Critical Illness Insurance
The University offers benefit-eligible faculty and staff access to voluntary critical illness insurance, administered by MetLife. Critical illness insurance provides a lump-sum benefit paid directly to the faculty or staff member upon diagnosis of a covered critical illness. The payment may be used to fill in gaps in major medical insurance, protect assets, or cover child care, transportation, special medical equipment, caregivers, or daily living expenses.
Eligibility
Benefit-eligible faculty and staff members are eligible to enroll. Participation is voluntary for an additional monthly premium. Evidence of insurability is not required.
Dependent children who meet the dependent verification requirements are eligible up to the age of 26. Once a child loses eligibility, the child’s coverage will terminate at the end of the calendar month in which eligibility is lost.
If both spouses are eligible University employees, only one of you (not both) may choose individual + 1 or family coverage, and only one of you may cover dependent children. You may not be concurrently enrolled both as an employee and as a dependent.
Covered Conditions
| Covered Conditions | Initial Benefit | Recurrence Benefit |
|---|---|---|
| Full Benefit Cancer | 100% of Initial Benefit | 50% of Initial Benefit |
| Partial Benefit Cancer | 25% of Initial Benefit | 12.5% of Initial Benefit |
| Heart Attack | 100% of Initial Benefit | 50% of Initial Benefit |
| Stroke | 100% of Initial Benefit | 50% of Initial Benefit |
| Coronary Artery Bypass Graft | 100% of Initial Benefit | 50% of Initial Benefit |
| Kidney Failure | 100% of Initial Benefit | Not applicable |
| Alzheimer’s Disease | 100% of Initial Benefit | Not applicable |
| Major Organ Transplant Benefit | 100% of Initial Benefit | Not applicable |
| Additional covered illnesses* | 25% of Initial Benefit | Not applicable |
Please refer to the table below for the percentage benefit amount for each Covered Condition.
*Additional covered illnesses include: Alzheimer’s Disease – 100%; 22 listed conditions – 25% Addison’s disease; ALS (Lou Gehrig’s disease); Cerebrospinal meningitis (bacterial); Cerebral palsy; Cystic fibrosis; Diphtheria; Encephalitis; Huntington’s disease; 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 erythematous (SLE); Systemic Sclerosis (scleroderma); Tetanus; and Tuberculosis
Critical Illness Coverage and Rates
Faculty and staff have the option to purchase coverage for themselves and/or their dependents for a monthly premium based upon the faculty/staff member’s age at initial enrollment. The full cost of this coverage is paid through after-tax payroll deductions.
| Initial Benefit Coverage | Amount |
|---|---|
| Faculty/Staff* | $10,000 |
| Spouse | $5,000 |
| Child(ren) | $5,000 |
*Participants who enroll in the University High Deductible Plan (HDHP) are automatically enrolled in the Critical Illness $5,000 individual coverage at no additional cost. For more information please review the information on HDHP.
Critical Illness Insurance Monthly Rates
| Issue Ages** | Individual* | Individual + 1 | Family |
|---|---|---|---|
| < 25 | $5.30 | $8.50 | $11.40 |
| 25-29 | $5.30 | $8.50 | $11.40 |
| 30-34 | $7.30 | $11.10 | $14.30 |
| 35-39 | $10.00 | $14.70 | $18.30 |
| 40-44 | $15.10 | $21.50 | $26.00 |
| 45-49 | $20.90 | $29.30 | $34.70 |
| 50-54 | $28.10 | $38.90 | $45.60 |
| 55-59 | $35.70 | $49.10 | $57.00 |
| 60-64 | $43.90 | $60.00 | $69.30 |
| 65-69 | $49.80 | $67.80 | $78.10 |
| 70+ | $59.60 | $80.90 | $92.80 |
| Benefit Reduction | 25% at age 65; 50% at age 70 | ||
*$5,000 of individual coverage is included at no cost with HDHP enrollment.
**Age of individual Notre Dame faculty/staff member. Initial rate locked upon enrollment.
How Critical Illness Benefit Payments Work
The Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition. The plan pays a Recurrence Benefit (payments for the same condition) 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 that have a 180-day separation between recurrences. Initial Benefits and Recurrence Benefits will be paid until the Total Benefit Amount has been reached.
You may also receive Additional Benefit (payments for multiple conditions) that have a 0-day separation between conditions.
Claims Process
MetLife administers the University’s critical illness insurance claim process. Eligible faculty and staff must contact MetLife directly to file a claim by writing or calling their toll-free number, 1-800-GET-MET8 (1-800-438-6388) and speaking with a MetLife benefits consultant or through Metlife’s website at www.metlife.com/mybenefits. Please reference policy #0162427. Notice of claim and proof is generally described below. Please refer to the Certificate of Coverage for complete information on claim information.
Step 1: Initiate claim by writing or calling MetLife’s toll free number within 30 days of the date of incident.
Step 2: MetLife will send a claim form for completion within 15 days of notice of claim.
Step 3: Complete claim form as instructed and return it with the required proof with 90 days, but no later than 12 months from the date of incident.
Additional Information
How to register on www.metlife.com/mybenefits
Critical Illness Insurance Certificate of Coverage (PDF)
HDHP Critical Illness Plan Summary (PDF)
Frequently Asked Questions:
What is the maximum amount I can receive?
The maximum amount that you can receive through your Critical Illness Insurance plan is called the Total Benefit. This means that you can receive multiple Initial Benefit and Recurrence Benefit payments until you reach the maximum up to 300% of the initial benefit amount.
How do I pay for my coverage?
Your coverage is paid through payroll deduction.
Are pre-existing conditions covered?
Pre-existing conditions are excluded if you received diagnosis or treatment 3 months prior or 6 months after the policy effective date. This exclusion does not apply to heart attack or stroke.
Is there a waiting period before my policy is effective?
No. Your policy is effective the first of the month following date of hire or qualifying event.
Do benefits reduce as I age?
Yes, benefits are reduced 25% at age 65 and 50% at age 70.
Are there any other benefits included with Critical Illness coverage?
You will receive a $50 Wellness Benefit per calendar year per covered persons. You can request this benefit via phone or by submitting a claim form.
Telephonic Claims Submission:
- MetLife can now process Health Screening/Wellness claims via the phone!! Claims will be processed without completing claims forms
- Claimant can simply call 1-800-GET-MET8 or the direct line for A&H claims at 1-866-626-3705
- Claimant will be asked a short series of questions regarding the test performed and a check and Explanation of Benefits (EOB) will be mailed to the claimant
Paper Claims Submission: MetLife health screening benefit claim form (PDF)
If I separate from the University, can I keep my coverage?
Yes, you must make a request within 31 days of separation from the University and you must continue to pay the premiums to keep your coverage in force.
