new ireland life choice - home policy conditions · vivendo, ut nostro nominavi cum, no nostro...

NEW IRELANDLIFE CHOICE - HOMEPOLICY CONDITIONS

PROTECTION

New Ireland Assurance Company plc.,11-12 Dawson Street, Dublin 2.T: (01) 617 2000 F: (01) 617 2075. E: [email protected] W: www.newireland.ieA Member of Bank of Ireland Group.

New Ireland Assurance Company plc is regulated by the Central Bank of Ireland.

301673 V4.02.12

1. SubHeading

Nomeiagamluptatumsenserit,vulputate

reprehenduntnecei.Eunostroobliqueaccusata

duo,periddoloremsensibus.Hasnoquodsimelius

theophrastus,nonecputentomittam,andicononumy

deseruisseper.

TextHeading

Anquidamnemorecotidiequeusu.Euviderermolestie

voluptuapri,adeosquisoblique.Noiudicoreferrentur

eos,pronenobisdelicataevertitur,placerat

consequunturatvel.

l Dolordiscereperpetuaetper,quasmentitum

l Cunibhobliqueinermissed.

l Eivixsolumoblique.

l Eiusprimisadipiscietvix,facetevim.

Dicamdignissiminius,aequemunerereformidanssitan.Vixexmodusvituperata,indoctumconceptamvimte,eueamvitaequodsi.Iniusnatumdocendi,probopertinaxexeos.Adhasvulputatecotidieque.Nameuismodmoderatiusan.

TextHeading

Duovocentmolestiaeut.Justonosterdeterruisset

vixex,nominavicorrumpithonestatismelne,vim

idautemnobisquodsi.Quoidpropriaepericula

consulatu.Iustritaniponderumne,homeroputant

causaehisin.Uthisviditmaiestatis,atconsulprompta

sit.

Minimviderereligendieuius,dolorpopuloeumut.

Dicantdelicatissimianhas.Intellegamappellantur

cumno,librisvirtuteincum.Eugraecelobortis

sit,hisvituperatoribusscriptane.Namnoutinam

alienum,noeosunumincorrupte.Quoinwisiliber

vivendo,utnostronominavicum,nonostroadipisci

concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

1

CONTENTSIntroduction 2

SectionA.GeneralConditions 31. Definitions 32. LegalBasis 43. PaymentofBenefits 5

SectionB.Detailsofthepolicy 61. PayingPremiums 62. AmendingyourPolicy 6 2.1.Medical-FreeConversionOption 6 2.2.LifeEventsOption 7 2.3.OtherPolicyOptions 83. RestartingyourPolicy 84. CancellingyourPolicy/BenefitsCeasing 85. WhoisCovered 86. Settlement/Correspondence 97. NoPolicyValue 98. TheActuary 99. LegalInterestinYourPolicy 9

SectionC.Benefits 101. DeathBenefits 10 1.1.LumpSumonDeath 10 1.1.1TerminalIllnessBenefit 10 1.1.2AccidentalDeathBenefit 112. AdditionalBenefits 11 2.1.AcceleratedSpecifiedIllnessBenefit 11 2.1.1PartialPaymentSpecifiedIllnessBenefit 12 2.1.2WaitingListBenefit 12 2.2. AccidentPayment 13 2.3. HospitalisationPayment 14 2.4. BrokenBonesPayment 14 2.5. SurgeryPayment 153. Children’sProtectionBenefits 16 3.1.Children’sLumpSumonDeath 16 3.2.Children’sSpecifiedIllnessBenefit 16 3.3.Children’sHospitalisationPayment 17

SectionD.ClaimProceduresandExclusions 181. ClaimProcedures 182. Exclusions 18

AppendixA 20

AppendixB 29

1

ComhluchtnahÉireannumÁrachas,cpt/NewIrelandAssuranceCompanyplc

RegisteredinDublin,Ireland,RegisteredNo.7336.

RegisteredOffice:11–12DawsonStreet,Dublin2.

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

2

INTRODUCTION

ThisisthePolicyDocumentforyourLifeChoice–Homepolicy.TogetherwiththePolicySchedulewhichis

containedinthepocketinsidethefrontcoverandanyendorsementstothispolicy,itcontainsthedetailsofyour

policyandtheconditionsandruleswhichsetouthowthepolicyworks.

ThePolicyDocumentisalegaldocumentandshouldbekeptinasafeplace.Itwouldalsobeusefulifyour

solicitor,arelativeorafriendknewwhereitiskept.

2

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

3

1. Definitions

AcceleratedSpecifiedIllnessBenefit

Thisbenefit(ifselectedandacceptedbytheCompany)

providesforanamounttobepaidiftheLifeInsured

isdiagnosedwithaSpecifiedIllnessasoutlinedin

AppendixAduringtheTermofCoverforthisbenefit.

AccidentPayment

TheamountofAccidentPaymentshowninthe

PolicyScheduleasapplyingtoaLifeInsured,oras

subsequentlychanged.ConditionsapplyingtoAccident

PaymentaredescribedinSectionC,Condition2.2.

Actuary

NewIreland’sAppointedActuary.

Application

Thecompletedapplicationformand/orallthe

informationinconnectionwiththispolicy,provided

byyouand/ortheLivesInsuredtoyourintermediary

and/ortotheCompany,orbyyourintermediarytothe

Company,priortothecommencementofthepolicy

andanydeclarationssignedbyyouand/ortheLives

Insured.

Assigned

YoucanmaketheProtectionBenefitsunderthepolicy

payabletosomeoneelsebymakingyourpolicyAssigned.

Thisinvolvesyouandtheotherpersonmakingalegal

agreementastowhowillreceivetheProtectionBenefits.

Normally,thisisdoneifthispolicyisusedassecurityfor

aloan,andtheProtectionBenefitsarepaidtothelender.

YouarestillliabletopaythePremiums.

Assignee

IfyoumakeyourpolicyAssigned,thentheperson

whohastakenoverthelegalinterestisknownasthe

Assignee.ItisthispersontowhomtheProtection

Benefitswillbepaid.

BrokenBonesPaymentConditionsapplyingtoBrokenBonesPaymentare

describedinSectionC,Condition2.4.

Consultant

Amedicalpractitionerwhoisonthespecialistregister

withtheIrishMedicalCouncilortheBritishMedical

Councilinrelationtoaspecificfieldofmedicineand

whoispractisingatanIrishorUnitedKingdomHospital.

ExpiredTerm

Thisisthenumberofpolicyanniversariesattainedsince

thePolicyStartDate.

Hospital

Thisisamedicalinstitutionregisteredwiththe

relevantauthorityintheRepublicofIrelandorthe

UnitedKingdomwhichhascontinuousfacilities

fordiagnosis,treatmentandmajorsurgery,which

isoperatedprimarilyforthesurgicalandmedical

treatmentofacuteillnessandinjury,andwhich

providesaccommodationforsickandinjuredpeopleas

in-patients.Forthepurposesofthispolicy“Hospital”

doesnotincludeahospice,convalescence,geriatric

orrehabilitationfacilityortheNationalRehabilitation

Hospital(DúnLaoghaire,Co.Dublin).

HospitalisationPayment

ThedailyamountofHospitalisationPaymentshown

inthePolicyScheduleasapplyingtoaLifeInsured,

orassubsequentlychanged.Conditionsapplyingto

HospitalisationPaymentaredescribedinSectionC,

Condition2.3.

Insurer

NewIrelandAssuranceCompanyplcistheCompany

thathasissuedthepolicy.Whereverthewords“we”,

“us”,“NewIreland”,“theInsurer”and“theCompany”

areusedinthepolicytheyrefertoNewIreland

AssuranceCompanyplc.NewIrelandAssurance

CompanyplcisregulatedbytheCentralBankof

Ireland.AmemberofBankofIrelandGroup.

LifeInsured

Apersonwhoselifeisinsuredbythepolicy,andwho

isnamedinthePolicySchedule.Iftherearetwolives

insurednamedinthePolicySchedulethenthepolicyis

ajointlifepolicy.

3

SECTION A – GENERAL CONDITIONS

LumpSumonDeathBenefit

Thisbenefitprovidesforthepaymentofalumpsum

amountonthedeathoftheLifeInsuredduringtheTerm

ofCoverforthisbenefit.

PartialPaymentSpecifiedIllnessBenefitThisbenefit(whichappliesonlyifAcceleratedSpecified

IllnessBenefithasbeenselectedandacceptedbythe

Company)providesforanamounttobepaidiftheLife

InsuredisdiagnosedwithaPartialPaymentSpecified

IllnessasoutlinedinAppendixBduringtheTermof

CoverforAcceleratedSpecifiedIllnessBenefit.

PolicyAnniversary

Thisisthedate12monthsafterthepolicystartsand

every12monthsthereafter.

Policyholder

Thepersonorpersonswithwhomthecontractof

insuranceismadeandwhoisresponsibleforthepayment

ofthePremiums.Whereverthewords“you”and“your”

areusedinthepolicy,theyrefertothePolicyholder.The

PolicyholderisnamedinthePolicySchedule.

PolicySchedule

ThePolicyScheduleformspartofthepolicyandsets

outthespecificdetailsofyourpolicy.

PolicyStartDate

Thisisthedatethatthepolicy,theProtectionBenefitsand

thePremiumsstart.ItisstatedinyourPolicySchedule.

PolicyTerm

ThisistheTermofCoverchosenfortheLumpSum

onDeathBenefitasstatedinyourPolicyScheduleor

anyendorsement.Thepolicymayendearlierthanthe

expiryoftheTermofCoverifProtectionBenefitsare

paidorthepolicylapsesorceasesassetoutinthese

policyconditions.

PremiumorPremiums

TheamountshowninthePolicyScheduleorarevised

amountasstatedonanyendorsementorletterfrom

theCompanyasaresultofvoluntaryrevision.The

frequencyatwhichPremiumsarepayableisalso

showninthePolicySchedule.

ProtectionBenefits

TheLumpSumonDeathBenefit,AcceleratedSpecified

IllnessBenefit,AccidentPayment,Hospitalisation

Payment,BrokenBonesPaymentandSurgeryPayment,

asapplicable,applyingtoaLifeInsuredarecollectively

referredtoastheProtectionBenefits.

SpecifiedIllness

ASpecifiedIllnessisthedefinitediagnosisbya

ConsultantofanIrishorUnitedKingdomHospital,and

asverifiedbytheCompany’sChiefMedicalOfficer,ofthe

firstoccurrenceofanyoftheSpecifiedIllnessesoutlined

inAppendixAand/orAppendixBduringtheTermof

CoverforAcceleratedSpecifiedIllnessBenefit.

SurgeryPaymentTheamountofSurgeryPaymentandtheconditionsthat

applyaredescribedinSectionC,Condition2.5.Surgery

PaymentonlyappliestoaLifeInsuredifstatedinthe

PolicyScheduleoranyendorsement.

TermofCover

Thisistheperiod(s)ofcoverchosenforeachofthe

ProtectionBenefitsthathavebeenselectedunder

yourpolicy.CoverforeachoftheProtectionBenefits

willendontheexpiryofthechosenTermofCover

or,ifearlier,thepaymentofProtectionBenefit(s)or

thelapseorcessationofthepolicyassetoutinthese

policyconditions.

2. LegalBasis

ThecontractwithNewIrelandAssuranceisalegal

agreementandconsistsof:

• theApplication(includinganyrecorded

telephoneinterview)completedbyyou,andthe

LifeInsured;

• thisPolicyDocumentwhichsetsoutthe

standardpolicyconditions;

• thePolicySchedule;

• anywrittenstatementsmadebyyou,andthe

LifeInsured(s);

• anystatementsmadebyanauthorisedperson

onyourbehalf;

4

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

55

• changesinthepolicyconditionsorPolicy

Schedulenotifiedtoyouinwritingbythe

Company(thesearecalledendorsements);

and

• anyscheduleofrevisedtermsissuedbythe

Companytoyou.

Theabovecontainsallthetermsofthecontractand

weacceptliabilityonlyinaccordancewiththeseterms.

Forthepolicytobevalid,werequirefullandtrue

disclosureintheApplicationandinanymedicalor

otherstatementsmadebythePolicyholderorLife

Insured(s)orintermediaryinconnectionwiththe

Application.

ThepolicyisgovernedbythelawsofIreland.The

courtsofIrelandshallhaveexclusivejurisdictionin

relationtoallmattersarisingunderorinconnection

withthepolicy.

TheCompanywill,subjecttothepaymentofPremiums

andthepolicyterms,paythebenefitsprovidedby

thepolicy.Ifthereisanymisrepresentationofor

failuretodisclosematerialfactsbyoronbehalfofthe

Policyholder,oraLifeInsured,thepolicyisvoidandall

Premiumspaidwillberetainedbyus.

