Peace of Mind and

Real Cash Benefits

GROUP ACCIDENT INSURANCE

AC1
G

This brochure is a brief description of coverage and is not a contract. Read your certificate
carefully for exact terms and conditions. Definitions, Pre-Existing Condition limitation,
limitations and exclusions, benefits, termination, portability, etc., may vary based on your
employer's home office. Please see your agent for the plan details specific to your employer.
This product is not available in all states.

CAI77752 R1 IV(2/16)
 GROUP ACCIDENT INSURANCE
Policy Series CA7700-MP This brochure is a brief description of coverage and is not a contract.
Read your certificate carefully for exact terms and conditions.
AC1 G

Do you know how much a trip to the

emergency room could cost you?
An accident insurance plan provides benefits to help cover the costs
associated with unexpected bills. You don’t budget for accidents if
you’re like most people. When a Covered Accident occurs, the last
thing on your mind is the charges that may be accumulating while you’re
at the emergency room, including:

• The ambulance ride • Wheelchairs

• Use of the emergency room • Crutches
• Surgery and anesthesia • Bandages
• Stitches
• Casts

You get the picture. These costs add up—fast. You hope they never
happen, but at some point you may take a trip to your local emergency
room. If that time comes, wouldn’t it be nice to have an insurance plan
that pays benefits regardless of any other insurance you have? This
group accident plan does just that.

80.1
FE AT U R E S

•• 24-hour coverage
•• No limit on the number of claims
•• Pays regardless of any other insurance plans you may have
•• Benefits available for your Spouse and/or Dependent Children
•• Benefits for both inpatient and outpatient treatment of

••
Covered Accidents
Guaranteed issue (No underwriting is required to qualify for
MILLION
coverage.) People sought medical attention for an injury.*
•• Payroll deduction (Premiums are paid by convenient
payroll deduction.)
•• Portable coverage (You can continue coverage when you
leave employment; see back of brochure for guidelines.)
* All Injuries, 2014, Centers for Disease Control and Prevention.
HOSPITAL BENEFITS

EMPLOYEE SPOUSE CHILD

HOSP ITA L ADMISSIO N $1,000 $1,000 $1,000

We will pay this benefit when an insured is admitted to a hospital and confined
as a resident bed patient because of injuries received in a Covered Accident
(within six months of the date of the accident). We will pay this benefit once per
calendar year, per Covered Accident. We will not pay this benefit for confinement
to an observation unit, or for emergency room treatment or outpatient treatment.

HOSP ITA L CON FIN E M EN T (per day) $200 $200 $200

We will provide this benefit on the first day of hospital confinement for up to 365
days per Covered Accident when an insured is confined to a hospital due to a
Covered Accident. Hospital confinement must begin within 90 days from the date
of the accident.

HOSP ITA L IN TE N SIV E C A R E (per day) $400 $400 $400

This benefit is paid up to 30 days per Covered Accident. Benefits are paid in
addition to the Hospital Confinement Benefit.

MEDIC A L FE E S (for e a c h a c c ident) $125 $125 $75

If an insured is injured in a Covered Accident and receives treatment within one
year after the accident, we will pay up to the applicable amount for physician
charges, emergency room services, supplies, and X-rays. The total amount
payable will not exceed the maximum shown per accident. Initial treatment must
be received within 60 days after the accident.

PARA L Y S IS (lasting 90 days or more and diagnosed by a physician within 90 days)

Quadriplegia $10,000 $10,000 $10,000
Paraplegia $5,000 $5,000 $5,000

A C C I D E N T A L - D E A T H A N D - D I S M E M B E R M E N T (within 90 days)

EMPLOYEE SPOUSE CHILD

ACCIDE N T A L -DE ATH $50,000 $10,000 $5,000

ACCIDE N T A L COMMO N - C A R R I ER D EA T H (plane, train, boat, or ship) $100,000 $50,000 $15,000

SI NGL E DISME MB E RM EN T $6,250 $2,500 $1,250

DOU B L E DISME MB ER M E N T $25,000 $10,000 $5,000

LOSS OF ON E OR MO R E F I N G ER S O R T O E S $1,250 $500 $250

PART IA L AMP U TA T IO N O F F I N G ER S O R T O E S (including at least one joint) $100 $100 $100

If the Accidental Common-Carrier Death Benefit is paid, we will not pay

the Accidental-Death Benefit.

