Guide to critical illness health insurance in the Philippines

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Insurance is an important part of financial planning as a way to build strong financial foundation. It helps prepare for any untoward, trying events in our lives such as sickness or demise by providing financial assistance during the times that we need it.

According to the Department of Health, the leading causes of death in the Philippines are diseases related to the heart, diseases of the vascular system, pneumonias and cancers.

Research study also shown that overwhelming number of Filipios (95%) will be forced to dip into their savings to pay for serious illnesses. Another study also revealed that Pinoys have to pay 75% of the cost when they get seriously sick.

If you look at the treatment packages of Philippine Heart Center, some of these procedures can run up to several hundred thousand pesos to over a million pesos.

The saying is indeed true, “bawal magkasakit”. (You can’t afford to get sick.)

This article is going to look into health insurance products specific for critical illness available in the country.

What is critical illness?

All sickness is a concern, but critical illnesses are serious because they may need medical care immediately. Examples that come to mind are heart diseases, stroke, and cancer.

They might also lead to terminal illnesses which are conditions that may impair the ability to live life fully because is one is too weak, rendered totally and permanently disabled, and/or have less chances of survival.

The costs of treatment may be also expensive. Hospital confinement, therapy and surgeries can easily run into several thousands to millions of pesos. These can bring poverty to most families of modest income.

Health insurance plan specific for critical illness

That’s why in the market today, health insurance plans are tailored to insure against these critical illnesses. They are offered by insurance companies either as a rider or as a standalone plan.

A insurance rider is an add-on or supplementary contract to an existing life insurance plan or variable universal life, so it can’t be bought separately. What it does is to widen what your policy can give. A basic life insurance may only give lump sum on the time of death to the beneficiaries. Adding a rider can include cash benefits on diagnosis of any covered major diseases.

A standalone plan on the other hand can be bought alone. The plans that you see here are all stand-alone.

Benefits of critical illness insurance

What are the usual benefits that you get when you get a plan?

The purpose of insurance is to help you through when you’re severely sick, which is one of the financially challenging moments that can happen to anyone. All of plans that are discussed below provide cash that are generally given in lump sum when you get down with a serious sickness. Some may also provide a portion of the face value for minor illnesses which can be availed more than once.

Other benefits might include:

  • Income protection by way of daily or monthly financial assistance for hospital confinement, receiving intensive care, treatments, etc.
  • May include additional cash for accidents.
  • Death benefit.
  • The plan may be renewable or the coverage may last until old age.
  • There might be plans that also offer a savings component, where a fund gets accumulated over the years and becomes available for withdrawal at some later point in the future.

How is critical illness plan different from HMO?

An HMO or health maintenance organization plan gives you a certain virtual amount per year that can defray costs associated with any medical check-ups, hospitalization, and other healthcare services. The money is paid directly to the medical service provider such as hospitals, clinics, or doctors.

So that means you don’t get the money, it will be paid directly to your bill. The advantage is that such plans (depending on the services that are included) allow you to be admitted in a hospital (especially if it is within the network of partner institutions) without being asked to make a deposit.

The disadvantage is that the yearly limit may not be enough to pay for all expenses.

This is where the critical illness plan comes in. It pays for diagnosis of serious illnesses to you, so you can use the money for treatment or any hospital bills that go over the HMO limit.

Are all diseases covered in critical illness plan?

No.

This is one of the many frequently asked questions about insurance. Depending on the company and the specific plan that you get, not all diseases can be covered. This means that you have to know exactly the kind of illnesses that the plan helps financially protect you from.

Features of an critical illness plan

What are the things that you need to look out for when you’re trying to understand a plan?

  1. Covered illnesses
  2. Exclusions
  3. Pre-existing conditions
  4. Issue age
  5. Cover age
  6. Insurability
  7. Term or whole life
  8. Premum

1. Covered illnesses

As what has been said before, one of the things that you need to be careful when getting a plan is the number of diseases that are covered. Check the information or ask an explanation from the advisor. It also pays to look at the definitions of the following as they are very specific to any plans.

