Discover Critical Health and Vitality

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Discover Critical Health and Vitality

  1. 1. Discover <br />CRITICAL ILLNESS INSURANCE<br />Your “Health” is the Investment<br />Protecting your Financial Portfolio<br />1whealthcare™ Transforming Health care Insurance and Investments<br />
  2. 2. “ You need insurance, not only <br />because you’re going to die, but <br />because you’re going to live.”<br />Dr. Marius Barnard<br /> Creator of <br />Critical Illness Insurance.<br />
  3. 3. Critical Illness Insurance:<br /><ul><li>Pays a Lump Sum, Tax Free Benefit upon the </li></ul>first diagnosis of any covered condition.<br /> Usuallymust survive 30 days, after diagnosis.<br /> Benefit is paid based upon diagnosis, <br /> regardless of severity, degree of disability or<br />ability to work.<br />
  4. 4. DID YOU KNOW?<br /><ul><li> 200 Heart Attacks
  5. 5. 340 Cancer (new cases)</li></ul>- 137 Strokes<br />- 8 Kidney Failures<br />- 3 Multiple Sclerosis<br />Chances in any given year<br />before age 65: <br />CANADA<br />Every day<br />3.5% Death<br />34.7%Critical Illness<br />
  6. 6. Age Bands ►<br />Source: Munich Re 2007<br />
  7. 7. Critical Illness Insurance Comparative Claims Analysis<br />IndividualGroup<br />Cancer 70%66%<br />Heart Attack 14%16%<br />Stroke 5%4%<br />Other5%2%<br />CABS 4%6%<br />MS 2% 5%<br />Paralysis 1%<br />Source: Individual – Munich re Survey 2006 since inception. Group – ACE INA Canada – since 1998. <br />REASON FOR DENIED GROUP CLAIMS:<br />-About 80% are due to pre-existing conditions.<br /><ul><li>About 20% are due to failure to satisfy the definition.</li></ul>GCI Inc. 07/9 E.& O.E.<br />
  8. 8. HR NIGHTMARE<br />PERCEPTION<br />REALITY<br />What Employee<br />thinksis covered?<br />What Plan actually covers!<br />
  9. 9. Exclusions & Restrictions<br />To Avoid<br />BAKER’S DOZEN<br />+ 12<br />
  10. 10. PLAN STRUCTURE<br />X<br />vs<br />BUNDLED <br />STAND ALONE <br />AN AVOIDABLE TRAP<br />
  11. 11. BUNDLEDVS.STAND ALONE<br />►SUBSIDIZED RATES<br />► UNPREDICTABLE RATE<br /> INCREASES<br />► LOSS RATIO AFFECT<br /> (Life, A.D.& D., LTD, C.I.)<br />► LIMITS SHOPPING <br />► JEOPARDIZE PRE-EX<br />TRANSPARENT PRICING<br />PRICING STABILITY<br />MINIMIZE LOSS RATIO AFFECT<br />MARKET ACCESS<br />PRE-EX GRANDFATHERED<br />
  12. 12. CRITICAL ILLNESS INSURANCE <br />“DEFINITIONS”<br />MOST IMPORTANT CONSIDERATION<br />DETERMINE IF AND WHEN YOU WILL BE PAID<br />NOT ALL PLANS ARE THE SAME!<br />
  13. 13. Types of Exclusions&RestrictionsTo Avoid<br />►Obvious ► Subtle<br />► Omission ► Severity<br />► Restrictive ► Unreasonable<br />► Uncertainty ► Unilateral Changes<br />► Retroactive ► Not Legally Sound<br />► Subjective ► Denial & Termination<br />
  14. 14. PARALYSIS<br /> Good Definitionvs.Poor Definition<br /><ul><li>“the paralysis has persisted for</li></ul> 90 consecutive days, following<br /> the precipitating event, during <br /> which time there has been no<br /> sign of improvement.”<br /><ul><li>“ the paralysis has persisted for</li></ul>180 consecutive days, following<br /> the precipitating event, during<br /> which time there has been no<br /> sign of improvement.”<br />Obvious<br />
  15. 15. CANCER<br />Good Definitionvs.Poor Definition<br /><ul><li>“Means a malignant tumor </li></ul> characterized by the uncontrolled<br />growth and spread of malignant<br />cells and the invasion of tissue.<br />This includes Leukemia, Hodgkin’s<br />Disease and invasive Melanoma.”<br /><ul><li>“a definite diagnosis of a tumor</li></ul>characterized by the uncontrolled <br />growth and spread of malignant cells <br />and the invasion of tissue. The <br />diagnosis of Cancer must be made <br />by a Specialist.” <br />Omission<br />
  16. 16. HEART ATTACK<br />Good Definitionvs.Poor Definition<br /><ul><li>“ rise and fall of biochemical markers</li></ul>considered diagnostic of myocardial<br />Infarction (heart attack).”<br /><ul><li>“an elevation in cardiac biochemical</li></ul>markers, or the elevation of cardiac<br />enzyme levels, consistent with a heart<br />attack.”<br />Restrictive<br />
