Heart attack coverage

Heart attack coverage is an insurance benefit that pays a lump sum upon diagnosis of a myocardial infarction. Most critical illness policies in the U.S. (Like those from Aflac and MetLife) include heart attack as a covered condition.

Major insurers define “heart attack” using American Heart Association criteria, including elevated cardiac enzymes and ECG changes. Standard exclusions apply for non-cardiac chest pain or minor heart disorders such as angina.

Lump sum payouts usually range from $10,000 to $50,000; Guardian Life offers up to $100,000 on select plans. Waiting periods typically last 30 days after policy issuance; Prudential’s “Return of Premium” rider may modify this with additional cost.

Pre-existing conditions like prior heart attacks may limit eligibility or increase premiums by 20-40%. Heart attack coverage commonly pays out only once per insured event per policy period.

Benefits can cover deductibles, lost wages, or rehabilitation costs; UnitedHealthcare reports average out-of-pocket costs for major heart events exceed $4,400 annually, according to a report from YourInsurance.info. Tax treatment varies: most individual policy payouts are tax-free under IRS Code §104(a)(3).

Some policies exclude coverage if the heart attack results from drug use; Humana specifies this in its exclusions list. Group plans through employers often offer lower rates but reduced flexibility compared to individual policies available on the open market.