Critical Care Benefit Program

The Critical Care Benefit Program will cover up to $50,000 (“Annual Maximum”) per Trust fiscal year (March 1 – February 28) (“Plan Year”) for medically necessary Covered Services to treat Covered Conditions (as defined in FAQ #2 below), subject to the exclusions described in the Medical Expense Exclusion List. Eligible Former Players may receive coverage for Covered Services up to the Annual Maximum each Plan Year beginning on March 1, 2022. Any amounts due and owing above the Annual Maximum will be the responsibility of the eligible Former Player.

The Critical Care Benefit Program will provide coverage up to the Annual Maximum for medically necessary costs for medical care that is related to the treatment or alleviation of a Covered Condition (“Covered Services”). Covered Conditions are defined to include only the conditions listed below:

• Benign Brain Tumor or Osseous Tumor
• Invasive/Infiltrating Cancer
• Non-Invasive Cancer
• Skin Cancer
• Coronary Artery Bypass (CABG)
• Coma
• Loss of Ability to Speak, Hear, or See
• Paralysis of 2 or more limbs
• Heart Attack
• Sudden Cardiac Arrest
• Valve disease
• Arrhythmia
• Congestive Heart Failure
• Kidney Failure
• Major Organ Transplant
  • For bone marrow, heart, lung, pancreas, or liver
• ALS
• Alzheimer’s Disease
• Multiple Sclerosis
• Parkinson’s Disease (Advanced)
• Parkinsonism
• Essential tremor
• Severe Burn
• Stroke

Former Players must meet all of the following eligibility criteria to be eligible for the Critical Care Benefit Program:

• Enrolled in The Trust;
• Vested (Former Players with three or more credited seasons. Spouses and children are not eligible);
• Under age 65;
• Enrolled in the HRA Plan with an account balance of $50,000 or less;
• Must have a Covered Condition; and
• Financial need (income not greater than 500% of the Federal Poverty Level).

A Former Player is enrolled in The Trust when he has completed The Trust enrollment process, which includes the following:

• Completing The Trust intake process with a Trust Program Manager, Program Specialist or Service Specialist; and
• Submitting signed Trust Participation and Consent Form(s).

For any questions or to discuss eligibility, please contact The Trust at CriticalCare@playerstrust.com or by calling 866-725-0063.

An eligible Former Player should receive an enrollment decision within an average of 7-14 business days after submitting a completed Critical Care Benefit Program application and all required documentation. This time may be extended based on the specific Former Player circumstances or if additional documentation is required.

In addition to the application, required documentation includes the following:

• Documentation to support financial need. Any of the following are acceptable forms of income verification:
  • Recent pay stub
  • 1040 or similar tax documents
• Confirmation of HRA Plan enrollment and balance. Any of the following forms of account balance confirmation are acceptable:
  • Screenshot of your HRA Plan balance via any of the following:
    • NFL Player Benefits (NFLPlayerBenefits.com);
    • myCigna App; or
    • myCigna.com
  • Phone verification provided by the NFL Player Benefits Plan Office (CDS will provide guidance for scheduling a brief conference call between the NFL Player Benefits Plan Office, CDS and the Former Player)
• Evidence of medical diagnosis of a Covered Condition and treating healthcare provider’s contact information and any additional information requested by Cigna

The Trust will protect and hold confidential all private and sensitive information. All information received and maintained by the Critical Care Benefit Program’s vendor partners, including CDS and Cigna, will be subject to the protections of the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”). All parties have implemented protective measures to restrict access to sensitive player information.

No, the Critical Care Benefit Program is not health insurance. The Critical Care Benefit Program is a program that covers up to the Annual Maximum per Plan Year for Covered Services to treat Covered Conditions.

Yes. Former Players are eligible for the Critical Care Benefit Program whether they have insurance or not (including Medicare or Medicaid).

Enrollment in the Critical Care Benefit Program must be complete before claims for previously received services will be covered, regardless of date of diagnosis and treatment. In all cases, the Critical Care Benefit Program will only cover eligible expenses that were incurred on or after March 1, 2022.

Former Players must submit eligible claims within 12 months after the date of service for the expense to be eligible for coverage, with no claims predating March 1, 2022.

The Critical Care Benefit Program will cover no more than the Annual Maximum of $50,000 for eligible medical expenses each Plan Year. Any amounts remaining up to the Annual Maximum at the end of the Plan Year are forfeited. Please note: the Annual Maximum is per Former Player for any combination of eligible Covered Services provided by one or more providers.

No. Eligible Former Players may be covered up to the Annual Maximum each Plan Year. However, any and all amounts remaining of the Annual Maximum per eligible Former Player will be forfeited at the end of each Plan Year.

The Trust Critical Care Benefit Program will cover (up to the Annual Maximum) medical expenses for Covered Services to treat a Covered Condition (as defined in FAQ #2), subject to the exclusions described in FAQ #16.

