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Critical illness plans. Your guide to your cover

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Critical illness plans

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Contents 3

Understanding your cover 4

Glossary of key words 5

Exclusions 7

Critical illnesses and operations 8

Definitions 10

Children’s critical illness benefit 31

How to claim 34

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4

Understanding your cover

It’s important you understand the critical illness cover you’re buying from

us. This booklet sets out the medical conditions and operations covered

by the Decreasing Mortgage Cover Plan and the Level Protection Plan.

In some places we’ve had to use medical terms, but where this is the case

we’ve included additional background information to give you a better

understanding of what they mean.

The definitions in this booklet are the same as those in the plan terms

and conditions, which is your contract with us. If you have any questions

about your cover, please contact us – our address is at the back of this

booklet, or if you have an adviser they will be able to help you.

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We’ve tried to put all the definitions in plain English, but it is difficult to

completely avoid the use of medical terms. In some cases we’ve included

additional background medical information to help explain.

The Life Assurance Industry through the Association of British Insurers

(the ABI) has agreed standard definitions for a number of operations and

conditions. For those operations and conditions, our definitions meet,

and some exceed, the ABI standard.

There are certain key words and definitions to be aware of as you read this booklet, they are:

Diagnosis means unequivocal diagnosis of the relevant condition. All diagnosis and medical opinions must be given by a medical specialist who: – is a consultant at a hospital in

the UK

– is acceptable to our chief medical officer

– is a specialist in an area of medicine appropriate to the cause of the claim.

Irreversible means cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the National Health Service in the UK at the time of claim.

Permanent means expected to last throughout life with no prospect of improvement, irrespective of when the cover ends or the insured person expects to retire.

Permanent neurological deficit with persisting clinical symptoms means 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 co-ordination, 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.

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Important notes

We only cover the critical illnesses we define in our plan terms and conditions and no others. Each critical illness must meet our plan definition.

If you make a critical illness claim and:

your plan includes critical illness cover only, you must survive 14 days from the date your condition is diagnosed, or from the day you have your operation, before we’ll pay a successful critical illness claim on your plan.

your plan includes both life cover and critical illness cover and the life cover is equal to, or more than, the amount of the critical illness cover, you don’t have to survive for 14 days before we’ll pay a successful claim;

your plan includes both life cover and critical illness cover, and the critical illness cover amount is more than the life cover amount, you must survive 14 days from the date your condition is diagnosed, or from the day you have your operation, before we’ll pay a successful claim for the extra critical illness cover (the amount over the amount of the life cover).

Guaranteed Payments

For certain Guaranteed Payments versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, we cover additional critical illness conditions – please refer to your plan terms and conditions as these will confirm what cover applies to your plan.

The additional conditions are shown in the list of medical conditions and operations we cover (shown on pages 8 and 9) and are either marked with a 1 or a 2 in the same list. You will find more detailed descriptions of these in the ‘ Plan definitions’ section, which starts on page 10.

In the event of a successful claim those conditions marked with a 1 will result in payment of the full critical illness sum assured. Those marked with a 2 will result in payment of 20% of the level of critical illness cover on the plan at the time you claim, or £15,000, which ever is lower. We refer to these as additional critical illness cover cash payments.

If we make an additional critical illness cover cash payment this will not reduce the amount of critical illness cover provided by your plan. You will not be able to make any claims for an additional critical illness cover cash payments after the full critical illness cover sum assured has been paid out.

The information in this booklet does not take priority over, or change in any way, the cover provided by your plan or the definitions contained in the plan terms and conditions.

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The terms and conditions that apply to your plan include details of situations when we won’t pay out. For example, we won’t pay a critical illness claim or children’s critical illness claim if the illness suffered does not meet the plan definition exactly or the illness suffered is an illness that is not covered by the plan. You should also be aware that we won’t pay out a claim if the medical condition arises while you are living abroad and you don’t return to the United Kingdom or one of the other countries we specify. These are countries where, from our experience, we know we can manage the claims process effectively.

Our current list of countries is Australia,

Austria, Belgium, Bulgaria, Canada, Channel Islands, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, Republic of Ireland, Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Republic of Macedonia, Malta, Monaco, the Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United States of America.

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The complete list of critical illnesses and operations we cover is set out below. The headings are only a guide to what is covered. The full definitions of each and the circumstances in which you can claim them, start on page 10. These typically use medical terms to describe the illnesses but in some cases the cover may be limited. For example:

– Some types of cancer are not covered – To make a claim for some illnesses,

such as a stroke, you need to have permanent symptoms, and for others, such as a heart attack, the illness must be of a specified severity.

• Alzheimer’s disease before age 65 – resulting in permanent symptoms.

• Aorta graft surgery – for disease and trauma.

• Aplastic anaemia – resulting in permanent symptoms.

• Bacterial meningitis – resulting in permanent symptoms.

• Benign brain tumour – resulting in permanent symptoms.

• Benign spinal cord tumour. 1

• Blindness – permanent and irreversible.

• Brain abscess drained via craniotomy. 2

• Cancer – excluding less advanced cases.

• Carcinoma in situ of the breast – requiring mastectomy or lumpectomy. 2

• Carcinoma in situ of the testicle – requiring surgery to remove one or both testicles. 2

• Carcinoma in situ of the Urinary Bladder. 2

• Cardiac arrest – with insertion of a defibrillator. 1

• Cardiomyopathy.

• Cerebral arteriovenous malformation – resulting in specified treatment. 2

• Cerebral Aneurysm – treated by craniotomy or endovascular repair. 2

• Coma – with associated permanent symptoms.

• Coronary artery by-pass grafts – (a payment is available to pay for surgery after being placed on an NHS waiting list).

• Corticobasal ganglionic degeneration. 1

• Creutzfeldt-Jakob Disease (CJD) – requiring continuous assistance.

• Deafness – permanent and irreversible.

• Diffuse Lewy body disease. 1

• Encephalitis.

• Heart attack – of specified severity.

• Heart-valve replacement or repair.

• HIV caught from a blood transfusion, by physical assault or at work*.

• Kidney failure – requiring permanent dialysis.

• Liver failure – end stage.

