Understanding Critical Illness Insurance

Understanding Critical Illness Insurance

Covered Conditions

Critical Illness insurance doesn’t cover ‘critical illnesses’ in general. Instead, it covers a specific list of diagnosis of conditions. If you’re diagnosed with a particular condition, as specified in the policy then you receive a one-time benefit amount. If you develop a condition but it is not diagnosed as in the policy, then you won’t receive the benefit. The actual diagnosis are beyond the scope of this eBook, however if you develop a covered condition your first step is to pull out your original policy and read the diagnosis requirements – and make sure they are followed. Specific tests are sometimes required and if you don’t get those tests (and some are time sensitive) then you should not expect to receive a benefit. In short, if you get cancer but don’t have the proper diagnosis, you won’t get paid.

The good news is that the industry has a general list of covered conditions and further, most companies use the same definitions for each condition. If you’re looking at coverage for cancer, the definition of cancer will be virtually identical between most companies (with only infrequent and minor variations). Therefore for most of us it’s simply a matter of comparing covered conditions – otherwise the policies are pretty similar.

Critical Illness List of Covered Conditions

Here’s the generic list of covered conditions common in Canadian critical illness policies:

  • Aortic surgery
  • Aplasic anemia
  • Benign brain tumour
  • Blindness
  • Cancer
  • Coma
  • Coronary artery bypass surgery
  • Deafness
  • Dementia, including Alzheimer’s disease
  • Heart attack
  • Heart valve replacement or repair
  • Kidney failure
  • Loss of independent existence
  • Loss of limbs
  • Loss of speech
  • Major organ transplant
  • Major organ failure on waiting list
  • Motor neuron disease
  • Multiple sclerosis
  • Occupational HIV infection
  • Paralysis
  • Parkinson’s disease and specified atypical parkinsonian disorders
  • Severe burns
  • Strokes

In addition, a couple of companies offer coverage for two additional conditions:

  1. Acquired Brain Injury
  2. Bacterial Menengitis

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