Critical Illness Insurance
An unexpected medical event could be costly for your family, even when you have medical insurance. Stanford offers an optional benefit to ease the burden of expenses not typically covered by health or disability plans.
We don’t expect to have a serious health issue and it is not always top of mind to consider if we’re prepared should one occur. Your medical plan will cover expenses such as physician fees, surgery or hospitalization but have you thought about how you would pay for expenses that your health plan doesn’t cover, especially if you are unable to work for a while?
Stanford has partnered with MetLife to offer benefits-eligible employees and dependents additional coverage through a critical illness insurance plan. You select from three coverage options: $10,000, $20,000 or $30,000 and whom you would like to cover.
Then if you experience one of the covered conditions, upon diagnosis you can receive a lump sum payment of the coverage option you elected paid directly to you. The money you receive can be used as you see fit – living expenses, mortgage payments, out of pocket costs – it’s up to you to decide how to use it.
Because you pay your insurance premiums with after-tax dollars through a payroll deduction, the enrollment window is limited to:
- New hires within the 31-day enrollment period
- Active employees during annual Open Enrollment only
Elections are made through the My Benefits portal.
- Call MetLife at 800-GET-MET8 or visit metlife.com/info/stanford-university
- Summary of Benefits in Coverage
- Summary Plan Description
- Critical Illness Regulatory Disclosures
To calculate the monthly premium using this chart, multiply the Premium x Coverage Amount ÷ $1,000. Coverage options are: $10,000, $20,000 or $30,000.
For example, the cost for an employee (age 47) + Spouse for a $30,000 coverage plan is $1.84 x $30,000 ÷ $1,000 = $55.20 per month, or $27.60 per pay period.
|EMPLOYEE + SPOUSE/
|25 and younger||$0.22||$0.43||$0.41||$0.63|
|25 to 29||$0.23||$0.47||$0.43||$0.66|
|30 to 34||$0.33||$0.66||$0.52||$0.86|
|35 to 39||$0.49||$0.99||$0.69||$1.19|
|40 to 44||$0.69||$1.40||$0.87||$1.58|
|45 to 49||$0.90||$1.84||$1.06||$2.00|
|50 to 54||$1.51||$3.08||$1.69||$3.26|
|55 to 59||$2.19||$4.51||$2.38||$4.69|
|60 to 64||$3.10||$6.38||$3.29||$6.57|
|65 to 69||$4.79||$9.88||$4.99||$10.08|
*These rates are for non-smokers. Rates are higher for smokers; view the full rate chart for smokers and non-smokers. You will be asked if you are a smoker when you enroll through My Benefits.
Critical Illness Insurance FAQ
Can I enroll in critical illness insurance without having to take a medical exam?
Yes. Your critical illness coverage is guaranteed, regardless of your health. But to be covered by a critical illness insurance plan, you need to be actively at work and covered by a medical insurance plan. There are no medical exams to take and no health questions to answer.
Are there any other benefits payable under this critical illness insurance plan?
Yes. MetLife provides you with an extra $50 annual benefit per calendar year on top of your total benefit amount when you see your physician for eligible health screenings or prevention measures.
Are benefits paid directly to me or my health care provider?
Benefits will be paid directly to you, not to the doctors, hospitals or any other health care providers. There’s no need to work it around any other insurance you may have. Benefits are paid no matter what your other insurance plans may cover. There is no 1099 tax form issued to you after you have received a payment as this is a non-taxable benefit.
If leave Stanford, can I take my critical illness coverage with me?
Yes. This coverage is portable, meaning you can take it wherever you go. You have 30 days to contact MetLife to set up direct billing for a personal policy. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier.
How do I pay for coverage in the critical illness insurance plan?
You will pay with after-tax dollars through payroll deductions, so you never have to worry about writing a check or missing payments.
If you are on an unpaid leave of absence MetLife will bill you directly to continue your critical illness policy and you will be asked to pay three months of premiums in advance. If you decline to make the direct payment to MetLife your Critical Illness coverage will be suspended until you return from leave. Once you return to active status your payroll deductions will begin and your Critical Illness coverage will resume as of your return date.
I'm making my elections in My Benefits but do not see the critical illness plan option?
To be eligible to enroll for the critical illness insurance plan through MetLife, you must be actively at work when the plan year begins (Jan. 1). If you are on a leave of absence during Open Enrollment, you will not be able to enroll until you return from leave, and you will not see the critical illness plan as an option in My Benefits. If you elect critical illness during Open Enrollment, but start a leave of absence before the plan year begins (Jan. 1) your enrollment will be suspended until you return from leave and you will not be billed until you are returned to active status.
What conditions are covered under the critical illness insurance plan?
If you meet the group policy and certificate requirements, critical illness insurance provides you with a lump-sum payment upon diagnosis of these conditions:
- Full Benefit Cancer
- Partial Benefit Cancer
- Heart Attack
- Kidney Failure
- Coronary Artery Bypass Graft
- Alzheimer’s Disease
- Major Organ Transplant
- 22 Listed Conditions (view the Outline of Coverage for details)
How does the critical illness plan deal with recurrence of a condition?
Your plan pays an additional benefit (Recurrence Benefit) if a medical condition reoccurs for: a Heart Attack, Stroke, Coronary Artery Bypass Graft, Full Benefit Cancer and Partial Benefit Cancer. A recurrence benefit is only available if the initial benefit has already been paid for the covered condition. There is a benefit suspension period (or waiting period) between recurrences.
Is there a lifetime maximum benefit to the critical illness insurance?
The total lifetime benefit you can receive is three times the coverage option amount you elected for each covered person (i.e. if you are covering a spouse you can each receive up to three times your coverage option for the diagnosed conditions for each person).
I have a good medical plan at work, so why do I need critical illness insurance?
Even the best medical and disability income plans can leave you with extra expenses to pay or services that just aren’t covered. The average family spends thousands of dollars in times of critical illness and recovery. Many people aren’t prepared to handle these extra costs, so having this extra financial support when the time comes may mean less worry for you and your family.