> _Markdown transcription of AIA New Zealand AIA Living Critical Conditions Cover policy wording, effective 2026-05-18. Source: https://www.aia.co.nz/content/dam/nz/en/docs/our-products/policy-wordings/aia-living/personal/aia-living-personal-critical-conditions-policy-wording.pdf_ --- # AIA LIVING - PERSONAL OPTIONAL BENEFIT APPENDIX ## Critical Conditions Benefit This appendix only applies if cover under the schedule for your policy includes the Critical Conditions Benefit. This appendix forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix. This Critical Conditions Benefit may be standalone or accelerated. Details of the benefit and the life/lives assured are shown in the schedule. ## 1. When will AIA pay a Critical Conditions Benefit? AIA will pay you a Critical Conditions Benefit if the life assured suffers for the first time after the risk commencement date any of the conditions listed in the table below and survives for at least 14 days thereafter. An exception is the Optional Total Permanent Disablement condition, for which a three month survival period applies. ### What stand down periods apply? If, within the first three months after the risk commencement date, any of the conditions marked in the table below as having a three month stand down period occur, or symptoms or signs which lead to any of those conditions (whether or not a registered medical practitioner has been consulted) occur, then AIA will not pay a benefit for the life assured or any child of the life assured covered by the Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit. ### Cover added under the Critical Conditions Future Insurability Benefit or the Special Events Increase Facility A six month stand down period applies to increases made under the Built-in Critical Conditions Future Insurability Benefit or the Built-in Special Events Increase Facility, except where the claim is due to an accident, as outlined in Sections 9 and 10. Where the claim is due to an accident, the three month stand down period is waived on such increases, provided the life assured has already served the three month stand down period on the original Critical Conditions Benefit policy. ### Cover added under the Special Events TPD/Trauma Facility A six month stand down period applies to any accelerated Critical Conditions Benefit cover added for the life assured using the Special Events TPD/Trauma Facility under the Life Cover Benefit, except where the claim is due to an accident, as outlined in the Life Cover Benefit appendix. Where the claim is due to an accident, the three month stand down period applies to the added cover from the date the added cover commences, for any of the conditions marked in the table below as having a three month stand down period. ### Built-in Newborn Children's Benefit A 12 month stand down period applies to the Built-in Newborn Children's Benefit, meaning that AIA will only pay a claim for a child of a life assured, where the life assured is the biological parent, if birth of the child with one of the applicable conditions occurs at least 12 months after the risk commencement date. This 12 month stand down period applies anew to all added cover from the date the added cover commences, including cover added using the Critical Conditions Future Insurability Benefit, the Special Events Increase Facility, or the Special Events TPD/Trauma Facility under the Life Cover Benefit. ### Medical Advancements Provision If the medical diagnostic techniques and investigations used in our definitions of medical conditions have been superseded due to medical advancements, we will consider other appropriate and medically recognised methods or tests that conclusively diagnose the condition to at least the same severity. The following requirements must be met for a claim to be considered: - The new diagnostic techniques and investigations are not experimental and are medically necessary and medically equivalent or superior to the original diagnostic technique or investigation. - Any new diagnostic techniques and investigations must be deemed medically acceptable based on medical standards and medically recognised in Australia or New Zealand by specialist medical practitioners. ### Conditions Table | Condition | Three month stand down period | Full payment | Partial Payment | Built-in Children's Trauma Benefit (Section 4) | Optional Children's and Maternity Benefit (Section 17) | |-----------|-------------------------------|--------------|-----------------|------------------------------------------------|-------------------------------------------------------| | **Cancer** | | | | | | | Carcinoma-in-situ | ✓ | - | ✓ | ✓ | ✓ | | Carcinoma-in-situ radical surgery | ✓ | ✓ | - | ✓ | ✓ | | Malignant tumours and blood cancers | ✓ | ✓ | - | ✓ | ✓ | | Prostate Cancer | ✓ | ✓ | - | ✓ | ✓ | | **Heart** | | | | | | | Angioplasty – less than 3 vessels | ✓ | - | ✓ | ✓ | ✓ | | Angioplasty – 3 vessels or more | ✓ | ✓ | - | ✓ | ✓ | | Aortic surgery | ✓ | ✓ | - | ✓ | ✓ | | Cardiac Defibrillator Insertion | ✓ | - | ✓ | - | - | | Cardiomyopathy | - | ✓ | - | ✓ | ✓ | | Coronary artery bypass surgery | ✓ | ✓ | - | ✓ | ✓ | | Heart attack | ✓ | ✓ | - | ✓ | ✓ | | Heart valve surgery | ✓ | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Out-of-hospital cardiac arrest | - | ✓ | - | ✓ | ✓ | | Pacemaker insertion | ✓ | - | ✓ | - | - | | Pulmonary hypertension | - | ✓ | - | ✓ | ✓ | | **Major neurological disease** | | | | | | | Alzheimer's disease | - | ✓ | - | ✓ | ✓ | | Benign brain or spinal cord tumour | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Cerebral Aneurysm | ✓ | - | ✓ | - | - | | Coma | - | ✓ | - | ✓ | ✓ | | Creutzfeldt-Jakob disease | - | ✓ | - | ✓ | ✓ | | Dementia | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Encephalitis | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Idiopathic Parkinson's disease | - | ✓ | - | ✓ | ✓ | | Major head trauma | - | ✓ | - | ✓ | ✓ | | Meningitis | - | ✓ | - | ✓ | ✓ | | Motor neurone disease | - | ✓ | - | ✓ | ✓ | | Multiple sclerosis | ✓ | ✓ | - | ✓ | ✓ | | Muscular dystrophy | - | ✓ | - | ✓ | ✓ | | Peripheral neuropathy | - | ✓ | - | ✓ | ✓ | | Stroke | ✓ | ✓ | - | ✓ | ✓ | | **Paralysis and loss of functionality** | | | | | | | Diplegia | - | ✓ | - | ✓ | ✓ | | Hemiplegia | - | ✓ | - | ✓ | ✓ | | Loss of independent existence | - | ✓ | - | ✓ | ✓ | | Paraplegia | - | ✓ | - | ✓ | ✓ | | Permanent blindness | ✓ | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Permanent loss of hearing | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Permanent loss of speech | - | ✓ | - | ✓ | ✓ | | Permanent loss of use of limbs | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Quadriplegia / Tetraplegia | - | ✓ | - | ✓ | ✓ | | **Other key conditions** | | | | | | | Advanced AIDS | - | ✓ | - | ✓ | ✓ | | Advanced diabetes | ✓ | ✓ | - | ✓ | ✓ | | Aplastic anaemia | - | ✓ | - | ✓ | ✓ | | Chronic liver failure | ✓ | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Chronic lung disease | ✓ | ✓ | - | ✓ | ✓ | | Chronic renal failure | - | ✓ | - | ✓ | ✓ | | Cognitive impairment | - | ✓ | - | ✓ | ✓ | | Intensive care | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Major transplant surgery | - | ✓ | - | ✓ | ✓ | | Pneumonectomy | - | ✓ | - | ✓ | ✓ | | Severe burns | - | ✓ | ✓ | ✓ (partial payment unavailable) | ✓ (partial payment unavailable) | | Severe Crohn's disease | ✓ | - | ✓ | - | - | | Severe illness or injury | ✓ | ✓ | - | ✓ | ✓ | | Severe osteoporosis | ✓ | - | ✓ | - | - | | Severe rheumatoid arthritis | ✓ | - | ✓ | - | - | | Severe ulcerative colitis | ✓ | - | ✓ | - | - | | Systemic lupus erythematosus with lupus nephritis | - | ✓ | - | ✓ | ✓ | | Systemic sclerosis | - | ✓ | - | ✓ | ✓ | | Terminal illness | - | ✓ | - | ✓ | ✓ | | **Optional condition** | | | | | | | Total Permanent Disablement | - | ✓ | - | - | - | (Refer to Section 22 for a full description of these conditions.) If you receive a full payment claim for a life assured under this Critical Conditions Benefit, cover will cease for that life assured. If you receive a partial payment