CRITICAL ILLNESS
COVER
Critical illness cover provides financial protection for your client’s family if they’re diagnosed with a critical illness.
We offer 2 critical illness covers:
ESSENTIALS
Our standard range, ideal for clients who want quality cover at a more affordable price.
PROTECTION
Our signature range, ideal for clients who want enhanced cover with quality features.
Product overview
Policy details
Basis: Single or dual life
Premiums: Guaranteed
Pay outs: Lump sum or monthly income
Type of cover: Level Cover, Increasing Cover (RPI), Decreasing Cover (8%), Family Income Benefit
Minimum age at entry: 18
Maximum age at entry: 64
Maximum age at end of term: Age 70
Minimum cover amount: £10,000
Maximum cover amount: £3 million
Total permanent disability: Included
Key Product Features
Definitions designed to pay: Clearer, more all-encompassing definitions
Cover upgrade promise: If we improve our critical illness definitions for new policyholders, we’ll give those improved definitions to existing policyholders too
Dual life: Both partners’ cover is kept separate
Premium Waiver: Comes as standard with every policy
Optional Children’s Critical Illness Protection: Can be added to adult cover anytime
Protection Menu: Can be mixed and matched with any cover from either our Essentials or Protection ranges
Immediate Cover: Temporary cover up to £500,000 that starts as soon as we receive a completed application form
Lifestyle promise: We may be able to reduce smoker’s premiums if they were paying an increased amount and they subsequently stop smoking, lose weight, change job or give up activities
Guaranteed Increase Option: Increase cover with no underwriting, medical evidence, or application from
Additional Services
HALO: Access to tailored medical and legal support at the point of claim
Anytime: At no extra cost access to a GP 24/7, second medical opinions, wellbeing and aches and pains consultations at any time
HALO and Guardian Anytime don’t form part of your client’s contract with us, and we can change or remove the benefits included at any time.
Full payout conditions
If your client is diagnosed with one of the following illnesses or conditions, we’ll pay 100% of the amount of cover specified on their cover summary.
Placement on the NHS waiting list for, or the undergoing of, surgery for disease or trauma of the aorta requiring surgical replacement with a graft on the advice of a UK Consultant.
A definite diagnosis by a UK Consultant Haematologist of aplastic anaemia. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia.
A definite diagnosis of bacterial meningitis by a UK Consultant Physician supported by cerebrospinal fluid changes consistent with bacterial meningitis.
A definite diagnosis by a UK Consultant Neurologist of a non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull resulting in either:
- Placement on the NHS waiting list for, or the undergoing of, surgery to treat the tumour, radiotherapy, chemotherapy
OR
- Permanent neurological deficit with persisting clinical symptoms.
The following are not covered under this definition:
- Pituitary tumours.
Permanent and irreversible loss of sight to the extent that, even when tested with the use of visual aids, it’s measured by a certified UK Ophthalmologist as having a best corrected (with glasses or lenses) visual acuity in the better eye of:
- 6/60 or worse using a Snellen eye chart, or equivalent, or
- A loss of peripheral visual field and a central visual field of no more than 20 degrees in total.
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:
- Carcinoma in situ or neuroendocrine tumour (NET) of low malignant potential of the breast with surgery to remove the tumour.
- Ovarian tumour of borderline malignancy/low malignant potential that has resulted in the surgical removal of the ovary.
- Malignant tumour of the prostate histologically classified as having a Gleason score between 2 and 6 inclusive and having progressed to clinical TNM classification T1N0M0-T2aN0M0 inclusive. (If the prostate cancer is classified as having progressed to a Gleason score of 7 or above or clinical TNM classification T2bN0M0 or pT2N0M0 following prostatectomy (removal of the prostate), we’ll pay a claim under this full payment definition instead).
- Benign testicular tumour or intra-tubular germ cell neoplasia unclassified, that has resulted in an orchidectomy (removal of a testicle).
The following are not covered:
All cancers which are histologically classified as any of the following with the exception of the additional payouts listed above:
- Pre-malignant
- Non-invasive
- Having borderline malignancy
- Having low malignant potential
Any other cancer in situ. This includes melanoma in situ.
Neuroendocrine tumours without lymph node involvement or distant metastases unless classified as WHO Grade 2 or above.
