Group Critical Illness Insurance

Transcription

1 Group Critical Illness Insurance Critical Illnesses can happen at any age and more often than you might think. MetLife s Critical Illness insurance provides a lump-sum payment if you or a covered family member is diagnosed with one of the following medical conditions and meets the policy and certificate requirements. Payments will be made directly to you, not to the doctors, hospitals or other health care providers. You will receive a check mailed directly to your home. The payment you receive is yours to spend as you see fit. Covered Conditions Initial Benefit Recurrence Benefit Full Benefit Cancer 100% of Initial Benefit 100% of Initial Benefit Partial Benefit Cancer 1 25% of Initial Benefit 25% of Initial Benefit Heart Attack 100% of Initial Benefit 100% of Initial Benefit Stroke 2 100% of Initial Benefit 100% of Initial Benefit Coronary Artery Bypass Graft 3 100% of Initial Benefit Not applicable Kidney Failure 100% of Initial Benefit Not applicable Alzheimer s Disease 4 100% of Initial Benefit Not applicable Major Organ Transplant Benefit 100% of Initial Benefit Not applicable Policy Features Policy Features Benefit Description Recurrence 100% after 180-day suspension period Health Screening [ $50 ] Portability Guaranteed Yes Yes If an insured is diagnosed with another occurrence of certain covered conditions and MetLife has already paid the Initial Benefit for that covered condition, a Recurrence Benefit equal to 100% of the Selected Benefit Amount will be paid. A Recurrence Benefit payment is subject to a 180-day benefit suspension period. MetLife will not pay a Recurrence Benefit for a covered condition that recurs during this period. MetLife will pay the initial benefit amount and a recurrence benefit until the Total Benefit Amount of 300% for each covered person is reached. After your coverage has been in effect for 30 days, MetLife will provide an annual benefit of [ $50 ] per calendar year for taking one of the eligible screening/prevention measures. MetLife will pay only one health screening benefit per covered person per calendar year. Upon separation of employment, this policy can be continued on an individual basis without having to requalify for coverage. During the initial offering, or if you are a new hire, this policy is offered to you on a one time guaranteed issue basis, with no medical questions to answer. CONTINUED >

2 Coverage Options Eligible Individual Initial Benefit Requirements [ $10,000 or $20,000 ] Coverage is guaranteed provided you are actively at work 6 Spouse Coverage is guaranteed provided the employee is actively at work and 100% of the employee s the spouse is not subject to a medical restriction CONTINUED as set forth on > the Initial Benefit enrollment form and in the Certificate 6 Dependent Child(ren) 5 Coverage is guaranteed provided the employee is actively at work and 100% of the employee s the dependent child(ren) is not subject to a medical restriction as set Initial Benefit forth on the enrollment form and in the Certificate 6 Insurance Rates MetLife offers competitive group rates and convenient payroll deduction so you don t have to worry about writing a check or missing a payment! Your employee rates are outlined below. Weekly Spouse/ Spouse/ Semi - Monthly Spouse/ Spouse/ 1 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. 2 In certain states, the covered condition is Severe Stroke. 3 In NJ sitused cases, the Covered Condition is Coronary Artery Disease. 4 Please review the Outline of Coverage for specific information about Alzheimer s Disease. 5 Dependent Child coverage varies by state. Please contact MetLife for more information. 6 Coverage is guaranteed provided (1) the employee is actively at work and (2) 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. Additional restrictions apply to dependents serving in the armed forces or living overseas. 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 vary by state. There is a Benefit Suspension Period between Recurrences. MetLife s CII product is guaranteed renewable, but may be subject to benefit reductions that begin at age 65. Rates are subject to change. MetLife reserves the right to raise premium rates for CII on a class-wide basis. A more detailed description of the benefits, limitations, and exclusions applicable to 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 GPNP14-CI or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife s 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 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. L [exp0916][All States] PEANUTS 2015 Peanuts Worldwide, LLC

