Critical Illness Insurance
Critical illness insurance provides a lump-sum payment to help provide you and your family financial support in a difficult time.
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Lump-sum payment to use as you see fit for yourself and your family
Managing the emotional cost of illnesses like cancer, a heart attack or a stroke* is hard enough. Managing the financial cost as well can be overwhelming. Critical illness insurance provides a lump-sum payment to ensure you and your family have financial support in a difficult time. So, you can spend less time worrying about money and more time focusing on healing.
- Flexible benefit options to meet your budget and coverage needs from $10,000 to $50,000 coverage.
- You’ll receive a lump-sum payment upon verified diagnosis to use as you see fit
- Use it for prescriptions, deductibles, co-payments, experimental/non-traditional treatments and even non-medical expenses like everyday bills
- Pays out regardless of what your medical insurance covers
- Payments are paid directly to you, not to the doctors, to the hospitals or to the healthcare providers
Critical Illness Insurance Benefits
| Eligible Individual | Benefit Amount | Requirements |
|---|---|---|
| Coverage Optionss | ||
| Employee | $10,000, $15,000, $20,000, $25,000, $30,000, $40,000 or $50,000 | Coverage is guaranteed provided you are actively at work.1 |
| Spouse/Domestic Partner2 | 100% of the Employee’s Initial Benefit | Coverage is guaranteed provided the employee is actively at work and the spouse/domestic partner is not subject to a medical restriction as set forth on the enrollment form and in the Certificate.1 |
| Dependent Child(ren)3 | 50% of the Employee’s Initial Benefit | Coverage is guaranteed provided the employee is actively at work and the dependent is not subject to a medical restriction as set forth on the enrollment form and in the Certificate.1 |
Benefit Payment
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Your plan pays a lump-sum Initial Benefit upon the first verified diagnosis of a Covered Condition. Your plan also pays a lump-sum Recurrence Benefit4 for a subsequent verified diagnosis of certain Covered Conditions as shown in the table below. A Recurrence Benefit is only available if an Initial Benefit has been paid for the same Covered Condition. There is a Benefit Suspension Period that applies to Recurrence Benefits. Recurrence benefits for a Cancer covered condition will not be paid unless the insured has not been treated, nor had symptoms for at least 365 days.
There is no maximum amount that you can receive through your Critical Illness Insurance plan.
Please refer to the table below for the percentage benefit payable for each Covered Condition.
| Plan Design- Covered Conditions* | Initial Benefit | Recurrence Benefit |
|---|---|---|
| Invasive Cancer | 100% of Benefit Amount | 100% of Initial Benefit Amount |
| Non-Invasive Cancer | 100% of Benefit Amount | 100% of Initial Benefit Amount |
| Skin Cancer | 25% of Benefit Amount | 100% of Initial Benefit Amount |
| Cardiovascular Disease Category | ||
| Coronary Artery Bypass Graft (CABG) - where surgery involving either a median sternotomy or minimally invasive procedure is performed |
100% of Benefit Amount | 100% of Initial Benefit Amount |
| Childhood Disease Category | ||
| Cerebral Palsy | 100% of Benefit Amount | None |
| Cystic Fibrosis | 100% of Benefit Amount | None |
| Sickle Cell Anemia | 100% of Benefit Amount | None |
| Heart Attack Category | ||
| Heart Attack | 100% of Benefit Amount | 100% of Initial Benefit |
| Infectious Disease Category | ||
| For a benefit to be payable, the covered person must have been treated for the disease in a hospital for 5 consecutive days. | ||
| Anthrax | 25% of Benefit Amount | None |
| Bacterial Cerebrospinal Meningitis | 25% of Benefit Amount | 100% of Initial Benefit |
| COVID-19 | 25% of Benefit Amount | None |
| Diphtheria | 25% of Benefit Amount | 100% of Initial Benefit |
| Encephalitis | 25% of Benefit Amount | 100% of Initial Benefit |
| Legionnaire’s Disease | 25% of Benefit Amount | 100% of Initial Benefit |
| Lyme Disease | 25% of Benefit Amount | None |
| Malaria | 25% of Benefit Amount | 100% of Initial Benefit |
| Necrotizing Fasciitis | 25% of Benefit Amount | 100% of Initial Benefit |
| Osteomyelitis | 25% of Benefit Amount | None |
| Rabies | 25% of Benefit Amount | None |
| Rocky Mountain Spotted Fever | 25% of Benefit Amount | None |
| Tetanus | 25% of Benefit Amount | 100% of Initial Benefit |
| Tuberculosis | 25% of Benefit Amount | 100% of Initial Benefit |
