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What Illnesses Are Covered By Critical Illness Insurance
- Jody
- June 21, 2019
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We are often asked what is included with critical illness insurance and its quite difficult to answer. Often people will want to know how many conditions are covered and compare the numbers against each other but this really doesn’t give the full story.
What illnesses are covered by critical illness insurance?
Below are some of the main illnesses covered by critical illness insurance and the criteria to make a claim.
CANCER
ancer – excluding less advanced cases.
Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes leukaemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin).
For the above definition, the following are not covered:
All cancers which are histologically classified as any of the following:
pre-malignant,
non-invasive,
cancer in situ
having borderline malignancy; or having low malignant potential;
All tumours of the prostate unless histologically classified as having a Gleason score of 7 or above or having progressed to at least clinical TNM classification T2bN0M0.
Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A;
Any skin cancer (including cutaneous lymphoma) other than:
malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin); or
basal cell carcinoma or squamous cell carcinoma that has spread to lymph
nodes or metastasised to distant organs.
Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes:
Leukaemia;
Sarcoma; and
Lymphoma (except cutaneous lymphoma – lymphoma confined to the skin).
The following are not covered:
All cancers which are histologically classified as any of the following:
pre-malignant;
non-invasive;
cancer in situ;
having borderline malignancy; or
Having low malignant potential;
Malignant melanoma skin cancer that is confined to the epidermis (outer layer of skin);
Any non-melanoma skin cancer (including cutaneous lymphoma) that has not
spread to lymph nodes or metastasised to distant organs; and
All tumours of the prostate unless histologically classified as having a Gleason score of 7 or above, or having progressed to at least TNM classification T2bN0M0.
For less advanced cancers, please refer to the additional Group II critical illness
conditions.
Excluding less advanced cases.
Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes leukaemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin).
A definite diagnosis by a UK Oncologist of a malignant cancer with histological confirmation.
The following are not covered under this definition but are covered as additional
payouts:
All tumours of the prostate histologically classified as having a Gleeson score between 2 and 6 inclusive and having progressed to clinical TNM classification T1N0MO-T2aN0MO inclusive.
Cancer in situ.
Cancer of the ovary histologically classified as having borderline malignancy or low malignant potential.
Non-melanoma skin cancer histologically classified as having progressed to clinical TNM classification T1N0M0.
63.8% claims in 2017
Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes leukaemia, sarcoma, pseudomyxoma peritonei, merkel cell cancer and lymphoma except cutaneous lymphoma (lymphoma confined to the skin). For the above definition, the following are not covered:
All cancers which are histologically classified as any of the following:
pre-malignant;
non-invasive;
cancer in situ;
having either borderline malignancy; or
having low malignant potential.
All tumours of the prostate unless histologically classified as having a Gleason score of 7 or above or having progressed to at least clinical TNMclassification T2bN0M0.Malignant melanoma unless it has been histologically classified as having caused invasion beyond the epidermis (outer layer of the 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.
Cancer – Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes:
Leukaemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma
confined to the skin). For the above definition, the following are not covered:
All cancers which are histologically classified as any of the following:
pre-malignant;
non-invasive;
cancer in situ;
having either borderline malignancy; or
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.
Any skin cancer (including cutaneous lymphoma) other than:
malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin); or
basal cell carcinoma or squamous cell carcinoma that has invaded and spread to lymph nodes or metastasised to distant organs.
Cancer – excluding less advanced cases. Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, sarcoma, Merkel Cell Carcinoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin).
Exceeds ABI model definition as cover is included for Merkel Cell Carcinoma. Vitality also covers all Carcinoma in Situ on diagnosis and Non Melanoma Skin Cancers of specified severity at severity level G.
Covers Low Grade Prostate Cancers (histologically classified as having a gleason score between 2 and 6) without the requirement of treatment at severity level D.
Cancer – excluding less advanced cases. Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.
The term malignant tumour includes leukaemia, sarcoma and lymphoma except cutaneous lymphoma( lymphoma confined to the skin).
HEART ATTACK
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 (or findings on a heart scan); and
The characteristic rise of cardiac enzymes or Troponins. The evidence must show a definite acute myocardial infarction. For the above definition, the following is not
covered:
1 Other acute coronary syndromes or angina without myocardial infarction.
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; and the characteristic rise of cardiac enzymes or troponins. For the above definition, the following are not covered:
other acute coronary syndromes; and
Angina without myocardial infarction.
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 enzymes or Troponins.
The evidence must show a definite acute myocardial infarction
Death of heart muscle, due to inadequate blood supply, that has resulted in a definite diagnosis of a new myocardial infarction by a UK Cardiologist.
10.1% claims in 2017
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 or other positive findings on diagnostic imaging tests;
The characteristic rise of biochemical cardiac specific markers such as troponins or enzymes. The evidence must show definite acute myocardial infarction. For the above definition, the following are not covered:
Other acute coronary syndromes;
Angina without myocardial infarction.
Heart Attack – of specified severity. 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 (or findings on a heart scan); and the characteristic rise of cardiac enzymes or Troponins.
The evidence must show a definite acute myocardial infarction.
For this definition, the following are not covered:
other acute coronary syndromes or angina without myocardial infarction.
Heart Attack – death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial nfarction: 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;
AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin 1 methods.
The evidence must show a definite acute myocardial infarction.
