Critical Illness Insurance
Symetra Life Insurance Company
Symetra voluntary Critical Illness insurance for JPS Health Network team members that provides a lump-sum payment upon diagnosis of a covered critical illness condition, with benefit amounts from $5,000 to $30,000 and guaranteed issue up to the full elected amount.
Cost of Critical Illness Premium (Bi-Weekly)
| Team Member Age | Premium for $1,000 of Coverage | Team Member Age | Premium for $1,000 of Coverage |
|---|---|---|---|
| 18–24 | $0.1523 | 55–59 | $0.9462 |
| 25–29 | $0.1662 | 60–64 | $1.3154 |
| 30–34 | $0.1985 | 65–69 | $1.8508 |
| 35–39 | $0.2538 | 70–74 | $2.3492 |
| 40–44 | $0.3600 | 75–79 | $2.8846 |
| 45–49 | $0.4938 | 80–84 | $3.4015 |
| 50–54 | $0.6877 | 85+ | $3.7246 |
| Child | $0.04615 | $0.04615 | $0.04615 |
Note: Premium for team member and spouse is calculated by the team member's age at the beginning of each plan year.
Core Critical Illness Benefit Schedule
| Service | Benefit (% of Elected Amount) |
|---|---|
| Core Benefits | |
|
Invasive Cancer Must be diagnosed by a Specialist via Pathological or Clinical Diagnosis. Includes Leukemia, Lymphoma, Sarcoma, Malignant melanoma >1mm, breast cancer, Multiple myeloma. |
100% |
|
Minor Cancer (In Situ) Tumor cells lie within tissue of origin and have not spread. Includes CLL not beyond RAI Stage 0, Stage 1A melanoma ≤1.0mm, early prostate cancer T1a/T1b. |
50% |
|
Heart Attack (Myocardial Infarction) Ischemic death of heart muscle due to coronary artery blockage. Diagnosed by Specialist via serial cardiac biomarker measurement. |
100% |
|
Stroke Acute cerebrovascular incident with irreversible brain tissue death. Must result in neurological functional impairment confirmed by brain imaging. |
100% |
|
Coronary Artery Disease Needing Surgery or Angioplasty Coronary artery blockage requiring bypass surgery or angioplasty per clinically accepted cardiovascular surgery guidelines. |
25% |
|
Major Organ Failure Permanent failure of heart, liver, lung, or pancreas requiring surgical transplant. Transplant goal requirement waived if too ill for surgery. |
100% |
|
Occupational HIV HIV infection from accidental occupational exposure. Must occur in the U.S.; report to employer within 24 hours; negative HIV test within 14 days; seroconversion confirmed within 180 days. |
100% |
|
End-Stage Renal Failure Total and irreversible failure of both kidneys requiring permanent dialysis at least weekly or kidney transplant. |
100% |
|
Loss of Sight Permanent and irreversible loss of sight in both eyes. Corrected visual acuity 20/200 or less, or field of vision <20 degrees in both eyes. Covers accident, cataracts, glaucoma, macular degeneration, congenital disorder in covered newborn. |
100% |
|
Loss of Speech Permanent loss of intelligible speech. Loss must be continuous for at least 180 days. Covers accident, Guillain Barre, Huntington's, congenital disorder in covered newborn. |
100% |
|
Loss of Hearing Permanent reduction of hearing in both ears; unable to hear at or below 90 decibels. Diagnosed by audiometric testing. Covers accident, bacterial meningitis, Meniere's disease, congenital disorder in covered newborn. |
100% |
|
Paralysis Covers sickness and accident. Damage to brain or spinal cord resulting in quadriplegia, paraplegia, hemiplegia, or diplegia. Complete and permanent loss of 2+ limbs for at least 180 continuous days. |
100% |
|
Severe Burns Third-degree burns covering at least 20% of body surface area. |
100% |
| Neurological Conditions | |
|
ALS / Other Motor Neuron Disease Includes spinal muscular atrophy, progressive bulbar palsy, ALS (Lou Gehrig's Disease), primary lateral sclerosis. Permanent neurological impairment with muscle weakness persisting at least 90 continuous days. |
100% |
|
Advanced Alzheimer's Disease Progressive and permanent deterioration of memory and intellectual capacity. Must be unable to perform at least 2 of 6 Activities of Daily Living for 180 continuous days. Confirmed by Specialist with cognitive testing and neurological examination. |
100% |
|
Parkinson's Disease Idiopathic Parkinson's disease with resting tremor, rigidity, bradykinesia, and gait disturbance, assessed by a Specialist. |
