Voluntary Critical Illness Products

Cost: $4,000; published 2025

Voluntary critical illness products are in demand by brokers, employers and employees and have quickly become a fundamental part of every carrier’s voluntary product portfolio. Interest in these products continues to increase, and carriers have responded by adding new covered conditions with higher benefit amounts – while striving to keep pricing low and offer guaranteed issue underwriting.

The Voluntary Critical Illness Products Spotlight™ reviews existing products and the future outlook for the critical illness marketplace so carriers can better understand how their products compare to the competition and identify potential opportunities for growth.  The specific topics covered include:

  • Market overview for critical illness products
  • Product structure and benefits
  • Underwriting/eligibility guidelines
  • Sample rates
  • Commissions
  • Claims
  • Product results
  • Product differentiators, challenges and future trends
View Table of Contents

1. Executive Summary

A. Report Objectives
B. Methodology
C. Key Findings

2. Market Overview

1. The Overall Market
2. Employer Perspective
3. Employee Perspective
4. Broker Perspective
5. Key Competitors

3. Product Details by Carrier

A. Product Structure and Specifics

1. Product Platform
2. Definition of Voluntary for Critical Illness Products
3. Employer Contributions
4. Years in the Critical Illness Market and Last Product Revision
5. Standard Plan Design and Offering
6. Customized Product Options
7. Covered Conditions
8. Covered Heart, Vascular, Stroke and Lung Conditions
9. Covered Cancer/Benign Tumors
10. Covered Major Organ Conditions
11. Covered Functional/Catastrophic Loss Conditions
12. Covered Neurological Conditions
13. Covered Chronic Conditions
14. Covered Infectious Disease Conditions
15. Covered Mental Health Conditions
16. Covered Childhood Conditions
17. Additional Benefits/Riders
18. Additional Occurrence Benefits
19. Payment of Benefits
20. Partial Benefits
21. Lifetime Maximum
22. Minimum/Maximum Benefit Amounts Available
23. Elimination or Waiting Periods
24. Pre-Existing Conditions Exclusion
25. Wellness Benefit
26. Additional Occurrence Benefits
27. Reoccurrence Benefits
28. Payment of Benefits
29. Lifetime Maximum
30. Minimum/Maximum Benefit Amounts Available
31. Elimination or Waiting Periods
32. Pre-Existing Conditions Exclusion
33. Age-Based Reductions and/or Termination
34. Spouse and Dependent Coverage

B. Product Portability and Conversion

1. Group Product Portability and Ported Coverage and Rates

C. Rates and Commissions

1. Published or Census Rates
2. Issue-age or Attained-age Rates
3. Composite Rate Options
4. Rate Structure for Family Coverage
5. Tobacco/Non-Tobacco or Uni-Tobacco Rates
6. Re-rating
7. Renewability
8. Premium Guarantees
9. Monthly Premium Comparisons
10. Multi-Line Discount Offers
11. Critical Illness Commissions
12. High Minimum Loss Ratio State Changes
13. Reheaping Commissions

D. Underwriting

1. Account Eligibility Guidelines
2. Employee Eligibility Guidelines
3. Type(s) of Underwriting Used
4. Guaranteed Issue Guidelines
5. Simplified Issue Guidelines
6. Simplified Issue Health Questions
7. Other Questions
8. MIB, APS, Pharmacy Checks for Simplified Issue
9. Full Underwriting Guidelines
10. Spouse and Dependent Underwriting
11. Minimum Essential Coverage Plan Requirement
12. Coverage Increases
13. Annual Open Enrollment
14. Previously Offered Employee Guidelines

E. Claims

1. Types of Claims Problems
2. Average Speed of Claims Payment or Denial
3. Percent of Claims Denied and Most Common Reasons for Denial
4. Proof for Wellness Claims
5. Current vs. Expected Loss Ratios
6. Claims Utilization/Loss Ratio Reporting Requests

4. Differentiators, Results, Challenges and Future Trends

A. Product Differentiators and 2024 Results

1. Product Differentiators
2. 2024 Critical Illness Sales
3. Product Profitability
4. Participation Percentage
5. Typical Policyholder and Account Demographics
6. Average Amount of Coverage Purchased
7. Average Annual Premium per Employee
8. Persistency/Retention
9. Takeovers vs. Virgin Case
10. Original Age vs. Current Age for Replacement Plans
11. Occurrence of Takeovers Based on Attained or Issue Age Pricing

B. Challenges and Future Trends

1. Unique Product Challenges
2. Current and Future Product Trends

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