MoVLIC Critical Illness









FORMS
Wellness Claim Form
Employee Change Form
Enrollment Form
Payroll Deduction Form
Fax all forms to (573) 896-9971

Contact Us

	\|		\|		\|		\|		\|


..ADDITIONAL BENEFITS		Cheap oem software Generic viagra Online Buy Viagra Low Option	\|	Medium Option	\|	High Option
	WELLNESS BENEFIT (Cancer Screenings and Heart Screenings) - AWD pays $25 for each unit of coverage, up to a maximum of 4 units, each calendar year per covered person, for one of the following cancer screening tests or heart screening tests performed while not hospital confined: Bone Marrow Testing; CA15-3 (blood test for breast cancer); CA125 (blood test for ovarian cancer); CEA(blood test for colon cancer); chest X-ray; colonoscopy; flexible sigmoidoscopy; hemocult stool analysis; mammography, including breast ultrasound; Pap Smear, including Thin Prep Pap Test; PSA (blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); biopsy for skin cancer; stress test on bike or treadmill; electrocardiogram (EKG); carotid doppler; echocardiogram; lipid panel (total cholesterol count); and blood test for triglycerides. There is no limit to the number of years a covered person can receive cancer screening tests. This benefit is paid regardless of the result of the test(s) and is limited to one test per calendar year per covered person.	$100 4 units 25% of previously paid Category 1 or 2 benefits		$100 4 units 25% of previously paid Category 1 or 2 benefits		$100 4 units 25% of previously paid Category 1 or 2 benefits
	RECURRENCE BENEFIT - AWD pays this benefit if a covered person is diagnosed more than once with the same specified critical illness listed in category 1 or 2 for which a benefit was previously paid if there is more than 18 months between each diagnosis; and treatment was not received during that 18month period (for purposes of the preceding statement, treatment does not include medications and follow-up visits to your physician); and the subsequent date of diagnosis is while coverage is in force; and the specified critical illness is not excluded by name or specific description in the certificate. • AWD will pay an amount equal to 25% of the specified critical illness basic benefit amount previously paid for that specified critical illness. AWD will pay no more than one recurrence benefit per previously paid specified critical illness under Category 1 and 2.

Allstate* Workplace Division is the marketing name used by American Heritage Life Insurance Company (Home office: Jacksonville, FL), a wholly-owned subsidiary of The Allstate Corporation. © 2006 Allstate Insurance Company. All products are underwritten by American Heritage Life Insurance Company (Home office: Jacksonville, FL).

419 E. High Street | Jefferson City, MO 65101 | FAX: 573-896-9971