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• affects 1 in 4 women / 1 in 5 men before retirement
• 94.1% of the critical illness claims are paid
• protect yourself and your family if you get seriously ill

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Overview of Legal & General's Critical Illness Cover

Legal & General’s Critical Illness Cover is offered as Level Term Life and Critical Illness Cover, Mortgage Critical Illness Cover or Mortgage Decreasing Critical Illness Cover.  

Quick Facts on Legal & General Critical Illness

What Is the Critical Illness Cover of Legal & General?

Legal & General’s Critical Illness Cover is sold under:

• Critical Illness Cover (included in the Level Term Life and Critical Illness Cover)
• Mortgage Critical Illness Cover
• Mortgage Decreasing Critical Illness Cover

Amount of Coverage

Maximum sum insured is:

• £3,000,000 if the Total and Permanent Disability definition used is the Functional Assessments Tests (FATS) definition
• £2,000,000 if the Total and Permanent Disability definition used is the Own Occupation definition

Child critical illness cover is 50% of the sum insured or £25,000, whichever is lower.

Who Is Covered

The life insured. Age must be between 18 to 63 when the cover starts.

The life insured’s children:

• Children, either by birth or legal adoption, as well as step children
• The children should be between 30 days to 18 years old at the time of diagnosis of the critical illness
• For the critical illness benefit to be payable, the covered person must survive for at least 14 days from the day of the diagnosis
• There is no limit to how many children can be covered but only one claim can be made for each child. Also, a maximum of two claims (i.e. children) can be made. This only covers a diagnosis of critical illness, and not death. Any claims for children’s critical illness protection will not affect the “main” benefit amount (or, the amount to be paid in case of a diagnosis of a covered illness). However, if the “main” benefit has already been paid out, the cover stops and any succeeding claims for children’s critical illness will no longer be payable.

What You Will Receive

The critical illness benefit will pay:

• The benefit amount, if the insured person is diagnosed with a covered critical illness. That is, if the critical illness meets the definitions stated in the policy. The insured person should survive 14 days after the date of the diagnosis.
• The benefit amount, if the insured person dies.
• £25,000 or 25% of the sum insured, whichever is lower, if the person insured undergoes a mastectomy for breast cancer.
• £300,000 or the sum insured, whichever is lower, if the person insured dies as a result of an accident while the critical illness cover application is ongoing
• £25,000 or 50% of the sum insured, whichever is lower, if your child is diagnosed with a covered critical illness. If the chosen coverage is an income benefit, the supposed income benefit amount will be given out as a lump sum. Only one claim per child will be paid out, regardless of the number of policies the parents has with Legal & General.

The policies only pay out once – upon the death of the Insured or his diagnosis of a critical illness. Once a payout is made for a full claim, the policy ends and is no longer active. Claims for children’s critical illness claims and mastectomy for ductal carcinoma in situ of the breast are treated as separate benefits from the main life or critical illness benefit.

Length of the Cover

The length of the cover is from 2 to 40 years.

Critical Illnesses Covered by Legal & General

The Critical Illness benefit will pay the benefit amount (or a portion) for the following critical illnesses:

Additional Coverage Automatically Included

Accidental Death. Accidental death coverage is applicable while the application for Critical Illness cover is being processed. The cover generally lasts for 90 days from the day the completed application is submitted to Legal & General, or, until the policy is accepted, postponed or declined, or until the person applying no longer wishes to continue with the application. The cover will also not be effective if the purpose of the application is to replace a policy that is currently in force with Legal & General, for as long as the insured person remains covered under that policy.

“Accidental Death” excludes:

• Accidents that occurred before the cover became effective
• Suicide, suicide attempts and other acts of self-inflicted injury
• Dangerous activities, sports or pastimes
• Non-commercial flying, where the insured person is not a fare paying passenger riding with a licensed airline
• Criminal acts
• Acts of war, civil commotion or riots
• Accidents caused due to the Insured Person’s taking of drugs or alcohol (unless the drugs are prescription drugs given by a licensed doctor practicing in the United Kingdom)

Guaranteed Insurability Option. This allows the person insured to increase the amount of critical illness cover for selected life events without the need to show additional medical evidence. This option is only available for policies issued on standard terms and with normal premium rates. Also, the person insured should be younger than 45 years of age at the time this option if applied for and must be younger than 55 years old when the option is exercised.

