What does critical illness insurance cover?
A serious illness can lead to all sorts of unexpected expenses. Critical illness insurance pays benefits that can help you focus on your recovery, not your finances.
You have a medical issue
Symptoms may appear suddenly or over time, but at some point, you seek medical attention.
You receive a diagnosis
After going to a doctor or hospital1, you're diagnosed with a covered critical illness.
You get a lump sum¹ benefit payment
Simply, submit a claim and get a direct payment based on your diagnosis to help cover costs as you see fit.1
When people are struck with a major illness, they often face unplanned costs. Expenses such as co-pays and deductibles could quickly add up, threatening someone’s financial wellness at an already stressful time. While it can be purchased as an individual, critical illness insurance is more typically offered at work as an employee-paid voluntary benefit. Critical illness insurance provides financial support by paying a lump sum1 benefit directly to you if you ever experience a covered illness like cancer, heart attack, or stroke.
What is considered a critical illness?
Plans vary by provider, but the term “critical illness” in the context of this type of insurance can mean a wide range of diagnoses and related issues beyond traditionally serious health events like heart attacks or strokes. Some plans may even fertility treatments, mental health assessments, health screenings, and certain preventive health measueres1, subject to state restrictions and plan limitations.
For illustrative purposes only, here’s a sampling of some of the illnesses that may be covered by critical illness insurance, depending on the plan and availability.
Category | Covered Issues | ||
---|---|---|---|
Heart Disorders | Coronary artery disease (Stents, Angioplasty, Thrombectomy) Coronary artery disease - requiring a bypass Heart attack | Heart failure Implantable cardioverter defibrillator (ICD) | Pacemaker Sudden cardiac arrest |
Lung and Vascular Disorders | Acute respiratory distress syndrome (ARDS) Aneurysm | Pulmonary embolism Stroke - moderate | Stroke - severe Transient ischemic attack (TIA) |
Cancer and Benign Tumors | Benign brain or spinal cord tumor Bone marrow failure (including Stem Cells) | BRCA1 or BRCA2 mutation Carcinoma in situ | Invasive cancer (including Leukemia, Multiple Myeloma) Skin cancer |
Neurological Disorders | Alzheimer’s disease – early stage Alzheimer’s disease –advanced stage Amyotrophic lateral sclerosis (ALS) Dementia - other causes | Huntington’s disease Multiple sclerosis (MS) – early stage Multiple sclerosis (MS) – advanced stage | Myasthenia gravis Parkinson’s disease - early stage Parkinson’s disease – advanced stage |
Chronic Disorders | Crohn’s disease Epilepsy | Lupus | Ulcerative colitis |
Mental Health Disorders | Major depressive disorder – mild or moderate | Mental health disorder - severe | Post-traumatic stress disorder (PTSD) |
Pregnancy and Childbirth Disorders | Complications of birth Complications of pregnancy or delivery | Infertility - non-surgical treatment Infertility – surgical treatment | |
Childhood Illnesses and Disorders | Autism spectrum disorder Cerebral palsy Cleft lip or cleft palate Clubfoot | Congenital heart defect Cystic fibrosis Diabetes - type 1 Down syndrome | Hemophilia Multisystem inflammatory disease (MIS) Muscular dystrophy Spina bifida |
Additional Disorders | Addison’s disease Coma Infectious/Contagious disease Kidney failure | Loss of hearing Loss of sight Loss of speech Major organ donation | Major organ failure - liver, pancreas, lungs Permanent paralysis Severe burns |
Payouts vary, and may be provided for a second occurrence
Insurance companies may customize their plans in different ways, so some will cover more conditions and others will cover fewer. Additionally, some will only pay for a first occurrence, while others pay benefits if a disease, such as cancer, recurs. Payout amounts also vary, depending on the plan design and severity of diagnosis.
How critical illness insurance differs from cancer insurance
Generally speaking, critical illness plans cover a wide range of critical illnesses and conditions, and cancer insurance plans only pay benefits for diagnoses related to cancer. However, a cancer plan may provide payments for more kinds of cancer-related treatments (for example, for each session of radiation or chemotherapy), and/or those payments may be larger than they would be in a critical illness plan. Which is right for you? Some people will choose one over the other based on family medical history; others may opt to get both kinds of coverage for more comprehensive financial protection.
Why employees sign up for critical illness insurance coverage
A critical illness insurance plan can be a good option for anyone who wants additional financial protection that can help them preserve savings or minimize debt in the event of a significant health condition. Plus, some of our policies pay out benefits for preventing, diagnosing, and treating less serious conditions.
1 Lump sum payments, health screening benefits, and hospitalization benefit are optional plan choices determined by your employer.
In New York, Critical Illness is referred to as Specified Disease.
Guardian's Critical Illness Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. This is a limited plan of supplemental health insurance that provides the specified financial support, as a lump sum or indemnity payment, following the diagnosis of a critical illness. This is not minimum essential coverage as defined by federal law. This coverage will not reimburse for hospital or medical expenses. Generic Policy Form # GP-1-CI-14. The state approved form is the governing document.
This information is not intended for residents of Arizona and New Mexico.