CRITICAL ILLNESS INSURANCE
A valuable benefit included when you elect the MMO PPO/HSA Plan
Need to submit a claim? See the simple instructions at the bottom of this page.
The Diocese will continue to package Critical illness insurance with the MMO PPO/HSA plan. There is no added charge to you as this coverage has been embedded into the design of the plan.
If you are paid a benefit under the critical illness insurance, the money can be used for ANY purpose, and does not have to be deposited into your HSA. This important benefit may reduce the need to withdraw money from your HSA if you are stricken by a covered medical condition, many of which can be very costly.
The critical illness Insurance will pay a lump sum of up to $12,000 to individuals (employees or covered family members) in the event of a covered serious, costly medical event such as a heart attack, kidney failure or major organ transplant, among others. Here’s a chart that shows how it works:
RESOURCES
| COVERED CONDITIONS | INITIAL BENEFIT (1st Occurrence After Effective Date) | RECURRENCE BENEFIT |
| Full Benefit Cancer | 100% of $12,000 Benefit Amount | 100% |
| Partial Benefit Cancer | 25% of $12,000 Benefit Amount | 25% |
| Heart Attack | 100% of $12,000 Benefit Amount | 100% |
| Stroke | 100% of $12,000 Benefit Amount | 100% |
| Coronary Artery Bypass Graft | 100% of $12,000 Benefit Amount | 100% |
| Kidney Failure | 100% of $12,000 Benefit Amount | NONE |
| Alzheimer’s Disease | 100% of $12,000 Benefit Amount | NONE |
| Major Organ Transplant | 100% of $12,000 Benefit Amount | NONE |
| 22 Additional Listed Conditions* | 25% of $12,000 Benefit Amount | NONE |
*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.
NOTE: There is a $36,000 lifetime maximum benefit per person.
The Critical Illness Insurance Also Has These Important Features:
Guaranteed Acceptance – When you enroll in the MMO PPO/HSA plan you and your eligible family members are covered – no health questions, no medical exams and no hassle.
Portable – Your critical illness insurance will be made available on a direct bill basis if your employment terminates or you retire. You can take it with you at the same low group rate that was available when you were covered under the Diocesan plan.
Coverage for Spouse and Children – When enrolled in the MMO PPO/HSA plan your spouse and children who are covered by the health plan are also covered by the critical illness insurance.
Payments Made Directly to You – You decide how to spend the money — for medical expenses not covered by your medical plan like deductibles — or for non-medical expenses like extra household bills, childcare, or home modifications that might have resulted from your illness.
The critical illness insurance is underwritten by Metropolitan Life Insurance Company, New York, New York. Like most insurance this policy contains certain exclusions and limitations.
Click HERE for a more detailed summary.
Submitting a claim is as easy as 1-2-3:
- Call 1-800-GET-MET8 (1-866-626-3705) to request a claim form. MetLife can’t process your claim without completed form.
- Once received, answer some questions and have your physician complete and sign the Physician Statement. The claim cannot be processed without the physician form completed.
- Mail or Fax both forms back to:
Critical Illness Insurance Products
P.O. Box 80826
Lincoln, NE 68501-0826
Fax: 1-855-306-7350
