North america Critical Illness Insurance

Critical Illness & the Benchmark definition Challenge

By now most people have heard about “Critical Illness Insurance” an insurance benefit that protects the individual whilst they are still alive. This type of insurance plan pays a lump sum benefit tax-free in the event that you survive one of the covered illnesses or conditions (most programs have 20 plus covered conditions) by thirty days, in most cases.

The more severe conditions are Heart Attack, Stroke, Malignancy (life threatening) Coronary bypass surgical procedure, Kidney failure, Multiple Sclerosis as well as a number of other conditions.

However , the actual dilemma is whether you will actually get paid should you suffer from one of the twenty in addition covered conditions while your plan is in force.

Would you believe that depending on where you are when you have a heart attack, for instance, would determine when and if you obtain paid.?
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The new standardized benchmark meanings that many of the Insurance Companies are implementing may prevent some heart attack victims with a critical illness plan from getting paid.

Let me explain why: Many Insurance Companies are adopting the definition associated with heart attack that uses a test called “Biochemical Markers” which, along with other factors, determine that a heart attack did happen. Some hospitals, however , use a check involving “elevations in cardiac enzymes” to determine that a heart attack did occur.

Those Insurance Companies that do not recognize the test showing “Elevation of Cardiac Enzymes” will not honour the claim, when, in fact the individual did have a myocardial infarction.

So imagine you are in a huge city near a hospital using a Cardiac Unit and their check includes “Biochemical Markers” along with the rest of the information that would indicate you had a heart attack, if you survived the required thirty days your claim would be paid.

Right now let’s say you are in a small town hospital where the test used was with regard to “Elevation of Cardiac Enzymes” and you did indeed have a heart attack, in this instance your claim may be denied because your Insurance Company states only “Biochemical Markers” testing will be acceptable. Best-case situation, you go to court and win the ideal to be paid, after a lengthy and costly court battle.

We suggest, therefore , that you deal with an insurance provider that honors both tests.

At this point let me share more discouraging info. There are many other covered conditions which have been and will be modified by the new Regular Benchmark changes that will definitely make it more difficult to resolve a claim to get a condition that the average person would think is covered and yet does not qualify.

The attached table will display a number of covered conditions and how the newest Benchmark definitions apply.

If you have queries about an existing critical illness policy you own or one that you are considering, make sure you contact our office (866-341-3220) and ask for a comparison of definitions of protected conditions.

The price difference between the worst and the best plans in most cases can be less than 15% and as an associate of mine has said in the past, ” There are two things you don’t compromise on, the quality of your parachute and the meanings in your Critical Illness Plan”. Consider a plan that is legally and clinically sound; thereby reducing the chance for any dispute at claim time.

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