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AXA Protection Account

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Critical Illness Guide

Welcome to the AXA Protection Account Critical Illness Cover guide that provides a detailed list of critical illnesses, with jargon free definitions for each one. Critical Illness Cover is just one of the covers available from the AXA Protection Account.

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Contents

The AXA Protection Account 02

What is this guide for? 02

How does this guide work? 03

General exclusions 03

Added value with additional covers 04

Advanced Payments 06

Critical Illness Definitions

Most Common Conditions:

Cancer* 08 Heart Attack* 09 Multiple Sclerosis* 10 Stroke* 10

Heart Conditions:

Aorta Graft Surgery* 11 Cardiomyopathy 12 Coronary Artery Bypass Grafts 12 Heart Valve Replacement or Repair* 13 Primary Pulmonary Hypertension 13

Neurological Conditions:

Alzheimer’s Disease* 14 Benign Brain Tumour* 14 Creutzfeldt-Jakob Disease* 15 Encephalitis 15 Motor Neurone Disease* 16 Parkinson’s Disease* 16 Pre-Senile Dementia 17 Progressive Supranuclear Palsy 17

*The Association of British Insurers (ABI) has published model definitions for many of the critical illnesses. Where applicable, these model wordings have been adopted. Although both the ABI and AXA’s critical illness definitions may change for cover starting in the future, at no time after your cover has started will its scope be further restricted. Conditions marked with an asterisk follow the definitions of critical illness set down by the ABI in April 2006.

Immune System Conditions:

Aplastic Anaemia 19 Rheumatoid Arthritis 19 Systemic Lupus Erythematosus 20

Viruses:

Bacterial Meningitis 20 HIV Infection* 21

Accident or Disability:

Blindness* 22 Coma* 22 Deafness* 23 Loss of Hand or Foot* 23 Loss of Independent Existence 24 Loss of Speech* 24 Paralysis of Limb* 25 Third Degree Burns* 25 Traumatic Head Injury* 26

Organ Failure:

Kidney Failure* 27 Liver Failure 27 Major Organ Transplant* 28 Severe Lung Disease 29

Total and Permanent Disability (TPD) 30

Making a claim 32

Glossary of Key Terms 33

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We want you to know what you are covered for, so we have produced this handy guide for you. It gives you information about the medical conditions that are covered under your Account, including when we will pay and when we won’t, and how to contact us if you need to make a claim.

Now let’s see how this guide fits in with the rest of your Account pack. Your Account pack forms part of the legal contract between you and AXA. This guide explains the medical definitions which are set out in your Account pack. In the event of any conflict between the information in your Account pack and this guide, the information in your Account pack shall apply.

Critical Illness Cover aims to provide a one-off payment if on, or before, the cover end date on your Account, the person covered is:

• diagnosed with a critical illness, and survives for at least 14 days after diagnosis;

• diagnosed as suffering with a terminal illness which is expected to cause death within 12 months of diagnosis.

The amount we will pay is only payable once. Once it has been paid, your cover will end. This applies whether one or two persons are covered. There are some instances where we will not be able to pay a claim. These are called exclusions and they are detailed in your Key Features document and/or Account pack which you should read together with this guide.

What is this guide for?

The AXA Protection Account allows you to put the protection covers you need in one place, only charging one £2 fee no matter how many covers you include. It’s available to you if, at the start of your Account, you are aged between 18 and 64 and living in England, Scotland, Wales or Northern Ireland. Your cover must end before your 70th birthday. Certain covers will

be affected if you become a resident outside of these countries. Your Account does not have a cash-in value at any time. For more information please read the individual cover sections within your Key Features document, or the ‘How your covers and additional covers work’ section within your Account pack.

The AXA Protection Account

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There are some general exclusions that apply to the cover. We will not pay a claim if:

• the claim was caused by unreasonable failure to follow medical advice;

• the claim was caused by intentional self-inflicted injury;

• the claim arose directly or indirectly through infection by any Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) or related complex. This exclusion will not apply if the person covered satisfies any of the conditions described in the Human Immunodeficiency Virus (HIV) section on page 21 of this guide;

• the person covered dies within 14 days of diagnosis of the critical illness or within 14 days after surgery, unless that person has Life or Earlier Critical Illness Cover, in which case the claim will be treated as a death claim;

• the person covered does not meet the relevant definition of terminal illness or critical illness as set out in the Cover schedule;

• the claim is as a result of any excluded cause shown on the relevant Cover schedule; or

• the relevant person covered does not return to one of the permitted countries listed to the right to provide evidence in support of any Critical Illness Cover claim.

The permitted countries are: Andorra, Australia, Austria, Belgium, Canada, Channel Islands, Denmark, Finland, France, Germany, Gibraltar, Great Britain, Greece, Isle of Man, Italy, Liechtenstein, Luxembourg, Malta, Monaco, The Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Republic of Ireland, San Marino, Spain, Sweden, Switzerland and the United States of America.

If your cover is accepted on non-standard terms, then additional exclusions may apply. These will be shown in your Cover schedule. This will also show if you’re not covered for any of the critical illness conditions described in this guide. Please note all diagnoses on which a claim is based must be made by a Consultant at a UK hospital with an appropriate qualification who is a specialist in the field of medicine appropriate to the claim and to the satisfaction of our Chief Medical Officer.

General exclusions

On the following pages, you can see the definition of each critical illness as shown in your AXA Protection Account ‘How your covers and additional covers work’ section of your

Account pack. The bold text refers to a definition within the ‘Definitions’ section of your Account pack. You will also find an explanation in less technical non-binding terms.

How does this guide work?

What is it?

We will pay a claim if the person covered is diagnosed with prostate cancer where the tumour has been histologically classified as having a Gleason score from 2 to 6 inclusive or having progressed to a TNM classification of at least T1N0M0. The tumour must have been treated by complete removal of the prostate, external beam or interstitial implant radiotherapy.

