Tesco Bank Life and Critical Illness Insurance. Policy terms and conditions

Transcription

1 Tesco Bank Life and Critical Illness Insurance Policy terms and conditions

2 Policy terms and conditions These policy terms and conditions describe your policy, including: our obligations to you your cover claims conditions your obligations to us These policy terms and conditions provide you with information you need to know about your Tesco Bank Life & Critical Illness Insurance policy. It is important that you read them carefully along with your policy schedule. If a claim is to be made, these policy terms and conditions will be useful, so please keep them somewhere safe. Should you have any questions or queries about your policy then call us on and we will be pleased to help you. You will see some words shown in bold type which are defined terms and have specific meanings when used in this document. The meanings of these words are shown in the definitions section at the front. We will always act fairly, in good faith and in a reasonable manner towards you when dealing with your policy and when applying these policy terms and conditions. We encourage you to tell us whenever you feel we have not done so. This commitment is an overriding principle and you should read each of the sections in these policy terms and conditions in light of this commitment. Tesco Bank Life & Critical Illness Insurance is provided by Aviva Life & Pensions UK Limited. Contents Definitions 3 Summary of benefits 4 Entitlement to benefits 5 Benefits reflecting future life changes 6 Policy flexibility 8 Claims conditions 8 General conditions 9 Appendix A -details of critical illnesses and children s critical illnesses covered 10 Appendix B - details of additional critical illnesses and children s critical illnesses covered 22

3 Definitions Throughout these policy terms and conditions certain words are shown in bold type. These are defined terms and have specific meanings when used. The meanings of these words are set out below. Activities of daily work The activities of daily working or serious conditions, as detailed in Appendix A in respect of critical illness benefit. Additional critical illness An illness or condition suffered by the life insured, as detailed in Appendix B, which the life insured survives for at least 14 days after meeting the relevant additional critical illness definition. Anniversary date The anniversary of the start date. Application The application that you made and that we have accepted. Attending Consultant The appropriately qualified medical specialist supervising care of the life insured. Critical illness An illness or condition suffered by the life insured, as detailed in Appendix A, which the life insured survives for at least 14 days after meeting the relevant critical illness definition. Children s critical illness An illness or condition suffered by the life insured s child, as detailed in Appendix A (but excluding Total Permanent Disability), and Appendix B which the life insured s child survives for at least 14 days after meeting the relevant critical illness or additional critical illness definition. The illness or condition must not have been present at birth (whether diagnosed or not) and the symptoms must not have started before the start date. Duties The material and substantial duties that are normally required for and form a significant and integral part of the performance of the life insured s own occupation that cannot be reasonably omitted or modified. End date The date shown in the policy schedule on which benefits under this policy end. Life insured This is the person whose life is being covered and in the event of their death, diagnosis of terminal illness, diagnosis of critical illness or additional critical illness a claim could be made. Life insured s child This is the child of the life insured and in the event of their diagnosis of one or more of the children s critical illnesses covered a claim could be made. Life insured s child includes natural children, step children, legally adopted children and future children of the life insured. Cover will start from when a child of the life insured is 30 days old and end on their 18th birthday, or 21st birthday if they are in full time education. By full time education we mean attendance at a full time course at a school, college or university. This includes placements that are part of a full time course, but excludes breaks from education, for example gap years. Own occupation The occupation which the life insured is following before Total Permanent Disability in respect of critical illness benefit. Occupation means a trade, profession or type of work undertaken for profit or pay. It is not a specific job with any particular employer and is irrespective of location and availability. Policy This Tesco Bank Life and Critical Illness Insurance policy. Policyholder The person/persons or company named as policyholder in the policy schedule or any other person who becomes the legal owner of the policy. Policy schedule This will show the specific detail of your policy, such as who it covers, the amount covered, how much it will cost and any policy options and benefits included. Policy terms and conditions This document which forms our contract of insurance with the policyholder providing the cover under the policy as agreed. The application and policy schedule also form part of the contract and must be read together with these policy terms and conditions. Premium This is the monthly amount you will be required to pay in order for the benefits to be maintained. Monthly premiums must be paid by Direct Debit instruction from a current bank or building society account in the United Kingdom, Channel Islands or Isle of Man. Premium due date The day each month on which premiums are due.

4 Standard terms The premium and benefits we quote before the underwriting process is completed. Following an application being underwritten we may only be able to offer cover with a higher premium than first quoted, certain benefits excluded, or both. This would not be classed as standard terms. We will have confirmed whether you were accepted on standard terms when confirming our decision on your application. Start date The date shown in the policy schedule on which cover under this policy starts. Sum insured The amount payable under this policy in the event of a claim which we accept. The amount payable is set out in your policy schedule. Terminal illness A definite diagnosis by the attending Consultant of an illness that satisfies both of the following: The illness either has no known cure or has progressed to the point where it cannot be cured; and In the opinion of the attending Consultant, the illness is expected to lead to death within 12 months. We/our/us Aviva Life & Pensions UK Limited (company registration number ). You/your The person/persons or company named as policyholder in the policy schedule or any other person who becomes the legal owner of the policy. Summary of benefits These policy terms and conditions are written confirmation of a contract between Aviva Life & Pensions UK Limited and the policyholder. In return for the payment of the agreed premiums we will pay the benefits in accordance with the policy terms and conditions. The benefits available under this policy are set out in the table and are payable in the event of a claim which we accept. The table provides a brief summary of the benefits available under this policy. It is important to read the information in this table alongside these policy terms and conditions and policy schedule. Benefits Death benefit We will pay the death benefit if the life insured dies during the term of the policy. Terminal illness benefit We will pay the terminal illness benefit if, before the last 12 months of the policy, the life insured is diagnosed with a terminal illness. Critical illness benefit We will pay the critical illness benefit if the life insured is diagnosed with one or more of the critical illnesses covered by this policy during the term of the policy. Amount payable The sum insured as set out in the policy schedule less any unpaid premiums. The sum insured as set out in the policy schedule less any unpaid premiums. The sum insured as set out in the policy schedule less any unpaid premiums. Additional critical illness benefit We will pay the additional critical illness benefit if the life insured is diagnosed with one or more of the additional critical illnesses covered by this policy during the term of the policy. Children s critical illness benefit If this is included on your policy we will pay the children s critical illness benefit if a life insured s child is diagnosed with one or more of the children s critical illnesses covered by this policy during the term of the policy. Protection Promise (house purchase cover) We will pay the Protection Promise (house purchase cover) benefit if the life insured dies in the period covered by the Protection Promise (house purchase cover). The lower of 20,000 or 20% of the sum insured as set out in the policy schedule. The lower of 25,000 or 50% of the sum insured as set out in the policy schedule. The lower of the purchase price (as confirmed when contracts are exchanged), 1,000,000 or the sum insured as set out in the policy schedule.

