The AIB Specified Illness Definitions Guide. An explanation of the illnesses and disabilities covered

Transcription

1 The AIB Specified Illness Definitions Guide An explanation of the illnesses and disabilities covered

2 This booklet is a general guide to the illnesses and disabilities covered by Specified Illness Cover under the AIB Safeguard Plan and the AIB Mortgage Protection Plan. It also describes when and how you can make a claim. Please use this guide in conjunction with the AIB Safeguard Plan and the AIB Mortgage Protection Plan brochures. As far as possible, it has been written in layman s language and more precise definitions are set out in your policy document. In the event of any disparity between the wording in this guide and the wording in the policy document, the latter will prevail. The policy also contains certain exclusions, principally (but not exclusively) related to self-inflicted injuries and residence outside stipulated countries. You should note that all claims will need to be supported by the diagnosis of a specialist consultant in the appropriate medical discipline (in Ireland or any other country specified in the policy documents) and evidence may also be required in the form of relevant tests. Copyright Ark Life, July 2009.

3 Contents Alzheimer s disease (including Pre-senile dementia) 1 Angioplasty 1 Aorta graft surgery 2 Aplastic anaemia 2 Bacterial meningitis 2 Benign brain tumour 3 Blindness 3 Cancer (Invasive) 4 Cardiomyopathy (Dilated) 4 Coma 5 Coronary artery by-pass surgery (Grafts) 5 Creutzfeldt-Jacob disease 5 Deafness 6 Encephalitis 6 Heart attack 6 Heart valve replacement or repair 7 HIV infection 7 Kidney failure 8 Liver failure 8 Loss of speech 8 Loss of hands or feet 8 Major organ transplant 9 Motor neurone disease 9 Multiple sclerosis 9 Paralysis of limbs 10 Parkinson s disease 10 Pre-senile dementia 10 Progressive supra-nuclear palsy 11 Pulmonary artery replacement 11 Severe lung disease 11 Stroke 12 Third degree burns 12 Traumatic head injury 12 Total and permanent disability 13 How to make a Specified Illness Claim 14

4 An explanation of the illnesses and disabilities covered

5 Alzheimer s disease (including Pre-senile dementia) It is a form of dementia which attacks the brain, causing the death of cell tissue. It typically starts with memory lapses, difficulty in finding the right words for everyday objects or mood swings. Later, sufferers become confused, undergo personality changes, forget recent events and are unable to concentrate. Sufferers deteriorate over time and need constant supervision and help. However, they often remain strong physically and may retain a reasonably normal life expectancy. If you are diagnosed by a Consultant Neurologist, Psychiatrist or Geriatrician as suffering from either Alzheimer s disease or Pre-senile dementia and are displaying the symptoms which include a progressive and permanent deterioration of memory and the ability to reason and to perceive, understand, express and give effect to ideas to the extent that you require permanent supervision and assistance. The condition must have persisted for at least 6 months. Angioplasty This is a generic term for the surgical procedures which must be carried out in a single operation, to treat severe coronary artery disease the narrowing or blocking in 2 or more of the main arteries that carry the blood to and from the heart. A fine balloon catheter (a flexible plastic tube) is inserted into each artery then inflated, to force the walls of the artery apart and allow blood to flow freely. The term angioplasty is also applied to other procedures which deal with blocked arteries including atherectomy a procedure to remove fatty plaques and abnormal tissue from the walls of the artery; rotablation, under which fatty deposits are cut away from the arteries using a drill guided by a flexible tube; laser treatment under which the obstruction in the coronary artery is destroyed through the use of a laser beam; and stents, which are synthetic tubes inserted into arteries to relieve the obstruction caused by fatty deposits. If you undergo surgery to correct a narrowing of 70% or more in your coronary arteries provided that it was impossible to control the narrowing by non-invasive medical therapy and that the surgery is carried out on at least two coronary arteries in the same operation. The insertion of a coronary catheter to investigate the heart, where it does not result in treatment to correct a narrowing or blockage, as described above. Two or more procedures to the same artery or procedures to any of the branches of the main coronary arteries. 1

