Underwriting guide

THE QUESTIONS WE ASK AND THE INFORMATION WE NEED

“We consider the risk profile of each applicant looking at factors such as health, occupation, sports and residence. This helps us offer your clients the fairest possible terms based on their individual circumstances.”

Caroline Froude, Head of Underwriting Strategy & Development

Introduction

This guide will help you accurately complete our application for the most frequently disclosed medical conditions, sports activities, occupations and residence. It includes brief descriptions of conditions, and it covers the most relevant application questions and the things your clients need to know to be able to answer the application questions.

We can give an underwriting decision for many medical conditions your clients tell us about on their applications. For other conditions, we’ll request further medical information. For example, a customer questionnaire, GP report, nurse screening examination, medical examination, or blood test. Where we need medical evidence, this will be due to the level of cover you’ve asked us for, or the conditions disclosed by your client.

Key

In this guide we use the following acronyms

BMI – Body mass index, i.e. weight in kilograms/height in metres x height in metres

BP – blood pressure

CI – critical illness

Ex – exclusion

FIB – Family Income Benefit

GPR – general practitioners report

IP – Income Protection

IP D4 – Income Protection with a 4-week deferred period (same principle for other deferred periods)

MER – medical examination report

NSE – nurse screening examination

PP – postpone

TPD A – total and permanent disability based on ability to perform activities

TPD O – total and permanent disability based on ability to perform own occupation

Definitions

Decline – we can’t offer cover now or in the foreseeable future.

Exclude – we won’t pay a claim for the condition that’s excluded from the cover. An example exclusion wording is, ‘We won’t pay a total and permanent disability claim arising directly or indirectly from cancer or carcinoma in situ or its treatment’. Our underwriters can only apply exclusions to critical illness, total and permanent disability, or Income Protection.

Postpone – we can’t offer cover now but can consider it again after a defined period. For example, in a year’s time. However, your client’s health may change, so it’s not certain that cover will be possible after the postpone period.

Note total and permanent disability is part of our critical illness cover so if we decline to offer or postpone your clients’ critical illness cover, the decline and postponement applies to total and permanent disability too.

Removal – this is where we remove a critical illness definition from your client’s critical illness cover. An example removal wording is, ‘We won’t provide cover for cancer as a listed condition under critical illness’. If cancer or multiple sclerosis is removed or excluded, we’ll apply a premium discount.

Standard – standard premium rates.

Clinical Trials

Participation in a registered clinical trial, such as a vaccine trial, won’t affect our underwriting assessment of an application.

Financial Underwriting

We financially underwrite applications for large amounts of cover to make sure the proposed cover is in keeping with the client’s financial situation.

For life cover with a cover amount of over £1.5 million, critical illness cover with a cover amount of over £500,000 (£800,000 if mortgage related and total critical illness cover in the market isn’t greater than £1 million) and/or Income Protection with a cover amount over £150,000 a year (self-employed applicants only), we’ll ask for financial evidence. This will usually be a financial questionnaire, however, for Income Protection we’ll also require proof of income. For any Income Protection cover amount, we may request a financial questionnaire for those who have been self-employed for less than a year. For very high cover amounts, we’ll ask for independent third-party evidence such as a loan offer letter, or for an accountant to sign the financial questionnaire.

Genetics

We support and comply with the ABI Code on Genetic Testing and Insurance, which is in place to protect the interests of customers. We won’t ask anyone to have a genetic test.

Your clients don’t need to tell us the results of any genetic test, except for a positive test for Huntington’s disease if they’re applying for life cover with a cover amount of more than £500,000.

Some people choose to voluntarily disclose predictive genetic test results that are in their favour (i.e. negative) – for example, to provide context for family history information. We’re happy to take this information into account.

Ratings

Medical ratings are normally percentages known as ‘extra-mortality’ (risk of death) for life cases and ‘extra-morbidity’ (risk of disability) for disability. For Combined Life and Critical Illness Protection ratings are aggregated to generate an overall product rating. Per mille (pm) ratings are sometimes used. Per mille ratings may be for the whole policy term, or for some of the policy term.

Underwriting QI

You can use Underwriting Qi, our pre-sale tool, through your dashboard, to get an indication of the terms we may be able to offer before you submit an application. Underwriting Qi uses all the underwriting rules as our application, so the outcomes will be consistent.

Premium Waiver

Premium Waiver isn’t underwritten so would never be declined if we’re able to offer cover. If we offer terms on Life Protection, Life Essentials, Critical Illness Protection, Combined Life and Critical Illness Protection, or Income Protection, Premium Waiver is included as standard.

The type of Premium Waiver differs depending on the type of cover your client’s choose.

Hints and tips

Before submitting an application please check our underwriting non-medical limits and make sure your client is aware of and comfortable with any routine medical evidence requirements.
Our application automatically provides underwriting decisions for most occupations based on a list of more than 6,000 occupations. However, on price comparison portals, the number of occupations you can choose from is more limited. This means an occupation you can’t select when quoting may actually be available when you come through our Protection Builder 2.0 to apply. Please consider this before entering a job title that isn’t on the list.
If your client is a manager but you can’t find their exact job title on our application, please enter either ‘Manager – admin only’, ‘Manager – light manual work’ or ‘Manager – heavy manual work’.
If your client has more than one job, please enter their main job, i.e. the one they spend most of their time doing. If your client’s applying for Income Protection our application will ask about all jobs and if there are more than 2 jobs, we’ll be unable to offer terms
Please take care when answering the question, ‘Are you a UK resident who has lived in the UK for the last 2 years?’ the usual answer to the other application questions is ‘no’, so it’s easy to accidentally answer ’no’ to this question.
Application questions ask about different timeframes. For example, ‘Have you ever…?’, ‘In the last 5 years have you…?, ‘In the last 3 years have you…’, ‘In the last month have you…?’. Please read each question carefully to identify the timeframe. This will make sure you’re making the right level of disclosure. Disregarding limited timeframes can potentially lead to over-disclosure, which can mean we ask for unnecessary evidence and can lead to incorrect terms being offered.
If your client has a medical condition(s) for which we can’t give an immediate underwriting decision, providing copies of their relevant hospital letters can speed up the underwriting process. Recent letters and those from the time of diagnosis are most useful. Similarly, if we ask for a medical examination, blood test, or other medical test and your client has recently had one or all of these, providing copies of their recent results can speed up the underwriting process and make things easier for them. Please note, we’ll request a GP report directly if we need one.

Medical conditions

Below we give a description of the most commonly disclosed medical conditions, relevant application questions, information your clients need to know when answering the application questions and some examples of possible underwriting outcomes.

Alcohol

High alcohol consumption is associated with increased risk of liver disease / cirrhosis, certain types of cancer, high blood pressure and suicide. Alcoholism is where someone is physically or psychologically addicted to alcohol and therefore unable to control their consumption.

Treatment depends on whether the aim is abstinence or moderation. Treatment can include cognitive behavioural therapy, medication, group therapy, psychotherapy and detox.

Relevant application questions:

How much alcohol do you drink in a typical week?

Pints of beer, lager or cider
Wine (standard 175ml glass)/wine (large 250 ml glass)
Single measures of spirits (25 ml pub measure)

Have you ever received advice, treatment or counselling for the use of alcohol, drugs or non-prescribed medication?

Have you ever had a blood test as a result of drinking alcohol?

Things we’ll ask about:

Your client’s answers to the above application questions
Whether they have any alcohol-related medical conditions e.g. liver disease

Allergy

An abnormal immune system response to normally harmless substances (hypersensitivity) such as pollen, house dust mite and some foods (such as nuts) can show symptoms including sneezing, runny nose, rash, wheeziness, difficulty swallowing and sore eyes. Very severe allergic reactions can cause anaphylaxis which is a life-threatening medical emergency. Anaphylaxis symptoms include breathing difficulty, anxiety, fast heartbeat and collapse.

Treatment is usually by antihistamines, Anaphylaxis is treated with adrenaline.

Relevant initial application question:

There isn’t a specific question for allergy in our application although there are questions which may lead to a disclosure of this condition such as:

Apart from what you have already told us, in the last 3 years have you taken any form of medication or treatment lasting more than one month, been advised to see a specialist or had any tests, scans or investigations?

Things we’ll ask about:

Whether your client has made a full recovery
Whether they’re currently being treated
Whether they’ve been discharged from follow up
Whether the allergy is caused or made worse by their occupation
What time they’ve taken off work (if any)
Any recent hospital attendance and if so when it was
The nature of their treatment

Example underwriting outcomes:

Allergy	Life cover	Critical illness cover	Income protection
Fully recovered No current treatment Discharged from follow-up Not caused by work No time off work No hospital attendance No treatment	Standard	Standard	Standard
Not fully recovered One A&E attendance 2 years ago Not needed oral steroids, methotrexate or epipen No time off work	Standard	Standard	Standard
Not fully recovered 3 A&E attendances, last one a year ago Has used epipen twice No time off work	Individual consideration	Individual consideration	D4/8: Ex D13+: Individual consideration

Exclusion wording:
We won’t pay an Income Protection claim arising directly or indirectly from any allergic reaction or complications thereof.

Anaemia

A reduced number of red blood cells (haemoglobin) which help store and transport oxygen. There are several different types with different causes. The most common type is iron deficiency anaemia. Iron is used by the body to make red blood cells.

Symptoms include fatigue, shortness of breath, rapid heartbeat and pale skin.

Treatment depends on the cause. Iron deficiency anaemia is treated with iron tablets.

Relevant initial application question (other application questions may also be relevant):

Apart from what you have already told us, in the last 5 years have you had any of the following: anaemia, haemophilia or other blood disorder?

Things we’ll ask about:

The type of anaemia your client has
Whether they’re awaiting hospital referral, tests, investigations or results
Whether their anaemia is due to another medical condition
The outcome of their latest blood test and latest review
The cause of their anaemia (if known)
The nature of their latest medical advice and treatment
Any related medical conditions or complications
The date they first had symptoms

Example underwriting outcomes:

Anaemia	Life cover	Critical illness cover	Income protection
Iron deficiency anaemia Male customer aged 40 Treated by GP with iron supplements Latest blood results normal Not under investigation or awaiting results No time off work	Standard	Standard	Standard
Iron deficiency anaemia Female customer aged 45 Not under investigation or awaiting results Anaemia due to heavy periods Treated by GP Fully recovered No treatment needed for 6 months	Standard	Standard	Standard
Sickle cell anaemia No haemolytic crisis	Individual consideration	Unable to offer terms	Unable to offer terms
Fanconi’s anaemia (a rare form of aplastic anaemia)	Unable to offer terms	Unable to offer terms	Unable to offer terms

Angina

A restricted blood supply to the heart. This is usually caused by obstruction to coronary arteries due to fatty deposits on the artery wall or coronary artery spasm. Angina can be stable or unstable.

Stable angina has a defined trigger, such as climbing stairs and stops quickly after rest.
Unstable angina is more serious it may not have a trigger and can continue after rest.
Symptoms include chest pain, chest tightness and breathlessness on exertion.

Treatment can include lifestyle changes, medication such as glycerine trinitrate (GTN), statin to reduce cholesterol, beta blockers to reduce heart rate and medication to reduce blood pressure.

Relevant initial application question (other application questions may also be relevant):

Have you ever had any of the following: heart attack, heart disorder, angina, heart valve or structural abnormalities, or cardiomyopathy?

Things we’ll ask about:

Whether your client has been diagnosed with any associated conditions e.g. heart attack
The nature of their treatment including any surgery
Whether they’re awaiting investigations or treatment
When their symptoms first started
The nature of their recent symptoms

We can’t offer critical illness cover or income protection for applicants diagnosed with angina. Where application answers indicate that we may be able to offer terms for life cover we’ll request a GPR. The table below relates to life cover. We take many factors into account so we’ve provided a range of outcomes.

Example underwriting outcomes:

Angina	Life cover
Age 55, no tobacco or replacement No surgery Symptoms started 2 years ago No associated conditions Not awaiting investigations or surgery No recent symptoms No blood pressure treatment	GPR +150% to +250% rating
Age 50, 5 cigarettes per day No surgery Symptoms started 5 years ago No associated conditions Not awaiting investigations or surgery Ongoing chest pain	Unable to offer terms

Factor/s that affect the underwriting outcome:

Tobacco use, BMI above normal range, age at diagnosis (we would decline if age is less than 40), related conditions such as circulation problems.

Ankle disorder

Causes include fracture, osteoarthritis, rheumatoid arthritis, and ligament and tendon injury. Can affect one or both ankle joints. As severe ankle disorder can affect the ability to work, we need to know about this for underwriting assessment of total and permanent disability. If the cause is osteoarthritis or rheumatoid arthritis, please see the relevant section of this guide.

Symptoms include pain, swelling, stiffness, difficulty walking and bruising.

Treatment depends on the cause but can include rest and medication such as ibuprofen and steroid injection. Surgery may be needed for severe fracture or ruptured tendons.

Relevant initial application question, only asked for critical illness cover and income protection (other application questions may also be relevant):

In the last 5 years have you had joint pains, arthritis, or any other symptoms affecting the knees, hips, ankles, feet, elbows, wrists or hands?

Things we’ll ask about:

The cause of your client’s ankle disorder (if known)
Which ankle is affected or whether both ankles are affected
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
Whether they’re having ongoing symptoms or treatment
When their last treatment was
When the last symptoms were, how long they lasted and whether they’re affected by their job
The number of separate episodes and details of any time off work

Example underwriting outcomes:

Ankle disorder	Life cover	Critical illness cover	Income protection
Sports injury, 1 episode, left ankle only Not awaiting referral, investigation or surgery No current symptoms or treatment Last symptoms/treatment 2 years ago Symptoms for 1 month and no time off work	Standard	Standard	Standard
Both ankles sprained Not awaiting referral, investigation or surgery No current symptoms or treatment Last symptoms/treatment 1 year ago Symptoms for 1 month and no time off work	Standard	Standard	Ex
Right ankle sprained Not awaiting referral, investigation or surgery Current symptoms and treatment	Standard	Standard TPD O Ex TPD A Ex	Ex

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability, or income protection claim arising directly or indirectly from any disease or disorder of (either ankle/the right ankle/the left ankle), including the joint, muscle, cartilage, ligaments or tendons or related treatment or surgery.

Ankylosing spondylitis (AS)

Inflammatory disease of the spine causing pain and stiffness which most commonly occurs in males under the age of 40. The condition can also affect other joints and other parts of the body such as the eyes, lungs, heart and kidneys.

Symptoms include low back pain, restricted movement, and limited chest expansion.

Treatment includes painkillers, non-steroidal anti-inflammatory drugs (NSAIDS), disease modifying drugs, anti-TNF medication, and steroids.

Relevant initial application question, only asked for critical illness cover and income protection (other application questions may also be relevant):

In the last 5 years have you had back pain, slipped disc, sciatica, whiplash or anything else affecting your back, neck or shoulders?

Things we’ll ask about:

Whether your client is undergoing or awaiting hospital referral, tests, investigation, results or surgery
Whether they have any associated conditions
When their first and latest symptoms were
The nature of their current or previous treatment

Example underwriting outcomes:

Ankylosing spondylitis (AS)	Life cover	Critical illness cover	Income protection
No associated conditions Not awaiting referral, investigation or surgery Last treatment and symptoms 4 years ago No bending or mobility problems	Standard	Removal of chronic severe rheumatoid arthritis protection (TPD O Ex)	Ex
No associated conditions Not awaiting referral, investigation or surgery Current treatment and symptoms Mild bending and mobility problems	+100% to +150% rating	Removal of chronic severe rheumatoid arthritis protection (TPD O&A unable to offer terms)	PP until symptom free for 3 years
Not awaiting referral, investigation or surgery Current treatment and symptoms With breathing problems	Individual consideration	Individual consideration TPD O unable to offer terms TPD A unable to offer terms	Unable to offer terms

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability, or income protection claim arising directly or indirectly from ankylosing spondylitis, or any disorder of the spine or related extra articular complications.

Anxiety / Depression

These are the most common mental health problems in Britain. Anxiety and depression can coexist and be associated with other mental health conditions.

Symptoms include low mood, panic attacks, phobias, stress, lack of concentration, difficulty sleeping, irritability, excessive worry, poor appetite, low energy and low self-esteem.

Treatment can include cognitive behavioural therapy (CBT), increased exercise and antidepressant medication. Episodes may require time off work and severe symptoms may lead to hospital admission.

Relevant initial application questions (other application questions may also be relevant):

Have you ever had any mental health condition or illness where hospital treatment or referral to a mental health specialist of any profession has been advised?

Have you ever tried to take your own life or had thoughts about taking your own life?

Have you ever intentionally harmed yourself or had thoughts about harming yourself?

In the last 5 years, have you had depression, anxiety, stress, eating disorders, any other mental health conditions or illness?

Things we’ll ask about:

Whether your client is waiting to see a specialist
Any time they’ve had to take off work in the last 5 years
The date of their first/last symptoms and the number of episodes
The date/s of any referrals to a psychiatrist or psychiatric nurse
The date/s of any hospital admission due to anxiety/depression
Whether they’ve had any counselling, CBT or community psychiatric support

Example underwriting outcomes:

Anxiety / depression	Life cover	Critical illness cover	Income protection
One episode of anxiety in the last 5 years Not awaiting specialist appointment No symptoms for at least 2 years No current medication No time off work No suicide attempts or self-harm Never referred to psychiatrist Doesn’t affect daily life Never admitted to hospital Never had CBT or medication	Standard	Standard	Ex
3 episodes of depression in the last 5 years Not awaiting specialist appointment First symptoms 3 years ago CBT GP treatment No time off work One medication & never admitted to hospital No suicide attempts or self-harm	Standard	TPD O Ex TPD A Ex	Ex
1 severe episode of depression 3 years Ago Hospital admission 3 years ago Not awaiting specialist appointment Current medication No current symptoms No suicide attempts or self-harm	Individual consideration	Individual consideration	Individual consideration

Other factor/s that may affect the underwriting outcome:
Alcohol/drug abuse, long-term work absence, physical health

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability, or income protection claim arising directly or indirectly from any mental disorder including but not limited to depression, mood disorder, stress, anxiety or any behavioural disorder or any functional somatic disorder including but not limited to chronic pain syndromes, irritable bowel syndrome, chronic fatigue or myalgic encephalitis.

Aortic Regurgitation (Aortic Incompetence)

The aortic valve is one of the 4 heart valves. It is situated between the aorta (main artery) and the left ventricle (heart chamber that pumps blood around the body). Aortic regurgitation occurs when the aortic valve can’t close normally and blood flows back from the aorta to the left ventricle. This causes the left ventricle to become dilated and a characteristic heart murmur can be heard.

Symptoms occur once the condition becomes severe and can include shortness of breath on exertion and/or when lying down, angina (chest pain), fatigue and dizziness.

Treatments include water tablets (diuretics), vasodilator drugs to widen the blood vessels and reduced salt intake. In severe cases surgery will be required. This can be valve repair, or the valve can be replaced by a mechanical or tissue valve.

Relevant initial application question (other application questions may also be relevant):

Have you ever had heart attack, heart disorder, angina, heart valve or structural abnormalities, or cardiomyopathy?

