Critical Illness Insurance provides that necessary catch-all net for many Canadians in case something goes terribly wrong with their health. Still, as with all forms of insurance policies, there are specific exclusions associated with Critical Illness Insurance, which may affect whether the claim will be payable or not. Being aware of what these exclusions are can help to ensure you’re adequately covered and not caught off guard when the time comes to make a claim.
The following blog is going to cover the most common exclusions that a Critical Illness Insurance Policy has in Canada, how they may affect your coverage, and what you should know before buying a policy. We can take the time along the way to discuss how these can influence Critical Illness Insurance Quotes in general, as well as the overall cost of Critical Illness Insurance.
Understanding Critical Illness Insurance
Before discussing the exclusions, it is necessary to have an idea of what Critical Illness Insurance is and how it works. A Critical Illness Insurance Policy pays a lump sum if you get diagnosed with a covered illness. This lump sum can be utilized in any possible way, from spending on treatment, paying off debts, or making any necessary lifestyle changes.
These conditions usually include diseases such as cancer, heart attack, stroke, and multiple sclerosis. Again, not all the policies cover the same illnesses. This is the most probable reason for needing a Critical Illness Insurance quote that gives details on what is covered and, most importantly, what is not.
Common Exclusions in Critical Illness Insurance Policies
While Critical Illness Insurance provides valuable protection, it’s important to be aware of the exclusions that can prevent a claim from being paid out. Here are some of the most common exclusions found in Critical Illness Insurance policies in Canada:
Pre-Existing Conditions
Common exclusion as a result of common inclusion in Critical Illness Insurance policies is pre-existing conditions. Pre-existing conditions are illnesses or medical conditions for which a person has been treated before purchasing the policy. If you are suffering from it and weeks down the line you are diagnosed with a critical illness that pertains to that disease, then your claim might be null.
For example, if you had heart disease prior to taking a Critical Illness Insurance Policy and a heart attack occurs, the insurance company can deny the claim due to the exclusion of pre-existing conditions. That’s why it becomes very important to fully disclose your medical history at the time of applying for the policy, as it may cause difficulties later on.
You need to ask the provider how they treat pre-existing conditions while you are receiving Critical Illness Insurance Quotes. There may be some coverage offered for pre-existing conditions on policies once a waiting period has expired. Pre-existing conditions can help you make a better evaluation of your Critical Illness Insurance Cost under your policy and whether it fits your needs.
Waiting Periods
Another common exclusion is waiting periods. This refers to the time that you would have to wait following the purchase of the critical illness policy before you could make a claim. In case you are diagnosed with a critical illness within this waiting period, then you will probably have your claim denied.
Waiting periods differ on these policies, but they range from 30 to 90 days. This has been excluded so as not to prevent an occurrence when an individual might decide to purchase the policy when they have been diagnosed with a critical sickness or suspect they have one. It is important to be familiar with the actual number of days in the waiting period you are covered since this automatically determines when you qualify to use the benefits.
The second thing that you need to compare and examine in the proposals of the waiting period of Critical Illness Insurance Quotes is this: the longer the waiting period, the cheaper it is bound to be, but that also means a delay to the beginning of the coverage. One has to strike the right balance between this on one hand and one’s need for immediate protection when he or she looks for the right Critical Illness Insurance Policy.
Certain Types or Stages of Illnesses
Not all Critical Illness Insurance policies will cover all types and stages of an illness. For example, many policies will insure only those cancers that are invasive and will exclude cancerous tumours that are in the early stage or even non-invasive. In the same manner, some policies will cover only specific criteria of a heart attack, excluding milder forms of heart attack that do not severely damage the heart muscles.
In the case of those prone to certain types of illnesses, exclusions may be far more serious. Here, it is very important to read the fine print of your Critical Illness Insurance Policy in order to see just how many types and stages of illnesses it covers. This can prevent many surprises when a claim needs to be made and allow you to be properly covered with the level of protection that you require.
When making the inquiries for the quotations, inquire with the insurance provider to elucidate on the illnesses and stages that are catered for in the policy. This way, you will be in a position to tell if the policy provides you with a sufficient amount of protection or not. You will also be able to determine for yourself whether the cost of Critical Illness Insurance is covered and is so worth it.
Self-Inflicted Injuries and Suicide
Most policies of Critical Illness Insurance also contain exclusions for self-inflicted injuries and suicide. This means that if an illness or condition results from a self-inflicted injury or suicide attempt, no payment will result from such a policy. This is standard in most policies and has been designed to prevent insurers from claims due to intentional harm.
