Critical illness insurance covers up to 26 critical illnesses. If you have critical illness insurance, you’ll receive a lump sum after a diagnosis of any qualifying condition. You can use this money to cover lost wages, purchase assistive equipment, or anything else you may need after illness or injury.

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Critical illness insurance

Critical illness insurance helps you get back on your feet after a life changing diagnosis. Once the insurer approves your claim, you can use the money any way you see fit, no questions asked.

Unlike disability insurance, which is paid based on an inability to continue work, critical illness insurance provides a tax-free lump sum that is paid whether you are employed or not. The insurer pays out the critical illness insurance based on a medical diagnosis.

There are many companies offering critical illness insurance. Most are quite inexpensive, especially for young, healthy adults.

Some companies offer a refund on premiums if you have not made a claim by the time you reach 65 or 75 years old. If you start paying premiums as a twenty-five year old and never make a claim, you can withdraw quite a large sum of money at 75 years old.

Most claims are subject to survivability. This means that the insurer pays no benefit if a person dies immediately after their critical diagnosis. Most plans require a 30 day survival post diagnosis before the insurer approves the claim.

Critical illness statistics

The Canadian Cancer Society predicts 233,900 new cases of cancer in 2022 with a 64% chance of survical after 5 years. That is one disease out of many that you can survive.

What if you don’t have cancer, but instead need life-saving surgery? Critical illness insurance helps cover the costs of treating and surviving medical interventions.

Many Canadians still have young families to provide for. Critical illnesses can take anywhere from a few weeks to a few years to resolve.

This is why critical illness insurance is helpful for so many people. It provides a safety net for you and your family in a difficult situation.

Aortic surgery

The aorta is the large vessel leading from your heart to the rest of your body. When this vessel gets weak or swells, it can burst and cause severe bleeding or death.

A surgeon can open your abdomen or chest to repair the damaged tissue with a graft. The surgery takes anywhere from 2 to 6 hours. You’ll then spend a few days in the hospital before returning home.

After an aortic surgery, you’ll need four to six weeks before you can return to work. You should find someone else to drive you from place to place for at least three weeks after your surgery.

It will take two or three months to feel completely back to normal. You may need extra money to replace wages and to pay someone to do your household chores while you recover.

Coronary artery bypass surgery

Surgeons perform a coronary artery bypass graft (CABG) to correct a blockage of one or more coronary arteries. Your doctor may suggest this procedure to prevent future heart attacks.

The surgeon takes the graft for the bypass from the leg. So, in addition to a chest incision, you’ll have a surgical incision on your leg to care for.

Recovery from a CABG takes about 60 days. You should not lift weights, drive, bend over, or participate in strenuous activity until you have completely recovered. This means you’ll need time off from work in addition to help with household tasks and childcare.

Recovering from a CABG also requires many lifestyle changes. While the surgery fixes blockages, it does not prevent new ones from forming. After a CABG, it would be wise to invest in exercise equipment and a registered dietician to help you improve your exercise and eating habits.

Heart attack

Each year, about 63,000 Canadians suffer a first heart attack. A heart attack occurs when the coronary arteries cannot deliver blood to the heart muscle and the tissue dies.

A heart attack is survivable and the damage is reversible when it is caught early. However, many heart attacks lead to permanent heart failure or death.

You may be able to return to work a few weeks after a mild heart attack. More serious heart attacks can cause permanent disability.

A heart attack might force you to quit your job or find work that is less stressful or labor-intensive. For heart attacks leading to heart failure, tasks like mowing the lawn and washing windows become nearly impossible.

Even walking from one room to another might cause shortness of breath. To help with this, you can use critical illness payouts to purchase assistive devices such as a walker or wheelchair.

Some people use their funds to move from a multilevel to a single story home to avoid going up and down stairs after a heart attack.

Valve replacement or repair

A heart has four valves that keep blood flowing in the correct direction. Dysfunction of one of these causes shortness of breath, fatigue, heart failure, and death.

A surgeon can perform a valve replacement through open chest surgery or a trans catheter approach. The critical illness insurance only covers valve replacement if you need open chest surgery to complete the repair.

Similar to other heart surgeries, it takes two or three months to completely recover from a valve replacement. A patient can use money from a critical illness claim to supplement lost wages and hire help for household chores during recovery.

Critical illness of the organs

Cancer

Cancer is the most common critical illness that is claimed by people. A doctor must consider the cancer diagnosis to be life-threatening in order to quality for a claim. The insurer can deny the claim if a doctor diagnoses cancer within 90 days after signing a critical illness policy.

The International Journal of Cancer reports that lost productivity costs due to cancer surpass $75 billion per year in Europe. People with a cancer diagnosis are 2.5 times more likely to file for bankruptcy than those without cancer. 30% of cancer survivors are unable to return to work, even after successful treatment.

Besides an inability to work, cancer patients often need in-home medical care, which is not covered in the Canada Health Act. Here are some other eye-opening facts.

  • Home care services cost on average $1000 per week
  • Spouses and children often work 40 hours a week or more caring for their loved one with cancer.

