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What Is Critical Illness Insurance?
Critical illness insurance pays a one-time, tax-free lump sum if you're diagnosed with a covered condition — cancer, heart attack, stroke, or other specified illnesses. It's not health insurance. It's income replacement when you can't work. Use the cash for anything: treatment copays, mortgage payments, childcare, travel to specialists, or lost wages.
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How the Lump Sum Works
Choose a benefit amount from $10,000 to $100,000. If diagnosed with a covered condition, you receive the full lump sum (or a percentage for lesser conditions like TIA or skin cancer). The money is paid directly to you — not the hospital, not the insurance company. Subsequent diagnoses pay on a graduated scale: 20% after 13 months, scaling to 100% after 61 months.
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What Conditions Are Covered?
Cancer: All invasive cancers (100% lump sum), carcinoma in-situ (25%), skin cancer ($300). Heart & Stroke: Heart attack (100%), stroke (100%), coronary artery bypass (50%), angioplasty/stent (25%), TIA (25%). Combined plans also cover end-stage renal failure. All conditions must be first-time diagnoses after the policy effective date.
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Option A vs. Option B
Option A: Lump sum only — simple, clean, one payment on diagnosis. Option B: Lump sum PLUS hospital confinement ($200/day for days 1-30, $400/day for 31+), wellness screening benefit ($50-$100/year for preventative care), and radiation/chemo benefits ($200/day). Option B costs more but provides ongoing support during treatment.
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Health Insurance Gap Coverage
Health insurance covers medical bills. But it doesn't cover your mortgage, car payment, groceries, or childcare while you're in treatment. The average cancer patient faces $12,000+ in out-of-pocket costs in the first year alone — and that's with insurance. Critical illness insurance fills the gap between what health insurance covers and what life actually costs during a health crisis.
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Pennsylvania Consumer Protections
Pennsylvania requires a 10-day free-look period on all supplemental health policies (31 Pa. Code Ch. 89). Critical illness policies typically have a 12-month pre-existing condition lookback — conditions diagnosed or treated in the 12 months before your effective date are excluded during the first policy year. After that, full coverage applies. All policies are guaranteed renewable for life.
