Critical Illness Cover and Critical Illness with Life Cover Membership handbook

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Friends Life Individual Protection

Critical Illness Cover and

Critical Illness with Life Cover

Membership handbook

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Membership

handbook

Contents

Welcome 3

General definitions 5

Critical illness definitions 9

Your membership 19

Additional options 22

What you are covered for 30

What you are not covered for 39

Changes to your membership 42

Premium options 48

How to make a claim 51

Your right to cancellation 55

General information 57

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Welcome

Thank you for choosing Friends Life Individual Protection

Thank you for choosing critical illness cover or critical illness with life cover from Friends Life Individual Protection. Friends Life Individual Protection products are provided by Friends Life and Pensions Limited, part of the Friends Life group. With this membership we aim to provide you and your dependants with protection should serious illness or incapacity affect the member’s ability to work and cause you financial hardship, and help secure your dependants’ financial future if a member is to die.

The membership has been designed to offer you the flexibility to provide you with the right level of financial health protection to match your circumstances.

Friends Life flexible financial protection is the umbrella plan which provides cover through a series of separate memberships for different types and levels of cover.

Your registration certificate will show which type of membership you have. Each membership will have a separate handbook.

This handbook explains what is covered by Friends Life Individual Protection Critical Illness and Friends Life Individual Protection Critical Illness with Life Cover and what to do if you need to make a claim.

Using the membership handbook

The terms and conditions of this membership handbook are the terms and conditions on which we intend to rely. For your own benefit and protection, you should read the terms and conditions carefully. If you do not understand any point please ask us for further information.

Where the words ‘we’, ‘us’ or ‘our’ are used, this refers to Friends Life and Pensions Limited. The words ‘you’ or ‘your’ refer to the person, or people, who are entitled to receive the benefits of the membership. Where we refer to the member(s), this refers to the person, or people, covered under the same membership. The terms you and member may refer to the same people or different people. Words printed in bold type in this handbook are defined terms. Defined terms have a specific meaning explained in the definition section below or later on in the terms of this

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Welcome

Where we refer to you or to the member and this refers to two people, we mean both people jointly unless we say otherwise. For example, where we say we will pay the benefit to you, we mean both schemeholders jointly, we will not pay the benefit twice.

Fairness of Terms

(a) In making decisions and exercising discretions given to us under the terms and conditions of this membership handbook, Friends Life will act reasonably and with proper regard to the need to treat you and our other customers fairly.

(b) The terms and conditions in your membership handbook will only apply provided that they are not held by a relevant court or viewed by the Financial Conduct Authority or by us to be unfair contract terms. If a term is unfair it will, as far as possible, still apply but without any part of it which causes it to be unfair.

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General definitions

Please refer to the definition explanations below for further information on their meanings.

Average Weekly Earnings

The measure used by the Office of National Statistics which has replaced the average earnings index. This measure is an indicator of short-term earnings growth and provides a monthly estimate of the level of average weekly earnings per employee. Alternatively, if this measure is not published during any period of your membership the ‘average weekly earnings measure’ will be any substituted index or index of figures published by that Office.

Benefit

The critical event benefit shown on your registration certificate excluding the

terminal illness benefit. However, where benefit is used in this handbook as being of general application to all benefits covered by this handbook, it shall be read so as to read ‘the benefit or the terminal illness benefit

as appropriate’.

Friends Life Individual Protection approved hospital

A centre of treatment which is registered, or recognised under the local country’s laws, as existing primarily for:

•

carrying out major surgical operations; or

•

providing treatment which only

and which has been approved by Friends Life Individual Protection.

Child / children

Any natural child or adopted child of you or

your spouse, partner or civil partner or any child for which either you or your spouse, partner or civil partner are the legal guardian.

Childcover benefit

The childcoverbenefitas defined in the ‘What youare covered for’ section in this handbook.

Child funeral benefit

The child funeral benefit as defined in the ‘What you are covered for’ section in this

handbook.

Commencement date

The date your membership starts, as shown on your registration certificate.

Consultant

A surgeon, anaesthetist or physician who:

•

is legally qualified to practice medicine or surgery following attendance at a recognised medical school; and

•

is recognised by the relevant authorities in the country in which the treatment takes place as having specialised qualification in the field of, or expertise in, the treatment of the disease or illness being treated. By recognised medical school we mean a medical school which is listed in the World Directory of Medical Schools, as published from time to time by the World Health

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General definitions

Critical illness(es)

Any of the illnesses and operations as defined in the ‘Critical illness definitions’ section in this

handbook relate to any illness or operation separately, not all of them together.

Endorsement(s)

Change(s) that you require and we agree to be made to your membership after it commences which are recorded in the endorsement section of your registration certificate.

Fracture

Thefractures defined in ‘Black’s Medical Dictionary’ (39th edition), comminuted, complicated, compound, depressed, greenstick, pathological and simple. The fracture definition does not include any other type of fracture.

Full time employment

Working a minimum of 35 hours a week.

Handbook

This handbook setting out the general terms and conditions of your membership.

Irreversible

Cannot be reasonably improved upon by medical treatment and/or surgical

procedures used by the NHS in the UK at the time of the claim.

Member

The person (or people) named as a member in

Membership

The agreement between you and us to provide the benefit on the terms set out in the handbook and the documents referred to in the section ‘Yourmembership’.

Mental impairment

Mental disorder causing incapacity which has failed to respond to a minimum of two years optimal treatment by a consultant

psychiatrist and requires the need for continuous psychotropic medication, supervision and care from a consultant and results in severe dysfunctioning and the prognosis is considered poor or worse.

