Does critical illness insurance cover heart attack?

Every year in Canada, roughly 63,200 people are diagnosed with a heart attack for the first time (source: Government of Canada). With the heart attack mortality rate of about 12% (source: Healthline), that means that every year over 55,000 people live with varying degrees of heart damage, which can impact lifestyle, mobility, and the ability to work.

Critical illness insurance can play a vital role in supporting people’s heart attack recovery by providing financial protection should they undergo this life-threatening health event. Critical illness insurance is a living benefit that can be used at the insured’s discretion, whether it’s to pay for care, treatment, income replacement, or anything else they may need. Keep reading to learn more about who is eligible for heart attack insurance and how it can protect your financial future.

What is a heart attack?

A heart attack, also called myocardial infarction, is when the heart muscle suffers damage due to a lack of blood flow and, consequently, lack of oxygen. Just as a stroke is caused by loss of blood flow to the brain, a heart attack is caused by a lack of blood flow to the heart. The severity of heart attacks varies depending on how long the blood supply is cut off from the vital organ. In worst-case scenarios, it can lead to cardiac arrest and death.

There are several factors that can cause heart attacks. The most common cause is obstructed coronary arteries due to buildup of plaque, cholesterol plaque, or blood clots. Heart attacks can also be caused by a coronary artery spasm, which temporarily restricts the coronary artery, inhibiting blood flow. Symptoms of a heart attack include chest pain or discomfort, shortness of breath, and nausea, among others—though these manifest differently depending on the patient.

While heart attacks are often unexpected, there are certain factors that influence your risk of heart disease—some of which can be mitigated. For instance, smoking, stress, recreational drug use, obesity, high blood pressure, and high cholesterol can all increase your risk of this medical condition. Other uncontrollable factors—such as age, family medical history, and certain autoimmune conditions—can contribute to your risk of a heart attack.

What is critical illness insurance?

Critical illness insurance is a type of coverage offered by life insurance companies (typically as an add-on to a life insurance policy, but can also be purchased as a stand-alone policy) that pays out a tax-free lump sum should the insured be diagnosed with a life-threatening illness or suffer a serious health event while the policy is active. Unlike traditional life insurance, critical illness insurance issues a benefit while the insured is alive, providing them and their family with financial support as they manage the financial and health impact of a life-threatening illness. This money can be used to pay medical expenses, cover non-traditional treatment, travel expenses or any other expenses the family sees fit. It should be noted that the critical illness insurance benefit is only paid if the insured is diagnosed with a covered illness, as specified in the policy. The proceeds of the insurance can be used fully at the discretion of the insured.

Does critical illness insurance cover heart attack?

Yes, critical illness policies cover heart attacks. In fact, heart attacks are the second most claimed health event through critical illness coverage (representing 13%), following cancer (63%). If you’ve suffered from a heart attack, it is important to note what insurance companies consider when approving claims. First, a heart attack requires a medical specialist diagnosis, and the insured must have undergone symptoms as well as electrocardiogram (ECG) changes that are consistent with a heart attack.

There are certain exclusions that may apply. For instance, a claim may be denied if a policyholder has ECG changes that point to a pre-existing heart attack, displays other acute coronary syndromes, or has undergone a medical procedure or received another diagnosis that has caused elevated cardiac biomarkers.

How long do I have to wait to file a claim after having a heart attack?

In order to make a claim for heart attack insurance, policyholders must be diagnosed with a heart attack by a physician and wait 30 days after the diagnosis. This waiting period is called a survival period. Some insurance providers do offer shorter survival periods. Typically, the critical illness benefit will be paid within a month of the claim being submitted.

Can I start a critical illness insurance policy after I’ve had a heart attack?

While it is much easier to start a critical illness insurance policy before suffering any major health events, it is still possible to find coverage after a heart attack recovery. In other words, you have options, though you may not qualify for the most competitive rates or highest benefits.

The most common route for those who have recovered from a heart attack is guaranteed critical illness insurance. This type of policy, though inclusive, has some limitations. For example, guaranteed critical illness insurance typically includes a two-year pre-existing condition exclusion. This means that if you’ve suffered from a heart attack in the two-year period before the start of the policy, any heart attack or related health event in the next two years will not be covered.

Can I get critical illness insurance if my family has cardiovascular health concerns?

If your family has a history or signs of heart disease, it is prudent to think about investing in critical illness insurance. Though most life insurance companies take family medical histories into account when evaluating a critical illness insurance application, having an increased risk of heart disease will not necessarily exclude you from coverage. Your coverage limit and premium rates, however, may be impacted.

In cases where family history is a consideration, it is advisable to purchase critical illness insurance sooner rather than later. This will increase your chances of being able to place coverage and improve the premium rates you are offered.

To find out more about insurance for heart attacks and other critical health conditions, head to our critical illness insurance learning centre. To better understand how much critical illness insurance coverage you might need, consult our critical illness insurance calculator.

CLHIA heart attack definition

Heart Attack definition

Heart Attack means a definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following:

• Heart attack symptoms
• New electrocardiogram (ECG) changes consistent with a heart attack
• Development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.
• The diagnosis of Heart Attack (acute myocardial infarction) must be made by a specialist.

Exclusions: No benefit will be payable under this covered condition for:

• ECG changes suggestive of a prior myocardial infarction;
• Other acute coronary syndromes, including angina pectoris and unstable angina; or
• Elevated cardiac biomarkers and/or symptoms that are due to medical procedures or diagnoses other than heart attack.

Similarly, there may also be coverage for other cardiovascular conditions. To clarify what is usually covered, the CLHIA has defined the 26 conditions most commonly included in these insurance policies.