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29 Mar 2017
  1. Critical Illness Cover Options

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Critical Illness Cover

Critical Illness Cover Example

Critical illness cover usually pays a one off lump sum, if you are diagnosed with a qualifying critical illness covered during the term of the policy. But what is cover is provided in a typical critical illness policy.

Below we have set out the typical critical illness cover you would receive from your critical Illness policy.

The types and range of critical illnesses covered vary from company to company, so we recommend you read the key facts document before you apply for your critical illness policy.

Full definitions of each Critical illness Covered

The table below states the contractual definition for each of the critical illnesses which must be satisfied in order to claim. The specific critical illness cover for your policy will be included in the policy document supplied for your critical illness cover by the life insurance company:-

Critical Illnesses Covered

Critical Illness Cover Full definition

What Does This Mean ?

Alzheimer's Disease – resulting in permanent symptoms

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 condition
which affects the brain. Symptoms
include memory loss, confusion,
communication problems and general
impairment of mental function. The
condition gradually worsens, which
can lead to changes in personality and
makes routine tasks difficult. Eventually,
24 hour care may be needed.

Aorta Graft Surgery – requiring surgical replacement

surgical replacement of a portion of the aorta with a graft.
The term aorta includes the thoracic and abdominal aorta
but not its branches.
For the above definition, the following is not covered:
• Any other surgical procedure, for example the insertion
of stents or endovascular repair

The aorta is the body’s main artery carrying blood from the heart. This definition covers surgery to the aorta, where part of it is removed and replaced
with a graft. Surgery may be needed to correct a weakening or bulging in the artery. It covers only the aorta, which is the main blood vessel in the chest and
abdomen. This definition doesn’t cover the branches of the aorta.
We cover surgery for traumatic injury, as well as the ABI standard of surgery following disease.

Aplastic Anaemia  – with permanent bone marrow failure

A definite diagnosis of aplastic anaemia by
a consultant haematologist. There must be
permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia.

Aplastic anaemia is a rare but serious condition where
bone marrow fails to produce sufficient blood cells or
clotting agents. Symptoms include shortness of breath,
excessive bleeding and an increased chance of catching
infections. It can be life-threatening if left untreated.

Bacterial Meningitis – resulting in permanent symptoms

A definite diagnosis of bacterial meningitis
resulting in permanent neurological deficit
with persisting clinical symptoms*.
For the above definition, the following are
not covered:
• All other forms of meningitis other than
those caused by bacterial infection.

Bacterial meningitis causes inflammation to the
meninges, which is the protective layer around the brain
and spinal cord. It’s caused by a bacterial infection and
needs prompt medical treatment. Initial symptoms
include headache, fever and vomiting. If left untreated,
it can result in brain damage or death.
Some people will recover completely, while others will
be left with permanent symptoms, which may affect their
mobility or use of senses. This definition only covers
people left with permanent symptoms.
This definition covers the bacterial form of meningitis.
It excludes all other forms of meningitis – like viral
meningitis, which is usually milder.

Benign Brain Tumour - resulting in either surgical removal or permanent symptoms

A non-malignant tumour or cyst in the
brain, cranial nerves or meninges within
the skull, resulting in either surgical
removal or permanent neurological
deficit with persisting clinical
symptoms*.
For the above definition, the following
are not covered:
• Tumours in the pituitary gland.
• Angiomas.

A benign brain tumour is a non-cancerous abnormal growth
of tissue that can increase in size and cause pressure in the
brain. Symptoms may vary depending on where the tumour
is but may include headaches, seizures and blurred vision.
Surgery to remove the tumour might be possible and once
removed they tend not to recur.
However, surgery isn’t always an option due to the size or
location of the tumour.
This definition covers surgical removal of a tumour (whether
permanent neurological symptoms persist or not) and tumours
where surgery has not been performed but which result in
permanent neurological symptoms.
This definition doesn’t cover tumours in the pituitary gland
(a small gland within the brain) and angiomas (a benign tumour
of blood vessels).

