Trauma Cover Stand Alone

Transcription

1 TOWER Life 360 Trauma Cover Stand Alone Appendix for Life 360 Trauma Cover Stand Alone A Introduction 1 This Appendix only applies if you have chosen Trauma Cover Stand Alone, and we show that cover with this Document code on the policy schedule. (You will find the Document code in the bottom right hand corner of the back page). 2 You must read this Appendix, the Life 360 Base Policy and the policy schedule together as one document. 3 We define the words that appear in bold in this Appendix in Section P. The definitions in Section E of the Life 360 Base Policy also apply to this Appendix. B Who is covered 1 Trauma Cover Stand Alone insures the life insured shown in the policy schedule above this cover. C Trauma Cover Stand Alone 1 If the life insured suffers one of the Trauma Conditions in section C 3 below for the first time on or after the start date and before or on the end date, we will pay you the sum insured that applies at that time (except for Coronary Artery Angioplasty 2 vessels or less see Section D below). 2 If any of the underlined Trauma Conditions in section C 3 below occur, or symptoms leading to any of those Trauma Conditions occur, within: the first 90 days after: - the start date, or - the date cover is reinstated, we will not pay the sum insured, or 1

2 the first 90 days after you increased the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which the sum insured increased. If any of these apply, and the life insured suffers the same Trauma Condition again during this cover, we will also not pay anything in relation to that same Trauma Condition. 3 The Trauma Conditions are the medical conditions defined in Section O below. The life insured s medical condition must come exactly within any one of those definitions. The Trauma Conditions are summarised as follows: 3.1 Heart and circulation Aortic Surgery Cardiac Arrest Out of Hospital Coronary Artery Angioplasty 2 vessels or less (limits apply, see Section D below) Coronary Artery Angioplasty 3 vessels or more Coronary Artery Bypass Grafting Surgery Primary Pulmonary Hypertension Major Heart Attack (Myocardial Infarction) Heart Valve Surgery Cardiomyopathy 3.2 Cancer Cancer Life Threatening 3.3 Blood disorder Aplastic Anaemia 3.4 Functional Loss/Neurological Advanced Dementia (including Alzheimer s Disease) Benign Tumour of the Brain or Spinal Cord Coma Encephalitis Loss of Independent Existence Major Head Trauma Motor Neurone Disease Muscular Dystrophy Multiple Sclerosis 2

3 Paralysis (including): - Hemiplegia - Diplegia - Paraplegia - Quadriplegia - Tetraplegia Parkinson s Disease Stroke 3.5 Loss of use Deafness Loss of limbs and/or Sight Total and Permanent Blindness Loss of Speech 3.6 Organs Chronic Liver Failure Chronic Lung Failure Chronic Renal Failure Major Organ Transplant Pneumonectomy 3.7 Other conditions Intensive Care Severe Burns Medically Acquired HIV Occupationally Acquired HIV 4 If the Trauma Condition is a surgical procedure, then that surgical procedure must be the usual treatment in respect of the Trauma Condition. 5 We only pay one sum insured under this cover for each life insured. 3

4 D Coronary Artery Angioplasty Benefit 1 If a life insured undergoes a Coronary Artery Angioplasty 2 vessels or less, we will pay you 25% of the sum insured. However, we will not pay: less than $10,000, unless the sum insured is less than $10,000 in which case we will pay just the sum insured, and more than $50,000 2 We will reduce the sum insured for the life insured by the amount we pay under this Coronary Artery Angioplasty Benefit. 3 We only pay one claim under this Coronary Artery Angioplasty Benefit within any six-month period for each life insured. E Children s Benefit 1 If a child insured, suffers a Trauma Condition in section C 3 above for the first time on or after the start date and before or on the end date, we will pay you the lesser of: $50,000, or 50% of the sum insured provided that the child insured is aged between three and eighteen when he or she first suffers the Trauma Condition. 2 If any of the underlined Trauma Conditions occur, or symptoms leading to any of those Trauma Conditions occur, within: the first 90 days after: - the start date, or - the date cover is reinstated, we will not pay this amount, or the first 90 days after you increase the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which this sum increased. If any of these apply, and the child insured suffers the same Trauma Condition again during this cover, we will also not pay anything in relation to that same Trauma Condition. 3 We will not pay under this Children s Benefit if the child insured dies within the 14-day period immediately following the date of diagnosis of the Trauma Condition. Any time during which the child insured is totally dependent on artificial life support systems does not count towards this 14-day period. 4 We will not pay under this Children s Benefit if the Trauma Condition is in connection with: intentional self inflicted injury (whether sane or insane) by the child insured, or congenital defect, or an injury to the child insured by the child s parent or guardian. 5 We only pay one claim under this Children s Benefit for each child insured. This payment does not reduce the sum insured. 4

