Specified Illness Cover Ireland

Financial protection following a serious medical diagnosis

A serious illness can affect your income, household finances and ability to meet everyday financial commitments.

Specified illness cover can provide a once off lump sum if you are diagnosed with an illness listed in your policy and meet the insurer’s medical definition.

The payment can be used to reduce financial pressure while you receive treatment, recover or adjust to a change in your health.

At Dooley Insurance Group, we provide advice on specified illness cover, also known as serious illness or critical illness cover, for individuals, families, self employed professionals, company directors and business owners across Ireland.

We compare the options available through our agency appointments and explain the illnesses covered, medical definitions, exclusions, costs and policy conditions before you make a decision.

Arrange a Specified Illness Cover Review

What is specified illness cover?

Specified illness cover is an insurance policy that pays an agreed lump sum following the diagnosis of an illness specifically listed in the policy.

The diagnosis must meet the insurer’s medical definition and satisfy all other policy conditions.

The policy does not cover every illness or every diagnosis.

Even where an illness has the same name as one listed in the policy, a claim will only be payable where the diagnosis meets the required severity, medical evidence and policy definition.

This is why it is important to understand what is covered before arranging a policy.

Is specified illness cover the same as critical illness cover?

The terms specified illness cover, serious illness cover and critical illness cover are often used to describe the same type of insurance.

Insurers may use different product names, illness definitions and claim requirements.

The important details are:

• Which illnesses are covered
• The medical definition of each illness
• Whether severity requirements apply
• Whether partial payments are available
• What exclusions apply
• How long the policy lasts
• Whether cover reduces after a claim
• Whether the policy includes children’s cover
• Whether the cover is standalone or linked to life insurance

We compare the actual policy features rather than relying only on the product name.

What illnesses are covered?

The illnesses covered depend on the insurer and policy selected.

Specified illness policies commonly provide cover for conditions such as:

• Certain cancers
• Heart attack
• Stroke
• Coronary artery bypass surgery
• Multiple sclerosis
• Kidney failure
• Major organ transplant
• Parkinson’s disease
• Alzheimer’s disease
• Loss of limbs
• Blindness
• Deafness
• Paralysis
• Other defined medical conditions

This list is only an example.

Each condition will have a specific medical definition. A diagnosis does not automatically result in a claim.

You should review the full policy conditions and illness definitions before arranging cover.

How does specified illness cover work?

When you arrange specified illness cover, you select:

• The amount of cover
• The policy term
• Single, joint or dual life cover
• Standalone or accelerated cover
• Additional policy benefits
• Whether indexation applies
• Whether children’s cover is included

If you are diagnosed with a listed illness during the policy term, you notify the insurer and submit a claim.

The insurer will assess the diagnosis, medical evidence and policy definition.

If the claim is accepted, the agreed benefit is paid according to the policy terms.

How much specified illness cover do I need?

The appropriate level of specified illness cover depends on the financial effect a serious diagnosis could have on you and your family.

Your review should consider:

• Income
• Employer sick pay
• Self employed earnings
• Mortgage repayments
• Personal debts
• Household expenditure
• Medical and travel expenses
• Home alterations
• Childcare
• Recovery time
• Existing savings
• Income protection
• Health insurance
• Existing serious illness cover

The lump sum should be based on a realistic financial need rather than an arbitrary figure.

Some people want enough cover to repay or reduce their mortgage. Others want a fund that could support household expenditure during treatment and recovery.

What can the payment be used for?

A specified illness payment is generally not restricted to one particular expense.

The money may be used to:

• Repay or reduce a mortgage
• Pay household bills
• Replace lost income
• Clear personal debt
• Fund private treatment
• Pay travel and accommodation costs
• Make changes to the home
• Cover childcare
• Support a spouse or partner taking time away from work
• Pay for rehabilitation
• Build an emergency financial reserve

The payment provides financial flexibility at a time when your health and ability to work may be uncertain.

Standalone specified illness cover

Standalone specified illness cover is arranged separately from life insurance.

If a valid specified illness claim is paid, it does not normally reduce a separate life insurance policy.

Standalone cover may provide clearer separation between:

• Protection following a serious illness
• Protection following death

The cost, available term and policy features will depend on the insurer and cover selected.

Accelerated specified illness cover

Accelerated specified illness cover is linked to a life insurance policy.

If a valid specified illness claim is paid, the amount of life insurance remaining may be reduced by the amount paid.

For example, if a policy contains €300,000 of life insurance and €100,000 of accelerated specified illness cover, a full specified illness payment could reduce the remaining life cover.

The exact effect depends on the policy structure and conditions.

Accelerated cover may cost less than arranging completely separate policies, but the potential reduction in life insurance should be understood.

Partial specified illness payments

Some policies provide partial payments for certain illnesses or medical procedures that do not meet the definition for a full claim.

A partial payment is normally a percentage of the insured amount or a fixed maximum sum.

