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Policyholder suffers a heart attack and is transported to the hospital by ambulance.
He has heart surgery to implant a stent and is hospitalized. After leaving the hospital, he receives physical therapy.
Several months later, he has heart valve surgery and is hospitalized.
Policyholder submits via Aflac SmartClaim® by 3pm and receives benefits in just a day.
Payable to: You
weekly rates as low as a gallon of milk.8
Don’t wait until it’s too late. Help cover yourself and your family with affordable coverage from Aflac.
† One Day PaySM is available for certain individual claims submitted online through the Aflac SmartClaim® process. Claims may be eligible for One Day Pay processing if submitted online through Aflac SmartClaim®, including all required documentation, by 3 p.m. ET. Documentation requirements vary by type of claim; please review requirements for your claim(s) carefully. Aflac SmartClaim® is available for claims on most individual Accident, Cancer, Hospital, Specified Health, and Intensive Care policies. Processing time is based on business days after all required documentation needed to render a decision is received and no further validation and/or research is required. Individual Company Statistic, 2018.
1Heart Disease and Stroke Statistics 2017, American Heart Association & American Stroke Association. Accessed August 8, 2017. https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_491265.pdf.
2The above example is based on a scenario for Aflac Critical Care Protection – Option 3 that includes the following benefit conditions: First-Occurrence Benefit (heart attack) of $7,500, Ambulance Benefit (ground ambulance transportation) of $250, Specified Heart Surgery Benefit – Tier Two (Coronary Stent Implantation) of $2,000, Hospital Intensive Care Unit Benefit (4 days) of $3,200, Hospital Confinement Benefit (8 days) of $2,400, Specified Heart Surgery Benefit – Tier One (heart valve surgery) of $4,000, and Continuing Care Benefit (30 days) of $3,750.
SPECIFIED HEALTH EVENT - A74000 SERIES
In Arkansas, Policies A74100ARR, A74200ARR, A74300ARR. In Idaho, Policies A74100ID, A74200ID, A74300ID. In Oklahoma, Policies A74100OK, A74200OK, A74300OK. In Oregon, Policies, A74100OR, A74200OR, A74300OR. In Texas, Policies A74100TX, A74200TX, A74300TX. In Virginia, Policies A74100VA, A74200VA, A74300VA. This is a brief product overview only. Coverage may not be available in all states including but not limited to Arizona and 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 and Exclusions for residents of Idaho:
The Benefits for Intensive Care Unit Confinements will be reduced by one-half for confinements that begin on or after the policy anniversary date following the 70th birthday of a Covered Person. Aflac will not pay benefits for any Loss that is caused by a Pre-existing Condition unless the Loss occurs more than 12 months after the Effective Date of coverage. Aflac will not pay benefits for any Loss that is diagnosed or treated outside the territorial limits of the United States or its possessions. For any benefit to be payable, the Loss must occur on or after the Effective Date of coverage and while coverage is in force. If more than one Specified Health Event per Covered Person occurs on the same day, only the highest eligible benefit will be paid. The policy does not cover Losses or confinements caused by or resulting from:
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 will not be payable for any Loss that is caused by a Pre-existing Condition unless the Loss occurs more than 12 months after the Effective Date of coverage.
Limitations and Exclusions for residents of Virginia:
The Benefits for Intensive Care Unit Confinements will be reduced by one-half for confinements that begin on or after the policy anniversary date following the 70th birthday of a Covered Person. The Benefits for Intensive Care Unit Confinements are not payable for confinement in units such as telemetry or surgical recovery rooms, postanesthesia care units, private monitored rooms, observation units located in emergency room or outpatient surgery units, or other facilities that do not meet the standards for a Hospital Intensive Care Unit or Step-Down Intensive Care Unit. The Hospital Intensive Care Unit Benefit is not payable for confinement in progressive care units or intermediate care units. Aflac will not pay benefits for any claims incurred during the first twelve months for Pre-existing Conditions. Aflac will not pay benefits for any Loss that is diagnosed or treated outside the territorial limits of the United States or its possessions. Aflac will not pay benefits for any newborn’s Loss or confinement that occurs or begins during the first 28 days following birth when conception occurred prior to the Effective Date of coverage.
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. For any benefit to be payable, the Loss must occur on or after the Effective Date of coverage and while coverage is in force. If more than one Specified Health Event 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. This policy does not cover Losses or confinements caused by or resulting from:
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 a Physician, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Claims incurred during the first twelve months after the Effective Date of coverage will not be covered for pre-existing conditions.
3 Diagnosis & Treatment: Heart Attack Procedures and Surgeries, American Heart Association. Updated March 27, 2017.
Treatment Duration: Follow up Care & Resources After Heart Surgery, Cleveland Clinic. Updated 2017.
Costs of diagnosis and treatment(s) are based on:
Transport - Ambulance Ride (1): $800.00
ER - ER Visit (1): $1,575.00
Treatment - Stent (3 days in hospital + HCP fees+ anesthesia) (1): $38,250.00
Treatment - CABG (Coronary Artery Bypass Grafting) (1): $84,268.50
Follow Up - Cardiac Rehab (3 visits): $40.00 ea.
Total Cost: $125,013.50
4 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. View Data Sources to see our underlying sources.
5 Latest Smartphone costs are based on latest smartphone release, 10/17. This is how much the new iPhone will cost, Megan Rose Dickey, TechCrunch.com, September 12, 2017. https://techcrunch.com/2017/09/12/this-is-how-much-the-new-iphones-will-cost/.
6 How to Save Money on a Trip to Hawaii, Cameron Huddleston. March 2, 2015. Assumes average airfare, $1340 per person, average hotel, $271 per night for 5 nights, Rental car $35 per day for 5 days, food, $35 per day for average total of $3095. Per person. http://www.kiplinger.com/article/spending/T059-C011-S001-how-to-save-money-on-a-trip-to-hawaii.html.
7 Average Cost of a 5 day ski vacation to Salt Lake, UT. North America's most and least affordable ski destinations. Fox News, December 12, 2012. Assumes 5 days of the following daily costs hotel $121.32, ski gear rental, $31.65, lift ticket, $74.75, food $38.05, for an average total of $1707.00 per person. Does not include airfare. http://www.foxnews.com/travel/2012/12/12/north-america-most-budget-friendly-and-most-expensive-ski-destinations.html.
8Assumes the average cost of a gallon of whole fresh milk is $3.18*. Comparison is based on the average weekly premium for Nebraska Payroll Premium rates for industry Class A, Critical Care Protection Policy - Series A74100; Individual aged 18-35. Premiums may vary by coverage type, account, state of issue, and the election of additional/optional benefits.
*Source: Bureau of Labor Statistics, August 2017.