Critical Illness Insurance

Critical illness insurance provides a lump sum payment to help provide you and your family financial support in a difficult time.

What is Critical Illness insurance?

MetLife Critical Illness Insurance provides a lump-sum payment if you or a covered family member is diagnosed with a serious illness. Critical Illness insurance works to complement your medical coverage – and pays in addition to what your medical plan may or may not cover. Caregivers must have medical coverage in order to be eligible for this benefit. It’s coverage that provides financial support when you or a loved one becomes seriously ill. Upon diagnosis, it provides you with a lump-sum payment of $10,000, $20,000 or $30,000 in initial benefits. The payment you receive is yours to spend however you like.

Your plan includes a Total Benefit Amount of 5 times the Initial Benefit Amount you select, $50,000, $100,000 or $150,000. The Total Benefit Amount is the maximum amount MetLife will pay for any and all Covered Conditions, combined, per person, per lifetime.

Why is having Critical Illness insurance so important?

When a serious illness happens to you or a loved one, this coverage provides you with a lump-sum benefit of your choice of either $10,000, $20,000 or $30,000 in Initial Benefits upon diagnosis. The Total Benefit Amount available to you is 5 times the Initial Benefit Amount you select, $50,000, $100,000 or $150,000 in the event that you suffer more than one Covered Condition. Payment(s) you receive will be made in addition to any other insurance you may have and may be spent as you see fit.

Your family’s expenses will continue if and when a critical illness occurs. Studies show that some families spend as much as $14,444 or more during a time of critical illness and recovery.¹ And while financial experts recommend having 3–9 months of living expenses set aside to help in an emergency situation² like undergoing a serious illness, with today’s economy, most families don’t have that kind of money in reserve. Help protect yourself, your family, and your budget from the financial impact of a critical illness.

Quality health and disability income insurance plans aren’t always enough. There may still be coverage gaps. Disability income plans cover a portion of your income while health insurance may leave you with some expenses to pay including:

Health plan deductibles
Out-of-network treatments
Prescription copays
Alternative treatments

Plus, your plan includes a health screening benefit! Click here for more details.

How can having MetLife Critical Illness Insurance benefit you and your loved ones?

MetLife Critical Illness Insurance provides a lump-sum payment if you or a covered family member⁴is diagnosed with one of the following medical conditions and meets the policy and certificate requirements:

What is covered?

Full Benefit Cancer,⁵Partial Benefit Cancer,⁵Heart Attack, Stroke,⁶Coronary Artery Bypass Graft,⁷Kidney Failure, Alzheimer’s disease,⁸Major Organ Transplant and the 16 Listed Conditions.⁹Your plan pays a Recurrence 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.¹⁰

Your Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition. Your plan pays a Recurrence Benefit² for the following Covered Conditions: Full Benefit Cancer, Partial Benefit Cancer, Heart Attack, Stroke, and Coronary Artery Bypass Graft. A Recurrence Benefit is only available if an Initial Benefit has been paid for the Covered Conditions.

Please refer to the table below for the percentage benefit amount for each Covered Condition.

Covered to Conditions	Initial Benefit	Recurrence Benefit
Full Benefit Cancer³	100% Benefit Amount	100% Benefit Amount
Partial Benefit Cancer³	25% Benefit Amount	25% Benefit Amount
Heart Attack	100% Benefit Amount	100% Benefit Amount
Stroke⁴	100% Benefit Amount	100% Benefit Amount
Coronary Artery Bypass Graft	100% Benefit Amount	100% Benefit Aount
Kidney Failure	100% Benefit Amount	None
Major Organ Transplant Benefit	100% Benefit Amount	None
Alzheimer’s Disease⁵	100% Benefit Amount	None
16 Listed Conditions	25% Benefit Amount	None
Health Screening Benefit	$50 Per Year	None

16 Listed Conditions⁶

MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount when a covered person is diagnosed with one of the 16 Listed Conditions. A Covered Person may only receive one benefit payment for a Listed Condition in his/her lifetime. Refer to your Certificate or Outline of Coverage for Listed Conditions with Recurrence Benefits. The Listed Conditions are: Addison’s disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou Gehrig’s disease); Huntington’s disease (Huntington’s chorea); Legionnaire’s disease; malaria; multiple sclerosis (definitive diagnosis); myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis.

Why should I enroll now?