NHS

National Health Service.

Occupation

A trade, profession or type of work undertaken for profit or pay. It is not a specific job with any particular employer and is independent of location and availability.

Permanent

Expected to last throughout the life of the person covered, irrespective of when the

membership ends or the member expects to retire.

Permanent neurological deficit with persisting clinical symptoms

Symptoms of dysfunction in the nervous system that are present on clinical

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Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma. The following are not covered:

•

an abnormality seen on brain or other scans without definite related clinical symptoms

•

neurological signs occurring without symptomatic abnormality, eg. brisk reflexes without other symptoms

•

symptoms of psychological or psychiatric origin.

Registration certificate

The most recent registration certificate, we

issue to you.

Renewal date

If your registration certificate states that

your ‘Type of Cover’ is ‘Renewable Term (five years)’, therenewal datewill be the fifth anniversary of the commencement date and the end date of every following five year period. If your registration certificate says the ‘Type of Cover’ you have is ‘Renewable Term (ten years)’, therenewal datewill be the tenth anniversary of the commencement date and the end date of every following ten year period.

Retail Price Index

The general index of retail prices published by

if that index is not published during any period of your membership, the ‘retail price index’ will be any substituted index or index of figures published by that Office.

Special condition

Any condition we set to limit your

entitlement under your membership, as shown in the ‘Special Conditions’ section of

your registration certificate.

Suited occupation

Any work you could do for profit or pay taking into account your employment history, knowledge, transferable skills, training, education and experience, and is irrespective of location and availability.

Terminal illness benefit

The equivalent benefit in value to the benefit

but only relating to a member being diagnosed with a terminal illness under a Critical Illness with Life Cover membership.

UK

England, Northern Ireland, Scotland and Wales.

We / us / our

Refers to Friends Life and Pensions Limited.

You / your

Refers to the person (or people) named as the schemeholder on your registration certificate or any person (or people) to whom your membership is validly assigned. This is the person (or people) who hold the

membership. General definitions

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Critical illness definitions

Alzheimer’s disease

A definite diagnosis of Alzheimer’s disease by a consultantneurologist, 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.

The following are not covered:

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other types of dementia.

Aorta graft surgery

The undergoing of surgery to the aorta with excision and surgical replacement of a portion of the affected aorta with a graft. The term aorta includes the thoracic and abdominal aorta but not its branches. The following are not covered:

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

Aplastic anaemia

Confirmation by a consultanthaemotologist of a definite diagnosis of complete bone marrow failure which results in anaemia, neutropenia and thrombocytopenia and requires as a minimum, one of the following treatments:

•

blood transfusion

•

bone-marrow transplantation

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immunosuppressive agents

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marrow stimulating agents.

All other forms of anaemia are specifically excluded.

Bacterial meningitis

Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit with persisting clinical symptoms. The diagnosis must be confirmed by a consultant neurologist.

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all other forms of meningitis, not mentioned above, including viral meningitis.

Benign brain tumour

A non-malignant tumour or cyst originating in the brain, cranial nerves or meninges within the skull, resulting in any of the following:

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permanent neurological deficit with persisting clinical symptoms; or

•

undergoing invasive surgery to remove part or all of the tumour; or

•

undergoing either stereotactic

radiosurgery or chemotherapy treatment to destroy tumour cells.

•

tumours in the pituitary gland

•

tumours originating from bone tissue

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angiomas and cholesteatoma. Critical illness definitions

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Benign spinal cord tumour

A non-malignant tumour in the spinal canal, involving the meninges or the spinal cord. This tumour must be interfering with the function of the spinal cord which results in

permanent neurological deficit with persisting clinical symptoms. The diagnosis must be made by a relevant consultant and must be supported by CT, MRI or

histopathological evidence.

The following are not covered: cysts, granulomas, malformations in the arteries or veins of the spinal cord, haematomas, abscesses, disc protrusions and osteophytes.

Blindness

Permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 6/60 or worse in the better eyeusing a Snellen eye chart, or visual field is reduced to 20 degrees or less of an arc, as certified by an

ophthalmologist.

Cancer

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, lymphoma and sarcoma except cutaneous lymphoma (lymphoma confined to the skin).

•

all cancers which are histologically classified as any of the following: – pre-malignant

– non-invasive – cancer in situ

– having either borderline malignancy; or – having low malignant potential

•

all tumours of the prostate unless histologically classified as having a Gleason score greater than six or having progressed to at least clinical TNM classification T2N0M0

•

chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A

•

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 positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. To satisfy the definition of skin cancer in this bullet point, the skin cancer must have invaded and spread to lymph nodes or metastasised to distant organs.

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Cardiac arrest

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).

Cardiomyopathy

The unequivocal diagnosis by a consultant cardiologist of cardiomyopathy resulting in one or more of the following:

•

impaired ventricular function and marked limitation of physical activity where the

member is unable to progress beyond stage two of a treadmill exercise test using the standard Bruce protocol; or is

•

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

For the purpose of this definition NYHA Stage III is classified as a marked limitation in activity due to symptoms even during less than ordinary activity. The patient is only comfortable at rest.

•

all other forms, other than those specified above, of heart disease, heart

enlargement and myocarditis are specifically excluded.

Chronic rheumatoid arthritis

A definite diagnosis by a consultant rheumatologist of chronic rheumatoid arthritis as evidenced by widespread joint destruction with major clinical deformity. In addition the member must permanently satisfy three of the four following criteria: Bending -The inability to bend or kneel to pick up something from the floor and stand up again and the inability to get into and out of a standard saloon car.

