CLHIA-ACCAP - Consumer Information

TABLE OF CONTENTS 1. GETTING STARTED .............................. 4 Critical illness insurance: what is it? ........ 4 A little bit of history ................................. 4 What does critical illness insurance cover in Canada? .................................... 5 2. CRITICAL ILLNESS INSURANCE POLICIES .............................................. 6 Is critical illness insurance right for you? ....................................................... 6 How is critical illness insurance sold? ..... 8 3. WHAT ILLNESSES DOES CRITICAL ILLNESS INSURANCE COVER?............ 9 Covered conditions ................................. 9 How are conditions defined? ................ 10 4. UNDERSTANDING WHAT MIGHT BE EXCLUDED FROM YOUR POLICY ....... 11 Exclusions within the covered condition definitions ..............................................11 Covered condition moratorium or exclusion period ....................................11 Exclusions specific to your coverage .... 13 Pre-existing covered condition exclusion .............................................. 13 5. OTHER FEATURES OF YOUR POLICY 14 Eligibility requirements .......................... 14 Optional benefits .................................. 14 6. OTHER PLAN TYPES AND OPTIONS .............................................16 Plan guarantees .................................... 16 Plan types ............................................ 16 7. PREMIUMS: TYPES AND PAYMENT ....18 Premium options ................................... 18 Paying for your coverage ...................... 18 8. WHAT IS CRITICAL ILLNESS UNDERWRITING? ................................19 9. MAKING A CRITICAL ILLNESS CLAIM ..................................................21 What to do when you receive a diagnosis that may be covered under your policy .................................. 21 Submitting a claim ................................ 21 What's your doctor's role in your claim process? ..................................... 22 What to expect during the claim review process ..................................... 23 What happens after the insurance company makes their decision? ............ 23 Your right to appeal .............................. 24 10. WHERE TO GO FOR ASSISTANCE ......25 How do I buy a policy? ......................... 25 What if I have a question about my policy? ............................................ 25 I have a complaint. Who can help?........ 26 Policyholder protection ......................... 26 What role do insurance regulators play? .................................................... 27 A GUIDE TO CRITICAL ILLNESS INSURANCE 2

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