Before we pay a claim we will need confirmation from a Consultant Oncologist of a diagnosis of prostate cancer, and that treatment by complete removal of the prostate, external beam or interstitial implant radiotherapy has taken place.

Low-grade Prostate Cancer Cover

What will we pay?

The amount payable will be the lower of:

• 20% of the current amount of cover under your Critical Illness Cover; and

• £15,000.

Only one claim can be made per cover. Claims paid under Low-grade Prostate Cancer Cover will not affect the amount that can later be claimed under Critical Illness Cover.

When won’t we pay?

In all cases the general exclusions on page 3 apply.

We will not pay a claim for:

• Treatment of the tumour by any procedures other than complete removal of the prostate, external beam or interstitial implant radiotherapy.

What is it?

We will pay a claim for carcinoma in-situ of the breast which is treated by total mastectomy, which is the total removal of all of the tissue of one breast. Before a claim can be paid evidence must be provided to AXA confirming:

• a diagnosis of carcinoma in-situ of the breast; and

• that treatment by total mastectomy has taken place.

Total Mastectomy Cover

What will we pay?

The amount payable will be the lower of:


• £15,000.

Only one claim can be made per cover. Claims paid under Total Mastectomy Cover will not affect the amount that can later be claimed under Critical Illness Cover.



We will not pay a claim for:

• Treatment by any procedures other than total mastectomy.

• Preventative mastectomy unless this results in evidence of carcinoma in-situ.

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Each of the following covers offers you an additional payment on top of any claims you may need to make on your main cover.

Added value with additional covers

What is it?

We will pay a claim if an eligible child is diagnosed with a covered critical illness, physical injury or undergoes major heart surgery. The critical illnesses, injuries or surgeries are those defined in your Cover schedule as well as being shown in this guide.

An eligible child is one that has been born to, legally adopted by or attained through a legally recognised marriage or civil partnership of a person covered.

For a claim to be valid an eligible child must:

• not be less than 30 days old (this does not cover treatment between conception and birth);

• survive for at least 14 days following diagnosis of the critical illness; and

• be under 18 years of age.

Children’s Cover

What will we pay?

We will pay the lower of:


• £25,000.

You can make only one claim for any eligible child, but separate claims can be made for different eligible children. Once a total of four claims have been made, the Children’s Cover will stop.



Whilst there is no underwriting of this benefit Children’s Cover will not be payable in respect of:

• conditions that pre-date cover starting; and

• congenital conditions present at the birth of the child, whether or not evident before the child has reached 30 days old.

What is it?

We will pay a claim for Accident Hospitalisation Cover if a person covered is:

• injured as a result of a serious accident;

• admitted to hospital with severe physical injury; and

• confined to hospital for 28 consecutive days or more.

Accident Hospitalisation Cover

What will we pay?

We will pay the lower of:


• £50,000.

Only one claim can be made for each person covered. Claims paid under Accident Hospitalisation Cover will not affect the amount that can later be claimed under Critical Illness Cover.



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Advanced Payments

What is it?

We will pay a claim for Major Heart Surgery Cover if the person covered is registered on an approved National Health Service waiting list for one of the following and they opt to go privately:

• Coronary Artery Bypass Surgery;

• Aorta Graft Surgery; or

• Heart Valve Replacement or Repair.

These must be in accordance with the definitions detailed under the critical illness definitions.

Major Heart Surgery Cover also applies to eligible children.

Major Heart Surgery Cover

What will we pay?

This is an advanced payment of part of a critical illness claim and is paid as a one-off payment direct to the hospital after the person covered has undergone private heart surgery. If a payment is made it will reduce the amount of benefit that may be payable in the event of a critical illness being diagnosed. If we pay out the full level of Critical Illness Cover under Major Heart Surgery Cover the cover will cease.

The amount we pay for Major Heart Surgery Cover will be the lower of:

• the current amount of cover under Critical Illness Cover; and

• the amount shown on the fixed price quotation from the hospital concerned and including costs for the medical procedures, hospital accommodation, medication and any aftercare needed.

The amount we pay for an eligible child for Major Heart Surgery Cover will be the lower of:

• 50% of the current amount of cover under your Critical Illness Cover;

• the amount shown on the fixed price quotation from the hospital concerned and including costs for the medical procedures, hospital accommodation, medication and any aftercare needed; and

• £25,000.

If the amount claimed is less than the full amount of Critical Illness Cover, the balance will be paid when a subsequent valid claim occurs.

We will pay the hospital directly. We will only pay one claim for Major Heart Surgery Cover except for eligible children where separate claims can be made for different eligible children but you can make only one claim for any eligible child. Once a total of four claims have been made in respect of eligible children the Children’s Cover will stop. Full conditions can be found in your Account pack.



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What is it?

Advanced or rapidly progressing incurable illness where, in the opinion of an attending consultant at a UK hospital and our Chief Medical Officer, the person covered is expected to die within 12 months and before the relevant cover ends.

Terminal Illness

What will we pay?

We will pay 100% of the Critical Illness Cover if any disease that is likely to lead to death within 12 months is diagnosed. A doctor of consultant status who is attending the claimant and our Chief Medical Officer must both agree that death is likely within this period of time. After payment, the Critical Illness Cover will cease.


If the person covered is expected to die after the relevant cover ends or when the definition above is not met.

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Critical Illness DefinitionsMost Common Conditions:

Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, lymphoma and sarcoma.

For the above definition, the following are not covered:

• All cancers which are histologically classified as any of the following:

– pre-malignant;

– non-invasive;

– cancer in situ;

– having either borderline malignancy; or having low malignant potential.

• All tumours of the prostate unless histologically classified as having a Gleason Score greater than 6 or having progressed to at least clinical TNM classification T2N0M0.

• Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A.

• Any skin cancer other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin).

Cancer – excluding less advanced cases

What is it?

A cancer is an uncontrolled growth of abnormal ‘malignant’ cells which may spread from the original site to other parts of the body.

