Does critical illness insurance cover heart attack?

Every year in Canada, roughly 63,200 people are diagnosed with a heart attack for the first time (source: Government of Canada). With the heart attack mortality rate of about 12% (source: Healthline), that means that every year over 55,000 people live with varying degrees of heart damage, which can impact lifestyle, mobility, and the ability to work.

Critical illness insurance can play a vital role in supporting people’s heart attack recovery by providing financial protection should they undergo this life-threatening health event. Critical illness insurance is a living benefit that can be used at the insured’s discretion, whether it’s to pay for care, treatment, income replacement, or anything else they may need. Keep reading to learn more about who is eligible for heart attack insurance and how it can protect your financial future.

Can I claim critical illness insurance for a heart attack?

Yes, you can typically claim critical illness insurance for a heart attack, but it depends on the policy terms. Most critical illness policies cover heart attacks, but they may specify severity levels or medical criteria that must be met, such as evidence of heart muscle damage or elevated cardiac enzymes. 

Minor heart conditions might not qualify. It’s essential to review your policy’s definitions and exclusions to understand coverage details and ensure your claim aligns with the requirements.

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What is a heart attack?

A heart attack, also called myocardial infarction, is when the heart muscle suffers damage due to a lack of blood flow and, consequently, lack of oxygen. Just as a stroke is caused by loss of blood flow to the brain, a heart attack is caused by a lack of blood flow to the heart.

The severity of heart attacks varies depending on how long the blood supply is cut off from the vital organ. In worst-case scenarios, it can lead to cardiac arrest and death.

What are the probable causes of a heart attack?

There are several factors that can cause heart attacks. The most common cause is obstructed coronary arteries due to buildup of plaque, cholesterol plaque, or blood clots. Heart attacks can also be caused by a coronary artery spasm, which temporarily restricts the coronary artery, inhibiting blood flow.

While heart attacks are often unexpected, there are certain factors that influence your risk of heart disease—some of which can be mitigated. For instance, smoking, stress, recreational drug use, obesity, high blood pressure, and high cholesterol can all increase your risk of this medical condition. Other uncontrollable factors—such as age, family medical history, and certain autoimmune conditions—can contribute to your risk of a heart attack.

What is critical illness insurance?

Critical illness insurance is a type of coverage offered by life insurance companies (typically as an add-on to a life insurance policy, but can also be purchased as a stand-alone policy) that pays out a tax-free lump sum should the insured be diagnosed with a life-threatening illness or suffer a serious health event while the policy is active.

Unlike traditional life insurance, critical illness insurance issues a benefit while the insured is alive, providing them and their family with financial support as they manage the financial and health impact of a life-threatening illness. This money can be used to pay medical expenses, cover non-traditional treatment, travel expenses or any other expenses the family sees fit.

It should be noted that the critical illness insurance benefit is only paid if the insured is diagnosed with a covered illness, as specified in the policy. The proceeds of the insurance can be used fully at the discretion of the insured.

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How does critical illness insurance work?

Critical illness insurance offers financial protection by paying out a tax-free lump sum if you are diagnosed with a covered condition. To activate the policy, you must:

  • Be diagnosed with a specific illness listed in your plan (e.g., cancer, heart attack)
  • Submit a claim with medical documentation
  • Meet the waiting period requirements (if applicable)

The payout can be used for any purpose, including medical expenses, income replacement, or lifestyle adjustments during recovery.

Does critical illness insurance cover heart attack?

Yes, critical illness policies cover heart attacks. In fact, heart attacks are the second most claimed health event through critical illness coverage (representing 13%), following cancer (63%). If you’ve suffered from a heart attack, it is important to note what insurance companies consider when approving claims.

First, a heart attack requires a medical specialist diagnosis, and the insured must have undergone symptoms as well as electrocardiogram (ECG) changes that are consistent with a heart attack.

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How much does critical illness insurance cost?

Critical illness insurance can cost between $22 and $921 per month depending on factors like age, health, coverage amount, and policy term. For example, A 25-year-old male non-smoker could pay $22.49 per month for $100,000 coverage over 10 years and $56.70 per month for $250,000 coverage over 20 years.

Critical illness insurance premiums across different categories

Category/Coverage Period and Amount 10 Years ($100,000) 20 Years ($100,000) 10 Years ($250,000) 20 Years ($250,000) 10 Years ($500,000) 20 Years ($500,000)
Male Non-Smoker (Age 25) $22.49 $26.82 $48.09 $56.70 $90.21 $108.00
Male Non-Smoker (Age 35) $30.87 $42.50 $68.40 $96.75 $130.81 $187.25
Male Non-Smoker (Age 45) $63.18 $89.78 $136.35 $214.82 $267.30 $423.66
Male Non-Smoker (Age 55) $153.81 $234.09 $321.75 $470.02 $638.10 $921.15
Female Non-Smoker (Age 25) $24.20 $27.09 $47.88 $57.83 $91.49 $110.25
Female Non-Smoker (Age 35) $32.07 $44.04 $69.47 $100.04 $132.95 $195.37
Female Non-Smoker (Age 45) $62.01 $81.74 $135.45 $194.73 $266.40 $383.47
Female Non-Smoker (Age 55) $127.06 $173.70 $285.98 $408.60 $567.45 $801.00

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Is critical illness insurance tax deductible?

The payout from a critical illness policy  is tax-free. However, the premiums paid by individual policyholders, are considered a personal expense and are not tax deductible. For businesses providing critical illness coverage to employees, the premiums may be deductible as a business expense.  

How to claim critical illness insurance?

To claim your critical illness insurance, you need to submit a claim form to your provider within their specified timeframe. For instance, companies like Canada Life and RBC require you to submit your claim form along with satisfactory proof of diagnosis within 30 to 90 days of the diagnosis date or surgery.

Can I be denied critical illness claim for a heart attack?

There can be certain scenarios in which your critical illness claim may be denied. For instance, a claim may be denied if a policyholder has ECG changes that point to a pre-existing heart attack, displays other acute coronary syndromes, or has undergone a medical procedure or received another diagnosis that has caused elevated cardiac biomarkers.

How long do I have to wait to file a claim after having a heart attack?

In order to make a claim for heart attack insurance, policyholders must be diagnosed with a heart attack by a physician and wait 30 days after the diagnosis. This waiting period is called a survival period. Some insurance providers do offer shorter survival periods. Typically, the critical illness benefit will be paid within a month of the claim being submitted.

Can I start a critical illness insurance policy after I’ve had a heart attack?

While it is much easier to start a critical illness insurance policy before suffering any major health events, it is still possible to find coverage after a heart attack recovery. In other words, you have options, though you may not qualify for the most competitive rates or highest benefits.

The most common route for those who have recovered from a heart attack is guaranteed critical illness insurance. This type of policy, though inclusive, has some limitations. For example, guaranteed critical illness insurance typically includes a two-year pre-existing condition exclusion.

This means that if you’ve suffered from a heart attack in the two-year period before the start of the policy, any heart attack or related health event in the next two years will not be covered.

Can I get critical illness insurance if my family has cardiovascular health concerns?

If your family has a history or signs of heart disease, it is prudent to think about investing in critical illness insurance. Though most life insurance companies take family medical histories into account when evaluating a critical illness insurance application, having an increased risk of heart disease will not necessarily exclude you from coverage. Your coverage limit and premium rates, however, may be impacted.

In cases where family history is a consideration, it is advisable to purchase critical illness insurance sooner rather than later. This will increase your chances of being able to place coverage and improve the premium rates you are offered.

To find out more about insurance for heart attacks and other critical health conditions, head to our critical illness insurance learning centre. To better understand how much critical illness insurance coverage you might need, consult our critical illness insurance calculator.

How to get the best critical illness quotes in Canada?

Finding the best critical illness insurance quotes in Canada can be a hassle, but PolicyAdvisor makes it simple and stress-free. With the help of our experienced advisors, you can compare rates from Canada’s top insurance providers, offering side-by-side comparisons of critical illness plans tailored to your needs.

Whether you’re looking for broad coverage, competitive premiums, or specific illness inclusions, PolicyAdvisor can help you curate options based on your unique requirements.

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Frequently asked questions

How does critical illness insurance differ from disability insurance when covering heart attacks?

Critical illness insurance provides a one-time lump sum payment upon diagnosis of a covered condition, like a heart attack, while disability insurance replaces a portion of your income if you’re unable to work due to any medical condition. If your heart attack meets the criteria outlined in your critical illness policy, you’ll receive the payout regardless of your ability to continue working.

Does critical illness insurance cover rehabilitation costs after a heart attack?

The lump sum payout from critical illness insurance can be used for any purpose, including rehabilitation, medical expenses, lifestyle adjustments, or even paying off debt. Unlike health insurance, it doesn’t reimburse specific medical costs—it gives you the flexibility to allocate the funds where you need them most.

What happens if I have multiple heart attacks?

Most critical illness policies provide a one-time lump sum payout per insured condition. If you suffer multiple heart attacks, only the first eligible claim will be covered. However, some policies offer multi-condition coverage or allow for separate claims if different critical illnesses occur. 

Can I purchase critical illness insurance if I already have a heart condition?

If you have a pre-existing heart condition, insurers might exclude heart attacks from your coverage or charge significantly higher premiums. Some specialized policies cater to individuals with pre-existing conditions, though the terms might be more restrictive. Check out your policy documents to find out whether your insurance policy covers heart attack as a pre-existing condition.

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Does critical illness insurance cover diabetes?

 If you have diabetes or are at risk of developing it, you might be wondering whether critical illness insurance can offer financial protection for the condition.

In this article, we’ll explore how critical illness insurance covers diabetes in Canada, what coverage options exist if you’re already diagnosed, and what alternatives to consider if you don’t qualify.

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What is critical illness insurance?

​​Critical illness insurance is a type of insurance policy that pays out a tax-free lump sum should the insured be diagnosed with a life-threatening illness covered by the insurer. This type of coverage is also available as an optional add-on with life insurance policies.

Unlike traditional life insurance, critical illness insurance issues a benefit while the insured is alive, providing them and their family with financial support as they manage the financial and health impact of a life-threatening illness.

What does critical illness insurance cover?

Most critical illness insurance providers cover around 26 conditions, including blindness, limb loss, dementia, cancer, heart attack, and stroke, based on the definitions standardized by the Canadian Life and Health Insurance Association (CLHIA).

However, children’s critical illness policies, or riders, may cover up to 35 conditions, including illnesses commonly diagnosed in children such as autism, cerebral palsy, and more.

What is not covered by critical illness insurance?

Critical illness insurance in Canada typically excludes pre-existing conditions — conditions diagnosed before purchasing the policy, such as diabetes, arthritis, or osteoporosis. Most policies also have a waiting period of 90 days to one year for conditions like cancer and Parkinson’s disease. If you’re diagnosed during this waiting period, you won’t be eligible for benefits.

What is diabetes?

Diabetes is a chronic condition classified by the body’s inability to properly use or produce insulin. Insulin is a hormone normally found in your pancreas that controls glucose (sugar) levels in the blood. 

If you have diabetes, your body doesn’t respond to or produce insulin how it should. This results in high blood glucose (blood sugar) levels. High levels of blood glucose and diabetes can lead to a lot of complications such as cardiovascular disease, stroke, kidney disease, eye damage(retinopathy), glaucoma, gangrene, or even Alzheimer’s

Diabetes can impact anyone at any age although some types are more prevalent among certain demographics. According to the Public Health Agency of Canada, men are more likely to be diagnosed with diabetes than women, except for gestational diabetes. 

What are the various types of diabetes?

There are three main types of diabetes: type 1, type 2, and gestational.   

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease that typically develops during childhood but can also occur in adults. In this condition, the immune system destroys the pancreatic cells that produce insulin. Because Type 1 diabetes is an autoimmune disease, there are no proven ways to prevent it.

Type 2 Diabetes

Type 2 diabetes is a metabolic disorder that most typically appears in adults over the age of 40, however, you can be diagnosed when you’re younger. It occurs when your pancreas doesn’t produce enough insulin to metabolize the amount of glucose in your body or your body isn’t able to properly use the insulin it produces. Contributing factors include fitness levels, weight, ethnicity, family history, and genetics. This condition can be prevented to an extent through lifestyle choices such as diet and exercise.

Gestational Diabetes

Gestational diabetes occurs during pregnancy when your body is unable to produce enough insulin, leading to an increase in blood glucose levels. While gestational diabetes usually goes away a few weeks postpartum, it does signify an increased risk for developing type 2 diabetes in the future. Gestational diabetes can be prevented to an extent through lifestyle choices such as diet and exercise.

Symptoms and Complications

Diabetes can express itself through various symptoms and can lead to a variety of complications. Diabetics can experience increased thirst, increased urination, increased hunger, weight loss, blurry vision, numb hands or feet, and tiredness among other things.

If diabetes isn’t managed properly it can lead to conditions such as high blood pressure, heart disease, kidney failure, stroke, or other complications. These symptoms and complications will all be relevant in determining the level of coverage as well as the cost of a policy that an insurance provider may offer

Treatment & Management

Diabetes is treated through the management of blood sugar and insulin levels. Less serious cases of type 2 diabetes can be managed through diet and exercise. For type 1 and more serious cases of type 2, condition management involves monitoring blood glucose levels and administering insulin in response. 

