Group critical illness cover for employers

The benefit gives the recipient money following an accepted claim. It is distinct from insurance paying a hospital bill or replacing earnings throughout an absence. Some schemes allow a fixed benefit; others use a multiple of earnings. Family cover may be available on different terms. [S12]

Before comparing quotes, state the proposed employee benefit and who would pay for it. Where employees can buy additional cover, explain the selection process and what changes at the next enrolment window.

Ask the broker to show which choices alter the claim conditions, as well as which alter the amount. Avoid presenting a higher benefit as an equivalent purchase if the insured definitions differ.

A condition on a list still has a policy definition. It may specify the diagnosis, severity, evidence or procedure required. A survival period, where present, is another requirement. Unum's group critical illness guide illustrates these separate tests. Its terms are an example, not a definition of the whole market. [S13]

Ask the adviser to work through two of the proposed policy's definitions with you. Identify the wording that determines whether the insurer can pay. Do not ask HR to diagnose an employee or decide whether a condition qualifies.

An employee saying they have a serious diagnosis should receive the claim contact and support information. The insurer needs to assess the evidence against the insured definition; an employer summary cannot settle the claim.

Use the same comparison for an employer-funded scheme and an employee-funded option. The person choosing the benefit needs to understand its limitations whichever funding method applies.

Not being asked medical questions does not necessarily mean an existing condition is covered. Some arrangements use pre-existing or related-condition exclusions; other products have a different approach. Unum publishes products with different medical-history treatment, so the answer must identify the actual product and terms. [S12]

Ask what applies to a new member, an increase in cover and a transfer from another insurer. Ask how the insurer treats a condition related to something diagnosed before entry. Do not give a colleague a claim prediction based on another employee's experience.

Provide a private route to the insurer for individual questions. HR should not need a person's medical history merely to direct them to the correct policy contact.

If family cover is included or available, obtain its eligibility and benefit terms separately. The definitions, payment amounts, entry conditions and end dates may differ from the employee's cover. [S12]

Put family questions into the employee summary: who qualifies, whether registration is required, who pays, and where the detailed terms can be found. Ask what happens when a child no longer meets the definition or when a relationship or employment changes.

Do not assume an employee's own cover amount is also the amount available for a family claim. Use provider-approved examples tied to the actual scheme when explaining this.

Ask payroll and the adviser to confirm the treatment of the employer premium, any employee contribution and any benefit payment separately. Do not infer that the employer's purchase is tax-free because a product describes its lump sum that way.

Keep a scheme-specific tax explanation with the quote, including any employee-funded or salary-sacrifice arrangement. This guide does not calculate a person's liability or recommend a funding structure.

Request the current policy definitions alongside the renewal terms. Ask for a marked explanation of changed conditions, exclusions, family cover, benefit limits and claim requirements. A price comparison alone will not reveal those changes.

When considering a switch, ask about continuity for existing members, prior diagnoses, pending claims and increases in cover. Obtain the answer before cancelling the old policy. Keep the transfer decision and employee communication linked to the accepted terms.

Recheck how the employee summary describes the benefit. Replace any promise that all cancer, all serious illness or every recurrence is covered with the actual policy explanation.