Nationwide

Here's what you need to know

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

Critical Illness Insurance from Nationwide^® 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
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

You can elect this benefit in addition to other coverage you have, including your employer’s major medical plan, any other type of medical coverage, disability insurance, or other benefits you may be eligible to enroll in. However, it is NOT health insurance and does not satisfy the requirement of minimum essential coverage under 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 30-day new hire enrollment period
Within 60 days of a qualifying life event (you get married, have a baby, etc.)
During your employer’s open enrollment

This is group insurance offered at group rates. Your premium is conveniently deducted from your paycheck. See the below Rate Chart.

Critical Illness Insurance Rates

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

Critical Illness Insurance Certificate

Critical Illness Insurance Claim Form

Critical Illness Insurance Flyer

Critical Illness Insurance Portability Form

What is Critical Illness Insurance?

Critical Illness coverage provides you with a lump-sum payment if you or your covered dependent are diagnosed with a major illness such as a heart attack, stroke, cancer, major organ transplant or end-stage renal (kidney) disease. You have the option to choose a $20,000 or $10,000 benefit. If you elect coverage for yourself, you can also choose to cover your spouse and children at 50% of your benefit amount.

Payments are made directly to you to use as you see fit. They can be used to help pay for major medical costs, such as deductibles or coinsurance, or other expenses such as house payments, utility bills, or transportation costs.

When is a benefit paid under the plan?

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

Who in my family is eligible for this plan?
Members of your family who are considered eligible to enroll for this insurance include:
- You — if you are an active associate working a minimum of 19.375 hours per week and Actively at Work on your effective date of insurance.¹ Benefits terminate at the end of the calendar year in which you turn 70.
- Your spouse — Age 18-70. Benefits terminate at the end of the calendar year in which the spouse turns age 70.
- Your child(ren) — newborn to age 26. Benefits terminate at the end of the calendar year in which the child turns age 26.
You must be enrolled in coverage for members of your family to also enroll.

I have a good medical plan through work. Why do I need Critical Illness Insurance?

Even quality medical plans can leave you with unexpected expenses when you are diagnosed with a major illness. Costs like plan deductibles, copays and coinsurance for doctor and emergency room care, testing and supplies, and extra costs for out-of-network care may not be covered. Many people aren’t financially prepared to handle these extra costs. If you have an HSA, you can use your critical illness benefits to pay for out of pocket medical expenses and save your HSA funds for future use. Having extra financial support if the time comes may mean less worry for you and your family, and will give you the ability to protect your savings and focus on your recovery.

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

Am I eligible for coverage if I have an existing medical condition?

No benefits are payable if the first diagnosis or procedure for a covered critical illness occurs prior to the effective date of your initial coverage or increase in coverage. A pre-existing limitation does apply to the plan. No benefits are payable due to a pre-existing condition if the date of diagnosis or date of procedure occurs within 12 months after the person's effective date. A pre-existing condition is any disease or physical condition for which symptoms existed, treatment or medical advice is received, medication was prescribed, or other care or services were received within 12 months prior to the person's effective date.

What if my employment status changes?

If you (the associate) terminate employment for reasons other than disability or retirement, you may be eligible to continue your and your covered dependents’ coverage under the portability provision. To elect portability, you and your covered dependents must be under the age of 65 and have been covered under the Critical Illness plan for at least 12 months. You must elect the portability provision for yourself in order for your dependents to be covered. To apply for the portability provision, please contact Member Services at 877-717-4455.

Is the claims process simple?

Yes. Just complete the Critical Illness claim form and submit for processing. Once all required information is received, claims are generally processed within 10 business days from the date that all information is received to process the claim. Every claim is reviewed by a claim professional. Claim forms can be found under Forms and resources.

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

For maximum convenience, payments will be paid directly to you, not to the doctors, hospitals, or other health care providers. There is no coordination of benefits with any other insurance, which means you will receive the full benefit payment of the plan regardless of any other coverage you may have.

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. If 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.

Do You Need Help?

Our team is ready

M-F 9a-8p ET

Phone Number: 1-877-229-5254

Email
employerbenefitsinquiries.service@mercer.com

Legal Disclaimers

¹Actively at Work means that you are performing services for Nationwide Insurance, or its affiliate, for any portion of the scheduled work day or using Your Time. Actively at Work does not include periods when you are on emergency leave, Leave of Absence, military leave (unless otherwise required by USERRA), unpaid leave, or other similar absence, whether paid or unpaid. In addition, Actively at Work does not include any period of time when you are on “unassigned” status, as defined by Nationwide’s formal policy, unless the individual is scheduled to work at least 19.375 hours per week during the duration of the unassigned status period. Further, if you are participating in a partial return-to-work program, you will not be considered Actively at Work, even if you perform services for Nationwide for a portion of the day.

This is an outline of benefits. Limitations and exclusions apply. Please refer to the Certificate of Coverage for more details.

The product is underwritten by Nationwide Life Insurance Company, Columbus, Ohio. Critical Illness coverage is applicable to policy form GCI AO L20 000 1119.

Nationwide, the Nationwide N and Eagle and Nationwide is on your side are service marks of Nationwide Mutual Insurance Company. © 2024 Nationwide NSM-0355AO.2 (09/24)

Mercer's Role & Compensation

Critical Illness | Nationwide

Critical Illness Insurance

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

Here's what you need to know

How It Works

Doctor's test results indicate a heart attack diagnosis.

Doctor's test results indicate a heart attack diagnosis.

That’s when Critical Illness Insurance comes in.

Frequently Asked Questions

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