Critical Health Alert; Last Updated: April 07, 2020 1:40 P.M. EST
If you or an eligible family member have Hospital Indemnity Insurance or Accident Insurance that includes Sickness Hospital Benefits, and you are admitted to the hospital for treatment of COVID-19, you will be able to file a claim under your coverage provided you meet the plan requirements.
If the Health Screening Benefit is included in a Critical Illness, Accident or Hospital Indemnity Insurance certificate, the Health Screening Benefit would be payable for a COVID-19 laboratory screening test (regardless of the test result), subject to the requirements for payment of that benefit and the other terms and conditions of the certificate. Please check with your employer or sign into MyBenefits for plan details.
MetLife remains committed to ensuring employees get the service they expect and the timely handling of claims. At this time, we are confident in our abilities to service our employees.
If you have MetLife Disability Insurance, are diagnosed with COVID-19 and are unable to perform your job due to the sickness, you may be entitled to MetLife Disability Insurance benefits. Disability Insurance will replace a portion of your income for a given time period, which depends on your policy.
Being quarantined most likely does not meet the requirements for a disability and would not be covered by MetLife Disability Insurance. However, if you develop COVID-19, or another qualifying sickness while quarantined, and you meet the definition of disability within the policy, benefits would be reviewed for payment.
We will review each leave request on a case-by- case basis, however, in order to qualify for disability, quarantined employees would need to satisfy the definition of a “serious health condition.” If the employee is unsure if the claim will be approved, we encourage the claim to be submitted for review.
We will review each leave request on a case-by-case basis. However, in order to qualify for FMLA, quarantined employees would need to satisfy the definition of a “serious health condition” or be caring for a child if the school or place of care has closed or childcare provider is unavailable due to a public emergency regarding COVID-19, among the other FMLA eligibility requirements. If the employee is unsure if the claim will be approved, we encourage the claim to be submitted for review.
You do not have to complete the paramedical exam right away. Taking prompt action will ensure a faster decision, however, you have 6 months to complete the paramedical exam requirement. Once MetLife receives information and our review is complete, we will inform you of a decision in writing. We will also notify you if any additional information is required.
There are two additional ways to submit your Statement of Health for processing including email and fax submission options. You can find the email and fax information in the Instructions section on your Statement of Health form.
Self-service forms, answers to frequently asked questions, contact information, and performance information can be found on our website for those individuals who have purchased their policy through an agent (Life Insurance Policyholders site). You can also contact your financial professional for assistance.
At this time, we are seeing that dental offices are providing emergency dental care for patients. They are following the guidance from the American Dental Association, their state dental associations, and state regulators that they should offer emergency dental care as a response to the COVID-19 pandemic. Some states have begun to mandate that dentists can only offer care for dental emergency services. MetLife recommends that plan members contact their dentist for direction on how to seek the appropriate care. Plan members can also contact MetLife at 1-800-942-0854 or visit www.mybenefits.metlife.com for assistance in finding a dentist in their area in the event they don’t have a dentist or their dentist is not available.
Please visit the Dental Oral Health Library for ADA provided guidelines and other helpful information if you need to see a dentist.
MetLife dental plans provide coverage for dental services delivered through tele-dentistry. The coverage is handled the same as if the patient was receiving the dental services in a dental office. Dental services that can be delivered through tele-dentistry typically include problem focused exams and re-evaluations. The coverage is subject to the plan terms and conditions. Dentists can verify benefit coverage using MetLife’s web portal, www.MetDental.com as well as MetLife’s interactive voice response (IVR) capabilities. To the extent a state has enacted mandates regarding tele-dentistry due to the COVID-19 pandemic, MetLife will fully comply.
Our Client Service Center is open during its regular hours Monday through Friday, 8 am – 8pm ET, and we are operationally prepared to handle all calls and claims. You can reach out to us at 800-821-6400 with any questions or concerns.
Our attorneys can provide consultations over the telephone, and many can consult via virtual meetings. While our attorneys will do their best to handle all inquiries in a timely manner, our e-panel attorneys are also available to answer general questions online. You can submit questions and a Network Attorney will respond to within 24 to 48 hours.
What are MetLife Legal Plans’ portability options for furloughed, temporarily laid-off or reduced hours/salary employees?
Beginning April 1, 2020 through May 31, 2020, we are offering employees that would like to keep their plan benefits due to a COVID-19 related leave of absence, unpaid leave, or termination the option to either port their plans for 3 months or choose our standard 12-month portability. You can call our Client Service Center at 800.821.6400, Monday-Friday (8am - 8pm ET) to enroll in the portable plan. You must enroll within the month of April or May and within 30 days from your last date of employment. Enrollment is prepaid via remittance of a lump sum payment equal to the legal plan’s monthly rate times three months (or 12 months if you choose our standard portability plan).
Under portable enrollment, dependent definitions are the same as those for active employees. The covered services and exclusions are the same as those under the current plan. Members can visit members.legalplans.com or call 800.821.6400 for plan details.