5 Entitlement to benefits We will pay the death benefit if the life insured dies within the policy term; or We will pay the terminal illness benefit if, before the last 12 months of the policy, the life insured is diagnosed with a terminal illness; or We will pay the critical illness benefit if the life insured is diagnosed with one or more of the critical illnesses covered by this policy during the policy term; or We will pay the lower of the purchase price (as confirmed when contracts are exchanged), the death benefit or 1,000,000 if the life insured dies in the period covered by the Protection Promise (house purchase cover). We will pay the lower of 20,000 or 20% of the sum insured if the life insured is diagnosed with one or more of the additional critical illnesses covered by this policy during the policy term. If included on your policy we will pay the lower of 25,000 or 50% of the sum insured if a life insured s child is diagnosed with one or more of the children s critical illnesses covered by the policy during the policy term. We will pay benefits if we have accepted a claim. The policy has no cash-in value at any time. Death benefit If the life insured dies within the policy term and we have accepted the claim, we will pay the sum insured as set out in the policy schedule, less any unpaid premiums. We will only pay the death benefit on one occasion and once this is paid the policy will cease. Terminal illness benefit If the life insured is diagnosed with a terminal illness before the last 12 months of the policy, provided we have accepted the claim, we will pay the sum insured as set out in the policy schedule, less any unpaid premiums. We will only pay the terminal illness benefit on one occasion and once this is paid the policy will cease. Critical illness benefit If the life insured is diagnosed with a critical illness during the policy term, provided we have accepted the claim, we will pay the sum insured as set out in the policy schedule, less any unpaid premiums. We will only pay the critical illness benefit on one occasion and once this is paid the policy will cease. Additional critical illness benefit If the life insured is diagnosed with an additional critical illness during the policy term, provided we have accepted the claim, we will pay the lower of either 20,000 or 20% of the sum insured as set out in the policy schedule. We will only pay the additional critical illness benefit if no premium is due and unpaid, and provided a claim for critical illness benefit or terminal illness benefit has not already been accepted under this policy. If a claim meets the definition for critical illness benefit and an additional critical illness benefit at the same time, we will only pay a claim for the critical illness benefit. Additional critical illness benefit will only be paid once in respect of each of the conditions listed in Appendix B for each life insured and then the benefit will cease in respect of that life insured. Children s critical illness benefit This section only applies if you are the policyholder and life insured. Your policy schedule will confirm whether this benefit is included on your policy. If the life insured s child is diagnosed with a children s critical illness during the policy term, provided we have accepted the claim, we will pay the lower of 25,000 or 50% of the sum insured as set out in the policy schedule. We will only pay the children s critical illness benefit under the policy on one occasion in respect of the same child. Once we have paid a children s critical illness benefit the policy will continue and further children s critical illness claims can be made in respect of any other of the life insured s children. Once we have accepted a claim for the death benefit, the critical illness benefit or the terminal illness benefit, the policy will cease and no further claims for children s critical illness can be made. Protection Promise (house purchase cover) If your application for cover has: a. been accepted by us; and b. you have provided us with a cover start date in the future to coincide with the completion of your house purchase; and c. you have exchanged contracts on that house purchase we will provide free cover between exchange of contracts and completion of the property purchase. (In Scotland we will provide the free cover from when missives are completed for the property until the date of entry.) The amount of cover will be the lower of the purchase price (as confirmed when contracts are exchanged), the death benefit as set out in the policy schedule or 1,000,000. The cover will be provided for a maximum period of 90 days from the date that contracts are exchanged (or in Scotland missives are complete) on the property purchase. Cover will end on the earlier of 90 days, the date of the completion of your house purchase or the start date of your policy. We will only pay the Protection Promise (house purchase cover) benefit on one occasion, no further benefits will be payable and once paid the policy will cease.

6 Repayment guarantee The additional benefits section of your policy schedule will confirm whether this benefit is included on your policy. If you have chosen decreasing cover in connection with a mortgage loan in your name and at the time that you make a claim (which is accepted by us) for the death benefit, the critical illness benefit or the terminal illness benefit, the sum insured is less than the amount of the outstanding mortgage loan in your name, we will pay the outstanding mortgage loan provided that: a. The difference between the sum insured and the outstanding mortgage loan is due solely to a higher rate of interest being charged than that used in the calculation of the table of benefits in the policy schedule; b. The initial gross rate of interest charged on the mortgage loan at the start date of the policy was less than 10%; c. The policy does not end before your mortgage loan is due to be repaid; d. The amount of cover at the start date of the policy was at least the size of the mortgage loan (or the part of the mortgage loan the policy covers). c. the end date of the new policy is before the life insured s 70th birthday (for a joint life policy this would apply to the oldest life); and d. you have not made or are not eligible to make a claim for the death benefit, the critical illness benefit the additional critical illness benefit or the terminal illness benefit, and e. you take out a new policy within 90 days of the life change event occurring; and f. you send us the evidence of the life change event that we need. The terms and conditions applicable at the date when you take out the policy will apply to the new policy. We will use the premium rates in force at the time of the request based on the life insured s age at the time of making the applications. The new policy will not include life change benefit or replacement benefit but can include separation benefit. The new policy can include critical illness benefit (and therefore additional critical illness benefit) or you can choose not to include it. Benefits reflecting future life changes Life change benefit The additional benefits section of your policy schedule will confirm whether this benefit is included on your policy. This benefit only applies to a policy which: a. is taken out by you on your own life; and b. is accepted by us on our standard terms; and c. has not been taken out under the life change benefit, replacement benefit or separation benefit. For the life change events described in this section, you can take out a new policy with no requirement for further underwriting. The new policy can be either level or decreasing cover. If your policy is a joint life policy then the new policy can either be a joint life policy or single life policy only. The policyholders will need to be in agreement to the new policy, regardless of whether the new policy is a joint life policy or single life policy only. It is not possible to change the life insured. You may use this benefit as many times as you like provided that: a. the total sum insured for all policies issued under the life change benefit does not exceed 200,000 or the original sum insured of this policy (whichever is the lower); and b. you take out a new policy before the life insured s 55th birthday (for a joint life policy this would apply to the oldest life); and Life change event Marriage or Civil Partnership Divorce, dissolution of Civil Partnership or separation. Having or adopting a child Buying a first home (with a mortgage on the property) Moving house Buying a second home Home improvements Child starting higher education Salary increase of 20% or more Evidence needed Marriage certificate or Civil Partnership certificate. Decree Absolute or Dissolution order. Alternatively, evidence of a transfer of mortgage or new mortgage or evidence of new addresses. Birth certificate or adoption certificate. Evidence of the mortgage on the property. Evidence of new mortgage on the property or utility bills for the property. Evidence of new loan or mortgage on the property. Evidence of new loan or mortgage on the property or increase to the existing loan or mortgage on the property. Alternatively the builders receipt for the work undertaken. University or college registration document. Copy of payslips, dated within 90 days of each other, evidencing the increase in salary.

