Accident : simplebooklet.com

Group Accident InsurancePlan Description The Aflac Group Accident plan provides cash benefits directly to your employees (unless otherwise assigned) thathelp with out-of-pocket expenses - medical and nonmedical - associated with treatment in the event of a coveredaccident.Features and Plan Provisions(specific benefit provisions may vary by situs state)Benefit AmountsSee Premium Rates and Plan Benefits for available optionsCoverage24 HourCovered InsuredsAvailable for all family membersSpouse-only and Child-only coverage is not availableGuaranteed-IssueThe base accident product is always offered on a guaranteed-issue basisEnrollment AssumptionsEnrollments take place once each 12-month period. Late enrollees cannot enroll outsideof an annual enrollment period.Requirement for Group BillingTo establish group billing, 25 distinct individuals must be paying premiumsPayment Method Payroll DeductedWaiting Period There is no waiting periodBenefit Reductions No reduction at any ageRate Guarantee 2 YearsPortability 2019 PortabilityEligibilityEmployees must be actively-at-work on the application date and the effective date. Theymust work at least 16 hours per week and have been continuously employed for theduration set by the employer. Seasonal and temporary employees are not eligible.Dependents are eligible, but only if the employee is eligible and participates.Successor Insured IncludedSuccessor Insured Waiver ofPremiumNot IncludedIssue AgesEmployee: 18+Spouse: 18+Children: Under age 26Termination AgeNoneCertificate Effective DateCoverage is effective on the billing effective dateNote: Benefits are not payable for accidents that occurred prior to the effective date of coverageGP-33755.PLAN-221416 Page 2 of 13

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Group Accident InsuranceGP-33755.PLAN-221416 Page 3 of 13Plan Benefits(Benefit provisions may vary by situs state)Initial Accident Treatment Category - Mid-LT Employee Spouse ChildInitial Treatment - once per accident, within 7 days of the accident ER/Urgent Care $125 $125 $125ER/Urgent Care with X-Ray $175 $175 $175Doctor's Office $75 $75 $75Doctor's Office with X-Ray $100 $100 $100Ambulance - once per day, within 90 days of the accidentMaximum number of payments per covered accident: No MaximumGround $300 $300 $300Air $900 $900 $900Major Diagnostic Testing - within six months of the accidentMaximum number of diagnostic tests per covered accident: 1$150 $150 $150Pain Management - within six months of the accidentMaximum number of payments per covered accident: 1$75 $75 $75Blood/Plasma/Platelets - within six months of the accidentMaximum number of days per covered accident: 3$200 $200 $200Concussion - once per accident, within six months of the accident $350 $350 $350Coma - once per accidentWe will pay the amount shown if the insured is in a coma lasting 30 days or more as aresult of a covered accident $5,000 $5,000 $5,000Burns - once per accident, within six months of the accident Second Degree BurnsLess than 10% $50 $50 $50At least 10%, but less than 25% $100 $100 $100At least 25%, but less than 35% $250 $250 $25035% or more $500 $500 $500Third Degree BurnsLess than 10% $500 $500 $500At least 10%, but less than 25% $2,500 $2,500 $2,500At least 25%, but less than 35% $5,000 $5,000 $5,00035% or more $10,000 $10,000 $10,000Emergency Dental Work - once per accident, within six months of the accident Repair with Crown $120 $120 $120Extraction $30 $30 $30Eye Injury - removal of a foreign body $175 $175 $175Dislocations - once per accident, within 90 days of the accident Dislocation Open Reduction Closed ReductionScheduleEmployee Spouse Child Employee Spouse Child Hip $4,000 $4,000 $4,000 $2,000 $2,000 $2,000 Knee $2,600 $2,600 $2,600 $1,300 $1,300 $1,300 Shoulder $2,000 $2,000 $2,000 $1,000 $1,000 $1,000 Foot/Ankle $1,600 $1,600 $1,600 $800 $800 $800 Hand $1,400 $1,400 $1,400 $700 $700 $700 Lower Jaw $1,200 $1,200 $1,200 $600 $600 $600 Wrist $1,000 $1,000 $1,000 $500 $500 $500 Elbow $800 $800 $800 $400 $400 $400 Finger/Toe $320 $320 $320 $160 $160 $160Lacerations - once per accident, within 7 days of the accident Lacerations requiring stitchesUnder 5 centimeters $75 $75 $755 to 15 centimeters $150 $150 $150Over 15 centimeters $300 $300 $300Lacerations not requiring stitches $37.50 $37.50 $37.50

