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Discover Critical Health and Vitality

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  • 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. Critical Illness Insurance:
    • Pays a Lump Sum, Tax Free Benefit upon the
    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.
  • 4. DID YOU KNOW?
    • 200 Heart Attacks
    • 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. 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.
    • About 20% are due to failure to satisfy the definition.
    GCI Inc. 07/9 E.& O.E.
  • 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. PARALYSIS
    Good Definitionvs.Poor Definition
    • “the paralysis has persisted for
    90 consecutive days, following
    the precipitating event, during
    which time there has been no
    sign of improvement.”
    • “ the paralysis has persisted for
    180 consecutive days, following
    the precipitating event, during
    which time there has been no
    sign of improvement.”
    Obvious
  • 15. CANCER
    Good Definitionvs.Poor Definition
    • “Means a malignant tumor
    characterized by the uncontrolled
    growth and spread of malignant
    cells and the invasion of tissue.
    This includes Leukemia, Hodgkin’s
    Disease and invasive Melanoma.”
    • “a definite diagnosis of a tumor
    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
  • 16. HEART ATTACK
    Good Definitionvs.Poor Definition
    • “ rise and fall of biochemical markers
    considered diagnostic of myocardial
    Infarction (heart attack).”
    • “an elevation in cardiac biochemical
    markers, or the elevation of cardiac
    enzyme levels, consistent with a heart
    attack.”
    Restrictive
  • 17. PARKINSON’S DISEASE
    Good Definitionvs. Poor Definition
    • “by two or more of the following:
    ▪ 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
  • 18. CANCER
    Good Definitionvs.Poor Definition
    • “The following forms of cancer are
    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).”
    • “The following cancers are excluded
    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
  • 19. Sports Exclusion
    Good Definitionvs.Poor Definition
    • “ You are engaged in any hazardous sport including but not limited to sky or scuba diving; ballooning; hang gliding; bungee cord jumping; racing in any form (other than on foot) and all professional sports. This does not include normal vacation sports such as skiing or snorkeling. We will deny claims when we determine that undue risk or negligence was a factor. Other sports will also be excluded where they involve a higher risk due to inexperience, lack of care or adequate knowledge of conditions.”
    • 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. 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:
    • the date the application was signed
    • 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. CHANGE DEFINITIONS
    Good Definitionvs.Poor Definition
    • ( A good policy doesn’t list
    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
  • 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. CANCER
    Good Definitionvs. Poor Definition
    • no benefits of any kind are payable for any
    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
  • 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. . . THAT WAS DIAGNOSED WITH:
    CANCER?
    HEART ATTACK?
    • STROKE?
    . . . . AND IS STILL ALIVE TODAY!
  • 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