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Critical illness insurance FAQs


Published June 2019

We answer the frequently asked questions around critical illness insurance (also known as trauma insurance).

1. What is critical illness or trauma insurance?

Critical illness insurance can provide you with a lump sum payment if you’re diagnosed with certain covered medical conditions such as a heart attack, coronary bypass, cancer, stroke or a severe injury. Medical conditions, medical definitions and cover can vary between insurance policies, so it’s important read the disclosure material like a product disclosure statement for the policy you’re considering. 

2. Why do people get critical illness insurance?

Critical illness insurance usually pays a lump sum, which can be used to pay for things like repaying your debts, adjustment to housing, household expenses, medical costs above your health insurance or as source of income. People generally apply for this type of cover so they have peace of mind about having a financial safety net that could help with living and care costs if they suffer a critical illness. A critical illness payout has no restrictions on how you spend it, so it can also be used for mortgage payments, household expenses, to pay for a carer if needed, or for anything else.

3. How is critical illness insurance different to income protection insurance?

Income protection insurance can pay up to 75 per cent of your usual salary or income, on a monthly basis, if you are unable to work because of injury or illness. Critical illness, on the other hand, typically pays a lump sum benefit.

4. How much critical illness insurance do I need?

This will depend on your age, family circumstances and financial situation at the time you apply for cover. The factors you need to consider include any other types of life insurances you have, whether you have private health insurance, if any government benefits would be available to you, and what type of family support you’ll have.

5. How do I buy critical illness insurance?

You can buy critical illness insurance either as a stand-alone policy or as an optional benefit in a term life insurance policy.

6. What do I need to tell my insurer and can I get critical illness without a medical examination?

You generally don’t need to have a medical examination when applying for critical illness insurance but some insurers may ask you some questions about your medical history. 

If you are required to answer those questions, then you have a duty to tell the insurer anything that you know, or a reasonable person in the circumstances could be expected to know, is relevant to the insurer’s decision about whether to insure you and, if so, on what terms. This duty applies when you are first applying as well as if you extend, vary or reinstate your insurance policy.

In cases where the insurer does not ask medical questions then an exclusion related to pre-existing conditions (PEC) will usually apply. This means that any condition or illness you had before a specified period prior to the policy start date will not be covered. PEC exclusions can often apply for the life of the policy. 

Check the policy’s product disclosure statement (PDS) to understand any exclusions that might apply.

7. How much does critical illness insurance cost?

Generally, the cost depends on your age, gender, lifestyle and medical history. For example, premiums for smokers are higher than for non-smokers. Costs can also vary according to the policy’s features. The premiums you need to pay for your first year will be outlined in your policy.

8. Are critical illness insurance premiums tax deductible?

Unlike income protection insurance, the premiums you pay for critical illness insurance are not tax deductible. But the proceeds that you receive as a critical illness insurance payout are generally not subject to tax.  

9. How do I make a critical illness insurance claim?

To make a critical illness insurance claim the first thing you need to do is contact your insurer by phone or email. They will tell you what documents you need to provide. Usually you need to verify your claim by providing details of your policy; proof of your identity, such as a passport or driver’s licence; and details relating to your medical history. Your insurer will also send you a claim form, which will have sections you and your doctor or specialist will need to complete.

10. What are the main reasons a critical illness insurance claim is denied?

There are several reasons this may happen, including:

  • an exclusion applies
  • relevant information wasn’t disclosed when buying the policy
  • the claim was made outside of the qualifying period.

Find out more about ANZ critical illness insurance

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The above content relates to policies issued from 1 June 2019 under the ANZ Recover Well Product Disclosure Statement and Policy Document (PDF 132kB) and is current as of today. Previous products (with the same name) may have different features and benefits. If you are an existing customer, please contact us if you have any questions about your cover.

ANZ Recover Well is issued by OnePath Life Limited (OnePath Life) (ABN 33 009 657 176, AFSL 238 341). We recommend that you read the ANZ Financial Services Guide (PDF 479kB) and ANZ Recover Well Product Disclosure Statement and Policy Document (PDF 132kB) (available online or by calling 13 16 14) before deciding whether to acquire, or to continue to hold, this product. This PDS relates to policies issued from 1 June 2019. Previous products (with the same name) may have different features and benefits. If you hold insurance based on an earlier PDS, please contact us if you have any questions or to have a PDS sent to you.

This information is current as at date of publication and is subject to change.

The issuer of this information is ANZ. While ANZ has taken care to ensure that this information is from reliable sources, it cannot warrant its accuracy, completeness or suitability for your intended use. To the extent permitted by law, ANZ does not accept any responsibility or liability arising from your use of this information.

Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522 AFSL 234527 is an authorised deposit taking institution (Bank) under the Banking Act 1959 (Cth). The issuers of these products are not Banks. Although ANZ distributes these products, these products are not a deposit or other liability of ANZ or its related group companies. None of them stands behind or guarantees the issuers or the products. 

This information is of a general nature and has been prepared without taking account of your objectives, financial situation or needs. You should consider whether the information is appropriate for you having regard to your objectives, financial situation and needs. 

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