Working full time and being a full time caregiver is extremely difficult. Hiring outside help is a better option if you have the means to do it.

Organ transplant

Patients can claim critical illness insurance after a heart, lung, liver, kidney, or bone marrow transplant. Recovery from organ transplantation takes weeks to years.

Doctors recommend taking at least one full year off from work after any organ transplant. After receiving a transplant, you have to take immunosuppressive medications for life. This may mean changing to work from home to keep yourself safe from illnesses and infections.

Follow up appointments are required long after transplantation is complete. This results in high travel costs and more missed work days for you and your family.

Organ failure on transplant list

Being on a transplant waiting list means that you have irreversible organ failure. Depending on your blood type, organ needed, and severity of illness, the wait could be a few days or a few years.

While waiting for an organ, you may or may not be able to work. As your illness progresses, you may have to stay in a hospital until an organ becomes available.

Not every hospital is equipped to perform an organ transplant. If you are placed on the waiting list, you may have to move to be closer to a large hospital.

Only 6 kidney treatment centres in Ontario provide transplant services. Moving and travel costs are not covered by public health funds and would be your responsibility. A critical illness insurance claim can help ease some of the stress related to organ transplantation.

Occupational HIV infection

Human immunodefiency virus (HIV) is a virus that damages your immune system and makes you vulnerable to infection and disease. HIV can lead to acquired immunodeficiency syndrome (AIDS).

In order to be covered by critical illness insurance, an HIV infection must result from accidental injury at work. Coverage can be denied if you cannot provide proof of a workplace accident or injury.

Critical illness insurance can help pay for things like antiretroviral drugs and treatments.

Kidney failure

1 in 10 Canadians have kidney disease, and 46% of them are diagnosed before age 65. When kidney disease progresses to kidney failure, you will need dialysis or kidney transplantation.

Not all medications related to kidney failure are covered by universal healthcare programs. For example, meditation to lower phosphate levels costs over $3,000 per year and is not publicly funded. A medication used to lower parathyroid hormone costs over $800 per month, and is only publicly funded under strict conditions.

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Both of these medications are commonly used for kidney failure patients.

Aplastic anemia

Aplastic anemia is a chronic bone marrow failure resulting in anemia. Treatment includes blood product transfusion, immunosuppressive drugs, and bone marrow transplantation.

Aplastic anemia causes fatigue, shortness of breath, and unexplained bleeding. Mild infections can become life threatening for someone with aplastic anemia due to their decreased white blood cell count.

If you are diagnosed with aplastic anemia, quitting your job or working from home will protect you from infection. Because of bleeding risk, it is unwise to continue working in any job requiring hard manual labor or doing labor intensive tasks at home.

Hiring a housekeeper is a good way to keep yourself from getting an infection or getting an injury that causes bleeding. You should also purchase a good multivitamin and chemical free cleaning products to keep yourself as healthy as possible.

Neurological critical illness

Brain injury due to trauma

Acquired brain injury is the leading cause of death and disability for Canadians under 40 years old. This can be from anything: contact sports, leisure sports and activities, motor-vehicle accidents, and falling or slipping and hitting your head.

92% of men who sustain a brain injury never return to full-time employment and the economic burden of brain injuries is estimated at $12.7 billion per year.

Traumatic brain injuries range from mild to severe. A person who suffers a severe brain injury will need constant care. 22% of people who suffer a catastrophic brain injury never leave their homes again.

Someone with a critical brain injury will also necessitate several adaptive equipment items and possibly a modified home environment. Wheelchairs, adaptive showers, ramps, special beds, and lifts are just some of the items you or your family might have to purchase after a brain injury.

Benign brain tumor

A benign brain tumor is not cancerous, but it can cause issues with vision, hearing, coordination, and eating. You will need lifelong monitoring after brain tumor diagnosis. Depending on the location and growth rate of the tumor, you may not be able to continue working and may need to hire full time home care services.

Dementia and Alzheimer’s

Dementia and Alzheimer’s are progressive diseases that cause a loss of cognitive function. It is not uncommon for people with dementia to have dangerous accidents like getting lost or catching things on fire in their homes.

There is currently no cure for dementia or Alzheimer’s disease. Most people with dementia eventually need 24 hour care in a nursing facility.

Although medical costs are covered by public funding, room and board in a nursing facility is the responsibility of the resident or their family. Living in a special facility for people with dementia costs around $1800 per month.

Bacterial meningitis

Bacterial meningitis is a bacterial infection in the spinal fluid and fluid surrounding the brain. It can cause difficulties with hearing, vision, speech, motor function, and seizures. Bacterial meningitis must cause symptoms lasting for 90 days or more after the original diagnosis to qualify for critical illness coverage.

Survivors of meningitis can often return to their regular routine within a few weeks. However, they may feel more tired, have memory problems, and experience frequent headaches.

Because these problems are not considered debilitating, disability insurance claims for meningitis are usually denied. If you have critical illness insurance, the lump sum payment can help you ease back into working and your regular routine at a pace that is manageable.

