When a High-Deductible Health Plan Meets Critical Illness

When a serious diagnosis introduces expenses beyond traditional health insurance, including a high deductible, supplemental income support matters. The TMA Member Critical Illness Insurance plan, issued by the Prudential Insurance Company of America, is intended for situations like these. The following scenario* shows how this critical coverage can play out in practice.

Critical Illness Insurance in Action

Beginning in 2026, many health insurance premiums across Texas experienced double-digit rate increases.¹ In response, like many physicians, Dr. Smith selected a high-deductible health plan during Open Enrollment to manage rising costs.

Months later, a heart attack abruptly altered his daily routine.

Returning to work was not immediate. Nearly two months passed before it felt realistic. During that time, short-term disability replaced only a portion of his income, while regular household expenses continued. His health plan deductible came due, and additional assistance at home became necessary. This created costs that his health insurance did not fully cover.

Before his heart attack, Dr. Smith had enrolled in TMA Member Critical Illness Insurance through TMA Insurance Trust. As a TMA member under age 65, acceptance was guaranteed for $20,000 in coverage, with no medical exams, health questions, or underwriting required. Following his covered diagnosis, the lump-sum benefit was paid directly to him.

By the time Dr. Smith returned to work, the impact of time away was significant. During recovery, the benefit provided flexibility by supplementing his reduced income, offsetting the high deductible, and helping cover medical and non-medical expenses. Having coverage in place helped reduce financial strain, allowing him to avoid relying on long-term savings or returning to work before he was ready.

Why This Scenario Is Not Unusual

Recovery timelines like this are common. According to the Texas Heart Institute, returning to work after a myocardial infarction can take anywhere from a few weeks to two or three months.²

Serious illness is also more prevalent than many expect. The American Heart Association reports that someone in the United States experiences a myocardial infarction approximately every 40 seconds.³ The American Cancer Society estimates about two million new cancer diagnoses nationwide in 2024,⁴ including nearly 148,000 in Texas.⁵

Treatment and recovery can also involve additional expenses. Research published through the National Institutes of Health shows that about 40% of cancer patients use complementary or alternative medications during treatment,⁶ costs that may fall outside traditional health insurance coverage.

Together, these realities help explain why some physicians look for an insurance plan beyond medical coverage alone. Having quick access to funds can provide the added flexibility needed when income is disrupted and expenses arrive from multiple directions.

Key Features of the TMA Member Critical Illness Insurance Plan

The following features highlight how this coverage helps provide financial support when it is needed most.

• Guaranteed acceptance for TMA members. Members under age 65 are guaranteed acceptance for $20,000 in coverage with no medical exams, health questions, or underwriting required.
• Guaranteed acceptance for spouses. Once you enroll, guaranteed acceptance for $10,000 extends to a spouse or domestic partner under age 65.
• Direct benefit payments. Benefits are paid directly to you upon diagnosis of a covered illness and may be used for medical and non-medical expenses.
• Coverage that works alongside other insurance. Benefits are paid regardless of other insurance and are not subject to deductibles, co-pays, or coinsurance.
• Options to tailor coverage. You may apply for additional coverage up to $250,000, with options for spouse and family coverage.
• Coverage that stays with you. Coverage remains in place as long as you are a TMA member, regardless of changes in employment or practice structure.

Enrollment is simple and can be completed online (click below) or with guidance from a TMA Insurance Trust advisor. Members have 30 days to review their coverage. A full refund is available if canceled during that time. For questions or assistance, TMA Insurance Trust is available at 800-880-8181, Monday through Friday, from 8:00 AM to 5:00 PM CST.