【Critical Illness Definition Standardisation 2026】HKFI’s new definitions take effect. Are the new standards stricter than market products?

At the moment they are diagnosed with cancer, most patients feel distressed and overwhelmed. However, once the shock has subsided, they will rationally remind themselves to find out about the treatment options and whether the critical illness insurance premiums they have paid for years will provide any benefit. To the general public, critical illness means treatment, surgery and a threat to life; however, the payout under critical illness insurance depends on the definitions set out in the policy terms. The organ in which the cancer occurs, its stage, its degree of malignancy, the examination reports required for a heart attack, and how long functional impairment must persist after a stroke are all set out in the policy definitions, and the wording used by different insurers varies. Patients often find it difficult to understand these complex medical terms, let alone compare which policy terms are more favourable to them, giving rise to disputes over claims.

The standardisation of critical illness definitions introduced by the Hong Kong Federation of Insurers (HKFI) is intended to address this issue, making it easier for consumers to compare the terms offered by different insurers before taking out a policy. The Best Practice Guidelines on Standardisation of Critical Illness Definitions came into effect on 1 September 2026, establishing standardised Chinese and English definitions for 21 diseases. According to HKFI estimates, these cover approximately 90% of critical illness claims. 

As a one-stop insurance platform, 10Life supports the move towards standardising critical illness definitions, as common policy wording makes it easier for consumers to compare products. We compared the new definitions introduced by the Hong Kong Federation of Insurers, item by item, with the policy terms of seven mainstream critical illness products currently on the market, focusing on the claim conditions for the five most commonly claimed critical illnesses (including major cancer, severe heart attack, angioplasty, stroke and end-stage renal failure). Our conclusion is that the new standard establishes a baseline rather than upgrading coverage. For these five common critical illnesses, the claim conditions of existing critical illness products on the market are similar to or more lenient than those under the new standard. 

The Insurance Federation’s definition of major cancer requires the diagnosis to be based on the final histopathology report following excision. The seven products currently on sale only require a histopathology report; none stipulates that the report must be from excisional surgery.

For patients with advanced cancer, surgical excision may not be necessary treatment. For example, Stage 4 breast cancer that has spread is generally treated with chemotherapy, targeted therapy, immunotherapy or hormone therapy, with the diagnosis confirmed through a needle biopsy. Such patients simply cannot produce a report following excision. 10Life believes this is not the original intention of critical illness insurance and recommends that the Insurance Federation clearly explain the circumstances under which reports from needle or endoscopic biopsies may meet the requirements.

As for the details of individual cancers, such as which cancer types and stages fall within the exclusions, the wording of the thresholds for prostate cancer, thyroid cancer, melanoma and blood cancer is not consistent across the products. At this stage, it is not possible to draw an overall conclusion. 

The insurer’s claim requirements must meet all three criteria: typical ischaemic chest pain, electrocardiogram changes and blood markers. Of the seven products, four are more lenient in one or more areas: AXA does not require typical chest pain; FWD and Generali allow cardiac ultrasound to be used as alternative evidence when myocardial enzyme evidence cannot be obtained in specified circumstances; and the blood marker thresholds for AXA and Manulife are lower than those of the insurer. 

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Angioplasty is classified as an early critical illness under the Hong Kong Federation of Insurers’ standard, and claims are assessed based on the degree of stenosis in the coronary arteries. The threshold for all seven products is 50% (AXA’s wording states “more than 50%”), while the Federation’s threshold is 60%. The higher the threshold, the more difficult it is to qualify. Therefore, in this respect, the current market wordings are more favourable to claimants.

The scope of the arteries also differs. The Federation only recognises the four main coronary arteries—the left main stem, left anterior descending artery, circumflex artery and right coronary artery—and expressly excludes their branches. Four products’ angioplasty provisions simply refer to the “coronary arteries” without excluding their branches, giving them a broader scope of coverage than the Federation’s standard. 

For stroke, the HKFI requires at least 30 days to have elapsed after the onset, with a registered specialist in neurology still required to confirm neurological impairment, in order for this criterion to be met. The seven products currently on the market require 28 days or four weeks, which is two days earlier than the new standard. The number of days is only one of the conditions; the extent of neurological impairment, imaging evidence and exclusions must still be compared item by item.

For end-stage renal failure, the HKFI requires the insured to undergo permanent renal dialysis continuously for at least 90 consecutive days. None of the seven products specifies a minimum number of dialysis days in its definition; they only require irreversible renal failure and the need for long-term dialysis. Five of them (AIA, FWD, AXA, Generali and Sun Life) also list kidney transplantation as an alternative way of meeting the definition.

The longer the time threshold, the later the insured can submit a claim. For patients in urgent need of cash to cover treatment and living expenses, this represents the difference between a few days and 90 days. 

10Life believes that standardised critical illness definitions are worth supporting. They reduce the cost of comparing policy terms, but do not significantly enhance product coverage. The guidelines themselves state that they are premium-neutral and are expected to have only a minimal impact on pricing; if coverage were genuinely enhanced significantly, it would be difficult to keep premiums unchanged.

Before the new standards took effect, some salespeople in the market used “the terms will become less favourable after 1 September, so you should take out a policy as soon as possible” as a selling point. This statement is not comprehensive. The critical illness definitions are voluntary minimum standards, and insurers may offer coverage beyond the standards. Products currently on the market will not disappear on 1 September, so there is no practical benefit to signing up before the effective date.

