Health Care Focus: To die for - the cost of survival

The joy of overcoming a potentially fatal illness or accident can be dampened if you are no longer able to work and your insurance policy pays out only on your death. So how do you pick out a policy that covers you for both scenarios? By Iain Morse

You go on holiday and one day you have too much to drink in the heat of the day - you want to prove that your youth hasn't quite deserted you. Suddenly breathless, you feel pain in your left arm... It's a nightmare scenario, and one that can easily happen.

Your working life may come to a halt but your financial life continues: mortgage payments, school fees, bills and more bills. Medical advances mean more and more of us survive critical illnesses such as cancer, stroke and heart attack.

Tony Worthington, of the insurance underwriter Swiss-Re, says: "The problem is paying the cost of survival. This is often expressed as a loss in standard of living due to loss of income - so the impact is on lifestyle. Do you have too much straight life insurance - which pays out only on death - and not enough to cover survival of serious illness?"

Buying "critical illness benefits" (CIB) insurance cover is one possible antidote to the financial misery that can result from serious illness. But be careful; policy terms can differ widely, and a mass of small print covers up some hefty charges.

All critical illness policies have some core similarities; they pay out a "sum assured", or lump sum, on the diagnosis of a particular medical condition suffered by the person insured.

But there the similarities end, and costs escalate. Some policies are for a fixed term, others on a "whole of life basis". Some pay a "level sum assured", fixed at the outset, others are combined with a savings policy that should push up the real value of benefits over the longer term.

It has taken several years, and only now have most CIB providers even agreed to a standard set of medical definitions of relevant illnesses, the diagnoses of which allow a policyholder to make a claim.

The key point is making cost comparisons, and the way to choose a best policy for your circumstances lies in setting a standard for comparison between different providers. This comes down to three issues: the policy term, the range of illnesses it covers, and the level of benefit payable for a given premium. If you go to independent financial advisers for advice on this subject, they are obliged to know your circumstances and recommend an appropriate policy. They should also find the cheapest cover meeting this test. The problem is that so few policies on offer are exactly the same. This makes comparisons difficult, and makes justifying the sale of more expensive policies far easier.

Suppose, for example, that a non-smoking man, aged 30, wants CIB cover of pounds 100,000 over 10 years. Equitable Life, which pays no commission to intermediaries, offers cover at pounds 9 per month. But you can buy the "same" policy from Prudential CIC for pounds 30 a month. Prudential does pay commission, and covers a narrower range of illnesses under its policy than Equitable.

The reality is that few 30-year-olds are much interested in CIB, but looking at the way premium costs escalate with age - reflecting the increased probability of claims being made - the earlier you buy cover the cheaper it will be. So a 30-year-old buying term CIB with a sum assured of pounds 100,000 over 25 years could pay as little as pounds 18.94 for Virgin Direct's "Survival Plan".

The problem with this and many other CIB policies is that they will not insure above the age of 75. With life expectancies growing, you may want to look at a "whole of life" CIB policy. Most providers offer two versions of this policy. There is the more expensive "standard" version, and a low-cost "maximum" policy. Standard versions are more expensive, as they include some investment content designed to grow the real value of your policy pay-out.

Maximum versions are whole-of-life but typically fix benefits at outset; these will then be eroded by the effects of inflation over the policy term. Also, while standard policies may offer greater contractual flexibility, such as the right to increase both premiums and benefits as you get older, maximum policies are usually inflexible.

Again, the cost benefits of taking out over when young are evident; a man and a woman, both aged 30 and non-smokers, could buy "standard" cover of pounds 100,000 for as little as pounds 37.38 and pounds 28.78 a month. But the same couple buying the same cover at age 40 would find premium levels almost twice as expensive, at pounds 74 and pounds 51.70 a month. By age 50, premiums stand at pounds 92.70 per month.

One way to reduce the cost of cover is by buying a joint-life policy. This is where the pay-outs are paid to the survivor. Typically this can reduce the cost of premiums by 10 to 15 per cent. Look out also for "family" policies, on offer from providers such as Skandia; children are covered free up to the age of 18.

Many CIB policies are sold as "riders", bolted on to life insurance or an endowment savings plan used to pay off a mortgage. The appeal is obvious: for most of us, a mortgage is the largest debt we take on, and these "riders" pay it off if you fall ill.

Sorting out the real cost of a rider is worthwhile. Standard Life offers a low-cost endowment, with a sum assured of pounds 100,000 over 25 years to a man aged 40, for pounds 88.96 a month. With a CIB rider, premiums go to pounds 100.10 a month, an increase of just pounds 11.41. The same cover could not be bought at such a low cost through a "free-standing" CIB policy.