Cancer Plan Language.

rousemark

Still Here!
5000 Post Club
21,729
Niota, TN
How would you interpret this language that is found in a cancer plan should the insured have a diagnosis of cancer, is cured and then has another cancer diagnosed five years later? The plan an indemnity plan, not a lump sum. The face of the policy states "First Diagnosis Cancer Benefit Policy" In the definitions it reads,

"First Diagnosis means the first time in which the earliest of the following takes place:

1) Cancer is first diagnosed by a pathologist.. (then it goes on to define a pathological diagnosis)

2) cancer is first diagnosis by clinical or non-pathological diagnosis is a pathological diagnosis cannot be made. ( then it goes on to describe non-path and clinical diagnosis)
 
How would you interpret this language that is found in a cancer plan should the insured have a diagnosis of cancer, is cured and then has another cancer diagnosed five years later? The plan an indemnity plan, not a lump sum. The face of the policy states "First Diagnosis Cancer Benefit Policy" In the definitions it reads,

"First Diagnosis means the first time in which the earliest of the following takes place:

1) Cancer is first diagnosed by a pathologist.. (then it goes on to define a pathological diagnosis)

2) cancer is first diagnosis by clinical or non-pathological diagnosis is a pathological diagnosis cannot be made. ( then it goes on to describe non-path and clinical diagnosis)


Good question.

Equitable clearly says their First Occurrence Benefit is payable one time only.

UNL says: FIRST DIAGNOSIS CANCER BENEFITS – We will pay expenses incurred for treatment of cancer following a first diagnosis of cancer, subject to the waiting period.

I've always thought it was a one time only benefit, but I can see how it could be interpreted to say it will pay the benefit each time a new cancer's diagnosed.

Why didn't you post this while the companies were still open? LOL

Which company are you referring to?
 
Good question.

Equitable clearly says their First Occurrence Benefit is payable one time only.

UNL says: FIRST DIAGNOSIS CANCER BENEFITS – We will pay expenses incurred for treatment of cancer following a first diagnosis of cancer, subject to the waiting period.

I've always thought it was a one time only benefit, but I can see how it could be interpreted to say it will pay the benefit each time a new cancer's diagnosed.

Why didn't you post this while the companies were still open? LOL

Which company are you referring to?

UNL.. I realize the lump sum benefit is only payable one time.. But the language I quoted applies to the policy and not the lump sum rider.. By saying"First Diagnosis means the first time" a diagnosis is made, I think it indicates that subsequent diagnosis will not be covered. I have never seen another indemnity policy that has this wording.

I met with an UNL RD today and she didn't agree and I wondered how other folks might interpret it.

I have mentioned it before and they say they are paying for recurrence or second diagnosis. That is fine, but I have been through that before where a policy seemed to say one thing but the company was doing something different. Then, when new management came it, they would say, "Wait a minute. The policy says we don't have to pay it that way" and therefore they change the way things are being done. The next thing you know, you have upset clients and lawsuits.
 
UNL.. I realize the lump sum benefit is only payable one time.. But the language I quoted applies to the policy and not the lump sum rider.. By saying"First Diagnosis means the first time" a diagnosis is made, I think it indicates that subsequent diagnosis will not be covered. I have never seen another indemnity policy that has this wording.

I met with an UNL RD today and she didn't agree and I wondered how other folks might interpret it.

I have mentioned it before and they say they are paying for recurrence or second diagnosis. That is fine, but I have been through that before where a policy seemed to say one thing but the company was doing something different. Then, when new management came it, they would say, "Wait a minute. The policy says we don't have to pay it that way" and therefore they change the way things are being done. The next thing you know, you have upset clients and lawsuits.


I called UNL to see if their Choice Plus Plan covers observation days. I ended up talking to the claims department...they do cover them.

Try calling the claims department and Bobby Jann to see if you get the same answer. I agree with you, I like to know for sure.
 
Back
Top