| Further Explanation of the Critical Illness Insurance Program and some frequently asked questions an |
Features and Benefits of your CSEA Sponsored Critical Illness Program:
- Benefit Options: This plan offers members and spouses a choice of benefit amounts from $5,000 to $500,000 in $5,000 increments. Up to $250,000 is available for dependent children.
- Covered Illness: This plan pays scheduled benefit amounts upon diagnosis of cancer, heart attack, stroke, renal failure or a condition requiring a major organ transplant.
- Preventive Care: This plan has a benefit amount of $50 for only one of 18 specified screening tests during each calendar year.
- Lump Sum Cash Benefits: This plan pays the lump sum cash benefits upon diagnosis of any of the covered conditions.
- Payment of Benefits: This plan pays the full cash benefit directly to the insured and can be used for any purpose.
- Payroll Deductions: Members may elect to have their premiums deducted through payroll--no invoices, no checks, no hassles!
- Level Premium: The premium is based on the insured's age as of the effective date of coverage. After the initial rates have been determined, the age of the insured will not affect the premium rate.
- No Coordination of Benefits: This plan pays the full cash benefit in addition to any and all other benefits the insured might receive from any other insurance plan.
- Waiting Period: This plan has a waiting period of 30-days from the effective date of coverage before any conditions are covered. If the diagnosis occurs during this 30-day elimination period, the policy will be terminated, a full refund of the premium will be issued, and coverage will be null and void from the effective date of coverage.
- Termination Age: This plan terminates at age 65 for members and spouses and at age 19 (age 25 if full-time student) for dependent children.
Frequently Asked Questions about the CSEA-sponsored Critical Illness Coverage:
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How does this plan work?
If an insured is diagnosed with a covered illness 30-days or more after the effective date of his or her coverage under the policy, a lump sum benefit amount will be paid directly to the insured. If the diagnosis occurs during the 30-day waiting period, coverage will be terminated, a full refund of premium will be issued, and coverage will be null and void from the effective date of coverage.
EXAMPLE: If an insured has selected $100,000 of critical illness coverage and the coverage was in force for 30-days or more, and the insured is diagnosed as having had a stroke as defined in the policy, the insured would receive $100,000 cash benefit payment
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What are the critical illnesses covered under this policy?
This plan pays benefits for diagnosis of cancer, heart attack, stroke, a condition requiring a major organ transplant, or renal kidney failure. Please refer to the certificate for a benefit schedule and more details.
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What is the Maximum Benefit Amount available under this plan?
| Insured and Insured Spouse: |
$5,000 to $500,000 in $5,000 increments |
| Insured Dependent Child: |
$2,500 to $250,000 in $500 increments |
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| Diagnosis |
Benefit Payable |
| Invasive Cancer: |
100% of the maximum benefit amount |
| Localized Cancer: |
$1,000 per insured person per lifetime |
| Skin Cancer: |
$250 per insured person per lifetime |
| Heart Attack: |
100% of the maximum benefit amount |
| Kidney (Renal) Failure |
100% of the maximum benefit amount |
| Stroke: |
100% of the maximum benefit amount |
| Major Organ Transplant: |
100% of the maximum benefit amount |
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Is there any coverage for diagnostic tests?
This plan has a preventive care (wellness screening) benefit rider, which pays a benefit in the amount of $50 for 18 diagnostic tests. Only one test will be paid for each insured per calendar year.
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What are the 18 diagnostic tests?
They are:
- blood test for triglycerides
- bone marrow testing
- breast ultrasound
- CA 125 (blood test for ovarian cancer)
- CA 15-3 (blood test for breast cancer)
- chest x-ray
- colonoscopy
- fasting blood glucose test
- flexible sigmoidoscopy
- hemocult stool analysis
- mammogram
- pap test
- PSA (blood test for prostate cancer)
- serum protein electrophoresis
- stress test on a bicycle or treadmill
- thermography
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Who is eligible for this plan?
This plan is available to all CSEA members and spouses under age 60. A member may also apply for coverage for his/her dependent children under age 19 (age 25 if full time student).
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To be eligible for this plan, do I have to be currently insured under a basic hospital and basic medical and/or major medical insurance policy?
Yes. Under the New York law, anyone who is not insured under an individual or group policy that arranges or provides basic hospital and basic medical and/or major medical insurance is not eligible for Specified Disease Insurance.
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Do I have to go through medical underwriting before I am accepted into this plan?
Acceptance into this plan is subject to approval by the insurance company. You must complete an application, which will be used to evaluate your acceptance or rejection. A physical examination is not required.
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Are pre-existing conditions covered?
Benefits are not payable for a pre-existing condition during the initial six consecutive months the insured has been enrolled for coverage. A pre-existing condition means any condition for which an Insured Person received any medical advice or for which treatment was recommended by or received from a licensed health care provider during the six months immediately preceding the effective date of the Insured Person's coverage under the policy.
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Will my policy terminate because of age?
Member and spouse coverage terminate at age 65. Dependent children coverage terminates at age 19 (age 25 if full time student). Coverage will also terminate when the maximum benefit amount is paid for any covered condition.
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What is the name of the insurance company underwriting the Critical Illness insurance?
National Union Fire Insurance Company of Pittsburgh, PA. Executive offices: 70 Pine Street, New York, NY 10270.
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Is there a toll free number I can call if I have any questions?
For more information, please call toll free 1-800-929-6656 (Monday - Friday, 8:00 a.m. - 5:00 p.m. EST.) or send an email to CSEA Marketing.
If you are interested in a lower cost term life plan without additional benefits and features, please call Pearl Carroll & Associates LLC, toll free at 1-800-929-6656 or send an email to CSEA Marketing and inquire about the CSEA Life Basics Plan.
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