• Liver resection. 2

• Loss of independent existence – resulting in permanent symptoms.

• Loss of hand or foot – permanent physical severance.

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• Loss of speech – total permanent and irreversible.

• Major organ transplant – from another person.

• Motor neurone disease – resulting in permanent symptoms.

• Multiple sclerosis – with persisting symptoms.

• Multiple System Atrophy – resulting in progressive and permanent symptoms.

• Non malignant pituitary adenoma with specified treatment. 2

• Open heart surgery – with surgery to divide the breast bone.

• Paralysis of limb – total and irreversible.

• Parkinsonism-dementia-amyotrophic lateral sclerosis complex. 1

• Parkinson’s disease before age 65 – resulting in permanent symptoms.

• Pneumonectomy – for disease or trauma.

• Pre-senile dementia before age 65 – resulting in permanent symptoms.

• Primary pulmonary arterial hypertension – resulting in permanent symptoms.

• Progressive supranuclear palsy.

• Prostate cancer low-grade. 2

• Pulmonary artery surgery – with surgery to divide the breastbone.

• Removal of an eyeball as a result of injury or disease – permanent physical severance.

• Severe lung disease/respiratory failure – of specified severity.

• Single Lobectomy – the removal of a complete lobe of a lung. 2

• Stroke – resulting in permanent symptoms.

• Syringomelia or Syringobulbia – treated by surgery. 2

• Systemic lupus erythematosus – of specified severity.

• Terminal illness – where death is expected within 12 months.

• Third-degree burns – less extensive – covering 5% of the body’s surface area or 19% of the face’s surface area. 2

• Third degree burns – covering 20% of the body’s surface area or 50% of the face’s surface area.

• Total permanent disability – unable before age 65 to look after yourself ever again.

• Traumatic brain injury – resulting in permanent symptoms.

1 For certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan we cover these additional critical illness conditions (your plan terms and conditions will confirm what cover applies to your plan). 2 For certain Guaranteed Payment

versions of the Decreasing Mortgage Cover Plan and Level Protection Plan we cover these additional critical illness conditions (your plan terms and conditions will confirm what cover applies to your plan). A successful claim for this condition will result in an additional critical illness cover cash payment only. Please see page 6 for more information or your plan terms and conditions.

* The incident causing the infection must have occurred in a country that is listed on page 20 (the eligible countries).

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Alzheimer’s disease before age 65

– resulting in permanent symptoms

A definite diagnosis of Alzheimer’s disease 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.

For the above definition, the following is not covered:

• Other types of dementia.

Alzheimer’s disease is a progressive and degenerative disease. The nerve cells in the brain deteriorate and the size of the brain substance shrinks. There are various ways in which Alzheimer’s can affect a person, such as severe loss of memory and concentration; but overall, there is a general decline in all areas of mental ability.

Aorta graft surgery – for disease and trauma

The undergoing of surgery for disease or following traumatic injury to the aorta with excision and surgical replacement of a portion of the diseased aorta with a graft.

The term aorta includes the thoracic and abdominal aorta but not its branches. For the above definition, the following are not covered:

• Any other surgical procedure, for example the insertion of stents or endovascular repair.

The aorta is the main artery of the body from which all others derive, and it supplies oxygenated blood to other arteries. The aorta may be narrowed, typically as a result of fatty deposits that build up on the walls of the artery. It may also weaken due to ‘aneurysm’, which means that the artery wall has become thin and dilated. A graft may be needed to replace the part of the artery that has weakened. You will be able to claim if you need surgery to remove and replace the aorta or a segment of it.

Definitions

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Aplastic anaemia

– resulting in permanent symptoms

Bone marrow failure that results in permanent anaemia, neutropenia and thrombocytopenia requiring as a minimum one of the following treatments:

• marrow stimulating agents

• bone marrow transplant

• blood transfusion

• immunosuppressive agents. This is the permanent failure of the bone marrow to make new blood cells. This leads to anaemia, an increase in infections that the body cannot fight, and haemorrhaging. Treatment is usually by repeated blood transfusions or a bone marrow transplant.

Bacterial meningitis

– resulting in permanent symptoms

The unequivocal diagnosis of bacterial meningitis resulting in permanent neurological deficit with persisting clinical symptoms or physical deficit.

This is an infection of the meninges, the membrane covering the brain and spinal cord, caused by bacterial infection. The feverish illness can be life threatening and may cause permanent physical disability or permanent damage to the nervous system. Viral meningitis and other forms of meningitis are not covered.

Benign brain tumour

– resulting in permanent symptoms

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. The requirement for permanent neurological deficit with persisting clinical symptoms will be waived if the benign brain tumour is surgically removed.

For the above definition, the following are not covered:

• Tumours in the pituitary gland.

• Angiomas.

A benign tumour is a non-cancerous abnormal growth of tissue. A benign tumour in the brain, although not cancerous, is very serious because the growth may be pressing on areas of the brain. Such growths may be potentially life threatening and may need removing by surgery.

Benign spinal cord tumour 1

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. This diagnosis must be made by a medical specialist and must be supported by appropriate evidence.

For the above definition, the following are not covered:

• Cysts

• Granulomas

• Malformations in the arteries or veins of the spinal cord

• Haematomas

• Abscess

• Disc protrusion, and

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Tumours in the spinal cord are potentially dangerous as they can compress the spinal nerves and weaken the structure of the spine.

Blindness – permanent and irreversible

Permanent and irreversible loss of sight to the extent that, even when tested with the use of visual aids, it is measured by an ophthalmologist as having a best

corrected (with glasses or lenses) visual acuity in the better eye of:

• 6/60 or worse using a Snellen eye chart, or

• a loss of peripheral visual field and a central visual field of no more than 20 degrees in total.

You will be able to claim only if you have:

• permanent and irreversible loss of sight in both eyes, or

• almost lost with any remaining sight confined to a narrow point straight ahead of you (sometimes known as tunnel vision).

You do not need to be totally blind in both eyes, but your permanent and irreversible loss of sight must be to the extent that even when tested with the use of visual aids, vision is measured at 6/60 or worse in the better eye using the Snellen eye chart.

