Hospital Insurance

In Arkansas, Policies B40100AR & B401HAR. In Delaware, Policies B40100DE & B4010HDE. In Idaho, Policies B40100ID & B4010HID. In New York, Policies NYB40100 & NYB4010H. In Oklahoma, Policies B40100OK & B4010HOK. In Oregon, Policies B40100OR & B4010HOR. In Pennsylvania, Policies B40100PA & B4010HPA. In Texas, Policies B40100TX& B4010HTX. In Virginia, Policies B40100VA & B4010HVA. This is a brief product overview only. Coverage may not be available in all states including but not limited to New Jersey. Benefits/premium rates may vary based on plan selected. Optional riders are available at an additional cost. The policy has limitations and exclusions that may affect benefits payable. Refer to the policy for complete details, limitations, and exclusions. For costs and complete details of the coverage, please contact your local Aflac agent.

Limitations & Exclusions for the residents of Arizona:

Aflac will not pay benefits for care or treatment that is: (1) caused by a Pre-existing Condition, unless it begins more than 12 months after the Effective Date of coverage, or (2) received prior to the Effective Date of coverage.

Aflac will not pay benefits whenever coverage provided by the 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 will not pay benefits whenever fraud is committed in making a claim under the coverage. If you have received benefits that were not contractually due under the coverage, then Aflac reserves the right to offset any benefits payable under the coverage up to the amount of benefits you received that were not contractually due.

The policy does not cover losses caused by or resulting from:

1. Giving birth within the first ten months of the Effective Date of coverage; or pregnancy in existence prior to the Effective Date of coverage. Complications of Pregnancy, including nonelective cesarean, are covered to the same extent as a Sickness;
2. Receiving routine nursing or routine well-baby care for a newborn child;
3. 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 type of poison or inhaling any type of gas or fumes;
4. 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 detained in any detention facility or penal institution;
5. 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);
6. Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
7. Having dental treatment, except as a result of Injury;
8. Having cosmetic surgery that is not Medically Necessary;
9. Having elective surgery that is not Medically Necessary within the first 12 months of the Effective Date of coverage;
10. 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;
11. Actively participating in a riot, insurrection, or terrorist activity;
12. Donating an organ within the first 12 months of the Effective Date of coverage; or
13. Having mental or emotional disorders, including but not limited to the following: bipolar affective disorder (manicdepressive syndrome), delusional (paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders, bereavement, situational depression, depression, stress, or post-partum depression. The policy will pay, however, for covered losses resulting from Alzheimer’s disease, or similar forms of senility or senile dementia, first manifested while coverage is in force.

A “Pre-existing Condition” is an illness, disease, infection, disorder, condition, or injury for which, within the 12-month period before the Effective Date of coverage, prescription medication was taken or medical testing, advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-existing Condition, including deliveries for children conceived prior to the Effective Date of coverage, will not be covered unless it begins more than 12 months after the Effective Date of coverage.

Limitations and Exclusions for residents of Idaho:

Aflac will not pay benefits for care or treatment that is: (1) caused by a Pre-existing Condition, unless it begins more than 12 months after the Effective Date of coverage, or (2) received prior to the Effective Date of coverage. Aflac will pay benefits for elective surgery that is not Medically Necessary after the first 12 months of the Effective Date of coverage. The policy does not cover losses caused by or resulting from:

1. Pregnancy in existence on the Effective Date of coverage, including giving birth or maternal-fetal intervention procedure. Involuntary Complications of Pregnancy are covered to the same extent as a Sickness;
2. Elective abortions (an elective abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed);
3. Alcoholism or drug addiction;
4. Receiving routine nursing or routine well-baby care for a newborn child; Policy benefits will be paid for a newborn’s Sickness or Injury, including Congenital Anomaly;
5. Participating in a felony, whether charged or not (“felony” is as defined by the law of the jurisdiction in which the activity takes place);
6. Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
7. Having dental treatment, except as a result of Injury;
8. 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, infection or other diseases of the involved part and reconstructive surgery because of Congenital Anomaly or disease of the covered Dependent Child;
9. 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;
10. Actively participating in a riot or an insurrection; or
11. Having mental or emotional disorders.

