SlideShare una empresa de Scribd logo
1 de 33
Discover  CRITICAL ILLNESS INSURANCE Your “Health” is the Investment Protecting your Financial Portfolio 1whealthcare™ Transforming Health care Insurance and Investments
“ You need insurance, not only  because you’re going to die, but  because you’re going to live.” Dr. Marius Barnard        Creator of  Critical Illness Insurance.
Critical Illness Insurance: ,[object Object],first diagnosis of any covered condition.   Usuallymust survive 30 days, after diagnosis.   Benefit is paid based upon diagnosis,       regardless of severity, degree of disability or ability to work.
DID YOU KNOW? ,[object Object]
 340 Cancer (new cases)- 137 Strokes - 8 Kidney Failures - 3 Multiple Sclerosis Chances in any given year before age 65:   CANADA Every day 3.5% Death 34.7%Critical Illness
Age Bands ► Source:  Munich Re 2007
Critical Illness Insurance Comparative Claims Analysis IndividualGroup Cancer  70%66% Heart Attack               14%16% Stroke   5%4% Other5%2% CABS 4%6% MS       2%                5% Paralysis 1% Source:  Individual – Munich re Survey 2006 since inception. Group – ACE INA Canada – since 1998.  REASON FOR  DENIED GROUP CLAIMS: -About 80% are due to pre-existing conditions. ,[object Object],GCI Inc.  07/9  E.& O.E.
HR NIGHTMARE PERCEPTION REALITY What Employee thinksis covered? What Plan actually covers!
Exclusions & Restrictions To Avoid BAKER’S DOZEN + 12
PLAN  STRUCTURE X vs BUNDLED  STAND ALONE  AN AVOIDABLE TRAP
BUNDLEDVS.STAND ALONE ►SUBSIDIZED RATES ►  UNPREDICTABLE  RATE       INCREASES ►  LOSS RATIO AFFECT        (Life, A.D.& D., LTD, C.I.) ►  LIMITS  SHOPPING  ►  JEOPARDIZE PRE-EX TRANSPARENT PRICING PRICING STABILITY MINIMIZE LOSS RATIO AFFECT MARKET ACCESS PRE-EX GRANDFATHERED
CRITICAL ILLNESS INSURANCE             “DEFINITIONS” MOST IMPORTANT CONSIDERATION DETERMINE IF AND WHEN YOU WILL BE PAID NOT ALL PLANS ARE THE SAME!
Types of Exclusions&RestrictionsTo Avoid ►Obvious			► Subtle ► Omission			► Severity ► Restrictive			► Unreasonable ► Uncertainty		► Unilateral Changes ► Retroactive		► Not Legally Sound ► Subjective			► Denial & Termination
PARALYSIS     Good Definitionvs.Poor Definition ,[object Object],     90 consecutive days, following     the precipitating event, during      which time there has been no     sign of improvement.” ,[object Object],180 consecutive days, following     the precipitating event, during     which time there has been no     sign of improvement.” Obvious
CANCER Good Definitionvs.Poor Definition ,[object Object], characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This includes Leukemia, Hodgkin’s Disease and invasive Melanoma.” ,[object Object],characterized by the uncontrolled  growth and spread of malignant cells  and the invasion of tissue.  The  diagnosis of Cancer must be made  by a Specialist.”  Omission
HEART ATTACK Good Definitionvs.Poor Definition ,[object Object],considered diagnostic of myocardial Infarction (heart attack).” ,[object Object],markers, or the elevation of cardiac enzyme levels, consistent with a heart attack.” Restrictive
PARKINSON’S DISEASE Good Definitionvs.        Poor Definition ,[object Object],▪  muscle rigidity   ▪  tremor, or   ▪  bradykinesis”  “ by two or more of the following: ▪  muscle rigidity   ▪  tremor, or   ▪  bradykinesis and the insured person requires substantial physical assistance from  another adult to perform two or more activities of bathing, dressing, toileting, transferring,  bladder and bowel  continence and eating.”   Uncertainty
CANCER Good Definitionvs.Poor Definition ,[object Object],excluded: ▪  Cancer in situ; and ▪  Any skin cancer, other than malignant melanoma into the dermis or deeper; ▪  Early prostate cancer (stage A or  equivalent staging); ▪  Any tumor in the presence of any human Immunodeficiency virus (HIV).”  ,[object Object],from coverage: ▪  Carcinoma in situ; ▪  Stage 1A malignant melanoma  (melanoma less than or equal to 1.0 mm in thickness, not ulcerated and without level IV or V invasion); ▪  Stage A (T1a or T1b) prostate cancer, ▪  Any non-melanoma skin cancer that has not become metastatic (spread to distant organs.” Retroactive
Sports Exclusion Good Definitionvs.Poor Definition ,[object Object]
( A good policy doesn’t list       this exclusion.) Subjective
KIDNEY (RENAL) FAILURE Good Definitionvs.   Poor Definition  Kidney failure means a definite diagnosis of chronic  irreversible failure of both kidneys  to function, as a result of which regular haemodialysis, peritoneal dialysis or  renal transplantation is initiated  Means end stage renal disease due to chronic irreversible kidney failure, requiring the Insured Person to  undergo  regular hemodialysis, peritoneal dialysis, or require renal transplantation   Subtle
