Kyle J. Norton asked: As we mentioned in previous article, critical illness insurance is a type of insurance which will pay a lump tax free benefit to the insured if he is diagnosis of one of the critical illnesses covered by the policy. The benefit is intended to help insured persons maintain their quality of life and financial independence after suffering a life-threatening illness. In this article, we will give you the definitions of illness that are covered in the policy.
Medical wording is important for an objective claim assessment and consistency in pricing the product. Diagnosis often requires specialized tests interpreted by medical experts and the definitions of covered conditions are technical and exact.
The following interpretations of conditions may vary from the policies and insurance companies
1. Heart Attack
People who suffer a heart attack will sustain damage to the heart muscle. This causes
a) Changes in the electrocardiogram (ECG) and
b) Elevation of cardiac or heart enzymes.The chance finding of ECG changes suggestive of a previous silent heart attack is not covered.
2. Coronary Artery Disease Requiring Surgery (Coronary Bypass)
The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts. This exclude any non-surgical treatment.
3. Cancer
A malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This includes leukemia and Hodgkin disease. Stage A prostate cancer will be covered only if the diagnosis is made before the policy anniversary nearest to the life insured’s age of 75.
No benefit will be payable if
a) A diagnosis of any type of cancer is made within90 days of the effective date of coverage or the date of the latest reinstatement; or
b). Any symptoms of medical problems commence within 90 days of the effective date of the coverage or the date of the latest reinstatement that initiate any investigations that lead to a diagnosis of any type of cancer.
4. Stroke
It covers all 3mechanisms that cause strokes, including:
a. Thrombosis caused by a blockage by a clot that has built up on the wall of a brain artery;
2. Embolization caused by an embolus (usually a clot) that is swept into a brain artery causing blockage;
c. Hemorrhage - caused by the rupture of a blood vessel in or near the brain’s surface. Any incident with symptoms lasting less than 24 hours is referred to as a transient ischemic attack and it does not qualify for coverage under this definition.
5. Kidney Failure
End stage renal disease, due to whatever cause or causes, with the life Insured undergoing regular peritoneal dialysis or hemodialysis or having had renal transplantation.
6. Multiple Sclerosis
Benign, chronic and acute forms of multiple sclerosis are covered under this definition. Multiple Sclerosis is an extremely difficult condition to diagnose and usually takes a number of tests to exclude other possibilities before it is confirmed. Neurological abnormalities in this context must be evidenced by the typical symptoms of demyelination with resultant impairment of the brain stem or spinal cord.
7. Major Organ Transplantation
The actual undergoing as a recipient of a transplant of a heart, lung, pancreas, kidney and bone marrow will be covered under policy/
8. Blindess
Permanent loss of sight in both eyes, as confirmed by an ophthalmologist registered with government. The benefit will be paid regardless the cause, disease or degeneration of the eye ball, the optic nerve or the nerve pathways connecting to the brain or the brain itself.
9. Deafness
Total, permanent and profound loss of hearing in both ears with an auditory threshold of more than 90 decibels and confirmed by an registered otolaryngologist.
10. Alzheimer’s Disease
The diagnosis by a doctor (who is either a certified neurologist or a certified psychiatrist) that the Life Insured has Alzheimer’s Disease, and supported by evident of a progessive degeneration of the disease.The Life Insured must exhibit the loss of intellectual capacity involving impairment of memory and judgment. The disease progresses to severe loss of memory and death usually within 10 years.
11. Paralysis
Complete and permanent loss of use of two or more limbs for a continuous period of days following the precipitating event, during which time there has no sign of improvement.
12. Parkinson’s disease
The disease is progressive, degenerative of the central nervous system and characterized by muscular rigidity, tremor and slow movements. This definition only covers idiopathic’ Parkinson’s Disease. “Idiopathic” means that the disease must have originated from an unknown cause Parkinson’s disease originating from taking certain drugs or toxic chemicals, etc. will not be covered.
13. Occupational HIV Injury
The diagnosis of Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of insured’s normal occupation, which exposed the insured to HIV contaminated blood or body fluids.
Payment under this covered condition requires satisfaction of all of the following:
1. The accidental injury must be reported to the company within 14 days of its occurrence;
2. An HIV test must be taken within 14 days of the accidental injury and the result must be negative;
3. An HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
4. HIV tests must be performed by facilities approved by the Company;
5. All the accidental injury must have been reported, investigated and documented in accordance with workplace guidelines;
6. The accidental injury must have occurred while the life insured was working in Canada or the United States.
No payment will be made if:
1. The Life Insured has elected not to take any available licensed vaccine offering protection against HIV; or
2. A licensed cure for HIV infection has become available prior to the accidental injury; or
3. HIV infection has occurred as a result of non-accidental injury (including, but not limited to, sexual transmission or intravenous drug use).
For more information, please visit my home page atKyle J. Norton
http://lifeanddisabitityinsuranceunderwriter.blogspot.com/
http://businessdisabilityinsurance.blogspot.com/
http://criticalillnessinsurance03.blogspot.com/
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Nellie
