Full payout conditions

If your client is diagnosed with one of the following illnesses or conditions, we'll pay 100% of the amount of cover specified on their cover summary.

The undergoing of surgery for disease or trauma of the aorta requiring surgical replacement with a graft.

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

A definite diagnosis of bacterial meningitis by a UK Consultant Physician supported by cerebrospinal fluid changes consistent with bacterial meningitis.

A definite diagnosis by a UK Consultant Neurologist of a non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull resulting in either:

  • Surgery to treat the tumour, radiotherapy, chemotherapy.

OR

  • permanent neurological deficit with persisting clinical symptoms.

The following are not covered under this definition but are covered as an additional payment:

  • Pituitary tumours.

A definite diagnosis by a UK Consultant of a non-malignant tumour or cyst originating from the spinal cord, spinal nerves or meninges.

Permanent and irreversible loss of sight to the extent that, even when tested with the use of visual aids, it’s measured by a certified UK Ophthalmologist as having a best corrected (with glasses or lenses) visual acuity in the better eye of:

  • 6/60 or worse using a Snellen eye chart, or equivalent or
  • A loss of peripheral visual field and a central visual field of no more than 20 degrees in total.

A definite diagnosis by a UK Oncologist of a malignant cancer with histological confirmation.

The following are not covered under this definition but are covered as additional payouts:

  • All tumours of the prostate histologically classified as having a Gleason score between 2 and 6 inclusive and having progressed to clinical TNM classification T1N0M0-T2aN0M0 inclusive (if the Prostate Cancer is classified as having progressed to a Gleason score of 7 or above or clinical TNM classification T2bN0M0 we will pay out the full sum assured).
  • Carcinoma in situ with surgery to remove the tumour.
  • Ovarian tumour of borderline malignancy/low malignant potential that has resulted in the surgical removal of the ovary.
  • Non-melanoma skin cancer with histological confirmation of spread beyond the epidermal layer that has not caused invasion to the lymph glands or bones or spread to distant organs.

A sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and resulting in either of the following devices being surgically implanted:

  • Implantable cardioverter (defibrillator), or
  • Cardiac resynchronisation therapy with defibrillator (CRT-D).

A definite diagnosis of cardiomyopathy by a UK Consultant Cardiologist resulting in at least one of the following:

  • Left ventricular ejection fraction (LVEF) of less than 40% measured twice at an interval of at least 3 months.
  • Marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain equivalent to at least Class III of the New York Heart Association (NYHA) functional classification system over a period of at least 6 months.
  • Implantation of a Cardioverter Defibrillator (ICD) on the specific advice of a UK Consultant Cardiologist for the prevention of sudden cardiac death.

The following are not covered:

  • All other forms of heart disease, heart enlargement and myocarditis.
  • Cardiomyopathy secondary to alcohol or drug abuse.

A definite diagnosis by a UK Consultant of cauda equina syndrome evidenced by compression of the lumbosacral nerve roots (cauda equina) resulting in all of the following:

  • Permanent bladder dysfunction.
  • Permanent weakness and loss of sensation of the legs.

The diagnosis must be supported by appropriate evidence.

A definite diagnosis by a UK Consultant Rheumatologist of chronic rheumatoid arthritis as evidenced by widespread joint destruction with major clinical deformity that results in the permanent inability to perform at least 3 out of 8 of our daily activities.

A state of unconsciousness with no reaction to external stimuli or internal needs which requires the use of life support systems.

The following is not covered:

  • Coma secondary to alcohol or drug abuse.

The undergoing of surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft surgery.

A definite diagnosis by a UK Consultant Neurologist of Creutzfeldt-Jakob disease.

A definite diagnosis by a UK Consultant Gastroenterologist of Crohn’s disease.
There must have been at least one surgical intestinal resection.

Permanent and irreversible loss of hearing to the extent that the quietest sound that can be heard in the better ear is 70 decibels across all frequencies using a pure tone audiogram.

A definite diagnosis of Alzheimer’s disease or dementia by a UK Consultant Neurologist, Psychiatrist or Geriatrician.

There must be permanent clinical loss of ability to do all of the following:

  • remember: and
  • reason; and
  • perceive, understand, express and give effect to ideas.

The following is not covered:

  • Mild cognitive impairment is excluded.

Undergoing of surgery to brain tissue including vagus nerve and deep brain stimulation in order to control epilepsy that can’t be controlled by oral medication.

A definite diagnosis by a UK Consultant Neurologist of encephalitis resulting in permanent neurological deficit with persisting clinical symptoms.

A definite diagnosis by a UK Oncologist of a gastro intestinal stromal tumour with histological confirmation.

Death of heart muscle, due to inadequate blood supply, that has resulted in a definite diagnosis of a new myocardial infarction by a UK Cardiologist.