Accidental Injury means bodily injury caused solely by or as the result of a

Covered Accident.

Covered Accident means an accident that occurs on or after the Effective Date,
while the certificate is in force, and that is not specifically excluded.

This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions.
M A J O R I N J U R I E S (diagnosis and treatment within 90 days)

EMPLOYEE S P O U S E // C H I L D

FRACTU R E S (closed reduction):

••Open reduction
Hip/Thigh $4,500 $4,000
Vertebrae (except processes) $4,050 $3,600 is paid at 150%
Pelvis $3,600 $3,200 of closed reduc-
Skull (depressed) $3,375 $3,000 tion.
Leg $2,700 $2,400
Forearm/Hand/Wrist $2,250 $2,000
••Multiple fractures
Foot/Ankle/Knee Cap $2,250 $2,000 and dislocations
Shoulder Blade/Collar Bone $1,800 $1,600 are paid at 150%
Lower Jaw (mandible) $1,800 $1,600 of the benefit
Skull (simple) $1,575 $1,400 amount for open
Upper Arm/Upper Jaw $1,575 $1,400 or closed reduc-
Facial Bones (except teeth) $1,350 $1,200
tion.
Vertebral Processes $900 $800
Coccyx/Rib/Finger/Toe $360 $320
••Chip fractures

DI SL OC A T ION S (closed reduction): are paid at 10%

Hip $3,600 $2,700 of the fracture
Knee (not knee cap) $2,600 $1,950 benefit.
Shoulder $2,000 $1,500
Foot/Ankle $1,600 $1,200 ••Partial disloca-
Hand $1,400 $1,050 tions are paid at
Lower Jaw $1,200 $900 25% of the dislo-
Wrist $1,000 $750 cation benefit.
Elbow $800 $600
Finger/Toe $320 $240

SPECIFIC INJURIES

E M P L O Y E E // S P O U S E // C H I L D E M P L O Y E E // S P O U S E // C H I L D
RUPTURED DISC EM ERGENC Y DENT A L W ORK (pe r a c c i de nt)
(treatment within 60 days; surgical repair within one year) Repaired with crown $150
Injury occurring during first certificate year $100 Resulting in extraction $50
Injury occurring after first certificate year $400
BURNS (treatment within 72 hours
TEND ON S/ L IG AME N T S and based on percent of body surface burned):
(within 60 days; surgical repair within $400 (Single) Second-Degree Burns
90 days). If the insured fractures a bone $600 (Multiple) Less than 10% $100
or dislocates a joint, the amount paid will be At least 10%, but less than 25% $200
based on the number (single or multiple) of At least 25%, but less than 35% $500
tendons or ligaments repaired. We will only 35% or more $1,000
pay one benefit.
Third-Degree Burns
TO R N K N E E C A R T IL A G E Less than 10% $500
(treatment within 60 days; surgical repair within one year) At least 10%, but less than 25% $3,000
Injury occurring during first certificate year $100 At least 25%, but less than 35% $7,000
Injury occurring after first certificate year $400 35% or more $10,000
First-degree burns are not covered.
EYE INJURIES
Treatment and surgical repair within 90 days $250 L A C ERA T I ONS (treatment and repair within 72 hours):
Removal of foreign body $50 Under 2" long $50
2" to 6" long $200
CON C U S S ION Over 6" long $400
(a head injury resulting in electroencephalogram $200 Lacerations not requiring stitches $25
abnormality)
Multiple Lacerations: We will pay for the largest single
COMA (la st in g 3 0 d a y s o r m o r e ) $10,000 laceration requiring stitches.

This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions.
ADDITIONAL BENEFITS

E M P L O Y E E // S P O U S E // C H I L D

AMB U L AN CE $100

AI R A MB U L AN CE $500
If an insured requires transportation to a hospital by a professional ambulance or
air ambulance service within 90 days after a Covered Accident, we will pay the amount shown.

B LOOD/ P L ASMA $100

If the insured receives blood or plasma within 90 days following a Covered Accident,
we will pay the amount shown.

