Core covered conditions
Commonly covered illnesses can include life-threatening cancer, heart attack and stroke, with eligibility determined by the insurer’s specific criteria.
Group Critical Illness Insurance
Financial protection when employees face a serious illness.
Group critical illness insurance provides financial support when a covered serious illness occurs, helping employees manage the added costs and personal demands that may follow.
Lump-sum benefit · Flexible use
Critical illness at a glance
A living benefit for a covered serious illness.
Diagnosis-based benefitEligibility is based on the diagnosis and the terms of the coverage, rather than the employee’s ability to work.
Lump-sum paymentOnce paid, the benefit can be used according to the insured person’s individual needs.
Choice of benefit amounts
Covered-condition definitions
Survival-period requirements may apply
Optional spouse and dependent coverage may be available
Financial flexibilityA lump-sum benefit can help with costs that health insurance may not cover.
Complements disabilityCritical illness and disability insurance protect against different financial risks.
Flexible plan structuresCoverage may be employer-paid, employee-paid, voluntary or a combination, depending on the insurer.
Independent adviceCompare definitions, benefit amounts, exclusions, options and insurer pricing.
What is group critical illness insurance?
Protection when serious illness brings added costs.
Critical illness insurance provides financial protection following the diagnosis of a serious illness that qualifies for coverage under the plan.
Unlike disability insurance, the benefit is generally tied to the diagnosis of a covered condition rather than the insured person's inability to work. That distinction can make critical illness coverage useful even when an employee remains at work, returns quickly, or has other income protection in place.
The payment can help with additional costs that arise during treatment and recovery, including travel, caregiving, home modifications, household expenses and health-related costs not covered elsewhere.
How it works
From diagnosis to benefit payment.
Specific requirements depend on the insurer and diagnosis, while the overall process follows a similar sequence.
01
Coverage is in force
The employee and any eligible dependants must have coverage in place when the illness occurs.
02
A covered condition is diagnosed
The diagnosis must meet the insurer's contractual definition for that specific condition.
03
Claim requirements are satisfied
Medical evidence and any applicable survival period or other policy requirements are reviewed.
04
The benefit is paid
Once approved, the benefit is paid in accordance with the plan terms.
Additional conditions
Some plans extend protection to additional illnesses, but the scope of coverage depends on more than the number included. How each is defined and the benefits provided are equally important.
Early-assistance benefits
Some products include a partial benefit for certain less-severe or early-stage conditions. Availability and definitions vary by insurer.
Spouse & dependent coverage
Plans may allow coverage for spouses and dependent children, either as part of the employer program or through employee-paid options.
Benefit amounts
Employers can offer a set amount, give employees a choice of benefit levels, or provide a base amount with the option to purchase additional protection.
The real difference is in how conditions are defined.
Insurers can approach the same illness differently, with variations in definitions, exclusions, survival periods and claim requirements. Comparing plans means looking closely at how those provisions affect the protection provided.
Coverage note: The inclusion of an illness does not guarantee that a benefit will be payable. Eligibility depends on the specific provisions that apply to the diagnosis and claim.
Plan design
Start with what the coverage is intended to achieve.
Employers can fund the benefit, make it available as an employee-paid option, or combine both approaches. The structure should provide meaningful protection while remaining affordable and straightforward to administer.
01
Set the foundation for coverage
Decide what level of protection the employer will provide and whether employees can add to it at their own cost.
02
Review evidence requirements
Insurers may offer coverage up to specified limits without individual medical evidence, with underwriting required above those amounts or for certain optional elections.
03
Decide who pays the premium
How the benefit is funded can influence employer cost, employee participation and how employees value the coverage.
04
Consider spouse and child coverage
Extending protection to eligible dependants can help employees manage the practical and financial impact of a serious illness within their family.
05
Compare contractual details
Examine the provisions that can affect eligibility and payment, including survival periods, pre-existing conditions, exclusions, benefit reductions, and partial or repeat claims.
Independent comparison
A meaningful comparison looks beyond cost and covered conditions.
Plans that appear similar can differ significantly in how protection is structured, when benefits apply and how optional coverage is administered.
We help employers evaluate the choices available and consider how critical illness protection complements the rest of their benefits program.
What we compare
- Covered conditions and contractual definitions
- Core and optional benefit amounts
- Evidence-free limits and underwriting requirements
- Survival periods and other claim provisions
- Spouse and dependent options
- Partial-benefit or early-assistance features, where available
- Premium structure, rate guarantees and age reductions
- Administration and employee enrolment experience
Critical illness & disability
Different needs. Different forms of protection.
Employers sometimes ask whether one coverage makes the other unnecessary. In most cases, they serve different purposes.
Critical Illness
Designed around the diagnosis of a covered serious condition.
- Payment depends on whether the diagnosed illness qualifies under the plan
- Provides a lump-sum benefit
- Benefit is not generally based on the employee's salary
- Can provide financial flexibility even if the employee continues working
- May include spouse and dependent options
Disability Insurance
Designed around income replacement when disability prevents an employee from working.
- Payment depends on whether the employee meets the plan’s definition of disability
- Benefits are paid at regular intervals for as long as the employee remains eligible
- Benefit amount is based on earnings
- STD and LTD can protect different stages of an absence
- Focuses on replacing lost employment income
Coordination note: An employee could potentially qualify for critical illness and disability benefits from the same medical event if the requirements of both contracts are met. Each claim is assessed separately under its own policy terms.
Frequently asked questions
Critical illness insurance, explained.
Coverage varies by insurer, so the applicable contract should be reviewed before a plan is selected.
What does group critical illness insurance pay?
It provides a lump-sum payment when an insured person experiences a serious illness that qualifies under the plan.
What illnesses are covered?
The illnesses and procedures included vary by insurer and plan. Common examples include life-threatening cancer, heart attack and stroke, with additional conditions available under broader forms of coverage. Eligibility depends on how each condition is defined.
What is a survival period?
Some illnesses have a required survival period following the diagnosis or event. The applicable period can differ by condition and insurer.
Does an employee have to be unable to work to receive a critical illness benefit?
No. An employee does not have to stop working to qualify. Eligibility is based on the illness and whether the requirements of the plan are met.
How is critical illness different from long-term disability?
Long-term disability replaces a portion of income when an employee qualifies as disabled under the plan. Critical illness provides a lump-sum payment when a qualifying serious illness occurs. Together, they address different financial needs.
Can employees buy additional critical illness coverage?
Employees may be able to purchase additional coverage beyond the amount provided by the employer. Medical evidence may apply based on the amount requested and the insurer’s requirements.
Can spouses and children be covered?
Yes. Many plans can include coverage for spouses and dependent children, although the coverage available may differ from what is provided for employees.
What should employers compare between insurers?
Compare the quality of the coverage, not just the number of illnesses listed. Consider benefit levels, qualifying requirements, limitations, optional coverage and how the plan is administered.
Review your options
Would critical illness coverage strengthen your benefits program?
We can help you assess the role critical illness coverage could play in your benefits program and identify an approach that fits your organization.