Voya Critical Illness Benefit Summary

Critical illness benefits
Wellness Benefits

Critical Illness Benefits

Employees – basic and voluntary coverage:
- CMSU automatically provides you with $5,000 of basic Company-paid coverage at no cost to you.
- You may also purchase a critical illness benefit of $5,000, $10,000, $20,000, or $30,000 (this is in addition to your $5,000 Company-paid benefit).
Eligible children – basic and voluntary coverage:
- Eligible children are automatically covered at 25% of your basic and voluntary benefit at no cost to you.
Spouse/domestic partners –voluntary coverage only:
- If you purchase coverage for yourself, you may also purchase voluntary employee-paid coverage for your spouse/domestic partner of $5,000, $10,000, $20,000, or $30,000.

The diagnosis of a covered critical illness must occur on or after the coverage effective date. When the total maximum benefit amount for a covered critical illness is reached, no further benefits for that critical illness are payable.

Voya breaks out covered illnesses/conditions into groups called "modules".

Base module:

Heart attack—100% of critical illness benefit amount
Cancer (invasive)—100% of critical illness benefit amount
Cancer (non-invasive)—25% of critical illness benefit amount
Stroke—100% of critical illness benefit amount
Major organ transplant—100% of critical illness benefit amount
Coronary artery bypass—100% of critical illness benefit amount

A diagnosis of heart attack or coronary artery bypass must be made by a cardiologist or a doctor familiar with the specific condition. A diagnosis of stroke must be made by a neurologist or a doctor familiar with the diagnosis of stroke. A diagnosis of cancer (invasive) or cancer (non-invasive) must be made by a doctor familiar with the specific condition.

If you are on the UNOS (United Network for Organ Sharing) list for a combined transplant, only one major organ transplant benefit will be payable for the diagnosis.

Major organ module:

Type 1 diabetes—100% of critical illness benefit amount
Severe burns—100% of critical illness benefit amount
Transient ischemic attacks (TIA)—10% of critical illness benefit amount
Ruptured or dissecting aneurysm—10% of critical illness benefit amount
Abdominal aortic aneurysm—10% of critical illness benefit amount
Thoracic aortic aneurysm—10% of critical illness benefit amount
Open heart surgery for valve replacement or repair—25% of critical illness benefit amount
Transcatheter heart valve replacement or repair—10% of critical illness benefit amount
Coronary angioplasty—10% of critical illness benefit amount
Implantable/internal cardioverter defibrillator (ICD) placement—25% of critical illness benefit amount
Pacemaker placement—10% of critical illness benefit amount

A diagnosis of Type 1 Diabetes must:

Be made by a board-certified or board-eligible endocrinologist or other specialist in the treatment of diabetes,
Be based on blood tests, and
Require insulin administration for a continuous period of at least 3 months.

A diagnosis of ruptured or dissecting aneurysm, or transient ischemic attacks (TIA) must be confirmed by a neurologist or a doctor familiar with the diagnosis of the specific condition.

A diagnosis of abdominal aortic aneurysm, or thoracic aortic aneurysm, or open heart surgery for valve replacement or repair, or transcatheter heart valve replacement or repair, or coronary angioplasty, or implantable (or internal) cardioverter defibrillator (ICD) placement, or pacemaker placement, or must be made by a cardiologist or a doctor familiar with the diagnosis of the specific condition.

One benefit for open heart surgery for valve replacement or repair is payable if the diagnosis is for replacement or repair of one or more valves.

One benefit for transcatheter heart valve replacement or repair is payable if the diagnosis is for replacement or repair of one or more valves.

Enhanced cancer module:

Benign brain tumor—100% of critical illness benefit amount
Skin cancer—10% of critical illness benefit amount
Bone marrow transplant—50% of critical illness benefit amount
Stem cell transplant—50% of critical illness benefit amount

A diagnosis of benign brain tumor or skin cancer or pre-malignant diagnosis must be made by a doctor familiar with the specific condition.