7 Replacement benefit The additional benefits section of your policy schedule will confirm whether this benefit is included on your policy. This benefit only applies if: a. this is a joint life policy where both policyholders are the only lives insured; and b. the policy is accepted by us on our standard terms; and c. the policy was not taken out under a life change benefit; and d. the policy has ended due to a valid death benefit claim, critical illness benefit claim or terminal illness benefit claim which has been accepted by us; and e. you, being the person entitled to take out a new policy, are not eligible to make a claim for the critical illness benefit, the additional critical illness or the terminal illness benefit. You can take out a new policy with no requirement for further underwriting. The new policy can be either level or decreasing cover. The new policy must: a. start within 90 days of us accepting the claim on the original policy; and b. be taken out before your 55th birthday; and c. have an end date no later than the original policy; and d. have a maximum sum insured of the lower of 50,000 or the sum insured at the start date of the original policy. The new policy will be subject to the premium rates for your age and the terms and conditions applicable at the date when you take out the new policy. The new policy will not include the critical illness benefit, additional critical illness benefit, life change benefit, replacement benefit or separation benefit. You may only use the replacement benefit once. Separation benefit The additional benefits section of your policy schedule will confirm whether this benefit is included on your policy. This benefit only applies if: d. both policyholders are not eligible to make a claim for the terminal illness benefit, the critical illness benefit or the additional critical illness benefit at the time of applying for a new policy; and e. you send us the evidence we need. The policyholders, within 90 days of having divorced, having their civil partnership dissolved or having separated from each other or having their mortgage rearranged in the name of one policyholder only or either policyholder having taken out a mortgage on a new home, can cancel the existing policy and each take out a new policy with no requirement for further underwriting. The new policy must: a. have a sum insured less than or equal to the sum insured at the start date of the original policy; and b. be taken out before your 55th birthday; and c. have an end date before your 70th birthday; and d. have a start date no earlier than the date of cancellation of the original policy. The new policy can offer level cover or decreasing cover for each policyholder and can have the same policy options, including the critical illness benefit (and therefore additional critical illness benefit) that were included in the original policy or you can choose not to include these. The new policy will not include life change benefit, separation benefit or replacement benefit. The new policy will be subject to the premium rates for your age and the terms and conditions applicable at the date when you take out the new policy. You will be required to send us evidence to confirm: you have divorced or had your civil partnership dissolved (Decree Absolute or Dissolution order); or that the mortgage has been rearranged into one of your names only; or that one or both of you have taken out a new mortgage on a new property. You may only use the separation benefit once. a. this is a joint life policy where both policyholders are the only lives insured and you have divorced, your civil partnership has dissolved or you have separated from each other or your mortgage has been rearranged in the name of one policyholder only or one or both of you has taken out a mortgage on a new home; and b. the policy is accepted by us on our standard terms; and c. both policyholders are in agreement to cancel the original policy; and

8 Policy flexibility Once we have started cover under your policy, you can request that certain changes be made to it. The following amendments will result in us amending your existing policy and will not require any further underwriting. Decreasing the sum insured Decreasing the policy term For the avoidance of doubt, it is not possible to remove critical illness benefit or additional critical illness benefit from your policy. You may request these changes be made to your policy with effect from the date that the next premium is due. We will use the premium rates and age applicable at the time that we make the change. Your premium following the change cannot be less than the minimum premium of 5.00 per month. These policy terms and conditions will continue to apply. The following amendments will require your existing policy to be cancelled and be replaced by a new policy and may require further underwriting: Increasing the policy term Changing from level cover to decreasing cover Changing from decreasing cover to level cover Adding a life insured Removing a life insured You may request these changes be made to your policy with effect from the date that the next premium is due. We will use the premium rates and age applicable at the time that we make the change. New policy terms and conditions applicable at that time will be issued in place of these policy terms and conditions. The following amendment will require your existing policy to remain in force and we will issue a new policy to cover the change only and may require further underwriting: Increasing the sum insured You may request this change be made to your policy with effect from the date that the next premium is due. We will use the premium rates and age applicable at the time that we make the change. New policy terms and conditions applicable at that time will be issued to cover the increase to the sum insured only. Claims conditions Our requirements a. We will make payment of benefits provided we receive such evidence as we may reasonably require of: i. the occurrence of an event on which any benefits are payable or the continuation of the circumstances under which any benefit is payable; ii. the claimant having legal ownership of the policy; iii. the date of birth of the life insured or life insured s child; iv. our completed claim form; v. conversations with and reports from third parties, such as coroners, attending Consultants and the police; and vi. such other information as we may reasonably require to enable us to assess the claim. b. Payment of the terminal illness benefit, the critical illness benefit (including the children s critical illness benefit) and the additional critical illness benefit will be subject to us receiving, such other information and evidence as we may reasonably require, including: i. medical certificates and evidence of terminal illness to be provided at the policyholder s expense. When requesting such information, we will do no more than is reasonably necessary, having regard to the individual circumstances, to determine whether a benefit is payable. ii. medical examinations of the life insured (or life insured s child in respect of a claim for children s critical illness benefit) or tests (including blood tests) on the life insured (or the life insured s child in respect of a claim for the children s critical illness benefit) will be carried out at our expense at such intervals as we may reasonably require, having regard to the individual circumstances, by a medical examiner appointed by us. iii written consent to allow us to receive the results of any medical examinations and/or tests required. iv. signature on any declaration or consent form we provide allowing us access to the life insured s medical records or the medical records of the life insured s child in respect of a claim for the children s critical illness benefit. c. All medical certificates and the results of medical examinations and/or tests must be submitted to us in writing and must be provided by attending Consultants resident and practising in countries of the European Union, Andorra, The Channel Islands, The Faroe Islands, Gibraltar, The Isle of Man, Liechtenstein, Norway, Monaco, San Marino, Switzerland, Vatican City, USA, Canada, Australia or New Zealand. We may add further countries in the future. d. If any claim under this policy is in any respect unfounded, for example providing false information to support a claim, then without affecting any other legal rights we may have, any benefit paid for that claim will be reclaimed, and no further benefit will be paid. We will also have the right to cancel the policy without refunding any premiums.