100% |
|
Advanced Multiple Sclerosis Permanent functional neurological impairment with objective evidence of motor or sensory dysfunction persisting for at least 180 continuous days. Confirmed by neurological investigations including MRI. |
100% |
|
Coma Covers accident and sickness. No response to external stimuli for at least 96 hours; life support required; permanent neurological deficit assessed at least 30 days after onset. |
100% |
| Childhood Conditions | |
|
Major Congenital Structural Anomaly Structural malformation arising in utero requiring medical treatment (e.g., complex congenital heart disease, spina bifida, cleft lip/palate). Diagnosed and named by a Specialist with a treatment plan. |
100% |
|
Congenital Metabolic Disorder Genetic or inherited disorder from enzyme defect affecting metabolic pathways (e.g., PKU, Tay Sachs, cystic fibrosis). Diagnosed by a Specialist with a treatment plan. |
100% |
|
Congenital Chromosomal Abnormality Congenital abnormality in chromosome number or structure requiring medical treatment (e.g., Down syndrome, Turner syndrome, sickle cell disease, muscular dystrophy). Diagnosed by a Specialist with a treatment plan. |
100% |
|
Chronic Medical Condition Commonly Diagnosed in Childhood Named condition requiring ongoing treatment expected to persist at least 5 years (e.g., epilepsy, cerebral palsy, asthma, Type 1 Diabetes). Must meet severity criteria including 12+ consecutive months of treatment, therapy, or bracing. |
100% |
Plan Options and Additional Benefits
| Service | Details |
|---|---|
| Team Member Benefit Amounts | |
| Critical Illness Team Member Benefit | $5,000, $10,000, $15,000, $20,000, $25,000, or $30,000 |
|
Guaranteed Issue Benefit No evidence of insurability required at initial or annual enrollment. |
Up to $5,000, $10,000, $15,000, $20,000, $25,000, or $30,000 |
| Dependent Benefit Amounts | |
| Spouse Benefit | 100% of the team member benefit amount |
| Child Benefit | 25% of the team member benefit amount |
| Options | |
|
Health Screening Benefit Applies to team member, spouse, and child. Payable once per covered insured per calendar year regardless of number of screenings. For x-ray and laboratory tests only. |
$50 per covered insured per calendar year |
|
Recurrence Benefit Pays when a specific critical illness recurs more than 6 months after the first diagnosis. Payable an unlimited number of times unless otherwise specified in the certificate. |
100% of the critical illness benefit amount |
| Waiver of Premium | None |
|
Additional Occurrences If diagnosed with a second different covered condition at least one day after the first, full benefit is paid for the second condition. |
Full benefit for each different covered condition |
| Plan Provisions | |
| Lifetime Maximum Benefit Payout | No lifetime maximum |
| Benefit Waiting Period | None |
|
Pre-Existing Condition Limitation For new diagnosis after effective date of coverage |
None |
| Age-Based Benefit Amount Reductions | None |
|
Continuation of Coverage Current participants of an existing plan receive credit for time served under a prior carrier policy (Continuity with Prior Coverage). |
Included |
-
1
Tests to Screen for Cancer
- Biopsy
- Bone marrow testing
- Breast ultrasound
- CA 125 (blood test for ovarian cancer)
- CA 15-3 (blood test for breast cancer)
- CEA (blood test for colon cancer)
- Colonoscopy
- Flexible sigmoidoscopy
- Hemoccult stool specimen
- Mammogram
- Pap test
- PSA (prostate-specific antigen test)
- Serum protein electrophoresis (blood test for myeloma)
- Thermography
-
2
Tests to Screen for Heart-related Disease
- Blood test for triglycerides
- Chest x-ray
- Serum cholesterol test to determine HDL/LDL level
- Stress test on a bicycle or treadmill
-
3
Tests to Screen for Organ-related Disease
- Fasting blood glucose test
-
4
Additional Eligible Screenings
- COVID-19 (PCR, rapid, antibody)
The Health Screening Benefit is payable once per covered insured per calendar year, regardless of the number of exams, X-rays, or laboratory tests administered during that year. Benefit amount: $50 for team member, $50 for spouse.