Before offering coverage, most insurance providers will require at least two tests to determine how well your diabetes has been managed:

  • Glucose test or sugar reading: This reveals your current blood glucose level.
  • HbA1C or A1c test: This test shows your blood glucose levels over the past two to three months by measuring the amount of glucose attached to your red blood cells.

Higher glucose levels can be an indicator of poor health and diabetes management and could result in higher insurance prices.

Does critical illness insurance cover diabetes?

No. Critical illness insurance doesn’t cover diabetes, as it’s considered a chronic condition rather than a life-threatening illness. However, complications arising from diabetes can be life-threatening and are typically covered by critical illness insurance plans. For example, diabetes-related complications like cardiovascular disease, stroke, kidney failure, limb loss, and Alzheimer’s are often covered by these policies.

If you are at risk for diabetes due to your family history, consider getting critical illness insurance to protect yourself against any potential complications. To ensure coverage of future illnesses, be sure to consult your policy and any pre-existing condition exemptions. If you are unsure, consult an advisor to understand your coverage options.

Can I get critical illness insurance if I have been diagnosed with diabetes?

Yes, you can get critical illness insurance after a diabetes diagnosis, but your options will be limited. Your diabetes will be considered a pre-existing condition that can lead to higher premiums. Potential coverage will also vary, depending on the type of diabetes you have, past complications, and how well-managed your diabetes is. If your diabetes is well managed, then the insurance company may approve you for coverage, although there will be a risk of an insurance rating i.e. a price increase. 

Alternative coverage options for individuals with diabetes

If you don’t qualify for standard critical illness insurance coverage plans, you can still qualify for non-medical critical illness insurance policies — simplified issue or guaranteed issue.

If you have a family history of diabetes, it’s better to get critical illness insurance sooner than later as a diagnosis of diabetes can severely limit your coverage options. Simplified or guaranteed coverages, while being more accommodative, may impose a pre-existing condition exclusion as well as a 2-year waiting period.

Read more about simplified issue vs guaranteed issue insurance.

To determine what kind of coverage you qualify for, be sure to chat with one of our advisors.

How do I apply for critical illness insurance with diabetes?

If you want to buy critical illness insurance with diabetes, book a free consultation with our licensed advisors, who’ll help you compare different providers, understand policy terms and exclusions, and find coverage options that match your specific needs.

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Frequently asked questions

Is diabetes part of critical illness insurance?

No, diabetes itself isn’t covered under critical illness insurance as it’s considered a pre-existing condition, which can increase your premiums or disqualify you from coverage. However, many diabetes-related complications, like heart attack, stroke, kidney failure, and blindness, are covered under critical illness insurance, though specific coverage depends on your policy and insurer.

Will my insurance go up if I have diabetes? 

Yes, if you have diabetes, you are likely to pay higher premiums due to the health risks associated with the condition. The cost increase depends on how well-managed your diabetes is. Insurance companies may offer you a rated policy (with higher than standard rates) and require additional medical underwriting, which could lead to even higher premiums or coverage exclusions.

Do I need to inform my insurance company if I have diabetes? 

Yes, you need to disclose your diabetes diagnosis while applying for critical illness insurance. Insurers typically require detailed information about your condition, including ongoing treatments, medications, and recent diagnoses, to assess your risk level. This helps them determine your eligibility, premium costs, and coverage levels. Failing to disclose this information could result in denied claims or canceled coverage in the future.

Can I get life insurance if I have diabetes?

Yes, you can get life insurance if you have diabetes, but your options may be limited. Your coverage and rates will depend on how well-managed your condition is, the type of diabetes you have, and whether you’ve experienced any complications.

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Does critical illness insurance cover cancer?

With one in two Canadians expected to be diagnosed with cancer in their lifetime, as reported by the Canadian Cancer Society, it is no surprise that critical illness insurance covers cancer.

Cancer, a disease caused by the uncontrolled growth of abnormal cells, can affect nearly any part of the body. The treatment costs for cancer can be astronomical, involving surgeries, chemotherapy, radiation, and sometimes experimental treatments.  

In such cases, critical illness insurance provides a lump-sum benefit to help you focus on recovery without the added stress of finances. In this article, we’ll discuss how cancer is covered under critical illness insurance to ensure you’re always prepared for the unexpected.

What is critical illness insurance?

Critical illness insurance is a type of policy that provides a lump-sum payout if the insured person is diagnosed with a covered critical illness. It’s designed to help people financially when faced with a serious health condition.

Commonly covered illnesses include cancer, heart attack, stroke, and organ failure. This coverage can assist in managing medical costs, living expenses, or other financial burdens during a difficult time.

Learn more about how critical illness insurance works
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How does the CLHIA define cancer?

The Canadian Life and Health Insurance Association (CLHIA) defines cancer as a disease characterized by the uncontrolled growth and spread of malignant cells in the body.

It typically includes life-threatening types of cancer that invade tissue and have the potential to spread to other parts of the body.

Does critical illness insurance cover cancer?

Yes, most critical illness insurance policies cover cancer, as it is one of the most commonly diagnosed critical illnesses in Canada. According to the Canadian Cancer Society, cancer is the leading cause of death in Canada, responsible for 30% of all deaths. 

Approximately 2 in 5 Canadians (44% of men and 43% of women) are expected to develop cancer during their lifetime. However, coverage often depends on the type and severity of the cancer.

Policies typically cover life-threatening forms of cancer, while non-invasive or early-stage cancers may be excluded or covered under specific conditions.

What cancers are covered by critical illness insurance?

Critical illness insurance in Canada typically covers a wide range of cancers, including breast, lung, colon, leukemia, and lymphoma. Life-threatening cancers that are invasive and have the potential to spread to other parts of the body are generally included. 

However, non-invasive cancers, early-stage cancers, and some types of less aggressive cancers may be excluded or covered under certain conditions. 

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What cancers are not covered by critical illness insurance?

Typically, non-invasive or early-stage cancers (such as stage 0 or carcinoma in situ) and certain types of skin cancers, like basal cell carcinoma or squamous cell carcinoma, are not covered under most critical illness insurance policies in Canada. Coverage usually focuses on life-threatening and advanced-stage cancers.

However, melanoma, which is an aggressive form of skin cancer, is typically included if it meets the policy’s severity criteria (e.g., the cancer must have invaded deeper skin layers or spread). Other types of cancer that may be covered are:

  • Blood cancers like leukemia may be covered if they reach a specific stage
  • Thyroid cancers may only qualify if they exceed a specific tumor size or require aggressive treatment

Is breast cancer covered by critical illness insurance? 

Yes, breast cancer is covered by most critical illness insurance providers in Canada as long as the policyholder meets their terms and conditions and is not diagnosed during the initial waiting period (typically 90 days). 

Some policies, like RBC’s Critical Illness Insurance Plan, also provide you the full benefit amount if you’re diagnosed at an early stage.

Are genetic tests for cancer covered under critical illness insurance policies?

No, critical illness insurance policies typically do not cover genetic tests for cancer, as they are considered preventative or diagnostic rather than treatment-related.

Policies mostly cover the treatment of diagnosed conditions, rather than the cost of tests or screenings. However, some insurers may offer additional coverage or wellness benefits that could cover the cost of certain tests. 

Can I submit a claim on a critical illness policy upon diagnosis of cancer?

Yes, you can submit a claim on a critical illness policy upon being diagnosed with cancer, but it depends on the type and severity of the diagnosis. Most policies cover life-threatening cancers as defined in the terms of the policy. 

Early-stage or non-invasive cancers may not qualify for a claim or might require additional criteria to be met. You must always consult your insurer to understand the claims process and required documentation, such as medical reports.

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Is prostate cancer covered by critical illness insurance?

Yes, prostate cancer is generally covered by critical illness insurance in Canada, provided it meets the severity and life-threatening criteria set out in the policy. 

Early-stage prostate cancer may not qualify for a claim, but if the cancer progresses to a more serious stage and meets the policy’s definition, a claim can typically be made. 

For instance, Manulife’s Lifecheque® and Sun Life’s Critical Illness plans cover Stage A (T1a or T1b) prostate cancer, provided the diagnosis is made by a specialist and confirmed through a pathological examination of the tissue.

Can I get critical illness insurance if I am in remission?

Yes, you may be able to get critical illness insurance if you are in remission, but approval will depend on several factors, including how long you’ve been cancer-free and the specific policy guidelines.

Insurers often impose waiting periods or exclusions for pre-existing conditions. However, you should remain prepared for higher premiums or limited coverage, as a history of cancer increases the perceived risk.

Can I get critical illness insurance if I have a family history of cancer?

Yes, having a family history of cancer does not automatically disqualify you from getting critical illness insurance. However, insurers may consider it during the underwriting process. 

This could lead to higher premiums or additional exclusions, depending on the policy and how closely related the family members with cancer are. It’s important to disclose your family medical history accurately to avoid issues during claims.

How to buy critical illness insurance?

There are different ways to buy critical illness insurance, depending on your requirements, such as individual, group and special purpose policies. Here are the most common options:

  • Individual policy: Can be purchased through an agent or online, and usually requires medical underwriting to determine your eligibility and premium costs
  • Group plan: Available through your employer or association you’re enrolled with. These plans are either partially or fully paid for by the entity providing them (as they’re considered the policyholders). Coverage usually ends when you leave the employer or association
  • Special purpose plan: This type of critical illness insurance covers your loan payments for a specific period, if you’re diagnosed with a critical illness. You can apply for a special purpose policy by checking a box on your loan application or submitting an insurance application after your loan’s approval

You can have multiple types of critical illness insurance simultaneously. To determine the right coverage for your needs, schedule a free consultation with our licensed advisors.

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Frequently asked questions

Is there a waiting period for cancer coverage under critical illness insurance?

Yes, most critical illness insurance policies in Canada have a waiting period before cancer coverage applies. This waiting period can range from 30 days to several months, depending on the insurer. 

The waiting period typically ensures that the cancer diagnosis occurred after the policy was active and helps prevent claims for pre-existing conditions. 

Does critical illness insurance provide a lump sum payout for all types of cancer?

Critical illness insurance usually provides a lump sum payout for a range of life-threatening cancers, but not all types of cancer are covered equally. For example, invasive cancers that meet the severity criteria of the policy are typically eligible for a lump sum payout. 

However, early-stage or non-invasive cancers, like certain forms of skin cancer or Stage 0 cancers, may not qualify. It’s essential to understand the specifics of the policy, including the types of cancer covered and any exclusions or limitations.

Can cancer survivors increase their coverage amount after a policy is in place?

In most cases, cancer survivors cannot increase their critical illness insurance coverage amount once a diagnosis has been made. This is due to the fact that insurance companies typically do not allow coverage increases for pre-existing conditions. 

If you are a cancer survivor, any changes to your policy, such as increasing coverage, may be subject to additional underwriting or exclusions. 

How does a critical illness policy differ from a terminal illness benefit?

A critical illness policy and a terminal illness benefit both provide financial support in the event of a serious illness, but they differ in coverage and purpose.

Critical illness insurance provides a lump sum payout for a range of serious illnesses, such as cancer, heart attack, or stroke, provided the condition meets the policy’s severity criteria. 

On the other hand, a terminal illness benefit is specifically for situations where the illness is expected to result in death within a defined period, usually 12 months.

Some critical illness policies may include a terminal illness benefit as part of the coverage, allowing for an early payout if the policyholder is diagnosed with a terminal condition.

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Does critical illness insurance cover stroke?

Every year over 100,000 Canadians will experience a stroke, making it the leading cause of adult disability in the country (source: the Heart and Stroke Foundation of Canada). Symptoms vary, but the short and long-term effects of a stroke can be debilitating and even life-threatening. Strokes are also the third leading cause of death in Canada.

While insurance can’t protect against the medical risk of stroke, it can provide a financial safety net should you or a loved one be diagnosed with this critical illness. Critical illness insurance can help pay for treatment, care, or general support. In Canada, strokes represent the third most common diagnosis claimed through critical illness insurance. 

Keep reading to find out more about how critical illness insurance can benefit you if you or a loved one is at risk for stroke.

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What is critical illness insurance?

Critical illness insurance provides a tax-free lump sum payment if you’re diagnosed with a life-threatening illness or experience a serious health event covered by your insurer. While available as a standalone policy, you can also add it to your life insurance plan as a rider (or an optional add-on), though its coverage may be limited.

Unlike regular health insurance that covers ongoing medical expenses, critical illness insurance offers a one-time payment that you can use however you need, whether that’s for replacing lost income, supporting your family, or paying off debts.

What is a stroke?

A stroke, or cerebrovascular accident, occurs when the brain loses blood flow due to a hemorrhage, embolism, or thrombosis. This loss of blood damages brain cells, leading to stroke symptoms. Early warning signs include numbness, confusion, severe headaches, and loss of balance, while long-term effects can include speech impairments, memory problems, and permanent loss of function.

There are three main types of stroke:

  • Ischemic strokes: The most common type of strokes, ischemic strokes are caused when a blood vessel in the brain becomes blocked by a blood clot or plaque buildup
  • Hemorrhagic stroke: Occurs when a blood vessel in the brain ruptures. This type is often linked to high blood pressure and can cause severe damage as blood pools in the brain
  • Transient ischemic attack (TIA): Often called a “mini-stroke,” a TIA occurs when blood flow to the brain is temporarily blocked. While symptoms are usually mild and short-lived, a TIA often serves as a warning sign that a more severe stroke may be imminent

Does Critical illness insurance cover stroke?

