Critical illnesses you should be aware of (cancer, heart attack, and stroke)

According to the latest Philippine Statistics Agency (PSA) report, heart diseases, stroke, and cancers are the three leading causes of death in the Philippines. So naturally, we would be most interested in getting coverage for these when thinking about getting health insurance. But what makes cancer, heart attack, and stroke different from other diseases that HMO or health insurance can cover?

Cancer, heart attack, and stroke belong to a group of serious illnesses considered by insurance and health companies as critical illnesses. The risk of getting these illnesses can increase with age. More alarmingly, critical illness can strike when you least expect it and treatment is not cheap. 

For example, the cost of chemotherapy per session can start from P20,000 and reach up to P120,000 per cycle, depending on the cancer type. The overall cost can amount anywhere from P120,000 to over P1 million.

It’s highly likely that your average HMO and health insurance can’t cover all of this. In Manulife’s 2020 Health Study, “Understanding Filipino Sentiments Toward Critical Illness,” we found that at least 80% of Filipinos are aware of the cost of critical illnesses, yet more than half feel they’re not financially ready should it occur in their family.

A critical illness generally refers to a serious health condition that is life-threatening, may require extensive medical treatment, and can significantly affect daily functioning. Common examples often include cancer, heart attack, stroke, kidney failure, and major organ failure. Insurance providers can differ on what they consider as a critical illness, depending on the conditions they cover. This is why it is important to review the policy’s definition section to understand which illnesses are included and under what conditions benefits may apply.

The good thing is that most insurance companies provide critical illness insurance coverage for cancer, heart attack, stroke, and more. Critical illness insurance can also cover surgeries like those done for Idiopathic Scoliosis and major organ transplants.

Put simply, you need critical illness insurance to ensure that you have a financial plan to cover medical expenses for the specialized treatment needed in case you get diagnosed with a critical illness.

Critical illness insurance  is a type of coverage designed to provide financial support if you are diagnosed with a serious medical condition defined in the policy, such as cancer, heart attack, or stroke. Instead of reimbursing medical bills, it typically pays a lump-sum cash benefit upon diagnosis of a covered critical illness. This payout can be used at your discretion, whether for medical expenses, recovery-related costs, or everyday living needs during treatment.

A common misconception is that health insurance policies and HMOs automatically provide full coverage for critical illnesses. In reality, standard health insurance often focuses on hospitalization and treatment costs and may have limits, exclusions, or co-payments. Critical illness insurance is meant to complement existing coverage by helping address gaps, especially the non-medical and out-of-pocket expenses that can arise during a serious health event. 

There are ways to get coverage for critical illness. You can get a plan that focuses primarily on coverage for critical illnesses, or you can also get critical illness coverage as an added benefit (or rider) to a life or health insurance product. You can also add this coverage to your existing plan. For both cases, you pay premiums to be entitled to the critical illness coverage. The benefit amount depends on the amount of coverage you can purchase, as assessed through the underwriting process.

Most of the time, when you get health-related insurance coverage, you will have to go through a medical screening first. This will allow the company to assess your risk of contracting a critical illness and determine what coverage the company can offer you. Certain factors are taken into consideration, such as age, gender, family history, past medical history, smoking status, alcohol consumption, and body mass index (BMI). The higher the personal and health risks, the more you need to pay for your premium.

Some insurance companies can waive the health screening requirements, especially if you already have a recently purchased insurance product from the same company.

It depends on the product. An insurance company usually has a list of covered critical illnesses to cover. The covered illnesses and the following information will also be included when you get your policy contract:

1. The definition of each illness covered
2. When and how you qualify for the lump sum benefit
3. Whether there will be a waiting period before receiving the benefit
4. The percentage of the total benefit payable
5. What happens if the illness occurs again

How you receive your benefits and the amount paid depend on the specific terms outlined in your policy contract. Some policies may provide a fixed lump-sum payout upon diagnosis of a covered critical illness, while others may structure benefits based on hospitalization or vary the amount depending on the type and severity of the illness defined in the policy.

In many cases, the benefit is released after a valid claim is filed and the diagnosis meets the policy’s definition of a critical illness. Once received, the cash benefit can generally be used at your discretion to help manage medical expenses, recovery costs, or other financial needs. In certain situations, payments may be made directly to the hospital, and if medical expenses exceed the coverage amount, any remaining balance will need to be paid out of pocket or through other sources.

Because coverage details, definitions, waiting periods, and exclusions vary by policy, it is important to carefully review the policy contract before signing. Understanding what is covered, what is excluded, and how benefits are triggered can help set clear expectations and ensure the coverage aligns with your needs.

Ideally, you should get coverage even before you get diagnosed with a critical illness. So, when you need the benefit after you contract the illness, it’s already active. It means you would be able to reap the benefits of investing in critical illness insurance.

Age is a factor in contracting insurance; this can also affect the cost of your coverage. Your premium amount can be lower if you start getting covered earlier in life.

As mentioned earlier, the cost of critical illness varies based on several factors. One thing that makes this type of insurance product appealing to buyers is its potentially lower cost. Nonetheless, the more health conditions are covered in the plan, the higher the premium that you need to pay.

The cost will also differ if you buy the critical illness insurance coverage as a separate insurance product or as an added benefit. The same applies if the policy covers just you or if you will also include coverage for your loved ones.

Like other health insurance products, having critical illness insurance prepares you for a medical emergency, except it’s especially focused on the more expensive kind. And emergencies, by definition, are unpredictable. 

In making this decision, you can consider three scenarios:

1. You can get critical illness insurance and go through life without ever getting diagnosed with a critical illness.
2. You can take comfort in the health insurance plan you already have. However, in the future, you may end up taking some money out of your savings because it’s not enough to cover critical illness expenses.
3. You get critical illness insurance and end up using it to pay for your medical expenses in the 9^th year after you get your policy. 

Suppose you’re part of the population who will go through scenario 1, congrats! But comparing scenarios 2 and 3, wouldn’t you rather be part of the latter? Critical illness often requires long-term medical care and treatment. The impact on your finances can mean changing your lifestyle, putting on hold plans and other priorities for yourself and your family, and even adding stress.

While you consider these scenarios and information about critical illness, you can also ask yourself the following:

• What is my likelihood of developing a critical illness in the next 3, 5, or 10 years?
• Are other family members at high risk of developing a critical illness?
• What is my family’s history of critical illness? Does cancer run in my family?
• Is my health insurance coverage today enough? What illnesses does it cover?
• Am I ready to touch my savings in case of unexpected medical expenses?

Understanding what qualifies as a critical illness with your insurance provider, how coverage works, and where common gaps exist can help you make more informed health and financial decisions. Reviewing policy definitions, benefits, and exclusions is an important step in choosing coverage that aligns with your needs. In the Philippines, Manulife offers insurance solutions that may help provide added financial support in the event of a critical illness. Taking time to explore your options today can help you plan with greater clarity and confidence for the future.

• A critical illness refers to a serious medical condition that may require extensive treatment and long-term care.
• Coverage for critical illnesses such as cancer, heart attack, and stroke depends on the type of health insurance policy and its specific terms.
• Understanding the critical illness definition helps clarify what is considered a critical illness under a policy.
• Some insurance plans offer critical illness insurance benefits that provide financial support upon diagnosis of covered conditions.
• Reviewing policy details carefully is important to understand coverage limits, exclusions, and eligibility in the Philippines.