ADDENDUM TO THE TERMS AND CONDIITONS OF THE GREENLIGHT SEVERE ILLNESS BENEFITS (PREMIUM AND ELITE) - STANDALONE

Transcription

1 This document must not be read in isolation. It is an addendum to a letter dated 10 May 2017, that is either addressed to Old Mutual Greenlight Severe Illness (Premium and Elite) policyholders, or has been included in a GREENLIGHT Severe Illness Benefit (Premium or Elite) new business contract. This document must be read in conjunction with the important information contained in the letter. The tables below contain severe illnesses that are now covered by this benefit. Following is an explanation of the tables: The list is shown in two parts: o Section A shows new Severe Illness events o Section B shows enhanced s The tables are in alphabetical order. The illnesses that will be removed following a payment of a claim listed for each event below, are only relevant if multiple claims are applicable to your existing contract. SECTION A: New Severe Illness Events The full cover amount applicable at the date of the claim event is paid as a lump sum if the life covered suffers one of the illnesses defined in this Section A and meets the survival period if applicable. The tables below also show the evidence or symptoms that must be present before a claim will be considered and any exclusions where applicable. ACUTE RENAL DISEASE Acute renal disease requiring more than five treatments of haemodialysis. Acute renal disease is not covered if you have previously had a successful claim, or have a successful claim in Kidney transplant, Chronic kidney failure, Wegener's granulomatosis, related Activities of daily living, related Terminal illness, Acute renal disease, Connective tissue disease, Scleroderma, Systemic lupus erythematosis, Polymyositis AMPUTATION OF THE PENIS : Total amputation of the penis. Circumcision amputation for personal reasons (e.g. gender reassignment surgery) Amputation of the penis is not covered if you have previously had a successful claim, or have a successful claim in Related Cancer, related Trauma BILATERAL ANGIOPLASTY AND/OR STENTING The undergoing of endovascular surgery to both carotid arteries. Bilateral angioplasty and/or stenting is not covered if you have previously had a successful claim, or have a successful claim in Angioplasty and/or stenting, major artery aneurysm, carotid artery surgery BRAIN SURGERY Any condition for which the life covered has undergone open brain surgery; provided that best practice medical treatment has been adhered to and this is at the advice of a neurosurgeon. Includes depressed skull fracture requiring removal of bone or reconstruction of the skull as proved by a neurosurgeon s assessment. Tumours in the pituitary gland Angiomas AV malformations intracranial aneurysm endovascular procedures keyhole surgeries

2 BRAIN SURGERY Brain surgery is not covered if you have previously had a successful claim, or have a successful claim in future, for any of the illnesses below Related stroke, related coma, related dementia (including Alzheimer's disease), benign brain tumour, related cancer, related spinal cord tumor, related activities of daily living, related paralysis, related status epilepticus, related acquired mental retardation, related terminal illness, brain surgery, hemiparesis or cranial nerve deficit CAVERNOUS SINUS THROMBOSIS Unequivocal diagnosis of Cavernous sinus thrombosis. Cavernous sinus thrombosis is not covered if you have previously had a successful claim, or have a successful claim in Stroke, related paralysis, related coma, related dementia (including Alzheimer's Disease), related status epilepticus, related activities of daily living, related terminal illness, related brain surgery, cavernous sinus thrombosis CHRONIC BLOOD DISORDERS Any chronic disorder of the blood, where at least four units of blood or blood products has been transfused per month for at least 3 consecutive months. This must be confirmed by a specialist. Clinical records documenting the blood transfusions; Blood counts. Chronic blood disorders is not covered if you have previously had a successful claim, or have a successful claim in Related cancer, related hematopoietic stem cell (bone marrow) transplants, related activities of daily living, related bone marrow failure (including severe aplastic anaemia), related terminal illness. chronic blood disorders CIRRHOSIS OF THE LIVER Cirrhosis of the liver confirmed on liver biopsy by a gastroenterologist. Illnesses related to long-term alcohol or drug abuse Cirrhosis of the liver is not covered if you have previously had a successful claim, or have a successful claim in Liver transplant, related Coma, related Dementia (including Alzheimer's disease), chronic liver failure, related Activities of daily living, related Terminal illness, cirrhosis of the liver HEMIPARESIS OR CRANIAL NERVE DEFICIT A permanent hemiparesis or cranial nerve deficit that the insured life sustained in an accident or because of brain surgery or disease, as proved by a neurological assessment. Bell s Palsy Hemiparesis or cranial nerve deficit is not covered if you have previously had a successful claim, or have a successful claim in Stroke, related paralysis, related coma, related dementia (including Alzheimer's Disease), related cerebral aneurysm, bilateral carotid artery surgery, carotid artery surgery, related status epilepticus, related acquired mental retardation, related activities of daily living, related loss of hearing, related loss of sight, related loss of speech, related terminal illness, related Brain surgery, Hemiparesis or cranial nerve deficit, Cavernous sinus thrombosis