Things we’ll ask about:

Whether your client’s valve has been repaired or replaced and if so when the operation was
Whether they have any associated conditions
Whether they’re awaiting investigations or surgery
The nature and severity of the heart valve defect

Example underwriting outcomes:

Aortic regurgitation	Life cover	Critical illness cover	Income protection
Age 55 Mild regurgitation No surgery Not awaiting investigations or surgery No associated medical conditions	Individual consideration	Individual consideration	Individual consideration
Age 30 Moderate regurgitation Awaiting investigations	PP until investigations complete	PP until investigations complete	PP until investigations complete
Age 25 Severe regurgitation No surgery No associated medical conditions	Unable to offer terms	Unable to offer terms	Unable to offer terms

Other factor/s that may affect the underwriting outcome:
Angina, fainting, atrial fibrillation, heart failure, surgery

Asthma

A chronic respiratory condition of the airways. The bronchi (small tubes) swell causing breathing difficulty. This can usually be reversed with treatment. Asthma is common with some 5.4 million people in the UK receiving treatment at any given day.

Symptoms include wheezing, shortness of breath, cough, chest tightness, rapid breathing and rapid heartbeat.

Treatments include reliever inhalers (blue), preventative inhalers (brown), systemic steroids, leukotriene receptor antagonists (LTRAs), theophylline.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had asthma, sleep apnoea or anything else affecting your lungs or breathing?

Things we’ll ask about:

When your client’s last asthma symptoms were
Whether they’ve needed hospital treatment
How often they have asthma symptoms

Example underwriting outcomes:

Asthma	Life cover	Critical illness cover	Income protection
Occasional symptoms of asthma No asthma hospital treatment No tobacco	Standard	Standard	Standard
Occasional symptoms of asthma No asthma hospital treatment Smoker 15 cigarettes a day	+25% to +75% rating	+25% to +75% rating	+25% to +75% rating
Daily but not continuous symptoms of asthma No asthma hospital treatment No tobacco	+25% to +75% rating	+25% to +75% rating	+25% to +75% rating
Continual symptoms of asthma More than 2 weeks off work each year No tobacco	+100% to +175%	Unable to offer terms	Unable to offer terms

Other factor/s that may affect the underwriting outcome:
Tobacco use – we can’t offer Critical Illness Protection to asthmatic heavy smokers. The Life Protection decisions mentioned in the table above will be heavier for smokers, e.g. OR would become mild rating, mild rating would become moderate rating and moderate rating would require a GPR.

Back pain

Back pain is very common with pain in the lower back (lumbago) being the most common. It isn’t normally linked to a life-threatening cause but leads to more disability that any other condition and is a significant cause of time off work. Back pain without a significant underlying cause is unlikely to affect the life underwriting outcome but can affect the total and permanent disability outcome. Often the pain improves or resolves within a few weeks or months, but the condition can become chronic with continuous or intermittent long-term symptoms.

Treatments include non-steroidal anti-inflammatory drug (NSAID) tablets such as ibuprofen, back exercises, remaining active and manual therapy, e.g. chiropractor, osteopath. Surgery may be recommended where a specific cause is identified such as slipped disc.

Relevant initial application questions, only asked for critical illness cover or income protection (other application questions may also be relevant):

In the last 5 years, have you had any of the following: back pain, slipped disc, sciatica, whiplash or anything else affecting your back, neck or shoulders?

Things we’ll ask about:

Any underlying cause e.g. ankylosing spondylitis, osteoporosis
Whether your client is undergoing or awaiting hospital referral, tests, investigation, results or surgery
Whether they’ve had surgery
When they first consulted their GP (if applicable)
The number of separate occasions when they had symptoms
How long their symptoms lasted
When their last symptoms were and the severity of the pain
The type and date of their last treatment or therapy

Example underwriting outcomes:

Back pain	Life cover	Critical illness cover	Income protection
No underlying cause Not undergoing or awaiting hospital referral, tests, investigation, results or surgery Last treatment and symptoms >4 years ago One episode lasting <one month	Standard	Standard	Standard
No underlying cause Not undergoing or awaiting hospital referral, tests, investigation, results or surgery Last treatment and symptoms <3 years ago 2 episodes lasting >one month	Standard	Standard TPD O Ex TPD A Ex	Ex
Awaiting spinal surgery	PP until after surgery	PP until after surgery	PP until 3 months after surgery

Other factor/s that may affect the underwriting outcome:
Some conditions may cause back pain such as tumour, ankylosing spondylitis, scoliosis, arthritis, fracture and osteoporosis. Where there is an underlying condition, the underwriting outcome will be based on this as well as the back pain.

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from any injury to or disorder of the spine, intervertebral discs, nerve roots, cauda equina, spinal cord or supporting musculature and ligaments or related treatment or surgery.

Benign breast changes

A non-cancerous abnormal growth which may continue to grow but won’t invade or destroy surrounding tissue. Benign breast changes or lumps are very common and not life-threatening, but some types are associated with an increased risk of developing breast cancer.

Symptoms include breast lumpiness, tenderness and pain.

Fibrocystic breast changes don’t require specific treatment, simple cysts may be treated with fine needle aspiration, fibroadenoma and intraductal papilloma can be surgically removed.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had a growth, lump or cyst?

Things we’ll ask about:

Whether your client is awaiting any hospital referral, tests, investigations or treatment
Whether the change is confirmed benign
How many lumps they’ve had and whether they still have them
Whether they’ve had a biopsy or fine needle aspiration
The nature of their treatment and when their last treatment was
Whether they’ve made a full recovery
Whether they need any follow-up
Whether they’ve been seen by a hospital specialist

Example underwriting outcomes:

Benign breast changes	Life cover	Critical illness cover	Income protection
No biopsy or operation Not awaiting treatment or hospital appointment Breast changes benign Fully recovered, lump gone no ongoing treatment Only seen by GP, last seen 4 years ago No follow-up	Standard	Standard	Standard
Not awaiting treatment or hospital appointment Seen by a specialist Breast changes benign Lump still present Fine needle biopsy done Last seen by a doctor last month No follow-up	Individual consideration	Individual consideration	Individual consideration
Awaiting hospital appointment	PP until results known	PP until results known	PP until results known

Benign Tumour (non-breast, non-brain)

A lump, mass or tumour that is non-malignant, i.e. which may continue to grow but won’t invade or destroy surrounding tissue. Benign tumours can be present in many parts of the body. Examples include adenomas, lipomas, myomas. They can have adverse health effects due to their size impacting on surrounding tissues/organs, causing abnormally high hormone levels and some have the potential to become malignant. So benign tumours often need to be removed.

Benign tumours may not cause any symptoms initially. A lump may be seen or felt. Any other symptoms depend on the nature of the tumour.

Treatment may not be required but can include surgery to remove the tumour if related to hormone glands, e.g. pituitary gland medication to reduce hormone production.

Relevant initial application questions (other application questions may also be relevant):

In the last 5 years, have you had a growth, lump or cyst?

Things we’ll ask about:

Whether your client is awaiting hospital referral, tests, investigations or surgery
Where their tumour is/was on the body
Whether it was/is cancerous
Whether it’s been removed
When it was first noticed and when it was last present
Whether your client’s been discharged from medical follow-up
Whether they’ve been seen by a hospital specialist
Whether they’re having any ongoing symptoms
Any related family history (parent(s), brother(s) or sister(s))

Example underwriting outcomes:

Benign tumour	Life cover	Critical illness cover	Income protection
Not awaiting treatment, results or appointment Non-cancerous skin growth, not removed Seen GP only No skin cancer family history Last medical appointment in relation to the tumour 2 years ago and no follow-up needed No ongoing symptoms or skin moles	Standard	Standard	Standard
Non-cancerous ovarian cyst Not polycystic ovary syndrome Remains under specialist follow-up	Individual consideration	Individual consideration	Individual consideration
Awaiting hospital referral	PP until results known	PP until results known	PP until results known

Blindness

Around 360,000 people in the UK are registered sight impaired or severely sight impaired. Blindness doesn’t necessarily mean total loss of vision, it’s normally defined as visual acuity less than 20/200 after correction with glasses or contact lenses. This means that the person would need to be 20 feet away to see what an unaffected person would see at 200 feet. Blindness may be temporary or permanent. Treatment depends on the cause. For those who are permanently blind, there are assistive devises to help with daily living, e.g. big button telephones and keyboards.

Relevant initial application questions, only asked for critical illness cover and income protection (other application questions may also be relevant):

In the last 5 years, have you had impaired, blurred or double vision, optic neuritis or anything else affecting your eyes?

Things we’ll ask about:

Whether your client has any related medical conditions
Cause of their blindness (if known)
Whether their ability to work or do usual activities is limited
The nature of their symptoms and when they first occurred
Whether both eyes are affected
Whether they’ve made a full recovery
Any time they’ve had to take off work
When their last symptoms and treatment were

We may ask more questions depending on the specific cause.

Example underwriting outcomes:

Blindness	Life cover	Critical illness cover	Income protectiion
Loss of sight in one eye Caused by injury Sight in other eye normal and stable	Standard	Standard	Standard
Loss of sight in both eyes Since birth	Standard	Blindness protection removed TPD O Ex TPD A Ex	Ex
Loss of sight in both eyes due to cataract No operation	Individual consideration	Blindness protection removed TPD O Ex TPD A Ex	Ex

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from blindness or any disease or disorder of either eye.

Critical illness removal wording:

We won’t provide cover for blindness or significant visual impairment as a listed condition under critical illness.

Body Mass Index (BMI)/Waist (above or below normal range)

BMI is a measure of body fat based on weight in relation to height. The formula is a person’s weight in kilograms divided by their height in metres squared. Obesity is defined as BMI 20% or more above the normal range and statistics show that it’s associated with increased mortality and morbidity (being unable to work) risk. Underweight is defined as BMI 5-10% below the normal range and usually has an underlying cause. For example, chronic obstructive airways disease, anorexia nervosa, malabsorption syndromes.

Treatment for obesity includes diet and exercise. Medications include appetite suppressants and medication to inhibit absorption of dietary fat. Where these treatments haven’t helped and BMI is very high, surgery (known as bariatric surgery) can be very effective in achieving weight loss.

Relevant application questions:

What is your height without shoes?

What is your weight in normal indoor clothing?

Waist size (males only) UK dress size (females only)

Minimum and maximum BMI:

BMI	Life cover	Critical illness cover	Income protection
Minimum BMI we can consider	16	17	17
Maximum BMI we can consider	44	Age <30: BMI 38 Age >31: BMI 39	Age <30: BMI 38 Age >31: BMI 39

Further information:

If your client’s BMI is within the obesity or underweight range, we may apply a premium rating rather than decline to offer terms. The rating will depend on their exact BMI, age, waist measurement or dress size for females and any other medical conditions. If their BMI is close to our minimum or maximum, we’ll request medical evidence (usually an NSE and blood tests).

Bronchitis

Inflammation of the lung airways caused by infection. It can be acute or chronic. Acute bronchitis lasts around 3 weeks and is usually caused by a virus. Chronic bronchitis is defined as productive cough lasting for more than 3 months each year for the last 2 years. People with chronic bronchitis usually have chronic obstructive pulmonary disease (COPD) normally associated with smoking.

Symptoms include productive cough, wheezing and shortness of breath.

Treatment includes stopping smoking, inhalers, steroids, antibiotics and for severe cases oxygen therapy. For very severe cases lung transplantation may be required.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had asthma, sleep apnoea or anything else affecting your lungs or breathing?

Things we’ll ask about:

Whether your client’s bronchitis is acute or chronic
Whether they have any associated conditions
Whether they’re awaiting hospital referral, tests, investigations or results
When their last treatment and symptoms were
Any hospital treatment
Severity of their symptoms, how often they happen and any time off work
The nature and frequency of their treatment
Whether they’ve fully recovered and returned to normal daily activities

Example underwriting outcomes:

Bronchitis	Life cover	Critical illness cover	Income protection
Acute bronchitis One attack Last symptoms & treatment 3 years ago Not awaiting referral, tests or results One day off work	Standard	Standard	Standard
Age 40 Acute bronchitis 6 attacks per year Not awaiting referral, tests or results Last symptoms Treatment short courses of antibiotics Non-smoker No time off work	+25% to 75% rating	+25% to 75% rating	D4/8 +100% to 175% rating D13+ +25% to 75% rating
Age 39 Chronic obstructive pulmonary disease (COPD) diagnosis Mild severity Smoker	Individual consideration	Individual consideration	Individual consideration

Cancer

Malignant cancer is where cells divide in an uncontrolled way which can invade nearby tissue. If a tumour grows, cells can break off and form new tumours in distant parts of the body (metastatic cancer or metastases). Cancer can happen almost anywhere in the body including the blood (leukaemias). There are more than 100 types of cancer. Most but not all solid tumour cancers are classified using the T (size of original tumour), N (lymph node involvement), M (metastases) system. Some cancers are also given a grade which indicates how similar the cancerous cells are to normal cells. Grades range from 1 to 3, with grade 1 being cancer cells that look similar to normal cells and grade 3 being cancer cells that look abnormal and may grow more rapidly.

Symptoms vary according to the cancer type and how advanced the condition is.

Treatment depends on the cancer type but can include surgery to remove the tumour, chemotherapy, radiotherapy, hormone therapy and bone marrow/stem cell transplants.

Relevant initial application question (other application questions may also be relevant):

Have you ever had cancer, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma or leukaemia?

Things we’ll ask about (for specific cancer types we may need additional information):

Whether your client is awaiting any treatment, hospital appointments or results
Whether there has been any recurrence after the initial surgery or other treatment
The tumour staging and grading (if known)
Whether the cancer spread
When treatment ended (month/year)

Information regarding underwriting outcomes:

Life cover outcomes will vary according to the exact type and stage/grade of cancer and when treatment ended. If your client is waiting for treatment or for a hospital appointment, we’ll postpone. We won’t usually offer critical illness cover. However, if the cancer was several years ago, we may offer critical illness cover with a cancer exclusion. In some cases, e.g. if the cancer was several years ago, we may be able to offer income protection. If we might be able to offer terms, we’ll request a GPR.

Cervical Smear Test (Abnormal)

Cervical screening is the process of detecting and removing abnormal tissue or cells in the cervix before cervical cancer develops. By aiming to detect and treat cervical neoplasia early on, cervical screening aims at secondary prevention of cervical cancer.

If a cervical smear shows abnormal cells, a referral for colposcopy/biopsy will be made. This will identify any cervical intraepithelial neoplasia (CIN) which is cell change but not cancer. CIN is graded 1-3 with CIN 2 and 3 likely to require treatment by removing or destroying the abnormal cells.

Relevant initial application question (only women are asked this question):

In the last 5 years, have you had an abnormal cervical smear, abnormal mammogram or other gynaecological condition that has needed more than one consultation?

Things we’ll ask about:

The results of your client’s abnormal and the latest cervical smear
Their colposcopy or cervix removal results
The type of treatment they’ve had
Whether they’re under follow-up
Any tests, investigations, hospital referral or treatment they’re waiting for
The date of their last cervical smear

Example underwriting outcomes:

Cervical smear test (abnormal result)	Life cover	Critical illness cover	Income protection
History of HPV positive No abnormal cells Last cervical smear normal	Standard	Standard	Standard
History of Cervical intraepithelial neoplasia (CIN) 1 Not awaiting tests, investigations, hospital referral or treatment Normal colposcopy Discharged Last cervical smear normal	Standard	Standard	Standard
History of Cervical intraepithelial neoplasia (CIN) 3 Awaiting hospital referral	PP until results known	PP until results known	PP until results known

Chest Pain

There are several possible causes of chest pain such as indigestion, chest infection, angina, heart attack. If caused by angina or heart attack, please see relevant section of this guide for a description.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had raised blood pressure or cholesterol, chest pain, or irregular heartbeat?

Things we’ll ask about:

The cause of your client’s chest pain (if known)
The type of medical consultation or investigations they’ve had and if waiting for any further medical consultations or investigations
The date of their first symptoms and medical consultation
Any treatment, and the nature of their symptoms
Any time they’ve had to take off work
When their last symptoms occurred
Whether they’ve made a full recovery

Example underwriting outcomes:

Chest pain	Life cover	Critical illness cover	Income protection
Last symptoms 18 months ago Cause muscular pain Saw GP only No medication Fully recovered Not awaiting any tests or investigations	Standard	Standard	Standard
Consulted GP Cause unknown to applicant	Individual consideration – GPR may be needed	Individual consideration – GPR may be needed	Individual consideration – GPR may be needed

Chronic Fatigue Syndrome (CFS)

Severe fatigue which doesn’t improve with rest and can’t be attributed to another medical condition. The condition can also be called myalgic encephalomyelitis (ME).

Symptoms can include sore throat, muscle fatigue, headaches, insomnia, dizziness and difficulties with thinking e.g. concentration

Treatment can include graded exercise therapy (structured exercise), cognitive behavioural therapy (CBT), medication to control symptoms.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had chronic fatigue syndrome, or recurrent fatigue or tiredness?

Things we’ll ask about:

Whether your client has had a definite diagnosis from a doctor
Whether they’ve had any anxiety/depression/insomnia treatment
Whether they’re awaiting a hospital appointment, tests, investigations or results
When they last had treatment or symptoms and whether they’ve fully recovered

Example underwriting outcomes:

Unable to offer terms

Chronic fatigue syndrome (CFS)	Life cover	Critical illness cover	Income protection
Definite diagnosis of CFS Not waiting for tests, investigations or referral No anxiety/depression/stress/insomnia Last symptoms 1 year ago	Standard	Standard (TPD individual consideration)	Unable to offer terms
Definite diagnosis of CFS Waiting for further medical investigations	PP until results known	PP until results known	Unable to offer terms

COVID-19 (Coronavirus, SARS-CoV-2)

During the pandemic, we applied reduced underwriting rating limits. However, these restrictions have now been lifted. The exception is where the amount of cover requested for Life Protection is more than £3 million, where each case will be considered individually. Specific COVID-19 questions are included on our application form.

Relevant initial application questions (other application questions may also be relevant):

Have you ever:

Been treated in hospital for coronavirus?

Experienced symptoms of coronavirus that have lasted longer than 12 weeks? (known as long COVID)?

Things we’ll ask about:

Whether your client is waiting for referral, investigation or results of tests
What treatment or action your client had
When your client was last treated in hospital (if applicable)
Whether your client has fully recovered

Example underwriting outcomes:

COVID-19	Life cover	Critical illness cover	Income protection
Not awaiting referral, investigation or results Hospitalised for 2 days, 18 months ago Not admitted to ICU No oxygen or ventilation required Fully recovered	Standard	Standard	Standard
Long COVID	Individual consideration	Individual consideration	Individual consideration
Hospitalised for 1 week, 3 months ago Not Admitted to ICU Oxygen was required	PP for 1 year	PP for 1 year	PP for 1 year

Crohn’s disease

Crohn’s disease is a long-term condition that causes inflammation of the digestive system lining. The inflammation can damage sections of the digestive system and results in narrowing of the intestine and formation of fistulas (abnormal tunnels linking 2 hollow organs together or between the organ and the skin surface).

Treatment is initially by medication but if it stops working surgery becomes necessary.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had any of the following: Crohn’s, colitis, IBS, or anything else affecting your stomach, bowel, oesophagus or digestive system?

