Specified Disease (New York)

SLPC 26500 5/17 (exp. 5/19)

Focus on your health—not your wallet—if you’re diagnosed with a serious illness.

If you are diagnosed with a serious medical condition, specified disease insurance helps reduce daily stress about money, so you can focus on getting better.

How does it work?

Sun Life’s Specified Disease insurance gives you a check for a pre-determined amount once your claim for a covered condition is approved. Depending on your plan, your spouse1 or dependent children may also be able to sign up for coverage.

You can use this money to help pay for:

  • Out-of-pocket medical expenses
  • Alternative therapies
  • Everyday expenses, like groceries, transportation, or child care

The cost for this insurance depends on your age, the benefit amount, whether or not you smoke, and other factors.

What’s covered?

Specified Disease insurance provides you with a full or partial benefit (subject to a maximum) for a variety of covered conditions. Depending on your plan, you may receive a benefit for the following:

  • Circulatory conditions (e.g., heart attack)
  • Cancer diagnoses
  • Non-life threatening cancer diagnoses
  • Skin cancer
  • Major organ transplant

Whether you receive a full or partial benefit depends on the covered condition. It’s important to know what conditions are covered by your plan, since some specified disease plans cover a range of conditions and others are specific and may exclude cancer. Check your plan details for more information on covered conditions and plan maximums, exclusions, and limitations.

Additional benefits that may be available with your plan

Wellness screening benefit This benefit provides you with a payment once a year for various health screening tests, such as prostate cancer screening, electrocardiogram, or a lipid panel to test cholesterol. You will receive a check if any one of the tests outlined in your plan is performed, so you can get paid for preventive screenings.
Recurrence benefit This benefit pays you an additional lump-sum payment if you are diagnosed for a second time with a covered condition for which a benefit has already been paid. This diagnosis must be for a new event, and not a re-diagnosis of the covered condition for which a benefit was already paid, and a certain number of months must pass between the diagnoses. A recurrence benefit may be payable once per covered condition, up to a maximum. Does not apply for all conditions. Refer to certificate for details.
Health care support services2 With Sun Life’s Specified Disease insurance, you and your family have access to leading health care support services. The HealthChampionSM program by ComPsych® Corporation is staffed by registered nurses and medical benefits experts who can help answer questions about your medical coverage, provide guidance on your benefits, explain your diagnosis and treatment options, and much more. You can take advantage of these confidential services for any covered condition or health concern you and your family may face.

1. If permitted by the Employer’s employee benefit plan and not prohibited by state law, the term “spouse” in this benefit includes any individual who is either recognized as a spouse, a registered domestic partner, or a partner in a civil union, or otherwise accorded the same rights as a spouse.

2. Value-added services are offered only on specific lines of coverage, and carry a separate charge, which is added to the cost of the insurance. The cost is included in the total amount billed. HealthChampion® (a health care support service) is not insurance and is provided by ComPsych®. Sun Life is not responsible or liable for care, services, or advice given by any provider or vendor of the Services. Sun Life reserves the right to discontinue any of the Services at any time.

In New York, to be eligible for Specified Disease coverage, the Insured must also be covered under major medical, or at least basic hospital and basic medical insurance. This is a limited benefit policy. This coverage does not constitute comprehensive health insurance (often referred to as "major medical coverage") and does not satisfy the requirement for Minimum Essential coverage under the Affordable Care Act. The expected benefit ratio for this policy is 70%. This ratio is the portion of future premiums which the Company expects to return as benefits, when averaged over all people with the policy.

The certificate has exclusions, limitations, and benefit waiting periods for certain conditions that may affect any benefits payable. Benefits payable are subject to all terms and conditions of the certificate.

Note regarding Employees Covered or Considering Coverage under Health Savings Accounts (HSA) Established in Connection with High Deductible Health Plans (HDHP):
Based on the limited available regulatory guidance, Sun Life believes its “Specified Disease insurance” is appropriate for use with an HSA and may be purchased when employees and/or their family members are covered under an HDHP. However, Sun Life cannot provide legal or tax advice. If there are legal or tax questions, we suggest that employees consult their own legal or tax advisor before purchasing this insurance.

In New York, Specified Disease insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Windsor, CT) under Policy Form Series 12-GP-SD-01, 13-SD-C-01, and 13-SDPort-C-01.