People
are living longer today. Although survival rates are on the rise for
many medical conditions, a debilitating illness and the costs
associated with loss of income can lead to medical bankruptcy.
In a 2007 Thomson Reuters survey, 12 percent of late-stage colon cancer
patients surveyed had spent more than $25,000 out of pocket for
medication alone.
More alarming is a 2008
study by the American Cancer Society and the Kaiser Family Foundation
that found 20 percent of people with health insurance
still can't afford cancer therapy. In fact, the survey found that a
year of treatment for blood cancers such as leukemia reached $1 million
in 2008, maxing out the limits of most health insurance policies.
Even with advanced medicine and a health insurance
policy on your side, if you are diagnosed with a life-threatening
illness, there is a possibility that you would not be able to afford
the treatments recommended and needed. Critical illness insurance can
help.
| Some medical conditions covered by critical illness insurance |
| Heart attack |
Stroke |
| Kidney failure |
Paraplegia |
| Organ transplant |
Alzheimer's disease |
| Blindness, deafness |
Multiple sclerosis |
| Coma |
Coronary artery bypass graft |
| HIV (medical personnel only) |
aortic surgery |
| Angioplasty |
heart valve surgery |
| Loss of sight/speech/hearing |
Severe burns |
| Cancers that have spread |
Cancers that have not spread |
Critical illness insurance provides a payment if
you experience a critical illness that is covered under the policy
contract. You don't have to be disabled to collect. Unlike disability
insurance, you don't have to be employed. For example, Aflac offers an
individual critical illness policy that pays $5,000 if you develop a
condition that is covered, with another $2,500 benefit for any
recurrence. A critical illness insurance payment is
typically made in a lump sum and can be spent however you please — use
the money for medical bills, a wheelchair, retrofitting your home, your
mortgage or other bills, home health care or even a Hawaiian vacation.
Medical conditions that qualify usually include serious injuries,
diseases and major surgeries.
Critical illness insurance can be purchased several ways, including:
- On your own as an individual policy.
- As part of workplace benefits, either through employer-paid
benefits or payroll deduction (where you pay the premiums and they are
deducted from your paycheck).
- As a supplement to a health insurance policy.
- As a supplement to a life insurance policy.
Ken Smith, President of the National Association
for Critical Illness Insurance and director of Assurity Life Insurance
Co.'s critical illness and disability income lines, estimates that 75
percent of critical illness policies are purchased through workplace
benefits.
Some insurance companies
bundle critical illness coverage into categories, and you can make
claims in multiple categories. For instance, one category could cover
cancer-related conditions, another heart-related conditions and a third
category for organ transplants, kidney failure or severe burns. You can
buy a policy that pays for one category of conditions or a policy that
covers all three condition categories.
| Example of critical illness policy payouts |
|
Diagnosed covered condition |
Category |
Lump-sum benefit payment |
| Condition: lung cancer |
Category 1: Cancer policy |
$15,000 |
| Two years later, coronary artery bypass graft |
Category 2: Heart condition policy |
$3,750 |
| The next year, stroke |
Category 2: Heart condition policy |
$11,250 |
| Three years later, kidney failure |
Category 3: Other |
$15,000 |
| Total benefit paid: $45,000 |
| Source: MetLife |
For example, if you buy a
policy with multiple categories and you suffer a severe stroke that has
the potential to happen again, you might receive 25 percent of the
benefit amount, and the remaining 75 percent could cover another
condition or a recurrence of the same condition while the policy is in
force.
Critical illness insurance
limits typically run from $10,000 to $1 million. Mutual of Omaha
recommends purchasing a policy that covers these three factors:
- 12 to 18 months of income.
- Your mortgage payments for three to five years.
- The total of your outstanding credit card debt.
Examine your policy's waiting period, also called
the "elimination period," which is the time you have to wait after
diagnosis before receiving the insurance payment. For most policies, if
you die of the critical illness during the waiting period (and have no
special rider to cover that), no benefits will be paid to you or your
estate.
Before buying a policy, understand its exclusions
and limitations. Typical exclusions include critical illnesses that are
diagnosed during your policy's waiting period, self-inflicted injury,
suicide and illegal activity. Other exclusions may include balloon
angioplasty surgery, pre-malignant conditions or conditions with
malignant potential, and most skin cancers.