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GP-33755.PLAN-221416 Page 4 of 13Group Accident InsuranceFracture - once per covered accident, within 90 days of the accident Fracture Open Reduction Closed ReductionSchedule Employee Spouse Child Employee Spouse Child Hip/Thigh $5,000 $5,000 $5,000 $2,500 $2,500 $2,500 Vertebrae/Sternum $4,500 $4,500 $4,500 $2,250 $2,250 $2,250 Pelvis $4,000 $4,000 $4,000 $2,000 $2,000 $2,000 Skull (Depressed) $3,750 $3,750 $3,750 $1,875 $1,875 $1,875 Leg $3,000 $3,000 $3,000 $1,500 $1,500 $1,500 Forearm/Hand/Wrist $2,500 $2,500 $2,500 $1,250 $1,250 $1,250 Foot/Ankle/Kneecap $2,500 $2,500 $2,500 $1,250 $1,250 $1,250 Shoulder Blade/Collar Bone $2,000 $2,000 $2,000 $1,000 $1,000 $1,000 Lower Jaw $2,000 $2,000 $2,000 $1,000 $1,000 $1,000 Skull (Simple) $1,750 $1,750 $1,750 $875 $875 $875 Upper Arm/Upper Jaw $1,750 $1,750 $1,750 $875 $875 $875Facial Bones (except teeth)$1,500 $1,500 $1,500 $750 $750 $750 Vertebral Processes/Sacrum $1,000 $1,000 $1,000 $500 $500 $500 Coccyx/Rib/Finger/Toe $400 $400 $400 $200 $200 $200Outpatient Surgery and Anesthesia (per day) - within one year of the accidentPerformed in a Hospital or Ambulatory Surgical Center $300 $300 $300Maximum number of payments per covered accident: No MaximumPerformed in a Doctor's Office, Urgent Care Facility or Emergency Room $35 $35 $35Maximum number of payments per covered accident: 2Facilities Fee for Outpatient Surgery - within one year of the accidentPayable once per each Outpatient Surgery and Anesthesia Benefit (in a hospital orambulatory surgical center).$75 $75 $75Inpatient Surgery and Anesthesia (per day) - within one year of the accidentMaximum number of payments per covered accident: No Maximum$750 $750 $750Transportation - within six months of the accident Maximum number of payments per covered accident: 3Minimum Required Distance (miles): 100Plane $350 $350 $350Any ground transportation $150 $150 $150(Surgical procedures may include, but are not limited to, surgical repair of: ruptured disc, tendons/ligaments, hernia, rotator cuff, tornknee cartilage, skin grafts, joint replacement, internal injuries requiring open abdominal or thoracic surgery, exploratory surgery (with orwithout repair), etc., unless otherwise noted due to an accidental injury.)Hospitalization Category - Mid-LT (Custom) Employee Spouse ChildHospital Admission (per confinement) - once per accident, within six months of theaccidentMaximum number of admissions per covered accident: 1$1,000 $1,000 $1,000Hospital Confinement (per day) - within 6 months of the accidentMaximum days of confinement per covered accident: 365$300 $300 $300Hospital Intensive Care (per day) - within 6 months of the accidentMaximum days of confinement per covered accident: 30$450 $450 $450Family Member Lodging (per day) - within six months of the accident Maximum days of lodging per covered accident: 30 $150 $150 $150Minimum Required Distance (miles): 100

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GP-33755.PLAN-221416 Page 5 of 13Group Accident InsuranceAfter Care Category - Mid-LT Employee Spouse ChildAppliances - within six months of the accident CaneMaximum number of appliances per covered accident: No Maximum$50 $50 $50Ankle BraceMaximum number of appliances per covered accident: No Maximum$50 $50 $50Walking BootMaximum number of appliances per covered accident: No Maximum$50 $50 $50WalkerMaximum number of appliances per covered accident: No Maximum$50 $50 $50CrutchesMaximum number of appliances per covered accident: No Maximum$50 $50 $50Leg BraceMaximum number of appliances per covered accident: No Maximum$50 $50 $50Cervical CollarMaximum number of appliances per covered accident: No Maximum$50 $50 $50WheelchairMaximum number of appliances per covered accident: No Maximum$50 $50 $50Knee ScooterMaximum number of appliances per covered accident: No Maximum$50 $50 $50Body JacketMaximum number of appliances per covered accident: No Maximum$50 $50 $50Back BraceMaximum number of appliances per covered accident: No Maximum$50 $50 $50Accident Follow-Up Treatment - within 6 months of the accident Initial treatment is received within 7 days of the accident $35 $35 $35Maximum number of visits per covered accident: 6Rehabilitation Unit (per day)Maximum number of days per confinement: 31 $75 $75 $75No more than 62 days total per calendar year for each insuredTherapy - beginning within 90 days of the accident Initial treatment is received within 7 days of the accident $35 $35 $35Maximum number of visits per covered accident: 10Chiropractic or Alternative Therapy - beginning within 90 days of the accident Initial treatment is received within 7 days of the accident $10 $10 $10Maximum number of visits per covered accident: 6Life Changing Events Category - Mid-LT Employee Spouse ChildDismemberment - once per accident, within six months of the accident Single Loss $7,500 $3,000 $1,500Double Loss $15,000 $6,000 $3,000Loss of one or more fingers or toes $750 $300 $150Partial Dismemberment (includes at least one joint of a finger or toe) $75 $75 $75Paralysis - once per accident, diagnosed