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MetLife Critical Illness Insurance (CII) is a new member benefit designed to complement but not replace your current medical coverage. The coverage pays a lump-sum benefit if you experience one of the covered conditions within three distinct categories as defined on the certificate: certain cancer-related conditions, certain heart-related conditions and certain other conditions. You may use this lump-sum payment as you see fit to help keep your finances on track by paying for some of the expenses associated with a covered condition.
Premier Member: As a NASE Premier Member, you will receive $1,000 of MetLife Critical Illness Insurance as part of your association membership. You can receive the $1,000 benefit payment in each of the three different categories.
If you experience one of the covered conditions within any category and meet all the group policy and certificate requirements, you will receive a lump-sum benefit payment that you can use as you see fit. The payment can be used on anything from co-pays and deductibles to utility bills and rehabilitation.
What Are The Covered Conditions?
MetLife Critical Illness Insurance covers the following medical conditions and groups them into three distinct categories (as defined by the group certificate):
Category 1 incorporates certain cancer-related conditions Category 2 incorporates certain heart-related conditions Category 3 incorporates certain other conditions
| Category 1—cancer-related |
Category 2—heart-related |
Category 3—other conditions |
| Full Benefit Cancer |
Heart Attack |
Major Organ Transplant |
| Partial Benefit Cancer* |
Stroke+ |
(other than bone marrow and heart) |
| Bone Marrow Transplant |
Coronary Artery Bypass Graft* |
Kidney Failure |
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Heart Transplant |
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*For some types of cancer and a coronary artery bypass graft, you will receive 25% of the category benefit amount. The remaining 75% is available within that category should the covered individual experience another one of the covered conditions in that category while the certificate is in force.
+In certain states, the condition is severe stroke.
Can You Explain How Payments Within Each Category Occur?
You can receive benefit payments in three different categories:
Through the NASE, you will receive a category benefit amount of $1,000. If you are diagnosed with a covered condition in any of the three categories (cancer, heart, other) and meet the policy and certificate requirements, you will receive a lump-sum benefit payment. Covered condition must occur after the date of membership. The lump-sum benefit payment works like this:
For Coronary Artery Bypass Graft and Partial Benefit Cancer, you will receive 25% of the category benefit amount. The remaining 75% will be available should you experience another covered condition within the same category. For all other covered conditions, you will receive 100% of the category benefit amount provided that you have not received a partial benefit payment for a covered condition in that same category.** After 100% of any category benefit amount has been paid, that category will close and you will not receive additional payments for any other covered conditions within that category.
If you are later diagnosed with any other covered condition that falls within one of the two remaining categories, you can receive another lump-sum benefit payment for that category.** Once 100% of the category benefit amount has been paid in each of the three categories, the coverage is terminated.
**There is a 180-day benefit suspension period between diagnosed conditions in different Categories. The benefit suspension period starts when a covered condition occurs. The benefit suspension period does not apply within categories. MetLife will not pay a benefit for another covered condition that occurs during this period if it is in a different category. If a covered condition first occurs during the benefit suspension period, the next occurrence of the covered condition will be treated as a first occurrence.
Category Benefit Example
The following is a payment example for a $1,000 maximum category benefit payment where all group policy and certificate requirements for coverage have been met:
| You are diagnosed as having lung cancer. |
MetLife would pay 100% of the maximum category benefit amount for Category 1 = $1,000. This would terminate your coverage for all Category 1 – Cancer-Related conditions. You are still eligible for benefits for covered conditions in Categories 2 and 3. |
| Two years later, you have a coronary artery bypass graft. |
MetLife would pay 25% of the maximum benefit amount for Category 2 = $250. You would still have 75% of the maximum benefit amount to use if you experience another Category 2 – Heart Related condition. |
| Then, the following year, you suffer a debilitating stroke. |
MetLife would pay the remaining 75% of the maximum category benefit amount for Category 2 = 75% of $1,000 = $750. This would terminate your coverage for all Category 2 –Heart-Related conditions. You are still eligible for benefits for covered conditions in Category 3 – other conditions. |
| Three years later, you have kidney failure. |
MetLife would pay 100% of the maximum category benefit amount for Category 3 = $1,000. Since you have exhausted 100% of the category benefit amounts in each of the three categories, the coverage is terminated. |
| The above example illustrates that during the life of the Critical Illness Insurance certificate with a category benefit amount of $1,000, it is possible to receive a total of $3,000. This is the maximum amount that you could get under a certificate with a $1,000 category benefit amount. |
Policy Features:
Complements traditional medical coverage and disability income coverage Lump-sum benefit payment to use as you see fit. Additional occurrence benefit No need to submit expense receipts No pre-existing condition exclusion No waiting period
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