6 Aorta graft surgery for disease The aorta is the main artery of the body and it supplies oxygenated blood to the other arteries. If the aorta becomes narrowed, it cannot function properly; such narrowing may be due to the build-up of fatty deposits on the walls of the artery or to an aneurysm, which is where the artery becomes thin and dilated. In some instances the aorta may also become torn, leading to a surgical emergency. In any of these situations, a graft may be required to replace the part of artery that has been weakened. If you undergo surgery to correct by means of a graft any narrowing, tearing or aneurysm of the thoracic or abdominal aorta. What isn t covered Any other surgical procedure. Surgery following traumatic injury to the aorta (i.e. from an accident). Aplastic anaemia It is a decrease in the quantity of blood forming cells in the bone marrow, leading to impaired blood cell production. Regular blood transfusions are needed, but death may occur at any time, due to the severe anaemia, infection, haemorrhage or as a side effect of treatment. If you are suffering from aplastic anaemia that is so severe that you undergo a bone product or bone marrow transplant or are treated with drugs or marrow stimulating agents, to suppress your immune system. What isn t covered Any other forms of anaemia. Bacterial meningitis It is a bacterial disease causing inflammation of the meninges, which are the protective coverings that surround the brain and spinal cord. It can damage the physical neurological system resulting in permanent functional impairment or death. However, with prompt treatment, a full recovery can sometimes be made. If you are suffering from bacterial meningitis which results in brain damage, causing permanent neurological impairment. Bacterial meningitis which does not result in permanent neurological impairment. Other types of meningitis, including viral meningitis. 2

7 Benign brain tumour It is an abnormal, non-cancerous, tissue growth in the brain. It doesn t spread to other parts of the body but may cause brain damage or be life-threatening, because of pressure on areas of the brain. The tumour may have to be removed by surgery but there is a risk that this procedure may result in damage to other parts of the brain. In some instances, surgery is not possible. If you are diagnosed as having a benign tumour, growing within the tissue of the brain. Any non-malignant growth within the brain which does not cause permanent neurological symptoms. Growths outside the actual brain tissue. Blindness permanent and irreversible It is the total and permanent loss of sight in both eyes. After a period of at least six months in which you suffer the total and irreversible loss of sight in both of your eyes which means that you have no vision whatsoever. Partial sight being retained in either eye. Qualifying for a Department of Social Welfare blind pension will not necessarily justify a claim. 3

8 Cancer (Invasive) Cancer is the generic word covering a range of malignant invasive tumours, which can spread to surrounding tissues. They may then spread further via the blood stream or lymphatic system, to form more growths in other parts of the body. The term cancer includes leukaemia, which is cancer of the white blood cells; lymphoma, which is cancer of the lymphatic system (a vital part of the body s immune system); Hodgkin s disease, a type of lymphoma often associated with swelling in the neck, armpits, groin, chest or abdomen; and invasive malignant melanoma, an aggressive cancer which affects the skin and may spread to other parts of the body. If you are suffering from a malignant tumour which has invaded surrounding tissue and there are test results to confirm this, such as a sample of the relevant cells (called a histological sample). Pre-malignant and non-invasive cancer in situ (in the early stages and which hasn t spread to surrounding tissue) as they are unlikely to be life-threatening. Lymphoma or Kaposi s sarcoma in the presence of AIDS or HIV. Skin cancer, other than invasive malignant melanoma. Prostate tumours may be excluded depending on their severity, as defined by standard medical classifications. Cardiomyopathy (Dilated) It is a serious heart condition in which the heart muscle, usually the lower chamber, can no longer effectively receive or pump blood through the body resulting in shortness of breath, chest pain and fainting. The condition can be temporary or permanent. If permanent, it cannot be cured and usually deteriorates over time. If you are suffering from a dilated cardiomyopathy which is permanent and which is causing symptoms which significantly hinder normal everyday activities. Further evidence will be required in the form of recorded electrical impulses during an exercise test. Acute myocarditis (inflammation of the heart muscle) as sufferers usually make a full recovery. Cardiomyopathy caused by the misuse of alcohol or drugs. Less severe cardiomyopathy, which does not significantly hinder everyday activities. 4

