The Critical Illness plan with MetLife provides a lump-sum payment following the diagnosis of one or more of the covered conditions. This lump-sum payment may be used on anything you need - medical or non-medical expenses. This allows you to focus on recovery and not on economic issues. MetLife offers several benefit enhancements that include higher maximum guarantee issue amounts, additional diseases, higher payouts for five covered conditions and coverage for 17 additional conditions.
Coverage Amounts Available
Critical Illness benefit amounts are available in increments of $5,000: Employee benefit options are $5,000 to $50,000 and Spouse benefit options are $5,000 to $25,000, not to exceed one half of the employee’s amount.
You may only enroll in Critical Illness insurance as a new hire, during Open Enrollment or if you have a qualify life event (QLE). You may only make changes to your coverage level during Open Enrollment or if you have a qualify life event (QLE). You can only enroll a spouse if you elect coverage for yourself.
Evidence of Insurability is not required, you will received guarantee issue up to the maximum amount.
First Occurrence Benefit
After the waiting period, a lump sum benefit is payable upon initial diagnosis of a covered critical illness.
Additional Occurrence Benefit
If an insured collects full benefits for a critical illness under the plan and later is diagnosed with one of the remaining covered critical illnesses, then MetLife will pay the full benefit amount for each additional illness. Occurrences must be separated by at least 6 months (for cancer at least 6 months treatment free) and not caused by or contributed to by a critical illness for which benefits have been paid.
If you collect full benefits for a covered critical illness and are later diagnosed with the same condition, MetLife will pay the full benefit again. The two dates of diagnosis must be separated by at least 12 months or 12 months treatment free for cancer. Cancer that has spread (metastasized), even though there is a new tumor, will not be considered an additional occurrence unless you have been treatment free for 12 months.
50% Child Coverage at no Additional Cost
Each dependent child is covered at 50 percent of the primary insured amount at no additional charge.
$75 Health Screening Benefit
An insured (employee/spouse) may receive $75 for any one covered health screening test per calendar year. MetLife will pay this benefit regardless of the results of the test. Payment of this benefit will not reduce the amount payable for the diagnosis of a critical illness. This benefit is only payable for health screening tests performed as the result of preventive care, including tests and diagnostic procedures ordered in connection with routine examinations. The Mohawk Health Assessment program biometrics test is a fasting blood glucose test and is one of the eligible tests for the $75 reimbursement.
All states, except AR, CA, CT, ID, ME, NH, NJ, NY and UT situs
Your Critical Illness certificate provides limited benefits – read your certificate carefully when you receive it. MetLife’s Group Critical Illness product is intended to supplement, and is not a substitute for, comprehensive medical coverage. By enrolling for Critical l Illness Insurance, if I am a resident of Arkansas, Connecticut, Idaho, New Hampshire or Utah, I declare that no person proposed for Critical Illness coverage is covered under any Title XIX program (Medicaid or any similarly named program). I acknowledge that I have received a Shopper’s Guide to Cancer Insurance; and I have received and read a copy of the outline of coverage or other disclosure document for the group Critical Illness plan. In addition, I have read the enrollment documentation and declare that all information I have given is true and complete to the best of my knowledge and belief; I have read the applicable Fraud Warning(s) provided.
Critical Illness Rates*
Please note, all (employee and spouse) Critical Illness rates are based on the age and the tobacco use status of the employee. Critical Illness policies enrolled with MetLife February 2013 and later are subject to 10 year age bands - see MetLife Rates below.
*All Critical Illness policies are administered by MetLife. If you had a policy with Unum in 2013, MetLife took over that policy. You may have also enrolled in additional coverage through MetLife. The advantage to retaining the policy previously held with Unum, is that the rates will not increase as you age. The rates are locked in for the life of the policy, and are not reflected in the rates contained above. If you have any questions regarding your Critical Illness coverage, please contact the Benefits Service Center at 866.481.4922.
For Questions, contact MetLife or the BSC
Benefits Service Center | 1-866-481-4922
MetLife | 1-855-488-0520