1 Serious-illness insurance for independent information
2 About us We are an independent watchdog set up by the Government to: regulate firms that provide financial services; and help you make informed decisions about your personal finances. We do not sell anything. We give you free, independent information in plain English and help answer your questions. How to contact us... Phone In consumer help-line, lo-call Log In Drop In Information Centre, 6-8 College Green, Dublin 2
3 Contents Introduction 2 What is serious-illness insurance? 2 What is covered in a typical 5 serious-illness policy? What illnesses are not covered on 7 my policy? How much does it cost? 9 Adding serious-illness cover to a 12 life insurance policy Cost comparison 15 How can I buy serious-illness cover? 17 Questions to ask about 17 serious-illness policies Dos and don ts 18 Jargon buster 20
4 Introduction This booklet describes how serious-illness insurance works and helps you decide whether you need this type of insurance to protect you or your family if you become seriously ill. It gives you general information only, and you should always check your own policy for details of your insurance. For more information on insurance, go to our consumer website or you can order or download our Life insurance made easy guide and our Income protection insurance booklet. See page 20 for an explanation of the terms used in this booklet. What is serious-illness insurance? Serious-illness insurance pays out a tax-free lump sum if you are diagnosed with one of the specific illnesses or disabilities that your policy covers. It is also sometimes called critical-illness cover. It is often sold as an extra benefit on a life insurance or mortgage protection policy. It is important to realise, when considering this type of cover, that it would not replace your income if you were out of work because of a long-term illness. Some illnesses may be serious enough to prevent you from working full-time but are not covered by serious-illness policies and, even where the illness is covered, the policy pays a one-off lump sum and not an ongoing income. For information about insurance that covers you for an ongoing long-term loss of income, go to our consumer website or you can order or download our Income protection insurance booklet.
5 Serious-illness policies are not the same as private health-care plans. If you are ill and need medical or hospital care, private health care plans help to pay for your treatment. They do not pay out any extra cash benefit. Can I claim on my policy if I become seriously ill? The illnesses covered by serious-illness policies are generally very serious - such as cancer, a stroke or a heart attack - and many other serious conditions. However, you may or may not be able to claim for a serious illness, even if you have a serious-illness policy. You can claim the benefit on your policy only if: the illness you develop is one of the illnesses your policy covers at the time of your claim; a medical diagnosis confirms that your illness matches the definition of that illness set out by the insurance company in your policy terms and conditions; and you survive for a period after you are diagnosed. This period may be seven or 14 days, depending on the policy. Usually, you must meet all three conditions to claim your policy benefit. It is important you read the terms and conditions carefully before you sign up for the policy.
6 Do I need serious-illness insurance? You may want to consider serious-illness insurance if: you have no other cover for ill health; you are not in paid employment, so cannot buy income protection insurance; or you have a mortgage, personal loans or other debts that you would still have to pay even if you became seriously ill and were unable to earn an income. But do bear in mind that a serious-illness policy does not pay out an ongoing regular income, so if your illness prevents you from working, it may not be enough to replace your income in the longer-term. You can choose the number of years (term) your policy should last. But your cover usually ends when you reach 60 or 65 - depending on your individual policy - so it is important to check this with your provider.
7 What is covered in a typical serious-illness policy? Policies vary, but they usually include: cover for a number of serious illnesses, listed on your policy, which may include permanent total disablement (see page 6); and limited serious-illness cover for your children. The list of illnesses covered varies from company to company, but usually includes: stroke and heart attack; some types of cancer; coronary artery disease; multiple sclerosis; kidney failure; motor neurone disease; blindness; a benign brain tumour; and severe burns. Not all policies will cover all the illnesses listed above, so check with the provider for details of the illnesses a policy covers, before you buy. It is tempting to choose a policy that covers the most illnesses. But it is more important to consider the definitions of illnesses. With some policies, your condition would need to be extremely serious before you could claim any benefit.
