Critical Illness Insurance

Critical Illness Insurance

Critical Illness Insurance helps you focus on recovery & not on your finances.

What is Critical Illness insurance?

MetLife Critical Illness Insurance provides a lump-sum payment if you or a covered family member1 is diagnosed with a serious illness. Critical illness insurance works to complement your medical coverage—and pays in addition to what your medical plan may or may not cover. It’s coverage that provides financial support when you or a loved one becomes seriously ill. Upon diagnosis, it provides you with a lump-sum payment of $15,000 or $30,000 in initial benefits. The payment you receive is yours to spend however you like.

Quality health and disability income insurance plans aren’t always enough. There may still be coverage gaps. Disability income plans cover a portion of your income while health insurance may leave you with some expenses to pay including:

  • Health plan deductibles
  • Out-of-network treatments
  • Prescription copays
  • Alternative treatments

It’s your money.
Payment of your benefit is made directly to you, not your doctor or hospital. You can spend the money on whatever you choose.

You wouldn’t be denied coverage.
You and your eligible family members are guaranteed9 & coverage, as long as you are actively at work. No medical exam and no hassle.

Less expensive than you think.
Take advantage of employee rates when applying for coverage through your employer.

The enhanced 2022 Critical Illness plan includes:

  • No lifetime maximum for total benefits you may receive under the plan
  • Additional covered conditions
  • Increased benefit amounts
  • Coverage for COVID-19

What is covered?

Your Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition.

Your plan also pays a lump sum Recurrence Benefit6 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. After a covered condition occurs, there is a 90-day Benefit Suspension Period during which the plan does not pay 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 90 days.

New for January 1, 2022: Increased coverage for progressive diseases; Four additional covered childhood diseases: Cleft Lip/Cleft Palate, Diabetes (Type 1), Down Syndrome and Spina Bifida. Please consult your outline of coverage or certificate for proof requirements. Please refer to the table below for the percentage benefit amount for each Covered Condition.

Please refer to the table below for the percentage benefit amount for each Covered Condition. 

Covered Conditions

Initial Benefit Recurrence Benefit
Benign Brain Tumor 100% of Benefit Amount 100% of Initial Benefit
Invasive Cancer 100% of Benefit Amount  100% of Initial Benefit
Non-Invasive Cancer7 25% of Benefit Amount 100% of Initial Benefit
Skin Cancer 5% of Benefit Amount None
Heart Attack 100% of Benefit Amount 100% of Initial Benefit
Stroke8 100% of Benefit Amount 100% of Initial Benefit
Coronary Artery Bypass Graft 100% of Benefit Amount 100% of Initial Benefit
Kidney Failure 100% of Benefit Amount None
Major Organ Transplant Benefit 100% of Benefit Amount None
7 Childhood Diseases 100% of Benefit Amount None
11 Infectious Disease Conditions 25% of Benefit Amount None
11 Progressive Disease Conditions 100% of Benefit Amount None

Listed Conditions6

A Covered Person may only receive one benefit payment for a Listed Condition in his/her lifetime. Refer to your Certificate or Outline of Coverage for additional details. The Listed Conditions are:

  • Childhood Diseases: cerebral palsy, cleft lip of cleft palate, cystic fibrosis, diabetes (type 1), down syndrome, sickle cell anemia, spina bifida
  • Infectious Diseases: bacterial cerebrospinal meningitis, COVID-19, diphtheria, encephalitis, Legionnaire’s disease, malaria, necrotizing fasciitis, osteomyelitis, rabies, tetanus, tuberculosis
  • Progressive Diseases: adrenal hypofunction (Addison’s Disease), amyotrophic lateral sclerosis (Lou Gehrig’s disease), Alzheimer’s, Huntington’s Disease, multiple sclerosis, muscular dystrophy, myasthenia gravis, Parkinson’s (advanced), poliomyelitis, systemic lupus erythematosus (SLE), systemic sclerosis (scleroderma)

Plan Details

Lump sum payment to use as you see fit for yourself and your family

Benefit Payment Example

The example below illustrates an employee who elected an Initial Benefit of $15,000.

Illness – Covered Condition Payment
Heart Attack – first diagnosis Initial Benefit payment of $15,000 or 100%

Heart Attack – second diagnosis, two years later

Recurrence Benefit payment of $15,000 or 100%

Kidney Failure – first diagnosis, three years later

Initial Benefit payment of $15,000 or 100%
Total Benefit Amount (initial and recurrence) $45,000

Covered Family Member mean all persons eligible for coverage as defined in the Certificate.

3 We will not pay a Recurrence Benefit for a Covered Condition that Recurs during a Benefit Suspension Period. We will not pay a Recurrence Benefit for either a Full Benefit Cancer or a Partial Benefit Cancer unless the Covered Person has not had symptoms of or been treated for the Full Benefit Cancer or Partial Benefit Cancer for which we paid an Initial Benefit during the Benefit Suspension Period.

6 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.

7 Please review the Disclosure Statement or Outline of Coverage/Disclosure Document for specific information about cancer benefits. Not all types of cancer are covered.

8 In certain states, the covered condition is Severe Stroke.

9 Coverage is guaranteed provided (1) the employee is actively at work and (2) any dependents to be covered are not under medical restriction as described in the Certificate. Medical coverage is required to enroll. Additional restrictions apply to dependents serving in the armed forces or living overseas.

10 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations.

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. In most states, after a covered condition occurs there is a benefit suspension period during which most plans do not pay recurrence benefits. Attained Age rates are based on 5-year age bands and will increase when a Covered Person reaches a new age band. A more detailed description of the benefits, limitations, and exclusions applicable 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 or GPNP09-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.