Yes! Strokes fall under covered health conditions in most critical illness insurance policies. In fact, strokes are one of the main conditions covered by both basic critical illness policies (covering 3 or 4 conditions) and enhanced critical illness insurance policies (covering 25 or 26 conditions).

Coverage conditions

Most Canadian insurers use (and adhere to) the Canadian Life and Health Insurance Association’s (CLHIA) definition of stroke when assessing claims for the condition. According to the CLHIA, a stroke is an acute cerebrovascular event caused by intracranial thrombosis, or hemorrhage, or embolism from an extracranial source, with:

  • Acute onset of new neurological symptoms, and
  • New objective neurological deficits on clinical examination,
  • Persisting for more than 30 days following the date of diagnosis. These new symptoms and deficits must be corroborated by diagnostic imaging testing. The diagnosis of stroke must be made by a specialist

Potential Exclusions

Depending on the type or severity of stroke, there may be exclusions. For example, TIAs or mini-strokes, intracerebral vascular events (strokes caused by trauma), and lacunar strokes that don’t meet the above definition may not be covered.

Read our full guide on what critical illness insurance covers in Canada

How long do I have to wait to file a claim after having a stroke?

Most critical illness insurance policies include a survival period clause. This means you must survive for at least 30 days after a stroke diagnosis before filing a claim. It is only after this period that the benefit will be paid. 

Most companies will require medical information about the diagnosis, including signs, symptoms, and related investigations, within six months of the date of diagnosis.

Can I get critical illness insurance after having a stroke?

Yes, you can buy critical illness insurance after having a stroke in Canada. You have two options:

  • Guaranteed critical illness insurance: This coverage doesn’t require a medical evaluation but includes a two-year pre-existing condition exclusion. This means if you had a stroke within two years before applying, the policy won’t pay out if another stroke occurs during the first two years of coverage. The exclusion may also apply to other critical illnesses directly related to the stroke
  • Traditional fully underwritten insurance: Depending on the severity of your stroke and how much time has passed (typically several years), you may qualify for traditional, fully underwritten insurance. Your eligibility will be assessed based on your medical history and current health status

Can I get critical illness insurance if I have a family history of stroke?

Yes, but your eligibility and premiums will be based on your current health condition and risk factors. If you have a family history of stroke, insurers will take that into account while deciding on your premiums and coverage levels.  You may receive an insurance rating, leading to higher premiums, or specific coverage exclusions.

Despite this, if you’re at high risk for stroke due to family history, you should absolutely get critical illness insurance. We recommend speaking with an insurance advisor to understand how your family history might affect your coverage options.

How can I purchase critical illness insurance?

You can buy critical illness insurance as an individual policy, get coverage through your employer, or opt for a special plan that’s linked to your mortgage:

  • Individual policy: You can purchase this directly through an insurance agent or online. These types of policies usually require medical underwriting but also give you more control over your coverage
  • Group plan: You might already have access to this through your employer or a professional association. These plans are partially or fully paid for by their providers, and their coverage usually ends when you’re no longer associated with them
  • Special-purpose plan: This type of insurance covers your loan payments for a set period if you’re diagnosed with a covered condition. You can apply for it when completing your loan application or after your loan’s approval

You can hold multiple types of critical illness insurance simultaneously for broader protection. As always, we recommend booking a free consultation with our licensed advisors for personalized guidance on your coverage needs.

Need insurance help?

Give us a call at 1-888-601-9980 or book some time with our licensed experts.

Frequently Asked Questions

Is stroke covered by critical illness insurance?

Yes, most critical illness insurance policies cover stroke as a qualifying condition, provided it meets the CLHIA’s definition of stroke (see above) and doesn’t fall under any exclusions. Many insurance companies, including Sun Life, don’t cover mini-strokes (TIAs), strokes caused by trauma, or lacunar strokes that don’t meet the CLHIA’s definition.

What are the benefits of having critical illness insurance in case of a stroke?

Critical illness insurance provides a tax-free lump-sum payment upon the diagnosis of a stroke that you can use for:

  • Medical and recovery costs: Pay for specialized treatments and rehabilitation services, or hire private healthcare support
  • Income replacement: Cover your living expenses while you’re unable to work
  • Home modifications: Adapt your living space to accommodate any physical limitations
  • Debt management: Keep up with mortgage payments and other financial obligations
  • Family support: Help your family maintain their standard of living or cover caregiving costs
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Critical illness riders vs critical illness insurance — which one should you choose?

There are multiple ways to get critical illness insurance coverage. A critical illness rider is often a less expensive option, but whether it’s better for you than a full policy depends on your health risks, financial obligations, and personal and family needs.

This article examines the key features and differences between both options to help you decide which is right for your situation.

What is a critical illness rider?

A critical illness rider is an optional add-on for your main insurance policy. In Canada, most people add it onto their life insurance as a way to get additional coverage. But you can add it to other policies too, like mortgage insurance or disability insurance.

Riders will still cover you for major illnesses, but they won’t have all the same features a full policy can give you. A rider may also not cover you for as many health issues or for as much money as a full-scale critical illness policy will.

But, it does cost less than a full, separate policy does. And it can be convenient to buy multiple coverages at the same time like this. Critical illness is one of the most common riders Canadians get for their life insurance coverage.

How does a critical illness insurance rider work? 

With a critical illness rider, if you get a serious illness that your insurance provider has agreed to cover, they will pay you out a portion of your life insurance death benefit early.

They will give this to you as a one-time, lump sum payment that’s tax-free. But only once, and only for qualifying illness — which could be as little as 3 or 4.

Author Photo
There is much variation in the numbers and types of riders offered by various insurance companies. To ensure you get the right policy and type of coverage you want, we suggest enlisting the help of a licensed insurance broker.
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Jiten Puri
CEO, PolicyAdvisor.com

Does a critical illness rider cover the same things critical illness insurance does?

It depends. Most CI riders cover fewer conditions than a full-scale policy will. It depends on the company, though. Some life insurance companies have riders that cover the same number of illnesses as a regular plan. And some of those can cover as many as 26 health conditions. But that’s rare for riders.

Full list of conditions covered by critical illness insurance in Canada

What is a critical illness insurance policy?

Critical illness insurance is a form of insurance that pays you a lump sum if you are diagnosed with a serious illness. The critical illness benefit money can be used for anything you need, like covering costs for:

  • At-home or specialty medical care
  • Prescription medication
  • Other treatment costs
  • Home modifications
  • Debt
  • Lost income
  • Daily living expenses
  • Other financial obligations

Most standalone CI policies will cover at least the major health conditions that are most common in Canada, like cancer, heart disease, multiple sclerosis, and more.

If you get a critical illness diagnosis and you have a standalone policy, you get a full lump-sum payment to use however you need to.

What is the difference between critical illness riders vs critical illness insurance?

A critical illness rider is like a smaller version of a critical illness insurance policy. They’ll both give you a payout if you’re diagnosed with a serious, life-altering illness. But a full policy will normally give you better coverage. An optional rider will be cheaper, but will have more coverage limits.

Think of it like a donut vs a mini donut. They’re both the same thing in a way, but on different scales. Let’s look at the different features of each below.

critical illness riders vs policies
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Critical illness riders vs critical illness insurance: pros and cons

Let’s look at the pros and cons of both critical illness insurance and critical illness riders to determine which offers more benefits and flexibility.

Pros and cons of critical illness riders 

Critical illness riders offer several benefits, including no medical underwriting and lower costs compared to full policies. However, they also have some limitations:

Critical Illness Insurance Rider: Pros and Cons

Pros Cons
Lower cost Limited flexibility — you can’t customize it as much as a full policy
No underwriting — it comes with an insurance policy so underwriting has already been done Attached to another policy — if you lose that coverage, you also lose this rider
You can cancel it without losing the insurance policy it’s attached to You can only get it when you buy a new insurance policy — it can’t be added to an existing policy
Can be convenient to get multiples types of insurance coverage at the same time  No options to get your money back if you don’t submit a claim (return of premium)
Limited coverage amount
May not cover you for as many medical conditions as a full policy would
May not give partial payments for some conditions — check with your advisor
Can decrease your payout for other insurance — if you have to make a claim, the money will be taken from the payout of the insurance policy it’s attached to

Pros and cons of critical illness insurance

Critical illness insurance offers coverage for 26+ serious health conditions. However, it requires thorough medical underwriting and can be expensive for people with pre-existing conditions like diabetes and arthritis. Here are the key benefits and limitations of critical illness insurance:

Critical Illness Insurance Policy: Pros and Cons

Pros Cons
Full coverage — can cover up to 26 major illnesses Premium rates can be more expensive than riders and other types of insurance policies
Higher amount of coverage — up to $2.5 million Thorough underwriting process
More customization options and flexibility
Return of premium options — get your money back if you don’t end up having to make a claim
Many plans pay out for partial conditions — such as early-stage cancers
Some plans can give more than one lump sum payout if you get the same illness more than once

Get critical illness insurance

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Is it better to get a critical illness insurance rider or a full policy?

Whether you should get a rider or a stand-alone policy will depend on you and your family’s needs. Both have their pros and cons. It could come down to whether it’s most important that you have a lot of coverage, that you save as much as possible, that you have more flexible options, or more.

You should get a critical illness rider if:

  • You are about to buy life insurance and you want to get critical illness coverage at the same time
  • You want the lowest cost for coverage possible
  • You want to be approved very quickly
  • Optional features and high coverage amounts aren’t as important to you
  • You just want basic coverage

You should get a standalone critical illness insurance if:

  • You need to have a lot of coverage — such as if you’re a high-income earner or if you have a lot of debt
  • It’s important to you to have flexibility to change or customize your policy to fit your exact needs
  • You want critical illness coverage but you already have an existing life/mortgage/disability insurance policy
  • You don’t want to diminish your life insurance payout if you happen to become ill with a life-threatening illness in the future
  • You’re not on an extremely tight budget

How to buy critical illness insurance: rider vs full policy

You can only buy a critical illness insurance rider when you’re buying a new policy At PolicyAdvisor, we have a range of insurance products with the option to add this type of insurance as a rider.

If, however, you want to buy a standalone critical illness insurance policy, you can get the lowest rates from Canada’s top insurers using our online tool or schedule a free consultation with our licensed advisors, who can help you choose a plan more suitable for your requirements.

Need insurance help?

Give us a call at 1-888-601-9980 or book some time with our licensed experts.

Frequently asked questions

Is a critical illness insurance rider worth it?

It depends on you and your needs. A critical illness rider may be worth it if you just want something basic and are willing to sacrifice flexibility for a low cost.

In our opinion, though, most people are better off getting more comprehensive protection if it can fit in their budget.

Does a regular critical illness plan have the same survival period as a rider?

Yes, critical illness insurance coverage usually has the same survival period whether you buy it as its own policy or as an optional life insurance rider.

The survival period is the amount of time after a diagnosis that you have to live before the insurance provider will give you a claim payout. Most insurance companies have a 30-day survival period.

Does a critical illness (CI) rider have exclusions a stand-alone policy does not?

Yes, critical illness riders often have exclusions that a standalone policy does not. Here are some differences between the two in terms of exclusions:

  • Coverage amount: Most CI riders will only cover up to $25,000 for a critical illness. Full coverage could get you up to $2.5 million.
  • Covered conditions: Many riders won’t cover more than a handful of major illnesses. In our experience, most will cover just the basic 3 — life-threatening cancerheart attack, and stroke. Some may cover up to 26 like a full policy does, but these are pretty rare.
  • Can’t be retained upon cancellation of main policy: You can cancel a rider and keep the policy it’s attached to, but not the other way around. If your main policy is canceled, you also lose your rider. Or, if your base policy is only for a 10-year term, your critical illness cover will also only last for those 10 years.
  • Limited conversion options: With term insurance plans, some companies let you convert to permanent life insurance down the line — or to a different type of policy. But, if you had a critical illness insurance rider attached to that term life insurance, you may not have the same options to bring it over to your permanent plan.

What’s the difference between a critical illness rider and a terminal illness rider?

A critical illness rider is an optional add-on, which can be added to a life insurance policy for a small extra cost. It pays a one-time lump-sum amount iff you’re diagnosed with a covered illness.

A terminal illness rider is also an optional benefit that is usually included for free in life insurance plans. It pays a one-time lump-sum benefit (typically 50%-75% of the insured amount) if you’re diagnosed with a terminal illness and have two years or less to live.

What does life insurance with critical illness cover?

Life insurance with a critical illness rider in Canada combines death benefits and living benefits. If you are diagnosed with a covered critical illness, you receive a tax-free lump-sum payout. This money can help cover medical expenses, lost income, or other costs associated with recovery, ensuring financial support during a challenging time.

If no claim is made during the term of the policy and you pass away, your beneficiaries will receive the death benefit, which helps cover funeral costs, and outstanding debts, and provides financial support for your family after your passing.

What is the difference between critical illness insurance and life insurance?

