Group Accident, Critical Illness and Hospital Indemnity Insurance New Insurance Options Brought to You by MetLife ADF# AI-CI637.14

Transcription

1 Group Accident, Critical Illness and Hospital Indemnity Insurance New Insurance Options Brought to You by MetLife ADF# AI-CI637.14

2 Agenda New for 2015 MetLife s Voluntary Benefit offering our Supplemental Medical Plans Employees can choose any or all of our Supplemental Medical Plans: Critical Illness Group Accident Hospital Indemnity Key Terms What We Will Cover Critical Illness Group Accident Hospital Indemnity Q&A Session 2

3 Key Terms Guaranteed Acceptance For you and your family eligible family members. Coverage is guaranteed, regardless of your health (no EOI required). You just need to enroll during your enrollment period and be actively at work for your coverage to be effective. Portable Coverage is portable You can take it with you if your employment status changes. Your coverage will only end if you stop paying your premium. 3

4 Accident and Critical Illness Insurance Guaranteed acceptance for you and your eligible family members. 1 You just need to enroll during your enrollment period and be actively at work for your coverage to be effective. Employee Eligible Individuals Spouse/Domestic Partner 2 Dependent Child(ren) 3 Employee must enroll, for [Spouse/Domestic Partner] and Child(ren) to be eligible for coverage. 1 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. [For CA sitused cases: Coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of your job at the employer's place of business or at an alternate place approved by your employer (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.] 2 Coverage for Domestic Partners, civil union partners and reciprocal beneficiaries varies by state. Please contact MetLife for more information. 3 Dependent Child coverage varies by state. Please contact MetLife for more information. 4

5 Accident Insurance Accident Insurance provides the insured with payment for covered injuries and accident-related medical treatments, including medical services and hospitalization. It is not a replacement for traditional medical or disability income insurance rather it is a complement to these coverages. MetLife s Accident Insurance Over 150 covered events that could trigger benefits Has no waiting period for coverage to begin Provides you with payment(s) to use the way you see fit 5

6 Accident Insurance Covered Conditions Over 150 covered events that could trigger benefits...here are just a few! Injuries Fractures/Dislocations Concussion Coma Ruptured Disc Torn Cartilage in Knee Cuts/Lacerations Torn/Ruptured/Severed Tendon/Ligament Broken Tooth And more Accidental Death Accidental Death Common Carrier Medical Services & Treatments Air/Ground Ambulance Emergency/Non-Emergency Care Physician Follow-Up Transportation Therapy Services Pain Management Blood/Plasma/Platelets Inpatient Surgery Outpatient Ambulatory Surgery And more Dismemberment, Loss & Paralysis Dismemberment & Loss Catastrophic Dismemberment & Loss Paralysis Hospital - Accident Admission Confinement Admission - ICU Confinement - ICU Inpatient Rehab Unit Hospital Sickness 1 Admission ICU Admission non-icu Confinement ICU Confinement non-icu Additional Benefits 2 Lodging 3 1 Not available to groups in CA, CO, DC, KS, MO, NH, NJ, NY, VT or WA or with employees residing in NH, VT or WA. 2 Benefits must be tied to an accident 3 Provides a benefit for lodging for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from insured s primary residence. 6

7 Accident Insurance Low Plan and High Plan Benefits You have a choice of two plans Covered Conditions Low Plan MetLife Accident Insurance Pays YOU High Plan MetLife Accident Insurance Pays YOU Injuries - 12 covered injury types Ranging from $25 - $5,000 per injury 2 Ranging from $50 - $10,000 per injury 2 Medical Services & Treatment 15 covered medical services & treatments Ranging from $15-$1,000 per medical service/treatment Ranging from $25-$2,000 per medical service/treatment Hospital Coverage (due to an Accident) Accidental Death $500-$1,000 admission benefit per accident $100-$200 per day for confinement/rehab $1,000 - $2,000 admission benefit per accident $200-$400 per day for confinement/rehab $25,000 $50,000 $75,000 if passenger on common carrier 3 $150,000 if passenger on common carrier 3 Dismemberment, Loss & Paralysis $250-$10,000 per injury $500-$50,000 per injury Additional Benefits Lodging 1 $100 per night, up to 30 nights; up to $3,000 in total lodging benefits available per calendar year $200 per night, up to 30 nights; up to $6,000 in total lodging benefits available per calendar year In some cases, benefits reduce due to age. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details. 1 Provides a benefit for lodging for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from insured s primary residence. 2 Chip fractures are paid at 25% of Fracture Benefit and partial dislocations are paid at 25% of Dislocation Benefit. 3 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. 7

8 Accident Insurance Claim Scenario Molly experiences an accident during a soccer game Covered Benefits Benefit Amount 1 Ambulance (ground) $300 Emergency Care $100 Physician Follow-Up ($75 x 2) $150 Medical Testing $200 Concussion $400 Broken Tooth (repaired by crown) $200 Benefits paid by MetLife s Group Accident Insurance - High Plan $1,350 1 Benefit amount is based on sample MetLife plan design. Actual plan design and plan benefits may vary. 8