These are some examples of the many cancers covered:

• Leukaemia is a cancer of the white blood cells, lymphoma is a cancer of the lymphatic system and Hodgkin’s disease is a type of lymphoma. The lymphatic system helps maintain the body fluid balance and defends the body against disease.

• Prostate cancer is commonly graded using a system known as the Gleason Score. A low score indicates the early, slow growing stage of the disease, and a high score indicates an aggressive cancer.

• Invasive malignant melanoma is an aggressive and fast spreading skin cancer and is generally accepted as the most serious type of skin cancer and is the only skin cancer covered.

When would we pay?

Unless specifically excluded, we will pay upon confirmation of a diagnosis of invasive malignant cancer.


In the case of exclusions stated in the left hand column.

Cancers that have not yet progressed to the point where they have invaded the adjacent surrounding tissue might sometimes be referred to as ‘pre-malignant’, ‘non-invasive’ or as a ‘cancer in situ’ – cancers like these are not covered. For example, early forms of breast cancer are not covered where the tumour has not caused invasion, even if it is treated by a mastectomy.

Skin cancers, other than invasive malignant melanoma, are also not covered. These types affect only the surface layer of cells and do not attack or spread to other parts of the body. They are generally treated effectively with a high success rate.

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Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

• New characteristic electrocardiographic changes.

• The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher:

– Troponin T > 1.0 ng/ml

– AccuTnl > 0.5 ng/ml or equivalent threshold with other Troponin I methods.

The evidence must show a definite acute myocardial infarction.

For the above definition the following are not covered:

• Other acute coronary syndromes including but not limited to angina.

Heart Attack – of specified severity (ABI+)

What is it?

Myocardial infarction is commonly known as a heart attack. A heart attack is when part of the heart muscle dies as a result of a lack of blood supply. It may be characterised by severe chest pain, which may radiate to the left arm or neck. To diagnose a heart attack, the patient’s heart will be tested using an electrocardiograph (ECG), which over time can show that heart damage has occurred, but not when it occurred. Blood samples can show an abnormal level of chemicals, called ‘cardiac enzymes’, indicating a current problem with the heart, which might be something other than a heart attack. Troponin is a protein found in the blood, which is a good indicator of heart muscle damage. The diagnosis will be made by a cardiologist and will be typically based on ECG changes, raised cardiac enzymes, troponins, any history of chest pain and their experience, to decide whether and when a heart attack has taken place.

When would we pay?

Upon receipt of confirmation that your heart muscle had been permanently damaged following a heart attack. The medical findings must be supported by evidence confirming that the event has occurred within the period of cover.


When the definition has not been met, for example when the cardiac enzyme or Troponin levels do not reach the level required in the definition in the left hand column.

You may experience pain if the blood supply has only been temporarily restricted, this is known as angina, which, as no permanent damage has been sustained to the heart, is not covered. Other acute Coronary Syndromes are also not covered.

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


• Transient ischaemic attack.

• Traumatic injury to brain tissue; or

• Blood vessels.

Stroke – resulting in permanent symptoms

What is it?

A stroke is the result of permanent damage to the brain, either from bleeding into it or from an acute lack of blood in some part of the brain, so that the function of that part is permanently stopped. Strokes vary greatly in severity from a short period of muscle weakness to a more severe problem that can lead to death.

When would we pay?

We require a definite diagnosis of death of brain tissue together with confirmation of permanent residual neurological symptoms. The medical findings must be supported by evidence confirming that the event has occurred within the period of cover under the policy.


A Transient Ischaemic Attack (sometimes called a TIA or mini stroke) occurs where there is a shortage of blood supply which clears with no residual consequences. As TIAs do not produce lasting effects and may even go unnoticed, they are not covered. Traumatic injury to brain tissue or blood vessels not resulting in death of brain tissue is not covered.

A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist.

There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least six months.

Multiple Sclerosis – with persisting symptoms

What is it?

Multiple Sclerosis is a chronic, unpredictable and incurable disease of the central nervous system. It is as a result of damage to myelin – a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body. For some people, the symptoms of Multiple Sclerosis are characterised by periods of relapse and remission while for others it has a more progressive pattern.

When would we pay?

When a definite diagnosis of Multiple Sclerosis has been made and you have had impairment of motor or sensory symptoms for a continuous period of at least six months.


When the diagnosis is uncertain or not yet confirmed or there have not been continuous symptoms for at least six months.

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Critical Illness DefinitionsHeart Conditions:

The undergoing of surgery for disease or traumatic injury to the aorta with excision and surgical replacement of a portion of the aorta with a graft.

The term aorta includes the thoracic and abdominal aorta but not its branches.


• Any other surgical procedure, for example the insertion of stents or endovascular repair.

Aorta Graft Surgery – for disease or traumatic injury (ABI+)

What is it?

The aorta is the main artery of the body and takes blood away from the heart. It may become narrowed as a result of fatty deposits or weakened as a result of an ‘aneurysm’, where the artery wall becomes thin and stretched.

When would we pay?

When surgery is required to repair and replace the main aorta in the chest or abdomen with a graft, and has been carried out, a claim may be made.

Surgery to cut out any part of the main aorta that lies within the thorax (chest) and/or abdomen (stomach) and repair it with a graft is covered.


Where surgery has been carried out on any part of the aorta outside of the thoracic or abdominal cavities, or carried out on branches of the aorta.

Any other surgical procedure to the aorta is not covered.

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The undergoing of surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts.

For the above definition, the following procedures are not covered:

• Balloon angioplasty

• Atherectomy

• Rotablation

• Insertion of stents

• Laser treatment

Coronary Artery Bypass Grafts (ABI+)

What is it?

Surgery carried out to correct narrowing or blockage of one, or more, of the coronary arteries, which supply blood to the heart. Disease of the coronary arteries puts undue strain on the heart and may lead to ‘heart attack’, which is covered under another section, but it may be corrected by an operation. Once the obstruction has been located, it may be bypassed using a vein from the leg or an artery from the chest as a graft.