Dexterity - The inability touse hands and fingers to pick up and manipulate small objects such as cutlery, including being unable to writeusing a pen or pencil. Lifting - The inability to lift, carry or otherwise move everyday objects by hand. Everyday objects include a kettle of water, a bag of shopping and an overnight bag or briefcase. Mobility -The inability to walk a distance of 200 metres on flat ground, with or without the aid of a walking stick and without having to rest or experiencing severe discomfort.

Coma

A state of unconsciousness with no reaction to external stimuli or internal needs which:

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requires the use of life support systems; and

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results in permanentneurological deficit with persisting clinical symptoms. Critical illness definitions

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Critical illness definitions

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medically induced coma

•

coma secondary to alcohol or drug abuse.

Coronary artery by-pass grafts

The undergoing of surgery requiring thoracotomy (keyhole surgery or median sternotomy) on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts.

Creutzfeldt-Jakob disease

Confirmation by a consultant neurologist of a definite diagnosis of Creutzfeldt-Jakob disease resulting in permanent neurological deficit with persisting clinical symptoms.

Crohn’s disease

A definite diagnosis by a consultant gastroenterologist of Crohn’s disease. There must have been two or more bowel segment resections on separate occasions. There must also be evidence of continued inflammation with current symptoms.

Deafness

Permanent and irreversible loss of hearing to the extent that loss is greater than 95 decibels across all frequencies in the better earusing a pure tone audiogram.

Dementia

A definite diagnosis of dementia by a consultantneurologist, 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.

The following is not covered:

•

Alzheimer’s disease.

Diabetes mellitus type 1

A definite diagnosis of diabetes mellitus type 1 with first diagnosis over age 40, with abrupt onset requiring the permanent use of insulin injections that must have continued for a period of at least 12 months.

•

gestational diabetes

•

type 2 diabetes (including type 2 diabetes treated with insulin)

•

latent autoimmune diabetes of adulthood

We will not pay the benefit for type 1 insulin dependent diabetes mellitus, as defined above, if the diagnosis is made within the 12 months before the date on which your membership will end and may not be renewed.

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Heart attack

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

•

the characteristic rise of cardiac enzymes or Troponins

•

new characteristic electrocardiographic changes or other positive findings on diagnostic imaging tests.

The evidence must show a definite acute myocardial infarction.

•

other acute coronary syndromes

•

angina without myocardial infarction.

Heart valve replacement or repair

The undergoing of surgery requiring thoracotomy (keyhole surgery or median sternotomy) on the advice of a consultant cardiologist to replace or repair one or more heart valves.

HIV infection

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 from the eligible occupations listed below:

– ambulance workers – chiropodists – dental nurses – dental surgeons – district nurses – fire brigade firefighters – general practitioners – hospital caterers – hospital cleaners

– hospital doctors, surgeons and consultants

– hospital laboratory technicians – hospital laundry workers – hospital nurses

– hospital porters – midwives

– nurses employed by general practitioners

– occupational therapists – paramedics

– physiotherapists – podiatrists

– policemen and policewomen – prison officers

– radiologists – refuse collectors – social workers

after the start of the policy and satisfying all of the following:

•

the incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures

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•

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

•

there must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus.

•

HIV infection resulting from any other means, including sexual activity or drug misuse.

Kidney failure

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

Liver failure

Chronic liver disease, being end stage liver failure due to cirrhosis and resulting in all of the following:

•

permanent jaundice

•

ascites

•

encephalopathy.

Loss of hands or feet

Permanent physical severance of any combination of one or more hands or feet at or above the wrist or ankle joints.

Loss of independence

The total and permanent loss of the ability to perform routinely at least three of the specified six ‘activities of daily living’ without the continual assistance of someone else, even with theuse of special devices or equipment.

The following are activities of daily living: Washing - this means being able to wash and bathe unaided, including getting into and out of the bath or shower.

Dressing - this means being able to put on, take off, secure and unfasten all necessary items of clothing.

Feeding - this means being able to eat pre-prepared foods unaided.

Continence - this means being able to control bowel or bladder functions, whether with or without theuse of protective undergarments and surgical appliances. Moving -this means being able to move from one room to another on level surfaces. Transferring - this means being able to get on and off the toilet, in and out of bed and move from a bed to an upright chair or wheelchair and back again.

Loss of speech

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

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Major organ transplant

The undergoing as a recipient from another donor, or inclusion on an official UK waiting list for any of the following:

•

transplant of a bone marrow, or

•

transplant of a complete heart, kidney, liver, lung or pancreas, or

•

transplant of a lobe of liver, or

•

transplant of a lobe of lung. The following are not covered:

•

transplant of any other organs, parts of organs or cells.

Motor neurone disease

A definite diagnosis of one of the following motor neurone diseases by a consultant neurologist:

– Amyotrophic lateral sclerosis (ALS) – Primary lateral sclerosis (PLS) – Progressive bulbar palsy (PBP) – Progressive muscular atrophy (PMA). There must also be permanent clinical impairment of motor function.

Multiple sclerosis

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 three months; or

•

two 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.

Open heart surgery

The undergoing of open heart surgery requiring thoracotomy on the advice of a consultant cardiologist.

•

any percutaneous, transluminal or investigative procedure.

Paralysis of limbs

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

Parkinson’s disease

A definite diagnosis of Parkinson’s disease by a consultant neurologist.

There must be permanent clinical

impairment of motor function with associated tremor or muscle rigidity.