The new guidelines will not automatically change existing policies. However, some insurers have already responded to the new standards by offering existing customers more favourable definitions or claims arrangements. Practices vary between insurers, so existing customers should refer to their insurer’s official notices to understand the applicable scope and effective date.

Will insurers use the new standards as an opportunity to reduce policy terms? We have not seen any indication of this so far. In an increasingly transparent market, any reduction in policy terms would be easily identified through comparison, making it difficult to implement such adjustments quietly. 10Life will continue to compare the differences between the terms of new products in the market and the insurance association’s definitions.

Finally, remember to do your homework when taking out critical illness insurance: based on your health, family responsibilities and budget, compare the coverage amounts, claim conditions and exclusions for each critical illness. If you would like to review the data yourself first, visit 10Life’s whole life critical illness insurance comparison. If you would like someone to compare the details for you, or review whether your existing policies have any coverage gaps, consult a 10Life licensed insurance adviser for advice.

Further reading: 【Critical Illness Insurance Comparison 2026】Which whole life critical illness insurance is the best?｜How much critical illness cover is enough? 

What is the standardisation of critical illness definitions?

The Best Practice Guidelines on Standardisation of Critical Illness Definitions introduced by the Hong Kong Federation of Insurers (HKFI) establish unified Chinese and English definitions for 21 illnesses (namely 16 critical illnesses and five early-stage critical illnesses). Taking effect on 1 September 2026, the guidelines aim to make the claim requirements for major critical illnesses clearer, reduce claim disputes arising from differences in policy terms, and promote the standardisation and transparency of critical illness insurance. They set out voluntary minimum standards and do not require the market to adopt the same set of critical illness definitions.

Will my existing critical illness policy adopt the new definitions?

No, it will not change automatically. In principle, the guidelines only apply to new critical illness insurance products launched on or after 1 September 2026. Existing policies will continue to be handled according to their original terms. Insurers may decide independently whether to adopt the new definitions when policies are renewed or the sum assured is increased.

Will product coverage become less favourable after the new standards take effect? Should I take out a policy before they come into effect?

The guidelines will not change existing policies, and products currently available for sale will not disappear on the effective date. However, our comparison shows that the new standardised definitions impose stricter requirements than current market products in areas including proof of cancer diagnosis, PTCA, stroke and kidney dialysis. Even so, policyholders do not need to rush to take out a policy. Instead, they should compare the coverage amounts, claim conditions and exclusions for each critical illness based on their own health condition, family responsibilities and budget, and make an appropriate choice.

Does “complies with HKFI standards” mean that the coverage is better?

No. It only means that the product meets the minimum requirements. The guidelines state that insurers may provide additional coverage, but this must be clearly and separately specified. The comprehensiveness of the product coverage is determined by each insurer.

Will the new definitions cause premiums to increase?

The guidelines state that they are premium-neutral, and their impact on pricing is expected to be minimal. This also means that adopting the new standards will not, in itself, bring about a significant enhancement in coverage; otherwise, it would be difficult to keep premiums unchanged.

Should I switch policies because of the new definitions?

It is not advisable to switch policies solely because of the new definitions. Switching policies usually requires fresh underwriting: premiums are higher at an older age, and if you have developed health problems or received treatment after taking out your existing policy, the new policy may involve a premium loading, exclusions or may even be declined. It is recommended that you compare the costs and underwriting risks of increasing your coverage and switching policies before making a decision.

Notes and research methodology

1. Scope of research: This study compares the 2026 HKFI standardised definitions with the policy terms of seven individual critical illness products in respect of five critical illnesses. The five critical illnesses are major cancer, severe heart attack / myocardial infarction, stroke resulting in permanent neurological deficit, end-stage kidney failure, and percutaneous transluminal coronary angioplasty (PTCA, commonly known as “通波仔”). The product scope is based on whole-of-life critical illness products covered by 10Life ratings. The policy terms were compiled on 4 September 2026, and the original policy terms prevail in all cases. This study compares only the disease definitions and the specified thresholds within them. It does not cover premiums, claim percentages, claim limits or actual claim payout rates, nor does it provide an overall ranking of the products. Different products offered by the same insurer may have different definitions; the information listed in this article applies only to the products specifically named in the table.

2. Full names of the products compared: AIA On Your Side Insurance Plan 2、FWDCrisis OneMaster Pro、AXA TotalAssure Critical Illness Plan、Generali LionGuardian Beyond、ManulifeIncomeGuard Critical Illness Protector、Sun Life SunWell Supreme Care、CTF LifeFamCare 198。

3. Sources: the HKFI’s Best Practice Guidelines on Standardisation of Critical Illness Definitions and the 2026 Standardised Disease Definitions, HKFI frequently asked questions, the latest policy terms of the seven products listed above, and the American Cancer Society’s “Treatment of Stage IV (Metastatic) Breast Cancer”. 

Disclaimer: This article is for information and educational reference only and does not constitute individual advice on taking out, switching or surrendering an insurance policy. The product comparison in this article is a comparison of policy wording and is not advice on taking out insurance. Actual coverage and eligibility to make a claim are subject to the complete terms and conditions applicable to the relevant policy and any valid endorsements. 10Life Financial Limited is an insurance broker company licensed by the Insurance Authority of Hong Kong, licence number FB1526. 

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.