Brain abscess drained via craniotomy 2 Surgical drainage of an intracerebral abscess within the brain tissue through a craniotomy by a Consultant Neurosurgeon. There must be evidence of an intracerebral abscess on CT or MRI imaging.

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 of 7 or above or having progressed to at least TNM classification T2bN0M0.

• 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) or – the occurrence of a malignant basal

cell carcinoma or malignant squamous cell carcinoma that has invaded and spread to lymph nodes or metastasised to distant organs.

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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Cancer is the general term used to refer to all types of ‘malignant tumours’. An invasive malignant tumour is made up of cancerous cells which invade surrounding tissues and then may spread via the bloodstream or lymphatic system to form more growths in other parts of the body. You will be able to claim if you are diagnosed as suffering from a cancer, even if there is no evidence that the cancer has spread to other parts of the body, unless the type of cancer is specifically excluded.

Leukaemia (a cancer of white blood cells), lymphoma (a cancer of the lymphatic system, a vital part of the body’s immune system) and Hodgkin’s disease, a type of lymphoma, are all covered by your plan.

Pre-malignant tumours, non-invasive tumours and cancers in-situ are not covered. Such tumours are generally in a very early stage and have not shown signs of invasion in their native tissue or spread to surrounding tissues. These tumours are usually readily treatable and not life threatening. All forms of skin cancer are excluded apart from:

• invasive malignant melanoma which has spread beyond the outer layer of the skin.

• invasive malignant basal cell carcinoma or malignant squamous cell carcinoma that have spread to lymph nodes or distant organs. These are serious forms of skin cancer. Other skin cancers are usually easily treated, are unlikely to spread and are not usually life threatening.

Carcinoma in situ of the breast 2

– requiring mastectomy or lumpectomy

The undergoing of a mastectomy or lumpectomy operation following the diagnosis of carcinoma in situ of the breast.

In situ means tumours of the breast which are histologically confirmed as carcinoma in situ.

For the above definition, the following are not covered:

• Prophylactic mastectomy or lumpectomy without histological evidence of carcinoma in situ. Carcinoma in situ (CIS) is an early development of cancer cells within the breast without further spread or invasion of other parts of the breast or body.

You will be able to claim if you are diagnosed with CIS of the breast and undergo the specified surgery or treatment.

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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Carcinoma in situ of the testicle 2

– requiring surgery to remove one or both testicles

A definite diagnosis of a tumour of the testicle histologically classified as carcinoma in situ of the testicle (also known as intratubular germ cell neoplasia unclassified or ITGCNU) and as a result treated, on the advice of a Consultant Oncologist or Consultant Urologist with an orchidectomy (complete surgical removal of the testicle).

An additional payment on this specified event will be payable only once.

Carcinoma in situ is an early

development of cancer cells within the testicle without further spread or invasion of other parts of the body. You will be able to claim if you are diagnosed with CIS of the testicle and undergo the specified surgery.

Carcinoma in situ 2 of the urinary bladder A definite diagnosis of a tumour of the urinary bladder histologically diagnosed as carcinoma in situ of the urinary bladder. For the above definition, the following are not covered:

Non-invasive papillary carcinoma, stage Ta bladder carcinoma and all other forms of non-invasive carcinoma are specifically excluded.

Carcinoma in situ (CIS) is an early development of cancer cells within the urinary bladder without further spread or invasion of other parts of the urinary bladder or body. You will be able to claim if you are diagnosed with CIS of the Urinary Bladder and undergo the specified surgery.

Cardiac arrest 1– with insertion of a

defibrillator 1

Sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and resulting in either of the following devices being surgically implanted:

• Implantable Cardioverter-Defibrillator (ICD); or

• Cardiac Resynchronization Therapy with Defibrillator (CRT-D).

The following are not covered:

• Insertion of a pacemaker

• Insertion of a defibrillator without cardiac arrest

Cardiac arrest is a life threatening condition in which the heart suddenly stops pumping blood around the body. You must have had a cardiac arrest requiring resuscitation and have a defibrillator fitted. This is a device which is put in to your chest to correct and control heart rhythm.

1 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan (your plan

terms and conditions will confirm if this additional cover applies to your plan).

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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Cardiomyopathy

A definite diagnosis by a consultant cardiologist of cardiomyopathy causing permanent impaired ventricular function such that the ejection fraction is 35% or less for at least 6 months when stabilised on therapy advised by the consultant. The diagnosis must also be;

– evidenced by echocardiographic abnormalities consistent with the diagnosis of cardiomyopathy.

– classified as Stage III under the New York Heart Association (NYHA) Functional Classification.

For the purposes of this condition, NYHA Stage III (as classified) means:

– a marked limitation of physical activity of the person covered due to symptoms that less than ordinary activity causes fatigue, palpitations, dyspnoea or anginal pain. The person covered is only comfortable at rest. All other forms of heart disease, heart enlargement and myocarditis are specifically excluded.

Cardiomyopathy is the name given to a series of diseases affecting the heart muscle producing heart dysfunction. Symptoms vary depending on the type of cardiomyopathy but may include shortness of breath, fainting and palpitations.

Cerebral aneurysm 2– treated by

craniotomy or endovascular repair

The undergoing of craniotomy or endovascular repair to treat a cerebral aneurysm.

A cerebral aneurysm is a

cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localised dilation or ballooning of the blood vessel.

You will be able to claim if you are diagnosed with a cerebral aneurysm and undergo the specified surgery.

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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Cerebral arteriovenous malformation 2

– resulting in specified treatment

Undergoing any of the following procedures in order to treat a cerebral arteriovenous malformation:

• surgery via craniotomy (surgical opening of the skull), or

• repair using stereotactic radiosurgery, or

• endovascular treatment using coils or other materials (embolisation) The following is not covered:

• Intracranial aneurysm. Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an

arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins. A brain AVM contains abnormal and, therefore, “weakened” blood vessels that direct blood away from normal brain tissue. These abnormal and weak blood vessels dilate over time. Eventually they may burst from the high pressure of blood flow from the arteries, causing bleeding into the brain.

