Frequently Asked Questions

Home | Frequently Asked Questions
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    Q. Can a spouse of an eligible employee enroll in Critical Illness Plan without the employee enrolling?

    A. No, the employee must enroll in the plan to have spousal and/or family coverage.  Spouse coverage CANNOT EXCEED the employee coverage amount.
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    Q. Is the Critical Illness Plan portable?

    A. Yes, fully portable with same coverage and rates from day one.

    • Policy is Portable at any age
    • Insured can keep coverage as long as premiums are paid
    • Insured can keep policy if group terminates coverage
    • Portability availability is terminated at age 90
    • If Lincoln is notified that a member terminated employment, Lincoln will send a notice to the terminated employee that they can pay directly to Lincoln with no change in rates.
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    Q. Is there a benefit waiting period?

    A.  No, there is no waiting period for benefits
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    Q. What is the principal sum?

    A. The principal sum is the benefit amount selected by the employee at enrollment time.  This amount is from $5,000 up to $30,000 for the employee and from $5,000 up to $15,000 for the spouse.
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    Q. Will the policy terminate when an insured reaches a certain age?

    A. Employees who continue to work can continue their coverage.  If an employee ports their policy, coverage will terminate at age 90.
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    Q. How is the issue age determined?

    A. Issue age is based on the individual’s age on the policy’s effective date – January 1st 2014.
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    Q. Are the rates Unisex?

    A. Yes, both male and female rates are the same.
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    Q. Do Rates Increase as I get older?

    A. Once the coverage is issued, rates do not change or increase due to age.  They continue at the original age banded rate as long as premiums are paid.
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    Q. What is the spouse age and tobacco status based on?

    A. NSpouse’s age and tobacco status is based on the EMPLOYEE’s age and tobacco status.
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    Q. Will the benefit amount ever reduce?

    A. No, the employee must enroll in the plan to have spousal and/or family coverage.  Spouse coverage CANNOT EXCEED the employee coverage amount.
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    Q. What is a Recurrence Benefit?

    A. The Recurrence Benefit is payable for multiple events in the same category.
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    Q. What is the Lifetime Maximum Benefit option?

    A.

    An additional amount of 50% for each category is provided for occurrences inside the same category, OR a total of 150% of the Principal Sum in each category

    Example: A $30,000 Principal Sum of Benefit Elected By Insured

    50% Benefit provides $45,000 of Lifetime maximum Payout in each category

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    Q. Does LINCOLN require a waiting period between illnesses/events for the insured to collect a benefit?

    A.

    Yes, Same Benefit Category Occurrence – 180 days

    Separate Category Occurrence – 90 days

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    Q. Will LINCOLN pay for the same event/illness more than once?

    A.

    Yes, LINCOLN will pay benefit for the same event/illness as long as the event/illness was separated by 180 days and there is a balance remaining for that category.

    Example:  Heart Category- $25,000 Principal Sum and 50% Recurrent Benefit = $37,500 Lifetime Max Benefit.

    Jan 1 – Heart Attack – Principal Sum benefit Payment – $25,000

    Oct 1- Heart Attack- Recurrent Benefit Payment – $12, 500

    Total Benefit Paid =  $37,500 and category benefit is exhausted and the category is removed from the plan and the premiums are reduced.

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    Q. Does each insured have their own benefit or is it one bucket of money?

    A. No, each insured (employee & Spouse) has their own respective benefit.
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    Q. Does each event/illness pay out the entire principal sum?

    A.Certain events/illnesses pay percentage of the principal sum. (SEE TABLE BELOW)

    Heart Attack 100%
    Arteriosclerosis (limit 2) 10%
    Aneurysm 10%
    Cancer 100%
    Carcinoma in Situ 25%
    Stroke 100%
    ESRD (End Stage Renal Failure) 100%
    Major Organ Transplant (Excluding heart) 100%
    Coma 100%
    Paralysis (due to accident) 100%
    Severe Burns 100%
    Blindness (termed loss of sight) 25%
    Hearing 25%
    Speech 25%
    Advanced Alzheimer’s 100%
    Advanced Multiple Sclerosis 25%
    Advanced Parkinson’s 100%
    Benign Brain Tumor 25%
    ALS/Lou Gehrig’s Disease 100%
    Bone Marrow Transplant 25%
    Acute Respiratory Distress 25%

     

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    Q. How is the benefit determined if the insured sustains two or more Events/Illnesses simultaneously?