For the above definition, the following are not covered:
1 Other acute coronary syndromes including but not limited to Angina.
Death of heart muscle, due to inadequate blood supply that has resulted in the following:
Definite Diagnosis of an acute Myocardial Infarction by a Consultant Cardiologist, which is supported by current medical reports, tests and investigations, as defined by the recognised international standard* prevailing at the time of claim.
Exceeds ABI model definition as definition does not require new characteristic electrocardiographic changes.
Heart attack – of specified severity. Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:
new characteristic electrocardiograph 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 1 methods.
MULTIPLE SCLEROSIS
Multiple sclerosis – with persisting symptoms definite diagnosis of multiple sclerosis by a consultant neurologist. One of the following must be present:
Clinical impairment of motor or sensory function, which must have persisted from the time of diagnosis; or Two or more attacks of impaired motor or sensory function together with findings of clinical evidence of objective neurological investigations, such as lumbar puncture, evoked visual responses or MRI.
The evidence must show definite multiple sclerosis.
A definite diagnosis of multiple sclerosis by a consultant neurologist, that has resulted in either of the following:
clinical impairment of motor or sensory function, which must have persisted from the time of diagnosis; or two or more attacks of impaired motor or sensory function together with findings of clinical objective evidence on Magnetic Resonance Imaging (MRI).
All of the evidence must be consistent with multiple sclerosis.
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.
A definite diagnosis by a UK Consultant Neurologist of multiple sclerosis. There must have been clinical impairment of motor or sensory function caused by multiple sclerosis.
5.1% claims in 2017
A definite diagnosis of multiple sclerosis by a consultant neurologist. There must have been clinical impairment of motor or sensory function caused by multiple sclerosis.
Multiple Sclerosis – with persisting symptoms.
A definite diagnosis of multiple sclerosis by a Consultant Neurologist that has resulted in either of the following:
Clinical impairment of motor or sensory function, which must have persisted from the time of diagnosis; or
two or more attacks of impaired motor or sensory function together with findings of clinical objective evidence on magnetic resonance imaging (MRI scan).
All of the evidence must be consistent with multiple sclerosis.
Multiple Sclerosis – with persisting symptoms.
A definite diagnosis of multiple sclerosis by a consultant neurologist.
There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least three months.
Multiple Sclerosis – resulting in current symptoms.
A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist with evidence of previous or current symptoms (even if these are not permanent).
Multiple sclerosis – with persisting symptoms.
A definite diagnosis of multiple sclerosis by a consultant neurologist.
There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least six months.
STROKE
Stroke – resulting in permanent symptoms.
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in either:
Permanent neurological deficit with persisting clinical symptoms; or
Definite evidence of death of brain tissue or haemorrhage on a brain scan and neurological deficit with persistent clinical symptoms lasting at least 24 hours.
For the above definition, the following are not covered:
Transient ischaemic attack; or Death of tissue of the optic nerve or retina/eye stroke.
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull that has resulted in all of the following evidence of stroke:
Neurological deficit with persistent clinical symptoms lasting at least 24 hours; and definite evidence of death of tissue or haemorrhage on a brain scan.
For the above definition, the following are not covered:
Transient ischaemic attack; and death of tissue of the optic nerve or retina/eye stroke.
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in either: permanent neurological deficit with persisting clinical symptoms; or definite evidence of death of brain tissue or haemorrhage on a brain scan; and neurological deficit with persistent clinical symptoms lasting at least 24 hours.
A definite diagnosis by a UK Neurologist of a stroke with clinical symptoms that have lasted at least 24 hours.
The following is not covered: Transient ischaemic attack.
6.4% claims in 2017
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in neurological deficit with persisting clinical symptoms lasting at least 24 hours.
For the above definition, the following are not covered:
Transient ischaemic attack.
Death of tissue of the optic nerve or retina/eye stroke.
Stroke – of specified severity.
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull that has resulted in all of the following evidence of stroke:
Neurological deficit with persisting clinical symptoms lasting at least 24 hours; and Definite evidence of death of tissue or haemorrhage on a brain scan.
For this definition, the following are not covered under critical illness insurance coverage:
Transient ischaemic attack; Death of tissue of the optic nerve or retina/eye stroke.
Stroke – 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, the following is not covered under critical illness insurance coverage:
Transient ischaemic attack.
Stroke – resulting in permanent symptoms.
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull that results in persisting clinical symptoms lasting for at least 24 hours.
Exceeds ABI model definition as no requirement for permanent neurological deficit or persisting clinical symptoms.
Stroke – resulting in permanent symptoms.
Death of brain tissue due to inadequate blood supply or haemorrhage within the skull that results in persisting clinical symptoms lasting for at least 24 hours.
Exceeds ABI model definition as no requirement for permanent neurological deficit or persisting clinical symptoms.
Jody Pearmain
Jody is the Managing Director and founder of My Key Finance Ltd. He has over 22 years of experience as a mortgage & protection adviser. He is an authority within the UK business protection market & specialises in key man insurance, relevant life cover and shareholder protection. Jody has written articles for Business Matters, Business Directory and has been featured in Forbes. He is Authorised & Regulated by the Financial Conduct Authority and is CeMAP qualified.
As editor and author of our blog, Jody hopes to educate and advise people with more in-depth information & guidance on life insurance and business protection.
Jody & his wife Lori featured in the BBC programme “The House £100k Built” He is also a keen Arsenal fan and loves nothing more than watching his son & nephews play football at the weekend.
