NJEA Critical Illness Insurance FAQs

How can I enroll?

  • You may enroll within the first 120 days of NJEA membership without proof of good health (pre-existing condition limitation still applies).
  • During School Visit Enrollments, typically once every three years, you may enroll within 60 days of the meeting without proof of good health (pre-existing condition limitation still applies).
  • Enrollment outside of a School Visit Enrollment requires proof of good health that could include medical tests at your expense (pre-existing condition limitations applies). If you are denied coverage outside of the School Visit Enrollment, you may still enroll during a subsequent School Visit Enrollment in your building.

How can I get answers to my questions about my plan?

  • Educators Insurance Services representatives are available to answer your questions at 800.727.3414, option 3.

What does Critical Illness Insurance offer?

  • Critical Illness Insurance pays benefits when a covered person is diagnosed with a critical illness for the first time and that diagnosis occurs during the covered person’s lifetime. When diagnosed with a covered illness, you receive a single payment you can use for anything.

What is a covered illness?

  • Cancer, Heart Attack, Major Organ Transplant, Stroke, Renal Failure, Alzheimer’s disease and Parkinson’s disease are all covered at 100% of your selected benefit.
  • Cancer in Situ, Coronary Artery Bypass, Blindness, Coma, Deafness, Heart Valve and Terminal Illness are covered at 25% of your selected benefit.

When will my coverage be effective?

  • Your effective date is the first of the month after one full monthly deduction has been made.

How are benefits paid?

  • A lump sum is paid to you when Prudential receives satisfactory written proof of your critical illness.

Can I transfer my coverage?

  • Yes, you may transfer your coverage between New Jersey school districts. Please contact us to help you in your move to your new employer.

What happens to my coverage when I retire?

  • You may continue your coverage when you retire, so long as you remain a member of NJREA. Your coverage will be reduced to $5000 upon retirement and you may not continue your spouse or children coverage.

How can I apply for benefits?

  • To receive benefits, please call 800.727.3414, option 1, to report your disability directly to Prudential’s claims department.  No claim forms are needed.

What if I have a reoccurrence of my illness?

  • 50% of the payment for the First Occurrence is paid for a reoccurrence when:
    • A Doctor diagnoses an additional occurrence or reoccurrence of a Critical Illness for which a benefit was paid, and
    • The date of the diagnosis for the additional occurrence or reoccurrence is more than 180 days after the date of the previous benefit payment

What is the lifetime maximum benefit?

  • The Lifetime Maximum Benefit is 200% of the person’s selected benefit.

What is a pre-existing condition?

  • A pre-existing condition is one that was diagnosed or treated during the six months prior to the effective date of your coverage AND your Critical Illness or Procedure begins within six months of your effective date.

How does a pre-existing condition affect my benefits?

  • A Critical Illness or Procedure is not covered if it is caused by a pre-existing condition.

How does the pre-existing condition limitation affect me if I’m changing my plan?

  • The pre-existing condition limitation only applies to the increase(s) in your plan.

Who administers the program?

  • Critical Illness Insurance is issued by The Prudential Insurance Company of America, Newark, NJ.

 

Please refer to the booklet certificate, which is considered the governing document, for complete plan details.