Thepolicyandthebenefitsarepayableunderit

arebasedoncurrentlegislation,includingcurrent

taxationlegislation.Ifthereisanychangeintaxation

orotherlegislationaffectingthepolicywewillmake

suchalterationstothetermsofthepolicyas,inthe

Actuary’sopinion,arenecessarytotakeaccountof

suchchanges.

Complaintsanddisputesarisinginconnectionwith

yourpolicy,whichcometoberesolvedwithinthe

Company’sinternalcomplaintshandlingprocedure

maybereferredtotheFinancialServicesOmbudsmen.

DetailsoftheservicesprovidedbytheFinancial

ServicesOmbudsmenmaybeobtainedfrom

www.financialombudsman.ieandyourinsurance

advisororNewIreland.

Anyassignmentsofthepolicytoathirdpartymustbe

notifiedtotheCompanyatourheadoffice,

11/12DawsonStreet,Dublin2.

3. PaymentofBenefits

ProtectionBenefitsarepayabletothelegalowner

ofthepolicy.ThiswillnormallybethePolicyholder,

butiftherighttoreceivetheProtectionBenefitshas

beentransferredorAssignedtosomeotherperson

ororganisationsuchasabankorbuildingsociety,

thepaymentoftheProtectionBenefitswillbemade

directlytothem(unlesswereceivethewritten

instructionsofthelegalownertodootherwise).

Forexample,dependingonthecircumstanceswemay

payoneofthefollowing:

• thePolicyholder;

• atrustee(s)ofthepolicy;

• anexecutor(s)oradministrator(s);

• anAssignee(s)ofthepolicy.

IftherearetwoPolicyholderswewillpaybothjointly

orthesurvivorifonehasdied.Ifatthetimethebenefit

becomespayablethePolicyholderhasdied,wewill

paytheAssigneeortheexecutorsoradministrators

dealingwiththeestateasappropriate.Ifthepolicyhas

beenissuedunderTrust,wewillpaythetrusteewhois

responsibletothebeneficiariesoftheTrust.

1.PayingPremiums

YourfirstPremiumisdueonthePolicyStartDate.

SubsequentPremiumsarepayableatthefrequencyset

outinyourPolicyScheduleoranyendorsement.

ItisyourresponsibilitytoensurethatallPremiumsare

receivedbyus.Wewillallowyou30daysforpayment

fromthedatethatthePremiumisdue.IfthePremium

isnotpaidwithin30days,yourpolicyandProtection

Benefitswillcancelimmediatelywithoutfurthernotice

andyouarenolongeroncoverforanyProtection

Benefits.Ifyouinformusinwritingwithin30daysof

thepremiumduedatethatyouwanttocancelyour

policy,itwillbecancelledimmediately.Wherethis

policyisbeingreplacedbyanewpolicy,thispolicywill

becancelled(unlesspreviouslylapsed)witheffectfrom

thecommencementdateofthenewpolicy.

IfyouhaveAssignedyourpolicy,weareobligedto

notifytheAssigneethatPremiumshavenotbeenpaid

andthatcovernolongerapplies.

Ifaclaimarisesduringthe30dayperiodaftera

Premiumisdueandhasnotbeenpaid,butbeforethe

policyhasbeencancelled,wewilldeducttheamount

oftheunpaidPremiumfromtheclaimamount.

2. Amendingyourpolicy

2.1Medical–FreeConversionOption

ThePolicySchedulewillstatewhetherthisoption

appliestoyourpolicy.

IfthePolicySchedulestatesthattheMedical-Free

ConversionOptionapplies,thenatanystagebefore

theexpiryofyourTermofCoveryoumayeitherextend

theTermofCoverfortherelevantbenefitorcancel

thispolicyandtakeoutanewpolicywiththeCompany

withoutprovidinganyadditionalmedicalevidence.

Thisoptionissubjecttothefollowingprovisions.

To extend the Term of Cover all of the following must be satisfied: • TheLifeInsured(ortheolderLifeInsuredin

thecaseofajointlifepolicy)mustbeunder

65yearsofageonthedatetheoptionis

exercised.

• ThepremiumchargedfortheextendedTerm

ofCoverwillbedeterminedbytheCompany

basedonitspremiumratesforthatpolicyat

thetimeandtheageoftheLifeInsured(s)on

atthedatetheoptionisexercised

• Anyspecialtermswhichapplytothe

ProtectionBenefitswillcontinuetoapplyfor

theextendedTermofCover.

• FinancialUnderwritingwillapply.

To take out a new policy all of the following must be satisfied: • TheLifeInsured(ortheolderLifeInsuredin

thecaseofajointlifepolicy)mustbeunder

65yearsofageonthedatetheoptionis

exercised.

• ThenewpolicymaybeanyoftheCompany’s

rangeofnon-unitlinkedpoliciesavailableto

youatthetimetheoptionisexercised.The

Companyreservestherighttorestrictand/or

varythedefinitionofanyProtectionBenefits

underthenewpolicytobeconsistentwiththis

policy.

• TheamountofanyLumpSumonDeath

orLumpSumonDeathwithAccelerated

SpecifiedIllnessBenefitprovidedbythenew

policycannotbegreaterthantheamountof

anyLumpSumonDeathand/orAccelerated

SpecifiedIllnessBenefitsprovidedbythis

policyatthetimeofconversionandmaybe

forsuchlesseramountsastheCompanyat

itsdiscretionshalldecidetakingintoaccount

evidenceastotheextentofanyfinancialloss

youwouldincuronthedeathordiagnosisof

aSpecifiedIllnessoftheLifeInsuredandany

otherfinancialevidencethattheCompanymay

require.

6

SECTION B – DETAILS OF THE POLICY

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

7

• Ifconvertingfromajointlifepolicytoadual

lifepolicy,theamountofanyLumpSumon

Deathand/orAcceleratedSpecifiedIllness

Benefitsprovidedbythenewpolicyforeach

LifeInsuredwillbehalfthatoftheLumpSum

onDeathandAcceleratedSpecifiedIllness

Benefit,providedbythispolicy.

• ThePremiumchargedforthenewpolicywill

bedeterminedbytheCompanybasedonits

premiumratesforthatpolicyatthetimethe

optionisexercised.

• Anyspecialtermswhichapplytothe

ProtectionBenefitswillcontinuetoapplyfor

thenewpolicy.

2.2LifeEventsOption

WithLifeEventsOption,youcanincreasethelevelof

theLumpSumonDeathand/orAcceleratedSpecified

IllnessBenefitapplyingtoaLifeInsuredwithin3

monthsoftheoccurrenceofanyofthefollowinglife

eventswithoutprovidingevidenceoftheLifeInsured’s

currenthealthandoccupation:

(a) TheLifeInsuredhasincreasedamortgage

associatedwiththispolicybecausetheLifeInsured

hasmovedprincipalresidence;

(b) TheLifeInsuredhasmarried;

(c) TheLifeInsuredoraspouseoftheLifeInsured

hasgivenbirthtoachildorlegallyadoptedachild.

InthecaseofeachLifeInsured,theoptiontoincrease

abenefitwillonlyapplyiftheLifeInsuredisalready

coveredforthatbenefitwithinthepolicy.

Thetotalamountoftherelevantbenefitafter

exercisingtheLifeEventsOptioncannotexceedthe

maximumof(1)and(2)asfollows:

(1)Theamountofthebenefitprovidedbythispolicyat

thetimeofexercisingtheoption

Plus

Thelesserof:

(a)50%oftheamountofthebenefitatthePolicy

StartDate(or,ifthebenefitwassubsequently

addedtoyourpolicy,atthetimeitwasfirstadded),

and

(b)? 100,000,

and

(2)Thelesserof:

(a)TheamountofthebenefitatthePolicyStart

Date(or,ifthebenefitwassubsequentlyadded

toyourpolicy,atthetimeitwasfirstadded),

and

(b)? 500,000,whicheverislesser.

WheretheLifeEventsOptionisexercisedonmorethan

oneoccasion,thentheamountin(1)isrestrictedtoa

cumulativemaximumincreaseof? 200,000.

IfyouexercisetheMedical-FreeConversionOption,

thenthemaximumabenefitamountcanbeincreased

toundertheLifeEventsOption,withoutproviding

additionalmedicalevidence,isrestrictedto? 200,000

overtheamountofthebenefitatthePolicyStart

Dateor,ifthebenefitwassubsequentlyaddedtoyour

policy,atthetimeitwasfirstaddedtothepolicy.

Whereyouhavemorethanonepolicywiththe

Company,increasestootherpolicieswhichhavetaken

placeunderaLifeEventsOptionwillbetakeninto

accountforthepurposesofcalculatingthemaximum

increaseunderthispolicy.

InthecaseofAcceleratedSpecifiedIllnessBenefit,the

conditionsapplicabletotheincreaseandinparticular

theillnessescoveredwillbeinaccordancewiththe

termsandconditionsapplicableatthedateofthe

proposedincrease.

TheLifeEventsOptionissubjecttoallofthefollowing:

• WhenexercisingthisoptiontheLifeInsured(orthe

olderLifeInsuredinthecaseofajointlifepolicy)

isunder55yearsofageonthedateofapplication

toexercisethisoption.

• Youmustnotifyusthatyouwishtoexercisethis

optionwithin3monthsafterthedateofthelife

eventdescribedin(a)to(c)aboveandprovideus

withthefollowingevidence:

– Confirmationoftheloandrawdownforthe

mortgageintheeventofanincreaseinthe

mortgageandmovingprincipalresidence.

– Amarriagecertificateintheevent

ofmarriage.

– Abirthcertificateintheeventofabirth/legal

adoptionofachildtogetherwithacopyofan

7

appropriateAdoptionOrder.

• ThePremiumsmustbepaidinfullwhendueupto

thedateoftheexerciseoftheoption

• YourPremiumswillbere-calculatedto

takeaccountofanincreaseinbenefits

and/orTermofCover.

• Anyspecialtermsapplicablewhenthe

policywasissued.

2.3.OtherPolicyOptions

OutsidethetermssetoutinConditions2.1and2.2

above,atanystagethroughouttheTermofCoveryou

mayrequestanamendmenttotheTermofCoveror

theamountofProtectionBenefits.Youcanalsorequest

theadditionoforremovalofProtectionBenefitson

yourpolicy.AnyamendmentsoutsideofConditions

2.1and2.2abovewillbesubjecttounderwritingand

acceptancebytheCompany.Wherearequestfor

suchanamendmentisacceptedbytheCompany,this

willresultinyourPremiumbeingre-calculatedto

takeaccountofthechangesbeingmadeandwillbe

confirmedbyanendorsementtothePolicy.

3. RestartingyourPolicy

IfaPremiumhasnotbeenpaidwithin30daysfrom

thedateitwasdueforpayment,thenassetoutin

Condition1ofSectionB,yourpolicyandProtection

Benefitswillbecancelled.However,yourpolicymay

berestartedatourabsolutediscretionwithinoneyear

fromthedatethatthefirstunpaidPremiumwasdue.

Restartingyourpolicyissubjecttopaymentofall

premiumsoutstandingandthecompletionofa

DeclarationofHealthFormbyeachLifeInsured.

Dependingonwhatisdisclosedonthisformthe

Companymayrequestfurthermedicaland/orother

information,acceptordeclinethereinstatementand/

ormakechangestothepolicytermsorconditions

includingthePremiumtobepaid.

4. CancellingyourPolicy/Protection BenefitsCeasing

TheProtectionBenefit(s)willceasewhenanyoneof

thefollowingeventsoccurs:

• AclaimismadeundertheLumpSumon

DeathBenefit,onasinglelifeorthefirstdeath

inajointlifepolicy.

• YoumakeaclaimundertheAccelerated

SpecifiedIllnessBenefitwhichreducesthe

LumpSumonDeathBenefitamounttozero.

• TheLifeInsured(s)reachestheendofthe

TermofCoverfortheProtectionBenefit(s).

• Yougivewrittennotificationthatyouwishto

cancelyourpolicy.

• Wedonotreceiveapremiumonthedatethe

Premiumisdueforpaymentand30days

elapsesincethatdatethepremiumremains

unpaid.

TheCompanymayalsoretainanyPremiumspaid

underthePolicy.

5. WhoisCovered

TheLifeInsured(s)iscoveredfortheamountofthe

ProtectionBenefitsapplyinguntiltheendoftheTerm

ofCoverforeachoftheProtectionBenefits.TheLifeor

LivesInsured(s)detailsandchosenbenefitsarestated

inthePolicyScheduleoranyendorsement.Oncewe

havecollectedyourfirstPremiumandyourpolicyhas

started,theLifeorLivesInsured(s)is/arecoveredfor

theamountoftheProtectionBenefitsapplyingfrom

thelaterofthePolicyStartDateandthedatewe

collectyourfirstPremium.

