Critical Illness Protection Plan

A health plan only goes so far. Consider the cost and productivity impact due to heart attacks, stroke and cancer.

Give employees more security from the high cost of a critical illness.

Americans suffer 1.5 million heart attacks and strokes each year.1 About 1.6 million new cancer cases are expected to be diagnosed in the U.S. this year.2  Then consider that many employees are not prepared for high, unexpected costs. Almost two in three U.S. workers say they have less than $1,000 on hand to pay the out-of-pocket expenses of an unexpected, serious illness or emergency.3

Offer the Critical Illness Protection Plan.

Our Critical Illness Protection Plan is insurance that pays a lump-sum cash benefit directly to a covered employee after a diagnosis of a critical illness. The amount of the cash benefit is based on the condition, covered expenses and treatments covered by the employee’s plan.

Any payment the plan makes is in addition to the benefits your employees receive from their health plan. The employee can use the money to help pay their health plan deductible, prescription costs or for other expenses to manage their illness. Or, they can use it to help cover mortgage or rent payments, groceries and more.

Help your health plan.

With millions of employees now in high-deductible health plans, they are even more susceptible to high out-of-pocket costs.4 Offering the Critical Illness Protection Plan gives you and your employees added relief from the financial burdens and stress that can come with a major illness.

How it works: Sharon’s example5

Sharon signed up for the voluntary plan (she pays 100% of the plan premium). During the plan year, she is diagnosed with invasive cancer. Six months later she also has a stroke.

Sharon signs up for the Critical Illness Plan.

Sharon signed up for Plan A at a cost of about $17 per month. Play A pays her $10,000 for each covered base condition.

Sharon’s health care costs added up to $15,000+.

While her health plan helped, Sharon still has out-of-pocket costs and faced lost wages. She submitted a Critical Illness claim.

Sharon received $20,000.

After Sharon’s claim was verified and processed, she received a lump-sum payment for each covered condition. Sharon has an emergency fund to help her during her recovery.

This is insurance that pays benefits directly to the member after diagnosis of a covered critical illness. The following is a summary of the plan options available. Optional benefits are also available.

Covered Conditions

Conditions and coverage may vary by state and group size. All benefits are payable at 100% unless otherwise noted as a partial benefit. Contact your UnitedHealthcare representative for more information.

Base Conditions

  • Benign Brain Tumor
  • Cancer — Invasive
  • Cancer — Non-Invasive (25% partial benefit)
  • Chronic Renal Failure
  • Coma
  • Coronary Artery Disease (25% partial benefit)
  • Heart Attack
  • Heart Failure
  • Major Organ Failure
  • Permanent Paralysis
  • Ruptured Aneurysm
  • Stroke

Additional Conditions

  • Advanced Alzheimer’s
  • Advanced Multiple Sclerosis
  • Advanced Parkinson’s
  • Amyotrophic Lateral Sclerosis (ALS)
  • Complete Blindness
  • Complete Loss of Hearing

Child-Only Conditions

  • Cerebral Palsy
  • Cleft Lip/Palate
  • Cystic Fibrosis
  • Down Syndrome
  • Muscular Dystrophy
  • Spina Bifida

Benefit is 25 percent of employee coverage. Child-only coverage is included with Employee coverage. One covered condition per child. Coverage is from birth to age 26.

Eligibility and plan features may vary by state and group size.

Group size

  • 51 or more eligible employees.


  • Non-contributory
    • Fully paid by the employer
    • 100 percent participation of eligible employees required.
  • Voluntary
    • Fully paid by the employee
    • 20 percent participation of eligible employees required (51 to 2,999 employees).
    • 10 percent participation of eligible employees required (3,000 or more employees).
  • Base / Buy-up
    • Employer pays 100 percent of Base plan; Employee pays 100 percent of Buy-up plan.
    • 100 percent participation of eligible employees required on Base plan.
    • 20 percent participation of eligible employees required on Buy-up plan (51 to 2,999 employees).
    • 10 percent participation of eligible employees required on Buy-up plan (3,000 or more employees).


  • Must be actively at work a minimum of 20 hours per week.

Pre-existing condition exclusion.

  • 6/12 standard.
  • Other options available with underwriting approval.


  • Coverage portable at employer’s group rates.
  • See Certificate of Coverage for additional information.

Rating basis.

  • Issue age — premiums will be level throughout coverage.
  • Attained age — premiums will increase as member ages.

Rate guarantee.

  • Three years (3,000 or more employees).
  • Two years (51 to 2,999 employees).

Optional Benefits

Reoccurrence Benefit

This benefit is equal to 100 percent of the coverage amount if the:

  • Covered person is diagnosed with a second occurrence of a covered critical illness for which a benefit was previously paid.
  • Diagnosis is made 12 months or more following the initial covered critical illness diagnosis.
  • Covered person has not received treatment for the covered critical illness during this 12-month period. Maintenance medication or therapy is not considered to be treatment.

One reoccurrence benefit is payable for each of the covered base conditions. The benefit does not apply to additional or child-only covered conditions.

Additional Occurrence Benefit

This benefit is equal to 100 percent of the coverage amount. The covered person can receive benefits for different covered critical illnesses if the dates of diagnosis for each illness are separated by at least 90 days.

Optional Riders

Wellness Rider

Provides $50 or $100 benefit per plan year to employee and an insured spouse for designated health screening tests. The employer may select other wellness coverage options.

Occupational HIV Rider

Provides a one-time, lump-sum benefit equal to 100 percent of the coverage amount.

  • Benefit is paid to a covered person who sustains an injury in the performance of occupational duties that results in acquiring or testing positive for HIV.
  • Benefit is available to health care or other related professions and is elected at the employer/case level.

It's easy to add Critical Illness to your UnitedHealthcare health plan to:

  • See savings. You may qualify for significant savings by bundling your plans. You may also save time with more efficiency.
  • Enjoy simplicity. Get one account team, administration process and website, customer service line and more.
  • Inspire healthier. Bridge2Health®* uses health plan and specialty plan data to identify and empower your employees with support and resources that can help them make informed decisions and take control of their health. Learn more.

*To be eligible for Bridge2Health, employers must have 51+ eligible employees and have both a UnitedHealthcare health plan and a UnitedHealthcare Critical Illness Protection Plan.

1 American Heart Association. Disease and Stroke Statistics 2017 Update. A Report From the American Heart Association; Mar. 2017. Web.

2 American Cancer Society. Cancer Facts & Figures 2017. Atlanta: American Cancer Society; 2017. Web.

3 Weschler, Pat. “63% of Americans Can’t Cover Unexpected Expenses.” Fortune. 63% of Americans Can’t Cover Unexpected Expenses. Time Inc., 06 Jan.

4 “2015 Census of Health Savings Account - High Deductible Health Plans.” 2015 Census of Health Savings Account - High Deductible Health Plans. America’s Health Insurance Plans, Nov. 2015. Web.

5 For illustrative purposes. Premium, benefit and care amounts will differ based on market, plan and covered conditions.