Glossary of Protection Terms

Model wordings published by the Association of British Insurers that define how core conditions (heart attack, stroke, cancer) should be described. Most UK insurers adopt these wordings, creating a baseline standard. Updated in 2019 and 2022 to reflect advances in diagnostics.

A CI policy that pays out a percentage of the sum assured depending on the severity of the condition. For example, a heart attack might pay 25% if mild, 50% if moderate, and 100% if severe. Multiple claims are often possible. Vitality's SIC Plus pioneered this model in the UK.

A CI policy that pays the full sum assured only if the condition meets a specific definition threshold. If the condition is not severe enough, no payment is made. Most legacy policies and many standard policies still use this model.

A policy structure where a single set of conditions applies to all insured persons (adults and children) with the same definitions. Contrast with "specific clauses" that define different coverage for different ages or life stages.

An early stage of cancer where abnormal cells are present but have not invaded surrounding tissue. Most modern CI policies include CIS as a claimable condition (often paying 25–50% of the sum assured), but many older policies exclude it entirely.

A blood test that measures troponin proteins released during a heart attack. The 2019 ABI update replaced older enzyme-based diagnostic requirements with troponin-specific language. Policies written before 2019 may still require older diagnostic methods, making claims harder to satisfy.

A condition where patients experience neurological symptoms (weakness, seizures, sensory disturbance) without a structural brain lesion. Once dismissed as "hysteria," FND is now recognised and covered by many modern CI policies. A key example of how definitions have expanded since 2020.

A policy feature allowing the insured to claim more than once. Some policies allow a claim for each different condition up to a maximum number; severity-based models often allow claims at different severity levels. Traditional policies typically pay out once and then terminate cover.

A payment structure where the insurer pays a percentage (e.g. 25%, 50%) for conditions that fall short of the full definition. Common for early-stage cancer, CIS, and minor heart attacks. Some policies also offer a fixed-sum "partial payment" (e.g. £50,000) for certain conditions.

Critical illness cover for dependent children, typically attached to a parent's policy. Coverage and definitions vary significantly across providers. Some offer it free as a standard feature; others charge extra. Children's definitions are often broader than adult definitions and have seen substantial improvements since 2015.

CriticalIQ's proprietary rating of a provider's CI policy. Scores factor in condition count, severity model, claims payout rate, children's cover quality, and definition breadth. Higher scores indicate more comprehensive, consumer-friendly policies.

A mid-level policy tier (e.g. Aviva CIC+, L&G Extra) that sits between the standard policy and a premium severity-based model. Enhanced tiers typically cover more conditions than standard but stop short of full severity-based multiple-claim structures.

An insurance policy written under older definitions and standards. Legacy policies often cover far fewer conditions, use outdated diagnostic criteria, and exclude conditions that modern policies routinely include (e.g. CIS, FND, severe endometriosis). Reviewing legacy policies is a key adviser use case.

A policy add-on that waives future premiums if the policyholder becomes unable to work due to illness or injury. Typically kicks in after a deferred period (e.g. 6 months). Often sold alongside CI and life policies to ensure cover continues uninterrupted during incapacity.

The waiting period between when an illness or injury starts and when income protection benefits begin. Common deferred periods are 4, 8, 13, 26, or 52 weeks. Longer deferred periods mean lower premiums but more risk for the policyholder.

The maximum amount the insurer will pay out under a policy. For CI policies, this is the lump sum paid on diagnosis of a covered condition. For IP, it is the annual or monthly benefit amount. Advisers should ensure sums are appropriate for the client's needs and reviewed regularly.

Insurance that pays a lump sum on the death of the insured. Often sold as decreasing (tracking a mortgage), level (fixed sum), or increasing (inflation-linked). Many CI policies include automatic decreasing life cover as part of the package.

Insurance that replaces a portion of the policyholder's income if they cannot work due to illness or injury. Typically pays a monthly benefit of 50–67% of pre-disability earnings. Can be employed, self-employed, or limited company director versions. IP definitions vary by occupation class.

The standard used by an IP provider to assess whether a policyholder can claim. "Own occupation" means unable to do your specific job; "any occupation" means unable to do any job you are qualified for. "Suited occupation" sits between these. Most modern IP policies use "own occupation" definitions.

A benefit often included with life or CI policies that pays out if the policyholder becomes permanently unable to work. Definitions vary: some require inability to perform any occupation, others require specific functional criteria. TPI is sometimes confused with Income Protection but is a separate one-off lump sum benefit.

A clause that excludes cover for any medical condition the policyholder had before the policy started. The definition of "pre-existing" varies: some insurers apply a 2-year lookback, others exclude conditions known at inception. Disclosure is critical — undisclosed conditions can void cover.

A level of cover that is accepted without medical underwriting, typically up to a fixed amount (e.g. £100,000 for CI or £50,000 for IP). Some insurers offer automatic acceptance for children's CI as well. This is common for group schemes and some individual policies.

A premium structure where the cost of cover is fixed for the life of the policy and cannot be increased by the insurer. Guaranteed premiums are increasingly rare in the IP market, with most new policies using reviewable premiums that can change based on claims experience and investment returns.

A premium structure where the insurer can change the cost of cover at regular review dates (typically every 3–5 years). Premiums may go up or down based on the insurer's claims experience and economic conditions. Most modern IP policies use reviewable premiums.

A benefit that pays out the sum assured early if the policyholder is diagnosed with a terminal illness with less than 12 months to live. Usually included automatically with life cover. Some policies pay TIC as a separate benefit; others treat it as an advance of the death benefit.

An optional add-on that increases the sum assured annually in line with inflation (usually capped at a percentage, e.g. 5% or 10%). Premiums also increase. Advisers should consider indexation for long-term policies to ensure the sum keeps pace with rising costs.

A standard policy clause that excludes cover if the policyholder takes their own life within a specified period (typically 12 months) of the policy starting. After that period, suicide is generally covered. This protects insurers from adverse selection.

A 30-day window after policy inception during which the policyholder can cancel the policy and receive a full refund of premiums paid (provided no claim has been made). Required by FCA regulation for all insurance policies sold to consumers. Advisers must inform clients of this right.

The process by which an insurer assesses a policy application to decide whether to offer cover, at what premium, and under what terms. Underwriting considers age, health, lifestyle, occupation, and family medical history. Outcomes range from standard acceptance to declinature.

A type of IP underwriting where pre-existing conditions are excluded only for a fixed period (usually 2 years) rather than permanently. After the moratorium period, the condition may become claimable. Common in group income protection and some individual policies.

The percentage of claims that an insurer pays out, calculated as (claims paid / claims received) × 100. A higher rate indicates a more consumer-friendly claims process. The UK CI market average is approximately 90%. Advisers should consider claims rates alongside policy definitions when recommending.

The UK regulator that oversees financial services, including insurance. The FCA sets conduct standards for advice, product disclosure, claims handling, and complaints. All authorised advisers are FCA-regulated. CriticalIQ is not FCA-regulated — we are a technology provider, not an advice firm.

The trade association for UK insurance companies. The ABI publishes model wordings for critical illness conditions (the ABI Statement of Best Practice) that most UK insurers adopt. While not legally binding, the ABI wordings create an industry baseline that advisers can use to compare policies.