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Critical Illness Insurance
Critical Illness Insurance
Critical illness insurance is a type of supplemental health policy that pays cash benefits to a policyholder if they’re diagnosed with a medical condition that’s covered by the policy. Critical illness insurance is designed to be used in addition to major medical health insurance, but not replace it. It is not adequate to be your only source of health coverage, as the benefits are capped and the list of covered conditions is limited.
Plan Summary
Critical Illness Insurance
Highlights
Coverage is Guaranteed
Guarantee issue means that you can elect coverage up to the guarantee issue limits without having your current or past medical history taken into account nor will you have to submit an Evidence of Insurability form. Please refer to your policy for more information.
Coverage Portability
Portability allows you to continue your coverage without going through Evidence of Insurability.
Includes Subsequent and Recurrence Benefits
- Subsequent occurrence – if you were diagnosed with one covered condition and then you were diagnosed with a different covered condition
- Recurrence – if you were diagnosed with the same covered condition two different times.
Why Critical Illness Insurance?
Example – For Illustrative Purposes Only
Critical Illness Insurance Example
| Example of Out-of-Pocket Expenses | |
|---|---|
| Deductible/Co-Insurance | $3,500 |
| Living Expenses (mort/utilities) | $2,895 |
| Misc. | $1,000 |
| Total Expenses | $7,395 |
| Critical Illness Benefit | |
|---|---|
| Benefit Paid | $20,000 |
| Total Benefit Paid | $20,000 |
While working out in the yard, Jonah felt chest pain and fell to the ground. His wife called an ambulance and he was rushed to the hospital. Jonah was diagnosed with having a heart attack. Though Jonah will make a full recovery, his recovery could have been more challenging had it not been for his Critical Illness Insurance policy. Because Jonah had chosen the $20,000 benefit at open enrollment, he was paid the full benefit amount upon his diagnosis of his heart attack.
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Frequently Asked Questions
How do I qualify for the Critical Illness Insurance?
As long as you are actively at work and meet your employers eligibility requirements, you can elect the coverage. The Critical Illness does not have a waiting period or pre-existing condition limitation.
What is Critical Illness Insurance?
Critical Illness Insurance pays a lump sum benefit if you are diagnosed with a covered illness or condition on or after your coverage effective date. Critical Illness is called Specified Disease in some states.
Does this replace my major medical insurance?
No. Critical Illness Insurance is a limited benefit policy. This is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
What does Critical Illness cover?
Critical Illness will pay a lump sum benefit in the event you are diagnosed with a covered illness such as a heart attack, stroke, renal failure or cancer, to name a few.
How much does it cost?
The premium is based on the amount of coverage you elect and your age. Premiums are deducted from your paycheck.
What if I had one of the covered conditions previously, am I still eligible for benefits?
Yes. You may elect coverage during your open enrollment period. Depending on your policy, you may have a pre-existing condition limitation.