Critical illness insurance offers a living benefit designed to support you while you’re alive. Life insurance offers a death benefit to your beneficiaries in the event of your demise. 

Critical illness insurance offers a lump-sum payout if you’re diagnosed with a life-threatening illness like cancer, heart attack, or stroke. On the other hand, life insurance is meant to protect your loved ones after your passing. If you die, life insurance pays out a death benefit to your beneficiaries, helping them cover funeral expenses and debts, and maintain their lifestyle without the burden of financial uncertainty.

Does life insurance cover critical illness?

No, life insurance and critical illness insurance are separate products that serve different purposes. Life insurance covers you for a set period (or in the case of permanent life insurance, your entire lifetime) and only pays a benefit upon your passing. It does not cover conditions like heart attack, cancer, and stroke, nor does it provide benefits upon diagnosis.

Critical illness insurance, on the other hand, is a living benefit policy that covers these conditions and pays a lump-sum benefit upon their diagnosis. 

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When should I buy critical illness insurance?

You should buy critical illness insurance in Canada as early as possible, ideally in your 20s or 30s, when premiums are lower, and you’re more likely to qualify for coverage without health complications.

Purchasing coverage early ensures financial protection if you’re diagnosed with a severe illness later in life, offering a lump-sum payout to cover medical costs, lost income, or other expenses. 

In this article, we’ll explore the best time to buy critical illness insurance in Canada and why acting early can greatly benefit you.

What is critical illness insurance?

Critical illness insurance is a type of policy that provides a lump-sum payout if the insured person is diagnosed with a covered critical illness. It helps people financially when facing serious health conditions.

Commonly covered illnesses include cancer, heart attack, stroke, and organ failure. This coverage can assist in managing medical costs, living expenses, or other financial burdens during a difficult time.

Read more about how critical illness insurance works.
Critical illness statistics
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Is critical illness insurance worth it in Canada?

Yes, critical illness insurance is worth it in Canada because provincial healthcare only covers basic medical needs, such as hospital stays and essential treatments.

It doesn’t cover lost income, specialized treatments, or private care, leaving gaps that can cause financial strain during a serious illness. 

Critical illness insurance helps fill these gaps through a lump-sum payout. Given the high prevalence of serious illnesses like cancer, heart attacks, and strokes, critical illness insurance ensures that if you’re diagnosed with a life-threatening illness, you won’t have to bear the financial burden alone.

Here are a few situations where critical illness insurance can play a crucial role in saving your financial life:

  • Your spouse needs to take time off work and does not have allowances for paid extended leaves of absence; the critical illness insurance can be used to replace all or part of their income (depending on how much coverage you purchase)
  • You are self-employed and do not qualify for disability insurance, critical illness insurance can be used to replace your income
  • Your medical expenses are not covered by your extended medical or universal health care. This might include adapting your home for any new physical disability you may have or physio appointments
common critical illnesses in Canada

When is the best time to buy critical illness insurance?

The best time to buy critical illness insurance is when you’re young and healthy. Early purchase ensures lower premiums, broader coverage, and fewer restrictions based on pre-existing conditions.

Life milestones, health changes, or shifts in financial responsibilities are also key moments to consider buying a policy.

Buying critical illness insurance in your 20s or early 30s has distinct advantages like lower premiums, easier chances of approval, and a solid financial foundation for your future.

Additionally, major life events like marriage, starting a family, or purchasing a home are ideal times to assess your insurance needs. 

Lastly, and importantly, if you’ve experienced a recent health diagnosis or learned of medical conditions in your family history, it’s crucial to get critical illness insurance sooner. 

What age should you get critical illness coverage?

The younger you are when you get critical illness insurance, the better it is. Younger people are generally healthier, which means your premiums will be lower. Insurance companies base premiums on factors like age, health, and lifestyle, so securing coverage while you’re younger helps lock in more affordable rates. 

By purchasing critical illness insurance early, you also ensure that you’re covered before any pre-existing conditions develop.

Pre-existing conditions such as high blood pressure, diabetes, or heart problems can make it harder to qualify for coverage or result in exclusions from your policy.  

Parents can also buy critical illness insurance for their children right after birth up to the age of 25. The premium costs for children’s critical illness insurance are substantially lower and the coverage is guaranteed. 

Act early to protect your health!

Get the lowest critical illness insurance quote today!

What is the age limit for critical illness insurance?

The age limit for critical illness insurance typically varies by insurer and policy, but most Canadian insurers offer coverage up to the age of 65. Once you reach this age, some policies may offer renewal options but may not allow new applications. 

However, there are exceptions where certain policies may provide coverage beyond age 65. These extended policies may come with adjusted terms or premium rates. For example, Manulife’s Lifecheque® Basic critical illness insurance plan covers individuals till the age of 75.

As you age, you may face higher premiums or limitations on the types of illnesses covered. In some cases, insurers might impose restrictions or exclusions for certain pre-existing conditions or health risks that become more common as you get older.  

When can you buy critical illness insurance for your child?

You can purchase critical illness insurance for your child from birth until they turn 25, depending on the provider. Some companies even offer extended coverage for additional conditions if the child is under 17 years of age.

While you can apply for coverage as early as one day after your child is born, most insurers require the policy to be issued when the child is at least one month old. 

critical illness riders

What factors should you consider before purchasing critical illness insurance?

Before purchasing critical illness insurance, it’s important to assess factors such as the affordability of premiums within your budget, and whether existing coverage like life or disability insurance meets your needs. 

Consider your age, health, and financial responsibilities, as these affect premiums and coverage options. Additionally, reviewing policy details, including exclusions, is crucial. Here’s what you must bear in mind:

Budgeting for premiums: Ensure premiums align with your financial plan and are affordable long-term

Evaluating existing coverage: Review current insurance policies, such as life or disability insurance and Identify gaps that critical illness insurance can fill, such as covering medical costs or lost income

Health status: Purchase while you’re in good health to secure lower premiums and broader coverage

Age and eligibility: Younger applicants often benefit from lower premiums and better terms

Coverage needs: Consider the conditions covered and whether they align with your family’s medical history, and check for add-ons or riders, like return-of-premium or child coverage, to enhance protection

Policy terms and exclusions: Ensure you check waiting periods, claim limits, and exclusions specific to the policy 

Financial responsibilities: Assess current and future financial obligations, such as loans, mortgages, or dependents

Learn more about the best critical illness insurance companies in Canada

How to buy critical illness insurance?

You can purchase critical illness insurance through individual policies, group plans, or special-purpose plans, depending on your needs.

  • Individual policy: Can be purchased through an agent or online, and usually requires medical underwriting to determine your eligibility and premium costs
  • Group plan: Available through your employer or association you’re enrolled with. These plans are either partially or fully paid for by the entity providing them (as they’re considered the policyholders). Coverage usually ends when you leave the employer or association
  • Special purpose plan: This type of critical illness insurance covers your loan payments for a specific period, if you’re diagnosed with a critical illness. You can apply for a special purpose policy by checking a box on your loan application or submitting an insurance application after your loan’s approval

Note that you can have multiple types of critical illness insurance simultaneously. To determine the right coverage for your needs, schedule a free consultation with our licensed advisors.

Need help?

Call us at 1-888-601-9980 or book time with our licensed experts.

Frequently asked questions

Are the benefits from critical illness insurance taxable?

No, critical illness insurance payouts in Canada are entirely tax-free. This means the lump sum you receive can be used for any purpose—medical bills, living expenses, or even recovery-related travel without any tax deductions or implications.

What happens if I recover quickly from a critical illness?

Yes, you will still receive the benefits as long as you meet the policy criteria. Critical illness insurance is designed to provide a payout based on the diagnosis of a covered condition, not your recovery status.

Once you are diagnosed with a listed illness and survive the waiting period (typically 30 days), the payout is issued, even if you make a full recovery soon after. This flexibility ensures financial support regardless of your recovery timeline.

What is the rule of thumb for critical illness coverage?

The general rule of thumb is to aim for coverage that lasts at least five years. This timeframe accounts for the average recovery period from a critical illness, allowing time to recuperate, return to work, and adapt to any lifestyle changes. Additionally, consider the types of illnesses and treatments you may need, as these factors will influence the amount of coverage required.

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What does critical illness insurance cover in Canada?

Understanding what conditions are covered by critical illness insurance is crucial before purchasing a policy. While it provides a tax-free lump sum payment for serious health conditions like heart attack, cancer, and stroke, not all conditions qualify for a claim.

In this post, we’ll examine what critical illness insurance covers in Canada and what constitutes a valid claim.

But first, let’s take a closer look at how it works.

How does critical illness insurance work?

Critical illness insurance offers financial protection by paying out a tax-free lump sum if you are diagnosed with a covered condition. To activate the policy, you must:

  • Be diagnosed with a specific illness listed in your plan (e.g., cancer, heart attack)
  • Submit a claim with medical documentation
  • Meet the waiting period requirements (if applicable)

The payout can be used for any purpose, including medical expenses, income replacement, or lifestyle adjustments during recovery.

Commonly covered critical illnesses and conditions

In 2018, the Canadian Life and Health Insurance Association (CLHIA) updated its Critical Illness Benchmark Definitions in order to help standardize the language around common conditions and afflictions across the industry.

CLHIA listed and defined 26 common illnesses, conditions or health events in their publication, but that is not the maximum number of conditions that can or will be covered by an insurance provider. Some insurers may offer coverage for illnesses not defined by the CLHIA and some may even use their own qualifying language.

However, these definitions are commonly used and adhered to by many insurers, so you should familiarize yourself with them before choosing a provider. This is true whether you have a critical illness insurance policy or riders. There are some important distinctions in their descriptions. Whether it’s as broad as specifying coverage is only for bacterial meningitis and not viral, or as specific as the hourly length of time of a coma and its grade on the Glasgow coma scale, this language is ultimately used to determine the validity of your claim and therefore vital to understand.

The 26 conditions that most common carriers cover are:

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Please note that not all of these are included in every insurance policy, unless explicitly stated. If you have an existing policy or intend to buy one, please refer to the policy documents for full terms, conditions, and definitions.

What critical illness insurance is offered by Canada’s biggest insurers?

Critical illness insurance in its current form was introduced in Canada in the 1990s and is still a developing sector in the insurance industry today. Most of the major companies do offer some kind of policy though.

Some plans feature coverage for just one ailment, like cancer (and its many forms), whereas others cover the full 26 illnesses listed above, and sometimes even more. More commonly, carriers will cover the big three—cancer, heart attack, and stroke. The number of covered conditions varies somewhat from company to company. So if you’re looking to cover a specific illness, it’s worth exploring products from a variety of providers.

Putting cost aside, a quick glance at the offerings from most providers shows that critical illness products are often offered in a similar fashion no matter the company, with the biggest differentiator being the number of illnesses covered. However, there are some additional features and benefits you can look for when deciding which policy is best for you.

Partial payouts and non-life-threatening illnesses

An interesting feature included in some policies is the partial payout option or—as some companies may call it—“an early discovery benefit”. What this means is that you can receive a small amount of money if you contract a non-life threatening or less-critical illness/condition while insured.

An example of this would be if you develop treatable skin cancer. To the average person this definitely still means the big “C” cancer, however you will not qualify for full payment of the policy benefit amount as most policies do not consider it a “critical illness”. However, if you had a partial payout clause, you’d still receive some money as you did contract a form of cancer listed as eligible, and your policy would carry on through the length of your term.

These partial payout clauses typically payout between 10 to 25 percent of your policy’s value (though generally there is a maximum payout) and most importantly it doesn’t void your policy or reduce your final payout if you do end up subsequently contracting a defined life-threatening critical illness.

So, what illnesses qualify for partial payout?

These vary between provider and policy, but partial payouts often cover forms of non-life-threatening cancer and coronary angioplasty. The number of covered conditions will typically range between 4 and 16. Some companies will allow for one partial payout while others may allow for multiple partial payouts.

What are the most claims for critical illness?

In Canada, the majority of critical illness insurance claims are made for cancer, heart attack, and stroke. According to Health Risk Services Inc., approximately 67% of all critical illness claims are for cancer!
Cancer, followed by heart attack and strokes are conditions that dominate the landscape of critical illness insurance claims due to their high prevalence, severe impact on individuals’ health, and the significant financial burden they can cause.

Most claimed critical illnesses

How to claim critical illness insurance?

To claim your critical illness insurance, you need to submit a claim form to your provider within their specified timeframe. For instance, companies like Canada Life and RBC require you to submit your claim form along with satisfactory proof of diagnosis within 30 to 90 days of the diagnosis date or surgery.

How to get critical illness insurance?

There are several ways to obtain critical illness insurance, depending on your requirements. Here are the most common options:

  • Individual policy: Can be purchased through an agent or online, and usually requires medical underwriting to determine your eligibility and premium costs
  • Group plan: Available through your employer or association you’re enrolled with. These plans are either partially or fully paid for by the entity providing them (as they’re considered the policyholders). Coverage usually ends when you leave the employer or association
  • Special purpose plan: This type of critical illness insurance covers your loan payments for a specific period, if you’re diagnosed with a critical illness. You can apply for a special purpose policy by checking a box on your loan application or submitting an insurance application after your loan’s approval

Note that you can have multiple types of critical illness insurance simultaneously. To determine the right coverage for your needs, schedule a free consultation with our licensed advisors.