8 Permanent total disablement (PTD) is sometimes included in these policies. So, if you became permanently and totally disabled from an illness or condition that is not otherwise covered by the policy, you could claim the serious-illness benefit. There are two types of PTD cover. Any-occupation PTD Any-occupation PTD means you can only claim if you are not able to work at any job. It means you are permanently unable to do many normal daily activities such as walking, lifting, bending, writing or speaking. The risk of claiming for this type of severe disability is low, so it is often included in the standard illness list. Own-occupation PTD Own-occupation PTD means you can claim if you are permanently and totally unable to do your own job. The risk of a claim is higher, so you can expect to pay an extra premium for this type of PTD cover. You may not be able to get this extra cover if your job carries a higher risk of disability, for example, if you are a sports professional. Children s serious illnesses Your children may be covered for most of the serious illnesses listed on your policy, and sometimes for other child-related illnesses, such as meningitis. The maximum benefit for a child s claim depends on the policy, but it could be, for example, 50% of your cover or u25,000, whichever is less. Some policies also give you waiting-list and overseas-surgery benefit. This means they pay out part of the serious-illness benefit if you are put on a waiting list for certain major types of surgery or if it is essential for you to have major surgery outside of Ireland.
9 What illnesses are not covered on my policy? Most serious-illness policies will not cover you for many of the most common illnesses that prevent people from working. These include: stress-related illnesses; back injuries; diabetes; and most treatable cancers that are discovered early. Policies that cover heart attacks might exclude a related condition, such as angina. So, even if you develop an illness that is serious enough to prevent you from working and earning an income, your policy might not pay out any benefit.
10 What else is not covered? There are many situations where you may not be covered by your serious-illness policy. These are called exclusions. You will not usually be covered if: your illness was judged to be caused by drug or alcohol abuse, a self-inflicted injury or your failure to follow medical advice; your illness existed before you applied for insurance and you failed to say this in your application; your illness arose because you were involved in dangerous or criminal activities; or you live outside the territorial limits of the policy for a certain number of months of the year. The territorial limits may vary from policy to policy but would usually mean all EU countries. As well as these general exclusions, there may be specific exclusions on your policy based on your medical history, job or lifestyle. Make sure you fill in your proposal form fully and truthfully. If you give any inaccurate information when you apply for cover, any claim you make may not be valid.
11 How much does it cost? For any given amount of cover, serious-illness insurance costs more than life insurance. That is because the risk of you getting a serious illness during a given period is higher than the risk of you dying during the same period. For more information, go to our consumer website or you can order or download our Life insurance made easy guide. The monthly cost of the insurance (called the premium) depends on many factors, but the most important are: the sum assured (the amount of money you want to get if you become ill); who the insurance will cover - it could be: single cover for yourself; or joint cover for yourself and your partner; and the term of the policy (how long you want the policy for).
