Critical illness—muppet level question

Docsaibal

Among numerous other policies I have a critical illness one taken out around 2000 with Scottish Provident which is now under Phoenix Life. I have recently had an angiography which shows much more severe heart disease than anticipated from other tests over a year and and as my symptoms are worsening we anticipate an angioplasty as the next step since nothing else has helped so far. 

The policy document from back then does state they will pay out £25000 for angioplasty. Meanwhile the premiums have been increasing yearly with inflationary rises in sum assured for payout for ‘full’ claims equating to at present in the region of £43k. 

My questions are: is my policy governed by the contract I took out at the time rather than the fact that angioplasty is no longer covered according to the complaint’s website (as of Nov 2003)? And secondly, s it likely the payout for angioplasty will also likely be subject to an inflation link?

dunstonh

Docsaibal said:

Among numerous other policies I have a critical illness one taken out around 2000 with Scottish Provident which is now under Phoenix Life. I have recently had an angiography which shows much more severe heart disease than anticipated from other tests over a year and and as my symptoms are worsening we anticipate an angioplasty as the next step since nothing else has helped so far. 

The policy document from back then does state they will pay out £25000 for angioplasty. Meanwhile the premiums have been increasing yearly with inflationary rises in sum assured for payout for ‘full’ claims equating to at present in the region of £43k. 

My questions are: is my policy governed by the contract I took out at the time rather than the fact that angioplasty is no longer covered according to the complaint’s website (as of Nov 2003)? And secondly, s it likely the payout for angioplasty will also likely be subject to an inflation link?

Plan terms are set at the outset and not affected by revised plan versions sold in later years.

If my memory is right, Scot Prov had a yearly renewable plan where the premium was set annually rather than being guaranteed and set level at the outset.  If you have that version then the sum insureds remain the same.  If you included inflation indexation, then the sum assured would increase.

DullGreyGuy

Docsaibal said:

Among numerous other policies I have a critical illness one taken out around 2000 with Scottish Provident which is now under Phoenix Life. I have recently had an angiography which shows much more severe heart disease than anticipated from other tests over a year and and as my symptoms are worsening we anticipate an angioplasty as the next step since nothing else has helped so far. 

The policy document from back then does state they will pay out £25000 for angioplasty. Meanwhile the premiums have been increasing yearly with inflationary rises in sum assured for payout for ‘full’ claims equating to at present in the region of £43k. 

My questions are: is my policy governed by the contract I took out at the time rather than the fact that angioplasty is no longer covered according to the complaint’s website (as of Nov 2003)? And secondly, s it likely the payout for angioplasty will also likely be subject to an inflation link?

Yes, policy is locked in at point of purchase as a form of long term insurance. Often it works against you as medical advances mean that old tests or procedures no longer remain relevant but occasionally it can be beneficial. 

Does Angioplasty say it isnt a full claim? Its predominately an all or nothing type thing with CI

Docsaibal

Yes it says so on the original policy document, that angioplasty pays/paid out £25k, as opposed to what is now about 47k. There was quite a steep increase in premiums in 2023 compared to the trickle increase I’ve faced over the years and my IFA said to agree to it if I could afford it as starting from scratch with fresh underwriting for a new policy would guarantee a more expensive policy. It doesn’t actually say from what I recall that the policy would then lapse, but did make me think that being a ‘softer’ claim (reflecting even then the fact that such procedures were becoming commonplace in the treatment of cardiovascular illness, the commonest form of claim for morbidity and mortality for several decades) could allow the policy to continue and stand me in good stead were I to develop a more severe form of critical illness rather than leaving me potentially without any prot3ftion other than through two income protection policies I hzv3 that predate even this one. 

Weighty1

When I first started in the industry 18-years ago it was unusual for conditions to result in partial payouts.  It was typically an all or nothing situation, however, this is now quite common for some conditions which are deemed as 'less serious'.  Taking into account today's outlook, most companies will state that for these less serious conditions the payout would be "X% of your amount of cover up to a maximum of £25,000".

Historically, partial  payout conditions would also then be deducted from the full sum assured so that future claims would be the full cover amount minus what has already been paid, although not always (BUPA wouldn't discount the amount paid out from a full future claim)

That said, it is all going to be dependent on the exact wording in the policy document.  Based on you saying the policy document states the plan will pay out £25,000 for angioplasty, then that is what I would expect.

TDLR notes:  call the insurer and ask.  That's the only way to guarantee what will occur.