Does Critical Illness Insurance Cover Cancer? - PolicyAdvisor
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Does critical illness insurance cover cancer?

SUMMARY

Critical illness insurance policies may cover up to 26 diseases or illnesses. This insurance provides a lump-sum payment if you should be diagnosed with one of these illnesses. Cancer (life-threatening) is commonly covered under most critical illness insurance plans.

By Jiten Puri
CEO & Founder, Insurance Advisor, LLQP
10 min read
IN THIS ARTICLE

It’s incredibly likely you know someone who has or will be diagnosed with cancer. In fact, nearly half of all Canadians will battle the disease in their lifetime. Perhaps more shocking is that one in four people will die from cancer, making it the most common cause of death in Canada. 

Of all critical illness insurance payouts, over 60% are made to those diagnosed with cancer. While critical illness insurance can’t cure cancer, it can offer peace of mind and financial support to those diagnosed as well as their loved ones.  

Below we’ll give you a brief overview of critical illness insurance and coverage for cancer. 

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What is cancer?

Cancer is a type of disease which is classified by the uncontrolled spread of mutated or damaged cells (cancer cells). These cancerous cells disrupt the normal function of organs and systems within the body by destroying healthy cells. Cancer can appear in the body as a solid tumor or as tissue lesions. However exceptions to this general rule include cancers in the blood or bone marrow which do not have a “mass”. 

Cancers are curable if the diagnosis is early (early stage cancers). When cancers are caught early, they tend to be smaller and can be either removed surgically or be shrunk through therapy.

Cancers that have spread to different parts of the body (metastasized cancers) may not always be curable but are generally treatable. Increasingly therapies and treatments are becoming available that may extend a person’s life or ability to deal with the chronic illness.

What is critical illness insurance?

Critical illness insurance provides you with a one-time tax-free lump sum payment if you are diagnosed with a critical life-threatening disease or condition. This type of insurance is different from disability insurance, which only replaces part of your income when you cannot work. Critical illness insurance pays out in the event of a diagnosis of an illness specified in the contract, even if there was no disruption to employment earnings.

Does critical illness insurance cover cancer?

In short, yes cancer is one of the main conditions that critical illness insurance covers! But, there are some exceptions depending on the type and stage of cancer diagnosis, both of which determine whether or not the coverage will be paid and the amount of coverage that may be claimed. 

Cancer is a general term that is used to describe a wide variety of cell mutations, some less serious than others, including those that are not critical. Critical illness insurance covers life-threatening cancer as one of the main conditions that can trigger a full payout of the critical illness insurance policy. 

Most Canadian insurers will follow the definition provided by The Canadian Life and Health and Life Insurance Association (CLHIA) for various covered conditions including cancer. The CLHIA defines life-threatening cancer as “a definite diagnosis of a tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue.” Additionally, the CLHIA requires that the diagnosis be made by a specialist such as an oncologist (cancer doctor) and be confirmed by a pathology report. 

The CLHIA has fully defined all the 26 commonly covered illnesses

Are all forms of cancer covered for critical illness insurance?

Non-life-threatening cancers are typically excluded (see exclusions below) from the list of covered illnesses for most critical illness insurance policies. However, if one of these excluded cancers is not cured and becomes metastasized and life-threatening, then critical illness insurance benefits may become payable provided the policy remains in force. Certain less serious forms of cancer such as early stage skin cancer, early stage prostate cancer, or early stage breast cancer may be eligible for a partial benefit payout.

Read the full CLHIA definition of cancer here. 

What is cancer insurance and is it good enough?

Cancer insurance refers to a type of policy which only provides a lump-sum payment for cancer as the only covered condition. Cancer insurance can be great to cover things like chemotherapy treatments or alternative medications or lifestyle changes not covered by standard medical coverage, but critical illness insurance is better. Critical illness insurance is more comprehensive and can offer some comfort knowing that regardless of if you suffer a stroke or heart attack or are diagnosed with MS or cancer, some of the financial burden is taken care of. 

Can I submit a claim on a critical illness policy upon diagnosis of cancer?

Yes — submitting a claim upon diagnosis of an illness like cancer is what your critical illness insurance policy is for. 

Most companies will require that medical information about the diagnosis and any signs, symptoms or investigations leading to the diagnosis must be reported to the company within six months of the date of diagnosis. If this information is not provided within the six month period, the insurance companies have the right to deny any claim for cancer or any critical illness caused by any cancer or its treatment.

Additionally, as mentioned previously, coverage and future claims will depend on your specific cancer diagnosis. It’s important to note that most policies have a 30 day survival period after your diagnosis before a claim can be made. 

Another important note is that as with many types of insurance, there is the waiting period. Some companies may require you to have the policy for 90 days before you can make a claim for certain conditions, particularly cancer. As always, reach out to one of our insurance experts if you need help understanding the specifics of your policy. 

Can I start a critical illness insurance policy after my diagnosis?

