Critical illness cover: which conditions are covered?

It covers the conditions listed in your policy, as long as your illness meets the policy's definition. Having the named illness isn't enough on its own.

At Aviva, for example, the list in its Critical Illness Plan summary is only a guide, and the full definitions sit in the policy conditions. Some conditions pay on diagnosis, while others must reach a set level or need a named treatment.

MoneyHelper says most policies state how serious a condition must be to qualify. In the ABI's model wordings (its standard minimum definitions), that severity is set in four ways:

• Lasting symptoms. "Multiple sclerosis – with persisting symptoms" needs a definite diagnosis by a consultant neurologist. Impaired motor or sensory function must have lasted at least 6 months in a row.
• A named operation. "Coronary artery by-pass grafts – with surgery to divide the breastbone" requires median sternotomy (surgery dividing the breastbone) on a consultant cardiologist's advice. It must correct narrowing or blockage of one or more coronary arteries with by-pass grafts.
• A permanent outcome. "Kidney failure – requiring permanent dialysis" requires chronic and end-stage failure of both kidneys, so that regular dialysis is permanently needed.
• A measured threshold. "Deafness – permanent and irreversible" requires permanent hearing loss greater than 95 decibels across all frequencies in the better ear on a pure tone audiogram.

Beyond cancer, heart attack and stroke, MoneyHelper gives multiple sclerosis, major organ transplant, Parkinson's disease, Alzheimer's disease and traumatic head injury as examples of conditions that might be covered. It adds that most policies also consider permanent disabilities from injury or illness.

A standard critical illness policy pays out once and then ends. On Aviva's Critical Illness Plan, children's claims and additional critical illness claims are the exception and don't end the policy.

ABI members' policies must cover three core conditions: cancer, heart attack and stroke. Under the ABI's Guide to Minimum Standards, a member's policy can only be described as critical illness insurance if it covers all three to at least the guide's model wordings.

Together, those three conditions made up over 80% of all critical illness claims in 2016, ABI statistics show. In 2025, cancer alone accounted for 65% of individual claims.

Cancer

The ABI model wording is "Cancer – excluding less advanced cases". It covers any malignant tumour positively diagnosed with histological confirmation (tissue examined under a microscope) and characterised by uncontrolled growth of malignant cells and invasion of tissue.

Malignant tumour includes leukaemia, sarcoma and lymphoma, except those that arise from or are confined to the skin. The model wording doesn't cover:

• cancers classed as pre-malignant, in situ, of borderline malignancy or of low malignant potential
• prostate tumours, unless histologically classed as having a Gleason score (a cell-abnormality grade) of 7 or above, or having progressed to at least TNM classification cT2bN0M0 (or pT2N0M0 following prostatectomy)
• thyroid tumours, unless histologically classed as having progressed to at least TNM classification T2N0M0
• malignant melanoma confined to the epidermis (outer layer of skin), and other cancers arising from or confined to the epidermal, dermal or subcutaneous skin layers

MoneyHelper says some policies won't pay out for the early stages of common cancers, so you'll need to check which types of cancer a policy covers.

Some insurers pay a smaller sum for less advanced cancers instead. Aviva, Legal & General and Zurich do this for certain breast and prostate cancers, and 17 of Royal London's 32 additional conditions are early forms of cancer.

Heart attack

The model wording is "Heart attack – of specified severity". It requires a definite diagnosis of acute myocardial infarction (the medical term for a heart attack) with death of heart muscle.

The diagnosis needs typical clinical symptoms, such as characteristic chest pain, and new ECG or diagnostic imaging changes. It also requires a rise in cardiac enzymes or troponins (markers in the blood) to at least set levels.

It excludes myocardial injury without myocardial infarction, and angina without myocardial infarction. The ABI's 2021/22 review broadened the wording to cover all causes of heart attack, rather than only those from inadequate blood supply. See our heart attack critical illness guide for details.

Stroke

The model wording is "Stroke – resulting in permanent symptoms". It requires death of brain tissue from inadequate blood supply or haemorrhage (bleeding) within the skull, causing permanent neurological deficit with persisting clinical symptoms.

It doesn't cover a transient ischaemic attack (TIA, often called a mini-stroke), traumatic injury to brain tissue or blood vessels, or death of tissue of the optic nerve or retina (eye stroke).

Insurers can improve on the minimum wording if they make the difference clear. Legal & General's policy summary, for example, lists "Stroke – resulting in symptoms lasting at least 24 hours".

They set the lowest bar that ABI member insurers' definitions can meet. In 1998, the Office of Fair Trading found that differing technical definitions made critical illness policies confusing and hard to compare.

The ABI and its members brought in a Statement of Best Practice in 1999. It was renamed the Guide to Minimum Standards for Critical Illness Cover in the 2018 review, because many insurers now go beyond the model wordings.

The current guide came out on 16 September 2022, and insurers had to adopt it for new policies by 16 September 2023. Its next full review was set for 2025, though on 2 October 2026 the ABI's critical illness page still showed the 2022 guide as the latest.

