FREQUENTLY ASKED QUESTIONS

Why is Critical Illness coverage different?

The primary difference is that this term life insurance policy will pay a death benefit or a living benefit which ever comes first during the policy period.

Is there a waiting period on the coverage?*

There is no waiting period for the life insurance benefit of your policy.  The critical illness coverage does have a waiting period of 30 days following the effective date of the policy for all benefits except Cancer, which has a 60 day waiting period.

Why is there a waiting period on the benefit?

The waiting period is a type of safety measure for you and the company.  By having a waiting period we are able to avoid some "adverse selection" or, in lay terms, persons buying the insurance that know or suspect they already have one of the illnesses.  This is important to you, because it enables us to keep our premium rates low.  Without the waiting period, we would need to charge higher premiums.

How are claims paid on this type of policy?

The claim process for death is no different that any other life insurance policy.  A claim for one of the critical illnesses will be different because we will need to contact your doctors to confirm the diagnosis of the critical illness or procedure and receive test results before we can pay the claim.  Once all paperwork is received in our office the process moves very quickly, usually taking less than 10 days to process and complete.

What is typically covered by the policy?*

Critical Choice Plus is designed to pay a lump sum cash benefit equal to the MAXIMUM BENEFIT (100%) amount of the coverage to the insured when a covered event occurs.  The events include:

Death    Heart Attack    Stroke    Paralysis    Alzheimer's Disease    

Life Threatening Cancer    Loss of Independent Existence

The policy will pay a PARTIAL BENEFIT to the insured in the event of a covered procedure as follows:

Angioplasty                                        10%

Coronary by-pass surgery                 25%

A one time partial benefit will be paid on the first occurrence of either of these events

If a partial benefit is paid, the maximum benefit of the policy will be reduced in proportion to the amount of the benefit payment.  The policy premium will also be proportionally reduced.

The benefit will be paid after a claim has been submitted and confirmation of the diagnosis is received.  Your family doctor will  be asked to assist with the claims process by providing us with test results, confirmation of the diagnosis and a response to any other questions that we may ask to confirm the diagnosis.

What does Loss of Independent Existence mean?

This benefit is designed to pay the full benefit if you are permanently unable to perform three of the five required Activities of Daily Living listed below:

Transfer and Mobility;    Eating;    Dressing;    Toileting;    Continence

What is the diagnosis of a heart attack?

There are three criteria that we look for in diagnosing a heart attack.  They are:

- a clinical picture of myocardial infarction

- a change in your EKG

- elevation of cardiac enzymes

As you can see, these are medical terms. Your doctor will help us determine the diagnosis.

What about mild stroke? Is it covered?

Light strokes or transient ischemic attacks are not covered.  A stroke that causes neurological impairment, paralysis or other measurable neurological deficit must be diagnosed.

What does life threatening cancer mean?

This is a very common question, and one that we suggest you discuss with your doctor.

There are types of cancer today that are well encapsulated and have high cure rates.  Medical technology has advanced to the point where doctors are able to diagnose and identify cancer cells with a high level of accuracy.  Remember that this policy covers death or critical illness - an illness that can threaten your life or permanently disable you.  A malignant tumor that has properties to spread or metastasize is considered life threatening.  This is the type of cancer that would qualify for the benefit.  Skin cancers (except malignant melanomas) are not covered.  Pre-malignant tumors, cancer-in-situ and papillary cancer of the bladder are not covered.

How would I file a claim for a Critical Illness, especially if I'm critically ill?

This is an important question.  You may want to give a copy of this or your policy  to your doctor and to another family member so that they will be able to assist you.

A toll free call to our office will initiate the claim process.  We will mail a claim form, which will need to be completed by the insured and their doctor.  The doctor will be asked to mail the form and medical reports to our office for processing.

Will my premiums change?**

Your premium is guaranteed to remain level for 15 years.  After this time, you may apply for another 15-year period with proof of good health, convert to a permanent plan (with no evidence of insurability) or keep the policy at increasing premiums to age 90.

Are there exclusions in my policy?*

Yes.  No critical illness benefit will be paid if the claim results from the misuse of alcohol or drugs; suicide prior to the second policy anniversary; participation in an illegal activity; injury received during participation in a riot; strike; civil commotion or war; or mental disorders other than Alzheimer's disease.

 

*May vary by state.  Please refer to your policy for details.

**Applies to Critical Choice Plus only