Blindness – permanent and irreversible

Permanent and irreversible loss of sight
to the extent that even when tested with
the use of visual aids, vision is measured
at 3/60 or worse in the better eye using a
Snellen eye chart.

This means permanent loss of vision. It’s measured with
a Snellen eye chart: the chart commonly used by opticians,
which consists of a gradually decreasing series of letters and
numbers. 3/60 vision means you can read a letter at three
metres that can normally be read at 60 metres. To claim,
your vision must be 3/60 or worse in your better eye.
This definition doesn’t cover temporary blindness.

Cancer - excluding less advanced cases

Any malignant tumour positively diagnosed with histological
confirmation and characterised by the uncontrolled growth of
malignant cells and invasion of tissue.
The term malignant tumour includes leukaemia, sarcoma and
lymphoma except cutaneous lymphoma (lymphoma confined
to the skin).
For the above definition, the following are not covered:
• All cancers which are histologically classified as any of the
following:
– pre-malignant;
– non-invasive;
– cancer in situ;
– having either borderline malignancy; or
– having low malignant potential.
• All tumours of the prostate unless histologically classified as
having a Gleason score greater than 6 or having progressed
to at least clinical TNM classification T2N0M0.
• Chronic lymphocytic leukaemia unless histologically
classified as having progressed to at least Binet Stage A.
• Malignant melanoma unless it has been histologically
classified as having caused invasion beyond the epidermis
(outer layer of skin).
• Any other skin cancer (including cutaneous lymphoma)
unless it has been histologically classified as having caused
invasion in the lymph glands or spread to distant organs.

Cancer (also known as a malignant tumour) is a disease where normal cells change and grow in an abnormal way. If left untreated, they can destroy
surrounding healthy cells and eventually destroy healthy cells in other parts of the body.
There are about 200 different types of cancer, varying widely in outlook and treatment.
Some cancers are not covered by this definition. These tend to be ones that have not yet spread or are localised and can usually be successfully treated.
Examples of these include some skin cancers and early stage prostate cancer.

CARDIAC ARREST – with insertion of a defibrillator Sudden loss of heart function with interruption
of blood circulation around the body resulting
in unconsciousness, requiring resuscitation and
resulting in either of the following devices being
surgically implanted:
• Implantable cardioverter-defibrillator (ICD); or
• Cardiac resynchronisation therapy with
defibrillator (CRT-D).
For the above definition the following are not
covered:
• Insertion of a pacemaker.
• Insertion of a defibrillator without cardiac arrest.
• Cardiac arrest secondary to illegal drug abuse.
Cardiac arrest is a life threatening condition in which the heart suddenly stops pumping blood around the body.
There are various causes but the most common is abnormal and irregular heart rhythm.
For this definition you must have had cardiac arrest requiring resuscitation and have a defibrillator fitted. This is a device which is put in your chest and
used to correct and control dangerous and irregular
heart rhythm.

Cardiomyopathy  – of specified severity

A definite diagnosis of cardiomyopathy by a
consultant cardiologist. There must be clinical
impairment of heart function resulting in the
permanent loss of ability to perform physical
activities to at least Class 3 of the New York Heart
Association classification’s of functional capacity†.
For the above definition, the following are
not covered:
• Cardiomyopathy secondary to alcohol or
drug abuse.
• All other forms of heart disease, heart
enlargement and myocarditis.
† NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain.

Cardiomyopathy is the name given to a group of
disorders affecting the muscles of the heart that
affect its function. Symptoms vary depending
on the type of cardiomyopathy, but may include
shortness of breath, fainting and palpitations.
The New York Heart Association (NYHA) functional classification system is commonly used in the
UK to assess heart function. The system relates symptoms to everyday activities and the patient’s quality of life.
NYHA Class 3 is ‘Marked limitation of physical activity. Comfortable at rest, but less than ordinary
activity causes fatigue, palpitation or dyspnoea.’
(Source: Heart Failure Society of America, 2007).
Note: Dyspnoea is difficulty in breathing.

Coma – resulting in permanent symptoms

A state of unconsciousness with no reaction to external stimuli or internal needs which:
• Requires the use of life support systems; and
• Results in permanent neurological deficit with persisting clinical symptoms*.
For the above definition, the following is not
covered:
• Coma secondary to alcohol or drug abuse.

