CII R05 Critical Illness Cover

Question 1

Under a typical critical illness policy, when is the sum assured paid?

Accepted Answer

On diagnosis of a specified critical illness that meets the policy definition and after any survival period

Answer

Critical illness cover pays the sum assured on diagnosis of a specified illness that meets the exact policy definition, subject to any survival period (typically 14-28 days). The claimant must survive this period for the claim to be valid. Not all medical conditions are covered — only those specifically listed in the policy.

Question 2

The Association of British Insurers (ABI) model definitions for critical illness cover include a core set of conditions. Which of the following is included in the ABI core conditions?

Accepted Answer

Cancer (excluding less advanced cases)

Answer

The ABI Statement of Best Practice includes cancer as one of the core critical illness definitions, though it typically excludes less advanced cancers such as early-stage non-invasive cancers, certain skin cancers, and carcinoma in situ. The ABI core conditions also include heart attack, stroke, and other serious conditions.

Question 3

What is the purpose of the survival period in a critical illness policy?

Accepted Answer

To ensure the claimant survives for a minimum period after diagnosis before the benefit is paid

Answer

The survival period (typically 14 or 28 days) requires the claimant to survive for a specified number of days after diagnosis of a critical illness. If the life assured dies within the survival period, the critical illness benefit is not paid, though a separate death benefit may apply if the policy includes life cover.

Question 4

An accelerated critical illness policy differs from a standalone critical illness policy because:

Accepted Answer

A successful critical illness claim reduces or extinguishes the death benefit

Answer

Under an accelerated critical illness policy, the critical illness benefit is an advance payment of the death benefit. If a critical illness claim is paid, the death benefit is reduced by the same amount (or extinguished entirely if the full sum assured is claimed). A standalone policy pays the critical illness benefit separately from any death cover.

Question 5

Which of the following would typically NOT be covered under a standard critical illness policy?

Accepted Answer

A stress-related condition such as anxiety

Answer

Standard critical illness policies cover defined serious conditions such as heart attack, stroke, cancer, and major organ transplant. Mental health conditions such as stress, anxiety, and depression are not included in critical illness definitions as they do not meet the criteria of life-threatening or permanently debilitating physical conditions.

CII R05 Practice Test

CII R05 Practice Test

CII R05 Critical Illness Cover