Critical Illness

Here's what you need to know

What it does for you
Why it's important
When you can enroll
Forms & resources

Critical Illness Insurance helps provide financial support if diagnosed with a covered critical illness.

If you’re diagnosed with a critical illness like a heart attack or stroke, your life can change quickly. In addition to the emotional and physical toll, there may be strain on your personal finances. That’s because while a major medical plan may pay for some of the costs associated with treatment, out-of-pocket expenses like co-pays and deductibles can still put a strain on your savings.

However, once you’re enrolled in Critical Illness Insurance, you’ll have additional financial protection if you have a covered critical illness. With this policy, you receive cash benefits paid directly to you (unless otherwise assigned) to use however you choose.

Gives a payment to use however you see fit
The payment is made directly to you (unless otherwise assigned)
It can help pay out-of-pocket expenses related to medical care associated with covered illnesses
In addition to medical care, you may use it to pay for things like childcare, lodging, or over-the-counter medication

This payment is in addition to your employer’s major medical plan – and in addition to any other type of medical coverage, disability insurance, or other benefits you may be eligible for or collect. However, it is NOT a substitute for these coverages and does not meet minimum essential coverage as defined by federal law.

Dealing with a critical illness can be costly to you in 2 ways:

Medical Bills. It’s not unusual for a critical illness to result in out-of-pocket expenses. It starts with the usual, deductibles and copays, but it doesn’t end there. You might decide to go to a doctor or facility that’s “out of network.” You might decide to get a second opinion or type of treatment that isn’t covered at all. When your health is at stake, it's important to feel like you have control and choices.
Lost Income. Treatment and focus on recovery may require extra time away from work. That can impact the paycheck your family may rely on to keep everything on track. Or you might discover you have added expenses because you need more help around the house, extra childcare, or additional lodging near treatment. These costs can subtract from your wages or savings.

The advantage of this insurance is simple: you can use your critical illness benefit any way you choose. You can use it to help pay for medical expenses like deductibles and copays, as well as any non-medical expenses. You can also use this money to help pay daily living expenses such as grocery bills, mortgage payments, childcare, and transportation – all of which can be an added worry if you lose income while you’re out of work.

Access to this benefit helps you more control over your finances and ultimately your health care options, too. Less stress about money and added peace of mind are both great ways to support your recovery.

These are the periods when you are eligible to enroll for Critical Illness Insurance:

Within your new hire enrollment period
If you have a qualifying life event (you get married, have a baby, etc.)
During your employer’s annual enrollment

Check with your employer’s human resources/benefits team for specifics about these timeframes.

Keep in mind: If you enroll during these timeframes, you have what is called "guaranteed issue," which means you may qualify for Critical Illness Insurance without answering health questions.¹ You must have insurance in place before a covered critical illness occurs in order to be eligible to collect the benefit when you need it.

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

Who is the provider?

MetLife

MetLife is a market leader for the portfolio of coverage options they offer and has been in business for over 136 years. They serve over 24,000 Group Life customers, helping more than 23 million people enjoy an improved sense of financial security.

When is a benefit paid under the policy?

Once your insurance is in effect, you’ll collect benefits for a variety of events related to a covered critical illnesses. These benefits vary by state and may have other limitations and exclusions that may affect what’s payable. Refer to the policy documents for complete details.

Who in my family is eligible for this insurance?
Members of your family who are considered eligible to enroll for insurance include:²
- You – if you are an active employee working 16+ hours per week
- Your spouse – age 18 and older
- Your child(ren) – under age 26
You must be enrolled in Critical Illness Insurance for members of your family to also enroll.

How much does this insurance cost?

This is group insurance offered at group rates. Refer to the plan documents for complete details.

Do I have to answer health questions or take a medical exam?

No, you don’t. If you enroll during your eligible enrollment periods, you have "guaranteed issue," which means you may qualify for insurance without answering health questions.¹

What if my employment status changes?

Good news! If you leave or retire from your current employer, you can continue your Critical Illness Insurance without interruption (subject to applicable law and the policy’s terms and conditions). Although payroll deduction will no longer be available, you can opt for other payment methods such as direct bank account deduction, credit card billing or home billing. Higher rates may apply.

When would my insurance start?

For annual enrollment, coverage is effective on the date shown on the Certificate after the application is received and approved. You must be actively at work on the coverage effective date. For new hires and qualifying life events, coverage is effective the first of the month following the enrollment form approval date, provided the eligibility requirements are met.

Am I really free to use the payment any way I choose?

Yes, you are! There are no restrictions or requirements about how you can use your critical illness cash benefit. When you’re facing a critical illness, you want to be able to focus your time and energy on treatment and recovery. This policy can help you do just that. You’re free to use your benefit on medical expenses and/or non-medical expenses. Having that kind of flexibility can help you feel more in control over your care and your finances at a very stressful time.

Legal Disclaimers

Choose one of the following 2 sets of disclaimers based on the type of policy. In both cases, also include footnote 2 below underneath footnote 1.

If this is a CII 3.5:

¹Coverage 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. [For CA-sitused cases, coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of your job at the employer’s place of business or at an alternate place approved by your employer (2) dependents 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 may apply to dependents serving in the armed forces or living overseas.

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. The plan may include a pre-existing condition exclusion. 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. MetLife offers CII with either Attained Age or Issue Age rates. 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 include a Benefit Reduction Due to Age provision. 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 the initial coverage 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 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, GPNP10-CI, GPNP14-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.

L0823034073[exp0725][All States][DC,GU,MP,PR,VI]

OR

If this is a CI 19:

¹ 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. [For CA-sitused cases, coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of your job at the employer’s place of business or at an alternate place approved by your employer (2) dependents 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.

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 vary by state. There may be a preexisting condition exclusion. There may be a Benefit Reduction Due to Age provision. There may be a Benefit Suspension Period between recurrences of the same Covered Condition or occurrences of different Covered Conditions. MetLife offers CII on both an Attained Age basis, where rates will increase when a Covered Person reaches a new age band, and an Issue Age basis, where rates will not increase due to age. Rates are subject to change. MetLife reserves the right to raise premium rates for Issue Age CII on a class-wide basis. A more detailed description of the benefits, limitations, and exclusions applicable to MetLife’s CII product 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, GPNP10-CI, GPNP14- CI, GPNP19-CI or contact MetLife for more information. Please contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York.

L0823034073[exp0725][All States][DC,GU,MP,PR,VI]

AND

²Eligible Family Members means all persons eligible for coverage as defined in the Certificate.

Mercer's Role & Compensation

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Critical Illness | MetLife

Critical Illness Insurance

Helps you alleviate the expenses that comes with a covered critical illness.

Here's what you need to know

How It Works

Doctor's test results indicate a heart attack diagnosis.

That’s when Critical Illness Insurance comes in.

Frequently Asked Questions

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