WewillrequireproofoftheageoftheLifeInsured(s)

eitheronApplicationorbeforewepayaclaim.Ifitis

discoveredthattheageorthesexofaLifeInsured

hasbeenmis-stated,theamountpayableunderthe

provisionofthepolicywillbeadjustedasdetermined

bytheActuaryandmayresultinthenonpaymentof

thebenefit.TheCompanymayretainanyPremiums

paidunderthePolicy.

8

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

9

6. Settlement/Correspondence

Wewillmakepaymentsunderyourpolicybydirect

credittoanominatedbankaccount.Otherformsof

paymentcanbearrangedbyagreement.

Wewillsendyourcorrespondencetothemostrecent

addressgivenbyyou.Youmustnotifyusifyouchange

address.Ifyoudonot,wearenotresponsiblefor

correspondencebeingdeliveredtotheincorrect

address.

Anylettersornoticesfromyoumustbesenttousat

ourheadoffice,11/12DawsonStreet,Dublin2.

7. NoPolicyValue

Thepurposeofthispolicyistoprovidealumpsum

paymentintheeventofdeathand/or(ifselected)on

thediagnosisofaSpecifiedIllnessofaLifeInsured

duringtheTermofCover.Thispolicyisnotasavings

policyandatnopointduringthePolicyTerm,oratthe

endofthePolicyTerm,willithaveanymonetaryvalue.

8. TheActuary

TheInsurerappointsanActuarywhoseresponsibilities

includeadvisingusonhowthepolicyshouldprovide

youwithwhatyoureasonablyexpecttogetfromit.He/

shewilladviseushowtheinterestsofthePolicyholders

shouldbetakenintoaccountinanyvariationonthese

policyconditionsthatwemaypropose.

Wemayrevisetheconditionssetoutinthisdocument

if,intheopinionoftheActuary,circumstancesoutside

ourcontrolhavechangedinawaywhichcouldnot

reasonablyhavebeenpredictedatthestartofthe

policyandwhere,ifwewerenottoamendthesepolicy

conditions,theresultswouldbeunfairtotheInsureror

toourPolicyholders.Suchcircumstancesmightbe:

• achangeinthelawunderwhichthesepolicies

operate,or

• achangeinthetaxtreatmentofpolicybenefits

oroflifeassurancecompaniesandtheir

funds.

WhenconsideringanyproposalsbytheInsurerandhow

theyaffectyourinterests,theActuarywillrefertothe

GuidanceNotespreparedindependentlybytheSocietyof

ActuariesinIrelandandtoanylegislationthataffectsthe

waythathe/shemustactinthesecircumstances.The

Actuaryisrequiredtomakeastatementintheannual

returnstotheCentralBankofIrelandonwhetherhe/she

hasconformedwiththeGuidanceNotes.

9. LegalInterestinYourPolicy

Youcanusethispolicyassecurityforaloanbysigning

overyourlegalinteresttothelender.Thisisknown

asan“Assignment”.AnoticeofAssignmentmustbe

receivedbyusatourheadofficefromthepersonwho

hastakenoverthelegalinterest.Thispersonisknown

asthe“Assignee”.Thenoticemustbeinwritingand

mustshowthedateandreasonforthechangeinlegal

ownership.Wecannotacceptanyresponsibilityforthe

legaleffectorotherwiseofanyAssignments.

9

ThissectioncontainsdetailsoftheProtectionBenefits

providedbythepolicyandthecircumstancesinwhich

theyarepayable.Theparticularbenefitsapplyingtoa

LifeInsuredareshowninthePolicyScheduleorany

endorsement.IfabenefitisnotshownonthePolicy

Schedule,thatbenefitisnotprovidedbythepolicy.No

benefitispayableaftertheexpiryoftheTermofCover

forthatbenefitandnoProtectionBenefitsarepayable

aftertheexpiryofthePolicyTerm.

AllProtectionBenefitsprovidedbythepolicyare

currentlypayabletothePolicyholderfreeoftaxation.

Detailsofthecircumstanceswhenaclaimmaynotbe

payable,andtheprocedureyoumustfollowinorder

tomakeaclaim,arecontainedinSectionD“Claim

ProceduresandExclusions”.

1. DeathBenefits

1.1.LumpSumonDeath

ThisbenefitonlyappliestoaLifeInsuredifstatedon

thePolicyScheduleorsubsequentendorsement.

Thisbenefitprovidesforthepaymentofalumpsum

amountasstatedonthePolicyScheduleorany

endorsementonthedeathoftheLifeInsured(orthe

firstoftheLivesInsuredtodieifajointlifepolicy)

duringtheTermofCoverforthisbenefitasstatedin

thePolicyScheduleoranyendorsement.

TheLumpSumonDeathBenefitasstatedonthe

PolicyScheduleorsubsequentendorsementwill

reduceatmonthlyintervals.Themonthlyreductionwill

becalculatedwithreferencetotheproportionofthe

balanceoutstandingonarepaymentmortgageinan

amountequaltotheLumpSumonDeathBenefitand

forthesametermastheTermofCoverfortheLump

SumonDeathBenefitandascalculatedbytheActuary

usinganinterestrateof6%perannum.

If,underthetermsSectionB,Condition2,theTerm

ofCoverfortheLumpSumonDeathBenefithasbeen

extendedortheamountoftheLumpSumonDeath

Benefithasbeenincreased,theamountoftheLump

SumonDeathBenefitwillcontinuetoreduceat

monthlyintervalsinthemanneroutlinedabovewith

referencetotheextendedTermofCoverand/orany

revisionoftheamountofthebenefit.

ExactlywhentheLumpSumonDeathBenefitispaid

isdeterminedbythetypeofcoverthatwasselected

atthePolicyStartDateandisstatedonyourPolicy

Schedule.Thefollowingversionsofthepolicyare

available:

• SinglelifemeansthattheLumpSumonDeath

BenefitispaidwhentheonlyLifeInsured

underthepolicydiesduringtheTermofCover

forLumpSumonDeathBenefit.

• WheretherearetwoLivesInsured(jointlife)

theLumpSumonDeathBenefitispaidonthe

firstdeathofthetwoLivesInsuredunderthe

policyduringtheTermofCoverforLumpSum

onDeathBenefit.

ThepolicywillceaseonthepaymentofaLumpSum

onDeathBenefit.

IfAcceleratedSpecifiedIllnessBenefitapplies,then

theLumpSumonDeathBenefitwillbereduced(for

bothlivesinthecaseofjointlifepolicies)byanyprior

paymentofanyAcceleratedSpecifiedIllnessBenefit.

InthiseventtheremainingLumpSumonDeath

Benefitwillreducemonthlyinamannerconsistent

withanamendmentunderthiscondition.

NoclaimforLumpSumonDeathBenefitwillbe

admittedifdeatharisesfromanyoftheexclusions

containedinSectionDwhichareapplicabletoLump

SumonDeathBenefit.Theclaimsprocedures

describedinSectionDapplytoclaimsforLumpSum

onDeathBenefit.

1.1.1TerminalIllnessBenefit

ThisprovidesyouwithanearlypaymentofyourLump

SumonDeathBenefitifaLifeInsuredisdiagnosed

withaTerminalIllnessduringtheTermofCoverfor

yourLumpSumonDeathBenefit.

TerminalIllnessmeansanadvancedorrapidly

progressingincurableillness,whereintheopinionof

10

SECTION C – BENEFITS

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

11

anattendingmedicalConsultantofanIrishorUnited

KingdomHospitalandourCompany’sChiefMedical

Officer,aLifeInsured’slifeexpectancyisnogreater

than12months.IntheeventofTerminalIllness,the

TerminalIllnessBenefitpaymentwillnotapplywhere

therearelessthan18monthstogototheendofthe

TermofCoverforLumpSumonDeathBenefit.

TheTerminalIllnessBenefitwillbetheLumpSumon

DeathBenefitasoutlinedabove.Thepolicywillcease

followingtheTerminalIllnessBenefitbeingpaidout.

Inthecaseofajointlifepolicythisbenefitispayable

onthediagnosisofaTerminalIllnessofthefirstofthe

LivesInsured.

IntheeventofTerminalIllnessnoclaimwillbe

admittedifTerminalIllnessarisesfromanyofthe

exclusionscontainedinSectionDwhichareapplicable

toTerminalIllnessBenefit.Theclaimsprocedures

describedinSectionDapplytoclaimsforTerminal

IllnessBenefit.

1.1.2AccidentalDeathBenefit

IfaLifeInsuredisunderage55whenyousubmit

yourApplicationandyouhavechosenLumpSumon

Deathasabenefit,thenthepolicywillpayabenefit

ofthechosenLumpSumonDeathamountuptoa

maximumof?150,000shouldtheLifeInsureddiedue

toAccidentalDeath(orinthecaseofanapplicationfor

ajointlifepolicy,ontheAccidentalDeathofthefirstto

dieoftheLivesInsured)fromonorafterthedatethat

wereceiveyourcompletedApplicationinNewIreland’s

headoffice.

AccidentalDeathmeansdeathresultingfromaninjury

causedbyaccidental,violent,externalandvisible

meansandisinnowaylinkedtosickness,diseaseor

physicaldisorderofaLifeInsured.

AnAccidentalDeathdoesnotincludeanyofthe

followingcauses:

– suicide,attemptedsuicideorintentionalself

inflictedinjury

– deathlinkedtobeingundertheinfluenceofor

beingaffected(temporarilyorotherwise)by

alcoholordrugs

– engaginginmotorsports(includingmotorcars,

motorcyclesandspeedboats),rockclimbing,

mountaineeringinwhichtheuseofropesor

guidesisneeded,potholing,ordivingusing

artificialbreathingapparatus

– flying,exceptasafarepayingpassenger

– takingpartinanyriot,civilcommotion,

uprisingorwar(whetherdeclaredornot)or

anyrelatedactorincident

AccidentalDeathBenefitcoverwillceasewhen:

• theApplicationisunderwrittenandaccepted

onnormalterms;

• specialtermsareoffered;

• theApplicationisrefused;

• theApplicationispostponed;

• 30dayshavepassedsincethedatethe

completedApplicationwasreceivedinNew

Ireland’sheadoffice,

whicheverisearlier.

WewillonlypayonceunderAccidentalDeathBenefit

inrespectofanyLifeInsured,regardlessofthe

numberofApplicationsapersonhaswithNewIreland

Assurance.Thepolicywillceaseonpaymentofthe

AccidentalDeathBenefit.

2. AdditionalBenefits

2.1.AcceleratedSpecifiedIllnessBenefit

ThiscoverappliestoaLifeInsuredonlyifstatedinthe

PolicyScheduleorsubsequentendorsement.The

benefitisonlypayableiftheLifeInsuredisdiagnosed

withaSpecifiedIllnessasoutlinedinAppendixA

duringtheTermofCoverfortheAcceleratedSpecified

IllnessBenefitasstatedinthePolicySchedule.

ThisprovidesyouwithalumpsumamountifaLife

InsuredisdiagnosedwithaSpecifiedIllnessas

outlinedinAppendixAduringtheTermofCoverfor

theAcceleratedSpecifiedIllnessBenefit.Thebenefit

isonlyavailablewithLumpSumonDeathBenefit

andtheLumpSumonDeathBenefitwillbereduced

bytheamountofanyAcceleratedSpecifiedIllness

Benefitpaid.TheAcceleratedSpecifiedIllnessBenefit

decreasesatthesameintervalsandinthesame

mannerastheLumpSumonDeathBenefit,as

describedinSectionC,Condition1.

IntheeventofaclaimforAcceleratedSpecified

IllnessBenefitwhichisrelatedtoapriorclaimfor

PartialPaymentSpecifiedIllnessSeriousAccident

11

Cover(Number9ofAppendixB),theamountofany

AcceleratedSpecifiedIllnessBenefitpaymentwill

bereducedbytheamountofanyPartialPayment

SpecifiedIllnessBenefitpaid.

Ifthepolicyisajointlifepolicy,andAccelerated

SpecifiedIllnessBenefitisstatedtoapplyinthePolicy

Schedule,thentheamountofAcceleratedSpecified

IllnessBenefitappliestobothLivesInsuredunless

statedotherwiseinthespecialprovisions.

TheAcceleratedSpecifiedIllnessBenefitcoverwill

ceaseuponpaymentofanyclaimforAccelerated

SpecifiedIllnessBenefit.

2.1.1PartialPaymentSpecifiedIllnessBenefitThisisanadditionalbenefitthatautomaticallyapplies

toaLifeInsurediftheirPolicyScheduleorsubsequent

endorsementstatesthatAcceleratedSpecifiedIllness

BenefitappliestotheLifeInsured.

ThisprovidesyouwithalumpsumifaLifeInsuredis

diagnosedwithaPartialPaymentSpecifiedIllnessas

outlinedinAppendixBduringtheTermofCoverofthe

AcceleratedSpecifiedIllnessBenefit.

