Critical Illness Comparison Report

Transcription

1 Critical Illness Comparison Report Prepared by Arthur Adviser Of Adviser Firm Ltd On 29th June 2017 For John New client Client Details Age 36 Date of Birth 11/06/1980 Age Group Male, 35-44, Non-smoker Childrens Cover Yes Sum Assured 120,000 Contents Adviser Summary & Policies Compared Policy Ranking Versus Price Detailed Policy Comparison Detailed Description of Differentiating Conditions Introduction The detailed ranking system compares policies based upon incidence statistics of an event occurring taking into account the claims wording used by the insurer. Comparison of policy wording, calculates how likely an insurer is to pay out under the condition. This is influenced by the individual s age, sex, whether they are a smoker or have opted to include children s cover. The sum assured is also considered to ensure that the effect of partial payment conditions are taken into account. The resulting scores are rankings based upon the specific situation of the client. Note: the information provided is intended to support the research and advice of a qualified Adviser and should not be relied upon without such advice. Page 1 of 41

2 Policies Compared This enables two policies to be compared head-to-head. It lists all the possible conditions that can be incorporated by the insurers and indicates whether a condition is included. Where both are included it indicates which policy has preferential wording or payout terms. Differentiating Conditions are those conditions where a policy has a superior claims wording, partial payment or enhanced payment definition. Tick Icon Thumbs Up Icon Historical Icon Partial Payment Enhanced Payment indicates that this condition is included by the policy specified. indicates that this policy has preferential wording and has a higher statistical likelihood of paying out and/or superior partial payment or enhanced payment definition. indicates that this is a historical policy that a client may have previously acquired but is not currently available indicates that this is a partial payment indicates that this is an enhanced payment DEC 2015 NOV16 12/15 to present 11/16 to present Score: 8,953 Score: 10,752 Difference: +1,799 (+20.09%) Differentiating Conditions: 2 Differentiating Conditions: 57 Additional Payments: 4 Additional Payments: 41 Enhanced Payments: 0 Enhanced Payments: 0 Differentiating Conditions Accidental Hospitalisation Removal or Loss of an Eye Differentiating Conditions Aortic Aneurysm Aplastic Anaemia (of Specified Severity) Benign Brain Tumour Benign Spinal Cord Tumour Blindness Carotid Artery Stenosis Cauda Equina Central Retinal Artery Cerebral Aneurysm Cerebral Arteriovenous Malformation Childrens Cover Chronic Rheumatoid Arthritis Coronary Angioplasty Corticobasal Ganglionic Degeneration Crohn's Disease (by resection) Page 2 of 41

3 Policies Compared Devic's Disease Diabetes (Type 1 insulin-dependent) Diffuse Lewy Body Disease Drug Resistant Epilepsy Guillan-Barre Syndrome Heart Failure Hypoxia/Anoxia Intensive Care (Requiring mechanical ventilation) Interstitial Lung Disease Kennedy's Disease Less Advanced Cancer of the Anus Less Advanced Cancer of the Bile Duct Less Advanced Cancer of the Colon and Rectum Less Advanced Cancer of the Gallbladder Less Advanced Cancer of the Larynx Less Advanced Cancer of the Lung and Bronchus Less Advanced Cancer of the Oesophagus Less Advanced Cancer of the Oral Cavity or Oropharynx Less Advanced Cancer of the Pancreas Less Advanced Cancer of the Renal Pelvis (of the Kidney) and Ureter Less Advanced Cancer of the Small Intestine Less Advanced Cancer of the Stomach Less Advanced Cancer of the Testicle Less Advanced Cancer of the Thymus Less Advanced Cancer of the Thyroid Less Advanced Cancer of the Urinary Bladder Less Advanced Cancers Liver Failure Lobectomy Motor Neurone Disease Non-Malignant Pituitary Adenoma Open Heart (Structural) Surgery Parkinson Plus Syndromes Parkinsonism-Dementia-Amyotrophic Lateral Sclerosis Complex Peripheral Vascular Disease Page 3 of 41

4 Policies Compared Pneumonectomy Psychosis & Bipolar Affective Disorder Pulmonary Artery Replacement Severe Crohn's Disease Significant Visual Impairment Syringomelia or Syringobulbia - treated by surgery Ulcerative Colitis Page 4 of 41

5 Policy Rankings The following shows the relative ranking of the policies compared based upon the clients individual requirements compared with pricing information that can be provided by the adviser. Policy Score Monthly Cost Quoted Date Source 11,211 DEC /15 to present 10, March, 2017 LifeQuote NOV16 11/16 to present 10,220 NOV /16 to present 10,026 MAY /17 to present 9,955 JAN /16 to present 9,822 FEB /17 to present 9,582 NOV /16 to present 9,539 NOV /14 to present 9, March, 2017 LifeQuote JUN /16 to present 9,216 OCT /16 to present Page 5 of 41

