What is a critical illness?

9 May 2022

7 minutes

Thinking about becoming seriously ill is something everyone wants to avoid. But unfortunately, it can happen.

Understanding what's classed as a critical illness

What is classed as a critical illness?
What illnesses are typically covered by critical illness insurance?
What isn’t usually covered by critical illness insurance?

Without the right insurance cover in place, you could suffer financial hardship if you become critically ill – which is hard enough without the extra worry that struggling financially could bring.

Critical illness cover protects you if you are diagnosed with a critical illness before the end date of your policy. A claim is normally paid providing you survive past a specified number of days after the diagnosis or following an operation. Your provider will pay out a tax-free lump sum, but the illness must be listed in the policy conditions and meet the definition specified.

What is classed as a critical illness?

Critical illness insurance policies don’t cover every type of medical condition. The kinds of illnesses covered are usually long-term and serious. For example for some illnesses you would need to have permanent and ongoing symptoms. Every insurance provider has a different list of illnesses they define as critical, so make sure you check what you’d be covered for before you sign up.

Remember that critical illness insurance doesn’t usually cover you if you pass away. You need life insurance for that. Life insurance helps your family cover mortgage payments if you die, for example.

What illnesses are covered by critical illness insurance?

It’s important to have a thorough read of the terms and conditions of your provider’s policy before you agree to take out critical illness cover. You may also want to discuss this with your insurer if you’re not sure of something, either in person or over the phone.

The core conditions always covered by critical illness are: ^[1]

Heart attacks - there are around 7.6 million people living with heart and circulatory diseases in the UK. ^[2]
Cancer - one in two people born after 1960^[3] are expected to get cancer in their lifetime.
Strokes - around 100,000 people have strokes each year in the UK .^[4]

Critical illness policies often cover around 30 conditions upwards, so make sure you read the terms of a policy before taking it out. Other illnesses often covered include:

Multiple sclerosis
Alzheimer’s disease – resulting in permanent symptoms
Deafness - permanent and irreversible
Blindness - permanent and irreversible
Paralysis or paraplegia, including the complete and permanent loss of one or all of the limbs
Kidney failure - requiring permanent dialysis
Liver failure

Every claim is different, and your medical and family history are sometimes factors. Check with your insurer if specific conditions are covered and in what circumstances they may not be.

What isn’t covered by critical illness insurance?

Each insurance provider will state in their policy what is excluded. The most common exclusions, that people may think they can claim for, are:

Pre-existing conditions
Hereditary illnesses
Temporary illnesses
High blood pressure
Broken bones

Even if your illness is listed in the conditions that are covered, it must also match the definition given for that illness within your policy. Some types of non-invasive cancer aren’t covered, for example.

Also some causes of critical illness may be excluded where it’s clear that the activity could directly impact an individual's health. The number and type of exclusions varies between insurance companies, but some examples may include:

Alcohol and drug abuse
Hazardous sports and pastimes
Unreasonable failure to follow medical advice

It is important to ask your insurer what exclusions are in their policies and to read through these exclusions carefully.

If you were to pass away before the specified time between diagnosis and death in your policy, your provider may not pay out. For example, if your policy states no payment will be made if death occurs within 14 days of diagnosis or having an operation. However, if death happens after 14 days of diagnosis and before the end date of the policy, a death claim could be paid, if your policy also includes life insurance cover that pays out on death. Not all policies will include this.

FAQs – critical illnesses

What cancers are covered by critical illness insurance?

Each different insurers policy varies. Before buying cover, ask the insurer which cancers their policy includes. Cancers that are often not included are:^[5]

Skin cancer
Ductal carcinoma in situ (DCIS) – non-malignant tumours found in the breast
Chronic lymphocytic leukaemia
Prostate cancer - if the Gleason score is lower than 6, or the cancer hasn’t progressed to at least clinical TNM classification T2N0M0
Other types of cancers that have not yet attacked and infected surrounding tissue

Is the beneficiary of critical illness insurance responsible for funeral costs?

Potentially. The next of kin usually arranges the funeral and is responsible for the cost. As the next of kin is normally the spouse, partner or a child of the policyholder, they may also be the beneficiary of the insurance.^[6]

If you have any questions about paying for a funeral, your local funeral director can give advice.

Where can I find out more about critical illness insurance?

The Association of British Insurers (ABI) produce a guide to minimum standards for Critical Illness insurance, which all of their member insurance companies agree to follow. It provides that, to be called “critical illness” insurance, policies must include cover for cancer, heart attack and stroke according to specified minimum definitions of those conditions. It also sets out minimum definitions for some other conditions which insurers may or may not offer.

You can read more about Critical Illness insurance insurance on the ABI’s website. The ABI also produce a consumer guide to Critical Illness insurance which you may find useful.

Critical illness insurance can help protect your home, family and lifestyle through stressful times. Learn more about critical illness insurance and how to claim with LV=