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PLAN DESIGNOTHER BENEFITSRATESEXCLUSIONS

Benefit for Covered Conditions
Initial Benefit
Recurrence Benefit
Full Benefit Cancer2 100% of Benefit Amount 50% of Benefit Amount
Partial Benefit Cancer2 25% of Benefit Amount 12.5% of Benefit Amount
Heart Attack15 100% of Benefit Amount 50% of Benefit Amount
Kidney Failure 100% of Benefit Amount NONE
Stroke3 100% of Benefit Amount 50% of Benefit Amount
Benefit Suspension Period9 After a covered condition occurs there is a 365 days Benefit Suspension Period during which the plan does not pay Recurrence benefits.  The Benefit Suspension Period does not apply to first occurrences of distinct covered conditions.
We will not pay Recurrence benefits for Full Benefit Cancer or Partial Benefit Cancer benefits unless the insured has not been treated nor had symptoms for at least 180 days.

Plan is not available in Alaska, Colorado, Guam, Louisiana, Maine, New Hampshire, Oregon, Texas, Utah, Vermont, Washington.

Health Screen Benefits

You’re likely already getting one of these health screenings annually, so why not receive a benefit for doing so?

With MetLife’s Health Screening Benefit, available with MetLife’s critical illness insurance, you’ll receive $50 each calendar year you take one of the covered screenings or tests.
·         physical exam ·         flexible sigmoidoscopy
·         biopsies for cancer ·         hemoccult stool specimen
·         blood test to determine total cholesterol ·         hemoglobin A1C
·         blood test to determine triglycerides ·         human papillomavirus (HPV) vaccination
·         bone marrow testing ·         lipid panel
·         breast Magnetic Resonance Imaging ·         mammogram
·         breast ultrasound ·         oral cancer screening
·         breast sonogram ·         pap smears or thin prep pap test
·         cancer antigen 15-3 blood test for breast cancer (CA 15-3) ·         prostate-specific antigen (PSA) test
·         cancer antigen 125 blood test for ovarian cancer (CA 125) ·         serum cholesterol test to determine LDL and HDL levels
·         carcinoembryonic antigen blood test for colon cancer (CEA) ·         serum protein electrophoresis
·         carotid Doppler ·         skin cancer biopsy
·         chest X-rays ·         skin cancer screening
·         clinical testicular exam ·         skin exam
·         colonoscopy ·         stress test on bicycle or treadmill
·         digital rectal exam (DRE) ·         successful completion of smoking cessation program
·         Doppler screening for cancer ·         tests for sexually transmitted infections (STIs)
·         Doppler screening for peripheral vascular disease ·         thermography
·         Echocardiogram ·         two hour post-load plasma glucose test
·         electrocardiogram (EKG) ·         ultrasounds for cancer detection
·         endoscopy ·         ultrasound screening of the abdominal aorta for abdominal aortic aneurysms

Click Here to read your Outline of Coverage.

Click Here to see A Shoppers Guide to Cancer Insurance.

$5,000 benefit rates

Monthly Premium for $5,000 of Coverage
Attained Age Member Only Member + Spouse/ Domestic Partner Member + Children Member + Spouse/Domestic Partner + Children
<25 $2.65 $5.20 $4.00 $6.55
25–29 $2.80 $5.55 $4.10 $6.90
30–34 $3.45 $6.75 $4.75 $8.10
35–39 $3.75 $7.55 $5.10 $8.90
40–44 $4.50 $9.20 $5.85 $10.55
45–49 $6.50 $13.55 $7.85 $14.85
50–54 $9.20 $19.60 $10.50 $20.90
55–59 $12.75 $27.60 $14.10 $28.90
60–64 $17.05 $37.30 $18.35 $38.55
65–69 $22.90 $51.00 $24.25 $52.35

$10,000 benefit rates

Monthly Premium for $10,000 of Coverage
Attained Age Member Only Member + Spouse/Domestic Partner Member + Children Member + Spouse/ Domestic Partner + Children
<25 $5.30 $10.40 $8.00 $13.10
25–29 $5.60 $11.10 $8.20 $13.80
30–34 $6.90 $13.50 $9.50 $16.20
35–39 $7.50 $15.10 $10.20 $17.80
40–44 $9.00 $18.40 $11.70 $21.10
45–49 $13.00 $27.10 $15.70 $29.70
50–54 $18.40 $39.20 $21.00 $41.80
55–59 $25.50 $55.20 $28.20 $57.80
60–64 $34.10 $74.60 $36.70 $77.10
65–69 $45.80 $102.00 $48.50 $104.70

$15,000 benefit rates

Monthly Premium for $15,000 of Coverage
Attained Age Member Only Member + Spouse/Domestic Partner Member + Children Member + Spouse /Domestic Partner + Children
<25 $7.95 $15.60 $12.00 $19.65
25–29 $8.40 $16.65 $12.30 $20.70
30–34 $10.35 $20.25 $14.25 $24.30
35–39 $11.25 $22.65 $15.30 $26.70
40–44 $13.50 $27.60 $17.55 $31.65
45–49 $19.50 $40.65 $23.55 $44.55
50–54 $27.60 $58.80 $31.50 $62.70
55–59 $38.25 $82.80 $42.30 $86.70
60–64 $51.15 $111.90 $55.05 $115.65
65–69 $68.70 $153.00 $72.75 $157.05

Rates are based on 5-year age bands and will increase when a Covered Person reaches a new age band.  Rates are subject to change.  Please refer to the Disclosure Statement or Outline of Coverage/Disclosure Document for more information including the exclusions and limitations which apply to coverage.