  17. 17. PARKINSON’S DISEASE<br />Good Definitionvs. Poor Definition<br /><ul><li>“by two or more of the following:</li></ul>▪ muscle rigidity<br /> ▪ tremor, or<br /> ▪ bradykinesis”<br /> “ by two or more of the following:<br />▪ muscle rigidity<br /> ▪ tremor, or<br /> ▪ bradykinesis<br />and the insured person requires<br />substantial physical assistance from <br />another adult to perform two or more<br />activities of bathing, dressing, toileting,<br />transferring, bladder and bowel <br />continence and eating.” <br />Uncertainty<br />
  18. 18. CANCER<br />Good Definitionvs.Poor Definition<br /><ul><li> “The following forms of cancer are</li></ul>excluded:<br />▪ Cancer in situ; and<br />▪ Any skin cancer, other than malignant<br />melanoma into the dermis or deeper;<br />▪ Early prostate cancer (stage A or <br />equivalent staging);<br />▪ Any tumor in the presence of any human<br />Immunodeficiency virus (HIV).” <br /><ul><li>“The following cancers are excluded </li></ul>from coverage:<br />▪ Carcinoma in situ;<br />▪ Stage 1A malignant melanoma <br />(melanoma less than or equal to 1.0 mm<br />in thickness, not ulcerated and without<br />level IV or V invasion);<br />▪ Stage A (T1a or T1b) prostate cancer,<br />▪ Any non-melanoma skin cancer that<br />has not become metastatic (spread<br />to distant organs.”<br />Retroactive<br />
  19. 19. Sports Exclusion<br />Good Definitionvs.Poor Definition<br /><ul><li> “ 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. 20. ( A good policy doesn’t list</li></ul> this exclusion.)<br />Subjective<br />
  21. 21. KIDNEY (RENAL) FAILURE<br />Good Definitionvs. Poor Definition<br /> Kidney failure means a definite diagnosis<br />of chronic irreversible failure of both<br />kidneys to function, as a result of which<br />regular haemodialysis, peritoneal dialysis<br />or renal transplantation is initiated<br /> Means end stage renal disease due<br />to chronic irreversible kidney failure,<br />requiring the Insured Person to <br />undergo regular hemodialysis,<br />peritoneal dialysis, or require renal<br />transplantation <br />Subtle<br />
  22. 22. STROKE<br />Good Definitionvs. Poor Definition<br />Evidence of permanent neurological<br />deficit persisting for 30 consecutive<br />days<br />►New objective neurological deficits <br />on clinical examination persisting <br />continuously for at least sixty(60) days <br />following the diagnosis of the stroke.<br />Severity<br />
  23. 23. MULTIPLE SCLEROSIS<br />Good Definitionvs. Poor Definition<br /> Multiple Sclerosis means a definite <br /> diagnosis of at least one of the following:<br />▪two or more separate clinical attacks,<br /> confirmed by MRI showing multiple lesions <br />of demyelination<br />▪ well-defined neurological abnormalities<br />lasting more than 6months, confirmed by<br />MRI, showing multiple lesions of <br />demyelination; or<br />▪ a single attack, confirmed by repeated <br />MRI, which shows multiple lesions of <br />Demyelination which have developed at <br />intervals at least one month apart <br /> Means the definitive written <br />diagnosis by a Physician who is <br />certified as a neurologist confirming<br />at least moderate persisting <br />neurological abnormalities, with<br />impairment of function, but not<br />necessarily confining the insured to<br />a wheelchair or bed<br />Severity<br />
  24. 24. BENIGN BRAIN TUMOR<br />Good Definitionvs.Poor Definition<br /> The tumor must require surgical or<br />radiation treatment or cause irreversible<br />objective neurological deficits. <br /> No benefit will be payable under this<br />condition if within the first 90 days <br />following the later of: <br /><ul><li>the date the application was signed
  25. 25. the policy date, or
  26. 26. the most recent date of reinstatement
  27. 27. The Insured person has any of the following:
  28. 28. signs, symptoms or investigations that</li></ul> lead to a diagnosis of benign brain tumor<br /> The histologic nature of the tumor<br />must be confirmed by examination <br />of tissue (biopsy or surgical excision)<br />Unreasonable<br />
  29. 29. CHANGE DEFINITIONS<br />Good Definitionvs.Poor Definition<br /><ul><li>( A good policy doesn’t list</li></ul> this restriction.)<br />“ 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.”<br />Unilateral<br />