by a doctor within six months of the accident Paraplegia $3,500 $3,500 $3,500Quadriplegia $7,500 $7,500 $7,500Prosthesis - once per accidentMaximum number of prosthetic devices per covered accident: 2$1,000 $1,000 $1,000Prosthesis Repair/Replacement - once per prosthetic device, within three years ofinitial Prosthesis payment$1,000 $1,000 $1,000Residence/Vehicle Modification - once per accident, within one year of the accident $1,000 $1,000 $1,000Wellness Rider - Mid-LT Employee Spouse ChildAmount paid will be based on the certificate year in which the wellness test wasperformed:Maximum number of payments per calendar year, per insured: 1Year 1 - Once per calendar year $50 $50 $50Year 2 - Once per calendar year $50 $50 $50Year 3 - Once per calendar year $50 $50 $50Year 4 - Once per calendar year $50 $50 $50Year 5 - Once per calendar year $50 $50 $50Year 6+ - Once per calendar year $50 $50 $50Accidental Death Rider Employee Spouse ChildAccidental Death - within 90 days of the accident

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GP-33755.PLAN-221416 Page 8 of 13Group Accident InsuranceBenefits Summary(Benefit provisions vary by situs state)Initial Accident Treatment Category – Base PlanInitial TreatmentPayable for initial treatment received under the care of a doctor. This benefit is not payable for treatment via telemedicine services.AmbulancePayable when an insured receives transportation by a professional ambulance service.Major Diagnostic TestingPayable when one of the following exams is performed in a hospital, doctor's office, medical diagnostic imaging center, or anambulatory surgical center:• Computerized Tomography (CT/CAT scan)• Magnetic Resonance Imaging (MRI)• Electroencephalography (EEG)Emergency Room ObservationPayable when an insured receives treatment in a hospital emergency room and is held in a hospital for observation without beingadmitted as an inpatient.PrescriptionsPayable when a prescription is filled that is ordered by a doctor, dispensed by a licensed pharmacist, and medically necessary for thecare and treatment of the insured. Certain items are excluded from this benefit. See Master Policy for details.Pain ManagementPayable when an insured is prescribed and receives, in a doctor's office, a nerve ablation and/or block, or an epidural injectionadministered into the spine. This benefit is not payable for an epidural administered during a surgical procedure.Blood/Plasma/PlateletsPayable when an insured receives blood, plasma, or platelets.ConcussionPayable when an insured is diagnosed by a doctor with a concussion.Traumatic Brain Injury (TBI)Payable when an insured is diagnosed by a neurologist with a TBI. To qualify as a TBI, the neurological deficit must require treatmentby a neurologist, and a prescribed course of physical, speech, and/or occupational therapy under the direction of a neurologist.BurnsPayable when an insured is burned and then treated by a doctor. This benefit is payable according to the percentage of body burned.Emergency Dental WorkPayable when an insured has an accidental injury to natural teeth.Eye InjuryPayable for eye injuries requiring the removal of a foreign body by a doctor, with or without anesthesia.LacerationsPayable when an insured receives a laceration that is repaired by a doctor. Liquid skin adhesive will be paid as stitches.FracturesPayable when an insured fractures a bone and is treated by a doctor. For multiple fractures (more than one bone fractured in oneaccident), we will pay a maximum of 200% of the benefit amount for the bone fractured that has the highest dollar amount.For a chip fracture (a piece of bone that is completely broken off near a joint), we will pay 25% of the amount for the affected bone.This benefit is not payable for stress fractures.DislocationsPayable when an insured dislocates a joint and is treated by a doctor. We will pay benefits only for the first dislocation of a joint. Wewill not pay for recurring dislocations of the same joint. If the insured dislocated a joint before the effective date of his certificate andthen dislocates the same joint again, it will not be covered by the plan. For multiple dislocations (more than one dislocated joint inone accident), we will pay a maximum of 200% of the benefit amount for the joint dislocated that has the highest dollar amount. For apartial dislocation (joint is not completely separated, including subluxation), we will pay 25% of the amount for the affected joint.Outpatient Surgery and AnesthesiaPayable for each day that an insured has an outpatient surgical procedure performed by a doctor in one of the facilities listed.Surgical procedure does not include laceration repair. If an outpatient surgical procedure is covered under another benefit in the plan,we will pay the higher benefit amount.Facilities Fee for Outpatient SurgeryPayable once per each Outpatient Surgery and Anesthesia Benefit (in a hospital or ambulatory surgical center).Inpatient Surgery and AnesthesiaPayable for each day that an insured has an inpatient surgical procedure performed by a doctor. The surgery must be performedwhile the insured is confined to a hospital as an inpatient. If an inpatient surgical procedure is covered under another benefit in theplan, we will pay the higher of that benefit amount.

