What Is Critical Illness Insurance?

Life-altering medical conditions can also have major financial implications, often requiring time off work and payments for childcare, medications, alternative treatments, and even home modifications.

That’s where critical illness insurance comes in. It can provide a benefit, so if you’re ever diagnosed with a serious illness, you don’t have to dip into your RRSPs or take on debt just to keep life on track.

Read on to learn how to choose the best critical illness insurance in Canada that works for you.

Key takeaways

• Critical illness coverage is a type of insurance that pays a benefit if you’re diagnosed with a serious illness or condition, such as life-threatening cancer, a heart attack, or a stroke.
• The benefit is a tax-free lump sum that you can use to fill gaps in your provincial health insurance, modify your home, cover daily expenses, or even continue to pay into your retirement savings.
• This type of insurance has pros, including financial protection, income replacement, and flexibility.
• There are also contract conditions to consider, such as no coverage for pre-existing conditions and potential overlap with other types of insurance you’ve purchased.
• This insurance can be especially beneficial for primary breadwinners, caregivers, self-employed people, and business owners.

What is critical illness insurance, and why do I need it?

Critical illness insurance, sometimes called “critical care insurance” or “critical illness coverage,” is a type of coverage that pays out a tax-free lump sum if you’re diagnosed with a serious medical condition or illness. It’s designed to help Canadians or individuals living in Canada pay for all the additional costs (such as medications, home care, travel, accommodations, and childcare) and loss of income that can occur with certain types of life-threatening cancers, strokes, heart attacks, and more.

How does critical illness insurance work?

Are you interested in critical illness insurance? Here’s how to secure the right plan and, in the event of a serious illness, make a claim.

1. Choose a policy and coverage amount: First, you’ll need to choose the policy and coverage level that work for you. Typically, you can add a rider to another policy, such as life insurance, or buy a stand-alone policy. RBC Insurance, for example, has two stand-alone policies covering a different range of illnesses: Critical Illness Recovery Plan and Critical Illness Insurance Plan (a more basic type of coverage). You’ll then need to determine how much coverage (or the payout size) you want to receive in the event of a critical illness. The more coverage you want, the higher the premiums you’ll have to pay. Working with a licensed insurance advisor can help you get the right level of coverage for your unique situation.

2. Set your premium and pay it: You’ll need to pay a premium each month, quarter, or year (depending on the policy) in exchange for insurance coverage. The premium will depend on factors such as: the policy you choose, the coverage amount you want, your age, your overall health level, and your smoking status. Your premium may be fixed (meaning, it won’t change) or variable, depending on your policy.

3. File a claim: If you’re diagnosed with one of the illnesses covered in your policy, you’ll need to ensure that you meet all of the policy’s criteria for the survival period (number of days you’ve had the illness before the benefit will be paid out) and the severity. There may also be a waiting period after you purchase the insurance when you cannot make any claims. When you submit a claim to your provider, you’ll need medical documentation that proves the diagnosis and you may even require additional medical exams.

4. Receive the payout: If your claim is approved, your insurer will provide you with a lump-sum payout. It will be an amount that has been predetermined by your coverage level and is not tied to the actual cost of your lost wages or treatment. You can use the payout any way you want.

What is not covered by critical illness insurance?

All policies will have exemptions. Typically, critical illness insurance will not cover illness, injury, or death in these situations:

• Self-inflicted injury, attempted suicide, or suicide.
• Intentional use of any drug, intoxicant, narcotic, or poisonous substance.
• Participation in a war or a hostile action (insurrection, civil commotion, etc.).
• Attempt to commit or actual commission of a crime, whether charged or not.
• Operating any land, water, or air conveyance (a.k.a. car, boat, or plane) that requires more than muscular power while under the influence of any drug, intoxicant, narcotic, or poisonous substance. For alcohol, the limit is 80 milligrams of alcohol per 100 millilitres of blood.

It’s best to check with your insurer for specific exclusions, since policies vary.

What are the advantages of critical illness insurance?

• Financial protection: Treatments and time spent resting (not working) can be expensive. By using the lump-sum payout for your daily expenses, you can protect your savings and avoid drawing from your RRSPs and/or going into debt.

• Income replacement: If you’re unable to work during your treatment and recovery, the lump sum can replace lost income. For business owners or those who are self-employed, it can even be used to maintain operations, cover business expenses, or hire help.

• Coverage moves with you: If you have critical illness insurance through your employer and you lose your job or switch employers,you lose that coverage. Purchasing a policy separate from your employer ensures you have critical illness coverage regardless of your employer or employment status.

• Flexibility: Unlike regular health insurance, which usually pays directly to health-care providers, critical illness insurance pays a sum directly to you. You can use the payout however you want: for medication copayments, to take time off work to recover, for therapies not covered by health insurance, or even a vacation for you and your family during recovery.

• Coverage for multiple conditions: Thanks to advancements in modern medicine, you have a high chance of surviving a serious illness. The bad news? Your finances could be hit hard while you recover. Luckily, critical illness insurance covers many conditions that could affect you during your lifetime.