  30. 30. MAJOR ORGAN TRANSPLANT<br />Good Definitionvs.Poor Definition<br /> Major organ transplant means a definite<br />diagnosis of the irreversible failure of the<br />heart, both lungs, liver, both kidneys or<br />bone marrow and transplantation must<br />be medically necessary<br /> Means being either the recipient of<br />a transplanted heart, lung, liver,<br />kidney, pancreas or bone marrow<br />performed by a Physician who is <br />certified to conduct such transplant,<br />or enrolled in a recognized organ or<br />bone marrow transplant program in<br />Canada or the United States<br />Not Legally Sound<br />
  31. 31. CANCER<br />Good Definitionvs. Poor Definition<br /><ul><li>no benefits of any kind are payable for any </li></ul>condition under this policy and thispolicy<br /> will automatically terminate, if within 90 days <br />following the later of the Issue date and the <br />date of the last reinstatement of the policy:<br />1. You are diagnosed with Life Threatening<br /> Cancer; or<br />2. any sign or symptom of any type of cancer <br />becomes first Manifested; or<br />3. any medical testing or investigation <br />was initiated which subsequently leads to <br />a diagnosis of any type of cancer.”<br />The cancer exclusion period is<br />90 days from the later of: 1) the<br />Effective Date, or 2) the date of<br />The last reinstatement of the policy.<br />In the event of such diagnosis<br />the policy will remain in force<br />but cancer will no longer be<br />considered an Insured Condition,<br />except for a subsequent diagnosis<br />of unrelated cancer.<br />Denial & Termination<br />
  32. 32. Life Insurance Co.<br />Group C.I.I.<br />Pays Claims<br />Pays Premium<br />Insures Employees<br />Company<br />Employees<br />Critically Ill<br />Employee<br />Claimant<br />Premium is a<br />Tax Deductible<br />business expense<br />for Company.<br />Claimbenefit is received <br />Tax-Free,in a Lump Sum <br />payment, by Employee<br />Premium is NOTa <br />Taxable Employee Benefit<br />to the Employee<br />‘Based on a CRA ruling in 2003 involving an Alberta Group C.I.I. Case, Arthur Drache Q.C. (F.P. 2003/5/13)<br />“Benefits “ provided by an employer are taxable as a benefit unless there is a statutory exemption.<br />There is such an exemption for Group Sickness & Accident insurance - based on Provincial Insurance Act.’<br />
  33. 33. GROUP PLAN EVALUATIONCHECKLIST<br />1. Approval -Guaranteed Issue <br />2.Plan Structure -Stand Alone<br />3. Pre-existing -Reduce or Eliminate <br />4.General Exclusions -Few As Possible<br />5. Level of Benefits -No Restrictions Based On Income<br />6.Scope of Coverage -Most Comprehensive / Optional<br />7. Covered Conditions -Most Available / Occupational HIV<br />
  34. 34. GROUP PLAN EVALUATIONCHECKLIST (Cont’d)<br />8.Definitions -Legally & Medically Sound/ No Disability<br /> -Few Exclusions & Exceptions<br />9. Qualifying Period -Shortest Possible if Over 30 Days<br />10.Moratorium Period -Plan Shouldn’t Be Cancelled <br />11. Claim Assessment -Reasonable Criteria / Not Limited<br />12.Portability -Should Be Portable / Convertible<br />13. Premium -Employer Paid / Non-Taxable<br />14.Underwriter -Insurance Company / Tax Status<br />
  35. 35. ?<br />OVER THE PAST 5 YEARS<br />WHO DO YOU KNOW . . .<br />
  36. 36. . . THAT WAS DIAGNOSED WITH:<br />CANCER?<br />HEART ATTACK?<br /><ul><li>STROKE?</li></ul>. . . . AND IS STILL ALIVE TODAY!<br />
  37. 37. GROUP CRITICAL ILLNESS INSURANCE<br />Need?<br />Significant gaps in traditional Benefit plans.<br />Medical & pharmacological advances have drastically changed patients’ medical treatments.<br />Today’ fast paced stress inducing lifestyles are causing an alarming increase in acute illnesses.<br />
  38. 38. Critical Illness Insurance<br />Summary<br />Dr. Marius Barnard recognized that LTD (Disability) wasn’t adequately addressing person’s needs.<br />He realized that acute and life altering illnesses necessitate a large infusion of cash, usually immediately.<br />He observed that without the stress of financial worry, recuperation is frequently more successful and rapid.<br />
  39. 39. Thank You.<br />Download the latest<br />&quot;Critical Illness Insurance<br />Consumers’ Guide for Canadians©“<br />1whealthcare.com<br />Learn how the 1whealthcare solution: Critical Health & Vitality<br />Keeps you drug free & pain free for free<br />

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