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GP-33755.PLAN-221416 Page 9 of 13Group Accident InsuranceTransportationPayable for transportation when an insured is injured and requires doctor-recommended hospital treatment or diagnostic study that isnot available in the insured’s resident city.Hospitalization CategoryHospital AdmissionPayable when an insured is admitted to a hospital and confined as an inpatient. This benefit is not payable for confinement to anobservation unit, for emergency room treatment, or for outpatient treatment.Hospital ConfinementPayable for each day that an insured is confined to a hospital as an inpatient. This benefit is payable for only one hospitalconfinement at a time even if caused by more than one covered accidental injury. This benefit is not payable for confinement to anobservation unit or a rehabilitation facility.Hospital Intensive CarePayable for each day an insured is confined in a hospital intensive care unit. We will pay benefits for only one confinement in ahospital intensive care unit at a time, even if it is caused by more than one covered accidental injury. This benefit is payable inaddition to the Hospital Confinement Benefit.Family Member LodgingPayable for each night’s lodging in a motel/hotel/rental property for an adult member of the insured’s immediate family when theinsured is confined to a hospital under the insured’s treating doctor.If confinement benefits are paid, and the insured becomes confined again within six months because of the same or a relatedcondition, it will be treated as the same period of confinement.After Care CategoryAppliancesPayable when a doctor advises the insured to use a listed medical appliance as an aid in personal locomotion.Accident Follow-Up TreatmentPayable for doctor-prescribed follow up treatment for injuries received in a covered accident. Follow-up treatments may not includephysical, occupational, or speech therapy, chiropractic and/or acupuncture procedures. See Master Policy for details.Rehabilitation UnitPayable when an insured receives treatment as an inpatient at a rehabilitation facility following an inpatient hospital confinement. Thisis not payable for the same days that the hospital confinement benefit is paid. The highest eligible benefit will be paid.TherapyPayable when an insured has a covered doctor-prescribed therapy treatment.Chiropractic or Alternative TherapyPayable when an insured has a covered therapy treatment due to injuries received in a covered accident.Life Changing Events CategoryDismembermentPayable when an insured loses a hand, foot or sight as the result of a covered accident. For Dismemberment definitions, see MasterPolicy. If the Dismemberment Benefit is paid and the insured later dies as a result of the same covered accident, we will pay theappropriate death benefit (if available), less any amounts paid under this benefit.ParalysisPayable when an insured has permanent loss of movement of two or more limbs for more than 90 days (30 days in Utah) as theresult of a covered accidental injury.ProsthesisPayable when an insured receives a prosthetic device, prescribed by a doctor, as a result of a covered accidental injury. ProstheticDevice/Prosthesis means an artificial device designed to replace a missing part of the body. This benefit is not payable for hearingaids, wigs, or dental aids (to include false teeth), repair or replacement of prosthetic devices* and /or joint replacements.Prosthesis Repair/Replacement* We will pay this benefit again once to cover the replacement of a prosthesis for which a benefit has been paid, provided thereplacement takes place within three years of the initial benefit payment.Residence/Vehicle ModificationPayable for a permanent structural modification to an insured’s primary residence or vehicle when the insured suffers total andpermanent or irrevocable loss of the sight of one eye, the use of one hand/arm, or the use of one foot/leg.Wellness RiderPayable when an insured has a covered test performed as the result of preventive care, including tests and diagnostic proceduresordered in connection with routine examinations.

