What Does Critical Illness Insurance Cover? Your Comprehensive Guide

Critical illness insurance helps people pay for treatment and recovery when they’re diagnosed with serious diseases and conditions like cancer, heart attacks and more. It helps people to cover expenses like out-of-pocket costs for health insurance, lost income, travel for care or anything else. Instead of paying small amounts over the course of treatment, it pays a large lump sum when you’re diagnosed so you have money available for whatever you need.

Learn More: What Is Critical Illness Insurance?

Critical illness insurance covers the diagnosis of serious diseases and conditions like cancer, stroke, heart attack and more. It doesn’t cover routine medical procedures or exams, or more minor conditions like a cold, flu or broken bone.  

Some policies cover a wide range of diseases, including those that are less common. Other policies, like Assurity’s Critical Illness, keep critical illness coverage simple and affordable by focusing on just a few of the most common serious illnesses:

• Heart Attack*

• Cancer (invasive or non-invasive)**

• Stroke

• Advanced Alzheimer’s Disease

If you want to expand coverage to include conditions or situations critical illness insurance doesn’t typically cover, you may be able to add optional riders for an additional monthly cost. For instance, you might be able to extend coverage to your spouse or child or add additional illnesses to the covered conditions. You may even be able to modify your coverage so you get money back if you never need it. The exact conditions covered by your policy and the riders you can purchase vary between different critical illness insurance policies, so make sure to compare policies to find the best coverage for you. 

You can learn more about Assurity’s Critical Illness Insurance here, including how to get an online quote in minutes.

When you’re diagnosed with a covered condition, critical illness insurance pays you a lump sum benefit to help you afford treatment and stay on top of expenses. If you have a critical illness policy, you can submit a claim after being diagnosed with a covered serious illness and condition and get money paid directly to you. 

You can use this money to do whatever you need. You can cover bills and expenses like your mortgage or utility payments, or you could put it toward experimental treatments or out-of-pocket costs from your high deductible health plan (HDHP). It can help you cover travel or hotel stays if you need to go elsewhere for treatment, or you can use it to help make treatment more comfortable. It gives you the freedom to focus on your recovery during a difficult time. 

How do I claim a critical illness?

The process of making a critical illness insurance claim can vary depending on the product you buy and the carrier you buy from, but with Assurity, it’s easy. Once your doctor diagnoses you with a covered illness after the waiting period, you can submit a claim through our customer portal, MyAssurity.

Once your critical illness insurance claim is processed and approved, you’ll receive the benefit in one lump-sum payment. You can receive benefits for more than one diagnosis, provided it’s a different condition and separated from your first diagnosis by at least six months (depending on the state where you live).

Everyone’s situation is different, and it’s important to evaluate your own needs and risks before making a decision about critical illness insurance. 

First, consider the chances of suffering from a serious illness or condition. Cancer, heart attacks and stroke are more common than we’d like to believe: an estimated 1.9 million Americans received a cancer diagnosis in 2022, and more than 800,000 heart attacks occur annually. Strokes aren’t far behind, 795,000 people have a stroke each year and it remains a leading cause of disability among adults. 

Here’s the good news: while diagnoses are common, survival rates continue to increase as treatments improve. Of the 1.9 million cancer diagnoses mentioned above, less than a third of those patients died from cancer in the same year. Forty-one percent of Americans carried some amount of medical debt in 2022, largely due to high out-of-pocket costs for medical care. 

Currently, the out-of-pocket maximum for a family is $15,000, just a small portion of the cost for cancer treatment. If treatment takes multiple years, that’s a cost that you might have to pay each year. That’s in addition to the hidden costs of treatment like transportation, lodging, time off work, in-home care and more. Costs pile up quickly, and it’s no surprise that many people find themselves in debt. Critical illness insurance can help you meet these costs without needing to dip into your savings, potentially preventing a serious financial setback. 

Learn more: Is Critical Illness Insurance Worth It?

If you experience a covered disease or health event, a critical illness insurance policy will help you focus on your recovery by supporting your finances. You’ll receive a payment equal to the amount of insurance you purchase. You can use the money for whatever you need, from replacing lost wages or traveling for treatment to taking extra time off work or paying off your medical bills.

What types of illnesses are typically covered by critical illness insurance policies? 

Many serious illnesses are covered by critical illness policies, but the specific illnesses covered depend on the policy you purchase. Policies that cover more uncommon conditions can be more costly. Critical illness insurance from CriticalIllness.com is streamlined to cover four of the most common serious illnesses: Cancer, heart attack, stroke and advanced Alzheimer’s disease.  It’s important to look closely at which diseases your policy covers before you make a purchase.

Does critical illness insurance cover cancer?

 
Yes, most critical illness insurance policies cover cancer, including Assurity’s Critical Illness Insurance. Some policies may carve out exceptions for different types of cancer, so it’s important to note the specific conditions covered by your policy. 

What is the difference between a “basic” and “comprehensive” critical illness insurance policy?

There are a few key differences between basic and comprehensive coverage, but they can both be good for different needs. Basic critical illness coverage will cover a smaller number of conditions, but they’ll often be more common. This can make coverage more affordable. Comprehensive coverage covers a larger number of conditions, including those that are less common.