When would we pay?

When surgery to correct a narrowed or blocked coronary artery has taken place following the advice of a Consultant Cardiologist.


In the case of the procedures stated in the left hand column.

The unequivocal diagnosis by a Consultant Cardiologist of cardiomyopathy resulting in:

• impaired ventricular function and marked limitation of physical activity with the person covered unable to progress beyond stage 2 of a treadmill exercise test using the standard Bruce Protocol; or is

• classified as Stage III under the New York Heart Association Functional Classification. For the purposes of this condition, NYHA Stage III is (as classified):

– a marked limitation in activity of the person covered due to symptoms even during less than ordinary activity; and

– the person covered is only comfortable at rest.


• All other forms of heart disease, heart enlargement and myocarditis.

• Cardiomyopathy secondary to alcohol or drug abuse.

Cardiomyopathy – of specified severity

What is it?

Cardiomyopathy is a type of heart disease in which the heart is abnormally enlarged and thickened. As a result, the heart muscle’s ability to pump blood is usually weakened. There are three classifications of cardiomyopathy; dilated, hypertrophic and restrictive. In all cases damage is caused to the walls of the heart which commonly results in heart failure.

Depending on the type of cardiomyopathy, certain drugs may be prescribed to decrease the heart’s workload and regulate any abnormality of the heart rhythm. If end-stage heart failure develops, heart transplantation may be necessary.

When would we pay?

For a claim to be valid you will need to have been given a definite diagnosis of cardiomyopathy by a Consultant Cardiologist, and your cardiomyopathy is of a severity as detailed in the left hand column.


In the case of the exclusions stated in the left hand column. We will not pay if the condition has been brought about as a result of alcohol or drug misuse.

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A definite diagnosis of Primary Pulmonary Hypertension by a Consultant Cardiologist or specialist in respiratory medicine. There must be clinical impairment of heart function resulting in the permanent loss of ability to perform physical activities to at least Class 3 of the New York Heart Association classification of functional capacity.


• Pulmonary Hypertension secondary to any other cause i.e. not primary.

Primary Pulmonary Hypertension – of specified severity

What is it?

A rare blood disorder with no apparent cause which is characterised by raised blood pressure in the pulmonary arteries, which go from the heart to the lungs.

Symptoms are typically chronic shortness of breath, weakness, dizziness and fainting.

Untreated, the disease may result in heart failure.

When would we pay?

For a claim to be paid a Consultant Cardiologist or specialist in respiratory medicine must confirm that you are unable to perform less than ordinary daily activity without experiencing fatigue, palpitation, shortness of breath or anginal pain as a result of clinical impairment of your heart function.


If your Primary Pulmonary Hypertension does not result in the permanent loss of ability to perform physical activities to the New York Heart Association classification of functional capacity.

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The undergoing of surgery on the advice of a Consultant Cardiologist to replace or repair one or more heart valves.

Heart Valve Replacement or Repair (ABI+)

What is it?

The heart valves control the flow of blood through the various chambers of the heart. A valve may become damaged, usually through disease, and surgery may be necessary.

When would we pay?

Where surgery is carried out to replace or repair one or more damaged heart valves as advised by a Consultant Cardiologist.


When the definition is not met.

Critical Illness DefinitionsNeurological Conditions:

A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in permanent neurological deficit with persisting clinical symptoms or undergoing invasive surgery to remove part or all of the tumour.


• Tumours in the pituitary gland.

• Angiomas.

Benign Brain Tumour – resulting in permanent symptoms or requiring invasive surgery (ABI+)

What is it?

A benign tumour is an abnormal growth of tissue which is not cancerous. A benign tumour may cause pressure on the brain which can lead to residual neurological damage from which the patient never recovers. An operation may be needed to remove the tumour, or other treatment might be used to reduce its size.

When would we pay?

Confirmation of a definite diagnosis of a brain tumour and permanent damage to the nervous system or undergoing invasive surgery to remove part or all of the tumour.


If there is no permanent neurological damage or surgery does not result in removal of part or all of the entire tumour. The tumour or lesion (structural abnormality) is in the pituitary gland. Angiomas are also not included.

A definite diagnosis of Alzheimer’s disease by a Consultant Neurologist, Psychiatrist or Geriatrician. There must be permanent clinical loss of the ability to do all of the following:

• remember;

• reason; and

• perceive, understand, express and give effect to ideas.


• Other types of dementia.

Alzheimer’s Disease – resulting in permanent symptoms

What is it?

A degenerative disease causing a decline in mental functions and widely different degrees of disability. Patients ultimately become unable to look after themselves.

When would we pay?

You need to have been given a definite diagnosis of Alzheimer’s and meet all of the conditions in the left hand column.


If you haven’t had a definite diagnosis or if your inability to perform the tasks in the left hand column is not permanent. All other forms of dementia are not covered.

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Confirmation by a Consultant Neurologist of a definite diagnosis of Creutzfeldt-Jakob Disease resulting in permanent neurological deficit with persisting clinical symptoms.

Creutzfeldt-Jakob Disease – resulting in permanent symptoms

What is it?

This is a rare degenerative brain disorder that causes mental and physical disabilities. The disease is thought to be linked with a cattle disease called bovine spongiform encephalopathy (BSE, or ‘mad cow disease’).

When would we pay?

Upon confirmation by a Consultant Neurologist of a definite diagnosis of Creutzfeldt-Jakob Disease, resulting in permanent damage to the nervous system.


When the diagnosis is uncertain or not yet confirmed or symptoms are not yet displayed.

A definite diagnosis of Encephalitis by a Consultant Neurologist resulting in permanent neurological deficit and persisting clinical symptoms.

For the above definition the following are not covered:

• Chronic fatigue syndrome and myalgic encephalitis.

