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CRITICAL ILLNESS COVER.

YOUR POLICY DOCUMENT FROM LEGAL & GENERAL

CIC 11-15

CRITICAL ILLNESS COVER2

CONTENTS.CRITICAL ILLNESS COVER POLICY 3

1. PREMIUMS 4

1 Payment of premiums 2 Calculation of premiums 3 Change in unit rate or premium rates

2. CRITICAL ILLNESS BENEFIT 5

1 Eligibility 2 Amount of insurance 3 Payment of insurance

3. EXCLUSIONS 7

1 Pre-existing conditions exclusion 2 Related conditions exclusion 3 Other exclusions

4. INSURED CONDITIONS 9

1 Core conditions 2 Additional conditions

5. RELATED CONDITIONS 14

1 Related conditions for core conditions 2 Related conditions for additional conditions

6. COMMENCEMENT AND TERMINATION OF INSURANCE AND 17 RELATED PROVISIONS

1 Commencement of insurance 2 Termination of insurance 3 Temporary absence from employment 4 Parental leave 5 Financial crime risk management 6 Total discontinuance 7 Partial discontinuance 8 Overseas cover

7. GENERAL CONDITIONS 19

1 Provision of information and evidence 2 Provision of insurance and policy changes

8. EVIDENCE OF HEALTH AND INSURABILITY 21

1 Introduction 2 Providing medical evidence 3 Full medical evidence 4 Eligible entrants 5 Early entrants 6 Late entrants 7 Increases in respect of insured persons 8 Temporary accident cover

9. DEFINITIONS 23

CRITICAL ILLNESS COVER 3

This policy granted by Legal & General Assurance Society Limited, whose main office for the purpose of this policy is at Legal & General House, Kingswood, Tadworth, Surrey KT20 6EU, witnesses as follows:

1. This policy together with the schedule and any revised schedules, policy terms or endorsements made to the policy, form the contract under which this policy is issued. Any overriding terms shown in the schedule will take precedence over any other terms.

2. Any revised policy terms and schedules will apply from the effective date of the revised schedule. Any policy terms and schedules superseded by later policy terms and schedules will no longer apply from the effective date of the revised schedule.

3. Where appropriate, words in the singular include the plural and vice versa and words referring to males include females. The insured conditions appearing in bold are defined in Part 4 of the policy. All other words appearing in bold are defined in Part 9.

4. We will pay to you on trust, the benefit shown in the schedule when it becomes due, subject to the terms of the policy.

5. All payments made to or by us under this policy will be in UK sterling at our main office shown above.6. Our liability to you is set out in this policy. The terms of this policy will prevail in the event of any conflict

with any benefits promised under the scheme.7. The receipt of benefit by you or anyone to whom benefit may become payable under this policy will

discharge us from any further liability for that benefit. We do not need to see the application of such benefit.

8. The benefit provided and eligibility terms under this policy may be changed at your request subject to acceptance by us and to the terms that we set.

9. Reference to any Act of Parliament shall include any statutory modification or re-enactment of any statutory regulations made for the time being in force.

10. This policy will be governed by and subject to the laws of England and all communication in relation to this policy will be in English.

11. It is agreed and confirmed by the parties to this contract that none of its terms shall be enforceable by virtue of section 1 of the Contracts (Rights of Third Parties) Act 1999 by any person who is not a party to the contract and as a consequence the parties shall have no obligations to any such person in relation to the variation or rescission of the contract or otherwise.

CRITICAL ILLNESS COVER


1 Payment of Premiums You will pay all premiums (including any portion of premiums for an employer included in this policy) to us at the frequency and on dates agreed between you and us.If you do not pay all premiums under this policy by the due date, or within a period thereafter that we allow, we reserve the right by giving you at least 14 days written notice to end the insurance under this policy on expiry of such period of notice. All outstanding premiums due to the end date shall become payable immediately.If you do not pay a premium which is due under this policy during an accounting period, then we will not have any liability to pay benefit with respect to an insured person who is diagnosed with an insured condition during that accounting period.If you wish to stop paying future premiums under this policy you must give us written notice prior to the date from which you want payment of premiums to stop. The insurance under this policy shall end on that date.

2 Calculation of PremiumsWe will calculate premiums using the accounting method and this will apply from the inception date. If, for any later accounting period, we need to change the accounting method, this will take effect from the first day of the next accounting period subject to us giving you at least 30 days’ notice in writing expiring on that date.If we have not calculated the total members’ benefit as at the first day of any accounting period to allow us to notify you of the premium for that accounting period before that date, we may first calculate an approximate premium for payment. Following subsequent calculation of the premium, if the approximate premium for any accounting period proves to be:i. too large, we will refund the excess to you, orii. too small, we will notify you of the shortfall and the requirements for payment.

