Keep me safe. Document Reference: MIMICI19. Critical Illness. Policy Conditions

Transcription

1 Document Reference: MIMICI19 Keep me safe Critical Illness Policy Conditions

2 These Policy Conditions tell you how LV= Critical Illness Protection wks in me detail. Together with your application, any declarations you ve made, your Policy Schedule and any documents we send you confirming changes to your policy and the amount of cover, they fm the terms and conditions of your insurance (the contract between you and LV=). Please take the time to read them carefully and keep them in a safe place. LV= Critical Illness Protection is provided by Liverpool Victia Friendly Society Limited, which is part of LV=. Our illness and medical conditions definitions meet the ABI Statement of Best Practice f Critical Illness cover (February 2011). If you d like a copy please let us know. Contents Definitions 3 Why choose LV= Critical Illness? 4 Section A Your Critical Illness policy 5 A1 What you re covered f 5 A1(a) All critical illnesses including total permanent disability 5 A1(b) All critical illnesses excluding total permanent disability 8 A1(c) Total permanent disability only 10 A2 What are the types of cover available? 11 A2(a) Level amount of cover 11 A2(b) Inflation-linked amount of cover 11 A2(c) Decreasing amount of cover 12 A3 Children s cover 13 A4 When you need to tell us about your critical illness 14 A5 What you need to do to make a claim 14 A6 Who we ll pay the claim to 15 A7 What if you re insuring someone else? 15 A8 What happens when a claim has been paid f a partial payment condition? 15 A9 What if there are two people insured on the policy? 15 Section B Options to change your Policy 16 B1 Guaranteed Increase Options f personal cover 16 B2 Option to replace your policy with a Combined Life & Critical Illness policy 19 B3 Other ways to change your amount of cover 20 Section C Other conditions 21 C1 Paying your premiums 21 C2 Stopping your premiums 21 C3 Re-starting your premiums 21 C4 When we can change your premium (reviewable premiums) 21 C5 Proof of your age and name 22 C6 When you can cancel your policy 22 C7 When we can cancel your policy 22 C8 When your policy ends 23 C9 Arranging f the amount of cover to be paid to a specific person 23 C10 The law that applies to your policy 23 C11 How to make a complaint 23 Appendix The list of critical illnesses 24 2

3 Definitions We explain these terms because this is a legal document. In some cases the wds may have other meanings in everyday use. We have highlighted these wds in bold (other than personal terms such as you and we ) so you know when they apply. You means the person who applied f this policy, the person who is insured and the person legally entitled to the payment from it. Where we use your it has the same meaning. We, us, our means Liverpool Victia Friendly Society Limited. Child children means all of your natural children, stepchildren and legally adopted children. Critical illness and critical illnesses mean the illnesses, medical conditions operations detailed in the Appendix. Your Policy Schedule explains which of these you are covered f. Amount of your cover and amount of cover mean the amount you are insured f (shown on your Policy Schedule). This includes any inflation-linked increases. If you have applied f a decreasing amount of cover, then your amount of cover goes down each month. This is explained in me detail in Section A2(c). End date means the date when your policy ends. This date is shown in your Policy Schedule. Full payment condition means a critical illness where you re covered f the full amount of cover. Inflation means the rising cost of goods and services such as your weekly shopping, gas and electricity. We will measure this using the Retail Prices Index, unless this stops being published, in which case we would use another similar published index. Partial payment condition means a critical illness where you re covered f part of the amount of cover. The amount we would pay in the event of a claim is detailed under the relevant critical illnesses in the Appendix. Plan means your LV= Flexible Protection Plan, your Plan Schedule and any policies (including this policy) which are included in it. Plan anniversary means each 12 month anniversary from the date your plan iginally started. This will be the same as the 12 month anniversary of your policy unless you have added a new policy to an existing plan. You can check this on your Plan Schedule. Policy means these conditions, your Policy Schedule, any Special Provisions listed in your Policy Schedule and any documents we send you to confirm changes to your policy to the amount of your cover. We will apply a Special Provision when we are not able to offer you a policy based on the terms detailed in these conditions. This may be because of your occupation, your health and medical histy, your leisure activities. We will let you know if this applies to you befe we start asking you f any money. Premium and premiums mean the monthly amount you pay f the amount of your cover. Start date means the date when your policy started. This date is shown in your Policy Schedule. Critical Illness Policy Conditions 3