Encephalitis – resulting in permanent symptoms

What is it?

Inflammatory disease of the membranes that surround the brain and spinal cord. Some cases are short and not that severe but other cases are severe and result in permanent neurological impairment.

When would we pay?

Confirmation by a consultant neurologist of a definite diagnosis of Encephalitis with permanent neurological deficit with persisting clinical symptoms.


If there is no permanent neurological deficit with persisting clinical symptoms or if the symptoms and diagnosis relate to chronic fatigue syndrome and myalgic Encephalitis.

A definite diagnosis of Motor Neurone Disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function.

Motor Neurone Disease – resulting in permanent symptoms

What is it?

A progressive degenerative disease of the central nervous system, which affects the muscles causing rapid severe disability.

When would we pay?

Upon confirmation by a Consultant Neurologist of a definite diagnosis of Motor Neurone Disease, and that motor function is permanently impaired.


When the diagnosis is uncertain or not yet confirmed.

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A definite diagnosis of Parkinson’s Disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability.

For the above definition, the following is not covered:

• Parkinson’s Disease secondary to drug abuse.

Parkinson’s Disease – resulting in permanent symptoms

What is it?

Parkinson’s Disease is a progressive neurological condition affecting movements such as walking, talking, and writing. Symptoms include tremor, rigidity and loss of muscle power.

When would we pay?

Upon confirmation by a Consultant Neurologist of a definite diagnosis of Parkinson’s Disease that has caused permanent clinical impairment as listed in the left hand column.


When the diagnosis is uncertain or not clear. Also a claim will not be paid if the disease has been caused by drug abuse.

A definite diagnosis of pre-senile dementia supported by evidence of progressive loss of ability to:

•remember;

• reason; and

• perceive, understand, express and give effect to ideas,

which causes a significant reduction in mental and social functioning, requiring the continuous supervision of the person covered.

Pre-Senile Dementia

What is it?

A degenerative condition that causes a decline in mental functions and widely different degrees of disability. Patients ultimately become unable to look after themselves.

When would we pay?

For a claim to be valid there will need to be a definite diagnosis of pre-senile dementia and independent evidence that shows a decline in mental and social functions that have progressed to an extent that requires continuous supervision.


Where the diagnosis is uncertain or constant care or continuous supervision is not required.

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Confirmation by a Consultant Neurologist of a definite diagnosis of progressive supranuclear palsy. There must be permanent clinical impairment of motor function, eye movement disorder and postural instability.

Progressive Supranuclear Palsy – resulting in permanent symptoms

What is it?

A progressive degenerative disease of the central nervous system, which affects the muscles causing rapid severe disability.

When would we pay?

Following a definite diagnosis of the disease by a Consultant Neurologist, and when your symptoms include blurred vision related to your inability to move your eyes properly and the inability to control your movements and balance which may result in falling, particularly backwards.


When the diagnosis is uncertain or not yet confirmed, or your symptoms are not permanent.

Critical Illness DefinitionsImmune System Conditions:

Permanent and irreversible bone marrow failure which results in anaemia, neutropenia, and thrombocytopenia requiring treatment with at least one of the following:

• regular blood transfusions;

• marrow stimulating agents;

• immunosuppressive agents; or

• bone marrow transplantation.

The diagnosis must be confirmed by a Consultant Haematologist. For the above definition, the following are not covered:

• Other forms of anaemia.

Aplastic Anaemia – of specified severity

What is it?

Aplastic Anaemia occurs when the bone marrow completely fails to produce blood cells. It is usually treated by blood transfusion or drug therapy. Where bone marrow transplantation is possible the cure rate is high.

When would we pay?

A definite diagnosis must have been made by a Consultant Haematologist and the condition must have progressed to a stage where one of the treatments in the left hand column is required.


Where the condition has not progressed to the stage of requiring any of the treatments outlined or it is not permanent and irreversible. Other forms of anaemia are not covered.

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A definite diagnosis of Rheumatoid Arthritis by a Consultant Rheumatologist, evidenced by an inability to perform any three Activities of Daily Work without the direct assistance of another person, but with the use, where appropriate, of certain aids.

If you are a house person or not in full-time employment at the time of claim then we will use the Activities of Daily Living definition.

The disability must be permanent and irreversible.

Rheumatoid Arthritis – resulting in permanent symptoms

What is it?

A form of arthritis involving inflammatory changes that lead to stiffness and swelling of the affected joints. Reduced joint movement, muscular weakness and joint deformities are common features. In severe cases there will be widespread disability as well as the likelihood of disorders of the heart, lungs, nerves, eyes and blood vessels.

When would we pay?

For a claim to be valid you will need to have been given a definite diagnosis of rheumatoid arthritis and you are permanently unable to perform the activities as detailed in the left hand column.


We will not pay out if the disease has not progressed to the extent stated in the definition or for any other forms of arthritis.

Critical Illness DefinitionsViruses:

Bacterial Meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit with persisting clinical symptoms. The diagnosis must be confirmed by a Consultant Neurologist.


• All other forms of meningitis including viral meningitis.

Bacterial Meningitis – resulting in permanent symptoms

What is it?

Bacterial meningitis is an inflammation of the meninges and the brain. The meninges are membranes that enclose the brain.

When would we pay?

Confirmation of a definite diagnosis of bacterial meningitis by a Consultant Neurologist. For a claim to be paid, the disease must have caused permanent malfunction of the nervous system leading to permanent neurological or physical disability.


If there is no permanent neurological deficit or physical disability. Other forms of meningitis, including viral, are explicitly excluded.

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A definite diagnosis of Systemic Lupus Erythematosus (SLE) by a Consultant Rheumatologist where either of the following are also present:

• Severe kidney involvement with SLE as evidenced by:

– permanent impaired renal function with a glomerular filtration rate below 30ml/min/1.73m2 and

– abnormal urinalysis showing proteinuria or haematuria, or

• SLE affecting the central nervous system which has caused permanent neurological deficit with persisting clinical symptoms.