3 Group Accident Insurance Off The Job Coverage Accidents can happen at any time and when you least expect them. Today s active lifestyles may make you more susceptible, too. Accident insurance can help you be better prepared by providing you with a payment to use as you see fit if you experience a covered event. There s no waiting periods for coverage to begin and the payment will be in addition to any other insurance you may have. This payment can help you focus more on getting back on track and less on the extra expenses an accident may bring. Below is a list of benefits payable for covered accidents. Please see policy for all benefit definitions, limitations and exclusions. Common Accident Benefits 1 Plan Additional Benefits Included 1 Benefit Amount Non-Emergency Care $100 Broken Tooth Benefit $50-$200 Emergency Care $100 Transportation Benefit $400 Physician Follow-up $50 Inpatient Rehabilitation Unit Benefit 3 $200 per day Ground Ambulance $200 Modification Benefit $1,000 Air Ambulance $750 Prosthetic Device Benefit $750-$1,500 Hospital Admission Benefit 3 (Non-ICU and ICU) $1,000/$2,000 Pain Management Benefit for Epidural Anesthesia $100 Hospital Confinement Benefit 3 (Non-ICU and ICU) $200/$400 per day Cuts/Lacerations $50-$400 Medical Testing Benefit $200 Accidental Death Benefit Amount Medical Appliance Benefit $100-$1,000 Basic Accidental Death Benefit Therapy Services Benefit $25 - $25,000 Inpatient Surgery Benefit $200-$2,000 - Spouse $12,500 Outpatient Ambulatory Surgery $300 - Child(ren) $5,000 Fractures 2 $100-$6,000 2 Accidental Death Common Carrier 4 Dislocations 2 $100-$6, $100,000 Torn Cartilage in Knee Benefit $100-$500 - Spouse $50,000 Torn/Ruptured/Severed Tendon/Ligament Rotator Cuff Benefit Ruptured Disk with Surgical Repair Blood/Plasma/Platelets Benefit $1,000 $100-$750 - Child(ren) $20,000 Dismemberment, Loss & Paralysis Benefit Amount - $250-$2,500 - Spouse $250-$2,500 Concussions $400 - Child(ren) $250-$2,500 Coma Benefit $10,000 Catastrophic Dismemberment/Functional Loss Benefit Additional Benefits Included 1 Benefit Amount - $10,000 Eye Injury Benefit $300 - Spouse $10,000 Second and Third Degree Burns $100-$10,000 - Child(ren) $10,000 Skin Graft Benefit 50% of Burn Benefit Paralysis Benefit Other Plan Features - $5,000 or $10,000 Portability - Spouse $5,000 or $10,000 Guaranteed - Child(ren) $5,000 or $10,000

4 You can t plan for accidents but you can be better prepared financially to handle them when they do happen. Here is an example of how Accident insurance can help you with out of pocket expenses by providing lump sum benefits paid directly to you. Kathy s son, Michael, plays soccer on the varsity high school team. During a recent game, he collided with an opposing player causing him to fall to the ground. He was taken to the local emergency room by ambulance for treatment. The ER doctor diagnosed a forearm fracture and treated his cuts and bruises. He ordered an x-ray and Michael was released to his primary care physician for follow-up treatment. Depending on her health insurance, Kathy s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Accident Insurance payments can be used to help cover these unexpected costs. Covered Event 1 Benefit Amount Ambulance (ground) $200 Emergency Care $100 Physician Follow-Up ($50 x 2) $100 Medical Testing $200 Forearm Fracture $2,500 Cuts/Lacerations $100 Benefits paid by MetLife Group Accident Insurance $3,200 Insurance Rates MetLife offers competitive group rates and convenient payroll deduction so you don t have to worry about writing a check or missing a payment! Your employee rates are outlined below. Type Spouse Spouse/ $2.87 $4.34 $5.50 $7.08 Weekly $6.22 $9.40 $11.93 $15.35 Semi - Monthly 1 Covered services/treatments must be the result of a covered accident as defined in the group policy/certificate. See the Outline of Coverage for more details. 2 Chip fractures are paid at 25% of Fracture Benefit and partial dislocations are paid at 25% of Dislocation Benefit. 3 Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details. 4 Common Carrier refers to airplanes, trains, buses, trolleys, subways and boats. Certain conditions apply. See your Outline of Coverage for specific details. Be sure to review other information contained in this booklet for more details about plan benefits, monthly rates and other terms and conditions. METLIFE'S ACCIDENT INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. There is a preexisting condition exclusion for hospital sickness benefits, if applicable. There are benefit reductions that begin at age 65. And, like most group accident and health insurance policies, polices offered by MetLife contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife s Group Accident Insurance is pending regulatory approval. L [exp0916][All States] PEANUTS 2015 Peanuts Worldwide, LLC 2015 METLIFE, INC. Metropolitan Life Insurance Company, New York, NY 10166