•

Parkinsonian syndromes/Parkinsonism

Progressive supranuclear palsy

Confirmation by a consultant neurologist of a definite diagnosis of progressive

supranuclear palsy. Critical illness definitions

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There must be permanent clinical impairment of all of the following:

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motor function

•

eye movement disorder; and

•

postural instability.

Respiratory failure

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.

Stroke

Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in either:

•

permanent neurological deficit with persisting clinical symptoms; or

•

definite evidence of death of tissue or haemorrhage on a brain scan; and

•

neurological deficit with persistent clinical symptoms lasting at least 24 hours.

•

transient ischaemic attack

•

death of tissue of the optic nerve or retina/eye stroke.

Systemic lupus erythematosus (SLE)

A definite diagnosis of systemic lupus erythematosus (SLE) by a consultant rheumatologist resulting in:

•

permanent impaired renal function evidenced by a glomerular filtration rate below 30 ml/min/1.73m2; and

•

urinalysis showing proteinuria or haematuria;

or

•

permanent neurological deficit evidenced by one of the following persisting clinical symptoms - paralysis, localised weakness, dysarthria (difficulty with speech), dysphagia (difficulty in swallowing), difficulty in walking or lack of co-ordination.

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 neurological deficit.

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Critical illness definitions

Terminal illness

A definite diagnosis by the attending

consultant of an illness that satisfies both of the following:

•

the illness either has no known cure or has progressed to the point where it cannot be cured; and

•

in the opinion of the attending consultant, the illness is expected to lead to death within 12 months.

Third degree burns

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20 percent of the body’s surface area or 20 percent loss of surface area of the face which for the purposes of this definition includes the forehead and ears.

Traumatic brain injury

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

Ulcerative colitis

A definite diagnosis of ulcerative colitis which is treated with total colectomy (removal of entire large bowel).

A definite diagnosis of ulcerative colitis must be confirmed by a consultant gastroenterologist.

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Your membership

critical illness cover or

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Your membership - critical

illness cover or critical

illness with life cover

Your membership is made up of the following documents:

•

your application for cover

This includes your initial application and any further applications you make where

your membership is varied. It also includes any declarations you made at

our request when you applied for cover.

•

your registration certificate and any

endorsements

These set out the current details of your membership. The ‘Special conditions’ section of your registration certificate

shows any special conditions we apply to your membership.

Your registration certificate may also refer to othermemberships you have under the Friends Life flexible financial protection plan.

We explain how your registration certificate may change in the ‘General information’ section.

•

this handbook

This contains all the general terms and conditions of your membership. It is referred to as the ‘Friends Life Individual Protection Critical Illness and Friends Life Individual Protection Critical Illness with Life Cover’ membershiphandbook, reference number FLIP/4564/May14.

When your membership starts and ends

Your membership starts on the

commencement date and is subject to you

paying your first premium.

The date your membership ends depends on the type of cover you have.

If your registration certificate shows that the type of cover you have is ‘Renewable term’ (either five years or ten years), your membership will end on the earliest of the following:

•

any renewal date on which you do not renew your membership or we end your membership

•

where the renewal term is five years the

renewal date is before the member’s

65th birthday (or the eldest member if more than one)

•

where the renewal term is ten years, the

renewal date is before the member’s

70th birthday (or the eldest member if more than one)

•

where you have a critical illness cover

membership, the death of a member

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•

the date we pay you the benefit

•

30 days after the premium due date, we

will allow your membership to continue if

you pay any outstanding amount within the 30 day period after it became due. If you do not have ‘Renewable term’ cover

your membership will end on the earliest of the following:

•

the ‘expiry date’ shown on your registration certificate

•

where you have a critical illness cover

membership, the death of a member

•

the date we pay you the benefit

•

30 days after the premium due date where you do not pay any amounts. We

will allow your membership to continue if

you pay any outstanding amounts within the 30 day period after it became due. Failure to disclose a fact, giving false information or failing to tell us of a change in

your health or circumstances in relation to any question in your application before cover starts where done deliberately or recklessly gives us the right to cancel from the start any

membership issued as a result and may invalidate a future claim. However, where that information was given carelessly, or the failure to disclose relevant information was careless, then we will amend the terms of

yourmembership to be consistent with what the terms should have been based on

to cancel the membership from the start and return any premiums.

Your membership will end regardless of whether it was you or a member or both who misled us.

You can end your membership by writing to

us providing 30 days notice to tell us at the address stated in the ‘General information’ section.

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Additional options

Your registration certificate will show whether we have provided any of the following additional options to you. If there is more than one member, your registration certificate will show to which member the option applies or whether it applies to both. The following are the full list of additional options. These are only applicable if you

have selected and we have agreed to provide the option:

•

indexation options

•

fracture cover option

•

premium waiver option

•

total permanent disability option

•

reinstatement option.

Indexation options

For each of these options, on each anniversary of the commencement date,

we will increase the benefit under your membership. The amount the benefit

increases by will depend on the indexation option applicable.

If we have agreed to provide this option,

your registration certificate will show which indexation option you have of the following:

•

RPI (Retail Price Index)

•

AWE (Average Weekly Earnings)

•

five percent

•

three percent.

The increases for each indexation option are as follows:

RPI (Retail Price Index) option

On the anniversary of the commencement date, we will increase the benefit in proportion to the increase in the RPI during the first 12 months of the 15 month period immediately before the anniversary of the

commencement date.

The maximum increase on any anniversary will be 10 percent of the benefit.

