Critical Illness Protection Plan
Give employees more security from the high cost of a critical illness
Americans suffer 1.5 million heart attacks and strokes each year.1 About 1.6 million new cancer cases are expected to be diagnosed in the U.S. this year.2 Then consider that many employees are not prepared for high, unexpected costs. Almost two in three U.S. workers say they have less than $1,000 on hand to pay the out-of-pocket expenses of an unexpected, serious illness or emergency.3
A health plan only goes so far. Consider the cost and productivity impact due to heart attacks, stroke and cancer.
Offer the Critical Illness Protection Plan
Our Critical Illness Protection Plan is insurance that pays a lump-sum cash benefit directly to a covered employee after a diagnosis of a critical illness. The amount of the cash benefit is based on the condition, covered expenses and treatments covered by the employee’s plan.
Any payment the plan makes is in addition to the benefits your employees receive from their health plan. The employee can use the money to help pay their health plan deductible, prescription costs or for other expenses to manage their illness. Or, they can use it to help cover mortgage or rent payments, groceries and more.
Help your health plan
With millions of employees now in high-deductible health plans, they are even more susceptible to high out-of-pocket costs.4 Offering the Critical Illness Protection Plan gives you and your employees added relief from the financial burdens and stress that can come with a major illness.
How it works: Sharon’s example5
Sharon signed up for the voluntary plan (she pays 100% of the plan premium). During the plan year, she is diagnosed with invasive cancer. Six months later she also has a stroke.
Sharon signed up for the Critical Illness Protection Plan
Sharon signed up for Plan A at a cost of about $17 per month. Play A pays her $10,000 for each covered base condition.
Sharon’s health care costs added up to $15,000+
While her health plan helped, Sharon still has out-of-pocket costs and faced lost wages. She submitted a Critical Illness claim.
Sharon received $20,000
After Sharon’s claim was verified and processed, she received a lump-sum payment for each covered condition. Sharon has an emergency fund to help her during her recovery.
This is insurance that pays benefits directly to the member after diagnosis of a covered critical illness. The following is a summary of the plan options available. Optional benefits are also available.
Covered conditions
Conditions and coverage may vary by state and group size. All benefits are payable at 100% unless otherwise noted as a partial benefit. Contact your UnitedHealthcare representative for more information.
Base conditions
- Benign Brain Tumor
- Cancer — Invasive
- Cancer — Non-Invasive (25% partial benefit)
- Chronic Renal Failure
- Coma
- Coronary Artery Disease (25% partial benefit)
- Heart Attack
- Heart Failure
- Major Organ Failure
- Permanent Paralysis
- Ruptured Aneurysm
- Stroke
Additional conditions
- Advanced Alzheimer’s
- Advanced Multiple Sclerosis
- Advanced Parkinson’s
- Amyotrophic Lateral Sclerosis (ALS)
- Complete Blindness
- Complete Loss of Hearing
Child-only conditions
- Cerebral Palsy
- Cleft Lip/Palate
- Cystic Fibrosis
- Down Syndrome
- Muscular Dystrophy
- Spina Bifida
Benefit is 25 percent of employee coverage. Child-only coverage is included with Employee coverage. One covered condition per child. Coverage is from birth to age 26.
Eligibility and plan features may vary by state and group size.
Group size
- 51 or more eligible employees.
Funding
- Non-contributory
- Fully paid by the employer
- 100 percent participation of eligible employees required.
- Voluntary
- Fully paid by the employee
- 20 percent participation of eligible employees required (51 to 2,999 employees).
- 10 percent participation of eligible employees required (3,000 or more employees).
- Base / Buy-up
- Employer pays 100 percent of Base plan; Employee pays 100 percent of Buy-up plan.
- 100 percent participation of eligible employees required on Base plan.
- 20 percent participation of eligible employees required on Buy-up plan (51 to 2,999 employees).
- 10 percent participation of eligible employees required on Buy-up plan (3,000 or more employees).
Eligibility
- Must be actively at work a minimum of 20 hours per week.
Pre-existing condition exclusion
- 6/12 standard.
- Other options available with underwriting approval.
Portability
- Coverage portable at employer’s group rates.
- See Certificate of Coverage for additional information.
Rating basis
- Issue age — premiums will be level throughout coverage.
- Attained age — premiums will increase as member ages.
Rate guarantee
- Three years (3,000 or more employees).
