As an NASE Gold Member, you will receive $5,000 of MetLife Critical Illness Insurance as part of your association membership. You can receive a $5,000 benefit payment in each of three distinct categories, as defined by the group certificate.
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 of $5,000 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
Cancer-Related |
Category 2
Heart-Related |
Category 3
Other Conditions |
| Full Benefit Cancer2 |
Heart Attack5 |
Major Organ Transplant1
(other than bone marrow and heart) |
| Partial Benefit Cancer2 |
Severe Stroke3 |
Kidney Failure |
| Bone Marrow Transplant |
Coronary Artery Bypass Graft2,4 |
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Heart Transplant |
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1MetLife offers several different product variations. For certain products, the Major Organ Transplant Benefit is included with the Total Benefit Amount. With others, the benefit is payable in addition to the Total Benefit Amount. Please contact MetLife for additional information.
2For some types of cancer and Coronary Artery Disease, the insured may be eligible to receive 25% of the Category Benefit Amount. In certain states, the Covered Condition is Coronary Artery Bypass Graft. Not all Cancers are covered.
3In certain states, the condition is sever stroke.
4In NY and NJ sitused cases, the Covered Condition is Coronary Artery Disease.
5The 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 most states, we will not pay a Major Organ Transplant benefit if a covered person is placed on the organ transplant list prior to coverage taking effect and subsequently undergoes a transplant procedure for the same organ while coverage is in effect. Covered organs may vary by state; refer to the Certificate for details.
Can You Explain How Payments of $5,000 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 of $5,000. 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 category6.
- 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 of $5,000 for that category6.
- There is a Total Benefit Amount of $15,000. That means that once 100% of the category benefit amount has been paid in each of the three categories, the coverage is terminated.
6There 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% ($1,250) of the maximum benefit amount for Category 2 of $5,000. 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.
This 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. 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 $6,000. This is the maximum amount that you could get under a certificate with a $5,000 category benefit amount.
Coverage Features
- NASE Critical Illness Insurance supplements 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.
- No need to submit expense receipts7
- Age limitations vary by state (see state specific certificate)
7See your certificate for proof requirements.
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.
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