3 Change in Unit Rate or Premium RatesWe can change the unit rate or premium rates with effect from any annual renewal date provided it does not fall within a guarantee period. Any change will be effective from that date regardless of there being any delay by you in complying with our requirements in Part 6, Section 1.We can change the unit rate with effect from any annual renewal date if the number of insured members or the total members’ benefit at such annual renewal date differs by more than 25 per cent from the number of insured members or the total members’ benefit over all the policies on which the unit rate was calculated.

PREMIUMS1


1 Eligibilitya) An employee of the employers, an equity partner, and a LLP member will be included in this policy as an

insured member, subject to any overriding provisions and providing the following conditions are met:i. he is normally resident and working in the United Kingdom; and ii. he satisfies all the eligibility terms for a category; andiii. he is included in this policy as an eligible entrant or late entrant on the entry date, or as an early

entrant; andiv. he meets the evidence of health and insurability terms in Part 8 of this policy; andv. you have provided all the information requested by us.

b) In respect of an insured member whose eligibility for this policy is subject to him being a member of the employer’s retirement benefits arrangement:i. Unless we have agreed with you otherwise, we will regard his retirement benefits arrangement

membership as continuous if he crystallises some or all of his benefit from the arrangement, and applies to immediately restart contributions to a retirement benefits arrangement.

ii. Unless we have agreed with you otherwise, we will regard his retirement benefits arrangement membership as continuous if he stops regular contributions and keeps an entitlement to retirement benefits under that arrangement.

iii. If he subsequently withdraws from membership for those benefits, he will immediately cease to be an insured member.

c) A person who does not satisfy the eligibility terms may, at your discretion and subject to our prior agreement and terms, be included as an insured member.

d) Where there is more than one category, the category terms that apply to an insured member are those for which he has met the eligibility terms for that category. An insured member cannot be included in more than one category.

e) If an insured member becomes eligible for a different category, transfer to that category will take effect immediately.

f) If an insured member defers his retirement beyond the benefit termination date, any extension of cover provided under this policy will be shown in the schedule.

2 Amount of InsuranceSubject to the terms of this policy:a) For each insured member, insurance will be put in place under the policy equal to the member’s benefit in

respect of him from time to time. b) In respect of each child, insurance will be put in place under the policy equal to the children’s benefit in

respect of him from time to time. This insurance will start from the date:i. the insured member is accepted for cover under this policy if he has a child at that date; orii. a child first fulfils the definition of a child

c) In respect of each spouse and civil partner, insurance will be put in place under the policy equal to the spouse’s or civil partner’s benefit in respect of him from time to time, but only if the schedule shows this benefit is covered. If covered, this insurance will start from the date:i. the insured member is accepted for cover under this policy if he is already married or has a registered

civil partnership at that date, or ii. the insured member marries or registers a civil partnership.

d) We will restrict member’s benefit so it does not exceed the lesser of:i. £500,000, or such other amount agreed between you and us; orii. five times scheme earnings; or iii. such other amount agreed between you and us.

e) We will restrict spouse’s or civil partner’s benefit so it does not exceed £250,000, or such other amount agreed between you and us

3 Payment of Insurancea) The schedule shows if an insured person is covered for:

i. core conditions only, orii. core conditions and additional conditions excluding total and permanent disability, oriii. core conditions and additional conditions including total and permanent disability. It will also confirm

the total and permanent disability definition covered.

2 CRITICAL ILLNESS BENEFIT


We will not cover an insured person for terminal illness if they aren’t also covered for total and permanent disability.

Any differences from the cover above will be shown in overriding provisions. Both core conditions and additional conditions are listed and defined in Part 4. b) If, before termination of the insurance in respect of him as described in Part 6, Section 2, an insured person

fulfils the requirements applicable to one of the insured conditions, the benefit in respect of him shall become payable at the end of the survival period, subject to the terms of this policy.

c) Benefit will be worked out at the earliest of:i. the date a diagnosis is made in respect of an insured condition which refers to a diagnosis within its

definition, ii. the date confirmation is given in respect of an insured condition which refers to confirmation being

required within its definition,iii. the date the insured person undergoes a procedure referred to in the definition of an insured condition,iv. the start of any duration period specified in the insured condition, andv. the date of the incident giving rise to the insured condition.

d) We will pay benefit as a lump sum to you on trust to hold for the insured member. However, if you are subject to an effective winding up resolution, or cease to carry on business, we can pay benefit direct to the insured member.

e) We will not pay benefit if an exclusion applies to the cover. Exclusions are shown in Part 3 of the policy.


