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.

How critical illness coverage works

  • 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.

Already have Guardian critical illness insurance?

Let’s help you find what you need.

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.