AWE (Average Weekly Earnings) option

On the anniversary of the commencement datewe will increase the benefit in proportion to the increase in the AWE

measure over the first 12 months of the 17 month period immediately before that anniversary of the commencement date.

Five percent option

On the anniversary of the commencement date, we will increase the benefit by five percent a year.

Three percent option

On the anniversary of the commencement date, we will increase the benefit by three percent a year.

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Additional options

How does indexation affect your premiums?

You will have to pay an increased premium for any increase in the benefit. Your premium will increase at a higher rate than your benefit as we will allow for member’s age and remaining term at the time of the increase in the benefit. For guaranteed and reviewable premiums the increase will be based on our premium rates at the

commencement date. For renewable premiums, the increase will be based on our

premium rates applicable at the later of the

commencement date or at the last renewal. When we write to tell you about the increase in the benefit, we will tell you about the increase in your premium.

Cancelling an increase

You can cancel the increase in the benefit

and your premium by writing to us within 30 days of the date of our letter telling you

about the increase. If you cancel any increases we will cancel your indexation option and no further increases will be made (this will not affect previous increases).

Fracture cover option

If we have agreed to provide thefracture cover option, your registration certificate

will show this option. If there is more than one member we may have agreed to cover one or both members and this will also show on your registration certificate. If the

member suffers one of the fractures shown in the table below, we will payfracturecover

coverbenefit we will pay is shown in the table below:

To make a claim forfracturecoverbenefit

you must:

•

contact us to ask for a claim form; and then

•

fill in the claim form and return it to us.

You must make your claim as soon as reasonably practicable.

Fracture cover benefit

Fracture

closed fracture of the skull open fracture of the skull

fracture of the vertebra

fracture of the shoulder blade

fracture of the jaw

fracture of the sternum

fracture of the pelvis

fracture of the wrist

fracture of the hand

fracture of the upper leg

fracture of the knee

fracture of the lower leg

fracture of the arm

fracture of the cheekbone

fracture of the foot

fracture of the ankle

fracture of the ribs

fracture of the collar bone

£1,200 £2,100 £900 £900 £900 £900 £1,200 £900 £900 £2,100 £2,100 £1,200 £1,200 £900 £900 £1,200 £600 £600

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Additional options

We will only pay thebenefitto you for the following fractures as defined in ‘Black’s Medical Dictionary’ (39th edition); comminuted, complicated, compound, depressed, greenstick, pathological and simple. We will not pay thebenefitfor any other type of fracture.

Where more than one of the above fractures

occurs at any time, we will only payfracture coverbenefit for one of the fractures. You

can decide which fracture you claim for.

We will not payfracture coverbenefitto you

if the fracture arises out of the same event as that for which we have paid the benefit

to you.

We will only payfracturecoverbenefitto

you for one fracture suffered during any 12 month period. The first 12 month period will start on the commencement date and then each subsequent 12 month period will begin on each anniversary of the commencement date.

We will not payfracturecoverbenefitfor a

fracture suffered by a child.

Total permanent disability option

This is only applicable if you have selected and we have agreed to provide the total

permanent disability option, this will show on

your registration certificate. If there is more than one member we may have agreed to cover one or both members and this will also show on your registration certificate. This

With this option we will pay the benefit if the

member that the option applies to becomes totally and permanently disabled as defined in this handbook. Any disability must continue for a minimum of six months before

we will consider whether it is a ‘total

permanent disability’ for the purpose of your membership.

What is total permanent disability?

Your registration certificate will show whether the definition of total permanent

disability for a particular member is ‘own’, ‘suited’ or ‘activities of daily work’. The definitions are as follows:

‘Own’ definition

Loss of the physical or mental ability through an illness or injury to the extent that the

member is unable to do the essential duties of their own occupation ever again. The essential duties are those that are normally required for, and form a significant and integral part of, the performance of the

member’s own occupation that cannot reasonably be omitted or modified. The relevant consultant must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or the

member expects to retire.

‘Suited’ definition

Loss of the physical or mental ability through an illness or injury to the extent that the

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Additional options

of a suited occupation ever again. The essential duties are those that are normally required for, and form a significant and integral part of, the performance of a suited occupation that cannot reasonably be omitted or modified.

The relevant consultant must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or the

member expects to retire.

‘Activities of daily work’ definition

Loss of the physical ability through an illness or injury to do at least three of the six work tasks listed below ever again.

The relevant consultant must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or the

member expects to retire. The member 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.

‘Activities of daily work’

The work tasks are:

Walking

The ability to walk more than 200 metres on a level surface.

Climbing

The ability to climb up a flight of 12 stairs and down again, using the handrail if needed.

Lifting

The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table.

Bending

The ability to bend or kneel to touch the floor and straighten up again.

Getting in and out of a car

The ability to get into a standard saloon car, and out again.

Writing

The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal computer keyboard.

Premium waiver option

This is only applicable if you have selected and we have agreed to provide the premium waiver option, this will show on your registration certificate. If there is more than one member we may have agreed to cover one or both members and this will also show on your registration certificate.

This option ends when your membership

ends.

If the member that the option relates to is in an occupation and was on the

commencement date, we will waive your

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Additional options

result of illness and injury, provided that the

member is not doing any other occupation. If the member that the option relates to is not in an occupation or was not on the

commencement date, we will waive your

premiums for the period that the member is, as a result of illness or injury, unable to do at least three of the daily activities listed below:

Daily activities Shopping

Being able to get to and from the nearest shops and carry a small bag of shopping.

Cooking

Being able to prepare and cook a basic meal.

