| 26 | Critical Illness Insurance, continued 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/ Specified Disease form. *COVID-19 diagnosis must be confirmed by a medical professional. **A benefit is payable up to a maximum of 1 time per Covered Person per policy calendar year Infectious Condition Additional Benefit Rider If you are diagnosed with COVID-19*, this pays a benefit** of $100. If you are hospitalized for COVID-19* and there is a room and board charge for that hospitalization, this pays a benefit** amount of $1,000. Specified Conditions Diagnosis Benefit This benefit 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. 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, this benefit will pay you a Specified Condition Facility Confinement Benefit.