Critical Illness Benefit 危疾保險利益
In its accelerated form, this benefit pays part or all of the death benefit in advance when the life insured is diagnosed with a critical illness specified in the policy, or undergoes a specified surgical procedure. The list varies by policy, but common examples are cancer, heart attack and stroke.
The benefit is usually a lump sum calculated under the policy terms. It does not indemnify actual medical costs, so no receipts are needed and the money can be used freely, for example to cover lost income or household expenses.
After payment, the later death benefit is normally reduced by the amount advanced, and if the whole amount is accelerated the policy usually ends. For the exam, distinguish this from additional critical illness cover, which pays on top of the death benefit and leaves it unchanged.
The name of the illness alone is not enough for a claim: the condition must meet the policy's definition. Policies also commonly set a waiting period (no payment for a diagnosis made within a set time after the policy starts) and a survival period (the life insured must survive a set number of days after diagnosis). They also list exclusions, such as pre-existing conditions. The actual conditions depend on the individual policy.
Long-Term Care (LTC) Benefit 長期護理利益
The LTC benefit addresses the risk that the life insured will need sustained care from others because of old age, illness or injury. Part of the death benefit can be advanced during the life insured's lifetime to help meet the cost of care at home or in a care facility.
The trigger focuses on the ability to care for oneself rather than the diagnosis of a particular disease. A common test is that the life insured cannot independently perform a specified number of activities of daily living, such as bathing, dressing, eating, toileting, transferring and moving around, or has severe cognitive impairment. This must be confirmed by a doctor or by an assessment as the policy requires.
The benefit is usually paid periodically, such as monthly, with each payment set as a percentage of the sum insured, until the policy limit is reached. Payments may start only after the condition has lasted for a specified period, and the condition may be reassessed from time to time. Amounts paid are normally deducted from the death benefit.
LTC differs from medical insurance: LTC helps meet long-term personal care needs, while medical insurance mainly covers the cost of treating illness or injury. It also differs from disability income cover, because its trigger is not inability to work and it does not depend on the life insured losing income.
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