The medical expenses not covered by the Critical Care Benefit Program include, but are not limited to, the costs for items and services listed below. Additional exclusions can be found here:

• Expenses that are reimbursed by the HRA Plan, the 88 Plan, the NFL Player Disability & Neurocognitive Benefit Plan, the Former Player Life Improvement Plan and the NFL Dedicated Hospital Network Program.
• Expenses that are payable through an unrelated entity, such as an employer, an insurance company, a government agency or a health reimbursement account (other than the HRA Plan).
• Expenses that are not related to the treatment or alleviation of a Covered Condition.
• Expenses for services provided by a relative.
• Expenses that are not medically necessary.
• Charges which you are not obligated to pay or for which you are not billed or for which you would not have been billed except that they were covered under this Program.
• Assistance in the activities of daily living, including, but not limited to, eating, bathing, dressing or other custodial services or self-care activities, homemaker services and services primarily for rest, domiciliary or convalescent care.
• Experimental, investigational and unproven services including services that are medical, surgical, diagnostic or psychiatric in nature.
• Services to treat substance use disorders.
• Cosmetic surgery and therapies. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self-esteem.
• Dental treatment and dental implants for any condition.
• Consumable medical supplies other than ostomy supplies and urinary catheters.
• Additional charges for private hospital rooms and/or private duty nursing.
• Artificial aids including, but not limited to, corrective orthopedic shoes, arch supports, elastic stockings, garter belts, corsets, dentures and wigs.
• All non-injectable prescription drugs, unless physician administration or oversight is required; injectable prescription drugs to the extent they do not require physician supervision and are typically considered self-administered drugs; non-prescription drugs; and investigational and/or experimental drugs, except as provided in the Critical Care Benefit Program.

The Critical Care Benefit Program may establish minimum standards for providers, such as required certifications or licensing.

Benefits are payable for the duration of your Covered Condition. If Cigna or the Critical Care Benefit Program should determine that you no longer have a Covered Condition, your benefits will cease.

Yes. If an application is denied, the reason(s) for denial, as well as information on how to appeal the decision, will be provided to the Former Player applicant. The Critical Care Benefit Program’s appeal procedures can be found in the Former Player Benefits Plan Summary Plan Description.

If your provider charges more than the Annual Maximum, the portion above the Annual Maximum will not be covered by the Critical Care Benefit Program. In that case, your provider may bill you for the amount that was not paid under the Critical Care Benefit Program (also known as balance billing). If the provider bills you for an amount that is more than the Annual Maximum, you will be responsible for paying this amount.

The Critical Care Benefit Program will only issue payment directly to the Former Player’s healthcare provider(s). If the Former Player has already paid for services, the Critical Care Benefit Program will issue payment for approved expenses to the provider and the Former Player must contact the provider for a refund of any previously paid amounts. Please note, for eligible Former Players wishing to apply for the Critical Care Benefit Program for coverage of previously incurred medical expenses, the eligible Former Player will need to meet all of the eligibility criteria set forth in FAQ #3 and ensure that all eligibility criteria have been met as of the date of the subject claim. See also FAQ #20 for the process to submit claims for payment for Covered Services that a Former Player paid out-of-pocket.

Cigna will issue Former Players a Verification of Services letter (the “Letter”) when they have been approved to participate in the Critical Care Benefit Program. The Letter will be utilized by Former Players in lieu of a traditional Cigna ID card. Former Players will present the Letter at all doctor appointments, treatment sessions, procedures, etc. to treat the Covered Condition. The Letter will include a description of the Critical Care Benefit Program, list the Former Player’s Cigna ID number, and list the approved Covered Condition. Additionally, the Letter will provide instructions for the provider on how to contact Cigna with any questions they may have. The Letter will also instruct providers on how to bill Cigna appropriately for Covered Services.

• For in-network providers: If a Former Player received Covered Services by an in-network provider, the Former Player only needs to present the Letter at the time of services. The Letter will instruct in-network providers to bill Cigna directly for such Covered Services.
• For out-of-network providers and out-of-pocket costs:
  • Former Players should provide a copy of the Letter to out-of-network providers, which directs the provider to bill Cigna directly for all Covered Services.
  • Former Players should notify Cigna if the out-of-network provider still requires the Former Player to pay for Covered Services at the time of service (and will not bill Cigna directly for such services), and Cigna will work with the provider to educate them on the claims submission process for the Critical Care Benefit Program.

  • If a Former Players is still required to pay for covered services out of pocket, he should submit a Medical Claim Form: After payment has been rendered to the healthcare provider, the Former Player should complete and submit a Medical Claim Form, located HERE. (Scroll down and click the “Medical Forms” link to access the Medical Claim Form)

  • After approving the Covered Service, Cigna will pay such provider directly (regardless of any instructions or notes on the claim form to the contrary). After a payment is made to the provider, the Former Player should reach out to the provider to request reimbursement for paid amounts. If the Former Flayer is unable to obtain reimbursement from the provider, the Former Player should contact: theTRUST@Cigna.com. A Cigna team member will reach out to the provider to engage in additional discussion and request reimbursement on behalf of the Former Player.