Critical Illness1

SLPC 25096 11/15 (exp. 11/17)

Focus on your health—not your wallet—if you’re diagnosed with a serious illness.

If you are diagnosed with a serious medical condition, critical illness insurance helps reduce daily stress about money, so you can focus on getting better.

How does it work?

Sun Life’s Critical Illness insurance gives you a check for a pre-determined amount once your claim for a covered condition is approved. Depending on your plan, your spouse2 or dependent children may also be able to sign up for coverage.

You can use this money to help pay for:

  • Out-of-pocket medical expenses
  • Alternative therapies
  • Everyday expenses, like groceries, transportation, or child care

The cost for this insurance depends on your age, the benefit amount, whether or not you smoke, and other factors.

What’s covered?

Critical illness insurance provides you with a full or partial benefit (subject to a maximum) for a variety of covered conditions. Depending on your plan, you may receive a benefit for the following:

  • Circulatory conditions (e.g., heart attack)
  • Cancer diagnoses
  • Non-life threatening cancer diagnoses
  • Coma
  • Major organ failure
  • Childhood conditions (e.g., cerebral palsy)

Whether you receive a full or partial benefit depends on the covered condition. It’s important to know what conditions are covered by your plan, since some critical illness plans cover a range of illnesses and others are specific and may exclude cancer or provide coverage only for specific cancer diagnoses. Check your plan details for more information on covered conditions, benefit waiting periods, and plan maximums, exclusions, and limitations.

Additional benefits that may be available with your plan

Wellness screening benefit This benefit provides you with a payment once a year for various health screening tests, such as prostate cancer screening, electrocardiogram, or a lipid panel to test cholesterol. You will receive a check if any one of the tests outlined in your plan is performed, so you can get paid for preventive screenings.
Recurrence benefit This benefit pays you an additional lump-sum payment if you are diagnosed for a second time with a covered condition for which a benefit has already been paid. This diagnosis must be for a new occurrence, and not a re-diagnosis of the covered condition for which a benefit was already paid, and a certain number of months must pass between the diagnoses. A recurrence benefit may be payable once per covered condition, up to a maximum. Does not apply for all conditions. Refer to certificate for details.
Health care support services3 With Sun Life’s Critical Illness insurance, you and your family have access to leading health care support services. The HealthChampionSM program by ComPsych® Corporation is staffed by registered nurses and medical benefits experts who can help answer questions about your medical coverage, provide guidance on your benefits, explain your diagnosis and treatment options, and much more. You can take advantage of these confidential services for any critical illness or health concern you and your family may face.

1. In some states “Critical Illness” is referred to as “Specified Disease.”

2. If permitted by the Employer’s employee benefit plan and not prohibited by state law, the term “spouse” in this benefit includes any individual who is either recognized as a spouse, a registered domestic partner, or a partner in a civil union, or otherwise accorded the same rights as a spouse.

3. Value-added services are offered only on specific lines of coverage, and carry a separate charge, which is added to the cost of the insurance. The cost is included in the total amount billed. HealthChampion® (a health care support service) is not insurance and is provided by ComPsych®. Sun Life is not responsible or liable for care, services, or advice given by any provider or vendor of the Services. Sun Life reserves the right to discontinue any of the Services at any time.

“Critical Illness insurance” is a limited benefit policy. It does not provide basic hospital, basic medical, or comprehensive health insurance (often referred to as “major medical coverage”) and does not satisfy the requirement for Minimum Essential Coverage under the Affordable Care Act.

The certificate has exclusions, limitations, and benefit waiting periods for certain conditions (as detailed in the certificate) that may affect any benefits payable. Benefits payable are subject to all terms and conditions of the certificate. The policy, certificate and rider, if applicable, may not be available in all states and may vary based on state laws and regulations. This overview is preliminary to the issuance of the policy and certificate.

Note regarding employees covered or considering coverage under a Health Savings Account (HSA) established in connection with a High Deductible Health Plan (HDHP): Based on the limited available regulatory guidance, Sun Life believes its “Critical Illness insurance” is appropriate for use with an HSA and may be purchased when employees and/or their family members are covered under an HDHP. However, Sun Life cannot provide legal or tax advice. If there are legal or tax questions, we suggest that employees consult their own legal or tax advisor before purchasing this insurance.

Group Critical Illness insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under policy form series 12-GP-01, 13-Sd-c-01, and 13-SdPort-c-01. Product offerings may not be available in all states and may vary depending on state laws and regulations.

Not available in New York.