A coma is a state of unconsciousness from which
the patient cannot be aroused and has no control over bodily functions. It may be caused by illness, stroke, infection, very low blood sugar or serious accident. Recovery rates vary, depending upon the depth and duration of the coma.
While the ABI define a coma as lasting ‘at least 96 hours’, we don’t set a time limit.

Coronary Artery By-Pass Grafts – with surgical thoracotomy

The undergoing of surgery requiring
median sternotomy (surgery to divide
the breastbone) or anterolateral
thoracotomy on the advice of a
consultant cardiologist to correct
narrowing or blockage of one or more
coronary arteries with by-pass grafts.
For the above definition, the following is
not covered:
• Any other surgical procedure or
treatment.

Coronary arteries can become narrowed or blocked by the
build up of fatty deposits caused by poor lifestyle such as high
fat diet, smoking and high blood pressure. This may cause
symptoms including chest pain and can sometimes cause a
heart attack. Coronary artery by-pass surgery is used to treat
blocked arteries in the heart by diverting the blood supply
around the blocked artery using a vein, usually taken from the
leg, arm or chest.
This definition covers surgery if it requires the heart to be
reached by a surgical incision through the chest wall or
sternum (breastbone), to replace the blocked arteries with a
vein. This definition doesn’t cover keyhole surgery or other
surgical procedures to treat blocked arteries such as balloon
angioplasty or insertion of stents.

Creutzfeldt-Jakob Disease (CJD) – resulting in permanent symptoms

A definite diagnosis of Creutzfeldt-
Jakob disease made by a consultant
neurologist. There must be permanent
clinical loss of the ability in mental and
social functioning to the extent that
permanent supervision or assistance
by a third party is required.

Creutzfeldt-Jakob disease (CJD) is a rare disease of the nervous
system. CJD can be present without symptoms for many years.
Once they appear, symptoms may include failing memory,
problems with vision, immobility, loss of speech and coma in
advanced stages. There is currently no known cure.

Deafness - permanent and irreversible

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

This means permanent loss of hearing in both ears,
measured by using an audiogram across different frequencies, which vary from low to high pitch. The
hearing loss must be across all frequencies. This definition doesn’t cover partial loss of hearing.

Dementia – resulting in permanent symptoms

A definite diagnosis of dementia by a consultant neurologist, psychiatrist or geriatrician. The diagnosis must be supported by evidence of progressive loss of ability to do all of the following:
• remember;
• to reason; and
• to perceive, understand, express and give effect to ideas.
For the above definition, the following is not covered:
• Dementia secondary to alcohol or drug abuse.

Dementia is a term used to describe various different brain disorders that have in common a loss of brain function.
Symptoms may include memory loss, confusion and the inability to reason.
Dementia is usually progressive and eventually severe. It causes the sufferer to become confused and disorientated and often unable to perform routine tasks like cooking a meal.

Encephalitis - resulting in permanent symptoms

 

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

Encephalitis is inflammation of brain tissue. It is usually caused by an infection. Symptoms might
include severe headache, nausea, vomiting, convulsions, personality changes, problems with speech and/or hearing, confusion and
disorientation. Encephalitis 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 recorded at the following levels
or higher;
– Troponin T > 1.0 ng/ml
– AccuTnI > 0.5 ng/ml or equivalent threshold
with other troponin I methods.
The evidence must show a definite acute
myocardial infarction.
For the above definition, the following are not
covered:
• Other acute coronary syndromes including but
not limited to angina.

A heart attack, also known as a myocardial infarction, happens when part of the heart muscle
dies because it has been starved of oxygen. This causes severe pain and an increase in cardiac
enzymes and Troponins, which are released into the blood stream from the damaged heart muscle.
Our definition doesn’t include the words ‘typical clinical symptoms (for example, characteristic
chest pain)’ as in the ABI’s ‘Heart attack’ definition.
This is because other tests can prove that a heart attack has taken place and it’s possible to have a heart attack without common symptoms such as
chest pain.
This definition doesn’t cover angina or any other heart condition.