A definite diagnosis by a UK Consultant Cardiologist of the failure of the heart to function as a pump which is evidenced by all of the following:

  • Permanent and irreversible limitation to function to at least Class III of the New York Heart Association (NYHA) functional classification system.
  • Permanent and irreversible ejection fracture of 39% or less.

Undergoing of surgery, on the advice of a UK Consultant Cardiologist, to replace or repair one or more heart valves.

Infection by HIV resulting from:

  • A blood transfusion given as part of medical treatment
  • A physical assault, or
  • An accident 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 following is not covered:

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

Any sickness or injury resulting in the person covered requiring continuous mechanical ventilation by means of tracheal intubation for 7 consecutive days (24 hours per day) or more in an intensive care unit in a UK hospital.

The following are not covered:

  • Sickness or injury as a result of drug or alcohol misuse.

A definite diagnosis of interstitial lung disease by a UK Consultant Respiratory Physician resulting in all of the following:

  • Radiological evidence of pulmonary fibrosis.
  • Permanent and irreversible DLCO (diffusing capacity of the lung for carbon monoxide) below 40% of predicted.

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

End-stage liver failure resulting in all of the following:

  • Permanent jaundice.
  • Ascites.
  • Encephalopathy.

The following is not covered:

  • Liver disease secondary to alcohol or drug abuse.

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

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

The undergoing as a recipient, from another person, of a transplant of:

  • Bone marrow.
  • Haematopoietic stem cell proceeded by total bone marrow ablation.
  • A complete heart, kidney, liver, lung or pancreas.
  • A lobe of liver.
  • A lobe of lung.

Or inclusion on UK waiting list for any of the above-named procedures.

A definite diagnosis by a UK Consultant Neurologist of one of the following motor neurone diseases:

  • Amyotrophic lateral sclerosis.
  • Kennedy’s disease.
  • Primary lateral sclerosis.
  • Progressive bulbar palsy.
  • Progressive muscular atrophy.
  • Spinal muscular atrophy.

There must also be permanent clinical impairment of motor function.

A definite diagnosis by a UK Consultant Neurologist of multiple sclerosis. There must have been clinical impairment of motor or sensory function caused by multiple sclerosis.

A definite diagnosis by a UK Oncologist of a neuroendocrine tumour with histological confirmation.

A definite diagnosis by a UK Consultant Neurologist of neuromyelitis optica. There must have been clinical impairment of motor or sensory function.

The undergoing of heart surgery requiring thoracotomy on the advice of a UK Consultant Cardiologist.

The following is not covered:

  • Any percutaneous, transluminal or investigative procedure

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

A definite diagnosis by a UK Consultant Neurologist or Geriatrician of one of the following Parkinson-plus syndromes:

  • Multiple system atrophy.
  • Progressive supranuclear palsy.
  • Parkinsonism-dementia-amyotrophic lateral sclerosis complex.
  • Corticobasal ganglionic degeneration.
  • Diffuse Lewy body disease.

There must also be permanent clinical impairment of at least one of the following:

  • Motor function.
  • Eye movement disorder.
  • Dementia.

A definitive diagnosis by a UK Consultant Neurologist of parkinson’s disease. There must be permanent clinical impairment of motor function. This impairment should include either an associated tremor or muscle rigidity

A definite diagnosis by a UK Consultant Cardiologist or Vascular Surgeon of peripheral vascular disease with objective evidence from imaging of obstruction in the arteries which results in bypass graft surgery to the arteries of the legs.

The following is not covered:

  • Angioplasty.

The undergoing of surgery on the advice of a UK Consultant Medical Specialist to remove a complete lung due to disease or injury.

For the above definition, the following are not covered:

  • Removal of a lobe of the lungs (lobectomy).
  • Lung resection or incision.

A definite diagnosis of idiopathic pulmonary arterial hypertension that has caused permanent and irreversible impairment of heart function which is classified by a UK Consultant Cardiologist as at least Class III of the New York Heart Association (NYHA) functional classification system.

The undergoing of surgery on the advice of a UK Consultant Cardiologist for disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft.

Confirmation by a UK Consultant Physician of severe lung disease which is evidenced by the need for continuous daily oxygen therapy on a permanent basis.

Death of spinal cord tissue due to inadequate blood supply or haemorrhage within the spinal column resulting in permanent neurological deficit with persisting clinical symptoms.

A definite diagnosis by a UK Neurologist of a stroke with clinical symptoms that have lasted at least 24 hours.

The following is not covered:

  • Transient ischaemic attack.

Surgical removal of a complete eyeball as a result of injury or disease.

For the above definition the following are not covered:

  • Self-inflicted injuries.