Coma – with associated 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 associated permanent neurological deficit with persisting clinical symptoms.

A coma is a state of unrousable unconsciousness. Someone in a coma is unlikely to respond to any form of physical stimulation and unlikely to have any control of their bodily functions.

There are various depths to a coma, measured by the response to repeated external stimuli. A coma may be due to damage or disturbance to certain areas of the brain, which control and maintain conscious activity. A coma may, for example, occur as a result of a head injury, an abnormal growth like a brain tumour, or an abscess or ruptured blood vessel that bleeds into the brain.

If you are in a coma you will be covered provided there is no reaction to stimuli and life support systems are necessary resulting in permanent neurological deficit.

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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Coronary artery by-pass grafts

The undergoing of surgery on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. If you are placed on the NHS waiting list for coronary artery by-pass surgery, up to 20% of the critical illness cover amount can be accelerated to enable the surgery to be performed privately.

Coronary artery by-pass surgery may be needed when one or more coronary arteries, which supply blood to the heart, are narrowed or blocked. Coronary artery by-pass surgery is done by taking a vein, usually from the thigh, and using it by way of a graft to by-pass the diseased or blocked artery.

You will be able to claim if you undergo coronary artery by-pass surgery to correct one or more blocked arteries.

Balloon angioplasty, atherectomy and laser treatment are not covered under this condition.

Corticobasal ganglionic degeneration 1 A definite diagnosis by a Consultant Neurologist or Geriatrician.

There must also be permanent clinical impairment of at least one of the following:

• motor function; or

• eye movement disorder; or

• postural instability; or

• dementia.

Corticobasal ganglionic degeneration (CBD) is a progressive condition where brain cells become damaged over time and certain sections of the brain start to shrink. This means that the initial symptoms will become more severe over time and new symptoms may also develop. The initial symptoms of CBD include, sudden problems controlling certain limbs, loss of balance or coordination, slowness and reduced mobility. As the condition progresses, the symptoms become more wide-ranging and troublesome such as muscle spasms and weakness, ongoing decline of mental function, difficulty swallowing and speaking

Creutzfeldt-Jakob disease

– requiring continuous assistance

The unequivocal diagnosis of Creutzfeldt-Jakob disease, made by a consultant neurologist, evidenced by a significant reduction in mental and social functioning such that continuous supervision or assistance by a third party is required.

This is a rare disease with no known cure. From the onset of the first symptoms, intellectual ability deteriorates rapidly, leading to neurological problems and dementia. Constant care and nursing is usually required after six to 18 months.

1 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan (your plan

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Deafness – permanent and irreversible

Permanent and irreversible loss of hearing to the extent that the loss is greater than 90 decibels across all frequencies in the better ear using a pure tone audiogram. You will be able to claim if you have permanent and irreversible loss of hearing in both ears.

Diffuse Lewy body disease 1 A definite diagnosis by a Consultant Neurologist or Geriatrician.

There must also be permanent clinical impairment of at least one of the following:

• motor function; or

• eye movement disorder; or

• postural instability; or

• dementia.

Diffuse Lewy body disease (DLBD) is a degenerative disorder of the brain that leads to loss of memory and difficulty concentrating. People with DLBD not only experience problems with memory and judgement, like those with Alzheimer’s disease, but are also likely to have difficulty with concentration and visual perception. Other features of DLBD are slowed movement, visual hallucinations, sleep disturbances, fainting and falls.

Encephalitis

A definite diagnosis of encephalitis by a consultant neurologist resulting in permanent neurological deficit with persisting clinical symptoms.

For the above definition, the following is not covered:

• chronic fatigue syndrome and myalgic encephalomyelitis.

Encephalitis is inflammation of the brain. Symptoms might include severe headaches, nausea, vomiting,

convulsions, personality changes, problems with speech and/or hearing, confusion or disorientation. It’s usually caused by an infection and can range in severity from relatively mild to life threatening.

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.

The evidence must show a definite acute myocardial infarction.

For the above definition, the following is not covered:

• Other acute coronary syndromes or angina without myocardial infarction.

1 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan (your plan

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A heart attack, often called a

‘myocardial infarction’, happens when an area of heart muscle dies because it is deprived of oxygenated blood, usually because of a blocked artery (coronary occlusion) or a blood clot (coronary thrombosis).

You will be able to claim if you have been diagnosed as having suffered a heart attack. We will require your claim to be supported by new ECG changes (ECG is an abbreviation for electrocardiogram, a graphical record of the electrical impulses that make the heart beat), and an increase in cardiac enzymes (which are released into the blood stream from a damaged heart muscle), which are characteristic of a heart attack. The ECG will confirm that you have had a heart attack but raised levels of cardiac enzymes will support the diagnosis and confirm that the heart attack occurred recently. Your plan will not cover ‘angina’ as this

condition does not result in the death of a part of the heart muscle.

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.

When a heart valve is not working properly because it has become narrow or is leaking, an operation may be required to repair or replace the valve. You will be able to claim if you need to undergo heart surgery. The decision to operate will depend on the seriousness of the problem with the heart valve and the state of your general health.

HIV caught 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

• an incident occurring during the course of performing normal duties of employment;

after the plan starts 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 five days of the incident.

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– 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 an eligible country*. * The eligible countries are:

Australia, Austria, Belgium, Bulgaria, Canada, Channel Islands, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, Republic of Ireland, Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Republic of Macedonia, Malta, Monaco, the Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, and United States of America.

HIV is the virus that can lead to Acquired Immune Deficiency

Syndrome (AIDS). The body’s defence system breaks down and leaves the patient open to infections and cancers that eventually prove fatal.

Kidney failure

– requiring permanent dialysis

Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is permanently required.

The kidneys act as filters to remove waste materials from the blood. When the kidneys fail to function properly, a build-up of waste products in the blood can lead to life

threatening problems. Although the body can function with one kidney, if both kidneys fail completely, renal dialysis (kidney machine treatment) or a kidney transplant operation will be needed.

You will be able to claim if, as a result of both your kidneys failing

completely and permanently, you need regular long-term renal dialysis or a kidney transplant.