9 Coma It is a state of unconsciousness, due to brain damage, in which the sufferer has little or no response to any physical stimulation and has lost control of his/her bodily functions. It can be caused by a head injury, a stroke, abnormal growth, and a ruptured blood vessel in the brain or by lack of oxygen. The coma may result in permanent brain damage but, in some cases, the patient may recover completely. If you have been in a coma, with minimal reaction to external stimulation, for at least 96 hours, life support systems are necessary, and there is evidence of permanent neurological damage. A coma induced by either alcohol or drug abuse. Coronary artery bypass surgery (Grafts) It is a procedure under which a vein or artery is grafted on to your heart, to direct blood past a diseased or blocked artery; it usually involves a surgeon opening the chest wall to reach the heart known as open heart surgery. The procedure is used when coronary arteries have become narrowed or blocked. A triple bypass is the term used to describe the procedure when three coronary arteries are bypassed in this way. If you undergo open-heart surgery to divide the breastbone on the advice of a Consultant Cardiologist to correct a narrowing or blockage of one or more of your coronary arteries with bypass grafts. Creutzfeldt-Jakob disease It is a form of dementia which may be inherited or acquired, due to a progressive degeneration of the nerve cells of the central nervous system. There is no cure for this disease and death usually occurs within a year of the first symptom. New variant CJD is the name given to a similar disease, thought to be acquired from eating meat from cows that were infected by BSE (bovine spongiform encephalitis). If you are diagnosed as suffering from Creutzfeldt- Jakob disease or new variant CJD. 5

10 Deafness It is the total and permanent loss of hearing in both ears. After a period of at least six months in which you suffer the total and irreversible loss of hearing in both of your ears which means that you have no hearing whatsoever. Partial hearing being retained in either ear. Being diagnosed as deaf, with a reduced hearing ability, will not justify a claim. Encephalitis It is an inflammation of the brain, nearly always due to a viral infection but it can also be caused by parasites, fungi or malaria. The symptoms are fever, headache, drowsiness, lethargy, tremors and a stiff neck and back. Its severity and intensity can vary widely from a short-term mild attack to a long-term illness resulting in paralysis, coma and death. If you suffer from encephalitis which results in permanent neurological impairment. Encephalitis in the presence of HIV infection. Heart attack It is the death of part of the heart muscle. The heart pumps blood around the body and, if the supply of blood to the heart muscle is acutely restricted, a part of the muscle may die. This is technically known as a myocardial infarction and is commonly known as a heart attack. It is likely that severe chest pains will be experienced at the time of the heart attack. To diagnose that a heart attack has actually taken place, a doctor will use an electrocardiogram (ECG), which produces a graphic plot of the electrical activity in the heart. When the heart muscle dies, chemicals such as cardiac enzymes, troponins and other biochemical markers are released into the blood stream. A blood test showing higher than normal levels of these chemicals will indicate the likelihood that a heart attack has recently taken place. If you suffered from a heart attack and there are positive results from relevant tests to confirm this. Pain in the chest, including angina pectoris, where there is no evidence of myocardial infarction. 6

