Life and Critical Illness Insurance Policy terms and conditions

Transcription

1 Life ad Critical Illess Isurace Policy terms ad coditios These policy terms ad coditios describe your policy, icludig: our obligatios to you your cover claims coditios your obligatios to us ThesepolicytermsadcoditiosprovideyouwitheverythigyoueedtokowaboutyourLife ad Critical Illess Isurace policy. It is importat that you read them carefully alog with your policy schedule. If a claim is to be made, these policy terms ad coditios will be useful, so please keep them somewhere safe. Shouldyouhaveayquestiosorqueriesaboutyourpolicythecalluso ad we will be pleased to help you. You will see some words show i bold type which are defied terms ad have specific meaigs whe usedithisdocumet.themeaigsofthesewordsareshowithedefiitiossectioatthefrot. Wewillalwaysactfairly,igoodfaithadiareasoablemaertowardsyouwhedealigwithyour policyadwheapplyigthesepolicytermsadcoditios.weecourageyoutotelluswheeveryou feelwehaveotdoeso.thiscommitmetisaoverridigpricipleadyoushouldreadeachofthe sectios i these policy terms ad coditios i light of this commitmet. LifeadCriticalIllessIsuraceisprovidedbyAvivaadbroughttoyouiassociatiowithSatader, who sell Aviva life isurace products, which iclude the Life ad Critical Illess Isurace policy. Life ad Critical Illess Isurace provided by Aviva Satader UK plc sells Aviva Life ad Critical Illess Isurace

2 Isurace TermsadCoditios Cotets Defiitios 03 Summary of beefits 05 Etitlemet to beefits 06 Policy optios 08 Beefits reflectig future life chages 09 Policy flexibility 11 Claims coditios 12 Geeral coditios 13 Appedix A activities of daily work 14 Appedix B details of critical illesses ad childre s critical illesses covered 15 Appedix C details of additioal critical illesses ad childre s critical illesses covered 26 02

3 Defiitios Throughout these policy terms ad coditios certai words are show i bold type. These are defied terms ad have specific meaigs whe used. The meaigs of these words are set out below. Activities of daily work The activities of daily workig or serious coditios, as detailed i Appedix A i respect of waiver of premium optio or Appedix B i respect of critical illess beefit. Additioal critical illess A illess or coditio suffered by the life isured, as detailed i Appedix C, which the life isured survives for at least 14 days after meetig the relevat additioal critical illess defiitio. Aiversary date The aiversary of the start date. Ay occupatio Ay type of work which the life isured udertakes for profit or pay. Applicatio The applicatio that you made ad that we have accepted. Attedig Cosultat The appropriately qualified medical specialist supervisig care of the life isured. Critical illess A illess or coditio suffered by the life isured, as detailed i Appedix B, which the life isured survives for at least 14 days after meetig the relevat critical illess defiitio. Childre s critical illess A illess or coditio suffered by the life isured s child, as detailed i Appedix B (but excludig Total Permaet Disability), ad Appedix C which the life isured s child survives for at least 14 days after meetig the relevat critical illess or additioal critical illess defiitio. The illess or coditio must ot have bee preset at birth (whether diagosed or ot) ad the symptoms must ot have started before the start date. Deferred period The umber of cosecutive moths of icapacity which must pass before the policyholder becomes etitled to receive the beefit provided by the waiver of premium optio. The deferred period will be as set out i your policy schedule. Duties The material ad substatial duties that are ormally required for ad form a sigificat ad itegral part of the performace of the life isured s ow occupatio that caot be reasoably omitted or modified. Icapacity Icapacity meas that the life isured either: 1 is uable to perform the duties of their ow occupatio, because of their illess or accidetal ijury; or 2 meets the criteria of activities of daily work. Life isured This is the perso whose life is beig covered ad i the evet of their death, diagosis of termial illess, critical illess, additioal critical illess or icapacity a claim could be made. Life isured s child This is the child of the life isured ad i the evet of their diagosis of oe or more of the childre s critical illesses covered a claim could be made. Life isured s child icludes atural childre, step childre, legally adopted childre ad future childre of the life isured. Cover will start from whe a child of the life isured is 30 days old ad ed o their 18th birthday, or 21st birthday if they are i full time educatio. By full time educatio we mea attedace at a full time course at a school, college or uiversity. This icludes placemets that are part of a full time course, but excludes breaks from educatio, for example gap years. Ow occupatio The occupatio which the life isured is followig immediately before icapacity i respect of the waiver of premium optio ad before Total Permaet Disability i respect of critical illess beefit. Occupatio meas a trade, professio or type of work udertake for profit or pay. It is ot a specific job with ay particular employer ad is irrespective of locatio ad availability. Period of waiver This is the cotiuous period of icapacity durig which premiums are waived if the waiver of premium optio is icluded i your policy. The period starts after the deferred period detailed i your policy schedule. Policy This Life ad Critical Illess Isurace policy. Policyholder The perso/persos or compay amed as policyholder i the policy schedule or ay other perso who becomes the legal ower of the policy. Policy schedule This will show the specific detail of your policy, such as who it covers, the amout covered, how much it will cost ad ay policy optios ad beefits icluded. Ed date The date show i the policy schedule o which beefits uder this policy ed. 03