Liver failure – end stage

End stage liver failure due to cirrhosis and resulting in all of the following:

• Permanent jaundice

• Ascites

• Encephalopathy.

The liver controls certain metabolic functions and when cirrhosis is present, its ability to function is impaired. In severe cases, the liver is said to be in ‘chronic failure’. You can claim when so much damage to the liver has occurred that severe complications, including fluid retention (i.e. ascites) and impaired functioning of the brain (i.e. encephalopathy) have developed.

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Liver resection 2

The undergoing of a partial hepatectomy (liver resection) on the advice of a specialist surgeon in gastroenterology and hepatology.

For this definition the following are not covered:

• Surgery relating to liver disease resulting from alcohol or drug abuse

• Surgery for liver donation (as a donor)

• Liver Biopsy

Loss of hand or foot

– permanent physical severance

Permanent physical severance of a hand or foot at or above the wrist or ankle joints.

You will be able to claim if you have lost your limb whether by injury or necessary surgical removal.

Loss of independent existence – resulting in permanent symptoms

A condition which means that the life assured is, through an illness or accident, totally and irreversibly unable to do the things in four of the six following categories, without the assistance of someone else:

i. Personal hygiene – washing or bathing to the extent needed to maintain personal cleanliness.

ii. Dressing – putting on and taking off all necessary clothes.

iii. Mobility – moving from one room to another or getting in and out of a bed or chair.

iv. Eating and drinking – eating and drinking once food and drink has been prepared and made available.

v. Using the lavatory – getting on and off the lavatory and maintaining personal hygiene.

vi. Continence – controlling bowel and bladder functions.

Loss of speech

– total permanent and irreversible

Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

You will be able to claim if you suffer from total and permanent loss of speech as a direct result of physical injury or disease. Loss of speech as a direct result of mental trauma is not covered.

Major organ transplant

– from another person

The undergoing as a recipient of a transplant from another donor, of bone marrow or of a complete heart, kidney or pancreas, or transplant of a lobe of or an entire liver or lung, 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.

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Major organ transplant surgery is needed when it is necessary to replace a diseased or damaged organ with a healthy organ. Sometimes it is necessary to wait a long time because a suitable organ is not available. You will be able to claim if your condition is life threatening, a transplant is the best treatment, and you need to be included on

an official local health authority waiting list for one of the transplants listed in the definition.

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.

This is a rare progressive degenerative disorder which affects the central nervous system that controls muscular activity. As the nerves degenerate the muscles weaken and deteriorate. The cause of motor neurone disease is still unknown.

Multiple sclerosis

– with persistent symptoms

A definite diagnosis of multiple sclerosis by a Consultant Neurologist that has resulted in either of the following:

• clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 3 months, or

• 2 or more attacks of impaired motor or sensory function together with findings of clinical objective evidence on Magnetic Resonance Imaging (MRI). All of the evidence must be consistent with multiple sclerosis.

This is a progressive disease of the central nervous system in which the protective covering (myelin) of the nerve fibres in the brain and spinal cord is destroyed.

The cause of multiple sclerosis is unknown and the search for a cure is still being pursued. The severity of the disease can vary considerably and the symptoms can differ depending upon which areas of the brain or spinal cord have been affected.

Although there is no single diagnostic test for multiple sclerosis, which means it may take time to get a satisfactory diagnosis, a neurologist can perform various tests such as ‘CT scanning’ (computerised tomography, a computer and x-ray technique to produce images of the body from different angles); ‘lumbar puncture’ (a procedure to remove and test spinal fluid); or ‘evoked responses’ (which trace the electrical activity in the brain). These tests are done to help confirm the diagnosis of multiple sclerosis, once all other possible conditions have been considered.

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Multiple system atrophy

– resulting in progressive and permanent symptoms

A definite diagnosis of multiple system atrophy by a consultant neurologist. There must be evidence of disease progression and 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.

Multiple system atrophy is a progressive disease of the nervous system. Symptoms are varied and include muscle weakness, swallowing difficulties and increasingly severe impairment of physical function. There are treatments to delay some of the symptoms of the disease but no cure currently exists and life expectancy is greatly reduced.

Non malignant pituitary adenoma 2

– with specified treatment

Diagnosis of a non malignant pituitary tumour requiring radiotherapy or surgical removal.

For the above definition, the following are not covered:

• Non malignant tumours of the pituitary gland treated by other methods. You will be able to claim if you are diagnosed with a non malignant pituitary adenoma that is treated with radiotherapy or surgery.

Open heart surgery – with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist, to correct any structural abnormality of the heart.

Paralysis of limb – total and irreversible

Total and irreversible loss of muscle function to the whole of any limb.

The brain controls the muscle movement in the body by sending messages through the spinal cord and peripheral nerves. Paralysis/paraplegia is usually caused by an injury to the spinal cord.

You will be able to claim if you suffer complete and irreversible loss of the use of a limb.

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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Parkinson’s disease before age 65

– resulting in permanent symptoms

A definite diagnosis of Parkinson’s disease before age 65 by a consultant neurologist. There must be permanent clinical

impairment of motor function with associated tremor, and muscle rigidity.

Parkinson’s disease is a progressive, degenerative disorder of the central nervous system. There are three main characteristics: tremor, slow

movements and muscular rigidity. The symptoms may occur alone or in combination. As yet, there is no cure for Parkinson’s disease.

Parkinsonism-dementia-amyotrophic lateral sclerosis complex 1

A definite diagnosis by a Consultant Neurologist or Geriatrician.

There must also be permanent clinical impairment of at least one of the following:

• motor function; or

• eye movement disorder; or

• postural instability; or

• dementia.

Parkinsonism-dementia-amytrophic lateral sclerosis complex is a degenerative nerve disease which specifically affects the motor nerves in the body located in the brain and spinal cord. These provide movement of the skeletal muscles in either the upper or lower region of the body. As the motor neurones deteriorate so does the ability to perform voluntary movement, often leading to paralysis of the limbs, inability to speak and eventually breathe.

Pneumonectomy 1– for disease

and trauma

The undergoing of surgery on the advice of a consultant physician to remove an entire lung for disease or trauma.