Again, it is worth repeating that each provider and even each plan of the same provider has its own definition and coverage.

  • Dreaded diseases. This is the catch-all term to mean major or minor illnesses. Some companies use this to differentiate a group of diseases that are covered in one plan that are different or not included in another.
  • Major critical illness is medical condition that can lead to serious sickness, require immediate emergency care and/or long-term medical attention, and may include but not limited to lower quality of life. Most plans in the market would give out lump sum amount when a claim is made, at which point the plan terminates.
  • Minor illness is any medical condition that are considered to be less serious than major critical illness. A few plans allow multiple claims with or without deductions to the amount insured.
  • Terminal illness is a medical condition that may have low chance of survival, lead to lower quality of life, or may render one to be permanently and totally incapacitated.

2. Exclusions

As the name suggests, these are diseases that are opposite to Covered Illnesses. If you fall sick, it doesn’t mean you get the pay-out right away. There are specific medical conditions that are not part of the insurance coverage. For instance, not all types and severity of cancer are covered. So the rule is if the diagnosis is not part of the list of covered illnesses, then no pay-out is given.

3. Issue age

The issue age is the range of ages that the plan can be purchased. Some plans don’t insure if one is too young or too old. Older customers are more than likely asked to pay more to get the same coverage as those who are younger, and they may be declared to be not insurable anymore. Others also provide insurance for kids.

4. Cover age

The cover age is the age that the plan matures. Beyond this age, the plan terminates and no longer provides coverage.

5. Pre-existing conditions

You might also be asked for any pre-existing conditions. These are medical conditions that exist before you’d thought about getting a plan. You may be asked to disclose any previous diagnosis, hospital admission, medical tests, etc. The result would impact your ability to apply for an insurance, the amount of premium you’re going to pay, the extent of insurance protection, and other such conditions.

6. Insurability

Insurability is a measure of how likely you can purchase the plan. Just like pre-existing conditions, it may affect your chances in getting a plan. Such factors include age, gender, occupation, health/medical history, etc.

7. Term or whole life

Insurance policies are either term or whole life. A term insurance is renewable on shorter period of time such as a year or five years so they’re cheaper and they become more costly each time it renews. A whole life insurance covers you until old age, between 75 and 100 years old. It may be costlier, but you have the option to pay for the first 10 years or 20 years or until a certain age.

8. Premium

Another important factor is the amount that you are asked to pay to keep the policy active and remain in force. The amount of money that is required by the insurer is referred to as the premium. How long you’re asked to pay and how often within a year it is paid will depend on the terms of the contract of the policy.

Critical illness health insurance plans in the Philippines

There are various critical illness policies available in the market today. We have organized them into insurance types as you can see below.

A reminder though. The succeeding lists do not guarantee accuracy or completeness. The goal is to give you an idea on the choices you have. For more updated information on the products, check the website of the insurer or reach out to a company rep.

Critical illness term insurance

A term insurance plan is the cheapest, plain-vanilla coverage. It does not have the bells and whistles of other policies such as unit-linked or endowment. The trade-off is that it is in force for shorter period of time, such as 1 year or longer. It gets renewed until the insured gets to a certain age.