9 General conditions Premiums a. Premiums for your policy must be paid monthly by Direct Debit instruction from a current bank or building society account in the United Kingdom, Channel Islands or Isle of Man. b. The initial monthly premium payable and the date it is due are shown in the policy schedule. Subsequent premiums will be due on the premium due date. You are allowed 30 days from each premium due date for the payment of each premium. If a claim arises during this period, the unpaid premium will be deducted from any benefit payable. If a premium is not paid on the premium due date or within the 30 day period allowed the policy will be cancelled and all benefits under it will cease. c. All premiums due to us must be made in the currency of the United Kingdom. Policy term The policy term must be for a minimum period of 5 years. The maximum policy term is 40 years. However the actual maximum policy term available is restricted to the life insured being 75 years old or less at the policy end date. Where a policy has two lives insured the maximum age will apply to the oldest life insured. Change of address If you, or the life insured, change address you should tell us. Acceptance of instructions We will not accept any instruction, request or notice from you until we receive the information and documentation that we may reasonably require in order to administer the policy. We will make our requirements clear to you. Cancellation When you start your policy you will receive a cancellation notice which will confirm your 30 day cooling off period in which time you may cancel the policy and receive a refund of any premiums paid. After this time, the policy may be cancelled before the policy end date by you by providing your written consent to us at our administrative offices. We will not refund premiums paid if you cancel the policy outside of the cooling off period. If you cancel your policy the policy will end and all benefits under it will cease. Alterations a. We may change the terms of the policy for any of the following reasons: i. To respond, in a proportionate manner, to changes in the way we administer policies of this type. ii. To respond, in a proportionate manner, to changes in technology or general practice in the life and pensions industry. iii. To respond, in a proportionate manner, to changes in taxation, the law or interpretation of the law, decisions or recommendations of an Ombudsman, regulator or similar person, or any code of practice with which we intend to comply. iv. To correct errors, if it is fair and reasonable to do so. If we consider any variation to these conditions is to your advantage or is necessary to meet regulatory requirements, we may make the change immediately and will tell you at a later date. We will tell you in writing of any change we consider is to your disadvantage (other than any change necessary to meet regulatory requirements) at least 60 days before the change becomes effective, unless external factors beyond our control mean that only a shorter notice period is possible. If we change the terms of the policy and you are unhappy with the change then you will be able to cancel your policy. We will not refund premiums paid if you cancel your policy. If you cancel your policy the policy will end and all benefits under it will cease. b. If the date of birth of a life insured has been incorrectly stated, the benefits payable under your policy will be amended by us having regard to the true date of birth. We will advise you of any amendments we make. If the true date of birth is such that, had it been known by us at the time the policy was applied for, the life insured would have fallen outside of the prescribed age limits to be eligible for the policy, then the policy cannot continue. In such circumstances, the policy would be cancelled with no benefits payable and we would advise you of the cancellation. Premiums would be refunded without interest. c. We rely on the information given to us. If any of the information given to us is not true or not complete and this might reasonably have affected our decision to provide the policy, then we may: i. change the terms of the policy; ii. amend the premiums due under the policy; or iii. cancel the policy and refund the premiums paid without interest. If we cancel your policy the policy will end and all benefits under it will cease.

10 Third party rights This policy does not give any rights to any person other than the policyholder and Aviva Life & Pensions UK Limited. No other person shall have any rights to rely on any terms under the policy. The policyholder and Aviva Life & Pensions UK Limited may amend or cancel this policy without reference to, or the consent of, any other person. General a. If ownership of the policy is transferred to someone else (an assignment), we must be in receipt of the written notice of assignment before any payment can be made. b. The policy schedule records details of the policy at the start date. Any alteration resulting in a change to your policy may not be reflected in the policy schedule. In this event, we will record such changes. c. Where appropriate words in the masculine include the feminine and words in the singular include the plural and vice versa. Law This policy is issued in England under English law. Braille, large font, audio material, text phone You can order our literature in Braille, large font or audio. Just call or tesco@aviva.co.uk and tell us: the format you want your name and address the name or code of the document. The code is usually at the bottom of the page on the back of most documents. To contact Customer Services using a text phone, please call The Customer Call Centre is open Monday to Friday 8am to 8pm, and Saturday from 9am to 2pm. Tesco Bank Life and Critical Illness is provided by Aviva Life & Pensions UK Limited. Registered in England No Rougier Street, York, YO90 1UU. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm Reference Number Member of the Association of British Insurers. Appendix A Details of critical illnesses & children s critical illnesses covered. For each critical illness or condition listed in alphabetical order below, we have set out the definition we will use when assessing whether a claim will be valid under the policy. To help increase your understanding of the cover provided, we have included below each of the definitions a and. In respect of Total Permanent Disability please refer to your policy schedule which will confirm which definition applies to the life insured. If your policy schedule confirms the definition is own occupation but the life insured is no longer following their own occupation immediately before Total Permanent Disability then they will be assessed on activities of daily work. Please ensure you read the exclusions section which confirms when we will not pay critical illness benefit or children s critical illness benefit. Alzheimer s Disease Alzheimer s Disease or Pre-Senile Dementia (before age 65) resulting in permanent symptoms A definite diagnosis of Alzheimer s disease or Pre-Senile Dementia (before age 65), by a Consultant Neurologist, Psychiatrist or Geriatrician. There must be permanent clinical loss of the ability to do all of the following: remember; reason; and perceive, understand, express and give effect to ideas. Dementia a symptom of degenerative brain disease characterised by impairment of intellectual faculties, such as memory, concentration and judgement. Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. Alzheimer s disease is a degenerative condition which affects the brain. A claim will be valid if Alzheimer s disease or pre-senile dementia is diagnosed and the illness has reached the point where there are permanent clinical symptoms of dementia. This policy only covers this illness if it is diagnosed before age 65. Aorta Graft Surgery Aorta graft surgery for disease or trauma The undergoing of surgery for disease or trauma to the aorta with excision and surgical replacement of a portion of the diseased aorta with a graft. The term aorta includes the thoracic

11 and abdominal aorta but not its branches. For the above definition, the following is not covered: Any other surgical procedure, for example the insertion of stents or endovascular repair. Aorta the main artery of the body, arising from the heart and supplying oxygenated blood to the body. Branches Any smaller arteries that branch off from the main aorta. Endovascular repair A minimally invasive method of approaching and repairing the diseased portion of the aorta through the body s arteries. Graft Any organ or tissue implanted to repair or replace a diseased or damaged organ or body tissue. Stent A tubular structure placed within a blood vessel or organ, used to provide support during or after surgical procedures. Thoracic and abdominal aorta - the parts of the aorta that lie within the thorax (chest) and abdomen (stomach). Aorta graft surgery may be required if it is narrowed due to a build up of fatty deposits, weakened by a ballooning of the artery wall (an aneurysm) or following trauma. A claim will be valid if surgery has been carried out to repair the aorta with a graft after it has been damaged through disease or trauma. This does not cover surgery to repair the aorta in other circumstances. Aplastic Anaemia A definite diagnosis of Aplastic Anaemia by a Consultant Haematologist. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia. Anaemia having reduced haemoglobin concentration in the blood. Neutropenia abnormally low number of blood cells called neutrophils. Thrombocytopenia abnormally low number of platelets (particles involved in clotting) in the blood. Aplastic anaemia is a serious condition where there is a decrease in the blood forming cells in the bone marrow. It is rare but if left untreated can be fatal. Bacterial Meningitis A definite diagnosis of Bacterial Meningitis resulting in permanent neurological deficit with persisting clinical symptoms. Meninges membranes that cover and protect the brain and spinal cord. Permanent neurological deficit symptoms of dysfunction in the nervous system that are present on clinical examination. Symptoms would include impairment or loss of sight or hearing, spasticity, epilepsy/seizures, cognitive impairment (cognition involves perception, reasoning, and problem solving abilities). Bacterial Meningitis is an infection of the fluid in the spinal cord and the fluid that surrounds the brain. It is caused by an infection with a bacterium. It is a serious illness requiring prompt treatment, and can result in damage to the brain. It is important to understand that viral meningitis, which is usually relatively mild in nature and responds rapidly to treatment is not covered. Benign Brain Tumour Benign Brain Tumour resulting in permanent symptoms or requiring invasive surgery A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in permanent neurological deficit with persisting clinical symptoms or requiring invasive surgery. For the above definition, the following are not covered: Tumours in the pituitary gland. Angiomas. Angioma A benign tumour of blood vessels Benign Not malignant Cranial nerves Nerves that come from the base of the brain. Cyst A cavity or sac enclosed by a membrane, often containing liquid or semi-solid material. Lesions Areas of tissue with impaired function due to illness or injury. Meninges membranes that cover and protect the brain and spinal cord. Pituitary gland a small pea-sized organ connected by a stalk to the middle of the underside of the brain behind the nasal cavity. A benign tumour is an abnormal growth of cells which, unlike a malignant or cancerous tumour, does not spread to other parts of the body. Benign tumours in the brain are more dangerous because of the increase in pressure as they grow. Surgery to remove may be required but is not always possible. Malignant tumours are not covered under this definition as these are covered under the cancer definition. Benign tumours, angiomas or lesions in the pituitary gland are not covered. Benign Spinal Cord Tumour A non-malignant tumour in the spinal canal involving the meninges or spinal cord. This tumour must be interfering with the function of the spinal cord which results in permanent neurological deficit with persisting clinical symptoms.