Housework

Being able to carry out light housework such as dusting, washing dishes and making beds.

Handling money

Being able to handle basic household finances and recognise the value of money.

Taking medicine

Being able to take routine medication prescribed by a recognised medical practitioner.

Child minding

Being able to care for, feed, wash and dress a

child under the age of five.

We will waive your premiums until:

•

the member starts any paid work; or

•

the member becomes capable of doing four or more of the daily activities shown above (if the member was not in an

occupation); or

•

your membership ends.

If, as a result of illness or injury, the member

becomes unable to do their occupation or unable to do at least three of the daily activities listed above, you must make a claim to us to waive your premiums before

you are entitled to any waiver. To do this you

must:

•

contact us to ask for a claim form; and then

•

fill in the claim form and return it to us.

You must give us any information or proof

we reasonably require to consider your claim both at the time of your claim and at any time when we are waiving your premiums. If we accept your claim, we will not waive

your premiums until the end of the three month period following either the date the

member became unable to do their

occupation or the date they became unable to do at least three of the daily activities as appropriate.

You must make your claim within six months of the illness or injury arising or as soon as reasonably practicable. If you do not, we

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During any period where we waive your

premiums, you must notify us as soon as practicable of the member:

•

starting an occupation

•

no longer being incapable of doing three or more of the daily activities

•

being capable of doing their occupation. If you fail to do so, we may end your membership.

Reinstatement option

This is only applicable if you have selected and we have agreed to provide you with the reinstatement option.

If we have provided the reinstatement option and we pay the benefit to you in the event of a member suffering or undergoing a

critical illness, you can take out a new membership subject to all of the following:

•

you tell us in writing that you want to take out the newmembership

•

if the benefit was paid due to a member

having cancer, the newmembership can only be taken out within five years of the date we paid the benefit and you must provide us with all of the following:

– the written confirmation of the doctors who treated the member that the

member made a full recovery at least one year prior to you applying to us for the newmembership; and

– evidence that the member has not undergone any tests that show the presence of cancer since the full recovery from cancer was made; and

– evidence that the member has attended all consultations and check ups and undergone all tests

recommended by the medical specialist for cancer

•

if the benefit was paid due to a critical illness other than cancer, the new membership can only be taken out between 12 and 24 months after the date

we paid the benefit

•

the only critical illnesses to be covered under the newmembership are the following (the illnesses and definitions of these will be those we apply at the time the new agreement is taken out):

– aorta graft surgery

– aplastic anaemia – bacterial meningitis – cancer – cardiomyopathy – heart attack – HIV/AIDS – kidney failure – liver failure

– major organ transplant

– motor neurone disease

– multiple sclerosis

– Parkinson’s disease

– progressive supranuclear palsy

– stroke

– systemic lupus erythematosus

– third degree burns Additional options

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Additional options

•

claims for the same event for which we

paid benefit to you will be excluded from the newmembership

•

we will only consider claims under the newmembership for events or illnesses occurring or being diagnosed after the commencement of your newmembership

•

the newmembership will cover the same

member (or both if more than one) as under this membership

•

the newmembership will not continue beyond the date your membership would have ended

•

the membership must have been capable of continuing for at least five years after the date we receive the request for your

newmembership

•

the amount of benefit provided will be the lower of £100,000 or the benefit we paid under your membership

•

the member to be covered by the new membership (or eldest member if more than one) is under 50 years of age

•

life cover will only be provided under the newmembership where your original

membership is for critical illness with life cover

•

no additional options can be included in the newmembership

•

no claim for terminal illness benefit will be included in the newmembership

•

the terms and conditions of the new membership will be those we apply at the time the newmembership is taken out

•

we accepted the initial application for cover without increasing the premiums above our standard rates at that time or applying any special conditions to the

membership.

The premiums you will have to pay for the new membership will be based on our

premium rates and the member’s age on the

commencement date of the new membership.

The reinstatement option is not available for and will not include childcover benefit. The reinstatement option can only be effected once.

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What you are covered for

Benefit

We will pay the benefit to you if, during the period of your membership any of the following happens:

•

a member suffers or undergoes a critical illness; or

•

a member becomes totally and permanently disabled (if we have provided the total permanent disability option); or

•

where you have a critical illness with life cover membership, either of the following happens;

– a member dies; or

– a member is diagnosed with a terminal illness. The relevant benefit payable for a terminal illness for a Critical Illness with Life Cover membership will be the terminal illness benefit. Payment of the benefit is subject to:

•

you complying with the requirements and obligations set out in the ‘How to make a claim’ section.

•

your claim not being excluded by any of the circumstances listed in the ‘What you are not covered for’ section.

We will only pay the benefit or the terminal illness benefit once and not both under this

membership, on the first of the above events

For any claim under the total permanent

disability option, we will only pay the benefit

after the disability has continued for six months, subject to the additional terms of the total permanent disability option set out in the ‘Additional options’ section.

Carcinoma in situ of the cervix uteri – requiring hysterectomy

We will pay the lower of 12.5 percent of the

benefit and £12,500 if a member is diagnosed with carcinoma in situ of the cervix uteri (cervix) requiring treatment with hysterectomy.

The hysterectomy must have been performed on the advice of a consultant to treat carcinoma in situ.

The following tumors are excluded:

•

all grades of dysplasia;

•

cervical squamous epithelial lesion (SIL); and

•

cervical intra-epithelial neoplasia (CIN), unless carcinoma in situ is present. The carcinoma in situ of the cervix uteri requiring hysterectomybenefitis payable in addition to the benefit you have under your membership. We will only pay this benefit once for each member regardless of the number ofmemberships held.