4 Isurace TermsadCoditios Policy terms ad coditios This documet which forms our cotract of isurace with the policyholder providig the cover uder the policy as agreed. The applicatio ad policy schedule also form part of the cotract ad must be read together with these policy terms ad coditios. Premium This is the mothly amout you will be required to pay i order for the beefits to be maitaied. Mothly premiums must be paid by Direct Debit istructio from a curret bak or buildig society accout i the Uited Kigdom, Chael Islads or Isle of Ma. Premium due date The day each moth o which premiums are due. Retail Prices Idex The mothly idex calculated by the Govermet that demostrates the movemet of retail prices i the UK, or a equivalet replacemet of that idex. Stadard terms The premium ad beefits we quote before the uderwritig process is completed. Followig a applicatio beig uderwritte we may oly be able to offer cover with a higher premium tha first quoted, certai beefits excluded, or both. This would ot be classed as stadard terms. We will have cofirmed whether you were accepted o stadard terms whe cofirmig our decisio o your applicatio. Start date The date show i the policy schedule o which cover uder this policy starts. Sum isured The amout payable uder this policy itheevetofaclaimwhichwe accept. The amout payable is set out i your policy schedule. Termial illess A defiite diagosis by the attedig Cosultat of a illess that satisfies both of the followig: the illess either has o kow cure or has progressed to the poit where it caot be cured; ad i the opiio of the attedig Cosultat, the illess is expected to lead to death withi 12 moths. We/our/us Aviva Life & Pesios UK Limited (compay registratio umber ). You/your The perso/persos or compay amed as policyholder i the policy schedule or ay other perso who becomes the legal ower of the policy. 04

5 Summary of beefits These policy terms ad coditios are writte cofirmatio of a cotract betwee Aviva Life & Pesios UK Limited ad the policyholder. I retur for the paymet of the agreed premiums we will pay the beefits i accordace with the policy terms ad coditios. The beefits available uder this policy are set out i the table ad are payable i the evet of a claim which we accept. The table provides a brief summary of the beefits available uder this policy. It is importat to read the iformatio i this table alogside these policy terms ad coditios ad policy schedule. Beefits Death beefit We will pay the death beefit if the life isured dies durig the term of the policy. Termial illess beefit We will pay the termial illess beefit if, before the last 12 moths of the policy, thelife isured is diagosed with a termial illess. This beefit will oly be icluded if your policy has a term of more tha 12 moths. Critical illess beefit If this is icluded o your policy we will pay the critical illess beefit if the life isured is diagosed with oe or more of the critical illesses covered by this policy durig the term of the policy. Additioal critical illess beefit If critical illess beefit is icluded o your policy we will pay the additioalcriticalilless beefit if the life isured is diagosed with oe or more of the additioal critical illesses covered by this policy durig the term of the policy. Childre s critical illess beefit If critical illess beefit is icluded o your policy we will pay childre s critical illess beefit if a life isured s child is diagosed with oe or more of the childre s critical illesses covered by this policy durig the term of the policy. Protectio Promise (house purchase cover) We will pay the lower of the purchase price, the death beefit or 1,000,000 if the life isured dies i the period covered by the Protectio Promise (house purchase cover). Amout payable The sum isured as set out i the policy schedule less ay upaid premiums. The sum isured as set out i the policy schedule less ay upaid premiums. The sum isured as set out i the policy schedule less ay upaid premiums. The lower of 20,000 or 20% of the sum isured as set out i the policy schedule. The lower of 25,000 or 50% of the sum isured as set out i the policy schedule. The lower of the purchase price (as cofirmed whe cotracts are exchaged), 1,000,000 or the sum isured as set out i the policy schedule. 05

6 Isurace TermsadCoditios Etitlemet to beefits We will pay the death beefit if the life isured dies withi the policy term; or If your policy has a term of more tha 12 moths we will pay the termial illess beefit if, before the last 12 moths of the policy, the life isured is diagosed with a termial illess; or If icluded o your policy we will pay the critical illess beefit if the life isured is diagosed with oe or more of the critical illesses covered by this policy durig the policy term. If icluded o your policy we will pay the lower of 20,000 or 20% of the sum isured if the life isured is diagosed with oe or more of the additioal critical illesses covered by this policy durig the policy term. If icluded o your policy we will pay the lower of 25,000 or 50% of the sum isured if a life isured s child is diagosed with oe or more of the childre s critical illesses covered by this policy durig the policy term. We will pay the lower of the purchase price (as cofirmed whe cotracts are exchaged), the death beefit or 1,000,000 if the life isured dies i the period covered by the Protectio Promise (house purchase cover). We will pay beefits if we have accepted a claim. The policy has o cash-i value at ay time. Death beefit If the life isured dies withi the policy term ad we have accepted the claim, we will pay the sum isured as set out i the policy schedule, less ay upaid premiums. We will oly pay the death beefit o oe occasio ad oce this is paid the policy will cease. Critical illess beefit This sectio oly applies if your policy icludes the critical illess beefit. Your policy schedule will cofirm whether this beefit is icluded o your policy. If the life isured is diagosed with a critical illess durig the policy term, provided we have accepted the claim, we will pay the sum isured as set out i the policy schedule, less ay upaid premiums. We will oly pay the critical illess beefit o oe occasio ad oce this is paid the policy will cease. Additioal critical illess beefit This sectio oly applies if your policy icludes the critical illess beefit. Your policy schedule will cofirm whether this beefit is icluded o your policy. If the life isured is diagosed with a additioal critical illess durig the policy term, provided we have accepted the claim, we will pay the lower of either 20,000 or 20% of the sum isured as set out i the policy schedule. We will oly pay the additioal critical illess beefit if o premium is due ad upaid, ad provided a claim for critical illess beefit or termial illess beefit has ot already bee accepted uder this policy. If a claim meets the defiitio for critical illess beefit ad a additioal critical illess beefit at the same time, we will oly pay a claim for the critical illess beefit. Additioal critical illess beefit will be paid o oe occasio i respect of each of the coditios listed i Appedix C for each life isured ad the the beefit will cease i respect of that life isured. Termial illess beefit If the life isured is diagosed with a termial illess before the last 12 moths of the policy, provided we have accepted the claim, we will pay the sum isured as set out i the policy schedule, less ay upaid premiums. We will oly pay the termial illess beefit o oe occasio ad oce this is paid the policy will cease. Termial illess beefit will oly be icluded if your policy has a term of more tha 12 moths. The additioal beefits sectio of your policy schedule will cofirm whether this beefit is icluded o your policy. 06