Termination Age

Coverage terminates at age 70.

Member Eligibility
  • Members must be under age 60 to enroll
  • Members must not be subject to any medical restrictions as set forth on the enrollment form and in the Certificate.
  • A member must be enrolled for coverage for their Spouse / Domestic Partner13 and / or Dependent Child(ren)14 to be eligible for coverage. Child(ren) are eligible for coverage from birth to age 26.
  • Spouses / domestic partners13 and dependent child(ren)14 must not be subject to any medical restrictions as set forth on the enrollment form and in the Certificate.


Exclusions may vary by state. Click Here to read your Outline of Coverage.

Exclusions:

We will not pay benefits for a Verified Diagnosis of Full Benefit Cancer for:

  • any condition that is Partial Benefit Cancer;
  • any benign tumor, dysplasia, intraepithelial neoplasia or pre-malignant growth;
  • any papillary tumor of the bladder classified as Ta under TNM Staging;
  • any tumor of the prostate classified as T1N0M0 under TNM Staging;
  • any papillary tumor of the thyroid that is classified as T1N0M0 or less under TNM Staging and is one centimeter or less in diameter unless there is metastasis;
  • any cancer in the presence of human immuno-deficiency virus (HIV) for which there is a known increased risk due to the presence of Acquired Immune Deficiency Syndrome (AIDS) or the presence of HIV;
  • any non-melanoma skin cancer unless there is metastasis; or
  • any malignant tumor classified as less than T1N0M0 under TNM Staging. We will not pay benefits for a Diagnosis of Partial Benefit Cancer for:
  • any benign tumor, dysplasia, intraepithelial neoplasia or pre-malignant growth;
  • any papillary tumor of the bladder classified as Ta under TNM Staging;
  • any tumor of the prostate classified as T1aN0M0 under TNM Staging;
  • any papillary tumor of the thyroid that is classified as T1N0M0 or less under TNM Staging and is one centimeter or less in diameter;
  • any cancer in the presence of human immuno-deficiency virus (HIV) for which there is a known increased risk due to the presence of Acquired Immune Deficiency Syndrome (AIDS) or the presence of HIV;
  • any non-melanoma skin cancer; or
  • any melanoma in situ classified as TisN0M0 under TNM Staging. We will not pay benefits for a Diagnosis of Stroke for:
  • cerebral symptoms due to migraine;
  • cerebral injury resulting from trauma or hypoxia; or
  • vascular disease affecting the eye or optic nerve or vestibular functions.
General Exclusions:

We will not pay benefits for covered conditions caused by, contributed to by, or resulting from a covered person:

  • participating in a felony, riot or insurrection;
  • intentionally causing a self-inflicted injury;
  • committing or attempting to commit suicide while sane or insane;
  • voluntarily taking or using any drug, medication or sedative unless it is:
    • taken or used as prescribed by a physician;
    • an “over the counter” drug, medication or sedative taken according to package directions;
  • engaging in an illegal occupation; or
  • serving in the armed forces or any auxiliary unit of the armed forces of any country.

We will not pay benefits for covered conditions arising from war or any act of war, even if war is not declared.

We will not pay benefits for any covered condition for which diagnosis is made outside the United States, unless the diagnosis is confirmed in the United States, in which case the covered condition will be deemed to occur on the date the diagnosis is made outside the United States.

Other Exclusions:

Exclusion for Intoxication

We will not pay benefits for any covered condition that is caused by, contributed to by, or results from a covered person’s involvement in an incident, where such covered person is intoxicated at the time of the incident and is the operator of a vehicle involved in the incident.

Intoxicated means that the covered person’s alcohol level met or exceeded the level that creates a legal presumption of intoxication under the laws of the jurisdiction in which the incident happened.

Preexisting Condition Exclusion

A preexisting condition is a sickness or injury for which, in the 3 months before a covered person becomes insured under a certificate, or before any Benefit Increase with respect to such covered person:

  • medical advice, treatment or care was sought by such covered person, or recommended by, prescribed by or received from a physician or other practitioner of the healing arts; or
  • symptoms, or any medical or physical conditions existed that would cause an ordinarily prudent person to seek diagnosis, care or treatment.

We will not pay benefits for a covered condition that is caused by or results from a preexisting condition if the covered condition occurs during the first 6 months that a covered person is insured under the Certificate.

