The simple answer to the question – What illnesses are covered by critical illness insurance? – is this: the illnesses and conditions listed in your policy. Crucially, this list is likely to be different from policy to policy. What will also change, from insurer to insurer, is how the illnesses and conditions are defined.

As a ballpark, typical critical illness policies will cover:

  • 40-60 severe illnesses (as the core policy benefit)
  • 30-50 less severe illnesses (as an additional policy benefit)
  • Up to 10 child-specific illnesses (as an additional policy benefit)

And as for the type of illnesses and conditions covered, here are some examples:

  • Cancer
  • Heart attack
  • Stroke
  • Organ failure
  • Loss of limbs
  • Loss of hearing/sight
  • Multiple sclerosis
  • Parkinson’s disease
  • Alzheimer’s disease

For any of the illnesses and conditions covered, whether as the core benefit or an additional benefit, you must meet the insurer’s definition to be eligible to claim. What this means is that each illness and condition is accompanied by its required definition, which could be things like: meeting a specified severity level; requiring a certain procedure; or resulting in specified symptoms.

Core benefit illnesses in a critical illness policy

Each critical illness policy will have a core set of illnesses and conditions listed in it. If you’re diagnosed with one of these, and you meet the insurer’s definition or severity threshold, you’ll be eligible to claim your full critical illness payout. For example, if you have £50,000 critical illness cover, you’ll receive a £50,000 lump sum payout if diagnosed with one of your policy’s core illnesses.

Additional benefit illnesses in a critical illness policy

Many critical illness policies also have an additional set of illnesses and conditions listed in them. These are usually less severe – or, sometimes the same as the core illnesses, but with a lower severity threshold. If you’re diagnosed with one of these, and you meet the insurer’s definition, you’ll be eligible to claim part of your critical illness payout – normally 25% or £25,000 (whichever is lower). So, if you have £50,000 critical illness cover, you’d receive a £12,500 lump sum payout if diagnosed with one of your policy’s additional illnesses.

Good to know: If you make an additional illness claim, your policy stays in place. That means you can still make a claim for the full amount if you’re diagnosed with one of the core illnesses later on. You can also make more than one additional claim throughout the life of your policy (so long as it’s not for the same thing).

Additional benefit children's illnesses in a critical illness policy

Last up, lots of critical illness policies will also include an additional list of children’s illnesses and conditions at no extra cost. These are usually the same illnesses as listed for adults, as well as some child-specific ones – like Down’s Syndrome or cystic fibrosis. If your child is diagnosed with one of these, and it meets the insurer’s definition, you’ll again be eligible to claim part of your critical illness payout – normally 50% or £25,000 (whichever is lower). So, if you have £50,000 critical illness cover, you’d receive a £25,500 lump sum payout if your child is diagnosed with one of your policy’s children’s illnesses.

Good to know: If you make an children’s illness claim, your policy stays in place. That means you can still make a claim for the full amount if you’re diagnosed with one of the core illnesses later on. You can also make more than one children’s claim throughout the life of your policy, though there’s usually a limit to how many.

How to choose a critical illness policy

What’s really important, when choosing a critical illness policy, is not necessarily the number of illnesses covered, but the type. You shouldn’t pick one policy over an other simply because it covers more illnesses, but rather look into the illnesses covered and try to weigh up their relevance to you – because your risk of getting some illnesses be different to getting others.

There are some things, like cancer or heart attacks, which are fairly common to all of us, so it’s very important for your policy to include these (which most do). But there are also some which are extremely rare, so you might not need a policy which covers these if it’s extremely unlikely you’d suffer from them.

Common illnesses

These are the most important illnesses to cover. It’s vital to make sure your policy has these, no matter who you are. Broadly speaking, these are:

  • Cancer
  • Heart Attack
  • Stroke
  • Multiple Sclerosis
  • Total and permanent disablement

The good news is that almost all critical illness insurance policies have the first four. Total and permanent disablement, however, isn’t always included – but it’s something we’d highly recommend you look out for in a policy.

Depending on your age and gender, you’ll be more susceptible to certain illnesses by nature, or more susceptible as you get older. You should look out for illnesses that you’d be higher risk for based on age and gender, factoring in how long you want to be covered for (i.e. will you become higher risk during the time you hold the policy). In the table below, we’ve included some examples; by no means exhaustive lists, but the kind of things you should be looking out for.

Demographic Example illnesses
For men, cardiovascular diseases are a significant risk factor. Core benefit illnesses

  • Aorta graft surgery
  • Coronary artery bypass
  • Heart valve replacement

Additional benefit illnesses

  • Angioplasty
For women, illnesses which affect the reproductive system, as well as auto-immune diseases, present a significant risk. Core benefit illnesses

  • Systemic lupus

Additional benefit illnesses

  • Stage 0 breast cancer
  • Stage 0 cervical cancer
  • Pregnancy complications (if you plan on having children or more children)
For young people (aged 35 and under), it’s important to cover illnesses and accidents that are more likely to happen at that age. Core benefit illnesses

  • Third degree burns
  • Severe mental illness (e.g. psychosis and bipolar)
  • Type 1 diabetes (or as an additional illness)
For children, choose a policy which covers illnesses that present a significant risk to children.
  • Cancer
  • Type 1 diabetes
  • Traumatic brain injury
  • Benign brain tumour
For children (if you're planning more), it’s important to cover illnesses they’re born with or diagnosed with very young (a policy would be unlikely to pay out for a child who’s already been diagnosed).
  • Cerebral palsy
  • Down’s syndrome
  • Cystic fibrosis
  • Muscular dystrophy
  • Spina bifida
When buying critical illness cover, the important thing is to choose a policy that covers the conditions of greatest risk to you. This isn’t always easy to ascertain, but we can help with that – online or over the phone.

We also recommend familiarising yourself with the list of illnesses and conditions covered in a policy and the definitions set by the insurer. If you check out a few different policies, you’ll notice this can vary. Again, it can be difficult to get your head around all of this – but we can help determine how appropriate a policy is for your needs.

This post is intended for informative purposes only and does not constitute advice.