FAQs

Salesman's Prayer

Frequently Asked Questions

1. 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.

2. 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 to 90 day waiting period, depending on the plan.

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

3. Why do people buy a Critical Illness Policy?
We hear the two reasons time and again. First, in times of critical need, people need access to the best healthcare money can buy (in or out of Network) and secondly, they want to be worry free about loss of income, insurance shortfalls, mortgage payments and the list goes on.

4. Why is Critical Illness coverage essential?
Insured does not have to die to receive benefits, it pays upon diagnosis. Group Health plans including HMO's, PPO's, POS, EPO's etc., have restrictive limitations concerning treatments and services that will and will not be paid for. Advances in medical technology keep critical illness survivors alive longer. The Out of Pocket and the Out of Network expenses can be financially devastating. It can also allow the spouse to be able to take off work to help.

5. 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.

6. What is typically covered by the policy?
Critical Illness Insurance 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
Major Organ Transplant
Life Threatening Cancer
Renal Failure
Terminal Illness
Severe Burns
Blindness
Loss of Independent Existence (not approved in Texas)
HIV (Medical Personnel only)

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.

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

7. What does Loss of Independent Living 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

(This benefit is not approved in Texas.)

8. What is the diagnosis of a heart attack?
There are three criteria that we look for in diagnosing a heart attack. They are:

Clinical picture of myocardial infarction
Change in your EKG
Elevation of cardiac enzymes

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

9. 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.

10. 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.

11. 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 will initiate the claim process. We will mail a claim form, which will need to be completed by the insured and their doctor. They will mail you a claim form and medical reports for processing.

12. I have disability insurance, isn't that enough?
Disability is important, but, it is not the total solution for three reasons. First, the insured receives only a "portion" of their income, usually about 50% - 60%. Most people have a hard enough time making it on 100%! Critical Illness Policy can help "fill the gap!" Second, you have to wait several months before you can start receiving disability income. Over 92% of working Americans CANNOT survive financially for more than 6 weeks without a paycheck, a person will have to qualify for disability income benefits monthly. The Critical Illness Policy pays upon diagnosis regardless of your income or any other reason.

13. How much protection should I own?
As a rule of thumb you should have "as much as you can afford." You should consider a benefit that will replace at least one year of your annual income. However, you are free to select any benefit above or below your annual income. What is most important is to select what you can comfortably afford to keep.

14. I have a Cancer Policy, will this plan pay also?
Yes! They will pay in addition to any other insurance you may have, without any coordination of benefits!

15. I own a $50,000.00 Critical Illness Policy with the 100% Accelerated benefit. I have a Coronary Artery Bypass Surgery and receive 25% of $50,000.00 ($12,500.00) This leaves me with $37,500.00 coverage. Is the $37,500.00 for only another heart related illness or death only?
No! You have a balance of $37,500.00 that will be paid to you on any of the covered Critical Illnesses or Death, which ever comes first. So, five years after your surgery if you were to be diagnosed with Cancer or Kidney Failure you will be paid the $37,500.00. Or, if you should die in a car wreck or any other accidental or natural death, your policy would pay your beneficiary the $37,500.00.

16. I purchased a $100,000.00 Critical Illness Policy with a 50% Accelerated benefit. Two years later, I have a Heart Attack. IÕm paid $50,000.00 on the Heart Attack and I still have coverage for $50,000.00. Since I have already claimed on a Critical Illness. Does this mean that the remaining $50,000.00 is now only a Death benefit?
If you have a $100,000.00 Critical Illness Policy w/ 50% Accelerated Benefit. Once you have claimed and used up the 50% acceleration portion. The remaining 50% is a death benefit.

17. I purchased a $75,000.00 Critical Illness Policy. I develop Pneumonia and die. Pneumonia is not listed in the policy, does my Critical Illness Insurance pay?
Yes! Since death did occur. Your policy does not pay on the diagnosis of pneumonia, but since death did occur your policy will pay your beneficiary the full $75,000. This applies to ANY death from ANY sickness or accident.

18. I'm 30 years old. I purchased a $60,000.00 Critical Illness Policy. In twenty years I'm 50 and I haven't claimed. But, I have gained a lot of weight, I now have an irregular heart beat and diabetes. Will I not be able to renew my policy for another twenty years?
At the end of the 20 years, the policy maybe renewed without evidence of insurability for another 20 years or to age 70, whichever is less! The owner must request the renewal in writing within 60 days prior to the end of the benefit period and pay the premium for the new policy at the new attained age!

19. I own a $50,000.00 Critical Illness Policy with the 100% Accelerated Benefit. I have Coronary Artery Bypass Surgery and receive 25% of $50,000.00 ($12,500.00) This leaves me with $37,500.00 coverage. Is the $37,500.00 for only another heart related illness or death only?
No! You have a balance of $37,500.00 that will be paid to you on any of the covered Critical Illnesses or Death, whichever comes first. So, five years after your surgery if you were to be diagnosed with Cancer or Kidney Failure you will be paid the $37,500.00. Or, should you die in a car wreck or any other accidental or natural deathÉyour policy would pay your beneficiary the $37,500.00.

20. I purchase a $100,000.00 Critical Illness Policy with a 50% Accelerated benefit. Two years later, I have a Heart Attack. IÕm paid $50,000 on the Heart Attack and I still have coverage for $50,000.00. Since I have already claimed on a Critical Illness, does this mean that the remaining $50,000.00 is now only a Death benefit?
No! You have a total of $50,000.00 Critical Illness coverage left. If you were to go in the following year for a Coronary Angioplasty you will receive 10% of the remaining face value ($5,000.00). Now you have a $45,000.00 Critical Illness Protection. Should you then have another covered Critical Illness several years later you will receive the $45,000.00. Or, If you were to die from any accident or sickness. Your plan will pay your beneficiary the remaining $45,000.00.

21. I purchased a $75,000.00 Critical Illness Policy. I develop Pneumonia and die. Pneumonia is not listed in the policy, does my Critical Illness pay?
Yes! Your policy does not pay on the diagnosis of Pneumonia, but, since death did occur your policy will pay your beneficiary the full $75,000.00. This applies to ANY death from ANY sickness or accident.

22. I'm 30 years old. I purchased a $60,000.00 Critical Illness Policy. In twenty years I'm 50 and I have not had a claim. I have gained a lot of weight, and now have an irregular heart beat and diabetes. Will I not be able to renew my policy for another twenty years?
At the end of the 20 years, the policy may be renewed without evidence of insurability for another 20 years or to age 70, whichever is less! The owner must request the renewal in writing within 60 days prior to the end of the benefit period and pay the premium for the new policy at the new attained age!

23. If I have a question that is not covered here, how can I get the answer?
Please Contact Us. There you will find a list of the most qualified Critical Illness Specialist in the nation.