Critical illness term Company Info
Alliance eAZy HealthAllianz PNB Life Insurance, lnc.Term: 5 years
Issue age: 18 – 50 years
Details: Life insurance, critical illness, accident, disability
Family Care PlusBPI Philam Life Assurance Corp., IncTerm: 10 years
Issue age: 18 – 65 years old
Cover age: until age 75
Detail: Life insurance, critical illness
FORTUNE CRITICAL ILLNESS PLANFortune Life Insurance Company, lnc.Term: 1 year
Issue age: 18 – 59
Cover age: Until age 69
Details: Cash benefits on diagnosis of critical illness depending on chosen variant of this insurance product
PRIME CAREInsular Life Assce. Co., Ltd., TheTerm: 1 year
Issue age: 18 – 60
Details: Benefits upon diagnosis of any of the 35 critical illnesses, allowance for medical recovery and expenses, total and permanent disability, consultation, life insurance
Prime Secure LiteInsular Life Assce. Co., Ltd., TheTerm: 1 year
Issue age: 18 – 60
Details: Life insurance, accident insurance, critical illness, Covid-19
Critical Illness Insurance Health ChoiceManufacturers Life Ins. Co. (Phils.), Inc., TheCoverage: 20 years
Details: Life insurance, critical illness, hospitalization benefit, maturity benefit
ACTIVE JOINT CRITICAL PROTECTPhilippine American Life & Gen. Ins. Co.Term: 10 years
Issue age: 18 – 65
Cover age: For 10 years, until age 75
Details: Life insurance, critical illness
Health Start LitePhilippine AXA Life Insurance. Corp.Term: 1 year
Issue age: 18 – 60
Details: Life insurance, critical illness
Sun LifeAssureSun Life of Canada (Philippines), Inc.Term: 5 years
Issue age: 18 – 60
Cover age: until age 70
Details: Life insurance, critical illness
Sun Maiden and Sun Maiden PlusSun Life of Canada (Philippines), Inc.Term: 5 years
Issue age: 18 – 55, female
Cover age: until age 65
Details: Life insurance, critical illness, maternity benefits

Critical illness whole life insurance

Whole life insurance gives cover for the duration of a lifetime. Coverage is typically beyond retirement age. Usually, plans provide cover until age 100 years old. (Unit-linked plans, which are whole life, are on the next, separate list.) Some of them provide a health fund, which can be borrowed during emergency, dividends, loyalty bonuses, etc.

Critical illness whole life insuranceCompanyInfo
Critical Care 100BPI Philam Life Assurance Corp., IncIssue age: 0 – 65
Cover age: 100
Details: Life insurance, critical illness, investment
AEONFirst Life Financial Company, lnc.Issue age: 18 – 55
Details: Waiver of premium on total and permanent disabiolity, critical illness
AEON with Critical Illness BenefitFirst Life Financial Company, lnc.Issue age: 18 – 55
Details: Waiver of premium on total and permanent disability, critical illness
Set for HealthFWD Life Insurance Corp.Issue age:
Cover age: until age 75
Details: Life insurance, critical illness, return of premium
Set for Tomorrow Estate ProtectorFWD Life Insurance Corp.Cover age: until age 120
Details: Life insurance, overseas benefit, waiver of premium on toal and permanent disability or critical illness, terminal illness, spouse extension benefit, funeral benefit
HealthFlexManufacturers Life Ins. Co. (Phils.), Inc., TheIssue age: up to age 70
Cover age: until age 100
Details: Life insurance, critical illness
Health Insurance for Men: AdamManufacturers Life Ins. Co. (Phils.), Inc., TheDetails: Life insurance, critical illness
Health Insurance for Women: EveManufacturers Life Ins. Co. (Phils.), Inc., TheDetails: Life insurance, critical illness
Seasons 100Manufacturers Life Ins. Co. (Phils.), Inc., TheCover age: until age 100
Details: Life insurance, critical illness
MCBL HealthFlexManulife Chinabank Life Assce. Corp.Coverage: age 100
Details: Life insurance, critical illness
MCBL Health ChoiceManulife Chinabank Life Assce. Corp.Coverage: age 100
Details: Life insurance, critical illness
AIA All-in-OnePhilippine American Life & Gen. Ins. Co.Issue age: 18 – 60 years old
Cover age: 100 years old
Details: life insurance, accident, critical illness, disability
HEALTH ACHIEVEPhilippine American Life & Gen. Ins. Co.Issue age: 18 – 55
Cover age: Until 65 years old
Details: Life insurance, critical illness, hospitalization benefits
HealthMaxPhilippine AXA Life Insurance. Corp.Cover age: until 100
Premium: 10 years, 20 years, or until age 65
Details: Life insurance, health fund, critical illness
Health StartPhilippine AXA Life Insurance. Corp.Coverage: until age 75
Premium: 10 years or 20 years
Details: Two variants: individual or family, critical illness, return of premium, life insurance, 
Sun Fit and WellSun Life of Canada (Philippines), Inc.Cover age: until age 100
Premium: 10, 15, or 20 years
Details: Life insurance, investment, critical illness, dividends
Sun Senior CareSun Life of Canada (Philippines), Inc.Cover age: until age 100
Premium: 3, 5, or 10 years
Details: Life insurance, critical illness, dividends
Sun Cancer CareSun Life of Canada (Philippines), Inc.Cover age: until age 100
Premium: 5, 10, 15, or 20 years
Details: Life insurance, dividend, critical illness (cancer)