4 Why choose LV= Critical Illness? This policy is designed to pay out a cash sum if you are diagnosed with a critical illness which is covered under this policy, and you live f 14 days me after your diagnosis operation. The diagnosis operation must occur between the start date and the end date of your policy. If we pay out the cash sum befe the end date the policy will nmally end, unless we pay a claim f a partial payment condition, children s cover. We ve included a list of all the illnesses, medical conditions and operations covered in Section A1, and me detailed infmation including an explanation of when we will pay out f each one is detailed in the Appendix at the back of these Policy Conditions. Choosing the critical illnesses to be covered f When you apply you can choose to be covered f the following options: All of the critical illnesses including total permanent disability All of the critical illnesses excluding total permanent disability Total permanent disability only Me details can be found in Section A1, and your chosen option is shown on your Policy Schedule. Choosing the type of cover You can also choose whether you want your amount of cover to stay the same, increase, decrease, during the term of your policy. This will be shown on your personal quote if you haven t yet taken out a policy, and once your policy has started you will find this on your Policy Schedule. You can choose: Level cover - This means your amount of cover, is fixed when your policy starts, and doesn t change. We aim f the premium you pay to stay the same, but it may be changed. Me infmation on when we can change your premium can be found in Section C4. Inflation-linked cover - This means that your amount of cover and the premium you pay will go up each year in line with inflation. This may be shown on your personal quote as increasing amount of cover, index-linked amount of cover. We aim f the premium you pay to only be changed in line with inflation each year, but it may be changed at other times. Me infmation on when we can change your premium can be found in Section C4. Decreasing cover - This type of cover is specially designed to cover the reducing amount that you owe on a capital and interest repayment mtgage. Your amount of cover will go down each month. We aim f the premium you pay to stay the same, but it may be changed. Me infmation on when we can change your premium can be found in Section C4. These choices are explained in me detail in Section A2. 4

5 Section A Your Critical Illness policy This section tells you about: What you re covered f The types of cover available When we will pay the amount of cover How to make a claim How much we will pay Who the money will go to A1 What you re covered f There are three different options available. You will find which of the following you are covered f on your Policy Schedule. Me detailed infmation can be found in the Appendix. In some cases we may not be able to cover you f all of the illnesses operations listed in each section. If this happens, this will be noted on your Policy Schedule under the heading of Special Provisions. On the following pages we explain the different options available in me detail, and explain what you re covered f, and what you re not covered f. You only need to read the section that applies to the cover shown on your Policy Schedule. So, if your Policy Schedule shows that you are covered f all critical illnesses including total permanent disability, you only need to read Section A1(a). If it shows that you are covered f all critical illnesses excluding total permanent disability read Section A1(b). If it shows you are covered f total permanent disability only, read Section A1(c). A1(a) All critical illnesses including total permanent disability What s covered? Diagnosis of a critical illness We will nmally pay out the amount of cover if you are diagnosed with one of the critical illnesses listed in Section A1(a) between the start date and the end date of your policy. We have split the critical illnesses into full payment conditions and partial payment conditions. F a full payment condition we will nmally pay out the full amount of your cover. F a partial payment condition we will only pay out an amount equal to part of your amount of cover. The amount we pay f each partial payment condition is shown in the list of partial payment conditions, and me detail can be found in the Appendix under the partial payment conditions section. If we pay a claim f a partial payment condition, we don t reduce your amount of cover, and your policy continues f your full amount of cover. If you make a claim that meets the definition f both a partial payment condition and a full payment condition at the same time, then we will only pay a claim f the full payment condition and not the partial payment condition as well. F example if we paid a claim f the full payment condition f blindness (condition no. 7) we won t also pay a claim f the partial payment condition f partial loss of sight (condition no. 58). Similarly if you had one of the lobes of your lung removed as a result of being diagnosed with lung cancer and we agreed to pay the a claim f the full payment condition f cancer (condition no. 8), then we won t also pay a claim f the partial payment condition f removal of a lobe lobes of the lung (condition no. 61). Once we have paid a claim on this policy (unless we ve paid a claim f a partial payment condition f children s cover which is explained in Section A3), it will end. You re covered f the following critical illnesses: Full payment conditions 01. Alzheimer s disease resulting in 02. Ata graft surgery f disease traumatic injury 03. Aplastic anaemia complete 04. Bacterial meningitis resulting in 05. Benign brain tumour 06. Benign spinal cd tumour resulting in 07. Blindness permanent and irreversible 08. Cancer excluding less advanced cases Critical Illness Policy Conditions 5