9 Exclusions & Limitations No pre-existing condition limitation or coverage waiting periods. Standard list of exclusions*, including: Sickness Voluntary use of drugs, poison, gas or fumes Suicide or attempted suicide Self-inflicted injury War Active participation in riot or terrorist act Felony Infection (unless external wound resulting from Injury) Food poisoning Driving while intoxicated Dental or plastic surgery for cosmetic purposes Mental illness Service in armed forces Travel or flight in aircraft (unless passenger) Parachuting (unless for self-preservation) Race, stunt show or speed test Semi-professional or professional competitive athletics Dangerous activities (bungee jumping, base jumping, hang gliding, spelunking, scuba diving deeper than 130 feet, etc.) While incarcerated Medical treatment, hospitalization or inpatient stay outside of US, Canada or Mexico *summary for illustration only see certificate for details 9 9

10 Critical Illness Insurance Critical Illness Insurance provides coverage for specific critical illnesses, like certain cancers, 1 heart attack and stroke, 2 and helps offset expenses not reimbursed by other types of insurance. It is not a replacement for traditional medical or disability income insurance rather it is a complement to these other coverages. MetLife s Critical Illness Insurance Provides a lump-sum payment upon diagnosis verification Is not reimbursement-based so covered individuals only need to submit proof of a diagnosis Allows covered individuals to use the lump-sum payment the way they see fit 1 Please review the 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. In NH, for All Other Cancers, MetLife will pay a benefit of $100 initial benefit and $100 recurrence for all other cancers. 2 In certain states, the Covered Condition is Severe Stroke. 10

11 Critical Illness Insurance Covered Conditions Conditions Full Benefit Cancer 1 Partial Benefit Cancer 1 (25% of Selected Benefit Amount) Heart Attack Stroke 2 Coronary Artery Bypass Graft (CABG) 3 Kidney Failure Alzheimer s Disease 4 Major Organ Transplant 22 Listed Conditions 5 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. In NH, for All Other Cancers, MetLife will pay a benefit of $100 initial benefit and $100 recurrence for all other cancers. 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 MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount for each of the 22 Listed Conditions until the Total Benefit Amount is reached. A Covered Person may only receive one payment for each 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. 11

12 Critical Illness Insurance Initial Benefit Amount You have a choice of a $15,000 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 Benefit 1 payments until your Total Benefit Amount is reached Example of Initial & Recurrence Benefit Payments 2 The example below illustrates an employee who elected an Initial Benefit of $30,000 and has a Total Benefit Amount of 3 times (or 300%) of the Initial Benefit Amount or $90,000. Illness Covered Condition Payment Total Benefit Remaining Heart Attack first diagnosis Initial Benefit payment of $30,000 or 100%. 200% ($60,000) Heart Attack second diagnosis, two years later Recurrence Benefit payment of $30,000 or 100% 100% ($30,000) Kidney Failure first diagnosis, three years later Initial Benefit payment of $30,000 or 100% 0% ($0) 1 Your plan pays a Recurrence Benefit equal to the Initial Benefit 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. 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. 2 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. 12

13 Hospital Indemnity Insurance Guaranteed acceptance for you and your eligible family members 1. Eligible Individuals Employee Spouse/Domestic Partner 1 Dependent Child(ren) 1 Employee must enroll, for Spouse/Domestic Partner and Child(ren) to be eligible for coverage. 1 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents are not subject to medical restrictions as set forth 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. 13

14 Hospital Indemnity Insurance Hospital Indemnity Insurance provides you with payments for a covered event due to an accident or illness, when you are admitted or when you are confined to a hospital 2. It is not a replacement for traditional medical insurance rather it is a complement to this coverage. Hospital Indemnity Insurance Provides you with payment(s) to use the way you see fit The coverage is portable, meaning you can take it with you if your employment status changes. Your coverage will only end if you stop paying your premium or if your current employer chooses to terminate the Group Hospital Indemnity policy. 2 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. 14

15 Covered Benefits Here are the benefit types that provide payments... Hospital - Accident Admission Confinement Inpatient Rehab Unit (paid per accident) Intensive Care Unit Coverage - Accident Admission Confinement Hospital Sickness 3 Admission Confinement Intensive Care Unit Coverage - Sickness Admission Confinement Additional Benefits Lodging 4 Health Screening (Wellness) 5 3 There is a preexisting condition exclusion for Hospital Sickness benefits in all states. See your Disclosure Statement or Outline of Coverage/Disclosure Document for more details. 4 The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from the insured s primary residence. 5 The Health Screening Benefit is not available in all states. In most states where the benefit is available there is a one month waiting period for the Health Screening Benefit. 15