ForthePartialPaymentSpecifiedIllnessAngioplasty

forCoronaryArteryDisease–ofspecifiedseverity

(Number1ofAppendixB),themaximumamountwe

willpayisthelowerof:

• €40,000or;

• 75%oftheAcceleratedSpecifiedIllnessBenefitat

thetimeoftheproceduretakingplace.

FortheotherPartialPaymentSpecifiedIllnesses

outlinedinAppendixB,theamountwewillpayisthe

lowerof:

• €15,000or;


thetimeoftheillnessbeingdiagnosedorspecified

surgerytakingplace,asappropriate.

WewillmakeonlyonepaymentunderthisPartial

PaymentSpecifiedIllnessBenefitforeachofthe

PartialPaymentSpecifiedIllnessesoutlinedin

AppendixB.

WiththeexceptionofaPartialPaymentSpecified

IllnessBenefitpaidinrespectofSeriousAccident

Cover(Number9ofAppendixB),aPartialPayment

SpecifiedIllnessBenefitisindependentofthe


ThetotalamountwewillpayunderPartialPayment

SpecifiedIllnessBenefitislimitedtotheamountofthe


WewillnotpayanyPartialPaymentSpecifiedIllness

BenefitifaLifeInsureddieswithin14daysofthedate

thePartialPaymentSpecifiedIllnessisdiagnosedor

thespecifiedsurgerytakingplace,asappropriate.

IfaclaimunderPartialPaymentSpecifiedIllness

Benefitispaidandwithin30daysofthediagnosisor

surgery,asappropriate,anadmissibleclaimarises

undertheAcceleratedSpecifiedIllnessBenefit,then

theoverallamountpaidoutwillbetheAccelerated

SpecifiedIllnessBenefitamountatthattime.Once30

dayshaveelapsedsincethediagnosisorsurgeryofa

PartialPaymentSpecifiedIllness,asappropriate,then

anyadmissibleclaimforAcceleratedSpecifiedIllness

Benefitwillbeassessedandpaidindependently.

IntheeventofaclaimforAcceleratedSpecified




AcceleratedSpecifiedIllnessBenefitpaymentwill



OnceanAcceleratedSpecifiedIllnessBenefitclaim

ispaid,thePartialPaymentSpecifiedIllnessBenefit

ceasesimmediately.

2.1.2WaitingListBenefit

IfaLifeInsuredismakingaclaimrelatingto

• CoronaryArteryBy-passGrafts-withsurgeryto

dividethebreastbone;

• Heartstructuralrepairwithsurgerytodividethe

breastbone;

• HeartValveReplacementorRepair–withsurgeryto

dividethebreastbone;

• PulmonaryArteryGraftSurgery-withsurgeryto

12

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

13

dividethebreastbone;or

• AortaGraftSurgery–fordiseaseortraumatic

Injury,

andtheclaimisacceptedbytheCompany,wewill

makeapaymentinadvanceoftheLifeInsured

undergoingthesurgeryifaConsultantofan

IrishorUnitedKingdomHospitalconfirmstoour

Company’sChiefMedicalOfficer’ssatisfactionthat

thesurgeryisnecessaryformedicalreasons,and

theLifeInsuredisonanIrishorUnitedKingdom

Hospitalwaitinglist.Theadvancepaymentwillbe

50%oftheAcceleratedSpecifiedIllnessBenefitatthe

timetheLifeInsuredgoesontheHospitalwaitinglist,

subjecttoamaximumof€32,500.

AcceleratedSpecifiedIllnessBenefitandLump

SumonDeathBenefitwillbereduced(forboth

livesinthecaseofjointlifepolicies)bytheamount

oftheadvancepayment.ThereducedAccelerated

SpecifiedIllnessBenefitwillbecomepayablewhenthe

LifeInsuredactuallyundergoesthesurgery.

IntheeventofaWaitingListBenefitbeingpaid,the

remainingAcceleratedSpecifiedIllnessBenefitwill

reduceduringtheremainingTermofCoverin

accordancewiththeprinciplesoutlinedinrelationto

amendmentsinSectionC,Condition1.

ForaclaimforAcceleratedSpecifiedIllnessBenefit

(includingPartialPaymentSpecifiedIllnessBenefit)

tobevalidyoumustnotifyuswithin90daysofthe

diagnosisoftheillnessorthedateofthespecified

surgery,asappropriate.Themaximumamountpaidout

asAcceleratedSpecifiedIllnessBenefitisthatshownin

thePolicyScheduleasapplyingtoaLifeInsured,oras

subsequentlychangedorreducedovertheremaining

terminlinewiththeproportionatereductiondescribed

inSectionC,Condition1.

WhathappensonthediagnosisofaLifeInsuredwitha

SpecifiedIllnessdependson

•whetherAcceleratedSpecifiedIllnessBenefitapplies

tothatLifeInsured,

•theSpecifiedIllnesstheLifeInsuredisdiagnosed

with,and

•whetherthepolicyisasingleorjointlifepolicy.

NoclaimforAcceleratedSpecifiedIllnessBenefit

(includingPartialPaymentSpecifiedIllnessBenefit)will

beadmittediftheSpecifiedIllness(includingPartial

PaymentSpecifiedIllness)arisesfromanyofthe

exclusionscontainedinSectionDwhichareapplicable

toAcceleratedSpecifiedIllnessBenefit(including

PartialPaymentSpecifiedIllnessBenefit).Theclaims

proceduresdescribedinSectionDapplytoclaimsfor

AcceleratedSpecifiedIllnessBenefit(includingPartial

PaymentSpecifiedIllnessBenefit)

2.2AccidentPayment

AccidentPaymentonlyappliestoaLifeInsuredif

statedinthePolicySchedule.Theamountofbenefit

willbethelesserof50%oftheLifeInsured’saverage

grossweeklyearningsinthetwelvemonthperiod

priortothedateoftheclaimandtheamountofbenefit

statedinthePolicySchedule.Confirmationofearnings

fromanindependentsourcemayberequired.

IfaLifeInsuredistemporarilydisabledduetoan

accidentasdefinedinthisCondition,foracontinuous

periodofmorethan2weeksbeforehisorher65th

birthday,AccidentPaymentispayableinrespectof

eachwholeweekoftemporarydisabilityduetoan

accidentafterthelaterofthefirst2weeksandthe

dateofnotificationofaclaimforAccidentPayment.

NotificationofaclaimforAccidentPaymentmustbe

receivedwithin30daysoftheeventgivingrisetosuch

claim.Wewillonlypayamaximumof52weeksbenefit

intotalduringtheTermofCoverinrespectofanyLife

Insuredregardlessofthenumberofpoliciesaperson

haswithNewIreland.

Iftwoperiodsoftemporarydisabilityduetoanaccident

areseparatedbylessthanaweek,thentheywillbe

treatedasonecontinuousperiod.

ForthisCondition,temporarilydisabledduetoan

accidentmeansthattheLifeInsuredis,intheopinion

oftheCompany’sChiefMedicalOfficer,asaresultof

accidentalinjury,totallyunabletocarryouthisorher

normaloccupationasstatedintheApplicationform

onatemporarybasis,andisnotcarryingoutanyother

gainfuloccupation.

Accidentalinjuryandanyresultinginabilitybythe

LifeInsuredtocarryouthisorhernormaloccupation

mustbeverified,byaregisteredmedicalpractitioner

13

14

intheRepublicofIrelandortheUnitedKingdom,to

thesatisfactionoftheCompany’sChiefMedicalOfficer.

Accidentalinjurymeansthattheinjurymustbecaused

byaccidental,violent,externalandvisiblemeansandis

nowaylinkedtosickness,diseaseorphysicaldisorderof

theLifeInsured.

AccidentPaymentcoverceasesontheLifeInsured’s

65thbirthdayortheexpiryofthechosenTermofCover

oronpaymentofaclaimforAcceleratedSpecified

IllnessBenefit,whicheverfirstoccurs.

NoclaimforAccidentPaymentispayableiftheLife

Insuredisunemployedorredundantatthetimeofthe

eventgivingrisetoaclaim.

NoclaimforAccidentPaymentispayableunlessthe

Companyreceiveswrittennotificationoftheoccurrence

oftheeventgivingrisetoaclaimforAccidentPayment

within30daysofthedateofsuchevent.

NoclaimforAccidentPaymentwillbeadmittedif

temporarydisabilityduetoaccidentarisesfromany

oftheexclusionscontainedinSectionDwhichare

applicabletoAccidentPayment.Theclaimsprocedures

describedinSectionDapplytoclaimsforAccident

Payment.

2.3.HospitalisationPayment

HospitalisationPaymentonlyappliestoaLifeInsured

ifstatedinthePolicySchedule.

ThebenefitispayableinrespectofeverydaythateachLife

InsuredisconfinedtoHospitalasaresultofsicknessor

injury,providedthattheperiodisatleast3days(ora

continuous24hoursiftheLifeInsuredisinintensivecare).

IfaLifeInsuredisdischargedfromHospital,andis

thenre-admittedwithin7days,thetwoperiodsof

hospitalisationwillbetreatedasonecontinuousperiod.

HospitalisationPaymentcoverceasesontheLife

Insured’s65thbirthdayortheexpiryofthechosen

TermofCover,whicheverfirstoccurs.

HospitalisationPaymentwillnotbepaidformore

than365daysintotalduringtheTermofCoverfor

HospitalisationPayment.

ForthisConditiona“day”meansaperiodof24

consecutivehours.

NoclaimforHospitalisationPaymentwillbeadmittedif

hospitalisationarisesfromanyoftheexclusionscontained

inSectionDwhichareapplicabletoHospitalisation

Payment.TheclaimsproceduresdescribedinSection

DapplytoclaimsforHospitalisationPayment.

2.4.BrokenBonesPayment

BrokenBonesPaymentonlyappliestoaLifeInsured

ifstatedinthePolicySchedule.Theamountofbenefit

payableandthespecifiedinjuriescoveredarelistedbelow.

Ifaninjuryisnotlistedbelowthenitisnotcovered.

Specified Injury Definition Amount

Upper leg fracture Breaking the femur or hip. e3,000

Hip dislocation Displacement of the femur e1,700 from the acetabulum.

Open fracture A compound fracture where e3,000 of the skull the bone ends have

pierced the overlying skin with significant damage to the surrounding tissues (the nasal bones are not included).

Closed fracture A simple fracture (including e1,700 of the skull a hairline fracture) with little

damage to the surrounding tissue and no break in the overlying skin (the nasal bones are not included).

Lower leg or Breaking the tibia, fibula, e1,700 ankle fracture patella or tarsus (ankle bone).

Ankle dislocation Displacement of the talus e2,500 bone from the socket formed by the lower end of the tibia and fibula.

Arm fracture Breaking the humerus or the e1,700 upper two thirds of the radius or ulna.

Wrist fracture Breaking of any carpal bones or e1,300 lower one third of the radius or ulna (excluding metacarpals and phalanges, which are in the hand).

Jaw or Breaking the mandible, e1,300 cheekbone maxilla or cheekbone (the fracture nasal bones are not included).

Foot fracture Breaking the oscalcis, talus, e1,300 the tarsal bones or metatarsal bones (the toes (phalanges) are not included).

Elbow Displacement of the ulna to e1,700 dislocation radius bone in relation to

the lower end of the humerus.

Shoulder Displacement of the head e1,300 dislocation of the humerus from

the glenoid fossa.

Vertebrae, A breaking involving the e1,300 shoulder blade or body of any of the vertebrae, sternum fracture the scapula or the sternum.

Rib or collar Breaking any of the ribs e1,000 bone fracture or clavicle.

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

1515

BrokenBonesPaymentisonlypayableinrespectof

accidentalinjuriesthatareverifiedtothesatisfaction

oftheCompany’sChiefMedicalOfficer,that

necessitatemedicaltreatmentbyaregisteredmedical

practitionerintheRepublicofIrelandortheUnited

Kingdom.Accidentalinjurymeanstheinjurymust

becausedbyaccidental,violent,externalandvisible

meansandisinnowaylinkedtosickness,diseaseor

physicaldisorderoftheLifeInsured.

Ifasingleaccidentresultsinmorethanonespecified

injurywewillpayonlyonebenefitandtheamount

payablewillbethehighestindividualamountwhich

wouldbepaidinrespectofthespecifiedinjuries

suffered.

Intheeventoftherebeingmorethanoneaccident

inanyfourweekperiodresultinginmorethanone

specifiedinjurywewillpayonlyonebenefitandthe

amountpayablewillbethehighestindividualamount

whichwouldbepaidinrespectofthespecifiedinjuries

suffered.

TheoverallmaximumamountpayableduringtheTerm

ofCoverinrespectofaLifeInsuredunderthisbenefit

is?25,000.Thebenefitiscancelledinrespectofthe

LifeInsuredwhenthatlimitisreached.

