimental bone marrow transplants.

Physical and Speech Therapy – pays the actual charges up to $25 per therapy session up to a lifetime maximum of $1,000.

Extended Care Facility – pays up to $60 per day for confinement in such a facility. Confinement must be recommended by a physician and begin within 14 days following a covered hospital stay. Benefits are limited to the number of days of the prior hospital confinement.

Transportation and Lodging for Bone Marrow Donors - pays (a) actual charges up to $2,500 for medical expenses directly related to such a transplant, (b) pays actual charges for a round trip coach fare on a common carrier or a personal automobile allowance of 50 cents per mile in excess of 50 miles one-way to the city where the transplant is performed, up to 700 miles round trip, and (c) pays actual charges up to $50 per day for lodging and meal expenses when donor has to remain near the hospital. This payment is in lieu of any other benefit payable under this policy when the donor is a person insured under this policy.

Transportation for Non-local Treatment Which Requires Hospital Confinement – pays (a) actual charges for non-local round trip charges by common carrier to the nearest hospital that provides the prescribed treatment or (b) 50 cents per mile for personal automobile expenses in excess of 50 miles one way, up to 700 miles round trip.

Transportation for Non-local Treatment Which Does Not Require Hospital Confinement – pays (a) 50 cents per mile for personal automobile expenses in excess of 50 miles one way, up to 700 miles round trip with a maximum of $1,500 per calendar year, (b) pays actual charges for round trip coach fare on a common carrier or a personal automobile allowance of 50 cents per mile in excess of 50 miles one-way to the city where the transplant is preformed, up to 700 miles round trip and (c) pays actual charges up to $50 per day for lodging and meal expenses.

Adult Companion Transportation and Lodging - pays the following expenses for one adult companion to be near insured when insured is confined in a nonlocal hospital (a) up to a maximum of $1,500 per calendar year for actual charges for non-local round trip coach fare by a common carrier to the nearest hospital that provides the prescribed treatment or 50 cents per mile for personal automobile expenses in excess of 50 miles one-way, up to 700 miles round trip and (b) pays actual charges up to $50 per day for lodging and meal expenses limited to the number of days of each confinement.

Outpatient Positive Diagnostic Testing – pays actual charges up to $250 for the diagnostic test that leads to a positive diagnosis within 90 days of the test.

Skin Cancer – pays up to $150 for actual charges for the removal of skin cancer when diagnosis is made by a physician, other than a legally qualified pathologist.

Ambulance – pays actual charges up to $75 per trip to transfer an insured person to the hospital for confinement as an inpatient.

Hospice – pays actual charges up to $100 per day up to a lifetime maximum of $7,500.

Government or Charity Hospital – pays actual charges up to $200 per day for confinement in a government or charity hospital. Payment is in lieu of all other policy benefits.

Blood and Blood Plasma – pays the actual charges for blood, blood plasma and platelets. Policy does not pay for blood that is donated or replaced.

Breast Cancer / Breast Reconstruction / Breast Prosthesis – pays a benefit equal to the daily hospital confinement benefit for a minimum of 48 hours of inpatient care following a mastectomy and for a minimum of 24 hours following a lymph node dissection for the treatment of breast cancer. Lifetime maximum of $2,500 per breast.

Cancer (Wellness) Screening Tests – pays up to $100 per year for cancer screening test. Tests covered are:

• Mammography Screening
• CEA (blood test for colon cancer)
• Pap Smear (test only)
• Colonoscopy
• CA125 (blood test for ovarian cancer)
• Chest X-ray
• PSA (blood test for prostate cancer)
• Thermography
• Hemocult Stool Specimen
• Serum Protein Electrophoresis
• Flexible Sigmoidoscopy

Home Health Care Services – when services are provided by a Home Health Care Agency, policy pays (a) up to $60 per day for services provided at home, not to exceed 180 days per calendar year, (b) up to $100 per day for Private Duty Nursing, not to exceed 15 days per calendar year, and (c) pays actual charges for a physician’s visit up to $40 per day not to exceed 15 days per calendar year. Benefits herein are not payable under provisions of this policy.

Hairpiece Benefit – pays a one-time benefit of up to $150 for a hairpiece when hair loss is a result of cancer treatment.

Extended Benefits – If a covered hospital confinement lasts for more than 75 days in a row, policy pays usual and customary charges for hospital room and board, medicines, lab test and other normal charges, up to $1,000 per day beginning on the 76th day. Payable after the 75th day in lieu of all other policy benefits.

Waiver of Premium – premiums of the insured person will be waived while that person is receiving treatment for cancer or specified disease for which benefits are payable if that person meets all of the following requirements: (a)the insured person becomes disabled due to cancer or specified disease, (b) remains disabled for a period of 90 consecutive days, and (c) the insured person is less than 65 years of age at the time he/she becomes disabled. Premiums will be waived beginning with the first premium payment after the 90 day period of disability and continue to be waived for as long as the insured person remains disabled.

Specified Disease Benefits - The benefits of the policy will be extended to pay for the loss that results from the following specified diseases:

Intensive Care Rider - Provides a Daily Benefit if an Insured Person is confined to a Hospital’s Intensive Care Unit, up to a maximum of 20 days per period of confinement.

Internal Cancer First Occurrence Rider - pays $2,500 or $5,000 the first time an insured is diagnosed as having internal cancer.

Wellness Claims - You may file your Assurity Wellness Claim by faxing in the receipt to Assurity Customer Service. Your receipt must include the services performed, and must be on the list of covered tests. Should you have any questions on how to file or submit a Assurity Claim Form, please contact Assurity Customer Service.

Pre-Existing Conditions
We will not pay any Benefits for loss caused by a Pre-Existing Condition during the first year following the Issue Date; however, loss due to such conditions will be payable unless specifically excluded from coverage after such 1 year period.

30-Day Waiting Period
There is a 30-day waiting period during which no benefits will be paid during the first 30 days following the Issue Date. Covered losses which manifest after the Issue Date will be payable starting on the 31st day.