Understanding Critical Illness Insurance

Understanding Critical Illness Insurance

Early Intervention Benefit

Most full coverage policies have additional coverage for a handful of less critical conditions – conditions that are less likely to be life threatening.

These benefits are not easily comparable across plans as they vary in terms of conditions covered and amount of benefit paid. As a direct comparison is difficulty, you should at least evaluate the following attributes:

  1. Covered conditions: Generally there are 4 or 5 covered conditions (*) see below for an example).
  2. Benefit payable: The amount payable is not the full amount of the policy. Instead it will be a percentage of the total coverage, subject to a maximum. e.g. Early Intervention Benefit may pay 25% of the primary coverage, to a maximum of $50,000.
  3. Reduction in coverage: Some policies reduce the total coverage by the amount of any early intervention benefit paid, others do not. If you have a $100,000 policy with early intervention benefit of 25%, then the early intervention benefit would pay $25,000. At that point, some policies will still leave you with $100,000 of primary coverage. Other policies will reduce your coverage by the paid $25,000, leaving you with $75,000 of coverage.

(*) Typical early intervention benefit coverages are:

  1. Chronic Lymphocytic Leukaemia Rai State 0
  2. Coronary Angioplasty
  3. Ductal Carcinoma in Situ of the Breast
  4. Thyroid cancer stage 1
  5. Stage A Prostate Cancer
  6. Stage 1 Malignant Melanoma

Best Doctors Benefit

Some full coverage plans offer an additional benefit called Best Doctors. Early in my career I saw this as a soft benefit not directly related to insurance (because technically, it’s not) and would suggest this simply as a nice to have. However after having gone through a critical illness claim with a family member, my experience has changed my recommendation.

You should ensure that your critical illness plan has Best Doctors or a similar benefit.

In the event of a covered condition, the Best Doctors coverage offers you two benefits:

  1. Second Opinion – you can send in your paperwork on your covered condition (available from your doctor). A team of independent experts will review your case and provide their opinion on your diagnosis as well as offer a second opinion on treatment.
  2. Comprehensive Medical Database – The database of information available to you under this benefit is unbiased and vetted professional level. You’ll be able to read indepth information on your condition, knowing that it’s from a trusted source instead of trying to read blogs on the internet from suspect sources.

When our family member developed a covered condition, our first thought was not the coverage amount. Our first thought was ‘we need information’. What is the condtion, how serious is it, are there long term implications, what treatment options are available, and more. If you suffer a covered condition, expect the Best Doctors benefit to be a higher priority in the short term than a benefit cheque – you’ll go to Best Doctors immediately. And the information they provide is reassuring.

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