3 MYASTHENIA GRAVIS Unequivocal diagnosis of myasthenia gravis of at least severity Class III (as per the Myasthenia Gravis Foundation of America clinical classification) as confirmed by a specialist or neurologist. The symptoms should be present despite adequate treatment. Myasthenia gravis is not covered if you have previously had a successful claim, or have a successful claim in future, for any of the illnesses below Myasthenia gravis, related activities of daily living, related paralysis, related terminal illness, related Chronic Respiratory Failure PANCREATECTOMY Complete pancreatectomy. This must be confirmed with surgical reports by a specialist. Illnesses related to long-term alcohol or drug abuse Pancreatectomy is not covered if you have previously had a successful claim, or have a successful claim in future, for any of the illnesses below Pancreas transplant, related activities of daily living, related terminal illness, Pancreatectomy, related Cancer PARTIAL MASTECTOMY Partial mastectomy that is required for ductal or lobular carcinoma-in-situ of at least 50% of affected breast tissue in one breast. Lumpectomy Quandrantectomy Partial mastectomy is not covered if you have previously had a successful claim, or have a successful claim in Related Cancer PERMANENT ILEOSTOMY OR COLOSTOMY The presence of a permanent colostomy or ileostomy with a stoma bag. Permanent ileostomy or colostomy is not covered if you have previously had a successful claim, or have a successful claim in Ulcerative colitis, related cancer, related activities of daily living, related terminal illness, Pseudomyxoma Peritonei, Permanent ileostomy or colostomy POLYMYOSITIS Unequivocal diagnosis of polymyositis. dysphonia (voice disorders) and dysphagia (difficulty swallowing) Polymyositis is not covered if you have previously had a successful claim, or have a successful claim in future, for any of the illnesses below Scleroderma, connective tissue disease, related activities of daily living, related terminal illness, polymyositis PSEUDOMYXOMA PERITONEI Pseudomyxoma Peritonei with Disseminated Peritoneal Adenomucinosis. Pseudomyxoma Peritonei is not covered if you have previously had a successful claim, or have a successful claim in related cancer, related activities of daily living, related terminal illness, Pseudomyxoma Peritonei, Permanent ileostomy or colostomy

4 PSYCHIATRIC DISORDERS The diagnosis of a psychiatric disorder, according to the latest Diagnostic and Statistical Manual for Mental Disorders (DSM) classification. Institutionalisation in a registered psychiatric facility for more than 6 consecutive months with appropriate medical certification; Undergoing of constant supervision, with a permanent caregiver; Global Assessment Function (GAF) score of 30 or less. All of the above must be confirmed by at least two independent psychiatric reports. Psychiatric disorders is not covered if you have previously had a successful claim, or have a successful claim in Related stroke, related coma, dementia (including Alzheimer's disease), related activities of daily living, related status epilepticus, related acquired mental retardation, related terminal illness, Psychiatric disorders RETINITIS PIGMENTOSA Unequivocal diagnosis of retinitis pigmentosa. The diagnosis must be confirmed with supporting reports by an ophthalmologist Retinitis pigmentosa is not covered if you have previously had a successful claim, or have a successful claim in Loss of sight, Eye stroke, Retinitis pigmentosa SECTION B: Enhanced s The full cover amount applicable at the date of the claim event is paid as a lump sum if the life covered suffers one of the illnesses defined in this Section B and meets the survival period if applicable. The tables below also show the evidence or symptoms that must be present before a claim will be considered and any exclusions where applicable. AMPUTATION OF LIMB Permanent physical severance or total and permanent loss of use of any one or more hands or feet at or above the wrist or ankle joints. Related activities of daily living, related paralysis, related terminal illness BENIGN BRAIN TUMOUR A non-malignant tumour or cyst in the brain (including pituitary macroadenomas), cranial nerves or meninges within the skull. The tumour results in: Complete resection, partial resection or is irresectable, or causes permanent neurological deficit Pituitary micro-adenomas, and angiomas. Related stroke, related coma, related dementia (including Alzheimer's disease), benign brain tumour, related cancer, related spinal cord tumour, related activities of daily living, related paralysis, related status epilepticus, related acquired mental retardation, related loss of hearing, related loss of sight, related loss of speech, related terminal illness CANCER Confirmation of a malignant tumour positively diagnosed and characterised by the uncontrolled growth of malignant cells and invasion of surrounding tissue. The term malignant tumour includes ductal carcinoma in