5 F Paralysis Assistance Benefit 1 If the life insured suffers from Paralysis insured under this cover, we will pay you an additional amount equal to the amount of the sum insured. 2 The maximum payment for Paralysis under: Section C Trauma Cover, and Section F Paralysis Assistance Benefit in relation to: this cover, and the equivalent entitlements in all other trauma insurance with us, and other insurers insuring the life insured, can never be more than $1,000,000. However, if the sum insured is more than $1,000,000, we always pay just the sum insured. 3 We only pay one claim under this Paralysis Assistance Benefit for each life insured. G. Diagnosis Benefit 1 We will make a payment to you if the life insured is definitively diagnosed by an appropriately specialised medical practitioner as having: Primary Pulmonary Hypertension, or Multiple Sclerosis, or The definite diagnosis of Diabetes Mellitus Type 1, after the age of 30 years, or Dementia, or Alzheimers Disease, or The total and permanent loss of use of: a) one limb, or b) one eye as a result of injury or illness, or The definite diagnosis of death of a portion of heart muscle arising from inadequate blood supply to the relevant area. The diagnosis shall be based on the following criteria being present and consistent with a heart attack: - A diagnostic rise and fall in either Troponin I between 0.5 and 2.0ug/L, or - Troponin T between 0.25 and 0.6ug/L The medical diagnosis of the above conditions is sufficient for this Diagnosis Benefit, and the levels of diagnoses in Section O of this Appendix do not apply. 2 The amount of the payment is the lesser of: $50,000, and 25% of the sum insured (subject to a minimum payment of $10,000, unless the sum insured is less than $10,000, in which case we pay just the sum insured). 5

6 3 If any of the conditions covered by this Diagnosis Benefit occur, or symptoms leading to any of those conditions occur, within: the first 90 days after: - the start date, or - the date cover is reinstated, we will not make this payment to you, or the first 90 days after you increased the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which this payment to you increased. If any of these apply, and the life insured suffers the same condition again during this cover, we will not pay anything in relation to that same condition. 4 We will reduce the sum insured for the life insured by the amount we pay under this Diagnosis Benefit. 5 We only pay one claim under this Diagnosis Benefit for each life insured. H Special Events Increase Benefit 1 If a life insured: has a child (by birth or adoption), or moves house and as a result takes out a mortgage on his or her primary residence, or increases a mortgage on his or her primary residence, or marries, or divorces, you may request in writing for us to increase the sum insured for that life insured. We will do this by adding a separate Trauma Cover Stand Alone for that increased amount. Subject to 2 below, that separate Trauma Cover Stand Alone is on the same terms (including any special terms or premium loadings) as this cover. 2 You do not need to produce any medical evidence about the life insured when you request this increase, subject to the following conditions: you must make the request within 90 days of one of the above special events; each individual Special Events Increase cannot exceed the least of: - 50% of the sum insured that applied at the start date, or - $100,000, or - the amount of, or increase in, the mortgage (if applicable). once a Special Events Increase is exercised, no Special Events Increase is available on the increased amount of the sum insured. the total amount of all Special Events Increases under this cover is limited to a maximum of the sum insured that applied at the start date. 6

