Mid-America Apartment Communities
Critical Illness Insurance Plan Summary
COVERAGE OPTIONS
Critical Illness Insurance
Eligible Individual
Initial Benefit
Requirements
Employee
$10,000 or $20,000
Coverage is guaranteed provided you are actively at work. 3
Spouse/Domestic Partner 1
50% of the employee’s Initial Benefit
Coverage is guaranteed provided the employee is actively at work and the spouse/domestic partner is not subject to a medical restriction as set forth on the enrollment form and in the Certificate. 3 Coverage is guaranteed provided the employee is actively at work and the dependent is not subject to a medical restriction as set forth on the enrollment form and in the Certificate. 3
Dependent Child(ren) 2
50% of the employee’s Initial Benefit
BENEFIT PAYMENT Your Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition. Your plan pays a Recurrence Benefit 4 for the following Covered Conditions: 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. The maximum amount that you can receive through your Critical Illness Insurance plan is called the Total Benefit and is 3 times the amount of your Initial Benefit. This means that you can receive multiple Initial Benefit and Recurrence Benefit payments until you reach the maximum of 300% or $30,000 or $60,000.
Please refer to the table below for the percentage benefit amount for each Covered Condition.
Covered Conditions
Initial Benefit
Recurrence Benefit 50% of Initial Benefit
Full Benefit Cancer 5
100% of Initial Benefit
Partial Benefit Cancer 5
25% of Initial Benefit
12.5% of Initial Benefit
Heart Attack
100% of Initial Benefit
50% of Initial Benefit
Stroke 6
100% of Initial Benefit
50% of Initial Benefit
Coronary Artery Bypass Graft 7
100% of Initial Benefit
50% of Initial Benefit
Kidney Failure
100% of Initial Benefit
Not applicable
Alzheimer’s Disease 8
100% of Initial Benefit
Not applicable
Major Organ Transplant Benefit
100% of Initial Benefit
Not applicable
22 Listed Conditions
25% of Initial Benefit
Not applicable
22 Listed Conditions MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount when a covered person is diagnosed with one of the 22 Listed Conditions. A Covered Person may only receive one benefit payment for one Listed Condition in his/her lifetime. The Listed Conditions are 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.
ADF# CI1851.18
Example of Initial & Recurrence Benefit Payments The example below illustrates an employee who elected an Initial Benefit of $20,000 and has a Total Benefit of 3 times the Initial Benefit Amount or $60,000.
Illness – Covered Condition
Payment
Total Benefit Remaining
Initial Benefit payment of $20,000 or 100%
Heart Attack – first diagnosis
$40,000
Heart Attack – second diagnosis, two years later Kidney Failure – first diagnosis, three years later
Recurrence Benefit payment of $10,000 or 50%
$30,000
Initial Benefit payment of $20,000 or 100%
$10,000
In most states there is a preexisting condition limitation. If advice, treatment or care was sought, recommended, prescribed or received during the three months prior to the effective date of coverage, we will not pay benefits if the covered condition occurs during the first six months of coverage. The preexisting condition limitation does not apply to heart attack or stroke. SUPPLEMENTAL BENEFITS MetLife provides coverage for the Supplemental Benefits listed below. This coverage would be in addition to the Total Benefit Amount payable for the previously mentioned Covered Conditions. Health Screening Benefit 10 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. Eligible screening/prevention measures may include:
annual physical exam biopsies for cancer
• flexible sigmoidoscopy • hemoccult stool specimen
•
•
blood test to determine total cholesterol blood test to determine triglycerides
• hemoglobin A1C
•
• human papillomavirus (HPV) vaccination
•
bone marrow testing
• lipid panel
•
breast MRI
• mammogram
•
breast ultrasound breast sonogram
• oral cancer screening
•
• pap smears or thin prep pap test • prostate-specific antigen (PSA) test
•
• cancer antigen 15-3 blood test for breast cancer (CA 15-3) • cancer antigen 125 blood test for ovarian cancer (CA 125) • carcinoembryonic antigen blood test for colon cancer (CEA)
• serum cholesterol test to determine LDL and HDL levels
• serum protein electrophoresis
carotid doppler
• skin cancer biopsy • skin cancer screening
•
chest x-rays
•
clinical testicular exam
• skin exam
•
colonoscopy
• stress test on bicycle or treadmill
•
digital rectal exam (DRE) Doppler screening for cancer
• successful completion of smoking cessation program • tests for sexually transmitted infections (STIs)
•
•
• Doppler screening for peripheral vascular disease
• thermography
echocardiogram
• two hour post-load plasma glucose test • ultrasounds for cancer detection • ultrasound screening of the abdominal aorta for abdominal aortic aneurysms
•
electrocardiogram (EKG)
•
endoscopy
•
• fasting blood glucose test • fasting plasma glucose test
• virtual colonoscopy
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.