STROKE Good Definitionvs.                 Poor Definition Evidence of permanent neurological deficit persisting for 30 consecutive days ►New objective neurological deficits  on clinical examination persisting  continuously for at least sixty(60) days  following the diagnosis of the stroke. Severity
MULTIPLE  SCLEROSIS Good Definitionvs. Poor Definition  Multiple Sclerosis means a definite   diagnosis of at least one of the following: ▪two or more separate clinical attacks,  confirmed by MRI showing multiple lesions  of demyelination ▪ well-defined neurological abnormalities lasting  more than 6months, confirmed by MRI,  showing multiple lesions of  demyelination; or ▪ a single attack, confirmed by repeated  MRI, which shows multiple lesions of  Demyelination which have developed at  intervals at least one month apart   Means the definitive written  diagnosis by a Physician who is  certified as a neurologist confirming at least moderate persisting  neurological  abnormalities, with impairment of function, but not necessarily confining the insured to a wheelchair or bed Severity
BENIGN BRAIN TUMOR Good Definitionvs.Poor Definition  The tumor must require surgical or radiation treatment or cause irreversible objective neurological  deficits.     No benefit will be payable under this condition if within the first 90 days  following  the later of:  ,[object Object]
 the policy date, or
 the most recent date of reinstatement
The Insured person has any of the following:
 signs, symptoms or investigations that  lead to a diagnosis of benign brain tumor  The histologic nature of the tumor must be confirmed by examination  of tissue (biopsy or surgical excision) Unreasonable
CHANGE DEFINITIONS Good Definitionvs.Poor Definition ,[object Object],       this restriction.) “ Company reserves the right to change the contract definitions for Conditions covered under any given plan.All claims under this Policy shall be adjudicated using the definition of any Condition(s) that is in effect at the time the claim is incurred.  Accordingly, the Plan Member must ensure that he has the most current version of this Appendix at the time he submits a claim under this Policy.” Unilateral
MAJOR  ORGAN  TRANSPLANT Good Definitionvs.Poor Definition  Major organ transplant means a definite diagnosis of the irreversible failure of the heart,  both lungs, liver, both kidneys or bone marrow and transplantation must be medically necessary  Means being either the recipient of a transplanted heart, lung, liver, kidney, pancreas or bone marrow performed  by a Physician who is  certified  to conduct such transplant, or enrolled in a recognized  organ or bone marrow transplant program in Canada or the United States Not Legally Sound
CANCER Good Definitionvs.              Poor Definition ,[object Object],condition under this policy and thispolicy  will automatically terminate, if within 90 days  following the later of the Issue date and the  date of the last reinstatement of the policy: 1.  You are diagnosed with Life Threatening  Cancer; or 2. any sign or symptom of any type of cancer  becomes first Manifested; or 3. any medical testing or investigation  was initiated which subsequently leads to  a diagnosis of any type of cancer.” The cancer exclusion period is 90 days from the later of: 1) the Effective Date, or 2) the date of The last reinstatement of the policy. In the event of such diagnosis the policy will remain in force but cancer will no longer be considered an Insured Condition, except for a subsequent diagnosis of unrelated cancer. Denial & Termination
Life Insurance Co. Group C.I.I. Pays Claims Pays Premium Insures Employees Company Employees Critically Ill Employee Claimant Premium is a Tax Deductible business expense for Company. Claimbenefit is received  Tax-Free,in a Lump Sum  payment, by Employee Premium is NOTa  Taxable Employee Benefit to the Employee ‘Based on a CRA ruling in 2003 involving an Alberta Group C.I.I. Case, Arthur Drache Q.C. (F.P. 2003/5/13) “Benefits “ provided by an employer are taxable as a benefit unless there is a statutory exemption. There is such an exemption for Group Sickness & Accident insurance - based on Provincial Insurance Act.’
GROUP PLAN  EVALUATIONCHECKLIST 1.	Approval 		-Guaranteed Issue  2.Plan Structure 	-Stand Alone 3.	Pre-existing  		 -Reduce or Eliminate  4.General Exclusions 	-Few As Possible 5.	Level of Benefits 	-No Restrictions Based On Income 6.Scope of Coverage 	-Most Comprehensive / Optional 7.	Covered Conditions 	-Most Available / Occupational HIV