The conditions, payment amount and effect on the remaining cover vary between insurers.

A policy covering a larger number of partial payment conditions is not automatically better. The medical definitions and likelihood of those benefits being relevant should also be considered.

Children’s specified illness cover

Some adult specified illness policies include a level of cover for dependent children.

Children’s cover may provide a payment if a child is diagnosed with an illness listed in the policy and meets the insurer’s definition.

The payment could help parents manage:

• Time away from work
• Travel for treatment
• Accommodation
• Childcare for other children
• Additional household expenses
• Specialist care or rehabilitation

The amount, age limits, illnesses covered and claim conditions vary between insurers.

Children’s cover should be reviewed as part of the policy comparison rather than assumed to be identical across providers.

Specified illness cover and cancer

Cancer is one of the main reasons people consider specified illness insurance.

However, not every cancer diagnosis will result in a full claim.

Policies contain medical definitions relating to the type, severity, stage and characteristics of the cancer.

Some less advanced cancers may qualify for a partial payment, while others may not meet the policy definition.

Before arranging cover, you should understand:

• The full cancer definition
• Excluded or less advanced cancers
• Partial payment conditions
• Medical evidence required
• Survival periods where applicable
• The effect of a claim on remaining cover

No policy can guarantee payment for every cancer diagnosis.

Specified illness cover and heart conditions

A policy may provide cover for certain heart conditions or procedures, including a heart attack or coronary artery bypass surgery.

The diagnosis or procedure must meet the relevant policy definition.

Symptoms such as chest pain or a less severe cardiac event may not automatically qualify.

The insurer will assess medical reports, test results and other evidence before deciding whether the claim meets the policy requirements.

Specified illness cover and stroke

Stroke may be included in specified illness policies, but the policy will contain a detailed medical definition.

The definition may require evidence of permanent neurological symptoms or other specified medical findings.

A temporary ischaemic attack, sometimes known as a mini stroke, may not meet the definition for a full stroke claim.

The exact definition should be reviewed when comparing policies.

Specified illness cover for self employed people

A serious diagnosis can have an immediate financial effect on someone who is self employed.

There may be no employer sick pay, and business income could reduce if the person cannot continue working.

Specified illness cover can provide a lump sum, but it is not a direct replacement for ongoing income.

Self employed people should consider specified illness cover alongside:

• Income protection
• Life insurance
• Business overhead protection
• Emergency savings
• Pension planning
• Key person insurance
• Business loan protection

The correct protection plan should address both immediate capital requirements and the potential loss of ongoing earnings.

Specified illness cover for company directors

Company directors may require both personal and business protection.

A personal specified illness policy can provide a lump sum directly to the insured person following a valid claim.

A company may also need separate protection against the financial effect of a director or key employee becoming seriously ill.

A director protection review may consider:

• Personal specified illness cover
• Executive income protection
• Key person insurance
• Shareholder protection
• Business loans
• Personal guarantees
• Pension contributions
• Family life insurance

The ownership and purpose of each policy should be clear before cover is arranged.

Specified illness cover and income protection

Specified illness cover and income protection serve different financial needs.

Specified illness cover pays a lump sum following diagnosis of an illness listed in the policy and satisfaction of its medical definition.

Income protection pays a regular replacement income if you are unable to work because of an eligible illness, injury or disability.

You may be unable to work without having an illness covered by a specified illness policy. You may also receive a specified illness payment but return to work relatively quickly.

Depending on your financial circumstances, both forms of protection may be appropriate.

Specified illness cover and health insurance

Health insurance and specified illness cover are not the same.

Health insurance helps cover eligible medical and hospital expenses according to the selected plan.

Specified illness cover provides a cash payment following a qualifying diagnosis.

A health insurance plan may help pay treatment costs, while a specified illness payment can be used for mortgage repayments, household bills, lost income or other financial needs.

Holding health insurance does not remove the potential need for financial protection.

Specified illness cover and life insurance

Life insurance pays following the death of an insured person during the policy term, subject to the policy conditions.

Specified illness cover may pay while the insured person is alive and dealing with a serious medical diagnosis.

The two types of cover address different risks:

• Life insurance protects dependants following death
• Specified illness cover provides financial support following a qualifying diagnosis

The amount required for each type of cover may be different.

What affects the cost of specified illness cover?

The premium can be influenced by:

• Age
• Health
• Medical history
• Family medical history
• Smoking or nicotine use
• Occupation
• Amount of cover
• Policy term
• Single, joint or dual cover
• Standalone or accelerated cover
• Additional benefits
• Insurer underwriting

The insurer may request further medical information or a report from your doctor.

All application questions should be answered fully and accurately.

Specified illness cover with an existing medical condition

Having an existing medical condition does not automatically prevent you from obtaining cover.

The insurer will assess:

• The condition
• Date of diagnosis
• Treatment
• Medication
• Current symptoms
• Medical test results
• Family history
• Recovery
• Ongoing monitoring

The insurer may offer standard terms, increase the premium, apply an exclusion where permitted, postpone the application or decline cover.

