Posted 8 Dec 2020

What illnesses are covered by critical illness insurance?

People often ask us what they will be covered for by their critical illness cover policies. It can be very confusing to try to figure out what you’re covered for and when will it payout if you become ill.

One of the most important things to remember here is that every insurance company is different. Each insurer has different illnesses that they cover and will offer different definitions of those conditions.

This is why it’s very important to make sure that you do your research before you buy a new policy. If you’re buying a policy through an advisor or a broker then you should ask them for a list of what’s covered.

Will my pre-existing medical condition be covered by critical illness cover?

Generally, if you apply for a policy after you have been diagnosed with a medical condition, then that condition will be excluded. This can vary from one insurer to another and can change over time depending on the condition.

You might also find that conditions that are linked to your current illness may be excluded from your cover.

For example: If you have type 2 diabetes then you might be offered cover excluding cardiovascular conditions (e.g. Heart attack and stroke), eye problems or kidney disease.

More about CRITICAL ILLNESS COVER WITH DIABETES

How many conditions are covered?

  • Standard critical illness cover: 75 conditions
  • Enhanced critical illness cover: Up to 182 conditions

Here are some examples of cover from some of the top insurers in the UK and what to expect when you buy this type of cover.

Legal & General

This cover will payout for a ‘specified’ critical illness (as listed below) if you undergo a medical procedure and you survive for 14 days from diagnosis. This must, of course, happen during the term of the cover and while premiums are paid.

Critical illness Definition
Aorta graft surgery requiring surgical replacement
Aplastic anaemia with permanent bone marrow failure
Bacterial meningitis resulting in permanent symptoms
Benign brain tumour resulting in either surgical removal or permanent symptoms
Blindness permanent and irreversible
Cancer excluding less advanced cases
Cardiac Arrest with the insertion of a defibrillator
Cardiomyopathy of specified severity
Coma with associated permanent symptoms
Coronary artery by-pass grafts with surgery to divide the breast bone or thoracotomy
Creutzfeldt-Jakob disease (CJD) resulting in permanent symptoms
Deafness permanent and irreversible
Dementia including Alzheimer’s disease resulting in permanent symptoms
Encephalitis resulting in permanent symptoms
Heart attack of specified severity
Heart valve replacement or repair with surgery
HIV infection caught from a blood transfusion, physical assault or accident at work
Kidney failure requiring permanent dialysis
Liver failure of advanced stage
Loss of hand or foot permanent physical severance
Loss of speech total permanent and irreversible
Major organ transplant from another donor
Motor neurone disease resulting in permanent symptoms
Multiple sclerosis where there have been symptoms
Multiple system atrophy resulting in permanent symptoms
Open heart surgery with median sternotomy
Paralysis of limb total and irreversible
Parkinson’s disease resulting in permanent symptoms
Primary pulmonary hypertension of specified severity
Progressive supranuclear palsy resulting in permanent symptoms
Removal of an eyeball due to injury or disease
Respiratory failure of advanced stage
Spinal stroke resulting in symptoms lasting at least 24 hours
Stroke resulting in symptoms lasting at least 24 hours
Systemic lupus erythematosus with severe complications
Third-degree burns covering 20% of the surface area of the body or 20% of the face or head
Traumatic brain injury resulting in permanent symptoms

For a full list of definitions visit: https://www.legalandgeneral.com/landg-assets/personal/life-cover/_resources/documents/guide-to-cic.pdf

Exclusions and limits

  • The list of conditions that are covered includes cancer, heart attack, and stroke. However not all situations and occurrences of these conditions will be covered, such as cancer must have spread or reached a specified level
  • Each illness must be verified by a consultant or specialist at a hospital in the UK, who is considered to be qualified in the appropriate area.
  • Full definitions are provided on policy documents and details of how L&G will consider a claim that is made. Your policy terms and conditions will also provide information about what evidence is required at claims stage

Note: There are several insurance companies who offer very similar levels of cover to Legal & General, such as Zurich and Aviva.

There are also more comprehensive critical illness cover policies which will provide more illnesses and definitions. Some of these more comprehensive policies offer higher levels of cover and also include partial payments (see below).

What is a partial payout or severity based critical illness cover policy?

Some modern critical illness cover policies offer what is known as ‘partial payout’ which is where different conditions pay different payments. This is mainly based on the severity of the illness and the impact on your lifestyle.

Partial payments can offer some benefits to you depending on what your attitude to risk is and what you want.

Pro’s

  • Conditions: generally these policies will offer a far more comprehensive list of illnesses (up to 182)
  • Multiple claims: if you claim for a lower severity level illness then you’ll still keep the remaining element of your cover
  • Flexibility: you’ll have numerous options with these types of policies which means that you should be able to adapt the cover to your needs

Con’s

  • Coverage: some conditions where you would receive 100% payout with some providers will be a lower percentage with this type of cover
  • Confusing: these policies can be confusing and can make it difficult to compare against other similar insurance plans

There are several severity based policies currently available on the UK insurance market. Here is some information about Vitality’s Serious Illness Cover plan which was the first severity based partial payment cover introduced to the UK.

Vitality

One of the most comprehensive plans on the market currently in terms of the number of conditions covered is from Vitality. This policy covers up to 182 serious illnesses based on a severity based plan which was introduced by Vitality several years ago.

This award-winning critical illness cover policy (known as serious illness cover) is designed to reflect the level of impact that each condition will have on your lifestyle. The serious illness cover plan is directly linked to current medical treatments so it is better suited to your needs.

What’s the difference between serious illness cover and critical illness cover?

Essentially a Vitality Serious Illness Cover plan is the same as a standard critical illness cover plan in what it does, and what it’s designed for. The main difference between these policies is the levels of cover that you would have based on the number of conditions covered.

Both of these policies pay a tax-free lump sum when you become seriously or critically ill. These payouts are designed to provide some financial security for you and your family if you can’t work for a period of time due to illness.

The term ‘serious illness’ was introduced by Vitality to differentiate from the more commonly known ‘critical illness’. This is for the purpose of helping to explain how the plan is designed to protect against a wider range of conditions.

  • Serious illness: a medical condition or illness that may have a variety of levels of severity which can have a range of levels of impact on lifestyle
  • Critical illness: a medical condition or illness which is defined as critical so will have a severe impact on lifestyle

What illnesses are covered by a Vitality Serious Illness Cover plan?

Currently, there are 153 conditions covered by a ‘Serious Illness Cover’ policy and 182 conditions covered by a ‘Serious Illness Cover Plus’ policy.

For a full list of conditions covered by Vitality visit: https://vitalityconditionscovered.co.uk/

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Daniel Sharpe-Szunko
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