• Peace of mind: In the event that you do experience a critical illness, you won’t need to worry about finances and will be able to focus on your most important task: getting better. Plus, budgeting for annual premiums, which are typically fixed for a term, is a lot less stressful than falling ill and suddenly needing to come up with a huge sum of money without insurance. 

What are the contract conditions to be aware of with critical illness insurance?

• Lack of coverage for pre-existing health conditions: Typically, any illness you’ve already been diagnosed with before applying for insurance is not eligible for coverage. In some cases, you might not be eligible for critical illness insurance at all, or there may be a waiting period before coverage can begin.

• Survival period requirement: Some policies have a “survival period” clause, which means you must survive your illness for a certain number of days before receiving a payout. RBC Insurance’s minimum survival period for most covered conditions is 30 days; although, some covered conditions require a longer period before benefits are payable.

• Limited covered illnesses: Your policy will only cover you for a specified list of illnesses. The longer the list of covered conditions, the more you’ll pay in premiums. You won’t receive a payout if you’re diagnosed with an illness that’s not on the list.

Who should consider critical illness insurance?

There are certain people who will benefit the most from purchasing critical illness insurance.

• Primary breadwinners: Your family relies on you to cover the big expenses, such as mortgage payments, school fees, credit card bills, and more. Critical illness insurance can give you financial stability even if you aren’t able to work for a period of time due to illness, reducing stress for you and your dependants.

• Self-employed individuals and business owners: A payout from critical illness insurance can provide crucial financial support during a health crisis. It may even help to cover business expenses, hire temporary staff, and keep things running in your absence. 

• Caregivers with dependants: In addition to everything else you do, you’re a caregiver. And if you get sick, you might not be able to provide care to your children, aging parents, or family members with disabilities. Critical illness insurance can help you pay for substitute caregivers and other related costs if you need time off for treatment and rest.

• People with high-stress occupations or lifestyles: Whether you work in a hazardous environment or have a high-stress job, you may be at a greater risk for certain illnesses and conditions. Even if a career change isn’t in the cards, you can help guard against financial strain from future health issues with insurance. (Note: Some occupations are excluded from coverage. Be sure to clarify with your provider.)

Frequently asked questions

How do I choose the right critical illness insurance policy?

You’ll need to take a look at your unique situation and weigh these factors.

• Covered illnesses: Are you at risk for certain health conditions, and are they covered?
• Coverage amount: What lump-sum payout will be enough to cover your expenses?
• Premium costs: How much can you afford to pay in premiums each year, considering they might increase over time?
• Exclusions and limitations: Do you understand the potential exclusions or conditions that could affect your eligibility for a payout?
• Length of coverage: How long do you need coverage? Do you need to consider adding a rider (if your provider allows) to extend the length of your coverage?
• Insurer reputation: Does the insurer you want to use have a good reputation, financial stability, and a clear and reasonable claims-approval process?

What illnesses are typically covered by critical illness insurance?

Some policies are extensive, while others are limited. Here are some commonly covered illnesses:

• Cancer (life-threatening)
• Heart attack
• Stroke
• Kidney failure
• Major organ transplant
• Multiple sclerosis
• Coronary artery bypass surgery
• Dementia, including Alzheimer’s disease

If the disease or illness is not explicitly listed in your policy, you won’t receive any coverage for it.

How is critical illness insurance different from health insurance?

Critical illness insurance is a type of health insurance, but it’s different from health and dental insurance. Health and dental insurance typically cover medical costs directly related to treatment, such as hospitalization, surgery, medication, rehab, and medical equipment. The insurance payout directly goes to the health-care provider or reimburses the insured for their out-of-pocket expenses.

Critical illness insurance is a cash benefit paid directly to you. You can use it toward medical expenses, to take time off work to recover, to pay your mortgage, or to hire a babysitter to look after your kids when you need a nap. How you use the payout is entirely at your discretion.

How is critical illness insurance different from life insurance?

Life insurance and critical illness insurance are two different things. Critical illness insurance pays out when you’re diagnosed with a serious illness and need financial support. Life insurance only pays out a benefit to your estate or listed beneficiary/beneficiaries if/when you pass away.

Can my premiums increase over time?

They might. Renewable policies adjust the premium based on your age or health status. That said, some policies have fixed premiums (meaning, they don’t increase) for a certain period or even for the policy’s duration.

Is critical illness insurance expensive?

The cost depends on many factors, from the policy you choose and the level of coverage you need to personal information, such as age, assigned sex at birth, health status, and whether or not you smoke. Generally speaking, you’ll pay less for critical illness insurance if you’re young, healthy, and nicotine-free.

No one wants to imagine being diagnosed with a serious illness. But if you’re a primary breadwinner, parent, business owner, or someone with responsibilities, it’s the “worst-case- scenario” thinking that’s worth doing. Many Canadians will experience (life-threatening) cancer, a heart attack, a stroke, organ failure, or dementia at some point in their lives. If you’re one of them, will you have a plan? Book an appointment with your insurance advisor now to discuss your options.

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