12 What else can affect the cost? Your age, gender (sex), health and family medical history also affect how much you pay for your serious-illness insurance. Age Health risks increase as you get older, so the older you are when taking out a policy, the higher the premium. Gender Premiums are generally higher for women than men because women have more claims for certain types of serious illness. Smoking Premiums for smokers can be up to twice as much as non smokers because smoking increases health risks. The current and past state of your health If you have a medical condition or have a family history of certain types of illness, you generally pay a higher premium. 10
13 What benefits do I pay more for? Some insurance companies offer extra benefits on their policies, but they usually charge you more for these. The typical extra benefits are: personal-accident benefit, which gives you a weekly payment for a limited period if you can t work because of a disability caused by an accident; hospital cash, which is a daily payment you get if you have to stay in hospital for a certain period (it is paid for each day you spend in hospital after a certain time - for example, four days - because of an illness or accident); a conversion option, which lets you convert your cover into a new policy when you are older, even if you are in bad health at that stage; and indexation or inflation protection, which increases your cover each year by the rate of inflation. If you are considering indexation (also called index-linking), ask about the rate of increase in your premium and the rate of increase in your benefit. Many serious-illness policies are index-linked as standard. If you do not want this, you should contact your insurance company and discuss it with them. Do I have to pay tax on my benefit? The benefit that is paid out if you are diagnosed with one of the serious illnesses covered by the policy is tax free. You will not have to pay tax on the lump sum. 11
14 Adding serious-illness cover to a life insurance policy One of the most common ways to buy serious-illness cover is to include it as an extra benefit on a life insurance policy or a mortgage protection policy. Under this type of combined policy, the extra premium you pay to include serious-illness cover depends on whether the cover is: accelerated; or additional (separate) cover. For more information on life insurance, go to our consumer website or you can order or download our Life insurance made easy guide. 12
15 What is accelerated serious-illness cover? If you add serious-illness cover to your life policy, accelerated cover means that, while the total potential benefit on your life insurance policy is not increased, you will be entitled to receive it (or part of it) if you get a serious illness. Some accelerated cover policies let you choose a lower level of cover for serious illness than life insurance. For example, suppose you take out a life insurance policy for u150,000, and you choose to include accelerated serious-illness cover of u100,000. This means if you suffered a serious illness covered by the policy, you could claim u100,000 (the serious-illness benefit). If you died at a later date in the policy term, your policy would pay out the remaining u50,000 life insurance benefit to your estate. If you did not die during the policy term, the insurance company would not pay the remaining u50,000. If you add serious-illness cover to your mortgage protection policy, your lender would use the policy benefit to pay off your mortgage if you develop a serious illness or die during the term of your mortgage. For example, if you have a mortgage protection policy with accelerated serious-illness cover of u150,000, your insurance company pays out the u150,000 to your lender to pay off your mortgage if you develop a serious illness, or die, while the mortgage protection policy is in force. 13
16 What is additional cover? If you add serious illness to your life insurance policy as additional cover, it is like having two separate policies in one and it does increase your total potential benefit. This is also called separate cover, double cover or stand-alone cover. For example, if you have a u150,000 life insurance policy with u100,000 additional serious-illness cover, your policy would pay out u100,000 if you have a serious-illness claim and also u150,000 if you die during the policy term. The total policy benefit that could be paid out is u250,000. If you die without having suffered a serious illness, the insurance company would pay only the life insurance part of the policy (u150,000). Additional life insurance is more expensive than accelerated cover, as the potential total benefit you can claim is increased. The table on page 15 shows the difference in monthly premium between three insurance companies for: a life insurance policy with u150,000 benefit for a set term of 20 years; the same life insurance policy with accelerated serious-illness benefit of u150,000; and the life insurance policy with additional serious-illness benefit of u150,000. The premiums shown are for a male and female, both non-smokers in good health, who will be 40 on their next birthdays. Figures shown are correct at April
17 Example: Cost comparison monthly premium charged for y150,000 life insurance cover over a set term of 20 years Company Life insurance policy Life insurance with accelerated serious-illness cover Life insurance with additional serious-illness cover of f150,000 Male Female Male Female Male Female Insurance company A u22.69 u17.80 u82.43 u73.02 u u89.84 Insurance company B u24.25 u17.80 u73.90 u55.75 u86.95 u66.25 Insurance company C u29.30 u21.60 u80.68 u65.70 u95.40 u
