Critical illness cover is insurance that pays you a lump sum if you are diagnosed with an illness your policy names and the diagnosis meets its definition. The amount is the cover you chose; the wording of each definition decides whether a diagnosis counts.

If you would like someone to look at how a particular policy's definitions would apply to you, an FCA-authorised broker can get in touch if you complete the form on this page. It costs nothing and does not oblige you to buy.

How does critical illness cover work?

The Association of British Insurers (ABI) says in its Guide to Minimum Standards for Critical Illness Cover (16 September 2022, updated April 2023): "Critical illness insurance provides for payment to be made to a policyholder if they are diagnosed with one of the conditions that is specified in their policy." If the policy ends without a valid claim, nothing is paid: Legal & General's policy summary (QGI14786, October 2026, direct version) says its policies have no cash value and pay nothing at the end of the term unless a valid claim was made.

What happens to the rest of the cover after a payment depends on the policy. The same summary says that where critical illness cover is a separate policy alongside life insurance, it pays the amount of cover in full once, after which that policy ends and no cover remains. So whether it sits inside a life policy, beside one or on its own changes what a claim leaves behind: see life and critical illness cover and buying it on its own. Income protection and terminal illness cover pay out on different events, set out in two more of our critical illness and income guides: income protection, critical illness and life cover compared and critical illness and terminal illness cover.

How much does critical illness cover pay out?

The lump sum is the amount you pick, within the insurer's limits, so there is no standard payout.

For what has actually been paid, the ABI's press release of 29 June 2026 says "The total value of individual critical illness claims was £1.25 billion in 2025" and "The average payout in 2025 was £67,000". That describes claims paid across the industry; it is not a typical sum and not an amount to insure for (see how much cover you might need). More are on critical illness claims statistics. Price depends on your details (see critical illness insurance cost), and tax is on whether payouts are taxable.

What counts as a critical illness?

Each insurer chooses its list, above a floor the ABI sets for its members. The ABI guide says: "The three core conditions covered by all critical illness insurance policies are cancer, heart attack and stroke, and they must be covered to at least the standard model wordings set out in this Guide." Beyond those, insurers "may incorporate some, all or none" of the guide's further model definitions, so lists differ. Aviva's Life Insurance+ summary (AL50001, February 2026, from Aviva's adviser library) counts "32 critical illness conditions" and "2 additional critical illness conditions" as standard, with 15 more if you pay to upgrade, and says it covers only the critical illnesses defined in its policy. Scottish Widows describes its list as only a guide and tells readers to check the terms and conditions of their policy to see what it covers. Individual conditions are on pages such as stroke, heart attack and cancer, and conditions covered gives the wider picture.

How do the definitions and severity levels work?

Each condition has a medical definition, usually with a threshold. Aviva's summary gives three possible triggers, depending on the definition: diagnosis alone, a condition reaching a set severity, or named treatments or surgeries being carried out.

A definition can also limit what is covered. The ABI model wording for cancer begins: "Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue." It then excludes, among others, "All cancers which are histologically classified as any of the following: - pre-malignant; - cancer in situ; - having borderline malignancy; or - having low malignant potential;".

Wording for the same condition can differ. The ABI heading is "Stroke – resulting in permanent symptoms"; Legal & General's heading refers instead to symptoms lasting at least 24 hours. The headings show only that wordings differ, and a claim is judged against your own policy's full definition. The ABI edition quoted here said its next full review was due in 2025; its critical illness page still offered it in October 2026. See the ABI minimum standards.

If you would like a broker to read the definitions in the policies you are offered, ask through the form on this page.

What is the survival period on critical illness cover?

The four policy documents quoted here pay only if you are alive a set number of days after diagnosis. The ABI guide defines a survival period as "The period after an insured event that the insured person must survive to qualify for a benefit to be paid", and each insurer sets its own:

Insurer and documentRule
Legal & General, terms (QGI14872, October 2026, direct)"survives for 14 days from diagnosis, even if the policy has ended during this time."
Aviva, Life Insurance+ summary (February 2026)You must survive at least 10 days.
Scottish Widows, Protect summary (January 2026)"you survive 10 days after the diagnosis"
Scottish Widows, Plan & Protect Body Cover summary (October 2025)"If you die within seven days of an illness first being diagnosed, we won’t pay any claim."

Scottish Widows' summaries sit on its adviser site, linked from its consumer page; check your own policy's wording. Separately, the ABI says the assessment period for a condition that must be permanent "will not normally be longer than 12 months, as long as all the evidence is available."

What smaller payments and children's cover can come with a policy?

The ABI guide separates two terms: an additional payment "does not reduce the amount of benefit remaining", while a partial payment "does reduce the amount of benefit remaining." Aviva's Life Insurance+, Legal & General's policy and Scottish Widows Protect each describe smaller payments of the first kind for named conditions (in Aviva's and Legal & General's lists, less advanced breast and prostate cancers), with the main cover kept, and each includes cover for children on its own terms. The amounts, ages and conditions are compared in the provider-by-provider comparison, and child critical illness cover explains the children's benefit.

What does critical illness cover not pay out for?

Legal & General's summary says it will not pay out if you are diagnosed with a condition, or have a medical procedure, that does not meet its definition. Its terms say a claim "may be refused or impacted" if you did not answer its application questions correctly, and that a policy which lapsed because payments were missed before a claimable event pays nothing. See disclosure requirements and when critical illness cover does not pay out.

Exclusions are the insurer's choice: the ABI guide "does not require insurers to include or omit any particular exclusion or exclusions from the critical illness cover they offer", but an insurer using one with a model wording must use it. The model exclusions include alcohol or drug abuse, hazardous sports and pastimes, and living abroad; your policy wording says which apply. For a health condition you already have, Legal & General's summary says "We may restrict some elements of your cover based on the information that you give us at application stage." More: pre-existing conditions.

Does smoking change critical illness cover?

Smoking is named as a factor in the price. Aviva lists "smoking habits", Scottish Widows' Plan & Protect Body Cover summary lists "if you smoke", and its Protect summary lists whether you smoke, have smoked or have ever used nicotine replacements. Smoking usually raises the cost of cover; a quote shows by how much for you. See life insurance for smokers.

When you are ready to see how real policies treat your details, an FCA-authorised broker can talk you through each one; the form here puts you in touch at no cost to you.

Frequently asked questions

How do I know if I have critical illness cover?

Check your policy documents. Legal & General's summary says "After you take out a policy, we'll send you a Policy Schedule which will show you the details of your cover."

What critical illness cover does Scottish Widows offer?

Its page describes two products. Plan & Protect covers one person per policy, can be started up to age 59 for critical illness cover and has a "Total of £500,000" maximum; Scottish Widows Protect can be joint, covers children and can be started up to 64, with a £3 million critical illness maximum. The table above sets its survival periods beside Aviva's and Legal & General's.

Can a couple have critical illness cover?

Legal & General's summary says that on a joint policy it pays the amount of cover only once, which may be when the first person dies or has a valid claim. Scottish Widows says its Protect joint policy "will then end for both of you". See joint life insurance with critical illness.

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