1 ACCIDENT INSURANCE – T37000 SERIES
Accident - 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. Not available in New Jersey, New York or Virginia.
This is a brief product overview only. Benefits/premium rates may vary based on plan selected. Optional riders may be available for an additional premium cost. The policies may contain a waiting period. The policy/rider has limitations and exclusions that may affect benefits payable. Refer to outline of coverage and/or policy for complete benefit details, definitions, limitations, and exclusions.
These policies are a supplement to health insurance and are not substitutes for major medical coverage. Lack of major medical coverage (or other minimum essential coverage) may result in an additional payment with your taxes.
Limitations & Exclusions for 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 & Exclusions for 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.
2Broken Leg Diagnosis & Treatment, Mayo Clinic, July 01, 2022.
https://www.mayoclinic.org/diseases-conditions/broken-leg/diagnosis-treatment/drc-20370416.
Costs of diagnosis and treatment(s) are based on:
3 The information provided in the Benefits Estimator is illustrative only. Plans may not be available in all states, and benefits may vary by state, coverage, and plan level selected. Policies have limitations and exclusions that may affect benefits payable. The Aflac payout values do not guarantee an amount to be paid for the listed conditions. Benefits paid by Aflac (if any) will depend on the severity of the accident or illness, the physician diagnosis, and the treatment received. The “Aflac Pays You” data is an average of historical payments made to Aflac policyholders/certificateholders who qualified for benefits under their specific plans and does not reflect instances when benefits were not paid for a particular claim. Whether benefits are payable will be determined when a claim is processed. You must be 18 or older to apply for Aflac insurance. Availability varies by product; see your local Aflac agent for details. The out-of-pocket expenses displayed are estimated at 40% of the total medical cost, assuming that average major medical plans cover approximately 60% of the expense. Your major medical coverage may be more or less, and if an individual or family incurs expenses for non-covered benefits, these out-of-pocket expenses may increase potential unexpected costs. You will also need to pay for any limits or exclusions on your benefits which may include the number of refills for certain drugs, visits to certain specialists, or days covered for certain benefits.
4 Monte's claim estimate was calculated with the following scenario and benefits: Accident Insurance – T37000 Series - Elite Plan - $120 for emergency room visit, $200 for ambulance ride, $150 for a follow-up visit, $350 for physical therapy, $100 for walking appliance, $1750 for surgery = $2,670.
5 Assumes the average cost of a package of adhesive bandages is $6**. Comparison is based on the average weekly premium for Nebraska rates, Accident-Only Plan - Series T37000; Individual, Age 18-75. Premiums may vary by coverage type, state of issue, and the election of additional/optional benefits. **Source: cvs.com, 2022.
Please note Tier One policy premiums can only be paid monthly.
Aflac’s family of insurers include Aflac, Aflac New York, Continental American Insurance Company, and Tier One Insurance Company.
Coverage is underwritten by Tier One Insurance Company.
Aflac WWHQ | Tier One Insurance Company | 1932 Wynnton Road | Columbus, GA 31999.
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