Critical illness VUL or unit-linked insurance

Unit-linked insurance, more commonly referred to as variable universal life or VUL, combines investments and insurance coverage.

Critical illness VULCompanyInfo
Health DynamicsAllianz PNB Life Insurance, lnc.Details: Peso- or dollar-denominated plan, Life insurance, critical illness, investment
Critical Care MaxBPI Philam Life Assurance Corp., IncIssue age: 18 – 65
Cover age: whole life
Details: Life insurance, critical illness, accident, investment
Critical Care PlusBPI Philam Life Assurance Corp., IncIssue age: 18 – 65
Cover age: whole life
Details: Life insurance, critical illness, accident, investment
1st Peso iProtectFirst Life Financial Company, lnc.Issue age: 0 – 70
Cover age: until age 99
Details: Life insurance, accident, waiver of premium on total and permanent disability, critical illness
SHE CARES BY SHEROESInsular Life Assce. Co., Ltd., TheCover age: until age 70
Details: Life insurance, return of premium, critical illness or hospital benefit, investment
WEALTH ASSURE HEALTHInsular Life Assce. Co., Ltd., TheCoverage: Lifetime
Details: Life insurance, hospital benefits, critical illness, investment,
WEALTH SECURE HEALTHInsular Life Assce. Co., Ltd., TheCoverage: Lifetime
Details: Life insurance, hospital benefits, critical illness, investment,
HorizonsManufacturers Life Ins. Co. (Phils.), Inc., TheDetails: Life insurance, critical illness
MONEYWORKS FOR EDUCATIONPhilippine American Life & Gen. Ins. Co.Issue age: 18 – 65
Cover age: until 100 years old
Details: Life insurance, waiver of premium on critical illness or total and permanent disability, investment, education
AIA Health CoverPhilippine American Life & Gen. Ins. Co.Issue age: 0 – 60
Cover age: up to age 80 years old
Details: Critical illness, life insurance, hospitalization benefit, waiver of premium for critical illness
ACTIVE HEALTH INVEST PLUSPhilippine American Life & Gen. Ins. Co.Issue age: 18 – 65
Cover age: until 100 years old
Details: Life insurance, critical illness, accident, health fund
HEALTH INVEST PLUSPhilippine American Life & Gen. Ins. Co.Issue age: 18 – 65
Cover age: until 75 years old
Details: Critical illness, accident, waiver of premium on critical illness or total and permanent disability, life insurance, health fund
Life Basix PlusPhilippine AXA Life Insurance. Corp.Premium: 10 years (minimum)
Details: Life insurance, critical illness, investment
MyLifeChoce HealthPhilippine AXA Life Insurance. Corp.Details: Waiver of premium on disability, accident, investment, life insurance, critical illness
SmartStartPioneer Life lnc.Cover age: 0 – 99
Details: Life insurance, investment, critical illess
PRUHealth PrimePru Life Insurance Corp. of U.K.Issue age: 30 days to 60 years old
Cover age: until age 85
Premium: 20 years
Details: Life insurance, investment, critical illness, hospitalization benefit

Why is critical illness insurance important?

Is critical illness plan right for you? Having insurance provides peace of mind. Getting the right kind of cover with adequate benefits can definitely help in not worrying during emergency situations.

It is suitable for everyone as it can minimize the costs of sickness. It is like a parachute to can protect from bankruptcy and making decisions that undermine your goals (such as selling corporate stocks at a loss or getting into huge mounds of debts).