PRE-EXISTING CONDITION LIMITATIONS: A “Pre-existing Condition” is an illness, disease, infection, disorder, condition, or injury for which, within the six-month period before the Effective Date of coverage, prescription medication was taken or medical testing, advice, consultation, or treatment was recommended or received from a Physician. Pre-existing Conditions, including pregnancies in existence on the Effective Date of coverage, will not be covered during the first 12 months after the Effective Date of coverage.

Limitations and Exclusions for the residents of Virginia:

A. Aflac will not pay benefits for care or treatment that is: (1) caused by a Pre-existing Condition, unless it begins more than 12 months after the Effective Date of coverage, or (2) received prior to the Effective Date of coverage.

B. Aflac will not pay benefits for any Sickness that is medically evaluated, diagnosed, or treated by a Physician before coverage has been in force 30 days. Benefits for treatment of any Sickness will apply only to treatment occurring 30 days or more after the Effective Date of coverage.

C. Benefits for a covered Sickness for all persons added to this policy (including newborns) are subject to a 30-day waiting period. Aflac will waive the waiting period for newborns added after the policy has been in force for ten full months.

D. 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.

E. Aflac will not pay benefits whenever fraud is committed in making a claim under this coverage.

F. This policy does not cover losses caused by or resulting from:

1. Giving birth within the first 10 months of the Effective Date of coverage; or pregnancy in existence prior to the Effective Date of coverage (including maternal-fetal intervention procedure), except for any resulting Complications of Pregnancy. Complications of Pregnancy are covered to the same extent as a Sickness and pregnancy due to an act of rape or incest will be covered to the same extent as an Injury;
2. Receiving routine nursing or routine well-baby care for a newborn child;
3. 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);
4. Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
5. Having dental treatment, except as a result of Injury;
6. Having cosmetic surgery, exept that "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;
7. Having elective surgery that is not Medically Necessary within the first 12 months of the Effective Date of coverage;
8. 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);
9. Actively participating in a riot, insurrection, or terrorist activity;
10. Donating an organ within the frst 12 months of the Effective Date of coverage ; or
11. Having mental or emotional disorders, including but not limited to the following: Bipolar affective disorder (manic-depressive syndrome), Delusional (paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders, bereavement, situational depression, depression, stress, or post-partum depression. This policy will pay, however, for covered losses resulting from Alzheimer's disease, or similar forms of senility or senile dementia, that manifests itself while coverage is in force.
12. Donating an organ within the first 12 months of the Effective Date of coverage: or
13. Having mental or emotional disorders. Including but not limited to the following: bipolar affective disorder {man1cdepress1ve syndrome), delusional {paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic Illness), eating disorders, schizophrenia. anxiety disorders, bereavement, snuauonal depression, depression. stress, or post-partum depression. The policy will pay, however, for covered losses resulting from Alzheimer's disease, or s1m1lar forms of senility or senile dementia. first manifested while coverage Is In force.

A “Pre-existing Condition” is an illness, disease, infection, disorder, condition, or injury for which, within the 12-month period before the Effective Date of coverage, prescription medication was taken or medical testing, advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. No claim for the loss incurred that starts after one year from the date of issue of this policy will be reduced or denied because a sickness or physical condition, not excluded by name or specific description before the date of loss, had existed before the Effective Date of coverage.

Critical Illness: In Delaware, Policies A74100DE, A74200DE, A74300DE. Policies B71100, B71200, B7130H & B7140H. Policies A71100DE & A71200DE. In Idaho, Policies A74100ID, A74200ID, A74300ID. In Oklahoma, Policies A74100OK, A74200OK, A74300OK. Policies A73100OK & A7310HOK. Policies B71100OK & B7110HOK. Policies A71100OK & A71200OK. In Virginia, Policies A74100VA, A74200VA, A74300VA. Policy A73100VA. Policies A71100VA & A71200VA.

Coverage may not be available in all states, including but not limited to DE, ID, NJ, NM, NY or VA. Benefits/premium rates may vary based on state and plan levels. Optional riders may be available at an additional cost. Policies and riders may also contain a waiting period. Refer to the exact policy and rider forms for benefit details, definitions, limitations, and exclusions.