Things we’ll ask about:

When your client’s Crohn’s disease was diagnosed
When their last episode was
The severity of their condition
The nature of their treatment
Whether they’re undergoing or awaiting hospital referral, tests, results, surgery or investigations

Example underwriting outcomes:

Crohn’s disease	Life cover	Critical illness cover	Income protection
Age 32 Diagnosed 10 years ago Treatment Asacol only Not awaiting hospital referral, tests/investigations No surgery No complications Last episode 6 years ago	Standard	Ex	D4 unable to offer terms D13+ standard
Age 40 Diagnosed 5 years ago Not required immunosuppressant treatment Occasionally needs steroids One operation Not awaiting hospital referral, tests/investigations No complications Last episode one year ago	+25% to +75% rating	Ex	D4 unable to offer terms D13+ PP until 2 years after the last flare-up
Age 35 Diagnosed 7 years ago Immunosuppressant treatment Not awaiting hospital referral, tests/investigations No complications Last flare-up 4 years ago	Individual consideration	Individual consideration	D4 unable to offer terms D13+ Ex

Exclusion wording:
We won’t pay a critical illness or total and permanent disability claim arising directly or indirectly from Crohn’s disease or any disorder of the digestive system or complications and related treatment or surgery.

Deafness

Little or no hearing in one or both ears. There are many possible causes such as chronic infection, ageing, genetics, exposure to noise, tumour, certain medications and ear trauma. Deafness can be classified as slight, mild, moderate, moderately severe, severe, profound and totally deaf. There are 4 main types of deafness – conductive (sound not reaching the inner ear), sensorineural (inner ear not working properly), central deafness (damage to the brain) and mixed hearing loss (a combination of conductive and sensorineural).

Treatment is hearing aids, assistive devices, e.g. telephone typewriters and in some case surgery such a cochlea implant to artificially stimulate the cochlea nerve.

Relevant initial application question, only asked for critical illness cover and income protection:

In the last 5 years, have you had tinnitus, labyrinthitis, or anything else affecting your ears, hearing or balance?

Things we’ll ask about:

The cause of your client’s deafness
When they first had symptoms
Whether they’re awaiting any investigations or operations
Whether they’ve made a full recovery
Whether the left, right or both ears are affected
Whether their normal daily activities are affected

Example underwriting outcomes:

Deafness	Life cover	Critical illness cover	Income protection
Deafness in 1 ear Caused by exposure to noise First symptoms 1 year ago Normal daily activities not limited	Standard	Standard	Standard
Deafness in 1 ear Present since birth	Standard	Removal of deafness definition TPD O Ex TPD A Ex	Ex
Deafness in both ears Caused by an injury First symptoms 2 months ago	Individual consideration	Individual consideration	Individual consideration

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from deafness or any disease or disorder of either ear.

Critical illness removal wording:

We won’t provide cover for deafness as a listed condition under critical illness.

Dementia

A chronic and progressive disorder which affects a person’s memory, their ability to think and their behaviour. Alzheimer’s disease is the most common form of dementia.

While there’s currently no cure for dementia, there are medications that can temporarily help control the symptoms, e.g. donepezil and memantine.

Relevant initial application question (other application questions may also be relevant):

Have you ever had epilepsy, multiple sclerosis, muscular dystrophy, cerebral palsy, Parkinson’s disease, Alzheimer’s disease or dementia?

Things we’ll ask about:

Whether your client has Alzheimer’s disease or dementia

We’re unable to provide cover of any kind to people with dementia.

Dermatitis / Eczema

Eczema is a condition where the skin becomes dry, red and itchy. Dermatitis is skin inflammation with various causes such as allergy. It is a type of eczema. The conditions can have a specific causative agent such a latex, nickel or detergents. Mortality is very unlikely to be affected but the ability to work can be. Particularly if work involves exposure to a causative substance/agent.

Symptoms include skin inflammation, soreness, blisters, scaling/peeling, redness, oedematous swelling, extreme itching.

Treatment includes emollients (moisturisers), corticosteroid cream or ointment, avoiding any causative substance/agent, steroid tablets.

Relevant initial application question:

There isn’t a specific question for dermatitis/eczema. However, the cause may be the subject of a question. There are also other questions which may lead to a disclosure of this condition such as:

In the last 3 years, have you taken of been prescribed treatment or medication lasting more than 1 month?

In the last 3 years, have you been advised to see a specialist?

In the last 3 years, have you had any tests, scans or investigations?

Things we’ll ask about:

Whether your client is awaiting referral, tests or investigations
Whether there have been any complications
The nature of their treatment and whether they’ve needed hospital treatment
The severity of their condition
The date they first had symptoms
Time off work
Whether their condition is related to their occupation

Example underwriting outcomes:

Dermatitis / eczema	Life cover	Critical illness cover	Income protection
No complications or hospital treatment Treated by creams only Not awaiting referral, tests or investigations Not related to occupation 1 day off work	Standard	Standard	Standard
No complications or hospital treatment Treated by ongoing tablets	Individual consideration	Individual consideration TPD O Ex TPD A Ex	Ex
No complications or hospital treatment Treated by creams only Awaiting hospital referral	PP until results known	PP until results known	PP until results known

Exclusion wording:
We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from dermatitis, eczema or any other disease or disorder of the skin.

Diabetes mellitus (DM)

In the UK there are nearly 4.1 million people who have been diagnosed with diabetes mellitus. Others may have the condition without being aware of it. Most have type 2 diabetes (about 90%) with about 10% having type 1 diabetes. Long-term diabetic control is measured by glycated haemoglobin (HbA1c).

Type 1 diabetes: The body produces no insulin which stops glucose entering cells causing high levels of glucose in the blood. The cause is not known.

Type 2 diabetes: The body doesn’t produce enough insulin or insulin doesn’t work as it should. The cause is thought to be a combination of factors such as high BMI, family history and age.

Symptoms include lack of energy, being very thirsty, increased urination.

Treatment: Type 1 is treated with insulin either regularly injected or through a pump. Type 2 is initially treated by diet and exercise, medication such as metformin may be prescribed. If the condition can’t be well controlled using these treatments, insulin may be needed.

Relevant initial application question (other application questions may also be relevant):

Have you ever had any of the following: diabetes, impaired glucose tolerance or sugar in the urine?

Things we’ll ask about:

When your client’s diabetes was first diagnosed
Whether they have type 1 or type 2
The result of their last HbA1c test
Whether they’re undergoing or awaiting hospital referral, tests, results, surgery or investigations
Their treatment
The date of their last review
Any history of eye, kidney, circulation, hypo/hyper glycaemia or heart problems
Whether they’ve had any diabetic complications, e.g. foot ulcers
Whether they’ve needed any hospital treatment

Example underwriting outcomes:

We can’t offer critical illness cover or income protection for people diagnosed with diabetes. The table below relates to life cover:

Diabetes mellitus (DM)	Life cover
Type 1 diabetes diagnosed 31 years ago No related medical condition(s) No diabetic complications Not awaiting hospital referral, tests/investigations Aged 50 No tobacco use HbA1c 7.0% or less	Standard
Type 2 diabetes diagnosed 10 years ago No related medical condition(s) No diabetic complications Not on insulin treatment Aged 45 Not awaiting hospital referral, tests/investigations No tobacco use No raised blood pressure or cholesterol HbA1c 7.0% or less	+25% to +75% rating
Type 1 diabetes diagnosed 20 years ago No diabetic complications Not awaiting hospital referral, tests/investigations No related medical condition(s) Aged 55 No hospital treatment Tobacco 10 cigarettes a day No raised blood pressure or cholesterol HbA1c 7.9%	+100% to +175% rating
Type 1 diabetes diagnosed 30 years ago Aged 55 History of stroke and kidney problems No tobacco	Unable to offer terms

Other factor/s that affect the underwriting outcome:

Diabetic control (HbA1c), tobacco use, BMI greater than normal range, age, diabetic complications, e.g. eye problems, related medical conditions such as heart disease and stroke, raised cholesterol, raised blood pressure.

Dyspepsia

Otherwise known as indigestion, heartburn or gastritis, it’s a very common condition thought to affect around 40% of the UK population at some point each year. Dyspepsia itself is not dangerous and can usually be self-managed. However, it can be a symptom of something more serious.

Symptoms include tummy pain, heartburn, wind or bloating, nausea, flatulence.

Treatment includes healthy diet, weight loss, stopping smoking, stress reduction, reduced alcohol consumption, medication such as antacids, antibiotics and proton pump inhibitor.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had Crohn’s, colitis, IBS, or anything else affecting your stomach, bowel, oesophagus or digestive system?

Things we’ll ask about:

How often your client has symptoms
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
Whether they’ve had any complications,g. Barrett’s oesophagus
Whether they’ve been referred to a hospital specialist
The severity of their symptoms and when they last occurred
The nature of their treatment

Example underwriting outcomes:

Dyspepsia	Life cover	Critical illness cover	Income protection
Not awaiting investigations, results or appointment No complications No diagnosis of Barrett’s oesophagus First symptoms 2 years ago Last symptoms one year ago Not needed to consult a doctor	Standard	Standard	Standard
Not awaiting investigations, results or appointment No complications No diagnosis of Barrett’s oesophagus First symptoms 5 years ago Current symptoms Consulted GP treated with prescription medication	Standard	Standard	Standard
Not awaiting investigations, results or appointment Diagnosis of Barrett’s oesophagus Treated with laser ablation 18 months ago No endoscopy No symptoms for 12 months	Individual consideration	Individual consideration	Individual consideration

Epilepsy

A condition affecting about 1 in 100 of the UK population. A sudden burst of electrical activity adversely affects normal brain function. This results in an epileptic seizure. There are different types of seizure – some involve falling to the ground and not being conscious of surroundings, others don’t.

Treatment is by anti-epileptic medication. This acts to reduce or prevent seizures but doesn’t cure the condition. If medication is ineffective surgery may be considered.

Relevant initial application question (other application questions may also be relevant):

Have you ever had epilepsy, multiple sclerosis, muscular dystrophy, cerebral palsy, Parkinson’s disease, Alzheimer’s disease or dementia?

Things we’ll ask about:

Whether your client has any associated conditions
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
Whether their epilepsy is/was caused by another condition
The nature of their seizures and date of the first and latest attack
The number of seizures they have each year
Whether they’ve had any recent treatment changes
Whether they’ve been admitted to hospital
Time they’ve had to take off work

Most customers with epilepsy can be underwritten based on their application answers. However, sometimes we’ll need to request a GPR.

Example underwriting outcomes:

Epilepsy	Life cover	Critical illness cover	Income protection
First seizure 10 years ago Not caused by another medical condition Not awaiting referral, tests, investigations No emergency hospital admissions Absence seizures only no loss of consciousness Medication unchanged for 2 years	Standard	Standard	Standard
Diagnosed 5 years ago Not caused by another medical condition Not awaiting referral, tests, investigations No emergency hospital admissions Loss of consciousness Medication unchanged for 1 year No time off work 2 fits a year last 7 months ago	+25% to +75% rating	+25% to +75% rating	Unable to offer terms
Diagnosed 4 years ago Not caused by another medical condition No emergency hospital admissions Seizures with loss of consciousness Last seizure 4 months ago 12 seizures a year	+100% to +175% rating	+25% to +75% rating TPD unable to offer terms	Unable to offer terms

Other factor/s that affect the underwriting outcome:
If the first epilepsy symptoms were in the last 6 months we would postpone.

Exclusion wording:
We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from epilepsy, seizures or fits or related treatment.

Eye disorder

Sight can be affected by an accident or illness. Sight deterioration is assessed using the Snellen eye chart where the letters on the chart reduce in size as you go down the page. The fewer lines a person can read indicates deteriorating eyesight.

Relevant initial application questions, only asked for critical illness cover or income protection:

In the last 5 years, have you had impaired, blurred or double vision, optic neuritis or anything else affecting your eyes?

Things we’ll ask about:

Which of your client’s eyes is affected or whether both are
The cause of your client’s eye disorder
Whether they have any associated condition
Whether they’re awaiting hospital referral, tests, investigations or results
The nature and severity of their symptoms and date of first and latest symptoms
Their treatment details
The results of tests

Example underwriting outcomes:

Eye disorders	Life cover	Critical illness cover	Income protection
Not awaiting Minor blurred vision Caused by an injury Fully recovered	Standard	Standard	Standard
Cataracts No underlying cause Surgery to correct 2 years ago Now has moderate vision	Standard	Remove blindness TPD O Ex TPD A Ex	Ex

Critical illness removal wording:
We won’t provide cover for blindness or significant visual impairment as a listed condition under critical illness.

Exclusion wording:
We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from any disease or disorder of the eye including blindness.

Family history (FH) of Breast or Ovarian Cancer

We only take account of the relevant medical history of first-degree relatives, i.e. natural parents and brothers/sisters. Family history involving half-siblings is relevant and should be disclosed. If you tell us that a family history relates to your client’s half-sibling(s) or we note it from medical evidence, the underwriter will take this information into account.

Studies show that family history helps predict the risk of breast or ovarian cancer.

Relevant initial application question (we only ask this of women):

Have any of your natural parents, brothers or sisters been diagnosed with, or died from, any of the following illnesses before the age of 65: Cancer of the breast or ovary?

Things we’ll ask about:

The number of your client’s relatives affected and their relationship to your client
The age of your client’s affected relatives when diagnosed
The nature of and results of any screening/investigations your client has had
Details of any treatment/surgery they’ve had

Example underwriting outcomes:

Family history of breast or ovarian cancer	Life cover	Critical illness cover	Income protection
Applicant aged 25 1 relative diagnosed with breast or ovarian cancer at the age of 50 No screening, medication or surgery	Standard	Standard	+25% to 75% rating
Applicant aged 35 1 relative diagnosed with breast or ovarian cancer at the age of 35 No screening, medication or surgery	+25% to +75% rating	Ex	+25% to 75% rating
3 relatives diagnosed with breast or ovarian cancer, youngest age at diagnosis 30 Applicant aged 30	Individual consideration	Individual consideration (likely Ex)	Individual consideration (likely +25% to +75% rating)

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from breast or ovarian cancer, or carcinoma in-situ or related treatment or surgery.

Family history (FH) of Colon (bowel) Cancer

We only take account of the relevant medical history of first-degree relatives, i.e. natural parents and brothers/sisters. Family history involving half-siblings is relevant and should be disclosed. If you tell us that your client’s family history relates to half-sibling(s) or we note it from medical evidence, the underwriter will take this information into account.

Colon cancer is the third most common cancer accounting for approximately 12% of UK cancer diagnoses. It affects a higher proportion of males than females. The highest incidence is in older ages. Studies show that family history helps predict the risk of colon cancer.

Familial adenomatous polyposis (FAP) is an inherited condition where numerous polyps develop in the bowel resulting in colon cancer at a young age. Lynch syndrome is an inherited condition with a high risk of colon cancer.

Relevant initial application questions:

Have any of your natural parents, brothers or sisters been diagnosed with, or died from, any of the following illnesses before the age of 65: Cancer or polyps of the bowel or colon?

Things we’ll ask about:

Which of your client’s relatives were diagnosed with colon cancer
The exact nature of the family history e.g. familial adenomatous polyposis (FAP)
How many first-degree relatives had colon cancer before the age of 65
The age of the relative(s) when they were diagnosed
Whether your client has been advised to have a colonoscopy

Example underwriting outcomes:

Family history of colon (bowel) cancer	Life cover	Critical illness cover	Income protection
Age 25 Not diagnosed with FAP or Lynch syndrome Father diagnosed with colon cancer at age 55	Standard	+25% to +75% rating	+25% to +75% rating
Age 30 Not diagnosed with FAP or Lynch syndrome Father diagnosed with colon cancer at age 30	+25% to +75% rating	Ex	+25% to +75% rating
Age 35 Father diagnosed with FAP	Individual consideration	Individual consideration	Individual consideration

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from cancer or carcinoma in situ or related treatment or surgery.

Family history (FH) of diabetes

We only take account of the relevant medical history of first-degree relatives, i.e. natural parents and brothers/sisters. Family history involving half-siblings is relevant and should be disclosed. If you tell us that your client’s family history relates to half-sibling(s) or we note it from medical evidence, the underwriter will take this information into account.

Studies show that family history helps predict the risk of diabetes. However, many things influence the risk including environmental factors and genes. So, family history is an independent risk factor but not the only risk factor.

Relevant initial application question:

Have any of your natural parents, brother(s), sister(s) been diagnosed with or died from any of the following illnesses before the age of 65: Diabetes?

Things we’ll ask about:

How many of your client’s first-degree relatives have had a diabetes diagnosis
The relative(s) ages at diagnosis
The type of diabetes that the relative(s) have
The nature and results of any tests/investigations your client has had due to the diabetes family history

Example underwriting outcomes:

Family history of diabetes	Life cover	Critical illness cover	Income protection
Age 25 Mother diagnosed with diabetes at age 40 Normal diabetes test results	Standard	Standard	Standard
Age 30 Father and sister diagnosed with diabetes at age 30 Normal diabetes test results	Standard	+25% to +75% rating	+25% to +75% rating
Age 35 Mother, father and brother diagnosed with diabetes Normal diabetes test results	Standard	Individual consideration	+25% to +75% rating

Family history (FH) of heart attack, angina or stroke

We only take account of the relevant medical history of first-degree relatives, i.e. natural parents and brothers/sisters. Family history involving half-siblings is relevant and should be disclosed. If you tell us that your client’s family history relates to half-sibling(s) or we note it from medical evidence, the underwriter will take this information into account.

Studies show that family history helps predict the risk of heart attack, angina or stroke. However, many things influence the risk including environmental factors and genes. So, family history is an independent risk factor but not the only risk factor.

Relevant initial application question:

Have any of your natural parents, brother(s), sister(s) been diagnosed with or died from any of the following illnesses before the age of 65: Heart attack, angina or stroke (you don’t need to tell us about a family history of transient ischaemic attack / TIA)?

Things we’ll ask about:

How many of your client’s first-degree relatives have had a stroke, heart attack or angina before the age of 65
Which relative(s) and their age(s) at diagnosis
Their exact diagnosis

Example underwriting outcomes:

Family history of heart attack, angina or stroke	Life cover	Critical illness cover	Income protection
Age 50 Father heart attack at age 55	Standard	Standard	Standard
Age 30 Father angina at age 40	Standard	+25% to +75% rating	+25% to +75% rating
Age 25 Father heart attack at 50 Mother stroke at 55	+25% to +75% rating	+25% to +75% rating	+25% to +75% rating

If 3 or more first-degree relatives are affected, we’ll ask for a nurse screening examination with fasting lipid (cholesterol and triglyceride) test.

Family history (FH) of Multiple Sclerosis (MS)

We only take account of the relevant medical history of first-degree relatives, i.e. natural parents and brothers/sisters. Family history involving half-siblings is relevant and should be disclosed. If you tell us that your client’s family history relates to half-sibling(s) or we note it from medical evidence, the underwriter will take this information into account.

The risk of developing MS is 7 times greater if someone has a first-degree relative with the condition compared to someone who doesn’t. However, many thanks influence the risk including environmental factors and genes. So, family history is an independent risk factor but not the only risk factor.

Relevant initial application question:

Have any of your natural parents, brothers or sisters been diagnosed with, or died from, any of the following illnesses before the age of 65: Multiple sclerosis, Parkinson’s disease or Alzheimer’s disease?

Things we’ll ask about:

Whether your client has ever had tests or investigations for MS
Whether they’ve ever had symptoms of MS
How many first-degree relatives have had an MS diagnosis and their age(s) at diagnosis

Example underwriting outcomes:

Family history of MS	Life cover	Critical illness cover	Income protection
Applicant aged 35, Mother diagnosed with MS at age 40 No personal diagnosis or symptoms of MS	Standard	Ex	+25% to +75%
Applicant aged 45, Father diagnosed with MS at age 50 No personal diagnosis or symptoms of MS	Standard	+25% to +75%	+25% to +75%
Identical twin Brother diagnosed with MS No personal diagnosis or symptoms of MS	+25% to +75% rating	Ex	Ex

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from multiple sclerosis or any related complications, treatment or surgery, or any disease or disorder of the central nervous system.