Gastrointestinal stromal tumours without lymph node involvement or distant metastases unless classified by either AFIP/Miettinen and Lasota as having a moderate or high risk of progression, or as UICC/TNM8 stage II or above.
All urothelial tumours unless histologically classified as having progressed to at least TNM classification T1N0M0.
Non-melanoma skin cancer (including cutaneous lymphoma and cutaneous sarcoma) with histological confirmation of spread beyond the epidermal layer that has not caused invasion to the lymph glands or bones or spread to distant organs.
Tumours in the pituitary gland that have not invaded the lymph nodes or bones or spread to distant organs.
A sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and placement on the NHS waiting list for, or implantation of, either of the following devices on the advice of a UK Consultant:
- Implantable cardioverter (defibrillator), or
- Cardiac resynchronisation therapy with defibrillator (CRT-D).
A definite diagnosis of cardiomyopathy by a UK Consultant Cardiologist resulting in at least one of the following:
- Left ventricular ejection fraction (LVEF) of less than 40% measured twice at an interval of at least 3 months.
- Marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain equivalent to at least Class III of the New York Heart Association (NYHA) functional classification system over a period of at least 6 months.
- Placement on the NHS waiting list for, or the undergoing of, implantation of a cardioverter defibrillator (ICD) on the advice of a UK Consultant Cardiologist for the prevention of sudden cardiac death.
The following are not covered:
- All other forms of heart disease, heart enlargement and myocarditis.
- Cardiomyopathy secondary to alcohol or drug abuse.
A state of unconsciousness with no reaction to external stimuli or internal needs which requires the use of life support systems.
The following is not covered:
- Coma secondary to alcohol or drug abuse.
Placement on the NHS waiting list for, or the undergoing of, surgery to correct a narrowing or blockage of one or more coronary arteries with a bypass graft on the advice of a UK Consultant.
A definite diagnosis by a UK Consultant Neurologist of Creutzfeldt-Jakob disease.
Permanent and irreversible loss of hearing to the extent that the quietest sound that can be heard in the better ear is 70 decibels across all frequencies using a pure tone audiogram.
A definite diagnosis of Alzheimer’s disease or dementia by a UK Consultant Neurologist, Geriatrician, Neuropsychologist or Psychiatrist, supported by evidence such as neuropsychometric testing.
There must be permanent cognitive dysfunction with progressive deterioration in the ability to do all of the following:
- Remember; and
- Reason; and
- Perceive, understand, express and give effect to ideas
The following is not covered:
- Mild cognitive impairment.
A definite diagnosis by a UK Consultant Neurologist of encephalitis resulting in permanent neurological deficit with persisting clinical symptoms.
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 and evidenced by:
- new characteristic electrocardiographic changes or new diagnostic imaging changes; and
the characteristic rise of cardiac enzymes or Troponins.
Placement on the NHS waiting list for, or the undergoing of, surgery to replace or repair one or more heart valves on the advice of a UK Consultant Cardiologist.
Chronic and end-stage failure of both kidneys to function, as a result of which regular dialysis is permanently required.
End-stage liver failure resulting in all of the following:
- Permanent jaundice
- Ascites
- Encephalopathy.
The following is not covered:
- Liver disease secondary to alcohol or drug abuse.
Permanent physical severance of a hand or foot at or above the wrist or ankle joint.
Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.
Placement on the NHS waiting list for, or the undergoing as a recipient from another person or animal of, any of the following on the advice of a UK Consultant:
- Bone marrow
- Haematopoietic stem cell proceeded by total bone marrow ablation
- A complete heart, kidney, liver, lung or pancreas
- A lobe of liver
- A lobe of lung.
Or replacement of any of organs listed above with an artificial device.
A definite diagnosis by a UK Consultant Neurologist of one of the following motor neurone diseases:
- Amyotrophic lateral sclerosis
- Kennedy’s disease
- Primary lateral sclerosis
- Progressive bulbar palsy
- Progressive muscular atrophy
- Spinal muscular atrophy.
There must also be permanent clinical impairment of motor function.
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.
Placement on the NHS waiting list for, or the undergoing of, heart surgery requiring median sternotomy or thoracotomy on the advice of a UK Consultant Cardiologist.
The following is not covered:
- Any percutaneous, transluminal or investigative procedure.