18 Is my premium fixed? Fixed-term policies If you buy stand-alone serious-illness cover for a fixed term or serious-illness cover as part of a fixed-term life insurance policy, once the insurance company decides your premium, it stays fixed for the term of the policy, unless it is index-linked. With index-linked policies, the premium usually increases once a year in line with inflation, unless you ask your insurance company to stop index-linking. Whole-of-life policies If you buy serious-illness cover as part of a whole of life policy, your premium is not fixed and may increase from time to time. A whole-of-life policy is one that stays active throughout your life and does not end after a fixed length of time. For more information on whole-of-life policies, go to our consumer website or you can order or download our Life insurance made easy guide. 16
19 How can I buy serious-illness cover? You can buy serious-illness insurance direct from an insurance company or through a broker or other type of financial advisor. Mortgage lenders may also offer this cover when you apply for your mortgage. Your lender, broker or other financial advisor will usually earn commission from the insurance company they deal with when you buy a policy from them. For more information, go to our consumer website www. itsyourmoney.ie or you can order or download our Getting financial advice booklet. To apply for serious-illness cover, you will need to fill in a detailed application form, called a proposal form. You can usually choose: a stand-alone serious-illness policy (see page 5); or serious-illness cover as an extra benefit (and at extra cost) on a life insurance policy or a mortgage protection policy (see page 12). Questions to ask about serious-illness policies Do I need a serious-illness policy? What illnesses are covered and how are they defined? What illnesses are not covered? What other exclusions are there? Is the policy index-linked and how much does this cost? If it is being added to an existing life insurance policy or mortage protection policy, is it accelerated cover or additional cover? Does it include permanent total disablement cover? 17
20 Dos and don ts Do Do check that you don t already have serious-illness insurance. Also, check to see what cover you already have for ill health through your job or pension plan. Do consider whether income protection insurance or a combination of income protection and serious-illness cover might be better value than serious-illness cover alone. For more information, go to our consumer website or you can order or download our Income protection insurance booklet. Do shop around. Premiums and benefits can vary widely and make a large difference over the period of your cover. Do ask your provider about any fees you have to pay. Do consider giving up smoking. After one year (or in some cases two) of having given up, many insurance companies will give you non-smoker rates. This could cut your premium by half. Do fill in proposal forms fully and truthfully. If you provide false or incomplete information, any claim you make may not be paid. Do remember that (with some exceptions) you have a cooling-off period during which you can cancel a policy and get a refund of any premiums you have paid. 18
21 Do pay your premiums on time. If you don t, your policy could lapse. This means that you would not be covered if you made a claim. Do keep a list of your policies and let someone know where they are. Don t Don t cancel an existing policy to take out a new one unless you have a good reason. Because you are older, the new cover is likely to cost more than your existing policy. And you may not be able to get the same cover on the same terms, particularly if your job or health has changed. Don t buy insurance that you don t need or already have. Consider what types of benefits are covered by your job or by any pension plan you have. Don t assume that your policy covers everything. Ask for a detailed explanation when you are buying. 19
22 Jargon buster Accelerated cover: Accelerated cover pays out part or all of your life insurance policy benefit if you are diagnosed as suffering a serious illness covered by the policy. Additional cover: Additional cover is also called separate cover or double cover. The policy covers both the serious-illness benefit and life insurance benefit separately, and may pay out on both. Cover: The protection insurance gives you. Cover can also mean the amount of money or benefit you ll get if you are diagnosed as suffering a serious illness covered by the policy. Exclusions: Exclusions (or restrictions) are situations that are not covered by your policy. Permanent total disablement (PTD): PTD can mean two different things, depending on your policy. It can mean you are permanently and totally unable to do your own job. Or, it can mean you are not able to do many normal daily activities, so you are permanently unable to work at any job. Policy: The insurance contract between you and an insurance company. Premium: The money you pay to the insurance company in return for the cover of the insurance policy. You usually pay a monthly premium by direct debit. Sum assured or policy benefit: The amount of money you could receive if you have a successful claim for serious illness under the policy. Term: The number of years the policy will be in place. 20
23 How to contact us... Phone In consumer help-line, lo-call Log In Drop In Information Centre, 6-8 College Green, Dublin 2 This is a general guide to serious-illness insurance. Nothing in this booklet is intended to be, or should be considered to be: 1 an invitation, offer or incentive to you or any other person to enter into a financial arrangement; or 2 advice on, or a recommendation of any particular product or product provider. The contents of this publication may be reproduced with the acknowledgement of the Financial Regulator. Reproduction or use for commercial or marketing purposes is prohibited. Irish Financial Services Regulatory Authority 2007.
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