of this Critical Conditions Benefit for a life assured, cover will continue for that life assured with the sum assured being reduced by the amount of the partial payment amount. The premium will reduce with the reduction in sum assured. If the life assured suffers more than one condition (including the Optional Total Permanent Disablement condition), AIA will pay a maximum of the Critical Conditions Benefit sum assured for all claims (in total). ## 2. What effect does payment of an accelerated Critical Conditions Benefit have on the Life Cover Benefit? This section applies only if an accelerated Critical Conditions Benefit is shown in the schedule. When AIA pays an accelerated Critical Conditions Benefit, the Life Cover Benefit for the life assured will decrease by the same amount. Any other accelerated benefits relating to that Life Cover Benefit will also be reduced, if necessary, so that those accelerated benefits do not exceed the decreased Life Cover Benefit. If the Life Cover Benefit is reduced to nil, all accelerated benefits relating to that Life Cover Benefit will be removed. The maximum combined amount payable under the Life Cover Benefit, Specified Terminal Conditions Benefit, Terminal Illness Benefit, Bereavement Support Benefit, Repatriation Benefit, accelerated Critical Conditions Benefit and, if applicable, the accelerated Progressive Care Benefit and the accelerated Total Permanent Disablement Benefit is the amount of the Life Cover Benefit for that life assured. ## 3. Built-in Financial and Legal Advice Benefit If AIA pays a full payment claim under this Critical Conditions Benefit for a condition suffered by a life assured, then AIA will reimburse you for fees up to $2,500 including GST (in total) that you pay for financial planning you receive from an accredited Adviser or legal advice received from a legal professional approved by AIA, subject to the following conditions: - You must pay for the financial planning or legal advice within the three months following AIA paying the Critical Conditions Benefit claim. - You must provide AIA with a completed claim form and a receipt satisfactory to AIA for the fees you are claiming. - AIA will only pay one Financial and Legal Advice Benefit per life assured across all AIA policies. This is in addition to the sum assured. The Built-in Financial and Legal Advice Benefit is not payable for a claim for a child of the life assured under the Built-in Children's Trauma Benefit, the Built-in Parents Grieving Benefit, the Optional Children's and Maternity Benefit or the Built-in Newborn Children's Benefit. ## 4. Built-in Children's Trauma Benefit ### What is the Built-in Children's Trauma Benefit? AIA will pay a Built-in Children's Trauma Benefit if a child of a life assured suffers one of the applicable conditions listed in Section 1 of this appendix. This Benefit is only payable if the child of the life assured: - first suffers a condition after the risk commencement date, subject to the applicable stand down period provisions where these apply; - is aged from three months up to their 21st birthday at the time he or she first suffers from that condition; and - survives for at least 14 days after suffering from the condition. ### What are the applicable conditions and how much will AIA pay? For those conditions where the criteria for a full payment are met as detailed in Section 22 below, the Benefit payable is the lower of $50,000 or 50% of the sum assured across all Critical Conditions Benefit policies for the life assured. No payments are made under this Benefit for the Optional Total Permanent Disablement condition or any of those conditions where a partial payment applies, except for the following conditions: - Angioplasty – less than 3 vessels; - Carcinoma-in-situ. For these conditions, the Benefit payable is the lower of $50,000 or 10% of the sum assured across all Critical Conditions Benefit policies for the life assured. AIA will pay a maximum of one claim per child under either the Built-in Children's Trauma Benefit or the Built-in Newborn Children's Benefit, across all AIA policies. The Built-in Children's Trauma Benefit or the Built-in Newborn Children's Benefit is payable in addition to the Optional Children's and Maternity Benefit (if applicable). Payment of the Built-in Children's Trauma Benefit will not affect the amount of any Critical Conditions Benefit payable for the life assured. AIA will not pay a benefit under the Built-in Children's Trauma Benefit that arises as a direct or indirect consequence of: - a pre-existing condition; or - any congenital condition. The Built-in Children's Trauma Benefit ceases on the child's 21st birthday. ## 5. Built-in Newborn Children's Benefit ### What is the Built-in Newborn Children's Benefit? AIA will pay a Built-in Newborn Children's Benefit if a child of a life assured, where the life assured is the biological parent, is born with one of the following conditions and survives for thirty days after birth: - Cleft palate. - Down's syndrome. - Spina bifida. - Total blindness. - Absence of one or more limbs. - Tetralogy of Fallot. - Transposition of Great Vessels. - Deafness. Please refer to Section 23 for the definitions of these conditions. In order for AIA to pay a claim under this Benefit, we will require medical information from a registered medical practitioner acceptable to us that conclusively evidences the condition. In circumstances where a conclusive diagnosis cannot be made at birth, we will defer our assessment of the claim until sufficient evidence can be supplied. For example, this might apply in the case of total blindness or deafness, where a conclusive diagnosis may not be possible until later in the child's life. In these cases, the claims assessment will be based on the child's sight or hearing impairment at the date that conclusive diagnosis is first possible. A claim is only payable under the Built-in Newborn Children's Benefit if cover remains in effect for the life assured up to the date that the conclusive diagnosis for the child occurs. ### How much will AIA pay? The Benefit payable is the lower of $50,000 or 50% of the sum assured across all Critical Conditions Benefit policies for the life assured. AIA will pay a maximum of one claim per child under either the Built-in Newborn Children's Benefit or the Built-in Children's Trauma Benefit, across all AIA policies. The Built-in Newborn Children's Benefit is only payable where the birth of the child with one of the applicable conditions occurs at least 12 months after the risk commencement date. This requirement applies anew to all added cover from the date the cover commences; including cover added using the Built-in Critical Conditions Future Insurability Benefit, the Special Events Increase Facility, or the Special Events TPD/Trauma Facility under the Life Cover Benefit. The Built-in Children's Trauma Benefit or the Built-in Newborn Children's Benefit is payable in addition to the Optional Children's and Maternity Benefit (if applicable). Payment of the Built-in Newborn Children's Benefit will not affect the amount of any Critical Conditions Benefit payable for the life assured. ## 6. Built-in Children's Trauma Conversion Facility The Built-in Children's Trauma Benefit can be converted to: - a standalone Critical Conditions Benefit; or - an accelerated Critical Conditions Benefit with an equal amount of Life Cover benefit, with a maximum sum assured of $50,000 or 50% of the life assured's original sum assured whichever is the lesser, without further medical evidence. Where the life assured's sum assured has reduced the conversion will be calculated on the reduced amount. If the Optional Children's and Maternity Benefit is shown on the schedule, it can also be converted to a standalone Critical Conditions Benefit or an accelerated Critical Conditions Benefit with an equal amount of Life Cover benefit with a maximum sum assured of $75,000 without further medical evidence. The following conditions are applicable to both Children's Trauma Conversion options: - A conversion