5 MetLaw Smart. Simple. Affordable. For Goodman Manufacturing s $16.50 per month -- covers you, your spouse and dependents. Telephone and office consultations for an unlimited numbers of personal legal matters with an attorney of your E-Services -- Attorney locator, law firm e-panel, law guide, free, downloadable legal documents, financial planning, insurance and work/life resources Estate Planning Documents Simple and Complex Wills Trusts (Revocable and Irrevocable) Powers of Attorney (Healthcare, Financial, Childcare) Healthcare Proxies Living Wills Codicils Document Review Any Personal Legal Documents Family Law Prenuptial Agreement Protection from Domestic Violence Adoption and Legalization Guardianship or Conservatorship Name Change Immigration Assistance Advice and Consultation Review of Immigration Documents Preparation of Affidavits and Powers of Attorney Elder Law Matters Consultations and Document Review for issues related to your parents including Medicare, Medicaid, Prescription Plans, Nursing Home Agreements, leases, notes, deeds, wills and powers of attorney as these affect participant Real Estate Matters Sale, Purchase or Refinancing of Your Primary, Second or Vacation Home Eviction and Tenant Problems (Primary Residence) Home Equity Loans for Your Primary, Second or Vacation Home Zoning Applications Boundary or Title Disputes Property Tax Assessment Security Deposit Assistance (For Tenant) Document Preparation Affidavits Deeds Demand Letters Mortgages Promissory Notes Traffic Offenses* Defense of Traffic Tickets (excludes DUI) Driving Privilege Restoration (Includes License Suspension due to DUI) Personal Property Protection Consultations and Document Review for Personal Property s Assistance for disputes over goods and services Financial Matters Negotiations with Creditors Debt Collection Defense Identity Theft Defense **LifeStages - Identity Management Services Personal Bankruptcy Tax Audit Representation (Municipal, State or Federal) Foreclosure Defense Tax Collection Defense Juvenile Matters Juvenile Court Defense, including Criminal Matters Parental Responsibility Matters Defense of Civil Lawsuits Administrative Hearings Civil Litigation Defense Incompetency Defense School Hearings Pet Liabilities Consumer Protection Disputes over Consumer Goods and Services Small Claims Assistance Family Matters *** Available for an additional fee Separate plan for parents of participants for Estate Planning Documents Easy Enrollment - online or by phone For More Information: Visit our website info.legalplans.com and enter access code: Legal or call our Client Service Center at Monday - Friday from 8 a.m. - 7 p.m. (Eastern Time). Group legal plans and Family Matters provided by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, group legal plans and Family Matters provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. Please contact Hyatt Legal Plans for complete details on covered services including trials. No service, including advice and consultations, will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the employer, MetLife and affiliates, and plan attorneys; 3) matters in which there is a conflict of interest between the employee and spouse or dependents in which case services are excluded for the spouse and dependents; 4) appeals and class actions; 5) farm and business matters, including rental issues when the participant is the landlord; 6) patent, trademark and copyright matters; 7) costs and fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Additional representation is also included for certain matters listed above under Legal Representation. *Not available in all states. ** This benefit provides the Participant with access to LifeStages Identity Management Services provided by IDT911, LLC. IDT911 is not a corporate affiliate of Hyatt Legal Plans. ***For Family Matters, different terms and exclusions apply. ML3 L [exp0916][All States][DC,PR]

6 Rate Sheet - Weekly - MetLife Off Job Accident Policy MetLaw Legal Policy s 18 to 80 $2.87 & Spouse $4.34 & Child(ren) $5.50 Family $7.08 s 18 to 80 Hyatt Legal Plans Family $3.81 Critical Illness Policy with Cancer, Second Event Cancer/Heart Attack/Stroke, $50 Wellness, and no Pre Existing condition waiting period $10,000 ($10,000 for Spouse / coverage) $20,000 ($20,000 for Spouse / coverage) EE EE + SP EE + CH F EE EE + SP EE + CH F <29 $1.02 $2.01 $1.71 $2.70 $2.03 $4.02 $3.42 $ $2.12 $4.04 $2.82 $4.73 $4.25 $8.08 $5.63 $ $5.08 $9.48 $5.77 $10.18 $10.15 $18.97 $11.54 $ $10.43 $19.38 $11.12 $20.08 $20.86 $38.77 $22.25 $ $19.96 $37.20 $20.65 $37.89 $39.92 $74.40 $41.31 $ $31.78 $59.86 $32.47 $60.55 $63.55 $ $64.94 $ Need Further Help? Have a Question? Account Manager: Connie Sprang (800) x3 connie_sprang@ajg.com Policy limitations and exclusions exist. This is not an application for coverage or guarantee of claim payment. Please see policy brochure for all benefits, limitations and exclusions. Where discrepancies exist, policy language will overrule MEDICAID recipients are NOT recommended to participate in coverage

7 Rate Sheet - Semi - Monthly - MetLife Off Job Accident Policy MetLaw Legal Policy s 18 to 80 $6.22 & Spouse $9.40 & Child(ren) $11.93 Family $15.35 s 18 to 80 Hyatt Legal Plans Family $8.25 Critical Illness Policy with Cancer, Second Event Cancer/Heart Attack/Stroke, $50 Wellness, and no Pre Existing condition waiting period $10,000 ($10,000 for Spouse / coverage) $20,000 ($20,000 for Spouse / coverage) EE EE + SP EE + CH F EE EE + SP EE + CH F <29 $2.20 $4.35 $3.70 $5.85 $4.40 $8.70 $7.40 $ $4.60 $8.75 $6.10 $10.25 $9.20 $17.50 $12.20 $ $11.00 $20.55 $12.50 $22.05 $22.00 $41.10 $25.00 $ $22.60 $42.00 $24.10 $43.50 $45.20 $84.00 $48.20 $ $43.25 $80.60 $44.75 $82.10 $86.50 $ $89.50 $ $68.85 $ $70.35 $ $ $ $ $ Need Further Help? Have a Question? Account Manager: Connie Sprang (800) x3 connie_sprang@ajg.com Policy limitations and exclusions exist. This is not an application for coverage or guarantee of claim payment. Please see policy brochure for all benefits, limitations and exclusions. Where discrepancies exist, policy language will overrule MEDICAID recipients are NOT recommended to participate in coverage