11 Heart valve replacement or repair It is a procedure to replace one or more heart valves, which regulate and control the flow of blood into and out of the heart, or to correct structural abnormalities in the heart. If you undergo open-heart surgery to correct or replace heart valves or to remedy structural abnormalities. The heart has four valves and if they become narrow or leak, it may become necessary to replace or repair them. Structural abnormalities in the heart can cause an opening in the wall supporting the left and right chambers of the heart. HIV infection Human immunodeficiency virus (HIV) is generally recognised as the virus that causes Acquired Immune Deficiency Syndrome (AIDS). The virus can be passed on in several ways, including through contaminated blood, bloodstained fluids and infected needles. The main form of transmission is through the sexual interchange of body fluids. AIDS is usually fatal, although modern drugs can extend a sufferer s life expectancy significantly. Because the body s immune system is unable to fight off infections, death is often caused by other illnesses, such as pneumonia. Some professions, including emergency services and medical workers, may be at an increased risk, due to the accidental puncturing of their skin by needles or scalpels contaminated with infected blood. If you contract HIV and AIDS as a result of: A blood transfusion (within the territorial limits), or A physical assault on you, or An injury such as needlestick, in the course of your occupation if you provide accident and emergency, medical, dental or nursing services, or you work in the police or prison services. Your claim must follow the procedure set out in your policy document. HIV or AIDS contracted in other ways. 7

12 Kidney failure requiring dialysis It is an irreversible failure of both kidneys to function. The kidneys remove waste products from the blood and, if they both fail, the blood will not be cleaned and, ultimately, death will occur. When the kidneys cannot function properly, the sufferer will need renal dialysis (the regular use of a machine to replace the filtering function of the kidneys) to stay alive. The only cure is transplantation where the sufferer s diseased kidney is removed and replaced by a healthy kidney from a donor. If both of your kidneys have failed, you are undergoing regular dialysis or a transplant has been carried out. Losing a single kidney as the body can function adequately with only one. Donation of one of your kidneys to another person. Liver failure It is an irreversible failure of the liver to function. The liver secretes bile, forms and stores glycogen (a source of energy) and emits urea into the urine. It helps to break down foreign materials in the body and has exceptional powers of self-repair. End stage liver failure is likely to lead to death fairly quickly. If you are diagnosed as suffering from end stage liver failure. Liver failure caused by the misuse of alcohol or drugs. Loss of speech What it is? It is the total and permanent loss of speech as a result of physical damage to, or disease of, the vocal cords. After a period of at least 12 months in which you suffer the total and irreversible loss of speech. Loss of hands or feet The irreversible severance of two or more limbs from at or above the wrist or ankle. This may be caused by an accident or disease. Approximately half of all lower limb complications are due to diabetes. If you have lost two or more limbs as specified. 8

13 Major organ transplant It is the replacement of a severely diseased or damaged organ a heart, a kidney, a lung, a liver, a pancreas or bone marrow with a healthy organ. Early organ transplants were risky and mortality was high. However, today s drug treatments can help to prevent rejection and infection and, with improved surgical techniques, the success rate is now significantly higher. If you have undergone surgery to receive a new heart, lung, pancreas, kidney, liver or bone marrow or if you have been placed on a recognised waiting list for such a transplant by a suitably qualified consultant physician. Donation of one of your organs to another person. Motor neurone disease It is a disease of the central nervous system that controls muscular activity; as the nerves deteriorate, the muscles weaken and degrade, but without the loss of sensation. The condition is progressive and irreversible and its cause is unknown. If you contract motor neurone disease. Multiple sclerosis It is a progressive and incurable disease of the central nervous system. It destroys the protective covering (myelin) of the nerve fibres in the brain and spinal cord. The severity of the disease can vary considerably. The symptoms can differ, depending on which areas of the brain or spinal cord have been affected, but typically include temporary blindness, double vision, loss of balance and a lack of co-ordination. If you suffer from Multiple sclerosis. Your claim must be supported by the results of modern investigational techniques (such as a CT scan, lumbar puncture or MRI scan) and evidenced by the typical symptoms of demyelination we have described and the impairment of your motor and sensory functions, which must have persisted for a continuous period of at least six months. 9