cannot occur if the child has claimed or was eligible to claim under the Built-in Children's Trauma Benefit and/or Optional Children's and Maternity Benefit; and - Your request for conversion must be received by AIA within 60 days of the anniversary date after the child's 21st birthday; and - Your request must be received in writing. An applicable premium will be payable on converted cover. ## 7. Built-in Standalone Conversion Facility If the schedule shows the Critical Conditions Benefit as standalone you can convert this to an accelerated Critical Conditions Benefit with an equal amount of Life Cover Benefit without any further medical evidence subject to the following: - The life assured was accepted with standard underwriting terms (e.g. there are no special terms, exclusions or premium loadings applicable to the life assured); - The life assured is only eligible for the Standalone Conversion Facility where the conversion occurs before age 60; - The life assured has not made a claim, with AIA or any other insurer, and is not eligible to make a claim under their standalone Critical Conditions Benefit. This includes any claim currently under assessment; - The premiums for their standalone Critical Conditions Benefit are paid up to date; - The accelerated Critical Conditions Benefit sum assured must be less than or equal to the standalone Critical Conditions sum assured; and - The Life Benefit Cover sum assured does not exceed the accelerated Critical Conditions sum assured. The premium for the conversion will be based on the age of the life assured and our premium rates at the date of conversion. If you are issued a new policy for the amount of the standalone Critical Conditions Benefit being converted the new policy will be issued based on the information provided at the time of conversion, together with the information provided in the original proposal. If the death of the life assured occurs within three months of the date of conversion, other than by accidental death, then this conversion is void and the standalone Critical Conditions Benefit will be reinstated from the date of conversion. ## 8. Built-in Premium Conversion Facility You may at any time prior to the life assured reaching age 65: - Convert all or part of your Critical Conditions Benefit from the premium type shown in the schedule to a Level premium structure; or - Convert a Level premium structure to an alternate Level premium structure, of which term duration may be the same or less than current Level premium structure. AIA will not require you or the life assured to produce further medical evidence at the time of conversion. You will be issued a new policy for the sum assured amount of the Critical Conditions Benefit being converted, in which case: - The Critical Conditions Benefit under this policy will be reduced by the sum assured amount converted; - The new policy will be issued based on the information provided at the time of conversion, together with the information provided in the original proposal; - The terms and conditions of the new policy will be those which are then offered by us to the general public; - Premiums will be calculated on the current age of the life assured; - Any special terms, exclusions or premium loadings that applied to your existing Critical Conditions Benefit under this policy will apply to your new Critical Conditions Benefit under the new policy. ## 9. Built-in Special Events Increase Facility ### What is the Special Events Increase Facility? On each occasion when one of the following circumstances occurs for a life assured on the Critical Conditions Benefit: - having a child (by birth or legal adoption); - becoming married or entering into a civil union; - becoming legally separated, divorced or the dissolution of the life assured's civil union; - financially supporting a dependent child through a first course of full-time tertiary education; - the commencement of secondary school for the first time by a child of the life assured; - taking out or increasing a home loan because the life assured has purchased a new home, a new residential investment property, a vacation home, or a bare block of land zoned as residential, or is making extensions to a residential property or residential investment property owned by the life assured; - becoming responsible for the full-time care or payment for long term care of a close relative; - receiving an annual salary increase (this special event is not available to a life assured who is self-employed); or - experiencing the death of a spouse, civil or de facto partner, you may write to AIA asking us to increase the Critical Conditions Benefit for that life assured. ### What is the maximum cover that can be added? The maximum increase for each special event cannot exceed the lower of: - 50% of the original Critical Conditions Benefit for the life assured; or - $250,000. The total of all increases made under this Facility cannot exceed the lower of: - 100% of the original Critical Conditions Benefit for the life assured; or - $750,000. In the case of taking out or increasing a home loan, the individual increase cannot exceed the amount of the home loan or the increase in the home loan. In the case of an annual salary increase, the individual increase cannot exceed five times the annual salary increase. The maximum increases outlined above each apply in respect of all Critical Conditions Benefits, Progressive Care Benefits, and similar benefits for that life assured across all AIA policies. Both of the following maximum sum assured limits also apply across all AIA policies for each life assured: - the total of the sum assured for all Critical Conditions Benefits, Progressive Care Benefits, and similar trauma benefits (combined), including increases under this Facility must not exceed $2,000,000; and - the total of the sum assured for all trauma benefits combined must not exceed $2,000,000 and the total sum assured for all trauma and Total Permanent Disablement Benefits (and similar benefits) combined must not exceed $5,000,000. ### What are the other conditions applying to this Facility? You do not need to produce any medical evidence regarding the life assured when you request this increase, but any Special Events Increase is subject to the following conditions: - You must make the request within 60 days either side of the relevant special event and provide AIA with suitable evidence of the occurrence of the event. - A life assured is only eligible for Special Events Increases where the special event occurs from the age of 16 and before age 55. - If, at any time before you seek to exercise the Facility, a claim for the life assured had been accepted by us or notified to us, AIA will have discretion in determining whether the Facility can be exercised. In exercising discretion, we will consider whether, based on the medical evidence submitted in support of the claim, the life assured represents an increased risk of claim for the benefit being added under this Facility. - Only one of the following is available in any 12 month period: - A Critical Conditions Future Insurability Benefit increase (see Section 10 below). - A Special Events Increase under a Critical Conditions Benefit or Progressive Care Benefit. - (If applicable) exercising the Special Events TPD/Trauma Facility under the Life Cover Benefit and/or similar benefits to add an accelerated Critical Conditions Benefit or an accelerated Progressive Care Benefit. - The Optional Early Cancer Upgrade Benefit is not available for the purposes of determining Special Event Increases. AIA will increase the Critical Conditions Benefit for a life assured from the date we accept your request. Each increase will require an increase in premium. This increase will be calculated on the rates applicable at the time the Built-in Special Events Increase Facility is exercised. Any loadings, exclusions or special terms on the original Critical Conditions Benefit sum assured will be applied to the increased amount. If you have the Optional Critical Conditions Buyback