Limitations and Exclusions for residents of Arizona:

Benefits payable under the policy will be reduced by one-half for losses that begin on or after the 75th birthday of a covered person. Aflac will not pay benefits for any loss that is caused by a pre-existing condition, unless it begins more than 12 months after the effective date of coverage. Benefits are payable for only one covered loss at a time per covered person. Aflac will not pay benefits for any loss that is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico. Aflac will not pay benefits whenever coverage provided by the 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. For any benefit to be payable, the onset date of the loss must occur on or after the effective date of coverage and while coverage is in force. If more than one loss per covered person occurs on the same day, only the highest eligible benefit will be paid. Aflac will not pay benefits whenever fraud is committed in making a claim under this coverage or any prior claim under any other Aflac coverage for which you received benefits that were not lawfully due and that fraudulently induced payment.

The policy does not cover loss caused by or resulting from:

1. 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;
2. 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;
3. Intentionally self-inflicting a bodily injury or committing or attempting suicide, while sane or insane;
4. Being exposed to war or any act of war, declared or undeclared; or
5. Actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve.

PRE-EXISTING CONDITION LIMITATIONS

A pre-existing condition is an illness, disease, infection, disorder, or injury for which, within the 12-month period before the effective date of coverage, prescription medication was taken or medical testing, medical advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Benefits for a loss that is caused by a pre-existing condition will not be covered unless the onset date is more than 12 months after the effective date of coverage.

Limitations and Exclusions for residents of Idaho:

Benefits payable under the policy will be reduced by one-half for losses that begin on or after the 75th birthday of a covered person. Aflac will not pay benefits for any loss that is caused by a pre-existing condition, unless it begins more than 12 months after the effective date of coverage. Benefits are payable for only one covered loss at a time per covered person. Aflac will not pay benefits for any loss that is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico. For any benefit to be payable, the onset date of the loss must occur on or after the effective date of coverage and while coverage is in force. If more than one loss per covered person occurs on the same day, only the highest eligible benefit will be paid.

The policy does not cover loss caused by or resulting from:

1. Alcoholism or drug addiction;
2. Participating in a felony, whether charged or not (felony is as defined by the law of the jurisdiction in which the activity takes place);
3. Intentionally self-inflicting a bodily injury or committing or attempting suicide, while sane or insane;
4. Being exposed to war or any act of war, declared or undeclared; or
5. Actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Reserve.

PRE-EXISTING CONDITION LIMITATIONS

A pre-existing condition is an illness, disease, infection, disorder, or injury for which, within the six-month period before the effective date of coverage, prescription medication was taken or medical testing, medical advice, consultation, or treatment was recommended or received from a physician. Benefits for a loss that is caused by a pre-existing condition will not be covered unless the onset date is more than 12 months after the effective date of coverage.

Limitations and Exclusions for residents in Virginia:

Aflac will not pay benefits for any claims incurred during the first twelve months for Pre-existing Conditions. Benefits are payable for only one covered Loss at a time per Covered Person. Aflac will not pay benefits for any Loss that is diagnosed or treated outside the territorial limits of the United States, its possessions or the countries of Canada and Mexico. Aflac will not pay benefits whenever coverage provided by the 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. For any benefit to be payable, the Onset Date of the Loss must occur on or after the Effective Date of coverage and while coverage is in force. If more than one Loss per Covered Person occurs on the same day, only the highest eligible benefit will be paid. Aflac will not pay benefits whenever fraud is committed in making a claim under this coverage:

The policy does not cover Loss caused by or resulting from:

1. 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);
2. Intentionally self-inflicting a bodily injury or committing or attempting suicide, while sane or insane; or
3. 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.)

PRE-EXISTING CONDITION LIMITATIONS

A "Pre-existing Condition" is an illness disease, infection, disorder, or injury for which, within the 12-month period before the Effective Date of coverage, prescription medication was taken or medical testing, medical advice, consultation, or treatment was recommended by or received from Physician, or for which symptoms existing that would ordinarily cause a prudent person to seek diagnosis, care or treatment. Claims incurred during the first twelve months will not be covered for pre-existing conditions.

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