Systemic Lupus Erythematosus (SLE) – of specified severity

What is it?

A chronic auto-immune disease that attacks cells and tissue most commonly in the nervous system, kidneys, blood vessels, liver, heart and skin.

When would we pay?

Upon diagnosis by a Consultant Rheumatologist of SLE which has affected the central nervous system resulting in permanent neurological deficit with persisting clinical symptoms or severe kidney impairment to the level outlined in the column to the left.


When the diagnosis is uncertain or not yet confirmed or symptoms do not meet the necessary requirement.

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Infection by Human Immunodeficiency Virus resulting from:

• a blood transfusion given as part of medical treatment;

• a physical assault; or

• an incident occurring during the course of performing normal duties of employment from the eligible occupations listed below;

after the cover start date and satisfying all of the following:

• The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures.

• Where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within 5 days of the incident.

• There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus.

• The incident causing infection must have occurred in the UK.


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

Eligible Occupations

• Hospital – doctors, surgeons, consultants, nurses, porters, caterers and cleaners.

• General practitioners and employed nursing staff.

• Dental surgeons and nurses.

• District nurses.

• Midwives.

• Paramedics.

• Ambulance workers.

• Hospital laundry workers.

• Fire brigade workers.

• Policemen and policewomen.

• Laboratory technicians engaged in a medical facility.

• Prison staff.

Human Immunodeficiency Virus (HIV) – caught in the UK from a blood transfusion, a physical assault or at work in an eligible occupation

What is it?

As with other viruses, HIV attacks other living cells, some of which are vital to a healthy immune system. Acquired Immune Deficiency Syndrome (AIDS) sets in if the virus has killed so many cells that the immune system cannot react to attacks from everyday infections.

When would we pay?

Infection acquired as a result of assault, blood transfusion or carrying out duties in eligible occupations are covered.

In order to qualify for payment the incident must have been officially reported and investigated and the procedures strictly followed. At the very least, a negative result to an HIV test carried out within five days of the incident, and a positive result to an HIV test within twelve months of the incident must have been recorded.


We will not pay if you acquire the infection other than by assault, blood transfusion or as a result of your duties in one of the eligible occupations, or it’s acquired outside the UK. We would also not pay if the procedures shown above were not followed.

Also, a claim won’t be paid if the HIV infection is contracted as a result of sexual activity or drug abuse.

Critical Illness DefinitionsAccident or Disability:

A state of unconsciousness with no reaction to external stimuli or internal needs which:

• requires the use of life support systems; and

• results in permanent neurological deficit with persisting clinical symptoms.


• Coma secondary to alcohol or drug abuse.

Coma – resulting in permanent symptoms (ABI+)

What is it?

A state of unconsciousness where there is no response to any form of physical stimulation and no control of bodily functions. A coma may arise from head injury, brain tumour or other damage to the brain, such as bleeding or oxygen starvation.

When would we pay?

For a claim to be paid a life support system must be used and the coma must result in permanent damage to the nervous system.


In the case of the exclusions stated in the left hand column. We will not pay if the coma has been brought about as a result of alcohol or drug misuse.

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Permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse in the better eye using a Snellen eye chart.

Blindness – permanent and irreversible

What is it?

The loss of sight in both eyes where the condition cannot be cured and is permanent.

When would we pay?

Confirmation that the loss of sight is permanent and irreversible for both eyes.


Being registered blind or having an eye disease which can be treated does not necessarily mean that a claim will be paid, as the loss of sight may not be permanent and irreversible.

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Permanent physical severance of any hand or foot at, or above, the wrist or ankle joints.

Loss of Hand or Foot – permanent physical severance (ABI+)

What is it?

The loss of one or more hands or feet. A foot must be severed at the ankle joint or above, a hand at the wrist or above.

When would we pay?

Upon confirmation of the permanent loss of a hand or foot.


When the definition is not met.

Permanent and irreversible loss of hearing to the extent that the loss is greater than 95 decibels across all frequencies in the better ear using a pure tone audiogram.

Deafness – permanent and irreversible

What is it?

The total loss of hearing where the condition is expected to be permanent and irreversible.

When would we pay?

Upon confirmation of total and permanent loss of hearing as specified in the left hand column.


When deafness is not permanent. Being partially deaf or having ear disease which can be treated will not qualify as a claim.

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Inability of the person covered as a result of any injury or illness to perform any three Activities of Daily Living without the direct assistance of another person, but with the use, where appropriate of certain aids. The disability must be permanent and irreversible.

Loss of Independent Existence

What is it?

The inability to carry out basic everyday activities without the help of other people, but with the use of aids e.g. a wheelchair.

When would we pay?

A claim would be valid when you are no longer able to perform three or more of the Activities of Daily Living. The Activities of Daily Living are listed on page 30 of this guide.


If your condition does not prevent you from performing three or more of the Activities of Daily Living or is not regarded as permanent and irreversible.

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

Loss of Speech – permanent and irreversible

What is it?

The permanent loss of speech. This may be as a result of a trauma or an underlying disease.

When would we pay?

Benefit will be paid in the event of speech loss, which is total, permanent and irreversible as a result of injury or disease.


We won’t pay if the condition is temporary or treatable. Loss of speech other than as a result of a trauma or underlying disease is not covered.

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

Paralysis of Limb – total and irreversible (ABI+)

What is it?

Paralysis is the loss of movement or feeling caused by damage to nerves due to injury or disease.

When would we pay?

At least one arm or leg must be totally paralysed and this state must be irreversible.


Where the paralysis is incomplete or thought to be reversible.

Burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least:

• 20% of the body surface area, or

• 30% of the head and neck, or

• 50% of the face.

Third Degree Burns – covering 20% of the body’s surface or affecting 30% of the surface area of the head and neck or 50% of the face (ABI+)

What is it?