Benefit or the Optional Life Cover Buyback Benefit selected on the policy for your original Critical Conditions Benefit, you can choose to add these benefits to the portion of the increased sum assured when you exercise the Special Events Increase Facility. ### When will AIA not pay a claim for an increase under this Facility? #### a. Increases in sum assured added to this policy After an increase under this Facility has been made, AIA will not pay the increased benefit amount if, before the increase, or within six months of the Facility being exercised, the life assured: - suffers any condition for the first time other than due to an accident under the Critical Conditions Benefit; or - has any symptoms or signs leading to a condition (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Critical Conditions Benefit. #### b. Increases in sum assured issued as an additional new policy Where this policy or any part of the sum assured under it, has been issued as the result of an increase under the Built-in Special Events Increase Facility, then: - the Special Events Increase Facility will not be available under this policy for the proportion of the sum assured that represents the increase; - AIA will not pay the increased benefit amount if, before the increase, or within six months of the increase, the life assured: - suffers any condition for the first time other than due to an accident under the Critical Conditions Benefit; or - has any symptoms or signs leading to a condition (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Critical Conditions Benefit. ## 10. Built-in Critical Conditions Future Insurability Benefit At every third policy anniversary date you may write to AIA asking us to increase the Critical Conditions Benefit for a life assured. You do not need to produce any medical evidence regarding the life assured when you request this increase, but any increase in sum assured under this Benefit is subject to the following conditions: - You must request the increase by providing written advice to AIA within 60 days either side of the applicable anniversary date. Outside of this time frame, the Critical Conditions Future Insurability Benefit is not available. - Each individual increase cannot exceed 20% of the original Critical Conditions Benefit sum assured or $200,000, whichever is the lesser. - The total of all Critical Conditions Future Insurability Benefit increases for a life assured cannot exceed 100% of the original Critical Conditions Benefit for that life assured or $500,000, whichever is the lesser. - Both of the following maximum sum assured limits also apply across all AIA policies for each life assured: - The total of the sum assured for all Critical Conditions Benefits, Progressive Care Benefits, and similar trauma benefits (combined), including increases under this Benefit must not exceed $2,000,000; and - The total of the sum assured for all trauma benefits combined must not exceed $2,000,000 and the total sum assured for all trauma and Total Permanent Disablement Benefits (and similar benefits) combined must not exceed $5,000,000. - Where this Critical Conditions Benefit is shown in the schedule as accelerated against the Life Cover Benefit, the Critical Conditions Benefit, including the total of all Critical Conditions Future Insurability Benefit increases, cannot exceed the sum assured of the Life Cover Benefit. See Section 2 'What effect does payment of an accelerated Critical Conditions Benefit have on the Life Cover Benefit' for details. - A life assured is only eligible for Critical Conditions Future Insurability Benefit increases from the age of 16, and before age 55. - AIA will increase the Critical Conditions Benefit for a life assured from the date we accept your request. - If, at any time before you seek to exercise an increase under this Benefit, a claim for the life assured had been accepted by us or notified to us, AIA will have discretion in determining whether the increase will be accepted. In exercising discretion, we will consider, based on the medical evidence submitted in support of the claim, whether the life assured represents an increased risk of claim for the cover being added under this Benefit. - Only one of the following is available in any 12 month period: - A Built-in Critical Conditions Future Insurability Benefit increase; - A Special Events Increase under a Critical Conditions Benefit or Progressive Care Benefit; or - (If applicable) exercising the Special Events TPD/Trauma Facility under the Life Cover Benefit and/or similar benefits to add an accelerated Critical Conditions Benefit or an accelerated Progressive Care Benefit. - The Optional Early Cancer Upgrade Benefit is not available for the purposes of determining Built-in Critical Conditions Future Insurability Benefit increases. Each Built-in Critical Conditions Future Insurability Benefit increase in sum assured will require an increase in premium. This increase will be calculated on the rates applicable at the time the Built-in Critical Conditions Future Insurability Benefit is exercised. Any loadings, exclusions or special terms on the original Critical Conditions Benefit sum assured will be applied to the increased amount. The Built-in Critical Conditions Future Insurability Benefit is not available for the Optional Early Cancer Upgrade Benefit or the Optional Children's and Maternity Benefit. If you have the Optional Critical Conditions Buyback Benefit or the Optional Life Cover Buyback Benefit selected on the policy for your original Critical Conditions Benefit, you can choose to add these benefits to the portion of the increased sum assured when you exercise the Built-in Critical Conditions Future Insurability Benefit. ### When will AIA not pay a claim for an increase under this Benefit? #### a. Increases in sum assured added to this policy After a Built-in Critical Conditions Future Insurability Benefit increase has been made, AIA will not pay the increased amount if, before the increase, or within six months of the increase, the life assured: - suffers any condition for the first time other than due to an accident under the Critical Conditions Benefit; or - has any symptoms or signs leading to a condition (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Critical Conditions Benefit. #### b. Increases in sum assured issued as an additional new policy Where this policy or any part of the sum assured under it, has been issued as the result of an increase under the Built-in Critical Conditions Future Insurability Benefit, then the Built-in Critical Conditions Future Insurability Benefit under this policy will not be available for the proportion of the sum assured that represents the increase. AIA will not pay the increased amount if, before the increase, or within six months of the increase, the life assured: - suffers any condition for the first time other than due to an accident under the Critical Conditions Benefit; or - has any symptoms or signs leading to a condition (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Critical Conditions Benefit. ## 11. Built-in Return Home Benefit AIA will pay a Return Home Benefit if the life assured is outside of New Zealand and suffers, for the first time, a covered condition. The Return Home Benefit will reimburse the cost of a standard economy flight back to New Zealand for the life assured and one support person. You will need to provide evidence of the transport costs satisfactory to us before a claim under the Return Home Benefit will be paid. In total the maximum we will pay over the life of the policy under the Return Home Benefit is $10,000. A Return Home Benefit is paid in addition to the Critical Conditions Benefit. No payment will be made if the life assured is covered for the same event with a travel insurance provider. ## 12. Built-in Parents Grieving Benefit ### When is a Parents Grieving Benefit payable? AIA will pay a Parents Grieving Benefit if a child of a life assured dies: - prior to birth but after at least 24 weeks gestation, provided the child would have been