Critical Illness Insurance Frequently Asked Questions
What is Critical Illness insurance?
Critical Illness Insurance provides a lump-sum benefit that helps alleviate some of the financial stress that may result from being diagnosed with a critical illness. Pacific Blue Cross offers two Individual Critical Illness Insurance Plans. Our Basic plan covers 3 conditions, heart attack, stroke, and cancer and our Enhanced Plan covers 25 conditions. With both plans, if you are diagnosed with one of the Covered Critical Conditions and survive the specified Survival Period (noted in the conditions definition), you are eligible to make a claim. With extra financial protection during your recovery, you’re able to spend less time worrying about your finances and more time concentrating on getting well.
Why do I need Critical Illness insurance?
With advances in medicine, more and more people are surviving critical illnesses; however, recovery can come at a financial cost. Our Critical Illness Insurance provides plan holders with a one-time tax-free payout upon diagnosis of a Covered Critical Illness. How you use the money is completely up to you. Critical Illness Insurance can help you pay for:
- Rent or mortgage
- Child care costs
- Replacement of spousal salary
- Experimental medical treatments
- Private nursing or rehabilitative services
- A getaway to help recharge
- Anything else you need or want.
How much coverage can I get?
Basic Plan: You can apply for coverage in units of $25,000, up to a maximum of $100,000. (ie. $25,000, $50,000, $75,000 or $100,000).
Enhanced Plan: You can apply for coverage in units of $25,000, up to a maximum of $1 Million.
Am I eligible for coverage?
Basic Plan: To be eligible for coverage, you must be between 18 and 50 years of age.
Enhanced Plan: To be eligible for coverage, you must be between 18 and 65 years of age.
What are the covered conditions?
- Heart Attack
- Aortic surgery
- Coronary artery bypass surgery
- Heart attack
- Heart valve replacement or repair
- Loss of limbs
- Loss of speech
- Occupational HIV infection
- Severe burns
- Dementia including Alzheimer’s disease
- Benign brain tumour
- Kidney failure
- Loss of independent existence
- Major organ failure on waiting list
- Major organ transplant
- Motor neuron disease
- Multiple sclerosis
- Parkinson’s disease and specified atypical parkinsonian disorders
- Aplastic anemia
- Bacterial meningitis
Detailed definitions for each Covered Critical Condition, including any exclusions, can be found in our Definitions Guide.
What if I am diagnosed with an illness that is not a covered condition?
The Critical Illness Benefit Amount is only paid if a valid claim is made for one of the Covered Critical Conditions. The Enhanced Plan offers Supplementary Care Benefits where you can receive 15% of the face amount of coverage, to a maximum of $25,000 for any four of the following six Supplementary Covered Conditions (no more than 1 payment for the same condition). These payouts are independent from the Covered Critical Conditions (listed above) and don’t impact your eligibility for claiming the Benefit Amount for a Covered Critical Illness.
- Coronary angioplasty
- Ductal carcinoma in situ (DCIS) of breast
- Stage A (T1a or T1b) prostate cancer
- Stage 1A malignant melanoma
- Early chronic lymphocytic leukemia
- Early thyroid cancer
Can I get coverage for my family?
Spouses can apply for their own Critical Illness Insurance plan with Pacific Blue Cross. Just ask your sales rep! Additionally, with our Enhanced Plan, you can purchase a Child Critical Illness Benefit Rider for the coverage amount of $25,000. The Child Critical Illness Benefit Rider provides a lump-sum payment of the Benefit Amount at the end of a 30 day Survival Period from date of Diagnosis, for one of the Child Critical Illness Benefit Rider Covered Conditions listed below. Detailed definitions for each Child Rider Covered Condition can be found in our Definitions Guide.
- Kidney Failure
- Major Organ Transplant and Major Organ Failure on Waiting List
- Congenital Heart Conditions
- Cerebral Palsy
- Down’s Syndrome
- Cystic Fibrosis
- Muscular Dystrophy
To be eligible for coverage, each Insured Child must be under 18 years old.
In addition to purchasing a Child Critical Illness Benefit Rider with your Enhanced Plan, you also have the option to purchase a Waiver of Premium Rider and a Return of Premium upon Expiry Rider.
The Waiver of Premium Rider pays your premiums while you are disabled. Prior to your 60th birthday, if you have been totally disabled for 90 consecutive days, we will refund any premium paid during this 90 day period and waive any premium that comes due while disability continues. The premium is payable again from the date you are no longer totally disabled.
The Return of Premium upon Expiry Rider provides for the return of eligible premium paid for the Policy if the Policy is still active on your 75th birthday and you have not submitted a Critical Illness claim under your Policy.
The Return of Premium upon Expiry Rider and Waiver of Premium Riders are only available at Policy issue.
- Individuals age 18 to 60 are eligible to apply for a Return of Premium upon Expiry Rider as part of their Individual Enhanced Critical Illness Insurance Policy.
- Individuals prior to age 60 are eligible to apply for a Waiver of Premium Rider as part of their Individual Enhanced Critical Illness Insurance Policy.
Included in the Enhanced Plan are two value-added services. The first is Second Medical Opinion. It’s a service offered by Pacific Blue Cross in collaboration with WorldCare International, Inc, giving members and their treating physicians’ access to leading specialists in North America’s top-ranked teaching and research hospitals for a medical second opinion on their diagnosis and treatment plan. Also included is a Funeral Expense Benefit where we will pay for funeral costs up to a maximum of $5,000. Both of these benefits are included in the Enhanced Plan with no additional cost.
Is the lump-sum benefit considered taxable income?
Proceeds from a Critical Illness Insurance Policy are not considered taxable.
What to do if I am diagnosed with a critical illness and I need to make a claim?
Call Pacific Blue Cross at 604 419-2000 or toll free at 1 800 USE-BLUE (873-2583), Monday to Friday, 8:00 a.m. to 4:30 p.m. PST and a Customer Service Representative will send you a claim form to complete.
How do I apply?
Contact us here or call us toll free 1 800 USE-BLUE.