Más contenido relacionado

Destacado

Health Insurance - a presentation by Richard Strauss Insurance Brokers
Health Insurance - a presentation by Richard Strauss Insurance BrokersHealth Insurance - a presentation by Richard Strauss Insurance Brokers
Health Insurance - a presentation by Richard Strauss Insurance BrokersRSIB
 
Critical Illness Sales Presentation created by Catherine Chaney Bowman
Critical Illness Sales Presentation created by Catherine Chaney BowmanCritical Illness Sales Presentation created by Catherine Chaney Bowman
Critical Illness Sales Presentation created by Catherine Chaney BowmanCatherine Chaney Bowman
 
Bootstrap Business Seminar 5: Creating an Awesome Brand
Bootstrap Business Seminar 5: Creating an Awesome BrandBootstrap Business Seminar 5: Creating an Awesome Brand
Bootstrap Business Seminar 5: Creating an Awesome BrandCityStarters
 

Destacado (6)

Critical Illness Insurance Policy
Critical Illness Insurance PolicyCritical Illness Insurance Policy
Critical Illness Insurance Policy
 
Health Insurance - a presentation by Richard Strauss Insurance Brokers
Health Insurance - a presentation by Richard Strauss Insurance BrokersHealth Insurance - a presentation by Richard Strauss Insurance Brokers
Health Insurance - a presentation by Richard Strauss Insurance Brokers
 
Critical Illness Sales Presentation created by Catherine Chaney Bowman
Critical Illness Sales Presentation created by Catherine Chaney BowmanCritical Illness Sales Presentation created by Catherine Chaney Bowman
Critical Illness Sales Presentation created by Catherine Chaney Bowman
 
Financial planning
Financial planningFinancial planning
Financial planning
 
Li Selling Techniques
Li Selling TechniquesLi Selling Techniques
Li Selling Techniques
 
Bootstrap Business Seminar 5: Creating an Awesome Brand
Bootstrap Business Seminar 5: Creating an Awesome BrandBootstrap Business Seminar 5: Creating an Awesome Brand
Bootstrap Business Seminar 5: Creating an Awesome Brand
 

Similar a Discover Critical Health and Vitality

Critical illness brochure
Critical illness brochureCritical illness brochure
Critical illness brochureAlyssa Macaluso
 