BrokenBonesPaymentceasesontheLifeInsured’s



IllnessBenefit,whicheverfirstoccurs

NoclaimforBrokenBonesPaymentwillbeadmitted

ifthespecifiedinjuryarisesfromanyoftheexclusions

containedinSectionDwhichareapplicabletoBroken

BonesPayment.Theclaimproceduresdescribedin

SectionDapplytoclaimsforBrokenBonesPayment.

2.5.SurgeryPayment

SurgeryPaymentonlyappliestoaLifeInsuredifstated

inthePolicySchedule.Theamountofbenefitpayable

andthesurgicalprocedurescoveredarelistedbelow.

Ifasurgicalprocedureisnotlistedbelow,itisnot

covered.

Surgeryisdefinedasrequiringasurgicalincisionand

operationtooronanorganorbodypartandmust,in

theopinionoftheCompany’sChiefMedicalOfficerbe

medicallyneccessary,performedinanIrishorUnited

KingdomHospitalandmustbecarriedoutunder

generalorspinalanaesthesia.

IntheeventoftheLifeInsuredundergoingoneof

thefollowingsurgicalprocedures,theamountof

thebenefitpayablewillbe12.5%oftheAccelerated

SpecifiedIllnessBenefitatthetimeofthesurgery

subjecttoamaximumof?32,500:

• Surgerytothebrainormeningesofthebrain

excludingsurgeriestothepituitarygland,

pinealglandsandcerebralarteries;

• Surgerytothecranialnerves;

• Surgerytothelungs

• Surgerytotheliver

IntheeventoftheLifeInsuredundergoingoneofthe

followingsurgicalprocedures,theamountofbenefit

payablewillbe5%oftheLifeInsured’sAccelerated

SpecifiedIllnessBenefitatthetimeofthesurgery

subjecttoamaximumof€13,000:

• Hiporkneereplacement;

• Surgerytotheintervertebraldiscs

• Surgerytothespinalcordorcanalexcluding

spinalpunctureorinjection;

• Surgerytothekidneysorpancreasorspleen;

• Surgerytotheurinarybladderexcluding

surgeriesorproceduresforurinary

incontinence,bladderprolapse,rectalprolapse,

vaginalprolapseoruterineprolapse

• Surgerytothelarynxexcludingbenignpolyps

ornodulesofthevocalchords;

• Surgerytotheoesophagusincludingrepairof

hiatushernia;

• Surgerytothecolonandrectumexcluding

surgeriestotheanus;

• Surgerytothepharynxexcludingadenoids;

• Surgerytothecerebralorcarotidoriliacor

femoralarteries;

• Surgerytothepituitaryorpinealglands;

• Surgerytotheadrenalglands;

• Surgerytothestomach,duodenum,jejunumor

ileum;

• Surgerytothethymus;

• Surgerytothethyroidorparathyroid;

• Surgerytotheureter;

16

SurgeryPaymentwillonlybepayableamaximumof

fourtimesinrespectofaLifeInsured.Thebenefitis

cancelledinrespectoftheLifeInsuredwhenthatlimit

isreached.TheoverallmaximumSurgeryPayment

payableinrespectofaLifeInsuredunderthepolicy

isthelesserof€132,000and50%oftheAccelerated

SpecifiedIllnessBenefitatthetimeofthesurgery.

IfAcceleratedSpecifiedIllnessBenefitispayablein

respectofaLifeInsured,SurgeryPaymentwillbe

cancelled.IfonreceiptofaclaimforSurgeryPayment

theCompanyissatisfiedthattheconditionsofpayment

forAcceleratedSpecifiedIllnessBenefitarefulfilled,

theCompanywillpaytheAcceleratedSpecifiedIllness

BenefitprovidedbythepolicyandnoSurgeryPayment

willbepayablebytheCompany.

SurgeryPaymentcoverceasesontheLifeInsured’s



IllnessBenefit,whicheverfirstoccurs.

IftheconditionorsurgerygivingrisetoaSurgery

PaymentclaimalsogivesrisetoaPartialPayment

SpecifiedIllnessBenefitclaim,thenwewillonlypayout

thehigherbenefitamount.

WheretherearetwoormorevalidSurgicalPayment

claimsinrespectofaLifeInsuredarisingfromsurgical

operationswithin14daysofeachother,onlyone

SurgicalPaymentbenefitwillbepaid.

WewillonlymakeonepaymentunderthisSurgery

Paymentforeachofthesurgeriesoutlinedinthis

Condition.

NoclaimforSurgeryPaymentwillbeadmittedifthe

surgicalprocedurearisesfromanyoftheexclusions

containedinSectionDwhichareapplicabletoSurgery

Payment.TheclaimsproceduresdescribedinSectionD

applytoclaimsforSurgeryPayment.

3. Children’sProtectionBenefitsChildren’sProtectionBenefitsapplytoallthenatural

orlegallyadoptedchildrenoftheLifeorLivesInsured

whoareagedbetween6monthsand18yearsatthe

datethebenefitispayableandallnaturalorlegally

adoptedchildrenoftheLifeorLivesInsuredaged,

atthedatethebenefitispayable,between18and21

yearswhoareinfulltimeeducation.

NoclaimforChildren’sProtectionBenefitswillbe

admittediftheclaimarisesfromanyoftheexclusions

containedinSectionDwhichareapplicableto

Children’sProtectionBenefits.Theclaimprocedures

describedinSectionDapplytoclaimsforChildren’s

ProtectionBenefits.

3.1.Children’sLumpSumonDeath

Anamountof?4,000ispayableonthedeathofachild

ofaLifeInsuredduringtheTermofCoverforLump

SumonDeathBenefitfortheLifeInsured.

Themaximumamountofbenefitpayableinrespect

ofanychildfromallpoliciesissuedbytheCompany

cannotbemorethan?4,000.

3.2.Children’sSpecifiedIllnessBenefit

IfAcceleratedSpecifiedIllnessBenefitappliestoaLife

Insured,thelesserof50%oftheAcceleratedSpecified

IllnessBenefitatthetimeoftheillnessbeing

diagnosedorthespecifiedsurgerytakingplace,as

appropriate,andE25,000ispayableifachildofaLife

InsuredisdiagnosedashavinganyoftheSpecified

IllnessesasoutlinedinAppendixAduringtheLife

Insured’sTermofCoverforAccelerated


IfachildofaLifeInsuredisdiagnosedashavingany

ofthePartialPaymentSpecifiedIllnessesoutlinedin

AppendixBduringtheLifeInsured’sTermofCoverfor

AcceleratedSpecifiedIllnessBenefit,theamountwe

willpayisthelowerof:

• E7,500or;


thetimeofbeingdiagnosedorspecifiedsurgery

takingplace,asappropriate

Thechildmustsurviveforatleast14daysfollowing

thediagnosisorthedateofaspecifiedsurgerytaking

placeasoutlinedinAppendixAand/orAppendixB

fortheChildren’sSpecifiedIllnessBenefitorPartial

PaymentSpecifiedIllnessBenefittobepayable.

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

1717

Children’sSpecifiedIllnessBenefitandPartial

PaymentSpecifiedIllnessBenefitisonlypayableonce

inrespectofanychildandthemaximumamountof

benefitpayableinrespectofanychildfromallpolicies

issuedbytheCompanycannotbemorethanE25,000

inthecaseofChildren’sSpecifiedIllnessBenefitand

E7,500inthecaseofaPartialPaymentSpecified

IllnessBenefit.

WiththeexceptionofaPartialPaymentSpecified

IllnesspaidinrespectofSeriousAccidentCover

(Number9ofAppendixB),aPartialPaymentSpecified

IllnessBenefitisindependentoftheChildren’s


IntheeventofaclaimforChildren’sSpecified




Children’sSpecifiedIllnessBenefitpaymentwill



OnceaChildren’sSpecifiedIllnessBenefitclaimis

paid,thePartialPaymentSpecifiedIllnessBenefit

ceasesimmediatelyforanychild.

3.3.Children’sHospitalisationPayment

IfHospitalisationPaymentappliestoaLifeInsured,

aChildren’sHospitalisationPaymentof?35per

dayappliestothechildrenoftheLifeInsured.The

Children’sHospitalisationPaymentispayablein

respectofeverydaythatthechildisconfinedto

HospitalduringtheLifeInsured’sTermofCoverfor

HospitalisationPaymentasaresultofsicknessor

injury,providedthattheperiodisatleast3days.For

thisconditiona‘day’meansaperiodof24consecutive

hours.Children’sHospitalisationPaymentwillnotbe

paidformorethan365daysintotalduringtheLife

Insured’sTermofCoverforHospitalisationPaymentin

respectofanychild.

Unlessachildhasbeenlegallyadopted,thenameof

aLifeInsuredmustappearasaparentonthechild’s

birthcertificate.

18

1. ClaimProcedures

TheCompanymustreceiveacompletedclaimform

togetherwiththispolicydocumentincludingthePolicy

Scheduleatitsheadofficeat11/12DawsonStreet,

Dublin2.Allitemsofproof,certificates,information,

medicalandotherevidencethattheCompanymay

requireinsupportofaclaimmustbeprovidedatyour

ownexpense.

Wheretheconditionsrequirethediagnosisbya

Consultant,heorshemustbeaConsultantofanIrish

orUnitedKingdomHospital.

Allclaimsshouldbenotifiedtousassoonaspossible

aftertheevent.Anyclaimmustbereceivedwithin90

daysoftheeventorthediagnosisgivingrisetothe

claim(exceptforthespecialproceduresthatapplyto

claimsinrelationtoHIVinfectioncontractedfroma

bloodtransfusion,physicalassaultoratwork(please

refertoAppendixAforfurtherdetails)andAccident

Paymentwherewerequirewrittennotificationof

theoccurrenceoftheeventgivingrisetoaclaimfor

AccidentPaymentwithin30daysofthedateofsuch

event.

2. Exclusions

Thereareanumberofcircumstancesinwhichaclaimfor

paymentofaProtectionBenefitoraChildren’sProtection

Benefitwillnotbeadmittedorpaid.Theseexclusions,

andtheProtectionBenefitstowhichtheyapply,areas

follows:

•NoclaimforHospitalisationPayment,Children’s

HospitalisationPayment,AccidentPayment,Surgery

PaymentorBrokenBonesPaymentispayableifa

LifeInsured,orwhererelevantthechildofaLife

Insured,isresidentoutsidetheRepublicofIreland

ortheUnitedKingdomformorethan13weeksin

anyconsecutive12monthperiodpriortothetimeof

claim.

•NoclaimforAcceleratedSpecifiedIllnessBenefit

orChildren’sSpecifiedIllnessBenefit(including

PartialPaymentSpecifiedIllnessBenefit)ispayable

ifaLifeInsured,orwhererelevant,thechildofa

LifeInsured,isresidentoutsidethecountriesof

theEuropeanUnionasatthe1stJanuary2011

(Austria,Belgium,Bulgaria,Cyprus,CzechRepublic,

Denmark,Estonia,Finland,France,Germany,

Greece,Hungary,Ireland,Italy,Latvia,Lithuania,

Luxembourg,Malta,Netherlands,Poland,Portugal,

Romania,Slovakia,Slovenia,Spain,Sweden,United

Kingdom)orAustralia,Canada,NewZealand,

Norway,SwitzerlandortheUnitedStatesofAmerica

formorethan13weeksinanyconsecutive12month

periodpriortothetimeofclaim.

•NoLumpSumonDeathBenefit,TerminalIllness

BenefitorChildren’sLumpSumonDeathBenefit

ispayableiftheLifeInsuredorachildoftheLife

Insureddiesbyhisorherownhandoractoris

diagnosedasbeingterminallyillasaresultof

hisorherowndeliberateactwithin1yearofthe

PolicyStartDateorwithin1yearofthedateof

anyreinstatementofthepolicyorwithin1year

ofavoluntaryincreaseinLumpSumonDeath

Benefit,orwithin1yearofbeingaddedontothe

policy,whicheverisapplicable,exceptthatifthe

policyhasbeenAssignedtoathirdpartyingood

faith,thebenefitpayableislimitedtotheinterest

ofthatthirdpartywhichwasacquiredformonetary

consideration.

•Anyspecificexclusionsrelatingtoparticular

illnessescoveredbyAcceleratedorChildren’s

SpecifiedIllnessBenefit(includingPartialPayment

SpecifiedIllnessBenefit)arecontainedinthe

relevantpartofAppendixAand/orAppendixB.

•NoclaimforHospitalisationPaymentorChildren’s

HospitalisationPaymentispayablewithinthe

first9monthsofthePolicyStartDateorwithin

the9monthsfollowinganyreinstatementofthe

policy,orwithin9monthsofavoluntaryincrease

inHospitalisationPayment,orwithin9monthsof

theHospitalisationPaymentbeingaddedtothe

policy,ifthehospitalisationisduetopregnancyora

pregnancyrelatedcomplication.