6 Policy Comparison No.1 The following detailed compares two policies and shows the wording for each condition that is included in the policy. Tick Icon Thumbs Up Icon Historical Icon indicates that this condition is included by the policy specified. indicates that this policy has preferential wording and has a higher statistical likelihood of paying out and/or superior partial payment or enhanced payment definition. indicates that this is a historical policy that a client may have previously acquired but is not currently available Additional Payment indicates that this is a additional payment Enhanced Payment Gender specific condition indicates that this is an enhanced payment indicates that this condition is not relevant to the comparison DEC 2015 NOV16 12/15 to present 11/16 to present Total Score Quoted Price 8,953 10,752 Difference: +1,799 (+20.09%) Differentiating Conditions: 2 Differentiating Conditions: 57 Additional Payments: 4 Additional Payments: 41 Enhanced Payments: 0 Enhanced Payments: 0 Accidental Hospitalisation Payment of 5,000 if life assured admitted to hospital with physical injuries for a minimum of 28 consecutve days immediately following an accident. Physical injury must have resulted solely and directly from unforeseen, external, violent and visible means and must be independent from any other cause. Only one claim per life assured and not payable if a valid claim has been made for terminal illness or a critical illness - Not Included Aorta Graft Undergoing of surgery to the aorta with replacement of a portion of the aorta with a graft The undergoing of surgery to the aorta with excision and surgical replacement of a portion of the affected aorta with a graft. The term aorta includes the thoracic and abdominal aorta but not its branches. The following is not covered: any other surgical procedure, for example, the insertion of stents or endovascular repair Aortic Aneurysm Lower of 25,000 or the sum insured if the undergoing of endovascular repair of an aneurysm of the thoracic or abdominal aorta with a graft. The following is not covered: - procedures to any branches of the thoracic or abdominal aorta Page 6 of 41

7 Aplastic Anaemia (of Specified Severity) Lower of 25,000 or the sum insured if a definite diagnosis of aplastic anaemia by a consultant haematologist. There must be bone marrow hypercellularity confirmed by biopsy with at least two of the following - a) absolute neutrophil count (ANC) Aplastic Anaemia (with Bone Marrow Failure) Bacterial Meningitis Definite diagnosis of apalstic anaemia. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia Definite diagnosis with permanent neurologicial deficit with persisting clinical symptoms. Excludes meningococcal septicaemia and any other form of meningitis A definite diagnosis of aplastic anaemia by a Consultant Haematologist. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia 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. The following are not covered: - all other forms of meningitis including viral meningitis Benign Brain Tumour A non-malignant tumour or cyst originating from the brain, cranial nerves or meninges within the skull, resulting in either surgical removal or permanent neurological deficit with persisting clinical symptoms. For the above definition, the following are not covered: Tumours in the pituitary gland. Angiomas and cholesteatoma. Tumours originating from bone tissue A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull resulting in any of the following - a) permanent neurological deficit with persisting clinical symptoms, or b) undergoing invasive surgery to remove part or all of the tumour, or, c) undergoing either stereotactic radiosurgery or chemotherapy treatment to destroy tumour cells. Excludes: tumours in the pituitary gland, tumours originating from bone tissue, angiomas & cholesteatoma. Benign Spinal Cord Tumour A non-malignant tumour in the spinal canal, involving the meninges or the spinal cord. This tumour must be interfering with the function of the spinal cord which results in permanent neurological deficit with persisting clinical symptoms. The following are not covered: - cysts - granulomas - malformations in the arteries or veins of the spinal cord - haematomas - abscesses - disc protrusions - osteophytes Bladder Removal - Not Included Blindness Permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids, vision is measured at 6/60 or worse in the better eye using a Snellen eye chart Permanent and irreversible loss of all sight to the extent that even when tested with the use of visual aids, vision is measured at 6/60 or worse in the better eye using a Snellen eye chart or visual field is reduced to 20 degrees or less of an arc as certified by an opthalmologist Page 7 of 41

8 Cancer 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, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin). 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 of 7 or above or having progressed to at least clinical TNM classification T2bN0M0. Malignant melanoma unless it has been histologically classified as having caused invasion beyond the epidermis (outer layer of the skin). Any other skin cancer (including cutaneous lymphoma) unless it has been histologically classified as having caused invasion in the lymph glands or spread to distant organs 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 sarcoma lymphoma (except cutaneous lymphoma - lymphoma confined to the skin) pseudomyxoma peritonei Merkel cell cancer. The following are not covered: all cancers which are histologically classified as any of the following: pre-malignant non-invasive cancer in situ having borderline malignancy having low malignant potential - all tumours of the prostate unless histologically classified as having a Gleason score of 7 or above, or having progressed to at least TNM classification T2bN0M0 - malignant melanoma skin cancer that is confined to the epidermis (outer layer of skin) - any non-melanoma skin cancer or cutaneous lymphoma unless it has spread to lymph nodes or distant organs Cardiac Arrest Cardiomyopathy Sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and resulting in either of the following devices being surgically implanted - implantable cardioverter-defibrillator (ICD), or cardiac resynchronisation therapy with defibrillator (CRT-D) Definite diagnosis with clinical impairment of heart fucntion resulting in permanent loss of ability to perform physical activities to at least class 3 NYHA classification. Excluded: all other forms of heart disease, enlargement and myocarditis or secondary to alcohol or drug abuse Sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and resulting in either of the following devices being surgically implanted - implantable cardioverter-defibrillator (ICD), or cardiac resynchronisation therapy with defibrillator (CRT-D) A definite diagnosis of cardiomyopathy by a Consultant Cardiologist. 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 classifications of functional capacity. The diagnosis must be supported by echocardiogram. The following are not covered: All other forms of heart disease, heart enlargement and myocarditis Carotid Artery Stenosis The lower of 25,000 or the sum insured if the undergoing of endarterectomy or angioplasty with or without stent on the advice of a consultant physician to treat severe symptomatic stenosis in a carotid artery. This operation must be to treat: at least 50% diameter narrowing; and angiographic evidence will be required Page 8 of 41