born at least 12 months after the risk commencement date if the pregnancy continued to full term, where the life assured is the biological mother of the child; or - after birth and at least 12 months after the risk commencement date. This Parents Grieving Benefit ceases on the child's 21st birthday. ### How much will AIA pay for the Parents Grieving Benefit? The benefit payable is: - $2,000 if the child is under 10 years of age, or - $15,000 if the child is 10 years of age or over. Payment of the Parents Grieving Benefit will not reduce the sum assured of the Critical Conditions Benefit for the life assured. AIA will pay a maximum of one claim per child under the Parents Grieving Benefit across all AIA policies for a life assured. ## 13. Built-in Counselling Benefit The Counselling Benefit covers the cost of a Psychiatrist or Psychologist consultation and/or counselling for the life assured and/or a close relative of the life assured where the support treatments and/or consultations directly relate to a claim under the Critical Conditions Benefit. After referral by an appropriate specialist we will reimburse up to $2,500 including GST (in total) per life assured, subject to the following conditions: - The consultation and/or counselling must be paid for within three months following AIA paying the Critical Conditions Benefit; and - AIA must be provided with a receipt for the consultation and/or counselling being claimed. The $2,500 is payable once per life assured per policy. This is in addition to the sum assured. ## 14. Built-in Suspension of Cover Benefit A life assured can suspend their cover under this benefit appendix for up to 12 months if they: - go on parental leave; - go on leave without pay for any reason; - become unemployed or redundant; - experience at least a 20% reduction in pay (comparing the most recent payslip against a previous payslip from the same year); or - if self-employed, experience a 30% reduction in revenue (by comparing one month's revenue against the same month for the previous year), provided that: - you notify AIA within three months of one of the above listed suspension events occurring and provide evidence to AIA of the suspension event; and - AIA acknowledges in writing receipt of that notification. Cover for the life assured will be suspended from the date set out in AIA's written acknowledgement. No premium will be payable during the period that the cover is suspended. No claim under this benefit appendix will be payable for any condition that occurs during, the period that the cover is suspended. A claim may only be payable if the life assured first meets the criteria for an eligible claim under this policy after their cover is reinstated. Cover under this benefit appendix may be reinstated at the end of the suspension period in accordance with this Section without the need to provide further medical evidence, provided that the benefit has been suspended for no longer than 12 months. At the end of the suspension period, the benefit will be automatically reinstated for the life assured. Cover for the life assured will be reinstated from the date set out in AIA's written acknowledgement. The premium payable for the reinstated benefit will be based on AIA's premium rates at the time of the reinstatement. ## 15. Optional Early Cancer Upgrade Benefit The Early Cancer Upgrade Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Early Cancer Upgrade Benefit. AIA will pay an Optional Early Cancer Upgrade Benefit (subject to the provisions of this policy) if the life assured suffers for the first time one of the cancer conditions listed below, after the date cover commences under the Optional Early Cancer Upgrade Benefit. AIA will not pay an Optional Early Cancer Upgrade Benefit if the life assured suffers the cancer condition or has any symptoms or signs leading to the cancer condition (whether or not a registered medical practitioner has been consulted) within three months after the date cover commences under the Optional Early Cancer Upgrade Benefit. The Optional Early Cancer Upgrade Benefit does not apply to children of the life assured covered under the Children's Trauma Benefit or the Optional Children's and Maternity Benefit. Only one claim per life assured can be made under the Optional Early Cancer Upgrade Benefit. The Optional Early Cancer Upgrade Benefit will cease once a claim is paid and your premiums will reduce accordingly. If at claim time, the life assured does not have a base Critical Conditions Benefit, no Optional Early Cancer Upgrade Benefit will be payable and any premiums paid for the Optional Early Cancer Upgrade Benefit after the base Critical Conditions Benefit has been cancelled will be refunded to the policy owner. The life assured's Optional Early Cancer Upgrade Benefit sum assured under this policy is shown in the schedule and is subject to the following maximums: - 25% of the Critical Conditions Benefit sum assured at the date cover under the Optional Early Cancer Upgrade Benefit first commences for the life assured; and - $75,000 per life assured across all AIA policies. The sum assured amount is calculated when cover under the Optional Early Cancer Upgrade Benefit first commences for the life assured under this policy and does not change with any subsequent changes that increase or decrease the life assured's Critical Conditions Benefit sum assured, such as: - annual indexation increases after the date cover commences under the Optional Early Cancer Upgrade Benefit; - cover added using the Special Events Increase Facility or the Special Events TPD/Trauma Facility; - Critical Conditions Future Insurability Benefit increases; or - reductions in the Critical Conditions Benefit sum assured due to voluntary reduction or due to a partial payment claim. Payment of the Optional Early Cancer Upgrade Benefit may be in addition to any other payments made under this policy. Payment of the Optional Early Cancer Upgrade Benefit will not reduce the Critical Conditions Benefit sum assured. The Optional Early Cancer Upgrade Benefit covers carcinoma-in-situ of the following sites and is defined as a focal autonomous new growth of carcinomatous cells which has not yet resulted in the invasion of normal tissue. 'Invasion' means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The carcinoma-in-situ must be positively diagnosed by biopsy and be classified as TIS according to the TNM staging method or FIGO Stage 0: - Breast. - Cervix. - Vagina. - Vulva. - Ovary. - Fallopian tube: tumour limited to tubal mucosa. The Optional Early Cancer Upgrade Benefit also covers the following cancers: - Chronic lymphocytic leukaemia: where there must be the presence of chronic lymphocytic leukaemia which is histologically described as at least RAI Stage 0. - Malignant melanoma which is determined by histological examination to be less than Clark Level 3 depth of invasion, and less than 1.0mm maximum thickness as measured using the Breslow method, and shows no evidence of ulceration. - Malignant tumour of the prostate histologically described as TNM classification T1 or has a Gleason score of 5 or less for which treatment is not considered medically necessary, and undertaken by an appropriate specialist to arrest the spread of malignancy including but not limited to prostatectomy, chemotherapy, radiotherapy, or surgery. The Optional Early Cancer Upgrade Benefit will cease when cover under the Critical Conditions Benefit ceases. Where the life assured has the Optional Critical Conditions Buyback Benefit, the Optional Early Cancer Upgrade Benefit can be reinstated in addition to their Critical Conditions Buyback Benefit, subject to the life assured satisfying the terms of the Optional Critical Conditions Buyback Benefit. The Optional Critical Conditions Buyback Benefit cannot be used to reinstate the Optional Early Cancer Upgrade Benefit following a claim payment under the Optional Early Cancer Upgrade Benefit. ## 16. Optional Total Permanent Disablement condition The Optional Total Permanent Disablement condition is available