HospitalisationPaymentispayablewithinthe

first2yearsofthePolicyStartDateorwithin

the2yearsfollowinganyreinstatementofthe

SECTION D – CLAIM PROCEDURES AND EXCLUSIONS

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

1919

policyorwithin2yearsofavoluntaryincreasein

HospitalisationPayment,orwithin2yearsofthe

HospitalisationPaymentbeingaddedontothepolicy

ifhospitalisationisduetoaconditionfromwhich

theLifeInsuredsufferedbeforethePolicyStartDate

orthedateofanyreinstatementofthepolicy,or

thedateofavoluntaryincreaseinHospitalisation

PaymentorthedateHospitalisationPaymentwas

addedtothepolicy,whicheverisapplicable.


HospitalisationPaymentispayableifhospitalisation

isduetocosmeticorelectivesurgery,psychiatric

illness,orfailuretoseekorfollowmedicaladvice.

•NoclaimforSurgicalPaymentispayableinrespect

ofprocedureswhichareendoscopic,diagnostic,

investigative,exploratoryorcosmetic,organor

tissuedonation,surgerytothetonsils,surgeryto

theappendix,surgeryforhaemorrhoids,surgery

duetoselfinflictedinjury,electivesurgery,cosmetic

surgery,diagnosticorexploratorysurgeryincluding

genetic,foetal,contraceptiveorcontraceptive

reversalprocedures,infertilitytreatment,pregnancy,

childbirth,orterminationofpregnancy.

•NoclaimforAccidentPayment,SurgeryPayment

orBrokenBonesPaymentispayableinrespectof

claimsarisingfromaccidents,injuriesorillnesses

whichoccurbeforethePolicyStartDateorbefore

thedateofanyreinstatementofthepolicy,orbefore

thedatethatanyofthesebenefitswereaddedto

thepolicy,oraftertheLifeInsuredpasseshis/her

65thbirthday,andinadditioninrelationtoAccident

Paymentbeforethedateofavoluntaryincreaseto

thisbenefit.

•NoclaimforaChildren’sProtectionBenefit

ispayableiftheclaimis,intheopinionofthe

Company’sChiefMedicalOfficer,duetoany

congenitalillnessand/ormedicalconditionwhich

existedwhethersymptomswerepresentornot

•sincethedateofbirthofthechild;or

•beforethePolicyStartDate;or

•beforethedatetheChildren’sProtectionBenefit

becomesapplicableunderthepolicy;

•beforethedateofanyincreaseinProtection

Benefits

•beforethedateofanyreinstatementofthepolicy,

whereapplicable;or

•beforethedatethechildwaslegallyadopted;or

•beforethechildwas6monthsold

•ThespecificexclusionsrelatingtoAccidentalDeath

BenefitarecontainedinSectionC,Condition1.1.2.

Specified Illnesses

1.Alzheimer’sDisease–resultinginpermanentsymptoms

AdefinitediagnosisofAlzheimer’sDiseasebya

ConsultantNeurologistofanIrishorUnitedKingdom

Hospital.Theremustbepermanentclinicallossofthe

abilitytodoallofthefollowing:

• remember;

• reason;and

• perceive,understand,expressandgiveeffect

toideas.

Fortheabovedefinition,thefollowingisnotcovered:

• Alzheimer’sDiseasesecondarytoalcoholor

drugmisuse

2.AortaGraftSurgery–fordiseaseortraumaticinjury

Theundergoingofsurgerytotheaortawithexcision

andsurgicalreplacementofaportionoftheaortawith

agraft.

Thetermaortameansthethoracicandabdominal

aortabutnotitsbranches.


• Anyothersurgicalprocedure,forexamplethe

insertionofstentsorendovascularrepair.

3.AplasticAnaemia-ofspecifiedseverity

AdefinitediagnosisbyaConsultantHaematologistof

anIrishorUnitedKingdomHospitalofpermanentbone

marrowfailurewhichresultsinanaemia,neutropenia

andthrombocytopeniaandrequiresasaminimumone

ofthefollowingtreatments:

• Bloodtransfusion;

• Bone-marrowtransplantation;

• Immunosuppressiveagents;

• MarrowStimulatingagents.

Allotherformsofanaemiaarespecificallyexcluded.

4.BacterialMeningitis-resultinginpermanentsymptoms

AdefinitediagnosisofBacterialMeningitisbya


Hospitalcausinginflammationofthemembranes

ofthebrainorspinalcordresultinginpermanent

neurologicaldeficitwithpersistingclinicalsymptoms*.

Allotherformsofmeningitisincludingviralmeningitis

arenotcovered.

*Permanentneurologicaldeficitwithpersistingclinical

symptomsisdefinedas:

- Symptomsofdysfunctioninthenervoussystemthat

arepresentonclinicalexaminationandexpectedto

lastthroughouttheinsuredperson’slife.

- Symptomsthatarecoveredincludenumbness,

hyperaesthesia(increasedsensitivity),paralysis,

localisedweakness,dysarthria(difficultywith

speech),aphasia(inabilitytospeak),dysphagia

(difficultyinswallowing),visualimpairment,difficulty

inwalking,lackofcoordination,tremor,seizures,

dementia,deliriumandcoma.

Thefollowingarenotcovered:-

• Anabnormalityseenonbrainorotherscans

withoutdefiniterelatedclinicalsymptoms.

• Neurologicalsignsoccurringwithout

symptomaticabnormality,e.g.briskreflexes

withoutothersymptoms.

5.BalloonValvuloplasty

Theactualinsertion,ontheadviceofaConsultant

CardiologistofanIrishorUnitedKingdomHospital,

ofaballooncatheterthroughtheorificeofoneofthe

valvesoftheheartandtheinflationoftheballoonto

relievevalvularabnormalities.

6.BenignBrainTumour-resultinginpermanentsymptomsorrequiringsurgery

Anon-malignanttumourorcystinthebrain,cranial

nervesormeningeswithintheskull,resultingin

permanentneurologicaldeficitwithpersisting

clinicalsymptoms*Thediagnosismustbemadebya

ConsultantNeurologistorNeurosurgeonofanIrishor

UnitedKingdomHospitalandmustbesupportedbyCT,

MRIorhistopathologicalevidence.

20

APPENDIX A

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

21

Fortheabovedefinition,thefollowingarenotcovered:

• Tumourinthepituitarygland

• Angiomas

Therequirementforpermanentneurologicaldeficit

willbewaivedifthebenignbraintumourisremovedby

invasivesurgeryortreatedbystereotaticradiosurgery.










(difficultyinswallowing),visualimpairment,

difficultyinwalking,lackofcoordination,tremor,

seizures,dementia,deliriumandcoma.







7.BenignSpinalCordTumour–resultinginpermanentsymptomsorrequiringsurgery

Anon-malignanttumourofthespinalcanalorspinal

cord,causingpressureand/orinterferingwiththe

functionofthespinalcordwhichrequiressurgery

orresultsinpermanentneurologicaldeficitwith

persistingclinicalsymptoms*.Thediagnosismustbe

madebyaConsultantNeurologistorNeurosurgeon

ofanIrishorUnitedKingdomHospitalandmustbe

supportedbyCT,MRIorhistopathologicalevidence.


• Angiomas

• Prolapsedorherniatedintervertebraldisc

Therequirementforpermanentneurologicaldeficit

willbewaivedifthebenignspinalcordtumouris

removedbyinvasivesurgeryortreatedbystereotatic

radiosurgery.















withoutdefiniterelatedclinicalsymptoms



withoutothersymptoms

8.Blindness–permanentandirreversible

Permanentandirreversiblelossofsighttotheextent

thatevenwhentestedwiththeuseofvisualaids,vision

ismeasuredat3/60orworseinthebettereyeusinga

Snelleneyechart.

9.Cancer–excludinglessadvancedcasesAnymalignanttumourpositivelydiagnosedwithhistologicalconfirmationandcharacterisedbytheuncontrolledgrowthofmalignantcellsandinvasionoftissue.

Thetermmalignanttumourincludesleukaemia,lymphomaandsarcoma.


• Allcancerswhicharehistologicallyclassifiedasanyofthefollowing:

- pre-malignant

- non-invasive

- cancerinsitu

- havingeitherborderlinemalignancy;or

- havinglowmalignantpotential.

- AlltumoursoftheprostateunlesshistologicallyclassifiedashavingaGleasonscoregreaterthan6orhavingprogressedtoatleastclinicalTNMclassificationT2N0M0.

- Chroniclymphocyticleukaemiaunless

21

histologicallyclassifiedashavingprogressedtoatleastBinetStageA.

- Anyskincancerotherthanmalignantmelanomathathasbeenhistologicallyclassifiedashavingcausedinvasionbeyondtheepidermis(outerlayerofskin).

- AnybladdercancerunlesshistologicallyclassifiedashavingprogressedtoatleastTNMclassificationT2N0M0

10.CardiacArrest–withinsertionofadefibrillator

Suddenlossofheartfunctionwithcessationofbloodcirculationaroundthebodyresultinginunconsciousnessandresultingineitherofthefollowingdevicesbeingsurgicallyimplanted

• ImplantableCardioverter-Defibrillator(ICD),or

• CardiacResynchronizationTherapywithDefibrillator(CRT-D)

Fortheabovedefinitionthefollowingisnotcovered

• Insertionofapacemaker

• Insertionofadefibrillatorwithoutcardiacarrest

• Cardiacarrestsecondarytoalcoholordrugmisuse

11.Cardiomyopathy–ofspecifiedseverity

AdefinitediagnosisbyaConsultantCardiologistfrom

anIrishorUnitedKingdomHospitalofcardiomyopathy

resultinginpermanentlyimpairedventricularfunction

suchthattheejectionfractionis40%orlessforat

least6monthswhenstabilisedontherapyadvisedby

theConsultant.

Thediagnosismustalsobeevidencedby:

• electrocardiographicchanges;and

• echocardiographicabnormalities.

Theevidencemustbeconsistentwiththediagnosisof

cardiomyopathy.


• allotherformsofheartdiseaseand/orheart

enlargement;

• myocarditis;and

• cardiomyopathysecondarytoalcoholordrug

misuse.

12.ChronicLungDisease-ofspecifiedDiseaseseverity

ConfirmationbyaConsultantPhysicianofanIrish

orUnitedKingdomHospitalofchroniclungdisease

whichisevidencedbyallofthefollowing:

- Theneedforcontinuousdailyoxygentherapyona

permanentbasis;

- Evidencethatoxygentherapyhasbeenrequiredfor

aminimumperiodofsixmonths;

- FEV1beinglessthan40%ofnormal;

- VitalCapacitylessthan50%ofnormal.

13.Coma-resultinginpermanentsymptoms

Astateofunconsciousnesswithnoreactiontoexternal

stimuliorinternalneedswhich:

• requirestheuseoflifesupportsystemsfora

continuousperiodofatleast96hours;

and

• resultsinpermanentneurologicaldeficitwith

persistingclinicalsymptoms*.


• Comasecondarytoalcoholordrugmisuse.



















14.CoronaryArteryBy-passGrafts-withsurgerytodividethebreastbone

Theundergoingofheartsurgeryrequiringmedian

sternotomy(surgerytodividethebreastbone)onthe

22

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

23

adviceofaConsultantCardiologistofanIrishorUnited

KingdomHospitaltocorrectnarrowingorblockageof

oneormorecoronaryarterieswithby-passgrafts.


• balloonangioplasty;

• atherectomy;

• rotablation;

• insertionofstents;

• lasertreatment.

15.Creutzfeld-JacobDisease–resultinginpermanentsymptoms

AdefinitediagnosisofCreutzfeld-JacobDiseasebyaConsultantNeurologistofanIrishorUnitedKingdomHospitalresultinginpermanentneurologicaldeficitwithpersistingclinicalsymptoms*.

*Permanentneurologicaldeficitwithpersistingclinicalsymptoms”isclearlydefinedas:

- Symptomsofdysfunctioninthenervoussystemthatarepresentonclinicalexaminationandexpectedtolastthroughouttheinsuredperson’slife.

- Symptomsthatarecoveredincludenumbness,hyperaesthesia(increasedsensitivity),paralysis,localisedweakness,dysarthria(difficultywithspeech),aphasia(inabilitytospeak),dysphagia(difficultyinswallowing),visualimpairment,difficultyinwalking,lackofcoordination,tremor,seizures,dementia,deliriumandcoma.


• Anabnormalityseenonbrainorotherscanswithoutdefiniterelatedclinicalsymptoms.

• Neurologicalsignsoccurringwithoutsymptomaticabnormality,e.g.briskreflexeswithoutothersymptoms.