Family history (FH) of Polycystic Kidney Disease (PKD)

Autosomal dominant PKD is one of the most common serious hereditary diseases. The offspring of an affected parent have a 50% chance of developing it themselves. In affected individuals’ kidney cysts develop which reduce kidney function and can lead to end stage kidney failure.

Relevant initial application question:

Have any of your natural parents, brothers or sisters been diagnosed with, or died from, any of the following illnesses before the age of 65: Polycystic kidney disease?

Information customers need to know when answering application questions:

None, our underwriters will either ask your client to answer some specific questions or request appropriate medical evidence

Example underwriting outcomes:

Family history of Polycystic Kidney Disease	Life cover	Critical illness cover	Income protection
Applicant aged 50, Father diagnosed with PKD at age 25 Fully investigated 2 years ago and no personal diagnosis	Standard	Standard	Standard
Applicant aged 30, Mother diagnosed with PKD at age 20 Fully investigated 7 years ago and no personal diagnosis	+25% to +75% rating	Decline	+100% to +150% rating
Applicant aged 25, Mother diagnosed with PKD at age 30 Not investigated	PP until investigated	Decline	Decline

Other factor/s that affect the underwriting outcome:

Critical illness cover isn’t available for applicant’s who have a family history of PKD and are aged less than 36.
Income protection cover isn’t available for applicant’s who have a family history of PKD and are aged less than 30.

Fracture

Most, but not all, bone fractures (breaks) heal without any long-term consequences. Fractures are usually caused by trauma although conditions such as osteoporosis or osteogenesis imperfecta (brittle bones) weaken the bones which increases the chance of fractures.

Relevant initial application question:

In the last 5 years, have had joint pains, arthritis, or any other symptoms affecting the knees, hips, ankles, feet, elbows, wrists or hands?

Things we’ll ask about:

Which part of your client’s body was affected by the fracture (if applicable left or right)
Whether they’re awaiting a hospital referral, tests, investigation or surgery
The date the fracture happened
Whether they’ve fully recovered
Any time they’ve had to take off work
Whether the fracture was related to another condition,g. osteoporosis
Whether they need any walking aids

Example underwriting outcomes:

Fracture	Life cover	Critical illness cover	Income protection
Age 30 Broken leg due to accident Not awaiting referral, tests or surgery Fully recovered	Standard	Standard	Standard
Age 30 Spine fracture 2 years ago due to accident Fully recovered 2 years ago No weakness, damage or residual problems Not awaiting referral, tests or surgery Not off work and no walk aids Mild ongoing symptoms	Standard	CI standard TPD 0 Ex TPD A Ex	Ex
Age 40 Left hip fracture due to accident Hip replacement surgery Last symptoms 3 months ago Fully recovered	Standard	CI standard TPD 0 Ex TPD A Ex	Ex
Age 25 Not awaiting referral, tests or surgery Osteogenesis imperfecta (brittle bones)	Individual consideration, +200% rating to unable to offer terms	Unable to offer terms	Unable to offer terms

Exclusion wording:

Wording depends on the fracture, e.g. for spine fracture:
We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from any injury to or disorder of the spine, intervertebral discs, nerve roots, cauda equina, spinal cord or supporting musculature and ligaments or related treatment or surgery.

Gallstones (cholelithiasis) / Cholecystitis

Cholecystitis is inflammation of the gallbladder usually caused by gallstones. Gallstones are made of cholesterol and calcium they can cause intense pain if one becomes stuck inside a gallbladder duct. More than 10% of the UK adult population are thought to have gallstones with many having no symptoms.

Symptoms can include abdominal pain (biliary colic), loss of appetite, high temperature and yellowing of the skin (jaundice).

If treatment is needed, it includes medication to dissolve the stones, a procedure to remove the gallstones or surgery to remove the gallbladder. Gallstone surgery is one of the most common operations performed in the UK.

Relevant initial application question:

We don’t ask a specific question about gallstones, but there are other questions which may lead to a disclosure of gallstones such as:

In the last 3 years, have you taken or been prescribed treatment or medication lasting more than 1 month, been advised to see a specialist, had any tests scans or investigations?

Things we’ll ask about:

Whether your client is awaiting any investigations, results or hospital appointments
Whether they have any associated conditions
When they had their first and latest symptoms
Their treatment details including the nature and date of any surgery
How many episodes they’ve had
Whether they’ve made a full recovery

Example underwriting outcomes:

Gallstones / cholecystitis	Life cover	Critical illness cover	Income protection
Not awaiting any investigations, results or hospital appointment Gallbladder removed 1 year ago Fully recovered	Standard	Standard	Standard
Not awaiting any investigations, results or hospital appointment No surgery Last symptoms 6 months ago Fully recovered	Standard	Standard TPD O Ex TPD A Ex	Ex
Not awaiting any investigations, results or hospital appointment No surgery Not fully recovered	Individual consideration	Individual consideration	Ex

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from any disease or disorder of the gall bladder or the biliary tract or from resulting surgery or treatment.

Gout

Gout is a type of arthritis in which small crystals form inside and outside the joints. It affects around 1 in 40 of the UK population, more commonly men that women. The condition causes sudden attacks of severe pain and swelling. If someone produces too much uric acid or the kidneys don’t filter enough out, it can build up and cause tiny sharp crystals to form in and around the joints. Gout is more common in people with high blood pressure and kidney disease.

Gout causes the joints to become inflamed (red and swollen) and painful, severe gout can cause kidney stones.

Treatment includes losing weight, reducing alcohol consumption, anti-inflammatory drugs, e.g. Ibuprofen and uric acid lowering medicine such as allopurinol or febuxostat.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had joint pains, arthritis, or any other symptoms affecting the knees, hips, ankles, feet, elbows, wrists or hands?

Things we’ll ask about:

Whether there is a diagnosis of high blood pressure or kidney problem
Whether your client has a diagnosis of high blood pressure or a kidney problem
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
How often they have attacks of gout
When their first and latest symptoms were, and investigation results
Whether they’ve had any surgery
The number of joints involved and whether there’s been any permanent damage

Most customers with gout can be underwritten based on application answers. However, sometimes we’ll need to request a GPR.

Example underwriting outcomes:

Gout	Life cover	Critical illness cover	Income protection
Not awaiting referral, tests, surgery 0 attacks in the last year One joint affected No raised blood pressure or kidney problem Last symptoms one year ago	Standard	Standard	Standard
Not awaiting referral, tests, surgery 2 attacks in the last year One joint affected No raised blood pressure or kidney problem	+25% to +75% rating	+25% to +75% rating	D4 unable to offer terms, D13+ +100% to +175% rating
Not awaiting referral, tests, surgery 4 attacks in the last year 3 joints affected No raised blood pressure or kidney problem	+25% to +75% rating	+25% to +75% rating	Unable to offer terms

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from gout, arthritis or any related treatment or surgery.

Growths and Lumps

An abnormal mass or swelling caused by cells growing abnormally. A growth or lump may be benign (non- cancerous) or malignant (cancerous).

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had a growth, lump or cyst?

Things we’ll ask about (for some types of lumps/growths may need additional information):

Whether your client is awaiting hospital referral, tests, investigations, results or surgery
Their specific diagnosis, date (if known) and where the lump/growth is located
Whether it’s malignant, a cancer or contained abnormal cells
Whether your client is fully recovered or still under follow-up
Whether they’ve been seen by a specialist and the date of their last medical consultation
The nature of their symptoms and treatment
Whether they’ve had to take any time off work
Any related family history

Example underwriting outcomes:

Growths and lumps	Life cover	Critical illness cover	Income protection
Age 25 Not awaiting any treatment, results, investigations, surgery or medical appointment Confirmed benign Last consulted GP 3 years ago Fully recovered with no current treatment or follow-up	Standard	Standard	Standard
Growth diagnosed as malignant	See cancer	See cancer	See cancer
Awaiting treatment	PP until after surgery	PP until after surgery	PP until after surgery

Heart Attack (Myocardial Infarction)

Approximately 550 people in the UK have a heart attack each day and about 30% of these are fatal. More than 900,000 people alive today in the UK have survived a heart attack. Heart attacks are caused by a blockage to the heart blood supply, usually due to a clot in one of the arteries supplying the heart. The lack of blood supply and therefore oxygen causes part of the heart muscle to die.

Symptoms include breathlessness, feeling lightheaded and chest pain spreading to the jaw, neck, arms, back. However, occasionally there may not be recognisable symptoms and this can be called a silent heart attack.

Treatment includes medication to clear the clots and surgery such as coronary angioplasty, a balloon to open the blockage or coronary artery bypass graft (CABG). There’s likely to be ongoing blood thinning and cholesterol reducing medication.

Relevant initial application question (other application questions may also be relevant):

Have you ever had a heart attack, heart disorder, angina, heart valve or structural abnormalities, or cardiomyopathy?

Things we’ll ask about:

Whether your client has any associated conditions e.g. diabetes
Whether they’re awaiting investigations or surgery
How many heart attacks they’ve had
How long ago their last heart attack was
Whether they have any calf pain when walking
The nature of their treatment including surgery
The nature of their recent symptoms
Whether they’re on treatment for raised blood pressure

We can’t offer critical illness cover or income protection if your client has had a heart attack. We can consider offering life cover unless your client also has diabetes, is under 40 years old, and/or they’ve had more than 2 heart attacks. If we may be able to offer terms, we’ll request a GPR.

Example underwriting outcomes:

Heart attack (myocardial Infarction)	Life cover
Age 62 Not awaiting investigations or surgery No associated conditions Moderate disease No surgery No tobacco 1 heart attack 6 years ago No symptoms since heart attack On statin medication	+100% to +150% rating
Age 55 Not awaiting investigations or surgery No associated conditions Coronary artery bypass graft Moderate disease No tobacco 1 heart attack 3 years ago No symptoms since heart attack On statin medication	+100% to +200% rating
Age 50 Age at date of heart attack 45 Tobacco, 10 cigarettes a day No associated conditions Significant disease Blood pressure and cholesterol normal Coronary artery bypass graft Statin treatment	+200% to +400% rating

Other factor/s that affect the underwriting outcome:

Tobacco use, BMI above normal range, recent heart surgery (we would postpone where surgery was less than 6 months ago), age at diagnosis, heart rhythm disorders, family history, related conditions such as circulation problems.

Heart murmur

An unusual heart sound, e.g. whoosh or swish, which may or may not be innocent i.e. of no consequence. In adults an abnormal heart murmur is usually caused by a heart valve abnormality. The characteristics of a murmur can help doctors identify the cause.

A heart murmur is not a condition itself but may indicate a structural heart abnormality.

Innocent heart murmurs don’t require treatment because the heart is normal. Abnormal murmurs may require treatment depending on the cause. Possible treatments include repair or replacement of an abnormal heart valve.

Relevant initial application question (other application questions may also be relevant):

Have you ever had a heart attack, heart disorder, angina, heart valve or structural abnormalities, or cardiomyopathy?

Things we’ll ask about:

Whether your client is awaiting any tests, investigations or results
The cause of their heart murmur (if known)
When they had their first and latest symptoms and the nature of any symptoms
Their treatment, investigation results and any time off work
When they last saw a doctor about their heart murmur
Whether the heart murmur is still present

Example underwriting outcomes:

Heart murmur	Life cover	Critical illness cover	Income protection
Not due to a hole in the heart or heart valve No surgery or treatment needed No symptoms or follow-up	Standard	Standard	Standard
Due to a hole in the heart in infancy Surgery in childhood Murmur resolved No symptoms or follow-up	Individual consideration	Individual consideration	Individual consideration
Awaiting investigations	PP until results are known	PP until results are known	PP until results are known

Heart Rhythm Disorder (Arrhythmia)

This is where the heartbeat differs from normal rhythm. It can be too fast (tachycardia), too slow (bradycardia) or irregular. Severity can range from minor through to life-threatening. Types of heart rhythm disorder are atrial fibrillation (AF), supraventricular tachycardia (SVT), heart block, bradycardia and ventricular tachycardia.

Symptoms can include palpitations, dizziness, being short of breath and fainting.

Treatment includes medication to help maintain normal rhythm and to reduce the risk of stroke, pacemaker (see separate section in this guide), cardioversion (electric shock reverting heart to normal rhythm), catheter ablation (removes diseased tissue causing the arrythmia) and implantable cardioverter defibrillator (ICD) (shocks heart back to normal rhythm when required).

Relevant initial application question (other application questions may also be relevant):

Have you ever had any of the following: a heart attack, heart disorder, angina, heart valve or structural abnormalities, or cardiomyopathy?

Things we’ll ask about:

Whether your client has or has had any related conditions e.g. a thyroid condition
Whether they’re awaiting hospital consultation, tests, investigation, results or surgery
The nature of any treatment
Whether they’re under regular medical follow-up
The date of their last symptoms and last medical consultation
Whether they’ve had to take any time off work

Example underwriting outcomes:

Heart rhythm disorder	Life cover	Critical illness cover	Income protection
No associated conditions No treatment required No symptoms for 2 years Not awaiting hospital consultation, tests, investigation, results or surgery	Standard	Standard	Standard
Atrial fibrillation diagnosed 2 years ago 2 episodes a year each lasting less than a day No associated conditions	+25% to +75% rating	Individual consideration	Individual consideration
No associated diagnosis or related conditions Not awaiting hospital consultation, tests, investigations, results or surgery Pacemaker fitted	Individual consideration based on GPR	Unable to offer terms	Unable to offer terms

Hepatitis

Inflammation of the liver caused by viral infection, an autoimmune process (where the immune system attacks normal cells), excessive alcohol consumption and some types of medication.

There are currently 6 viruses known to cause hepatitis. They are called hepatitis A, B, C, D, E and G. Chronic hepatitis may cause cirrhosis (liver scarring) or liver cancer both of which can result in death. Depending on the type of hepatitis anti-viral medication is available that can either cure or suppress the condition. Acute disease refers to recovery within 6 months and doesn’t occur in all types, chronic disease lasts longer than 6 months.

The types of hepatitis that we most commonly see are B and C. Therefore, the example underwriting outcomes table below refers to those types. If the answers to our application questions indicate that cover may be possible, a GP report will usually be needed to assess hepatitis.

Relevant initial application question (other application questions may also be relevant):

Have you ever had a positive test for HIV or Hepatitis B or C or are you waiting for the results of such a test?

In the last 5 years have you had any abnormality or disease of the kidneys, bladder, liver or pancreas?

Things we’ll ask about:

The type or cause of the hepatitis, if known
Whether liver cirrhosis and/or pancreatitis have been diagnosed
Whether chronic hepatitis has been diagnosed
Whether treatment has been or is being received
If treatment has stopped, when did it stop
Whether there has been a full recovery

Example underwriting outcomes:

Hepatitis	Life cover	Critical illness cover	Income protection
Acute hepatitis B Fully recovered Recent liver function tests normal No inflammatory liver markers	IC, Standard might be possible	IC, Standard might be possible	Unable to offer terms
Age 35 Chronic hepatitis C No cirrhosis of the liver or pancreatitis No liver fibrosis No current or previous treatment Not also infected with hepatitis B or HIV Recent liver function tests normal Alcohol consumption 2 units per week	+50% to +100% rating	Unable to offer terms	Unable to offer terms
Hepatitis B or C Diagnosed with cirrhosis of the liver	Unable to offer terms	Unable to offer terms	Unable to offer terms

Hernia

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. The muscles are usually strong and tight enough to keep the intestines and organs in place, but a hernia can develop if there are any weak spots. There are many different types of hernia, e.g. inguinal (groin) hernia, umbilical hernia, hiatus hernia, but they’re essentially all caused by muscular weakness. A hernia may be reducible (able to be pushed back to the correct position) or irreducible.

Treatment isn’t always needed for hernias. If it is, it’s through surgery to push the lump back to the correct position and repair the weakness.

Relevant initial application question (other application questions may also be relevant):

Hiatus hernia: In the last 5 years, have you had Crohn’s, colitis, IBS, or anything else affecting your stomach, bowel, oesophagus or digestive system?

Other hernias: There isn’t a specific question for other hernias. But there are other questions which may lead to a disclosure of this condition such as:

In the last 3 years, have you taken or been prescribed treatment or medication lasting more than 1 month, been advised to see a specialist or had any test, scans or investigations?

Things we’ll ask about:

The type of hernia your client has
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
Whether they’ve made a full recovery with no symptoms or complications
The nature of their treatment including date of any surgery
When they last had symptoms
Whether there are any complications

Many customers with hernia can be underwritten based on application answers. However, sometimes we’ll need to request a GPR.

Example underwriting outcomes:

Hernia	Life cover	Critical illness cover	Income protection
Inguinal hernia Not awaiting, referral, tests or surgery Fully recovered, no symptoms or complications	Standard	Standard	Standard
Hiatus hernia Not awaiting, referral, tests or surgery No complications or surgery No diagnosis of Barrett’s oesophagus Last symptoms 6 months ago	Standard	Standard TPDO Ex	Standard

Exclusion wording (hiatus hernia):

We won’t pay a total and permanent disability claim arising directly or indirectly from hiatus hernia including any complications arising from treatment thereof

High Blood Pressure (Hypertension)

Blood pressure is the force the heart needs to use to pump blood around the body. If blood pressure is high, the risk of serious conditions such as stroke, coronary heart disease, eye problems (retina changes) and kidney disease can be increased. Blood pressure is given as 2 figures:

Systolic pressure – the pressure when the heart pushes blood out

Diastolic pressure – the pressure when the heart rests between beats

Blood pressure up to 130/80 mm/Hg is generally considered to be within normal limits.

There are usually no symptoms unless blood pressure is extremely high.

Treatment includes exercise, lifestyle and diet changes and often medication. There are many blood pressure medications. Examples include ramipril, amlodipine and bendroflumethiazide.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had any of the following: raised blood pressure or cholesterol, chest pain, or irregular heartbeat?

Things we’ll ask about:

When your client was diagnosed with high blood pressure
The outcome of their last blood pressure check by a doctor or at a clinic
Whether they’ve been diagnosed with any related medical condition(s)
Whether they’re awaiting any hospital referral, tests, investigations or results

Many customers with high blood pressure can be underwritten based on application answers. However, sometimes we’ll need to request a GPR or NSE with blood tests.

Example underwriting outcomes:

High blood pressure (hypertension)	Life cover	Critical illness cover	Income protection
Age 45 No tobacco Diagnosed 3 years ago Not awaiting tests, investigation or referral No related medical conditions Well controlled by medication, average BP Most recent BP, 1 month ago, less than 130/80 Annual review	Standard	Standard	Standard
Age 40 Diagnosed 4 years ago Not awaiting tests, investigation or referral No tobacco Most recent BP, 1 month ago, 135/85 Currently on 1 medication No related medical conditions Review in 9 months	+25% to +75% rating	+25% to +75% rating	+25% to +75% rating
Age 45 Diagnosed 4 years ago No tobacco Not awaiting tests, investigation or referral Not on medication Most recent BP, 2 months ago, 190/100 No related medical conditions	Individual consideration	PP to unable to offer terms	Unable to offer terms

Other factor/s that affect the underwriting outcome:

- Tobacco use
- BMI greater than normal range
- High cholesterol
- Family history of circulatory disease
- Impaired glucose tolerance

High Cholesterol (Hypercholesterolaemia)

Cholesterol is a fatty substance needed by the body to function normally. It’s mostly produced by the liver. If there’s too much cholesterol in the blood, the risk of heart disease, stroke and artery blockages increases. Cholesterol combines with proteins to travel round the body. High density lipoproteins (HDL) carry cholesterol back to the liver from cells for disposal and is known as good cholesterol. Low density lipoproteins (LDL) carry cholesterol from the liver to the cells. If there’s too much cholesterol in the cells, LDL can cause artery blockage and so is known as bad cholesterol.