6 09. Cardiac arrest 10. Cardiomyopathy of specified severity 11. Coma resulting in 12. Conary artery bypass grafts 13. Creutzfeldt-Jakob disease 14. Deafness permanent and irreversible 15. Dementia (including senile dementia) resulting in 16. Encephalitis resulting in 17. Heart attack of specified severity 18. Heart valve replacement repair 19. HIV infection caught in a specified list of countries from a blood transfusion, a physical assault at wk 20. Idiopathic pulmonary arterial hypertension of specified severity 21. Kidney failure requiring dialysis 22. Liver failure 23. Loss of hands feet permanent physical severance 24. Loss of independent existence unable to look after yourself ever again 25. Loss of speech permanent and irreversible 26. Maj gan transplant 27. Mot neurone disease resulting in 28. Multiple sclerosis with persisting symptoms 29. Multiple system atrophy resulting in 30. Neuromyelitis optica (Devic s disease) with persisting symptoms 31. Open heart surgery with surgery to divide the breastbone 32. Paralysis of a limb total and irreversible 33. Parkinson s disease resulting in 34. Pneumonectomy Removal of an entire lung 35. Progressive supranuclear palsy resulting in 36. Pulmonary artery surgery f disease only 37. Severe lung disease 39. Surgical removal of an eyeball 40. Systemic lupus erythematosus 41. Terminal illness 42. Third degree burns covering 20% of the body s surface area affecting 50% of the area of the face head 43. Traumatic head injury resulting in 44. Total permanent disability of specified severity Partial payment conditions 45. Accident hospitalisation cover (lower of 25% of cover 25,000) 46. Arteriovenous malfmation (AVM) of the brain with specified treatment (lower of 12.5% of cover 12,500) 47. Carcinoma in-situ of the cervix uteri requiring treatment with hysterectomy (lower of 12.5% of cover 12,500) 48. Carcinoma in-situ of the urinary bladder (lower of 12.5% of cover 12,500) 49. Carotid artery stenosis - treated by endarterectomy angioplasty (lower of 12.5% of cover 12,500) 50. Cerebral aneurysm with surgery radiotherapy (lower of 12.5% of cover 12,500) 51. Central retinal artery vein occlusion resulting in permanent visual loss (lower of 12.5% of cover 12,500) 52. Conary artery angioplasty (lower of 25% of cover 25,000) 53. Diabetes mellitus type 1 - requiring permanent insulin injections (lower of 12.5% of cover 12,500) 54. Ductal lobular carcinoma in-situ of the breast with specified treatment (lower of 25% of cover 25,000) 55. Non-severe cardiomyopathy definite diagnosis (lower of 25% of cover 25,000) 56. Ovarian tumour of bderline malignancy/low malignant potential with surgical removal of an ovary (lower of 12.5% of cover 12,500) 57. Partial loss of hearing of specified severity (lower of 12.5% of cover 12,500) 38. Stroke of specified severity 6

7 58. Partial loss of sight permanent and irreversible (lower of 12.5% of cover 12,500) 59. Partial third degree burns covering 10% of the body s surface area affecting 25% of the area of the face head (lower of 12.5% of cover 12,500) 60. Prostate cancer (lower of 25% of cover 25,000) 61. Removal of one me lobe(s) of the lung f disease trauma (lower of 12.5% of cover and 12,500) 62. Severe Crohn s disease surgically treated (lower of 12.5% of cover and 12,500) 63. Severe ulcerative colitis with operation to remove the entire large bowel (lower and 12.5% of cover 12,500) 64. Testicular carcinoma in situ requiring surgery to remove at least one testicle (lower of 12.5% of cover and 12,500) To help you understand what these critical illnesses cover, please refer to the explanation in the Appendix at the back of this document. Existing illness medical condition that you had befe you applied As we ask you f all your medical histy befe we offer you the policy, you are covered f all the critical illnesses listed in Section A1(a) unless we have told you that you re not befe your policy starts. We will list any exclusions on your Policy Schedule under the heading of Special Provisions. We will tell you about any exclusions befe we ask you f the first premium. Travelling abroad If you re diagnosed with one of the critical illnesses listed, we will pay your claim provided the diagnosis has been confirmed by a doct who practices in one of the following countries: Australia, Austria, Belgium, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Isle of Man, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, New Zealand, Nway, Poland, Ptugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, UK USA. What s not covered All types of illness You are only covered f the critical illnesses listed in the What s covered section. If you are diagnosed with any other illness, medical condition have an operation that is not listed, then we will not pay a claim under this policy. Also, if your illness, medical condition, operation does not meet our definition of one of the critical illnesses we cover then we will not pay a claim. F example some types of cancer are not covered. You are not covered f any exclusions listed on your Policy Schedule under the heading of Special Provisions. If we ve paid a claim f a partial payment condition. We ll only pay one claim f each partial payment condition under the policy. However, you can make a claim under any of the other critical illnesses covered by this policy. F severe Crohn s disease (condition no. 62) and severe ulcerative colitis (condition no. 63) we will only make one partial payment. So if we ve paid a partial payment f one of them, you won t then be covered f the other one. F example if we pay a claim f severe Crohn s disease, you won t then be covered f severe ulcerative colitis. Death within 14 days of your critical illness being diagnosed, having the operation. If you die within 14 days of being diagnosed with one of the critical illnesses having the operation, then won t pay a claim under this policy. Fraud and deliberate non-disclosure Please understand that whilst we know that the vast majity of our customers are honest, we do have to protect ourselves (and our customers) against the effects of fraud. F this reason we can cancel the policy and not pay a claim if we find you anyone you are insuring has deliberately withheld infmation from us has intentionally provided us with false infmation lied to us, when they applied, when they claim, when they apply to re-start their premiums (see Section C3). Me detailed infmation on when we can cancel the policy can be found in Section C7. If you re diagnosed in a country not listed above, you will need to go to one of the countries listed, to have that diagnosis confirmed, to have the operation. Critical Illness Policy Conditions 7

