Critical Health Alert; Last Updated: April 07, 2020 3:15 P.M. EST
Please know that each claim received will be reviewed consistent with policy terms and applicable insurance law.
Life Insurance: For Group Life Insurance (Basic, Optional, Dependent, GUL and GVUL), there are no policy limitations that would limit a claim payment resulting from COVID-19, provided the individual met all other certificate requirements.
Accidental Death and Dismemberment (AD&D): AD&D policies do not cover diseases. Therefore, death due to COVID-19 is excluded, as are all deaths caused by disease.
Hospital Indemnity: Because COVID-19 is a viral infection it would be considered a sickness and the Sickness Hospital benefits (admission and confinement) would be payable provided the individual met all other certificate requirements.
Accident Insurance: The definition of an “accident” includes that it is not a sickness so this condition would not be covered under our standard accident plan for COVID-19. However, it would be covered if the accident plan included Sickness Hospital benefits (admission and confinement) and would be payable provided the individual met all other certificate requirements.
Critical Illness/Cancer Insurance: Because COVID-19 is not a listed “covered condition” it would not be covered under any of our Critical Illness product versions.
Disability Insurance: There are no policy limitations that would apply for COVID-19. MetLife will evaluate each claim in accordance with the terms of the policy and use claim processes already in place for disability claims.
For insured business, rates in effect during the current policy period would not be affected. For self-funded business or for absence administration, the terms of the applicable Administrative Service Agreement will apply.
During this period of uncertainty, MetLife will make an exception to extend the Grace Period for premium payment to 60 days after the Premium Due Date, for customers with a policy Grace Period less favorable than 60 days. Customers with Grace Periods greater than 60 days will retain the Grace Period in their policy. This policy will be applied for all premiums due 3/1/2020 and forward, until this crisis is deemed over, as well as apply to any premium within the current 30-day grace period. MetLife will continue to monitor the situation and will provide additional guidance as it becomes available. We are also monitoring state specific mandates and will comply with those mandates. As the coronavirus situation continues to evolve, MetLife will review this guidance for necessary actions and provide updates where the guidance or process has changed.
For employees with the MetLife AXA Travel Assistance1 program we provide medical evacuation/repatriation if an employee was exposed to COVID-19 or is in a high-risk area or country. The employee would be eligible for evacuation/ repatriation services, and AXA would coordinate the employee’s return.
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.
Employee Assistance Program (EAP)
For employees with MetLife’s Employee Assistance Program (EAP)2 we provide 24/7 confidential access to professional support to help employees manage stress, anxiety, grief, financial concerns, and much more. Employees can connect to support by phone, video, or chat anytime, anywhere, and they have access to a vast library of online resources for coping with trauma, building resiliency, self-care, and managing change.
Our EAP program also offers manager consultations and webinars to support leaders in dealing with sensitive workplace situations.
MetLife is committed to helping employees get maximum value from their benefits. Once we receive a MetLife Group Disability claim, we automatically look at whether the employee has hospital indemnity coverage. If they do, we will inform and guide the employee so they can understand and use the benefits available to them.
MetLife Legal Plans and Will Preparation
For our Optional Life and MetLife Legal Plan customers, employees have access to Will Preparation3 services including telephone or in-person consultations with an attorney in the MetLife Legal Plan attorney network. Covered services include preparing important planning documents like a power of attorney, which is a document that allows someone to conduct transactions on another person’s behalf, and a health care proxy, where someone can appoint another person to make medical decisions on their behalf.
PlanSmart Financial Wellness
For customers with PlanSmart Financial Wellness4, the financial education and guidance available may be helpful in managing finances during times of increased market volatility such as we’ve seen in recent weeks.
For our Life Insurance policy customers, licensed Grief Counselors are available from Lifeworks5 for insured employees and their dependents if they experience a loss, regardless of cause of death, or are diagnosed with a potentially life-threatening disease such as COVID-19. Whether it’s help coping with a loss or a major life change, confidential counseling sessions can be tailored to meet the individual needs.
For other questions and assistance please reach out to your MetLife Representative
Claimants are unlikely to satisfy the definition of disability in the applicable plan solely due to being quarantined. If the claimant develops COVID-19 or even some other qualifying sickness while quarantined, and it meets 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 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. For additional guidance on FML compliance related to COVID-19, please refer to the DOL guidelines at https://www.dol.gov/agencies/whd/pandemic/ffcra-questions.
For all other questions regarding inforce IDI policies, please contact your Account Manager, Account Executive or MetLife representative.
The Health Screening Benefit would be payable for a Coronavirus 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.
Claimants would not satisfy the definition of disability in the applicable plan solely due to being quarantined. If the claimant develops COVID-19 or some other qualifying sickness while quarantined, the claim would be reviewed per the requirements of the plan.
Unfortunately, MetLife is unable to support direct billing when MetLife is not the recordkeeper. Where MetLife is the recordkeeper, or for ported certificates MetLife does and will continue to handle direct billing.
MetLife is leveraging its existing Business Continuity Plans due to the global pandemic. For our Dental business these plans include continued staffing to respond to inquiries from customers, plan members and dentists as well as process and pay claims. MetLife remains committed to ensuring our customers, plan members, and dentists get the service they expect.
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.
1 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.
2 EAP services provided through an agreement with LifeWorks US Inc. (LifeWorks by Morneau Shepell). LifeWorks is not a subsidiary or affiliate of MetLife.
3 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.
4 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.
5 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.
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.