7 Reasons why we choose term plan
 7 Reasons why we choose term plan 7 Reasons why we choose term plan
7 Reasons why we choose term planAlok Singh
 
Critical illness cover – a guide to the
Critical illness cover – a guide to theCritical illness cover – a guide to the
Critical illness cover – a guide to theKelly Shultis
 
"KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER"
"KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER""KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER"
"KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER"viralAgarwal
 
Aviva's my shield policy contract - 18feb2013.pdf
Aviva's my shield   policy contract - 18feb2013.pdfAviva's my shield   policy contract - 18feb2013.pdf
Aviva's my shield policy contract - 18feb2013.pdfMohd Khair Mohd
 
Critical illness insurance
Critical illness insuranceCritical illness insurance
Critical illness insuranceSilvia Breahna
 
Aflac Cancer Indemnity
Aflac Cancer IndemnityAflac Cancer Indemnity
Aflac Cancer Indemnitybgarrett3131
 
Cancer cover
Cancer coverCancer cover
Cancer coverpmarunj
 
Aviva's my shield plus policy contract - 18feb2013.pdf
Aviva's my shield plus   policy contract - 18feb2013.pdfAviva's my shield plus   policy contract - 18feb2013.pdf
Aviva's my shield plus policy contract - 18feb2013.pdfMohd Khair Mohd
 
Buy Direct PPO-final
Buy Direct PPO-finalBuy Direct PPO-final
Buy Direct PPO-finalMelissa Lewis
 
Critical illness insurance pros and cons
Critical illness insurance pros and consCritical illness insurance pros and cons
Critical illness insurance pros and consKelly Shultis
 
Family health optima insurance policy
Family health optima insurance policyFamily health optima insurance policy
Family health optima insurance policySalil Berde
 
Maximum difference cancer
Maximum difference cancerMaximum difference cancer
Maximum difference cancerYonas Tadesse
 
CRITICAL ILLNESS BROCHURE-GEORGIA
CRITICAL ILLNESS BROCHURE-GEORGIACRITICAL ILLNESS BROCHURE-GEORGIA
CRITICAL ILLNESS BROCHURE-GEORGIADoug Johnson
 

Similar a Discover Critical Health and Vitality (20)

Critical illness brochure
Critical illness brochureCritical illness brochure
Critical illness brochure
 
Optima vital-prospectus
Optima vital-prospectusOptima vital-prospectus
Optima vital-prospectus
 
7 Reasons why we choose term plan
 7 Reasons why we choose term plan 7 Reasons why we choose term plan
7 Reasons why we choose term plan
 
Critical illness cover – a guide to the
Critical illness cover – a guide to theCritical illness cover – a guide to the
Critical illness cover – a guide to the
 
"KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER"
"KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER""KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER"
"KOTAK CRITICAL ILLNESS PLUS BENEFIT RIDER"
 
Aviva's my shield policy contract - 18feb2013.pdf
Aviva's my shield   policy contract - 18feb2013.pdfAviva's my shield   policy contract - 18feb2013.pdf
Aviva's my shield policy contract - 18feb2013.pdf
 
Have you known anyone with cancer?
Have you known anyone with cancer?Have you known anyone with cancer?
Have you known anyone with cancer?
 
First occurence cancer insurance.
First occurence cancer insurance.First occurence cancer insurance.
First occurence cancer insurance.
 
