What does critical illness cover pay, and when will it not pay?

Critical illness cover pays a cash sum if you are diagnosed with one of the illnesses or conditions defined in the policy.¹ The payout is yours to use. Zurich lists paying for a family member to give up work to care for you, or home care, among the uses.¹

Does it reduce your life cover?

That depends on whether it is accelerated or additional.

• Accelerated cover is an advance on your life cover. Zurich pays a critical illness claim as an advance, and the life cover falls by the amount paid. If the claim equals the life cover, the policy ends.¹
• Additional cover is paid on top of the life cover. Sukoon Takaful’s additional option pays 50% of the takaful benefit or USD 1.5 million, whichever is lower.²

Some term plans include a small critical illness payment as standard. Sukoon’s Term Protect and Sukoon Takaful’s Family Takaful Term pay 15% of the cover on diagnosis of a listed illness. The death cover then falls to 85% for three months and to 50% for the rest of the term.³²

Check whether your quote is accelerated or additional before you compare prices.

Which illnesses are covered?

Only those on the insurer’s list, as the policy defines them. The lists differ in length and in severity tests.

Sources: ADCB,⁴ MetLife,⁵ Sukoon Takaful² and Zurich.¹

Wording matters. Zurich covers cancer “excluding less advanced cases”, heart attack “of specified severity” and stroke “with permanent symptoms”, and pays part of the sum for ductal carcinoma in situ of the breast.¹ The built-in benefit on Sukoon Takaful’s plan covers three illnesses: stroke, heart attack and late-stage cancer.²

Read the definitions in the policy terms, not only the list of names.

When will a claim not be paid?

The documents above share some common limits:

• Waiting period. MetLife applies 90 days from the benefit’s start or reinstatement.⁵ Zurich does not pay a claim in the first 90 days of the policy, of any increase in cover or of a reinstatement.¹ ADCB says a claim is accepted only where the event occurs 90 days or more after the policy start date.⁴ Sukoon Takaful’s document gives a 90-day waiting period from policy issue.²
• Price reviews. Zurich may review the critical illness premium every five years.¹
• Non-disclosure. ADCB warns that not disclosing your health history may void the application or lead to a rejected claim.⁴

Its report covers claims paid in the Middle East from 2021 to 2023, and says 56% of all claims paid were “living benefits” such as critical illness.⁶

Note the date your cover starts. A diagnosis inside the first 90 days will usually not be paid.

What do you need to claim?

A claim form and medical evidence. MetLife’s published checklist for disability claims, for example, asks for claimant and physician statements, test reports and a medical report from the treating doctor.⁷ Ask your insurer for its critical illness claim form as soon as you are diagnosed, and keep copies of every report.