1 Pre-Existing Conditions Exclusiona) In respect of an insured person, we will not pay benefit for any insured condition:

i. that he has already met the definition of before the day he was included for cover under the scheme.ii. for which he is in the insured condition’s qualifying period when he is included for cover under

the scheme. Qualifying periods, where applicable, are shown in the insured condition definition. For example, as part of the qualification for multiple sclerosis specified symptoms must persist for 6 months.

iii. for which the scheme has already paid benefit in respect of him.b) For the purpose of Part 3 Section 1 (a). We will consider the following to be the same condition:

• angioplasty

• aorta graft surgery

• balloon valvuloplasty

• cardiomyopathy

• coronary artery by-pass grafts

• a heart attack

• heart surgery • undergoing a complete heart transplant as a recipient (with reference to major organ transplant)• the inclusion on an official United Kingdom, Channel Islands or the Isle of Man transplant waiting list to

receive a complete heart (with reference to major organ transplant)• heart valve replacement or repair

• pulmonary artery surgery

• a stroke

c) For the purpose of Part 3 Section 1 (a) (above). Where the insured person has suffered from any malignant tumours defined as cancer, we will not pay benefit for any subsequent cancer. For this purpose the subsequent cancer doesn’t have to be connected to, or associated with, the earlier diagnosis of cancer.

d) For the purpose of Part 3, Section 1 (a) (above). We will consider the following to be the same condition:• kidney failure

• undergoing a complete kidney transplant as a recipient (with reference to major organ transplant) • the inclusion on an official United Kingdom, Channel Islands or the Isle of Man transplant waiting list to

receive a complete kidney (with reference to major organ transplant)e) For the purpose of Part 3, Section 1 (a) (above). We will consider the following to be the same condition:

• liver failure

• undergoing a complete liver, or a lobe of liver, transplant as a recipient (with reference to major organ transplant)

• the inclusion on an official United Kingdom, Channel Islands or the Isle of Man transplant waiting list to receive a complete liver or lobe of liver (with reference to major organ transplant)

f) For the purpose of Part 3, Section 1 (a) (above). We will consider the following to be the same condition:• respiratory failure

• undergoing a complete lung transplant as a recipient (with reference to major organ transplant) • the inclusion on an official United Kingdom, Channel Islands or the Isle of Man transplant waiting list to

receive a complete lung (with reference to major organ transplant)g) For the conditions named in this Section 1 (g):

i. We will not pay benefit for the following conditions if the disablement or illness started before cover for the insured person started under the scheme:• loss of independent existence (including muscular dystrophy)• terminal illness

• total and permanent disability

ii. For the conditions loss of independent existence (including muscular dystrophy), paralysis of limbs, terminal illness and total and permanent disability we will not pay benefit if:• the insured person has previously at any time, met any of the insured condition definitions, or• a medical adviser chosen by us, believes it has resulted from a condition which the insured person

was known to be suffering from, at or before, the day their cover started under the scheme.

EXCLUSIONS3


h) For the purpose of Part 3 Section 1, as long as a later diagnosis confirms it, we will consider an insured person to have:i. met an insured condition, orii. been in the duration period included within an insured condition definition,

before their cover started under the scheme, whether or not the insured condition had been formally diagnosed.

i) The pre-existing conditions exclusion shown in Part 3, Section 1 will also apply to any increase in benefit under the scheme from the day of the increase. For this purpose:i. references to benefit in the exclusion shall be read as the increase in benefit, andii. references to the day an insured person’s cover started under the scheme shall be read as the day of

the increase.

2 Related Conditions Exclusionsa) We will not pay benefit for any insured condition occurring within two years of an insured person’s cover

starting under the scheme that has resulted from any related condition for which they:i. have received treatment,ii. have, or had, symptoms of,iii. have sought advice on, oriv. were aware of.

For the above, the insured condition may have directly or indirectly resulted from a related condition. The decision as to whether something is a related condition will be based on the opinion of a medical adviser chosen by us. A list of related conditions is shown in Part 5.

b) The related conditions exclusion shown in Part 3, Section 2 will also apply to any increase in benefit under this policy from the day of the increase. For this purpose:i. references to benefit in the exclusion shall be read as the increase in benefit, andii. references to the day an insured person’s cover started under the scheme shall be read as the day of

the increase.