once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Total Permanent Disablement condition and, subject to the provisions of this appendix, is included as a full payment condition under the Critical Conditions Benefit. The Optional Total Permanent Disablement condition does not apply to any child of a life assured covered under the Children's Trauma Benefit or the Optional Children's and Maternity Benefit. The Optional Total Permanent Disablement condition does not apply once the life assured attains age 65. ## 17. Optional Children's and Maternity Benefit The Children's and Maternity Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Children's and Maternity Benefit. The Benefit is payable in addition to any Benefit payable under the Built-in Children's Trauma Benefit or the Built-in Newborn Children's Benefit. ### a. Children's Critical Conditions Benefit #### What is the Children's Critical Conditions Benefit? AIA will pay a Children's Critical Conditions Benefit if a child of a life assured suffers one of the applicable conditions listed in Section 1 of this appendix. This Benefit is only payable if the child of the life assured: - first suffers a condition after the risk commencement date, subject to the three month stand down period provisions where these apply; - is aged from three months up to their 21st birthday at the time he or she first suffers from that condition; and - survives for at least 14 days after suffering from the condition. AIA will pay a maximum of one claim for a child under the Children's Critical Conditions Benefit across all AIA policies for a life assured. In cases where two policies each name a distinct parent of the child as a life assured, both policies are eligible to claim under the Children's Critical Conditions Benefit for that child, provided the Optional Children's and Maternity Benefit is shown in the schedule of both policies. #### What are the applicable conditions and how much will AIA pay? For those conditions where the criteria for a full payment are met as detailed in Section 22 below, the Benefit payable is the lower of $75,000 or 50% of the Critical Conditions Benefit sum assured. No payments are made under this Benefit for the Optional Total Permanent Disablement condition or any of the conditions where a partial payment applies, except for the following conditions: - Angioplasty – less than 3 vessels. - Carcinoma-in-situ. For these conditions, the Benefit payable is the lower of $75,000 or 10% of the Critical Conditions Benefit sum assured. Before cover for a child can commence under the Children's Critical Conditions Benefit, you must advise us in writing of the child's name, date of birth and gender. Cover for a child will only commence once we have confirmation of the child's details in writing. ### b. Pregnancy Complications Benefit #### When is a Pregnancy Complications Benefit payable? This Benefit is payable if a life assured for the Critical Conditions Benefit suffers for the first time and at least 12 months after the risk commencement date one of the defined pregnancy complication conditions. AIA will not pay this benefit if the life assured suffers the condition or has any symptom or signs leading to the condition (whether or not a registered medical practitioner has been consulted) within 12 months after the risk commencement date. #### What pregnancy complication conditions are covered? - Disseminated intravascular coagulation. - Eclampsia. - Hydatidiform mole. See Section 24 for a full description of these conditions. #### How much will AIA pay for the Pregnancy Complications Benefit? The Benefit payable is $10,000. Payment of the Pregnancy Complications Benefit will not reduce the Critical Conditions Benefit. ### c. Children's Congenital Conditions Benefit #### When is the Children's Congenital Conditions Benefit payable? This Benefit is payable if at least 12 months after the risk commencement date a child of a life assured is unequivocally diagnosed by an appropriate specialist and undergoes treatment or therapy for one of the congenital conditions listed below. #### What congenital conditions are covered? - Coarctation of the Aorta. - Infantile Hydrocephalus. - Anal atresia. - Oesophageal atresia. - Congenital diaphragmatic hernia. - Tracheo-oesophageal fistula. - Truncus arteriosis. - Retinopathy of prematurity. #### How much will AIA pay for the Children's Congenital Conditions Benefit? The Benefit payable is $5,000, regardless of the number of congenital conditions diagnosed. AIA will pay a maximum of one claim for a child under the Children's Congenital Conditions Benefit across all AIA policies for a life assured. In cases where two policies each name a distinct parent of the child as a life assured, both policies are eligible to claim under the Children's Congenital Conditions Benefit for that child, provided the Optional Children's and Maternity Benefit is shown in the schedule of both policies. Payment of the Children's Congenital Conditions Benefit will not reduce the Critical Conditions Benefit. ### When will AIA not pay a claim under the Optional Children's and Maternity Benefit? AIA will not pay a benefit under the Optional Children's and Maternity Benefit that arises as a direct or indirect consequence of: - a pre-existing condition; or - any congenital condition, except where expressly covered under the Children's Congenital Conditions Benefit. The Optional Children's and Maternity Benefit will cease if cover under the Critical Conditions Benefit ceases. Where the life assured has the Optional Critical Conditions Buyback Benefit, the Optional Children's and Maternity Benefit can be reinstated in addition to their Critical Conditions Benefit, subject to the life assured satisfying the terms of the Optional Critical Conditions Buyback Benefit. The Optional Children's and Maternity Benefit ceases on the child's 21st birthday. ## 18. Optional Life Cover Buyback Benefit The Life Cover Buyback Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Life Cover Buyback Benefit and if you have selected an accelerated Critical Conditions Benefit. Where an Optional Life Cover Buyback Benefit is selected, this allows the Life Cover Benefit to be reinstated without the need to provide further medical evidence following an accelerated Critical Conditions Benefit claim, subject to the following conditions: - The Life Cover Benefit can be reinstated to the level applying immediately before the accelerated Critical Conditions Benefit claim. - The life assured must have had a claim paid on their accelerated Critical Conditions Benefit for one of the following conditions and have survived a period of six months after the claim payment date: - Paraplegia. - Quadriplegia. - Diplegia. - Hemiplegia. - Alzheimer's disease. - Permanent blindness. - Permanent loss of hearing. - Dementia. - Permanent loss of use of limbs. - Multiple sclerosis. - Idiopathic Parkinson's disease. - For all other conditions (including the Optional Total Permanent Disablement condition, where applicable), the life assured must have had a claim paid on their accelerated Critical Conditions Benefit and have survived a period of 12 months after the claim payment date. - The Life Cover Benefit can be reinstated following a full payment claim or a partial payment claim. - Only one Life Cover Buyback reinstatement will apply per life assured per policy. - The Life Cover Benefit must be reinstated within 60 days of the date that the Life Cover Benefit is first eligible to be reinstated. - The maximum Life Cover Benefit that can be reinstated is 100% of the accelerated Critical Conditions Benefit claim or $2,000,000, whichever is the lesser. - No Life Cover Buyback Benefit is available if the life assured has suffered a claim event under a Terminal Illness Benefit or a Specified Terminal Conditions Benefit under any AIA policy, whether or not a claim has been made. - Any exercise of the Life Cover Buyback Benefit may require an increase in premium. This premium increase will be calculated on the rates applicable at the