7 Childre s critical illess beefit This sectio oly applies if your policy icludes the critical illess beefit ad you are the policyholder ad life isured. Your policy schedule will cofirm whether this beefit is icluded o your policy. If the life isured s child is diagosed with a childre s critical illess durig the policy term, provided we have accepted the claim, we will pay the lower of 25,000 or 50% of the sum isured as set out i the policy schedule. We will oly pay the childre s critical illess beefit uder the policy o oe occasio i respect of the same child. Oce we have paid a childre s critical illess beefit the policy will cotiue ad further childre s critical illess claims ca be made i respect of ay other of the life isured s childre. Oce we have accepted a claim for the death beefit, the critical illess beefit or the termial illess beefit, the policy will cease ad o further claims for childre s critical illess ca be made. Protectio Promise (house purchase cover) If your applicatio for cover has: a) bee accepted by us; ad b) you have provided us with a cover start date i the future to coicide with the completio of your house purchase; ad c) you have exchaged cotracts o that house purchase we will provide free cover betwee exchage of cotracts ad completio of the property purchase. (I Scotlad we will provide the free cover from whe missives are completed for the property util the date of etry.) The amout of cover will be the lower of the purchase price (as cofirmed whe cotracts are exchaged), the death beefit as set out i the policy schedule or 1,000,000. The cover will be provided for a maximum period of 90 days from the date that cotracts are exchaged (or i Scotlad missives are complete) o the property purchase. Cover will ed o the earlier of 90 days, the date of the completio of your house purchase or the start date of your policy. We will oly pay the Protectio Promise (house purchase cover) beefit o oe occasio, o further beefits will be payable ad oce paid the policy will cease. Repaymet guaratee The additioal beefits sectio of your policy schedule will cofirm whether this beefit is icluded o your policy. If you have chose decreasig cover i coectio with a mortgage loa i your ame ad at the time that you make a claim (which is accepted by us) for the death beefit, the critical illess beefit or the termial illess beefit, the sum isured is less tha the amout of the outstadig mortgage loa i your ame, we will pay the outstadig mortgage loa provided that: a) The differece betwee the sum isured ad the outstadig mortgage loa is due solely to a higher rate of iterest beig charged tha that used i the calculatio of the table of beefits i the policy schedule; b) The iitial gross rate of iterest charged o the mortgage loa at the start date of the policy was less tha 10%; c) The policy does ot ed before your mortgage loa is due to be repaid; d) The amout of cover at the start date of the policy was at least the size of the mortgage loa (or the part of the mortgage loa the policy covers). 07

8 Isurace TermsadCoditios Policy optios I additio to the critical illess beefit, the followig optios ca be icluded i your policy, subject to uderwritig. Each additioal optio you choose will icrease your total premium. If these optios are icluded i your policy the optioal beefits sectio of your policy schedule will cofirm this. Idexatio optio If you have chose the idexatio optio, we will review the beefits at the aiversary date i lie with the Retail Prices Idex calculated 12 weeks before the aiversary date. If you have chose level cover, the followig the review your sum isured will icrease i lie with the icrease i the Retail Prices Idex over the 12 moth period to the review date. Your premium will icrease based o a rate of 1.4 times the percetage icrease i the Retail Prices Idex. The premium will ot icrease by more tha 14% ad will ot reduce i the evet of the Retail Prices Idex beig egative. If you have chose family decreasig cover the followig the review your sum isured will icrease i lie with the icrease i the Retail Prices Idex over the 12 moth period to the review date, but your premium will remai the same. Whe we review the beefits: If the Retail Prices Idex icrease is greater tha 0%, ad is 10% or less, idexatio will be applied to the beefits. If the Retail Prices Idex is over 10% we will oly icrease the beefits up to a maximum of 10%. If the Retail Prices Idex is egative there will be o reductio to the beefits. We will advise you of ay chage to the beefits, ad premium for level cover, eight weeks before the aiversary date. Ifyou have level cover, if we do ot receive cofirmatio from you that idexatio is ot required the the chage will be applied o the aiversary date. If you wish to cacel idexatio before the icrease takes effect the you will eed to cotact us before the aiversary date. If you do ot cotact us before the aiversary date we will still permit you to cacel idexatio up to 30 days after the aiversary date ad if ecessary we will either refud the icrease i premium or adjust future collectios. If you have family decreasig cover the it will ot be possible to cacel or remove idexatio from your policy. Ay icrease i the Retail Prices Idex will ot be applied to the maximum limits payable for childre s critical illess or additioal critical illess beefit. Waiver of premium optio If you have chose the waiver of premium optio, the if the life isured meets the defiitio of icapacity, we will waive future premiums uder your policy provided your waiver of premium claim is accepted by us. We will waive premiums durig the period of waiver, which starts after the deferred period detailed i your policy schedule, util the earliest of: the policy ed date; or the date o which the icapacity eds; or the date o which the life isured begis ay occupatio; or we accept a claim for the death beefit, the critical illess beefit or the termial illess beefit. We will ot waive premiums followig a waiver of premium claim if we reasoably determie: 1 that the life isured is livig outside the Europea Uio, Adorra, The Chael Islads, The Faroe Islads, Gibraltar, The Isle of Ma, Liechtestei, Norway, Moaco, Sa Mario, Switzerlad, Vatica City, USA, Caada, Australia or New Zealad for more tha 13 cosecutive weeks i ay 12 moth period. 2 that the icapacity is caused directly or idirectly through the life isured s use or ivolvemet i the followig: a) Alcohol or drug misuse icludig but ot limited to the followig: cosumig too much alcohol. takig a overdose of drugs, whether lawfully prescribed or otherwise. takig Cotrolled Drugs (as defied by the Misuse of Drugs Act 1971) other tha i accordace with a lawful prescriptio. b) Crimial acts takig part i a crimial act. c) Self-iflicted ijury itetioal self-iflicted ijury. 08