Burns that are the most serious type and involve the full thickness of the skin.

When would we pay?

A claim will be paid in cases where burns cover at least:

• 20% of the body surface area; or

• 30% of the head and neck; or

• 50% of the face

and have destroyed or damaged the skin to its full thickness.


Burns covering less than quoted percentages and do not damage or destroy the skin to its full thickness are not covered.

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Death of brain tissue due to traumatic head injury resulting in permanent neurological deficit with persisting clinical symptoms.

For the above definition the following is not covered:

• Traumatic Head Injury secondary to alcohol or drug abuse.

Traumatic Head Injury – resulting in permanent symptoms

What is it?

A head injury which has come as a result of a physical wound or injury (not caused by a disease) that has caused permanent damage to the brain leading to a neurological or physical disability.

When would we pay?

On confirmation that the person affected has had a traumatic head injury which has caused permanent neurological or physical symptoms as a result of the death of brain tissue.


If the traumatic head injury has not resulted in permanent neurological deficit or physical disability. We will not pay if the traumatic head injury was brought about as a result of use of alcohol or drug misuse.

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Critical Illness DefinitionsOrgan Failure:

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

Kidney Failure – requiring dialysis

What is it?

The kidneys remove the body’s waste products from the blood. If they fail, this job can be done either temporarily or permanently by regular dialysis.

When would we pay?

The total failure of both kidneys to function that is irreversible and permanent and that requires regular dialysis.


As the body can function quite normally on one kidney we do not cover the loss of function of a single kidney.

End stage irreversible liver failure due to cirrhosis and resulting in all of the following:

• permanent jaundice;

• ascites, and

• encephalopathy.


• End stage liver failure secondary to alcohol or drug abuse.

Liver Failure – end stage

What is it?

The liver plays an important part in the digestion of food as well as breaking down harmful substances, removing waste products from the blood and making chemicals that the body needs to stay healthy. Cirrhosis is a serious condition where normal liver tissue is progressively destroyed preventing the liver from working properly. Permanent jaundice, ascites and encephalopathy are indicators of end-stage irreversible liver disease. Jaundice is a yellowing of the skin or whites of the eyes, ascites is the accumulation of free fluid in the abdominal cavity and encephalopathy often results in mental confusion.

When would we pay?

For a claim to be valid there will need to have been made a definite diagnosis of irreversible end stage liver failure and symptoms of permanent jaundice, ascites and encephalopathy resulting.


We will not pay if the condition has been brought about as a result of alcohol or drug misuse or abuse.

The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, liver, lung, or pancreas, or inclusion on an official UK waiting list for such a procedure.


• Transplant of any other organs, parts of organs, tissues or cells.

Major Organ Transplant

What is it?

Some diseases may reach the point when the only possible remaining treatment is an organ transplant. If so, the patient may be referred to a UK transplant centre and, if considered suitable, be placed on the official UK waiting list for transplantation.

When would we pay?

A claim will be paid either on being placed on such a list or actually receiving a transplanted organ as follows:

1. Heart.

2. Lung (if a lung needs replacement, the heart will normally be replaced as well).

3. Liver.

4. Bone marrow (normally carried out for cancer, but there are other diseases leading to this).

5. Pancreas.

6. Kidney.


When not on an official UK waiting list for one of the organ transplants listed above. Transplant of any other organs, or parts of organs, tissues or cells are not covered.

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Confirmation by a Consultant Physician of chronic lung disease which is evidenced by all of the following:

• the need for continuous daily oxygen therapy on a permanent basis with evidence that oxygen therapy has been required for a minimum of six months;

• vital capacity being less than 50% of normal; and

• FEV1 (Forced Expiratory Volume at 1 second) being less than 40% of normal.

Severe Lung Disease – of specified severity

What is it?

The lungs bring oxygen into our bodies and pass it into the bloodstream so that it can circulate to every cell in the body. Severe lung diseases will cause breathlessness and will mean that oxygen cannot get to the body’s muscles and vital organs. A severe lung disease can lead to disability and ultimately to lung and heart failure.

When would we pay?

For a claim to be paid a Consultant Physician will need to confirm that you have chronic lung disease which has damaged your lungs (as detailed in the left hand column) and also requires you to permanently have oxygen therapy.


If your lung disease does not permanently require you to have oxygen therapy and your lung disease has not severely affected your lung function.

If you have not required continuous daily oxygen therapy for six months or more.

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Total and Permanent Disability (TPD)

How can I include this cover?

So far in this guide we have concentrated on illnesses, but other events can cause a permanent and irreversible disability. So for added protection you can choose to add Total and Permanent Disability to your Critical Illness Cover for an additional charge.

What is Total and Permanent Disability?

It is designed to cover other chronic conditions and circumstances that are not included under Critical Illness Cover. For example, osteoarthritis may result in gradually increasing symptoms eventually leading to the permanent inability to work or carry out day to day activities. When recovery is not expected, a Total and Permanent Disability claim may be paid. A serious injury or accident may cause similar disability. Different definitions of disability are used for this type of cover, depending on your age and circumstances. You should refer to your Cover schedule for confirmation of the definition that will apply to you when your cover starts.

What definition is used for my Total and Permanent Disability?

There are three definitions of disability that may apply to your cover. These are shown below. In all cases your disability must be permanent and irreversible, which means that the problem leading to the claim must be expected to last throughout your life and not be reasonably improved by medical treatment.

The definition applied at outset will be ‘Own Occupation’ or ‘Activities of Daily Work’ depending on your occupation and the duties that you carry out. This will be shown on your Cover schedule. If you are not working at the time of your claim then we will use the ‘Activities of Daily Work’ definition irrespective of what is shown on your Cover schedule. If you are over age 65 at the time of your claim then we will always use the ‘Activities of Daily Living’ definition.