Most critical illness policies are issued for a
minimum of 2 years and a maximum of 20 to 25 years. If you are over age
65, most insurers will not sell you a policy. If you purchase a policy
in your early 60s, the cost will be steep.
Scott Kreinke, Senior Vice President of Product
Lines at Assurant Health, says, "The critical illness supplemental
polices that we market with major medical policies typically have
exclusions relative to how long it will take for the insured to get
paid 100 percent of the benefit. There is usually a 90-day elimination
period before it covers an illness that occurred in the first year,
which is usually 50 percent of the benefit." Assurant Health sells
supplemental critical illness policies only to customers who purchase
major medical plans.
While individual and worksite policies are
medically underwritten, meaning the price is based on your individual
factors, if you buy a group plan it is considered "guaranteed issue."
For group plans, the price is determined by your age and the number of
people who work for the company, and no medical questions are asked.
However, group plans will exclude coverage for any conditions you had
before the policy took effect.
|
Voluntary payroll-deduction plans, group/worksite: Unum, Colonial Life Insurance Co., Guardian Life
Group plans: Metlife
Individual plans: Mutual of Omaha, Assurity, Trustmark, AIG
Supplemental plans to major medical policies: Aflac, Assurant Health
Source: National Association for Critical Illness Insurance
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If
you are buying an individual policy, you will likely have a phone
interview from the insurer's underwriting department, as well as oral
fluid and blood and urine tests. If you have a heart condition or
family members with a heart condition, you could be required to take a
medical examination, EKG, paramedical examination, treadmill
electrocardiogram (TEKG) and, if you are a smoker, a chest X-ray.
Critical
illness insurance is priced with several factors in mind, according to
Smith. Your age, height, weight, family's health history and conditions
you have now that could lead to more serious conditions are considered.
An individual critical illness plan usually starts at $50 a month and
goes up, depending on your age and the amount of the benefit you chose.
A group plan purchased through work can cost $4 to
$5 a month, depending on your age. For example, a nonsmoking 18- to
24-year-old employee could pay $2 a month for a group critical illness
insurance plan. An employee in their 40s could pay about $18 a month.
Someone between age 60 to 64 could pay $46 a month for the same
coverage.
When it comes to family
history, you could be declined if you are a female under age 50 and who
has two or more first-degree relatives who have been diagnosed with
breast cancer. This can include a mother, a sister or an aunt. If you
have two or more first-degree relatives who have been diagnosed with
cancer, heart disease or kidney disease before the age 65, you would
likely be charged more for the policy or declined, depending on the
insurer.
You pay premiums until the
"termination age" of the policy. The typical termination age of a
policy is when the policy pays out the maximum benefit.
"If
you died from a heart attack and the maximum benefit is $50,000, and
the cost of treating you for a heart attack reaches the full maximum
benefit, insurance would pay out the full maximum and then the policy
would terminate," says Jeanne Reynolds, spokesperson for Colonial Life.
The insurance company will generally
cancel policies if premiums aren't paid, if the maximum payout is made,
if you die or if you request cancellation.
You
won’t get your money back or a reimbursement if you cancel or if you
never get sick, unless you buy a critical illness policy with a
"premium return" feature. For instance, if you die during the policy's
waiting period and have a return-of-premium death rider, any premium
you paid will be returned to the beneficiary listed on your policy or
your estate. To receive the returned premium, you cannot die from a
condition or event that is excluded or that isn't defined in the
policy. For example, if your policy does not cover an aneurysm, and you
die from one, your family cannot take advantage of the
return-of-premium death rider. If you die from an excluded illness such
as skin cancer, premiums will not be refunded.
Conseco
Insurance Group's 2009 study, "Supplemental Health Insurance: A Must
for Americans in the Current Economy," highlights what look for in a
critical illness policy:
- Lump-sum benefits, which are paid when you are diagnosed with a common catastrophic illness.
- Indemnity
benefits, which offset the medical costs associated with hospital and
ICU stays, chemotherapy, radiation and corrective or preventive surgery.
- Premium-return
feature, which returns the premium to you if you keep the coverage for
a certain period of time without making a claim.
- Transportation benefits, which help you cover the cost of travel to and from a medical center for treatment.
- Coverage for regular diagnostic tests, such as mammograms, pap smears and colon screenings.
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