Monthly Premium/$1,000 of Coverage (Tobacco)
Attained Age
Employee Only
Employee + Spouse
Employee + Children
Employee + Spouse + Children
<25
$0.33
$0.58
$0.58
$0.83
25–29
$0.36 $0.50 $0.73 $1.11 $1.70 $2.52 $3.59 $5.21
$0.61 $0.83 $1.16 $1.74 $2.62 $3.83 $5.42 $7.83
$0.61 $0.75 $0.98 $1.36 $1.95 $2.77 $3.84 $5.47
$0.86 $1.08 $1.41 $1.99 $2.87 $4.09 $5.67 $8.08
30–34 35–39 40–44 45–49 50–54 55–59 60–64
65–69
$7.95
$11.89 $17.97
$8.20
$12.14 $18.22
70+
$12.02
$12.28
Monthly Premium/$1,000 of Coverage (Non-Tobacco)
Attained Age
Employee Only
Employee + Spouse
Employee + Children
Employee + Spouse + Children
<25
$0.27 $0.28 $0.37 $0.50 $0.72 $1.06 $1.52 $2.12 $3.03 $4.56
$0.48 $0.50 $0.63 $0.82 $1.15 $1.65 $2.34 $3.23 $4.59 $6.85
$0.52 $0.53 $0.62 $0.75 $0.97 $1.31 $1.77 $2.37 $3.28 $4.81
$0.73 $0.75 $0.88 $1.07 $1.40 $1.90 $2.59 $3.48 $4.84 $7.10
25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69
70+
$6.83
$10.24
$7.08
$10.49
QUESTIONS & ANSWERS
How do I enroll? Enroll for coverage at mybenefits.metlife.com.
Who is eligible to enroll? Regular active full-time employees who are actively at work along with their spouse/domestic partner and dependent children can enroll for MetLife Critical Illness Insurance coverage. 3
How do I pay for coverage? Coverage is paid through convenient payroll deduction.
What is the coverage effective date? The coverage effective date is 1/1/2018.
If I Leave the Company, Can I Keep My Coverage? 11 Under certain circumstances, you can take your coverage with you if you leave. You must make a request in writing within a specified period after you leave your employer. You must also continue to pay premiums to keep the coverage in force.
Who do I call for assistance? Contact a MetLife Customer Service Representative at 1 800- GET-MET8 (1-800-438-6388), Monday through Friday from 8:00 a.m. to 8:00 p.m., EST.
Footnotes:
1 Coverage for Domestic Partners, civil union partners and reciprocal beneficiaries varies by state. Please contact MetLife for more information. 2 Dependent Child coverage varies by state. Please contact MetLife for more information. 3 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. 4 We 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. 5 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. For NH- sitused cases and NH residents, there is an initial benefit of $100 for All Other Cancers. 6 In certain states, the covered condition is Severe Stroke. 7 In NJ sitused cases, the Covered Condition is Coronary Artery Disease. 8 Please review the Outline of Coverage for specific information about Alzheimer’s disease. 10 The Health Screening Benefit is not available in all states. See your certificate for any applicable waiting periods. There is a separate mammogram benefit for MT residents and for cases sitused in CA and MT. 11 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative. 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. In most plans, there is a preexisting condition exclusion. After a covered condition occurs, there is a benefit suspension period during which benefits will not be paid for a recurrence, except in the case of individuals covered under a New York certificate. Attained Age rates are based on 5-year age bands and will increase when a Covered Person reaches a new age band. A more detailed description of the benefits, limitations, and exclusions applicable 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 GPNP07-CI, GPNP09-CI or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. 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.
Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0519514696[exp0720][All States] © 2019 MetLife Services and Solutions, LLC NW 3.5 AA OHIV
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