9 Cauda Equina Lower of 25,000 or sum insured if compression of the lumbrosacral nerve roots (cauda equina) resulting in all of the following: (a) permanent bladder dysfunction; and (b) permanent weakness and loss of sensation in the legs. The diagnosis must be supported by appropriate neurological evidence Central Retinal Artery Cerebral Aneurysm Lower of 25,000 or sum insured if death of the optic nerve or retinal tissue due to inadequate blood supply or haemorrhage within the central retinal artery or vein, resulting in permanent visual impairment of the affected eye. The following are not covered: branch retinal artery or vein occlusion or haemorrhage traumatic injury to tissue of the optic nerve or retina Lower of 25,000 or sum insured if the undergoing of either of the following surgical procedures: surgical correction via craniotomy (surgical opening of the skull) or embolisation treatment using coils or other materials, in order to treat a cerebral aneurysm; or surgical resection, wrapping, clipping or embolisation of a spinal aneurysm Cerebral Arteriovenous Malformation Childrens Cover Lower of 50% of sum assured or 25, days to 18 or age 21 if in full time education - 14 day survival period. No pre-existing conditions. Also, 5,000 accidental hospitalisation benefit after 28 consecutive days. Also, 4,000 funeral expenses on death of a child. Also, up to 1,000 childcare costs if you claim and have a child under age 5. Also, Up to 100 per night ( 1,000 maximum) for every night the child spends in hospital in the 3 months following diagnosis of a critical illness. Excludes T&PD, Early stage prostate cancer and mastectomy cover Lower of 25,000 or sum insured if the undergoing of either of the following surgical procedures: surgical correction via craniotomy (surgical opening of the skull) or endovascular treatment using coils or other materials, in order to treat a cerebral arteriovenous malformation; or surgical correction or embolisation of a spinal arteriovenous malformation From birth to age 18 (21 if in full-time education). 10 day survival period. Fixed 25, days survival period. If a child extra care cover condition then a fixed 50,000 or 25,000 if already claimed for an ugpraded child condition. Includes hospital benefit, 5,000 death benefit and advanced illness benefit Page 9 of 41

10 Chronic Lung Disease/Emphysema Chronic Rheumatoid Arthritis Coma Advanced emphysema or other chronic lung disease resulting in all of - continuous daily oxygen on a permanent basis FVC & FEV1 less than 50% of normal A state of unconsciousness with no reaction to external stimuli or internal needs which, - requires the use of life support systems, and, - with associated permanent neurological deficit with persisting clinical symptoms. The following aren't covered - medically induced coma, coma secondary to drug abuse Confirmation by a consultant physician of severe lung disease with permanent impairment of lung function resulting in all of the following: the need for daily oxygen therapy for a minimum of 15 hours per day for at least six months forced expiratory volume at 1 second (FEV1) below 50% of normal forced vital capacity (FVC) below 50% of normal Severe chronic Rheumatoid Arthritis evidenced by joint destruction and deformity of at least three major joint groups, resulting in the inability to do three of the following; bend or kneel to pick up an object from the floor; use hands or fingers to pick up or manipulate small objects such as cutlery or a pen; lift or carry an everyday object such as a kettle; walk a distance of 200m on flat ground with or without use of a walking stick and without experiencing severe discomfort 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 Coronary Angioplasty Lower of 25,000 or sum inured if percutaneous coronary intervention (PCI) to correct narrowing or blockages of the left main stem artery, or two or more main coronary arteries. Multiple vessels must be treated at the same time or as part of a planned stage procedure within 60 days for the first PCI. The main coronary arteries for this purpose are defined as right coronary artery, left anterior descending artery, circumflex artery, or their branches. PCI is defined as any therapeutic intra-arterial catheter procedure including balloon angioplasty and/or stenting. The following are not covered: - diagnostic angioplasty - two angioplasty procedures to a single main artery or branches of the same artery Coronary By-Pass Grafts Undergoing of surgery requiring median sternotomy or anterolateral thoracotomy to correct narrowing or blockage of one of mre coronary arteries with by-pass grafts 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 Page 10 of 41