3 Other Exclusions a) We will not pay benefit for the condition terminal illness submitted to us after the death of the insured

person.b) You can claim for more than one insured condition. However, we will only pay one valid claim if more than

one claim arises from a single incident.c) We will not pay benefit for terminal illness where the schedule states there is no cover for total and

permanent disability.d) If we pay benefit in respect of an insured person, we will apply a new pre-existing conditions exclusion

and a related conditions exclusion in respect of later claims. This new pre-existing conditions exclusion and related conditions exclusion will apply to all his benefit, at the date he last met an insured condition.

e) The insured condition definitions shown in Part 4 include circumstances where we will not pay benefit for specific conditions.

f) Part 8, Section 8 shows circumstances where we will not pay benefit when we provide temporary accident cover.

g) The overriding provisions may include further exclusions.


The schedule shows if an insured person is covered for:a) core conditions only, orb) core conditions and additional conditions. Any differences from the cover above will be shown in overriding provisions.

1 Core conditionsAlzheimer’s disease – resulting in permanent symptoms

A definite diagnosis of Alzheimer’s disease by a consultant neurologist, psychiatrist or geriatrician. There must be permanent clinical loss of the ability to do all of the following:i. remember,ii. reason, andiii. perceive, understand, express and give effect to ideas.For the above definition, the following are not covered:i. other types of dementia.

Cancer (including Hodgkin’s disease) – excluding less advanced cases

Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue.The term malignant tumour includes leukaemia, lymphoma and sarcoma, except cutaneous lymphoma (lymphoma confined to the skin).For the above definition, the following are not covered:i. 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.

ii. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2bN0M0.

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

iv. Malignant melanoma unless it has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin).

v. 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.

Coronary artery by-pass grafts – with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts.

Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms

A definite diagnosis of CJD made by a consultant neurologist. There must be permanent clinical loss of the ability in mental and social functioning to the extent that permanent supervision or assistance by a third party is required.

Heart attack – of specified severity

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:i. New characteristic electrocardiographic changes.ii. The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher:

• Troponin T > 1.0 ng/ml.• AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods.

The evidence must show a definite acute myocardial infarction.For the above definition, other acute coronary syndromes including but not limited to angina will not be covered.

INSURED CONDITIONS4


Kidney failure – requiring dialysis

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

Major organ transplant

The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, liver or a lobe of the liver, lung, or pancreas, or inclusion on an official UK, The Channel Islands or The Isle of Man waiting list for such a procedure. For the above definition, transplant of any other organs, parts of organs, tissues or cells, are not covered:

Motor neurone disease – resulting in permanent symptoms

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

Multiple sclerosis – with persisting symptoms

A definite diagnosis of Multiple Sclerosis by a consultant neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

Parkinson’s disease – resulting in permanent symptoms

A definite diagnosis of Parkinson’s disease by a consultant neurologist. There must be permanent clinical impairment of motor function with associated tremor, rigidity of movement and postural instability. For the above definition, other Parkinsonian syndromes are not covered.

Pre-senile Dementia – resulting in permanent symptoms

A definite diagnosis of Dementia by a consultant neurologist, psychiatrist or geriatrician. The diagnosis must be supported by evidence of progressive loss of ability to do all of the following:i. remember,ii. to reason, andiii. to perceive, understand, express and give effect to ideas.For the above definition, the following are not covered:i. Dementia secondary to alcohol or drug abuse.

Stroke – resulting in symptoms lasting at least 24 hours

Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms lasting at least 24 hours.For the above definition, the following are not covered:i. Transient ischaemic attack.ii. Traumatic injury to brain tissue or blood vessels.iii. Death of tissue of the optic nerve or retina / eye stroke.

2 Additional conditions The schedule will also show if total and permanent disability is an insured condition. Where the schedule states there is no cover for total and permanent disability, we will not include terminal illness as an insured condition.

Angioplasty – for disease

The undergoing of balloon angioplasty to correct the narrowing or blockage of two or more arteries, when the insured person has limiting anginal symptoms. Any claim must be supported by the evidence of:i. prior treatment (on appropriate medication) from an appropriate registered medical practitioner holding

such an appointment at a hospital in the European Union, Channel Islands, the Isle of Man, USA, Australia, New Zealand, Japan or Canada, and

ii. significant electrocardiogram changes, and evidence of Angiography showing 70% obstruction of two or more coronary arteries.

Aplastic Anaemia – with permanent bone marrow failure

A definite diagnosis of Aplastic Anaemia by a consultant haematologist. There must be permanent bone marrow failure with anaemia, neutropenia and thrombocytopenia.

Aorta graft surgery – requiring surgical replacement

The undergoing of surgery to the aorta with excision and surgical replacement of a portion of the aorta with a graft. The term aorta includes the thoracic and abdominal aorta but not its branches.For the above definition, the following are not covered:i. Any other surgical procedure, for example the insertion of stents or endovascular repair.