Its purpose is to complement your existing Philhealth, employer-sponsored HMO/healthcare plan or your personal HMO and life insurance cover.

How?

Philhealth pays a specific amount of money depending on the sickness, and more often than not it can be inadequate.

Your employer HMO or healthcare plan may have certain exclusions, such as pre-existing medical conditions.

Also, there can be a limit to how much of the hospital bills that they’re going to cover. When your total bill exceeds your HMO’s annual benefit limit, you’d be forced to pay from your own pocket. More importantly, it gets terminated the moment you resign or retire from the company.

The critical illness cover comes in the minute that you’re seriously sick of and/or need to go through very expensive procedures for a disease that is covered.

Its benefit is issued to you unlike Philhealth and HMO where the benefits are paid directly to the healthcare providers, physicians and hospitals. Thus, you get the money and that gives you more control on how it is going to be spent.

What are the things you need to do before getting a critical illness policy?

It is worth repeating that you need to make sure that getting critical illness policy is part of an overall financial plan. Don’t get a plan just because you heard someone else got one or that you’re convinced by the words of an advisor (or, shudder, you’re persuaded by this article). Avoid getting under- or over-insured.

Check the following:

  • PhilHealth
  • Employer insurance
  • Personal HMO and insurance plan

Your mandatory Philhealth membership is the first safety net. This can cover getting hospitalized for more than 72 hours, undergoing surgeries, availing of lab tests, medicines, and treatments.

Philhealth coverage covers almost all, if not all, diseases however most of the time the amount is not enough. That’s where your employer insurance comes in. Some companies give employees and their dependents healthcare cover through HMO and life insurance.

How to apply for critical illness insurance?

1. Review your existing insurance

What insurance plans do you already have? And what kind of coverage are you looking for? These are questions that can help you decide. So if you have healthcare plans that you own personally and/or provided by your employer, check the coverage, exclusions, and termination.

2. Want to lessen cost? Buy insurance rider

Do you want to get a plan that can pay when one is sick with dreaded diseases but at a cheaper price? Get an insurance critical illness rider. This is applicable to those who already have an existing life insurance plan. Contact your company or financial advisor and inquire about adding more coverage through riders.

Depending on the plan, the rider is either coterminus or a yearly renewal plan. Co-terminus means that it expires the minute the life insurance policy expires, such as what happens when adding this rider to a term insurance. In the case of a whole life insurance such as variable universal plan or VUL, it renews each year.

Bear in mind that the insurable amount (the maximum amount of money) that the critical illness rider can give is generally limited to the face amount of the life insurance. So if the life insurance component is only going to pay ₱1 million, then the maximum money that can be insured in the rider may be set to only ₱1 million.

3. Due diligence

Now, if you don’t have a life insurance plan yet or the insurance provided to you by your company cannot be customized, then you can purchase a standalone critical illness plan.

Visit websites of Philippine insurance companies. Search for their offers that fit you. Reach out and talk to advisors. Make sure that you are able to get information. Compare plans in terms of premium, covered illnesses, rules on pre-existing condition, etc.

  • Check which diseases are covered.
  • Get a clear definition of major critical illness, minor illnesses, dreaded diseases, and terminal illnesses. A few providers and even among similar products have a different consideration on these items.
  • Ask when the plan’s benefits will be released. Is it upon diagnosis?
  • What severity of the disease that is considered for a claim? Is it early stage? Is it late stage?
  • What proofs would be required when making a claim? Are lab tests results needed? Will the company require a second opinion?
  • Make sure that you understand exclusions: those diseases that are not covered in your plan.
  • When is the end of the coverage? Ask how old a customer must be when the policy is no longer enforceable.

4. Prepare requirements

Once you’ve decided on a product, prepare valid identification cards, and application documents. You may be asked to provide details of previous hospitalization, name of doctor, diagnosis, medicines, lab tests results, treatment and result of the treatment.

Be ready to undergo medical exams and wait for the results.

Once your application is approved, pay the premium diligently according to schedule and keep the contract in a safe place.

References

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