7 the total of: - the sum insured, and - the sums insured under all other insurance of this type with us, and all other insurers, insuring the life insured (including all increases for any reason) is limited to $2,000,000. for the first six months of each individual Special Events Increase, the amount of the increase covers the life insured for a Trauma Condition in connection with injury only. Special Events Increases are no longer available after the policy anniversary date on or immediately after the life insured s 55 th birthday. you can only make one increase under this Special Events Increase Benefit in any 12-month period. 3 A premium is payable for the amount of each Special Events Increase from the date of the increase. This premium is calculated on the rates applicable at the time you take up the Special Events Increase. I Financial and Legal Advice Benefit 1 After we pay the sum insured under this cover, we will reimburse you for fees up to a maximum of $1,500 including GST (in total) that you pay for: Financial planning advice you receive from an approved financial adviser, and Legal advice you receive from a lawyer. This is subject to the following conditions: You must pay for the advice within three months after we pay you the sum insured. You must submit all claims for the Financial and Legal Advice Benefit within three months after we pay you the sum insured. The advice you receive must be regarding the sum insured paid to you by us. You must provide us with a completed claim(s) form and a receipt(s) satisfactory to us for the fees you are claiming. 2 We only make one payment under this Financial and Legal Advice Benefit for each life insured 3 The payment under this Benefit is in addition to the sum insured. J Advance Payment for Cancer Option 1 This option only applies if it appears in the policy schedule for this cover. 2 We will make an advance payment to you if the life insured is diagnosed by an appropriately specialised medical practitioner as having one of the following conditions: Carcinoma in situ of the following sites: - Cervix-uteri: the tumour must be classified as TisN0M0 according to the TNM staging method or FIGO stage 0. Cervical Intraepithelial Neoplasia classifications (CIN) including CIN-1, CIN-2 and CIN-3 are not covered 7

8 - Fallopian Tube: the tumour must be limited to the tubal mucosa and classified as TisN0M0 according to the TNM staging method or FIGO stage 0 - Vagina: the tumour must be classified as vaginal carcinoma in situ TisN0M0 according to the TNM staging method or FIGO stage 0 - Vulva: the tumour must be classified as vulval carcinoma in situ TisN0M0 according to the TNM staging method or FIGO stage 0 - Breast: the tumour must be classified as ductal carcinoma in situ (DCIS) TisN0M0 according to the TNM staging method or FIGO stage 0 - Prostate: the tumour is confined within the prostate and histologically described as T1N0M0 according to the TNM staging method or a Gleason score of either 2, 3, 4, or 5 Note: FIGO refers to the staging method of the Federation Internationale de Gynecologie Chronic Lymphocytic Leukaemia (Rai stage 0) Melanoma (up to 1.5mm maximum thickness as determined by histological examination using the Breslow method). 3 The amount of the advance payment is the lesser of: $25,000, and 10% of the sum insured. 4 If any symptoms leading to any of the above conditions occur, or the above conditions occur within: the first 90 days after: - the start date, or - the date cover is reinstated, we will not make this advance payment to you, or the first 90 days after you have increased the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which this advance payment to you increased. If this clause J 4 applies, and the life insured suffers the same condition again during this cover, we will not pay anything in relation to that same condition. 5 We will pay only once for each condition in J 2 above for each life insured. 6 The maximum we pay for each life insured under this option is $100, Payments made under this option are not eligible for reinstatement under the Trauma Buy Back Option. 8 This option ends on the policy anniversary date on or immediately after the life insured s 65 th birthday. K Inflation Protection Option 1 If this option appears in the policy schedule for this cover, we offer the key contact the opportunity to increase the sum insured before each policy anniversary date, without providing us with further health information about the life insured. 8