9 Beefits reflectig future life chages Life chage beefit The additioal beefits sectio of your policy schedule will cofirm whether this beefit is icluded o your policy. This beefit oly applies to a policy which: a) is take out by you o your ow life; ad b) is accepted by us o our stadard terms; ad c) has ot bee take out uder the life chage beefit, replacemet beefit or separatio beefit. For the life chage evets described i this sectio, you ca take out a ew policy with o requiremet for further uderwritig. The ew policy ca be either level or decreasig cover. If your policy is a joit life policy the the ew policy ca either be a joit life policy or sigle life policy oly. The policyholders will eed to be i agreemet to the ew policy, regardless of whether the ew policy is a joit life policy or sigle life policy oly. It is ot possible to chage the life isured. You may use this beefit as may times as you like provided that: a) the total sum isured for all policies issued uder the life chage beefit does ot exceed 200,000 or the origial sum isured of this policy (whichever is the lower); ad b) you take out a ew policy before the life isured s 55th birthday (for a joit life policy this would apply to the oldest life); ad c) the ed date of the ew policy is before the life isured s 70th birthday (for a joit life policy this would apply to the oldest life); ad d) you have ot made or are ot eligible to make a claim for the death beefit, the critical illess beefit, the additioal critical illess beefit or the termial illess beefit. If your policy icludes the waiver of premium optio you will ot be able to use this beefit if you are curretly claimig, are i the process of makig a claim or are eligible to make a claim for premiums to be waived; ad e) you take out a ew policy withi 90 days of the life chage evet occurrig; ad f) you sed us the evidece of the life chage evet that we eed. The terms ad coditios applicable at the date whe you take out the policy will apply to the ew policy. We will use the premium rates i force at the time of the request based o the life isured s age at the time of makig the applicatios. The ew policy will ot iclude life chage beefit, replacemet beefit or idexatio optio but ca iclude separatio beefit. If your policy curretly icludes the waiver of premium optio, the ew policy ca iclude this provided the deferred period is o shorter tha that icluded o this policy. If your policy curretly does ot iclude the waiver of premium optio the ew policy ca ot iclude it. If your policy curretly icludes the critical illess beefit (ad therefore additioal critical illess beefit) the ew policy ca iclude this or you ca choose ot to iclude it. If your policy curretly does ot iclude critical illess beefit (ad therefore additioal critical illess beefit) the ew policy caot iclude it. Life chage evet Marriage or civil partership Divorce or Dissolutio of civil partership or separatio Havig or adoptig a child Buyig a first home (with a mortgage o the property) Movig house Buyig a secod home Home improvemets Child startig higher educatio Evidece eeded Marriage certificate or civil partership certificate. Decree Absolute or Dissolutio order. Alteratively, evidece of a trasfer of mortgage or ew mortgage or evidece of ew addresses. Birth certificate or adoptio certificate. Evidece of the mortgage o the property. Evidece of ew mortgage o the property or utility bills for the property. Evidece of ew loa or mortgage o the property. Evidece of ew loa or mortgage o the property or icrease to the existig loa or mortgage o the property. Alteratively the builders receipt for the work udertake. Uiversity or college registratio documet. Salary icrease of 20% or more Copy of payslips, dated withi 90 days of each other, evidecig the icrease i salary. 09

10 Isurace TermsadCoditios Replacemet beefit The additioal beefits sectio of your policy schedule will cofirm whether this beefit is icluded o your policy. This beefit oly applies if: a) this is a joit life policy where both policyholders are the oly lives isured; ad b) the policy is accepted by us o our stadard terms; ad c) the policy was ot take out uder a life chage beefit; ad d) the policy has eded due to a valid death beefit claim, critical illess beefit claim or termial illess beefit claim which has bee accepted by us; ad e) you, beig the perso etitled to take out a ew policy, are ot eligible to make a claim for the waiver of premium optio, the critical illess beefit, the additioal critical illess beefit or the termial illess beefit. You ca take out a ew policy with o requiremet for further uderwritig. The ew policy ca be either level or decreasig cover. The ew policy must: a) start withi 90 days of us acceptig the claim o the origial policy; ad b) be take out before your 55th birthday; ad c) have a ed date o later tha the origial policy; ad d) have a maximum sum isured of the lower of 50,000 or the sum isured at the start date of the origial policy. The ew policy will be subject to the premium rates for your age ad the terms ad coditios applicable at the date whe you take out the ew policy. The ew policy ca iclude the waiver of premium optio oly if it was icluded o the origial policy ad must have either the same or loger deferred period as the origial policy. The ew policy will ot iclude the critical illess beefit (ad therefore additioal critical illess beefit), life chage beefit, replacemet beefit, separatio beefit or idexatio optio. You may oly use the replacemet beefit oce. Separatio beefit The additioal beefits sectio of your policy schedule will cofirm whether this beefit is icluded o your policy. This beefit oly applies if: a) this is a joit life policy where both policyholders are the oly lives isured ad you have divorced, your civil partership has dissolved or you have separated from each other; ad b) the policy is accepted by us o our stadard terms; ad c) both policyholders are i agreemet to cacel the origial policy; ad d) both policyholders are ot eligible to make a claim for waiver of premium optio, the critical illess beefit, the additioal critical illess beefit or the termial illess beefit at the time of applyig for a ew policy; ad e) you sed us the evidece we eed. The policyholders, withi 90 days of havig divorced, havig their civil partership dissolved or havig separated from each other, ca cacel the existig policy ad each take out a ew policy with o requiremet for further uderwritig. The ew policy must: a) have a sum isured less tha or equal to the sum isured at the start date of the origial policy; ad b) be take out before your 55th birthday; ad c) have a ed date before your 70th birthday; ad d) have a start date o earlier tha the date of cacellatio of the origial policy. The ew policy ca offer level cover or decreasig cover for each policyholder ad ca have the same policy optios, icludig the critical illess beefit (ad therefore additioalcriticalilless beefit), that were icluded i the origial policy. If the waiver of premium optio is icluded o the ew policy, because it was icluded o the origial policy, it must have the same or loger deferred period as the origial policy. The ew policy will ot iclude life chage beefit, separatio beefit or replacemet beefit. The ew policy will be subject to the premium rates for your age ad the terms ad coditios applicable at the date whe you take out the ew policy. You will be required to sed us evidece to cofirm: you have divorced or had your civil partership dissolved (Decree Absolute or Dissolutio order); or that the mortgage has bee rearraged ito oe of your ames oly; or thatoeorbothofyou have take out a ew mortgage o a ew property. You may oly use the separatio beefit oce. 10