Changes from the 2021/22 review apply only to policies sold after the new version took effect. Claims are judged against your own policy's definitions: LV= says its definitions meet or exceed the 2022 guide, while Vitality's plan provisions follow the 2018 edition. Your policy documents say which edition applies to you.

• Who must follow them. Complying with the guide is a condition of ABI membership. A small number of critical illness insurers aren't ABI members and can't be required to adopt the minimum definitions, though most do.
• No weaker wordings. When an insurer covers a condition that has an ABI model wording, it must use that wording and can't make it less generous. If it claims to exceed the model wording, its definition must provide extra cover and result in extra claims being paid.
• Other conditions are optional. Beyond the core three, insurers can include some, all or none of the guide's further conditions, or add others. Those further conditions have model wordings because they were common at the guide's last full review.
• Ombudsman checks. Regulators and the Financial Ombudsman Service are likely to treat the guide as good industry practice. The ombudsman checks that your insurer followed the ABI guidelines and was clear about what is and isn't covered.

What does "specified severity" mean?

It means the definition sets a severity threshold you must meet to claim. Each condition in the ABI guide has a heading, an extended heading (where applicable) and a definition, and the headings must be included in full.

The extended heading flags the main requirement, such as "of specified severity", "resulting in permanent symptoms" or "requiring permanent dialysis". Insurers use the same pattern on their own lists: Legal & General includes "Cardiomyopathy – of specified severity" and "Primary pulmonary hypertension – of specified severity".

Severity is behind many declined claims. Legal & General says most of the critical illness claims it turns down fail because the condition doesn't meet the specified severity definition. Vitality says the claims it declines most often haven't met the severity threshold. The ABI says medical advances mean many conditions are now picked up earlier, when they're less severe.

What is total permanent disability cover?

Total permanent disability (TPD) cover pays a lump sum if you become permanently disabled and can't work any more. The Financial Ombudsman Service notes it's usually included in critical illness insurance as additional cover for illnesses that aren't specifically listed.

The ABI guide sets out four acceptable TPD wordings, such as being unable to do your own occupation ever again or losing the physical ability to do at least 3 of 6 listed work tasks. Under each one, specialists must reasonably expect the disability to last throughout life with no prospect of improvement.

Most of the plans compared below have two tiers: full payment conditions pay your whole cover amount, and additional conditions pay a smaller sum for less severe illnesses. MoneyHelper suggests checking whether a policy pays 25% or 50% of the lump sum for less serious conditions.

The ABI guide uses two terms for these smaller payments, and they're worth checking when you compare policies:

• Additional payment: a claim payment that doesn't reduce the amount of benefit you have left.
• Partial payment: a part payment for a condition that does reduce the amount of benefit you have left.

At Legal & General, LV=, Royal London and Scottish Widows, an additional payment doesn't reduce your main sum assured (the amount of cover). Royal London pays it on top of any later critical illness claim, and LV= says your policy doesn't end after one. Legal & General says your premiums won't change, and it pays once for each additional condition.

Zurich gives this example of how the two tiers work on a Life Cover and Critical Illness policy with a £130,000 sum assured:

1. A less advanced cancer You're diagnosed with "less advanced cancer of the breast – with surgical removal". Zurich pays £25,000 (the lower of £25,000 or 25% of the £130,000 sum assured).
2. A later full claim You later suffer a "stroke, resulting in specified symptoms". Zurich pays the full £130,000 sum assured.
3. The policy ends After that full payment, the policy stops.

How do Vitality's graded payments work?

Vitality calls its product Serious Illness Cover, saying "not every serious illness is critical". Rather than a separate additional tier, it pays a percentage of your cover on a severity scale from 5% (Severity G, the lowest) to 100% (Severity A, the highest).

Serious Illness Cover 1X covers severity levels A to D, 2X covers A to E and 3X covers A to G. Across several claims, you can claim up to 100% of your initial cover on 1X, 200% on 2X and 300% on 3X.

Cancer is included at a minimum severity of 25%, and higher-staged tumours may qualify for a larger payment. Vitality says the payout for a covered condition may be more than, the same as or less than a critical illness policy's. For cancer, heart attack or stroke, it may be the same or less.

They vary widely. MoneyHelper says the most comprehensive policies cover 50 or more conditions, while others are much more limited. The ABI says a policy's terms and cost reflect, among other things, how many conditions it covers, and MoneyHelper notes that policies with more coverage tend to cost more.

Headline counts aren't directly comparable between insurers. Some include total permanent disability in their total, while Aviva's 52 conditions combine 41 full and 11 additional conditions. LV='s enhanced plan counts 49 full payment definitions and 38 additional conditions, 20 of which sit under one "Less advanced cancers" definition.

Some policies include children's cover as standard, while others charge extra for it. It pays a smaller sum if one of your children has a specified condition. Aviva, LV= and Royal London say a children's claim doesn't end or affect your main cover.