The person covered will be regarded as being permanently and totally disabled if, because of any injury or illness:

• they are unable to perform any three Activities of Daily Living without the direct assistance of another person, but with the use, where appropriate, of certain aids; or

• they suffer from mental incapacity*.


* Mental incapacity is defined as an impairment of brain function either through an organic brain disease or injury which affects the ability of the person covered to:

• reason;

• remember; and

• accurately understand, perceive and express ideas and intentions,

leading to a significant reduction in mental functioning such that they are no longer able to look after themselves without the continued supervision and assistance of others.

Activities of Daily Living

What are they?

The Activities of Daily Living are as follows:

Washing

The ability to wash in the bath or shower, including getting in and getting out, or wash satisfactorily by other means.

Dressing

The ability to put on and take off all items of clothing without requiring the assistance of another person.

Eating

To be able to feed oneself once the food has been prepared and made available.

Toileting

The ability to use the lavatory or otherwise manage bowel and bladder function so as to maintain a satisfactory level of personal hygiene.

Mobility

The ability to move indoors from room to room on level surfaces.

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The person covered will be regarded as being totally and permanently disabled if, because of any injury or illness, they are unable to carry out the essential duties of their own occupation. The disability must be permanent and irreversible.

Own Occupation

What is it?

The essential duties of an occupation are those that cannot reasonably be omitted without affecting the ability to carry out that occupation.

The person covered will be regarded as being permanently and totally disabled if, because of any injury or illness:

• they are unable to perform any three Activities of Daily Work without the direct assistance of another person, but with the use, where appropriate, of certain aids; or

• they suffer from mental incapacity*.


* Mental incapacity is defined as an impairment of brain function either through an organic brain disease or injury which affects the ability of the person covered to:

• reason;

• remember; and

• accurately understand, perceive and express ideas and intentions,

leading to a significant reduction in mental functioning such that they are no longer able to look after themselves without the continued supervision and assistance of others.

Activities of Daily Work

What are they?

The Activities of Daily Work are as follows:

Walking

The ability to walk a distance of 200 metres on flat ground without stopping or experiencing severe discomfort.

Climbing

The ability to walk up or down a flight of 12 stairs without holding onto a rail or resting.

Bending

The ability to bend or kneel to pick something up from the floor and stand up again. Also the ability to get into and out of a standard saloon car.

Communicating

The ability to answer the telephone and take a simple message.

Eyesight

Having eyesight, after correction if required, sufficient to read 16 point print.

Healthcare

Having the ability to independently make arrangements, when necessary, to seek medical attention and take medication as prescribed.

Financial Independence

The ability to handle routine day to day financial transactions.

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Making a claim

It is always best to call the number on your latest AXA Protection Account communication.

Or call the AXA Protection Account helpline: 0845 300 3460

The helpline is open – 8.30am to 6pm Monday to Friday

How to make a claim

Once you have told us that you wish to make a claim we will send you a claim pack and guide. The pack will include a claim form for you to provide us with the information that we will need to assess your claim. The information required will vary according to the type of claim. At this time we will also request your consent to approach other parties, such as your doctor, for a report.

Once the claim form has been received, our Claims Assessor will make an initial assessment of your case and decide what further information we will need. The Claims Assessor will then write directly to your doctor and consultant for reports and will write to let you know what has been done.

Additional information may be needed. This could include a medical examination or a meeting with our Claims Visitor.

During the course of your claim, it will be necessary for us to request and hold details of your personal and medical information. You can be assured that all information received will be handled sensitively and will be kept in a secure environment at all times.

Getting in touch with us

If you need to make a claim we realise this may occur some time after you received this guide. During that time the procedures for making a claim may be different from what you read here, so it is always best to call the number on your latest AXA Protection Account communication.

Your AXA Protection Account is here to provide financial support to you and your dependents through a range of benefit covers. Emotional and practical support is also provided via our Assistance Services. When notified of a claim, we aim to provide you with:

• Direct access to a dedicated, specialised professional and experienced claims team;

• Hassle free service;

• Accurate payments of claims;

• Claims paid on time and without unnecessary delay;

• Up to date information throughout the process; and

• Access to a wide range of additional services to help support you.

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Glossary of Key Terms

Definitions of terms used in this document and within your Account pack.

Invasive (Cancer)

Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues.

Irreversible

Cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the National Health Service in the UK at the time of the claim.

Occupation

A trade, profession or type of work undertaken for profit or pay. It is not a specific job with any particular employer and is independent of location.

Permanent

Expected to last throughout the insured person’s life, irrespective of when the cover ends or the insured person retires.

Permanent neurological deficit with persisting clinical symptoms

Symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the insured person’s life.

Symptoms that are covered include numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma.

The following are not covered:

• An abnormality seen on brain or other scans without definite related clinical symptoms.

• Neurological signs occurring without symptomatic abnormality, e.g. brisk reflexes without other symptoms.

• Symptoms of psychological or psychiatric origin.

Alcohol or drug abuse

Inappropriate use of alcohol or drugs, including but not limited to the following:

• Consuming too much alcohol.

• Taking an overdose of drugs, whether lawfully prescribed or otherwise.

• Taking Controlled Drugs (as defined by the Misuse of Drugs Act 1971) otherwise than in accordance with a lawful prescription.

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AXA, PO Box 1810, Bristol BS99 5SN. Telephone: 0117 989 9000. AXA is a worldwide insurance group. In the UK, one of the AXA companies is AXA Sun Life Services plc, which distributes and administers financial products and services. AXA Sun Life Services plc is authorised and regulated by the Financial Services Authority and is a company limited by shares, registered in England No. 3424940, registered office: 5 Old Broad Street, London, EC2N 1AD. As part of our commitment to quality service, telephone calls may be recorded.

AXA Protection Account Proud to have been voted “Most Trusted Critical Illness Provider 2009”

Questions?Please contact your financial adviser if you:

•have a question,

•would like more information, or

•would like a revised Quotation Summary.

Their details are on your Quotation Summary.

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