5 CANCER situ (DCIS) of the breast with microinvasion, leukaemia, sarcoma and lymphoma except cutaneous lymphoma (lymphoma confined to the skin). All cancers which are histologically classified as any of the following: o pre-malignant, or o non-invasive, or o cancer in situ, or o having either borderline malignancy (except Ovarian stage 1 or worse), or o having low malignant potential, and all tumours of the prostate unless histologically classified as having a Gleason score greater than six or having progressed to at least clinical TNM classification T2N0M0, and chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet stage A, and any skin cancer (including cutaneous lymphoma and dermatofibrosarcoma protuberans) other than: o malignant melanoma that has been histologically classified as at least T1N0M0, or o the occurrence of a basal cell carcinoma or malignant squamous cell carcinoma that has invaded and spread to lymph nodes or metastasised to distant organs. Related cancer, related advanced skin cancer: basal cell, related advanced skin cancer: squamous cell, related hematopoietic stem cell (bone marrow) transplants, related activities of daily living, related bone marrow failure (including severe aplastic anaemia), related terminal illness CAROTID ARTERY SURGERY The undergoing of bypass grafting or endarterectomy to one carotid artery to correct narrowing in the vessel. Angioplasty and/or stenting, carotid artery surgery CEREBRAL MALARIA A confirmed diagnosis of cerebral malaria resulting in admission to an ICU for more than 72 hours, with evidence of parasitaemia. Coma lasting more than 6 hours with either o epileptic seizures, or o permanently impaired neuro-cognitive functioning Cerebral malaria, related dementia (including Alzheimer's disease), related coma, related stroke, related paralysis, related status epilepticus, related acquired mental retardation, related activities of daily living, related loss of hearing, related loss of sight, related loss of speech, related terminal illness. CHRONIC KIDNEY FAILURE The diagnosis of chronic renal failure despite adequate medical treatment by a nephrologist or urologist. Chronic renal disease with an estimated Glomerular Filtration Rate (GFR) 40ml/min, or Chronic renal disease with creatinine clearance of 55ml/min, with clinically significant progressive renal function decline as confirmed by 3 renal function (creatinine clearance) measurements in a 12 month period Kidney transplant, chronic kidney failure, related coma, related cardiomyopathy, Wegener s granulomatosis, related activities of daily living, related terminal illness CONNECTIVE TISSUE DISEASE A definite diagnosis of a connective tissue disorder by a consultant rheumatologist, confirmed by serological markers. The disease is unresponsive or poorly responsive despite adequate treatment with disease modifying drugs, including biologics and surgical intervention, resulting in an inability to perform 2 of the activities of daily living and 2 of the instrumental activities of daily living. All clinical signs and measurement of impairments should be supported by special investigations including pathology. Or,

6 CONNECTIVE TISSUE DISEASE definite diagnosis of either Giant cell arteritis or Polyarteritis nodosa by a consultant rheumatologist, confirmed by serological markers, with failed response to disease-modifying regimens, including biologic disease-modifying anti-rheumatic drugs for a minimal period of 6 months. Connective tissue disease, chronic kidney failure, systemic lupus erythematosis, advanced rheumatoid arthritis, scleroderma, Wegener's granulomatosis, related terminal illness LIFE THREATENING ARRHYTHMIA Life threatening arrhythmia with insertion of a defibrillator. Life threatening arrhythmia with insertion of a defibrillator resulting in either of the following devices being surgically implanted: implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy with defibrillator (CRT-D). Insertion of a pacemaker Life threatening arrhythmia, pacemaker or defibrillator insertion, heart attack, cardiomyopathy, heart transplant, heart valve replacement or repair, heart surgery, pathway ablation, related terminal illness. LOSS OF SIGHT The diagnosis of visual impairment by an ophthalmologist. Bilateral visual impairment of 50%, with evidence of one of the following: a reading of at least 20/125 (or equivalent measure) in each eye, or diabetic retinopathy grade III/grade III retinopathy of a chronic disease, or a visual field loss to a 20 radius, or enucleation of the eye Loss of sight, related terminal illness MAJOR BURNS The diagnosis of external third degree burns by a plastic surgeon or trauma specialist. At least 10% of total body surface affected, or 30% loss of surface area of the face which for the purposes of this definition includes the forehead and ears. Related major burns, related less extensive burns, related activities of daily living, related terminal illness. PNEUMONECTOMY The undergoing of surgery on the advice of a consultant medical specialist to remove more than one lobe of lung due to any physical injury or disease. Pneumonectomy, lung transplant, lobectomy, chronic respiratory failure, cardiomyopathy, related cancer, related terminal illness.

7 PULMONARY ARTERIAL HYPERTENSION The diagnosis of pulmonary hypertension by a medical specialist. Raised systolic pulmonary artery pressure, complicated by at least one of the following: right-sided heart failure, or marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (New York Heart Association Class III). Pulmonary arterial hypertension, cardiomyopathy, heart surgery, life threatening arrhythmia, chronic respiratory failure, pulmonary artery surgery, related terminal illness.