Critical Illness Cover Conditions

What illnesses does critical illness insurance cover?

The answer, of course, depends on what kind of policy you have currently, or plan to buy. Though there are some ‘core’ conditions covered by critical illness insurance, there can be plenty of exceptions, especially amongst lesser-known or less severe conditions.

The critical illness insurance experts we work with can help address any concerns you may have. Get in touch if you’d like a little friendly advice, or to find a quote that specifically suits you and your unique circumstances.

Here’s what you’ll learn in this article:

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What illnesses are commonly covered?

It’s important to remember that critical illness insurance doesn’t cover every kind of illness.

The clue is in the name – it’s cover for illnesses which are deemed ‘critical’. These are conditions which are severe enough to affect your ability to provide for yourself, or your family.

There are a number of severe conditions that are usually included…

In many cases (and especially for the ‘major’ conditions) the definitions are set by the Association of British Insurers (ABI).

While a number of major policies are covered, the kind of diseases that are covered by your specific policy will depend, to an extent, upon the kind of plan that you choose. And they can vary from provider to provider.

If you’re a smoker, the rules will be a little different and you’ll want to take a look at our guide to critical illness cover for smokers.

If you want coverage for a particular disease, you can always inquire with your provider / potential provider, or check your policy documentation to see if it’s included. It’s always advisable to read the policy documentation carefully before committing to anything.

You may also want to speak to an expert, who can help you to get the best deal on a policy that provides the exact cover you need. Get in touch if you’d like to talk with one of the whole-of-market professionals we work with.

Not every occurrence of the major diseases is covered

Though there are many critical illness cover illnesses, the symptoms need to be severe and/or the condition needs to be advanced for you to claim. In many instances, you’ll need to be able to demonstrate to the insurer that your condition is truly disabling before you can make a claim.

Cancer, as one example, comes in many permutations – some of which are more debilitating than others. A full payout may require the cancer to become malignant and start to spread. Smaller payouts could even be given for early stage cancers.

As such, ‘cancer’ isn’t a blanket diagnosis that will automatically qualify you for a payout. It will depend on the variety of cancer you have, and if the symptoms have advanced enough for treatment to be seriously expensive, and for this to interfere with your ability to work.

For more information about how this works, speak with an expert.

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

If the condition that you’re concerned about is not on the usual list, you may be able to upgrade your coverage. Again, you can ask your provider about this or speak to one of the experts we work with, they can track down the most cost-effective policy for the cover you need.

What’s covered, and what counts as a ‘critical illness’ will change over time

As medical technology improves, the things we deem to be ‘critical’ illnesses are changing. As such, a policy you buy five years from now may very well be stricter around the conditions it deems to be ‘critical’.

With this in mind, it’s a good idea to review policies every few years to ensure you have the best cover possible. If you have an existing policy and want to know if it’s up to today’s standard against the current market, speak with an expert.


What you need to know about getting cover with pre-existing conditions

Getting critical illness cover with pre-existing conditions is certainly not impossible, and many serious conditions are not a dealbreaker for coverage (assuming you can still work in spite of your condition).

However, if you have a pre-existing condition (or more than one), this could affect the kind of cover you can get, or the price of your insurance premium. You might not be covered for an illness which you already have, or one which runs in your family.

Honesty is the best (insurance) policy

In order to provide a quote, an insurer will ask you for a detailed medical history, which includes any pre-existing conditions, plus your family medical history.

You might be tempted to omit certain information in order to save money on your premium, but this isn’t advisable. In the worst case, you could be stung for insurance fraud.

Alternatively, future claims could be voided or dramatically reduced if your insurer finds out.


FAQs

Below we’ve answered some of the most common questions around critical illness cover. If you have a question that’s not answered here, or you’d just like to discuss your options, get in touch and one of the experts that we work with will be happy to advise you.

Is epilepsy covered?

It can, though this will depend on a range of factors. These include the kind of epilepsy you have (e.g. petit mal, grand mal or nocturnal), how severe your seizures are, how long ago you were diagnosed, how many seizures you’ve had in the last year, and the last time you had a seizure.

Is gallbladder surgery covered?

In many cases, yes. As an example, less advanced cancer of the gallbladder with surgical removal is not uncommon. However, it’s worth confirming with the policy documentation.

Is lymphoma covered?

This depends how advanced the lymphoma is.

Like with many cancers, it’s possible to get cover if you’ve been deemed in remission, or if it’s been a long time since you had treatment, though if the condition has advanced quite far, it may be harder to find cover, or you may have to pay a higher premium.

If you take out a policy and subsequently develop the condition, you’re quite likely to be able to make a claim, as it’s a commonly insured cancer. Of course, check your policy documents first.