8 A1(b) All critical illnesses excluding total permanent disability What s covered? Diagnosis of a critical illness We will nmally pay out the amount of cover if you are diagnosed with one of the critical illnesses listed in Section A1(b) between the start date and the end date of your policy. We have split the critical illnesses into full payment conditions and partial payment conditions. F a full payment condition we will nmally pay out the full amount of your cover. F a partial payment condition we will only pay out an amount equal to part of your amount of cover. The amount we pay f each partial payment condition is shown in the list of partial payment conditions, and me detail can be found in the Appendix under the partial payment conditions section. If we pay a claim f a partial payment condition, we don t reduce the amount of your cover, and your policy continues f your full amount of cover. If you make a claim that meets the definition f both a partial payment condition and a full payment condition at the same time, then we will only pay a claim f the full payment condition and not the partial payment condition as well. F example if we paid a claim f the full payment condition f blindness (condition no. 7) we won t also pay a claim f the partial payment condition f partial loss of sight (condition no. 58). Similarly if you had one of the lobes of your lung removed as a result of being diagnosed with lung cancer and we agreed to pay the a claim f the full payment condition f cancer (condition no. 8), then we won t also pay a claim f the partial payment condition f removal of a lobe lobes of the lung (condition no. 61). Once we have paid a claim on this policy (unless we ve paid a claim f a partial payment condition f children s cover which is explained in Section A3), it will end. You re covered f the following critical illnesses: Full payment conditions 01. Alzheimer s disease resulting in 02. Ata graft surgery f disease traumatic injury 03. Aplastic anaemia complete 04. Bacterial meningitis resulting in 05. Benign brain tumour 06. Benign spinal cd tumour resulting in 07. Blindness permanent and irreversible 08. Cancer excluding less advanced cases 09. Cardiac arrest 10. Cardiomyopathy of specified severity 11. Coma resulting in 12. Conary artery bypass grafts 13. Creutzfeldt-Jakob disease 14. Deafness permanent and irreversible 15. Dementia (including senile dementia) resulting in 16. Encephalitis resulting in 17. Heart attack of specified severity 18. Heart valve replacement repair 19. HIV infection caught in a specified list of countries from a blood transfusion, a physical assault at wk 20. Idiopathic pulmonary arterial hypertension of specified severity 21. Kidney failure requiring dialysis 22. Liver failure 23. Loss of hands feet permanent physical severance 24. Loss of independent existence unable to look after yourself ever again 25. Loss of speech permanent and irreversible 26. Maj gan transplant 27. Mot neurone disease resulting in 28. Multiple sclerosis with persisting symptoms 29. Multiple system atrophy resulting in 30. Neuromyelitis optica (Devic s disease) with persisting symptoms 31. Open heart surgery with surgery to divide the breastbone 8

9 32. Paralysis of a limb total and irreversible 33. Parkinson s disease resulting in 34. Pneumonectomy Removal of an entire lung 35. Progressive supranuclear palsy resulting in 36. Pulmonary artery surgery f disease only 37. Severe lung disease 38. Stroke of specified severity 39. Surgical removal of an eyeball 40. Systemic lupus erythematosus 41. Terminal illness 42. Third degree burns covering 20% of the body s surface area affecting 50% of the area of the face head 43. Traumatic head injury resulting in Partial payment conditions 45. Accident hospitalisation cover (lower of 25% of cover 25,000) 46. Arteriovenous malfmation (AVM) of the brain with specified treatment (lower of 12.5% of cover 12,500) 47. Carcinoma in-situ of the cervix uteri requiring treatment with hysterectomy (lower of 12.5% of cover 12,500) 48. Carcinoma in-situ of the urinary bladder (lower of 12.5% of cover 12,500) 49. Carotid artery stenosis - treated by endarterectomy angioplasty (lower of 12.5% of cover 12,500) 50. Cerebral aneurysm with surgery radiotherapy (lower of 12.5% of cover 12,500) 51. Central retinal artery vein occlusion resulting in permanent visual loss (lower of 12.5% of cover 12,500) 52. Conary artery angioplasty (lower of 25% of cover 25,000) 54. Ductal lobular carcinoma in-situ of the breast with specified treatment (lower of 25% of cover 25,000) 55. Non-severe cardiomyopathy definite diagnosis (lower of 25% of cover 25,000) 56. Ovarian tumour of bderline malignancy/low malignant potential with surgical removal of an ovary (lower of 12.5% of cover 12,500) 57. Partial loss of hearing of specified severity (lower of 12.5% of cover 12,500) 58. Partial loss of sight permanent and irreversible (lower of 12.5% of cover 12,500) 59. Partial third degree burns covering 10% of the body s surface area affecting 25% of the area of the face head (lower of 12.5% of cover 12,500) 60. Prostate cancer (lower of 25% of cover 25,000) 61. Removal of one me lobe(s) of the lung f disease trauma (lower of 12.5% of cover and 12,500) 62. Severe Crohn s disease surgically treated (lower of 12.5% of cover and 12,500) 63. Severe ulcerative colitis with operation to remove the entire large bowel (lower and 12.5% of cover 12,500) 64. Testicular carcinoma in situ requiring surgery to remove at least one testicle (lower of 12.5% of cover and 12,500) To help you understand what these critical illnesses cover, please refer to the explanation in the Appendix at the back of this document. Existing illness medical condition that you had befe you applied As we ask you f all your medical histy befe we offer you the policy, you are covered f all the critical illnesses listed in Section A1(b) unless we have told you that you re not befe your policy starts. We will list any exclusions on your Policy Schedule under the heading of Special Provisions. We will tell you about any exclusions befe we ask you f the first premium. 53. Diabetes mellitus type 1 - requiring permanent insulin injections (lower of 12.5% of cover 12,500) Critical Illness Policy Conditions 9