16.Deafness–permanentandirreversible

Permanentandirreversiblelossofhearingtothe

extentthatthelossisgreaterthan95decibelsacross

allfrequenciesinthebetterearusingapuretone

audiogram.

17.Dementia–resultinginpermanentsymptoms

AdefinitediagnosisofDementiabyaConsultant

NeurologistorGeriatricianofanIrishorUnited

KingdomHospital.Theremustbeprogressiveand

permanentclinicallossoftheabilitytodoallofthe

following:

• remember;

• reason;and

• perceive,understand,expressandgiveeffect

toideas.


• Dementiasecondarytoalcoholordrug

misuse.

18.Encephalitis-resultinginpermanentsymptoms

AdefinitediagnosisofEncephalitisbyaConsultantNeurologistofanIrishorUnitedKingdomHospitalresultinginpermanentneurologicaldeficitwithpersistingclinicalsymptoms*.

UndertheabovedefinitionMyalgicEncephalomyelitis(ME)isnotcovered.

*Permanentneurologicaldeficitwithpersistingclinicalsymptomsisdefinedas:

- Symptomsofdysfunctioninthenervoussystemthatarepresentonclinicalexaminationandexpectedtolastthroughouttheinsuredperson’slife.

- Symptomsthatarecoveredincludenumbness,hyperaesthesia(increasedsensitivity),paralysis,localisedweakness,dysarthria(difficultywithspeech),aphasia(inabilitytospeak),dysphagia(difficultyinswallowing),visualimpairment,difficultyinwalking,lackofcoordination,tremor,seizures,dementia,deliriumandcoma.


• Anabnormalityseenonbrainorotherscanswithoutdefiniterelatedclinicalsymptoms.

• Neurologicalsignsoccurringwithoutsymptomaticabnormality,e.g.briskreflexeswithoutothersymptoms.

19.HeartAttack-ofspecifiedseverityDeathofheartmuscle,duetoinadequatebloodsupply,thathasresultedinallofthefollowingevidenceofacutemyocardialinfarction:

- Typicalclinicalsymptoms(forexample,characteristicchestpain).

- Newcharacteristicelectrocardiographicchanges.

- ThecharacteristicriseofcardiacenzymesorTroponinsrecordedatthefollowinglevelsorhigher;TroponinT>1.0ng/ml,AccuTnl>0.5ng/mlorequivalentthresholdwithotherTroponinImethods.

23

Theevidencemustshowadefiniteacutemyocardialinfarction.


• Otheracutecoronarysyndromesincludingbutnotlimitedtoangina.

20.Heartstructuralrepairwithsurgerytodividethebreastbone

Theundergoingofheartsurgeryrequiringmediansternotomy(surgerytodividethebreastbone)ontheadviceofaConsultantCardiologistofanIrishorUnitedKingdomHospital,tocorrectanystructuralabnormalityoftheheart.

21.HeartValveReplacementorRepair-withsurgerytodividethebreastbone

Theundergoingofheartsurgeryrequiringmediansternotomy(surgerytodividethebreastbone)ontheadviceofaConsultantCardiologistofanIrishorUnitedKingdomHospitaltoreplaceorrepaironeormoreheartvalves.

22.HIVinfection

HIVinfection–contractedincountriesthatwere

membersoftheEuropeanUnionon1stJanuary2011,

Australia,Canada,NewZealand,Norway,Switzerland

ortheUnitedStatesofAmericafromablood

transfusion,aphysicalassaultoratwork.

InfectionbyHumanImmunodeficiencyVirusresulting

from:

- abloodtransfusiongivenaspartofmedical

treatment;or

- aphysicalassault;or

- artificialinseminationorin-vitrofertilisationgiven

aspartofmedicaltreatment;or

- anincidentoccurringduringthecourseof

performingnormaldutiesofemployment

afterthestartofthepolicyandsatisfyingallofthe

following:

- Theincidentmusthavebeenreportedto

appropriateauthoritiesandhavebeeninvestigated

inaccordancewiththeestablishedprocedures.

- WhereHIVinfectioniscontractedthrougha

physicalassaultorasaresultofanincident

occurringduringthecourseofperformingnormal

dutiesofemployment,theincidentmustbe

supportedbyanegativeHIVantibodytesttaken

within5daysoftheincident.

- TheremustbeafurtherHIVtestwithin12months

confirmingthepresenceofHIVorantibodiestothe

virus.


• HIVinfectionresultingfromanyothermeans,

includingsexualactivityordrugmisuse.

23.IntensiveCare–requiringmechanicalventilationfor10consecutivedays

AnysicknessorinjuryresultingintheLifeInsured

requiringcontinuousmechanicalventilationbymeans

oftrachealintubationfor10consecutivedays(24hours

perday)ormoreinanintensivecareunitinanIrishor

UnitedKingdomHospital.

Fortheabovedefinitionthefollowingarenotcovered:

• sicknessorinjuryasaresultofdrugor

alcoholmisuseorotherselfinflictedmeans

• childrenundertheageof90days

24.KidneyFailure–requiringongoingdialysis

Chronicandendstagefailureofbothkidneysto

function,asaresultofwhichregulardialysisis

necessary.


• Kidneyfailuresecondarytoalcoholordrug

misuse.

25.LiverFailure–IrreversibleandEndStage

Chronicliverdisease,beingendstageandirreversible

liverfailureduetocirrhosisandresultinginallofthe

following:

• permanentjaundice,

• ascites;and

• hepaticencephalopathy.


• LiverFailuresecondarytoalcoholordrug

misuse.

26.LossofHandsorFeet–permanentphysicalseverance

Permanentphysicalseveranceofanycombinationof2or

morehandsorfeetatorabovethewristoranklejoint.

27.LossofSpeech–permanentandirreversible

Totalpermanentandirreversiblelossoftheabilityto

24

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

25

speakasaresultofphysicalinjuryordisease.

28.MajorOrganTransplant–specifiedorgans

Theundergoingasarecipientofatransplantofbone

marroworofacompleteheart,kidney,liver,lung,or

pancreas,orinclusiononanofficialIrelandorUnited

Kingdomwaitinglistforsuchaprocedure.


• Transplantofanyotherorgans,partsof

organs,tissuesorcells.

• MajorOrganTransplantsecondarytoalcohol

ordrugmisuse.

29.MotorNeuroneDisease–resultinginpermanentsymptoms

AdefinitediagnosisofMotorNeuroneDiseasebya


Hospital.Theremustbepermanentclinical

impairmentofmotorfunction.

30.MultipleSystemAtrophy–resultinginpermanentsymptoms

Adefinitediagnosisofmultiplesystematrophybya


Hospital.Theremustbeevidenceofpermanentclinical

impairmentofeither:

• motorfunctionwithassociatedrigidityof

movement;or

• theabilitytocoordinatemusclemovement;or

• bladdercontrolandposturalhypotension

31.MultipleSclerosis–withpersistingsymptoms

AdefinitediagnosisofMultipleSclerosisbya


Hospital.Theremustbecurrentclinicalimpairmentof

motororsensoryfunction,whichmusthavepersisted

foracontinuousperiodofatleast6months.

32.MuscularDystrophy–resultinginpermanentsymptoms

AdefinitediagnosisofMuscularDystrophybya


Hospitalresultinginpermanentneurologicaldeficit

withpersistingclinicalsymptoms*.

*Permanentneurologicalsymptomswithpersistent

clinicalsymptomsisdefinedas:










seizures,lethargy,dementia,deliriumandcoma.

Thefollowingarenotcovered






33.ParalysisofLimbs–totalandirreversible

Totalandirreversiblelossofmusclefunctiontothe

wholeofany2limbs.

34.Parkinson’sDisease(idiopathic)–resultinginpermanentsymptoms

AdefinitediagnosisofidiopathicParkinson’sDisease

byaConsultantNeurologistofanIrishorUnited

KingdomHospital.Theremustbepermanentclinical

impairmentofmotorfunctionwithassociatedtremor,

rigidityofmovementandposturalinstability.


• Parkinson`sDiseasesecondarytoalcoholor

drugmisuse.

35.Pneumonectomy–removalofacompletelung

Theundergoingofsurgeryontheadviceofa

ConsultantPhysicianofanIrishorUnitedKingdom

Hospitaltoremoveanentirelungfordiseaseor

traumaticinjury.


• removalofalobeofthelungs(lobectomy);

• lungresectionorincision

25

36.PrimaryPulmonaryHypertension–ofspecifiedseverity

AdefinitediagnosisofPrimaryPulmonary

HypertensionbyaConsultantCardiologistofan

IrishorUnitedKingdomHospital.Theremustbe

substantialrightventricularenlargementestablished

byinvestigationsincludingcardiaccatheterisation,

resultinginthepermanentlossofabilitytoperform

physicalactivitiestoatleastClass3oftheNew

YorkHeartAssociationclassificationsoffunctional

capacity*.

*NYHAClass3.Heartdiseaseresultinginmarked

limitationofphysicalactivitieswherelessthanordinary

activitycausesfatigue,palpitation,breathlessnessor

chestpain.

37.ProgressiveSupra-nuclearPalsyresultinginpermanentsymptoms

AdefinitediagnosisofProgressiveSupra-nuclear

PalsybyaConsultantNeurologistofanIrishorUnited

KingdomHospital.Theremustbepermanentclinical

impairmentofmotorfunction,eyemovementdisorder

andposturalinstability.

38.PulmonaryArteryGraftSurgery-withsurgerytodividethebreastbone

Theactualundergoingofsurgeryrequiringmedian

sternotomy(surgerytodividethebreastbone)onthe

adviceofaConsultantCardiothoracicSurgeonofan

IrishorUnitedKingdomHospitalforadiseaseofthe

pulmonaryarterytoexciseandreplacethediseased

pulmonaryarterywithagraft.

39.RheumatoidArthritis-ofspecifiedseverity

Adefinitediagnosisofchronicrheumatoidarthritis

byaconsultantrheumatologistofanIrishorUnited

KingdomHospitalresultinginallofthefollowing:

- theconditionmustbediagnosed,establishedand

treatedforaperiodofatleast12months;

- theremustbemorningstiffnessintheaffected

jointsofatleastone-hourduration;

- theremustbearthritisofatleastthreejoint

groupswithjointdestructionandeithersofttissue

swellingorfluidobservedbyarheumatologist;

- thearthritismustinvolveatleastoneormoreof

thefollowingsites:

o wristsorankles;

o handsandfingers;

o feetandtoes;

- thearthritismustaffectbothsidesofthebody;

- presenceofrheumatoidfactororantiCCP

(anticycliccitrullin-atedprotein)antibodies,unless

allothercriteriaaremet;

- theremustbesubcutaneousnodules(nodular

swellingbeneaththeskin);

- theremustberadiographicchangestypicalof

activerheumatoidarthritis.

40.Stroke–resultinginpermanentsymptoms

Deathofbraintissueduetoinadequatebloodsupplyor

haemorrhagewithintheskullresultinginpermanent

neurologicaldeficitwithpersistingclinicalsymptoms*.


- Transientischaemicattack.

- Traumaticinjurytobraintissueorbloodvessels.


clinicalsymptomsisdefinedas:












•Anabnormalityseenonbrainorotherscans


•Neurologicalsignsoccurringwithout



41.SystemicLupusErythematous–ofspecifiedseverity

AdefinitediagnosisofSystemicLupusErythematosus

byaConsultantRheumatologistofanIrishorUnited

KingdomHospitalresultingineitherofthefollowing:

• Permanentneurologicaldeficitwithpersisting

26

1. SubHeading





deseruisseper.

TextHeading




consequunturatvel.






TextHeading






sit.







concludaturquepro.

2. SubHeading





deseruisseper.

TextHeading




consequunturatvel.

3. SubHeading






sit.







concludaturquepro.

Table Heading

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

Col1 Col2 Col3

27

clinicalsymptoms*,or

• Permanentimpairmentofkidneyfunctiontests

asfollows:

- GlomerularFiltrationRate(GFR)below

30ml/min.

- Abnormalurinalysisshowingproteinuriaor

haematuria.


symptomsisclearlydefinedas:

- Symptomsofdysfunctioninthenervoussystem

thatarepresentonclinicalexaminationand

expectedtolastthroughouttheinsuredperson’s

life.








Forthepurposesofthisdefinition–seizures,

headaches,fatigue,lethargyoranysymptomsof

psychologicalorpsychiatricoriginwillnotbeaccepted

asevidenceofpermanentdeficitoftheneurological

system.

42.ThirdDegreeBurns–covering20%ofthebody’ssurfacearea

Burnsthatinvolvedamageordestructionoftheskin

toitsfulldepththroughtotheunderlyingtissueand

coveringatleast20%ofthebody’ssurfacearea.