    A. If Insured Person or Insured Dependent sustains two or more Events/Illnesses simultaneously, the highest applicable benefit is payable.  Certain Events/Illnesses are only payable once per the insured’s or insured’s dependents lifetime as shown in the Schedule of Benefits.
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    Q. Does the plan include a Pre-existing Condition Exclusion?

    A. The plan has a 12/12 Pre-existing condition exclusion.
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    Q. How is the event/illness determined?

    A. The event/illness is based on diagnosis.

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    Q. Does the insured have to survive the Event/Illness to be paid a benefit?

    A. No. LINCOLN does not require a survival period.  Benefits are paid to selected beneficiary upon death of the insured.

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    Q. What happens to the covered dependents if the employee dies?

    A. The dependents may continue the plan for three months (longer if required by state or federal law). The group must continue to submit the premium on behalf of the surviving dependents.
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    Q. Can the Critical Illness Plan be under a Section 125 and paid for with pre-tax dollars?

    A. Yes, the premiums can be paid either on a pre-tax or post– tax determined by UMass.
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    Q. Is LINCOLN’s CI Plan HSA Compatible?

    A. An employer who offers a Critical Illness Plan is not precluded from also offering a High Deductible Health Plan/Health Savings Account.
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    Q. If a married couple works together, can they both enroll on each others plan?

    A. Yes, there is nothing in our contract that prohibits a married couple from enrolling on each other’s plan and collect benefits on both plans.  (No coordination of benefits)
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    Q. What is the maximum age of a dependent?

    A. The plan offered allows dependent children to age 26.
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    Q. How are new spouse dependents handled?

    A.

    If additional premium is required to add a new dependent, coverage for the new dependent will become effective on the date the dependent is acquired

    • Requirements: The insured dependent completes a written application and a payroll deduction order and the additional premium is paid to the company
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    Q. What are the eligibility requirements for this plan?

    A.

    UMass Employees must be actively at work on the effective date, work a minimum of 20 hours per week

BENEFIT CATEGORIES

Critical Illness Assessment Benefit (i.e., Screening Benefit)

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    Q. Is the Critical Illness Assessment Benefit payable per covered person or one per family?

    A. The plan pays per insured per policy year.
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    Q. Are immunizations and physical exams covered on the Critical Illness Assessment Benefit?

    A. No, neither are payable under the Critical Illness Assessment Benefit.
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    Q. Is there a waiting period before an insured can collect on the Critical Illness Assessment Benefit?

    A. No, the insured can use this category on or after the effective date.
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    Q. What is the Critical Illness Assessment Benefit?

    A. $50 per covered person, per plan year.
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    Q. Can the employee claim for the Assessment Benefit even if they incur no cost?

    A. Yes.  The employee can claim the benefit even if they incurred no cost.
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    Q. What are the covered tests under the Critical Illness Assessment Benefit?

    A.

    (1)           abdominal aortic aneurysm ultrasonography;

    (2)           blood test for triglycerides;

    (3)           bone marrow testing;

    (4)           bone density screening;

    (5)           breast ultrasound;

    (6)           CA 15-3 (blood test for breast cancer);

    (7)           CA125 (blood test for ovarian cancer);

    (8)           carotid ultrasound;

    (9)           CEA (blood test for colon cancer);

    (10)         chest X-ray;

    (11)         colonoscopy;

    (12)         EKG;

    (13)         double contrast barium enema;

    (14)         fasting blood glucose test;

    (15)         flexible sigmoidoscopy;

    (16)         hemoccult stool analysis;

    (17)         mammography;

    (18)         pap smear;

    (19)         PSA (blood test for prostate cancer);

    (20)         serum cholesterol test to determined level of HDL and LDL;

    (21)         serum protein electrophoresis (blood test for myeloma);

    (22)         stress test;

    (23)           thermography.