time the Life Cover Benefit is reinstated. - Any accelerated benefits relating to the Life Cover Benefit for the life assured that have been reduced or removed as a result of an accelerated Critical Conditions Benefit claim will not be reinstated. ## 19. Optional Critical Conditions Buyback Benefit ### What is the Optional Critical Conditions Buyback Benefit? The Optional Critical Conditions Buyback Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Critical Conditions Buyback Benefit. Where an Optional Critical Conditions Buyback Benefit is selected, this allows the Critical Conditions Benefit and where applicable, the Optional Early Cancer Upgrade Benefit and/or Optional Children's and Maternity Benefit to be reinstated without the need to provide further medical evidence following a Critical Conditions Benefit claim, subject to the following conditions: - The life assured must have had a claim paid on their Critical Conditions Benefit that has reduced the sum assured to a nil balance, and have survived a period of 12 months after the claim payment date. - The Benefit(s) must be reinstated within 60 days of the first anniversary of the Critical Conditions Benefit claim payment. - Buyback of the Benefit(s) is not available following a Critical Condition Benefit claim for a condition listed in Section 1 which results in a partial payment. - No Critical Conditions Buyback Benefit is available if the life assured has suffered a claim event under a Terminal Illness Benefit or a Specified Terminal Conditions Benefit under any AIA policy, whether or not a claim has been made. - A life assured can only exercise the Critical Conditions Buyback Benefit for the cover provided under this policy once. ### What is the maximum amount of cover that can be reinstated? The maximum Critical Conditions Benefit that can be reinstated is 100% of the Critical Conditions Benefit claim payment or $2,000,000, whichever is the lesser. ### What other conditions apply to cover reinstated under the Optional Critical Conditions Buyback Benefit? On AIA's acceptance of an application for reinstatement of the Critical Conditions Benefit, and, where applicable, to the Optional Early Cancer Upgrade Benefit and/or Optional Children's and Maternity Benefit, you will be issued a new policy for the Benefit(s) and sum assured amount(s) being reinstated in which case: - The new policy will be issued based on the information provided at the time of buyback, together with the information provided in the original proposal. - The terms and conditions of the new policy will be those which are then offered by us to the general public, with the exception that no further reinstatements under an Optional Critical Conditions Buyback Benefit will be available in respect of the reinstated Benefit(s). - The reinstated Benefit(s) may require an increase in premium. This premium increase will be calculated at the rates applicable at the time the Benefit(s) are reinstated. However, where the Benefit(s) are reinstated after a full Critical Conditions Benefit claim has been paid for cancer, stroke or heart attack – a discount will be applied to the Critical Conditions Benefit premium. - Any special terms, exclusions or premium loadings that applied to the original Benefit(s) will also apply to the reinstated Benefit(s) under the new policy. - If you had selected the Optional Total Permanent Disablement condition at the time of the first Critical Conditions Benefit claim, this condition will be included under the reinstated Critical Conditions Benefit, except where the Optional Total Permanent Disablement condition was the subject of the Critical Conditions Benefit claim. - If you had selected the Optional Early Cancer Upgrade Benefit at the time of the first Critical Conditions Benefit claim, this benefit can be reinstated alongside the original Critical Conditions Benefit, except where you have previously received a claim payment under the Optional Early Cancer Upgrade Benefit. - If you had selected the Optional Children's and Maternity Benefit at the time of the first Critical Conditions Benefit claim, this benefit can be reinstated alongside the original Critical Conditions Benefit. ### In the event of a claim in respect of the reinstated Critical Conditions Benefit, no claim will be paid for: - Any condition for the subsequent claim that is a related condition to the condition which was the subject of the first Critical Conditions Benefit claim, as determined by AIA. - The same condition for which AIA has paid a claim under a Critical Conditions Benefit for the life assured, unless the original claim was for any of the conditions under the category of cancer, then the same condition shall include any cancer that is either: - of the same organ system as the original cancer; - considered by the treating oncologist as likely to be a secondary cancer of the original cancer; or - a related cancer. - Any heart (or heart-related) condition if the original claim was for a heart condition or a stroke, except where the claim in respect of the reinstated Critical Conditions Benefit is for heart valve surgery or pulmonary hypertension, and these conditions have not previously been claimed for and are not considered by an appropriate specialist as likely to be secondary or directly resulting from the original condition. - Stroke, or any condition directly resulting from a stroke, if the original claim was for a heart (or heart-related) condition, except where the original claim was for heart valve surgery or pulmonary hypertension. - Any exclusion which applied to the original Critical Conditions Benefit. ### In the event of a claim in respect of the reinstated Optional Early Cancer Upgrade Benefit, no claim will be paid for: - The same cancer condition for which AIA has paid a claim under a Critical Conditions Benefit for the life assured. The same cancer condition shall include any cancer that is either: - of the same organ system as the original cancer; - considered by the treating oncologist as likely to be a secondary cancer of the original cancer; or - a related cancer. ### In the event of a claim in respect of the reinstated Optional Children's and Maternity Benefit, no claim will be paid for: - The Children's Critical Conditions Benefit where you have already received a claim payment for the same child under the original Children's Critical Conditions Benefit; - The Children's Congenital Conditions Benefit where you have already received a claim payment for the same child under the original Children's Congenital Conditions Benefit; or - Any exclusion which applied to the original Optional Children's and Maternity Benefit. ## 20. Exclusions – when AIA won't pay a benefit AIA will not pay any benefit described in this appendix where any of the following (and in each case either directly or indirectly) causes or contributes to the claim: - The life assured (or the child in the case of a Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit) deliberately injures himself or herself or attempts to do so. - The life assured (or the child in the case of a Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit) engages in or is part of any conduct that is criminal. - Any condition or any symptom or signs leading to the condition (whether or not a registered medical practitioner has been consulted) that existed before the risk commencement date, unless AIA is satisfied that you or the life assured could not have known of the existence of the condition or symptom or signs leading to the condition, or the condition or symptom or signs leading to the condition were declared on your application and accepted by AIA. AIA will not pay any benefit described in this appendix where any of the following occurs before a life assured (or any child in the case of a Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit) reaches age 21, and (in each case either directly or indirectly) causes or contributes to a claim for that life assured (or child): - any intentional act by you or by any parent or guardian of the life assured, or