Critical illness insurance
Critical illness insuranceCritical illness insurance
Critical illness insurance
 
Aflac Cancer Indemnity
Aflac Cancer IndemnityAflac Cancer Indemnity
Aflac Cancer Indemnity
 
Cancer cover
Cancer coverCancer cover
Cancer cover
 
Aviva's my shield plus policy contract - 18feb2013.pdf
Aviva's my shield plus   policy contract - 18feb2013.pdfAviva's my shield plus   policy contract - 18feb2013.pdf
Aviva's my shield plus policy contract - 18feb2013.pdf
 
Buy Direct PPO-final
Buy Direct PPO-finalBuy Direct PPO-final
Buy Direct PPO-final
 
Critical illness insurance pros and cons
Critical illness insurance pros and consCritical illness insurance pros and cons
Critical illness insurance pros and cons
 
Family health optima insurance policy
Family health optima insurance policyFamily health optima insurance policy
Family health optima insurance policy
 
Cigna choice
Cigna choiceCigna choice
Cigna choice
 
Critical Illness Insurance from Allstate Benefits
Critical Illness Insurance from Allstate BenefitsCritical Illness Insurance from Allstate Benefits
Critical Illness Insurance from Allstate Benefits
 
Maximum difference cancer
Maximum difference cancerMaximum difference cancer
Maximum difference cancer
 
CRITICAL ILLNESS BROCHURE-GEORGIA
CRITICAL ILLNESS BROCHURE-GEORGIACRITICAL ILLNESS BROCHURE-GEORGIA
CRITICAL ILLNESS BROCHURE-GEORGIA
 
SMART-Accident-Program
SMART-Accident-ProgramSMART-Accident-Program
SMART-Accident-Program
 