9 2 The sum insured will be increased at the policy anniversary date by the annual rate of increase in the latest published consumer price index available at the date of the offer. 3 The premium will be recalculated for the increased sum insured at the policy anniversary date. 4 This option ends on the earlier of: the policy anniversary date on or immediately after the life insured s 65 th birthday, or the combined sums insured for all insurance of this type with us insuring the life insured reach $2,000,000 for any reason. L Trauma Cover Buy Back Option 1 This option only applies if we show it in the policy schedule for this cover. 2 After we pay a claim under this cover, you may request us in writing to reinstate the Trauma Cover sum insured by the amount paid, without providing us with further health information about the life insured. This is subject to the following: the life insured is still alive and a period of 12 months has elapsed since we paid the Trauma Cover, and you exercise the option within 30 days after the end of that 12-month period, and the maximum Trauma Cover sum insured we will reinstate is the lesser of: - 100% of this payment, and - $2,000, The total amount of Trauma Cover with us, including the reinstated amount and cover with all other insurers, cannot exceed $2,000, A premium is payable if you exercise this option. We will calculate the premium based on the rates applicable for both the age of the life insured and the sum insured reinstated, at the time you exercise the option. 5 If this option is exercised any special terms and premium loadings which applied to this cover will also apply to the Trauma Cover sum insured reinstated. 6 If the original Trauma Condition claimed for was one of the following; Cancer Life Threatening, Aortic Surgery, Coronary Artery Angioplasty 3 vessels or more, Coronary Artery Bypass Grafting Surgery, Primary Pulmonary Hypertension, Major Heart Attack (Myocardial Infarction), Heart Valve Surgery or Cardiomyopathy, a discount of at least 10% will apply to the premium on the reinstated cover. 7 We will not pay the reinstated amount if the Trauma Condition: is the same as the original Trauma Condition, or is directly or indirectly caused by or related to the original Trauma Condition, or symptoms or conditions which caused the occurrence of the original Trauma Condition, or is a Loss of Independent Existence, or is a Heart and Circulation Condition (defined below) and the original Trauma Condition was also a Heart and Circulation Condition, or 9

10 is a Stroke or Paralysis (directly or indirectly resulting from a stroke) and the original Trauma Condition was a Heart and Circulation Condition. A Heart and Circulation Condition means any of the following: - Aortic Surgery - Cardiac Arrest Out of Hospital - Coronary Artery Angioplasty 2 vessels or less - Coronary Artery Angioplasty 3 vessels or more - Coronary Artery Bypass Grafting Surgery - Primary Pulmonary Hypertension - Major Heart Attack (Myocardial Infarction) - Heart Valve Surgery - Cardiomyopathy 8 This option cannot be exercised where payment is made for Coronary Artery Angioplasty Benefit, Diagnosis Benefit, Paralysis Assistance Benefit or Advance Payment for Cancer Option. 9 The reinstated amount will not be eligible for increases under the Inflation Protection Option or the Special Events Increase Benefit. 10 This option ends: on the policy anniversary date on or immediately after the life insured s 65 th birthday, or immediately after the option is exercised, whichever happens first. 11 If this option is exercised the premium will be reduced accordingly. M When we will not pay 1 We will not pay anything under this cover if what happens to the life insured or child insured is in connection with: intentional self inflicted injury (whether sane or insane) by the life insured or child insured, or the life insured or child insured engaging in conduct which gives rise to any criminal offence for which the life insured or child insured is convicted, or the life insured or child insured not following the advice and treatment recommended by a medical practitioner. 2 We will not pay anything under this cover, if the life insured or child insured dies within the 14-day period immediately following the date of diagnosis of the Trauma Condition. 10

11 3 We will not pay anything under the Children s Benefit for any pre-existing condition of a child insured: at the date the Children s Benefit starts for that child insured, and at the date of any increase in the sum insured, and at the date cover is reinstated. N How to make a claim 1 You must follow the requirements of Section B 5 Claims in the Life 360 Base Policy. 2 In addition, if you wish to claim under this cover you must: advise us as soon as possible, but no later than 30 days after the life insured suffers the Trauma Condition give to us an original or certified copy of the life insured s birth certificate, driver s licence or passport and the complete policy document complete and return our claim form. You can call us on to request a claim form at your own expense: - supply medical certificates and any other information that we may require from time to time - obtain a definite diagnosis of the Trauma Condition as soon as possible after the life insured first becomes aware that he or she might be suffering from a Trauma Condition. The diagnosis must be by an appropriately specialised medical practitioner (or other medical practitioner approved by us) and the investigations must be based on (but not limited to):» clinical, and» radiological, and» histological, and» laboratory evidence acceptable to us. obtain, as soon as possible after the life insured first becomes aware that he or she might be suffering from a Trauma Condition, advice and medical treatment from an appropriately specialised medical practitioner (or other medical practitioner approved by us) and to follow that advice and medical treatment. 3 If requested by us, the life insured must undergo medical examinations and other tests by a medical practitioner of our choice to enable us to confirm that the life insured is suffering from one of the Trauma Conditions. This will be at our expense. 4 If the life insured suffers Medically Acquired HIV, we will not pay anything until the life insured meets the definition in Section O. 5 Before we pay any amount, you and the life insured must comply with your obligations under this policy. 6 A child insured under Children s Benefit above must also comply with this Section N, as though he or she is the life insured. 11