APPL IA N C E S $100
We will pay this benefit when an insured is advised by a physician to use a medical appliance
due to injuries received in a Covered Accident. Benefits are payable for crutches, wheelchairs,
leg braces, back braces, and walkers.

I NTE R N AL IN J U R IE S $1,000
(resulting in open abdominal or thoracic surgery)

ACCIDE N T F OL L OW - U P T R E A T M EN T $25
We will pay this benefit for up to six treatments per Covered Accident, per insured for follow-up
treatment. The insured must have received initial treatment within 72 hours of the accident, and
the follow-up treatment must begin within 30 days of the Covered Accident or discharge from
the hospital. This benefit is not payable for the same visit that the Physical Therapy Benefit is paid.

EXPL OR ATOR Y SU R GE R Y $250

[without repair (i.e., arthroscopy)]

PROSTHE SIS $500

If an insured requires the use of a prosthetic device due to injuries received in a Covered
Accident, we will pay this benefit. Hearing aids, wigs, or dental aids, including but not limited
to false teeth, are not covered.

PHYSICAL THERAPY $25

We will pay this benefit for up to six treatments per Covered Accident, per insured for treatment
from a physical therapist. The insured must have received initial treatment within 72 hours of
the accident, and physical therapy must begin within 30 days of the Covered Accident or discharge
from the hospital. Treatment must take place within six months after the accident. This benefit is not
payable for the same visit that the Accident Follow-Up Treatment Benefit is paid.

TRANSPORTATION $300 (train/plane)

If hospital treatment or diagnostic study is recommended by the insured’s physician $150 (bus)
and is not available in the insured’s city of residence, we will pay the amount shown.
Transportation must begin within 90 days from the date of the Covered Accident.
The distance to the hospital must be greater than 50 miles from your residence.

F A M I L Y L O D G I N G B E N E F I T ( p e r ni g ht) $100
If an insured is required to travel more than 100 miles from his or her home for inpatient treatment of
injuries received in a Covered Accident, we will pay this benefit for an immediate adult family member’s
lodging. Benefits are payable up to 30 days per accident and only while the insured is confined to the
hospital. The treatment must be prescribed by the insured's local physician.

W E L L N E S S B E N E F I T ( p e r 1 2 - m o n th pe r i o d ) $60
After 12 months of paid premium and while coverage is in force, we will pay this benefit for preventive
testing once each 12-month period. Benefits include and are payable for annual physical exams,
mammograms, Pap smears, eye examinations, immunizations, flexible sigmoidoscopies, PSA tests,
ultrasounds, and blood screenings.

This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions.
LIMITATIONS AND EXCLUSIONS