14 Paralysis of limbs Total and irreversible Paralysis is the complete and permanent loss of function in two or more limbs. It can arise from an accident or can be caused by a disease, such as cerebral palsy or muscular dystrophy. You can claim if you have lost the use of two or more limbs as described above and the condition is permanent and cannot be cured by medical treatment or surgical procedure. Parkinson s disease It is a progressive and degenerative disorder that affects the central nervous system. It becomes apparent when 80% of the nerve cells that produce dopamine fail; dopamine is the chemical messenger which helps to co-ordinate the body s movements. The principal symptoms are shaking (which affects 70% of sufferers), stiffness and slowness of movement (bradykinesia), rigid facial expression and unstable gait. The progression of the disease is slow and there is no known cure although drugs and physical therapies can help to minimise mobility problems. If you are diagnosed as suffering from idiopathic Parkinson s disease to the extent that you need supervision in daily tasks, such as dressing and eating and the condition has persisted for at least six months. Diagnosis of the disease is not itself covered; you must also require personal supervision. Only idiopathic Parkinson s disease is covered, idiopathic means that the cause is unknown. Non-idiopathic Parkinson s disease which results from a known cause, such as certain drugs or toxic chemicals is not covered. Pre-senile dementia See Alzheimer s disease (page 1) 10

15 Progressive supra-nuclear palsy A rare brain disorder that causes serious and permanent problems of balance and movement. The progressive nature of this disease means that sufferers lose control of eye movement, and have increased bouts of giddiness, incidents of falls and changes of mood for no apparent reason. Swallowing liquids or solid foods becomes progressively more difficult and the voice also becomes increasingly slurred. When an unequivocal diagnosis of Progressive Supra-Nuclear Palsy has been made by a Consultant Neurologist. Pulmonary artery replacement The pulmonary arteries deliver unoxygenated blood from the right ventricle of the heart to the lungs. They are the only arteries in the human body that carry unoxygenated blood and are naturally protected by the breastbone and upper rib-cage. When these arteries are damaged or need replacement, the surgical procedure requires the breastbone to be separated. If you undergo surgery to repair or replace the pulmonary artery. Severe lung disease As the title suggests, it is disease of the lungs, similar to a chronic or longstanding form of bronchitis. The small air sacs of the lungs are destroyed or distorted leaving larger spaces than normal, often surrounded by fibrous scar tissue. If you suffer from a severe and restrictive chronic lung disease which significantly hinders your everyday activities and is evidenced by tests to show that: Your vital capacity is less than 50% of normal, and Your FEV1 (forced expiratory volume at one second) is less than 40% of normal, and You need to use an oxygen mask every day 11

16 Stroke It is an incident which results in permanent damage to brain function caused when the blood supply to the brain is disrupted, usually when a blood clot blocks an artery. It may also be caused by bleeding within or around the brain from a burst blood vessel. The most common effects are paralysis on one side of the body and the loss of the ability to speak, read or write. If you suffer from a stroke that leaves evidence of permanent damage to the neurological system. Transient ischaemic attacks (known as ministrokes) as these are only short term interruptions of the blood supply to the brain and do not cause permanent damage. Third degree burns What are they? There are three levels or degrees which classify the extent of burns. First degree burns damage only the upper layer of the skin (eg sunburn). Second-degree burns go deeper, but can heal without scarring. Third degree burns destroy the full thickness of the skin; they are usually treated by skin grafts taken from other parts of the body or from a tissue bank or by using artificial skin. If you suffer third degree burns over at least 20% of the surface area of your body. Traumatic head injury It is a physical injury to the head which results in brain damage, leading to permanent neurological impairment. If, as a result of a head injury, you suffer severe and permanent brain damage, evidenced by modern scanning or imaging techniques. 12