10 Travelling abroad If you re diagnosed with one of the critical illnesses listed, we will pay your claim provided the diagnosis has been confirmed by a doct who practices in one of the following countries: Australia, Austria, Belgium, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Isle of Man, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, New Zealand, Nway, Poland, Ptugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, UK USA. If you re diagnosed in a country not listed above, you will need to go to one of the countries listed, to have that diagnosis confirmed, to have the operation. Fraud and deliberate non-disclosure Please understand that whilst we know that the vast majity of our customers are honest, we do have to protect ourselves (and our customers) against the effects of fraud. F this reason we can cancel the policy and not pay a claim if we find you anyone you are insuring has deliberately withheld infmation from us has intentionally provided us with false infmation lied to us, when they applied, when they claim, when they apply to re-start their premiums (see Section C3). Me detailed infmation on when we can cancel the policy can be found in Section C7. A1(c) Total permanent disability only What s not covered All types of illness You are only covered f the critical illnesses listed in the What s covered section. If you are diagnosed with any other illness, medical condition have an operation that is not listed, then we will not pay a claim under this policy. Also, if your illness, medical condition, operation does not meet our definition of one of the critical illnesses we cover then we will not pay a claim. F example some types of cancer are not covered. You are not covered f any exclusions listed on your Policy Schedule under the heading of Special Provisions. If we ve paid a claim f a partial payment condition. We ll only pay one claim f each partial payment condition under the policy. However, you can make a claim under any of the other critical illnesses covered by this policy. F severe Crohn s disease (condition no. 62) and severe ulcerative colitis (condition no. 63) we will only make one partial payment. So if we ve paid a partial payment f one of them, you won t then be covered f the other one. F example if we pay a claim f severe Crohn s disease, you won t then be covered f severe ulcerative colitis. Death within 14 days of your critical illness being diagnosed, having the operation. If you die within 14 days of being diagnosed with one of the critical illnesses having the operation, then won t pay a claim under this policy. What s covered You re covered f the following critical illness only: Total permanent disability of specified severity (condition no. 44).To help you understand what this critical illness covers, please refer to the explanation in the Appendix at the back of this document. Existing illness medical condition that you had befe you applied As we ask you f all your medical histy befe we offer you the policy, you are covered f any cause of total permanent disability, unless we have told you that you re not befe your policy starts. We will list any exclusions on your Policy Schedule under the heading of Special Provisions. We will tell you about any exclusions befe we ask you f the first premium. Travelling abroad If you re diagnosed with total permanent disability, we will pay your claim provided the diagnosis has been confirmed by a doct who practices in one of the following countries: Australia, Austria, Belgium, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Isle of Man, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, New Zealand, Nway, Poland, Ptugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, UK USA. If you re diagnosed in a country not listed above, you will need to go to one of the countries listed, to have that diagnosis confirmed. 10

11 What s not covered All types of illness You are only covered f total permanent disability. If you re diagnosed with any other illness, medical condition, have any operation, then we will not pay a claim under this policy. You are not covered f any exclusions listed on your Policy Schedule under the heading of Special Provisions. If you die within 14 days of being diagnosed. If you die within 14 days of being diagnosed with total permanent disability then we will not pay a claim under this policy. Fraud and deliberate non-disclosure Please understand that whilst we know that the vast majity of our customers are honest, we do have to protect ourselves (and our customers) against the effects of fraud. F this reason we can cancel the policy and not pay a claim if we find you anyone you are insuring has deliberately withheld infmation from us has intentionally provided us with false infmation lied to us, when they applied when they claim, when they apply to re-start their premiums (see Section C3). Me detailed infmation on when we can cancel the policy can be found in Section C7. A2 What are the types of cover available? There are three different types of cover available. You will find which type of cover you have on your Policy Schedule. You only need to read the section that applies to the type of cover you have. A2(a) Level amount of cover This means that your amount of cover does not change between the start date and the end date of your policy. It won t keep up with inflation and you will be able to buy less with it in the future. We aim f the premium you pay to stay the same, but it may be changed. Me infmation on when we can change your premium can be found in Section C4. A2(b) Inflation-linked amount of cover This means that your amount of cover increases each year in line with inflation. We may also refer to this as index-linked increasing cover on your personal quote. If you re unsure whether this applies to you, you will find whether not this is included, on your Policy Schedule. What inflation-linked means We will increase your amount of cover on each plan anniversary. Where we apply this increase, your amount of cover and premium will both go up in line with inflation. This increase will be based on the 12 month period ending three months befe your plan anniversary. We aim f the premium you pay to only be changed in line with inflation each year, but it may be changed at other times. Me infmation on when we can change your premium can be found in Section C4. If you have added this policy to an existing plan and your plan anniversary is less than 3 months after the start date of this policy, the first increase to your amount of cover will be made on the next plan anniversary. We ll tell you what we ll increase your amount of cover to and what your new premium will be befe we increase them. Any Special Provisions that apply to your policy are shown in your Policy Schedule and will also apply to any inflation-linked increases. You can ask us not to increase your amount of cover. If you don t want us to increase your amount of cover, you must let us know befe the plan anniversary when the increase is due. We then won t make any further increases to your amount of cover f the rest of the term of your policy. This means your cover will change to a level amount of cover (as explained in A2(a)) f the rest of the term of your policy. Please note if you ask us not to increase your amount of cover, but later on decide that you want us to start increasing it again, you will need to re-apply f inflationlinked cover. We can t guarantee that we will be able to offer you inflation-linked cover again, as it will depend on your health, occupation and leisure activities and whether we are offering the same type of insurance at that time. Critical Illness Policy Conditions 11

