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Critical illness plans have evolved over the past 25 years. Initially there was a condition race where insurers sought to leapfrog their competitors by adding ever greater numbers of illnesses.

Changes have also been made to definitions as insurers have tried to ‘future proof’ the wordings to reduce the risk of advances in diagnostic techniques causing an unwelcome increase in claims.

Definition wording changes in 2003/04 served to weaken the cancer definition. This suggests that pre-2004 plans offer superior cover to the current crop.

Nothing is so simple, newer style variations, may include additional cover for Mastectomy, Early Stage Prostate Cancer, Third Degree Burns and Loss of One Limb, so a detailed assessment is required.

Insurers (ABI) define a Critical Illness Plan as:

“Critical Illness cover means cover which pays out on diagnosis of a listed critical illness. The list of illnesses must include cancer, heart attack and stroke.”

How does my old policy compare?
68% of consumers surveyed believed that they could claim for any illness that meant they could not work
55% did not understand what is meant by full medical disclosure

The insurance industry uses statistics to set their rates and these are based around the likelihood of somebody suffering from one of the conditions covered. The prime statistical figures relate to incidence. This is a figure for the number of individuals who have suffered from a condition in a particular year.

Another descriptive term is prevalence. This means the number of people suffering at any given time from one of the conditions. Incidence is of greater importance when we assess the worth of having a particular condition included.

The difference is best explained by reference to Multiple Sclerosis. In the UK around 100,000 people are currently suffering from MS and this is the prevalence figure. In a typical year 2,600 individuals between the ages of 25-65 are diagnosed with MS and this is the incidence figure.

The relevant statistical figures are those of incidence. This is a figure for the numbers of individuals who are first diagnosed with a condition in a particular year.

What conditions will be most likely to occur

CIExpert is an independent organisation that creates in depth analysis to assist advisers in choosing the best policy for their clients.

We also seek to provide guidance and education to consumers in understanding the value and choice of Critical Illness Insurance.

We pride ourselves on maintaining an objective view.

Consumer Guide To Critical Illness Insurance


Policies are constantly changing

Critical illness plans have been available in the UK for over 25 years and the one constant is that they keep undergoing change. Conditions are added and sometimes they are taken away.

Frequently they are adjusted and just when you have become accustomed to them they alter yet again.

The ABI operates a working party which determines model wordings for those conditions offered by at least 75% of its members.

These are reviewed every three years and wordings are frequently modified and fine-tuned to reflect advances in medical science or to better describe the claim wording.

No surprise that consumers and even some advisers do not understand them

The industry, and particularly the insurers who market these plans, have an obligation to explain using non-ambiguous phraseology, an obligation to design plans which clarify rather than confuse and an obligation to simplify whenever possible.

However there are many examples of design found wanting, for example:

Our services to Advisers assist them in understanding Condition Definitions

Condition definitions are not easily understood

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