To file: Call 1-800-497-3699 (Monday-Friday, 8 a.m. to 8 p.m. ET) or email sbclaims@symetra.com and provide (1) the name of the insured, (2) the type of screening, and (3) the date the screening was completed. Claims may also be submitted online at symetra.com/MyGO, or by mail to P.O. Box 674419, Houston, TX 77267-4419, or by fax to 1-715-682-5919.
- Team members who want supplemental coverage to help with out-of-pocket costs not covered by major medical insurance following a serious diagnosis
- Team members who want coverage for transportation, child care, and other non-medical expenses during recovery
- Team members seeking guaranteed-issue coverage with no medical underwriting
Policyholder: JPS Health Network. Policy Issue State: TX. Critical Illness Plan insured by Symetra Life Insurance Company.
If the benefits described are included in your plan, state requirements may apply depending on the state where you live or the policy issue state. Apart from any state requirements, please see your plan's enrollment material to determine if these benefits are available.
Invasive Cancer: Benefits will not be paid for pre-malignant tumors or polyps, Non-Melanoma Skin Cancer, or Minor Cancer (In Situ), except breast cancer (considered Invasive Cancer). This benefit is always included for policies issued in IA, MO, MT, and WA.
Minor Cancer (In Situ): Benefits will not be paid for skin cancer other than invasive malignant melanoma of the dermis or deeper, pre-malignant lesions, Non-Melanoma Skin Cancer, Invasive Cancer, or benign tumors/polyps.
Non-Invasive Cancer (CA only): Benefits will not be paid for Non-Melanoma Skin Cancer, Invasive Cancer, pre-malignant lesions (such as intraepithelial neoplasia), histologically benign/non-malignant/premalignant/borderline/low malignant potential/dysplasia tumors, or intraepithelial neoplasia.
Non-Melanoma Skin Cancer: Benefits will not be paid for tumors described as benign, non-malignant, pre-malignant, borderline, low malignant potential, dysplasia (all grades), intraepithelial neoplasia, or Melanoma skin cancer. Not available for policies issued in NJ.
This document is intended as a summary of information on exclusions and state-required plan variations. For complete details, please see the certificate of coverage. If there is a discrepancy between this summary and the terms of the policy, the policy will govern. REV. 11/23.
- ✓Full benefit paid even if another insurance plan has already covered some or all of the medical costs
- ✓Easy online claims submission through My Group Online (MyGO) at symetra.com/MyGO
- ✓If you have multiple Symetra group coverages, claims are automatically cross-checked for additional benefits
- ✓Claims can also be submitted by phone (1-800-497-3699), email (sbclaims@symetra.com), mail, or fax
- ✓If you miss annual enrollment, you may still enroll within 30 days of a qualifying life event (marriage, divorce, birth of a child)
- ✓Passive enrollment option may automatically re-enroll you in selections each year (depends on employer setup)
- ⚠If you do not enroll during annual enrollment and do not have a qualifying life event, you must wait until the following year's annual enrollment
- ⚠Health screening benefit is payable only once per covered insured per calendar year regardless of number of screenings performed
- 👤Team members at any career stage who want financial protection against unexpected medical events
- 👤Team members who want to cover expenses not addressed by major medical insurance, such as transportation, child care, and household help during recovery
Your coverage through Symetra includes the following benefits at no additional cost to you:
Travel Assistance Program: 24/7 emergency medical assistance and other key services.
Identity Theft: Protect yourself from identity theft.
Estate Guidance: Create wills, healthcare and financial power of attorney, and/or final arrangement documents. Get more information at estateguidance.com.
For more information, call 1-833-808-0253, 1-978-651-9223 (international).
Symetra
1-877-377-6773
symetra.com