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Critical Illness Insurance

Basics

Critical Illness Insurance complements your medical and disability income coverage. It can ease the potential financial impact of certain critical illnesses by helping you pay for some of the expenses that are not covered, such as medical co-pays, transportation to treatment centers, childcare, and more.

Critical Illness Insurance does not replace current medical insurance; rather, it provides a lump-sum payment if you experience certain covered conditions.

Covered Illnesses and Features

If you meet the group policy and certificate requirements, Critical Illness Insurance provides you with a lump-sum payment upon diagnosis of the following conditions:

Covered Illnesses Collapsed Expanded
  • Full Benefit Cancer1
  • Partial Benefit Cancer1
  • Heart Attack
  • Stroke2
  • Coronary Artery Bypass Graft3
  • Kidney Failure
  • Alzheimer's Disease4
  • Major Organ Transplant
  • 22 Listed Conditions5 (see your Outline of Coverage for details)
Critical Illness Insurance Features Collapsed Expanded
  • Enhances coverage to traditional medical plans, consumer-driven health plans, and disability income coverage
  • A lump-sum benefit payment to use as you see fit
  • Guaranteed acceptance for you and other eligible family members6
  • Convenient payment options
  • No obligation to submit expense receipts
  • Coverage that can go with you if you leave your employer under certain circumstances7
Frequently Asked Questions
What is Critical Illness Insurance? Collapsed Expanded

This is coverage that can help cover the extra expenses associated with a serious illness. When a serious illness happens to you or a loved one, this coverage provides you with a lump-sum payment upon diagnosis. Payments may be used to help pay for expenses generally not covered by medical and disability income coverage. Payment(s) you receive will be made in addition to any other insurance you may have and may be spent as you see fit.

Who is eligible to enroll for this coverage? Collapsed Expanded

You and your eligible family members1 such as spouse/domestic partner2 and dependent children.3 You just need to enroll during your Open Enrollment.1

I have a good medical plan at work. Why do I need Critical Illness Insurance? Collapsed Expanded

Even quality medical and disability income plans don't always cover all of your expenses. For example, your medical coverage may have deductibles and copays and may not cover out-of-network treatments. And if you're out on disability, only a portion of your income may be covered. With the average person spending thousands of dollars during a time of critical illness and recovery,4 most people will need the means to cover extra medical and daily living expenses for items like groceries, housing expenses, car payments, and more.

Can I enroll for this coverage without having to take a medical exam? Collapsed Expanded

Yes. Provided you are actively at work, your enrollment is guaranteed.5

How do I pay for my coverage? Collapsed Expanded

Premiums will be conveniently paid through payroll deduction, so you never have to worry about writing a check or missing a payment.

Are payments made directly to me or my health care provider? Collapsed Expanded

Payments will be made directly to you, not to the doctors, hospitals or other health care providers. You will receive a check, mailed directly to your home.

What happens if my employment status changes? Can I take my coverage with me? Collapsed Expanded

Yes. This coverage is "portable," meaning you can take it with you if your employment status changes.6

Covered Illnesses and Features Disclaimer

1 Please review the Disclosure Statement or Outline of Coverage/Disclosure Document for specific information about cancer benefits. Not all types of cancer are covered. Some cancers are covered at less than the Initial Benefit Amount. In NH, for All Other Cancers, MetLife will pay a benefit of $100 initial benefit and $100 recurrence benefit for all other cancers.

2 In certain states, the Covered Condition is Severe Stroke.

3 In NJ sitused cases, the Covered Condition is Coronary Artery Disease.

4 Please review the Outline of Coverage for specific information about Alzheimer's Disease.

5 MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount for each of the 22 Listed Conditions until the Total Benefit Amount is reached. A Covered Person may only receive one payment for each Listed Condition in his/her lifetime. The Listed Conditions are: Addison's disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou Gehrig's disease); cerebrospinal meningitis (bacterial); cerebral palsy; cystic fibrosis; diphtheria; encephalitis; Huntington's disease (Huntington's chorea); Legionnaire's disease; malaria; multiple sclerosis (definitive diagnosis); muscular dystrophy; myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis.]

6 Coverage is guaranteed provided (a) the employee is actively at work and (b) dependents are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.

7 See your Certificate for details.

FAQ Disclaimer

1 Eligible Family Members means all persons eligible for coverage as defined in the Certificate.

2 Coverage for Domestic Partners, civil union partners and reciprocal beneficiaries varies by state. Please contact MetLife for more information.

3 Dependent Child coverage varies by state. Please contact MetLife for more information.

4 MetLife Financial Impact of Critical Illness Study, April 2010.

5 Coverage is guaranteed provided (a) the employee is actively at work and (b) dependents are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.

6 See your Certificate for details.