Which illnesses are covered?
Critical illness insurance can cover as many as 60 illnesses, conditions and treatments. Each insurer has their own list of illnesses and conditions for which the policy will pay out.
Definitions for the progression, symptoms, severity or treatment required before the policy pays out vary by insurer.
How is a critical illness defined?
The Association of British Insurers (ABI) produces critical illness policy definitions for some illnesses to help guide insurers. These definitions are determined by the ABI to be fair to the consumer.
Insurers commonly use ABI definitions for some of the conditions covered under the policy. However, not all illnesses covered will use ABI definitions.
Insurers often use their own definitions, some of which exceed those of the ABI e.g. they will pay out at a less advanced stage of progression. These are referred to as ABI+ definitions.
Some definitions however may fall short of those recommended by the ABI. For this reason it’s important to study the terms and conditions of your policy carefully.
Critical illnesses covered by all policies
Although the number of illnesses and the severity or progression at which policies will pay out can vary significantly, most critical illness policies protect you with ABI or ABI+ definitions against 4 of the most common illnesses and conditions.
What is it?
Cancer is caused by an uncontrolled division of abnormal cells. These cells can spread throughout the body in the form of tumours. These tumours can have adverse effects on healthy tissue and organs. There are over 100 types of cancer many of which are treatable with a high rate of success.
"Statistics from Cancer Research UK state that one in three of us will be diagnosed with some form of cancer in our lifetime"
(source: Cancer Research UK)
Cancer and critical illness insurance
Most critical illness insurance policies follow or exceed the ABI’s definition for the severity and progression at which the policy must pay out on diagnosis of cancer. Generally, critical illness cover won't pay out for cancer at an early stage of progression. Some specific types of cancer such as prostate cancer are often excluded or result in a partial payout.View ABI definition*
Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
All cancers which are histologically classified as any of the following:
- cancer in situ
- having either borderline malignancy
- having low malignant potential
- All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0.
- Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A.
- Malignant melanoma unless it has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin).
- Any other skin cancer (including cutaneous lymphoma) unless it has been histologically classified as having caused invasion in the lymph glands or spread to distant organs.
What is it?
A heart attack can occur when the heart or parts of the heart become starved of blood and oxygen. This can happen when there is a blockage or obstruction, restricting blood flow to the heart and causing the tissue to die.
"Research from The British Heart Foundation states over 25,000 heart failures occur each year in the UK. Despite this, over 750,000 are living with heart failure" (source: British heart foundation).
Heart attacks and critical illness insurance
Nearly all critical illness policies cover heart attacks, using ABI or ABI+ definitions. Policies with ABI+ definitions tend to require fewer or less specific symptoms to be present following a heart attack, such as chest pains.View ABI definition*
Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:
- New characteristic electrocardiographic changes.
- The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher:
- Troponin T < 1.0 ng/ml
- AccuTnl < 0.5 ng/ml or equivalent threshold with other Troponin I methods.
- The evidence must show a definite acute myocardial infarction.
For the above definition, other acute coronary syndromes (including but not limited to angina) are not covered.
What is it?
Unlike most illnesses, a stroke can occur very suddenly with no prior symptoms to warn the patient. A stroke can occur when the blood supply to the brain is cut off, causing brain cells to become damaged or die altogether.
People suffering from a stroke typically have a very high rate of recovery, although often the damage caused to the brain can be lasting or even fatal.
"Research by Stroke.org.uk states that over 100,000 each year in the UK suffer from a stroke" (source: Stroke Association).
Stroke and critical illness insurance
Nearly all critical illness policies covering stroke follow or exceed ABI definitions. It’s important to note that transient ischaemic or ’mini strokes’ aren't covered under the standard ABI definition but can result in a partial payment from some insurers.View ABI definition*
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms.
For the above definition, transient ischaemic attacks (mini-strokes) are not covered.
What is it?
Multiple Sclerosis (MS) is a condition affecting the nervous system and is much more prevalent in females than males. The central nervous system is responsible for the communications between the different parts of your body. MS can affect vision, memory, emotions and muscular control.
"The NHS estimates there are around 100,000 people in the UK suffering from MS"
Multiple sclerosis and critical illness insurance
The vast majority of critical illness policies covering multiple sclerosis follow or exceed ABI definitions.View ABI definition*
A definite diagnosis of multiple sclerosis by a consultant neurologist. There must be current clinical impairment of motor or sensory function caused by multiple sclerosis.
What else is covered?
Despite the name, critical illness insurance policies can also pay out for circumstances other than the diagnosis of an illness. These could include:
- Total permanent disability
- Loss of independence
- Intensive care
Partial payment conditions
As well as a list of conditions for which the cover will pay out in full, critical illness cover policies often include list of conditions, treatments or circumstances for which a partial payment will be made by the insurer.
Conditions covered resulting in partial payments can include:
- Ductal carcinoma in situ of the breast (early stage breast cancer)
- Prostate cancer
- Accidental hospitalisation
- Type 1 diabetes
Which insurer covers the most illnesses?
The following tables shows a comparison of critical illness cover offered by some of the UK's largest insurers**:
|Definitions resulting in partial payment||1||8||7||8||11|
|Face to face support|
|Definitions resulting in partial payment||3||16||4||6|
|Face to face support|
Comparing critical illness cover
When comparing critical illness cover, it’s wise to take into consideration:
- The number of illnesses covered
- The definitions that must be met for the policy to pay out
- The likelihood of being diagnosed with those conditions
- The cost and affordability of the cover
- The historical payout rate for critical illness claims
- Any additional extras or perks that come with the policy
*ABI Definitions and exclusions accurate as of January 2014. Please check with your insurer as to the illnesses, conditions and definitions for which the policy will pay out.
** Accurate as of April 2014. Please check with your insurer as to the illnesses, conditions and definitions for which the policy will pay out.