CICA State Differences

Accident

  • Activate up to age 70 *NY- age 64, age 24 for dependent children
  • NY State - No Sports Package or Recovery Benefit and Hospital Confinement Benefits pay differently for Metro vs 

Non Metro NY.

  • Professions not covered: NY - Fire Department Employees including EMTs & Correctional Officers; All States – Longshoremen & Port Workers

Critical Illness

  • Activate up to age 65 (64 in NY and SC)
  • 30 day Waiting Period in all states except CT, MD, MO, NJ, SC and TX
  • Pre-Existing Conditions- 12 months, NJ and NY- 6 months, GA- No Pre-Existing
  • Cannot split coverage in NJ, Critical Illness Only policies not available in GA
  • NJ, TN, WA- Applicants must be working, WA- min coverage of $25,000

State Specifics

Most States

Cancer, Heart Attack, Stroke, ALS, Kidney Failure, Benign Brain Tumor, Multiple Sclerosis, Coma, *Carcinoma in Situ, *Coronary Artery Obstruction, **Skin Cancer, ***Major Organ Failure

NJ

Same as above except No Coma Benefit

NY

Cancer, Heart Attack, Stroke, Benign Brain Tumor, Multiple Sclerosis, Coma, *Carcinoma in Situ, *Coronary Artery Obstruction, *Stage 1 Hodgkin’s Disease, *Stage 1 Prostate Cancer, **Skin Cancer, ***Major Organ Failure (including kidney failure)

GA

Cancer, Heart Attack, Stroke, ALS, Kidney Failure, Multiple Sclerosis, *Carcinoma in Situ, *Coronary Artery Bypass, **Skin Cancer, ***Major Organ Transplant

* 25% OF FACE AMOUNT PAID ** $250 BENEFIT PAYMENT, ***Must be placed on UNOS List for transplant to Qualify

Best Doctors

NO Best Doctors in CA, CT, GA, MO, OH, WA or NJ

Major Medical 

Applicants in CA, GA, NJ, and NY MUST have medical coverage to be eligible

Medicaid

Applicants on Medicaid in CT or DE are not eligible

Disability

  • Activate up to age 63   - Guaranteed renewable till age 72
  • If a member works part-time but works at least 30 hours per week we can sell it
  • Pre-Existing Conditions – 12 months back from the start date of the policy
  • Policy does not pay for on the job injuries if Worker’s Compensation covers the injuries

Not Covered:

  • Self-Inflicted Injuries
  • Elective surgery/cosmetic surgery
  • Mental Illness or Rest Cures (Stress/Anxiety)
  • Normal Pregnancy  or childbirth
  • Complications of Pregnancy until 10 months after effective date (DC, FL, GA, IL, MD, MI, MO, NJ, NC, NY, PA & SC)

Professions not covered:

  • Professional Pilots and Flight Attendants 
  • Air Traffic Controllers
  • Longshoremen
  • Port/Dock Workers
  • Fire Department and FD Employees including EMTs (NY Only)



 

 

State Specifics

MI

  • 20% of income replacement for union employees

FL Miami Dade Employees

  • If member has MetLife’s Group Plan- sell 20% of income replacement 
  • If not, sell 40% of income replacement

NJ- If member qualifies for State Disability Plan

  • 180 day elimination period with 40% of income replacement 
  • 14/30 day elimination period with 20% income replacement

Hospital Sickness

  • Activate up to age 65
  • Benefits in NJ include Hospital Confinement and ICU Confinement only
  • All benefits payable for sickness and accidents in CT and PA. Accident benefits are limited to $25. 
  • Hospital admission or confinement due to pregnancy, childbirth, or complications of pregnancy, during the first 10 months after the policy effective date, are not covered. 
    1. FL, MD, PA – No childbirth limitations
    2. NC, TX—No complications of pregnancy limitations
    3. NJ- Hospital admission and/or hospital confinement due to pregnancy, childbirth or complications of pregnancy will not be covered unless conception occurs after policy effective date. After coverage has been in force for 30 days or more, benefits for pregnancy and complications of pregnancy will be covered the same as a covered sickness
  • Wellness Benefits available after 30-day Waiting Period in all states except MD & MO
  • A Pre-Existing condition is not covered unless such condition begins 12 monthsfrom the Policy Effective Date. 
    1. MD- 3 months, NJ- 6 months, TX- Age 65 or older: 6 months
  • A Pre-Existing conditionmeans a condition for which medical advice or treatment was received or recommended by a physician within 12 months before the effective date.
    1. MD, PA- 3 months, NJ- 6 months
  • MAJOR MEDICAL- Applicants in DC MUST have medical coverage to be eligible.