Critical illness insurance: partial benefits and refunds attract clients

According to the database of InsuranceINTEL, our insurance product information centre, all insurers offer at least one form of return of premiums paid for critical illness insurance. Most of the options they offer allow policyholders to recover 100% of the premiums they have paid if no illness occurs. 

InsuranceINTEL has identified three types of premium refunds offered by most individual critical illness insurance products: 

• Premium return on maturity (or expiration) of the policy
• Premium return on death of the insured
• Premium return on cancellation (or surrender) of the policy 

Reimbursement may be offered on one or more of the critical illness insurance coverages offered by insurers. There is considerable variation among insurers in this regard, as shown in the following comparison table prepared by the Insurance Portal based on data from InsuranceINTEL.

Some insurers offer a wide range of coverage options for certain types of premium refunds but not for others.

Some insurers offer the same coverage options regardless of the type of premium refund.

Three insurers offer premium return on death: ivari, Canada Protection Plan (CPP), and RBC Insurance. Desjardins Insurance does not offer refunds on maturity, while Humania Assurance does not offer premium return on cancellation. All insurers offer premium refunds upon the death of the insured.

To simplify the presentation, we have chosen to present information on the most comprehensive product offered by each company in terms of premium refunds. CUMIS Life is not included in the table because its product features are identical to those of Co-operators. CUMIS Life is a subsidiary of Co-operators.

Progressive refunds 

The amount that insurers return at the maturity or termination of a critical illness insurance policy depends on when either of these events occurs. To determine this, insurers each have a progressive scale that varies according to the type of coverage and the number of years since the policy was taken out or the age of the customer.

In April 2025, Beneva announced changes to these two premium return categories, as Nicolas Trépanier, Senior Director, Actuarial and Product Development, Individual Insurance, mentioned in an interview with the Insurance Journal. His comments were included in a special report published in the October 2025 issue of the magazine, with a view to publishing this supplementary article on the Insurance Portal.

“Since 2025, we have been offering two premium return options upon cancellation or expiry to meet the needs of our customers and their ability to pay,” said Trépanier:

• ROP 15: offers a 100% return of premiums in the event of cancellation on or after the 15th anniversary of the policy. 
• ROP 20: offers a 100% return of premiums in the event of cancellation on or after the 20th anniversary of the policy.

“Both options also allow for a partial refund of premiums upon cancellation starting on the fifth anniversary of the policy,” explains Nicolas Trépanier.

Regardless of the type of refund considered, insurers also have their own specific features. Here are a few of them.

In response to a request for clarification from the Insurance Portal, Humania Assurance indicated that premium refunds are made at 20 years. As with most insurers, Humania Assurance offers refunds as a rider, i.e., as an option. It is available on its 10-year term (T10) and 20-year term (T20) coverage options for insureds who are 45 years of age or younger.

The insurer notes that this is not a return on policy expiration, as the insurer will automatically pay it every 20 years. The policy continues after the payments: young people could receive a second refund in the 40th year of the policy, according to Humania Assurance. The return on death corresponds to 100% of the premiums paid, which is the case with other insurers. 

Humania Assurance mentions other products besides Critical Illness Insurance without Medical Exam. For example, progressive premium refunds are offered if you cancel your Prodigy policy.

Important for advisors and clients  

According to Nicolas Trépanier, premium returns attract many clients. “I can't tell you exactly how many, but we have a lot of critical illness insurance sales that come with premium returns,” he adds.

Premium returns are one of the most important features of individual critical illness insurance, according to Liane Goulet, Director, Health Insurance Product Management at Sun Life, also quoted in the special report.

Goulet says that the insurer offers this on all of its critical illness insurance policies. "We offer simple and easy-to-understand premium return options. The Return of Premium on Death and Premium Refund or the Return of premium on cancellation or expiry (progressive) benefits are available for all coverage, including T10," she points out. Goulet adds that the Return of premium on cancellation or expiry benefit can be added at the time of conversion without being subject to underwriting.

Partial benefits (indemnities)  

Individual critical illness insurance products protect the possibility for an insured to receive a partial benefit in the event of an illness that is not life-threatening (also known as an additional benefit), which is another important feature in the eyes of clients and advisors.

The offering aims to create a safety net for insured persons who have a more benign medical condition that does not meet the criteria for basic critical illness.

Partial benefits “effectively reduce the denial rate,” says Liane Goulet of Sun Life. She explains that this is because illnesses eligible for partial benefits, which she refers to as Group 2, are among those excluded from illnesses eligible for full benefits, or Group 1.

With many insurers, partial benefits amount to 15% of the coverage amount chosen by the insured, up to a maximum of $50,000. As a general rule, the payment of partial benefits does not reduce the total amount of coverage purchased by the insured.

At Beneva, Nicolas Trépanier describes how this works by giving the example of an insured person with a critical illness policy with an insurance amount of $100,000. In his example, the insured person received a partial benefit of $15,000 for ductal carcinoma in situ breast cancer. “The person would still receive $100,000 if she were later diagnosed with life-threatening cancer. In addition, if this person were to undergo coronary angioplasty, she could receive another $15,000 without affecting her $100,000 coverage,” explains Trépanier. 

Among its new features for April, Trépanier says that Beneva has improved its additional benefit, included in enhanced and children's coverage. "Coverage has been increased from four to eight medical conditions. The amount paid has been increased to 15% with a maximum of $50,000 per claim. It was previously 10%. The maximum number of benefits paid has increased to four, whereas previously only one partial benefit could be received," he explains.

At Desjardins Insurance, Health Priorities pays a partial benefit in the event of a non-life-threatening illness. The client is entitled to one payment per category of covered health conditions. There are five categories for which a benefit is payable, for a maximum of five times.

The payment of a partial benefit does not seem to be common. At Sun Life, Liane Goulet mentions that in 2024, partial benefits represented only 6% of all critical illness insurance claims paid by the insurer. In terms of fully insured conditions, cancer alone accounted for 62%, heart attack 12%, stroke 5% and coronary artery bypass grafting 3%, according to the Sun Life document she cites: Understanding Critical Illness Insurance Claims. According to this document, Sun Life paid out $94 million in critical illness benefits in 2024.