- Two years (51 to 2,999 employees).
Optional benefits
Reoccurrence benefit
This benefit is equal to 100 percent of the coverage amount if the:
- Covered person is diagnosed with a second occurrence of a covered critical illness for which a benefit was previously paid.
- Diagnosis is made 12 months or more following the initial covered critical illness diagnosis.
- Covered person has not received treatment for the covered critical illness during this 12-month period. Maintenance medication or therapy is not considered to be treatment.
One reoccurrence benefit is payable for each of the covered base conditions. The benefit does not apply to additional or child-only covered conditions.
Additional occurrence benefit
This benefit is equal to 100 percent of the coverage amount. The covered person can receive benefits for different covered critical illnesses if the dates of diagnosis for each illness are separated by at least 90 days.
Optional riders
Wellness rider
Provides $50 or $100 benefit per plan year to employee and an insured spouse for designated health screening tests. The employer may select other wellness coverage options.
Occupational HIV rider
Provides a one-time, lump-sum benefit equal to 100 percent of the coverage amount.
- Benefit is paid to a covered person who sustains an injury in the performance of occupational duties that results in acquiring or testing positive for HIV.
- Benefit is available to health care or other related professions and is elected at the employer/case level.
This is insurance that pays benefits directly to the member after a hospital stay and related expenses. The following is a summary of the plan options available.
Base plan benefits:
- Hospital admission
- Hospital confinement
- Intensive care unit (ICU) confinement
Base + enhanced plan benefits:
- Hospital admission
- Hospital confinement
- Intensive care unit (ICU) admission
- Intensive care unit (ICU) confinement
- Emergency room
- Lodging
- Transportation
Optional benefits are also available.
Eligibility and plan features may vary by state and group size.
Group size
- 51 or more eligible employees.
Funding
Non-contributory
- Fully paid by the employer
- 100 percent participation of eligible employees required.
Voluntary
- Fully paid by the employee
- 20 percent participation of eligible employees required (51 to 2,999 employees).
- 10 percent participation of eligible employees required (3,000+ employees).
Base / Buy-up
- Employer pays 100 percent of Base plan; Employee pays 100 percent of Buy-up plan.
- 100 percent participation of eligible employees required on Base plan.
- 20 percent participation of eligible employees required on Buy-up plan (51 to 2,999 employees).
- 10 percent participation of eligible employees required on Buy-up plan (3,000+ employees).
Eligibility
- Must be actively at work a minimum of 20 hours per week.
Pre-existing condition exclusion
- 12/12 standard.
- Other options available with underwriting approval.
Portability
- Coverage portable at employer’s group rates for first 12 months.
- See Certificate of Coverage for additional information.
Rating basis
- Guaranteed issue.
- Composite rates.
- Four coverage levels:
- Employee
- Employee + spouse
- Employee + child
- Employee + spouse + child
Rate guarantee
- Three years (3,000+ employees).
- Two years (51 to 2,999 employees).
Optional riders
- Wellness rider: Provides $50 benefit per calendar year to employee and an insured spouse for designated health screening tests.
Customers may select other wellness coverage options.
It's easy to add Hospital Indemnity to your UnitedHealthcare health plan to:
- See savings. You may qualify for significant savings by bundling your plans. You may also save time with more efficiency.
- Enjoy simplicity. Get one account team, administration process and website, customer service line and more.
It's easy to add Critical Illness to your UnitedHealthcare health plan to:
- See savings. You may qualify for significant savings by bundling your plans. You may also save time with more efficiency.
- Enjoy simplicity. Get one account team, administration process and website, customer service line and more.
Footnotes
- American Heart Association. Disease and Stroke Statistics 2017 Update. A Report From the American Heart Association; Mar. 2017. Web.
- American Cancer Society. Cancer Facts & Figures 2017. Atlanta: American Cancer Society; 2017. Web.
- Weschler, Pat. “63% of Americans Can’t Cover Unexpected Expenses.” Fortune. 63% of Americans Can’t Cover Unexpected Expenses. Time Inc., 06 Jan.
- “2015 Census of Health Savings Account - High Deductible Health Plans.” 2015 Census of Health Savings Account - High Deductible Health Plans. America’s Health Insurance Plans, Nov. 2015. Web.
- For illustrative purposes. Premium, benefit and care amounts will differ based on market, plan and covered conditions.