Critical Illness Insurance, continued Infectious Condition Additional Bene昀椀t Rider If you are diagnosed with COVID-19*, this pays a bene昀椀t** of $100. If you are hospitalized for COVID-19* and there is a room and board charge for that hospitalization, this pays a bene昀椀t** amount of $1,000. Speci昀椀ed Conditions Diagnosis Bene昀椀t This bene昀椀t will pay you a Speci昀椀ed Condition Diagnosis bene昀椀t if you are diagnosed with autism spectrum disorder Level 3 on or after the coverage effective date. Speci昀椀ed Condition Facility Con昀椀nement Bene昀椀t If you are diagnosed with bipolar disorder or depressive disorder that results in a con昀椀nement to a hospital, rehabilitation facility or transitional care facility, this bene昀椀t will pay you a Speci昀椀ed Condition Facility Con昀椀nement Bene昀椀t. Although there is not a pre-existing condition limitation on the Critical Illness plan, the plan will only cover illnesses/diseases that are diagnosed after the effective date of coverage. At the time of claim, each claimant will be asked to provide supporting medical documentation along with the Attending Physician’s Statement of Critical Illness/ Speci昀椀ed Disease form. *COVID-19 diagnosis must be con昀椀rmed by a medical professional. **A bene昀椀t is payable up to a maximum of 1 time per Covered Person per policy calendar year | 26 |