Specialist Guide · May 2026
What does ‘limits tables’ mean on a serious illness policy?
The schedule buried in your policy document that determines whether a claim pays — and how much.
By Donal Milmo-Penny QFA FLIA · May 2026
The 40-word answer
Limits tables are schedules in a serious illness policy that define the minimum severity required for a payout and the percentage payable condition by condition. Early-stage prostate cancer might pay 25%; an advanced diagnosis pays 100%. Each Irish insurer publishes its own schedule.
What does ‘limits tables’ mean on a serious illness policy?
When you buy a specified serious illness (SSI) policy — also called critical illness cover — you are insuring against a list of named conditions. The policy pays a lump sum if you are diagnosed with a condition on the list and the diagnosis meets the severity threshold defined in the policy document.
The limits table (also called the conditions schedule, definitions schedule, or partial payments schedule, depending on the insurer) sets out, for every covered condition: whether it is a full-payment or partial-payment condition; the severity threshold; and any waiting periods or exclusions specific to the condition.
A worked example — prostate cancer
Prostate cancer illustrates how the limits table works in practice. The five Irish life offices use broadly similar but not identical definitions.
| Severity | Typical payout | Clinical criteria (illustrative) |
|---|---|---|
| Early-stage (low grade) | 25% of sum assured | Gleason score ≤6, Stage T1 or T2a, PSA <10 ng/mL |
| Intermediate / advanced | 100% of sum assured | Gleason score ≥7, Stage T2b or higher, or requiring radical treatment |
| Below threshold | 0% | Diagnosed but does not meet minimum severity criteria in limits table |
The clinical threshold that separates €0 from €25,000 or €100,000 is defined in the limits table, not in general policy descriptions. Reading the full policy document — not just the product brochure — is essential.
Why this matters — the market evidence
The limits table is not an academic concern. mylife.ie's whole-of-market claims report for 2024 — the first study to consolidate published claims experience across all five Irish life offices — shows the schedule is the single biggest driver of whether a serious illness claim is paid.
In 2024 the five offices paid out more than €847.7m in total protection claims, of which roughly €152m related to specified serious illness. Serious illness paid rates ranged from 82% (Aviva) to 92.5% (Irish Life), materially below the 98–99%+ life cover rate. The dominant reason for declines in both Irish Life and New Ireland disclosures: definition not met.
How limits tables differ across the five Irish life offices
| Variable | What to look for | Why it matters |
|---|---|---|
| Number of partial conditions | Higher is broader cover | More diagnoses eligible for partial payout |
| Partial payment % for early-stage cancer | 10% vs 25% across offices | Material difference in payout on common cancers |
| Minimum severity for full-payment heart attack | Troponin level or territory of damage | Some offices pay full on less-severe events |
| Stroke definition | Neurological deficit duration | 24-hour vs permanent deficit threshold varies |
| Children's conditions | Included as standard vs optional | Some offices cover paediatric conditions without extra charge |
Frequently asked
Do all Irish life offices use the same serious illness definitions?
No. While broadly similar, each of the five offices publishes its own policy document with its own conditions schedule, severity thresholds, and partial payment percentages. Differences are most pronounced for early-stage cancers and less-severe heart attacks.
What is the most commonly claimed serious illness condition in Ireland?
Cancer is consistently the most-claimed category across all five Irish offices, accounting for 62–68% of serious illness claims depending on the insurer. Heart attack and stroke are the next most common. mylife.ie's whole-of-market claims report for 2024 sets out the full breakdown by condition and by office.
Can a condition be on the list but still not pay out?
Yes — if the diagnosis does not meet the severity threshold defined in the limits table, the policy pays nothing for that condition, even if the condition name is listed in the brochure. This is the single most common source of consumer disappointment in serious illness claims.
How often are serious illness claims declined in Ireland?
In 2024, paid rates ranged from 82% (Aviva) to 92.5% (Irish Life), materially below the 98–99%+ paid rate on life cover. The dominant reason for declined SI claims is that the diagnosis did not meet the severity threshold defined in the limits table.
Is it worth adding serious illness to my mortgage protection?
It depends on your budget and risk tolerance. A diagnosis of a serious illness while you still have a mortgage creates a double financial burden — you may be unable to work while still needing to service the loan. A serious illness accelerator on the mortgage protection policy can clear the mortgage on diagnosis, not just on death.
About the author
Donal Milmo-Penny QFA FLIA — Research Lead, mylife.ie. Qualified Financial Adviser and Fellow of the Life Insurance Association. Former Chairman of PIBA and Director of Brokers Ireland.
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This article provides general information only and does not constitute personal financial, tax, or legal advice. mylife.ie is a trading name of SMP Financial Ltd, regulated by the Central Bank of Ireland as an insurance intermediary (C42382). Telephone 01 662 9133.