11 Policy flexibility Oce we have started cover uder your policy, you ca request that certai chages be made to it. The followig amedmets will result i us amedig your existig policy ad will ot require ay further uderwritig. Decreasig the sum isured. Decreasig the policy term. Removig the idexatio optio o level cover. Removig the waiver of premium optio. Removig the critical illess beefit (ad therefore additioal critical illess beefit). You may request these chages be made to your policy with effect from the date that the ext premium is due. Where we are asked to remove a optio we will simply deduct the charge for that optio from the premium. For all other chages we will use the premium rates ad age applicable at the time that we make the chage. Your premium followig the chage caot be less tha the miimum premium of 5.00 per moth. These policy terms ad coditios will cotiue to apply. The followig amedmets will require your existig policy to be cacelled ad be replaced by a ew policy ad may require further uderwritig: Icreasig the policy term. Chagig from level cover to decreasig cover. Chagig from decreasig cover to level cover. Addig the critical illess beefit (ad therefore additioal critical illess beefit). Addig a life isured. Removig a life isured. You may request these chages be made to your policy with effect from the date that the ext premium is due. We will use the premium rates ad age applicable at the time that we make the chage. New policy terms ad coditios applicable at that time will be issued i place of these policy terms ad coditios. The followig amedmet will require your existig policy to remai i force ad we will issue a ew policy to cover the chage oly ad may require further uderwritig: Icreasig the sum isured. You may request this chage be made to your policy with effect from the date that the ext premium is due. We will use the premium rates ad age applicable at the time that we make the chage. New policy terms ad coditios applicable at that time will be issued to cover the icrease to the sum isured oly. 11

12 Isurace TermsadCoditios Claims coditios Our requiremets a) We will make paymet of beefits provided we receive such evidece as we may reasoably require of: (i) the occurrece of a evet o which ay beefits are payable or the cotiuatio of the circumstaces uder which ay beefit is payable; (ii) the claimat havig legal owership of the policy; (iii) the date of birth of the life isured or life isured s child; (iv) our completed claim form; (v) coversatios with ad reports from third parties, such as coroers, attedig Cosultats ad the police; ad (vi) such other iformatio as we may reasoably require to eable us to assess the claim. b) Paymet of the termial illess beefit, the critical illess beefit (icludig the childre s critical illess beefit ad the additioal critical illess beefit) or the waiver of premium optio will be subject to us receivig such other iformatio ad evidece as we may reasoably require, icludig: (i) medical certificates ad evidece of icapacity or termial illess to be provided at the policyholder s expese. Whe requestig such iformatio, we will do o more tha is reasoably ecessary, havig regard to the idividual circumstaces, to determie whether a beefit is payable. (ii) medical examiatios of the life isured (or life isured s child i respect of a claim for childre s critical illess beefit) or tests (icludig blood tests) o the life isured (or life isured s child i respect of a claim for the childre s critical illess beefit) will be carried out at our expese at such itervals as we may reasoably require, havig regard to the idividual circumstaces, by a medical examier appoited by us. (iii) writte coset to allow us to receive the results of ay medical examiatios ad/or tests required. (iv) sigature o ay declaratio or coset form we provide allowig us access to the life isured s medical records or the medical records of the life isured s child i respect of a claim for the childre s critical illess beefit. Claims for the waiver of premium optio should be set to us i writig as soo as possible after the start of icapacity. c) All medical certificates ad the results of medical examiatios ad/ or tests must be submitted to us i writig ad must be provided by attedig Cosultats residet ad practisig i coutries of the Europea Uio, Adorra, The Chael Islads, The Faroe Islads, Gibraltar, The Isle of Ma, Liechtestei, Norway, Moaco, Sa Mario, Switzerlad, Vatica City, USA, Caada, Australia or New Zealad. We may add further coutries i the future. d) Followig acceptace of a claim for the waiver of premium optio the life isured must take reasoable steps as are ecessary to assist recovery. This icludes, but is ot limited to: (i) allowig access by disability cousellors ad/or advisers appoited at our istructio; (ii) acceptig reasoable medical treatmet; ad (iii) sigig coset forms that are reasoably ecessary. e) If ay claim uder this policy is i ay respect ufouded, for example providig false iformatio to support a claim, the without affectig ay other legal rights we may have, ay beefit paid for that claim will be reclaimed, ad o further beefit will be paid. We will also have the right to cacel the policy without refudig ay premiums. 12