Is hypertrophic cardiomyopathy covered?

It depends. This one is usually grouped within ‘cardiomyopathy’ – which not all insurers cover. Check with your provider or speak to an expert to be sure.

Does cover include lupus?

In many cases, yes – though this will depend on the kind and severity of lupus you have.

People who experience DLE may find it easier to arrange cover than those with SLE, though it will depend on your individual policy. Clinical symptoms (such as renal function) will tend to be favoured over subjective measurements, such as lethargy or fatigue.

Again, ask an expert or check with your provider.

Is HIV covered?

The vast majority of critical illness cover providers would not offer a policy that includes HIV to anyone currently living with the condition.

It is possible to get critical illness cover for HIV if you don’t currently have it, but whether your policy pays out in the event of a diagnosis will likely depend on how the virus was contracted. Most providers only cover “accidental” contraction, which means caught in a specified list of countries from a blood transfusion, as a result of a physical assault or at work.

Does cover include a hysterectomy?

Many policies will cover hysterectomy that is carried out as the result of cervical cancer, though you’ll want to check your policy beforehand.

Is Alzheimer’s covered?

Yes, please see this article’s section on dementia for more information.

Does critical illness cover angina?

Cover for angina is a lot less common, and you may need to upgrade your policy or find a more specialist provider. Get in touch if you’d like some help with this.

If you’d like to know more about cover for other kinds of heart conditions, take a look at our guide on critical illness cover for heart attacks.

Does cover include Transient Ischaemic Attack (TIA)?

It depends. Many providers won’t cover TIA under a basic policy, as the ABI’s definition excludes this from their definition of stroke. So, you’ll want to check with your provider, or ask one of the experts we work with to find a policy that covers TIA.

Take a look at our guide to critical cover for strokes, if you’d like to know more.

Is blindness covered?

Many do, assuming that the blindness is ‘permanent and irreversible’. Check with your provider to be sure.

Does cover include hip replacements?

Hip replacements for arthritis are often covered under the arthritis section of a basic policy. A hip replacement carried out for other reasons may require more specialist cover. Get in touch if you’d like to know more – one of the experts that we work with will be able to advise.

Does it include Ductal Carcinoma In Situ (DCIS)?

This depends. Many recent policies have been updated to include DCIS as part of their cover – which includes mastectomy, partial mastectomy, segmentectomy and lumpectomy.

However, a number of older policies (often before 2013) don’t pay out for the condition, despite covering a number of other cancers. The reason they usually give is because DCIS is an early-stage cancer.

If in doubt, check with your provider/potential provider.

Take a look at our guide to critical illness cover for cancer if you’d like more detail about how critical illness insurance treats other kinds of cancer

Can I get critical illness insurance to cover a brain aneurysm?

Yes. Many critical illness plans cover cerebral aneurysm (requiring surgical intervention) as a default, though you’ll want to obviously confirm this in your policy.

Does insurance cover kidney disease?

Often. Plenty of providers offer critical illness insurance for kidney disease as part of their standard coverage, though many of them will require the condition to be ‘advanced’ (eg. requiring permanent dialysis).

Does cover include ankylosing spondylitis?

It depends. Critical illness cover for ankylosing spondylitis is less common than many other kinds of arthritis – but is often available through specialised providers, or as an upgrade to an existing plan.

Again, the symptoms may have to be severe for a claim to be eligible, and advanced AS may incur a higher premium on a new plan. Get in touch if you’d like one of the experts we work with to help you find the right plan for you.

Alternatively, take a look at our guide to critical illness cover for arthritis, if you’d like to see how coverage for other kinds of arthritis works.

Can I get cover for organ transplants?

Most policies cover what they deem ‘major’ organ transplants – the heart, the lungs, the liver, pancreas and bone marrow (though some will exclude bone marrow).

As a general rule, the procedure needs to be deemed ‘medically necessary’ by a doctor in order to be eligible for cover.

Does cover include dementia?

In many instances, yes, though in some cases a diagnosis needs to be given before the age of 65 for a claim to be valid. In many instances, there will need to be demonstrated evidence that there’s been a permanent effect on the claimant’s ability to reason, remember and perceive.

One thing to bear in mind about critical illness cover for Alzheimer’s is the matter of ‘agency’. Some people choose to put their critical illness insurance in a trust, in the result that any future progression of Alzheimer’s impedes their decision-making ability.


Talk to an expert today

If you have questions about critical illness cover conditions and want to speak to an expert for the right advice, call us today on 0808 189 0463 or make an enquiry online.

Then sit back and let us do all the hard work in finding the advisor with the right expertise for your circumstances. We don’t charge a fee and there’s absolutely no obligation or marks on your credit rating.

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