Heart Valve Replacement or Repair – with surgical thoracotomy

The undergoing of surgery on the advice
of a consultant cardiologist to replace or
repair one or more heart valves.

Healthy heart valves are important to make sure blood flows through the heart in the right direction so that blood is circulated
around the body efficiently. There are various causes of heart
valve disease including birth defects, rheumatic fever and other
heart related conditions such as cardiomyopathy. Symptoms of
heart valve disease include breathlessness, chest pain, swelling of the ankles and legs and fainting. This definition covers surgery to replace or repair a heart valve.

HIV infection – caught from a blood transfusion, physical assault or accident 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 start of the policy and satisfying all of the following:
• The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures.
• Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within 5 days of the incident.
• There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus.
• The incident causing infection must have occurred in one of the following countries: Australia, Austria, Belgium, Bulgaria,
Canada, the Channel Islands, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, Iceland, the Isle of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, New Zealand, Norway, Poland, Portugal,
Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom and the United States of America.
For the above definition, the following is not covered:
• HIV infection resulting from any other means, including sexual activity or drug abuse.

This definition covers HIV infection from a blood transfusion, physical assault or when caught at work.
HIV can lead to the development of Acquired Immune Deficiency Syndrome (AIDS). This is when the body’s immune system breaks down, increasing the risk of infections and tumours. Although
there are treatments for AIDS and HIV to slow down the virus’s progression, there is currently no known cure.
When HIV is caught during an
incident at work, our definition includes all occupations with established reporting procedures.
This definition doesn’t cover HIV
infection through other means, including sexual activity or drug abuse.

Kidney failure – requiring dialysis

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

The kidneys perform an important role filtering the body’s waste to pass as urine. If the kidneys
fail, there is a harmful build up of the body’s waste products. In severe cases it may be necessary for the filtering to be done by a dialysis machine or, in some cases, a transplant may be needed. Kidney failure can become life threatening. This definition covers kidney failure that requires dialysis.

Liver failure – of advanced stage

Liver failure due to cirrhosis and resulting in all of the following:
• permanent jaundice
• ascites
• encephalopathy
For the above definition, the following is not
covered:
• Liver disease secondary to alcohol or drug abuse.

The liver is an important organ, which carries out several of the body’s vital functions such as helping with digestion and clearing toxins. This definition covers liver failure at an advanced stage.
This type of liver failure must lead to permanent jaundice (yellow discolouration of the skin),
ascites (build up of fluid in the abdomen), and encephalopathy (brain disease or damage).
This definition doesn’t cover liver disease that’s secondary to alcohol or drug abuse.

Loss of hand or feet – permanent physical severance

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

This means physical severance and may be caused by illness or serious accident. This definition only requires severance of either a hand or foot above the wrist or ankle joints.

Loss of Speech - permanent and irreversible

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

This is when you won’t be able to talk again. It’s often caused when the vocal cords need to be
removed because of a tumour or a serious injury.
This definition doesn’t cover temporary loss of speech.

Major Organ Transplant

The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, lung, pancreas, liver or lobe of liver, or inclusion on an official UK, Channel Islands or Isle of Man 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.

Occasionally, an organ may become so diseased that it needs to be replaced.
You will be covered as soon as you are put on the official UK waiting list because it may take a long time to find a donor.
This definition doesn’t cover donating an organ.

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.

Motor neurone disease (MND) is a gradual weakening and wasting of the muscles, usually beginning in the arms and legs. This may cause difficulty walking or holding objects.
As the disease develops, other muscle groups may be affected,
such as those involving speech, swallowing and breathing.
Eventually, 24 hour care may be needed. The progression rate of MND varies between individual
sufferers. An effective treatment has yet to be discovered.

Multiple Sclerosis – with persisting symptoms

A definite diagnosis of multiple sclerosis
by a consultant neurologist. There must
be current clinical impairment of motor
or sensory function caused by multiple
sclerosis.