43.TotalandPermanentDisability

1.TotalandPermanentDisabilitybeforeage65means

thatintheDisabilityopinionoftheCompany’sChief

MedicalOfficer,theLifeInsuredis,becauseofillness

oraccident,permanentlyandirreversiblyunableto

carryoutatleast3ofthe6activitieslistedbeloworis

permanentlydisabledbyreasonofmentalincapacity.

Thepersonmusthavetakenanyappropriate

prescribedmedicationandthenbeunabletoperform

thetaskontheirown.

TotalandPermanentDisabilitymustpersistfora

continuousperiodofatleast12monthsbeforeany

entitlementtoTotalandPermanentDisabilityBenefit

arises.

The6activitiesare:

• Walking–theability(usingawalkingstickfor

balanceorconfidenceifnecessary)towalk

200metersontheflatwithoutstoppingor

severediscomfort.

• Mobility–theabilitytobendorkneeldown

topickupsomethingfromthefloorand

straightenupagain.

• Lifting–liftinga1kilogramweightfromtable

heightwitheitherhandandcarryingitfor5

meters.

• ManualDexterity–usingapen,pencilor

keyboardwitheitherhand.

• Communication–theabilitytoanswera

telephoneandreliablytakeamessage.

• Climbing–theabilitytoclimbupandthen

downaflightof12stairswiththeuseofa

handrailifneeded.

Permanentlydisabledbyreasonofmentalincapacity

meansthattheLifeInsuredissufferingfrom:

• anorganicbraindiseaseorbraininjurywhich

affectstheLifeInsured’sabilitytoreasonand

understand,and

• thementalincapacityhasdeterioratedtothe

extentthatcontinualsupervisionoftheLife

Insuredandtheassistanceofanotherperson

isrequired,and

• thementalincapacityisirreversiblewithno

reasonableprospectofthereeverbeingany

improvementintheLifeInsured’scondition.


• TotalandPermanentDisabilitysecondaryto

alcoholordrugmisuse

2.TotalandPermanentDisabilityatage65orover

meansthatintheopinionoftheCompany’sChief

MedicalOfficer,theLifeInsuredis,becauseofillness

oraccident,permanentlyandirreversiblyunableto

carryoutatleast3ofthe6activitieslistedbeloworis

permanentlydisabledbyreasonofmentalincapacity.

Thepersonmusthavetakenanyappropriate

prescribedmedicationandthenbeunabletoperform

thetaskontheirown,evenwiththeuseofappropriate

assistiveaidsandappliances(e.g.ahandrailtohelp

gettingintoandoutofthebathorshower).

27

28

TotalandPermanentDisabilitymustpersistfora

continuousperiodofatleast12monthsbeforeany

entitlementtoTotalandPermanentDisabilityBenefit

arises.

The6activitiesare:

• Washing–theabilitytowashinthebathor

shower(includinggettingintoandoutofthe

bathorshower)orwashsatisfactorilybyother

means.

• Dressing–theabilitytoputon,takeoff,

secureandunfastenallgarmentsand,as

appropriate,anybraces,artificiallimbsor

othersurgicalappliances.

• Feeding–Theabilitytofeedone’sselfonce

foodhasbeenpreparedandmadeavailable.

• Toileting–theabilitytousethelavatoryor

otherwisemanagebowelandbladderfunction

soastomaintainasatisfactorylevelof

personalhygiene.

• Mobility–theabilitytomoveindoorsfrom

roomtoroomonlevelsurfaces.

• Transferring–Theabilitytomovefrombedto

anuprightchairorwheelchairandviceversa.

Permanentlydisabledbyreasonofmentalincapacity

meansthattheLifeInsuredissufferingfrom

• anorganicbraindiseaseorbraininjurywhich

affectstheLifeInsured’sabilitytoreasonand

understand,and

• thementalincapacityhasdeterioratedtothe

extentthatcontinualsupervisionoftheLife

Insuredandtheassistanceofanotherperson

isrequired,and

• thementalincapacityisirreversiblewithno

reasonableprospectofthereeverbeingany

improvementintheLifeInsured’scondition.


• TotalandPermanentDisabilitysecondaryto

alcoholordrugmisuse.

44.TraumaticHeadInjury–resultinginpermanentsymptoms.

Deathofbraintissueduetotraumaticinjuryresulting

inpermanentneurologicaldeficitwithpersisting

clinicalsymptoms*.Thediagnosismustbeconfirmed


KingdomHospitalandagreedbyourChiefMedical

Officer.


• TraumaticHeadInjurysecondarytoalcoholor

drugmisuse.


clinicalsymptomsaredefinedas:

















29

Partial Payment Specified Illnesses

1.AngioplastyforCoronaryArteryDisease-ofspecifiedseverity

Undergoingoftreatmentforseverecoronaryartery

disease,ofanyofthefollowing

•balloonangioplasty

•atherectomy

•rotablation

•lasertreatment

•and/orinsertionofstent(s)

totreatthenarrowingorblockageinaMainCoronary

Artery.Thisproceduremusthavebeencarriedouton

theadviceofaConsultantCardiologistofanIrishor

UnitedKingdomHospital.

Angiographicevidencetosupportthenecessityfor

theprocedurewillberequired.Theinterventionmust

betotreatatleast70%diameternarrowinginaMain

CoronaryArtery.

Providedtheaboverequirementsaremet,wewill

makeapaymentof€5,000oncompletionofballoon

angioplasty,atherectomy,rotablation,lasertreatment

and/orinsertionofstent(s),tocorrectatleast70%

diameternarrowinginoneMainCoronaryArtery.

Wewillmakeasecondpaymentonthecompletion

ofballoonangioplasty,atherectomy,rotablation,

lasertreatmentand/orinsertionofstent(s)tocorrect

atleast70%diameternarrowingofoneoftheother

MainCoronaryArteries.Thesecondpaymentisthe

balanceforPartialPaymentSpecifiedIllnessBenefit

forAngioplastyforCoronaryArteryDiseasesetoutin

SectionC,Condition2.1.1

ForthepurposesofthisdefinitionMainCoronary

Arteriesaredefinedasbeing:-

-RightCoronaryArtery

-LeftMainStem

-LeftAnteriorDescending

-Circumflex

2.BrainAbscessdrainedviacraniotomy

Undergoingofsurgicaldrainageofanintracerebral

abscesswithinthebraintissuethroughacraniotomy

byaConsultantNeurosurgeonofanIrishorUnited

KingdomHospital.Theremustbeevidenceofan

intracerebralabscessonCTorMRIimaging.

3.CarcinomainSitu–Oesophagus,treatedbyspecificsurgery

Adefinitediagnosisofacarcinomainsituofthe

oesophagusbyaConsultantPhysicianofanIrishor

UnitedKingdomHospital,whichhasbeentreated

surgicallybyremovalofaportionorallofthe

oesophagus.Acarcinomainsituisamalignancy

thathasnotinvadedthebasementmembranebut

showscytologiccharacteristicsofcancer.Histological

evidencewillberequired.


•Treatmentbyanyothermethodisspecifically

excluded.

4.CarotidArteryStenosis-treatedbyEndarterectomyorAngioplasty

Undergoingofendarterectomyortherapeutic

angioplastywithorwithoutstenttocorrect

symptomaticstenosisinvolvingatleast70%

narrowingorblockageofthecarotidartery.

Angiographicevidencewillberequired.

5.CerebralArteriovenousMalformation-treatedbycraniotomyorendovascularrepair

Undergoingofsurgicaltreatmentviacraniotomy

byaConsultantNeurosurgeonofanIrishor

UnitedKingdomHospitalofacerebralAVfistulaor

malformation.Alternatively,wewillpayaPartial

PaymentSpecifiedIllnessBenefitifaLifeInsured

undergoesendovasculartreatmentbyaConsultant

NeurosurgeonorRadiologistofanIrishorUnited

KingdomHospitalusingcoilstocausethrombosisof

acerebralAVfistulaormalformation.


•Intracranialaneurysm

APPENDIX B

30

6.DuctalCarcinomainSitu–Breast,treatedbysurgery

Adefinitediagnosisofaductalcarcinomainsituof

thebreast,whichhasbeenremovedsurgicallyby

mastectomy,partialmastectomy,segmentectomy

orlumpectomy.Acarcinomainsituisamalignancy

thathasnotinvadedthebasementmembranebut

showscytologiccharacteristicsofcancer.Histological

evidencewillberequired.

7.LossofoneLimb

Permanentlossofahandfromabovethewristora

footfromabovetheanklejoint.Permanentlossdoes

notincludelossofuseorfunctiononly.Itmeans

havingahandorfootcompletelysevered.

8.EarlyStageProstateCancerwithGleasonscorebetween2and6–andwithspecifictreatment

Adefinitediagnosisofprostatecancerbya

ConsultantofanIrishorUnitedKingdomHospital

whichhasbeenhistologicallyclassifiedashavinga

Gleasonscorebetween2and6provided:

• Thetumourhasprogressedtoatleastclinical

TNMclassificationT1N0M0;and

• TheLifeInsuredhasundergonetreatmentby

prostatectomy,externalbeamorinterstitial

implantradiotherapy.


• Treatmentwithcryotherapy,transurethral

resectionoftheprostate,‘experimental’

treatmentsorhormonetherapy.

9.SeriousAccidentCover–resultinginatleast28consecutivedaysinhospital

Aseriousaccidentresultinginseverephysicalinjury

wheretheLifeInsuredisimmediatelyadmittedto

hospitalforatleast28consecutivedaystoreceive

medicaltreatment.

Forthepurposesofthisdefinitiononly,ahospitalstayalso

includestreatmentinaninpatientrehabilitationcentre,if

theLifeInsuredistransferreddirectlyfromhospitalto

therehabilitationcentreforcontinuoustreatment.

Severephysicalinjurymeansinjuryresultingsolely

anddirectlyfromunforeseen,external,violentand

visiblemeansandindependentofanyothercauses.

OnlyonePartialPaymentSpecifiedIllnessBenefit

willbepaidforPartialPaymentSpecifiedIllnesses

resultingfromthesameaccident.AnyAccelerated

SpecifiedIllnessBenefittobepaidwillbereduced

byanyPartialPaymentSpecifiedIllnessBenefitpaid

wheretheAcceleratedSpecifiedIllnessresultsfrom

thesameaccident.

Fortheabovedefinitionthefollowingarenotcovered:

• Staysinhospitaloflessthan28consecutive

days

• Seriousaccidentinjurysecondarytoalcoholor

drugmisuse

10.SignificantVisualImpairment

Permanentandirreversiblereductioninthesightof

botheyestotheextentthatevenwhentestedwiththe

useofvisualaids,visionismeasuredat6/36orworse

inthebettereyeusingaSnelleneyechart,while

wearinganycorrectiveglassesorcontactlens.

11.SingleLobectomy–theremovalofacompletelobeofthelung

Theundergoingofmedicallyessentialsurgeryto

removeacompletelobeofalungfordiseaseor

traumaticinjury

Fortheabovedefinitionthefollowingarenotcovered

• Partialremovalofalobeofthelungs

(segmentalorwedgeresection)

• Anyotherformoflungsurgery

12.ThirdDegreeBurnscoveringatleast5%ofthebody’ssurface

Burnsthatinvolvedamageordestructionoftheskin

toitsfulldepththroughtotheunderlyingtissueand

coveringatleast5%andlessthan20%ofthebody’s

surfaceareaoratleast25%ofthesurfaceareaofthe

facewhichforthepurposeofthisdefinitionincludes

theforeheadandtheears.

31

13.SurgicalRemovalofOneEye

Surgicalremovalofacompleteeyeballfordiseaseor

trauma.

14.ParalysisofOneLimb–totalandirreversible

Totalandirreversiblelossofmusclefunctiontothe

wholeofanyonelimb

15.TotalColectomy–withpermanentileostomy

Removalofthewholeofthecoloncreatinganopening

ontheabdomenjoiningthesmallintestinetothe

abdomenwallcalledanileostomy.Thisprocedure

iscoveredifitisestablishedthattheileostomy

ispermanentintheopinionofbothaConsultant

GastroenterologistofanIrishorUnitedKingdom

HospitalandtheCompany’sChiefMedicalOfficer.

16.SyringomyeliaorSyringobulbia–treatedbysurgery

AdefinitediagnosisofSyringomeliaorSyringobulbia


KingdomHospital,whichhasbeensurgicallytreated.

Thisincludessurgicalinsertionofapermanent

drainageshunt.

17.EarlyStageBladderCancer–ofspecifiedseverity

AdefinitediagnosisofbladdercancerbyaConsultant

ofanIrishorUnitedKingdomHospitalwhichhas

beenhistologicallyclassifiedashavingprogressedto

atleastclinicalTNMclassificationT1N0M0.

new ireland life choice - home policy conditions · vivendo, ut nostro nominavi cum, no nostro...

Documents