Group critical illness insurance

The lump sum benefit payable can be a fixed amount or a multiple of salary. The maximum benefit available for a member is £500,000. For workers on zero hours contracts, the maximum fixed amount we’ll normally offer is £50,000. You can vary the basis (including the multiple of salary or value of the fixed amounts) from one category to another, but not within a category.

If it’s a flexible benefit scheme, members choose from a range of fixed amounts or salary multiples on offer.

The insured illnesses are listed below. The member, child and, if covered, a spouse/partner of a member are covered for these illnesses. However children are covered under the child specific illness of permanent dependence rather than the illness loss of independence.

You can add total permanent disability (TPD) at an additional cost. For information on TPD and for the full definitions of the insured illnesses, visit our technical guide. Our cover matches or exceeds the cover provided by the ABI’s model definitions.

The following illnesses are grouped, focusing on their impact rather than a named condition:

• Blindness or removal of an eyeball – permanent and irreversible
• Brain injury – resulting in permanent symptoms
• Degenerative neurological disorder – of specified severity
• Loss of use of a limb
• Lung disease or removal – as specified
• Reduced heart function – of specified severity
• Surgery to the heart, aorta or pulmonary artery – as specified
• Surgery via the skull – as specified.

These conditions are also covered:

• Angioplasty – requiring treatment to multiple coronary vessels
• Bacterial meningitis – resulting in permanent symptoms
• Balloon valvuloplasty
• Benign brain tumour – resulting in permanent symptoms or specified treatment
• Benign spinal cord tumour – resulting in permanent symptoms or specified treatment
• Cancer – excluding less advanced cases and including aplastic anaemia
• Cancer – second & subsequent
• Coma – of specified severity
• Deafness – permanent and irreversible
• Encephalitis – resulting in permanent symptoms
• Heart attack – of specified severity
• Kidney failure – requiring permanent dialysis
• Liver failure – end stage
• Loss of independence – of specified severity (for adults only)
• Major organ transplant – from another donor
• Multiple sclerosis or Neuromyelitis optica (Devic’s disease) – where there have been symptoms
• (Chronic) Rheumatoid arthritis – of specified severity
• Stroke – of specified severity
• Systemic Lupus Erythematosus (SLE) – of specified severity
• Terminal illness – where death is expected within twelve months
• Third degree burns – covering 20% of the body’s surface area or 20% of the face’s surface area.

The following conditions are specific to any children covered:

• Cerebral palsy
• Cystic fibrosis
• Down’s syndrome
• Edwards’ syndrome
• Hydrocephalus – treated with the insertion of a shunt
• Muscular dystrophy
• Osteogenesis imperfecta
• Patau syndrome
• Permanent dependence – of specified severity
• Spina bifida.

For full information about the quote and apply process, please visit our 'Working with us' page. There, you’ll find a step-by-step guide, tailored to the size of the scheme you’re applying for.

In many circumstances, cover continues while a member is absent from work, including ill-health, maternity, paternity and adoption leave. If they’re absent from work for any other reason, cover will end after three years. There’s slightly different rules for fixed term and zero hours contractors – the full details are in our technical guide.

It’s normally possible to provide cover for all eligible employees up to a certain limit without the need to individually assess them. This limit is known as the automatic acceptance limit. Individuals are automatically covered up to the policy’s automatic acceptance limit, subject to exclusions on pre-existing insured illnesses and related medical conditions. These exclusions will always apply to a member’s benefit unless we’ve individually assessed them and advised of the removal of the exclusions in writing.

Full details are included in the technical guide.

The automatic acceptance limit is reviewed at the end of every rate guarantee period (usually two years) and is dependent on the number of members insured.

Cover can be provided for spouses or partners at an additional cost, with limits set at the member’s benefit up to a maximum of £250,000. Cover for spouse/partner will always be subject to exclusions on pre-existing insured illnesses and related medical conditions, unless we’ve individually assessed them and advised of the removal of the exclusions in writing.

All children are automatically covered up to their 18th birthday (23rd birthday if in full-time education), including stepchildren or legally adopted children. The benefit for each child will be 25% of the member’s benefit up to a maximum of £25,000. Children’s cover will be subject to further child-specific exclusions and exclusions on pre-existing insured illnesses and related medical conditions.

Full details are included in the technical guide.

For tax purposes, premiums paid by the employer in respect of employees are treated as a business expense. For employees, they’re treated as a P11D benefit. Any employee with a proprietorial interest in the company aren’t generally eligible for tax relief on premiums paid. HMRC may agree to allow such relief if similar benefits are provided for a substantial number of other employees. Clarification of the tax position in such cases should be sought from your tax advisers.

Equity partners pay for their own premiums and there’s no tax relief on these premiums. The benefit paid to the member (including equity partners) isn’t normally subject to income tax. We’ll always pay them gross of any tax that may be due.

This is our understanding of current legislation - we recommend that your clients take professional legal and tax advice.