Carcinoma in situ of the urinary bladder

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The diagnosis must be histologically confirmed on a pathology report. This benefit is payable only once. Non-invasive papillary carcinoma, stage Ta bladder carcinoma and all other forms of non-invasive carcinoma are specifically excluded.

The carcinoma in situ of the urinary bladder benefit is payable in addition to the benefit you have under your membership. We will only pay this benefit once for each member

regardless of the number of memberships held.

Cerebral aneurysm - with surgical repair

benefit and £12,500 if a member undergoes either of the following surgical procedures in order to treat a cerebral aneurysm:

•

surgical correction via craniotomy (surgical opening of the skull); or

•

endovascular treatment using coils or other materials (embolisation).

The cerebral aneurysm benefit is payable in addition to the benefit you have under your membership. We will only pay this benefit once for each member regardless of the number of memberships held.

Cerebral arteriovenous malformation - with surgical repair

benefit and £12,500 if a member undergoes either of the following surgical procedures in order to treat a cerebral arteriovenous malformation:

•

surgical correction via craniotomy (surgical opening of the skull); or

•

endovascular treatment using coils or other materials (embolisation). The cerebral arteriovenous malformation benefit is payable in addition to the benefit you have under your membership. We will only pay this benefit once for each member

Coronary angioplasty

We will pay the lower of 25 percent of the

benefit and £25,000 if a member undergoes any of the following:

•

balloon angioplasty

•

atherectomy

•

rotablation

•

laser treatment, or

•

insertion of stents.

The above operations must have been carried out on the advice of a consultant cardiologist to treat severe coronary artery disease in two or more main coronary arteries. The above operation must be to treat at least 70 percent diameter narrowing. If an operative procedure is only performed on one main coronary artery there must be at least 70 percent diameter narrowing in another main coronary artery. For the purposes of this definition main coronary arteries are described as one or more of the following:

•

right coronary artery

•

left main stem What you are covered for

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•

left anterior descending

•

circumflex.

•

procedures to any branches of any of the main coronary arteries.

The coronary angioplasty benefitis payable in addition to the benefit you have under

your membership. We will only pay this benefitonce for each member regardless of the number ofmemberships held.

Crohn’s disease – treated with surgical intestinal resection

benefit and £12,500 if a member is diagnosed with Crohn’s disease and has undergone surgical intestinal resection. A definite diagnosis of Crohn’s disease must be confirmed by a consultant gastroenterologist. Crohn’s disease treated with surgical intestinal resection benefit is payable in addition to the benefit you have under your membership. We will only pay thisbenefit once for each member regardless of the number of memberships held.

We will not pay thisbenefitto you if we have already paid the benefit to you for Crohn’s disease - of specified severity, as defined in the ‘Critical illness definitions’ section of this

handbook.

Ductal carcinoma in situ of the breast - with specified treatment

benefit and £12,500 if a member is diagnosed with ductal carcinoma in situ (DCIS), histologically confirmed, and as a result requires total mastectomy, segmentectomy or lumpectomy.

DCIS of the breast treated by other methods and lobular carcinoma in situ are specifically excluded.

DCIS of the breastbenefitis payable in addition to the benefit you have under your membership. We will only pay thisbenefit once for each member regardless of the number of memberships held.

Low-grade prostate cancer

benefit and £25,000 if a member is diagnosed with 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 clarity, cases treated with cryotherapy, other less radical treatment (eg. transurethral resection of the prostate), experimental treatments or hormone therapy are not included.

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The low-grade prostate cancer benefit is payable in addition to the benefit you have under your membership. We will only pay thisbenefitonce for each member

Non-malignant pituitary adenoma - with specified treatment

benefit and £12,500 if a member is diagnosed with a non-malignant pituitary tumour requiring radiotherapy or surgical removal.

Non-malignant tumours of the pituitary gland treated by other methods are specifically excluded.

This benefit is payable in addition to the

benefit you have under your membership. We will only pay this benefit once for each

member regardless of the number of memberships held.

Removal of one or more lobe(s) of the lung – for disease and trauma

benefit and £12,500 if a member undergoes the removal of one or more lobes of the lung due to underlying disease or trauma. The surgery must be carried out on the advice of a consultant physician. The removal of one or more lobe(s) of the lung – for disease and trauma benefit is payable in addition to the

benefit you have under your membership.

We will only pay this benefit once for each

member regardless of the number of memberships held.

Significant visual loss

benefit and £25,000 if a member suffers

permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 6/24 or worse in the better eye using a Snellen eye chart, or visual field is reduced to 45 degrees or less of an arc, as certified by an

ophthalmologist.

Significant visual loss benefit is payable in addition to the benefit you have under your membership. We will only pay this benefit once for each member regardless of the number of memberships held.

We will not pay this benefit to you if we have already paid the benefit to you for blindness as defined in the ‘Critical illness definitions’ section of the membership handbook.

Acceleration payment benefit for specified surgical treatments

We will make an advance payment if a

member is on the NHS waiting list for one of the following types of surgical treatments, as defined in ‘Critical illness definitions’ section of this handbook:

•

aorta graft surgery

•

coronary artery by-pass grafts

•

heart valve replacement or repair

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benefit and £25,000.

To be eligible for this acceleration payment benefit, the member must be on the relevant

NHS waiting list for the hospital where it is proposed the surgical treatment is to take place.

