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18 August 2025

Critical illness cover – definitions designed to pay

Critical illness cover – definitions designed to pay

The importance of critical illness cover

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Recovery from critical illness can disrupt careers, family life and long-term financial plans, as it often comes with big unanticipated costs. These costs range from expensive care or rehabilitation not covered by the NHS, changes to the home to improve mobility, emotional and mental health challenges, as well as extended time off work.

Critical illness cover helps make sure that if this sort of diagnosis happens, clients can make the changes they need and focus solely on recovery, without worrying about money. That’s why it’s so important to choose critical illness cover that gives the most certainty at point of claim.

What’s the difference?

With our critical illness cover, our definitions are designed to pay out, giving your clients peace of mind.

At Guardian, we focus on providing the best possible cover for the most common illnesses. We aim to make our definitions clearer and more all-encompassing than the rest of the market. In many cases, the confirmation of a UK Consultant is all we need to pay out.

In 2024, we paid 92% of critical illness claims. 82% were for the big 4, cancer, heart attack, stroke and multiple sclerosis1. Here are some examples of how our definitions improved outcomes for our policyholders.

Definition Other providers Guardian
Low-grade prostate cancer Some require treatment or surgery if someone is diagnosed with a Gleason score of between 2 and 6 to pay a claim2. We’ll pay out on diagnosis with a Gleason score of between 2 and 6 and placed under surveillance, without needing surgery or named treatment.

In 2024, we paid one low-grade prostate cancer claim, the policyholder had no treatment and was placed under surveillance1.
Angioplasty Require 2 or more stents to be inserted into different arteries, or the left main stem artery to be treated2. We don’t specify which artery needs to be treated or the number of stents needed.

In 2024, we paid 3 angioplasty claims. 2 had 2 stents inserted into the same artery. One had only one stent inserted1.
Low-risk non-melanoma skin cancer The tumour has to be at least 2cm in order to claim2. If the tumour is less than or equal to 2cm across, we’ll pay 10% of the cover amount (up to £50,000).

If it’s larger than 2cm, we’ll pay 50% of the cover amount (up to £50,000).

In 2024, we paid 3 non-melanoma skin cancer claims, all were for basal cell carcinoma under 2cm1.
Coma Some providers exclude medically induced comas or require a minimum duration (e.g. 72 or 96 hours)2. We’ll pay out on unconsciousness which requires the use of life support system – we don’t exclude medically induced comas or specify a minimum duration.

In 2024, we paid a £100,000 children’s critical illness claim for a medically induced coma1.

As well as our crystal clear definitions, here are lots of other great reasons to recommend our critical illness cover:

Generous Additional Payouts

We pay up to 50% of the cover amount (up to a maximum of £50,000), which is higher than most providers. 3

Cover Upgrade Promise

When we improve our critical illness definitions, every customer can benefit. Not just the new ones.

Optional Children’s Critical Illness Cover

An optional extra that can be added to any adult cover, and parents can choose any amount of cover between £10,000 and £100,000, limited to their own cover amount.

Dual Life Approach

Protection for couples that gives each partner their own cover, so if one is diagnosed with a critical illness and claims, the other is still protected.

When it comes to critical illness cover, clarity and certainty aren’t just nice-to-haves but essential. Clients often don’t understand what’s covered because definitions are complex or unclear. If they don’t understand it, they won’t value it.

That’s why it’s crucial to recommend cover with definitions that are simple to explain and built to pay out. It also gives you confidence in your advice and reassures your clients that they’re protected when they need it most.

Find out more about our critical illness cover here.

Or register for one of our regular webinars here.

Sources:

  1. All claims with a decision made from 1 January 2024 – 31 December 2024.
  2. Defaqto, Definitions of low-grade prostate cancer, angioplasty, non-melanoma skin cancer and coma, 28 July 2025.
  3. Defaqto, Critical illness full grid, 30 July 2025.