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Critical Illness Cover
Critical Illness Cover Example
Critical illness cover usually pays a one off lump sum, if you are diagnosed with a qualifying critical illness covered during the term of the policy. But what is cover is provided in a typical critical illness policy.
Below we have set out the typical critical illness cover you would receive from your critical Illness policy.
The types and range of critical illnesses covered vary from company to company, so we recommend you read the key facts document before you apply for your critical illness policy.
Full definitions of each Critical illness Covered
The table below states the contractual definition for each of the critical illnesses which must be satisfied in order to claim. The specific critical illness cover for your policy will be included in the policy document supplied for your critical illness cover by the life insurance company:-
Critical Illnesses Covered |
Critical Illness Cover Full Definition |
What Does This Mean ? |
Alzheimer's Disease – resulting in permanent symptoms |
neurologist, psychiatrist or geriatrician. |
|
Aorta Graft Surgery – requiring surgical replacement |
surgical replacement of a portion of the aorta with a graft. |
The aorta is the body’s main artery
carrying blood from the heart. This
definition covers surgery to the aorta,
where part of it is removed and replaced |
Aplastic Anaemia – with permanent bone marrow failure |
A definite diagnosis of aplastic anaemia by |
Aplastic anaemia is a rare but serious condition where |
Bacterial Meningitis – resulting in permanent symptoms |
A definite diagnosis of bacterial meningitis |
Bacterial meningitis causes inflammation to the |
Benign Brain Tumour - resulting in either surgical removal or permanent symptoms |
A non-malignant tumour or cyst in the |
A benign brain tumour is a non-cancerous abnormal growth |
Blindness – permanent and irreversible |
Permanent and irreversible loss of sight |
This means permanent loss of vision. It’s measured with |
Cancer - excluding less advanced cases |
Any malignant tumour positively diagnosed with histological |
Cancer (also known as a malignant
tumour) is a disease where normal
cells change and grow in an abnormal
way. If left untreated, they can destroy |
CARDIAC ARREST – with insertion of a defibrillator | Sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness, requiring resuscitation and resulting in either of the following devices being surgically implanted: • Implantable cardioverter-defibrillator (ICD); or • Cardiac resynchronisation therapy with defibrillator (CRT-D). For the above definition the following are not covered: • Insertion of a pacemaker. • Insertion of a defibrillator without cardiac arrest. • Cardiac arrest secondary to illegal drug abuse. |
Cardiac arrest is a life threatening condition in which
the heart suddenly stops pumping blood around
the body. There are various causes but the most common is abnormal and irregular heart rhythm. For this definition you must have had cardiac arrest requiring resuscitation and have a defibrillator fitted. This is a device which is put in your chest and used to correct and control dangerous and irregular heart rhythm. |
Cardiomyopathy – of specified severity |
A definite diagnosis of cardiomyopathy by a |
Cardiomyopathy is the name given to a group of |
Coma – resulting in permanent symptoms |
A state of unconsciousness with no reaction to
external stimuli or internal needs which: |
A coma is a state of unconsciousness from which |
Coronary Artery By-Pass Grafts – with surgical thoracotomy |
The undergoing of surgery requiring |
Coronary arteries can become narrowed or blocked by the |
Creutzfeldt-Jakob Disease (CJD) – resulting in permanent symptoms |
A definite diagnosis of Creutzfeldt- |
Creutzfeldt-Jakob disease (CJD) is a rare disease of the nervous |
Deafness - permanent and irreversible |
Permanent and irreversible loss of hearing to the extent that the loss is greater than 95 decibels across all frequencies in the better ear using a pure tone audiogram. |
This means permanent loss of hearing in both ears, |
Dementia – resulting in permanent symptoms |
A definite diagnosis of dementia by a consultant neurologist,
psychiatrist or geriatrician. The diagnosis must be supported by
evidence of progressive loss of ability to do all of the following: |
Dementia is a term used to describe
various different brain disorders that
have in common a loss of brain function. |
Encephalitis - resulting in permanent symptoms
|
A definite diagnosis of encephalitis by a consultant neurologist resulting in permanent neurological deficit with persisting clinical symptoms*. |
Encephalitis is inflammation of brain tissue. It is
usually caused by an infection. Symptoms might |
Heart Attack – of specified severity |
Death of heart muscle, due to inadequate blood
supply, that has resulted in all of the following |
A heart attack, also known as a myocardial
infarction, happens when part of the heart muscle |
Heart Valve Replacement or Repair – with surgical thoracotomy |
The undergoing of surgery on the advice |
Healthy heart valves are important to make sure blood flows
through the heart in the right direction so that blood is circulated |
HIV infection – caught from a blood transfusion, physical assault or accident at work |
Infection by Human Immunodeficiency Virus resulting from: |
This definition covers HIV infection from
a blood transfusion, physical assault or
when caught at work. |
Kidney failure – requiring dialysis |
Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is necessary. |
The kidneys perform an important role filtering
the body’s waste to pass as urine. If the kidneys |
Liver failure – of advanced stage |
Liver failure due to cirrhosis and resulting in all of
the following: |
The liver is an important organ, which carries out
several of the body’s vital functions such as helping
with digestion and clearing toxins. This definition
covers liver failure at an advanced stage. |
Loss of hand or feet – permanent physical severance |
