Critical Illness
This document provides details on Symetra's Critical Illness Insurance, which offers financial support for unexpected medical events, including coverage for childhood conditions.
Symetra Life Insurance Company Critical Illness Insurance Including coverage for childhood conditions For the critical moments in your life Whether you’re stepping into your first job or looking toward retirement, you never know when you may experience a health challenge. That’s why Symetra Critical Illness Insurance is designed to provide financial support whenever you’re faced with an unexpected medical event. Why critical illness insurance? An unexpected diagnosis usually leads to unexpected expenses. And many of these—such as additional needs for transportation, child care, help around the house and more—aren’t covered by major medical insurance. Symetra Critical Illness Insurance can help pay for these expenses through a lump-sum benefit paid directly to you, so you can focus on your recovery, rather than your finances. How it works If you and/or a covered dependent are diagnosed with a covered condition after the policy is in effect, you’ll receive a lump-sum benefit payment based on the terms of your policy and the diagnosis. This benefit is paid to you regardless of any other insurance coverage you may have. Continued > SBM-6393/CC 5/25
What’s covered Your coverage includes benefits for the following conditions. Please refer to your enrollment materials for a complete list of conditions and details, including information on who is considered an eligible dependent. 1 Covered conditions include: 2 • Invasive cancer • Minor cancer (in situ*) • Heart attack (myocardial infarction) • Stroke • Coronary artery disease needing surgery or angioplasty • Major organ failure • Occupational HIV • End-stage renal failure • Loss of sight • Loss of speech • Loss of hearing • Paralysis due to accident or illness 3 • Severe burns • ALS (amy otrophic lateral sclerosis )/Lou Gehrig’s disease Other motor neuron diseases are also covered, including primary lateral sclerosis, progressive bulbar palsy and spinal muscular atrophy. • Advanced Alzheimer’s disease • Parkinson’s disease • Advanced multiple sclerosis (MS) • Coma due to accident or illness 3 Childhood conditions If you enroll your dependent child in the plan, they may be eligible for a benefit if they’re diagnosed with a covered condition under one of these categories. Please note that only dependent children are eligible for these benefits, and the condition must be diagnosed while the coverage is in effect. • Major congenital structural anomaly Examples: Cleft lip/palate, clubfoot, complex congenital heart disease • Congenital metabolic disorder Examples: Cystic fibrosis, Gaucher’s disease, Tay-Sachs • Congenital chromosomal abnormality Examples: Down syndrome, sickle cell disease, hemophilia • Chronic medical condition commonly diagnosed in childhood Examples: Severe asthma, Type 1 diabetes, epilepsy 1 Eligible dependents may include your spouse or domestic partner (as defined by state or federal law) and your biological children, adoptive children or stepchildren. Contact your benefits representative to determine eligibility for dependent coverage. 2 In New Hampshire, occupational HIV is not covered, stroke is referred to as severe stroke, and advanced Alzheimer’s disease is referred to as Alzheimer’s disease. 3 May vary by state. * The term “in situ” refers to abnormal (cancerous) cells that have not spread. D I D YO U KN OW? If you or a covered dependent are later diagnosed with a second covered condition, you’ll receive the full benefit amount for that condition. 1 Please refer to your enrollment materials for complete details of the coverage. Simple coverage when you need it the most You’re diagnosed with a covered condition. Symetra approves your claim. A lump-sum benefit is paid directly to you. 2 Critical Illness Insurance | Including coverage for childhood conditions
Claim examples Meet Kristen and Eric In addition to their major medical insurance, Kristen and Eric each enroll in Symetra Critical Illness Insurance with a $10,000 policy benefit amount. Their employer provides the option to add dependents, so Eric enrolls his daughter Lexi in his plan with a $5,000 policy benefit amount. See how the benefits they receive help each of them after they're diagnosed with covered conditions. Kristen Kristen goes in for treatment after doctors discover she has breast cancer. They use a combination of surgery and radiation therapy treatment. Since Symetra considers any stage of breast cancer to be invasive cancer, Kristen receives the higher benefit amount typically associated