This is a brief product overview only. Coverage may not be available in all states. Benefits/premium rates may vary based on plan selected. Optional riders may be available at an additional cost. Plans and riders may also contain a waiting period. Refer to the exact plans and riders for benefit details, definitions, limitations and exclusions. For availability and costs, please contact your local Aflac agent/producer.
1 Johnnie is a real policyholder. This is her story. Your benefits from Aflac may differ. Johnnie was paid for her time telling this story.
Aflac
In Arkansas, Policy A37000AR. In Delaware, Policies A371AA & A371BA. In Idaho, Policy A37000ID. In New York, Policy NY37000. In Oklahoma, Policy A37000OK. In Oregon, Policy A37000OR. In Pennsylvania, Policy A37000PA. In Texas, Policy A37000TX. In Virginia, Policies A371AAVA & A371BAVA.
Limitations and Exclusions for residents of Arizona:
Aflac will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person. For any benefit to be payable, the Injury, treatment, Accidental-Death, Dismemberment, or loss must occur on or after the Effective Date of coverage and while coverage is in force. Aflac will not pay benefits for treatment or loss due to Sickness including (1) any bacterial, viral, or microorganism infection or infestation or any condition resulting from insect, arachnid, or other arthropod bites or stings; or (2) an error, mishap, or malpractice during medical, diagnostic, or surgical treatment or procedure for any Sickness. Aflac will not pay benefits whenever coverage provided by this policy is in violation of any U.S. economic or trade sanctions. If the coverage violates U.S. economic or trade sanctions, such coverage shall be null and void. Aflac may void this policy and will not pay benefits whenever: (1) material facts or circumstances have been concealed or misrepresented in making a claim under this policy; or (2) fraud is committed or attempted in connection with any matter relating to this policy. If you have received benefits that were not contractually due under this policy, then Aflac reserves the right to offset any benefits payable under this policy up to the amount of benefits you received that were not contractually due.
Aflac will not pay benefits for an Injury, treatment, Accidental-Death, Dismemberment, or loss that is caused by or occurs as a result of a Covered Person's:
- Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve;
- Being intoxicated or under the influence of alcohol, drugs, or any narcotic, unless administered on the advice of a Physician and taken according to the Physician's instructions (the term “intoxicated” refers to that condition as defined by the law of the jurisdiction in which the cause of the loss occurred);
- Using any drug, narcotic, hallucinogen, or chemical substance (unless administered by a Physician and taken according to the Physician’s instructions) or voluntarily taking any kind of poison or inhaling any kind of gas or fumes;
- Participating in, or attempting to participate in, an illegal activity that is defined as a felony (“felony” is as defined by the law of the jurisdiction in which the activity takes place); or being incarcerated in any detention facility or penal institution;
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery or other elective procedures that are not Medically Necessary; or
- Having dental treatment except as a result of Injury.
Limitations and Exclusions for residents of Idaho:
Aflac will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person. For any benefit to be payable, the Injury, treatment, Accidental-Death, Dismemberment, or loss must occur on or after the Effective Date of coverage and while coverage is in force. Aflac will not pay benefits for an Injury, treatment, Accidental-Death, Dismemberment, or loss that is caused by or occurs as a result of a Covered Person's:
- Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve;
- Alcoholism or drug addiction;
- Participating in a felony, whether charged or not (“felony” is as defined by the law of the jurisdiction in which the activity takes place);
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery that is not Medically Necessary (except that “cosmetic surgery” shall not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma and reconstructive surgery because of Congenital Anomaly or disease of the covered Dependent Child); or
- Having dental treatment except as a result of Injury.