There are some circumstances where you can start a critical illness insurance policy after a cancer diagnosis. Some policies offer guaranteed coverage, regardless of when you signed up for the policy and received your diagnosis. However, such policies will have exclusions for pre-existing conditions for a specified period of time and the premium cost for guaranteed coverage will be high. If you already have a cancer diagnosis, cancer would be considered a pre-existing condition for the period specified in the policy. In situations like these, it’s always best to consult an advisor to understand the specifics of the coverage that may be available to you.  

Can I get critical illness insurance if I am in remission?

Remission means that you no longer have detectable active cancer cells and are no longer receiving treatment such as chemo or radiation. Depending on the provider, you may be able to get critical illness insurance once you are in remission. However, the type of coverage available and the cost for it will depend on how long you have been in remission and your original diagnosis and prognosis. 

Can I get critical illness insurance if I have a family history of cancer?

As with life or health policies, an insurance company will look at your family history to determine risk, eligibility, coverage, and cost of critical illness insurance. If you have a family history of cancer (or any other critical illness), you may receive an insurance rating  (i.e. a higher insurance price or an exclusion (i.e. certain conditions may not be covered for claims). It’s best to chat with an advisor to determine how your family’s health history may impact your critical illness insurance coverage. 

If you know you are at a high risk of cancer through either genetic testing or through family history, you should absolutely get critical illness insurance. But the bottomline is, given the increasing incidence of cancer, critical illness insurance is an essential component of financial protection for every individual.

Definition of cancer according to CLHIA

Cancer (Life-Threatening) means the definite diagnosis of a malignant tumour. This tumour must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma.

The diagnosis of cancer must be made by a specialist and must be confirmed by a pathology report.

For purposes of the policy:

  • T1a or T1b prostate cancer means a clinically inapparent tumour that was not palpable on digital rectal examination and was incidentally found in resected prostatic tissue.
  • The term gastrointestinal stromal tumours (GIST) classified as AJCC Stage 1 means:
  • Gastric and omental GISTs that are less than or equal to 10 cm in greatest dimension with five or fewer mitoses per 5 mm2, or 50 per HPF; or
  • Small intestinal, esophageal, colorectal, mesenteric and peritoneal GISTs that are less than or equal to 5 cm in greatest dimension with 5 or fewer mitoses per 5 mm2, or 50 per HPF;
  • The terms Tis, Ta, T1a, T1b, T1 and AJCC Stage 1 are as defined in the American Joint Committee on Cancer (AJCC) cancer staging manual, 8th Edition, 2018.
  • The term Rai stage 0 is as defined in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219,1975.

Exclusions: No benefit will be payable under this Covered Condition for the following:

  • Lesions described as benign, non-invasive, pre-malignant, of low and/or uncertain malignant potential, borderline, carcinoma in situ, or tumors classified as Tis or Ta;
  • Malignant melanoma of skin that is less than or equal to 1.0mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis;
  • Any non-melanoma skin cancer, without lymph node or distant metastasis. This includes but is not limited to, cutaneous T cell lymphoma, basal cell carcinoma, squamous cell carcinoma or Merkel cell carcinoma;
  • Prostate cancer classified as T1a or T1b, without lymph node or distant metastasis;
  • Papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0cm in greatest dimension and classified as T1, without lymph node or distant metastasis;
  • Chronic lymphocytic leukemia classified as Rai stage 0 without enlargement of lymph nodes, spleen or liver and with normal red blood cell and platelet counts;
  • Gastro-intestinal stromal tumours classified as AJCC Stage 1;
  • Grade 1 neuroendocrine tumours (carcinoid) confined to the affected organ, treated with surgery alone and requiring no additional treatment, other than perioperative medication to oppose effects from hormonal oversecretion by the tumour; or
  • Thymomas (stage 1) confined to the thymus, without evidence of invasion into the capsule or spread beyond the thymus.

90-Day Exclusion: No benefit will be payable under this covered condition if, within the first 90 days following the later of the issue date of an insured person’s coverage, or the last reinstatement date of an insured person’s coverage, the insured person has any of the following:

  • Signs, symptoms or investigations leading directly or indirectly to a diagnosis of any cancer (covered or not covered under the policy), regardless of when the diagnosis is made; or
  • A diagnosis of any cancer (covered or not covered under the policy).

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Want to learn more?

Critical illness insurance is a great option for those who are concerned about future diagnoses and the costs associated. Cancer is an unpredictable disease that impacts those diagnosed emotionally, physically, and financially. With critical illness insurance, some of that financial burden and worry can be alleviated. For more info, reach out to one of our advisors to chat about which options and policies are best for you.

 


The information provided herein is for general informational purposes only. It is not intended and should not be construed to constitute legal aid, financial advice, or diagnostic purposes.

KEY TAKEAWAYS

  • Cancer is commonly covered under most critical illness insurance policies
  • Over 60% of critical illness insurance payouts are cancer-related
  • Given the higher incidence of cancer, critical illness coverage is an an essential component of a financial protection plan for most individuals

By Jiten Puri
CEO & Founder, Insurance Advisor, LLQP
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