with an invasive cancer diagnosis. She uses her critical illness benefit to help pay for her deductible and coinsurance, as well as other expenses while she’s recovering. Cancer benefit paid: 100% of policy benefit amount = $10,000 Kristen uses her benefit dollars on related medical costs, child care and transportation, then puts the rest in savings. These examples are for illustrative purposes only and are meant to provide a general overview of how coverage works. Any resemblance to actual persons is purely coincidental. Please refer to your complete set of enrollment materials for your plan’s benefit amounts and costs of coverage. Eric and Lexi Shortly after enrolling in his coverage, Eric suffers a heart attack and has to spend two days in the hospital. Later that year, Lexi is diagnosed with severe asthma. Eric receives two critical illness benefits, one for his heart attack and one for Lexi’s diagnosis, which help with a variety of related health care costs. Heart attack benefit paid: 100% of policy benefit amount = $10,000 Severe asthma dependent benefit paid: 100% of policy benefit amount = $5,000 Eric uses these benefits to pay for related medical costs and continue growing Lexi’s college fund. Each policy includes coverage for different conditions and life events. For costs and complete details of the coverage, contact your benefits representative. Continued > Continued > Critical Illness Insurance | Including coverage for childhood conditions 3
Frequently asked questions Will I receive reduced benefits from Symetra if another insurance plan covers my medical costs? No. We’ll still pay your full benefit, even if another insurance plan has already picked up some or all of the bill. Is it easy to use my supplemental health benefits? Yes! Watch this brief video to learn how to make the most of your benefits. Why should I enroll during annual enrollment? If you don’t enroll in coverage during annual enrollment, you’ll have to wait until the following year’s annual enrollment, unless you have a qualifying life event like a marriage, divorce or birth of a child. If I enroll now, will I be automatically reenrolled in the plan next year? It depends on how your employer sets up annual enrollment. You may need to review all of your selections and reelect coverage, or you may be automatically reenrolled in your current selections. Be sure to review your enrollment instructions and connect with your benefits representative if you have questions. Once I’m enrolled, how will I file a claim? You’ll have access to a user-friendly online portal where you can submit claims in just a few minutes. And if you have other group coverage with Symetra, we’ll automatically check to see if you’re eligible for additional benefits. Why Symetra? Symetra provides employee benefits, life insurance and annuities that have helped people live with financial security and confidence for more than 65 years. We’re committed to providing value to our customers, supporting our communities, providing a great place to work for our employees, and promoting diversity, equity and inclusion in everything we do. To learn more about our company, products and services, visit www.symetra.com . Note: Any critical illness benefits totaling more than the costs incurred for medical care are generally taxable if the employee or employer paid the premium on a pretax basis. It’s also important to note that critical illness benefits may affect eligibility for public assistance like federal, state or local welfare programs. For specific information, please consult a tax professional and/or your benefits representative. Don’t miss your opportunity to enroll in this valuable coverage. To get started, review your enrollment materials or talk to your benefits representative. Critical illness policies, insured by Symetra Life Insurance Company (est. 1957), 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, are not available in all U.S. states or any U.S. territory. They provide benefits at a preselected, fixed dollar amount for covered conditions. They are not a replacement for major medical or other comprehensive coverage, and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. Base certificate form number is SBC-04535 1/21. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions. 1 There must be a one-day separation between additional diagnoses. If two or more covered critical illnesses are diagnosed on the same day, only the benefit that provides the largest benefit amount will be paid. Symetra Life Insurance Company 777 108th Avenue NE, Suite 1200 Bellevue, WA 98004-5135 www.symetra.com Symetra® is a registered service mark of Symetra Life Insurance Company.
