1. Critical illness insurance – Initial benefit amount
You have a choice of a $10,000, $20,000, or $30,000 Initial Benefit Amount
Your Total Benefit Amount will be 3 times the Initial Benefit Amount you selected
You can receive Initial and Recurrence Benefit1 payments until your Total Benefit Amount is reached
Example of Initial & Recurrence Benefit Payments2
The example below illustrates an employee who elected an Initial Benefit of $20,000
and has a Total Benefit Amount of 3 times (or 300%) of the Initial Benefit Amount or $60,000.
Illness – Covered Condition
Payment
Total Benefit Remaining
Heart Attack – first diagnosis
Initial Benefit payment of $20,000
$20,000
Heart Attack – second diagnosis, two years later
Recurrence Benefit payment of $10,000
$10,000
Kidney Failure – first diagnosis, three years later
Initial Benefit Payment of $10,000
Let’s see how the coverage really works. When you enroll for coverage, you select an Initial Benefit Amount of $20,000.
If you are diagnosed with one of the Covered Conditions and meet all the group certificate requirements, you will receive a lump-sum benefit payment equal to the Initial Benefit Amount. In addition, you can also receive a Recurrence Benefit for certain covered conditions, including 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.
MetLife will pay Initial Benefits and Recurrence Benefits until the Total Benefit Amount has been reached.
The example on the chart illustrates an employee who elected an Initial Benefit of $20,000 and has a Total Benefit of 300% or $60,000. See how the employee received several lump-sum payment at different times when he was enrolled for Critical Illness Insurance coverage.
1We 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.
2This example is for illustrative purposes only.  The MetLife Critical Illness Insurance Policy and Certificate are the governing documents with respect to all matters of insurance, including coverage for specific illnesses.  The specific facts of each claim must be evaluated in conjunction with the provisions of the applicable Policy and Certificate to determine coverage in each individual case.

2. Critical illness insurance – Claim scenario
Example Coverage: $30,000 initial benefit with a 3x total benefit amount of $90,000.
Illness — Covered Condition
Benefit
Paid
Total Benefit Remaining
Lung Cancer – initial diagnosis
$30,000
$60,000
Lung Cancer – second diagnosis, two years later (recurrence)
$15,000
$45,000
Heart Attack – first diagnosis, three years later. MetLife will pay out the total benefit amount remaining ($10,000)
Total Benefit Paid
$75,000
To give you a better understanding of this coverage, let’s run through a claim example…
Jeanette receives an initial diagnosis of lung cancer, receives treatment, and is eventually cancer free.
Two years later she is diagnosed with a recurrence of cancer and must undergo additional treatments. Once again she is deemed cancer free after completing treatments.
Three years later Jeanette experiences a heart attack, but recovers and survives.
Her primary doctor is now keeping a close watch over her overall health. Depending on their health insurance, Jeanette’s out-of-pocket costs could run into hundreds or thousands of dollars to cover expenses like insurance co-payments and deductibles. Critical Illness Insurance payments can be used to help cover these unexpected costs.
Depending on her health insurance, expenses like co-pays and deductibles for an event like this could cost Jeanette hundreds of dollars!
Note that the benefit amount in this claim example is based on a sample MetLife High plan design. Actual plan design and plan benefits may vary.
Jeanette
Mother of two and a cancer survivor.
Benefit amount is based on a sample MetLife plan design.
Actual plan design and plan benefits may vary.