Does critical illness insurance cover the cost of ongoing treatment or just the initial diagnosis?

Unlike some types of insurance, critical illness insurance pays a large sum at once instead of small amounts over time. It pays when you’re diagnosed with a serious illness and you have access to all the money immediately, so you can use the money throughout your treatment or however you choose.

Can critical illness insurance cover non-medical expenses such as lost income or travel expenses?

Yes, your critical illness payment is used to cover whatever you’d like, including lost income, travel expenses, home care, time off work and more. 

Are there any exclusions or limitations to what critical illness insurance covers?

Critical illness insurance often has limitations and exclusions. Benefits might not be paid or may be delayed under certain circumstances, like if answers on the application were incorrect or if the insured person had pre-existing conditions. Illegal and high-risk activities may also result in unpaid benefits. See the full limitations and exclusions here.

If you’re ready to learn more about critical illness insurance and see your personalized price, or if you’d like to purchase coverage, you can get a no-commitment quote in moments. Find your price and customize coverage to create insurance that meets your unique needs. 

Get your quote: https://criticalillness.com/app/quote   

Additional disclosure information

LIMITATIONS AND EXCLUSIONS (may vary by state)

Pre-existing Condition. Pre-existing condition means a sickness or physical condition for which, during the 12 months before the issue date or last reinstatement date, the insured person received medical consultation, diagnosis, advice or treatment from a physician or had taken prescribed medication. No benefits will be paid for a critical illness that is caused by a pre-existing condition unless the date of diagnosis is after the policy has been in force for 12 months from the issue date or last reinstatement date.

Waiting Period. Waiting period means the 30 days following the issue date or ten days following the last policy reinstatement date. The date of diagnosis of a covered critical illness must be made while the coverage is in force and after any waiting period. No benefits will be paid if a diagnosis or a medical consultation that leads to diagnosis of invasive cancer or non-invasive cancer occurs during the waiting period. If cancer is diagnosed during the waiting period, benefits will be paid for a subsequent diagnosis of cancer if the insured person is symptom- and treatment-free for at least 12 consecutive months and in complete remission prior to subsequent diagnosis.

Misstatement of Age and/or Gender. If the insured person’s age and/or gender has been misstated, an adjustment in premiums, coverage or both will be made based on the correct age and/or gender. If, according to the correct age, the coverage provided by the policy would not have become effective or would have ceased, Assurity’s only liability during the period in which the insured person was not eligible for coverage shall be limited to a refund of premiums.

Misstatement of Tobacco Use. If, during the first two years of the policy, the tobacco status of the insured person has been misstated, Assurity will revise the policy’s benefit amount to the amount the premium paid would have purchased using the correct tobacco status on the issue date.

The policy will not pay benefits for losses that are caused by or are the result of an insured person:

• being exposed to war or any act of war, declared or undeclared;

• actively serving in any of the armed forces or units auxiliary thereto, including the National Guard or Army Reserve, except during active duty training of less than 60 days;

• engaging in hang-gliding, hot air ballooning, bungee jumping, parachuting, scuba diving, sail gliding, motor vehicle racing, parasailing, parakiting, mountain or rock climbing, B.A.S.E. jumping, sky diving or cave diving;

• being addicted to drugs or suffering from alcoholism;

• being intoxicated (as determined by the laws governing the operation of motor vehicles in the jurisdiction where loss occurs) or under the influence of an illegal substance or a narcotic (except for narcotics used as prescribed to the insured person by a physician);

• committing or attempting to commit a felony;

• being incarcerated in a penal institution or government detention facility;

• engaging in an illegal occupation;

• intentionally self-inflicting an injury; or

• committing or attempting to commit suicide, while sane or insane.

Policy Form No. I H1820 underwritten by Assurity Life Insurance Company, Lincoln, NE.

IMPORTANT NOTICE— CRITICAL ILLNESS INSURANCE PROVIDES LIMITED BENEFIT COVERAGE. It is not a comprehensive major medical plan or Medicare supplement policy and does not satisfy the requirement for minimum essential coverage under the Affordable Care Act (ACA). It is not a substitute for major medical insurance and may not be appropriate for Medicaid recipients.

This policy may contain reductions of benefits, limitations and exclusions. Click here for standard Limitations and Exclusions. Product availability, features, rates, limitations and exclusions may vary by state. The state specific policy form is the ultimate authority for any questions about this product.

*Heart attack does not include established (old) myocardial infarction occurring prior to the issue date, sudden cardiac arrest, cardiac arrest or cardiopulmonary arrest.

**In some states, diagnosis of cancer during the first 30 days following the policy’s issue date results in a significant benefit reduction or policy cancellation. The percentage benefit amount payable for invasive and non-invasive cancer combined cannot exceed 100%.

Assurity reserves the right to order, at the company’s expense, evidence of insurability which the company feels is necessary for the prudent evaluation of the risk.

Assurity is a marketing name for the mutual holding company Assurity Group, Inc. and its subsidiaries. Those subsidiaries include but are not limited to: Assurity Life Insurance Company and Assurity Life Insurance Company of New York. Insurance products and services are offered by Assurity Life Insurance Company in all states except New York. In New York, insurance products and services are offered by Assurity Life Insurance Company of New York, Albany, NY. Product availability, features and rates may vary by state.