The ABI minimum standards for critical illness cover are model wordings, published by the Association of British Insurers (ABI), that set the least generous definition a policy may use for cancer, heart attack and stroke, and for any other condition it covers that has a model wording. The guide in force was released on 16 September 2022 and clarified in April 2023.

If you are comparing policies and want to know how each one's definitions stack up against the ABI guide, a broker authorised by the FCA can go through them with you. Fill in the short enquiry form on this page and they will ring you back; there is no charge.

What is the ABI Guide to Minimum Standards, and who does it bind?

The ABI is the trade body for UK insurers. Its Guide to Minimum Standards for Critical Illness Cover sets model definitions that insurers use when they write their own policy wording. Complying with the guide, by offering cover "no less generous than the minimum standards set out in it", is a condition of ABI membership for firms that sell critical illness insurance (page 6 of 36).

Some insurers are not members and "cannot therefore be required to adopt these minimum definitions", though "most do". The guide adds that regulators and the Financial Ombudsman Service are likely to have regard to the guide as good industry practice. It covers the critical illness element of individual long-term policies, including where it is added to term or whole of life cover, and also group critical illness cover. Where the law and the guide conflict, the guide says the legal or regulatory requirement wins (page 5 of 36). For the basics of how a policy pays out, start with how critical illness cover works, one of our critical illness and income guides.

Which conditions does every critical illness policy have to cover?

Three: cancer, heart attack and stroke, each to at least the guide's model wording. Each has a fixed heading that forms part of the wording and must appear in full:

Those pages set out each definition. The guide puts the three at over 80% of critical illness claims in 2016 (page 8 of 36); more recent claims figures are on the page about critical illness claims statistics. Its chapter on generic terms then defines critical illness cover itself as insurance that pays out "when an insured person meets the policy definition of a specified critical illness" with all three included "before the application of any individual underwriting decision" (page 20 of 36). If you want to know how underwriting could shape the terms offered to you personally, ask the broker when they phone; that conversation costs nothing.

What does the guide say about other conditions and exclusions?

Beyond the three, the guide offers optional model wordings for: aorta graft surgery, benign brain tumour, blindness, coma, coronary artery bypass grafts, deafness, dementia including Alzheimer's disease, heart valve replacement or repair, kidney failure, loss of speech, loss of hand or foot, major organ transplant, motor neurone disease, multiple sclerosis, paralysis of limb, Parkinson's disease, third degree burns, total permanent disability and traumatic brain injury. Insurers can include some, all or none of them (page 11 of 36), so cover beyond the core three is a matter of comparing policies; see which illnesses a typical critical illness list includes. Dementia, motor neurone disease, Parkinson's disease and the total permanent disability options carry an optional age limit in the model wording, shown as "[before age x]", and dementia and Parkinson's disease have their own pages.

Which of these extras a policy carries, and on what wording, is exactly what an FCA-authorised broker can set side by side for you. Fill in the enquiry box here and they will phone you, at no cost.

The guide also gives model wordings for common exclusions: alcohol or drug abuse, child cover for pre-existing medical conditions, criminal acts, flying, hazardous sports and pastimes, living abroad, self-inflicted injury, unreasonable failure to follow medical advice, and war and civil commotion. Insurers do not have to apply them, but if one is used the model wording applies, and an insurer must not amend a condition's model wording "to exclude or qualify the cover" (page 18 of 36). Wider refusals are covered in why critical illness claims are declined.

How do insurers use the model wordings in their policies?

Where a policy includes a condition or exclusion that has a model wording, the insurer "must use that model wording and cannot amend that wording to provide cover which is less generous" (page 7 of 36). An insurer may add cover on top, or drop a limitation from the model wording while leaving the remaining words unchanged, and it may use or omit the optional age limits. Where it goes further, "the difference must be made clear" (page 5 of 36). A claim that a definition exceeds the model has to be backed by something real: it "must provide additional cover and result in additional claims being paid by the policy as a whole" (page 7 of 36).

The guide also says insurers "should state in their product information" that their cover complies with it (page 7 of 36). Beagle Street's terms (April 2025) say: "Our Critical Illness cover complies with the ABI Guide to Minimum Standards for Critical Illness Cover" (page 5 of 20). Vitality's plan provisions (February 2025), which are addressed to the plan owner but published in its adviser literature library, say the plan "follows the ABI Guide to Minimum Standards for Critical Illness Cover (2018)" (page 100 of 159). So a policy document may name the guide, and may name a particular edition.

In a 2023 article on the guide, the ABI described cover going "above and beyond" the minimum as an important part of competition between insurers. That is why the same condition can read differently from one insurer to the next, as the pages on Legal & General's critical illness policy and Royal London's critical illness policy show.

Which edition of the ABI guide is current?

The ABI's critical illness page says the guide "was released on 16 September 2022, following the last review in 2018". Insurers had to adopt it by 16 September 2023, and its provisions "apply to new policies effected on or after the implementation date adopted by the insurer" (page 6 of 36). Its history section says the 2021/22 review behind it changed the cancer, heart attack and dementia definitions (page 35 of 36); the condition pages linked above cover those wordings.

The title page carries a footnote: "Updated April 2023 to clarify the Myocardial Injury exclusion and the classification systems used for Gastrointestinal Stromal Tumours." The ABI said the two clarifications "do not affect the minimum scope of cover that the Standards prescribe", and that members should implement them before 31 January 2024.

The guide says full reviews normally take place every 3 years and that "The next full review is to take place in 2025" (page 32 of 36). Checked in October 2026, the ABI's critical illness page still offers the April 2023 version as the guide to download. A later edition would replace it for policies sold after insurers adopt it, so that page is the place to confirm which version a new policy should be measured against.

Frequently asked questions

What defines a critical illness for insurance purposes?

There is no single legal list. Each policy names the conditions it covers and defines them, and a claim is paid when the insured person meets that definition. The ABI guide sets the floor for cancer, heart attack and stroke and for any other condition that has a model wording.

Is the ABI guide a law?

No. It is an industry standard that members of the ABI must follow, and the guide says it supplements legal and regulatory requirements rather than replacing them.

Does the ABI guide apply to a policy I already hold?

The 2022 guide applies to new policies taken out on or after the date an insurer adopted it, and that date was no later than 16 September 2023. Your own policy documents set out which definitions apply to you.

Should you want your shortlisted policies measured against the ABI standards, the short form beside this guide leads to a call-back from a broker, which is free.

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