| Typhoid Fever | 25% of Benefit Amount | None |
| Kidney Failure Category | ||
| Kidney Failure | 100% of Benefit Amount | None |
| Major Organ Transplant Category | ||
| Major Organ Transplant For bone marrow, heart, lung, pancreas, kidney, and liver |
100% of Benefit Amount | None |
| Progressive Disease Category | ||
| Adrenal Hypofunction (Addison’s Disease) | 25% of Benefit Amount | None |
| ALS | 100% of Benefit Amount | None |
| Alzheimer’s Disease | 100% of Benefit Amount | None |
| Huntington’s Disease | 25% of Benefit Amount | None |
| Multiple Sclerosis | 100% of Benefit Amount | None |
| Muscular Dystrophy | 100% of Benefit Amount | None |
| Myasthenia Gravis | 25% of Benefit Amount | None |
| Poliomyelitis | 25% of Benefit Amount | None |
| Systemic Lupus Erythematosus (SLE) | 100% of Benefit Amount | None |
| Systemic Sclerosis (Scleroderma) | 25% of Benefit Amount | None |
| Stroke Category | ||
| Stroke | 100% of Benefit Amount | None |
All Benefit Levels include Social Security Disability Advocacy and Advisory Service (DAS)1, which can be initiated regardless of the outcome of a submitted Critical Illness claim filed with MetLife. To determine if your critical illness and disability qualify for Disability Advocacy Services through SSDC, call SSDC Services Corp. at 866-587-2853.7
* Notes Regarding Covered Conditions
MetLife will not pay a benefit for a Covered Condition that is diagnosed prior to the coverage effective date.
- Alzheimer’s Disease – Please review the Outline of Coverage/Disclosure Document for specific information about Alzheimer’s disease.
- Cancer – Please review the certificate for specific information about cancer benefits. In most states, not all types of cancer are covered.
- Coronary Artery Bypass Graft – In certain states, the Covered Condition is Coronary Artery Disease.
- Heart Attack – The Heart Attack Covered Condition pays a benefit for the occurrence of a myocardial infarction, subject to the terms of the certificate. A myocardial infarction does not include sudden cardiac arrest.
- Infectious Disease Covered Condition Category – For an Infectious Disease Category benefit to be payable, the covered person must have been treated for the disease in a hospital for a consecutive number of days as specified in the certificate.
- Major Organ Transplant – In most states, we will not pay a Major Organ Transplant benefit if a covered person is placed on the organ transplant list prior to coverage taking effect and subsequently undergoes a transplant procedure for the same organ while coverage is in effect. Covered organs may vary by state; refer to the Certificate for details. In some states, the condition is Major Organ Failure.
- Stroke – In certain states, the Covered Condition is Severe Stroke.
- The following benefits are not available in all states. Please review the Disclosure Statement or Outline of Coverage/Disclosure Document for details.
- Coma
- Major Organ Transplant Donation
GUAM, NEW MEXICO AND WASHINGTON RESIDENTS: Please refer to the Disclosure Document/Outline of Coverage for the terms of your coverage which may differ materially from what is shown in this plan summary.
Example of How Benefits are Paid
The example below illustrates an employee who elected a Benefit Amount of $30,000.
| Illness – Covered Condition | Payment Amount |
|---|---|
| Heart Attack — first verified diagnosis | Initial Benefit payment of $30,000 or 100% |
| Kidney Failure – first verified diagnosis, two years later | Initial Benefit payment of $30,000 or 100% |
| Heart Attack — second verified diagnosis, four years later | Recurrence Benefit payment of $30,000 or 100% |
This example is for illustrative purposes only. The MetLife Critical Illness Insurance Policy and Certificate are the governing documents with respect to all matters of insurance, including coverage for specific illnesses. The specific facts of each claim must be evaluated in conjunction with the provisions of the applicable Policy and Certificate to determine coverage in each individual case.
Documents
All Benefit Levels include Social Security Disability Advocacy and Advisory Service (DAS)1, which can be initiated regardless of the outcome of a submitted Critical Illness claim filed with MetLife. To determine if your critical illness and disability qualify for Disability Advocacy Services through SSDC, call SSDC Services Corp. at 866-587-2853.7
Insurance Rates
MetLife offers group rates and payment of premium through payroll deduction, so you don’t have to worry about writing a check or missing a payment! Your employee rates are outlined below.
