Consumer Connection: Learn About Specific Disease Insurance to Protect Your Heart and Wallet

By Sonya Sellmeyer, Consumer Advocacy Officer for the Iowa Insurance Division

Valentine’s Day provides an opportunity to think with our hearts, but it may also be a good time to think about heart health and the insurance that keeps you financially covered. 

One product you may find is a specific disease policy. These types of policies can cover a heart attack, stroke or cancer depending on the policy. These policies can be sold as individual policies or through an employer or member group.

It’s important to educate yourself before purchasing any type of insurance, but since specified disease policies are not a substitute for major or comprehensive medical coverage, it's important to read the fine print.

Specific disease policies generally will not cover a disease or condition diagnosed before you apply for the policy, and will not cover other related illnesses, such as pneumonia, that would result from an immune system weakened by the covered disease.  They may provide coverage per day, per medical service, or a lump sum amount once you are diagnosed with the covered illness. Many specific disease policies have fixed dollar amount limits, meaning that they will only provide a predetermined benefit, which is often a fraction of total expenses.  Some may only pay for hospital care if you stay a required minimum number of days, which is becoming more rare due to decreased hospital stays and more outpatient procedures.

Remember specific disease policies are not major medical policies, and specific disease insurance may be duplicative or even unneeded.

Some additional questions to ask yourself before purchasing a specific disease policy: 

• What is your family history?  How likely are you to be inflicted with the covered disease or illness?
  
  
• Is your current health coverage adequate for the condition treatment? If you are on Medicare with a supplement, or Medicaid do you have sufficient coverage?
    
• Is a specific disease policy duplicative coverage?
  
  
• Are experimental or investigative treatments covered under the policy?
   
• Does the policy have a waiting period before you can collect benefits? Is there a limit on how long payments will be paid? Will the benefits run out if the condition is long-term?
  
  
• Does the policy have a free look period? If so, make sure you review and ask questions during this 10 day period so that you may return the policy if the policy doesn’t fit your needs.
   
• Do you already have one of these policies? Do you need more than one? Please discuss this with a trusted family member or friend. 

Now that you’ve learned more about specific disease policies, protect your health and wallet this Valentine’s Day by shopping around, reading the contract, and understanding the terms, conditions, waiting periods, and what the policy will and will not cover. Once the policy is reviewed, protect your wallet by ensuring the policy is what you purchased, ask questions before the end of the free look period, and file your claims timely.

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