For the above definition the following are not covered:

• removal of a lobe of the lungs (lobectomy);

• lung resection or incision.

Pneumonectomy is the medical term used for removal of a lung.

A lung may be removed to treat disease or following a severe traumatic injury.

1 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan (your plan

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Pre-senile dementia before age 65

– resulting in permanent symptoms

A definite diagnosis before your 65th birthday, by a consultant neurologist, psychiatrist or geriatrician, of pre-senile dementia. The diagnosis must, at the time it is made, be supported by evidence of progressive deterioration of memory and of the ability to reason and to perceive, understand, express and give effect to ideas.

Dementia is a term describing a number of progressive diseases of the brain. There are various ways in which dementia can affect a person, such as severe loss of memory and concentration; but, overall, there is a general decline in all areas of mental ability.

Primary pulmonary arterial hypertension – resulting in permanent symptoms

Primary pulmonary arterial hypertension with substantial right ventricular

enlargement established by investigations including cardiac catheterisation, resulting in permanent irreversible physical

impairment to the degree of at least Class III of the New York Heart Association Classification of cardiac impairment. For the purposes of this condition, NYHA Class III (as classified):

– a marked limitation of physical activity of the person covered due to symptoms of less than ordinary activity causing fatigue, palpitations, dyspnoea or anginal pain. The person covered is only comfortable at rest.

The pulmonary artery is the large vessel that carries blood from the heart into the lungs so it can pick up oxygen. Pulmonary arterial

hypertension is a blood vessel disorder of the lung in which the pressure in the pulmonary artery rises above normal levels and becomes life threatening. Pulmonary arterial hypertension is known as primary where there is no known cause for the condition. Secondary pulmonary hypertension, where the cause is known, is not covered.

Progressive supranuclear palsy

A definite diagnosis by a consultant neurologist of progressive

supranuclear palsy.

Progressive supranuclear palsy (PSP) is a rare brain disorder that causes serious and permanent problems with control of gait and balance. The symptoms of PSP are caused by a gradual deterioration of brain cells in a few tiny but important places at the base of the brain, in the region called the brainstem.

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Prostate cancer low-grade 2

A definite diagnosis of a tumour of the prostate histologically classified as having a Gleason score between 2 and 6 inclusive provided: the tumour has progressed to at least clinical TNM classification T1N0M0; and treatment included the complete removal of the prostate or external beam or interstitial implant radiotherapy. For the above definition, the following are not covered:

• Tumours treated with cryotherapy, other less radical treatment (e.g. transurethral resection or the prostate), experimental treatments or hormone therapy.

Low grade prostate cancer means that cancer cells have been found only in the prostate gland without further spread or invasion of other parts of the body.

You will be able to claim if you are diagnosed with low grade prostate cancer of the required severity and under go the specified procedures, surgery or treatment.

Pulmonary artery surgery – with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breast bone) on the advice of a consultant cardiothoracic surgeon for disease of the pulmonary artery to excise and replace the diseased pulmonary with a graft.

‘Open heart’ surgery is performed to gain access to repair the diseased section of the pulmonary artery with a graft.

Removal of an eyeball – as a result of injury or disease – permanent physical severance

Permanent surgical removal of an eyeball as a result of injury or disease.

Single Lobectomy 2 – the removal of a

complete lobe of a lung

The undergoing of medically essential surgery to remove a complete lobe of a lung for disease or traumatic injury. For the above definition, the following are not covered:

• Partial removal of a lobe of the lungs (segmental or wedge resection)

• Any other form of lung surgery. Lobectomy is the medical term used for removal of a lobe of the lung. A lobe may be removed to treat disease or following a severe traumatic injury.

Severe lung disease/respiratory failure

– of specified severity

Confirmation by a consultant physician of severe lung disease which is evidenced by all of the following:

• the need for continuous daily oxygen therapy on a permanent basis;

• evidence that oxygen therapy has been required for a minimum period of six months;

• FEV1 being less than 40 percent of normal; and

• vital capacity less than 50 percent of normal.

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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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 are not covered:

• Transient ischaemic attack

• Death of tissue of the optic nerve or retina / eye stroke.

The brain controls all the functions to the body, so damage to it can have serious effects. A stroke takes place when there is severe damage in the brain due to internal bleeding (haemorrhage) or when the flow of blood in an artery has been blocked by a piece of tissue or a blood clot (an embolus).

You will only be able to claim if you suffer a stroke that leaves evidence of permanent damage to the nervous system. Some examples of such evidence may be paralysis of the right or left side of the body, or disturbance of speech or vision.

Subarachnoid haemorrhages, although not technically strokes, are covered, provided permanent neurological damage has occurred.

Your plan will not cover ‘transient ischaemic attacks’ (sometimes known as mini strokes). Although there is a short term interruption of the blood supply to all or part of the brain, it does not result in permanent effects. Your plan will also not cover central retinal artery or vein occlusions (sometimes known as an eye stroke) as for many people this will not result in permanent visual impairment.

Syringomelia or Syringobulbia 2

– treated by surgery

A definite diagnosis of Syringomelia or Syringobulbia by a Consultant

Neurologist, which has been surgically treated. This includes surgical insertion of a permanent drainage shunt.

Syringomyelia or syringobulbia is a disorder in which a cyst, or cavity, forms within the spinal cord. Over time, this cyst can expand and elongate destroying the spinal cord. The damage may result in pain, paralysis, weakness and stiffness in the back, shoulders and extremities.

Systemic lupus erythematosus

– of specified severity

A definite diagnosis of systemic lupus erythematosus (SLE) by a consultant rheumatologist where either of the following are also present:

Severe kidney involvement with SLE as evidenced by:

• permanent impaired renal function with a glomerular filtration rate (GFR) below 30 ml/min/1.73m2 and

• abnormal urinalysis showing proteinuria or haematuria, or Severe Central Nervous System (CNS) involvement with SLE as evidenced by;

Permanent deficit of the neurological system as evidenced by at least any one of the following symptoms, which must be present on clinical examination and expected to last for the remainder of the claimant’s life:

• paralysis

• localized weakness

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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• dysarthria (difficulty with speech)

• aphasia (inability to speak)

• dysphagia (difficulty in swallowing)

• difficulty in walking, lack of coordination

• severe dementia where the insured needs constant supervision

• permanent coma.