Monthly Premium per $10,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $0.86 | $1.82 | $1.68 | $2.64 |
| 25–29 | $1.24 | $2.51 | $2.05 | $3.33 |
| 30–34 | $2.07 | $4.33 | $2.89 | $5.05 |
| 35–39 | $3.20 | $6.65 | $4.02 | $7.47 |
| 40–44 | $5.44 | $11.12 | $6.18 | $11.97 |
| 45–49 | $8.26 | $16.88 | $9.10 | $17.72 |
| 50–54 | $12.72 | $25.35 | $13.60 | $26.24 |
| 55–59 | $18.34 | $36.43 | $19.11 | $37.33 |
| 60–64 | $26.93 | $53.65 | $27.81 | $54.48 |
| 65–69 | $39.14 | $76.09 | $39.93 | $76.96 |
| 70+ | $58.64 | $115.59 | $59.53 | $116.46 |
Monthly Premium per $15,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $1.26 | $2.67 | $2.48 | $3.89 |
| 25–29 | $1.79 | $3.66 | $3.00 | $4.88 |
| 30–34 | $3.02 | $6.28 | $4.24 | $7.35 |
| 35–39 | $4.70 | $9.70 | $5.92 | $10.92 |
| 40–44 | $8.04 | $16.32 | $9.13 | $17.57 |
| 45–49 | $12.26 | $24.88 | $13.50 | $26.12 |
| 50–54 | $18.87 | $37.50 | $20.15 | $38.79 |
| 55–59 | $27.19 | $53.73 | $28.31 | $55.03 |
| 60–64 | $40.03 | $79.40 | $41.31 | $80.58 |
| 65–69 | $58.69 | $114.09 | $59.83 | $115.36 |
| 70-74 | $87.94 | $173.34 | $89.23 | $174.61 |
Monthly Premium per $20,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $1.66 | $3.52 | $3.28 | $5.14 |
| 25–29 | $2.34 | $4.81 | $3.95 | $6.43 |
| 30–34 | $3.97 | $8.23 | $5.59 | $9.65 |
| 35–39 | $6.20 | $12.75 | $7.82 | $14.37 |
| 40–44 | $10.64 | $21.52 | $12.08 | $23.17 |
| 45–49 | $16.26 | $32.88 | $17.90 | $34.52 |
| 50–54 | $25.02 | $49.65 | $26.70 | $51.34 |
| 55–59 | $36.04 | $71.03 | $37.51 | $72.73 |
| 60–64 | $53.13 | $105.15 | $54.81 | $106.68 |
| 65–69 | $78.24 | $152.09 | $79.73 | $153.76 |
| 70-74 | $117.24 | $231.09 | $118.93 | $232.76 |
Monthly Premium per $25,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $2.06 | $4.37 | $4.08 | $6.39 |
| 25–29 | $2.89 | $5.96 | $4.90 | $7.89 |
| 30–34 | $4.92 | $10.18 | $6.94 | $11.95 |
| 35–39 | $7.70 | $15.80 | $9.72 | $17.82 |
| 40–44 | $13.24 | $26.72 | $15.03 | $28.77 |
| 45–49 | $20.26 | $40.88 | $22.30 | $42.92 |
| 50–54 | $31.17 | $61.80 | $33.25 | $63.89 |
| 55–59 | $44.89 | $88.33 | $46.71 | $90.43 |
| 60–64 | $66.23 | $130.90 | $68.31 | $132.78 |
| 65–69 | $97.79 | $190.09 | $99.63 | $192.16 |
| 70-74 | $146.54 | $288.84 | $148.63 | $290.91 |
Monthly Premium per $30,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $2.46 | $5.22 | $4.88 | $7.64 |
| 25–29 | $3.44 | $7.11 | $5.85 | $9.53 |
| 30–34 | $5.87 | $12.13 | $8.29 | $14.25 |
| 35–39 | $9.20 | $18.85 | $11.62 | $21.27 |
| 40–44 | $15.84 | $31.92 | $17.98 | $34.37 |
| 45–49 | $24.26 | $48.88 | $26.70 | $51.32 |
| 50–54 | $37.32 | $73.95 | $39.80 | $76.44 |
| 55–59 | $53.74 | $105.63 | $55.91 | $108.13 |
| 60–64 | $79.33 | $156.65 | $81.81 | $158.88 |
| 65–69 | $117.34 | $228.09 | $119.53 | $230.56 |
| 70-74 | $175.84 | $346.59 | $178.33 | $349.06 |
Monthly Premium per $40,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $3.26 | $6.92 | $6.48 | $10.14 |
| 25–29 | $4.54 | $9.41 | $7.75 | $12.63 |
| 30–34 | $7.77 | $16.03 | $10.99 | $18.85 |
| 35–39 | $12.20 | $24.95 | $15.42 | $28.17 |
| 40–44 | $21.04 | $42.32 | $23.88 | $45.57 |
| 45–49 | $32.26 | $64.88 | $35.50 | $68.12 |
| 50–54 | $49.62 | $98.25 | $52.90 | $101.54 |
| 55–59 | $71.44 | $140.23 | $74.31 | $143.53 |
| 60–64 | $105.53 | $208.15 | $108.81 | $211.08 |
| 65–69 | $156.44 | $304.09 | $159.33 | $307.36 |
| 70-74 | $234.44 | $462.09 | $237.73 | $465.36 |
Monthly Premium per $50,000 of Coverage
| Age | Employee Only | Employee + Spouse | Employee + Children | Employee + Spouse + Children |