12 This diagnosis must be made by a medical specialist and must be supported by appropriate evidence. Excluded under this definition are cysts, granulomas, malformations in the arteries or veins of the spinal cord, haematomas, abscesses, disc protrusions and osteophytes. Meninges The protective tissue that covers the brain and spinal cord. Spinal cord The nerve tissue that extends from the brain along the spine. Spinal canal The space in the bones of the backbone (vertebrae) through which the spinal cord passes. Guidance notes Tumours in the spinal cord are potentially dangerous as they can compress the spinal nerves and weaken the structure of the spine. Blindness Blindness permanent and irreversible Permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse in the better eye using a Snellen eye chart. 3/60 means the person whose eyesight is being assessed can see an object up to 3 feet away that a person with perfect eyesight could see if it were 60 feet away. Irreversible cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the NHS in the UK at the time of a claim. Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. Snellen eye chart a chart showing letters in rows of decreasing size that opticians use to measure visual ability. Visual aids anything which helps improve vision, for example contact lenses or a pair of glasses. Blindness means a significant loss of sight in both eyes to the extent that the person can only see an object up to 3 feet away that a person with perfect eyesight could see if it were 60 feet away. The condition must be incurable and therefore expected to be permanent. Please note that being registered blind may not be a valid claim. Cancer Cancer excluding less advanced cases Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin). For the above definition, the following are not covered: All cancers which are histologically classified as any of the following: pre-malignant; non-invasive; cancer in situ; having either borderline malignancy; or having low malignant potential. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0. Any skin cancer (including cutaneous lymphoma) other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin) unless the skin cancer has been confirmed as malignant and has spread to the lymph nodes or distant organs. Borderline malignancy potentially malignant cells that form in the tissue covering the organ and have not invaded the adjacent tissue. Cancer in-situ the presence of malignant/cancerous cells at a stage of development such that they have not spread into surrounding healthy tissue. In medical terminology, this means that the cancer cells are confined to the epithelium (the tissue that lines the internal and external surfaces of the body) of origin and have not yet invaded the adjacent tissue. For malignant melanomas of the skin, this means that cancer cells are confined to the epidermis (the outermost layer of skin) and may be categorised as Clark s level 1. Epidermis the outer layer of skin. Gleason score a system of grading prostate cancer. The Gleason grading system assigns a grade to each of the two largest areas of cancer in the tissue samples. Grades range from 1 to 5, with 1 being the least aggressive and 5 the most aggressive. The two grades are then added together to produce a Gleason score. A score from 2 to 4 is considered low grade; 5 to 7, intermediate grade; and 8 to 10, high grade. Histologically the appearance of the cancer under the microscope which leads to its diagnosis and, additionally, gives information on its differentiation or grading (how aggressive it may be). Hodgkin s disease a type of cancer (lymphoma) affecting lymphatic tissue. Invasion the occurrence of malignant/cancerous cells that have spread into surrounding healthy tissue (that is, more extensive than cancer in-situ). Invasive malignant melanoma a malignant melanoma which has progressed beyond the point of being confined to the

13 epidermis (the outermost layer of skin). This will be categorised as Clark s level 2 or above. Leukaemia a disease of the blood forming tissues characterised by increased numbers of immature or abnormal blood cells, that leads to an increased tendency to infection, anaemia and haemorrhage. Lymphoma cancer of the lymphatic (glandular) system, including Hodgkin and Non-Hodgkin lymphoma. Low malignant potential potentially malignant cells that form in the tissue covering the organ and have not invaded the adjacent tissue. Malignant tumour a tumour that invades the tissue in which it originates and can spread to other parts of the body. Non-invasive Malignant/cancerous cells that have not spread into surrounding healthy tissue. Sarcoma cancer of connective tissue such as bone, muscle, nerves, fatty tissue or cartilage. Pre-malignant cells which may develop into a malignant tumour but have not yet done so. TNM classification an internationally recognised standardised method of staging cancers. Broadly, the three parts of the system relate to: Tumour (T) a scale of 0 to 4 is used to record details about the primary tumour. T0 means there is no evidence of a primary tumour, T1 to T4 shows the size and extent of spread of the primary tumour. Tis may be used for cancer in situ. Nodes (N) a scale of 0 to 3 is used to record the extent of spread to the regional lymph nodes. N0 means the lymph nodes are not involved, N1 N3 shows the extent of the involvement. Metastases (M) either M0 or M1, the latter indicating metastases (more distant spread of the cancer). What is cancer? Cancer is complex to define because it isn t a single illness. There are around 200 types and they affect people in different ways. A cancer is an uncontrolled growth of abnormal malignant cells which, if left untreated, can invade and destroy the surrounding healthy tissue. In the later more advanced stages, it can spread from the original site to other parts of the body. When would a critical illness plan pay out? Generally speaking, cancer claims are valid on the diagnosis of a malignant cancer that has reached the point where it has invaded and started to destroy the adjacent surrounding tissue. However, a few types of cancer are not covered. What types of cancer are not covered? The plan doesn t cover very early cases that have not yet started to invade the adjacent surrounding tissue in the organ, even if you receive treatment. Doctors sometimes call these cases premalignant, non-invasive, cancer in situ, having borderline malignancy or having low malignant potential. Skin cancers other than malignant melanoma normally only affect the surface area of the skin and don t spread to other areas of the body. They are only covered in the very rare event when they have been confirmed as malignant and have spread extensively. Cardiomyopathy Cardiomyopathy of specified severity. A definite diagnosis of cardiomyopathy by a Consultant Cardiologist. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classifications of functional capacity (i.e. heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain). The following are not covered: Cardiomyopathy secondary to alcohol or drug abuse. All other forms of heart disease, heart enlargement and myocarditis. New York Heart Association (NYHA) functional classification system a method, commonly used in the UK, to assess heart function by relating symptoms to everyday activities and the patient s quality of life. NYHA Class 3 Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dysponea (difficulty in breathing). Myocarditis Acute inflammation of the heart muscle caused by infection. Cardiomyopathies are a group of disorders of the heart muscle. They can cause sudden death or heart failure. Coma Coma resulting in permanent symptoms A state of unconsciousness with no reaction to external stimuli or internal needs which: requires the use of life support systems; and results in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following is not covered: Coma secondary to alcohol or drug abuse.