Competitive group rates
Your acceptance is guaranteed providing you are actively at work.¹¹
Rates will not increase due to age.¹²
Convenient payroll deduction
Portable coverage enables you to take it with you if your employment status changes.¹³

Monthly Premium per $1,000 of Coverage (Non-Smoker)

Issue Age Caregiver	Caregiver Only	Caregiver + Spouse/Domestic Partner	Caregiver + Child(ren)	Caregiver + Family
<25	$0.15	$0.30	$0.27	$0.42
25–29	$0.16	$0.34	$0.28	$0.46
30–34	$0.23	$0.49	$0.35	$0.60
35–39	$0.32	$0.71	$0.44	$0.83
40–44	$0.48	$1.08	$0.60	$1.19
45–49	$0.70	$1.58	$0.81	$1.70
50–54	$0.97	$2.27	$1.09	$2.38
55–59	$1.33	$3.21	$1.45	$3.33
60–64	$1.91	$4.70	$2.03	$4.82
65–69	$2.87	$7.07	$2.99	$7.19
70+	$4.46	$10.62	$4.58	$10.74

Monthly Premium per $1,000 of Coverage(Smoker)

Issue Age Caregiver	Caregiver Only	Caregiver + Spouse/Domestic Partner	Caregiver + Child(ren)	Caregiver + Family
<25	$0.20	$0.41	$0.32	$0.52
25–29	$0.22	$0.47	$0.34	$0.59
30–34	$0.34	$0.72	$0.46	$0.84
35–39	$0.50	$1.10	$0.62	$1.22
40–44	$0.79	$1.74	$0.90	$1.86
45–49	$1.17	$2.63	$1.29	$2.75
50–54	$1.66	$3.85	$1.77	$3.97
55–59	$2.30	$5.54	$2.42	$5.66
60–64	$3.33	$8.20	$3.45	$8.32
65–69	$5.03	$12.45	$5.15	$12.56
70+	$7.88	$18.80	$8.00	$18.92

Rate Calculation Example

Karen, age 57, elected $20,000 Critical Illness coverage for herself and her family. Karen does not smoke or use tobacco.

Non-tobacco rate, age 57: $3.33 per $1,000 coverage

Calculation for $20,000 coverage: $3.33 x 20 = $66.60 per month

¹ MetLife Accident and Critical Illness Impact Study, October 2013.

² www.bankrate.com, How big should your emergency fund be?, Accessed May 2017.

³ e-personalFinance.com, How Does Critical Illness Insurance Work, Accessed March 2014.

⁴ Eligible Family Members mean all persons eligible for coverage as defined in the Certificate.

⁵ 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. For NH sitused groups and NH residents, there is an initial benefit of $100 for All Other Cancer.

⁶ In certain states, the Covered Condition is Severe Stroke.

⁷ In NJ sitused cases. the Covered Condition is Coronary Artery Disease.

⁸ Please review the Outline of Coverage for specific information about Alzheimer’s disease.

⁹ MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount when a covered person is diagnosed with one of the 16 Listed Conditions. A Covered Person may only receive one benefit payment of a Listed Condition in his/her lifetime. The Listed Conditions are: Addison’s disease (adrenal hypofunction); amyotrophic lateral sclerosis (Lou Gehrig’s disease); Huntington’s disease (Huntington’s chorea); Legionnaire’s disease; malaria; multiple sclerosis (definitive diagnosis); myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis.

¹⁰ 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 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.

¹¹ Coverage is guaranteed provided (1) the employee is actively at work and (2) any dependents to be covered are not under medical restriction as described in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the Armed Forces or living overseas.

¹² The plan is guaranteed renewable, and may not be canceled due to an increase in your age or a change in your health. Premium rates can only be raised as the result of a rate change made on a class-wide basis. Benefit reduces by 25% at age 65 and 50% at age 70. Coverage is guaranteed renewable provided: (1) premiums are paid as required under the Certificate; and (2) in a situation where the Group Policy ends, it is not replaced by a substantially similar critical illness policy as described in the Certificate.

¹³ Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative.

¹⁴ 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 sitused in CA and MT.

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. Product features and availability may vary by state. In most plans, there is a pre-existing condition exclusion. In most states, after a covered condition occurs there is a benefit suspension period during which benefits will not be paid for a recurrence. MetLife’s Issue Age CII product is guaranteed renewable, and may be subject to benefit reductions that begin at age 65. 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 that increase’s 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 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 GPNP14-CI or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In New York, availability of MetLife's Issue Age CII product is pending regulatory approval.

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. ADF# CI798.15

Critical Illness Insurance