A definite diagnosis by a UK Consultant Rheumatologist of systemic lupus erythematosus resulting in either of the following:

  • Permanent neurological deficit with persisting clinical symptoms.
  • Permanent impairment of kidney function with glomerular filtration rate below 30ml/min.

You’re diagnosed with a terminal illness which, in the opinion of your UK Consultant, is expected to lead to your death within 12 months.

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 10% of the body’s surface area or 20% loss of surface area of the face which for the purposes of this definition includes the forehead and ears.

Removal of the whole of the colon creating an opening on the abdomen joining the small intestine to the abdomen wall called an ileostomy. This procedure is covered if, in the opinion of a UK Consultant Gastroenterologist, it’s established that the ileostomy is permanent.

Loss of the physical or mental ability through an illness or injury:

a) To the extent that the person covered is permanently 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 person’s own occupation that can’t reasonably be omitted or modified.

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 person covered expects to retire.

OR

b) That results in the permanent loss of the ability to perform 3 or more of our daily activities.

OR

c) That causes mental incapacity (as defined by the Mental Capacity Act) which:

  • Has failed to respond to optimal treatment and requires the need for continuous medication, and
  • Is due to an organic brain disease or brain injury supported by permanent evidence of progressive loss of the ability to:
    • remember
    • reason, or
    • perceive, understand, express and give effect to ideas

causing a significant reduction in mental and social functioning, requiring constant supervision of another person.

For the above definition, disabilities for which the relevant specialists can’t give a clear diagnosis and prognosis are not covered.

OR

d) A diagnosis by a consultant psychiatrist of Bipolar affective disorder, schizophrenia, schizo-affective disorder, paranoid (delusional) psychosis where:

  • There has been an admission as an inpatient to a psychiatric ward for at least 14 days, and
  • The condition is chronic and incurable where symptoms have lasted at least 1 year and
  • In the opinion of the treating consultant the permanently inability to perform any type of work for payment or reward. For the above definition, disabilities for which the relevant specialists can’t give a clear prognosis are not covered.

Your cover summary will state which Total Permanent Disability definition applies to you.

Death of brain tissue due to traumatic injury with subsequent neurological symptoms with corresponding neuroimaging abnormality.

A definite diagnosis by a UK Consultant Gastroenterologist of Ulcerative Colitis. There must have been at least one surgical intestinal resection.

Additional Payout Conditions

If you’re diagnosed with one of the following illnesses or conditions, we’ll pay an additional amount.

We’ll pay you 25% of the amount you’re covered for up to a maximum of £50,000. The exception being for low risk non-melanoma skin cancer which pays 10% of the amount you’re covered for, up to a maximum of £50,000.

Additional payouts are payable more than once, but not for the same condition twice, with the exception of carcinoma in situ which can be claimed multiple times so long as the site of each carcinoma in situ is different. The amount covered (on your cover summary) would remain intact should you need it in the future for a further claim.

The undergoing of balloon angioplasty, or stent insertion on the advice of a UK Consultant Cardiologist to correct a lesion that has been shown to produce ischaemia.

The following are not covered:

  • Atherectomy.
  • Rotablation.
  • Laser treatment.

The surgical drainage of an intracerebral abscess within the brain tissue by a UK Consultant Neurosurgeon.

A positive diagnosis by a UK Consultant Oncologist of any carcinoma in situ with histological confirmation and surgery to remove the tumour. We’ll pay more than once if the carcinoma in situ is found at a different organ. We won’t pay a second or further claim if the carcinoma in situ occurs or reoccurs at the same site or location.

The following are not covered:

  • Any carcinoma in situ of the skin or any other cancer or tumour covered elsewhere.
  • Tumours treated with radiotherapy, laser therapy, cryotherapy, loop excision, conisation, or diathermy.

Surgery doesn’t include biopsies or non-invasive therapies, procedures or investigations (for example, endoscopies) or any radio-surgical procedures or therapies.

A positive diagnosis by a UK Consultant Oncologist of carcinoma in situ of the breast with histological confirmation and surgery to remove the tumour.

Undergoing endarterectomy or angioplasty with or without stent on the advice of a UK Consultant Physician to treat symptomatic stenosis of at least a 50% diameter narrowing of the carotid artery. Supported by corresponding angiographic evidence.

Death of optic nerve or retinal tissue due to inadequate blood supply or haemorrhage within the central retinal artery or vein, resulting in permanent visual impairment of the affected eye.

The following are not covered:

  • Branch retinal artery or vein occlusion or haemorrhage.

The undergoing of treatment on the advice of a UK Neurosurgeon for a cerebral aneurysm using any one of the following:

  • Craniotomy.
  • Stereotactic radiotherapy.
  • Endovascular treatment by using coils to cause thrombosis (embolisation).