High cholesterol itself doesn’t usually cause symptoms so a blood test is needed to identify it. Sometimes a circular fatty deposit can appear around the cornea of the eye (arcus senilis) and fatty deposits can affect some joints.

Treatment is increased exercise, changes to diet, not smoking and in some cases medication such as statins and/or ezetimibe.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had any of the following: raised blood pressure or cholesterol, chest pain, or irregular heartbeat?

Things we’ll ask about:

Your client’s medication details
The date they were diagnosed
Their last cholesterol check-up result and most recent cholesterol reading (if known)
Whether they’re awaiting any tests/investigations, results or hospital referral
Details of any related medical conditions
Family history of raised cholesterol or heart disease

Many customers with high cholesterol can be underwritten based on application answers. However, sometimes we’ll need to request a GPR or NSE with blood tests.

Example underwriting outcomes:

High cholesterol (hypercholesterolaemia)	Life cover	Critical illness cover	Income protection
Age 50 No tobacco Not awaiting referral tests or investigations No related medical conditions Treated by diet and exercise only Last total cholesterol reading 5.8 mmol/l	Standard	Standard	Standard
Age 45 No tobacco Not awaiting referral tests or investigations No related medical conditions Treated by ezetimibe Last total cholesterol reading, 2 months ago, 7.0 mmol/l Next review in 12 months	+25% to +75% rating	+25% to +75% rating	Standard
Age 38 No tobacco Not awaiting referral tests or investigations No related medical conditions Treated by statins Last total cholesterol reading 8.6 mmol/l Next review in 8 months	+100% to +150% rating	PP	PP

Other factor/s that affect the underwriting outcome:

- Tobacco use
- BMI greater than normal range
- High blood pressure
- Circulatory disease
- Kidney problems
- Impaired glucose tolerance
- Diabetes.

Human Immunodeficiency Virus (HIV) positive

HIV is a virus transmitted by certain bodily fluids which causes damage to the immune system, specifically CD4 cells, enabling cancers and opportunistic infections to thrive. Those who have tested positive for the HIV virus are ‘HIV positive’. The stage at which these associated conditions become present is called acquired immunodeficiency syndrome (AIDS). Before development of highly active antiretroviral treatment (HAART), it was a fatal condition. The treatment is effective at preventing progression to AIDS and usually well tolerated although it isn’t a cure. The condition is monitored by measuring CD4 count which indicates the extent of damage to the immune system and viral load which indicates how much virus is in the blood.

Relevant initial application question (other application questions may also be relevant):

Have you ever had a positive test for HIV or hepatitis B or C or are you waiting for the results of such a test?

Things we’ll ask about:

Whether your client is receiving highly active antiretroviral treatment and when the treatment started
Whether they have had any HIV related complications
When they last had an HIV check up with a doctor
Latest CD4 count and viral load (if known)

We can usually give a life cover quote for HIV positive people aged 18 to 64 and an income protection quote for those aged from 30 to 60 (we don’t offer critical illness cover) subject to HAART treatment having started more than 1 year ago (3 years ago for income protection), viral load and CD4 count must be satisfactory and the expiry age must be less than 80 for life cover, less than 60 for income protection. We could need medical evidence, usually a specialist GPR, and ratings would be on extra mortality basis (not per mille loadings).

A term of up to 30 years is usually acceptable.

Example underwriting outcomes:

HIV positive	Life cover	Income protection
Age 40 On HAART treatment for 10 years CD4 count 700 Viral load undetectable No hepatitis B or C infection No AIDS related illnesses Policy term 15 years	+25% to +75% rating	+75% to +125% rating
Age 30 On HAART treatment for 2 years CD4 count 600 Viral load undetectable No hepatitis B or C infection No AIDS related illnesses Policy term 15 years	+100% to +175% rating	+150% to unable to offer terms
Age 27 On HAART treatment for 1 year CD4 count 500 Viral load undetectable No hepatitis B or C infection No AIDS related illnesses Policy term 10 years	+200% to +400% rating	Unable to offer terms

Hysterectomy

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. Usually performed by a gynaecologist, hysterectomy may be total or partial and may be performed for a variety of different underlying reasons.

Relevant initial application question:

We dont ask a specific question for hysterectomy, but there are other questions that might lead to a disclosure of this medical history, such as:

In the last 5 years, have you had an abnormal mammogram or other gynaecological condition that has needed more than one consultation?

In the last 3 years, have you taken or been prescribed treatment or medication lasting more than 1 month, been advised to see a specialist or had any tests, scans or investigations?

Things we’ll ask about:

When your client’s operation took place or when it will take place
The reason for their operation e.g. benign fibroids/cysts, endometriosis cancer or growth
Their diagnosis and any treatment following surgery
Whether they’ve fully recovered and returned to normal daily activities

Example underwriting outcomes:

Hysterectomy	Life cover	Critical illness cover	Income protection
Benign fibroids cysts or endometriosis only Fully recovered with no symptoms No post-surgery treatment Discharged from medical follow-up	Standard	Standard	Standard
Awaiting the operation	PP until after the surgery	PP until after the surgery	PP until after the surgery

If the hysterectomy was due to cancer, we’d request a GPR and the final underwriting outcome would be subject to individual consideration.

Insomnia

This is regularly having trouble sleeping, i.e. finding it difficult to go to sleep and waking up several times during the night. There can be an underlying cause such as depression, anxiety or stress. The underwriting outcome will depend on severity and any underlying cause.

Treatment includes lifestyle changes, cognitive behavioural therapy. Sleeping tablets are only rarely prescribed due to possible side effects.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had depression, anxiety, stress, eating disorders or any other mental health condition or illness?

Things we’ll ask about:

Whether your client is awaiting hospital referral, investigations or results
Any time they’ve had to take off work due to the condition
The type of medical professional they’ve consulted
When their last symptoms were
The number of separate episodes they’ve had
The nature of their treatment
Whether they’ve had any suicide attempts or thoughts

Example underwriting outcomes:

Insomnia	Life cover	Critical illness cover	Income protection
Not awaiting referral, investigations or results Last symptoms 2 years 6 months ago No suicide attempts or thoughts Not consulted a medical professional No time off work 1 episode of symptoms Never admitted to hospital due to the condition	Standard	Standard TPDO & A Ex	Ex
Not awaiting referral, investigations or results Last symptoms 1 year ago No suicide attempts or thoughts Not consulted a medical professional No time off work More than 3 episodes of symptoms Never admitted to hospital due to the condition	Individual consideration	Individual consideration	Ex

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from any mental disorder including but not limited to depression, mood disorder, stress, anxiety, or any behavioural disorder or any functional somatic disorder including but not limited to chronic pain syndromes, irritable bowel syndrome, chronic fatigue or myalgic encephalomyelitis.

Iron Deficiency Anaemia

Please see anaemia in this guide.

Irritable Bowel Syndrome (IBS)

IBS is a common condition of the digestive system. It’s thought to affect between 15 and 20% of the UK population. Sometimes it’s associated with anxiety or depression. Normally there’s no additional risk of death however severe it is.

Symptoms include abdominal pain, bloating, altered bowel habit, diarrhoea and constipation.

Treatment includes changes to diet such as increased fibre and sometimes medication such as Imodium and Buscopan. Any associated anxiety or depression will be treated as described above.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had Crohn’s, colitis, IBS, or anything else affecting your stomach, bowel, oesophagus or digestive system?

Things we’ll ask about:

Whether your client has been diagnosed with any related conditions or complications
Whether they’re awaiting any tests/investigations, results or hospital referral
Whether they’ve had to take time off work
The date when symptoms started and how regularly they happen
Whether their condition has been investigated
Whether they’ve been seen by a specialist

Many customers with IBS can be underwritten based on application answers. However, sometimes we’ll need to request a GPR

Example underwriting outcomes:

Irritable bowel syndrome (IBS)	Life cover	Critical illness cover	Income protection
Diagnosed after full investigations No related medical conditions Not awaiting hospital referral, tests, Investigations or results First symptoms 4 years ago No complications Not referred to a specialist No current symptoms not worsening Symptoms have improved No time off work	Standard	Standard	Standard
Diagnosed after full investigations No related medical conditions Not awaiting hospital referral, tests, Investigations or results First symptoms 4 years ago Not referred to a specialist Symptoms once a week, getting worse	Individual consideration	Individual consideration	D4 +25% to +75% rating

Other factor/s that affect the underwriting outcome:

If your client is awaiting any tests or test results we’ll postpone their application

Kidney Stones

Kidney stones can develop in one or both kidneys and most often affect people aged 30 to 60. They’re quite common, with around 3 in 20 men and up to 2 in 20 women developing them at some stage of their lives. The medical term for kidney stones is nephrolithiasis, and if they cause severe pain it’s known as renal colic. Small kidney stones may go undetected and be passed out painlessly in the urine. But it’s common for a stone to block part of the urinary system. Long-term kidney damage can be caused. High blood pressure may be a sign of kidney damage.

Symptoms include persistent ache, intense pain, blood in urine, pain when urinating, nausea or there might not be any symptoms.

Treatment includes drinking plenty of water, painkiller medication. If the stone is too large to pass naturally, intervention may be needed to remove it another way, e.g. lithotripsy (high-frequency sound waves (shock waves) to break up the stone), ureteroscopy (long, thin telescope passed into ureter to remove the stone or break it into small pieces using a laser), percutaneous nephrolithotomy (thin telescopic instrument passed into kidney through an incision in the back to remove the stone or break it into small pieces using a laser).

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had abnormality or disease of the kidneys, bladder, liver or pancreas?

Things we’ll ask about:

Whether your client’s kidney stone/s are still present
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
When they had their first and latest symptoms
Their kidney function
Whether they’ve made a full recovery, with no treatment or follow-up
What treatment they’ve had and how many times,g. number of operations
The number of attacks they’ve had in any one year
Whether their condition is associated with another underlying disorder

Example underwriting outcomes:

Kidney stones	Life cover	Critical illness cover	Income protection
Normal kidney function Stones passed naturally 2 attacks Not awaiting tests, investigations or results Fully recovered, no current treatment or follow-up	Standard	Standard	Standard
Successful shock wave treatment 4 attacks Not awaiting tests, investigations or results Normal kidney function Last symptoms 6 months ago Fully recovered, no current treatment or follow-up	+25% to +75% rating	+25% to +75% rating	D4 ex D13+ +25% to +75% rating
History of operation to remove stone Not awaiting tests, investigations or results Not fully recovered Stones present in 1 kidney	+25% to +75% rating	+25% to +75% rating	D4 ex, D13+ +25% to +75% rating

Exclusion wording:

We won’t pay an income protection claim arising directly or indirectly from renal calculus or renal colic or related treatment or surgery.

Knee disorder

There are several possible causes of knee disorder such as fracture, osteoarthritis, cartilage injuries, rheumatoid arthritis, meniscus tears, ligament and tendon injuries, soft tissue injuries, e.g. housemaid’s knee, osteochondritis where cracks form in the articular cartilage.

Symptoms are likely to be pain and restricted movement.

Treatment includes painkillers, anti-inflammatories (NSAIDS), physiotherapy and surgery e.g. knee replacement and repairs.

Relevant initial application question, only asked for critical illness cover or income protection (other application questions may also be relevant):

In the last 5 years, have you had joint pains, arthritis, or any other symptoms affecting the knees, hips, ankles, feet, elbows, wrists or hands?

Things we’ll ask about:

Which of your client’s knees are affected or whether both are
The severity of their condition and whether they’re having treatment
Whether they have any related conditions
Whether they’re awaiting any tests/investigations, results or hospital referral
The number of separate episodes they’ve had
Whether they have current symptoms
When their last symptoms were and how long they lasted
Any time they’ve had to take off work
Details of their treatment/surgery

Example underwriting outcomes:

Knee disorder	Life cover	Critical illness cover	Income protection
Age 50 Caused by accident Not awaiting hospital referral or investigation Left knee only No current symptoms or treatment Last symptoms 5 years ago	Standard	Standard	Standard
Age 45 Cartilage problem Not awaiting hospital referral or investigation Right knee only Had surgery 2 years ago, full recovery 2 years ago	Standard	Standard	Ex
Age 35 Meniscus tear due to accident Not awaiting hospital referral or investigation No surgery Both knees Ongoing knee pain	Standard	Standard TPD O Ex TPD A Ex	Ex

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from any disease or disorder of (either knee/left knee/right knee), including the joint, muscle, cartilage, ligaments or tendons or related treatment or surgery.

Menstrual (Period) Disorders

There are several period-related symptoms that can happen. Examples include stopped periods (amenorrhoea), pain (dysmenorrhoea), irregular periods (metrorrhagia), heavy periods (menorrhagia). Related conditions can include endometriosis, polycystic ovary syndrome (PCOS), fibroids, pelvic inflammatory disease. Treatments depend on the nature of the condition.

Relevant initial application question (we only ask this of female applicants, other application questions may also be relevant):

In the last 5 years, have you had an abnormal cervical smear, abnormal mammogram, or other gynaecological condition that has needed more than one consultation?

Things we’ll ask about:

The cause of your client’s menstrual disorder, if known, including whether associated with cancer
Whether they’re awaiting any treatment or hospital appointment
Whether they’ve consulted a GP or specialist
The nature of their menstrual disorder
Whether they’re having treatment
Whether they’ve made a full recovery with no impact on daily activities
When their first and latest symptoms were
Details of any time they’ve had to take off work

If there’s a known cause of the symptoms, we’ll ask about the cause.

Example underwriting outcomes:

Menstrual (period) disorders	Life cover	Critical illness cover	Income protection
Painful periods (dysmenorrhoea) First symptoms 4 years ago Consulted GP only Not awaiting referral, tests or results No time off work Fully investigated and no underlying cause	Standard	Standard	Standard
Painful periods (dysmenorrhoea) Not awaiting referral, tests or results No time off work Fully investigated and no underlying cause Under review by a gynaecologist	Individual consideration	Individual consideration	Individual consideration
Awaiting an appointment for investigations	PP until results are known	PP until results are known	PP until results are known

Metabolic Syndrome

A cluster of factors that significantly increase the risk of diabetes and heart/blood vessel disease, e.g. stroke, angina, heart attack, cardiomyopathy and heart failure. It’s thought that 20-25% of the UK adult population fulfil the diagnostic criteria. The factors are high blood pressure, high blood sugar levels, high triglyceride levels, low levels of HDL cholesterol and abdominal obesity (too much fat around the waist). The most commonly used definition of metabolic syndrome is known as NCEP ATP111 which requires 3 factors to be present, above specific measurement criteria.

The main sign of the condition is central obesity.

Treatment includes healthy diet, increase in exercise sometimes medication is needed to treat the individual risk factors.

See high blood pressure and high cholesterol for more information.

Migraine (Headaches)

Migraines are moderate to severe throbbing pain on one side of the head often with nausea and vomiting. It’s more common in women than men with approximately 20% of women and 6% of men having migraines.

There isn’t a cure but treatments such as painkillers and anti-emetics (to reduce vomiting) can help relieve symptoms.

Relevant initial application question (other application questions may also be relevant):

There isn’t a specific question for migraine. But, there are other questions that may lead to a disclosure of this condition such as:

Apart from what you have already told us, in the last 3 years have you taken any form of medication or treatment lasting more than 1 month, been advised to see a specialist or had any tests, scans or investigations?

Things we’ll ask about:

The nature of any investigations your client has had done or been advised to have and the results
Whether they’re awaiting any investigations, tests, results or hospital appointments
Whether they’ve ever admitted to hospital due to migraine
When their first and latest symptoms were
How often they have symptoms
The nature and severity of symptoms

Example underwriting outcomes:

Migraine	Life cover	Critical illness cover	Income protection
Not awaiting investigations, results or hospital appointment Headache only once a month or less Not consulted a medical professional No time off work	Standard	Standard	Standard
Not awaiting investigations, results or hospital appointment Symptoms include visual disturbance	Individual consideration	Individual consideration	Individual consideration
Awaiting further investigations	PP for investigations	PP for investigations	PP for investigations

Mole/Atypical (or dysplastic) Mole (or naevus) Syndrome

A mole or naevus is a pigmented or non-pigmented spot on the skin. Most moles are harmless. Atypical moles are larger than other moles with an irregular border, different shades of colour and may have raised parts.

Atypical naevus syndrome is where multiple moles are present which change throughout life. The moles are benign but there is an increased risk of developing malignant melanoma. Familial atypical multiple mole melanoma (FAMMM) syndrome is where many moles are present, some of which are atypical, together with a family history of malignant melanoma.

Treatment is not usually needed, but regular monitoring would be advised especially for those with atypical mole syndrome (AMS) or FAMMM.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years have you had a growth, lump or cyst?

Things we’ll ask about:

Whether your client is awaiting investigations, surgery, medical appointment or results
Whether their parent(s), brother(s) or sister(s) have had skin cancer
Whether they’ve consulted a GP or specialist, and if so the date they last saw them
Whether they’ve been diagnosed with skin cancer/malignancy
When they initially found the mole
The nature of any treatment they’ve had
The number of moles they have
Whether they’ve made a full recovery with no follow-up or ongoing treatment

Example underwriting outcomes:

Mole, AMS, FAMMM	Life cover	Critical illness cover	Income protection
Not awaiting referral, tests or results No family history of skin cancer No specialist referral Benign following investigations Last saw GP about mole 4 years ago No moles present currently Not under review	Standard	Standard	Standard
Awaiting medical appointment to investigate mole	PP until results known	PP until results known	PP until results known
Not awaiting referral, tests or results No family history of skin cancer Benign following investigations No specialist referral Last saw GP about mole 6 months ago 10 moles present currently Under review	Individual consideration	Ex	Ex

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from skin cancer, skin carcinoma in situ, melanoma in situ or related treatment or surgery.

Multiple Sclerosis (MS)

A neurological condition where the immune system doesn’t work correctly and attacks the protective layer around nerves known as the myelin sheath. Around 100,000 people in the UK have been diagnosed with MS. It can develop at any age but most often between 20 and 40. Women are more commonly affected than men. The exact cause isn’t known but family history and environmental factors are involved. The types of MS are relapsing remitting where there are periods with and without symptoms and primary progressive where symptoms gradually get worse. After many years relapsing remitting can develop into secondary progressive where symptoms gradually get worse.

Symptoms vary but include blurred vision, fatigue, numbness and tingling, difficulty walking, bladder problems, balance problems, muscle spasms and stiffness.

Treatments include steroids, exercise, cognitive behavioural therapy (CBT) and disease modifying therapy. There’s currently no cure for MS.

Relevant initial application questions (other application questions may also be relevant):

Have you ever had any of the following: epilepsy, multiple sclerosis, muscular dystrophy, cerebral palsy, Parkinson’s disease, Alzheimer’s disease or dementia?