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Group Accident InsuranceGP-33755.PLAN-221416 Page 10 of 13Limitations and ExclusionsWe will not pay benefits for accidental injury, disability, or death contributed to, caused by, or resulting from:• War - voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, or voluntarily participating orserving in the military, armed forces, or an auxiliary unit thereto, or contracting with any country or international authority. (Wewill return the prorated premium for any period not covered by the certificate when the insured is in such service.) War alsoincludes voluntary participation in an insurrection, riot, civil commotion or civil state of belligerence. War does not include actsof terrorism.• In California: voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, or voluntarilyparticipating or serving in the military, armed forces, or an auxiliary unit thereto, or contracting with any country orinternational authority. (We will return the prorated premium for any period not covered by the certificate when the insuredis in such service.) War also includes voluntary participation in an insurrection or riot.• In Connecticut: voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, or voluntarilyparticipating or serving in the military, armed forces, or an auxiliary unit thereto, or contracting with any country orinternational authority. (We will return the prorated premium for any period not covered by the certificate when the insuredis in such service.) War also includes voluntary taking part in an insurrection, riot, civil commotion, or civil state ofbelligerence. (A riot can be defined as a public uproar, disturbance, or outbreak.) War does not include acts of terrorism.• In Idaho: participating in any war or act of war, declared or undeclared, or participating or serving in the armed forces orunits auxiliary thereto. War also includes participation in a riot or an insurrection.• In Illinois: the statement "war does not include acts of terrorism" is not applicable• In Michigan: voluntarily participating in war or any act of war. War also includes voluntary felonious participation in aninsurrection, riot, civil commotion, or civil state of belligerence. War does not include acts of terrorism.• In New Hampshire: voluntarily participating in war any act of war, declared or undeclared, or serving in the armed forces oran auxiliary unit thereto. (We will return the prorated premium for any period not covered by the certificate when theinsured is in such service.) War also includes voluntary participation in an insurrection or riot. War does not include acts ofterrorism.• In North Carolina: War - voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, orvoluntarily participating or serving in the military, armed forces, or an auxiliary unit thereto, or contracting with any countryor international authority. (We will return the prorated premium for any period not covered by the certificate when theinsured is in such service.) War also includes civil participation in an active riot. War does not include acts of terrorism.• In New York: war or act of war (whether declared or undeclared); participation in a riot or insurrection; and service in theArmed Forces or units auxiliary thereto.• In Maryland: War - voluntarily participating in war, any act of war, or military conflicts, declared or undeclared, orvoluntarily participating or serving in the military, armed forces, or an auxiliary unit thereto, or contracting with any countryor international authority. (We will return the prorated premium for any period not covered by the certificate when theinsured is in such service.) War does not include acts of terrorism.• Suicide - committing or attempting to commit suicide, while sane or insane.• In Montana and Missouri: committing or attempting to commit suicide, while sane• In Illinois, Michigan, and Minnesota: this exclusion does not apply• In New York: attempted suicide, or intentionally self-inflicted injury.• Sickness - having any disease or bodily/mental illness or degenerative process. We also will not pay benefits for:• Allergic reactions• Any bacterial, viral, or microorganism infection or infestation or any condition resulting from insect, arachnid, or otherarthropod bites or stings• In Illinois: any bacterial infection, except an infection which results from an accidental injury or an infection whichresults from accidental, involuntary, or unintentional ingestion of a contaminated substance; any viral ormicroorganism infection or infestation; or any condition resulting from insect, arachnid, or other arthropod bites orstings• In North Carolina: any viral or microorganism infestation or any condition resulting from insect, arachnid, or otherarthropod bites or stings• An error, mishap, or malpractice during medical, diagnostic, or surgical treatment or procedure for any sickness• Any related medical/surgical treatment (in New Hampshire, medical/surgical care) or diagnostic procedures for such illness• In New York: having any disease or bodily/mental illness or degenerative process. (However, we will not exclude coveragefor an infection that was the result of a covered accident.)• Self-Inflicted Injuries - injuring or attempting to injure oneself intentionally.• In Idaho: intentionally self-inflicting injury.• In Montana: injuring or attempting to injure oneself intentionally, while sane