Total permanent and irreversible loss of muscle function to the whole of any one limb.
A definitive diagnosis by a UK Consultant Neurologist of Parkinson’s disease. There must be permanent clinical impairment of motor function. This impairment should include either an associated tremor or muscle rigidity.
The following are not covered:
- Parkinsonian syndromes
- Parkinsonism
Placement on the NHS waiting list for, or the undergoing of, surgery for disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft on the advice of a UK Consultant Cardiologist.
A definite diagnosis of pulmonary hypertension that has caused permanent and irreversible impairment of heart function which is classified by a UK Consultant Cardiologist as at least Class III of the New York Heart Association (NYHA) functional classification system.
Confirmation by a UK Consultant Physician of severe lung disease which is evidenced by the need for continuous daily oxygen therapy on a permanent basis.
Death of spinal cord tissue due to inadequate blood supply or haemorrhage within the spinal column resulting in permanent neurological deficit with persisting clinical symptoms.
A definite diagnosis of a stroke by a UK Neurologist with evidence of death of brain tissue or haemorrhage within the skull resulting in either:
permanent neurological deficit with persistent clinical symptoms,
or neurological deficit with persistent clinical symptoms lasting at least 24 hours.
The following is not covered:
- transient ischaemic attack (TIA)
- death of tissue of the optic nerve or retina/eye stroke
A definite diagnosis by a UK Consultant Rheumatologist of systemic lupus erythematosus resulting in either of the following:
- Permanent neurological deficit with persisting clinical symptoms.
- Permanent impairment of kidney function with glomerular filtration rate below 30ml/min.
Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 10% of the body’s surface area or 20% loss of surface area of the face which for the purposes of this definition includes the forehead and ears.
Death of brain tissue due to traumatic injury with subsequent neurological symptoms with corresponding neuroimaging abnormality.
Additional payout conditions
If your client is diagnosed with one of the following illnesses or conditions, we’ll pay an additional amount.
We’ll pay you 50% of the amount you’re covered for up to a maximum of £50,000. The exception being for low risk non-melanoma skin cancer which pays 10% of the amount you’re covered for, up to a maximum of £50,000.
Additional payouts are payable more than once, but not for the same condition twice, with the exception of carcinoma in situ which can be claimed multiple times so long as the site of each carcinoma in situ is different. The amount covered (on your cover summary) would remain intact should you need it in the future for a further claim.
Placement on the NHS waiting list for, or the undergoing of, balloon angioplasty or stent insertion to correct a lesion that has been shown to produce ischaemia, on the advice of a UK Consultant Cardiologist.
The following are not covered:
- Atherectomy.
- Rotablation.
- Laser treatment.
The surgical drainage of an intracerebral abscess within the brain tissue by a UK Consultant Neurosurgeon.
A positive diagnosis by a UK Consultant Oncologist of any carcinoma in situ with histological confirmation and surgery to remove the tumour. We’ll pay more than once if the carcinoma in situ is found at a different organ. We won’t pay a second or further claim if the carcinoma in situ occurs or reoccurs at the same site or location.
The following are not covered:
- Any carcinoma in situ of the skin or any other cancer or tumour covered elsewhere.
- Tumours treated with radiotherapy, laser therapy, cryotherapy, loop excision, conisation, or diathermy.
Surgery doesn’t include biopsies or non-invasive therapies, procedures or investigations (for example, endoscopies) or any radio-surgical procedures or therapies.
A positive diagnosis by a UK Consultant Oncologist of carcinoma in situ of the breast with histological confirmation and surgery to remove the tumour.
Undergoing endarterectomy or angioplasty with or without stent on the advice of a UK Consultant Physician to treat symptomatic stenosis of at least a 50% diameter narrowing of the carotid artery. Supported by corresponding angiographic evidence.
Death of optic nerve or retinal tissue due to inadequate blood supply or haemorrhage within the central retinal artery or vein, resulting in permanent visual impairment of the affected eye.
The following are not covered:
- Branch retinal artery or vein occlusion or haemorrhage.
The undergoing of treatment on the advice of a UK Neurosurgeon for a cerebral aneurysm using any one of the following:
- Craniotomy.
- Stereotactic radiotherapy.
- Endovascular treatment by using coils to cause thrombosis (embolisation).