14 External stimuli outside sensory events that would normally produce a response e.g. sight, hearing, touch, taste or smell. Internal needs needs of the body to survive i.e. food, drink, using the toilet etc. Life support systems equipment used to assist breathing, feeding, drinking etc. Alcohol or drug abuse inappropriate use of alcohol or drugs, including but not limited to the following: consuming too much alcohol. taking an overdose of drugs, whether lawfully prescribed or otherwise. taking Controlled Drugs (as defined by the Misuse of Drugs Act 1971) other than in accordance with a lawful prescription. Permanent neurological deficit with persisting clinical symptoms - symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the insured person s life. Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma. The following are not covered: An abnormality seen on brain or other scans without definite related clinical symptoms. Neurological signs occurring without symptomatic abnormality, e.g. brisk reflexes without other symptoms. Symptoms of psychological or psychiatric origin. Unconsciousness the lack of normal sensory awareness caused by temporary or permanent damage to brain function. Being in a coma is covered in the following circumstances: The person must have been on life support. The incident must have caused permanent neurological deficit. However, comas caused by any of the following are not covered: Consuming too much alcohol. Taking an overdose of drugs, prescribed or otherwise. Taking controlled drugs unless lawfully prescribed. Coronary Artery By-Pass Surgery The undergoing of surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Balloon angioplasty a procedure to correct a narrowing of an artery and improve the blood flow. A balloon tipped catheter (fine tube) is passed along the affected artery and then inflated. Coronary artery an artery that supplies blood to the heart. Coronary Artery By-Pass Grafts involves attaching a short length of vein or by using arteries in the area of the breast to by-pass a blockage in one or more of the coronary arteries that supply blood to the heart. The plan doesn t cover procedures like balloon angioplasty, atherectomy, rotablation lasers or the insertion of stents. Creutzfeldt Jakob Disease An unequivocal diagnosis of Creutzfeldt-Jakob Disease made by a Consultant Neurologist. N/A This is a disease affecting the brain and spinal cord, for which there is no effective treatment. The disease usually progresses rapidly resulting in loss of intellectual capacity and co-ordination. Deafness Deafness permanent and irreversible Permanent and irreversible loss of hearing to the extent that the loss is greater than 95 decibels across all frequencies in the better ear using a pure tone audiogram. Decibels a measure of the level of sound. Irreversible cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the NHS in the UK at the time of a claim. Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. Pure tone audiogram a device for measuring the extent of a person s hearing ability. Deafness means a profound loss of hearing in both ears where the condition cannot be cured and is expected to be permanent. Please note that being registered deaf may not be a valid claim.

15 Encephalitis A definite diagnosis of encephalitis by a Consultant Neurologist resulting in permanent neurological deficit with persisting clinical symptoms. Permanent neurological deficit with persisting clinical symptoms - symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the insured person s life. Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma. The following are not covered: An abnormality seen on brain or other scans without definite related clinical symptoms. Neurological signs occurring without symptomatic abnormality, e.g. brisk reflexes without other symptoms. Symptoms of psychological or psychiatric origin. Encephalitis is a swelling of brain tissue. It is usually caused by an infection and can be life threatening. Heart Attack Heart attack of specified severity Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: New characteristic electrocardiographic changes. The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher; Troponin T > 1.0 ng/ml AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods. The evidence must show a definite acute myocardial infarction. For the above definition, the following is not covered: Other acute coronary syndromes including but not limited to angina. Acute intense and/or sudden in onset. Angina the, often severe, chest pain or discomfort that is a symptom of coronary artery disease. Cardiac enzymes or Troponins chemicals found in the blood that when elevated above normal levels may indicate damage to the heart muscle. Electrocardiographic (ECG) a tracing on graph paper representing the electrical events associated with the beating of the heart. Changes to the shape of the heartbeat trace can help diagnose a number of heart abnormalities, including acute myocardial infarction. Myocardial infarction death of a portion of the myocardium (heart muscle) due to an abrupt obstruction of the coronary blood flow. If the blood supply to the heart is interrupted, this can cause a portion of the heart muscle to die. Doctors call this sudden death of heart muscle an acute myocardial infarction, but the condition is widely known as a heart attack. A heart attack causes permanent damage to the heart muscle which can be detected using an ECG machine which traces the heartbeat. When someone has a heart attack, chemicals such as cardiac enzymes and troponins are released into the blood stream these are usually present for several days after the event and can be detected by using a blood test. The presence of these chemicals provides important diagnostic information but they can also be present, usually at lower levels, for reasons other than a heart attack. At the time of having a heart attack, most people experience very severe chest pain and/or other symptoms such as sweating, vomiting, fainting and nausea. These symptoms can help doctors pinpoint precisely when the incident happened. It is important to note that the term heart attack may sometimes be used loosely to describe a range of other heart conditions but none of these other conditions, for example angina, are covered under this definition. Also, the medical profession has more than one definition for a heart attack as the effects of advancing medical science are debated by the profession. However, only this definition will be used to decide if a heart attack is covered. Heart Valve Replacement or Repair The undergoing of surgery on the advice of a Consultant Cardiologist to replace or repair one or more heart valves. N/A The heart contains valves which help the pumping of blood around the body. If they become diseased this ability is reduced and surgery to replace or repair them may be undertaken. HIV Infection HIV infection caught in the European Union, Andorra, The Channel Islands, The Faroe Islands, Gibraltar, The Isle of Man, Liechtenstein, Norway, Monaco, San Marino, Switzerland, Vatican City, USA, Canada, Australia or New Zealand from a blood transfusion, a physical assault or at work. Infection by Human Immunodeficiency Virus resulting from: a blood transfusion given as part of medical treatment; a physical assault; or