13 Geeral coditios Premiums a) Premiums for your policy must be paid mothly by Direct Debit istructio from a curret bak or buildig society accout i the Uited Kigdom, Chael Islads or Isle of Ma. b) The iitial mothly premium payable ad the date it is due are show i the policy schedule. Subsequet premiums will be due o the premium due date. You are allowed 30 days from each premium due date for the paymet of each premium. If a claim arises durig this period, the upaid premium will be deducted from ay beefit payable. If a premium is ot paid withi 30 days from the premium due date the policy will be cacelled ad all beefits uder it will cease. c) All premiums due to us must be made i the currecy of the Uited Kigdom. Policy term The policy term must be for a miimum period of 12 moths. The maximum policy term is 40 years. However the actual maximum policy term available is restricted to the life isured beig 75 years old or less at the policy ed date. Where a policy has two lives isured the maximum age will apply to the oldest life isured. Chage of address If you, or the life isured, chage address you should tell us. Acceptace of istructios We will ot accept ay istructio, request or otice from you util we receive the iformatio ad documetatio that we may reasoably require i order to admiister the policy. We will make our requiremets clear to you. Cacellatio Whe you start your policy you will receive a cacellatio otice which will cofirm your 30 day coolig off period i which time you may cacel the policy ad receive a refud of ay premiums paid. After this time, the policy may be cacelled before the policy ed date by you by providig your writte coset to us at our admiistrative offices. We will ot refud premiums paid if you cacel the policy outside of the coolig off period. If you cacel your policy the policy will ed ad all beefits uder it will cease. Alteratios a) We may chage the terms of the policy for ay of the followig reasos: (i) To respod, i a proportioate maer, to chages i the way we admiister policies of this type. (ii) To respod, i a proportioate maer, to chages i techology or geeral practice i the life ad pesios idustry. (iii)to respod, i a proportioate maer, to chages i taxatio, the law or iterpretatio of the law, decisios or recommedatios of a Ombudsma, regulator or similar perso, or ay code of practice with which we ited to comply. (iv) To correct errors, if it is fair ad reasoable to do so. If we cosider ay variatio to these coditios is to your advatage or is ecessary to meet regulatory requiremets, we may make the chage immediately ad will tell you at a later date. We will tell you i writig of ay chage we cosider is to your disadvatage (other tha ay chage ecessary to meet regulatory requiremets) at least 60 days before the chage becomes effective, uless exteral factors beyod our cotrol mea that oly a shorter otice period is possible. If we chage the terms of the policy ad you are uhappy with the chage the you will be able to cacel your policy. We will ot refud premiums paid if you cacel your policy. Ifyou cacel your policy the policy will ed ad all beefits uder it will cease. b) If the date of birth of a life isured has bee icorrectly stated, the beefits payable uder your policy will be ameded by us havig regard to the true date of birth. We will advise you of ay amedmets we make. If the true date of birth is such that, had it bee kow by us at the time the policy was applied for, the life isured would have falle outside of the prescribed age limits to be eligible for the policy, the the policy caot cotiue. I such circumstaces, the policy would be cacelled with o beefits payable ad we would advise you of the cacellatio. Premiums would be refuded without iterest. c) We rely o the iformatio give to us. If ay of the iformatio give to us is ot true or ot complete ad this might reasoably have affected our decisio to provide the policy, the we may: (i) chage the terms of the policy; (ii) amed the premiums due uder the policy; or (iii) cacel the policy ad refud the premiums paid without iterest. If we cacel your policy the policy will ed ad all beefits uder it will cease. Third party rights This policy does ot give ay rights to ay perso other tha the policyholder ad Aviva Life & Pesios UK Limited. No other perso shall have ay rights to rely o ay terms uder the policy. The policyholder ad Aviva Life & Pesios UK Limited may amed or cacel this policy without referece to, or the coset of, ay other perso. Geeral a) If owership of the policy is trasferred to someoe else (a assigmet), we must be i receipt of the writte otice of assigmet before ay paymet ca be made. b) The policy schedule records details of the policy at the start date. Ay alteratio resultig i a chage to your policy may ot be reflected i the policy schedule. I this evet, we will record such chages. c) Where appropriate words i the masculie iclude the femiie ad words i the sigular iclude the plural ad vice versa. Law This policy is issued i Eglad uder Eglish law. 13

14 Isurace TermsadCoditios Appedix A Activities of daily work If the life isured is o loger followig their ow occupatio immediately before icapacity they will be assessed o activities of daily work. To meet the activities of daily work criteria the life isured must: be uable to perform at least two of the work tasks; or be diagosed as sufferig from oe of the serious coditios. Work tasks The life isured must eed the help or supervisio of aother perso ad be uable to perform the task o their ow, eve with the use of special equipmet routiely available to help ad havig take ay appropriate prescribed medicatio. Walkig the ability to walk more tha 200 metres o a level surface. Climbig the ability to climb up a flight of 12 stairs ad dow agai, usig the hadrail if eeded. Liftig the ability to pick up a object weighig 2kg at table height ad hold for 60 secods before replacig the object o the table. Bedig the ability to bed or keel to touch the floor ad straighte up agai. Gettig i ad out of a car the ability to get ito a stadard saloo car, ad out agai. Writig the maual dexterity to write legibly usig a pe or pecil, or type usig a desktop persoal computer keyboard. Complete depedecy beig totally icapable of carig for oeself, requirig 24 hour medical supervisio i a hospital or ursig home. Metal illess diagosis of a severe metal illess by a Cosultat Psychiatrist which has resulted i i-patiet admissio for at least seve cosecutive days o the directio of the Cosultat Psychiatrist, ad results i both: (i) severe ad cotiuous reductio i metal ad social fuctioig; ad (ii) cotiuous supervisio ad care uder the NHS Care Programme approach at the highest level. or Brai disease or brai ijury causig progressive loss of ability to uderstad, perceive, reaso, express ad remember, givig rise to the life isured requirig cotiuous persoal care. Serious coditios Blidess permaet 1 ad irreversible 2 loss of sight to the extet that eve whe tested with the use of visual aids visio is measured at 3/60 or worse i the better eye usig a Selle eye chart. Deafess permaet 1 ad irreversible 2 loss of hearig to the extet that the loss is greater tha 95 decibels across all frequecies i the better ear usig a pure toe audiogram. 1 By permaet we mea expected to last throughout the life isured s life, irrespective of whe your cover eds or you retire. 2 By irreversible we mea caot be reasoably improved upo by medical treatmet ad/or surgical procedures used by the NHS i the UK at the time of a claim. 14