11 Corticobasal Ganglionic Degeneration NOTE: This condition is shown in policy under PARKINSON PLUS SYNDROMES - A definite diagnosis by a consultant neurologist or geriatrician of Corticobasal ganglionic degeneration. There must also be permanent clinical impairment of at least one of the following; motor function, or, eye movement disorder, or, postural instability, dementia. Excludes degenerative disorders secondary to drug abuse Craniotomy to Drain a Brain Abscess - Not Included Creutzfeldt-Jakob Disease Diagnosis of CJD evidenced by significant reduction in mental and social functioning so that permanent supervision or assistance by a third party is required A definite diagnosis of Creutzfeldt-Jakob disease by a consultant neurologist Critical Fracture Cover - Not Included Crohn's Disease (by resection) Deafness Permanent and irreversible loss of hearing to the extent that the loss is greater than 70 decibels across all frequencies in the better ear using a pure tone audiogram Lower of 25,000 or sum insured if a definite diagnosis by a consultant gastroenterologist of Crohn s disease, which has been treated with surgical intestinal resection Permanent and irreversible loss of hearing to the extent that the loss is greater than 70 decibels across all frequencies in the better ear using a pure tone audiogram Dementia (inc AD & PSD) Definite diagnosis of AD or pre-senile dementia supported by evidence of progressive loss of ability to; a) remember, b) reason, c) perceive, understand, express and give effect to ideas. Excludes alcohol or drug misuse Definite diagnosis of AD or pre-senile dementia supported by evidence of progressive loss of ability to; a) remember, b) reason, c) perceive, understand, express and give effect to ideas Devic's Disease A definite diagnosis of neuromyelitis optica (Devic s disease) by a consultant neurologist. There must have been clinical impairment of motor or sensory function caused by neuromyelitis optica. The following is not covered: neuromyelitis optica spectrum disorder Diabetes (Type 1 insulin-dependent) Lower of 25,000 or sum insured if a definite diagnosis of type 1 diabetes mellitus, requiring the permanent use of insulin injections. The following are not covered: gestational diabetes type 2 diabetes (including type 2 diabetes treated with insulin) Page 11 of 41

12 Diffuse Lewy Body Disease NOTE: This condition is shown in policy under PARKINSON PLUS SYNDROMES - A definite diagnosis by a consultant neurologist or geriatrician of diffuse lewy body disease. There must also be permanent clinical impairment of at least one of the following; motor function, or, eye movement disorder, or, postural instability, dementia. Excludes degenerative disorders secondary to drug abuse Donor Cover - Not Included Drug Resistant Epilepsy Lower of 25,000 or sum insured if undergoing invasive surgery to brain tissue in order to control epilepsy that cannot be controlled by oral medication. The following is not covered: deep brain stimulation Early-stage Prostate Cancer Encephalitis Lower of 25,000 or 25% of sum insured if diagnosed with prostate cancer with a Gleason score 2 to 6 and the tumour has progressed to at least T1N0M0 and undergoing any treatment. Excludes Prostatic intraepithelial neoplasia. observation or surveillance or surgical biopsy. A claim does not reduce the sum insured Definite diagnosis resulting in permanent neurological deficit with persisting clinical symptoms Lower of 25,000 or sum insured if tumours of the prostate histologically classified as having a Gleason score between 2 and 6 inclusive providing the tumour has progressed to a clinical TNM classification between T1N0M0 and T2aN0M0 and the tumour has been treated by one of the following: complete removal of the prostate external beam or interstitial implant therapy cryotherapy hormone therapy high intensity focused ultrasound. The following is not covered: prostate cancers where the treatment is not one of the specified treatments above, or requires observation only A definite diagnosis of encephalitis by a Consultant Neurologist resulting in permanent neurological deficit with persisting clinical symptoms Extra Care Cover - Not Included Guillan-Barre Syndrome Lower of 25,000 or sum inssured if a definite diagnosis of Guillain-Barre syndrome by a consultant neurologist. There must be cinical impairment of motor or sensory function which must have persisted for a continuous period of 6 months Page 12 of 41

13 Heart Attack 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 biochemical cardiac specific markers such as troponins or enzymes. The evidence must show a definite acute myocardial infarction. For the above definition, the following are not covered: Other acute coronary syndromes. Angina without myocardial infarction 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 The evidence must show a definite acute myocardial infarction.for the above definition, the following are not covered:- other acute coronary syndromes - angina without myocardial infarction Heart Failure A definite diagnosis by a consultant cardiologist of failure of the heart to function as a pump which is evidenced by all of the following Permanent and irreversible limitation of function to at least class III on the New York Heart Association functional classification (i.e. heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitations, breathlessness or chest pain. Permanent and irreversible left ventricular ejection fraction of 39% or less Heart Valve Repair or Replacement Undergoing of surgery to replace or repair one or more heart valves Undergoing surgery on the advice of a consultant cardiologist to replace or repair one or more heart valves Hepatitis B or C - Not Included Page 13 of 41

14 HIV/AIDS Covers physical assault, blood transfusion and health & emergency workers if accidental infection at work - wide geographical area Infection by Human Immunodeficiency Virus resulting from: a blood transfusion given as part of medical treatment; or a physical assault; or an incident occurring during the course of performing normal duties of employment, after the start of the policy and satisfying all of the following: the incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures where HIV infection is caught through a physical assault or as a result of an incident occurring during the course of performing normal duties of employment, the incident must be supported by a negative HIV antibody test taken within five days of the incident there must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus. The following are not covered: HIV infection resulting from any other means, including sexual activity or drug misuse Hypoxia/Anoxia Death of brain tissue due to reduced oxygen supply (anoxia or hypoxia) resulting in permanent neurological deficit with persisting clinical symptoms Infective Bacterial Endocarditis - Not Included Intensive Care (Requiring mechanical ventilation) Any sickness or injury resulting in the insured requiring continuous mechanical ventilation by means of tracheal intubation for 10 consecutive days (24 hours per day) or more in an intensive care unit in a UK hospital Interstitial Lung Disease A definite diagnosis of interstitial lung disease by a consultant respiratory physician resulting in all of the following - radiological evidence of pulmonary diseaseand permanent and irreversible DLCO (diffusing capacity of the lung for carbon monoxide) below 40% of predicted Kennedy's Disease NOTE: Covered within the motor neurone disease definition Kidney Failure Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is permanently required Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is permanently required Page 14 of 41

