Critical Illness

SLPC 25096 11/18 (exp. 11/20)

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

What’s covered?

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

  • Circulatory conditions (e.g., heart attack)
  • Invasive and non-invasive cancer diagnoses
  • Coma
  • Major organ failure
  • Alzheimer’s, Parkinson’s, ALS
  • Childhood conditions (e.g., cerebral palsy)

*conditions are payable once per lifetime, except if recurrence benefit is included.

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, exclusions, and limitations.

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.

The content on this page is not approved for use in New Mexico.

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.

Subject to policy terms, portability or continuation may be available when employment terminates. Coverage is subject to state variations. Refer to your certificate for specific conditions.

“Critical Illness insurance” is a limited benefit policy. It does NOT provide basic hospital, basic medical, or major medical insurance and does not satisfy the requirement for Minimum Essential Coverage under the Affordable Care Act. The certificate has exclusions and limitations for certain conditions that may affect any benefits payable. Benefits payable are subject to all terms and conditions of the certificate. This overview is preliminary to the issuance of the policy and certificate. The policy, certificate, and rider, if applicable, may not be available in all states and may vary based on state laws and regulations.

Note to employees covered or considering coverage under Health Savings Accounts (HSAs) 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 the employee and/or his or her 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 you consult your own legal or tax advisor before purchasing this insurance.

Subject to state law variations.

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 15-GP-01, 16-SD-C-01, 16-SDPort-C-0112-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.

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