15 Appedix B Details of critical illesses ad childre s critical illesses covered For each critical illess or coditio listed i alphabetical order below, we have set out the defiitio we will use whe assessig whether a claim will be valid uder the policy. To help icrease your uderstadig of the cover provided, we have icluded below each of the defiitios a ad Guidace Notes. I respect of Total Permaet Disability please refer to your policy schedule which will cofirm which defiitio applies to the life isured. If your policy schedule cofirms the defiitio is ow occupatio but the life isured is o loger followig their ow occupatio immediately before Total Permaet Disability the they will be assessed o activities of daily work. Please esure you read the exclusios sectio which cofirms whe we will ot pay critical illess beefit or childre s critical illess beefit. Alzheimer s Disease Alzheimer s Disease or Pre-Seile Demetia (before age 65) resultig i permaet symptoms. A defiite diagosis of Alzheimer s Disease or Pre-Seile Demetia (before age 65), by a Cosultat Neurologist, Psychiatrist or Geriatricia. There must be permaet cliical loss of the ability to do all of the followig: remember; reaso; ad perceive, uderstad, express ad give effect to ideas. Demetia a symptom of degeerative brai disease characterised by impairmet of itellectual faculties, such as memory, cocetratio ad judgemet. Permaet expected to last throughout the isured perso s life, irrespective of whe the cover eds or the isured perso retires. Guidace Notes Alzheimer s disease is a degeerative coditio which affects the brai. A claim will be valid if Alzheimer s disease or pre-seile demetia is diagosed ad the illess has reached the poit where there are permaet cliical symptoms of demetia. This policy oly covers this illess if it is diagosed before age 65. Aorta Graft Surgery Aorta Graft Surgery for disease or trauma. The udergoig of surgery for disease or trauma to the aorta with excisio ad surgical replacemet of a portio of the diseased aorta with a graft. The term aorta icludes the thoracic ad abdomial aorta but ot its braches. For the above defiitio, the followig is ot covered: Ay other surgical procedure, for example the isertio of stets or edovascular repair. Aorta the mai artery of the body, arisig from the heart ad supplyig oxygeated blood to the body. Braches ay smaller arteries that brach off from the mai aorta. Edovascular repair a miimally ivasive method of approachig ad repairig the diseased portio of the aorta through the body s arteries. Graft ay orga or tissue implated to repair or replace a diseased or damaged orga or body tissue. Stet a tubular structure placed withi a blood vessel or orga, used to provide support durig or after surgical procedures. Thoracic ad abdomial aorta the parts of the aorta that lie withi the thorax (chest) ad abdome (stomach). Guidace Notes Aorta graft surgery may be required if it is arrowed due to a build up of fatty deposits, weakeed by a ballooig of the artery wall (a aeurysm) or followig trauma. A claim will be valid if surgery has bee carried out to repair the aorta with a graft after it has bee damaged through disease or trauma. This does ot cover surgery to repair the aorta i other circumstaces. Aplastic Aaemia A defiite diagosis of Aplastic Aaemia by a Cosultat Haematologist. There must be permaet boe marrow failure with aaemia, eutropeia ad thrombocytopeia. Aaemia havig reduced haemoglobi cocetratio i the blood. Neutropeia abormally low umber of blood cells called eutrophils. Thrombocytopeia abormally low umber of platelets (particles ivolved i clottig) i the blood. Guidace Notes Aplastic aaemia is a serious coditio where there is a decrease i the blood formig cells i the boe marrow. It is rare but if left utreated ca be fatal. Bacterial Meigitis A defiite diagosis of Bacterial Meigitis resultig i permaet eurological deficit with persistig cliical symptoms. Meiges membraes that cover ad protect the brai ad spial cord. Permaet eurological deficit symptoms of dysfuctio i the ervous system that are preset o cliical examiatio. Symptoms would iclude impairmet or loss of sight or hearig, spasticity, epilepsy/seizures, cogitive impairmet (cogitio ivolves perceptio, reasoig, ad problem solvig abilities). 15

16 Isurace TermsadCoditios Guidace Notes Bacterial Meigitis is a ifectio of the fluid i the spial cord ad the fluid that surrouds the brai. It is caused by a ifectio with a bacterium. It is a serious illess requirig prompt treatmet, ad ca result i damage to the brai. It is importat to uderstad that viral meigitis, which is usually relatively mild i ature ad respods rapidly to treatmet is ot covered. Beig Brai Tumour Beig Brai Tumour resultig i permaet symptoms or requirig ivasive surgery A o-maligat tumour or cyst origiatig from the brai, craial erves or meiges withi the skull, resultig i permaet eurological deficit with persistig cliical symptoms or requirig ivasive surgery. For the above defiitio, the followig are ot covered: Tumours i the pituitary glad. Tumours origiatig from boe tissue. Agioma ad cholesteatoma. Agioma a beig tumour of blood vessels. Beig ot maligat. Craial erves erves that come from the base of the brai. Cyst a cavity or sac eclosed by a membrae, ofte cotaiig liquid or semi-solid material. Lesios areas of tissue with impaired fuctio due to illess or ijury. Meiges the protective tissue that covers the brai ad spial cord. Pituitary glad a small pea-sized orga coected by a stalk to the middle of the uderside of the brai behid the asal cavity. Guidace Notes A beig tumour is a abormal growth of cells which, ulike a maligat or cacerous tumour, does ot spread to other parts of the body. Beig tumours i the brai are more dagerous because of the icrease i pressure as they grow. Surgery to remove may be required but is ot always possible. Maligat tumours are ot covered uder this defiitio as these are covered uder the cacer defiitio. Beig tumours, agiomas or lesios i the pituitary glad are ot covered. Beig Spial Cord Tumour A o-maligat tumour i the spial caal ivolvig the meiges or spial cord. This tumour must be iterferig with the fuctio of the spial cord which results i permaet eurological deficit with persistig cliical symptoms. This diagosis must be made by a medical specialist ad must be supported by appropriate evidece. Excluded uder this defiitio are cysts, graulomas, malformatios i the arteries or veis of the spial cord, haematomas, abscesses, disc protrusios ad osteophytes. Meiges the protective tissue that covers the brai ad spial cord. Spial cord the erve tissue that exteds from the brai alog the spie. Spial caal the space i the boes of the backboe (vertebrae) through which the spial cord passes. Guidace otes Tumours i the spial cord are potetially dagerous as they ca compress the spial erves ad weake the structure of the spie. Blidess Blidess permaet ad irreversible. Permaet ad irreversible loss of sight to the extet that eve whe tested with the use of visual aids, visio is measured at 3/60 or worse i the better eye usig a Selle eye chart. 3/60 meas the perso whose eyesight is beig assessed ca see a object up to three feet away that a perso with perfect eyesight could see if it were 60 feet away. Irreversible caot be reasoably improved upo by medical treatmet ad/or surgical procedures used by the NHS i the UK at the time of a claim. Permaet expected to last throughout the isured perso s life, irrespective of whe the cover eds or the isured perso retires. Selle eye chart a chart showig letters i rows of decreasig size that opticias use to measure visual ability. Visual aids aythig which helps improve visio, for example cotact leses or a pair of glasses. Guidace Notes Blidess meas a sigificat loss of sight i both eyes to the extet that the perso ca oly see a object up to three feet away that a perso with perfect eyesight could see if it were 60 feet away. The coditio must be icurable ad therefore expected to be permaet. Please ote that beig registered blid may ot be a valid claim. Cacer Cacer excludig less advaced cases Ay maligat tumour positively diagosed with histological cofirmatio ad characterised by the ucotrolled growth of maligat cells ad ivasio of tissue. The term maligat tumour icludes leukaemia, sarcoma ad lymphoma except cutaeous lymphoma (lymphoma cofied to the ski). For the above defiitio, the followig are ot covered: All cacers which are histologically classified as ay of the followig: pre-maligat; o-ivasive; cacer i situ; havig either borderlie maligacy; or havig low maligat potetial. 16