12 O Definitions of the Trauma Conditions Advanced Dementia (including Alzheimer s Disease) Alzheimer s disease or other Dementia resulting in permanent irreversible failure of brain function and significant cognitive impairment for which no other recognisable cause can be identified. Significant cognitive impairment means a deterioration or loss of intellectual capacity that results in a requirement for a permanent caregiver. Aortic Surgery The undergoing of medically necessary surgery to: repair or correct an aortic aneurysm, or an obstruction of the aorta, or a coarctation of the aorta, or a traumatic rupture of the aorta. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches. Aplastic Anaemia Bone marrow failure resulting in anaemia, neutropenia and thrombocytopenia requiring treatment over a period of at least two months with at least one of the following: Blood product transfusion Marrow stimulating agents Immunosuppressive agents Bone marrow transplantation. Benign Tumour of the Brain or Spinal Cord A non-cancerous tumour in the brain or spinal cord, giving rise to characteristic symptoms of increased intracranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The tumour must result in either: Medically necessary surgery to remove the tumour, or Neurological deficit causing: - At least 25% impairment of whole person function, that is permanent, or - The life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. This does not include cysts, granulomas, cholesteatomas, malformations in or of the arteries or veins of the brain, haematomas, and tumours in the pituitary gland. 12

13 Cancer Life Threatening The presence of one or more malignant tumours including leukaemia, lymphomas and Hodgkins disease. The malignant tumour is to be characterised by the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue. The following are not included: tumours showing the malignant changes of carcinomas in situ* (including cervical dysplasia CIN-1, CIN-2 and CIN-3) or which are histologically described as pre-malignant all skin cancers, including hyperkeratoses, basal cell carcinomas and squamous cell carcinomas, unless there is evidence of metastases** prostatic cancers which are histologically described as TNM Classification T1 or are of another equivalent or lesser classification Chronic Lymphocytic Leukaemia less than Rai Stage 1 * Carcinoma in situ is covered if it results directly in the removal of the entire organ. The procedure used must be performed specifically to arrest the spread of malignancy and be considered to be the usual and necessary treatment. ** Malignant melanoma of greater than 1.5mm maximum thickness as determined by histological examination using the Breslow Method are covered. Cardiac Arrest Out of Hospital Cardiac Arrest which has occurred outside of hospital, and is not caused by or associated with any medical procedure. This must be documented by an electrocardiogram and be due to: Ventricular fibrillation, or Cardiac asystole. Cardiomyopathy Impaired ventricular function of variable aetiology, caused by primary disease of the heart muscle, causing permanent and irreversible physical impairments to the degree of at least Class 3 of the New York Heart Association Classification of cardiac impairment. Chronic Liver Failure End stage liver failure with permanent jaundice, ascites or encephalopathy. This does not include liver disease related to alcohol use or drug abuse. Chronic Lung Failure End stage respiratory failure requiring extensive, continuous and permanent oxygen therapy, and With FEV 1 test results of consistently less than one litre, or The life insured is constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Chronic Renal Failure End stage renal failure presenting as chronic irreversible failure of both kidneys to function as a result of which regular renal dialysis is instituted or renal transplantation performed. 13

