Critical Illness Insurance

What is Critical Illness Insurance?

Provides a lump-sum payment directly to you when you are diagnosed with one of the covered conditions. This plan does not provide any type of medical coverage and is not a substitute for medical coverage or disability insurance.  This plan:

  • Offers financial flexibility and can be used for additional expenses,
  • Compliments, not replaces your medical and disability income coverage, and
  • Receive $100 annually for taking a health screening like cholesterol, mammogram, prostate to name a few preventative measures.
  • Dependents of HSTA members are also eligible for this coverage.
  • PLEASE NOTE:  Critical Illness Insurance is only available during Annual Open Enrollment

Learn more about Critical Illness Insurance at

Who is Eligible?
  • Be an Active HSTA Member regularly employed on a scheduled basis, or
  • Be an Associate HSTA Member regularly employed by the State of Hawaii, or
  • Be a regularly scheduled employee of the Hawaii State Teachers Association.

Dependent Coverage

When you apply for insurance for yourself, you may also apply for coverage for your dependents.

See full dependent coverage description on page 23 of Summary Plan Description.

CII Health Screening/Wellness Benefit

Once your coverage has been in effect for 30 days, MetLife will provide an annual benefit of $100 per calendar year for taking one of the eligible screening/prevention measures.  MetLife will pay one health screening benefit per covered person per calendar year.

For a complete list of eligible screening/prevention measures, please refer to the Plan Summary.  This coverage would be in addition to the Total Benefit Amount payable for the previously mentioned Covered Conditions.

How to File a Claim

Please NOTE:  If you are filing a claim and the diagnosis was before May 1, 2022, please call 1-800-438-6388 (EST between 6 a.m. to 6 p.m. M-F) using policy #0154147.  If you are filing a claim after May 1, 2022, please use the instructions below.  Thank you.

STEP 1:  CLAIM REQUEST

1.  Request a claim form from:
      a.  MyBenefits (https://mybenefits.metlife.com)
            •   Follow the easy steps to submit the claim online and begin the claim process immediately.
      b.  Claim Direct Phone {1-866-626-3705)

2.  MetLife will mail the participant/claimant a claims packet that includes a medical authorization form and claim form.

3.  After you receive the packet, participant/claimant (or other representative) may return all necessary Information to MetLife via fax (1-855-306-7350) or mail to:

Metropolitain Life Insurance Company
Attn: _____ Insurance Product
(Fill in the product you are submitting the claim for, i.e. Accident or Critical Illness)
P.O. Box 80826
Lincoln, NE 68501-0826

Step 2:  CLAIM INITIATION
A claim is set up upon receipt of:

1.  Fully completed, signed (by claimant and physician) and dated claim form.
2.  Date Incurred or dates of service applicable.
3.  Proof Requirements (i.e. any medical documentation that will assist in getting the claim paid).

Step 3:  CLAIM REVIEW, PROCESSING AND DECISION

Once a claim is set up, the claims examiner:

  1. Validates eligibility and premium payments are current.

  2. Reviews information to ensure no additional information is necessary.
    a. If additional information is needed, the claimant will be mailed a letter and the examiner will call them directly. They will ask for the details required to continue the review.
    b. MetLife will then request the necessary medical information from your doctor to make a claim determination.

  3. The examiner will make a claim decision.

  4. They will notify claimant of decision in writing.
    a. The claimant may also check on status via MyBenefits – https://mybenefits.metlife.com or call customer service (1-866-626-3705).

  5. MetLife will issue benefits if claim approved.
    a. Claimant can receive the claim amount from:
        i. MyBeneflts (https://mybenefits.metlife.com, claims section, under specific product) or customer service (1-866-626-3705).
        ii. Direct Deposit (if they filled out their bank information on the claim form they received in their packet).

  6. If claim is denied, you will be sent a letter.  MetLife will include the denial and appeals process within the letter for next steps.

How to File a Claim

You can designate another person to act on your behalf in the handling of your benefit claims. In order to do so, you must complete and file a form with the Trust Office and/or the insurance carrier that identifies the individual that is authorized to act on your behalf as your authorized representative. If you designate an authorized representative to act on your behalf, all correspondence and benefit determinations will be directed to your authorized representative, unless you direct otherwise. You may also request that this information be provided to both you and your authorized representative.

To file a claim for benefits, notice of the claim and proof of the claim must be submitted as follows:

Step 1: You must give notice by writing or calling MetLife within 30 days of the date of your loss.

Step 2: MetLife will send you a claim form and instructions on how to complete it. You should receive the form within 15 days of giving notice of your claim.

Step 3: When you receive the claim form, you should fill it out as instructed and return it with the required proof of claim.

Step 4: You must provide proof of your claim within 90 days of the date of your loss. If notice or proof of your claim is not given within the time limits described, the delay will not cause a claim to be denied or reduced if such notice and proof are given as soon as reasonably possible, but in no event later than 15 months from the date of your loss.

Your Certificate of Coverage contains specific proof requirements for covered conditions. You may be required to also provide authorization for MetLife to obtain medical records and other information pertinent to your claim and/or be examined by an independent physician at the Company’s expense.

For assistance in filing a claim or if you have any questions regarding claims and appeals procedures, contact the MetLife Customer Service representative toll-free at 1-800-438-6388, Monday through Friday between 8:00 a.m. and 11:00 p.m. Eastern Standard Time. You may also write to MetLife at the following address:

Metropolitan Life Insurance Company
Critical Illness Insurance Department
P.O. Box 6120
Scranton, PA 18505-9972

No, you can only enroll during open enrollment for CII and this happens annually.

CII provides you with a lump-sum payment in the event a covered member is diagnosed with one of the following medical conditions (as they are defined by the group certificate).

You may elect $15,000.00 or $30,000.00 of CII for yourself, spouse and/or dependent child(ren).  Enrollment is guaranteed provided the member is actively at work.

Your initial benefit provides a lump-sum payment upon the first diagnosis of a covered condition.  Recurrence benefit is paid when a covered person is diagnosed with another occurrence of the same covered condition for which an initial benefit was previously paid.  For more details, see Outline of Coverage.

The benefit check will be payable to you and mailed to the address on file.  The monies can be spent on anything, whether or not it is directly related to your illness.

No.  If you get one of the covered illnesses, you need to notify the carrier (MetLife) with the initial diagnosis.

No, since you are paying your premium with after tax money.

A pre-existing condition is a sickness for which, in the 3 months prior to becoming insured, or before any benefit increase, the covered member sought medical care, treatment, or advise or had symptoms, or any medical or physical condition.  The carrier (MetLife) will not pay a benefit if covered condition occurs during first 6 months of coverage.  The preexisting condition limitation may not apply to all covered conditions and may vary by state.  Refer to Outline of Coverage for details.

Covered Condition Categories are:  Benign Tumor, Cancer, Cardiovascular Disease, Childhood Disease, Functional Loss, Heart Attack, Infectious Disease, Kidney Failure, Major Organ Transplant, Progressive Disease, Severe Burn, and Stroke.

The CII carrier (MetLife) provides an annual benefit of $100 per calendar year for taking one of the eligible screening/prevention measures.  There is a 30-day waiting period.

The Trust must receive a written request for continued insurance within 31 calendar days after your group billed insurance ends.  You will need to make payment directly to the carrier (MetLife) and continue to pay premiums to keep coverage in force.