17 All tumours of the prostate uless histologically classified as havig a Gleaso score of 7 or above or havig progressed to at least TNM classificatio T2bN0M0. Ay ski cacer (icludig cutaeous lymphoma) other tha maligat melaoma that has bee histologically classified as havig caused ivasio beyod the epidermis (outer layer of ski), uless the ski cacer has bee cofirmed as maligat ad has spread to the lymph odes or distat orgas. Borderlie maligacy potetially maligat cells that form i the tissue coverig the orga ad have ot ivaded the adjacet tissue. Cacer i-situ the presece of maligat/cacerous cells at a stage of developmet such that they have ot spread ito surroudig healthy tissue. I medical termiology, this meas that the cacer cells are cofied to the epithelium (the tissue that lies the iteral ad exteral surfaces of the body) of origi ad have ot yet ivaded the adjacet tissue. For maligat melaomas of the ski, this meas that cacer cells are cofied to the epidermis (the outermost layer of ski) ad may be categorised as Clark s level 1. Epidermis the outer layer of ski. Gleaso score a measure of how aggressive a idividual s prostate cacer is. It is calculated from examiig the prostate cacer cells uder a microscope. Scores ca rage from 2 to 10, with 2 idicatig the lowest degree of chage ad 10 the highest. Histologically the appearace of the cacer uder the microscope which leads to its diagosis ad, additioally, gives iformatio o its differetiatio or gradig (how aggressive it may be). Hodgki s disease a type of cacer (lymphoma) affectig lymphatic tissue. Ivasio the occurrece of maligat/cacerous cells that have spread ito surroudig healthy tissue (that is, more extesive tha cacer i-situ). Ivasive maligat melaoma a maligat melaoma which has progressed beyod the poit of beig cofied to the epidermis (the outermost layer of ski). This will be categorised as Clark s level 2 or above. Leukaemia a disease of the blood formig tissues characterised by icreased umbers of immature or abormal blood cells, that leads to a icreased tedecy to ifectio, aaemia ad haemorrhage. Lymphoma cacer of the lymphatic (gladular) system, icludig Hodgki ad No-Hodgki lymphoma. Low maligat potetial potetially maligat cells that form i the tissue coverig the orga ad have ot ivaded the adjacet tissue. Maligat tumour a tumour that ivades the tissue i which it origiates ad ca spread to other parts of the body. No-ivasive maligat/cacerous cells that have ot spread ito surroudig healthy tissue. Sarcoma cacer of coective tissue such as boe, muscle, erves, fatty tissue or cartilage. Pre-maligat cells which may develop ito a maligat tumour but have ot yet doe so. TNM classificatio a iteratioally recogised stadardised method of stagig cacers. Broadly, the three parts of the system relate to: Tumour (T) a scale of 0 to 4 is used to record details about the primary tumour. T0 meas there is o evidece of a primary tumour, T1 to T4 shows the size ad extet of spread of the primary tumour. Tis may be used for cacer i situ. Nodes (N) a scale of 0 to 3 is used to record the extet of spread to the regioal lymph odes. N0 meas the lymph odes are ot ivolved, N1 N3 shows the extet of the ivolvemet. Metastases (M) either M0 or M1, the latter idicatig metastases (more distat spread of the cacer). Guidace Notes What is cacer? Cacer is complex to defie because it is t a sigle illess. There are aroud 200 types ad they affect people i differet ways. A cacer is a ucotrolled growth of abormal maligat cells which, if left utreated, ca ivade ad destroy the surroudig healthy tissue. I the later more advaced stages, it ca spread from the origial site to other parts of the body. Whe would a critical illess policy pay out? Geerally speakig, cacer claims are valid o the diagosis of a maligat cacer that has reached the poit where it has ivaded ad started to destroy the adjacet surroudig tissue. However, a few types of cacer are ot covered. What types of cacer are ot covered? The policy does t cover very early cases that have ot yet started to ivade the adjacet surroudig tissue i the orga, eve if you receive treatmet. Doctors sometimes call these cases pre-maligat, oivasive, cacer i situ, havig borderlie maligacy or havig low maligat potetial. Ski cacers other tha maligat melaoma ormally oly affect the surface area of the ski ad do t spread to other areas of the body. They are oly covered i the very rare evet whe they have bee cofirmed as maligat ad have spread extesively. 17