Lifestyle Protection
Options
Life and Critical Illness Benefits - Your Questions
Answered
What is Life
Benefit?
What is not
covered by Life Benefit?
What
is Critical Illness Benefit?
Which
critical illnesses are covered?
How
do we measure total permanent disability?
What
is not covered by Critical Illness
benefit?
What
is Combined Life and Critical Illness
Benefit?
What
is not covered by Combined Benefit?
What
options do I have for these benefits?
Life Benefit
What is Life Benefit?
It
is a benefit that is designed to pay out if you die.
In addition we will pay out if you’re diagnosed
as terminally ill more than 12 months before your life cover
ends.
A
terminal illness is an illness which, in the opinion of a
specialist consultant and with the agreement of our Chief Medical
Officer, is likely to lead to your death within 12 months.
If
we pay out for either of these events this benefit will end.
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What is not covered by Life
Benefit?
We
will not pay if you die after the expiry date for your cover, or
you’re diagnosed as terminally ill but do not die in the 12 months
before your cover ends.
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Critical Illness Benefit
What is Critical Illness
Benefit?
It
is a benefit that is designed to pay out if, during your cover
term, you’re diagnosed as having one of a defined list of critical
illnesses and you survive for at least 30 days.
We
will also pay out if, during your cover term, you’re diagnosed with
a total permanent disability and you survive for at least six
months.
If
we pay out for either of these events this benefit will end.
In
order to pay out, the diagnosis must meet our plan definition
either for total permanent disability or for one of the critical
illnesses shown on our list.
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Which critical illnesses are
covered?
Here is a complete list of the critical illnesses we cover.
Alzheimer’s disease before
age 60 - resulting in permanent symptoms
Aorta graft surgery -
for disease
Benign brain tumour -
resulting in permanent symptoms
Blindness - permanent
and irreversible
Cancer - excluding
less advanced cases
Coma - resulting in
permanent symptoms
Coronary artery by-pass
grafts - with surgery to divide the breastbone
Deafness - permanent
and irreversible
Heart attack - of
specified severity
Heart valve replacement or
repair - with surgery to divide the breastbone
HIV as a result of an
assault - caught in the UK
HIV as a result of a blood
transfusion - caught in the UK
HIV through duties in
eligible occupations - (the emergency services, the medical
profession or the armed forces) caught in the UK
Kidney failure -
requiring dialysis
Loss of hands or feet
- permanent physical severance
Loss of speech -
permanent and irreversible
Major organ transplant
Motor Neurone disease
- resulting in permanent symptoms
Multiple Sclerosis -
with persisting symptoms
Paralysis of limbs -
total and irreversible
Parkinson’s disease before
age 60 - resulting in permanent symptoms
Stroke - resulting in
permanent symptoms
Third degree burns -
covering 20% of the body's surface area
Traumatic head injury
- resulting in permanent symptoms
Please remember that these headings are only a guide to what is
covered and for the full definitions of the illnesses covered, and
the circumstances in which you can claim, you should refer to the
Definitions section in our Terms and
Conditions. These definitions 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 you need to have permanent symptoms.
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How do we measure total permanent
disability?
We
measure total permanent disability by assessing your ability to
perform any three of the following activities, without the
assistance of another person or the use of special equipment:
washing or bathing so as
to maintain personal hygiene;
putting on and taking off
all necessary items of clothing;
moving from one room to
another or getting in or out of bed or a chair;
getting food or drink into
the body once it has been prepared and made available;
getting on and off the
toilet and maintaining personal hygiene following the use of
it;
controlling bowel or
bladder function.
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What is not covered by Critical
Illness benefit?
You are not covered if the cause of the claim results from alcohol
or drug abuse, HIV/AIDS (except where specifically included under
our plan definition), self inflicted injury or war and civil
commotion.
We
will not pay if you die, or if your cover ceases, within 30 days of
the diagnosis of critical illness or within six months of the
diagnosis of total permanent disability.
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Combined Life and Critical Illness
Benefit
What is Combined Life and Critical
Illness Benefit?
It
is a benefit which will pay out on the first of the following
events:
you die,
you are diagnosed with a
terminal illness more than 12 months before your cover ends,
you are diagnosed as
having one of a defined list of critical illnesses and you survive
for at least 30 days,
you are diagnosed with a
total permanent disability and survive for at least six months.
In
order to pay out on a diagnosis, your illness or injury must meet
our plan definition either for terminal illness, total permanent
disability or for one of the critical illnesses shown on our
list.
If
we pay out for any one of these events this benefit will end.
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What is not covered by Combined Life
and Critical Illness Benefit?
We
will not pay if you die after the expiry date for your cover, or
you are diagnosed as terminally ill but do not die in the 12 months
before your cover ends.
We
will not pay for critical illness if your cover period ends within
30 days of the diagnosis of critical illness or within six months
of the diagnosis of total permanent disability.
We
will not pay out for critical illness if the cause of the claim
results from alcohol or drug abuse, HIV/AIDS (except where
specifically included under our plan definition), self inflicted
injury or war and civil commotion.
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What options do I have for these
benefits?
Length of your cover
When you apply for your plan you choose how much cover you want and
how long you want it to last.
The minimum term is 5 years and you must be aged under 60 at the
start of your plan.
Lump sum or monthly
benefit
When you apply for your plan you can choose to have your benefits
paid either as a lump sum or as a monthly benefit.
If
you choose the lump sum option we’ll pay the benefit in full in the
event of a claim.
If
you choose the monthly benefit option we will pay an annual benefit
in monthly instalments until the end of the term for that cover.
The amount of your annual benefit will automatically increase each
year to help keep pace with inflation. See the ‘Will I be able to
increase my cover in the future’ section.
You cannot switch between options once the plan is in force.
Please remember that Critical Illness Benefit is not a substitute
for Income Protection Insurance.
Waiver Of Premium
If
you are not in a high risk occupation you can choose to have Waiver
Of Premium cover when you apply for your Plan. This pays your
premiums if you are unable to work due to incapacity.
If
you choose this cover, we’ll pay your premiums after 6 months of
incapacity and continue to pay them until the first of these
events:
you recover and are no
longer incapacitated,
your 65th birthday,
your cover ends,
you die.
We
will not pay out if the cause of the claim results from alcohol or
drug abuse, criminal acts, flying on a non-commercial basis,
hazardous sports and pastimes, HIV/AIDS, living abroad (defined as
outside of Australia, Canada, the European Union, New Zealand,
Switzerland or the USA for more than 13 consecutive weeks in any 12
months), self-inflicted injury, unreasonable failure to follow
medical advice, or war and civil commotion.
Increases in cover without medical
evidence
This option applies if your plan is accepted on standard terms. It
enables you to increase the amount of your cover on certain special
events such as marriage or childbirth, without having to provide us
with additional medical information.
There are also special events on which you can add or increase life
cover when life cover you hold elsewhere expires.
These increases and
additions are subject to maximum limits and conditions. See
section H of the Terms and
Conditions for full details.
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