Goose Critical Illness coverage is subject to a Pre-Existing Condition Exclusion. In general terms, this means that no benefit will be paid during the first 24 months after the purchase of this insurance for any medical condition which was present in the 24 months previous to the purchase.
CLAIM SCENARIO #1
A Member is diagnosed with angina in July 2019 and was advised to take medication. The Member takes no medication and does not follow-up with a Doctor.
The member purchases critical illness insurance effective Oct 1, 2020. The member then suffers a heart attack in Jan 2021 and survives for more than 30 days afterward.
Since the heart attack occurred within 24 months of the effective date of critical illness insurance and since a prudent individual would have been treated for angina within 24 months prior to the purchase of critical illness insurance, and the heart attack is directly related to the angina, the claim would be declined.
CLAIM SCENARIO #2
A member is diagnosed with angina in July 2012 and takes medication up to September 2014 and no longer requires treatment after September 2014.
The member purchases critical illness insurance effective Oct 1, 2015. The member suffers a heart attack in Jan 2018 and survives for more than 30 days afterwards.
Coverage has been in force for more than 24 months (i.e. heart attack is suffered at 28th month) therefore, the Pre-existing Condition exclusion has expired. The heart attack diagnosed in January 2021 will be adjudicated as a valid claim, assuming all other conditions of the Policy are satisfied.
CLAIM SCENARIO #3
Member had cancer in the past (March 2016) and has been deemed free of the disease since.
They purchase critical illness coverage in January 2019. They are diagnosed with cancer in another part of the body in June 2020, would they be covered for the disease under their critical illness insurance?
It really depends on the type of cancer suffered earlier and currently (some cancers may re-surface from an earlier instance, while other cancers would occur unrelated to previous history of cancer). Claims adjuster or examiner in the event of a claim would make a determination based upon the specific case presented to them.