17 Total and permanent disability It is a permanent and irreversible disability, caused by illness or accident, which results in an inability to perform: 1 if, at the start of the disability you are under age 65, three of the following activities without the assistance of another person: walking for 200 metres on a level surface, If you are permanently and irreversibly disabled to the extent that your inabilities fall within the relevant definition and persists for at least 12 months (24 months in the case of mental incapacity) within the terms of your Plan. Any disability that is not permanent. lifting a 1 kilogram weight from table height with either hand and carrying it for 5 metres, using a pen, pencil or keyboard with either hand, hearing well enough (without a hearing aid or sound enhancement appliance) to understand someone talking normally in a quiet room, or inability to be understood in a common language by work colleagues in a quiet room, reading (with spectacles or contact lenses), from a book with large print (16 point type), OR 2 if, at the start of the disability you are aged 65 or more and you are unable to carry out three of the following activities without the assistance of another person: walking 10 metres on a level surface without stopping, getting into or out of a standard saloon car, bathing or showering, dressing or undressing, eating with a knife, fork and spoon. Total and permanent disability will also be considered to have arisen in the event of severe mental incapacity which has failed to respond to at least 2 years treatment provided that it has also caused severe impairment to your psychological, social and occupational functioning and, as a result, you need continuous medication, plus ongoing supervision and care. 13

18 How to make a claim What you should do 1 Check your policy schedule and the special conditions (if any). These documents show who is covered and any specific exclusions to the cover that apply to your plan. 2 Check the policy documents for the relevant disease or disability, to make sure that your claim is valid. 3 Contact us on Telephone (01) , Fax (01) or write to us at: Ark Life Assurance Company Limited, One Park Place, Hatch Street, Dublin 2. 4 Tell us about your claim as soon as you can. We require you to tell us about your claim: Within 6 months of you suffering from a specified illness. No earlier than 3 months and no later than 9 months of you becoming totally and permanently disabled. Within 14 days of any occupational injury or physical assault which could result in an eligible claim for an HIV or AIDS infection. Please note that we may not pay a claim (except for a death claim) if the above time limits are exceeded. 5 Maintain the premium payments to the plan, until we confirm that all the requirements relating to your claim have been met and that the premiums can therefore cease. What we will need 1 A completed claim form. (We will send you a form as soon as you contact us.) If you have any difficulty in completing the form, please let us know and we may be able to send someone to help you. 2 Confirmation from an appropriate medical specialist that your claim satisfies the specified definition. An appropriate medical specialist is someone who holds an appointment as a consultant (or equivalent) at a hospital in Ireland or any other country specified in the policy documents, is a specialist in the medical discipline relevant to your illness or disability and is accepted as such by our Chief Medical Officer. 3 Evidence that you have survived for at least 14 days after the confirmation of your illness or disability by the appropriate medical specialist. (This requirement does not apply in the case of a life assurance claim.) 4 For some claims, we will also need evidence of the permanence of the condition. We aim to pay all valid claims as soon as possible but there may sometimes be a delay while we wait for additional evidence or tests. We will always seek to reach a decision within a maximum period of 6 to 12 months (but, in the case of mental incapacity, the conditions within the policy documents mean that it will take longer). 14

19 This brochure has been produced by Ark Life Assurance Company Limited, a subsidiary of Aviva Life Holdings Ireland Limited, a joint venture company between Aviva Group Ireland plc and Allied Irish Banks, p.l.c. Great care has been taken to ensure the accuracy of the information it contains. This brochure is not a legal document and, should there be any conflict between the brochure and the policy document, the latter will prevail. Copyright Ark Life Assurance Company Limited, July 2009.

20 Ark Life Assurance Company Limited One Park Place, Hatch Street, Dublin 2 Telephone: (01) This product is provided by Ark Life Assurance Company Limited, a subsidiary of Aviva Life Holdings Ireland Limited. Aviva Life Holdings Ireland Limited is a joint venture company between Aviva Group Ireland plc and Allied Irish Banks, p.l.c. Ark Life Assurance Company Limited and Allied Irish Banks, p.l.c. are regulated by the Central Bank of Ireland. Terms and Conditions apply.