Insurance can be affordable

Find the lowest quotes from the best critical illness insurance providers in Canada 

Comparison with other health insurance products

While it provides coverage for specific medical conditions, critical illness insurance shouldn’t be confused with health insurance, which reimburses certain medical expenses, or disability insurance, which replaces your income if you become disabled. Each of these products serves a distinct purpose, as explained below:

Category Critical illness insurance Health insurance Disability insurance
Definition Provides a one-time lump-sum payment if you’re diagnosed with a covered condition Covers medical expenses not covered by provincial healthcare Replaces 60 to 85 percent of your income if you become disabled
Payout type One-time tax-free benefit Reimburses covered medical expenses (upon submission of required documents) Pays monthly or weekly benefit until you return to work
Coverage duration Limited period (10 or 20 years) or lifetime (up to age 100) As long as premiums are paid Until the age of 65
What is covered?
  • Cancer 
  • Heart attack,
  • Stroke
  • Major organ failure
  • Other critical health conditions
  • Prescription drugs
  • Dental and vision care
  • Paramedical expenses
  • Medical equipment
  • Emergency travel medical insurance
Illness or injury that leads

to a loss of income

Maximum coverage limit $2-$3 million No maximum coverage limit Depends on age, occupation, income, and other limitations
Triggered by Diagnosis of a covered condition Medical treatment or hospitalization Illness or injury that keeps you from working

Definitions of critical illnesses in Canada

In 2013, the Canadian Life and Health Insurance Association published standardized definitions of critical illnesses to help create consistency around common conditions and afflictions across the insurance industry. Let’s look at 26 critical illness definitions used widely by Canadian insurance companies:

Cancers and Tumours

Benign Brain Tumour

Benign Brain Tumor is a definite diagnosis of a non-malignant tumor located in the cranial vault and limited to the brain, meninges, cranial nerves, or pituitary gland. The tumor must require surgical or radiation treatment or cause Irreversible objective neurological deficit(s).

Exclusions: No benefit will be payable under this condition for:

  • Pituitary adenomas less than 10 mm;
  • Vascular malformations;
  • Cholesteatomas; or
  • Infectious or inflammatory tumors

Cancer (life-threatening)

Cancer (life-threatening) means the definite diagnosis of a malignant tumor. This tumor must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma.

Exclusions: No benefit will be payable under this Covered Condition for the following:

  • Lesions described as benign, non-invasive, pre-malignant, of low and/or uncertain malignant potential, borderline, carcinoma in situ, or tumors classified as Tis or Ta
  • Malignant melanoma of skin that is less than or equal to 1.0mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis
  • Any non-melanoma skin cancer, without lymph node or distant metastasis. This includes but is not limited to, cutaneous T cell lymphoma, basal cell carcinoma, squamous cell carcinoma, or Merkel cell carcinoma
  • Prostate cancer classified as T1a or T1b, without lymph node or distant metastasis
  • Papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0cm in greatest dimension and classified as T1, without lymph node or distant metastasis
  • Chronic lymphocytic leukemia classified as Rai stage 0 without enlargement of lymph nodes, spleen, or liver and with normal red blood cell and platelet counts;
  • Gastro-intestinal stromal tumors classified as AJCC Stage 1
  • Grade 1 neuroendocrine tumors (carcinoid) confined to the affected organ, treated with surgery alone, and requiring no additional treatment, other than perioperative medication to oppose effects from hormonal oversecretion by the tumor 
  • Thymomas (stage 1) confined to the thymus, without evidence of invasion into the capsule or spread beyond the thymus

Cardiovascular

Aortic Surgery

Aortic Surgery means the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of any part of the diseased aorta with a graft. Aorta means the thoracic and abdominal aorta but not its branches. 

Exclusions: No benefit will be payable under this condition for:

  • Angioplasty
  • intra-arterial procedures
  • percutaneous trans-catheter procedures
  • non-surgical procedures

Coronary Artery Bypass Surgery

Coronary Artery Bypass Surgery means the undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s). 

Exclusions: No benefit will be payable under this Covered Condition for:

  • Angioplasty
  • Intra-arterial procedures
  • Percutaneous trans-catheter procedures
  • Non-surgical procedures

Heart Attack

Heart Attack means a definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following:

  • Heart attack symptoms
  • New electrocardiogram (ECG) changes consistent with a heart attack
  • Development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty

Exclusions: No benefit will be payable under this covered condition for:

  • ECG changes suggestive of a prior myocardial infarction
  • Other acute coronary syndromes, including angina pectoris and unstable angina
  • Elevated cardiac biomarkers and/or symptoms that are due to medical procedures or diagnoses other than heart attack

Heart Valve Replacement or Repair 

Heart Valve Replacement or repair means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve or to repair heart valve defects or abnormalities. 

Exclusions: No benefit will be payable under this condition for:

  • Angioplasty
  • Intra-arterial procedures
  • Percutaneous trans-catheter procedures
  • Non-surgical procedures

Stroke 

Stroke (cerebrovascular accident) means a definite diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis, hemorrhage, or embolism from an extra-cranial source, with:

  • Acute onset of new neurological symptoms, and
  • New objective neurological deficits on clinical examination,
  • Persisting for more than 30 days following the date of diagnosis. These new symptoms and deficits must be corroborated by diagnostic imaging testing. The diagnosis of stroke must be made by a Specialist

Exclusion: No benefit will be payable under this covered condition for:

  • Transient Ischaemic Attacks
  • Intracerebral vascular events due to trauma
  • Lacunar infarcts that do not meet the definition of stroke as described above

Neurological

Bacterial Meningitis

Bacterial Meningitis means a definite diagnosis of meningitis, confirmed by cerebrospinal fluid showing the presence of pathogenic bacteria.  The presence of pathogenic bacteria must be confirmed by culture or other generally medically accepted microbiological testing.  The Bacterial Meningitis must result in neurological deficits persisting for at least 90 days from the date of diagnosis.

Exclusion: No benefit will be payable under this condition for viral meningitis.

Dementia, including Alzheimer’s Disease

Dementia, including Alzheimer’s Disease, means a definite diagnosis of dementia, which must be characterized by a progressive deterioration of memory and at least one of the following areas of cognitive function:

  • Aphasia (a disorder of speech)
  • Apraxia (difficulty performing familiar tasks)
  • Agnosia (difficulty recognizing objects)
  • Disturbance in executive functioning (e.g. inability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior), which is affecting daily life

Exclusion: No benefit will be payable under this Covered Condition for affective or schizophrenic disorders, or delirium.

Motor Neuron Disease 

Motor Neuron Disease means a definite diagnosis of one of the following: amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), primary lateral sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy, or pseudo bulbar palsy, and limited to these conditions

Multiple Sclerosis 

Multiple Sclerosis means a definite diagnosis of one of the following occurring after the later of the issue date of an insured person’s coverage, or the last reinstatement date of an insured person’s coverage:

  • Two or more separate clinical attacks, confirmed by magnetic resonance imaging (MRI) of the nervous system, showing multiple lesions of demyelination
  • A single attack, with objective neurological deficits lasting more than 6 months, confirmed by MRI of the nervous system, showing multiple lesions of demyelination
  • A single attack, confirmed by repeated MRI of the nervous system, which shows multiple lesions of demyelination that have developed at intervals at least one month apart

Exclusion: No benefit will be payable for the following:

  • Solitary sclerosis
  • Clinically isolated syndrome
  • Radiologically isolated syndrome
  • Neuromyelitis optica spectrum disorders
  • Suspected multiple sclerosis or probable multiple sclerosis

Parkinson’s Disease and Specified Atypical Parkinsonian Disorders

Parkinson’s Disease and Specified Atypical Parkinsonian Disorders means a definite diagnosis of either A) Parkinson’s Disease or B) Specified Atypical Parkinsonian Disorders, as defined below.

  • Parkinson’s Disease means a definite diagnosis of primary Parkinson’s Disease, a permanent neurological condition that must be characterized by bradykinesia (slowness of movement) and at least one of the following: muscular rigidity or rest tremor. The insured person must exhibit objective signs of progressive deterioration in function for at least one year, for which the treating neurologist has recommended dopaminergic medication or other generally medically accepted equivalent treatment for Parkinson’s Disease
  • Specified Atypical Parkinson’s Disorders means a definite diagnosis of progressive supranuclear palsy, corticobasal degeneration, or multiple system atrophy

Exclusions: No benefit will be payable for Parkinson’s Disease or Specified Atypical Parkinsonian Disorders if, within the first year following the later of the issue date or the latest reinstatement date of an insured person’s coverage, such insured person has any of the following:

  • Signs, symptoms, or investigations that lead to a diagnosis of Parkinson’s Disease, a Specified Atypical Parkinsonian Disorder, or any other type of Parkinsonism, regardless of when the diagnosis is made
  • A diagnosis of Parkinson’s Disease, a Specified Atypical Parkinsonian Disorder, or any other type of Parkinsonism

Vital Organs

Kidney Failure

Kidney Failure means a definite diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular hemodialysis, peritoneal dialysis, or renal transplantation is initiated.

Major Organ Failure on Waiting List 

Major Organ Failure on Waiting List means a definite diagnosis of Irreversible failure of the heart, both lungs, liver, both kidneys, or bone marrow, and transplantation must be medically necessary.

Major Organ Transplant 

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. To qualify under Major Organ Transplant, the insured person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney, or bone marrow, and limited to these entities.

Accident and Functional Loss

Acquired Brain Injury

Acquired brain injury means a definite diagnosis of new damage to brain tissue caused by traumatic injury, anoxia, or encephalitis, resulting in signs and symptoms of neurological impairment that:

  • Are present and verifiable on clinical examination or neuropsychological testing,
  • Are corroborated by imaging studies of the brain such as Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) showing changes that are consistent in character, location, and timing with the new damage, and
  • Persist for more than 180 days following the date of diagnosis

Exclusion: No benefit will be payable under this condition for:

  • An abnormality seen on brain or other scans without definite related clinical impairment
  • Neurological signs occurring without symptoms of abnormality.

Blindness

Blindness means a definite diagnosis of the total and irreversible loss of vision in both eyes, evidenced by:

  • The corrected visual acuity being 20/200 or less in both eyes
  • The field of vision being less than 20 degrees in both eyes

Coma

Coma means a definite diagnosis of a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less. 

Exclusion: No benefit will be payable under this covered condition for:

  • A medically induced coma
  • A coma which results directly from alcohol or drug use
  • A diagnosis of brain death

Deafness 

Deafness means a definite diagnosis of the total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels or greater within the speech threshold of 500 to 3,000 hertz.

Loss of Independent Existence 

Loss of Independent Existence means a definite Diagnosis of the total inability, due to disease or injury, to perform independently, with or without the aid of assistive devices, at least 2 of 6 Activities of Daily Living listed below for a continuous period of at least 90 days with no reasonable chance of recovery. 

Activities of Daily Living are as follows:

  • Bathing: washing oneself in a bathtub, shower, or by sponge bath
  • Dressing: putting on and removing necessary clothing, braces, artificial limbs, or other surgical appliances
  • Toileting: getting on and off the toilet and maintaining personal hygiene
  • Bladder and bowel continence: managing one’s bladder and bowel function with or without protective undergarments or surgical appliances so that hygiene is maintained
  • Transferring: moving in and out of a bed, chair, or wheelchair
  • Feeding: consuming food or drink that already has been prepared and made available

Loss of Limbs

Loss of Limbs means a definite diagnosis of the complete severance of two or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation.

Loss of Speech

Loss of Speech means a definite diagnosis of the total and Irreversible loss of the ability to speak as a result of physical injury or disease, for a period of at least 180 days.

Exclusion: No benefit will be payable under this Covered Condition for all psychiatric-related causes.

Paralysis 

Paralysis means a definite diagnosis of the total loss of muscle function of two or more limbs as a result of injury or disease to the nerve supply of those limbs, for a period of at least 90 days following the precipitating event.

Severe Burns 

Severe Burns means a definite diagnosis of third-degree burns over at least 20% of the body surface. 

Other

Aplastic Anemia 

Aplastic Anemia means a definite diagnosis of a chronic persistent bone marrow failure, confirmed by biopsy, which results in anemia, neutropenia, and thrombocytopenia requiring blood product transfusion, and treatment with at least one of the following:

  • Marrow stimulating agents
  • Immunosuppressive agents
  • Bone marrow transplantation

Occupational HIV Infection 

Occupational HIV Infection means a definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the insured person’s normal occupation, which exposed the person to HIV-contaminated body fluids.

The accidental injury leading to the infection must have occurred after the later of the issue date or the latest reinstatement date of such insured person’s coverage.

Exclusion: No benefit will be payable under this covered condition if:

  • The Insured Person has elected not to take any available licensed vaccine offering protection against HIV
  • A licensed cure for HIV infection has become available prior to the accidental injury
  • HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use

Get a critical illness insurance quote

Ready to buy critical illness insurance? Book a free consultation with our licensed advisors, who’ll help you compare different providers, understand their offerings, and clarify any doubts about a policy’s financial and medical requirements. Call now to get tailor-made plans for your specific needs!

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Frequently asked questions

How quickly can I receive a payout after being diagnosed with a critical illness?

