Specified Conditions Rider ** Specified Conditions Diagnosis Benefit We will pay you a Specified Condition Diagnosis benefit if you are diagnosed with Autism Spectrum Disorder Level 3 on or after the coverage effective date. If your spouse and/or child(ren) are covered for Critical Illness, they are eligible for this benefit, also. This pays a benefit amount as shown below: CI Benefit Amount CI Benefit Amount Specified Condition $10,000 $20,000 EE SP CH EE SP CH Autism Spectrum Disorder Level 3 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 CI Benefit Amount $30,000 EE SP CH $5,000 $5,000 $5,000 Specified Condition Facility Confinement Benefit If you are diagnosed with Bipolar disorder or Depressive disorder that results in a Confinement to a Hospital*, Rehabilitation Facility or Transitional Care Facility, we will pay you a Specified Condition Facility Confinement benefit. This benefit is payable if the Confinement occurs on or after the coverage effective date regardless of when the Specified Condition is Diagnosed. If your Receive a spouse and/or child(ren) are covered for Critical Illness they are eligible for this benefit for a benefit. Specified Condition Confined or Confinement means that on the advice of a Health Care Provider, your assignment to a bed as a resident inpatient in a Hospital, Rehabilitation Facility or Transitional Care Facility. Being admitted to an Observation Unit for 20 hours or more also meets the definition of Confined or Confinement. There must be a charge for room and board for the Confinement, other than in any government, military or veterans’ facility or Observation Unit. A Specified Condition Facility Confinement benefit is payable up to a total maximum of one time per a Covered Person’s lifetime. This pays a benefit amount shown below: Benefit Amount Benefit Amount Specified Condition $10,000 $20,000 EE SP CH EE SP CH Bipolar disorder $2,500 $2,500 $1,250 $5,000 $2,500 $1,250 Depressive disorder $2,500 $2,500 $1,250 $5,000 $2,500 $1,250 Benefit Amount $30,000 EE SP CH $7,500 $2,500 $1,250 $7,500 $2,500 $1,250 **This rider is subject to approval by the Iowa Department of Insurance and Financial Services – Insurance Division and may change. Any claims that are filed prior to state approval may be delayed.