15 Less Advanced Cancer of the Anus Less Advanced Cancer of the Bile Duct Less Advanced Cancer of the Breast Benefit is lower of 25% of sum assured or 25,000 if the life assured, or for a joint life policy the first of the lives assured, or a relevant child meets the following definition: The undergoing of surgery on the advice of your hospital consultant following the diagnosis of carcinoma in situ of the breast. For the above definition the following is not covered: Any other type of treatment. Only one claim per policy can be made. Claim will not reduce the sum assured Lower of 25,000 or sum insured if a confirmation of cancer in situ of the anus with surgery to remove the tumour. The following are not covered: anal intraepithelial neoplasia (AIN) grade 1 or 2, or low grade squamous intraepithelial lesions (LGSIL) all non-surgical therapies which include but are not limited to all forms of ablative therapy and topical therapy Lower of 25,000 or sum insured if a confirmation of cancer in situ of the extra-hepatic bile ducts with surgery to remove the tumour Lower of 25,000 or sum insured if a confirmation of cancer in situ or neuroendocrine tumour (NET) of low malignant potential of the breast with surgery to remove the tumour Less Advanced Cancer of the Cervix Uteri (requiring Hysterectomy) Less Advanced Cancer of the Colon and Rectum Less Advanced Cancer of the Endometrium Lower of 25,000 or sum insured if a confirmation of cancer in situ of the cervix uteri resulting in trachelectomy (removal of the cervix) or hysterectomy. The following are not covered: loop excision laser surgery conisation cryosurgery cervical intraepithelial neoplasia (CIN) grade I or II, or low grade squamous intraepithelial lesions (LGSIL) Lower of 25,000 or sum insured if a confirmation of cancer in situ or neuroendocrine tumour (NET) of low malignant potential of the appendix, colon or rectum resulting in surgery to remove a portion of the colon, rectum or appendix NOTE: Shown in policy under Less advanced cancer of the uterus. Lower of 25,000 or sum insued if a positive diagnosis with histological confirmation of cancer in situ of the lining of the uterus (endometrium) resulting in hysterectomy resulting in hysterectomy Page 15 of 41

16 Less Advanced Cancer of the Gallbladder Less Advanced Cancer of the Larynx Less Advanced Cancer of the Lung and Bronchus Less Advanced Cancer of the Oesophagus Less Advanced Cancer of the Oral Cavity or Oropharynx Lower of 25,000 or sum insured if a confirmation of cancer in situ of the gallbladder with surgery to remove the tumour Lower of 25,000 or sum inured if a confirmation of cancer in situ of the larynx treated with surgery, laser or radiotherapy Lower of 25,000 or sum insured if a confirmation of any of the following tumours of the lung or bronchus resulting in wedge resection or lobectomy: - cancer in situ; or - neuroendocrine tumour (NET) of low malignant potential; or - carcinoid tumour Lower of 25,000 or sum insured if a confirmation of cancer in situ of the oesophagus with surgery to remove the tumour Lower of 25,000 or sum insured if a confirmation of cancer in situ of the oral cavity or oropharynx with surgery to remove the tumour. This includes lips, inside of the cheeks, floor of the mouth, tongue, gums, hard palate, soft palate and tonsils Less Advanced Cancer of the Other Sites - Not Included Less Advanced Cancer of the Ovary Less Advanced Cancer of the Pancreas Lower of 25,000 or sum insured if a confirmation of ovarian tumour of borderline malignancy or low malignant potential which has resulted in surgical removal of an ovary. The following is not covered: removal of an ovary due to a cyst Lower of 25,000 or sum insured if a confirmation of cancer in situ or neuroendocrine tumour (NET) of low malignant potential of the pancreas with surgery to remove the tumour Page 16 of 41

17 Less Advanced Cancer of the Renal Pelvis (of the Kidney) and Ureter Less Advanced Cancer of the Small Intestine Lower of 25,000 or sum insured if a confirmation of cancer in situ of the renal pelvis or ureter. The following are not covered: non-invasive papillary carcinoma tumours of TNM classification stage Ta Lower of 25,000 or the sum insured if a confirmation of neuroendocrine tumour (NET) of low malignant potential of the duodenum, jejunum or ileum resulting in intestinal resection Less Advanced Cancer of the Stomach Less Advanced Cancer of the Testicle Less Advanced Cancer of the Thymus Lower of 25,000 or sum insured if a confirmation of cancer in situ or neuroendocrine tumour (NET) of low malignant potential of the stomach with surgery to remove the tumour Lower of 25,000 or sum insured if a confirmation of intra-tubular germ cell neoplasia unclassified (ITGCNU) or benign testicular tumour resulting in orchidectomy (removal of a testicle) Lower of 25,000 or the sum insured if a confirmation of neuroendocrine tumour (NET) of low malignant potential of the thymus resulting in surgery to remove the tumour Less Advanced Cancer of the Thyroid Lower of 25,000 or the sum insured if a confirmation of neuroendocrine tumour (NET) of low malignant potential of the thyroid with surgery to remove the tumour Less Advanced Cancer of the Urinary Bladder Less Advanced Cancer of the Uterus Lower of 25,000 or sum insured if a confirmation of cancer in situ of the urinary bladder. The following are not covered:? non-invasive papillary carcinoma? TNM classification stage Ta bladder cancer. NOTE: More precisely called less advanced cancer of the endometrium (lining of the uterus) however in policy shown under Less Advanced Cancer of the uterus. Lower of 25,000 or sum insued if a positive diagnosis with histological confirmation of cancer in situ of the lining of the uterus (endometrium) resulting in hysterectomy Page 17 of 41