The speed at which you would receive your critical illness payout depends on your provider and policy terms. However, most providers, like RBC Insurance, will pay your benefit within 60 days of receiving completed claim forms and all the documents requested from your medical specialist.

Can I purchase critical illness insurance if I have a pre-existing condition?

Yes, you can purchase critical illness insurance in Canada if you have a pre-existing condition. However, you must disclose your condition details, ongoing treatments, and recent diagnoses during your application. Depending on the severity of your condition, the insurer may respond in one of these ways:

  • Decline: The insurer may automatically decline your application, particularly for serious conditions like advanced cancer, cystic fibrosis, and multiple sclerosis
  • Rated Policy: If your condition presents a higher risk, you may be offered a “rated” policy with higher premiums
  • Standard Approval: If your condition isn’t considered high-risk, your application may be approved with standard terms

Is critical illness insurance worth it for individuals with a family history of covered illnesses?

Yes, individuals with a family history of critical illnesses, such as cancer, heart attack, and stroke, should strongly consider critical illness insurance, as they have a higher susceptibility to these conditions.

How does critical illness insurance coverage change as I age?

As you age, critical illness insurance coverage becomes more expensive, since premiums tend to increase with age. Coverage availability also becomes limited, particularly for individuals over the age of 60.

Additionally, you may become more susceptible to pre-existing conditions such as arthritis, osteoporosis, and diabetes, or may already have them, which can make obtaining coverage more difficult.

Can I renew my critical illness insurance policy, and are there any changes on renewal?

Yes, you can renew your critical illness insurance policy at the end of its term. Some companies, like Sun Life, automatically renew 10-year term policies at guaranteed renewal premiums. You may also have the option to increase your coverage; however, this might require additional medical underwriting.

What is the difference between critical illness insurance and terminal illness benefit in life insurance?

Critical illness insurance covers serious health conditions like cancer, heart attack, and stroke, and provides a tax-free lump sum payment upon diagnosis. A terminal illness benefit, typically included in permanent life insurance plans, pays 50-75% of the insurance amount if you’re diagnosed with a terminal illness and have two years or less to live.

 Are children covered under my critical illness insurance plan?

No, you can’t add children to your own critical illness insurance. However, you can buy a separate children’s critical illness policy that covers over 30+ health conditions and provides a lump sum payment if your child is diagnosed with a covered condition. Children’s critical illness insurance can be purchased anytime from birth until age 25.

What happens if I move out of Canada? Does my critical illness insurance still cover me?

Yes, your critical illness insurance remains in effect if you relocate from Canada, as long as you continue paying your premiums. However, there may be additional requirements when filing a claim. For instance, your insurer might need to verify that your diagnosis and treatment meet Canadian standards.

Is COPD covered by critical illness insurance? 

No, critical illness insurance is specifically designed for severe health conditions, such as cancer, heart attack, and stroke, and usually doesn’t cover COPD, or chronic respiratory illnesses. 

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Is it Worth Getting Critical Illness Insurance?

 Imagine receiving a life-changing diagnosis like cancer, a heart attack, or a stroke—not only would you face emotional and physical challenges, but the financial strain could be overwhelming. 

Critical illness insurance promises a financial safety net during these difficult times, providing a lump sum payout to cover medical costs, replace lost income, or help with daily living expenses. But is it truly worth the investment? Let’s unpack the details together.

Is critical illness insurance worth it in Canada?

Yes, having critical illness insurance is worth it in Canada! It helps insured individuals during difficult times by paying them a lump sum benefit amount that is non-taxable. Canadians who have a critical illness insurance policy can utilize this payout for their treatment or other expenses and focus on complete recovery.

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Need insurance answers now?

Call 1-888-601-9980 to speak to our licensed advisors right away, or book some time with them below.

What is critical illness insurance?

Critical illness insurance is an agreement you make with an insurance provider that they will pay you a lump-sum benefit if you develop a life-threatening illness. Critical illnesses usually require a long and expensive treatment plan.

The payout can help individuals receive the best healthcare facility to proceed with their treatment. Additionally, it may also serve as an income backup in case the individual needs to take some time off work.

Here are some of the key features of critical illness insurance:

  • A one-time payment that is given regardless of any other health insurance policy
  • Coverage against 26 critical ailments, including heart attack, cancer, stroke, kidney failure, organ transplants, and more
  • Provision of additional coverage for diseases such as Alzheimer’s disease, severe burns, multiple sclerosis, etc
  • Critical illness insurance usually has a waiting period—a predefined duration during which you can’t make any claims 
  • Critical illness insurance is a living benefit—you will get the payout while you are alive and undergoing treatment

Why is critical illness insurance coverage worth it?

Critical illness insurance is worth the cost of monthly premiums because it’s very likely that you will be payed out for your policy. In fact, over 80% of critical illness insurance policies are paid out, and that number is growing. Because this type of insurance coverage can include a variety of illnesses, chances are, you’ll have to make a claim. That means it’s worth your money.

Let’s take a look at some stats.

Critical illness insurance statistics in Canada

  • More than 80 percent of working Canadians have either suffered from a critical illness themselves or know someone who has a critical illness.
  • More than 400,000 Canadians are still living with the after-effects of stroke.
  • The average out-of-pocket expenses for cancer in Canada is around $400 a month.
While not all illnesses are dire, they can sometimes require continued medical care as well as lifestyle changes. This entire spectrum of health expenses for treatment of medical conditions and aftercare that comes after a critical illness requires more than what your provincial health care plan will cover.
Critical illness statistics

What does critical illness insurance cover?

Critical illness insurance in Canada covers close to 26 diseases that require immediate medical intervention and management, including cancer, heart attack, strokes, kidney failure, brain tumor, and more. 

Here are a few prominent diseases covered by critical illness insurance:

  • Heart attack
  • Stroke
  • Cancers
  • Aortic surgery
  • Coronary artery bypass surgery
  • Major organ transplant
  • Major organ failure on a waiting list
  • Occupational HIV infection
  • Kidney failure
  • Aplastic anemia
  • Acquired brain injury
  • Benign brain tumor
  • Dementia (including Alzheimer’s disease)
  • Bacterial meningitis
  • Motor neuron disease
  • Multiple sclerosis
  • Parkinson’s disease
  • Loss of limbs
  • Paralysis
  • Severe burns

Advantages of critical illness insurance coverage

Critical illness insurance comes with many advantages as an insurance product beyond the high rate of payout, including flexibility, return of premium rider, easy conversion to permanent coverage, and more.

  • Flexibility in how benefit is used
  • Premiums can be returned if there are no claims (return of premium rider)
  • Ability to get coverage as a rider or separate policy
  • Ability to convert to permanent coverage

Disadvantages of critical illness insurance coverage

While critical illness insurance is a great product, there are some aspects that some may find negative in terms of pricing, underwriting guidelines, and claims processing process.

  • More expensive than life insurance
  • More stringent underwriting guidelines
  • Strict claims process (you must have an official diagnosis, which may take time)

How much does critical illness insurance cost?  

The cost of critical illness insurance can vary based on the type of coverage you want, your age, general health condition, etc. Usually, the price will range between $22 to $640 for non-smokers and $36 to $880 for smokers. The following tables show the estimated costs of critical insurance coverage based on the coverage period, and the age and gender of the insured:

10-year coverage for male non-smokers

10-year coverage 100K 250K 500K
Age 25 $22.49 $48.09 $90.21
Age 35 $30.87 $68.40 $130.81
Age 45 $63.18 $136.35 $267.30
Age 55 $153.81 $321.75 $638.10

10-year coverage for male smokers

10-year coverage 100K 250K 500K
Age 25 $36.49 $67.09 $102.21
Age 35 $58.87 $84.40 $165.81
Age 45 $95.18 $156.35 $321.30
Age 55 $198.81 $359.75 $879.10

10-year coverage for female non-smokers

10-year coverage 100K 250K 500K
Age 25 $24.20 $47.88 $91.49
Age 35 $32.07 $69.47 $132.95
Age 45 $62.01 $135.45 $266.40
Age 55 $127.06 $285.98 $567.45

10-year coverage for female smokers

10-year coverage 100K 250K 500K
Age 25 $29.20 $58.88 $98.49
Age 35 $43.07 $78.47 $154.95
Age 45 $85.01 $153.45 $287.40
Age 55 $147.06 $297.98 $590.45

Factors influencing the cost of critical illness in Canada

Several factors influence the cost of critical illness insurance in Canada, including age, health status, coverage amount and smoking status of the individual. Take a look at some of the most prominent ones:

  • Age: Premiums increase with age as the risk of developing a critical illness rises
  • Health status: Pre-existing conditions or a history of illness can lead to higher premiums or coverage denial
  • Coverage amount: Higher coverage amounts lead to more expensive premiums
  • Policy term: Longer policy terms often result in higher costs
  • Smoking status: Smokers typically face higher premiums due to increased health risks
  • Occupation and lifestyle: High-risk occupations or unhealthy lifestyle choices can elevate premiums
  • Family medical history: A family history of critical illnesses can also raise premium costs
Taking care of your healthcare needs!

Find the best critical illness and disability insurance quotes in Canada

What are the top 3 critical illnesses?

In Canada, the top three critical illnesses leading to insurance claims are cancer, heart attack, and stroke. These conditions are highly prevalent and are included in nearly all critical illness insurance policies, often accounting for the majority of claims due to their frequency and impact on individuals’ health and finances.

According to the Canadian Cancer Society, cancer is the leading cause of death in Canada, responsible for 30% of all deaths. Approximately 2 in 5 Canadians (44% of men and 43% of women) are expected to develop cancer during their lifetime.

Between 2015 and 2030, the number of new cancer cases diagnosed is expected to increase by about 40%. Lung, breast, colorectal, and prostate cancers are the top four types, accounting for 46% of diagnosed cases.

Do you need critical illness insurance cover?

Regardless of any disadvantages of the product, the rate at which you are likely to get paid out for this policy makes this policy worth it—it’s a very low-risk gamble compared to other insurance products. Critical illness insurance provides a different type of peace-of-mind than other insurance categories like term life or whole life insurance.

If you worry about your quality of life after a health scare, how a sickness could affect your family’s financial well-being, or having to work through an illness thus delaying or hampering your recovery, then critical illness can definitely be considered worth it.

Which is better life insurance or critical illness?

Life insurance and critical illness insurance are completely different insurance products that serve different purposes.

  • Life insurance: pays out a death benefit to your beneficiaries when you pass away
  • Critical illness insurance: pays out a benefit to you (the policyholder) if you are diagnosed with a critical illness

In the context of permanent (or whole life) coverage, permanent life insurance is more of a guaranteed product than critical illness, because one day you will pass away, but you may not necessarily be diagnosed with a critical illness. But that doesn’t make it a better product than critical illness insurance.

Both policies are important to have when considering the financial future of your family. Critical illness insurance will financially support your family if you are recovering where as life insurance will take care of your family if you have passed away.

What cancers are not covered by critical illness insurance?

Typically, non-invasive or early-stage cancers (such as stage 0 or carcinoma in situ) and certain types of skin cancers, like basal cell carcinoma or squamous cell carcinoma, are not covered under most critical illness insurance policies in Canada. Coverage usually focuses on life-threatening and advanced-stage cancers.

However, melanoma, which is an aggressive form of skin cancer, is typically included if it meets the policy’s severity criteria (e.g., the cancer must have invaded deeper skin layers or spread). Other types of cancer that may be covered are:

  • Blood cancers like leukemia may be covered if they reach a specific stage
  • Prostate cancer might require a diagnosis above a certain grade on the Gleason scale to qualify for a claim
  • Thyroid cancers may only qualify if they exceed a specific tumor size or require aggressive treatment

Do I need both income protection and critical illness cover?

Yes, you may need both income protection and critical illness cover. Income protection and critical illness insurance coverage are different insurance products with different purposes.

  • Income loss protection or job loss insurance: pays out a benefit if you lose your job
  • Critical illness insurance: pays out a benefit to you (the policyholder) if you are diagnosed with a critical illness
  • Disability insurance: replaces a portion of your income if you are sick or injured and cannot work for a short or long period of time (depending on the policy). This is different from job loss insurance as you are only temporarily off work.

Disability insurance will replace your income while you’re off work due to a critical illness, whereas critical illness insurance will pay you a one-time lump sum payment when you are diagnosed with that illness. We recommend both products to ensure your full financial security during your recovery period.

Does critical illness pay out on diagnosis?

Yes, critical illness insurance in Canada typically pays out after a diagnosis of a covered illness, provided you meet the conditions outlined in the policy. This often includes meeting a minimum survival period (typically 30 days) and providing the necessary documentation, such as medical reports with proof of diagnosis within 30 to 90 days of the diagnosis date or surgery

Once the policy requirements are met, you receive the payout as a tax-free lump sum. The money can be used at your discretion, whether for medical costs, living expenses, home care, or paying off debts.

What to look for in a critical illness insurance policy?

When selecting a critical illness policy and deciding if it’s worth it for your family, you should consider looking for simplified issue options, flexibility, eligible illnesses, coverage amounts, and survival periods for a well-rounded coverage.

