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What illnesses are covered by critical illness insurance?

Like all insurance policies, your Crucial Illness Cover will come with many terms and conditions that dictate when you are able to claim a payout and when you are not. Of course these things will vary policy by policy, but it is important to be aware of what to look out for. In many cases (and especially for the ‘major’ conditions) the definitions are given minimum standards by the Association of British Insurers. While a number of major conditions are covered, the actual list of diseases your specific policy covers will be subject to the type of plan you elect to purchase.

In addition, personal details and individual medical history will also be a factor. For example, if you have recently had a heart attack the conditions might be different and it might be a good idea to look at our article on “Critical Illness Cover and Heart Attacks”. Either way it is important to talk to any potential provider, and carefully read your policy documents to check what is and is not included. To get you familiar however, here we note the main coverage conditions you’d expect most Critical Illness policies to contain.

What's covered?

Whilst terms and conditions vary between all insurance providers, Critical Illness policies will cover in some degree the three “core illnesses” of cancer, heart attack and stroke. The extent of coverage provided will be determined by the package you elect to purchase, the insurance provider you choose, and also your personal circumstances and medical history.

In terms of specific illnesses that are covered within your policy, these vary from insurer to insurer but typical illnesses covered include:

Typical Conditions Covered

Alzheimer’s disease

Aortic surgery

Aplastic anaemia

Bacterial meningitis

Benign brain tumour

Blindness

Cancer (life-threatening)

Coma

Coronary artery- bypass surgery

Deafness

Heart attack

Heart valve replacement

Kidney failure

Loss of independent existence

Loss of limbs

Loss of speech

Major organ transplant

Major organ failure on waiting list

Motor neuron disease

Multiple sclerosis

Occupational HIV infection

Paralysis

Parkinson’s disease

Severe burns

Stroke (Cerebrovascular accident)

Now, when it comes to pre-existing conditions, getting Critical illness Cover is certainly not impossible, and, assuming you can still work despite the condition, should not be a dealbreaker for coverage. What this can do is affect the kind of cover you can get, or the price of your insurance premium, and you might not be covered for an illness which you already have, or one which runs in your family.

What's not covered?

In all policies there are some various limitations to be aware of.

The most important condition to be aware of is that the policy will not pay out and could even be cancelled if the information provided in your coverage application is not accurate or correct.

It is also essential to note that any changes in your personal circumstances, lifestyle, health and even family history between the completion of your application form and when the policy begins must also be given.

Other reasons for non-payment of claims include:

  • If you miss premium payments and fail to pay your premiums, cover will typically end 30 days after the first missed premium.
  • Medical diagnoses for a critical illness will have to meet the insurer’s definition if they are to be covered. If they do not, then any pay out could be affected so check your policy documents carefully

There will also be some limitations on coverage. Whilst not full exclusions, some cover may be limited in certain cases:

  • Some critical illness benefits will have a limit as to what the insurer provider will pay out
  • To make a claim for some critical illnesses, certain requirements will have to be met
  • Sometimes a benefit such as one for an extended stay in hospital will be limited or even not paid if caused by a policyholder’s alcohol or drug use

All these procedures and coverage conditions will be fully explained in the policy document.

Other things to note

Not every occurrence of disease is covered

Many symptoms need to be at a particular condition in order to claim. In many instances, you might have to show that your condition is truly disabling before you can make a claim.

For example, cancer comes in many forms, some of which are more serious than others. Because of that, “cancer” is rarely a blanket diagnosis that automatically qualifies for a fully paid claim. This is dependent on the type of cancer diagnosed together with how advanced the symptoms are. A benign tumour may not result in a valid claim, or one might be given a reduced payout for a diagnosis made at an early stage. Indeed it may be the case that a full payout is given only upon diagnosis of a malignant cancer that has seriously spread.

You may be able to increase your coverage if your condition is not listed

Whilst general policy conditions do dictate whether you are covered for particular illnesses or not, if there is an illness you are concerned about that is not listed, it could be a good idea to reach out to your provider to see if they are willing to give enhanced terms which will satisfy individual concerns.

Conditions over time

Medical progress is always being made year on year, such being the case that seriousness of some conditions and their ability to be treated are improved over time. With that, illnesses that were once excluded might not be covered. Conversely, some conditions covered today might require more costly treatment in the future or be deemed more serious than initially realised with stricter terms and differing conditions subsequently imposed.

With this in mind, even if you have a policy you have been happy with for a few years, it’s not a bad idea to review it against more up to date offerings so that you know you have the best cover available. Of course, if you would like a professional opinion, there will be independent experts who will be able to evaluate your policy against current trends and your own needs.

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