When an advance payment is made under this acceleration payment benefit for specified surgical treatments, your benefit

will be reduced by the amount of the accelerated payment we make to you. This accelerated payment is also applicable for eligible children.

We will always pay thebenefitin respect of carcinoma in situ of the cervix requiring hysterectomy; carcinoma in situ of the urinary bladder; Crohn’s disease treated with surgical intestinal resection; ductal carcinoma in situ of the breast - with specified treatment; low-grade prostate cancer; coronary angioplasty; cerebral aneurysm - with surgical repair; cerebral arteriovenous malformation - with surgical repair; non-malignant pituitary adenoma - with specified treatment; removal of one or more lobe(s) of the lung – for disease and trauma; significant visual loss or surgical treatments, as a lump sum, with the lump sum calculated by reference to the benefit.

Childcover benefit

We will pay childcover benefit to you, if

cerebral palsy, cystic fibrosis, hydrocephalus, muscular dystrophy or spina bifida as defined below, requires intensive care as defined below or suffers or undergoes one of the conditions as defined in the ‘What you are covered for’ section of this handbook, subject to you complying with the requirements and obligations set out in the ‘How to make a claim’ section, unless your

claim is excluded by any of the

circumstances listed in the ‘What you are not covered for’ section.

Children’s intensive care benefit – requiring mechanical ventilation for 7 days

We will pay childcover benefit to you, if during the period of the agreement, a child

due to sickness or injury is requiring continuous mechanical ventilation by means of tracheal intubation for 7 consecutive days (24 hours per day) unless it is as a result of the child being born prematurely (before 37 weeks). Please refer to ‘What you are not covered for’ section for exclusions and limitations of the cover.

Cerebral palsy

We will pay childcover benefit to you if the

child receives a definite diagnosis of cerebral palsy made by an attending consultant.

Cystic fibrosis

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Hydrocephalus - treated with the insertion of a shunt

child suffers hydrocephalus if the

hydrocephalus is treated with an insertion of a shunt.

Muscular dystrophy

child receives a definite diagnosis of muscular dystrophy made by a consultant neurologist.

Spina bifida

child receives a definite diagnosis of spina bifida myelomeningocele or rachischisis by a paediatrician.

•

spina bifida occulta

•

spina bifida with meningocele.

Childcover benefit is the lower of 50 percent of the benefit and £25,000 unless;

•

the child suffers: – coronary angioplasty; – low-grade prostate cancer; or – significant visual loss;

then the childcover benefit will be the lower of 25 percent of the benefit and £25,000, or;

•

the child suffers:

– carcinoma in situ of the cervix requiring hysterectomy;

– carcinoma in situ of the urinary bladder;

– cerebral aneurysm - with surgical repair;

– cerebral arteriovenous malformation - with surgical repair;

– Crohn’s disease treated with surgical intestinal resection;

– ductal carcinoma in situ - with specified treatment;

– non-malignant pituitary adenoma with specified treatment; or

– removal of one or more lobe(s) of the lung - for disease and trauma; in which case the childcover benefit will be the lower of 12.5 percent of the benefit

and £12,500.

The childcover benefit will be payable once per child. The maximum benefit payable is the lower of 50 percent of the benefit and £25,000, regardless of the number of

memberships held by you.

We will only pay childcover benefit where the child is under 18 years of age, or under 21 years of age if not in full time employment,

when the child suffers or undergoes a

critical illness, any of the conditions listed in the ‘What you are covered for’ childcover benefit section and children’s intensive care benefit.

We will only pay childcover benefit where the member is either the parent or legal guardian of the child or if the member is the spouse, partner or civil partner of the parent or legal guardian of the child.

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We will pay the childcover benefit as a lump sum, with the lump sum calculated by reference to the benefit.

Child funeral benefit

We will pay £5,000 towards the cost of a funeral, if during the period of the agreement, a child dies, subject to you complying with the requirements and obligations set out in the ‘How to make a claim’ section, unless

your claim is excluded by any of the circumstances listed in the ‘What you are not covered for’ section.

Child funeral benefit is payable in addition to childcover benefit.

The child funeral benefit payable is £5,000. The benefit is payable once per child, regardless of the number of memberships

held by you. We will only pay child funeral benefit where the member is either the parent or legal guardian of the child or if the

member is the spouse, partner or civil partner of the parent or legal guardian of the child.

We will pay the child funeral benefit as a lump sum.

Family income benefit

We will pay the benefit to you as an annual income where the benefit is a family income benefit, subject to you complying with the requirements and obligations set out in the ‘How to make a claim’ section, unless

your claim is excluded by any of the circumstances listed in the ‘Whatyouare not

until the last anniversary before the expiry date set out in your registration certificate. If you select the indexation option your benefit will stop increasing once we pay

your claim.

If your registration certificate shows that

you have family incomebenefit, the benefit

figure that will beused for the lump sum calculation for these benefits will be the annual benefit as per the following calculations:

The annual benefit as shown on your registration certificate x the remaining number of years of your membership x 12.5 percent, up to a maximum of £12,500, for the followingbenefits:

•

carcinoma in situ of the cervix requiring hysterectomy;

•

carcinoma in situ of the urinary bladder;

•

cerebral aneurysm - with surgical repair;

•

cerebral arteriovenous malformation - with surgical repair;

•

Crohn’s disease treated with surgical intestinal resection;

•

ductal carcinoma in situ of the breast- with specified treatment;

•

non-malignant pituitary adenoma - with specified treatment;

•

removal of one or more lobe(s) of the lung – for disease and trauma.

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Each of thesebenefits is defined i