16 an incident occurring during the course of performing normal duties of employment after the start of the policy and satisfying all of the following: The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures. Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within 5 days of the incident. There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus. The incident causing infection must have occurred in the European Union, Andorra, The Channel Islands, The Faroe Islands, Gibraltar, The Isle of Man, Liechtenstein, Norway, Monaco, San Marino, Switzerland, Vatican City, USA, Canada, Australia or New Zealand. For the above definition, the following is not covered: HIV infection resulting from any other means, including sexual activity or drug abuse. N/A HIV is covered if it is caught in the European Union, Andorra, The Channel Islands, The Faroe Islands, Gibraltar, The Isle of Man, Liechtenstein, Norway, Monaco, San Marino, Switzerland, Vatican City, USA, Canada, Australia or New Zealand through a blood transfusion, a physical assault or at work. HIV resulting from any other cause, for example sexual activity or drug abuse, is not covered. Where the incident relates to a physical assault, the incident should be reported to the police. Similarly, if the incident occurred at work, the incident should be reported in line with the employer s procedures. Many employers, including people who work in the health or emergency services, have set procedures for dealing with incidents that may potentially result in the person becoming infected by HIV. In all cases, a test for HIV should be taken within 5 days of the incident - a negative test result will show that the person did not have HIV before the incident. A further test within a year where the test result is positive will confirm that the infection resulted from the reported incident. Intensive Care Intensive care requiring mechanical ventilation for 30 consecutive days Any sickness or injury resulting in the insured requiring continuous mechanical ventilation by means of tracheal intubation for 30 consecutive days (24 hours per day) or more in an Intensive Care Unit in a UK hospital. For the above definition the following is not covered: sickness or injury as a result of drug or alcohol intake or other self-inflicted means. Continuous mechanical ventilation Replacing spontaneous breathing by use of a machine. Tracheal intubation Placing a tube into the windpipe to maintain an open airway. Intensive Care requiring mechanical intervention may be required due to an acute or chronic illness or following a serious injury such as a road traffic accident. Kidney Failure Kidney failure requiring dialysis Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is necessary. Chronic of long duration. End stage The final phase of a disease process. Dialysis The artificial means of removing toxic substances (impurities and wastes) from the blood when the kidneys are unable to do so. Kidneys clean the blood of waste products produced by the body. A claim for kidney failure will be valid if both kidneys have irreversibly stopped functioning and the person is having regular dialysis (a process using a machine to perform the function of the kidneys). Liver Failure A definite diagnosis, by a Consultant Physician, of irreversible end stage liver failure due to cirrhosis resulting in all of the following: Permanent jaundice; Ascites; and Encephalopathy. The following is not covered: Liver failure secondary to alcohol or drug abuse. Cirrhosis long standing damage to the liver. Jaundice Yellow discolouration of the skin. Ascites Build up of fluid in the abdomen. Encephalopathy Brain disease or damage. The liver is a large organ that is essential to life. It carries out many functions including metabolizing nutrients and destroying toxins.

17 Loss of Hand or Foot Loss of hand or foot permanent physical severance Permanent physical severance of either a hand or a foot at or above the wrist or ankle joint. Not applicable. Loss of Hand or Foot is covered where the limb is permanently severed at or above the wrist in the case of a hand or the ankle in the case of a foot. The limb might have been lost through physical injury or perhaps as a result of medical necessity to remove it using surgery. Loss of Independent Existence Loss of Independent Existence will mean a permanent inability to perform independently three or more activities of daily living with or without the use of mechanical equipment, special devices or other aids. Confirmation must be received by a Consultant Physician and be supported by our medical adviser. The definitions of the Activities of Daily Living are: 1. Transferring The ability to move from a bed to an upright chair or wheelchair and vice versa, or to get on or off a toilet or commode. 2. Continence The ability to manage bowel and bladder functions such that an adequate level of personal hygiene can be maintained. 3. Dressing The ability to put on, take off, secure and unfasten all necessary garments and any braces, artificial limbs or other surgical appliances. 4. Mobility The ability to move indoors from one room to another on a level surface in the life insured s normal place of residence. 5. Feeding The ability to feed oneself once food and drink has been prepared and made available. 6. Washing The ability to wash in the bath or shower (including getting into and out of the bath or shower) such that an adequate level of personal hygiene can be maintained. Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. Typically, a person claiming for benefit requires daily assistance to help with personal care needs. Loss of Speech Loss of speech permanent and irreversible Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease. Irreversible cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the NHS in the UK at the time of a claim. Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. Loss of speech means completely losing the ability to speak as a result of physical injury or disease where the condition cannot be cured and is expected to be permanent. Cases arising as a consequence of surgery or medical treatment for an illness are also covered. Major Organ Transplant The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, liver, lung or pancreas, or a whole lobe of the lung or liver, or inclusion on an official UK waiting list for such a procedure. For the above definition, the following is not covered: Transplant of any other organs, parts of organs, tissues or cells. N/A A claim for major organ transplant will be valid if any of the following organs need to be replaced by undergoing a transplant: bone marrow a whole heart a whole kidney a whole liver a whole lung a whole pancreas whole lobe of the lung whole lobe of the liver A claim will be valid from the point at which either: the person is added to a UK waiting list for a suitable replacement organ to become available, or the organ transplant takes place.

18 Motor Neurone Disease Motor neurone disease resulting in permanent symptoms A definite diagnosis of Motor Neurone Disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function. All forms of motor neurone disease are covered including spinal muscular atrophy. Motor relating to movement. Permanent expected to last throughout the insured person s life, irrespective of when the cover ends or the insured person retires. Spinal muscular atrophy A genetic disease that causes muscle weakness and a progressive loss of movement due to deteriorations of motor neurones in the spinal cord. Motor neurone disease is a degenerative condition that results in weakness and the wasting of muscles. The condition is covered if there is a definite diagnosis made by a Consultant Neurologist and the disease has reached the point where it has caused permanent impairment of the ability to move. Multiple Sclerosis Multiple sclerosis with persisting symptoms A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least three months. Clinical impairment - the clinical symptoms associated with the condition that can be detected through examination. Motor relating to movement Sensory relating to the senses (sight, hearing, touch, taste or smell). Multiple Sclerosis (MS) is a disease which attacks the central nervous system. The definition requires that there are continuous symptoms for a period of at least three months that include deterioration of the senses (sight, hearing, touch, taste or smell) and/or the ability to control movement. The diagnosis must be confirmed by a Consultant Neurologist. Multiple System Atrophy A definite diagnosis of multiple system atrophy confirmed by a Consultant Neurologist. There must be evidence of permanent clinical impairment of either: Motor function with associated rigidity of movement or the ability to coordinate muscle movement or bladder control and postural hypotension. Postural hypotension A sudden drop in blood pressure when standing up or stretching, which causes dizziness or blackouts. Multiple System Atrophy is a progressive neurological disorder. Degeneration of nerve cells in specific areas of the brain lead to problems with movement, balance and other functions of the body such as bladder control. Paralysis of a Limb Paralysis of a limb total and irreversible Total and irreversible loss of muscle function to the whole of a limb. Irreversible cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the NHS in the UK at the time of a claim. Paralysis the loss of power of movement of a part of the body. Paralysis and paraplegia are covered if the insured person totally and irreversibly loses the ability to move, or use, a limb. The disability must be considered permanent. Paralysis of the right or left half of the body is called hemiplegia. If all four limbs are paralysed this is called quadriplegia. Parkinson s Disease Parkinson s Disease before age 65 resulting in permanent symptoms A definite diagnosis of Parkinson s Disease or other named Parkinsonian Syndrome of specified severity (before age 65) by a Consultant Neurologist. The additional Parkinsonian Syndromes covered are corticobasal degeneration and diffuse lewy body disease. There must be permanent clinical impairment of motor function with associated tremor, muscle rigidity and postural instability. For the above definition the following are not covered: Other Parkinsonian syndromes Clinical impairment the clinical symptoms associated with the condition that can be detected through examination. Corticobasal degeneration A rare condition where brain cells become damaged over time and certain sections of the brain start to shrink. Diffuse lewy body disease A progressive condition similar to Parkinson s Disease that leads to dementia. Postural instability loss of the ability to prevent falling over by maintaining your balance. Tremor involuntary, rhythmic movement of part of the body, most commonly the hands and arms, often the head and voice, and rarely the legs.