child. - any intentional act by someone who lives with or supervises the life assured, or child. AIA will not pay a benefit under the Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit that arises as a direct or indirect consequence of: - a pre-existing condition; or - any congenital condition, except where expressly covered under the Children's Congenital Conditions Benefit. These exclusions apply to any subsequent benefit increase you make. ## 21. How to make a claim To make a claim, refer to the section in your AIA Living policy entitled 'How to make a claim'. In addition, for a Critical Conditions Benefit claim, AIA will require information acceptable to us, including medical evidence and reports, showing proof of the condition giving rise to the claim. AIA may require the life assured or his or her child (if applicable) to have an examination by a registered medical practitioner appointed by AIA before accepting liability for a claim. Where the Optional Total Permanent Disablement condition is the condition giving rise to the claim, AIA will also require: - An AIA claims form completed by the life assured and a registered medical practitioner (at your expense). - Other information which AIA may reasonably request to help assess the claim, which may include evidence of earnings, taxable income, business accounts, ACC details or similar. - The life assured to undergo medical and/or surgical treatment (including any operation or vocational, medical and/or social rehabilitation) at your expense which the life assured's registered medical practitioner, or a registered medical practitioner approved by AIA, considers necessary. - Any other information that AIA may deem relevant to the assessment of the claim. For advice about submitting a claim you can phone AIA on 0800 500 108 or your Adviser. Find claim information online at AIA.co.nz ## 22. Definitions of medical conditions ### Cancer The life assured has suffered or undergone one of the following conditions: #### Carcinoma-in-situ A focal autonomous new growth of carcinomatous cells which has not yet resulted in the invasion of normal tissues. 'Invasion' means an infiltration and/or active destruction of normal tissue beyond the basement membrane. This benefit only covers carcinoma-in-situ of the following sites: - Breast. - Cervix. - Vagina. - Vulva. The carcinoma-in-situ must be positively diagnosed by biopsy and be classified as TIS according to the TNM staging method or FIGO Stage 0. The benefit payable is 25% of the sum assured to a maximum of $75,000 across all Personal AIA policies for the life assured. #### Carcinoma-in-situ radical surgery As a result of a carcinoma-in-situ, an operation to arrest spread of the malignancy is performed which involves the removal of the entire organ (which includes: breast, cervix, ovary, fallopian tube, vagina, vulva, prostate, colon/rectal, bladder) affected, or the organ requires systemic chemotherapy, radiotherapy or immunotherapy, and that treatment is considered medically necessary by an appropriate specialist. The carcinoma-in-situ must be positively diagnosed by biopsy and be classified as TIS according to the TNM staging method or FIGO Stage 0. #### Malignant tumours and blood cancers The presence of one or more malignant tumours, characterised by uncontrolled growth and spread of malignant cells, with the invasion and destruction of normal tissue for which major interventional treatment or surgery is considered medically necessary by an appropriate specialist. The following tumours are excluded: - Tumours classified as carcinoma-in-situ (including intra-epithelial neoplasia). - Prostate tumours with a Gleason score of less than 6. (If the Gleason score is unavailable, we will use the TNM classification and tumours classified as T1 or its equivalent will be excluded). - All malignant melanomas unless they: - are at least 1.0mm in maximum thickness as determined by histological examination using the Breslow thickness histological classification; or - are graded higher than Clark level 2 depth of invasion; or - show evidence of ulceration as determined by histological examination. - Skin cancers unless they have spread to other organs. - Chronic lymphocytic leukaemia less than RAI Stage 1. #### Prostate Cancer As a result of a prostate tumour, the entire prostate is removed to arrest spread of the malignancy and this is considered medically necessary by an appropriate specialist. The benefit also covers malignant tumour of the prostate histologically described as T1 or Gleason score of 5 or less for which treatment is considered medically necessary, and undertaken by an appropriate specialist to arrest the spread of malignancy including but not limited to chemotherapy, radiotherapy, immunotherapy or surgery. ### Heart The life assured has suffered or undergone one of the following conditions: #### Angioplasty – less than 3 vessels The actual undergoing of coronary artery angioplasty with or without a stent, laser or atherectomy, considered medically necessary by an appropriate specialist cardiologist, to correct a narrowing or blockage of one or two coronary arteries during the same procedure. The benefit payable is 25% of the sum assured to a maximum of $75,000 across all Personal AIA policies for the life assured per claim. For each life assured you can make more than one claim for this condition as long as the subsequent claim for this condition is not in respect of the same coronary artery or arteries as any previous claim for this condition. #### Angioplasty – 3 vessels or more The actual undergoing of coronary artery angioplasty to correct a narrowing or blockage of at least three coronary arteries within a period of 60 days that is considered medically necessary on the basis of angiographic evidence, indicating obstruction of at least three coronary arteries. Repeat procedures to the same coronary artery are not covered. #### Aortic surgery Medically necessary surgery to correct or repair: - an aortic aneurysm; - an obstruction of the aorta; - a coarctation of the aorta; - a traumatic rupture of the aorta; or - an aortic dissection. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta. #### Cardiac Defibrillator Insertion The permanent insertion of an automatic implantable defibrillator after the occurrence of ventricular tachycardia or ventricular fibrillation. The benefit payable is 25% of the sum assured to a maximum of $75,000 across all Personal AIA policies for the life assured. The benefit is not payable if the life assured satisfies the criteria for a claim payment under another heart condition across all Personal AIA policies. #### Cardiomyopathy Impaired ventricular function of variable aetiology due to primary disease of the heart muscle, resulting in permanent and irreversible physical impairments to the degree of at least Class 3 of the New York Heart Association classification of cardiac impairment. #### Coronary artery bypass surgery Medically necessary surgery to correct the narrowing of, or blockage to, one or more coronary arteries by means of a bypass graft. #### Heart attack The death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply to the relevant area, confirmed by a cardiologist or general physician and evidenced by: Typical rise and/or fall of cardiac biomarkers with at least one value above the 99th percentile of the upper reference limit and at least one of the following: - Signs and symptoms of ischaemia which are consistent with myocardial infarction; or - Confirmatory new (or presumed new) ECG changes associated with myocardial infarction with the development of any one of the following: - ST changes; - T wave inversion; - Left bundle branch block (LBBB); - Pathological Q waves; or - Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. A rise in cardiac biomarkers resulting from a percutaneous procedure for coronary artery disease is excluded unless the baseline value is normal and the elevation is greater than 5 times the 99th percentile of the upper reference limit. If the above evidence is inconcl