'This often understated CI benefit could be life changing'

There has also been a great focus on how health and wellbeing services can help ease some of the pressures from the NHS.

But what else do today’s critical illness products include that might help the eligible adults and/or children covered by the plan when they need surgery provided by the NHS?

Health and wellbeing services range from single transactional services such as GP 24/7, health MOT, second medical opinions, to lifetime services such as mental health counselling and long-term support.

However, an often understated benefit in many policies is essentially an ‘accelerated claims’ feature, which typically takes the form of a defined list of conditions that are paid out as soon as any eligible person covered by the plan is placed on an NHS waiting list for surgery.

This can have a dramatic impact for the individual, particularly when delay of a surgery could result in the condition becoming more serious.

It provides the claimant with choices that might otherwise not be economically viable.

Instead of waiting for the surgery to take place on the NHS before a claim can be made or paid, the plan's proceeds can be released immediately once it is confirmed that the person is on an NHS waiting list. 

This immediate payment can be used in various ways:

• paying for the needed surgery privately to expedite treatment;
• making necessary changes or adaptations to their home;
• replacing lost income while waiting for surgery;
• repaying some of their mortgage; or
• reducing worry and uncertainty during times of extreme stress.

CI Expert's Critical Thinking 2024 research highlighted that 22 per cent of consumers would use the claim proceeds for private treatment, which clearly if faced with a protracted waiting list delay could be a life changing event.

The research also revealed a significant lack of understanding and awareness of CI cover among consumers.

How many readers and their clients are aware of NHS waiting list payments and their benefits? 

Insurer specific coverage

Not all insurers offer cover for the same conditions or pay claims in the same way, however.

Typically, covered conditions include various heart surgeries and major organ transplants.

Here's a brief summary of what's on offer by some:

• Full payment conditions: insurers like Aviva, HSBC Life, LV, L&G, and Scottish Widows offer full payment for certain conditions.
• Additional payments: insurers like Royal London and Zurich offer additional payments for conditions like bowel disease.
• Other approaches: Guardian offers surgery cover, paying the lower of £50,000 or 25 per cent of the cover for eight conditions. This reduces the cover by the amount paid but allows the plan to continue. Vitality offers payments based on the type of plan and the severity of the diagnosed condition.

Arguably the value of these benefits is becoming increasingly important and understanding the different offerings by insurers is an important factor for advisers to consider in making decisions regarding CI cover and its benefits for their clients.

This is also an area where there is room for more innovation; it's often the less serious conditions that are additional payments conditions that can have the longest waiting lists, and also include conditions where a delay can result in a more serious illness arising.

Paul Roberts is propositions and distribution director at CI Expert