Understanding Critical Illnesses and Coverage: Updates and What You Need to Know

Did You Know?
A serious illness can strike unexpectedly — and the financial impact can be just as severe. It’s vital to know which conditions are covered under critical illness insurance, how definitions have changed recently, and how you can protect yourself and your family financially.

In Singapore, the number of people diagnosed with critical illnesses like cancer, heart attack, and stroke remains significant. On average, 46 Singaporeans are diagnosed with cancer every day. The costs of treatment for conditions like breast and prostate cancer have also risen over time. While schemes such as MediSave and MediShield Life can help, they may not fully cover the broader expenses associated with long-term critical illnesses, especially when you’re unable to work.

What Does Critical Illness Insurance Cover?

Critical illness (CI) insurance generally pays out a lump sum if you’re diagnosed with a condition covered by your policy, giving you financial flexibility while you focus on treatment and recovery. The Life Insurance Association Singapore (LIA Singapore) sets the standard definitions for CI, which were updated in 2024 to reflect advances in medical knowledge and treatment.

The “Big 3” and Other Common Conditions

The three major critical illnesses — cancer, stroke, and heart attack — account for over 90% of all CI claims in Singapore. According to HealthHub:

• Heart disease and stroke are among the top causes of death in Singapore.

   

• The most common cancers differ for men and women:

   

  • Men: Prostate (16.8%), Colon-rectum (16.3%), Lung (13.5%)

     

  • Women: Breast (29.7%), Colon-rectum (12.9%), Lung (7.9%)

Updated List of Covered Critical Illnesses

The LIA framework defines 37 critical illnesses, including:

1. Major Cancer
2. Heart Attack of Specified Severity
3. Stroke with Permanent Neurological Deficit
4. Coronary Artery By-pass Surgery
5. End Stage Kidney Disease
6. Irreversible Aplastic Anaemia
7. End Stage Lung Disease
8. End Stage Liver Disease
9. Coma
10. Deafness (Irreversible Loss of Hearing)
11. Open-Heart Heart Valve Surgery
12. Irreversible Loss of Speech
13. Major Burns
14. Major Organ / Bone Marrow Transplantation
15. Multiple Sclerosis
16. Muscular Dystrophy
17. Idiopathic Parkinson’s Disease
18. Surgery to Aorta
19. Alzheimer’s Disease / Severe Dementia
20. Fulminant Hepatitis
21. Motor Neurone Disease
22. Primary Pulmonary Hypertension
23. HIV Due to Blood Transfusion and Occupationally Acquired HIV
24. Benign Brain Tumour
25. Severe Encephalitis
26. Severe Bacterial Meningitis
27. Angioplasty & Other Invasive Treatment for Coronary Artery
28. Blindness (Irreversible Loss of Sight)
29. Major Head Trauma
30. Paralysis (Irreversible Loss of Use of Limbs)
31. Terminal Illness
32. Progressive Scleroderma
33. Persistent Vegetative State (Apallic Syndrome)
34. Systemic Lupus Erythematosus with Lupus Nephritis
35. Other Serious Coronary Artery Disease
36. Poliomyelitis
37. Loss of Independent Existence

Key Changes Since 2024

The most recent updates aim to clarify the scope and definitions of certain illnesses to reduce ambiguity for claims. Some examples include:

• Major Cancer: Certain tumors, such as Pituitary Neuroendocrine Tumors (PitNET), are now explicitly excluded.

   

• Coma: Clarified that self-inflicted injuries are excluded.

   

• Deafness: Clearer criteria for “total” and “irreversible” loss of hearing.

   

• Open-Heart Heart Valve Surgery: Now defined more precisely to include only direct, open-heart procedures, excluding operations via catheter or keyhole surgery.

   

• Terminal Illness: The prognosis must now be certified by a medical specialist, with an expected lifespan of no more than 12 months despite treatment.

   

• Other conditions, such as coronary artery disease, have updated wording to ensure better alignment with medical practice.

   

If you have a CI plan purchased before 30 June 2025, your plan will remain under the previous definitions.

Types of Critical Illness Coverage

CI coverage isn’t “one-size-fits-all.” There are typically three main levels:

1. Early Stage CI Coverage: Payouts for early detection, helping you manage treatment from the outset.

    

2. Intermediate Stage CI Coverage: Protection during the moderate stages of illness.

    

3. Advanced/Major CI Coverage: Payouts when the illness reaches a severe or advanced stage.

    

Some insurers offer standalone CI plans, while others allow you to add CI coverage as a rider to term or whole life insurance. The scope and number of conditions covered vary, so always check your policy details carefully.

Is Critical Illness Insurance Necessary?

While you may feel well-protected with basic health insurance, a serious illness can bring significant extra costs — from long-term treatments and caregiving needs to the loss of income during recovery. Here are some pros and cons to weigh:

Benefits:
✅ Lump sum payout can be used however you need — treatment, daily expenses, or rehabilitation.
✅ The payout is tax-free.
✅ Some plans also include life insurance benefits.
✅ It helps fill the gaps where MediSave or MediShield Life may not fully cover expenses.

Considerations:
⚠️ CI policies come with medical definitions and exclusions. Understanding them is crucial for successful claims.
⚠️ Premiums are generally lower if you apply while young and healthy.
⚠️ Policies often have waiting periods, typically around 90 days.
⚠️ Coverage might be declined if you have pre-existing conditions.

What Should You Consider When Choosing a Plan?

✅ Coverage: Does it include early, intermediate, and late-stage CI?
✅ Sum Assured: Will the payout amount be enough to cover your income loss and medical expenses?
✅ Riders: CI riders can extend protection on life policies, but note how this affects your overall benefits.
✅ Premiums: Make sure the plan remains affordable as you age.

Review Your CI Protection Regularly

A critical illness can happen to anyone. As medical costs continue to rise, it’s wise to review your CI insurance needs every few years to ensure you and your loved ones are adequately protected from the financial impact.

If you’d like help understanding what’s right for you, consider consulting a qualified financial advisor who can guide you through your options based on your health, lifestyle, and long-term goals.