The life events include:

• Getting married or being registered in a civil partnership
• Becoming a parent
• Increasing the mortgage (due to major renovations or moving to a new home)
• Getting a salary increase (due to a promotion or a transfer to a new job)

Carcinoma in Situ of the Breast. This involves the advice of a hospital consultant and surgery to remove the entire tissue of at least one breast). The coverage will pay the lower of £25,000 or 25% of the sum insured. The cover does not include: Surgery, prophylactic mastectomy or other procedures done without historical evidence or cancer in situ, as well as lumpectomy, partial mastectomy and partial or total subcutaneous mastectomy.

Carcinoma in situ of the breast is an additional coverage on top of the covered critical illnesses in the list. Payment of a claim for mastectomy for carcinoma in situ of the breast will not affect the amount to be received in case of a claim for a critical illness included in the list. However, if a claim for a covered critical illness is paid out, the coverage will stop and succeeding claims for carcinoma in situ will no longer be payable.

Life Cover. This is covered for all mortgage related plans with Critical Illness Cover. This will pay out the lower of:

• The sum assured
• The amount of the loan
• £300,000

This is effective for up to 90 days between the exchange of contracts to completion. In addition,

• There are no other mortgage life insurance coverage in force or being applied for with regards to that specific mortgage
• The person insured is under 55 years of age

SmoothMove. This is for mortgage-related plans with Critical Illness Cover. This will provide additional protection for transferring from one home to another. This includes for:

• Car recovery. This covers towing and roadside repair services, as well as car rental while the Insured Person is moving to the new home.
• Moving van mishaps. This covers problems arising from delays in the arrival of a moving van, as well as lost or damaged items. The cover will pay for hotel accommodation (for the family and pets) for up to three (3) nights. It will also cover emergency purchases (personal needs and toiletries).
• New home still occupied. If the home being transferred to is still occupied, the cover will pay for up to three nights’ accommodation in a hotel. This includes accommodation for pets and storage of the Insured’s things while waiting for the house to be vacant.
• Emergency repairs and assistance. After the new home is occupied, this cover will pay for emergency repairs (i.e. damaged piping or roofing).

What You Are NOT Covered For

The client will not receive any Critical Illness payouts for:

• Diagnoses that does not match the definitions provided for a specific critical illness
• Claims made where the insured failed to survive for at least 14 days after the diagnosis
• Children’s Critical Illness Claims that are pre-existing, genetic (runs in the family), or congenital (existing at birth). No payouts will also be given if the child does not survive for at least 14 days after the date of diagnosis.
• Terminal Illness Claims that occur within the plan’s last 18 months
• Illnesses related to alcohol or drug abuse. This is only for the following critical illnesses: cardiomyopathy, coma, liver failure and Parkinson’s disease
• Injuries that result from suicide or acts of self-injury

Making a Claim

To file a claim, contact Legal & General’s Claims Department at 0800 0680789 (if you are in the UK) or 0044 1273374414 (if you are calling from outside the UK). You need to have your policy number, as well as the doctor’s diagnosis. The claims department will send in a blank claim form for you to fill up and submit.

Legal & General will ask for medical evidence as relates to the diagnosis of a critical illness. Once all the documents are in place and the claim is processed, payment of the claim will be paid directly to the claimant’s bank account or

While the claim is being processed and there are additional benefits to the cover (i.e. Waiver of Premium Benefit or Life Cover), you must continue to make payments until such a time as the claim is processed. Any premiums paid in excess will be refunded to you.

This article is for informational pruposes only and should not be considered a financial advice. Contact Legal & General directly for information about their products.

Last updated on: 25.07.2012

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