Critical Illness Insurance: Coverage and Policy Guide

Critical illness insurance fills the gap in existing medical insurance coverage or can be a last stop if you're not able to afford or you lost your major health insurance. Generally, critical illness insurance pays a lump sum monetary benefit for hospital charges, an I.C.U. stay, organ transplants, ambulance fees, or transportation and lodging.

As breast cancer awareness month winds to a close and pink ribbons symbolizing the brave fight against this disease take their place on survivors' dressers, the fight continues. Putting the spotlight on this devastating disease has made people think about their own mortality and what would happen if they were diagnosed with a critical illness.

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If your family's medical history includes, heart disease, stroke, cancer, diabetes or renal disease, then critical illness insurance might add an additional layer of financial protection for you.

Critical illness insurance fills the gap in existing medical insurance coverage or can be a last stop if you're not able to afford or you lost your major health insurance. Generally, critical illness insurance pays a lump sum monetary benefit for hospital charges, an I.C.U. stay, organ transplants, ambulance fees, or transportation and lodging. This sum can be used for payment towards any aspect of the illness or for food, clothing, gas or the mortgage. This coverage sounds simple, but folks must understand exactly what they are paying for and exactly what is covered.

Critical illness insurance is not meant to replace health, life or disability insurance. Instead, its purpose is payment for illness and specific kinds of treatment not ordinarily covered by traditional insurance or for any other expenses the insured wants to spend the lump sum on. Dire medical conditions are difficult enough to get your arms around, you don't need mounting financial worries to add insult to the illness.

Do Your Homework

• Find a licensed agent you trust and ask for three quotes from three different companies.
• Take the time and ask your agent to walk you through the policy features, advantages and benefits so you know what you bought and how to access the benefits should you need them.
• A family history of a certain illness may be enough for the company to exclude that disease. Most policies are priced based on the age, gender and family history so the more medical questions you can honestly answer no to, the better.
• Find the pre-existing limitation clause and understand or have it explained to you so there is no gray area.
• Does the insurance company you are planning on giving your hard earned dollars to have stellar claims paying history? If you satisfy the claim requirements, when will you get paid

Critical Illness Insurance Terms

• Pre-existing Conditions: Pre-existing condition limitations vary, so read the fine print.
• Covered Illnesses: What specific illnesses are covered? Will they be paid at 100%
• Underwriting: Simplified underwriting applies to policy benefits less than $100,000; full underwriting applies to benefits over $100,000.
• Guaranteed Renewable "To Age": Most policies are guaranteed renewable; some continue for life, others terminate at age 75-80.
• Issue Ages: Generally 18-69; some companies have maximum issue ages of 65, 70 or 75.
• Minimum and Maximum Benefit Amounts: $10,000 up to $1 million or more.
• Waiting Period: How many days you must wait before benefits are paid.
• Survival Period: Number of days the insured must live following diagnosis, to receive benefits.
• Conditions of Payment: Specific criteria that must be met before the benefit is paid.
• Benefit Reduction Age and Amount: Most policies maximum benefit drops by 50% at age 65.
• Return of Premium: Most policies refund your premium less the benefits paid only upon the death of the insured.

Making smart choices and having a trustworthy, knowledgeable professional to give you competent advice, can save you big dollars in the long run.

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Author Credentials: Ian is the founder and Editor-in-Chief of Disabled World, a leading resource for news and information on disability issues. With a global perspective shaped by years of travel and lived experience, Ian is a committed proponent of the Social Model of Disability-a transformative framework developed by disabled activists in the 1970s that emphasizes dismantling societal barriers rather than focusing solely on individual impairments. His work reflects a deep commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.