Critical Illness Insurance

Critical Illness Insurance is supplementary insurance which can help you pay for your medical expenses. Being diagnosed with an illness or condition is not uncommon, and it can be very costly. An affordable Critical Illness Insurance policy can help you pay for the expenses that your health insurance doesn’t cover, so you can focus on your recovery. Critical Illness Insurance pays a lump-sum cash benefit if you, or a family member on the policy, gets diagnosed with a serious illness or condition.

Each policy covers a different list of illnesses, but all of the plans on our platform cover cancer, stroke and heart attack.

You can use the benefit money in any way you choose, but most people use it to help cover:

• Medical expenses: such as deductibles, copays, coinsurance, out-of-network care, medical costs not covered by your health plan
• Non-medical expenses: such as lost wages (due to missed work), travel and lodging for care, homecare, childcare

You cash benefits allow you to take time off work so you can spend more time resting and getting healthy and less time worrying about unpaid bills or incurring medical debt.

Each policy covers a different list of conditions, but all of the plans on the Emerge platform cover cancer, stroke and heart attack.

There are a few important coverage exceptions, so make sure to check the policy details of each policy before purchasing to ensure you choose a plan with the coverage you need.

• Some policies offer partial coverage for less severe illnesses. For example, some plans pays 25% of benefit amount for cancer in situ
• Some policies offer a lower coverage amount for spouse, domestic partner, and/or children
• After paying for the first covered illness, some policies will pay additional benefits for the diagnosis of a different covered illness. In addition, some policies will pay for the recurrence of a covered illness, but the benefit amount paid for the additional illnesses may be different than what was paid for the first covered illness. There is a wide variety of rules, so it is important to carefully read your policy information.

Critical Illness Insurance policies are generally simplified issue types of insurance coverage, which means anyone who passes a series of health questions is generally approved for Critical Illness Insurance. The policy can cover you, your spouse/domestic partner, and your children. Some plans offer each family member the same level of coverage. Whereas other plans offer a lesser amount of coverage for the spouse and dependent children. So, it is important to pay careful attention to the plan information of each plan.

If you are diagnosed with a covered illness, you should start the claim submission process as soon as possible. You can find specific claim submission instructions in the policy documents. Generally the process involves:

1. Filling out a claim submission form and signing the Authorization for the Release of Information form
2. Asking your doctor to fill out a physician statement
3. Gathering medical bills
4. Mailing all of the above to the insurers
5. If the insurer needs any additional information, they will follow up within 15 days. By submitting all the required documents, you can usually speed up the claim process.
6. You can check the status of your claim by calling the insurer
7. After the insurer processes your claim, you will receive payment in the form of a check or wire transfer.

If your claim is denied, you can contact the insurer to start an appeal process.

Click here to see a sample claim form

It depends on which plan you purchased. There are three common setups:

1. The plan terminates after 100% of the benefit has been paid out
2. The plan categorizes covered illnesses into several categories such as cardiovascular, cancer, and other, and you can receive up to 100% of the benefit in each category. With this type of plan, you can receive up to 300% of the benefit
3. The plan pays a partial or full benefit for the recurrence of a previous illness or the occurrence of a new illness, with no lifetime maximum

Please refer to the plan brochure for the specific setup of each plan.

If your plan terminated after all the benefits are paid out usually you aren’t eligible to buy another Critical Illness policy. However, some states have policies with a “guaranteed issue” feature which accepts anyone regardless of health history.

A pre-existing condition is a medical condition for which medical treatment was received or symptoms existed before the effective date of the Critical Illness coverage. For example, a lump in the breast is considered a pre-existing condition; an active diagnosis of breast cancer is not needed for a pre-existing condition.

Some Critical Illness policies don’t have a pre-existing condition exclusion. For those plans that do have a pre-existing condition exclusion, the most common rule is a “12/12 exclusion,”which does not cover an illness or injury for which you received treatment within the 12 months prior to your effective date of coverage, and illnesses that occur during the first 12 months of coverage due to a pre-existing condition are excluded from receiving benefits. For example, your coverage starts on January 1st, 2017, and you received treatment for chest pain on June 1st, 2016. If you have a heart attack on March 1st, 2017, the heart attack is not covered because the heart attack results from the chest pain you had 7 months before the coverage effective date. However, if you have liver cancer on April 1st, 2017, the cancer is covered because the cancer isn’t the result of the chest pain.

Another example, your coverage starts on January 1st, 2017, and you received treatment for chest pain on June 1st, 2016. If you have a heart attack on May 1st, 2018, the heart attack is covered because the heart attack occurred more than 12 months after the effective date.

Some plans may have a different definition of pre-existing conditions or do not use the 12/12 exclusion, please refer to the policy brochure for the specific rules of each plan.

A waiting period is a period of time in which benefits are not payable. Critical Illness Insurance usually have 30 days waiting period for all illnesses, while some plans only have a waiting period for cancer.

All plans on our platform have fixed premiums that won’t change as you age. Some plans have a reduction of benefit feature that decrease the coverage at older ages. The most common benefit reductions features are a 50% reduction of coverage at age 65 or 70, but the reduction parameters can vary from plan to plan. Please refer to the policy details for the specific rules of each plan.