14 Coma A state of unconsciousness with no reaction to external stimuli or internal needs, resulting in either: Continuous mechanical ventilation by means of tracheal intubation for three consecutive days (24 hours per day), or Admission for at least five consecutive days (24 hours per day) in an authorised intensive care unit of an actue care hospital, on the recommendation of an appropriately specialised medical practitioner. This does not include coma as a result of alcohol use or drug abuse. Coronary Artery Angioplasty 2 vessels or less The actual undergoing of Coronary Artery Angioplasty that is considered medically necessary to correct or treat a narrowing or blockage of one or two coronary arteries during the same procedure. Coronary Artery Angioplasty 3 vessels or more The actual undergoing of Coronary Artery Angioplasty that is considered medically necessary to correct or treat a narrowing or blockage of three or more coronary arteries during the same procedure. Coronary Artery Bypass Grafting Surgery The undergoing of medically necessary Coronary Artery Bypass Grafting Surgery to correct or treat coronary artery disease. Deafness The complete and irrecoverable loss of hearing of both ears (whether aided or unaided) as a result of illness or injury, as assessed three months after the illness or injury. Encephalitis resulting in Functional Loss The severe inflammatory disease of the brain resulting in neurological deficit causing either: At least 25% impairment of whole person function, that is permanent, or The life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Heart Valve Surgery The undergoing of surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. Repair via angioplasty, intra-arterial procedures or other non-surgical techniques are specifically excluded. Intensive Care Means that an injury or illness has resulted in the life insured requiring Continuous mechanical ventilation by means of tracheal intubation for three consecutive days (24 hours per day), or Admission for at least five consecutive days (24 hours per day) in an authorised intensive care unit of an acute care hospital, on the recommendation of an appropriately specialised medical practitioner. This does not include medically induced comas or comas caused by alcohol or drug abuse. 14

15 Loss of Independent Existence A condition as a result of illness or injury whereby the life insured is totally and permanently unable to perform (whether aided or unaided) at least two of the five activities of daily living, or suffers cognitive impairment that results in the life insured requiring permanent and constant supervision. Loss of Limbs and/or Sight The total and irrecoverable: loss of two or more limbs, or loss of sight of both eyes, or loss of one limb and the sight of one eye. The loss of sight of an eye means the complete and irrecoverable loss of sight (whether aided or unaided). The loss of a limb means complete loss of the use of an entire hand or entire foot. Loss of Speech The complete and irrecoverable loss of speech (whether aided or unaided) as a result of illness or injury. Major Head Trauma resulting in Functional Loss Accidental cerebral injury resulting in permanent neurological deficit causing either: at least 25% impairment of whole person function that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Major Heart Attack (Myocardial Infarction) Means the life insured has had a myocardial infarction (other than as a direct result of cardiac or coronary intervention) with the following criteria being satisfied: a diagnostic rise and fall in either Troponin I in excess of 2.0ug/L, Troponin T in excess of 0.6ug/L or cardiac enzyme CK-MB, and development on an ECG of either new pathological Q waves or new changes indicative of ischaemia. If the above criteria are not met then we will pay a claim based on satisfactory evidence that the life insured has suffered a Myocardial Infarction which has resulted in a permanent reduction in the Left Ventricular Ejection Fraction to less than 50%. Major Organ Transplant Means either The undergoing of, or Upon the advice of a specialist medical practitioner being on a waiting list of a Transplantation Society of Australia or New Zealand recognised transplant unit for at least four weeks to undergo the medically necessary human to human transplant from a donor to the life insured of one or more of the following complete organs: kidney, liver, heart, lung, pancreas, small bowel or the transplantation of bone marrow. 15

16 Medically Acquired HIV Infection with the Human Immunodeficiency Virus (HIV) which, must have occurred to the life insured in New Zealand or Australia from a health professional who is registered with the appropriate statutory body, where in our opinion the infection arose from one of the following medically necessary events: transfusion with blood products organ transplant to the life insured assisted reproductive techniques a medical procedure or operation performed by a doctor or dentist. Notification and proof of the incident will be required via a statement from the appropriate statutory health authority that the infection is medically acquired. This benefit will not apply in the event that any medical cure is found for AIDS or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS. Infection in any other manner, including infection as a result of sexual activity or intravenous drug use is excluded. We must have open access to all blood samples and be able to obtain independent testing of such blood samples. Motor Neurone Disease The unequivocal diagnosis of Motor Neurone Disease. Multiple Sclerosis resulting in Functional Loss Multiple Sclerosis with significant persistent neurological deficit resulting in either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Muscular Dystrophy The unequivocal diagnosis of Muscular Dystrophy. Occupationally Acquired HIV Infection with the Human Immunodeficiency Virus (HIV) where HIV was acquired as a result of an accident during the course of carrying out normal occupational duties with sero-conversion to HIV infection occurring within six months of the incident. Any incident giving rise to a potential claim must be reported to us within 30 days of the incident and be supported by a negative HIV antibody test taken by the life insured, taken within seven days after the incident. This benefit will not apply in the event that any medical cure is found for AIDS or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS. Infection in any other manner, including infection as a result of sexual activity or intravenous drug use is excluded. We must have open access to all blood samples and be able to obtain independent testing of such blood samples. 16