Quality of life module:

Permanent paralysis—100% of critical illness benefit amount
Loss of sight, hearing, or speech—100% of critical illness benefit amount
Coma—100% of critical illness benefit amount
Multiple sclerosis—100% of critical illness benefit amount
Amyotrophic lateral sclerosis (ALS)—100% of critical illness benefit amount
Parkinson's disease—100% of critical illness benefit amount
Advanced dementia, including Alzheimer's disease—100% of critical illness benefit amount
Huntington's disease—100% of critical illness benefit amount
Muscular dystrophy—100% of critical illness benefit amount
Infectious disease (hospitalization requirement)—25% of critical illness benefit amount
Addison's disease—10% of critical illness benefit amount
Myasthenia gravis—50% of critical illness benefit amount
Systemic lupus erythematosus (SLE)—50% of critical illness benefit amount
Systemic sclerosis (scleroderma)—10% of critical illness benefit amount

A critical illness under this module, other than coma, is not eligible for multiple benefit payments.

A diagnosis of loss of sight must be certified by an ophthalmologist or a doctor familiar with the diagnosis of loss of sight.

A diagnosis of loss of hearing must be made by an otolaryngologist or a doctor familiar with the diagnosis of loss of hearing.

Additional child diseases module (applies to insured children only and is in addition to the other modules):

Cerebral palsy—100% of critical illness benefit amount
Congenital birth defects—100% of critical illness benefit amount
Cystic fibrosis—100% of critical illness benefit amount
Down syndrome—100% of critical illness benefit amount
Gaucher disease, type II or III—100% of critical illness benefit amount
Infantile Tay-Sachs—100% of critical illness benefit amount
Niemann-Pick disease—100% of critical illness benefit amount
Pompe disease—100% of critical illness benefit amount
Sickle cell anemia—100% of critical illness benefit amount
Type 1 diabetes—100% of critical illness benefit amount
Type IV glycogen storage disease—100% of critical illness benefit amount
Zellweger syndrome—100% of critical illness benefit amount

A diagnosis of any additional child disease listed above must be made after your child’s live birth and by a doctor familiar with the diagnosis of the specific condition.

Different diagnosis

Multiple payments for different diagnoses may be available. Different diagnosis means any of the following:

A diagnosis of a critical illness that is for a different illness/condition than a previously diagnosed illness/condition. note: a cancer (invasive) that has spread to a different area of the body is not a different illness/condition than the previously diagnosed cancer (invasive).
A subsequent diagnosis of a critical illness that is for the same illness/condition (including a cancer (invasive) that has spread to a different area of the body) as a critical illness for which benefits were payable under the policy, and that occurs more than 12 months after the date of the previous diagnosis.
A subsequent diagnosis of a critical illness that is for the same illness/condition (including a cancer (invasive) that has spread to a different area of the body) as an illness/condition diagnosed prior to your coverage effective date under the policy, and that occurs more than 30 days after the date of the previous diagnosis.

Exception: A subsequent diagnosis of the same illness/condition under the quality of life module, other than coma, is not considered a different diagnosis regardless of the time period between diagnoses.

A diagnosis of skin cancer is considered a different diagnosis from cancer (invasive) or cancer (non-invasive).
A diagnosis of cancer (non-invasive) is considered a different diagnosis from cancer (invasive).

Wellness Benefits

In addition to providing critical illness benefits, the plan also pays you for receiving covered health tests or screenings.

Basic plan wellness benefits

Benefit amount. The plan pays $75 for receiving a covered health screening. If more than one test is received in a year, the plan will only pay $75. The annual benefit for each child is 100% of your benefit amount, with an annual maximum of $150 for all children.
Who’s eligible. CMSU employees and their eligible children.
How often. The benefit is payable once per year for each covered person.

See the full list of covered health screenings.

Voluntary plan wellness benefits

Benefit amount. The plan pays $100 for receiving a covered health test or screening (the same as are covered by the basic plan). The annual benefit for each child is 100% of your benefit amount, with an annual maximum of $200 for all children.
Who’s eligible. CMSU employees and their spouse/domestic partner enrolled in voluntary coverage.
How often. The benefit is payable once per year for each covered person.