19 Parkinson s disease is a degenerative brain disease that causes involuntary tremor of the hands, muscle rigidity and the slowing of body movements. The other named conditions have a very similar pathology. The condition is covered if there is a definite diagnosis made by a Consultant Neurologist before age 65 and the disease has reached the point where there is permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability. Pneumonectomy Pneumonectomy removal of a complete lung The undergoing of surgery on the advice of a consultant medical specialist to remove an entire lung due to disease or traumatic injury. Other forms of surgery to the lungs including removal of a lobe of the lungs (lobectomy) or lung resection are not covered under this definition. Lung resection Removal of part of a lung. A lung may be removed to treat disease or following a severe traumatic injury. Primary Pulmonary Hypertension Primary Pulmonary Hypertension of specified severity Primary pulmonary hypertension with permanent clinical impairment of heart function resulting in marked limitation of physical activities to at least Class 3 of the New York Heart Association s classification of functional capacity. New York Heart Association Class 3 Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dysponea (difficulty in breathing). New York Heart Association (NYHA) functional classification system A method, commonly used in the UK, to assess heart function by relating symptoms to everyday activities and the patient s quality of life. Primary Pulmonary Hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein or pulmonary capillaries, leading to shortness of breath, dizziness, fainting and other symptoms. Progressive Supranuclear Palsy A definite diagnosis by a consultant neurologist of progressive supranuclear palsy. There must be permanent clinical impairment of eye movement and motor function with associated tremor, rigidity of movement and postural instability. N/A Progressive Supranuclear Palsy is a progressive, incurable brain disease. Initial symptoms usually include loss of balance, slowing of movement and visual symptoms. As the disease advances other symptoms including dementia develop. Pulmonary Artery Surgery The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist for disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft. Pulmonary artery The artery carrying blood from the heart to the lungs. Graft Any organ or tissue implanted to repair or replace a diseased or damaged organ or body tissue. Some illnesses may lead to this surgery being required. Rheumatoid Arthritis Rheumatoid Arthritis - of specified severity Severe chronic Rheumatoid Arthritis evidenced by joint destruction and deformity of at least three major joint groups, resulting in the inability to do three of the following; bend or kneel to pick up an object from the floor; use hands or fingers to pick up or manipulate small objects such as cutlery or a pen; lift or carry an everyday object such as a kettle; walk a distance of 200m on flat ground with or without use of a walking stick and without experiencing severe discomfort. Not applicable Rheumatoid Arthritis is a condition that causes pain and swelling in the joints. Severity can vary from individual to individual. Severe Lung Disease Severe Lung Disease of specified severity Severe lung disease where there is permanent impairment of lung function with lung function tests: Forced Vital Capacity (FVC) and Forced Expiratory Volume at 1 second (FEV1) below 50% of normal and a need for daily oxygen therapy for a minimum of 15 hours per day for at least six months. Glossary of terms Forced vital capacity The volume of air that can be forcibly blown out after full inspiration. Forced expiratory volume at one second The volume of air that can be forcibly blown out in one second after full inspiration. Oxygen treatment Breathing high concentrations of oxygen from a cylinder or machine through a mask or tubes into the nostrils. Guidance notes Severe Lung Disease can have many causes such as emphysema or chronic asthma. They make breathing difficult and can have a major impact on quality of life.

20 Stroke Stroke resulting in permanent symptoms Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following is not covered: Transient ischaemic attack. Haemorrhage bleeding from a ruptured blood vessel. Permanent neurological deficit with persisting clinical symptoms symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the insured person s life. Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma. The following are not covered: An abnormality seen on brain or other scans without definite related clinical symptoms. Neurological signs occurring without symptomatic abnormality, e.g. brisk reflexes without other symptoms. Symptoms of psychological or psychiatric origin. Transient ischaemic attack temporary disruption of the blood circulation to part of the brain. The symptoms may initially be similar to those of a stroke but patients recover within 24 hours. A stroke (doctors call these cerebrovascular accidents, CVAs) is caused by an interruption to the flow of blood to the brain. This can be due to either a blocked artery which prevents blood reaching the brain or a burst blood vessel in the brain. In either case, a claim will be valid if it causes ongoing clinical symptoms of a stroke which are expected to be permanent. Transient ischaemic attacks are not covered. These are attacks that produce temporary symptoms similar to a mild stroke but typically patients recover completely in less than 24 hours. Structural Heart Surgery The undergoing of heart surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist to correct any structural abnormality of the heart. Median sternotomy Opening the chest cavity and dividing the breastbone. Covers surgery to the heart for reasons not already covered elsewhere. Systemic Lupus Erythematosus Systemic Lupus Erythematosus of specified severity A definite diagnosis with either, permanent impaired kidney function with glomerular filtration rate below 30ml/min or permanent neurological deficit resulting in persistent symptoms of paralysis, localised weakness, dysarthria, dysphagia or difficulty in walking. Glomerular filtration rate A measure of the flow rate of filtered fluid through the kidneys. Dysarthria Difficulty in pronouncing words. Dysphagia Difficulty in swallowing. Systemic Lupus Erythematosus (often known as lupus) is a chronic inflammatory disease that affects the blood vessels and connective tissues of the skin and various parts of the body. Severity may vary from person to person. There may be acute episodes (flare ups) from time to time. Third Degree Burns Third Degree Burns covering at least 20% of the body s surface area or covering at least 20% of the surface area of the face or head Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body s surface area or covering at least 20% of the surface area of the face or head. N/A Third degree burns damage or destroy the skin to its full depth and cause damage to the tissue underneath. These are covered if at least 20% of the body surface area or at least 20% of the surface area of the face has been affected. Total Permanent Disability This illness does not apply to children s critical illness benefit. Total Permanent Disability definition can be either: own occupation activities of daily work Own occupation Total permanent disability unable before age 65 to do your own occupation ever again Loss of the physical or mental ability through an illness or injury before age 65 to the extent that the insured person is unable to do the material and substantial duties of their own occupation ever again. The material and substantial duties are those that are normally required for, and/or form a significant and integral part of, the performance of the person s own occupation that cannot reasonably be omitted or modified.