18 Less Advanced Cancer of the Vagina Less Advanced Cancer of the Vulva Lower of 25,000 or sum insured if a confirmation of cancer in situ of the vagina resulting in surgery to remove the tumour. The following are not covered: all non-surgical therapies which include but are not limited to all forms of ablative therapy and topical therapy vaginal intraepithelial neoplasia (VAIN) grade 1 or 2 or low grade squamous intraepithelial neoplasia Lower of 25,000 or sum insured if a confirmation of cancer in situ of the vulva resulting in surgery to remove the tumour. The following are not covered: all non-surgical therapies which include but are not limited to all forms of ablative therapy and topical therapy vulval intraepithelial neoplasia (VIN) grade 1 or 2 or low grade squamous intraepithelial neoplasia Less Advanced Cancers Numerous Less Advanced Cancers are shown individually Liver Failure Advanced liver failure due to cirrhosis resulting in all of - a) permanent jaundice, b) ascites and c) encephalopathy. Excludes alcohol or drug abuse Chronic liver disease, being end stage liver failure due to cirrhosis and resulting in all of the following: permanent jaundice, ascites encephalopathy Liver Resection - Not Included Lobectomy Lower of 25,000 and sum insured if undergoing of surgery for the removal of one or more lobes of the lung due to underlying disease or trauma. The surgery must be carried out on the advice of a consultant physician Loss of Hands or Feet Permanent physical severance of either a hand or a foot at or above the wrist or ankle joint Permanent physical severance of either a hand or a foot at or above the wrist or ankle joint Loss of Speech Total, permanent and irreversible loss of the ability to speak as a result of physical injury or disease Total, permanent and irreversible loss of the ability to speak as a result of physical injury or disease Page 18 of 41

19 Major Organ Transplant The undergoing as a recipient of a transplant from another donor, of bone marrow or of a complete heart, kidney, lung, pancreas, liver, or a lobe of the liver, or inclusion on an official UK, the Channel Islands or the Isle of Man waiting list for such a procedure. For the above definition, the following is not covered: Transplant of any other organs, parts of organs, tissues or cells The undergoing as a recipient a transplant of: bone marrow; or haematopoietic stem cells preceded by total bone marrow ablation; or a complete heart, kidney, liver, lung, or pancreas from another donor; or a whole lobe of the lung or liver from another donor; or inclusion on an official UK waiting list for such a procedure. The following is not covered: transplant of any other organs, parts of organs, tissues or cells Minor Heart Attack - Not Included Minor Stroke - Not Included Motor Neurone Disease A definite diagnosis of one of the following motor neurone diseases by a consultant neurologist - Amyotrophic Lateral Sclerosis (ALS), Primary Lateral Sclerosis (PLS), Progressive Bulbar Palsy (PBP), Progressive Muscular Atrophy (PMA), Spinal Muscular Atrophy (SMA). There must also be permanent clinical impairment of motor function A definite diagnosis of one of the following motor neurone diseases by a consultant neurologist - Amyotrophic Lateral Sclerosis (ALS), Primary Lateral Sclerosis (PLS), Progressive Bulbar Palsy (PBP), Progressive Muscular Atrophy (PMA), Kennedy's disease, also known as spinal and bulbar muscular atrophy (SBMA) and spinal muscular atrophy (SMA). There must also be permanent clinical impairment of motor function Multiple Sclerosis Multiple System Atrophy Definite diagnosis with current or previous/historic clinical impairment of motor or sensory function caused by MS Definite diagnosis with permanent impairment of either (a) motor function with associated rigidity of movement, (b) ability to coordinate muscle movement, or (c) bladder control and postular hypotension A definite diagnosis of multiple sclerosis by a consultant neurologist. There must have been clinical impairment of motor or sensory function caused by multiple sclerosis NOTE: This condition is shown in policy under PARKINSON PLUS SYNDROMES - A definite diagnosis by a consultant neurologist or geriatrician of one of multiple system atrophy. There must also be permanent clinical impairment of at least one of the following; motor function, or, eye movement disorder, or, postural instability, dementia. Excludes MSA secondary to drug abuse Non Severe Cardiomyopathy - Not Included Non-Malignant Pituitary Adenoma Lower of 25,000 or sum insured if a non-malignant pituitary tumour requiring radiotherapy or surgical removal. The following is not covered: non-malignant tumours of the pituitary gland treated by any other method Page 19 of 41