Things we’ll ask about:

Whether your client is awaiting hospital referral, tests, investigations or results
When they first had symptoms
The nature/severity of their symptoms
The sub-type of MS (if known) e.g. relapsing remitting
The number of attacks they have each year

We can’t offer critical illness cover or income protection for people with MS. Nor can we offer life cover if your client’s MS subtype is primary progressive, secondary progressive, or progressive relapsing or if their symptoms are severe. Where we may be able to offer terms, we’ll request a GPR.

Example underwriting outcomes:

Multiple sclerosis (MS)	Life cover (policy term might be limited)
Not awaiting referral, tests or results Relapsing remitting MS First symptoms 10 years ago 4 relapses since diagnosis No symptoms for 3 years	+25% to +75% rating
Not awaiting referral, tests or results Relapsing remitting MS First symptoms 10 years ago 2 relapses a year Moderate symptoms	+100% to +175% rating
Not awaiting referral, tests or results Relapsing remitting MS Diagnosed 10 years ago 2 relapses a year Moderate to severe symptoms	+200% rating to unable to offer terms

Other factor/s that affect the underwriting outcome:

If your client has had possible MS symptoms but no diagnosis, the outcome will depend on the number of episodes and when the last one was.

Neck Pain

There are several possible causes of neck disorder such as injury/trauma, disc degeneration, and non-specific neck pain (e.g. whiplash or where the exact cause is not clear). Other causes include ankylosing spondylitis and osteoarthritis. For these, please see the specific condition in this guide.

Symptoms include pain and restricted movement.

Treatment includes painkiller medication, nonsteroidal anti-inflammatory drugs (NSAIDS), rest, and physiotherapy.

Relevant initial application question, only asked for critical illness cover and income protection (other application questions may also be relevant):

In the last 5 years, have you had back pain, slipped disc, sciatica, whiplash or anything else affecting your back, neck or shoulders?

Things we’ll ask about:

Any underlying cause of your client’s neck pain e.g. ankylosing spondylitis, osteoporosis
Whether they’re awaiting hospital referral, tests, investigation, results or surgery
When they first consulted a GP (if applicable)
Whether they’ve had surgery
The number of separate occasions they’ve had symptoms
How long their symptoms lasted
When their last symptoms were and the severity of the pain
The type and date of their last treatment or therapy

Example underwriting outcomes:

Neck pain	Life cover	Critical illness cover	Income protection
No underlying cause Not undergoing or awaiting hospital referral, tests, investigation, results or surgery Last treatment and symptoms more than 4 years ago One episode lasting less than one month No time off work	Standard	Standard	Standard
No underlying cause Not undergoing or awaiting hospital referral, tests, investigation, results or surgery Last treatment and symptoms less than 3 years ago 2 episodes lasting more thanone month	Standard	Standard TPD O Ex TPD A Ex	Ex
Awaiting neck surgery	PP until after surgery	PP until after surgery	PP until 3 months after surgery

Exclusion wording:

Numbness/Tingling/Paraesthesia (abnormal sensation)

Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they’re often felt in the fingers, hands, feet, arms and legs. There are many possible causes such as a pinched nerve, carpel tunnel syndrome, narrowing of the spaces of the spinal canal, vitamin deficiency, diabetes, underactive thyroid and multiple sclerosis.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had paralysis, seizures, loss of balance, loss of feeling, numbness, persistent and/or recurrent tingling or pins and needles?

Things we’ll ask about:

Whether your client is awaiting hospital referral, tests, investigations, results or surgery
The cause of their symptoms (if known)
The nature and results of any tests/investigation they’ve had done
Exact nature of their symptoms and when they first occurred
How many episodes they’ve had
Whether they’ve made a full recovery with no current treatment or symptoms
Time they’ve had to take off work
When they last had symptoms

Example underwriting outcomes:

Numbness/tingling/paraesthesia	Life cover	Critical illness cover	Income protection
Cause unknown Not awaiting hospital referral, investigations, tests, or surgery No need to see a doctor or nurse One episode Fully recovered, no current symptoms or treatment First symptoms 3 years ago Last symptoms 2 years ago	Standard	Standard	Individual consideration
Not awaiting hospital referral, investigations, tests, or surgery Symptoms due to a disc problem Last symptoms 8 months ago	Individual consideration	Individual consideration	Individual consideration
Awaiting test results	PP until outcome known	PP until outcome known	PP until outcome known

Osteoarthritis (OA)

This is the most common joint condition, with 18% of UK adults aged over 45 having hip OA and 10% having knee OA. Osteoarthritis means the joint surfaces become damaged such that the joint doesn’t move smoothly. OA only affects the joints.

Symptoms include pain, swelling, and restricted movement.

Treatment includes painkillers, non-steroidal anti-inflammatory drugs (NSAIDS), steroid injections, transcutaneous electrical nerve stimulation (TENS) and surgery such as hip or knee replacement.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had joint pains, arthritis, or any other symptoms affecting the knees, hips, ankles, feet, elbows, wrists or hands?

Things we’ll ask about:

The part(s) of your client’s body that are affected
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
The nature of their treatment and whether they’ve had any surgery
The date of their first symptoms
The nature of their treatment
The severity of their condition including details of time off work

Example underwriting outcomes:

Osteoarthritis (OA)	Life cover	Critical illness cover	Income protection
Not awaiting hospital referral, investigations, tests, or surgery Anti-inflammatory medication, e.g. ibuprofen Minor ongoing symptoms Only affecting the ankles	Standard	Standard TPD O Ex TPD A Ex	Ex
Not awaiting hospital referral, investigations, tests, or surgery Persistent pain, use of walking aid(s)	Standard	Standard TPD unable to offer terms	Unable to offer terms

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from osteoarthritis, arthritis or any related treatment or surgery. Note the specific exclusion wording may vary depending on the part of the body affected, e.g. We won’t pay an income protection claim arising directly or indirectly from osteoarthritis or arthritis of either ankle or any related treatment or surgery.

Osteoporosis

A reduction in bone mass, more common in women and older ages. Reduced bone mass increases the risk of fracture especially hip, vertebrae and wrist.

Symptoms are not always present but may include, pain, muscle weakness, loss of appetite and loss of height.

Treatment includes calcium, vitamin D supplements, hormone replacement therapy (women), testosterone treatment (men) and there are also several other medications to treat the condition.

Relevant initial application question:

There isn’t a specific question for osteoporosis. There are other questions which may lead to a disclosure of this condition such as:

Apart from what you have already told us, in the last 3 years have you taken or been prescribed treatment or medication lasting more than one month, been advised to see a specialist or had any tests, scans or investigations?

Things we’ll ask about:

How your client’s osteoporosis was discovered
Whether they’ve had any broken bones
When their first and latest symptoms were
The nature of their treatment
Whether they’ve had to take any time off work
The severity of their osteoporosis

Example underwriting outcomes:

Osteoporosis	Life cover	Critical illness cover	Income protection
Mild condition No broken bones Found on routine bone scan Diagnosed 3 years ago No symptoms Daily activities not restricted	Standard	Standard TPD O Ex TPD A Ex	Ex
Moderate to severe condition History of 3 broken bones	+25% to +75% rating	Standard TPD O&A not available	Unable to offer terms

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from osteoporosis or any disease or disorder of the bone or any bone fractures or related surgery.

Pacemaker

A small device which sends electrical pulses to the heart. This regulates the heartbeat to ensure that it’s not too slow or too fast. Modern pacemakers can operate on demand, i.e. only sending electrical pulses when an abnormality is detected. A pacemaker may be appropriate for patients with slow heartbeat, fast heartbeat, heart block (irregular heartbeat due to abnormal electrical signal transmission).

A pacemaker is a treatment rather than condition. Where we may be able to offer terms, we’ll request a GP report. Underwriting outcomes will depend on the reason your client needs the pacemaker. See heart rhythm disorder for further information.

Paralysis

Paralysis can be caused by trauma or disease. It can be of various degrees of severity, i.e. Bell’s palsy (face only), paraplegia (paralysis of the lower part of the body), quadriplegia or tetraplegia (paralysis of all four limbs). Paraplegia and quadriplegia can be complete or incomplete.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had paralysis, seizures, tremor, loss of balance, loss of feeling, numbness, persistent and/or recurrent tingling or pins and needles?

Things we’ll ask about:

The type of paralysis your client has
Which parts of their body are affected
The cause of their paralysis
Whether their mobility is affected
Whether they’ve had any bladder problems

If they’ve been diagnosed with Bell’s Palsy:

Whether they have any associated conditions
The nature of their treatment and symptoms
Investigation results
The number of episodes they’ve had
When their first and latest symptoms were

Example underwriting outcomes:

Paralysis	Life cover	Critical illness cover	Income protection
Bell’s palsy only Not caused by another condition One episode Not awaiting any referral, tests or surgery No investigations GP only First symptoms 4 years ago Last episode 3 years ago	Standard	Standard	Standard
Hemiplegia due to an accident Legs affected but able to walk without aids No bladder problems	Individual consideration Standard rates could be possible	Individual consideration TPD unable to offer terms	D4 unable to offer terms D13+ Individual consideration
Complete quadriplegia due to accident No respiratory infections or pneumonia No urinary tract infections	Individual consideration	Unable to offer terms	D4 unable to offer terms D13+ Individual consideration

Pericarditis

Pericarditis is the inflammation of the membrane surrounding the heart (pericardium). It’s most commonly caused by a viral infection or more rarely by bacterial infection. It can also be caused by other conditions such as heart attack. Acute pericarditis may recur but usually the condition will resolve without complications. However, sometimes healed acute pancreatitis can cause permanent pericardium damage due to scar tissue. This is known as chronic pericarditis.

Symptoms include chest pain and high temperature.

Treatment may not be needed but can include painkillers, non-steroidal anti-inflammatory drugs (NSAIDS), steroids and antibiotics (if bacterial).

Relevant initial application question (other application questions may also be relevant):

Have you ever had any heart attack, heart disorder, angina, heart valve or structural abnormalities, or cardiomyopathy?

Things we’ll ask about:

How many times your client has had pericarditis
When their first and latest symptoms happened
The nature of their symptoms and treatment
Any time they’ve had to take off work
Whether they’ve made a full recovery
Whether the pericarditis was caused by another condition

Example underwriting outcomes:

Pericarditis	Life cover	Critical illness cover	Income protection
Full recovery Last symptoms 2 years ago Caused by virus One occurrence	Standard	Individual consideration Standard may be possible	Individual consideration Standard may be possible
Full recovery Last symptoms one month ago Caused by infection Not waiting for treatment or investigations	Unable to consider cover until 6 months after last symptoms	Unable to consider cover until 6 months after last symptoms	Unable to consider cover until 6 months after last symptoms

Recreational Drug Use

Taking unprescribed drugs may change the terms we’re able to offer. There are many drugs or drug groups that can be involved such as misuse of prescription drugs, anabolic steroids, stimulants, e.g. ecstasy and cocaine, inhalants, e.g. amyl nitrate, hallucinogens, e.g. LSD, ‘legal highs’, and opiates, e.g. heroin. Use of some of these drugs leads to drug dependence (addiction). We don’t ask about cannabis use so past or current use of cannabis is normally standard rates. However, if we become aware of cannabis use during the underwriting process, it could be a relevant factor in the presence of a mental illness.

Treatment includes cognitive behavioural therapy, group therapy and medications.

Relevant initial application questions:

Have you ever used recreational drugs other than cannabis?
Have you ever received advice, treatment or counselling for the use of alcohol, drugs or non-prescribed medication?

Things we’ll ask about:

Which drug or drugs your client has used
Whether use is current or in the past
The frequency and method of use
When they last used the drug/s
Whether they used the drug/s intravenously (injected)

Example underwriting outcomes:

Recreational drug use	Life cover	Critical illness cover	Income protection
Ecstasy last used 4 years ago Occasional use No associated risk factors	+25% to +75% rating	+25% to +150% rating	Unable to offer terms
Cocaine last used 2 months ago	PP 2 years	PP 2 years	Unable to offer terms
Intravenous heroin last used 3 years ago	Unable to offer terms	Unable to offer terms	Unable to offer terms

Reflux, Gastro-oesophageal reflux (GORD)

A very common condition involving inflammation of the oesophagus due to reflux of stomach contents. Severe, long-term GORD can lead to Barrett’s oesophagus which is a pre-malignant condition associated with an increased risk of oesophageal cancer.

Symptoms include hiccups, cough, unpleasant taste in mouth, bad breath, heartburn, bloating and nausea.

Treatment includes medication such as antacid, omeprazole, lansoprazole, ranitidine and lifestyle changes such as reducing alcohol intake.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had Crohn’s, colitis, IBS, or anything else affecting your stomach, bowel, oesophagus or digestive system?

Things we’ll ask about:

The nature and severity of your client’s recent symptoms
The date of their first symptoms
Whether they’re awaiting any treatment, results or hospital appointment
Whether there are any complications such as bleeding
Whether they’ve fully recovered
Investigation results
When their last symptoms and treatment were
Whether they’ve been diagnosed with Barrett’s oesophagus
If they’re having any new or worsening symptoms
Whether their normal daily activities are affected

Example underwriting outcomes:

Reflux	Life cover	Critical illness cover	Income protection
No results, investigations or appointment awaited BMI within normal limits No complications or Barrett’s oesophagus Fully recovered with no current treatment Last symptoms 1 year ago	Standard	Standard	Standard
No results, investigations or appointment awaited BMI within normal limits No complications or Barrett’s oesophagus Longstanding mild symptoms on medication	Standard	Standard	Standard
Barrett’s oesophagus No laser ablation or surgery No dysplasia Regular endoscopy surveillance	Individual consideration	Individual consideration	Individual consideration

Rheumatoid Arthritis (RA)

A condition where the immune system mistakenly attacks the joints. The most commonly affected are knees, elbows, feet, hands, wrists and ankles. In addition to the joints, other parts of the body can be affected such as the heart, eyes and kidneys.

Symptoms include pain, stiffness, swelling of the affected joints. There can also be fatigue, loss of appetite and high temperature.

Treatments to relieve symptoms and prevent progression include disease-modifying anti-rheumatic drugs (DMARDs), e.g. methotrexate, biological treatments, e.g. rituximab, and JAK inhibitors, e.g. tofacitinib. Other medications include painkillers, non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids. Physiotherapy and surgery are additional treatment options.

Please note that we’re unable to offer income protection to people diagnosed with rheumatoid arthritis.

Relevant initial application question, only asked for critical illness cover (other application questions may also be relevant):

In the last 5 years, have you had joint pains, arthritis, or any other symptoms affecting the knees, hips, ankles, feet, elbows, wrists or hands?

Things we’ll ask about:

Whether your client is awaiting hospital referral, tests, investigations, results or surgery
Whether they have any related conditions,g. eye inflammation
When their last treatment was
When their last symptoms were
The nature and severity of their symptoms
Current and recent medication
The severity of their condition including any time off work

Example underwriting outcomes:

Rheumatoid arthritis (RA)	Life cover	Critical illness cover
Not awaiting hospital referral, investigations, tests, or surgery No related conditions No current treatment or symptoms No time off work	Standard	+25% to +75% rating TPD ex
Not awaiting hospital referral, investigations, tests, or surgery No complications Daily pain relief required Mild joint swelling Mildly reduced mobility	Standard	+25% to +75% rating TPD unable to offer terms
Not awaiting hospital referral, investigations, tests, or surgery No complications Current symptoms Many joints affected Methotrexate and pain relief treatment	Individual consideration	Individual consideration

Other factor/s that affect the underwriting outcome:

We’re unlikely to be able to offer cover if your client has amyloidosis (build-up of amyloid in organs).

Exclusion wording:

We won’t pay a total and permanent disability claim arising directly or indirectly from rheumatoid arthritis or any disease or disorder affecting the joints and including any extra-articular complications, and any other connective tissue disorder.

Shoulder disorder

Examples of shoulder disorders and causes are tendonitis, osteoarthritis, rheumatoid arthritis, rotator cuff disease, torn rotator cuff, frozen shoulder, dislocation and fracture. If the disorder is due to osteoarthritis or rheumatoid arthritis, please see the relevant section of this guide.

Symptoms include pain, inflammation around the joint and/or restricted movement.

Treatment includes painkiller medication, anti-inflammatory medication (NSAIDS), physiotherapy, corticosteroid injections and surgery to repair ligaments/tendons or replace the joint.

Relevant initial application question, only asked for critical illness cover and income protection (other application questions may also be relevant):

In the last 5 years, have you had back pain, slipped disc, sciatica, whiplash or anything else affecting your back, neck or shoulders?

Things we’ll ask about:

The cause of your client’s shoulder disorder (if known)
Which shoulder is affected or whether both shoulders are affected
Whether they’re awaiting hospital referral, tests, investigations, results or surgery
Whether they’re having any ongoing symptoms or treatment
When their last symptoms were
Details of any time off work
The number of separate episodes they’ve had

Example underwriting outcomes:

Shoulder disorder	Life cover	Critical illness cover	Income protection
Not awaiting hospital referral, investigations, tests, or surgery Frozen shoulder 1 shoulder affected Cause not known No current symptoms or treatment Last symptoms 3 years ago	Standard	Standard TPD O ex affected shoulder TPD A ex affected shoulder	Ex
Not awaiting hospital referral, investigations, tests, or surgery Rotator cuff injury No surgery 1 shoulder affected Current symptoms	Standard	Standard TPD O & A Ex affected shoulder	Ex
Not awaiting hospital referral, investigations, tests, or surgery Shoulder Injury Joint replacement surgery 1 year ago Both shoulders affected	Standard	Standard TPD O & A Ex both shoulders	Ex

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from any disease or disorder of (either shoulder/left shoulder/right shoulder), including the joint, muscles, cartilage, ligaments or tendons or related treatment or surgery.

Stroke / Transient Ischaemic Attack (TIA)

A stroke is a blockage of the blood supply to an area of the brain or bleeding into part of the brain. Symptoms vary depending on which part of the brain is affected and can include, slurred speech, face dropped on one side, arm weakness and confusion. The symptoms may improve over time.

A TIA has similar symptoms to a stroke but they disappear within 24 hours. A TIA is sometimes called a mini stroke.

Treatment depends on whether the cause is a blockage (blood clot) or bleeding. For a blood clot, the aim is to remove the clot using ‘clot-busting’ medication or surgery known as thrombectomy. In the long term, medication to reduce blood pressure/cholesterol and to reduce the risk of further clots may be used. For a brain bleed, surgery known as craniotomy may be needed to repair any burst blood vessels and remove blood from the brain. Medication aims to reduce blood pressure and cholesterol.

Relevant initial application question (other application questions may also be relevant):

Have you ever had a stroke or transient ischaemic attack (TIA), brain injury, brain haemorrhage, any form of bleeding into your brain or any surgery to your brain?

Things we’ll ask about:

The date/s of your client’s stroke/s and or TIA/s
Whether they’ve been diagnosed with any associated conditions such as kidney, heart, circulation problems or diabetes
How many strokes or TIAs they’ve had
The cause (if known)
How long their symptoms lasted
Whether they’re taking a combined oral contraceptive pill (if applicable)
Their current symptoms

Example underwriting outcomes:

We can’t offer critical illness cover or income protection for people who have had a stroke/TIA. We can consider life cover if your client has had only one stroke/TIA.

If your client has suffered a subarachnoid haemorrhage, a bleed into the space around the brain, the underwriting outcome would vary depending on the cause, e.g. if caused by a head injury a GPR would be requested and a final decision based on individual consideration.

