I’m sure many of us hope that a critical illness is something we never have to face in our lifetime. And in that sense, critical illness cover is something that we buy but hope we never have to use.
However, in the tragic circumstances that you are diagnosed with a critical medical condition, the support insurance can provide is essential. The tax-free lump sum can be vital in supporting you and your family while you undergo treatment, by covering lost earnings, household bills and private medical care.
That is why, in 1999, the ABI produced its Guide to Minimum Standards of Critical Illness Cover. This guide provides customers with an overview of critical illness insurance and presents them with clear information so that they can compare different policies.
To be able to offer such cover, insurers need to be able to distinguish conditions by severity and medical prognosis. This is because critical illness insurance will pay a lump-sum if you are diagnosed with a serious condition, and insurers need to understand the severity of the condition to make that payment.
The guide sets the minimum standards that insurers must meet to call their product “critical illness cover”. However, many insurers offer products that go above and beyond the guide and this is an important part of competition in the market.
The three conditions that must be covered by all “critical illness insurance” products are cancer, heart attack and stroke. Many insurers also cover a wide range of other conditions, such as Parkinson’s disease, kidney failure and major organ transplant, so checking through a policy carefully before purchasing is key.
Advances in medical testing and treatment means that the prognosis for some conditions continues to improve, meaning what is typically covered by critical illness policies has changed over time. To keep pace with ever-changing medical technology, research and regulation, our guide is reviewed every three years.
This latest review includes some changes to the definitions for Alzheimer’s, cancer and heart attack which are set out below.
Alzheimer’s disease
The definition for Alzheimer’s disease has now been expanded so that it covers all forms of dementia. It also includes what evidence is required to make a claim, and an updated list of the types of physicians or doctors who can make the diagnosis.
Cancer
The changes to the definition for certain types of cancer provide clarity for consumers on what is and isn’t covered, and reflect the latest medical developments and prognosis. They are not intended to change the scope of what is covered. The guide includes amendments to the definition of certain conditions, for example tumours in the urinary tract or digestive tract, but only in instances where the cancer is considered low-risk and the prognosis for the patient is very good.
Heart attack
The change to the definition of what constitutes a heart attack means that there is now more alignment between medical professionals and critical illness insurers.
The updated guide clarifies that less severe heart injuries, which are different to heart attacks, are not included in the minimum standards. The difference reflects the death of heart muscle in heart attacks as opposed to the damaged tissue one would see after an episode of heart rhythm abnormality or a marathon run.
The changes in the review only affect new critical illness polices purchased by customers from 16 September 2022. If you’re looking to purchase critical illness cover, be sure to talk the policy through with your insurer so that you’re clear exactly what is and isn’t included.
Update 14 April 2023: In response to feedback on the 2022 review of the Standards, the ABI has made two clarifications to improve understanding of these changes. These changes do not affect the minimum scope of cover that the Standards prescribe.
First, we clarify that the definition of less severe heart injuries only refers to injuries that occur without heart attacks (excluding myocardial injury without myocardial infarction). Second, we clarify which classification system is appropriate for a specific type of cancer (GIST) when determining that it has a low-risk of progression and the prognosis for the patient is very good.
These clarifications should be implemented by members before 31 January 2024. The ABI will also be reviewing the Guide to Minimum Standards for Critical Illness Cover for compliance with the consumer duty in due course.