12 A2(c) Decreasing amount of cover You would generally take out this type of cover to provide the money to pay off a capital and interest repayment mtgage in the event of you being diagnosed with a critical illness. Your amount of cover goes down each month, we aim f the premium you pay to stay the same, but it may be changed. Me infmation on when we can change your premium can be found in Section C4. Example In this example we have used approximate figures to try and make it easier to follow. They do not reflect the precise amounts that would be outstanding and payable in this case. Mark and Sarah took out a capital and interest repayment mtgage f 100,000 over a term of 25 years. Their monthly repayments are 780 a month, and the interest on the amount they browed is calculated at the end of each year of their mtgage. When they took out their mtgage, they chose to protect it with a Critical Illness policy, with a decreasing amount of cover. The amount of cover is 100,000 f a term of 25 years, which is the same as their mtgage. They are both insured on the policy, and they are both policy owners. 10 years after taking out their mtgage and their policy, Sarah is diagnosed with cancer, and Mark and Sarah make a claim. They complete their claim fm, and as the cancer that Sarah is diagnosed with meets the definition f the full payment condition f cancer we agree to pay their claim. The amount remaining on their mtgage at that time is 80,000. They have paid their mtgage each and every month, on time, and there are no arrears outstanding. They have not increased the amount browed on their mtgage, and have not made any changes to their policy. First we calculate the amount that would be outstanding on the mtgage if the interest rate they had been paying was fixed at 12%. This is to wk out the maximum amount we would pay out. In this example this is 87,000. Then we calculate how much would have been outstanding on the same mtgage if they had been paying an interest rate fixed at 6%. This is to wk out the minimum amount we would pay out. In this example this is 76,000. Therefe as the amount outstanding on their mtgage is less than 87,000 (the maximum we would pay out) and me than 76,000 (the minimum we would pay out), we would pay out the amount outstanding on their mtgage when Sarah was diagnosed with a critical illness, which was 80,000. If Mark and Sarah had made any changes to their mtgage since it started, without making any changes to their policy then we would have paid out at least 76,000 as this was the minimum payout. We will nmally pay out the amount of your outstanding mtgage on the date of your diagnosis with a critical illness (including any interest that has built up since that date) as long as: You still have a mtgage that is repayable by equal monthly repayments and the mtgage was taken out no later than three months after the start date of your policy (you will find this on your Policy Schedule), and the mtgage is a capital and interest repayment mtgage which is on track to be fully repaid at the end of the term of the mtgage and the term of the mtgage is the same as the term of your policy, and the outstanding mtgage is not me than it would have been had you browed the same amount on the start date of your policy with the same term, and interest rates had been 12% compounded annually. F the purposes of this section, if you have changed your amount of cover since the start date, we treat the start date of your policy as being the date that you made the changes to your amount of cover. If you have changed the term of your policy, this means the end date of your policy will have changed, so f the purposes of this section,we will use this new end date. Me details about how you can change the amount of your cover, the term of your policy can be found in Section B. 12

