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Symetra Critical Illness Insurance
Symetra Life Insurance Company
Voluntary Critical Illness insurance providing a lump-sum payment upon first diagnosis of a covered critical illness condition. Benefit amounts of $5,000 to $30,000 are available with guaranteed issue up to the full benefit amount selected.
Starting from
$0.35
/mo
Employee Only
Monthly rate per $1,000 of benefit — Uni-Tobacco. Rates are age-banded based on employee attained age. Benefit amounts available: $5,000, $10,000, $15,000, $20,000, $25,000, or $30,000. All benefit amounts carry the same per-$1,000 rate.
—
/mo
Enter your age to see your estimated cost
Employee + Spouse
Monthly rate per $1,000 of benefit — Uni-Tobacco. Rates are age-banded based on employee attained age. Spouse benefit is 100% of employee benefit amount.
—
/mo
Enter your age to see your estimated cost
Employee + Child(ren)
Monthly rate per $1,000 of benefit — Uni-Tobacco. Rates are age-banded based on employee attained age. Child benefit is 25% of employee benefit amount. Rates include Health Screening benefit for Employee, Spouse, and Child.
—
/mo
Enter your age to see your estimated cost
Family
Monthly rate per $1,000 of benefit — Uni-Tobacco. Rates are age-banded based on employee attained age. Spouse benefit is 100% and child benefit is 25% of employee benefit amount. Rates include Health Screening benefit for Employee, Spouse, and Child.
—
/mo
Enter your age to see your estimated cost
Core Benefit Schedule
| Covered Condition | Benefit (% of Selected Amount) |
|---|---|
| Core Benefits | |
|
Invasive Cancer Includes Leukemia, Lymphoma, Sarcoma, Malignant melanoma >1mm, breast cancer, Multiple myeloma; must be diagnosed by Specialist via Pathological or Clinical Diagnosis |
100% |
|
Minor Cancer (In Situ) Cancer confined to tissue of origin; includes certain CLL, Stage 1A melanoma, early prostate cancer T1a/T1b |
50% |
|
Heart Attack (Myocardial Infarction) Ischemic death of heart muscle; diagnosis based on serial cardiac biomarkers by Specialist |
100% |
|
Stroke Acute cerebrovascular incident with irreversible brain tissue death; must result in neurological functional impairment confirmed by brain imaging |
100% |
|
Coronary Artery Disease Needing Surgery or Angioplasty Coronary artery blockage requiring bypass surgery or angioplasty as confirmed by cardiac catheterization angiography |
25% |
|
Major Organ Failure Permanent failure of heart, liver, lung, or pancreas requiring surgical transplant; Specialist must confirm transplant necessity |
100% |
|
Occupational HIV HIV infection from accidental occupational exposure to HIV-contaminated blood/fluids; must report within 24 hours; negative blood test within 14 days and seroconversion within 180 days required |
100% |
|
End-Stage Renal Failure Total and irreversible failure of both kidneys requiring permanent weekly dialysis or kidney transplant |
100% |
|
Loss of Sight Permanent and irreversible loss of sight in both eyes; corrected visual acuity 20/200 or less, or field of vision less than 20 degrees in both eyes; covers Accident, cataracts, glaucoma, macular degeneration |
100% |
|
Loss of Speech Permanent loss of ability to speak intelligibly; must be continuous for at least 180 days; covers Accident, Guillain Barre, Huntington's disease chorea |
100% |
|
Loss of Hearing Permanent reduction of hearing in both ears below 90 decibels; covers Accident, bacterial meningitis, Meniere's disease; confirmed by audiometric testing |
100% |
|
Paralysis Covers Sickness and Accident; quadriplegia, paraplegia, hemiplegia, or diplegia due to brain or spinal cord damage; complete and permanent loss of two or more limbs for at least 180 days |
100% |
|
Severe Burns Third degree burns covering at least 20% of body surface area |
100% |
| Neurological Conditions | |
|
ALS / Other Motor Neuron Disease Includes spinal muscular atrophy, progressive bulbar palsy, ALS (Lou Gehrig's Disease), primary lateral sclerosis; permanent functional neurological impairment persisting at least 90 days |
100% |
|
Advanced Alzheimer's Disease Progressive and permanent deterioration of memory; unable to independently perform at least 2 of 6 ADLs for at least 180 days; diagnosis confirmed by Specialist with standardized cognitive testing |
100% |
|
Parkinson's Disease Unequivocal diagnosis of idiopathic Parkinson's; must have resting tremor, rigidity, bradykinesia and gait disturbance as assessed by Specialist |
100% |
|
Advanced Multiple Sclerosis Definite MS with permanent functional neurological impairment persisting at least 180 days; confirmed by lumbar puncture, evoked responses, or MRI |
100% |
|
Coma Covers Accident and Sickness; profound unconsciousness with no response to stimuli for at least 96 hours; life support required; permanent neurological deficit assessed at least 30 days after onset |
100% |
| Childhood Conditions | |
|
Major Congenital Structural Anomaly Structural malformation arising in utero requiring medical treatment; examples include complex congenital heart disease, spina bifida, cleft lip/palate; must be named by Specialist with treatment plan |
100% |
|
Congenital Metabolic Disorder Genetic/inherited enzyme defect disorder; examples include phenylketonuria, cystic fibrosis, Tay Sachs; must be named by Specialist with treatment plan |
100% |
|
Congenital Chromosomal Abnormality Congenital abnormality in number or structure of chromosomes; examples include Down syndrome, Turner syndrome, sickle cell disease; must be named by Specialist with treatment plan |
100% |
|
Chronic Medical Condition Commonly Diagnosed in Childhood Named condition requiring ongoing treatment expected to persist at least 5 years; examples include epilepsy, cerebral palsy, asthma, Type 1 Diabetes; condition must be severe meeting defined criteria |
100% |
Optional / Additional Benefits
| Benefit | Details |
|---|---|
| Options | |
|
Health Screening Benefit For x-ray and laboratory tests only; payable once per covered insured per calendar year regardless of number of tests. $50 for employee, $50 for spouse. Eligible tests include biopsy, mammogram, colonoscopy, PSA, Pap test, chest x-ray, blood tests, stress test, and others. |
$50 per covered insured per calendar year |
|
Recurrence Benefit Payable when a specific critical illness recurs more than 6 months after the first diagnosis; each condition payable an unlimited number of times unless otherwise specified |
100% of critical illness benefit amount |
| Waiver of Premium | None |
| Dependent Benefits | |
| Spouse Benefit | 100% of employee benefit amount |
| Child Benefit | 25% of employee benefit amount |
| Additional Occurrences | |
|
Additional Occurrences / Second Condition If diagnosed with a different Covered Critical Illness at least one day after first diagnosis, full benefit paid for second condition |
100% of benefit amount for second covered condition |
Policy Definitions & Key Provisions
| Provision | Details |
|---|---|
| Benefit Provisions | |
|
Guaranteed Issue Full elected benefit amount up to $30,000 is GI |
Benefit amount available without evidence of insurability at time of first eligibility |
|
Evidence of Insurability (EOI) EOI not required during plan year for new employees or existing employees within 30 days of eligibility or approved life status change |
Not required at initial open or annual enrollment |
| Age-Based Benefit Amount Reductions | None |
| Lifetime Maximum Benefit Payout | No lifetime maximum |
| Benefit Waiting Period | None |
| Pre-Existing Condition Exclusion | None |
|
Continuation of Coverage Continuity with Prior Coverage feature applies if switching from another carrier; existing participants receive credit for time served |
Included |
|
Post-Termination Continuation of Coverage Coverage may continue for an unlimited period of time following termination of employment or loss of eligibility; see certificate for full details |
Unlimited period |
Continuation of Coverage During Temporary Absence
| Reason for Absence | Maximum Continuation Period |
|---|---|
| Temporary Absence Provisions | |
|
Illness or Injury From date last actively at work |
6 consecutive months |
|
Family Medical Leave of Absence (FMLA) Approved in accordance with federal FMLA 1993 or similar state law |
Up to 3 months |
|
Personal Leave of Absence Documented leave; ceases if leave terminates early |
Up to 2 months |
|
Military Leave of Absence (USERRA) Per federal USERRA 1994; ceases if leave terminates early |
Up to 12 weeks |
|
Sabbatical Employer-approved; ceases if sabbatical terminates early |
Up to 2 months |
|
Temporary Layoff Due to lack of work; ceases immediately if layoff becomes permanent |
Up to 2 months |
|
Temporary Production Shutdown Ceases immediately if shutdown becomes permanent |
Up to 2 months |
|
Labor Strike / Labor Dispute Ceases if strike or dispute ends earlier |
Up to 1 month |
Is This Right for You?
- Employees seeking financial protection against unexpected critical illness diagnoses
- Individuals wanting to cover costs not addressed by major medical (transportation, child care, lost income)
- Employees with dependents who want family coverage for neurological and childhood conditions
- Those wanting guaranteed issue coverage without medical underwriting
Who Can Enroll
- 👨👩👧👦Dependents covered up to age 26
- ✅Guarantee Issue — no medical exam required
- 📋EOI will not be required at initial open or annual enrollment.
- 📋Outside of enrollment periods, EOI will not be required when coverage is elected within 30 days of eligibility or an approved life status change.
What's Covered
Core Benefits (Cancer, Cardiac, Organ, Sensory)
Neurological Conditions
Childhood Conditions
Options (Health Screening, Recurrence)
Covered Conditions
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Eligible Health Screening Tests
| Eligible Tests / Screenings | |
|---|---|
| Tests to Screen for Cancer | |
| Biopsy | |
| 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) | |
| Colonoscopy | |
| Flexible sigmoidoscopy | |
| Hemoccult stool specimen | |
| Mammogram | |
| Pap test | |
| PSA (prostate-specific antigen tests) | |
| Serum protein electrophoresis (blood test for myeloma) | |
| Thermography | |
| Tests to Screen for Heart-related Disease | |
| Blood test for triglycerides | |
| Chest x-ray | |
| Serum cholesterol test to determine HDL/LDL level | |
| Stress test on a bicycle or treadmill | |
| Tests to Screen for Organ-related Disease | |
| Fasting blood glucose test | |
| Additional Eligible Screenings | |
| COVID-19 (PCR, rapid, antibody) |
Important Legal Disclosure
Critical Illness insurance policies are designed to provide benefits at a preselected, fixed-dollar amount, for specific critical illness conditions. Coverage may be subject to exclusions, limitations, reductions, and termination of benefit provisions. The policies do not satisfy the minimum essential coverage requirements of the Affordable Care Act. Critical Illness policies are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004. Base policy form number is SBC-00535 in most states and is not available in all U.S. states or any U.S. territory. State variations may apply.
Continuity with Prior Coverage
If/when Critical Illness coverage is currently offered through a different carrier, the current participants of an existing plan will receive credit for time served under that policy as part of the Continuity with Prior Coverage feature found in the Critical Illness policy offered by Symetra Life Insurance Company. Symetra will rely on the Policyholder to confirm existing coverage status.
Tax Notice
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 pre-tax basis. Critical illness benefits may also affect eligibility for public assistance programs such as federal, state, or local welfare programs. Consult a tax professional and/or your benefits representative for specific information.
State-Specific Plan Variations Notice
State-specific requirements may apply to certain benefits depending on the state where you live or the policy issue state (TX). State-specific variations include modifications to Invasive Cancer, Minor Cancer (In Situ), Non-Invasive Cancer, Non-Melanoma Skin Cancer, Heart Attack, Coronary Artery Disease, Stroke, Major Organ Failure, End Stage Renal Disease, Loss of Sight, Loss of Speech, Loss of Hearing, Paralysis, Severe Burns, ALS, Alzheimer's Disease, Coma, Parkinson's Disease, Multiple Sclerosis, Occupational HIV, Stem Cell/Bone Marrow Transplant, and Portability. Please see your plan's enrollment material to determine if these benefits are available. This document is intended as a summary of information; for complete details, see the certificate of coverage. If there is a discrepancy between this summary and the terms of the policy, the policy will govern.
Ventajas principales
- ✓File claims online in minutes through MyGO (symetra.com/MyGO) — create an account using your policy number
- ✓Submit health screening claims by calling 1-800-497-3699 (Mon-Fri 8am-8pm ET) or emailing sbclaims@symetra.com
- ✓Mail claims to: P.O. Box 674419, Houston, TX 77267-4419 | Fax: 715-682-5919
- ✓If you have multiple Symetra group coverages, claims are automatically cross-checked for additional eligibility
- ✓Enroll during annual enrollment to avoid waiting until the next enrollment period (unless you have a qualifying life event)
- ✓Health screening benefit: Simply provide the insured's name, type of screening, and date completed to file
Limitaciones
- ⚠If you do not enroll during annual enrollment, you must wait until the next annual enrollment unless you experience a qualifying life event (marriage, divorce, birth of child)
- ⚠For policies issued in CA or PA, upload the actual bill and the EOB from your health insurance carrier when filing claims through MyGO
Ideal para
- 👤Employees who want quick, paperless claims submission
- 👤Members who also have other Symetra coverages and want automatic cross-plan benefit checking
Which coverage amount is right for your age and situation?
Violet compares the $10k, $20k, $30k, and $40k options based on your age and budget.