Limitations and Exclusions for residents of New Jersey:
Aflac will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person. For any benefit to be payable, the Injury or treatment must occur on or after the Effective Date of coverage and while coverage is in force. Aflac will not pay benefits whenever coverage provided by this policy is in violation of any U.S. economic or trade sanctions. If the coverage violates U.S. economic or trade sanctions, such coverage shall be null and void. Aflac may void this policy and will not pay benefits whenever: (1) material facts or circumstances have been intentionally concealed or misrepresented in making a claim under this policy; or (2) fraud is committed or attempted in connection with any matter relating to this policy. If you have received benefits that were not contractually due under this policy, then Aflac reserves the right to offset any benefits payable under this policy up to the amount of benefits you received that were not contractually due. Aflac will not pay benefits for an Injury, treatment, Accidental-Death, Dismemberment, or loss that is caused by or occurs as a result of a Covered Person's:
- Being involved in war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve. (We will return the premium paid during such service, and upon termination of military service, you have the right to renew coverage.);
- Loss sustained or contracted in consequence of the Covered Person’s being intoxicated or under the influence any narcotic unless administered on the advice of a Physician;
- Committing or attempting to commit a felony or being engaged in an illegal occupation;
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery except reconstructive surgery when such service is incidental to or follows surgery resulting from trauma; or
- Having dental care or treatment except as a result of Injury.
Limitations and Exclusions for residents of Virginia:
Aflac will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person. For any benefit to be payable, the Injury, treatment, Accidental-Death, Dismemberment, or loss must occur on or after the Effective Date of coverage and while coverage is in force. Aflac will not pay benefits for treatment or loss due to Sickness. This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. Aflac will not pay benefits whenever fraud is committed in making a claim under this coverage.
Aflac will not pay benefits for an Injury, treatment, Accidental-Death, Dismemberment, or loss that is caused by or occurs as a result of a Covered Person's:
- Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve (Aflac will upon receipt of written notice of military service, refund all premiums as is applicable to such persons on a pro rata basis.);
- Participating in, or attempting to participate in, an illegal activity that is defined as a felony (“felony” is as defined by the law of the jurisdiction in which the activity takes place);
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery or other elective procedures that are not Medically Necessary (cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered dependent child which has resulted in a functional defect); or
- Having dental treatment except as a result of Injury.
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
Tier One
T37000 Series: In Arkansas, Policy T37000ARR. In Delaware, Policy T37000. In Idaho, Policies T37100IDR, T37200IDR, & T37300IDR. In Oregon, Policy T37000OR. In Oklahoma, Policy T37000OK. In Pennsylvania, Policies T37000PA, T37300PA, & T37500PA. In Texas, Policy T37000TX. In Virginia, Policies T37100VA, T37200VA, T37300VA, T37400VA, T37600VA.
Limitations and Exclusions for residents of Arizona:
Tier One will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person.
[Tier One will not pay benefits for treatment or loss from an On-the-Job Injury.]
For any benefit to be payable, the [Off-the-Job] Injury, treatment, [Accidental-Death, Dismemberment,] or loss must occur on or after the Effective Date of coverage and while coverage is in force.
Tier One will not pay benefits for treatment or loss due to Sickness including (1) any bacterial, viral, or microorganism infection or infestation or any condition resulting from insect, arachnid, or other arthropod bites or stings; or (2) an error, mishap, or malpractice during medical, diagnostic, or surgical treatment or procedure for any Sickness.
Tier One will not pay benefits whenever coverage provided by this policy is in violation of any U.S. economic or trade sanctions. If the coverage violates U.S. economic or trade sanctions, such coverage shall be null and void.
Tier One may void this policy and will not pay benefits whenever: (1) material facts or circumstances have been concealed or misrepresented in making a claim under this policy; or (2) fraud is committed or attempted in connection with any matter relating to this policy. If you have received benefits that were not contractually due under this policy, then Tier One reserves the right to offset any benefits payable under this policy up to the amount of benefits you received that were not contractually due.
Tier One will not pay benefits if you fail to cooperate with our investigation into the validity of your claim. [We may examine any Covered Person under oath, while not in the presence of any other Covered Person and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including a Covered Person’s books and records. In the event of an examination, a Covered Person’s answers must be signed.]