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Group Accident InsuranceGP-33755.PLAN-221416 Page 11 of 13• In Michigan: this exclusion does not apply• In New York: this exclusion does not apply• Racing - riding in or driving any motor-driven vehicle in a race, stunt show or speed test in a professional or semi-professionalcapacity.• In Idaho: this exclusion does not apply• In New York: this exclusion does not apply• Illegal Occupation - voluntarily participating in, committing, or attempting to commit a felony or illegal act or activity, orvoluntarily working at, or being engaged in, an illegal occupation or job.• In California, Nebraska and Tennessee: voluntarily participating in, committing, or attempting to commit a felony orvoluntarily working at, or being engaged in, an illegal occupation or job.• In Connecticut: Felonious Occupation - voluntarily participating in, committing, or attempting to commit a felony.• In Illinois and Pennsylvania: committing or attempting to commit a felony or being engaged in an illegal occupation• In Michigan: voluntarily participating in, committing, or attempting to commit a felony, or being engaged in an illegaloccupation• In New Hampshire: voluntarily participating in, committing, or attempting to commit a felony• In Idaho, South Dakota and Maryland: this exclusion does not apply• In New York: Any loss to which a contributing cause was the insured's commission of a felony or to which a contributingcause was the insured's being engaged in an illegal occupation.• Sports - participating in any organized sport in a professional or semi-professional capacity for pay or profit.• In California and Idaho: participating in any organized sport in a professional capacity for pay or profit• In New York: participation as a professional in athletics or sports.• Cosmetic Surgery - having cosmetic surgery or other elective procedures that are not medically necessary or having dentaltreatment except as a result of a covered accident.• In Alaska, Massachusetts, and Montana: having cosmetic surgery, other elective procedures, or dental treatment except asa result of a covered accident.• In California: having cosmetic surgery or other elective procedures that are not medically necessary ("cosmetic surgery"does not include reconstructive surgery when the service is related to or follows surgery resulting from a covered accident);or having dental treatment except as a result of a covered accident.• In Idaho: having cosmetic surgery or other elective procedures that are not medically necessary or having dental treatmentexcept as a result of a covered accident. Cosmetic surgery shall not include reconstructive surgery because of aCongenital Anomaly of a covered Dependent Child.• In New Hampshire: Cosmetic Surgery - having cosmetic surgery or other elective procedures that are not medicallynecessary except that "cosmetic surgery" shall not include reconstructive surgery, when such service is incidental to orfollows surgery resulting from injury; or having dental care except as a result of a covered accident• In New York: having cosmetic surgery except that cosmetic surgery does not include reconstructive surgery when suchservice is incidental to or follows surgery resulting from trauma, infection, or other diseases of the involved part, andreconstructive surgery because of congenital disease or anomaly of a covered dependent child which has resulted in afunctional defect.• In Maryland: Cosmetic Surgery - having cosmetic surgery or other elective procedures that are not medically necessary, asdetermined by a treating doctor, or having dental treatment except as a result of a covered accident.• Dental Care and Treatment• In New York : except for such care or treatments due to accidental injury to sound natural teeth within 12 months of thecovered accident, and except for dental care or treatment necessary due to congenital disease or anomaly.• Felony (In Idaho only) - participation in a felony• In Maryland: We will not pay benefits for any claim that the appropriate regulatory board determines were provided as aresult of a prohibited referral as defined in §1-302 of the Health Occupations Article.For 24-Hour Coverage, the following exclusions will not apply:• An injury arising from any employment.• An injury or sickness covered by worker's compensation.