20 Open Heart (Structural) Surgery Paralysis of Limbs Undergoing surgery requiring median sternotomy (surgery to divide the breastbone) to correct any structural abnormality of the heart Total and irreversible loss of muscle function to the whole of any limb The undergoing of heart surgery requiring median sternotomy (surgery to divide the breast bone) or thoracotomy on the advice of a consultant cardiologist to correct any structural abnormality of the heart Total and irreversible loss of muscle function to the whole of any limb Parkinson Plus Syndromes A definite diagnosis of one of the following Parkinson s plus syndromes by a consultant neurologist: multiple system atrophy progressive supranuclear palsy Parkinsonism-dementia-ALS complex diffuse lewy body disease corticobasal degeneration. There must also be permanent clinical impairment of at least one of the following: motor function; or eye movement disorder; or postural instability; or dementia. The following are not covered: other Parkinsonian syndromes Parkinsonism Parkinson's Disease A definite diagnosis of Parkinson s disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function with either associated tremor or muscle rigidity.for the above definition, the following are not covered: Parkinsonian syndromes/parkinsonism A definite diagnosis of Parkinson's Disease by a consultant neurologist. There must be permanent clinical impairment of motor function with associated tremor or muscle rigidity. Excludes : Parkinsonian Syndromes/Parkinsonism Parkinsonism-Dementia-Amyotrophic Lateral Sclerosis Complex NOTE: This condition is shown in policy under PARKINSON PLUS SYNDROMES - A definite diagnosis by a consultant neurologist or geriatrician of Parkinsonism-dementia-amyotrophic lateral sclerosis complex. There must also be permanent clinical impairment of at least one of the following; motor function, or, eye movement disorder, or, postural instability, dementia. Excludes degenerative disorders secondary to drug abuse Partial Loss of Hearing - Not Included Pericarditis - Not Included Page 20 of 41

21 Peripheral Vascular Disease A definite diagnosis of peripheral vascular disease by a consultant cardiologist or vascular surgeon with objective evidence from imaging of obstruction in the arteries requiring by-pass graft surgery to the arteries of the legs. The following is not covered: angioplasty Permanent Pacemaker Incertion - Not Included Pneumonectomy The undergoing of surgery on the advice of a consultant medical specialist to remove an entire lung due to disease or traumatic injury. The following is not covered: other forms of surgery to the lungs including removal of a lobe of the lungs (lobectomy) or lung resection Primary Pulmonary Hypertension Progressive Supranuclear Palsy Definite diagnosis with clinical impairment of heart function resulting in permanent loss of ability to perform physical activities to at least Class 3 of the NYHA classification of functional capacity Definite diagnosis. There must be permanent clinical impairment of eye movements and motor function A definite diagnosis of one of the following by a consultant cardiologist or consultant respiratory physician of either: idiopathic pulmonary arterial hypertension chronic thrombo-embolic pulmonary hypertension. There must be all of the following a systolic pulmonary arterial pressure (PAP) of greater than 50mmHg (mm of mercury) for more than a year permanent and irreversible right ventricular dilatation and hypertrophy on echocardiogram and electrocardiogram (ECG) NOTE: This condition is shown in policy under PARKINSON PLUS SYNDROMES - A definite diagnosis. There must be permanent clinical impairment of eye movements and motor function confirmed by diagnostic techniques current at the time of claim There must also be permanent clinical impairment of at least one of the following; motor function, or, eye movement disorder, or, postural instability, dementia. Excludes degenerative disorders secondary to drug abuse Page 21 of 41

22 Psychosis & Bipolar Affective Disorder A definite diagnosis by a consultant psychiatrist of any of the following Bipolar affective disorder Paranoid (delusional) psychosis Schizo-affective disorder Schizophrenia. Which has resulted in at least three of the following occurring within one year: a) Being under the care of a psychiatrist, psychiatric nurse, community mental health team or approved social worker, b) Chronic symptoms lasting at least a year or requiring continuous therapy or medication to control them, c) In-patient admission to a psychiatric ward for at least 14 consecutive nights, d) A court order being made by the Court of Protection under the Mental Capacity Act. For the above definition the following are not covered; Delerium where there is no underlying psychiatric disorder Conditions caused by or exacerbated by alcohol or drug misuse Pulmonary Artery Replacement The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) or thoracotomy on the advice of a consultant cardiologist for disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft Removal or Loss of an Eye Permanent surgical removal of an eyeball as a result of injury or disease. Excluded: Self-inflicted injury - Not Included Severe Crohn's Disease A definite diagnosis by a consultant gastroenterologist of Crohn s disease, resulting in either: surgical intestinal resection to remove part of the small intestine or bowel on at least two separate occasions; or total colectomy (removal of entire large bowel) Significant Visual Impairment Lower of 25,000 or sum insured if permanent and irreversible loss of sight to the extent that even when tested with the use of visual aids vision is measured at 6/24 or worse in the better eye using a Snellen eye chart, or visual field is reduced to 45 degrees or less of an arc, as certified by an ophthalmologist Skin Cancer - Not Included Spinal Stroke Death of spinal cord tissue due to inadequate blood supply or haemorrhage within the spinal canal resulting in neurological deficit with persisting clinical symptoms lasting at least 24 hours Death of spinal cord tissue due to inadequate blood supply or haemorrhage within the spinal column resulting in permanent neurological deficit with persisting clinical symptoms Page 22 of 41

