NASE Benefit Details

Critical Illness Insurance - $5,000

Receive $5,000 of Critical Illness insurance in each of three categories as part of your NASE Gold Membership!

As an NASE Gold Member, you will receive $5,000 of MetLife Critical Illness Insurance as part of your association membership. You can receive the $5,000 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

 

 

Heart Transplant

 

 

*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 your NASE Gold Membership, you receive a category benefit amount of $5,000.

*       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 covered conditions in different categories. The benefit suspension period starts when a covered condition occurs. MetLife will not pay a benefit for another covered condition that occurs during this period if it is in a different category than the covered condition experienced at the start of the benefit suspension period.  If a covered condition in a different category first occurs during the benefit suspension period, the next occurrence of the covered condition outside of the benefit suspension period will be treated as a first occurrence.  The benefit suspension period does not apply within categories.

Category Benefit Example

The following is a payment example for a $5,000 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 = $5,000. 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 = $1,250. 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 $5,000 = $3,750. 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 = $5,000. 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 $5,000, it is possible to receive a total of $15,000. This is the maximum amount that you could get under a certificate with a $5,000 category benefit amount.

This example is for illustrative purposes only.  The MetLife Critical 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.

Coverage Features:

*       NASE Critical Illness Insurance complements traditional medical coverage and disability income coverage

*       No waiting period

*       No pre-existing condition exclusion

*       Lump-sum benefit payment to use as you see fit.

*       Additional occurrence benefit

*       No need to submit expense receipts

*       Age limitations vary by state (see state specific certificate)

Critical Illness Insurance Availability

MetLife Critical Illness Insurance coverage for NASE Gold Members in all states will be subject to the applicable legal requirements of each state.  Coverage is not currently available in all states.

If you have questions or wish to obtain more information about this benefit please call 800-232-6273.

Metropolitan Life Insurance Company, New York, NY.

L0212236921[exp0413]All States

 

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The benefits explained herein are offered at the sole discretion of the association and may vary by availability, vendor and state of residence of the member. Vendors reserve the right to withdraw or change their offers without notice. The association makes no affirmation of fact or promise relating to the goods and services, and specifically disclaims any warranty, expressed or implied, as to the merchantability of the goods and services reflected. To be entitled to the association benefits, you must be a member in good standing and dues must be paid current.