CI cover changes as medicine advances

29 March 2010

In 2006 the Association of British Insurers published model wordings for medical conditions and surgical procedures covered by critical illness insurance.

This was to ensure an appropriate standard so when advisers sell CI cover it is clear what the baseline cover will be. But that’s exactly what the model wordings are - a baseline.

Some CI insurers have begun to exceed this wording for certain conditions by introducing ABI+ definitions, allowing them to add value by going beyond the requirements of the industry body.

For example, for heart valve replacement or repair the model wording requires open heart surgery - division of the breast bone. But a few insurers have taken medical advances into account and are offering an ABI+ definition so clients can also claim if they’re treated by keyhole surgery.

When selecting a product the number of ABI+ definitions offered and what they are is important, as they increase the likelihood that individuals will be able to claim.

The ABI has pledged to review its statement of best practice which sets out the model wordings every three or four years.

It will be interesting to see whether ABI+ definitions become the next generation of model wordings.

Alternatively, we could see a swing in the other direction. The review will take into account changes in medical science and if better treatments are developed wordings could be amended so that conditions have to be more severe before claims are payable.

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