16 Low Plan and High Plan Benefits You have a choice of two plans Covered Benefits 6 Low Plan MetLife Hospital Indemnity Insurance Pays YOU High Plan MetLife Hospital Indemnity Insurance Pays YOU Hospital Coverage (Accident) Admission must occur within 180 days of accident Non-ICU - $500 per accident ICU - $1,000 per accident Non-ICU - $1,000 per accident ICU $2,000 per accident Confinement must occur within 180 days of accident Non-ICU - $100 a day up to 365 days ICU - $200 a day up to 30 days Non-ICU $200 a day up to 365 days ICU - $400 a day up to 30 days Inpatient Rehab stay must occur immediately following hospital confinement and occur within 365 days of accident $100 day, up to 15 days per accident and 30 days per calendar year $200 day, up to 15 days per accident and 30 days per calendar year 6 Covered services/treatments must be the result of an accident or sickness as defined in the group policy/certificate. See the Disclosure Statement or Outline of Coverage/Disclosure Document for more details. 16

17 Low Plan and High Plan Benefits You have a choice of two plans Covered Benefits 6 Hospital Coverage (Sickness) 3 Admission Payable 1x per calendar year Low Plan MetLife Hospital Indemnity Insurance Pays YOU Non-ICU - $500 ICU - $1,000 High Plan MetLife Hospital Indemnity Insurance Pays YOU Non-ICU - $1,000 ICU - $2,000 Confinement Paid per sickness Non-ICU - $100 a day, up to 365 days ICU - $200 day, up 30 days Non-ICU - $200 a day, up to 365 days ICU - $400 day, up 30 days Additional Benefits Lodging 4 Benefit provided for a companion accompanying a covered insured while hospitalized Health Screening (Wellness) 5 Benefit provided if the covered insured takes one of the covered screening/ prevention tests $100 per day Paid up to 30 days per calendar year; lodging facility must be located more than 50 miles from covered person s primary residence $50 Payable once per covered insured per calendar year, if covered insured takes a covered test. $200 per day Paid up to 30 days per calendar year; lodging facility must be located more than 50 miles from covered person s primary residence $100 Payable once per covered insured per calendar year, if covered insured takes a covered test. 3 There is a preexisting condition exclusion for Hospital Sickness benefits in all states. See your Disclosure Statement or Outline of Coverage/Disclosure Document for more details. 4 The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from the insured s primary residence. 5 The Health Screening Benefit is not available in all states. In most states where the benefit is available there is a one month waiting period for the Health Screening Benefit. 6 Covered services/treatments must be the result of an accident or sickness as defined in the group policy/certificate. See the Disclosure Statement or Outline of Coverage/Disclosure Document for more details. 17

18 Claim Scenario Susan experiences chest pains and is rushed to the hospital Covered Benefit 6 Admission - Intensive Care Unit Coverage (Sickness) Confinement for 1 day- Intensive Care Unit Coverage (Sickness) Confinement for 2 days Hospital Coverage (Sickness) Benefits paid by MetLife s Group Hospital Indemnity Insurance - High Plan Benefit Amount 7 $2,000 $400 $400 $2,800 6 Covered services/treatments must be the result of an accident or sickness as defined in the group policy/certificate. See the Disclosure Statement or Outline of Coverage/Disclosure Document for more details. 7 Benefit amount is based on sample MetLife plan design. Actual plan design and plan benefits may vary. 18

19 Why Should You Enroll? It s Easy to Enroll! Guaranteed acceptance for you and your eligible family members 1 Convenience of Payroll Deduction means continuous, worry-free coverage Competitive Group Rates Take your coverage with you if your employment status changes Enroll 10/27/14 11/21/14 at: Access Colleague Connect ( Go to TAKE NOTE in the upper right hand corner Select the link 2015 Health and Benefits Annual Enrollment Then click the Mercer Marketplace benefits enrollment website link. While these offerings are made directly available to you on the Mercer Marketplace benefits enrollment website, they are not sponsored or endorsed by MMC. 1 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents are not subject to medical restrictions as set forth 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. 19

20 Questions? While these offerings are not sponsored by MMC, the Employee Service Center will be able to answer questions, particularly regarding how they are different from MMCsponsored benefits. Call the Employee Service Center: Any business day, 8 a.m. to 8 p.m. ET (until 10 p.m. between October 27 - November 21, 2014) METLIFE'S HOSPITAL INDEMNITY INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage. The policy or its provisions may vary or be unavailable in some states. There is a preexisting condition exclusion for hospital sickness benefits. There is a benefit reduction at age 65. And, like most group accident and health insurance policies, polices offered by MetLife may include waiting periods and 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 GPNP12-HI or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife s Group Hospital Indemnity Insurance is pending regulatory approval. L [exp0615][All States] Metropolitan Life Insurance Company, New York, NY PEANUTS 2013 Peanuts Worldwide, LLC 20

21 Questions Question and Answer Session 21