23 Stroke Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in neurological deficit with persisting clinical symptoms lasting at least 24 hours. Excluded: Transient ischaemic attacks and death of tissue of the optic nerve or retina Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in either a) permanent neurological deficit with persisting clinical symptoms or b) definite evidence of death of tissue or haemorrhage on a brain scan and neurological deficit with persistent clinical symptoms lasting at least 24 hours. Excludes transient ischaemic attacks, death of the optic nerve or retina/eye stroke Syringomelia or Syringobulbia - treated by surgery The undergoing of surgery to treat a syrinx in the spinal cord or brain stem Systemic Lupus Erythematosus Third Degree Burns (20% of the body and above) Definite diagnosis resulting in either of the following (1) permanent neurological deficit with persisting clinical symptoms, or; (2) permanent impaired kidney function with Glomerular Filtration Rate (GFR) below 30 ml/min Third degree burns involving damage or destruction of the skin to its full depth through to the underlying tissue either - covering at least 20% of body area or 20% surface area of the face A definite diagnosis of systemic lupus erythematosus by a consultant rheumatologist resulting in either of the following: permanent neurological deficit with persisting clinical symptoms; or permanent impairment of kidney function with glomerular filtration rate (GFR) below 30 ml/min 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 s surface area or covering at least 20% of the surface area of the face or head Third Degree Burns (up to 20% of the body) - Not Included Traumatic Brain Injury Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms Death of brain tissue due to traumatic injury resulting in permanent neurological deficit with persisting clinical symptoms Ulcerative Colitis A definite diagnosis of ulcerative colitis by a consultant gastroenterologist, which is treated with total colectomy (removal of entire large bowel) Page 23 of 41

24 Differentiating Conditions Detail The following provides an explanation of the differentiating conditions of each policy together with a summary of incidence rates. DEC 2015 NOV16 12/15 to present 11/16 to present Score: 8,953 Score: 10,752 Difference: +1,799 (+20.09%) Differentiating Conditions: 2 Differentiating Conditions: 57 Additional Payments: 4 Additional Payments: 41 Enhanced Payments: 0 Enhanced Payments: 0 Differentiating Conditions Accidental Hospitalisation Being admitted to a hospital due to an accident that has caused a physical injury and on the advice of a medical expert having to stay in hospital for at least 28 consecutive days. No figures are yet available and it is likely that claims will be few as many instances will be covered under conditions such as loss of limbs and paralysis. Removal or Loss of an Eye The physical removal of an eyeball due to injury or disease. In majority of instances this is due to cancer which is likely to be covered under the cancer definition. Figures from HES suggest around 820 instances p.a. but around 75% of these will be due to cancer, UK cancer statistics highlight that, annually, over 800 incidences of eye cancer occur. Differentiating Conditions Aortic Aneurysm A swelling of the aorta the main blood vessel that leads away from the heart. The abdominal aorta is the largest blood vessel in the body. Surgeons have a preference for endovascular repair, which is a minimally-invasive option to open surgery. Over 3,800 interventions were carried out during 2014/15 with 92% being on people age 65 and over. Nearly 90% are carried out on males. Aplastic Anaemia (of Specified Severity) Aplastic anaemia is a rare, potentially life-threatening failure of haemopoiesis (the ability to produce sufficient red blood cells). This leaves the sufferer liable to infections and bleeding. A Swedish study suggests that smokers are more susceptible but this has yet to be validated. This affects around 180 people each year and statistics suggest that only around 100 of these. It is most common between the ages of 4 and 16. Page 24 of 41

25 Differentiating Conditions Detail Benign Brain Tumour Malignant tumours will be covered under the cancer definition. Benign brain tumours grow placing pressure on the brain and causing brain damage. They are less likely to come back if completely removed, less likely to spread to other parts of the brain or spinal cord and may simply require surgery as opposed to radiotherapy or chemotherapy. Angiomas are excluded as these are benign tumours on the surface of the skin and in themselves present no concern other than cosmetic. Tumours in the pituitary gland are also excluded in these account for 15% of all brain tumours although they frequently go undiagnosed. Statistics regarding brain tumours are confusing and it is generally accepted that the incidence of brain tumours is under-recorded. McMillan Cancer and Cancer Research UK both suggest almost 4,500 p.a. There appears to be agreement on this figure although some statistics fail to differentiate between primary and secondary cancers. For claim purposes only primary cancers are likely to result in a successful claim as it is likely that an earlier claim under the cancer heading will have been made.2013 English cancer statistics imply a UK figure of around 3,900 benign tumours of which 68% fall into the age range. HES procedural figures suggest that surgery is used in nearly 50% of instances. Brain tumours are often not treated but dealt with by surveillance as this avoids the dangers of surgery. Benign Spinal Cord Tumour A benign growth on or within the spinal canal. To qualify there must also be permanent neurological deficit as a result. Benign brain tumours are always primary. In the UK around 900 p.a. are diagnosed with benign tumours in the spinal cord or spinal meninges but in most instances they are surgically removed without causing any neurological deficit. Page 25 of 41