MetLife Critical Illness Insurance: How It Pays for Cancer and Other Conditions

Key Takeaway

MetLife critical illness insurance is a group, limited-benefit policy sold mainly through employers that pays you a lump sum when you are diagnosed with a covered condition such as cancer, heart attack or stroke. It adds cash on top of your health plan but does not replace health insurance.

Important: MetLife states that this coverage is not a substitute for medical coverage. It is supplemental, limited-benefit insurance that pays cash on top of your health plan. It does not pay your medical bills directly and does not replace employer, ACA Marketplace or Medicare coverage.

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Full Benefit Cancer. Invasive cancer that spreads into normal tissue and needs surgery, radiation or chemotherapy, has spread to other parts of the body, or is terminal. Typically pays 100% of your benefit.

Partial Benefit Cancer. Early cancers such as carcinoma in situ that needs treatment, some tumors removed by endoscopy alone, very thin melanomas and certain early prostate cancers. Typically pays 25%.

Skin cancer. Most non-melanoma skin cancers are left out of the full and partial tiers. Some plans pay a small separate skin cancer benefit.

Cancer before coverage. A cancer diagnosed before your coverage start date is not covered.

Broker tip: Some people carry both: workplace critical illness for broad protection and an individual cancer policy that stays with them no matter where they work. Make sure the combined premium still fits your budget.

Enroll at work. Sign up during open enrollment or when you are first eligible. Many plans need no medical exam or health questions if you are actively at work.

Add family. Spouses, domestic partners and children can often be covered, frequently at a share of your benefit, such as 50%. Rules vary by state.

Watch for exclusions. Some plans have a pre-existing condition exclusion, and some states require you to have medical coverage to enroll.

Keep it if you leave. MetLife lets many members continue coverage after a job change or retirement by paying premiums directly. You usually must ask in writing within a set time.

Get your diagnosis in writing. Ask your doctor for the pathology report and the date of diagnosis.

Start the claim. File through MetLife’s MyBenefits website, the MetLife mobile app or a paper claim form, depending on your employer’s setup.

Add the physician statement. Your doctor completes a section that confirms the condition and diagnosis date.

Submit and track it. MetLife says claims are generally processed within 10 business days once it has everything it needs.

Receive your payment. Benefits are paid to you by direct deposit or check.

Don’t forget: Many MetLife plans include a yearly health screening benefit, often $50 in plan summaries we reviewed, for tests such as a mammogram or colonoscopy. It is not offered in every state, but it can partly offset your premium. For more on paperwork, see our cancer insurance claim steps.

Related: Prudential critical illness insurance How Prudential’s workplace plan pays for cancer, travel extras and portability.

Related: Voya critical illness insurance How ReliaStar’s workplace plans pay for early, invasive and repeat cancer.

➤ Does MetLife critical illness insurance cover cancer?

Yes. Most MetLife plans cover cancer in two tiers: Full Benefit Cancer, which typically pays 100% of your benefit, and Partial Benefit Cancer, which typically pays 25%. Not every type of cancer is covered, and most non-melanoma skin cancers are excluded from those tiers.

➤ Does it pay for carcinoma in situ?

Carcinoma in situ that needs treatment usually falls under Partial Benefit Cancer. That means it pays a smaller share of your benefit, often 25%, rather than the full amount.

➤ Will MetLife pay if my cancer comes back?

Many plans include a recurrence benefit, but only after an initial benefit was paid and a benefit suspension period has passed. You generally must have had no symptoms or treatment for that cancer during that period.

➤ Can I keep MetLife critical illness insurance if I leave my job?

Often, yes. MetLife offers continuation of coverage when you change jobs or retire, as long as you request it in time and keep paying premiums. Eligibility rules and limits apply.

➤ Can I buy MetLife critical illness insurance on my own?

MetLife sells this coverage mainly through employers and some groups. If you cannot get it through work, an individual cancer or critical illness policy from another carrier is usually the option.

➤ How long does a MetLife critical illness claim take?

MetLife says claims are generally processed within 10 business days after it receives all the required information. Payment goes straight to you by direct deposit or check.

➤ Does MetLife critical illness insurance replace health insurance?

No. MetLife says it is not a substitute for medical coverage. It is a limited-benefit supplemental policy that pays cash on top of your employer plan, ACA plan or Medicare.

➤ What is MetLife’s AM Best rating?

AM Best rates Metropolitan Life Insurance Company, the insurer behind MetLife critical illness insurance, A+ (Superior) with a stable outlook.

Cancer Insurance Quotes

Call a Licensed Agent Now

Compare cancer insurance plans and cash benefits from several insurance companies in one call.

☎ 1-888-891-0229

No obligation to buy