Where a policy uses the ABI's optional model exclusion for children's cover, it won't pay if the condition was present at birth or symptoms began before the child was covered. It also won't pay if the child dies within 28 days of meeting the critical illness definition.

The ages covered differ too. Our guide to life insurance for children explains children's benefits in more detail.

If an illness isn't on your policy's list, or doesn't meet the policy's definition, it isn't covered. Vitality, for example, won't pay for any condition not on its policy list, even if medical definitions or treatments change after your cover starts.

MoneyHelper lists non-invasive cancers, hypertension (abnormally high blood pressure) and injuries such as broken bones as common exclusions. Common illnesses that keep people off work, such as back problems and stress, aren't covered either. Vitality gives influenza, sprains and muscle injuries as examples of conditions its Serious Illness Cover doesn't cover.

Milder forms of covered illnesses, such as less advanced cancers or a transient ischaemic attack, fall outside the ABI's definitions. Citizens Advice says that even for covered illnesses, you usually have to be extremely ill or totally disabled before you can claim.

MoneyHelper notes that if an existing health issue puts you at risk of a condition, the insurer could exclude that illness or charge a higher premium. A claim might also be rejected if you didn't answer the application questions truthfully or accurately, or left something out. Our guide to life insurance with pre-existing medical conditions has more on this.

What are the ABI's model exclusions?

The ABI guide includes model wordings for exclusions that were common at its last full review. Insurers don't have to use them, may add their own, and should state clearly which exclusions apply to which conditions:

• Alcohol or drug abuse: inappropriate use of alcohol or drugs, including consuming too much alcohol or taking an overdose of drugs, whether lawfully prescribed or not
• Criminal acts: taking part in a criminal act
• Flying: taking part in any flying activity other than as a passenger in a commercially licensed aircraft
• Hazardous sports and pastimes: taking part in (or practising for) activities such as boxing, caving, climbing, horse-racing, jet skiing, martial arts, mountaineering, off-piste skiing, pot-holing and power-boat racing
• Living abroad: living outside the UK or European Union for more than 13 weeks in a row in any 12 months
• Self-inflicted injury: intentionally self-inflicted injury
• Unreasonable failure to follow medical advice: unreasonable failure to seek or follow medical advice
• War and civil commotion: war, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution, or taking part in a riot or civil commotion

What is a survival period?

A survival period is how long you must survive after diagnosis to qualify for a payout. Aviva says most critical illness policies have one, usually 10 to 14 days depending on the product.

At Aviva, the Critical Illness Plan requires you to survive 10 days after diagnosis. Vitality won't pay out under Serious Illness Cover unless you survive at least 14 days after the event that caused the claim.

Cancer is the most common reason to claim. It made up 65% of individual critical illness claims in 2025, up from 62% in 2024. Individual critical illness claims totalled £1.25 billion in 2025, with an average payout of £67,000.

Cancer was also the top cause of Scottish Widows' critical illness claims in 2025, at 65%. Five other insurers published their top three causes for 2025:

Across individual and group policies combined, ABI and GRiD figures show 90.2% of new critical illness claims were paid in 2025. In its 2024 claims figures, the ABI named two common reasons for declined claims: failing to disclose an existing medical condition when applying, and not meeting the policy definitions.

At Aviva in 2025, 5.2% of critical illness claims (including children's benefit) weren't paid because the definition wasn't met. Another 3.9% failed for misrepresentation (incomplete or misleading application answers) and 0.2% for other reasons, 9.3% in all. Our guide to critical illness payout rates has each insurer's claims figures.

Look past the headline number of conditions and check the definitions, smaller payments and exclusions in the policy terms. Two policies with a similar condition count can cover different things.

1. Read the definitions, not just the count MoneyHelper notes that definitions and exclusions can vary between insurers. Check the full policy conditions as well as the policy summary.
2. Compare cancer and early-stage payouts Cancer caused 65% of individual claims in 2025, and some policies exclude early-stage cancers. MoneyHelper suggests checking which types of cancer are covered and whether less serious illnesses pay 25% or 50% of your lump sum.
3. Check whether total permanent disability and children's cover are included Children's cover is built in on some plans (such as Aviva, Legal & General and Scottish Widows) and costs extra on others (such as LV= standard cover and Zurich). On LV='s standard plan, total permanent disability also costs extra and must be bought through a financial adviser.
4. Weigh coverage against cost MoneyHelper points out that policies with more coverage tend to cost more. Our critical illness calculator and guide to how much critical illness cover you need can help you work out a lump sum, and a broker can compare insurers' wordings.
5. Answer every health question accurately Not disclosing an existing medical condition is one of the common reasons claims are declined. Answer every application question truthfully and in full.

• How to compare critical illness cover: what to weigh up beyond the condition count
• Critical illness calculator
• Aviva critical illness cover
• Legal & General critical illness cover
• Vitality Serious Illness Cover
• Zurich critical illness cover