Critical Illness Insurance
Critical Illness Insurance pays a benefit if you or a covered family member is diagnosed with a listed medical condition.
The following information and benefits chart have been supplied by MetLife to describe their Critical Illness Insurance Plan.
Critical Illness Insurance can help safeguard your finances by providing you with a lump sum payment. This payment is yours to spend as you see fit and is in addition to any other insurance you may have. Critical Illness Insurance pays a benefit if you or a covered family member is diagnosed with one of the listed medical conditions below and meets the policy and certificate requirements.
Coverage Options
| Eligible Individual | Initial Benefit | Requirements |
|---|---|---|
| Associate | $10,000 or $20,000 | Coverage is guaranteed provided you are actively at work. |
| Spouse/Domestic Partner1 | 50% of the Associate’s Initial Benefit | Coverage is guaranteed provided you are actively at work and the spouse/domestic partner is not subject to a medical restriction as set forth in the Certificate of coverage. |
| Dependent Child(ren) | 50% of the Associate’s Initial Benefit | Coverage is guaranteed provided you are actively at work and the dependent is not subject to a medical restriction as set forth on the enrollment form and in the Certificate of coverage. |
Benefit Payment
Your Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition. Your plan pays a Recurrence Benefit1 equal to the Initial Benefit for the following Covered Conditions: Heart Attack, Stroke, Coronary Artery Bypass Graft, Full Benefit Cancer and Partial Benefit Cancer. A Recurrence Benefit is only available if an Initial Benefit has been paid for the Covered Condition. There is a Benefit Suspension Period between Recurrences.
The maximum amount that you can receive through your Critical Illness Insurance plan is called the Total Benefit and is 3 times the amount of your Initial Benefit. This means that you can receive multiple Initial Benefit and Recurrence Benefit payments until you reach the maximum of 300% or $30,000 or $60,000.
Please refer to the table below for the percentage benefit amount for each Covered Condition.
| Covered Conditions | Initial Benefit | Recurrence Benefit |
|---|---|---|
| Full Benefit Cancer2 | 100% of Initial Benefit | 100% of Initial Benefit |
| Partial Benefit Cancer2 | 25% of Initial Benefit | 25% of Initial Benefit |
| Heart Attack | 100% of Initial Benefit | 100% of Initial Benefit |
| Stroke3 | 100% of Initial Benefit | 100% of Initial Benefit |
| Coronary Artery Bypass Graft | 100% of Initial Benefit | 100% of Initial Benefit |
| Kidney Failure | 100% of Initial Benefit | Not applicable |
| Alzheimer’s Disease4 | 100% of Initial Benefit | Not applicable |
| Major Organ Transplant Benefit | 100% of Initial Benefit | Not applicable |
| 22 Listed Conditions | 25% of Initial Benefit | Not applicable |
22 Listed Conditions
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.
1 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.
2 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.
3 In certain states, the covered condition is Severe Stroke.
4 Please review the Outline of Coverage for specific information about Alzheimer’s disease.
Health Screening
After your coverage has been in effect for thirty days, MetLife will provide an annual benefit of $50 per calendar year for taking one of the eligible screening/prevention measures. MetLife will pay only one health screening benefit per covered person per calendar year. For a complete list of eligible screening/prevention measures, please refer to the Outline of Coverage and Disclosures.
You may cancel this coverage at any time during the year by emailing benefits@choc.org. Upon termination of employment, this coverage ends on the date of termination.
METLIFE’S 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. In most plans, there is a pre-existing condition exclusion. 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 to CII can be found in the Outline of Coverage and Disclosures. For complete details of coverage and availability, please refer to the Outline of Coverage or contact MetLife.
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.