For the purposes of this definition:

• seizures, headaches, fatigue, lethargy or any symptoms of psychological or psychiatric origin will not be accepted as evidence of permanent deficit of the neurological system.

To avoid doubt, all other forms of SLE are specifically excluded from the cover provided by this policy.

SLE involves chronic inflammation of body tissues caused by autoimmune disease. Autoimmune diseases are illnesses that occur when the body’s tissues are attacked by its own immune system.

Terminal illness – where death is expected within 12 months

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.

Where life or earlier critical illness cover is included in your plan, terminal illness benefit up to the value of the critical illness sum assured can be paid irrespective of the cause of illness if, in the opinion of your attending consultant, the illness is expected to lead to death within 12 months or less. Where extra life cover is included in your plan, and you are diagnosed with a terminal illness within the last 12 months of the term of the plan, the extra life cover amount will only be paid if you die during the remaining term of the plan.

Third-degree burns – covering 20% of the body’s surface area or 50% of the face’s surface area

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 50% of the face’s surface area. Please go to page 29 for more

information on Third-degree burns.

Third-degree burns 2 – less extensive

– covering 5% of the body’s surface area or 19% of the face’s surface area

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 5% of the body’s surface area or 19% loss of the surface area of the face which for the purposes of this definition includes the forehead and ears.

No claim will be payable in respect of this benefit where a claim for Third-degree burns – covering 20% of the body’s surface area or 50% of the face’s surface

2 Eligible only on certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan, as an

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area, is submitted at the same time as or within 30 days of the diagnosis of Third-degree burns – covering 20% of the body’s surface area or 50% of the face’s surface area.

There are three levels of burns. The ‘degree’ of burning depends on the extent of the damage done to the skin. They are medically known as ‘first’, ’second’ and ‘third-degree’. ‘First-degree’ burns damage the top layer of skin (a common example of this is sunburn). ‘Second-degree’ burns go deeper into the layers of skin, but some may heal without scarring. ’Third-degree’ burns are the most serious, as they destroy the full thickness of the skin.

For Third-degree burns – covering

20% of the body’s surface area or 50% of the face’s surface area, you will be able to make a claim if you have suffered ‘third-degree’ burns covering at least 20% or more of the surface area of your body or covering 50% of the face’s surface area. For the purpose of this definition the forehead and ears are included as part of the face.

For Third-degree burns 2 – less

extensive – covering 5% of the body’s surface area or 19% of the face’s surface area, you will be able to make a claim if you have suffered ‘third-degree’ burns covering at least 5% or more of the surface area of your body, or 19% of the face’s surface area. For the purpose of this definition the forehead and ears are included as part of the face.

Total permanent disability

– unable before age 65 to look after yourself ever again.

Loss of the physical ability through an illness or injury before age 65 to do at least 3 of the 6 tasks listed below ever again.

The relevant specialists must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or the insured person expects to retire.

The insured person must need the help or supervision of another person and be unable to perform the task on their own, even with the use of special equipment routinely available to help and having taken any appropriate prescribed medication.

The tasks are:

• Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.

• Getting dressed and undressed

– the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.

• Feeding yourself – the ability to feed yourself when food has been prepared and made available.

• Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.

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• Getting between rooms – the

ability to get from room to room on a level floor.

• Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again. For the above definition, disabilities for which the relevant specialists cannot give a clear prognosis are not covered.

Any disability which, in our reasonable opinion, arises or continues directly or indirectly as a result of infection by, or treatment of, human immunodeficiency virus and/or acquired immune deficiency syndrome is not covered.

You will be able to claim for this if you are unable to perform certain activities of daily living before you are aged 65.

Traumatic brain injury – resulting in permanent symptoms

Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms.

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A child means your natural or legally adopted child. In either case, the

child must be financially dependent on you.

Your children are also covered for the conditions in the following list at no extra cost. Children’s critical illness benefit applies from the date each child turns three months and lasts until they reach age 18, as long as the plan is in force. The most we will pay for a child is half the level of critical illness cover provided by the plan at claim subject to a maximum of £25,000. We will only pay one claim for each child but there is no limit to the number of children covered.

The conditions covered under the children’s critical illness benefit are:

• Alzheimer’s disease – resulting in permanent symptoms.

• Aorta graft surgery – for disease and trauma.

• Aplastic anaemia – resulting in permanent symptoms.

• Bacterial meningitis – resulting in permanent symptoms.

• Benign brain tumour – resulting in permanent symptoms.

• Benign spinal cord tumour. 1

• Blindness – permanent and irreversible.

• Brain abscess drained via craniotomy. 2

• Cancer – excluding less advanced cases.

• Carcinoma in situ of the breast – requiring mastectomy or lumpectomy. 2

• Carcinoma in situ of the testicle – requiring surgery to remove on or both testicles. 2

• Carcinoma in situ of the urinary bladder. 2

• Cardiac arrest – with insertion of a defibrillator. 1

• Cardiomyopathy.

• Cerebral aneurysm – treated by craniotomy or endovascular repair. 2

• Cerebral arteriovenous malformation – resulting in specified treatment. 2

• Coma – with associated permanent symptoms.

• Coronary artery by-pass grafts – (a payment is available to pay for surgery after being placed on an NHS waiting list.)

• Corticobasal ganglionic degeneration. 1

• Creutzfeldt-Jakob Disease (CJD) – requiring continuous assistance.

• Deafness – permanent and irreversible.

• Diffuse Lewy body disease. 1

• Encephalitis.

• Heart attack – of specified severity.

• Heart-valve replacement or repair.

• HIV caught from a blood transfusion, by physical assault or at work#.

• Kidney failure – requiring dialysis.

Children’s critical illness benefit

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• Liver failure – end stage.

• Liver resection. 2

• Loss of hand or foot – permanent physical severance.

• Loss of independent existence – resulting in permanent symptoms.

• Loss of speech – total permanent and irreversible.

• Major organ transplant – from another person.

• Motor neurone disease – resulting in permanent symptoms.