Stroke / transient ischaemic attack (TIA)	Life cover
Age 56 No tobacco BMI within normal limits 1 TIA 2 years ago Cause unknown No ongoing symptoms No associated conditions	Individual consideration Indication +100% to +175% rating
Age 42 No tobacco Cause unknown BMI within normal limits 1 stroke 2 years ago Some ongoing symptoms No associated conditions	Unable to offer terms

Other factor/s that affect the underwriting outcome:

- Tobacco use
- BMI above normal range
- Recent diagnosis (we would postpone where the condition was diagnosed less than 6 months ago)
- Age at diagnosis
- Related conditions such as diabetes
- Heart and circulation problems.

Suicide Attempt

Suicide is the most common cause of death for men aged 20-49 in England and Wales. Around one in 15 people have attempted suicide at some point in their lives. The presence of depression, panic disorder and some other psychiatric disorders increases the suicide risk. Previous suicide attempt/s also indicates an increased risk of future attempts.

Relevant initial application questions:

Have you ever tried to take your own life?

Have you ever had thoughts about taking your own life?

Have you ever intentionally harmed yourself?

Have you ever had thoughts about harming yourself?

Things we’ll ask about:

How many suicide attempts your client has made
How many times they’ve had suicidal thoughts or self-harmed
Whether they have any associated mental health conditions
The date of their most recent suicide attempt and suicidal thoughts
The nature of their treatment who they’ve seen for this

Example underwriting outcomes:

Suicide attempt	Life cover	Critical illness cover	Income protection
One previous suicide attempt 7 years ago No underlying psychiatric disorder	Individual consideration likely standard	Individual consideration likely standard	Individual consideration likely standard
One previous suicide attempt 6 months ago No underlying psychiatric disorder	PP one year	Individual consideration	Unable to offer terms
4 previous suicide attempts No underlying psychiatric disorder	Unable to offer terms	Unable to offer terms	Unable to offer terms

Thyroid disorder

The thyroid gland, located in the neck, produces hormones (a substance produced by the body that regulates and controls cells or organs). There are 2 types of thyroid disorder, known as underactive (hypothyroidism) and overactive (hyperthyroidism) meaning too little or too much hormone production. Hyperthyroidism is also known as thyrotoxicosis. Occasionally a thyroid disorder can be caused by a cancerous tumour.

Hypothyroidism affects women about 10 times more than it affects men. It’s a common condition although estimates of the percentage of people who have the condition vary widely.

Symptoms include fatigue, sensitivity to cold, slow movements, weight gain, muscle aches and depression.

Treatment is hormone replacement tablets called levothyroxine.

Hyperthyroidism affects women about 6 times more than it affects men. It’s estimated that about 1% of the population have this condition.

Symptoms include fatigue, sweating, heart palpitations, weight loss, anxiety, shortness of breath, tremor and exophthalmos (bulging or protruding eyeball/s).

Treatment can include medication to stop the thyroid gland producing too much hormone, radioiodine where a low dose of radiation damages the gland and reduces hormone production and surgery to remove all or part of the gland. If the whole gland is removed, hormone replacement will be needed.

Goitre is a swelling of the thyroid gland that can cause hyperthyroidism.

Treatment is by radioiodine or thyroid surgery although in some cases no treatment will be needed.

Relevant initial application question (other application questions may also be relevant):

There isn’t a specific question for thyroid disorder. However, the cause may be the subject of a question. There are also other questions which may lead to a disclosure of this condition such as:

Apart from what you have already told us, in the last 3 years have you taken or been prescribed treatment or medication lasting more than 1 month, been advised to see a specialist or had any tests, scans or investigations?

Things we’ll ask about:

Which thyroid disorder your client has been diagnosed with
The date of their first symptoms
Whether they’ve been diagnosed with thyroid cancer
Whether they’re awaiting any tests/investigations, results or hospital referral
The outcome of their last GP consultation
The date and outcome of their last specialist referral if applicable
Whether they’ve had to take time off work
Whether they’ve been diagnosed with heart rhythm problems or eye problems
The date of any surgery or radioiodine treatment they’ve had
Whether they’ve been diagnosed with any related conditions
The nature of their treatment and medication start date
Whether their condition is well controlled
Whether there’s a family history of thyroid cancer

Example underwriting outcomes:

Thyroid disorder	Life cover	Critical illness cover	Income protection
Age 40 Hypothyroidism noticed 4 years ago Not awaiting tests, investigations, hospital referral Not needed to see a specialist No time off work No thyroid lump Well controlled	Standard	Standard	Standard
As above with benign thyroid lump Seeing a specialist	Individual consideration	Individual consideration	Individual consideration

Tobacco

Smoking damages artery lining leading to a build-up of fatty material (atheroma) which narrows the artery. This can cause angina, heart attack or stroke. The carbon monoxide in tobacco reduces the amount of oxygen in the blood. This means that the heart needs to pump harder to supply the body with the oxygen it needs. The nicotine in cigarettes stimulates the body to produce adrenaline, which makes the heart beat faster and raises blood pressure making the heart work harder. The blood is more likely to clot, which increases the risk of having a heart attack or stroke.

There are 3 levels of standard premium rates depending on tobacco use:

– None in the last 5 years gets our lowest non-smoker rate.

– None in the last 12 months selected gets non-smoker rates.

– Used tobacco or replacement products in the last 12 months gets smoker rates. If your client answers yes and still uses tobacco or replacement products, we’ll ask the question under relevant application question below. If they’ve now stopped using tobacco or replacement products, we’ll apply smoker rates.

Relevant initial application questions:

What best describes your use of tobacco or nicotine replacement products?
None in the last 5 years, none in the last 12 months or I have used tobacco or replacement products in the last 12 months. Tobacco products include cigarettes, cigars and pipes. Nicotine replacement products include patches, electronic cigarettes, chewing gum, lozenges, inhalers and sprays.

How much do you smoke a day on average? If you use tobacco occasionally or are a social smoker who does not smoke every day, please enter 0.

Things we’ll ask about:

How many cigarettes, cigars or pipes your client smokes each day (if applicable)

Example underwriting outcomes:

Tobacco (smoker rates)	Life cover	Critical illness cover	Income protection
Low tobacco use No medical conditions	Standard	Standard	Standard
Moderate tobacco use No medical conditions	+25% to +75% rating	+25% to +75% rating	+25% to +75% rating
High tobacco use No medical conditions	+25% to +75% rating	Unable to offer terms	Unable to offer terms

Non-nicotine vaping: if your client can select ‘not used tobacco or nicotine replacement products in the last 12 months’, they’ll get non-smoker rates.

Ulcerative Colitis

This is a long-term condition resulting in inflammation of the colon. Symptoms include abdominal pain, diarrhoea, and weight loss.

Treatment depends on severity. There are several medications aimed at reducing inflammation and inducing remission, e.g. aminosalicylates such as sulphasalazine, corticosteroids such as prednisolone, immunosuppressants such as azathioprine, biological medications such as infliximab. If medication stops being effective, surgery is generally needed, i.e. removal of the colon (colectomy).

Relevant initial application question (other application questions may also be relevant):

In the last 5 years, have you had any of the following: Crohn’s, colitis, IBS, or anything else affecting your stomach, bowel, oesophagus or digestive system?

Things we’ll ask about:

When your client was diagnosed with ulcerative colitis
When their last episode was
The nature and severity of their symptoms
Which part of their bowel is affected if known
The nature of their treatment including nature and date(s) of any surgery
Whether there have been any complications
Whether they’re undergoing or waiting hospital referral, tests, results, surgery or investigations

Example underwriting outcomes:

Ulcerative colitis	Life cover	Critical illness cover	Income protection
No restriction to daily activities or work No complications or surgery Mild condition severity affecting rectum only No recent symptoms Diagnosed 8 years ago	Standard	+25% to +75% rating and Ex	D4/D8 ex D13+ standard
No restriction to daily activities or work No complications or surgery Moderate condition severity Left side of bowel affected Methotrexate medication Diagnosed 3 years ago	+25% to +75% rating	Ex	Individual consideration
Diagnosed 4 years ago No complications Daily activities unaffected Surgery 9 months ago	Standard	PP 12 months	Individual consideration

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from ulcerative colitis, inflammatory bowel disease or complications and related treatment or surgery.

Urinary Tract Infection (UTI)

An infection occurring in any part of the urinary system, e.g. bladder (cystitis), urethra (urethritis) or kidneys (kidney infection or pyelonephritis). More common in women than men. Usually UTIs are easily treated. However, if the infection involves the kidneys they can be damaged.

There are not always any symptoms. Where symptoms do occur, they can include pelvic pain (in women), persistent urge to urinate, burning sensation when urinating, fatigue, pain and blood in the urine.

Treatment may not be needed but can include a short or longer course of antibiotics.

Relevant initial application questions:

We don’t specifically ask about UTIs although there are questions which may lead to a disclosure of this condition such as:

In the last 5 years have you had abnormality or disease of the kidneys, bladder, liver or pancreas?

Apart from what you have already told us, in the last 3 years have you taken of been prescribed treatment or medication lasting more than one month, been advised to see a specialist, or had any tests, scans or investigations?

Things we’ll ask about:

Whether your client has been diagnosed with any associated conditions, g. kidney stones
Whether they’re awaiting referral, tests, investigations or surgery
When their first symptoms were
When their last symptoms and treatment were
The number of infections they’ve had in the last 2 years
Whether they’ve been referred to a specialist
Whether they’ve made a full recovery

Example underwriting outcomes:

Urinary tract infection	Life cover	Critical illness cover	Income protection
No kidney problem Fully recovered from UTI no ongoing treatment Last symptoms one year ago 1 infection in the last 2 years No specialist referral No diagnosis of associated conditions	Standard	Standard	Standard
No kidney problem Fully recovered from UTI no ongoing treatment Last symptoms 6 months ago 3 infections in the last 2 years No diagnosis of associated conditions	Standard	Standard	+25% to +75% rating
Kidney problem diagnosed Nature of the kidney problem not known	Individual consideration	Individual consideration	Individual consideration

Uveitis

Inflammation most commonly affecting the uvea (middle layer of the eye). However, other parts of the eye can be affected. If the condition isn’t treated, it can cause blindness.

Symptoms include eye redness, eye pain, blurred vision, floaters, light sensitivity.

Treatment includes steroid eyedrops and eyedrops to dilate the pupil. Sometimes immunosuppressant medication may be prescribed.

Relevant initial application questions, only asked for critical illness cover and income protection:

In the last 5 years, have you had impaired, blurred or double vision, optic neuritis or anything else affecting your eyes?

Things we’ll ask about:

Whether your client is awaiting any treatment, results or hospital appointment
Whether their condition has an underlying cause
Which eye(s) are affected
Whether their sight is now normal (corrected or uncorrected by glasses,)
Whether their normal activities of daily living are affected
The number of episodes they’ve had
Whether they’ve been referred to a specialist

Example underwriting outcomes:

Uveitis	Life cover	Critical illness cover	Income protection
2 attacks of uveitis Caused by infection Not waiting for treatment, operation or investigations No restriction to normal daily activities Sight now normal	Standard	Standard	Standard
2 attacks of uveitis Caused by infection Not waiting for treatment, operation or investigations Sight affected, both eyes	Standard	CI blindness removal TPDO&A Ex	Ex
Waiting for test results	PP until test results available	PP until test results available	PP until test results available

Removal wording:

We won’t provide cover for blindness or significant visual impairment as a listed condition under critical illness.

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from blindness or any disease or disorder of either eye.

Varicose veins

Varicose veins are swollen and enlarged veins that usually occur on the legs and feet. They may be blue or dark purple, and are often lumpy, bulging or twisted in appearance.

Symptoms include discomfort when standing.

Treatment includes compression stockings or surgery.

Relevant initial application question:

There isn’t a specific question for varicose veins although there are questions which may lead to a disclosure of this condition such as:

Apart from what you have already told us, in the last 3 years have you taken or been prescribed treatment or medication lasting more than one month, been advised to see a specialist, or had any tests, scans or investigations?

Things we’ll ask about:

Whether your client has any associated conditions or complications
Whether they’re awaiting referral, investigations, surgery or any other treatment procedure
When they had their first and latest symptoms
Whether the varicose veins are in their legs only
The nature of their treatment
Whether they have any restriction to their normal daily activities, e.g. time off work
Whether they’ve made a full recovery with no ongoing treatment or follow-up

Example underwriting outcomes:

Varicose veins	Life cover	Critical illness cover	Income protection
Not awaiting referral, investigations or surgery Only in the legs No skin problems around the varicose veins No associated conditions Fully recovered, no ongoing symptoms or treatment	Standard	Standard	Standard
Not awaiting referral, investigations or surgery Only in the legs No skin problems around the varicose veins Varicose eczema Fully recovered, no ongoing symptoms or treatment	Standard	Standard (TPD Ex)	Ex
Affecting the oesophagus	Unable to offer terms	Unable to offer terms	Unable to offer terms

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from deep vein thrombosis, phlebitis, thrombophlebitis or varicose veins.

Vertigo and Dizziness

Vertigo is a symptom where a person feels like they or their surroundings are moving or spinning. This feeling can last for a very short time or much longer. Long-term symptoms can make normal activities difficult. Dizziness can be a symptom of vertigo or unrelated to it.

Other symptoms of vertigo include feeling or being sick and losing balance.

Treatment depends on the cause and may not be required but can include special movements exercises, dietary advice and medication.

Relevant initial application questions:

There isn’t a specific question for vertigo and dizziness although there are questions which may lead to a disclosure of this condition such as:

In the last 5 years, have you had tinnitus, labyrinthitis, or anything else affecting your ears, hearing or balance? (We’ll only ask this for critical illness cover and income protection applications.)

Things we’ll ask about:

Whether your client is awaiting any treatment, results or hospital appointment
Whether their symptoms are related to another condition
When their first and latest symptoms were
Any time they’ve had to take off work
The nature of their treatment and recent investigations
Whether they’ve been referred to a specialist
Their diagnosis and nature of recent symptoms

Example underwriting outcomes:

Vertigo and dizziness	Life cover	Critical illness cover	Income protection
Not waiting for treatment, operation or investigations No investigations GP only First symptoms 3 years ago Fully recovered Symptoms not related to another condition Last symptoms 2 years ago	Standard	Standard	Standard
Not waiting for treatment, operation or investigations Symptoms related to Meniere’s disease No other associated medical condition First symptoms 3 years ago Seen GP only Ongoing mild symptoms	Individual consideration Standard rates may be possible	Individual consideration Likely CI deafness cover removal TPD ex	Individual consideration Likely Ex
Awaiting specialist appointment	PP until outcome is known	PP until outcome is known	PP until outcome is known

Exclusion wording (if related to Meniere’s disease):

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from Meniere’s disease or any disease or disorder of either ear including deafness.

Critical illness removal wording (if related to Meniere’s disease):

We won’t provide cover for deafness as a listed condition under critical illness.

Vitamin B12 anaemia

This is where a lack of vitamin B12 causes large red blood cells to be produced which don’t work correctly.

Symptoms include weight loss, fatigue, psychological problems, numbness/pins and needles.

Treatment includes vitamin B12 replacement and dietary advice.

Relevant initial application question (other application questions may also be relevant):

In the last 5 years have you had anaemia, haemophilia, or other blood disorder?

Things we’ll ask about:

Whether your client is waiting for a referral, tests, investigations, results or surgery
Whether their last blood tests were normal or not
The cause of their condition (if known)
Whether they have any complications
Whether they’ve been seen by a specialist
When their first and latest symptoms were
The nature of their symptoms and whether their normal activities of daily living are affected
The nature of their treatment
Whether their condition is fully controlled by medication or diet

Example underwriting outcomes:

Vitamin B12 anaemia	Life cover	Critical illness cover	Income protection
Latest blood tests normal Not awaiting a specialist appointment, tests or results Caused by diet No complications Condition controlled with no symptoms or complications Seen GP only	Standard	Standard	Standard
Latest blood tests normal Not awaiting a specialist appointment, tests or results Caused by diet No complications Condition not yet under control Seen GP only	Individual consideration	Individual consideration	Unable to offer terms
Waiting for a specialist appointment	PP until outcome available	PP until outcome available	PP until outcome available

Sports activities

Various activities can involve a higher level of risk when it comes to protection.

Relevant application question:

Do you currently, or do you intend to, participate in any of the following?

Mountaineering
Scuba or deep-sea diving
Sailing (other than inland)
Flying (other than as a fare-paying passenger)
Motor sports
Extreme sports (including, but not limited to, bungee or base jumping, canyoning, caving/potholing, white water rafting, extreme mountain biking)
Professional or semi-professional sport (including, but not limited to, rugby league, rugby union, football)

Ratings:

Sports activities ratings are normally £1 per £1,000 of cover a year. Otherwise known as per mille (pm) ratings. For example, a £2.5pm rating for a cover amount of £20,000 would be £2.5 x 20 = £50 a year.

Climbing/Mountaineering

Things we’ll ask about:

Whether or not your client climbs/mountaineers only in Europe
Where they climb, how many times a year and at what altitude
Whether they undertake any expeditions, record attempts or solo climbing
Whether they climb/mountaineer professionally
Whether they do any snow or ice climbing
Whether they’re a member of the British Mountaineering Club
The maximum height they climb to in metres

Example underwriting outcomes:

Climbing/mountaineering	Life cover	Critical illness cover	Income protection
UK only Mountaineering No ice or snow climbing, expeditions or record attempts	Standard	Standard	Standard
Artificial climbing walls only Not a professional	Standard	Standard	Standard
Abseiling only Not a professional	Standard	Standard	Standard
Europe Mountaineering No ice or snow climbing	Individual consideration Likely £1.25pm to £2.50pm rating	Individual consideration Likely Standard TPD O ex TPD A ex	Individual consideration Likely ex
Worldwide	Individual consideration Likely >£6.25pm rating	Individual consideration Likely Standard TPD O ex TPD A ex	Unable to offer terms

Exclusion wording:

We won’t pay a total and permanent disability or income protection claim arising directly or indirectly from participation in mountaineering activities including rock climbing, ice climbing, ski mountaineering and all climbing at altitudes of over 3000 metres.

Diving, Scuba diving

Things we’ll ask about:

Whether your client only dives occasionally when on holiday
The maximum depth they dive to in metres
Whether they have any diving certification
Whether they ever dive solo
Whether they do cave, ice, wreck or free diving
Whether they take part in record attempts or expeditions
Whether they’re a current BSAC member

Example underwriting outcomes:

Diving, scuba diving	Life cover	Critical illness cover	Income protection
Occasional diving only when on holiday	Standard	Standard	Standard
Snorkelling only	Standard	Standard	Standard
Never solo Certified diver level 1 Max depth 20 metres No cave, ice or wreck diving, etc.	Standard	Standard	Standard
Certified diver open water Maximum depth 41-50 metres No cave, ice or wreck diving	£1.25pm to £2.50pm rating	Ex	Ex
Certified diver open water Maximum depth 51-60 metres No cave, ice or wreck diving	£1.25pm to £2.50pm rating	Ex	Ex

Other factor/s that affect the underwriting outcome:

We won’t be able to offer any cover if they dive regularly and are uncertified or if they do solo dives or record attempts. Diving to depths greater than 60 metres or free diving to depths greater than 25 metres is subject to individual consideration by our underwriters. Taking part in cave, ice or wreck diving attracts an increased life cover rating.

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from participation in diving and any diving related activity.