13 However if we only pay a claim f one of the partial payment conditions then we ll only pay out the amount shown f that condition, and not the full amount of cover. Please see the partial payment conditions section of the Appendix f me details on the amounts we ll pay out f each partial payment condition. We must have written confirmation of the mtgage details and the amount outstanding, from your lender, befe we pay a claim f decreasing cover. There are some exceptions. We won t pay any mtgage repayment arrears. If, during the term of the mtgage, you have reduced stopped your repayments f any period (other than as a result of an interest rate reduction), we may reduce the amount we pay out to the amount that you would have owed if the repayments had not been changed, had been paid in full and on time. If the amount of your mtgage was me than the amount of your cover at the start date of your policy we ll reduce the amount we will pay out proptionately. Example Assume you had a 100,000 mtgage and you insured it f 90,000 at the start of the policy. Your cover is 10% less than your mtgage. On diagnosis of a critical illness the outstanding mtgage was 80,000. We would pay out 72,000 which is 10% less than the outstanding mtgage. We realise that it is quite possible you will have changed your mtgage even paid all of it off, without changing stopping your policy. So, as a minimum we will payout the amount that would have been outstanding if you had taken out a capital and interest mtgage, which is repaid by equal monthly payments: f the same amount as your amount of cover, and that started on the same date as the start date, and that ends on the same date as the end date, and the interest rate on that mtgage had been 6% each year compounded annually. F the purposes of this section, if you have changed your amount of cover since the start date, we treat start date of your policy as being the date that you made the changes to your amount of cover. If you have changed the term of your policy, this means the end date of your policy will have changed, so f the purposes of this section, we will use this new end date. Me details about how you can change your amount of cover, the term of your policy can be found in Section B. A3 Children s cover Children s cover is automatically included in your policy at no extra cost. It covers your children (from birth to age 21) f all of our critical illnesses listed in Section A1, except f total permanent disability (condition no. 44) and diabetes mellitus type 1 (condition no. 53). We do apply some limits to children s cover which are explained in the What s not covered section. If you need to make a claim under children s cover we will pay the lower of: 50% of your amount of cover 25,000 If we pay a claim f a partial payment condition f children s cover it will be limited to 50% of the amount we would pay if you made a partial payment condition claim f the person insured (see Section A1 f details). You can only claim once f each child and can only make a maximum of two children s cover claims on this policy. If your child has children s cover under me than one policy with us, the most we would pay out across all the policies is 50,000 in total. What s covered? Travelling abroad If your child is diagnosed with one of the critical illnesses listed in Section A1, we will pay a claim provided that diagnosis has been confirmed by a doct who practices in one of the following countries: Australia, Austria, Belgium, Bulgaria, Canada, Channel Islands, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Isle of Man, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, New Zealand, Nway, Poland, Ptugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, UK USA. Critical Illness Policy Conditions 13

14 If your child is diagnosed in a country not listed, they will need to go to one of the countries listed, to have that diagnosis confirmed, have the operation. What s not covered All types of illness Your child is only covered f the critical illnesses listed in the Appendix, apart from total permanent disability (condition no. 44) and diabetes mellitus type 1 (condition no. 53). If they are diagnosed with any illness, medical condition, have an operation that is not listed, then we will not pay a claim f children s cover. If the illness, medical condition, operation does not meet our definition of one of the critical illnesses we cover then we will not pay a claim. F example some types of cancer are not covered. All causes of critical illness We won t pay a claim f children s cover if: you were aware of an increased risk of your child suffering the critical illness befe the start date of your policy (f example you had received medical advice counselling in relation to the critical illness befe your policy started), symptoms relating to the critical illness had arisen befe the start date of your policy. However if your child had already suffered the critical illness, and had been discharged from follow-up, and had not consulted any medical practitioner, received treatment advice f the condition f at least five years befe the diagnosis of the critical illness, then they would still be covered. Also we will not pay a claim if the critical illness your child has been diagnosed with, the reason they need to have an operation is caused by any of the following: intentional self-inflicted injury, alcohol solvent abuse, the taking of drugs (unless prescribed by a doct), failing to follow medical advice. We would only not pay a claim f this, if the reason that you chose not to follow medical advice is unreasonable. If your child dies within 14 days of their critical illness being diagnosed, having the operation. If your child dies within 14 days of being diagnosed with a critical illness, having one of the operations covered, we will not pay a claim f children s cover. A4 When you need to tell us about your critical illness To help us process your claim quickly, if you re diagnosed with a critical illness, please tell us as soon as you can after your diagnosis the date the operation takes place. You can tell us in writing, by phone, by by fax. F details of how best to contact us please visit A5 What you need to do to make a claim Once you ve told us about your critical illness, we ll ask you to complete a claim fm (which we ll send you at the time). This allows us to collect the infmation we need from you about your critical illness. We want to make sure that your claim is dealt with quickly, and to help us with this, it is imptant that you complete and return the fm to us as soon as you can. If you need help completing the fm, please let us know. So that we can properly assess your claim we ll need evidence from your doct ( the medical practitioner who is treating you) confirming that you have been diagnosed with a critical illness. We may also need to get medical repts from your doct. If we do, we ll send you a consent fm to complete. The fm explains your rights under the Access to Medical Repts Act We don t know exactly what evidence we ll need until you make a claim, as all claims are looked at individually. We appreciate this is a difficult time, so we won t ask f anything unreasonable unnecessary, and we will explain why we need anything we ask f We may need you to be examined by a doct of our choice. We may also ask f other evidence to consider your claim, such as: a rept from your doct, any other doct who has treated examined you, any alternative medical practitioner a rept on tests investigations carried out to make the diagnosis a rept from a consultant that we appoint, confirming the diagnosis. 14