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GP-33755.PLAN-221416 Page 12 of 13Group Accident Insurance• In North Carolina: services or supplies for the treatment of an occupational injury or sickness which are paid under theNorth Carolina workers' compensation act only to the extent such services or supplies are the liability of the employee,employer, or workers' compensation insurance carrier according to a final adjudication under the North CarolinaWorkers' Compensation Act or an order of the North Carolina Industrial Commission approving a settlementagreement under the North Carolina Workers' Compensation Act.• An injury or sickness covered by any state or federal worker's compensation, employers. liability, or occupational diseaselaw, unless where otherwise provided in State or Federal statute.*"Contributed to" language doesn't apply in IllinoisCatastrophic Accident Rider Limitations and ExclusionsWe will pay the Catastrophic Accident Benefit once per lifetime for each insured covered under this rider. Refer to your certificate forother exclusions applicable to this coverage.Outpatient Doctor Treatment Benefit RiderThe sickness exclusion above does not apply to this benefit.Sickness Rider Limitations and ExclusionsPre-existing Condition LimitationWe will not pay benefits for any loss resulting from or affected by a pre-existing condition if the loss occurs within the 12-monthperiod after the rider effective date.We will pay the Catastrophic Accident Benefit once per lifetime for each insured covered under this rider. Refer to your certificate forother exclusions applicable to this coverage.Pregnancy is a "Pre-existing Condition" if conception was before an insured's effective date (except in Florida, North Carolina,Montana, and Wyoming)Pre-existing Condition Limitation in North CarolinaWe will not reduce or deny a claim for benefits for any loss that occurred more than twelve months after the effective date ofcoverage.Coverage for these pre-existing conditions will only be excluded for a maximum period of twelve months from the effective date.ExclusionsWe will not pay benefits for a loss that is wholly or partly caused by or results from:• Mental or emotional disorders without demonstrable organic disease.• In Montana, mental or emotional disorders, except for mental illness, without demonstrable organic disease.• Alcoholism, drug addiction, or chemical dependency.Organized Athletic Activity Rider LimitationThe Organized Athletic Activity Benefit is not payable for accidental injuries that are caused by or occur as a result of an insured'sparticipating in any sport or sporting activity for wage, compensation, or profit, including officiating or coaching; or racing any typevehicle in an organized event (in Idaho, in a professional capacity). This benefit is also not payable for accidental injuries whichoccur during or are due to physical education classes (except in Idaho).Life Changing Events Exclusions• In Maryland: The following exclusions are applicable to the Dismemberment Benefit only:Illegal Occupation - loss to which a contributing cause was the insured being engaged in an illegal occupation or the insured’scommission of or attempt to commit a felony.Intoxication - loss sustained or contracted in the consequence of the insured being intoxicated or under the influence of anynarcotic, unless taken under the direction of a doctor.

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Notices This proposal is a brief description of coverage, not a contract. Read your policy and riders (as applicable) carefully forexact plan language, terms, and conditions.If this coverage will replace any existing individual policy, please be aware that it may be in your employees' bestinterest to maintain their individual guaranteed-renewable policy.For residents of New Mexico, we are required to administer some coverages in accordance with the minimumapplicable standards of New Mexico law.Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) representsupplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy therequirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace orbe issued in lieu of major medical coverage. It is designed to supplement a major medical program. Lack of majormedical coverage (or other minimum essential coverage) may result in an additional payment with your taxes.Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-ownedsubsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York,Guam, Puerto Rico, or the Virgin Islands. For groups sitused in California, group coverage is underwritten by ContinentalAmerican Life Insurance Company. For groups sitused in New York, coverage is underwritten by American Family LifeAssurance Company of New York. Continental American Insurance Company, Columbia, South CarolinaGP-33755.PLAN-221416 Page 13 of 13Group Accident Insurance