• Multiple sclerosis – with persisting symptoms.

• Multiple system atrophy – resulting in progressive and permanent symptoms.

• Non malignant pituitary adenoma – with specified treatment. 2

• Open heart surgery – with surgery to divide the breastbone.

• Paralysis of limb – total and irreversible.

• Parkinsonism-dementia-amyotrophic lateral sclerosis complex. 1

• Parkinson’s disease before age 65 – resulting in permanent symptoms.

• Pneumonectomy – for disease or trauma.

• Pre-senile dementia before age 65 – resulting in permanent symptoms.

• Primary pulmonary arterial hypertension – resulting in permanent symptoms.

• Progressive supranuclear palsy.

• Prostate cancer low-grade. 2

• Pulmonary artery surgery – with surgery to divide the breastbone.

• Removal of an eyeball as a result of injury or disease – permanent physical severance.

• Severe lung disease/respiratory failure – of specified severity.

• Single Lobectomy – the removal of a complete lobe of a lung. 2

• Stroke – resulting in permanent symptoms.

• Syringomelia or Syringobulbia – treated by surgery. 2

• Systemic lupus erythematosus – of specific severity.

• Terminal illness – where death is expected within 12 months.

• Third-degree burns – covering 20% of the body’s surface area or 50% of the face’s surface area.

• Third-degree burns – less extensive – covering 5% of the body’s surface area or 19% of the face’s surface area. 2

• Total permanent disability*.

• Traumatic brain injury – resulting in permanent symptoms.

1 For certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan we cover these additional critical illness conditions (your plan terms and conditions will confirm what cover applies to your plan).

2 For certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan we cover these additional critical illness conditions (your plan terms and conditions will confirm what cover applies to your plan). A successful claim for this condition will result in an additional critical illness cover cash payment only. Please see page 6 for more information or your plan terms and conditions.

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* For children’s critical illness benefit ‘total permanent disability’ means an irreversible level of disability which, in Zurich’s reasonable opinion, means the child would be disabled from performing any occupation whatsoever if he or she were an adult.

# The incident causing the infection must

have occurred in an eligible country. The eligible countries are:

Australia, Austria, Belgium, Bulgaria, Canada, Channel Islands, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, Republic of Ireland, Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Republic of Macedonia, Malta, Monaco, the Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, and United States of America.

The children’s critical illness benefit is only payable if the child undergoes the relevant condition or operation and survives for 14 days. Only one claim can be made per child.

The benefit is included, for the conditions and operations outlined above, from the date each child turns three months until their 18th birthday. If your child is under the age of three months at the start of your plan, they will be included on reaching the age of three months. Each child will be covered for half the critical illness cover on the plan or £25,000, whichever is lower, and we’ll pay a maximum of one claim per child.

For certain Guaranteed Payments versions of Decreasing Mortgage Cover Plan and Level Protection Plan we cover additional critical illness conditions (your plan terms and conditions will confirm what cover applies to your plan). The additional conditions are shown in the list of medical conditions and operations we cover (shown on pages 31 and 32) and are either marked with a 1 or a 2 in the same list. In the event of a successful claim those conditions marked with a 1 will result in payment of the children’s critical illness sum benefit. Those marked with a 2 will result in payment of 20% of the level of critical illness cover on the plan at the time you claim, or £15,000, which ever is lower. We refer to these as additional critical illness cover cash payments, and for these conditions only, we’ll pay a maximum of one claim per child for each of the conditions covered.

We do not ask for any medical details on children before they are included on your plan. So you should be aware that you would not be able to claim if your child had previously suffered, or was suffering, from one of the above conditions, or had previously had or was about to undergo one of the operations, before they were included on your plan.

For further details on the conditions and operations included for this benefit, please see the relevant pages in this booklet. For details of the exclusions, please see page 7.

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If you need to claim, you, or the person dealing with your affairs, should contact us on the telephone number noted below. We’ll provide any claim form we require and it must be completed in full and signed before we can proceed with the claim.

We’ll confirm what information we’ll need from your doctor, consultant or any other third party. We always try to pay all valid claims as soon as possible and we’ll keep you, informed of how the claim is progressing.

To claim for Critical illness cover Telephone number 0370 243 0827 Opening hours 9am to 5pm

Claiming for critical illness cover and children’s critical illness benefit

You must tell us within six months of you or your child being diagnosed with the critical illness or having the operation. At the point of claim we’ll usually carry out a telephoned based interview unless this is not possible at the time, when we will instead send you a claim form. We’ll then send you a summary of our conversation for you to check, sign and return. Once we have received your signed confirmation or alternatively your signed claim form, we’ll tell you what medical evidence we’ll be obtaining and any documents you need to send to us before we can pay the claim. You will need to carry on making payments to the plan until we agree to pay the claim.

You will need to carry on making payments to the plan until we agree to pay the critical illness claim. Where your plan includes a higher level of life cover than critical illness cover, and we pay a critical illness claim, you will need to carry on making payments for the remaining life cover which will be reduced by the amount of the critical illness cover we’ve paid. For children’s critical illness benefit claims and additional critical illness cover cash payment claims (applicable only to certain Guaranteed Payment versions of the Decreasing Mortgage Cover Plan and Level Protection Plan), you will need to continue making payments to the plan until we agree to pay the claim and after we agree to do so.

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If you want to contact us you can phone or write.

How to contact us

Phone

01793 514514

Monday to Friday 8.30am – 6pm (excluding bank holidays). We may record or monitor calls to improve our service.

Write to

Zurich Assurance Ltd Tricentre One New Bridge Square Swindon

SN1 1HN UK

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If you would like further details or clarification on any of the information in this booklet, please contact us. We have based this information on our understanding of law and practice as at May 2015. Zurich Assurance Ltd

Registered in England and Wales under company number 02456671. Registered Office: The Grange, Bishops Cleeve, Cheltenham, GL52 8XX. Telephone: 01793 514514.

www.zurich.co.uk/life

We may record or monitor calls to improve our service. PW113293052 (06/15) RRD

Please let us know if you would like a copy of this in

large print or braille, or on audio tape or CD.

References

Related documents

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