Benefits
Symetra Health
A supplemental health insurance plan
> Examples of covered conditions
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Overview
Whether you need to see a doctor for a mild medical issue, visit urgent care or pay for chemotherapy, Symetra Health can help you navigate today’s rising medical costs. This supplemental health insurance plan covers over 13,000 conditions, and you can receive a direct benefit payment if you're diagnosed with any one of them.
Watch our brief video to learn how this innovative plan can help protect your finances if you experience an unexpected illness or injury.
How it works
Symetra Health benefits are based solely on the diagnosis codes a medical provider uses to document an injury or illness.
Each covered diagnosis falls into a category of Moderate, Severe, or Catastrophic, and each category pays a set benefit amount. Once enrolled in Symetra Health, coverage is automatically provided for all three levels.
For example, let's say a Symetra Health plan includes the following benefit amounts:
Moderate benefit amount = $300
Severe benefit amount = $1,000
Catastrophic benefit amount = $2,000
If you receive a diagnosis in the Moderate category, you'd receive a lump-sum benefit payment of $300. A Severe diagnosis would pay $1,000, and Catastrophic would pay $2,000.
These benefits are paid regardless of any other coverage you may have, and the payment can cover anything, including out-of-pocket costs like copays, deductibles or other expenses.
Note: This example is for illustrative purposes only. Please refer to your enrollment materials for complete details and actual benefit amounts.
Easy to enroll
- No medical questionnaires to complete.
- No preexisting condition exclusions.
- Option to add spouse and dependent coverage.
Easy to use
- Submit claims online or via the Symetra Health mobile app by answering just four questions.
- Receive benefits directly to your PayPal, Venmo or bank account within 72 hours of an approved claim.
- Talk to the same member support representative anytime you need help.
Examples of covered conditions
Examples of covered conditions
This list is for illustrative purposes only. Symetra Health covers over 13,000 conditions across all three categories of severity.
Moderate
Anaphylactic reactions
Basal cell carcinoma
Bell's palsy
Benign breast tumor
Concussion
Dehydration
Foreign body in eye/ear/nose
Hepatitis C
Kidney stone
Knee sprain
Laceration
Pneumonia
Preterm newborn (34-35 weeks)
Simple fracture
Severe
Acute respiratory failure
Appendicitis
Benign neoplasm
Chronic adenoiditis/tonsillitis
Deep-vein thrombosis
Detached retina
Diverticulitis
Gallstones
Inguinal hernia
Preterm newborn (32-33 weeks)
Pulmonary embolism
Torn ACL
Torn rotator cuff
Unstable angina
Catastrophic
Abdominal aortic aneurysm
ALS (Lou Gehrig's disease)
Alzheimer's disease
Cardiac arrest
Heart attack
HIV
Leukemia
Malignant neoplasm
Multiple sclerosis
Parkinson's disease
Perforation of intestine
Preterm newborn (<31 weeks)
Sepsis
Spina bifida
FAQ
Does Symetra Health replace major medical or other comprehensive health insurance?
No. Symetra Health is a supplemental health insurance plan that's designed to complement your primary medical insurance. It pays you cash benefits to help with out-of-pocket costs (such as deductibles and copays) and things that your health plan doesn't cover, like groceries and transportation.
What's covered?
The full list of covered conditions is provided with your certificate of insurance and any applicable riders. Once enrolled, you'll have access to a lookup tool to see all the conditions covered under your plan.
Will I be covered 24 hours a day?
Yes. Since Symetra Health pays benefits based on a diagnosis of a covered condition, it doesn't matter what time of day you become sick or injured. Coverage is also available regardless of where you become sick or injured, whether at home, work or elsewhere.
Do I have to go to an in-network doctor to receive benefits?
No. Symetra Health pays benefits based on your diagnosis. It doesn't matter where you get care, as long as you're diagnosed by a medical professional in the United States, Mexico or Canada. We do still encourage you to seek in-network care within your major medical plan so you can get the best rates possible.
Next steps
To learn more about Symetra Health, contact your benefits representative.
IMPORTANT: This is a fixed indemnity policy, NOT health insurance
This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.
- The payment you get isn’t based on the size of your medical bill.
- There might be a limit on how much this policy will pay each year.
- This policy isn’t a substitute for comprehensive health insurance.
- Since this policy isn’t health insurance, it doesn’t have to include most Federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
- Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
- To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about this policy?
- For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (naic.org) under “Insurance Departments.”
- If you have this policy through your job, or a family member’s job, contact the employer.
Symetra Health is insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004. It is designed to provide benefits at a preselected, fixed dollar amount for covered diagnoses. This policy provides limited benefit coverage and is a supplement to health insurance. It is not a replacement for major medical or other comprehensive coverage, and does not satisfy the minimum essential coverage requirements of the Affordable Care Act. Base certificate form number is SBC-05545 03/22.
Administration of Symetra Health is managed by a third-party administrator that provides enrollment, claims and billing administration. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions.
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