In this first (Part I of VII) of a series of articles on covered conditions for critical illness insurance we’re going to look at the definitions and coverages for cancer.
Life Threatening Cancer:
Exclusion: No benefit will be payable under the condition for the following non-life threatening cancers:
- Carcinoma in situ.
- Stage 1a Malignant Melanoma (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without Clark level IV or level V Invasion).
- any non-melanoma skin cancer that has not metastisized.
- Stage A (T1A or T1B) Prostate Cancer
Moratorium Period Exclusions
No benefit will be payable under this condition if within the first 90 days following the later of the effective date of the policy or the effective date of the last reinstatement of the policy, the life insurance has any of the following:
- signs, symptoms or investigations that lead to a diagnosis of cancer (covered or excluded under the policy) regardless of when the diagnosis is made
- a diagnosis of cancer (covered or excluded under the policy)
The medical information as described above must be reported to the company within 6 months of the date of the diagnosis. If this information is not provided, the company has the right to deny an claim for cancer or any critical illness caused by any cancer or its treatment.
This definition of cancer has a variety of things you need to be very aware of. First, as noted above, not all types of cancers are covered. Note the four exclusions above.
Secondly, there is no coverage for cancer in the first 90 days of the policy, per the Moratorium exclusion above.
And lastly, note that the benefit requires you to report the coverage within 6 months of the diagnosis. If you develop a covered cancer and then realize a year later that you had coverage, you can expect your claim to be denied.
Note that in some policies (but not all!) Early Prostate Cancer, Ductal Breast Cancer, and Superficial Malignant Melanoma may have partial coverage (they may pay a small portion of the benefit amount, i.e. 10-15%).
Benign Brain Tumour
or cause irreversible objective neurological deficits. The diagnosis of benign brain tumour must be made by a specialist.Exclusions: We will not pay a covered condition benefit for benign brain tumour for pituary adenomas less than 10mm.
Note the very specific definition of Brain Tumour. Tumours located near the brain but not specifically in the areas indicated are not covered. And like the previous definition of life threatening cancer above, brain tumours are not covered in the first 90 days of the policy.
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