What Does Critical Illness Cover?

Posted 16th August 2021 by Chris Reed

Last updated on August 8th, 2022 at 05:14 pm

A comprehensive critical illness list can be difficult to find, as every insurer covers different conditions. If you’re particularly passionate about a certain condition, then we’re here to help. At Protect Line, we believe in helping you to find the facts and letting you decide what’s best for you and your family.

We are not an insurance company, but instead provide information on how to choose between competing insurers. We do this by helping you compare their policies side-by-side so that you can make informed decisions based on all the available options. Our goal is to give you peace of mind when it comes to choosing life insurance and critical illness insurance cover.

Our team of specialists has been providing unbiased information since 2010. Sometimes, it can be easier to talk through your needs with one of our helpful specialists. However, we know some people prefer to do a little research on their own first. That is why we’ve covered this today.

Core Medical Conditions Covered

3 core conditions must be covered by any critical illness policy to be classed as a critical illness insurance product, according to the Association of British Insurers (ABI). These are:

• Cancer (Excluding less advanced cases)
• Heart Attack
• Stroke

These three medical conditions account for the majority of claims made^[1]. That’s hardly surprising considering 1 in 2 people born after 1960 are expected to get cancer in their lifetime (Cancer Research UK).

In addition to these core mandatory conditions, the ABI also set out a list of optional conditions that insurers can choose to offer. However, if they choose to offer cover for any of these conditions, they must also use the ABI’s model wording.

Critical illness list

1. Alzheimer’s disease [before age x] – resulting in permanent symptoms
2. Aorta graft surgery – for disease
3. Benign brain tumour – resulting in permanent symptoms
4. Blindness – permanent and irreversible
5. Coma – with associated permanent symptoms
6. Coronary artery by-pass grafts – with surgery to divide the breastbone
7. Deafness – permanent and irreversible
8. Heart valve replacement or repair – with surgery to divide the breastbone
9. Kidney failure – requiring permanent dialysis
10. Loss of speech – total permanent and irreversible
11. Loss of hand or foot – permanent physical severance
12. Major organ transplant – from another donor
13. Motor neurone disease [before age x] – resulting in permanent symptoms
14. Multiple sclerosis – with persisting symptoms
15. Paralysis of limb – total and irreversible
16. Parkinson’s disease [before age x] – resulting in permanent symptoms
17. Third degree burns – covering 20% of the body’s surface
18. Total permanent disability
19. Traumatic brain injury – resulting in permanent symptoms

Total permanent disability

Total permanent disability (TPD) is designed as a “catch all” type of condition. It’s there to ensure you can still make a claim if you are totally and permanently disabled^[2] but you’ve not got one of the defined conditions.

TPD is one of the main reasons the Financial Ombudsman Service (FOS) gets involved in complaints relating to critical illness. This is because often it’s not explained or understood correctly. Also, it’s often excluded from individual’s policies because of their occupation or health and lifestyle disclosures.

There are usually 3 different classifications of cover and how a claim would then be assessed. In addition, your insurer could change this classification if you change your job role or duties in the future. Typically, they’re broken down into these categories:

• Own occupation– Loss of ability to do your current occupation
• Any suited occupation – based on your previous work and qualifications
• Any occupation / specified tasks -measured against activities of daily living (ADLs) or activities of daily work (ADWs), which will be set out in the policy documents.

All insurers define total permanent disability slightly differently and some newer policies exclude TPD altogether. Ensure you carefully check your policy documents to understand what you’re covered for.

 

Partial Payouts and Additional Payouts

When you receive a life-changing diagnosis, the last thing you want to hear is your policy will not pay out. Historically, insurers did not pay out for things like low grade cancers. However, nowadays we have partial and additional payouts that are designed to pay out a lump sum for some lower grade illnesses.

These payments are usually a fixed amount or a percentage of your cover. For example, some providers may cover: 

£30,000 or 50% of your cover amount (whichever is lower).

It’s important to note the specific wording surrounding these extra payouts on your policy:

Additional Payouts – when a successful claim is made, it will not reduce the benefit payable should you need to claim on your policy in the future.

Partial Payouts – the value of a successful claim will be deducted from any benefit payable in the future.

Comparing partial/additional payout benefits can feel like a minefield. A non-advised, fee-free broker like Protect Line can help you compare different cover levels and insurers to find the one that fits you.

Examples of additional and partial payouts

Additional condition claims vary greatly from one insurer to another. The list of what is covered also vastly varies. Below is a list of conditions covered by some UK insurers:

• Accident hospitalisation cover
• Less advanced cancer examples – (dependant on severity, situ and treatment required):
  • Carcinoma in-situ of the bile ducts
  • Carcinoma in-situ of the cervix uteri 
  • Carcinoma in-situ of the gallbladder 
  • Carcinoma in-situ of the lung or bronchus
  • Carcinoma in-situ of the oesophagus
  • Carcinoma in-situ of the pancreas 
  • Carcinoma in-situ of the vagina
  • Ductal or lobular carcinoma in-situ of the breast
  • Ovarian tumour of borderline malignancy/low malignant potential
  • Prostate cancer
  • Testicular carcinoma in-situ
• Other carcinomas in-situ
• Cerebral or spinal aneurysm
• Coronary artery angioplasty
• Guillain-Barré syndrome 
• Removal of one or more lobe(s) of the lung

Please remember to check carefully with your broker so you know what they cover you for. Partial payout critical illness definitions vary from one insurer to another. Some of these conditions may qualify for a full critical illness claim. It will often depend if it’s an advanced stage or early stage diagnosis, some may not be included at all.

Additional payments sometime come as part of an extra cost add on. The additional cost may also give you extra benefits, so be sure to ask your broker about any options available.

What other benefits do you get with critical illness insurance?

Each insurer has their own bespoke offering. Let your broker know what’s important to you and they’ll be happy to explain all the relevant options that suit your needs.

Bottom Line

We hope you have found our critical illness list a helpful overview, but always check insurance documentation for full details. Cover levels and definitions can seem complicated, especially when you try to compare insurers. An specialist fee-free broker such as Protect Line can help take the strain out of comparing as they’ll shop around for you.

Insurance companies are constantly improving their offering and critical illness payout levels differ between insurers. If you have an existing policy in place, be sure to compare the policy documents carefully.

It’s often wise to consider how much critical illness cover you need before getting bogged down in the details of the cover. Once you know what ideal looks like, you can then more easily consider the pros and cons of cover.

 

If you’d like to learn more about life insurance before applying for a bespoke quote, check out our Ultimate Life Insurance Guide.

 

All statistics and sources correct at the time of posting. Sources for data include:All statistics and sources correct at the time of posting. Sources for data include:

Reference Critical Illness List: ABI GUIDE TO MINIMUM STANDARDS FOR CRITICAL ILLNESS COVER

[1] Claim Stats from Legal and General in 2020 shows the top 3 conditions as: Cancer-64%, Heart Related-13%, Stroke-7%. 84% of claims paid in 2020 were for these 3 conditions. https://www.legalandgeneral.com/landg-assets/adviser/files/protection/_resources/documents/critical-illness/ci-guide-w13802.pdf

[2] To be eligible to claim on Total and Permanent disability, you must meet your provider’s definition. Not all critical illness policies have total and permanent disability. Check your documents carefully to ensure you know what you are covered for.