Different insurers may assess the same medical history differently.

Reviewing existing specified illness cover

An existing policy should be reviewed when your income, debts or family circumstances change.

A review may be appropriate if you:

• Buy a home
• Increase your mortgage
• Have a child
• Change employment
• Become self employed
• Start a company
• Take on business debt
• Experience a significant income change
• Stop smoking
• Separate or divorce
• Approach the end of the policy term

The review should examine the insured amount, policy term, illness definitions, additional benefits and whether the cover remains suitable.

Do not cancel existing cover until any replacement policy has been fully accepted and placed in force.

Making a specified illness claim

If you receive a diagnosis that may be covered, contact the insurer or broker as soon as reasonably possible.

The insurer may require:

• A completed claim form
• Medical reports
• Confirmation from a consultant
• Test results
• Treatment information
• Identification documents
• Other relevant medical evidence

The insurer will compare the medical evidence with the definition contained in the policy.

A claim is only payable where the diagnosis meets the relevant definition and all other policy conditions.

Dooleys can help existing clients understand the claims process and supporting information required.

Our specified illness advice process

Understanding the financial risk

We assess your income, mortgage, debts, household expenditure, family responsibilities and existing financial protection.

Reviewing existing cover

We examine any specified illness, life insurance, income protection and employer benefits already in place.

Establishing the level of cover

We calculate a suitable benefit based on the financial effect a serious diagnosis could have.

Comparing available policies

We review the options available through our agency appointments, including illness definitions, partial payments, additional benefits and premiums.

Completing medical underwriting

We help you complete the application and respond to any requests for additional medical information.

Reviewing the policy

Cover should be reviewed as your health, income, family and financial responsibilities change.

Why choose Dooley Insurance Group?

Dooley Insurance Group has supported individuals, families and Irish businesses since 1957.

Our financial services team provides advice across specified illness cover, income protection, life insurance, mortgage protection and business protection.

We compare the policies available through our agency appointments and explain the cover, definitions, exclusions and costs before you proceed.

Our financial services team includes Conor Swan, QFA, RPA and SIA, Director, and David Renwick, Senior Financial Consultant.

With offices in Naas, County Kildare and Edenderry, County Offaly, we provide specified illness cover advice to clients locally and throughout Ireland.

Specified illness cover questions

What is specified illness cover?

Specified illness cover pays a lump sum if you are diagnosed with an illness listed in the policy and meet the insurer’s medical definition.

Is specified illness cover the same as critical illness insurance?

The terms specified illness, serious illness and critical illness cover are commonly used to describe the same type of insurance.

Does specified illness cover every illness?

No. It only covers the illnesses and medical procedures listed in the policy, subject to the relevant definitions and conditions.

Does specified illness cover pay for cancer?

Many policies cover defined forms of cancer, but not every cancer diagnosis will meet the definition for a full payment.

How much specified illness cover do I need?

The amount should reflect your income, debts, mortgage, household costs, savings, employer sick pay and existing financial protection.

Is specified illness cover taxable?

The tax treatment of a payment depends on policy ownership, the recipient and individual circumstances. Financial and tax advice may be required.

Can I get specified illness cover with a medical condition?

It may be possible. The insurer will assess your medical history and may offer standard terms, an increased premium, an exclusion or another underwriting decision.

Does specified illness cover replace income protection?

No. Specified illness cover provides a lump sum for a listed illness. Income protection provides a regular benefit following an eligible inability to work.

Does health insurance include specified illness cover?

No. Health insurance helps cover eligible medical expenses, while specified illness cover provides a cash benefit following a qualifying diagnosis.

Can children be covered?

Some adult policies include children’s specified illness cover. The benefit, age limits and medical definitions vary between insurers.

What is accelerated specified illness cover?

Accelerated cover is linked to life insurance. A specified illness payment may reduce the amount of life cover remaining.

Can I make more than one claim?

This depends on the policy. A full claim may end the cover, while certain partial payments may allow some protection to continue.

How long should specified illness cover last?

The term should reflect how long the financial need is expected to continue, including the mortgage term, dependent children and remaining working years.

When should I review my cover?

Cover should be reviewed following major changes such as buying a home, having children, changing employment, starting a business or increasing debt.

Arrange a specified illness cover review

A serious diagnosis can affect far more than your health.

The right financial protection can provide greater flexibility while you focus on treatment, recovery and your family.

Contact Dooley Insurance Group to arrange a specified illness cover review.

The information on this page is general and does not constitute personal financial, medical, legal or tax advice. Cover is subject to medical and financial underwriting, policy definitions, exclusions, terms and conditions. A diagnosis must meet the insurer’s specified definition before a claim is payable.

Dooley Insurances Ltd t/a Dooley Insurance & Mortgage Brokers and Dooley Insurance Group is regulated by the Central Bank of Ireland.