Microlighting

Things we’ll ask about:

Whether your client takes part in competitions, test flying or record attempts
How many hours they fly in a year
Whether they only took part as a one-off lesson
Whether they’ve attained a certification level
How many years’ experience they have

Example underwriting outcomes:

Microlighting	Life cover	Critical illness cover	Income protection
A one-off lesson, no expectation of future participation	Standard	Standard	Standard
50 hours a year No higher risk flying activities e.g. stunts 5 years’ experience	£1.25pm to £2.5pm rating	Ex	Ex
150 hours a year No higher risk flying activities e.g. stunts 1 years’ experience	£3.75pm to £6.25pm rating	Ex	Ex

Other factor/s that affect the underwriting outcome:

Microlighting for more than 200 hours a year, test flying and taking part in competitions or record attempts would be subject to individual consideration by our underwriters.

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from microlighting, powered hang-gliding, trikes, ultralighting, aviation related sports and private aviation, except as a fare paying passenger on a scheduled airline

Motor car sport

Things we’ll ask about:

The type of motor car sport e.g. karting, drag racing, stock car, track days, etc.
The type of vehicle/engine size
Whether your client is an amateur or professional
How many events they take part in a year
How many track days a year they do (if applicable)
Whether they take part in races outside the UK
Whether they only took part as a one-off e.g. an experience day
Whether they do marshalling only

Example underwriting outcomes:

Motor car sport	Life cover	Critical illness cover	Income protection
Track days, 12 a year	Standard	Standard	Standard
Karting, fun days/indoor karting only	Standard	Standard	Standard
Drag racing Not a professional	£1.25pm to £2.5pm rating	Ex	Ex
Stage rallies Not a professional	£1.25pm to £2.5pm rating	Ex	Individual consideration

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from any motor car sports activity.

Motor cycle sport

Things we’ll ask about:

The type of motorcycle sport
The type of vehicle/engine size
Whether your client is an amateur or professional
How many events they take part in a year
How many track days a year they do (if applicable)
Whether they take part in races outside the UK
Whether they only took part as a one-off, e.g. an experience day
Whether they do marshalling only

Example underwriting outcomes:

Motorcycle sport	Life cover	Critical illness cover	Income protection
History of one-off participation with no expectation of future participation	Standard	Standard	Standard
Circuit racing UK only Engine size 250cc 6 events a year Not a professional	£1.25pm to £2.5pm rating	Ex	Ex
Speedway racing Not a professional	£3.75pm to £6.25pm rating	Ex	Ex

Other factor/s that affect the underwriting outcome:

We won’t be able to offer any cover if they take part on a professional basis or in road racing, e.g. the Isle of Man TT.

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from any motorcycle sports activity.

Paragliding

Things we’ll ask about:

Whether your client takes part in competitions, test flying or record attempts
How many hours they fly in a year
Whether they only took part as a one-off lesson
Whether they’ve attained a certification level
How many years’ experience they have

Example underwriting outcomes:

Paragliding	Life cover	Critical illness cover	Income protection
25 hours a year No higher risk flying activities, e.g. stunts	£1.25pm to £2.50pm rating	Standard	Ex
100 hours a year No higher risk flying activities, e.g. stunts Intermediate rating P3 BHGPA member	£1.25pm to £2.50pm rating	+25% to +75% rating	Ex
75 hours a year Participation in national competitions	£1.25pm to £2.50pm rating	Ex	Ex

Other factor/s that affect the underwriting outcome:

Test flying or record attempts would be subject to individual consideration by our underwriters.

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from paragliding, parascending, paramotor, aviation related sports and private aviation except as a fare paying passenger on a scheduled airline.

Private flying

Things we’ll ask about:

The type of aircraft – fixed wing, rotary (helicopter) or both
Whether your client takes part in competitions, experimental, test, stunt, aeronautics, acrobatics, air racing or air rallying
Whether they only took part as a one-off experience
The type of licence they have
How many hours they fly in a year
Their total flying hours
Their accident history
Where they fly

Example underwriting outcomes:

Private flying – fixed wing	Life cover	Critical illness cover	Income protection
Trainee (student) pilot Recreation only No accidents No higher risk flying activities, e.g. stunts	£1.25pm to £2.5pm rating	Ex	Ex
Private pilot licence (PPL) Recreation only No accidents No higher risk flying activities e.g. stunts	£1.25pm to £2.5pm rating	Ex	Ex
101-150 hours a year Private pilot’s licence (PPL) Recreation only No accidents No higher risk flying activities e.g. stunts	IC	Ex	Ex

Private flying – rotary	Life cover	Critical illness cover	Income protection
Trainee pilot Recreation only No accidents No higher risk flying activities e.g. stunts	£1.25pm to £6.5pm rating	Ex	Ex
Private pilot licence (PPL) Recreation only No accidents No higher risk flying activities e.g. stunts 50 Hours per year	£1.25pm to £2.5pm rating	Ex	Ex
More than 100 hours a year Private pilot licence (PPL) Recreation only No accidents No higher risk flying activities e.g. stunts More than 100 hours a year	£3.75pm to £6.25pm rating	Ex	Ex

Exclusion wording:

We won’t pay a critical illness, or total and permanent disability or income protection claim arising directly or indirectly from fixed wing aviation, rotary wing aviation, aviation related sports and any other private aviation except as a fare paying passenger on a scheduled airline.

Occupation

We have a list of more than 6,000 job titles, which automatically provides underwriting decisions for most occupations.

If you can’t find your client’s job title on the Protection Builder or Underwriting Qi occupation dropdown list, please try describing the job a different way or pick the closest match. Specific automated rules are in place for higher risk occupations.

This section also covers housepersons.

For income protection, occupations are allocated a class 1 to 4. The allocated class influences the premium.

Occupation ratings are normally £1 for each £1,000 of cover a year. Otherwise known as per mille (pm) ratings. For example, a £2.5pm rating for a cover amount of £20,000 would be £2.5 x 20 = £50 a year.

Exclusion wording:

“We won’t pay a critical illness claim arising directly or indirectly from any accident, injury or condition that occurs as a result of performing your occupation. Any accident or injury that occurs outside of your work or occupation that causes a valid claim is covered.”

Things we’ll ask:

What is your job? Are you a member of the armed forces, Territorial Army or a reservist?

Job types that have specific automated underwriting rules are shown below. However, some jobs within these areas will be underwritten based on the job title only. Where that happens, no further job-related questions will be asked:

Armed forces
Aviation
Explosives
Fishing
General labouring
Heights
Merchant marine
Mining
Oil & natural gas
Publican
Underwater

Actual outcomes depend on your client’s answers to application questions. Below are example outcomes for armed forces, aviation, diving, fishing, housepersons, merchant marine, mining, oil/natural gas, police and quarrying.

Armed Forces (Including Territorial Army (TA) and Reservists)

Military risks include the risk of accident and the obvious danger of being involved in active operations.

Our underwriting approach for members of the armed forces can vary over time. For example, if UK armed forces take part in active operations in different parts of the world, our underwriting approach may change. We won’t be able to provide income protection or TPD O for any members of the armed forces.

The Ministry of Defence (MoD) has a scheme for refunding additional life insurance premiums charged because of the forces occupation. It is called the Ministry of Defence Service Risks Insurance Premium Refunds (SRIPs) scheme. With some exceptions, the MoD will refund 90% of any additional premiums for the total amount covered up to a certain limit that increases each year. For further details, your client in the armed forces can contact their HR department to see if they’re eligible and to get the form they need, called a JPA F010.

Things we’ll ask about:

Whether your client is deployed outside the UK
Whether they’re under orders or on notice to move
Whether they have a state of readiness to deploy in the next year
Whether they’re flying as pilot or aircrew, and if so the aircraft type and role
Whether they have special duties e.g. bomb disposal, diving, parachuting, etc.
Whether they’re serving with an elite force e.g. SAS

Example underwriting outcomes:

Armed forces including Territorial Army (TA) and reservists	Life cover	Critical illness cover
Full-time military Not under orders for active service No special duties No flying as pilot or aircrew	Standard	Ex theatre of war TPD O decline TPD A Ex theatre of war
Full-time military Not under orders for active service Parachuting No flying as pilot or aircrew	Individual consideration Likely: £1.25pm to £2.5pm rating	Individual consideration Likely: Ex occupation TPD O unable to offer terms TPD A Ex occupation
Full-time military Not under orders for active service Bomb disposal No flying as pilot or aircrew	Individual consideration Likely: £3.75pm to £6.25pm rating	Individual consideration Likely: Ex occupation TPD O unable to offer terms TPD A Ex occupation
Full-time military Not under orders for active service Fast jet pilot or crew	Individual consideration Likely: >£6.25pm rating	Individual consideration Likely: Ex occupation TPD O unable to offer terms TPD A Ex occupation

Exclusion wordings:

We won’t pay a critical illness or total and permanent disability claim arising directly or indirectly from an accident or injury or wound sustained in an active theatre of operations or an area of hostility, war, or conflict.

We won’t pay a critical illness or total and permanent disability claim arising directly or indirectly from any accident, injury or condition that occurs as a result of performing your occupation. Any accident or injury that occurs outside of your work or occupation that causes a valid claim is covered.

Aviation (Pilot or Aircrew)

The risks involved in flying are obvious, although accidents are rare. The risk varies according to the type of aircraft and the purpose of the flight. For example, crop spaying is higher risk than flying a passenger jet. Pilots have rigorous annual medical examinations and can lose their licence due to relatively minor health conditions.

Things we’ll ask about:

The type of aircraft your client flies
The nature of the company they fly for
How many hours they fly in a year
Whether they’re involved in higher risk flying, e.g. low-level flying, test pilot, crop spraying
Whether they’re working as a flying instructor
Whether they’ve attained a certification level
Whether they’ve had any accidents
Which parts of the world they fly in
Whether they transport passengers, cargo or neither

Example underwriting outcomes:

Aviation (pilot or aircrew)	Life cover	Critical illness cover	Income protection
International passenger airliner air steward/stewardess	Standard	Standard TPD O unable to offer terms TPD A standard	Occupation class 4
Large passenger airliner pilot No higher risk flying activities	Standard	Standard TPD O unable to offer terms TPD A standard	Unable to offer terms
Helicopter pilot To and from oil rigs No higher risk flying activities	£1.25pm to £2.5pm rating	Ex occupation TPD O & A unable to offer terms	Unable to offer terms
Hot air balloon pilot 150 hours a year No higher risk flying activities	£1.25pm to £2.5pm rating	Ex occupation TPD O & A unable to offer terms	Unable to offer terms

Diving (Commercial)

This is one of the most dangerous occupations. There are several accident and health risks such as decompression sickness (the bends) and becoming entangled in ropes. We won’t be able to provide income protection for commercial divers.

Things we’ll ask about:

The maximum depth your client dives to
The capacity they dive in e.g. police, instructor
How often they dive
Whether their dives are coastal, inland or deep waters
Whether they do any higher risk diving e.g. explosives, ice fields, saturation diving

Example underwriting outcomes:

Diving (commercial)	Life cover	Critical illness cover
Police diver Working in coastal waters No higher risk diving activities	Standard	Standard TPD O & A unable to offer terms
Working on rig construction in deep waters, max 150m	£1.25pm to £2.5pm	Ex occupation TPD O&A unable to offer terms
Cable laying Working in deep waters, max 150m	£3.5pm to £4.5pm rating	Ex occupation TPD O&A unable to offer terms

Fishing

Fishing work presents various accident and health risks such as falling into the water, injury due to machinery, respiratory disorders and mental illness. We won’t be able to provide income protection or TPD for fishing workers.

Things we’ll ask about:

The size of vessel your client works on
The nature of their duties
Whether they fish alone
Whether they work at sea

Example underwriting outcomes:

Fishing	Life cover	Critical illness cover
Vessel >40m Admin work only	£1.25pm to £2.5pm rating	TPD O unable to offer terms TPD A unable to offer terms
Vessel 10m Fishes alone	£1.25pm to £2.5pm rating	Ex occupation TPD O unable to offer terms TPD A unable to offer terms
Vessel >40m Heavy manual work/work with machines	£3.75pm to £6.25pm rating	Ex occupation TPD O unable to offer terms TPD A unable to offer terms

Houseperson

We won’t be able to provide income protection for housepersons.

Things we’ll ask about:

No additional information is needed.

Underwriting outcomes:

Occupation	Life cover	Critical illness cover
Houseperson	Standard	Standard TPD O unable to offer terms TPD A Standard

Merchant Marine

There are accident and health risks such as falling overboard, falling cargo, fires, musculoskeletal disorders related to heavy lifting, high alcohol consumption, noise induced deafness and more.

Things we’ll ask about:

The nature of your clients’ duties e.g. clerical, light manual, heavy manual
Whether the vessel goes to sea
Whether the vessel transports passengers or cargo

Example underwriting outcomes:

Merchant marine	Life cover	Critical illness cover	Income protection
Officer Light manual duties Cargo ship	Standard	TPD O unable to offer terms TPD A standard	Occupation class 4
Working on the ship’s engine	£1.25pm to £2.5pm rating	Ex occupation TPD O unable to offer terms TPD A unable to offer terms	Unable to offer terms

Mining

There are accident and long-term health risks linked with mining. Possible accidents include rock falls, roof collapse, fires, explosions, falling and flooding. Possible long-term health effects include respiratory diseases, lung cancer, back disorders, hearing loss and neurological conditions caused by poisoning. We won’t be able to provide income protection for those working in the mining industry.

Things we’ll ask about:

The nature of your client’s duties e.g. underground, administrative, drilling
Whether their work involves using explosives
Whether they do open-cast or underground mining

Example underwriting outcomes:

Mining	Life cover	Critical illness cover
Mining engineer, admin duties only, no manual work	Standard	TPD O unable to offer terms TPD A unable to offer terms
Miner	£1.25pm to £2.5pm rating	Ex occupation TPD O unable to offer terms TPD A unable to offer terms
Mining engineer Use of explosives Light manual work	£1.25pm to £2.5pm rating	Ex occupation TPD O unable to offer terms TPD A unable to offer terms

Oil and Natural Gas

Offshore work presents various risks such as travel to and from rigs in various parts of the world, and risks related to the heavy manual nature of many roles. But the risks vary according to the exact role of the client. We won’t be able to provide TPD O for oil or natural gas workers.

Things we’ll ask about:

Your client’s job title
Whether they work indoors or outdoors
Percentage of light and heavy manual work/admin, supervisory duties
Whether they work with machinery
Whether they work at heights
Whether they work on the rig floor
Whether their job involves diving or not
If they dive, see the diving (commercial) section above

Example underwriting outcomes:

Oil and natural gas	Life cover	Critical illness cover	Income protection
Offshore, works indoors, e.g. manager No manual duties 100% admin	Standard	Standard TPD O unable to offer terms TPD A Standard	Occupation class 3
Offshore production worker Driller	£1.25pm to £2.5pm rating	Ex occupation TPD O unable to offer terms TPD A Standard	Unable to offer terms

Police

Occupational risks include road traffic accidents, assault, musculoskeletal disorders due to physical activity and mental health disorders such as post-traumatic stress. We won’t be able to provide income protection for police.

Things we’ll ask about:

Your client’s job title

Example underwriting outcomes:

Police	Life cover	Critical illness cover
Police constable No special duties	Standard	TPD O unable to offer terms TPD A standard
Motorcycle police	Standard	TPD O unable to offer terms TPD A standard
Armed response unit	Individual consideration Likely £1.25pm to £2.5pm rating	Individual consideration Likely Ex occupation TPD O unable to offer terms TPD A standard
Bomb disposal	Individual consideration Likely: £3.75pm to £6.25pm rating	Individual consideration Likely: Ex occupation TPD O unable to offer terms TPD A Ex occupation

Quarrying

This can be heavy manual work. Accident and health risks include rock falls, extreme weather, working with explosives and heavy machinery, and exposure to dust which can cause lung and eye disorders.

Things we’ll ask about:

Your client’s job title
The nature of their duties e.g. underground, administrative, drilling
Whether their work involves using explosives

Example underwriting outcomes:

Quarrying	Life cover	Critical illness cover	Income protection
Manager, admin duties only, no outdoor or manual work	Standard	Standard	Occupation class 2
Quarry master	Standard	TPD O unable to offer terms TPD A standard	Unable to offer terms
Quarry man Heavy manual work No use of explosives	£1.25pm to £2.5pm rating	Ex occupation TPD O unable to offer terms TPD A unable to offer terms	Unable to offer terms

Residence

Living in other countries can involve a higher level of risk because of things like political instability or poor healthcare facilities.

Residence ratings are normally £1 for each £1,000 of cover a year. Otherwise known as per mille (pm) ratings. For example, a £2.5pm rating for a cover amount of £20,000 would be £2.5 x 20 = £50 a year.

Applicants need to be a UK resident which is defined as someone who fulfils the following requirements:

They have been permanently resident in the UK for past 2 years with the right to remain in the UK.
Their permanent home must be in the UK.
They have a UK bank account which must be used to make payment.
They have a UK address (not a ‘care of’ address).
They’ve been registered with a UK doctor for the past 2 years.

Because of US taxation we only cover US nationals if they fulfil the following requirements:

they’re permanently resident in the UK
they work for a UK company
they only pay tax in the UK.

If your client lives in or is planning to live in the US, we won’t be able to offer them cover. If they have dual US and UK nationality, we’ll be able to offer them cover subject to normal underwriting. For the avoidance of doubt, Canadian nationals or residents are underwritten in the usual way.

Relevant application questions:

Have you lived in Africa, Thailand, Russia, Ukraine or the Caribbean for more than 3 months during the last 5 years?

If your client answers ‘yes’ to the above question, we’ll request an HIV test for Life Protection and HIV/hepatitis B&C tests for Combined Life and Critical Illness Protection, Critical Illness Protection and Income Protection.

In the next 2 years, are you planning to travel, live or work outside of the European Union (EU), Isle of Man, Channel Islands, Australia or New Zealand? (They don’t need to tell us about any holiday they’re taking which is less than 30 days in a year.)

We also ask if your client has lived in the UK for the last 2 years, and if they’ve been registered with a UK doctor for the last 2 years. We wouldn’t be able to offer cover to anyone who hasn’t lived in the UK and been registered with a UK GP for the last 2 years. We also ask whether they’ve visited, are currently visiting, or intending to visit any doctor outside the UK for medical treatment, investigations or advice.

Things we’ll ask about:

Your client’s intended country or countries of residence
How long they expect to live in the intended country or countries of residence
Whether they plan to leave the UK permanently
The number and duration of trips they take each year
Their reason for travelling there

Example underwriting outcomes:

Future residence	Life cover	Critical illness cover	Income protection
Low-risk country e.g. Norway Residence of less than 12 months Currently resident in the UK	Standard	Standard	Standard
Moderate-risk country e.g. Nepal No travel to hazardous parts of the country Residence of less than 12 months Currently resident in the UK	Individual consideration Likely £1.25pm to £6.25pm rating	Individual consideration Likely £1.25pm to £6.25pm rating TPD O unable to offer terms TPD A unable to offer terms	Unable to offer terms
High-risk country e.g. Yemen	Unable to offer terms	Unable to offer terms	Unable to offer terms

WE MAKE EVERY EFFORT TO UNDERWRITE EVERYONE AND OFFER THEM THE BEST POSSIBLE TERMS.

Underwriting guide

THE QUESTIONS WE ASK AND THE INFORMATION WE NEED

Introduction

Key

Definitions

Clinical Trials

Financial Underwriting

Genetics

Ratings

Underwriting QI

Premium Waiver

Hints and tips

Medical conditions

Sports activities

Occupation

Residence

Tools and Literature

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