Motor neuron disease

Motor neuron disease includes amyotrophic lateral sclerosis, primary lateral sclerosis, progressive spinal muscular atrophy, and progressive bulbar palsy. These diseases are progressive and cause loss of function over time. There is currently no treatment for motor neuron disease.

As the disease progresses, you’ll find that you need more help and assistive devices to complete activities of daily living. While universal healthcare will help with the cost of a wheelchair, some of the better options can cost more than $10,000.

With critical illness insurance money, you can alter your home to be more wheelchair friendly. Plus, you can purchase a special car that is wheelchair accessible.

Critical illness of the senses

Blindness

Blindness is defined as corrected visual acuity of 20/200 or less, or the field of vision being less than 20 degrees in both eyes. Irreversible blindness requires assistive devices and home modifications. Blindness makes it more difficult to maintain employment and complete household tasks independently.

A service dog can help you navigate the world safely if you have a vision impairment. Unfortunately, guide dogs are expensive and are not paid for by government programs.

A well trained guide dog costs anywhere from $3,000 to $50,000. This does not include food and veterinary care for your service animal.

Deafness

Deafness has to be quite severe to qualify for critical illness coverage. In order to qualify, the deafness threshold must be above 90 decibels. This means you cannot hear anything quieter than a leaf-blower or a concert.

Hearing aids may or may not be covered by your health plan, depending on your providence. Good hearing aids can cost up to $10,000. You may also need special talk to text phones and a strobe light fire alarm to keep you safe.

Loss of speech

Loss of speech is always a symptom of some other illness. The loss of speech condition must be irreversible to be covered by a critical illness insurance policy. No benefit will be paid for psychiatric causes of loss of speech. The most common cause of loss of speech is traumatic brain injury.

Loss of limbs

Loss of limbs means the loss of two or more limbs at or above the ankle or wrist. This may be the result of an accident or an amputation due to a medical condition. Most provinces will help pay for prosthetics, but the costs often exceed funding limits.

A prosthetic leg costs between $5,000 and $100,000. Unfortunately, most prosthetic limbs need to be replaced every five years.

Loss of independent existence

Loss of independent existence is defined as the inability to perform at least two self care tasks with no reasonable expectation of recovery. Self care tasks include; bathing, dressing, toileting, control of bowel and bladder, transferring, and feeding.

Loss of independent existence may cause you to lose employment and income. It almost always requires hiring outside help and the purchase of several assistive devices. In some cases, you’ll need to move from your home into an assisted living center.

Paralysis

Critical illness insurance benefits will be paid for complete paralysis of two or more limbs for a period of at least 90 days following an injury or disease. Depending on the paralysis, you may or may not be able to continue in your current occupation.

However, it will take time to adjust to your new situation. Loss of productivity, home modifications, physical therapy equipment, and special devices all add to the cost of dealing with paralysis. The estimated lifetime economic burden of a spinal cord injury resulting in paraplegia ranges from $1.5 to $3 million.

Severe burns

Severe burns are third-degree burns that cover at least 20% of the body. It takes months for third degree burns to heal.

Burns in the healing process are at high risk of infection and complications. In many cases, third degree burns cause long term damage to skin and surrounding areas.

Burns around joints can cause mobility issues and chronic pain. Depending on the area, you may need devices to help with writing, walking, or eating.

Critical illness insurance cost vs benefit

The cost of critical illness insurance depends on the coverage you want and the current state of your health. A young, healthy adult can get $10,000 worth of critical illness coverage for just a few dollars a month.

Pre-existing conditions make insurance coverage more expensive. So do high risk behaviours like smoking.

A healthy lifestyle lowers insurance costs and makes it more likely that you’ll get a refund on premiums later in life. Many employers offer critical illness insurance as part of their benefits package.

Frequently asked questions about critical illness insurance

What is critical illness insurance in Canada?

Critical illness insurance provides a lump sum payment in the event of a qualifying critical illness. Once your claim is approved, the lump sum will be paid to you and you can use it for anything you need. Unlike disability insurance, critical illness insurance is not paid based on your inability to work or previous employment history.

Is critical illness insurance worth it?

25% of men aged 20 to 65 will experience some kind of critical illness or disability. Having critical illness insurance can help bridge the gap caused by early retirement in critical illness. Most critical illness claims are made by working men and women under the age of 54. Many critical illnesses result in an inability to work and earn a living. Critical illness insurance provides a safety net for you and your family, a great value for the relatively low cost. Many companies offer a refund of premiums if the policy is not used.

Is critical illness insurance taxable?

If you make a critical illness claim you will receive a tax free lump sum.

What does critical illness insurance cover?

The most basic critical illness plans cover only the most common illnesses including cancer and heart disease. More comprehensive plans cover up to 26 different illnesses.

Can I get critical illness coverage after cancer?

You cannot enroll in a critical illness insurance plan after you have already gotten a diagnosis of any critical illness. A cancer diagnosis is only eligible for critical illness coverage if the diagnosis is made more than 90 days after plan enrollment.

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