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Critical illness insurance

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Critical illness insurance provides you with a lump sum benefit if you suffer a serious medical condition. This lump sum benefit can be used to ease your financial strain during an already stressful time. What’s covered in each policy varies by provider, but some can cover up to 40 different medical conditions including:





Heart attack

Critical illness insurance can either be bought as a standalone policy or bundled with your life insurance policy. Keep reading to find out more about the benefits of critical illness insurance.


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      What does critical illness insurance cover?

      Critical illness insurance provides you with a lump sum benefit when you’re unable to work due to a listed condition. Listed conditions can vary from provider to provider but some conditions that can be covered are:
      • Alzheimers disease
      • Aortic surgery
      • Aplastic anaemia
      • Benign brain tumour
      • Blindness
      • Severe burns
      • Cancer
      • Cardiomyopathy
      • Coma
      • Coronary artery angiography
      • Coronary bypass surgery
      • Deafness
      • Dementia
      • Diplegia
      • Encephalitis
      • Hemiplegia
      • Heart Attack
      • HIV accidental infection
      • HIV occupational acquired
      • Kidney failure chronic
      • Loss of limbs or eye
      • Loss of speech
      • Loss of independent existence
      • Lung disease
      • Major head trauma
      • Major organ transplant
      • Motor neurone disease
      • Multiple sclerosis
      • Out of hospital cardiac arrest
      • Parkinson’s disease
      • Peripheral neuropathy
      • Pulmonary hypertension
      • Quadriplegia
      • Stroke
      • Terminal illness

      There’s no restriction on how you use the payout from a critical illness insurance policy claim. You can use it to pay your mortgage, medical expenses, for a long rehabilitation vacation, to clear yourself of debt, to pay for childcare services or to hire help around the house.

      A major point to keep in mind is that the benefit is only payable should you survive.

      Some insurance providers have a survival period of just 14 days while others require at least a month. To get around this, some insurers will let you combine your life insurance and critical illness insurance into one policy.

      When will a critical illness insurance policy payout?

      Some of the main requirements for a payout when it comes to critical illness insurance include:

      • Diagnosis of a covered condition. The conditions covered are listed in the terms and conditions of your policy. Depending on the condition, you can either receive a full or partial pay-out.
      • Your diagnosis occurs after the waiting period. This is typically after 30-90 days from when you first purchase your policy.
      • You live through the survival period. This is typically set at two weeks from when you’re diagnosed with an illness. The reason behind a survival period is because critical illness coverage is designed to pay if you survive a traumatic event and not in the event of death.

      Before taking out a life insurance policy, read the contract from the insurer to understand when claims will be paid or rejected.

      Why would a claim not be accepted by an insurer?

      Some of the common reasons why an illness claim wouldn’t be paid out include:

      • Pre-existing medical conditions Many policies will not cover illnesses that arise from pre-existing medical conditions.
      • The exact illness is not covered. Most critical illness policies will have a set list of what conditions are covered. If you don’t check the exclusions in your policy, you’ll be in the dark if it comes time to make a claim — always know what is and isn’t covered.
      • Nondisclosure. Your claim can be declined if you failed to disclose a pre-existing medical condition, meaning if the sickness or injury started or was diagnosed before the insurance was purchased.
      • Self-inflicted. Any injuries that were caused by the person insured from attempted suicide or any other situation would typically result in a rejected claim.

      What are the key features of critical illness insurance?

      Critical illness insurance is a policy that pays a lump sum in case of serious illness so that you can concentrate on recovery instead of finances. Common features include:

      • Coverage for common critical conditions and illnesses. Some policies have coverage for over 40 different illnesses. If you receive a diagnosis, you can begin the claim process.
      • Access to premium treatment. Some insurers will also provide access to medical specialists, as well as financial help for treatment and procedures.
      • Lump sum payment. This can range from $20,000 to $500,000 (if fully underwritten) depending on the illness.
      • Wider range of coverage. With higher premiums, the range of covered conditions increases to include things like organ failure, HIV, intensive care or loss of senses.
      • Children can be insured. Some insurers bundle the policy with added coverage for your children.

      Are critical illness premiums tax-deductible?

      Premiums paid are not tax-deductible, however the benefits paid from the claim are tax-free.

      When would a critical illness policy be canceled?

      Consult the terms and conditions for your plan for a full list of circumstances, but be aware that your policy will end if:

      • The policy is canceled.
      • You are paid out the full amount of insurance benefits.
      • The life insurance coverage that the critical illness insurance is attached to ends.
      • Non-disclosure of important details (a pre-existing medical condition) when you apply.
      • Premiums aren’t paid.
      • The termination date is reached — either as part of the policy or age of the insured.
      • A fraudulent claim is made.
      • The individual dies.

      Traps to look out for when it comes to critical illness insurance

      • An added cost. If you’ve been looking at general insurances, you may find that critical illness insurance is added in as an extra. This means you should consider if you really need this supplemental protection so you’re not over extending your finances.
      • Pre-existing conditions. If you’re already in poor health, or you’re a smoker, then odds are good you’ll be paying high premiums — that’s if you can even find coverage. So, if you’re already suffering from a critical illness, this type of insurance may not make the most sense because you won’t be eligible to claim for a pre-existing condition.

      Is critical illness insurance worth it?

      Critical illness insurance is important to consider for multiple reasons. It can help you cover the costs of bills, childcare, groceries and other expenses like mortgage payments or rehabilitation while your incapacitated.

      Essentially, critical illness is a useful form of life insurance that can protect your assets and allow you to continue with your way of living if you’re ill and unable to work.

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