GH-D100-07

[HeppeBunnie]

What's the difference between specified/dread disease (page 17) vs. critical illness (page 21)?
Seems to me that there's a lot of overlap between the two sections... a quick google search suggests that they are the same thing.

[neverending]

From the reading I did it seemed that benefits under a dread disease policy may be an amount per day hospitalized (although a lump sum benefit may be paid out upon diagnosis of the disease) while the benefit under a critical illness policy is typically paid out as a lump sum. For the most part, I think they are the same, although this was the one main difference I was able to find in the GRASP manual on pages 45 and 47. I just looked and I believe it also states these facts on the two page references you posted.

[HeppeBunnie]

From the reading I did it seemed that benefits under a dread disease policy may be an amount per day hospitalized (although a lump sum benefit may be paid out upon diagnosis of the disease) while the benefit under a critical illness policy is typically paid out as a lump sum. For the most part, I think they are the same, although this was the one main difference I was able to find in the GRASP manual on pages 45 and 47. I just looked and I believe it also states these facts on the two page references you posted.

Agreed. The descriptions sort of suggest that CI is a subset of dread disease.
I was just reviewing Individual Health Insurance Ch.2, which also describes CI as a new form of dread disease.

[Rainson]

A dread disease policy, the most common of which is a cancer policy, pays for a specified illness. The beneift can vary. For example, a cancer policy may pay a lump sum benefit upon diagnosis of cancer, or it may pay for limited reimbursement of medical expenses or scheduled benefits related to a cancer diagnosis (many times with caps on chemo treatment in order to keep the premium down).

A critical illness policy is broader in that it covers a group of listed "critical" conditions. For example, the policy may pay for cancer, heart attack, stroke, alzheimers, multiple sclerosis, and organ transplants. Naturally since there is great probability of claim due to covering more conditions, the premiums are higher.

Both of these types of policies are not really "health insurance" in that they either pay lump sum benefits or pay schuduled amounts with low maximums. They are intended more to provide financial protection and to fill the gaps (e.g. lost income, out of pocket cost sharing on your comprehensive policy, other expenses/losses that are not health care expenses) while one is critically ill. I beleive the State of NY does not allow cancer policies stating they are misleading and give policyholders a false sense that the cancer policy will cover their medical expenses should they be diagnosed with cancer.