To give you a better idea of how to select the best critical illness insurance policy, here’s a breakdown of policy benefits you should look for:

  • Simplified issue options: Many insurance providers offer online options to purchase policies with quick, easy, and instant approval.
  • Flexibility in premiums: Options such as limited pay and return of premium change the way pay for premiums or lessen the financial impact of those premiums.
  • Eligible illnesses: Many of the providers in Canada offer enhanced coverage for 25+ illnesses. However, there are a few companies that offer basic coverage only (16 or even sometimes 4 illnesses). Some even have policies that cover only 1 type of illness, like heart-related events or cancer.
  • Coverage amounts: Canadian insurance companies offer critical illness insurance coverage from $10,000 to millions of dollars, but each provider has different minimum and maximum coverage amounts.
  • Survival period: As we have already discussed, insurance providers in Canada generally instill a 30-day survival period (which is also known as a waiting period).
  • Coverage for children: Many policies offer optional riders for coverage for children.
  • Partial payouts: Some policies have options that cover partial conditions and thus disburse partial benefit payouts.

Several Canadian insurance providers offer different types of critical insurance policies. Each of these policies has its own merits and drawbacks. PolicyAdvisor has reviewed all the major critical illness insurance offerings in Canada. In doing so, we come up with a list of features, details, and options Canadians should look for when shopping for their own critical illness coverage.

It may be the case that every feature is available in one policy, but with the help of an experienced insurance broker, you can find the coverage that is best for you.

Critical illness insurance vs. disability insurance

Critical illness insurance and disability insurance serve different purposes in financial protection. 

One one hand, critical illness insurance provides a lump-sum payment if you’re diagnosed with a specified serious illness. Disability insurance, on the other hand, provides regular income replacement if you’re unable to work due to an injury or illness. Both types of insurance offer vital protection, but they address different financial needs.

Here is a detailed comparison of the two insurance plans. Check out to know more:

Difference between critical illness insurance and disability insurance

Comparison features Critical illness insurance (CI) Disability insurance (DI)
Claim event(s) Diagnosis of a covered life-

threatening illness or condition

Any illness or injury that leads to a loss of income
Covered conditions 26+ common conditions including:

  • Heart attack
  • Cancer
  • Stroke
  • MS
  • Kidney failure
  • Parkinson’s disease
  • Aplastic anemia
  • And more
Any medical condition that would prevent you from working, including:

  • Mental health struggles
  • Broken bones
  • Back injuries
  • Carpal tunnel
  • Seizures
  • Hearing or vision loss
Benefit amount $25K – $2.5M+ depending on

your policy

Replaces a part of your monthly income
Benefit duration One or more lump-sum

payment(s)

Monthly payments Until you

recover or your policy lapses

(can last until you reach 65 or

older)

Coverage term You can get coverage up to age 100 Most policies end when you turn 65
Period before benefits begin Survival period of 30 days Waiting period (or elimination

period) of 30 days to 1 year

When combined, these two types of insurance provide both immediate financial relief and ongoing income support, ensuring that you’re financially protected from both the short-term and long-term impacts of a serious health issue.

Is it worth paying for critical illness insurance?

Yes, in general, it is worth it to buy critical illness insurance. The coverage starts from as low as $20 per month, but it and may go up to as high as a few hundred dollars a month. If you’re worried about it not being worthwhile, you may consider purchasing a return of premium rider. This rider will return your premiums back to you if no claim was made during the policy term or at death if no claims were made during the policyholder’s life.

The bottomline is, if you can’t afford the monthly premium, it is not worth it. But if you can, then this insurance is well-worth the monthly premium. You already know the likelihood of being diagnosed with a critical illness in your lifetime (80%), so it is worth it to make sure you will at least be financially secure while you recover.

In Canada, the average life expectancy is 83 years. Healthcare is world-class. Apart from healthcare facilities, there are renowned lab and research facilities. Despite having all this, one can not deny the toll that lengthy treatment takes on one’s financial condition.

Recovery from life-threatening diseases is also often about care and facilities being made available for a longer than normal period. Critical illness insurance is worth its money in cases like these where one does not need to put the concern about receding income as a hurdle on the way to recovery.

Find out if critical illness insurance is worth it for your family

Those seeking coverage should consider this carefully and choose the policy (or critical illness insurance rider) that suits them best, considering both their coverage requirements and their budget. Better yet, get in touch with one of our experienced advisors to help educate you on your options.

Looking for expert advice?

Give us a call at 1-888-601-9980 or book some time with our licensed experts.

Frequently asked questions (FAQs)

What is the difference between critical illness insurance and health insurance?

Critical illness insurance in Canada provides a lump-sum payment if you’re diagnosed with a life-threatening illness. This payment can help pay for any purpose, like covering treatment costs, paying off debts, or adapting your lifestyle. 

Health insurance covers routine medical expenses that provincial health coverage may not offer. This may include doctor visits, prescription drugs, and hospital stays. It may also include extended benefits like dental and vision care.

Can I purchase critical illness insurance if I have a pre-existing condition?

Yes, you can purchase critical illness insurance if you have a pre-existing condition, but it may be more challenging.

Insurers often assess the risk associated with your pre-existing condition.  This could lead to higher premiums, exclusions, or denial of coverage for illnesses related to that condition. 

Can I customize my critical illness insurance policy?

Yes, you can often customize your critical illness insurance policy to fit your specific needs. Insurers typically offer various options that allow you to tailor your coverage. They are as follows:

  • You can select from a range of critical illnesses to include in your policy
  • You can determine the lump-sum payout amount
  • You can add optional riders, like the return of premium or disability income,  for additional benefit
  • You can choose the length of coverage, whether it’s a set number of years or until a certain age

What are the exclusions typically found in critical illness insurance policies?

Critical illness insurance policies often include several common exclusions. These exclusions may vary from one insurer to another, but they generally include:

  1. Self-inflicted injuries: Conditions resulting from intentional self-harm are usually not covered
  2. Substance abuse: Illnesses arising from alcohol or drug abuse are commonly excluded
  3. Non-disclosure: Failure to fully disclose your medical history can lead to denial of claims
  4. Less severe conditions: Early-stage or less severe forms of certain illnesses, like some cancers, may be excluded
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What is critical illness insurance & How does it work in Canada? – Updated 2025

Each year, thousands of Canadians are diagnosed with serious health conditions like cancer, heart attack, and stroke—life-altering events that bring unexpected financial challenges, from higher expenses to lost income to lifestyle adjustments.

Critical illness insurance provides financial protection during these difficult times through a lump sum payment upon diagnosis of a covered condition. In this post, we’ll explore how critical illness insurance works and help you decide if it’s a worthwhile investment for your future.

What is critical illness insurance?

Critical illness insurance is an agreement you make with a life insurance company that they will pay you a tax-free lump-sum of money if you…

  • develop a life-threatening illness
  • have a serious health event
  • or undergo treatment while under their coverage

Unlike life insurance, the payout doesn’t happen after you die. It’s a living benefit you receive while you are alive to help with immediate financial burdens of a critical illness. You get the payout once proof of a specified illness or incident is established (barring any policy waiting period).

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Need insurance answers now?

Call 1-888-601-9980 to speak to our licensed advisors right away, or book some time with them below.

How does critical illness insurance work?

Critical illness insurance (also known as CI insurance) works by offering financial support should you or your family member be diagnosed with a serious illness such as cancer, heart attack, or stroke.

Just like with life insurance, you’ll be required to pay monthly premiums over the course of your term length to maintain that protection. Both the amount of the benefit and the monthly payments are decided when you apply for the policy.

During your policy term, if you are diagnosed with a critical illness, you submit a claim that includes your official diagnosis documentation. Then the insurance company pays you the benefit.

How does critical illness insurance work?

*Subject to waiting period

Is critical illness insurance taxable?

No, the lump sum payment received from a critical illness insurance policy is generally tax-free in Canada. This tax-free benefit helps policyholders use the payout for necessary expenses without worrying about deductions. However, exceptions apply if the policy is owned by a business and premiums were deducted as a business expense.

Common uses for critical illness insurance

The payout (or benefit) from a critical illness insurance policy can help replace lost income, support personal and family needs, and pay a mortgage and other loan payments.

Let’s look at the different ways to use a critical illness insurance benefit:

Income

Replacing income

For you or your family to take time off work.

Debt

Debts

Mortgages, business loans and other liabilities.

At home care

At-home care

Hiring nurses or other home-care practitioners.

Medicine

Prescription medicine

Out-of-pocket expenses not covered by provincial plans

Enhanced care

Enhanced care

Upgraded medical facilities and services

Medical device

Modifications

Renovations or modifications to your home, car, or other household expenses

Treatment

Additional treatment

Out-of-country or alternative medical expenses

Protection

Savings protection

Eliminate the need to use retirement savings

What illnesses are covered by critical illness insurance?

Critical illness insurance in Canada covers over 30 life-threatening conditions, including cancer, heart attack, kidney failure, and stroke. These conditions are selected because they often involve high medical costs and lifestyle changes that impact your ability to work.

Here’s a list of conditions usually covered by critical illness insurance:

Basic critical illness coverage

  • Cancer
  • Heart attack
  • Stroke

Enhanced critical illness policy coverage

  • Acquired Brain Injury
  • Aortic Surgery
  • Aplastic Anemia
  • Blindness
  • Bacterial Meningitis
  • Cancer
  • Coma
  • Coronary Artery Bypass Surgery
  • Dementia, including Alzheimer’s Disease
  • Deafness
  • Heart Attack
  • Heart Valve Replacement or Repair
  • Kidney Failure
  • Loss of Independent Existence
  • Loss of Limbs
  • Loss of Speech
  • Major Organ Failure on Waiting List
  • Major Organ Transplant
  • Motor Neuron Disease
  • Multiple Sclerosis
  • Occupational HIV Infection
  • Paralysis
  • Parkinson’s Disease
  • Severe Burns
  • Stroke (Cerebrovascular accident)
Critical illness insurance coverage list

What is partial payout in critical illness insurance policies?

A partial payout allows you to receive a portion of your critical illness insurance benefit if you’re diagnosed with an early-stage or less severe covered condition.

Partial payment details:

  • The specified illnesses will be made clear to you before your coverage begins
  • Often non-life-threatening cancers fall into this category
  • This clause allows you to receive some money (typically between 10-25 percent of your coverage amount and is subject to dollar value limits) during your recovery
  • You can maintain your protection should you contract a terminal condition down the road

The conditions eligible for partial payment vary from company to company.

Some conditions eligible for partial payout are:

  • Early thyroid cancer
  • Early prostate cancer
  • Stomach tumours
  • Superficial skin cancers
  • Ductal breast cancers
  • Coronary angioplasty

Can I receive multiple critical illness insurance payouts if I am diagnosed with multiple conditions?

Yes. It is possible to receive multiple payouts on a critical illness insurance policy for partially critical conditions. However, coverage only pays out once in its entirety for fully critical conditions. The amount of times you can claim partial conditions depends on your policy wording.

How much does critical illness insurance cost?

In general, you can expect to pay anywhere from $21-70 per month for critical illness insurance. On average, it’s more expensive than term life insurance but not so expensive that you can’t afford it. Just like life insurance, the younger and healthier you are, the less expensive your critical illness insurance premium is.

Coverage amounts are smaller than what you’d see for a life insurance death benefit, so that also helps keep premiums low. Canadians typically elect for an average critical illness coverage of $77,000 according to the Canadian Society of Actuaries.

Other factors that can affect the cost of premiums include:

  • your term length
  • the number of conditions covered by your policy
  • any riders or clauses you opt for
  • smoking status

Critical illness insurance riders

Some companies allow you to add riders to a critical illness insurance policy that can add coverage or return your premiums. With some policies, you may be able to choose the number of illnesses covered as well as the amount of coverage and the term length of the rider. Critical illness riders typically have a 30 day survival period that needs to be completed, before the policy can pay out the proposed benefit of the rider.

Child critical illness rider

A Child Critical Illness rider provides coverage for the insured’s children if they are diagnosed with a childhood illness. The exact list and number of illnesses covered vary across insurers.

Return of Premium on Death rider or Expiry rider

A Return of Premium on Death or Expiry rider returns all or a part of the premiums one has paid over the course of their policy when the policy term ends or when the individual passes away.

Is critical illness insurance worth it?

Yes, critical illness insurance is worth the money. Critical illness insurance is protection you buy to protect you and your family from the financial fallout that happens if you get critically sick. If you want the financial freedom to recover from a serious illness on your own terms, then you need this type of insurance.

Because critical illness insurance pays a living benefit, getting coverage is even more of a personal decision than life insurance. Life insurance is really about your family’s needs. Critical illness insurance is about your financial needs while you recover.

Look at the stats: 

  • 1/2 of Canadians will be diagnosed with cancer in their lifetime
  • The average out-of-pocket expenses for cancer in Canada is around $400 a month. This excludes treatment covered by public or private health care and can be more depending on the type of cancer
  • When you’re diagnosed with cancer, you’ll likely have to take time off work to recover

So, can you afford to take time off work, cover your usual bills, plus at least $400 a month to pay for your treatment/recovery? If you can’t, critical insurance is worth it.

Buying this insurance can give you the peace of mind to know, that if you’re facing a critical diagnosis, you’ll be able to focus completely on recovery.

Learn more about whether critical illness insurance is worth it.

