Critical Illness Insurance

Critical Illness insurance provides a lump sum payment to provide financial support if you or your covered family member are diagnosed with a covered illness.

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Critical Illness Insurance

Lump sum payment for a covered illness provides support when you or your family may need it most.

Wells Fargo is providing Basic Critical Illness Insurance coverage to all regular and fixed term employees. Optional Critical Illness Insurance is also available.

Emotionally managing illnesses like cancer, a heart attack or stroke is hard enough. Financially managing the costs on top of this is often overwhelming. Critical illness insurance provides a lump sum payment for a covered illness to help you and your family with finances during a difficult time.

  • You’ll receive a lump sum payment 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.
  • Critical illness insurance pays a benefit for a covered illness regardless of what your medical insurance may cover.
  • Payments for a covered illness are made directly to you either by direct deposit or a check made payable to you.

Documents

Sample Basic Critical Illness Certificate

Documents Download (PDF - 379 KB)
Sample Optional Critical Illness Certificate

Documents Download (PDF - 431 KB)
Basic Critical Illness Outline of Coverage

Documents Download (PDF - 2 MB)
Optional Critical Illness Outline of Coverage

Documents Download (PDF - 2 MB)
Critical Illness Disclosures

Documents Download (PDF - 1 MB)
HOW TO ACCESS YOUR CERTIFICATE ONLINE

Documents Download (PDF - 932 KB)

Critical Illness Insurance FAQs

If you are a regular or fixed term Wells Fargo employee, you can enroll both yourself and your eligible family members during your initial enrollment period or during Annual Benefits Enrollment.  If you live in MN, ND, TX or MT eligible family member includes eligible grandchildren.

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

One of the hardest parts of managing illnesses like Cancer, Heart Attack, or Stroke is providing the support and comfort your family needs beyond the cost of care.  Even the best medical plans have associated expenses that you’ll likely have to pay for, such as deductibles and copays or coinsurance. In addition, you may have other expenses you need to pay for such as childcare, household assistance, or transportation costs. So, having extra financial support for a covered illness may mean less worry for you and your family.

In certain states, the Covered Condition is Severe Stroke.

Yes, if you are a regular or fixed term Wells Fargo employee, you can enroll in Critical Illness Insurance, regardless of your health status. There are no medical exams to take and no health questions to answer.

Your plan pays an additional benefit (Recurrence Benefit) if a medical condition reoccurs for certain covered conditions as defined by your state specific Certificate of Insurance. A recurrence benefit is only available if the initial benefit has already been paid for the covered condition. And there is a benefit suspension period (or waiting period) between recurrences.2

Payments for a covered illness are made directly to you either by direct deposit or a check made payable to you.

MetLife considers Critical Illness Insurance to be “accident or health insurance” for purposes of Federal income tax. Thus, in general the taxation of benefits paid under such insurance differs depending on the premium mode, as described below. 

For employee paid Critical Illness plan, because all premiums are paid by the employee on an after-tax basis, benefit payments are tax-free in accordance with Section 104(a)(3) of the Internal Revenue Code of 1986, (as amended (the “Code”) and as a result, MetLife does not tax report such amounts to you or the IRS. 

For the employer paid Critical Illness plan, since premium is paid on a pre-tax basis the benefit payments are generally taxable under Section 105(a) of the Code unless the benefit is used to reimburse the individual for medical care expenses in accordance with Section 105(b) of the Code. Since MetLife’s products have not historically tied benefit amounts to actual charges for medical care nor do recipients customarily inform MetLife of the manner in which such benefit amounts are directed, MetLife is unaware whether benefits are used for out of pocket medical expenses. As a result, MetLife will issue an IRS Form 1099-Misc to the payee and the IRS when benefits paid exceed $600. 

By tax-reporting benefits in this manner, MetLife believes that each employee is in the best position to determine how much of the benefit payment in excess of their out of pocket medical care expenses must be included as ordinary income on their personal income tax return for that year. MetLife is not permitted to provide tax or legal advice so we recommend that our customers consult with a tax or legal professional as to their particular situation.

As long as you are actively at work, your enrollment in the coverage is guaranteed.1 You would be eligible to receive benefits if a recurrence of the same form of cancer or critical illness is diagnosed while coverage is in force. You are not eligible to receive benefits in connection with conditions that are diagnosed before the coverage effective date. With respect to cancer or benign tumor conditions, in order to establish that it is a new diagnosis, you must be symptom free and not receiving treatment or care from a physician in connection with the prior diagnosis.2

1 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents are not subject to medical restrictions as set forth on the enrollment materials and in the Certificate. Some states may require the insured to have medical coverage.

2 Please review the Outline of Coverage for information on which Covered Conditions are eligible for a Recurrence Benefit. There is a Benefit Suspension Period between recurrences of the same 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 Benign Brain Tumor or Cancer Covered Condition, we will not pay such benefit unless the covered person has not had symptoms of or been treated for the same tumor or cancer for which we paid a benefit during the Treatment Free Period.

CRITICAL ILLNESS INSURANCE (CII) FROM METLIFE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. Like most group accident and health insurance policies, CII policies offered by MetLife contain certain exclusions, limitations and terms for keeping them in force. Product features and availability may vary by state. 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 individuals covered under a New York certificate. 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. For complete details of coverage and availability, please contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. 

Critical Illness Insurance from MetLife is not intended to be a substitute for medical coverage providing benefits for medical treatment, including hospital, surgical and medical expenses. Critical Illness Insurance offered by MetLife does not provide reimbursement for such expenses.