The ABI’s Best Practice For Critical Illness Cover With Model Definitions

The model definitions you will find as you read further in the article has been taken from the ABI’s best practice for critical illness cover (May 2002). Insurance companies, members of the ABI must adhere to these model definitions when they sell critical illness policies.

Concerning the core illnesses, all ABI members must cover at least heart attack, cancer and stroke. Other companies might offer better critical illness cover and you may discover that there may be dissimilarity between policies and conditions covered. On the other hand if a member of the ABI prefers to use a different critical illness policy definition, you could assure yourself that the advantages may be much favourable than the model definition.

Let’s have a look at the model definitions, carefully explained and categorised by the ABI.

Statistics show that 1 out of every 3 men may contract a critical illness such as cancer. The same thing may happen to 1 out of every 5 women.

Any malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes a critical illness like leukaemia and Hodgkin’s disease but the following are excluded:
• All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ.
• All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0M0.
• All forms of lymphoma in the presence of any Human Immunodeficiency Virus.
• Kaposi’s sarcoma in the presence of any Human Immunodeficiency Virus.
• Any skin cancer other than invasive malignant melanoma.

Heart attack
Heart attack is believed to be the second critical illness in the UK responsible for most critical illness claims. 1 out every 5 women may suffer from heart attack at some point in their lives before reaching the age of 65.

The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:
• typical chest pain;
• new characteristic electrocardiographic changes;
• the characteristic rise of cardiac enzymes, troponins or other biochemical markers;
• where all of the above shows a definite acute myocardial infarction.
Other acute coronary syndromes, including but not limited to angina, are not covered under this definition.

Kidney failure
As per the UK Renal Registry 1998, at the end of the year 1998, around 31,000 people could have suffered from a critical illness like kidney failure. Also, approximately 50 percent of these people, victims of this critical illness may have undergone a surgery whilst the remaining could have been treated by dialysis.

End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated.

Major organ transplant
The actual undergoing as a recipient of, or inclusion on an official UK waiting list for, a transplant of a heart, liver, lung, pancreas or bone marrow.

Multiple sclerosis
According to the Multiple Sclerosis Society 2002, the number of people suffering from this critical illness may count up to 85,000 in the UK. Additional figures show that around 2,500 new cases of a critical illness such as multiple sclerosis could be detected each year in the UK.

A definite diagnosis by a Consultant Neurologist of Multiple Sclerosis which satisfies all of the following criteria:
• There must be current impairment of motor or sensory function, which must have persisted for a continuous period of at least six months.
• The diagnosis must be confirmed by diagnostic techniques current at the time of the claim.

According to the Stroke Association 2002, around 100,000 people may suffer from this critical illness each year in the UK. Furthermore, stroke is a critical illness that can be considered as the largest factor for disability cause in the UK with around 300,000 people disabled at a time.

A cerebrovascular incident resulting in permanent neurological damage. Transient Ischaemic Attacks are specifically excluded.