For the above definition, the following is not covered:

  • Cerebral arteriovenous malformation.

The undergoing of surgery, embolisation or radiosurgery to treat an arteriovenous malformation of the brain.

The following are not covered:

  • Cerebral aneurysm or any other malformations in the brain.

A definite diagnosis by a UK Consultant of one of the following conditions that results in the permanent inability to perform at least 1 of 8 daily activities:

  • Giant cell arteritis.
  • Polyarthritis nodosa.
  • Polymyositis.
  • Rheumatoid arthritis.
  • Systemic lupus erythematosus.
  • Systemic sclerosis.
  • Wegener’s granulomatosis.
  • Pemphigus vulgaris.

Any endovascular procedure to widen one or more narrowed or obstructed artery with 50% or more stenosis, including any angioplasty procedures.

The above procedure must have been carried out on the advice on a UK Consultant Cardiologist.

A definite diagnosis by a UK Consultant of a malignant tumour of the prostate positively diagnosed and histologically classified as having a Gleason score between 2 and 6 inclusive and having progressed to clinical TNM classification T1N0MO – T2aN0M0 inclusive.

If the Prostate Cancer is classified as having progressed to a Gleason score of 7 and above or clinical classification T2bN0M0 we will pay out the full sum assured.

A definite diagnosis by a UK Consultant of a high risk non-melanoma skin cancer diagnosed with histological confirmation that the tumour is either larger than 20 millimetres (mm) across OR has at least one of the following features:

  • tumour thickness of at least 6 millimetres (mm);
  • invasion into subcutaneous tissue;
  • invasion into nerves in the skin (perineural invasion);

We’ll pay 10% of the amount covered up to a maximum of £50,000 for:

A definite diagnosis by a UK Consultant of a low risk non-melanoma skin cancer diagnosed with histological confirmation that the tumour has spread beyond the epidermal layer, and is less than or equal to 20mm across but has none of the other features listed above.

The following is not covered:

  • Any carcinoma in situ of the skin (including Bowen’s disease) or any other cancer or tumour covered elsewhere

Diagnosis by a UK Consultant of an ovarian tumour of borderline malignancy/low malignant potential that has resulted in surgical removal of an ovary.

The following is not covered:

  • Removal of an ovary due to a cyst.

Diagnosis by a UK Consultant of a non-malignant tumour in the pituitary gland resulting in either of the following:

  • Surgical removal of the tumour.
  • Use of radiotherapy to destroy tumour cells.

The following are not covered:

  • Tumours treated with forms of treatment other than those stated.

Any accident resulting in the person covered requiring continuous hospitalisation for more than 28 consecutive days (24 hours per day).

Permanent and irreversible loss of sight in the better eye to the extent that even when tested with the use of visual aids is measured by a certified Ophthalmologist as follows:

  • Acuity of up to 6/24 (Snellen) with moderate contraction of the field, or aphakia (lens removal) or opacities blocking vision in the eye itself.
  • Acuity of 6/18 or better, if in addition suffering from a gross defect of visual fields (of both eyes, such as hemianopia) or marked contraction of the visual field due to retinitis pigmentosa, or glaucoma.

The undergoing of treatment on the advice of a UK Neurosurgeon for a spinal aneurysm using any one of the following:

  • Surgical resection.
  • Wrapping.
  • Clipping or embolisation.

The undergoing of treatment on the advice of a UK Neurosurgeon for a spinal arteriovenous malformation using any one of the following:

  • Surgical resection or removal.
  • Endovascular embolisation.
  • Stereotactic radiosurgery.
  • Radiation therapy.

The undergoing of surgery to treat a syrinx in the spinal cord or brain stem.

The undergoing of an orchidectomy (removal of a testicle) following diagnosis of intra-tubular germ cell neoplasia unclassified or benign testicular tumour.

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 5% of the body’s surface area.

A definite diagnosis of type 1 diabetes mellitus, requiring the permanent use of insulin injections.

The following are not covered:

  • Gestational diabetes.
  • Type 2 diabetes (including type 2 diabetes treated with insulin).
  • Latent autoimmune diabetes of adulthood.

Surgery cover

If on the advice of a UK Consultant you’re waiting to have one of the surgeries listed below, we’ll pay an amount in advance. We’ll pay you 25% of the amount you’re covered for or £50,000, whichever is less. The amount covered (on your cover summary) will be reduced by the amount we’ve paid in advance of the surgery.


Surgeries covered:
  • Aorta graft surgery.
  • Coronary artery bypass grafts.
  • Heart valve replacement or repair.
  • Insertion of a defibrillator following a cardiac arrest.
  • Pneumonectomy.
  • Pulmonary artery surgery.
  • Structural heart surgery.
  • Total Colectomy.