Citi Benefits Handbook
Critical Illness Plan
The Critical Illness Plan provides cash benefits to help cover out-of-pocket costs that come after a covered critical illness, such as a heart attack, stroke or cancer. You can choose between two coverage levels:
The plan pays benefits as a percentage of your Face Amount or in some cases, the plan pays a flat dollar benefit amount, no matter which coverage level you choose. Note: Benefits for covered child(ren) are 50% of the amount that would be paid to a covered employee or spouse.
1 The separation period is waived if the subsequent diagnosis is in a different benefit category. Benefit category is defined as either cancer or non-cancer benefits.
2 In addition to the separation period, you must be treatment free during the separation period. Treatment does not include maintenance drug therapy or routine follow-up visits to a physician to confirm the initial cancer or carcinoma in situ has not returned.
1 The plan limits payment of benefits to once per lifetime.
2 The plan limits payments for infectious disease diagnosis to once per lifetime.
3 The following infectious diseases require a hospital stay of at least five days: coronavirus, Creutzfeldt-Jakob disease, Ebola, pneumonia, septic shock and severe sepsis, tularemia and variant influenza virus (swine flu in humans)
4 If you were diagnosed with cancer before the effective date of your coverage under the Critical Illness Plan, and you receive a new cancer diagnosis while covered under the plan, your new diagnosis will be treated as an initial diagnosis.
Waiver of Premium
If you miss 30 continuous days of work as a result of critical illness, cancer (invasive), carcinoma in situ or skin cancer, your Critical Illness coverage premium will be waived beginning on the first pay period that occurs after the 30th day of your absence, through the next six months of coverage. You must remain employed to qualify for a waiver of premium. This waiver of premium benefit does not apply to your covered dependents.
Exclusions and Limitations
Benefits will not be paid for a diagnosis related to:
- Act of war, riot or war;
- Assault, felony, illegal occupation or other criminal act;
- Care provided by immediate family members or any household member;
- Suicide or attempt at suicide, intentionally self-inflicted injury, or any attempt at self-inflicted injury, or any form of intentional asphyxiation, except when resulting for a diagnosed disorder; or
- Being under the influence of a stimulant (such as amphetamines), depressant, hallucinogen, narcotic or any other drug intoxicant, including those prescribe by a physician that are misused by the covered person, except when resulting from a diagnosed disorder.
The critical illness date of diagnosis must be on or after the effective date of the certificate of coverage and while coverage is in force. The diagnosis must be given or received in the United States or its territories.