15 We ll pay f the cost of all medical repts and other evidence which we ask f. Because we rely on the infmation we re given to assess your claim, if any of the infmation is untrue incomplete you may not be covered and we may not be able to pay your claim. Please understand that whilst the vast majity of our customers are honest, we do have to protect ourselves (and our customers) against the effects of fraudulent claims. Therefe if we ask f additional infmation, please do not take this as a reflection of our opinion of you. A6 Who we ll pay the claim to Once your claim has been approved, we ll pay the amount of cover to you, as the owner of the policy. Once we have paid a claim f a full payment condition, your policy will end. However, your policy won t end if the claim we ve paid relates to children s cover (which we ve explained in Section A3) is f a partial payment condition (see Section A8). When we pay a claim, we ll try to do this as quickly as possible. Sometimes it s not possible to pay straight away, so if it takes longer than 60 days from the date of diagnosis of the insured event, we ll add interest to the amount we pay, from day 61, to the date of payment. If this changes we will let you know at the time of claim. A7 What if you re insuring someone else? If you are insuring someone else, you will be the policy owner, and they will be the person insured. We will pay a claim to you if the person insured is diagnosed with a critical illness, befe the end date of your policy. If we need any doct s repts, these will need to be provided by the doct of the person you are insuring and they will need to give us their consent f us to ask f these. If you make a claim that meets the definition f both a partial payment condition and a full payment condition at the same time, then we will only pay a claim f the full payment condition and not the partial payment condition as well. F example if we paid a claim f the full payment condition f blindness (condition no. 7) we won t also pay a claim f the partial payment condition f partial loss of sight (condition no. 58). Similarly if you had one of the lobes of your lung removed as a result of being diagnosed with lung cancer and we agreed to pay the a claim f the full payment condition f cancer (condition no. 8), then we won t also pay a claim f the partial payment condition f removal of a lobe lobes of the lung (condition no. 61). We will only pay out one claim f each partial payment condition f each person insured. However you can still make a claim f any other critical illnesses covered by the policy. If we pay a claim f a full payment condition (unless this relates to children s cover) then your policy will end. A9 What if there are two people insured on the policy? If there are two people insured on the policy, we will pay a claim if either of you are diagnosed with a critical illness befe the end date of your policy. Once we have paid a claim f a full payment condition the policy will end. However your policy won t end if the claim we ve paid relates to children s cover (which we ve explained in Section A3) if we pay a claim f a partial payment condition (see Section A8). A8 What happens when a claim has been paid f a partial payment condition? If we pay a claim f a partial payment condition, your policy will continue in full, f your full amount of cover. We don t reduce the amount of cover by the amount of the partial payment we ve paid. This is as long as you continue to pay the premiums f your policy as and when they are due. Critical Illness Policy Conditions 15

16 Section B Options to change your policy This section tells you about how you can change the amount of your cover, the term of your policy. It also explains how you can replace your policy with a Combined Life & Critical Illness policy. If you have chosen f the amount of your cover to increase in line with inflation this is explained in section A2(b). However you can also choose to change the amount of your cover, the term of your policy between the start date and the end date. If you want to do this, please let us know, and we ll send you an application fm to complete. We ll let you know what infmation we need at the time, and if you want us to, we ll be able to help you complete the application. It is very imptant that you don t cancel your existing policy. We will confirm the changes you ve requested to you, and if you wish to proceed with them, we ll tell you if your existing policy needs to be cancelled. If it does need to be cancelled, we ll automatically do this f you. B1 Guaranteed Increase Options f personal cover You can increase your amount of cover and in some cases replace your policy with a new policy, without completing a full application, if certain events happen. We call these Guaranteed Increase Options,because we guarantee that you can change your policy, within certain limits, as long as you are eligible. Occasionally, due to your medical histy, your personal circumstances you may not be able to take advantage of these options. If this applies to you, we will tell you befe your policy starts. This will be detailed on your Policy Schedule under the heading of Special Provisions. The event must happen to the person insured. This means that if you re insuring someone else then it s their circumstances we ll consider, not yours. Unftunately you won t be able to use these options if: The person insured has been diagnosed with a critical illness had an operation covered by this policy. The person insured has been advised by a medical practitioner to have an operation covered by this policy. You don t need to have told us that you intend to make claim. Your policy must be current with all premiums paid to date. If you want to change your policy using one of the Guaranteed Increase Options, you won t have to provide any additional medical infmation at that time. This means we do have to apply some limits to the amount you can change your cover by. Please see the table on page 18 f me details. The events which are covered by our Guaranteed Increase Options f personal cover are: Marriage civil partnership - You can use this option if you marry enter a civil partnership. You can increase the amount of cover by up to 50% of the amount of cover shown on your Policy Schedule, at the time you wish to use this option. Example James has a Critical Illness policy f 200,000. He and his partner Susan decide to marry, so James wants to increase his cover to make sure his new wife is protected financially if he s diagnosed with a critical illness. He can use this option to increase the amount of cover. The maximum amount that James can increase his cover by is 100,000, which means he could increase the amount of cover to a maximum of 300, ,000 x 50% = 100, , ,000 = 300,000 James is able to increase his cover using this Guaranteed Increase Option without having to complete another full application, providing any additional medical infmation. 16