Critical Illness Insurance Support
AF Limited Benefit Group Critical Illness Insurance is a specialized policy designed to pay a lump-sum benefit upon diagnosis of certain covered life-altering illnesses. Learn more about critical illness insurance from the frequently asked questions and additional resources below.
Critical Illness Insurance FAQs
General
What is critical illness insurance?
Critical illness insurance provides a benefit to the Insured when he or she suffers from the following health conditions:
- Heart attack
- Coronary artery bypass surgery
- Permanent damage due to a stroke
- Permanent paralysis resulting from a covered accident
- Major organ failure
- End stage renal failure
Does the payment go to me or my doctor?
Your benefit is paid directly to you, so you may apply the money toward your medical costs or daily living expenses as needed.
What is a Pre-Existing Condition?
A condition for which medical advice, consultation or treatment, including prescription medications, was recommended by or received from a member of the medical profession, prior to the Covered Person’s Effective Date of coverage, within the timeframe listed in the Schedule of Benefits.
How do I allow others to speak to American Fidelity on my behalf?
In order for American Fidelity to release information to anyone other than the policyholder, the policyholder will need to update the Friends/Family Authorization to Disclose Information Including PHI to include the names of the individuals or organization we can release information to. Alternatively, the policyholder may create and submit a signed and dated statement indicating who they are giving authorization to speak on their behalf. If the policyholder is unable to sign their own authorization, we would need a Power of Attorney on file to release any information.
Claims
How do I file a critical illness insurance claim?
The fastest way to file a critical illness insurance claim is through your online account, or on our mobile app, AFmobile®.
- Log in to your online account
- Download AFmobile from the Apple App Store or Google Play Store
For more details on how to file a claim, including required documentation and a step-by-step instructional video, visit our critical illness insurance claim page.
Where do I get a claim form?
You can download and print a paper claim form here. Please note, paper claim filing is not the fastest option. File a claim online or through AFmobile to get your money faster.
For more details on how to file a claim, including required documentation and a step-by-step instructional video, visit our critical illness insurance claim page.
What documentation do I need to submit?
When filing a critical illness insurance claim you will need to provide the following documentation:
- Statement of Insured, completed via online claim filing or paper claim form.
- Attending Physician Statement: Complete the Statement of Insured on the first page, then have the physician in charge of your care complete the remaining pages. Upload the form via your online account, or mail or fax it.
- Medical records or office notes from the date you were first treated for symptoms associated with the condition until the present date.
- If filing for occupational HIV/Hepatitis B, C, or D, you will also need to provide an incident report or notice of exposure.
- If filing for Sudden Death due to Cardiac Arrest, you will need to provide a copy of the Death Certificate of the Insured.
We may also need:
- Authorization to Disclose Information Including PHI: This form gives us authorization to get records from your medical provider(s) and others who may hold information necessary for us to review your claim. Upload the form via your online account, or mail or fax it.
For more details on how to file a claim, including a step-by-step instructional video, visit our critical illness insurance claim page.
What is the processing time once a claim is submitted?
Claims are generally processed within 5-7 business days.
However, your critical illness policy’s annual wellness screening benefit may qualify for quick processing. When you submit your wellness benefit claim online or through AFmobile, you can receive payment in as little as one day when enrolled in direct deposit, no extra documentation required.
Are there circumstances when claims may be excluded?
Exclusions may include self-inflicted injury or sickness, suicide or attempted suicide, under influence of narcotics outside of physician care, committing a felony, incarceration 30 days or longer, alcoholism or drug addiction, or diagnosis outside the United States. May vary as described in the policy.
Benefits
What is the Critical Illness Benefit?
A lump sum of money paid to the Insured, based upon the Benefit Amount purchased. Benefit amounts range from $5,000 to $50,000, in $5,000 increments. Children are included and covered at 25% of the employee benefit amount at no additional cost. Spousal coverage is available at 50% of the employee benefit amount at an additional cost.
What is a Schedule of Benefits?
A document that details information about specific plan benefits. You can view your Schedule of Benefits in your policy document through your online account.
What is the Wellness Screening Benefit?
This benefit is payable for the Insured and spouse, if applicable, once per calendar year for annual health screening tests. Maximum of one covered test per year. Screening tests include:
- Blood test for triglycerides
- Doppler ultrasound
- Echocardiogram
- Electrocardiogram (EKG)
- Fasting blood glucose test
- Serum cholesterol test to determine HDL and LDL levels
- Exercise or Pharmacologic stress test
- Neuroimaging studies
What is the Recurrent Diagnosis Benefit?
If you (the Insured) receives a recurrent diagnosis or second occurrence date for a covered critical illness, for which the Critical Illness Benefit has been paid, we will pay an additional benefit equal to 50% of the benefit amount purchased.
What is the Heart Attack Benefit?
A benefit will be paid following a Heart Attack (Acute Myocardial Infarction) due to Coronary Artery disease resulting in death of a portion of the heart muscle.
What is the Stroke Benefit?
A benefit will be paid for permanent damage due to a stroke. A stroke is defined as permanent neurological damage to the brain which results from an acute or sub-acute interruption of blood flow to brain tissue, including infarction of brain tissue due to blood flow to the brain tissue, including infarction of brain tissue due to embolism, thrombus, or bleeding.
What is the Major Organ Failure Benefit?
A benefit will be paid for failure of major organ function diagnosed by a physician that results in placement on the United Network for Organ Sharing (UNOS) list for transplant of the heart, liver, lungs or entire pancreas.
What is the End Stage Renal Failure Benefit?
A benefit will be paid for irreversible failure of both kidneys to function and which requires regular dialysis or renal transplantation.
What is Permanent Paralysis Due to a Covered Accident Benefit?
A benefit will be paid for a spinal cord injury due to a covered accident resulting in the loss of use of two or more limbs. Paralysis must be diagnosed by a physician as permanent, total and irreversible.
Eligibility
Am I able to continue this coverage after I’m no longer an eligible employee?
As long as you were continuously covered for 12 consecutive months prior to the date your coverage under the policy ends, you can submit a request to American Fidelity within 30 days of losing eligibility, for continuation of coverage.
Learn more about keeping your coverage, or if you have any questions, please contact the Conservation Department online or call 800-943-2231.
Examples of Critical Insurance Benefits
For a covered illness, you may receive a lump sum benefit for the following:
- Heart attack
- Coronary artery bypass surgery
- Permanent damage due to a stroke
- Permanent paralysis resulting from a covered accident
- Major organ failure
- End stage renal failure
Wellness Screening Benefit
This benefit pays a lump sum when a covered person receives a health screening test. This benefit may also qualify for quick claims processing. Tests include but are not limited to:
- Blood test for triglycerides
- Doppler ultrasound
- Echocardiogram
- Electrocardiogram
- Fasting blood glucose
- Serum cholesterol
- Exercise or pharmacologic stress test
- Neuroimaging studies
Log in to your online account to view your policy details.
Surviving a Critical Illness Doesn’t Have to Come at a High Price
Critical illness insurance can help you with out-of-pocket expenses your medical plan may not cover, like deductibles, copayments, or even everyday living expenses. Watch this short video for more details on how critical illness insurance can help you protect your finances.
Get Paid Quicker
Your annual wellness screening may qualify for AFQuickClaims® processing, meaning you could receive your benefit for eligible claims in as little as one day when you’re enrolled in direct deposit.