Symetra Life Insurance Company Critical Illness Insurance Understanding your health screening benefit Health screenings are essential when it comes to early detection of serious conditions. Fortunately, through your critical illness policy, you can receive a financial benefit for being proactive about your health and your family’s. After completing a health screening, just give us a call or send us an email and let us know (1) the name of the insured, (2) the type of screening, and (3) the date the screening was completed. Eligible health screenings • Annual physical exam • Biopsy • Blood test for triglycerides • 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) • Chest X-ray • Childhood vaccinations • Colonoscopy • COVID-19 (PCR, rapid, antibody) • Fasting blood glucose test • Flexible sigmoidoscopy • Hemoccult stool specimen • Mammogram • Pap test • Prostate-specific antigen (PSA) test • Serum cholesterol test to determine HDL/LDL level • Serum protein electrophoresis (blood test for myeloma) • Stress test on a bicycle or treadmill • Thermography Please refer to your certificate for complete details. Your health screening benefit amount: Policy #: Policyholder: You can also submit claims through My Group Online (MyGO). Simply use the policy information above to self-register and create an account. Contact us: Call 1-800-497-3699 Monday–Friday 8 a.m. to 8 p.m. ET sbclaims@symetra.com symetra.com/MyGO Mailing address: P.O. Box 674419 Houston, TX 77267-4419 Fax: 715-682-5919 Continued > SBM-6396/NS 6 / 2 4
Frequently asked questions How do I let Symetra know I had a health screening? It’s easy. Give us a call or send us an email and let us know three things: the name of the insured, the type of screening, and the date the screening was completed. You can also submit a claim through MyGO . Once you’ve created an account and logged in, click Submit my claim and add any required information. You can also upload any relevant documentation from a desktop computer or mobile device. 1 Is there another way to file my health screening benefit claim? Yes. You can also send claims by mail or fax. Please use the contact information on the first page and we’ll be happy to assist. Who can receive a health screening benefit? Anyone covered under your plan is eligible for these benefits. Please review your enrollment information for more details. How often can I receive a health screening benefit? This benefit is payable once per covered member during a calendar year. What if I have a screening that qualifies for benefits under more than one of my Symetra plans? If you have multiple coverages with Symetra, we’ll automatically cross-check to see if you’re eligible for more than one benefit and submit the claim on your behalf. Critical illness policies, insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, are not available in all U.S. states or any U.S. territory. They provide benefits at a preselected, fixed dollar amount for covered conditions. They are not a replacement for major medical or other comprehensive coverage, and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. Base certificate form number is SBC-04535 1/21. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions. For costs and complete details of the coverage, contact your benefits representative. 1 If your policy was issued in CA or PA, please upload the actual bill and the Explanation of Benefits (EOB) from your health insurance carrier. Symetra Life Insurance Company 777 108th Avenue NE, Suite 1200 Bellevue, WA 98004-5135 www.symetra.com Symetra® is a registered service mark of Symetra Life Insurance Company.
Symetra Life Insurance Company Critical Illness Insurance How to file a claim Your policy information Policy #: Policyholder: Option 1 Use My Group Online ( MyGO ) Initiate a critical illness claim within minutes on MyGO . This secure, user-friendly platform is available 24/7 through your computer or mobile device. To submit your claim: 1 Register your account at symetra.com/MyGO . Log in and select Submit my claim. 2 Fill out a few simple fields and upload documents. 3 Select Submit. With MyGO, you can also: Check the status of a claim. View an Explanation of Benefits (EOB) and enroll in paperless statements. Download important forms. Submit scans, photos or electronic versions of claim documents. Enter banking information to receive ACH benefit payments. Option 2 Contact Symetra Start your critical illness claim by phone, email or fax. One of our representatives will walk you through the steps and send you the necessary documents. Continued > SBM-6378 7/25
Frequently asked questions When do I need to submit my claim? We encourage submitting claims promptly after the date of diagnosis to help avoid delays. When will Symetra make a decision on my claim? Symetra typically makes decisions on claims within 10 business days of receiving all necessary information. If your claim is approved, you can expect to receive payment within 7–10 business days. Can Symetra help me gather any remaining information from my medical provider? Yes. Additional information such as doctor notes may be requested, and we’re happy to help you gather the remaining details after you initiate a claim. We’ll just need you to sign a release of information form so we can contact the provider on your behalf. What if I have a claim that qualifies for benefits under more than one of my Symetra plans? If you have multiple coverages with Symetra, we’ll automatically cross-check to see if you’re eligible for more than one benefit and will submit the claim(s) on your behalf. Does the policy have to be in effect to receive benefits? Yes. The diagnosis of a covered health condition must occur while the policy is active. Are my critical illness benefits taxable? Any critical illness benefits totaling more than the costs incurred for medical care are generally taxable if the employee or employer paid the premium on a pretax basis. It’s also important to note that critical illness benefits may affect eligibility for public assistance like federal, state or local welfare programs. For specific information, please consult a tax professional and/or your benefits representative. Contact us for additional questions about your coverage and filing a claim. Call 1-800-497-3699 Monday through Friday 8 a.m. to 8 p.m. ET sbclaims@symetra.com symetra.com/MyGO Fax: (715) 682-5919 Mailing address: P.O. Box 674419 Houston, TX 77267-4419 Critical illness policies, insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, are not available in all U.S. states or any U.S. territory. They provide benefits at a preselected, fixed dollar amount for covered conditions. They are not a replacement for major medical or other comprehensive coverage, and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions. For costs and complete details of the coverage, contact your benefits representative. Symetra Life Insurance Company 777 108th Avenue NE, Suite 1200 Bellevue, WA 98004-5135 www.symetra.com Symetra® is a registered service mark of Symetra Life Insurance Company.
