Editor’s Note: This guide was originally published in 2020 and has been fully reviewed and updated for 2026 to reflect current Irish insurer definitions, partial payment limits and claims data.
Serious illness cover pays a tax-free lump sum if you are diagnosed with one of a defined list of serious medical conditions such as cancer, heart attack or stroke. It pays while you are alive. It does not replace long-term income.
For most working people, income protection is the foundation. Serious illness cover is the support layer on top.
Serious illness cover, also known as specified illness or critical illness cover, is simple in principle.
If you’re diagnosed with one of the illnesses listed in your policy, the insurer pays out a lump sum of money.
The money goes to you if you own the policy. However, if the illness cover is attached to a mortgage, the bank receives the payout.
A serious illness cover payout is designed to give you breathing space at a difficult time. It is not designed to permanently replace your salary.
That distinction matters.
Income protection, on the other hand, pays you a monthly income if you cannot work due to any type of illness.
Both have a role to play in protecting you and your family, but they do different jobs.
You’ll often see insurers advertising how many illnesses they cover. Some list 60. Some list 80. Some list more.
In reality, most claims come from a small group of conditions.
Irish Life’s latest claims breakdown showed:
That means almost 90% of claims were concentrated in four medical areas.
When you expand that to the top 11 illnesses across the market, you cover roughly 95% of real-world claims.
All insurers cover the big ones: cancer, heart attack, stroke, MS and the other high-frequency neurological and cardiac conditions.
So when comparing policies, the length of the list is far less important than how clearly those key illnesses are defined.
This is where serious illness cover becomes technical, and where advice matters.
Every illness on the policy is defined in detail.
A payout depends on your diagnosis matching that definition.
Take heart attacks as an example:
Years ago, heart attack claims were harder to qualify for. Insurers often required blood test results to reach a high level before they would pay. Today, most policies will pay once doctors clearly confirm a heart attack, without demanding extreme test results. That makes a real difference when someone is actually claiming.
Stroke definitions have improved too. In the past, you often had to show permanent damage before a claim would be paid. Now, most policies will pay if a stroke is confirmed on a brain scan and symptoms last at least 24 hours. You do not usually have to prove lifelong disability.
Multiple sclerosis is similar. Older policies sometimes required symptoms to continue for months. Modern policies usually pay once the diagnosis is medically confirmed.
This is not about saying one insurer is good and another is bad. It is about understanding that small wording differences change real outcomes.
Two policies might both say “heart attack” on the front page. Whether they pay depends on how that condition is defined inside the contract.
That is why choosing an insurer is not about brand name. It is about the detail in the policy wording.
In addition to full payouts for major illnesses, most policies include partial payments for less severe conditions.
These typically pay the lower of a fixed euro amount or 50% of your serious illness sum insured.
| Insurer | Partial Cap |
|---|---|
| Aviva | €20,000 or 50% |
| Irish Life | €15,000 or 50% |
| New Ireland | €25,000 or 50% |
| Royal London | €15,000 or 50% |
| Zurich | €15,000 or 50% |
If you’ve €50,000 of serious illness cover and something happens that qualifies for a partial payout, you’re not automatically getting the full €50,000. You might get €15,000, €20,000 or €25,000, depending on the insurer.
Now, if you only have €30,000 of cover, the 50% rule kicks in. So the most you’re getting is €15,000.
That’s one of the reasons I’m slow to recommend small serious illness amounts. The partial limits can really water down the payout, and most people don’t realise that when they’re picking the figure.
Yes, they do pay.
Across the Irish market, serious illness payout rates are usually somewhere between about 85% and 95%. Irish Life reported 92% in 2024, and the other big insurers are broadly in that same range.
So the idea that “insurers never pay” just doesn’t stack up with the actual Irish figures.
When a claim is turned down, it’s normally for one of three reasons.
That’s it. There’s no mystery to it.
Most claim problems don’t start at claim stage. They start years earlier, when the application was filled out, and something that should have been mentioned wasn’t.
That’s why we’re so particular about the forms.
The paperwork isn’t just admin.
It’s what protects the claim down the line.
To learn more, read about what happens at claim stage?
The Irish Cancer Society estimates that someone going through cancer treatment can face extra costs of about €756 a month. In plenty of cases it’s over €1,000 once you factor in travel, parking, heating, medication and all the bits and pieces that crop up.
Then there’s income.
It’s very common for someone to cut back hours or step away from work for a while. A drop of €1,500 a month isn’t unusual.
Put those together and you’re looking at a hit of €2,000 to €2,500 a month.
Over a year, that’s roughly €30,000.
That’s why I often say €30,000 is a sensible starting point if you already have income protection in place. It covers a year of financial disruption without being excessive.
If you don’t have income protection, it’s a different conversation. In that case, you may need more of a cushion, maybe €50,000 or more, depending on your income and what you’ve committed to.