If this coverage will replace any existing individual policy, please be aware that You and Your refer to an employee as defined in the plan.
it may be in your best interest to maintain your individual guaranteed-renewable Spouse means the person married to you on the Effective Date of the rider. The
policy. rider may only be issued to your Spouse if your Spouse is between ages 18 and
WE WILL NOT PAY BENEFITS FOR LOSS, INJURY, OR DEATH 64, inclusive. Coverage on your Spouse terminates when your Spouse attains age
CONTRIBUTED TO, CAUSED BY, OR RESULTING FROM: 70.
• Participating in war or any act of war, declared or not, or participating in the Dependent Children means your natural children, stepchildren, foster children,
armed forces of or contracting with any country or international authority. We legally adopted children, or children placed for adoption, who are under age 26.
will return the prorated premium for any period not covered when you are in
such service. Your natural Children born after the Effective Date of the rider will be covered
• Operating, learning to operate, serving as a crew member on, or jumping or from the moment of live birth. No notice or additional premium is required.
falling from any aircraft, including those that are not motor-driven. Coverage on Dependent Children will terminate on the child's 26th birthday.
• Participating or attempting to participate in an illegal activity or working at an However, if any child is incapable of self-sustaining employment due to mental
illegal job. retardation or physical handicap and is dependent on his or her parent(s) for
• Committing or attempting to commit suicide, while sane or insane. support, the above age 26 limitation shall not apply. Proof of such incapacity and
• Injuring or attempting to injure yourself intentionally. dependency must be furnished to the company within 31 days following such
• Having any disease or bodily/mental illness or degenerative process. We also child’s 26th birthday.
will not pay benefits for any related medical/surgical treatment or diagnostic
Y O U M AY C O N T I N U E Y O U R C O V E R A G E
procedures for such illness.
Your coverage may be continued with certain stipulations. See certificate for
• Traveling more than 40 miles outside the territorial limits of the United States,
details.
Canada, Mexico, Puerto Rico, the Bahamas, the Virgin Islands, Bermuda, and
Jamaica, except under the Accidental Common-Carrier Death Benefit. T E R M I N AT I O N
• Riding in or driving any motor-driven vehicle in a race, stunt show, or speed Your insurance may terminate when the plan is terminated; the 31st day after the
test. premium due date if the premium has not been paid; or the date you no longer
• Participating in any professional or semiprofessional organized sport. belong to an eligible class. If your coverage terminates, we will provide benefits for
• Being legally intoxicated or under the influence of any narcotic, unless taken valid claims that arose while your coverage was in force.
under the direction of a physician. E F F E C T I V E D AT E
• Driving any taxi, or intrastate or interstate long-distance vehicle for wage,
compensation, or profit. The Effective Date for an employee is as follows: (1) An employee's insurance
• Mountaineering using ropes and/or other equipment, parachuting, or hang will be effective on the date shown on the Certificate Schedule, provided the
gliding. employee is then actively at work. (2) If an employee is not actively at work on
• Having cosmetic surgery or other elective procedures that are not medically the date coverage would otherwise become effective, the Effective Date of his or
necessary, or having dental treatment, except as a result of a covered accident. her coverage will be the date on which such employee is first thereafter actively
A doctor or physician does not include you or a member of your immediate family. at work.
A hospital is not a nursing home, an extended-care facility, a convalescent home, Continental American Insurance Company is not aware of whether you
a rest home or a home for the aged, a place for alcoholics or drug addicts, or a receive benefits from Medicare, Medicaid, or a state variation. If you or
mental institution. a dependent are subject to Medicare, Medicaid, or a state variation, any
PRE-EXISTING CONDITION LIMITATION and all benefits under the plan could be assigned. This means that you
We will not pay benefits for a loss that is caused by, that is contributed to, or that may not receive any of the benefits outlined in the plan. Please check
results from a Pre-Existing Condition for 12 months after the Effective Date of the coverage in all health insurance plans you already have or may have
your certificate and attached riders, as applicable. before you purchase the insurance outlined in this summary to verify the
absence of any assignments or liens.
Pre-Existing Condition means within the 12-month period prior to the Effective
Date of a certificate and attached riders, as applicable: (1) those conditions for Notice to Consumer: The coverages provided by Continental American
which medical advice or treatment was received or recommended, or (2) the Insurance Company (CAIC) represent supplemental benefits only. They
existence of symptoms that would cause an ordinarily prudent person to seek do not constitute comprehensive health insurance coverage and do
diagnosis, care, or treatment. not satisfy the requirement of minimum essential coverage under the
A claim for benefits for loss starting after 12 months from the Effective Date of a Affordable Care Act. CAIC coverage is not intended to replace or be issued
certificate and attached riders will not be reduced or denied on the grounds that in lieu of major medical coverage.
it is caused by a Pre-Existing Condition.
Treatment means consultation, care, or services provided by a physician,
including diagnostic measures, and taking prescribed drugs and medicines.
A certificate may have been issued as a replacement for a certificate previously
issued under the plan. If so, then the Pre-Existing Condition Limitation provision
of the certificate applies only to any increase in benefits over the prior certificate.
Any remaining period of the Pre-Existing Condition Limitation of the prior
certificate will continue to apply to the prior level of benefits.

We’ve got you

Continental American Insurance Company (CAIC), a proud member of the
Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and
underwrites group coverage. CAIC is not licensed to solicit business in New
under our wing.® York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance
Company • Columbia, South Carolina
aflacgroupinsurance.com 1.800.433.3036 This brochure is a brief description of coverage and is not a contract.
Read your certificate carefully for exact terms and conditions. This brochure
The certificate to which this sales material pertains is written only in is subject to the terms, conditions, and limitations of Policy Form Series
English; the policy prevails if interpretation of this material varies. CA7700-MP.