Disclosures

In California, review “A Consumer’s Guide to Long-term Care from the Department of Aging” at https://www.aging.ca.gov/aboutcda/publications/Taking_Care_of_Tomorrow_English/.

Limitations for Long-Term Care (LTC) Insurance Accelerated Death Benefit Rider

For benefits to be payable under this LTC insurance rider, you must:

• Be certified by a licensed healthcare practitioner as chronically ill and
• Be confined in a long-term care facility or assisted living facility; or
• Receive services for home healthcare or adult day care.

There are no deductibles for benefits. The elimination period is the first 90 days of services or confinement during which no benefits are payable.

Limitations and Exclusions

Benefits will not be paid for loss:

• Due to mental or nervous disorders other than Alzheimer’s disease and related degenerative and dementing illnesses.
• Incurred while residing or confined outside the United States and Canada.
• Due to alcohol or drug addiction, unless the addiction results from administration of drugs for treatment taken as directed or as prescribed by a licensed healthcare practitioner.
• In any government facility contracted for or operated by the United States government (unless otherwise required by law), services for which benefits are available under Medicare or other governmental program (except Medicaid), any state or federal workers’ compensation, employer’s liability or occupational disease law, or any motor vehicle no-fault law, services provided by a member of the covered person’s immediate family, and services for which there is no cost to the insured.
• Due to illness, treatment or medical conditions arising out of:
  • war or act of war (whether declared or undeclared), except for acts of terrorism;
  • participation in a felony, riot or insurrection;
  • service in the armed forces or units auxiliary thereto; or
  • suicide (while sane or insane), attempted suicide or intentionally self-inflicted injury.
• Which does not satisfy all the conditions stated in the provision captioned Conditions on Eligibility for Benefits.

Pre-Existing Condition Limitation: Benefits will not be paid for loss due to a pre-existing condition that starts during the first six months after the effective date.

BENEFITS MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONG-TERM CARE NEEDS.

Guaranteed Renewability: The rider is guaranteed renewable as long as premiums are paid on time, subject to material misrepresentation on the application. The company cannot change the terms of coverage, but it may increase the premiums you pay. Any change in monthly cost will be subject to applicable state laws and regulations.

The rider terminates on the earliest of: 1) written notice by you; 2) termination of the certificate, or 3) when the company has paid benefits for the maximum number of months.

Benefits paid under this rider may or may not be taxable. Whether or not you or your beneficiary incurs a tax liability when benefits are paid depends on how the IRS interprets applicable portions of the Tax Code. As with all tax matters, you should consult your personal tax advisor to assess the impact of this benefit. Trustmark Insurance Company has no responsibility for any tax consequences of any benefits paid under this rider. This rider is not intended to be qualified long-term care insurance within the meaning of the Internal Revenue Code of 1986.

Exclusions and limitations of rider HH/LTC.205 KS:

This rider does not pay benefits for loss:

• Due to a Pre-existing Condition that starts during the first six (6) months after the application date for this rider.
• Due to mental, psychoneurotic or personality disorders without clinically diagnosed organic disease. However, nervous or mental disorders which are caused by clinically diagnosed organic disease, such as Alzheimer’s Disease and related degenerative and dementing illnesses are covered.
• Incurred while residing or confined outside the United States and Canada.
• Due to chronic alcohol or drug addiction, unless the addiction results from administration of drugs for treatment prescribed by a Physician.
• In any facility contracted for or operated by the United States Government when there is no cost to the Insured.
• In any facility for which no charge is made to the Insured.
• Due to illness, treatment or medical conditions arising out of:
  • war or act of war (whether declared or undeclared);
  • participation in a felony, riot or insurrection;
  • attempted suicide or intentionally self-inflicted Injury; or
  • normal pregnancy and childbirth. However, Complications of Pregnancy are considered as Sickness under this rider.

Exclusions and Limitations:

This rider does not pay benefits for loss:

• For nervous or mental disorders. However, nervous or mental disorders which are caused by clinically diagnosed organic disease, such as Alzheimer’s Disease and related degenerative and dementing illnesses are covered.
• For alcoholism or drug addiction.
• In any facility contracted for or operated by the United States Government when there is no cost to the Insured.
• In any facility for which no charge is made to the Insured.
• Due to illness, treatment or medical conditions arising out of:
  • war or act of war (whether declared or undeclared);
  • participation in a felony, riot or insurrection;
  • attempted suicide or intentionally self-inflicted Injury; or
  • normal pregnancy and childbirth. However, Complications of Pregnancy are considered as Sickness under this rider.
• Which does not satisfy all the conditions stated in the provision captioned Conditions on Eligibility for Benefits.

Pre-existing condition limitation:

This rider does not pay benefits for loss due to a Pre-existing Condition that starts during the first six (6) months after the application date for this rider.

EZ Value Future Purchase Option/EZ Value Benefit Increase is not available in New York.

Limitations for Convalescent Care Benefit Rider

Provided the conditions for payment are met, and upon certification from a Licensed Health Care Practitioner, benefits are payable after you have received services while confined in a long-term care or assisted living facility or received home health care or adult day care services for 90 days, and benefits are payable retroactive to the first day of service. This 90-day period need not be continuous. It must, however, be entirely within one Benefit Period.

The following conditions must be met to qualify for benefits:

• You are chronically ill.
• The licensed health care practitioner must approve a plan of care in writing prescribing services that are to be provided to you. You must receive the services prescribed under the approved plan of care while this rider is in force.
• At least once every 12 months following a prior certification of chronic illness, and for as long as you continue to be ill, the licensed health care practitioner:
  1. Must again certify that your chronic illness is expected to continue for at least 90 days; and
  2. Either approve a new plan of care, or reconfirm the existing plan of care in writing.

Chronically ill or chronic illness means that you have been certified, within the preceding 12 months, by a licensed health care practitioner as:

• being unable to perform without substantial assistance from another individual at least two activities of daily living for a period of at least 90 days as a result of loss of functional capacity; or
• requiring substantial supervision to protect you from threats to health and safety caused by severe cognitive impairment

This rider does not pay benefits for loss:

• Due to mental, psychoneurotic or personality disorders without clinically diagnosed organic disease. However, nervous or mental disorders which are caused by clinically diagnosed organic disease, such as Alzheimer’s Disease and related degenerative and dementing illnesses are covered.
• Due to treatment or care received while outside the United States and its possessions.
• Due to alcoholism or drug addiction, unless the addiction results from administration of drugs for treatment prescribed by a licensed health care practitioner.
• In any facility contracted for or operated by the United States government when there is no cost to you.
• In any facility for which no charge is made to you.
• Due to illness, treatment or medical conditions arising out of:
  • war or act of war (whether declared or undeclared);
  • participation in a felony, riot or insurrection;
  • service in the armed forces or units auxiliary thereto; or
  • suicide, attempted suicide or intentionally self-inflicted Injury.
• Which does not satisfy all the conditions stated in the provision captioned conditions on eligibility for benefits.

Premium

We have the right to adjust the premium rates with notice to the department of insurance. Any increase in premium rates will be done on a class basis. Your maximum premium rate for this rider is shown on your schedule.

This rider is intended to be a qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code. This is not a health insurance rider and is not subject to the minimum requirements of New York Law pertaining to long-term care insurance. This rider does not qualify for the New York Long-Term Care Partnership Program, and is not a Medicare Supplement Policy. This rider is intended to be a qualified long-term care insurance contract for federal tax law only.

See Rider HH/LTC.205 (I) NY for exact terms, provisions, exclusions and limitations.