Tier One will not pay benefits for an [Off-the-Job] Injury, treatment, [Accidental-Death, Dismemberment,] or loss that is caused by or occurs as a result of a Covered Person's:
- Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve;
- Being intoxicated or under the influence of alcohol, drugs, or any narcotic, unless administered on the advice of a Physician and taken according to the Physician's instructions (the term “intoxicated” refers to that condition as defined by the law of the jurisdiction in which the cause of the loss occurred);
- Using any drug, narcotic, hallucinogen, or chemical substance (unless administered by a Physician and taken according to the Physician’s instructions) or voluntarily taking any kind of poison or inhaling any kind of gas or fumes;
- Participating in, or attempting to participate in, an illegal activity that is defined as a felony, (“felony” is as defined by the law of the jurisdiction in which the activity takes place); or being incarcerated in any detention facility or penal institution;
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery or other elective procedures that are not Medically Necessary; or
- Having dental treatment except as a result of [Off-the-Job] Injury.
Limitations and Exclusions for residents of Idaho:
Tier One will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person.
For any benefit to be payable, the Injury, treatment, Accidental-Death, Dismemberment, or loss must occur on or after the Effective Date of coverage and while coverage is in force.
Tier One will not pay benefits if you fail to cooperate with our investigation into the validity of your claim. We may examine any Covered Person under oath, while not in the presence of any other Covered Person and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including a Covered Person’s books and records. In the event of an examination, a Covered Person’s answers must be signed.
Tier One will not pay benefits for an Injury, treatment, Accidental-Death, Dismemberment, or loss that is caused by or occurs as a result of a Covered Person's:
- Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve;
- Alcoholism or drug addiction;
- Participating in a felony, whether charged or not (“felony” is as defined by the law of the jurisdiction in which the activity takes place);
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery that is not Medically Necessary (except that “cosmetic surgery” shall not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma and reconstructive surgery because of Congenital Anomaly or disease of the covered Dependent Child); or
- Having dental treatment except as a result of Injury.
Limitations and Exclusions for residents of Virginia:
Tier One will not pay benefits for services rendered by you or a member of the Immediate Family of a Covered Person.
For any benefit to be payable, the Injury, treatment, Dismemberment, or loss must occur on or after the Effective Date of coverage and while coverage is in force.
Tier One will not pay benefits for treatment or loss due to Sickness.
This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims.
Tier One will not pay benefits whenever fraud is committed in making a claim under this coverage.
The following conditions are Sicknesses, not Injuries, under the terms of this policy, therefore, benefits are not payable for these conditions: occupational diseases; conditions caused by overuse; conditions caused by repetitive motion, strain, or stress; conditions caused by prolonged or repetitive exposure to substances, materials, gases, toxins, light, or processes; any bacterial, viral, or microorganism infection or infestation or any condition resulting from insect, arachnid, or other arthropod bites or stings; and an error, mishap, or malpractice during medical, diagnostic, or surgical treatment or procedure for any Sickness.
Tier One will not pay benefits for an Injury, treatment, Dismemberment, or loss that is caused by or occurs as a result of a Covered Person's:
- Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve (Tier One will upon receipt of written notice of military service, refund all premiums as is applicable to such persons on a pro rata basis.);
- Participating in, or attempting to participate in, an illegal activity that is defined as a felony (“felony” is as defined by the law of the jurisdiction in which the activity takes place);
- Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
- Having cosmetic surgery or other elective procedures that are not Medically Necessary (cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered dependent child which has resulted in a functional defect); or
- Having dental treatment except as a result of Injury.
Aflac’s family of insurers includes Aflac, Aflac New York, Continental American Insurance Company, and Tier One Insurance Company. Tier One Insurance Company is part of the Aflac family of insurers. In California, Tier One Insurance Company does business as Tier One Life Insurance Company (Tier One NAIC 92908).
Aflac | Tier One | WWHQ | 1932 Wynnton Road | Columbus, GA 31999
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