Discover Critical Health and Vitality

  • 1. Discover CRITICAL ILLNESS INSURANCE Your “Health” is the Investment Protecting your Financial Portfolio 1whealthcare™ Transforming Health care Insurance and Investments
  • 2. “ You need insurance, not only because you’re going to die, but because you’re going to live.” Dr. Marius Barnard Creator of Critical Illness Insurance.
  • 3.
  • 4.
  • 5. 340 Cancer (new cases)- 137 Strokes - 8 Kidney Failures - 3 Multiple Sclerosis Chances in any given year before age 65: CANADA Every day 3.5% Death 34.7%Critical Illness
  • 6. Age Bands ► Source: Munich Re 2007
  • 7.
  • 8. HR NIGHTMARE PERCEPTION REALITY What Employee thinksis covered? What Plan actually covers!
  • 9. Exclusions & Restrictions To Avoid BAKER’S DOZEN + 12
  • 10. PLAN STRUCTURE X vs BUNDLED STAND ALONE AN AVOIDABLE TRAP
  • 11. BUNDLEDVS.STAND ALONE ►SUBSIDIZED RATES ► UNPREDICTABLE RATE INCREASES ► LOSS RATIO AFFECT (Life, A.D.& D., LTD, C.I.) ► LIMITS SHOPPING ► JEOPARDIZE PRE-EX TRANSPARENT PRICING PRICING STABILITY MINIMIZE LOSS RATIO AFFECT MARKET ACCESS PRE-EX GRANDFATHERED
  • 12. CRITICAL ILLNESS INSURANCE “DEFINITIONS” MOST IMPORTANT CONSIDERATION DETERMINE IF AND WHEN YOU WILL BE PAID NOT ALL PLANS ARE THE SAME!
  • 13. Types of Exclusions&RestrictionsTo Avoid ►Obvious ► Subtle ► Omission ► Severity ► Restrictive ► Unreasonable ► Uncertainty ► Unilateral Changes ► Retroactive ► Not Legally Sound ► Subjective ► Denial & Termination
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20. ( A good policy doesn’t list this exclusion.) Subjective
  • 21. KIDNEY (RENAL) FAILURE Good Definitionvs. Poor Definition  Kidney failure means a definite diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular haemodialysis, peritoneal dialysis or renal transplantation is initiated  Means end stage renal disease due to chronic irreversible kidney failure, requiring the Insured Person to undergo regular hemodialysis, peritoneal dialysis, or require renal transplantation Subtle
  • 22. STROKE Good Definitionvs. Poor Definition Evidence of permanent neurological deficit persisting for 30 consecutive days ►New objective neurological deficits on clinical examination persisting continuously for at least sixty(60) days following the diagnosis of the stroke. Severity
  • 23. MULTIPLE SCLEROSIS Good Definitionvs. Poor Definition  Multiple Sclerosis means a definite diagnosis of at least one of the following: ▪two or more separate clinical attacks, confirmed by MRI showing multiple lesions of demyelination ▪ well-defined neurological abnormalities lasting more than 6months, confirmed by MRI, showing multiple lesions of demyelination; or ▪ a single attack, confirmed by repeated MRI, which shows multiple lesions of Demyelination which have developed at intervals at least one month apart  Means the definitive written diagnosis by a Physician who is certified as a neurologist confirming at least moderate persisting neurological abnormalities, with impairment of function, but not necessarily confining the insured to a wheelchair or bed Severity
  • 24.
  • 25. the policy date, or
  • 26. the most recent date of reinstatement
  • 27. The Insured person has any of the following:
  • 28. signs, symptoms or investigations that lead to a diagnosis of benign brain tumor  The histologic nature of the tumor must be confirmed by examination of tissue (biopsy or surgical excision) Unreasonable
  • 29.
  • 30. MAJOR ORGAN TRANSPLANT Good Definitionvs.Poor Definition  Major organ transplant means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow and transplantation must be medically necessary  Means being either the recipient of a transplanted heart, lung, liver, kidney, pancreas or bone marrow performed by a Physician who is certified to conduct such transplant, or enrolled in a recognized organ or bone marrow transplant program in Canada or the United States Not Legally Sound
  • 31.
  • 32. Life Insurance Co. Group C.I.I. Pays Claims Pays Premium Insures Employees Company Employees Critically Ill Employee Claimant Premium is a Tax Deductible business expense for Company. Claimbenefit is received Tax-Free,in a Lump Sum payment, by Employee Premium is NOTa Taxable Employee Benefit to the Employee ‘Based on a CRA ruling in 2003 involving an Alberta Group C.I.I. Case, Arthur Drache Q.C. (F.P. 2003/5/13) “Benefits “ provided by an employer are taxable as a benefit unless there is a statutory exemption. There is such an exemption for Group Sickness & Accident insurance - based on Provincial Insurance Act.’
  • 33. GROUP PLAN EVALUATIONCHECKLIST 1. Approval -Guaranteed Issue 2.Plan Structure -Stand Alone 3. Pre-existing -Reduce or Eliminate 4.General Exclusions -Few As Possible 5. Level of Benefits -No Restrictions Based On Income 6.Scope of Coverage -Most Comprehensive / Optional 7. Covered Conditions -Most Available / Occupational HIV
  • 34. GROUP PLAN EVALUATIONCHECKLIST (Cont’d) 8.Definitions -Legally & Medically Sound/ No Disability -Few Exclusions & Exceptions 9. Qualifying Period -Shortest Possible if Over 30 Days 10.Moratorium Period -Plan Shouldn’t Be Cancelled 11. Claim Assessment -Reasonable Criteria / Not Limited 12.Portability -Should Be Portable / Convertible 13. Premium -Employer Paid / Non-Taxable 14.Underwriter -Insurance Company / Tax Status
  • 35. ? OVER THE PAST 5 YEARS WHO DO YOU KNOW . . .
  • 36.
  • 37. GROUP CRITICAL ILLNESS INSURANCE Need? Significant gaps in traditional Benefit plans. Medical & pharmacological advances have drastically changed patients’ medical treatments. Today’ fast paced stress inducing lifestyles are causing an alarming increase in acute illnesses.
  • 38. Critical Illness Insurance Summary Dr. Marius Barnard recognized that LTD (Disability) wasn’t adequately addressing person’s needs. He realized that acute and life altering illnesses necessitate a large infusion of cash, usually immediately. He observed that without the stress of financial worry, recuperation is frequently more successful and rapid.
  • 39. Thank You. Download the latest "Critical Illness Insurance Consumers’ Guide for Canadians©“ 1whealthcare.com Learn how the 1whealthcare solution: Critical Health & Vitality Keeps you drug free & pain free for free