|---|---|---|---|---|
| <25 | $4.06 | $8.62 | $8.08 | $12.64 |
| 25–29 | $5.64 | $11.71 | $9.65 | $15.73 |
| 30–34 | $9.67 | $19.93 | $13.69 | $23.45 |
| 35–39 | $15.20 | $31.05 | $19.22 | $35.07 |
| 40–44 | $26.24 | $52.72 | $29.78 | $56.77 |
| 45–49 | $40.26 | $80.88 | $44.30 | $84.92 |
| 50–54 | $61.92 | $122.55 | $66.00 | $126.64 |
| 55–59 | $89.14 | $174.83 | $92.71 | $178.93 |
| 60–64 | $131.73 | $259.65 | $135.81 | $263.28 |
| 65–69 | $195.54 | $380.09 | $199.13 | $384.16 |
| 70-74 | $293.04 | $577.59 | $297.13 | $581.66 |
Rates will increase when a Covered Person reaches a new age band. Rates are subject to change.
Help protect your health
You can never be fully prepared for a major illness. But with critical illness insurance, you can be financially prepared.
1 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents to be covered 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.
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 Review the Disclosure Document or Outline of Coverage/Disclosure Document for information on which Covered Condition may be eligible for a Recurrence Benefit. There may be a Benefit Suspension Period between recurrences of the same Covered Condition, as well as occurrences of different Covered Conditions. There may be a limitation on the number of Recurrence Benefits payable per Covered Condition. We will not pay a benefit for a Covered Condition that is subject to a Benefit Suspension Period. If a Recurrence Benefit is payable for a Cancer Covered Condition, we will not pay such benefit unless the Covered Person has not had symptoms of or been treated for the same cancer for which we paid a benefit during the Treatment Free Period.
5 Eligible Family Members means all persons eligible for coverage as defined in the Certificate.
6 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative.
7 Social Security Disability Advocacy and Advisory Services (DAS) are provided by SSDC Services Corp. SSDC Services Corp. is not affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife. The Social Security Disability Advocacy and Advisory Service (DAS) Benefit is provided to employees enrolled in the Critical Illness or Personal Accident insurance you purchase. These services are provided by SSDC Services Corp., and DAS is a subscription service available to employees enrolled in the Critical Illness or Personal Accident insurance you purchase. The services are provided by SSDC Services Corp., and DAS is a subscription service available in all 50 states and is not subject to insurance regulations.
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 vary by state. There may be a preexisting condition exclusion. There may be a Benefit Reduction Due to Age provision. There may be a Benefit Suspension Period between recurrences of the same Covered Condition or occurrences of different Covered Conditions. MetLife offers CII on both an Attained Age basis, where rates will increase when a Covered Person reaches a new age band, and an Issue Age basis, where rates will not increase due to age. Rates are subject to change. MetLife reserves the right to raise premium rates for Issue Age CII on a class-wide basis. A more detailed description of the benefits, limitations, and exclusions applicable to MetLife’s CII product 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 GPNP07-CI, GPNP09-CI, GPNP10-CI, GPNP14-CI, GPNP19-CI or contact MetLife for more information. Please 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.