This is something certain to pay attention to, especially in a case where either you or a loved one has some past records related to mental health issues. Although Critical Illness Insurance mostly includes conditions related to physical health, awareness of all potential exclusions helps ensure one is properly informed about the limitations of the policy.
Substance Abuse
If usage or over-dependence is the cause of illness, the majority of the exclusions in most of the Critical Illness Insurance policies talk about substance abuse. This is extended to both the legal and illegal ones.
For example, if liver disease is caused by excessive consumption of alcohol, then for sure, your Critical Illness Insurance Policy will exclude this disease. If a critical illness arises from a drug overdose, then a claim is most probably going to get rejected.
When considering Critical Illness Insurance Quotes, make sure to understand how substance abuse exclusions may apply. If you are concerned about the nature of this exclusion, feel free to discuss it further with the insurance provider and get clarity on the terms of the policy.
Non-compliance with Medical Advice
Many critical illness policies are non-compliance exclusions, such as failing to adhere to your doctor’s advice for follow-up care or other treatments to maintain your ailment. In other words, in the event of not adhering to such advice and consequently worsening your condition, your insurance company will refuse the claim. Suppose your doctor recommends certain drugs or treatments that you decide to forego, and your condition deteriorates because of it. Your insurance company will now refuse to pay the claim.
This exclusion actually proves that adherence to medical advice and treatment is not only crucial for health reasons but also to keep your policy against critical illness in a valid state. Comparisons of quotes for illnesses show that adhering to medical advice is one of the factors that will keep your policy valid.
Travel to High-Risk Areas
Some Critical Illness Insurance policies do exclude travel to high-risk areas. These may include but are not limited to areas with armed conflicts, outbreaks of certain diseases, or places that are under government advisories. When you expose yourself to these areas and contract an illness or injury, your insurance company might deny your claim.
For those who travel often, in particular to places that may be considered as high risk, this should be discussed with your insurance provider in seeking quotes for Critical Illness Insurance. They should be able to inform you of certain exclusions related to travel and let you understand how this may affect your coverage.
Participation in High-Risk Activities
Another common exclusion that one may find in a Critical Illness Insurance Policy is participation in high-risk activities. These can include extreme sports, like skydiving, bungee jumping, or scuba diving, and even jobs or hobbies that expose you to unusual risks, such as working with hazardous materials or engaging in professional sports.
Most insurance companies will not cover the insurance claim if one has engaged in a high-risk activity and has ended up in any critical illness or injury. Therefore, ensure that you disclose everything, including engaging in high-risk activities, when looking at the quotes for Critical Illness Insurance. This honesty may assist you in buying a policy that would cover this or one that will state transparently what is not covered.
War and Acts of Terrorism
Many Critical Illness Insurance policies exclude from their coverage illnesses or injuries resulting from war or acts of terrorism. This means that if, for example, your critical illness diagnosis results from chemical or biological agents released in an act of war or terrorism, your claim is not payable.
This would especially be the case for individuals residing or working in areas vulnerable to such occurrences. While collecting Critical Illness Insurance Quotes, it’s crucial you understand how your policy would attend to these exclusions and if you would need further coverage for being in a high-risk area.
Age-Related Exclusions
Finally, some of the Critical Illness Insurances come with age-related exclusions. As a person ages, at some point, the likelihood of a particular condition occurring rises as a matter of course in life, so some policies exclude that condition from coverage beyond a particular age. For instance, a policy may exclude coverage for cancer after the age of 70 or heart disease after the age of 75.
You will want to consider such exclusions, if possible, at the time of purchase if you are older or if there is a history of illness in your family linked to older age. In conducting Critical Illness Insurance comparisons, be sure to inquire into any age-related exclusions and how those might affect you as you age.
Final Thoughts
The more common exclusions in a Critical Illness Insurance Policy, therefore, mean that the key to protection when you need it lies in understanding those. In fact, an understanding of these exclusions may help you make informed decisions at the time of purchasing any policy and avoid getting rude shocks should you need to make a claim. When seeking quotes for Critical Illness Insurance, it is worth taking the time to delve into the details of what is and is not covered. Consider how such exclusions may impact your coverage and whether the cost of Critical Illness Insurance really equates to the protection you will have. After all, a well-informed decision will give you peace of mind and financial security in case the unexpected occurs.
