Getting advice on critical illness cover

What should critical illness cover advice give you?

A useful outcome is a written explanation connecting your household's needs to the policy being proposed. It should show what the money is intended to do, which limitations matter and why that policy was selected. You should be able to recognise your own circumstances in it.

Critical illness cover pays when a listed illness or procedure meets its definition, meaning the policy's written test for a claim. That makes the detail behind a recommendation particularly significant. Two policies can show the same adult cover amount and end date while paying in different circumstances.

You can test the explanation with three practical questions. What event releases the money, how much is paid for that event, and what cover remains afterwards? Applying those questions to actual policy clauses makes the proposed cover easier to assess.

A protection specialist is an adviser or broker who deals with insurance against events such as serious illness or death. MoneyHelper identifies specialist advice as a way to work through this complicated product. The depth and scope of the service still need checking.

What does a critical illness cover broker do?

The word broker alone leaves a question unanswered. Does the firm assess your circumstances and make a personal recommendation, or are you choosing the policy yourself? Execution-only is the term for a service that carries out your choice without giving you a personal recommendation.

Someone explaining an application form can be helpful, but establish who is responsible for selecting suitable cover. You can ask this before discussing policy options. Also ask which insurers the firm can consider and whether its service covers the type of protection you want to discuss.

Payment is another part of the service to establish early. A fee is money you pay the adviser directly, while commission is a payment the adviser receives from the insurer for setting up the policy. MoneyHelper explains that insurance advice can be paid for through commission, and some firms charge fees.

Ask for the firm's charges and payment arrangements in writing. Include any circumstances in which you would owe the firm money if you decided against proceeding or ended a policy. The answer depends on the firm's agreement, so a general description of brokers cannot settle it.

What information makes the conversation useful?

Bring a picture of the household finances that the specialist can question. That includes regular commitments, people who depend on your earnings, accessible savings and any support available through work. Existing policy schedules, which record your individual cover details, also help establish what is already in place.

Separate the documents from your assumptions about them. For example, a workplace handbook might describe sick pay, while an insurance certificate describes a different benefit. Recording the name of each benefit and when it applies helps the specialist investigate any uncertainty.

The amount and length of cover need their own discussion. Our guide to how much critical illness cover you might need explains the household calculation in more detail.

Health questions require accurate answers to the questions actually asked. Underwriting means the insurer's assessment of the application, including relevant health and other information. An exclusion is a written restriction removing particular circumstances from cover.

A specialist can check how insurers assess a particular history, without predicting an individual's application result. Dates of treatment, medication details and outstanding investigations can help clarify answers where the form asks about them. The guide to pre-existing conditions covers that separate issue.

Ask for one definition to be worked through

An explanation becomes easier to judge when it uses an actual condition. Ask the specialist to open the proposed policy's heart attack definition and explain what evidence it requires. Then ask what difference another policy's wording would make to that same evidence.

The Association of British Insurers, or ABI, publishes minimum standards for critical illness policies. Its model definitions provide a starting point, and insurers can offer broader cover. A recommendation can identify the specific wording that extends the circumstances in which a claim would be paid.

For example, some heart attack definitions specify blood-test thresholds, while other published wordings require a characteristic rise without setting those numerical limits. The significance lies in the whole definition, including the other evidence required. A specialist should be able to point to the relevant clauses and explain the difference accurately.

A useful response makes the contractual difference understandable and connects it to the reasons for the recommendation. Our guide to critical illness definitions explains how to read those clauses.

Put smaller payments and children's benefits into the discussion

Some policies pay a smaller amount for specified conditions or procedures. The ABI distinguishes an additional payment, which leaves the main cover amount intact, from a partial payment, which reduces the amount remaining. Ask which arrangement the proposed policy uses and where its limits are recorded.

The label alone is insufficient to describe the benefit. Ask the specialist to show the amount payable, any maximum limit and the rules for later claims. A worked explanation can follow one smaller claim through to the cover that would remain for a later, different event.

Children's benefits have their own conditions, age limits and payment limits, which can differ between policies. The children's critical illness cover guide sets out the checks in detail.

In an advice appointment, the question is how those rules fit the family being discussed. If a teenager is approaching a policy's age limit, ask the specialist to identify the applicable date and any education requirement. The written explanation should identify how the rules apply to that child.

A worked example of an advice appointment

Jo is a teaching assistant in Sheffield whose son is 19 and studies part time at college. She has an existing policy and wants to understand a proposed replacement after moving home. This is a fictional example of the questions an appointment can resolve.

At first, Jo has only the adult cover amount and end date for each policy on her notes. The specialist asks for the existing schedule and terms, plus the documents for the proposed cover. Jo's first task is to establish which version of each policy is being discussed.

The specialist then records three differences for Jo to review. These concern the heart attack evidence required, the treatment of a smaller claim and the age rules for her son. Each entry gives the relevant document page and explains what the difference would mean if a claim arose.

Suppose the proposed policy has a wider adult definition but its children's benefit ends at 18 unless the child studies full time. If her existing children's benefit still covers her son, the replacement would remove that protection. Jo needs both the adult improvement and the loss of her son's cover recorded together.

The discussion also establishes what happens after an adult payment. In combined cover, sometimes called accelerated cover, a critical illness payment uses up some or all of the linked life cover. The guide to additional and combined cover explains that choice.

Jo can now ask why the specialist considers the proposed change suitable despite the differences recorded. The explanation should also identify any terms still awaiting confirmation from the insurer. That gives Jo a clear record of the comparison and any outstanding questions.

Existing cover makes the comparison more demanding

A replacement involves the benefits being given up as well as those being gained. The Financial Ombudsman Service sees complaints where an earlier policy covered an illness but the replacement did not. Its guidance looks at the explanation of the change and the reasons for it.

Ask for a comparison using your existing contract and the final proposed terms. A new application involves a fresh assessment, and the insurer's final offer may contain restrictions. An illustration produced before that assessment does not establish the eventual cover.

The sequence of any change also needs explaining. The specialist can set out when the proposed policy would start, what remains outstanding and how the existing policy would be dealt with. A pending application and an accepted policy with an agreed start date are different stages.

Where something is unclear, put the question against the relevant document. For example, ask if a restriction appears only on the individual schedule or also in the general terms. This keeps a discussion about replacing cover tied to the contracts involved.

What to keep after getting critical illness insurance advice

Keep the recommendation, the reasons given, the application answers and the documents describing the final cover. They provide a record of what was proposed and what was accepted. Check that any unresolved question has a written answer before treating it as settled.

A clear recommendation should let you explain the intended use of the payment and the main limitations in ordinary language. If the explanation depends on unfamiliar terminology, ask for it to be rephrased against an example. You can also ask which parts of the policy were decisive in the specialist's reasoning.

If a problem later concerns the advice given, the sales records may help establish what happened. Our guide to complaints about mis-sold critical illness cover explains that process. Critical Illness Cover provides information and an enquiry route to a protection specialist, who can assess your circumstances and explain a recommendation.

Questions people ask

Sources

We checked this guide against these sources. It is general information, not advice.

• What is critical illness cover, MoneyHelperSupports the role of specialist advice, household needs and the importance of policy limitations.
• How to choose a financial adviser, MoneyHelperSupports checking the service's scope and obtaining an understandable written explanation.
• Financial adviser fees, MoneyHelperExplains direct fees and commission for insurance advice.
• Guide to Minimum Standards for Critical Illness Cover, ABISupports model definitions and the distinction between additional and partial payments.
• Critical illness cover complaint guidance, Financial Ombudsman ServiceExplains how suitability and replacement policy complaints are assessed.