Multiple sclerosis (MS) is the most common disabling neurological disease among young adults and is usually diagnosed between the ages of 20 and 40.
Symptoms may be slight, particularly in the early stages.
Symptoms may include changes in vision, altered sensation, loss of muscle strength and lack of coordination. There’s no known cure and treatment aims to manage symptoms only.
To claim, there must be a definite diagnosis of MS and symptoms must be present at the time of claim.

MULTIPLE SYSTEM ATROPHY – resulting in permanent symptoms A definite diagnosis of multiple system atrophy by a consultant neurologist. There must be evidence of permanent clinical impairment of either:
• motor function with associated rigidity of
movement; or
• the ability to coordinate muscle movement; or
• bladder control and postural hypotension.
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.
OPEN HEART SURGERY – with Median Sternotomy 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.
Open heart surgery is an operation in which the heart is
opened by a surgical incision for a corrective procedure to be carried out. This definition covers any surgery which involves dividing the breast bone.
This definition doesn’t cover other surgical procedures, such as balloon angioplasty or insertion of stents.

Paralysis of limbs –total and irreversible

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

Paralysis is the complete loss of use. It may be caused by injury or illness. A limb is an arm or leg.

Parkinson's Disease – resulting in permanent symptoms

A definite diagnosis of Parkinson’s disease
by a consultant neurologist. There must
be permanent clinical impairment of motor
function with associated tremor, muscle
rigidity and postural instability.
For the above definition the following are not
covered:
• Other Parkinsonian syndromes.

Parkinson’s disease is a slowly progressive disease of the brain. Symptoms can include tremors (uncontrollable shaking or trembling), muscle stiffness and slowness of movement. Treatment focuses on slowing the progression of symptoms. There’s currently no known cure.

Primary Pulmonary Hypertension  - of specified severity

 

A definite diagnosis of primary pulmonary
hypertension. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classification’s
of functional capacity†.
For the above definition, the following is
not covered:
• Pulmonary hypertension secondary to any other known cause i.e. not primary.
† NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain.

Primary pulmonary hypertension is abnormally high blood pressure in the arteries of the lungs.
It’s a rare but serious condition, causing a range of symptoms. These commonly include
breathlessness, dizziness, fainting, chest pain and palpitations. Symptoms can occur at rest or during mild exercise.
The New York Heart Association (NYHA) functional classification system is commonly used in the
UK to assess heart function. The system relates symptoms to everyday activities and the patient’s quality of life.
NYHA Class 3 is ‘Marked limitation of physica activity. Comfortable at rest, but less than ordinary
activity causes fatigue, palpitation or dyspnoea.’
(Source: Heart Failure Society of America, 2007)
Note: Dyspnoea is difficulty in breathing. Primary pulmonary hypertension may eventually
lead to heart failure.

Progressive Supranuclear Palsy – resulting inpermanent symptoms

A definite diagnosis of progressive
supranuclear palsy by a consultant
neurologist. There must be permanent
clinical impairment of eye movements
and motor function.

Progressive supranuclear palsy (PSP) is a brain disease that
develops slowly. It progresses to seriously affect vision and movement. PSP can also cause changes in behaviour and
personality, memory loss and slurred speech.
As the disease progresses, the ability to swallow becomes
difficult and physical movement less stable. ‘Weighted walkers’ and wheelchairs may be needed for mobility and communication may also become more difficult.
The effect and pattern of the disease varies between sufferers.
Most cases start between ages 50 and 60, although it can occur from the late thirties onwards.
There’s currently no effective treatment or cure.

REMOVAL OF AN EYEBALL – due to injury or disease Surgical removal of an eyeball as a result
of injury or disease.
For the above definition the following is
not covered:
• Self inflicted injuries.
This means total removal of either eye due to illness or injury.

Respiratory failure – of advanced stage

Advanced stage emphysema or other chronic lung disease, resulting in all of the following:
• The need for regular oxygen treatment on a permanent basis.
• The permanent impairment of lung function tests as follows; Forced Vital Capacity (FVC) and Forced Expiratory Volume at 1 second (FEV1) being less than 50% of normal.