Permanent physical severance of a hand or foot at |
This means physical severance and may be caused by illness or serious accident. This definition only requires severance of either a hand or foot above the wrist or ankle joints. |
Loss of Speech - permanent and irreversible |
Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease. |
This is when you won’t be able to talk again. It’s
often caused when the vocal cords need to be |
Major Organ Transplant |
The undergoing as a recipient of a transplant of
bone marrow or of a complete heart, kidney, lung,
pancreas, liver or lobe of liver, or inclusion on an
official UK, Channel Islands or Isle of Man waiting
list for such a procedure. |
Occasionally, an organ may become so diseased
that it needs to be replaced. |
Motor Neurone Disease – resulting in permanent symptoms |
A definite diagnosis of motor neurone |
Motor neurone disease (MND) is a gradual weakening and
wasting of the muscles, usually beginning in the arms and
legs. This may cause difficulty walking or holding objects. |
Multiple Sclerosis – with persisting symptoms |
A definite diagnosis of multiple sclerosis |
Multiple sclerosis (MS) is the most common disabling
neurological disease among young adults and is usually
diagnosed between the ages of 20 and 40. |
MULTIPLE SYSTEM ATROPHY – resulting in permanent symptoms | A definite diagnosis of multiple system atrophy by a
consultant neurologist. There must be evidence of
permanent clinical impairment of either: • motor function with associated rigidity of movement; or • the ability to coordinate muscle movement; or • bladder control and postural hypotension. |
Multiple system atrophy is a progressive disease
of the nervous system. Symptoms are varied and
include muscle weakness, swallowing difficulties and increasingly severe impairment of physical function. There are treatments to delay some of the symptoms of the disease but no cure currently exists and life expectancy is greatly reduced. |
OPEN HEART SURGERY – with Median Sternotomy | The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist to correct any structural abnormality of the heart. |
Open heart surgery is an operation in which the heart is opened by a surgical incision for a corrective procedure to be carried out. This definition covers any surgery which involves dividing the breast bone. This definition doesn’t cover other surgical procedures, such as balloon angioplasty or insertion of stents. |
Paralysis of limbs –total and irreversible |
Total and irreversible loss of muscle function |
Paralysis is the complete loss of use. It may be caused by injury or illness. A limb is an arm or leg. |
Parkinson's Disease – resulting in permanent symptoms |
A definite diagnosis of Parkinson’s disease |
Parkinson’s disease is a slowly progressive disease of the brain. Symptoms can include tremors (uncontrollable shaking or trembling), muscle stiffness and slowness of movement. Treatment focuses on slowing the progression of symptoms. There’s currently no known cure. |
Primary Pulmonary Hypertension - of specified severity
|
A definite diagnosis of primary pulmonary |
Primary pulmonary hypertension is abnormally
high blood pressure in the arteries of the lungs. |
Progressive Supranuclear Palsy – resulting inpermanent symptoms |
A definite diagnosis of progressive |
Progressive supranuclear palsy (PSP) is a brain disease that |
REMOVAL OF AN EYEBALL – due to injury or disease | Surgical removal of an eyeball as a result of injury or disease. For the above definition the following is not covered: • Self inflicted injuries. |
This means total removal of either eye due to illness or injury. |
Respiratory failure – of advanced stage |
Advanced stage emphysema or other chronic lung
disease, resulting in all of the following: |
The lungs allow us to breathe in oxygen and get rid
of harmful carbon dioxide. This definition covers
advanced lung failure when breathing is severely
affected and regular oxygen therapy is required. |
Stroke – resulting in permanent symptoms |
Death of brain tissue due to inadequate blood
supply or haemorrhage within the skull resulting
in permanent neurological deficit with persisting
clinical symptoms*. |
Strokes are caused by a sudden loss of blood supply
or haemorrhage to a particular part of the brain. |
Systemic Lupus Erythematosus – with severe complications
|
A definite diagnosis of Systemic Lupus |
Systemic lupus erythematosus (SLE), sometimes
called ‘lupus’, involves chronic inflammation of |
Terminal Illness |
A definite diagnosis by the attending consultant of
an illness that satisfies both of the following: |
This definition provides cover for illnesses or
conditions where in the opinion of your hospital
|
Third Degree Burns – – covering 20% of the surface area of the body or 20% of the face or head |
Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body’s surface area or covering 20% of the area of the face or head. |
Third degree burns are the most serious type of
burns, involving the full thickness of the skin and
|
Total and Permanent Disability |
We define total and permanent disability in two ways. The definition we
apply to you will depend on what kind of job you do and if you’re paid for
the work you do. You’ll be assessed on the occupation you were following immediately
before the onset of disability. However, if you are not in paid employment
at the time of a claim, then your claim will be assessed under the Specified |
This benefit may cover any |
2. Total and permanent disability – unable to do three specified work tasks
ever again. |
All reasonable treatment
options must have been
tried and given sufficient
time to work before making a claim. |
|
Traumatic head injury - resulting in permanent symptoms |
Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms*. |
Traumatic head injury is covered by this
definition when permanent symptoms result
from the injury. An example is a severe head |
* Permanent neurological deficit with persisting clinical symptoms
Symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last
throughout the insured person’s life.
Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised
weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual
impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma.
Additional Cover
Legal & General critical illness plans also automatically include additional cover for Mastectomy for Ductal Carcinoma In Situ and Children’s Critical Illness Cover.
Mastectomy for Ductal Carcinoma in Situ
If you have a valid claim under this definition they will
pay out 25% of the amount you’re covered for up to a
maximum of £25,000. This cover is in addition to your
main plan so your chosen cover and the premiums you
pay won’t be affected. This additional payment helps
to ensure that you have some financial protection
against the impact a mastectomy will have on your
lifestyle, and also means that your full cover is still
intact in case you suffer another critical illness.
Children's Critical Illness Cover
If any of your children suffer from a critical illness covered by this plan, they will pay out 50% of the amount you’re covered for up to a maximum of £25,000. For Family and Personal Income Plans they will pay out 60 times the chosen monthly benefit or a maximum total of £25,000 – whichever is the lowest amount. This cover is in addition to your main plan and so won’t affect the amount you’re covered for or the premiums you pay. They also pay out one claim per child under your plan and once two claims have been paid, the children’s cover part of your plan will end. If you have more than one Critical Illness Cover plan with us, and pay out a maximum of £50,000 for that child.
Legal & General automatically include
children’s cover with your policy.
This will cover any natural child,
legally adopted child or stepchild
of the person/s covered, and also
any children you may have in
the future.
They will pay a lump sum if a child is
diagnosed with one of the critical illnesses we cover during your
plan, as long as they survive for
14 days from diagnosis.
Children are covered provided they are more than 30 days old and less than 18 years old. The 14 day survival period may extend beyond their 18th birthday.
Children are covered for the
same critical illnesses covered
by the plan, except for total and
permanent disability. Children’s
cover is only for the defined
critical illnesses and isn’t paid
on a child’s death.
Are There any Exclusions for Children’s Cover?
As well as total and permanent disability, children’s cover also excludes any condition that arises as a direct or indirect result of congenital (present at birth), hereditary and pre-existing conditions.
When will Children’s Critical Illness Cover End?
Legal & General only pay one claim for each child per policy and once two claims have been accepted, children’s critical illness cover will end. However, cover will continue for you. Children’s cover will also end once you make a claim yourself.
Source Legal & General 07/12/2014
MASTECTOMY FOR DUCTAL CARCINOMA IN SITU – requiring total removal of the breast |
The undergoing of a mastectomy operation (total
removal of all the tissue of at least one breast) on
the advice of your hospital consultant following the
diagnosis of ductal carcinoma in situ of the breast. For the above definition, the following are not covered: • Prophylactic mastectomy without histological evidence of ductal carcinoma in situ, and • Any other surgical procedures such as lumpectomy, partial mastectomy and partial or total sub cutaneous mastectomy. |
Early cancerous changes in the breast may occur
before the cancer spreads to other parts of the body
(this is called in situ cancer). In these circumstances, removal of the breast (mastectomy) may be advised to protect against the disease spreading. This definition doesn’t cover partial breast removal or lump removal only. The cover provided under this definition is extra cover to your main plan. If you make a valid claim we’ll pay out 25% of your sum assured up to a limit of £25,000. This pay out is separate from your main plan and won’t affect your chosen cover or the premiums you pay. This ensures that your overall amount of cover remains intact. See page 25 for more details. |
There are other providers of critical illness cover policies that may be more suitable to your needs.
Instant Critically Illness Cover Quote
Our Critical illness insurance quote tool allows you to compare the leading insurance companies critical illness premiums. What's more Go Direct guarantee that at the time of application you will not get cheaper like for like cover as we rebate 50% of the initial commission the provider pays us back into your critical illness insurance policy.
Do you want advice on Critical illness cover?
After looking through the critical illness insurance information if you would like , complete our critical illness cover and life insurance enquiry form and we will contact you to discuses your critical insurance and protection needs.
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