For the above definition, the following is not covered:
- Cerebral arteriovenous malformation.
The undergoing of surgery, embolisation or radiosurgery to treat an arteriovenous malformation of the brain.
The following are not covered:
- Cerebral aneurysm or any other malformations in the brain.
A definite diagnosis by a UK Consultant of one of the following conditions that results in the permanent inability to perform at least 1 of 8 activities of daily living:
- Giant cell arteritis.
- Polyarteritis nodosa.
- Polymyositis.
- Rheumatoid arthritis.
- Systemic lupus erythematosus.
- Systemic sclerosis.
- Wegener’s granulomatosis.
- Pemphigus vulgaris.
Any endovascular procedure to widen one or more narrowed or obstructed artery with 50% or more stenosis, including any angioplasty procedures.
The above procedure must have been carried out on the advice of a UK Consultant Cardiologist.
Placement on the NHS waiting list for, or the undergoing of, surgery to remove one or more lobe(s) of the lung due to underlying disease or trauma, on the advice of a UK Consultant.
A definite diagnosis by a UK Consultant of a malignant tumour of the prostate positively diagnosed and histologically classified as having a Gleason score between 2 and 6 inclusive and having progressed to clinical TNM classification T1N0MO. – T2aN0MO inclusive. (If the Prostate Cancer is classified as having progressed to a Gleason score of 7 and above or clinical TNM classification T2bN0M0 or pT2N0M0 following prostatectomy (removal of prostate) we will pay out the full sum assured.)
A definite diagnosis by a UK Consultant of a high-risk non-melanoma skin cancer diagnosed with histological confirmation that the tumour is either larger than 20 millimetres (mm) across OR has at least one of the following features:
- Tumour thickness of at least 6mm,
- Invasion into subcutaneous tissue,
- Invasion into nerves in the skin (perineural invasion).
We’ll pay 10% of the amount covered up to a maximum of £50,000 for:
A definite diagnosis by a UK Consultant of a low-risk non-melanoma skin cancer diagnosed with histological confirmation that the tumour has spread beyond the epidermal layer, and is less than or equal to 20mm across but has none of the other features listed above.
The following is not covered:
- Any carcinoma in situ of the skin (including Bowen’s disease) or any other cancer or tumour covered elsewhere.
Diagnosis by a UK Consultant of an ovarian tumour of borderline malignancy/low malignant potential that has resulted in surgical removal of an ovary.
The following is not covered:
- Removal of an ovary due to a cyst.
Diagnosis by a UK Consultant of a tumour in the pituitary gland resulting in either of the following:
- Surgical removal of the tumour.
- Use of radiotherapy to destroy tumour cells.
The following are not covered:
- Tumours treated with any other form of treatment other than those stated.
Any accident resulting in the person covered requiring continuous hospitalisation for more than 28 consecutive days (24 hours a day).
Permanent and irreversible loss of sight in the better eye to the extent that even when tested with the use of visual aids is measured by a certified Ophthalmologist as follows:
- Acuity of up to 6/24 (Snellen) with moderate contraction of the field, or aphakia (lens removal) or opacities blocking vision in the eye itself.
- Acuity of 6/18 or better, if in addition suffering from a gross defect of visual fields (of both eyes, such as hemianopia) or marked contraction of the visual field due to retinitis pigmentosa, or glaucoma.
The undergoing of treatment on the advice of a UK Neurosurgeon for a spinal aneurysm using any one of the following:
- Surgical resection.
- Wrapping.
- Clipping or embolisation.
The undergoing of treatment on the advice of a UK Neurosurgeon for a spinal arteriovenous malformation using any one of the following:
- Surgical resection or removal.
- Endovascular embolisation.
- Stereotactic radiosurgery.
- Radiation therapy.
The undergoing of surgery to treat a syrinx in the spinal cord or brain stem.
The undergoing of an orchidectomy (removal of a testicle) following diagnosis of intra-tubular germ cell neoplasia unclassified or benign testicular tumour.
Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 5% of the body’s surface area.
A definite diagnosis of type 1 diabetes mellitus made by a UK Consultant, requiring the permanent use of insulin injections.
The following are not covered:
- Gestational diabetes.
- Type 2 diabetes (including type 2 diabetes treated with insulin).