Advantages Disadvantages
Financial protection for your family More expensive than life insurance
Flexibility in how benefit is used Some companies only offer basic policies
Premiums can be returned if there are no claims
Ability to get coverage as a rider or separate policy

Cancer and heart disease are common critical illnesses in Canada.

Can I get life insurance and critical illness insurance together?

Yes, many Canadian insurance companies offer life insurance and critical illness coverage together. You can add critical illness coverage as a rider to your life insurance policy. This can help you apply for both life insurance and critical illness coverage at the same time without having to go through underwriting again.

Learn more about critical illness insurance versus critical illness riders.

How much critical illness insurance coverage do I need?

In general, Canadians commonly purchased between $50,000 and $100,000 in coverage or more.

Because the coverage pays a living benefit, it’s intended to cover a shorter period of time, specifically while you are treating and recovering from an illness. Hopefully, your recovery will be swift, and you wouldn’t be reliant on the money paid out by your policy for the remainder of your life.

If you’re unsure how much coverage you want, an insurance calculator can suggest a coverage amount based on your estimated needs and give you an estimate of the monthly expenses associated with the policy.

Learn your coverage needs with our critical illness insurance calculator.

Which are the best critical illness insurance companies in Canada?

We reviewed the top companies offering such policies so you can make an informed decision on your critical illness insurance provider. Companies like Canada Protection Plan (which allows credit card payments), Sun Life, Canada Life, BMO Insurance, and more offer critical illness benefits in Canada.

Read more about the best critical illness insurance companies in Canada.

How can I get my critical illness insurance quotes?

Still have questions? Schedule a chat with a licensed insurance agent from PolicyAdvisor.  They’re happy to go over anything you’re curious about and provide you with many quotes from the best insurance companies in Canada. Save time and money when you speak to our brokers, form your life insurance plan, and compare quotes online.

Insurance can be affordable

Find the lowest critical illness insurance quotes in Canada within minutes!

Frequently asked questions

How often do critical illness insurance payout?

On average, about 80 percent of critical illness insurance claims are approved, and this percentage continues to rise. Approval rates vary by provider, which is why you should research different companies and understand their coverage definitions and waiting periods before purchasing a policy.

Which three illnesses are covered under most critical illness policies?

Cancer, heart attack, and stroke are covered under most basic critical illness insurance policies. Enhanced policies may include up to 26 conditions or more.

How much is the maximum coverage for critical illness?

The maximum amount of coverage offered by Canadian critical illness insurance providers is $3 million. Usually, Canadians get $50,000 – $100,000 in critical illness coverage.

Do you need critical illness or disability insurance?

You need both critical illness insurance and disability insurance to fully financially protect yourself from injury or illness. They are two different insurance products. Critical illness insurance will pay you a lump sum payment if you are diagnosed with a critical illness.

Disability insurance will replace a portion of your income if you are sick or injured and cannot work. Both products will help ensure your family is financially taken care of if you become very sick.

Can I be refused critical illness coverage?

The average Canadian resident should have their application accepted depending on their history. However, you can be refused or denied coverage by the insurance carrier you applied to.

You and your family’s medical history will factor heavily into the underwriting process. If you have already been diagnosed with an illness, or have pre-existing conditions your likelihood of being insured or availability of coverage options may be reduced.

Will I get my money back if I do not claim on my critical illness policy?

Yes, some critical illness policies allow for a return of premium. Some insurers will return all of the premiums you’ve paid if you haven’t made a successful claim at the end of your term, hit certain age milestones, or surrender your policy.

This is an optional clause and it will increase the cost of premiums.

There’s also a return of premium on death clause, which means your premiums will be paid back to your chosen beneficiary should you pass away unexpectedly, without receiving a full benefit payment under your critical illness policy.

Do you have to spend a critical illness insurance payout on treating your illness?

No. You only need to be diagnosed with a covered condition to receive your critical illness insurance benefit. The tax-free payment can be used however you choose—whether for medical expenses, replacing lost income, supporting family needs, hiring care providers, or seeking treatment abroad.

What is the survival period in critical illness insurance?

In order to get your payout,  you must pass the 30-day survival period after your diagnosis. This waiting period is consistent across most insurance companies and covers most types of diseases. Some companies now permit a zero-day survival period for certain conditions.

If I get better, do I have to return the benefit?

You do not have to give back your critical illness payout if you recover from the covered medical condition. Critical illness plans are not defined by recovery, treatment, or death. It is a one-time payment that is triggered by the diagnosis of specific diseases or conditions.

Critical illness insurance coverage differs from other types of insurance in that it is a living benefit that pays out a one-time lump sum.

  • Term life insurance – pays out after your death
  • Long-term care insurance –  pays for assistance for those who can no longer take care of themselves
  • Disability insurance – pays out monthly if you cannot work due to an illness or disability
  • Critical illness insurance – pays out a one-time lump sum when you are diagnosed with a life-threatening illness or disease
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Return of Premium in Critical Illness Insurance: What You Need to Know

A return of premium (ROP) rider in critical illness insurance is an optional add-on that refunds the premiums you’ve paid if you don’t make a claim during the policy term or under specific conditions, such as surviving the term or passing away.

If you’re considering critical illness insurance, adding an ROP rider can help you feel more secure about your investment. This rider ensures that even if you never need to use the coverage, you’ll still benefit financially.

In this article, we’ll explain how the return of premium rider works and benefits your finances.

How does a return of premium work?

In critical illness insurance, return of premium riders are available usually as an add-on. With this rider, you pay your monthly premiums as usual, and the policy provides coverage for critical illness or disability claims.

However, if no claim is made or under specific conditions, the insurance provider refunds a portion or all of the premiums you’ve paid.

There are three common types of ROP:

  • Upon death (Return of premium on death – ROPD): If you pass away while the policy is active, the insurer refunds all eligible premiums to your appointed beneficiary
  • At the end of the contract (Return of premium on expiry): If the policy term ends without a claim, the insurer refunds the premiums paid
  • On cancellation or surrender (Return of premium on cancellation/surrender): Some insurers offer partial or full premium refunds after a set number of years or at specific ages, like 65 or 75

Each provider has unique rules about how premiums are refunded and under what circumstances. To ensure you choose the right option for your needs, we recommend that you schedule a call with our experienced advisors.

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Can I get a return of premium with critical illness insurance?

Yes, you can get a return of premium (ROP) rider with critical illness insurance. This optional add-on allows you to receive a refund of the premiums you’ve paid if no claim is made during the policy term, on the expiry of the policy or death. 

Since critical illness coverage pays out a lump sum if you’re diagnosed with a covered condition, the ROP rider ensures your investment isn’t lost even if you remain healthy.

What are the benefits of return of premium riders?

Return of Premium (ROP) riders provide peace of mind by refunding premiums, adding value to your insurance, offering flexible refund options, and reassuring risk-averse policyholders.

A return of premium rider:

  • Ensures that you get a refund of premiums if no claim is made 
  • Turns your policy into a savings tool with either coverage or a payout
  • Offers reassurance for those worried about losing their investment
  • May offer refunds on expiry, surrender, or death, depending on the rider

What are the disadvantages of return of premium riders?

The disadvantages of return of premium riders are that they come with higher premiums, require long-term commitment, may exclude certain fees from refunds, and could limit potential investment opportunities.

  • Higher premium costs: The rider significantly increases your policy premiums
  • Long-term commitment: Requires maintaining the policy for the full term to benefit
  • Limited returnable premiums: Refundable premiums may exclude certain fees or add-ons
  • Opportunity cost: Extra premiums could be invested elsewhere for potentially higher returns

Which critical illness insurance providers offer return of premium riders?

Many Canadian insurance providers such as Beneva, Sun Life, RBC, Industrial Alliance, Desjardins, Manulife, Canada Life, and Empire Life offer return of premium (ROP) riders. 

These riders are offered with different options like Return of Premium on Death (ROPD), Return of Premium on Expiry (ROPX), Return of Premium on Cancellation (ROPC), and other flexible refund features.

Insurers offering return of premium riders with critical illness plans

Insurance Provider ROP Options
Beneva  ROPD, ROPX, ROPC
Sun Life  ROPD, ROPX, ROPC
RBC  ROPD, refunds all premiums if the policyholder dies while the policy is active
Industrial Alliance ROPD and flexible ROP options that vary by term
Desjardins  ROPD, ROPX, ROPC
Manulife  ROPD, ROPX, Return of Premium on Surrender (ROPS), with partial/full refunds based on term
Canada Life Various ROP options included in critical illness plans; specifics depend on the plan
Empire Life Return of Premium on Surrender or Maturity, offering percentage refunds if no claims are made

Learn more about the best critical illness insurance companies in Canada
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What is the cost of a return of premium rider in critical illness insurance?

The cost of adding a return of premium (ROP) rider in a basic critical illness policy costing $79.65 per month could be $117.99 per month.

A return of premium rider significantly increases your critical illness insurance premiums, typically by 30–50%, depending on the rider type, insurer, and your policy details.

These costs also differ based on the type of return of premium rider:

  • Return of premium on death (ROPD): Lower additional cost since it refunds premiums only if the insured passes away during the policy term
  • Return of premium on expiry (ROPX): Higher cost as it guarantees a full refund of premiums if no claim is made by the end of the term
  • Return of premium on surrender (ROPS): Costs are similar to ROPX but allow partial refunds if the policy is canceled early

Additionally, long-term policies like term-75 or lifetime coverage tend to incur higher premiums for ROP riders due to extended refund commitments.

Is a return of premium on critical illness taxable?

No, the return of premium (ROP) benefit on critical illness insurance is generally not taxable in Canada. When you purchase a critical illness insurance policy, you pay your premiums using after-tax dollars, meaning the money you use to pay for the policy has already been taxed. 

Therefore, when you receive a refund of those premiums through an ROP rider whether upon expiry, surrender, or death, it is treated as a return of your personal contributions, not as income.

Comparison of return of premium riders with traditional critical illness insurance

Return of premium riders enhance critical illness policies by offering premium refunds, unlike traditional plans that provide coverage only. Here’s how these differ:

Premium refunds:

  • ROP riders: Refund premiums if no claim is made (on expiry, death, or surrender)
  • Traditional CI plans: Do not refund premiums regardless of claims

Cost:

  • ROP riders: Typically 30–50% more expensive
  • Traditional CI plans: More affordable but lack refund benefits

Flexibility:

  • ROP riders: Allow refunds under specific conditions (expiry, death, surrender)
  • Traditional plans: Offer no such options

Best suited for:

  • ROP riders: Ideal for risk-averse individuals seeking financial security
  • Traditional plans: Suitable for those focused on lower premiums
Critical illness riders vs Critical illness insurance: Read more!

How do I get a return of premium coverage?

You can add a return of premium rider to your critical illness insurance policy while purchasing the plan or during eligible upgrade periods.

To get ROP coverage, you need to consult with your insurance provider to explore available rider options. Typically, a return of premium rider is added when purchasing a long-term critical illness policy. The process may involve assessing your eligibility based on age, health, and other criteria.

To qualify for ROP coverage, you must meet specific insurer requirements regarding age, policy type, and health status.

  • Age requirements: Most insurers offer ROP riders to individuals aged 18–65
  • Policy type: ROP is typically available on long-term critical illness policies, not short-term plans
  • Health status: Eligibility may require passing a medical exam or meeting the insurer’s health guidelines
  • Consistent premium payments: Some insurers mandate a history of timely premium payments
  • Insurer-specific rules: Each provider may have unique conditions for adding ROP, such as coverage amount or policy terms
Read more about when to get critical illness coverage.
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Frequently asked questions

What happens to my return as a premium rider if I cancel my policy early?

If you cancel your critical illness insurance policy early, the impact on your return of premium (ROP) rider depends on the specific terms of the rider. Policies with a Return of Premium on Surrender (ROPS) option may provide a partial refund based on how long the policy was active.

For example, you might receive 50% of your premiums back after 20 years, with the percentage increasing the longer you keep the policy. However, not all ROP riders include this option, so it’s important to review your policy details.

Can return of premium riders be added to existing critical illness policies?

In most cases, return of premium (ROP) riders cannot be added to an existing critical illness insurance policy. ROP riders are usually selected at the time of purchase and integrated into the policy from the start. If you are interested in this feature, you may need to apply for a new policy that includes an ROP option. 

How does a return of premium rider affect my overall premium rates compared to standard policies?

Adding a return of premium (ROP) rider to your critical illness insurance policy can significantly increase your premium rates—typically by 30–50%. The exact increase depends on the type of ROP rider (e.g., on expiry, death, or surrender), the policyholder’s age, and the duration of the policy. 

For instance, a standard premium of $79.65 per month could rise to $117.99 with an ROP rider, reflecting an additional $33.84 monthly. While the cost is higher, the rider offers added financial security and peace of mind.

Are there any age restrictions for purchasing a return of premium rider with critical illness insurance?

Yes, there are generally age restrictions for purchasing return of premium (ROP) riders, and these vary by insurer. Most providers allow ROP riders for policyholders up to a specific age, such as 60 or 65, since the rider often involves long-term commitments or payouts tied to policy maturity.

Additionally, age impacts the cost, as older policyholders typically face higher premiums for adding an ROP rider. Be sure to check the eligibility criteria with your insurer.

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