A guide to how critical illness insurance works in Canada – Updated 2023

Could I make a critical illness insurance claim if I was diagnosed with any of these conditions?

Well, it’s not that simple. The language in critical illness insurance plans is very specific. For example, what the average Joe or Jane would call a ‘heart attack’ or ‘heart disease’, might not meet the specified level of damage to the organ that is written in the language of your contract.

A covered condition is defined by the 2013 Critical Illness Benchmark Definitions published by the Canadian Life and Health Insurance Association.

For example: to claim ‘deafness’ as defined by the CLHIA, you’d need to be

• diagnosed with ‘total and irreversible hearing loss in both ears,
• with an auditory threshold of 90 decibels or greater,
• and within the speech threshold of 500 to 3,000 hertz’.

In other words, while critical illness insurance can cover a large number of common ailments, it’s extremely important to clarify the wording of your policy.

Does critical illness insurance ever payout?

Yes, 80 percent of claims are approved, and that percentage has been rising steadily.

Is critical illness insurance expensive?

On average, it’s more expensive than term life insurance but not so expensive that you can’t afford it. Just like life insurance, the younger and healthier you are, the less expensive your critical illness insurance premium is.

Coverage amounts are smaller than what you’d see for a life insurance death benefit, so that also helps keep premiums low. Canadians typically elect for an average critical illness coverage of $77,000 according to the Canadian Society of Actuaries.

Other factors that can affect the cost of premiums include:

• your term length
• the number of conditions covered by your policy
• any riders or clauses you opt for
• smoking status

Can I receive multiple critical illness insurance payouts if I am diagnosed with multiple conditions?

Yes and no. The coverage only pays out once in its entirety. It will pay out either

• through one condition you claim and receive approval for

OR

• through partial coverage of multiple conditions

What is partial payout in critical illness insurance policies?

Some conditions and illnesses while not considered terminal or critical, can still produce a partial payout of your policy.

Partial payment details:

• The specified illnesses will be made clear to you before your coverage begins.
• Often non-life-threatening cancers fall into this category.
• This clause allows you to receive some money (typically between 10-25 percent of your coverage amount and is subject to dollar value limits) during your recovery.
• You can maintain your protection should you contract a terminal condition down the road.

Can i get life insurance and critical illness insurance together?

Many Canadian insurance companies offer life insurance and critical illness coverage together. You can add critical illness coverage as a rider to your life insurance policy. This can help you apply for both life insurance and critical illness coverage at the same time without having to go through underwriting again.

Learn more about critical illness insurance versus critical illness riders.

How long are critical illness insurance term lengths?

Coverage is typically sold in ten-year renewable increments, but it’s very common to see policies that cover applicants to a specific age like 65, 75, or even 100.

Most policies will let you renew your coverage when your term expires without redoing a medical exam, but renewal usually comes with an increase in premiums. Typically you can only renew to a specific age.

Will I get my money back if I do not claim on my critical illness policy?

Yes, some critical illness policies allow for a return of premium. Some insurers will return all of the premiums you’ve paid if you haven’t made a successful claim at the end of your term, hit certain age milestones, or if you surrender your policy.

This is an optional clause and it will increase the cost of premiums.

There’s also a return of premium on death clause, which means your premiums will be paid back to your chosen beneficiary should you pass away unexpectedly, without receiving a full benefit payment under your critical illness policy.

Learn more about return of premium.

When should I get critical illness insurance?

You should get critical illness insurance ASAP.

Like any other type of insurance, this coverage gets more expensive as you age. It’s best to apply for coverage before a pre-existing condition can affect your eligibility.

Learn more about when is the right time to get critical illness coverage.

How much critical illness insurance coverage do I need?

Because the coverage pays a living benefit, it’s intended to cover a shorter period of time, specifically while you are treating and recovering from an illness. Hopefully, your recovery will be swift, and you wouldn’t be reliant on the money paid out by your policy for the remainder of your life.

If you’re unsure how much coverage you want, an insurance calculator can suggest a coverage amount based on your estimated needs and give you an estimate of the monthly expenses associated with the policy.

Learn your coverage needs with our critical illness insurance calculator.

Can I be refused critical illness coverage?

The average Canadian resident should have their application accepted depending on their history.

However, you can be refused or denied coverage by the insurance carrier you applied to. You and your family’s medical history will factor heavily into the underwriting process. If you have already been diagnosed with an illness, or have pre-existing conditions your likelihood of being insured or availability of coverage options may be reduced.

Learn more about pre-existing conditions.

Is critical illness insurance worth it?

Because critical illness insurance pays a living benefit, getting coverage is even more of a personal decision than life insurance. Life insurance is really about your family’s needs. Critical illness insurance is about your financial needs while you recover.

Look at the stats: 

• 1/2 of Canadians will be diagnosed with cancer in their lifetime.
• The average out-of-pocket expenses for cancer in Canada is around $400 a month. This excludes treatment covered by public or private health care and can be more depending on the type of cancer.
• When you’re diagnosed with cancer, you’ll likely have to take time off work to recover.

So, can you afford to take time off work, cover your usual bills, plus at least $400 a month to pay for your treatment/recovery? If you can’t, critical insurance is worth it.

Buying this insurance can give you the peace of mind to know, that if you’re facing a critical diagnosis, you’ll be able to focus completely on recovery.

Learn more about whether critical illness insurance is worth it.

How can I get my critical illness insurance quotes?

Still have questions? Schedule a chat with a licensed insurance agent from PolicyAdvisor.  They’re happy to go over anything you’re curious about and provide you with many quotes from the best insurance companies in Canada. Save time and money when you speak to our brokers, form your life insurance plan, and compare quotes online.