With respect to a Benefit Increase, we will not pay benefits for such Benefit Increase for a covered condition that is caused by or results from a preexisting condition if the covered condition occurs during the first 6 months after such increase in the Total Benefit Amount.

LIMITATIONS
Reduction of Benefits On Account of Prior Claims Paid

We will reduce what we pay for a claim so that the amount we pay, when combined with amounts for all claims we have previously paid for the same covered person, does not exceed the Total Benefit Amount that was in effect for that covered person on the date of the most recent Covered Condition. This provision does not apply to claim payments for Supplemental Benefits.

Questions?

What’s covered under this plan?

If you meet the group policy and certificate requirements, critical illness insurance provides you with a lump-sum payment upon verified diagnosis of these conditions:

•               Full Benefit Cancer2 •         Stroke3 •         Alzheimer’s Disease5
•               Partial Benefit Cancer2 •         Kidney Failure •         Major Organ Transplant6
•               Heart Attack15 •     Coronary Artery
Bypass Graft7		 •         22 Listed Conditions8 (see your Outline of Coverage for details)

What happens if I have a recurrence?

Your plan pays an additional benefit (Recurrence Benefit) if a medical condition reoccurs for: a Heart Attack, a Stroke, a Coronary Artery Bypass Graft, Full Benefit Cancer, and Partial Benefit Cancer. A recurrence benefit is only available if the initial benefit has already been paid for the covered condition. And there is a benefit suspension period (or waiting period) between recurrences.9

Am I eligible to enroll for this coverage?

Yes, you can enroll both yourself and your eligible family members.10 All you need to do is enroll while an active member of NFICA.

I have a medical plan at work, so why do I need critical illness insurance?

One of the hardest parts of managing illnesses like Cancer, a Heart Attack, or a Stroke is providing the support and comfort your family needs beyond the cost of care. Even the best medical and disability income plans can leave you with extra expenses like medical plan deductibles and co-pays or extra costs for out-of-network care. And if you’re out of work because of a disability, it is possible that only a portion of pre-disability income is being paid to you. Many people aren’t prepared to handle these extra costs, so having this extra cash lump sum payment may mean less worry for you and your family.

Can I enroll for this insurance without having a medical exam?

Yes. Your critical illness coverage is guaranteed,11 regardless of your health. You need to be actively at work to be covered. There are no medical exams to take and no health questions to answer, so the whole process might be easier than you think

Are there any other benefits payable under this critical illness insurance plan?

Yes. Early detection of a serious illness is important to your recovery. We provide you with a $50 annual benefit per calendar year when you see your physician for covered health screenings or prevention measures.12

How much will it cost?

Critical illness insurance may be more affordable than you think. It’s designed to be a way to supplement your health care and disability plans. Exact rates are displayed in the rate tab above.

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

Benefits will be paid directly to you, not to the doctors, to the hospitals or to any other health care providers. There’s no need to coordinate with any other insurance you may have. Benefits are paid no matter what your other insurance plans may cover or pay.

If my membership status changes, can I take my coverage with me?

Your coverage will end if your NFICA membership isn’t active.

Is the claims process simple?

Yes. Once we’ve received all the necessary information, claims are generally processed within 10 business days 4. www.metlife.com/mybenefits

1Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.
2Please 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 cases and NH residents, there is an initial benefit of $100 for All Other Cancer.
3In certain states, the Covered Condition is Severe Stroke.
4Applies only to “clean” claims. A clean claim is a claim submitted with all the required information necessary to process the claim; no missing information requiring additional follow up with the subscriber. It generally takes 10 business days to process “clean” claims.
5Please review the Outline of Coverage for specific information about Alzheimer’s disease.
6MetLife offers several different product variations.  For certain products, the Major Organ Transplant Benefit is included within the Total Benefit Amount.  With others, the benefit is payable in addition to the Total Benefit Amount.  Please contact MetLife for additional information.
7In NJ-sitused cases, the Covered Condition is Coronary Artery Disease.
8MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount when a covered person is diagnosed with one of the 22 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); 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.
9We 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 a 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.
10Eligible Family Members means all persons eligible for coverage as defined in the Certificate.
11Coverage is guaranteed provided you are a NFICA member and 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.
12 The Health Screening Benefit may not be available in all states.
13Coverage for Domestic Partners, civil union partners and reciprocal beneficiaries varies by state. Please contact MetLife for more information.
14Dependent Child coverage varies by state. Please contact MetLife for more information.
15The Heart Attack Covered Condition pays a benefit for the occurrence of a myocardial infarction, subject to the terms of the certificate. A myocardial infarction does not include sudden cardiac arrest. In certain states, the Covered Condition is Severe Stroke. 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 cases and NH residents, there is an initial benefit of $100 for All Other Cancer.

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. In most plans, there is a pre-existing condition exclusion. After a covered condition occurs, there is a benefit suspension period during which most plans do not pay recurrence benefits, except in the case of insureds covered under a New York certificate. MetLife offers CII on both an Attained Age and an Issue Age basis. 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. 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 to both Attained Age and Issue Age CII 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 or 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.

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