How long will MetLife Legal Plans offer this three-month portability plan?
At the end of May, we will evaluate whether to continue the three-month portability option in June. For those who enroll in the three-month program, we will evaluate at the end of the period whether to extend for an additional three-month renewal option.
*Standard Exclusions apply. See a full list of our exclusions here:
No service provided, not even consultation for:
1 Grief Counseling services are provided through an agreement with LifeWorks. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. LifeWorks has a nationwide network of over 30,000 counselors. Counselors have master’s or doctoral degrees and are licensed professionals. The Grief Counseling program does not provide support for issues such as: domestic issues, parenting issues, or marital/relationship issues (other than a finalized divorce). For such issues, members should inquire with their human resources department about available company resources. This program is available to insureds, their dependents and beneficiaries who have received a serious medical diagnosis or suffered a loss. Events that may result in a loss are not covered under this program unless and until such loss has occurred. Services are not available in all jurisdictions and are subject to regulatory approval. Not available on all policy forms.
2 Will Preparation is offered by MetLife Legal Plans, Inc., a MetLife company. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service.
3 MetLife administers the PlanSmart Financial Wellness program, but has arranged for Massachusetts Mutual Life Insurance Company (MassMutual) to have specially trained financial professionals offer in-person financial education and, upon request, provide personal guidance to employees and former employees of companies providing the program through MetLife. Guidance and coaching online and by phone is provided by trained and credentialed financial planners through our alliance with EY (Ernst & Young LLP). PlanSmart Financial Wellness planner line access for COVID-19 relating financial questions is being offered to employers under 100 lives at no cost for a limited time. If you’d like additional details on this offer, please contact email@example.com. No MetLife customer relationship required.
4 EAP services provided through an agreement with LifeWorks US Inc. (LifeWorks by Morneau Shepell). LifeWorks is not a subsidiary or affiliate of MetLife.
5 Travel Assistance services are offered and administered by AXA Assistance USA, Inc. Certain benefits provided under the Travel Assistance program are underwritten by Certain Underwriters at Lloyd’s London (not incorporated) through Lloyd’s Illinois, Inc. Neither AXA Assistance USA Inc. nor the Lloyd’s entities are affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife.
6 Proof must be established that the employee does not have COVID-19 even if the evacuation is for another reason. In addition, destination countries are implementing more stringent screening practices at points of entry. Access to and clearances for air and ground ambulance providers, as well as other transportation options, are becoming more challenging to secure as action is taken to contain the spread of the virus.
Group Life, Group Disability and Group Dental Insurance:
Like most insurance policies and benefit programs, insurance policies and benefit programs offered by Metropolitan Life Insurance Company and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations and terms for keeping them in force. Please contact MetLife for complete details.
The MetLife Cancer Insurance plan is based on the MetLife Critical Illness Insurance (CII) policy. MetLife Cancer Insurance includes only the Covered Conditions of Full Benefit Cancer and Partial Benefit Cancer.
METLIFE CRITICAL ILLNESS INSURANCE (CII) IS A LIMITED BENEFIT GROUP INSURANCE POLICY. Like most group accident and health insurance policies, MetLife’s CII policies contain certain exclusions, limitations and terms for keeping them in force. Product features and availability may vary by state. In most plans, there is a pre-existing condition exclusion. After a covered condition occurs, there is a benefit suspension period during which benefits will not be paid for a recurrence, except in the case of insureds covered under a New York certificate. MetLife’s Issue Age CII is guaranteed renewable, and may be subject to benefit reductions that begin at age 65. Premium rates for MetLife’s Issue Age CII are based on age at the time of the initial coverage effective date and will not increase due to age; premium rates for increases in coverage, including the addition of dependents’ coverage, if applicable, will be based on the covered person’s age at the time of the initial coverage effective date. Rates are subject to change for MetLife’s Issue Age CII on a class-wide basis. A more detailed description of the benefits, limitations, and exclusions can be found in the applicable Disclosure Statement or Outline of Coverage/Disclosure Document available at time of enrollment. For complete details of coverage and availability, please refer to the group policy form GPNP14-CI or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York.
MetLife's Critical Illness Insurance is not intended to be a substitute for Medical Coverage providing benefits for medical treatment, including hospital, surgical and medical expenses. MetLife's Critical Illness Insurance does not provide reimbursement for such expenses.
METLIFE'S ACCIDENT AND HOSPITAL INDEMNITY INSURANCE POLICIES ARE LIMITED BENEFIT GROUP INSURANCE POLICIES. The policies are not intended to be a substitute for medical coverage. The policies or their provisions may vary or be unavailable in some states. There is a preexisting condition limitation for hospital sickness benefits, if applicable. There are benefit reductions that begin at age 65, if applicable. And, like most group accident and health insurance policies, polices offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or GPNP13-HI or contact MetLife.
Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife’s Group Hospital Indemnity Insurance is pending regulatory approval. Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See MetLife’s Disclosure Statement or Outline of Coverage/Disclosure Document for full details.
MetLife Auto & Home® is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI.