Critical Illness Plan
Assistance When Facing Illness
NCFlex's Critical Illness Plan provides a vital safety net during challenging times. The Plan pays a lump sum benefit to you or your covered family member when diagnosed with a covered illness or condition on or after the coverage effective date. Benefits are paid directly to you and issue is guaranteed meaning no health questions are required at initial enrollment. This financial support can alleviate the stress of financial burdens allowing you to focus on recovery.
The Critical Illness Plan is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
Plan Highlights
- No waiting period for new diagnosis.
- Benefits for covered dependents are the same as those for covered employees.
- Unmarried children up to age 26 may be covered at no cost but must be added to the plan.
- Total payable for each insured person is unlimited for most diagnoses.
Note that if benefits were paid by Voya previously for a critical illness, a 6-month separation period between diagnoses for that same illness is required. Skin cancer benefits are payable up to 10 times per covered member only.
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Coverage
You can choose a benefit amount of $15,000, $25,000 or $40,000, and benefits are paid directly to you. Some covered conditions pay out a percentage of the maximum lump sum.
In the event of the illnesses below, covered individuals will receive the entire elected benefit amount.
- Heart Attack
- Stroke
- Major Organ Transplant
- Bone Marrow Transplant
- Cancer
- Carcinoma in situ
- Permanent paralysis
- Coma
- Severe Burns
- Loss of Sight/Speech/Hearing
- Advanced Dementia
- Benign Brain Tumor
- Parkinson's Disease
- Multiple Sclerosis
- Muscular Dystrophy
- Occupational HIV
- Hepatitis B or C
- Type 1 Diabetes
- ALS
- Huntington's Disease
- Coronary artery bypass
- Stem cell transplant
In the event of the illnesses below, covered individuals will receive a percentage of the elected benefit amount.
- Skin Cancer: 10%
- Sudden Cardiac Arrest: 25%
- Pacemaker placement: 10%
- Infectious disease: 25%
- Transient Ischemic Attack: 10%
- Open heart surgery for valve replacement or repair: 25%
- Transcatheter heart valve replacement or repair: 10%
- Coronary angioplasty: 10%
- ICD placement: 25%
- Aneurysm (ruptured or dissecting, abdominal aortic or thoracic aortic): 10%
- Addison's disease: 10%
- Systemic sclerosis: 10%
- Myasthenia gravis: 50%
- Systemic Lupus Erythematosus: 50%
- Wellness Benefit: To make preventive screenings more accessible, each Critical Illness option includes a $50 or $25 Wellness Benefit per covered person for one health screening test per year.
- Infectious Disease Rider: This rider is specific to the diagnosis of COVID-19 by a medical professional.
- Diagnosis Benefit: This benefit pays $100 once per calendar year per covered person for a COVID-19 diagnosis.
- Hospital Confinement Benefit: If you or a covered dependent is confined to a hospital due to COVID-19, you'll receive $2,000 once per calendar year.
- Infectious Disease Benefit: If your COVID-19 diagnosis then results in you being confined to a hospital for five or more consecutive days or a transitional facility for five or more consecutive days, you are additionally owed 25% of your Critical Illness benefit amount.
Monthly Premiums
The monthly premium for you and/or your spouse is based on your age as of January 1 of the current plan year. An employee may not be covered both as an employee and as a dependent. Children up to age 26 can be covered at no cost.
Rates for you and your spouse are based on your age as the employee.
| Premiums for Employee/Spouse | |||
|---|---|---|---|
| Employee Age: | Benefit Amount* | ||
| $15,000 | $25,000 | $40,000 | |
| <25 | $0.90 | $1.50 | $2.40 |
| 25–29 | $1.20 | $2.00 | $3.20 |
| 30–34 | $2.10 | $3.50 | $5.60 |
| 35–39 | $2.70 | $4.50 | $7.20 |
| 40–44 | $4.20 | $7.00 | $11.20 |
| 45–49 | $7.80 | $13.00 | $20.80 |
| 50–54 | $10.80 | $18.00 | $28.80 |
| 55–59 | $15.90 | $26.50 | $42.40 |
| 60–64 | $29.70 | $49.50 | $79.20 |
| 65–69 | $42.00 | $70.00 | $112.00 |
| 70+ | $49.80 | $83.00 | $132.80 |
*The costs are per covered person (employee/spouse) for the benefit amount elected.
Your monthly premium will depend on several factors including age and dependents covered. Below you'll find an example to help you understand how overall cost is determined. The example is based on the cost for the $15,000 option of the Plan.
| Factor Contributing to Cost | Monthly Rate |
|---|---|
| Employee age is 43 | $4.20 |
| Spouse rate based on employee age | $4.20 |
| Three children (varying ages up to 26 and unmarried) | $0 |
| Total Monthly Premium: | $8.40 |
Your benefit payment depends on numerous factors. The example below is for an employee who chose the Plan's $25,000 option. An employee's individual experience may vary.
| Covered Condition | Lump-Sum Benefit Payment Received |
|---|---|
| Employee has a heart attack. | $25,000 |
| Three months later, the employee is diagnosed with noninvasive cancer. | $6,250 |
| 12 months later the employee has another heart attack. | $25,000 |
| Two months later the employee becomes paralyzed. | $25,000 |
| Total Payout: $81,250 | |
Need to Know Details
The same diagnosis of a covered critical illness for which benefits were previously paid by Voya must have a six-month separation period between diagnoses to receive another payout.
When you enroll in NCFlex's Critical Illness Plan, be sure to designate beneficiaries in your enrollment platform.
If Voya — the Critical Illness Plan's vendor — pays an employee benefits totaling $600 or more in a plan year, the employee will receive an IRS 1099-MISC after the plan year ends. The employee should consult with a tax advisor regarding the possible effects on their taxes.
There are no pre-existing condition limitations on NCFlex's Critical Illness Plan.
A pre-existing condition is a sickness or condition that resulted in medical treatment, consultation, care or services (including diagnostic measures) for a designated period of time before the coverage or increase effective date.
Covered members will be eligible for the benefit amount as shown on the schedule of benefits in the certificate if they are diagnosed with a covered critical illness on or after their coverage effective date. For a complete description of available benefits, exclusions and limitations, see the certificate of insurance and any riders.
If you leave state employment or retire prior to age 70, the Critical Illness Plan is portable at the same rate you would pay as an employee. Find details in our guide to continuing coverage or contact Voya at 877-464-5111 to learn more.
Skin cancer benefits are payable up to 10 times only per covered member.
Supporting documentation must be included. For questions, contact LifeHelp.
Any diagnosis claims prior to 1/1/2023 should be filed with Allstate instead of Voya.
| Critical Illness Plan Contact Information | |
|---|---|
| Customer Service | 877-464-5111 Fax claims: 1-612-467-8721 9 a.m.–5 p.m. (EST), Monday–Friday |
| Mailing Address | LifeHelp Attn: NCFlex 2990 Innsbruck Dr Redding, CA 96003 |
| ncflex@lifehelp.com | |
| Claims | Follow these directions for filing claims. |
The NCFlex Critical Illness Plan is administered by Voya Financial and underwritten by ReliaStar Life Insurance Company.