The lungs allow us to breathe in oxygen and get rid of harmful carbon dioxide. This definition covers advanced lung failure when breathing is severely affected and regular oxygen therapy is required.
Respiratory failure may be described by some insurers as ‘chronic lung disease’ or ‘severe lung disease’.

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.
                

Strokes are caused by a sudden loss of blood supply or haemorrhage to a particular part of the brain.
The symptoms and how well a person recovers will depend on which part of the brain is affected and the extent of the damage. Strokes are a significant cause
of disability in the UK.
A transient ischaemic attack, sometimes referred to as a ‘mini-stroke’, is similar to a stroke. These are not covered by this definition, because symptoms aren’t permanent and will disappear within 24 hours.

Systemic Lupus Erythematosus – with severe complications

 

A definite diagnosis of Systemic Lupus
Erythematosus by a Consultant Rheumatologist resulting in either of the following:
• Permanent neurological deficit with persisting clinical symptoms*; or
• The permanent impairment of kidney function tests as follows; Glomerular Filtration Rate (GFR) below 30 ml/min.

Systemic lupus erythematosus (SLE), sometimes called ‘lupus’, 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, i.e. the body creates antibodies, which work
against it.
SLE causes a variety of symptoms, which may flare up from time to time but rarely disappear completely. These may include painful, swollen joints, unexplained fever and extreme fatigue.
‘Systemic’ means it can affect many parts of the body, from the skin to joints and kidneys.
Although it can occur at any age, it’s more common in women in their early twenties. There’s currently no known cure and treatment involves managing
symptoms.

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 your hospital consultant and our medical officer, the illness is expected to lead to death within 12 months.
No terminal illness claim can be made after the death of the life assured or within the 12 months immediately before the policy expiry date.

This definition provides cover for illnesses or conditions where in the opinion of your hospital
consultant and our medical officer, life expectancy is 12 months or less.
A claim cannot be made after death or within the 12 months immediately before the expiry of
the policy.
Please note: Terminal Illness Cover is not available on plans of less than two years

 

Third Degree Burns – – covering 20% of the surface area of the body or 20% of the face or head

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body’s surface area or covering 20% of the area of the face or head.

Third degree burns are the most serious type of burns, involving the full thickness of the skin and
underlying connective tissue.
These can be life threatening and need numerous skin grafts.
The burns must cover at least 20% of the body’s surface area or 20% of the face or head.

 

Total and Permanent Disability

We define total and permanent disability in two ways. The definition we apply to you will depend on what kind of job you do and if you’re paid for the work you do.
Your Policy Schedule will show if total and permanent disability is included
in your policy and which of the following definitions apply to you:
1. Total and permanent disability – unable to do your own occupation ever again.
Loss of the physical or mental ability through an illness or injury to the extent that the life assured is unable to do the material and substantial duties of their own occupation ever again. The material and substantial
duties are those that are normally required for, and/or form a significant and integral part of, the performance of the life assured’s own occupation that cannot reasonably be omitted or modified.
Own occupation means your trade, profession or type of work you do for
profit or pay. It is not a specific job with any particular employer and is irrespective of location and availability.
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 life assured expects to retire.
For the above definition, disabilities for which the relevant specialists cannot give a clear prognosis are not covered.

You’ll be assessed on the occupation you were following immediately before the onset of disability. However, if you are not in paid employment at the time of a claim, then your claim will be assessed under the Specified
Work Tasks definition described below.

This benefit may cover any
condition not specifically
covered elsewhere, which
results in total and permanent disability. The exact definition that applies to you depends upon your
occupation and is in the policy terms and conditions.
‘Permanent’ is defined as
“expected to last throughout
the insured person’s life,
irrespective of when the
cover ends or the insured
person retires.”
All reasonable treatment options must have been tried and given sufficient time to work before making a claim.
Conditions where the long term outlook is not clear are not covered.

 

2. Total and permanent disability – unable to do three specified work tasks ever again.
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 specialists must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or the life assured expects to retire.
The life assured 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 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

All reasonable treatment options must have been tried and given sufficient time to work before
making a claim.

Traumatic head injury - resulting in permanent symptoms

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

Traumatic head injury is covered by this definition when permanent symptoms result from the injury. An example is a severe head
injury caused by a road accident.

