MetLife’s Critical Illness Insurance pays a lump-sum benefit if you are diagnosed with a covered illness or condition on or after your coverage effective date. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. *Critical Illness is referred to as Specified Disease in some states.
Associates will be offered a choice of $10,000, $20,000 or $30,000 Guaranteed Issue Coverage. Your Spouse/Domestic Partner and child(ren) will be offered 100% of your associate benefit amount. Benefits are paid directly to the associate based on flat schedule (not reimbursement) and there is no coordination with other insurance coverage. An assignment of benefits to a hospital or healthcare facility will be available when required by applicable law.
22 Additional Covered 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 adrenal hypofunction (Addison’s disease); 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.
Health Screening Benefit
The Health Screening Benefit is not available in all states. See your certificate for any applicable waiting periods. There is a separate mammogram benefit for MT residents and for cases situated in CA and MT.
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| Benefits for Covered Conditions | Initial Benefit | Recurrence Benefit |
|---|---|---|
| Alzheimer’s | 100% of benefit amount | not applicable/td> |
| Coronary Artery Bypass Graft | 100% of benefit amount | 100% of benefit amount |
| Full Benefit Cancer | 100% of benefit amount | 100% of benefit amount |
| Partial Benefit Cancer | 25% of benefit amount | 25% of benefit amount |
| Heart Attack | 100% of benefit amount | 100% of benefit amount |
| Kidney Failure | 100% of benefit amount | not applicable |
| Major Organ Transplant | 100% of benefit amount | not applicable |
| Stroke | 100% of benefit amount | 100% of benefit amount |
| 22 Listed Conditions | 100% of benefit amount | not applicable |
Effective immediately, 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 Disclosure Statement/Outline of Coverage.