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Accident and Health FAQs

I want to learn more about accident insurance.
What types of Accident & Health coverage does MetLife offer?

We offer accident insurance, critical illness insurance, hospital indemnity insurance and cancer insurance to help you and your family be better prepared financially if an accident or serious illness occurs.

Who is eligible to enroll for these products?

If your employer offers this benefit, you and your eligible family members are eligible to enroll for these coverages.1 You just need to enroll during your Enrollment Period and be actively at work for coverage to be effective.

I have a good medical plan at work. Why would I need additional coverage for accidents and illnesses?

Accidents and critical illnesses can happen anytime, to anyone and when you least expect them – and they can be costly. Even quality medical plans can leave you with extra expenses to pay. Costs like plan deductibles, copays for doctor visits and extra costs for out-of-network care can add up fast. Having the financial support you may need when the time comes means less worry for you and your family.

Can I enroll for these insurance plans without having to take a medical exam?

Yes. These coverages are guaranteed issue, which means your acceptance is guaranteed, regardless of your health. You just need to be actively at work for your coverage to be effective.2There are no medical exams to take and no health questions to answer. 

Is there a waiting period before my coverage begins?

No. These supplemental Insurances will be effective on the date of your coverage as long as you are actively at work. There are no waiting periods to satisfy.

Does this plan cover any other out-of-pocket costs?

Yes, you can use your payment as you see fit. Use it to help cover your household bills, medical insurance deductibles, copayments and more.

How do I pay for my supplemental accident or critical illness insurance?

Premiums will be conveniently paid through payroll deduction, so you don't have to worry about writing a check or missing a payment.

Are benefits paid directly to me or to my health care provider?

Payments will be paid directly to you, not to the doctors, hospitals or other health care providers. You will receive a check, payable to you, for maximum convenience.

Is the claims process simple?

Yes. Once all required information is received, claims are generally processed within 10 business days. Only one claim form is needed per accident and every claim is reviewed by a claims professional.

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 and certain states may require the insured to have medical coverage to enroll for the 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. MetLife’s Accident and Hospital Indemnity Insurance may be subject to benefit reductions that begin at age 65. And, like most group accident and health insurance policies, policies offered by MetLife may 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.

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.   In most states, after a covered condition occurs, there is a benefit suspension period during which most plans do not pay recurrence benefits.  MetLife offers CII on both an Attained Age and an Issue Age basis.  Attained Age rates are based on 5-year age bands and will increase when a Covered Person reaches a new age band.  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 that increase’s 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 applicable to both Attained Age and Issue Age CII 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 or GPNP14-CI, or contact MetLife for more information.  Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In New York, availability of MetLife's Issue Age CII product is pending regulatory approval.

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.

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

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. Additional restrictions apply to dependents serving in the armed forces or living overseas. For CII CA sitused cases, coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of the employee's job at the employer's place of business or at an alternate place approved by the employer (2) dependents are not subject to medical restrictions as set forth on the enrollment form and in the Certificate.

ADF# AI-CA-CI-HI1395.16