* Permanent neurological deficit with persisting clinical symptoms
Symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last
throughout the insured person’s life.
Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised
weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual
impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma.

Additional Cover

Legal & General critical illness plans also automatically include additional cover for Mastectomy for Ductal Carcinoma In Situ and Children’s Critical Illness Cover.

Mastectomy for Ductal Carcinoma in Situ

If you have a valid claim under this definition they will pay out 25% of the amount you’re covered for up to a
maximum of £25,000. This cover is in addition to your main plan so your chosen cover and the premiums you
pay won’t be affected. This additional payment helps to ensure that you have some financial protection against the impact a mastectomy will have on your lifestyle, and also means that your full cover is still intact in case you suffer another critical illness.

Children's Critical Illness Cover

If any of your children suffer from a critical illness covered by this plan, they will pay out 50% of the amount you’re covered for up to a maximum of £25,000. For Family and Personal Income Plans they will pay out 60 times the chosen monthly benefit or a maximum total of £25,000 – whichever is the lowest amount. This cover is in addition to your main plan and so won’t affect the amount you’re covered for or the premiums you pay. They also pay out one claim per child under your plan and once two claims have been paid, the children’s cover part of your plan will end. If you have more than one Critical Illness Cover plan with us, and pay out a maximum of £50,000 for that child.

Children’s Critical Illness Cover

Legal & General automatically include children’s cover with your policy. This will cover any natural child, legally adopted child or stepchild of the person/s covered, and also any children you may have in the future. They will pay a lump sum if a child is diagnosed with one of the critical illnesses we cover during your plan, as long as they survive for 14 days from diagnosis.

Children are covered provided they are more than 30 days old and less than 18 years old. The 14 day survival period may extend beyond their 18th birthday.

Children are covered for the same critical illnesses covered by the plan, except for total and permanent disability. Children’s cover is only for the defined critical illnesses and isn’t paid on a child’s death.

Are There any Exclusions for Children’s Cover?

As well as total and permanent disability, children’s cover also excludes any condition that arises as a direct or indirect result of congenital (present at birth), hereditary and pre-existing conditions.

When will Children’s Critical Illness Cover End?

Legal & General only pay one claim for each child per policy and once two claims have been accepted, children’s critical illness cover will end. However, cover will continue for you. Children’s cover will also end once you make a claim yourself.

Source Legal & General 07/12/2014

MASTECTOMY FOR DUCTAL CARCINOMA IN SITU – requiring total removal of
the breast
The undergoing of a mastectomy operation (total removal of all the tissue of at least one breast) on the advice of your hospital consultant following the diagnosis of ductal carcinoma in situ of the breast.
For the above definition, the following are
not covered:
• Prophylactic mastectomy without histological
evidence of ductal carcinoma in situ, and
• Any other surgical procedures such as
lumpectomy, partial mastectomy and partial or total sub cutaneous mastectomy.
Early cancerous changes in the breast may occur before the cancer spreads to other parts of the body (this is called in situ cancer). In these circumstances,
removal of the breast (mastectomy) may be advised
to protect against the disease spreading.
This definition doesn’t cover partial breast removal or lump removal only.
The cover provided under this definition is extra cover to your main plan. If you make a valid claim we’ll pay out 25% of your sum assured up to a limit of £25,000. This pay out is separate from your main plan and won’t affect your chosen cover or the
premiums you pay. This ensures that your overall amount of cover remains intact. See page 25 for
more details.

 

There are other providers of critical illness cover policies that may be more suitable to your needs.

Critically Illness Cover Quote

Our Critical illness insurance quotation tool allows you to compare the leading insurance companies critical illness premiums. What's more Go Direct guarantee that at the time of application you will not get cheaper like for like cover as we rebate 50% of the initial commission the provider pays us back into your critical illness insurance policy.

Do you want advice on Critical illness cover?

After looking through the critical illness cover information if you would like Critical Illness Cover Advice , complete our critical illness cover and life insurance enquiry form and we will contact you to discuses your critical insurance and protection needs.

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