Critical Illness claim process

Critical Illness

claim process

Submitting a Critical Illness Insurance claim doesn’t have to be challenging.

Below you’ll find the information you need to make the process go smoothly,

so that you can receive payments quickly and focus on your recovery.

Obtain and complete the Critical Illness Insurance claim forms:

1. Visit mybenefits.metlife.com to access and submit your claim forms electronically. You may also call

MetLife at 866-626-3705 to request claim forms to be sent via mail. You will need to submit the following

two documents: a) Critical Illness claim form b) Physician Statement

2. Be sure to complete all necessary sections outlined in the forms and sign where required. Section 1 of the

Physician Statement must be signed and delivered to your Physician.

3. Your Physician must complete and sign Section 2 of the Physician Statement and return with the

supporting medical information that is outlined in the form.

4. Please include supporting documents from the provider related to the Critical Illness for which a claim is

being made. The supporting documents must include: 1) the diagnosis; 2) pathology reports, surgical

notes, lab results, or clinical records that support the diagnosis of the covered condition and 3) the date(s)

of diagnosis.

Submitting a Critical Illness Insurance claim:

Once claim forms have been completed and accompanying documentation (physician statement, medical

information, etc.) have been obtained, you may submit as follows:

• Submit electronically through MyBenefits (mybenefits.metlife.com). **preferred method**

• E-mail to ahmetlifeclaims@metlife.com

• Fax or mail directly (Information can be found on the claim form)

MyBenefits: quick and easy online claim submission

MyBenefits is the web portal for MetLife group participants. Once registered, you can log in to:

• Submit a claim

• See claim status, history, and payments

• Set up direct deposit of benefits

• Read messages from MetLife

• Download accident and health forms

You can register at www.mybenefits.metlife.com

For questions please call a MetLife Customer Service Representative at

1 866-626-3705.

METLIFE CRITICAL ILLNESS INSURANCE (CII) IS A LIMITED BENEFIT GROUP INSURANCE POLICY. Like most group accident and health

insurance policies, MetLife’s CII policies contain certain exclusions, limitations and terms for keeping them in force. Product features and availability

may vary by state. In most plans, there is a pre-existing condition exclusion. After a covered condition occurs, there is a benefit suspension period

during which most plans do not pay recurrence benefits, except in the case of insureds covered under a New York certificate. MetLife offers CII on

both an Attained Age and an Issue Age basis. Attained Age rates are based on 5-year age bands and will increase when a Covered Person reaches

a new age band. MetLife’s Issue Age CII is guaranteed renewable, and may be subject to benefit reductions that begin at age 65. Premium rates for

MetLife’s Issue Age CII are based on age at the time of the initial coverage effective date and will not increase due to age; premium rates for increases

in coverage, including the addition of dependents’ coverage, if applicable, will be based on the covered person’s age at the time of the initial coverage

effective date. Rates are subject to change for MetLife’s Issue Age CII on a class-wide basis. A more detailed description of the benefits, limitations,

and exclusions applicable to both Attained Age and Issue Age CII can be found in the applicable Disclosure Statement or Outline of Coverage/

Disclosure Document available at time of enrollment. For complete details of coverage and availability, please refer to the group policy form GPNP07-

CI, GPNP09-CI or GPNP14-CI, or contact MetLife for more information. Benefits are underwritten by Metropolitan Life Insurance Company, New

York, New York. MetLife’s Critical Illness Insurance is not intended to be a substitute for Medical Coverage providing benefits for medical treatment,

including hospital, surgical and medical expenses. MetLife’s Critical Illness Insurance does not provide reimbursement for such expenses.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166

What happens after my claim is submitted?

A MetLife claims specialist will review your information and request any additional medical information

(if necessary). An acknowledgement letter is sent from MetLife when the claim is successfully submitted.

Visit MyBenefits frequently to check claim status, letters and benefit payments.

Approval process and payment process:

There are two available payment methods, which are a physical check or direct deposit. Upon claim

approval, an Explanation of Benefits (EOB) explains the claim that was processed and payment provided.

The EOB is attached to the check or available to be viewed on MyBenefits if payment is made via direct

deposit. Payments to the claimant will be received within 7 – 10 business days after the claim is approved.

Important information — Before submitting your claim, be sure to read your MetLife

certificate carefully to see what you are eligible for.

The certificate issued by MetLife contains detailed information on the covered services and benefits you are eligible to

submit a claim for. Therefore, it is important that you read your certificate carefully before submitting a claim.

Your MetLife certificate can be found on mybenefits.metlife.com under the Certificate Detail tab.