    (24)           CT Angiography

HEART CATEGORY

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    Q. What triggers the benefit for the Heart Transplant?

    A.

    Insured is put on the UNOS- United Network for Organ Sharing list the benefit will be paid.

    Insured is determined to be too ill for the transplant but otherwise meets the criteria for being on the list.   Then the insured receives the transplant prior to placement on the list.

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    Q. Is there a limit on the number of payouts Arteriosclerosis and Aneurysm due to Arteriosclerosis?

    A. Yes, the benefit is 10% of the Principal Sum selected subject to a lifetime maximum of two payments.
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    Q. Is the benefit payable for sudden cardiac arrest?

    A. No, since this does not constitute a heart attack.  Example of sudden cardiac arrest: getting hit by ball in chest creates sudden cardiac arrest that results in death.
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    Q. What is a heart attack?

    A. Heart attack means death of a portion of heart muscle due to inadequate circulation in coronary arteries.
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    Q. Are transient ischemic attacks (TIA) considered a stroke?

    A. A TIA is not considered a stroke nor is it a pre-existing condition on the policy.

ORGAN CATEGORY

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    Q. What are considered as major organs?

    A.

    • Heart
    • Liver
    • Lungs
    • Pancreas
    • Intestines
    • Combination of these organs
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    Q. What triggers the benefit for Organ Transplant?

    A. Insured is put on the UNOS- United Network for Organ Sharing list the benefit will be paid. The insured receives the transplant prior to placement on the list
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    Q. Can the insured collect the Major Organ Transplant benefit without receiving the transplant?

    A. Yes, if the insured is determined to be too ill for a transplant, but otherwise meets the criteria for placement on UNOS.
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    Q. Is a kidney transplant a covered benefit?

    A. No, kidney transplants are not covered under this benefit.  If the insured is experiencing a chronic and irreversible failure of the kidneys the benefit will be payable under the End Stage Renal Failure benefit.

CANCER CATEGORY

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    Q. What is the policy’s definition of Cancer?

    A. Malignant cells or tumors characterized by uncontrolled growth with spread beyond the initial tissue.
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    Q. How must the diagnosis be certified?

    A. Diagnosis must be by a board-certified or board-eligible oncologist or board-certified or board-eligible pathologist and based on microscopic tissue evaluation (biopsy). 
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    Q. What is Cancer in Situ?

    A.

    Cancer cells confined to the surface tissues (epithelium) without invasion of the basement membrane and with no spread to regional lymph nodes or other tissues. The contract defines it as follows:

    Basal cell carcinoma and squamous cell carcinoma of the skin; and Melanoma that is diagnosed as Clark’s level I or II, or Breslow less than 0.75 mm.

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    Q. Is the benefit the same for Cancer in Situ?

    A. The benefit for Cancer in Situ is 25% of the principal sum.

QUALITY OF LIFE CATEGORY

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    Q. What is the definition of Advanced Alzheimer’s?

    A. Dementia of the Alzheimer’s Type that has progressed to the point that the individual can be classified as Functional Assessment Staging (FAST) Scale Stage 6.
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    Q. What is the definition of Advanced Multiple Sclerosis?

    A. Multiple Sclerosis with demonstrated neurological deficits that have been present for six months or more.

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    Q. What is the definition of Advanced Parkinson’s?

    A. Parkinson’s Disease that has progressed to Stage 4.

ACCIDENT CATEGORY

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    Q. What are the covered accidents payable under this category?

    A. Coma, Severe Burn, or Paralysis.
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    Q. For the coma benefit to be payable, does the insured have to be a coma for a specific length of time?

    A. The benefit amount is equal to the insured’s principal sum.
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    Q. Is this category cover both on the job and off the job accidents?

    A. Yes, the insured must be in a coma for 7 consecutive days before benefit is payable.  In addition, the coma cannot be medically induced.
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    Q. What is the policy’s definition of paralysis?

    A. The policy’s definition of paralysis is the complete and permanent loss of the use of two or more limbs.
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    Q. What is meant by “Severe Burn”?

    A. Third degree burn covering at least 18% of the body, or Second degree burn covering at least 36% of the body.