17 Paralysis The permanent and total loss of function of two or more limbs as a result of injury to, or disease of, the spinal cord or brain as defined below. Limb is defined as the complete arm or the complete leg: Hemiplegia: the permanent and total loss of function of one side of the body as a result of injury to, or disease of, the spinal cord or brain Diplegia: the permanent and total loss of function of both sides of the body as a result of injury to, or disease of, the spinal cord or brain Paraplegia: the permanent and total loss of function of both legs as a result of injury to, or disease of, the spinal cord or brain Quadriplegia: the permanent and total loss of function of both arms and both legs as a result of injury, to or disease of, the spinal cord or brain Tetraplegia: the permanent and total loss of function of both arms and both legs and loss of head movement as a result of injury to, or disease of, the spinal cord or brain. Parkinson s Disease The unequivocal diagnosis of degenerative idiopathic Parkinson s Disease as characterised by the clinical manifestation of one or more of the following: Rigidity, Tremor, Akinesia, resulting in the degeneration of the nigrostriatal system. All other types of Parkinsonism are excluded (eg. secondary to medication). Pneumonectomy The surgical excision of an entire lung. Primary Pulmonary Hypertension Primary Pulmonary Hypertension with substantial right ventricular enlargement resulting in permanent irreversible physical impairment to the degree of at least Class 3 of the New York Heart Association Classification of Cardiac Impairment, and resulting in the life insured being unable to perform his/her usual occupation. Severe Burns Tissue injury caused by thermal, electrical or chemical agents causing third degree or full thickness burns to at least: 20% of the body surface area as measured by 'The Rule of Nines' or the Lund & Browder Body Surface Chart (or similar means of measurement as determined by us),or 50% of both hands, requiring surgical debridement and/or grafting, or 25% of the face, requiring surgical debridement and/or grafting. 17

18 Stroke The suffering of a Stroke as a result of a cerebrovascular event. This requires clear evidence on a Computerised Tomography Scan or Magnetic Resonance Imaging Scan or similar appropriate scan that a stroke has occurred and evidence of: Infarction of brain tissue, or Intracranial or subarachnoid haemorrhage. This does not include transient ischaemic attacks, migraine, cerebral injury resulting from trauma or hypoxia and vascular disease affecting the eye, optic nerve or vestibular functions. Total and Permanent Blindness The complete and irrecoverable loss of the sight of both eyes to the extent that: a) visual acuity is less then 6/60 vision, in both eyes after correction, or b) field vision is constricted to 10 degrees or less, or c) combined visual defects result in the same degree of visual impairment as that occurring in a) or b). 18

19 P Definitions applicable to this cover 1 You must read the following definitions with the definitions in Section E of the Life 360 Base Policy. activities of daily living are: bathing and showering dressing and undressing (including grooming and fitting artificial limbs) eating and drinking using a toilet to maintain personal hygiene moving to or from place to place by walking, wheelchair or walking aid. approved financial adviser: Either an adviser with a current financial adviser agreement with us or a member of a financial services industry body approved by us carcinoma in situ: carcinoma in situ characterised by a focal autonomous new growth of carcinomatous cells, which has not yet resulted in the invasion of normal tissues. Invasion means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The diagnosis of carcinoma in situ must be based on histological examination of tissue. A clinical or radiological diagnosis will not be sufficient. child insured: a natural or legally adopted child of a life insured, aged between three and eighteen years. lawyer: a lawyer who holds a current practising certificate in New Zealand as a barrister or a barrister and solicitor. usual occupation: the occupation in which the life insured was engaged and from which he or she was deriving income at the time of diagnosis of the Trauma Condition. whole person function: a criteria based on the current edition of the American Medical Association publication entitled Guides to the Evaluation of Permanent Impairment until similar means of measurement have been established by the New Zealand or Australian medical associations that are acceptable to us. Trauma S 0604 V6 19

20 TOWER Health & Life Limited. All rights reserved. LTSAPD 07/10