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The Truth about Critical Illness Insurance

According to the Department for Work & Pensions, 58% of the causes of long term disability are not covered by critical illness. This is an amazing statistic, and one that I bet a lot of people with critical illness policies do not know about.

This doesn’t mean that you should ignore insurance which could be used to protect you if you develop a critical illness, or long term disability, it just means that you need to be considering what type of insurance is exactly right for you, and which are most likely to pay out if you need to make a claim.

What is Critical Illness Cover?

Critical Illness Cover is an insurance policy which will pay out if the person covered is diagnosed with a specified critical illness and does not die within a set term. A lot of Critical Illness policies have the option to include life insurance, in case the person dies during the waiting period.

For the critical illness policy to pay out the severity of the illness also needs to be at a certain level, and potentially for some conditions you might need to be under a certain age, even if your policy covers you beyond that age.

This type of policy can be joint or single, and for either a set term, or for whole of life. It can include different conditions. The Association of British Insurers has set standards for Critical Illness policies, which include which core conditions should be covered, and what the severity of the condition should be for a claim to be successful. A critical illness policy should always cover the 24 core conditions. Some providers cover over 150 illnesses.

What is the Problem with Critical Illness Cover?

There are three main problems. The average critical illness policy covers only 28 conditions. This means that if you are off work long term sick or ill, there are more reasons for the policy not to be valid, than there is for it to be valid.

The second reason is that your critical illness has to be of a certain severity for the critical illness policy to pay out. For this reason sometimes a critical illness policy is referred to as an “all or nothing policy”. If you meet the definition in the policy wording then the policy will pay out. If you do not, then you will get nothing. There is no middle ground.

Thirdly, there are standard exclusions which critical illness insurance providers can apply to a policy, to make it even harder for a claim to be successful. Not all critical illness policies have exclusions, but many do, and you need to be very careful when choosing the right critical illness policy.

The Solutions to Restrictive Critical Illness Cover.

Critical Illness Cover certainly has its place, but it might be more appropriate to consider Serious Illness Cover, and Income Protection. Serious Illness Cover covers a much broader range of conditions, and will pay out a varying lump sum based on a severity basis.

For example, a condition which might not permit any pay out on a critical illness policy, might warrant a 60% pay out on a serious illness policy, and for most conditions, the serious illness policy will continue to run, so if the condition got worse, or another condition occurred, the policy has the potential to pay out again. Most critical illness policies will only pay out once.

A serious illness policy might be an alternative policy when you are looking to sure against liabilities such as a mortgage, or provide a lump sum to provide money to pay for paying for a home to be adapted or other expenses related to the illness suffered. It can even be used to pay for a holiday, to buy a new home in a new area etc, basically exactly the same reasons as a critical illness policy. There is just more chance of it paying out.

The other alternative, Income Protection is where you are looking to replace an income rather than provide a lump sum. The definitions for income protection are a lot broader than critical illness. For example, an income protection policy might have an “own occupation” definition, where if your condition means you are unable to carry out your own occupation, the policy will pay out after a waiting period of between 7 days and two years until the end of the term, or until you are able to carry out your own occupation. The maximum cover for this type of policy is usually about two thirds of your monthly income. This policy might pay out for a few month, or many years depending on how ill you are, and how long you are ill for.

So Why Do So Many Companies Recommend Critical Illness Cover?

Basically critical illness insurance is very profitable for the company which sells it. The profit margins on income protection are generally lower than Critical Illness so advisers are incentified better for selling critical illness policies instead of income protection policies.

With regards to serious illness cover, the sad truth is that advisers do not understand it, or do not want to spend time trying to explain it to customers.

As we said before, Critical Illness Insurance is appropriate for many circumstances, but it might be worth your while considering serious illness insurance and income protection before making a decision to buy critical illness cover as a policy to meet your needs.