As a rough guide, €30,000 is a sensible starting point. €50,000 gives you more breathing space. Two times your net annual income would be considered strong protection.
But those are just guides. Your mortgage, your dependants, your employer benefits and your savings all feed into the right number for you.
A lot of people frame this as a choice. Income protection or serious illness.
It’s not really a choice. They solve different problems.
Income protection pays you every month if you can’t work because of illness or injury. It covers far more than just cancer, heart attack or stroke. Back issues, mental health, long recoveries. Claims can last for years.
Serious illness pays once. A lump sum. And only if you’re diagnosed with one of the specific conditions listed in the policy.
If someone can only afford one, income protection is usually the stronger foundation because it protects your income properly over time.
Serious illness then sits on top as a buffer.
It all comes back to this: what financial risk are you trying to protect against?
If you’d like a deeper comparison, we break it down properly here: Income Protection or Serious Illness Cover
Serious illness can be structured in two main ways.
With accelerated cover, if you claim, the payout comes off your life cover. So you’re effectively using part of that life cover early.
With additional cover, the serious illness payout is separate. If you claim, your life cover stays exactly as it was.
For most families, accelerated makes sense. It’s usually cheaper and, in straightforward family protection setups, it does what it needs to do.
Additional has its place, but that’s normally in more specific planning situations.
The key isn’t the label. It’s knowing why you’re choosing one structure over the other, rather than just ticking a box because it sounds better.
We explain this in detail here: Accelerated, additional or independent serious illness cover
Most serious illness policies include child cover automatically.
Usually, it is the lower of 50% of your own cover or a set euro cap, depending on the insurer.
If a child is diagnosed with something serious, one or both parents often step back from work.
The payout is about breathing space, giving the option to take time off work.
The detail does vary between insurers, so it is worth checking properly.
Serious illness cover must be in place before:
Once something appears in your medical file, insurers must consider it.
Cover is easiest to obtain when you are healthy and before investigations begin.
Serious illness cover isn’t about who lists 70 conditions versus 80.
It’s about the handful people actually claim for… and whether those definitions are written in a way that makes a real payout possible.
That’s why insurer choice matters.
That’s why filling out the application properly matters.
And that’s why going to the right insurer first can matter more than most people realise.
If you want me to look at your own setup properly — income, mortgage, illness cover, what you already have in place — the next step is straightforward.
Complete our financial questionnaire
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Thanks for reading
Nick
Editor’s Note: This guide was originally published in 2020 and has been fully reviewed and updated for 2026 to reflect current Irish insurer definitions, partial payment limits and claims data.
Written by Nick McGowan, QFA RPA APA
Nick is a qualified financial advisor and founder of Lion.ie, an independent Irish life insurance and income protection brokerage based in Tullamore. He’s been helping people get fair, transparent cover for over 15 years and was named Protection Broker of the Year 2022.
If you’d like straight answers without the sales pitch, learn more about Nick here.
Serious illness cover pays you a tax-free lump sum if you’re diagnosed with one of the serious illnesses listed in your policy.
It covers a wide range of conditions, from different types of cancer to MS, heart attack, stroke and other major illnesses.
If budget is tight, there’s also the option of Cancer Only Cover, which can be a low-cost way to put some protection in place.
You don’t always need a huge amount of cover either. Even a modest lump sum can give you breathing space at the right time, so it’s often more affordable than people expect.
Some insurers include extras like hospital cash, rehabilitation support, broken bone payments or personal accident benefits. They’re not the reason to buy the policy, but they can add value around the edges.
Across the Irish market, roughly 9 out of 10 serious illness claims are paid.
My role is to compare all the main insurers properly, look at the definitions that matter, and make sure you don’t end up with a policy that looks good on paper but causes problems later.
You might be wondering why you should trust us at all.
Fair question.
There are plenty of brokers and comparison sites that make serious illness cover look simple.
What we do differently at Lion.ie is focus on how the policy behaves at claim stage, not just how it looks on a quote screen.
We compare Aviva, Irish Life, New Ireland, Zurich and Royal London properly. We look at the definitions. We look at how they handle medical disclosures. We make sure the structure fits your situation.
And we explain it in plain English.
No jargon. No bundling something to a mortgage without explaining who actually gets paid. No pushing whatever happens to be convenient.
For example, if serious illness cover is attached to mortgage protection and the policy is assigned, the bank gets the payout. That may be exactly what you want. It may not be. The important thing is that you know before you sign.
We arrange everything online, including digital signatures, so the process is straightforward.
We also specialise in cases where health history isn’t textbook. A previous condition doesn’t automatically mean no cover. It just means the application needs to be handled carefully.
Lion.ie is independent. That means we’re not tied to one insurer. You get advice based on your situation, not on one provider’s product.
If you want a proper recommendation based on your income, mortgage and medical history, fill in the questionnaire or book a call.
We’ll build it properly from the start.