Bacterial meningitis – resulting in permanent neurological deficit

A definite diagnosis of Bacterial Meningitis resulting in permanent neurological deficit with persisting clinical symptoms. For the above definition the following are not included: i. All other forms of meningitis other than those caused by bacterial infection.

Balloon valvuloplasty – to relieve heart valvular abnormalities

The actual insertion on the advice of a consultant cardiologist of a balloon catheter through the orifice of one of the valves of the heart and the inflation of the balloon to relieve valvular abnormalities.

Benign brain tumour – resulting in either surgical removal or permanent symptoms

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:i. Tumours in the pituitary gland.ii. Tumours originating from bone tissue.iii. Angiomas and cholesteatoma.

Blindness – permanent and irreversible

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

Cardiomyopathy – of specified severity

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*.For the above definition, the following are not covered:i. Cardiomyopathy secondary to alcohol or drug abuse.ii. All other forms of heart disease, heart enlargement and myocarditis.* NYHA Class 3. Heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain.

Coma – resulting in permanent symptoms

A state of unconsciousness with no reaction to external stimuli or internal needs which:i. requires the use of life support systems, andii. results in permanent neurological deficit with persisting clinical symptoms.For the above definition, Coma secondary to alcohol or drug abuse is not covered.

Deafness – permanent and irreversible

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

Encephalitis – resulting in permanent neurological deficit

A definite diagnosis of encephalitis by a consultant neurologist resulting in permanent neurological deficit with persisting clinical symptoms.

Heart surgery – with surgery to divide the breastbone

The undergoing of open-heart surgery, on the advice of a consultant cardiologist, to correct valvular and structural abnormalities.

Heart valve replacement or repair – with surgery to divide the breastbone

The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a consultant cardiologist to replace or repair one or more heart valves.

HIV infection – caught in the European Union, Channel Islands, the Isle of Man, USA, Australia, New Zealand, Japan or Canada from a blood transfusion, a physical assault or at work in an ‘eligible occupation’

Infection by Human Immunodeficiency Virus resulting from:i. a blood transfusion given as part of medical treatment,ii. a physical assault, oriii. an incident occurring during the course of performing normal duties of employment (from the ‘eligible

occupations’ listed below), after the start of the policy and satisfying all of the following:


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

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

iii. There must be a further HIV test within 12 months confirming the presence of HIV or antibodies to the virus.iv. The incident causing infection must have occurred in the European Union, the Channel Islands, the Isle of

Man or the USA, Australia, New Zealand, Japan or Canada.For the above definition, the following is not covered:i. HIV infection resulting from any other means, including sexual activity or drug abuse.The ‘eligible occupations’ for HIV caught at work are:i. The emergency services – police, fire, ambulance.ii. The medical profession – including administrators, cleaners, dentists, doctors, nurses and porters.iii. The armed forces.

Liver failure – of advanced stage

Liver failure due to cirrhosis and resulting in all of the following: permanent jaundice; ascites; encephalopathy. For the above definition the following is not covered: i. Liver disease secondary to alcohol or drugs.

Loss of hands or feet – permanent physical severance

Permanent physical severance of any combination of two or more hands or feet at or above the wrist or ankle joints.

Loss of independent existence (including muscular dystrophy) – permanent and irreversible

The permanent inability to perform without the assistance of another person three or more of the following activities of daily living as confirmed by an appropriate consultant physician:Washing The ability to wash in the bath or shower (including getting into or out of the bath or shower)

or wash satisfactorily by other means.Dressing The ability to put on, take off, secure and unfasten all garments and, as appropriate, any

braces, artificial limbs or other surgical appliances.Feeding The ability to feed oneself once food has been prepared and made available.Toileting The ability to use the lavatory or otherwise manage bowel and bladder functions so as to

maintain a satisfactory level of personal hygiene.Transferring The ability to move from a bed to an upright chair or wheelchair and vice versa.

Loss of speech – permanent and irreversible

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

Paralysis of limbs – total and irreversible

Total and irreversible loss of muscle function to the whole of any two limbs.

Pulmonary artery surgery – to excise and replace with a graft

The actual undergoing of surgery on the advice of a consultant cardiothoracic surgeon for a disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft.

Respiratory failure – of advanced stage

Advanced stage emphysema or other chronic lung disease, resulting in all of the following:i. The need for regular oxygen treatment on a permanent basis.ii. The permanent impairment of lung function tests as follows; Forced Vital Capacity (FVC) and Forced

Expiratory Volume at 1 second (FEV1) being less than 50% of normal.

Rheumatoid arthritis – of specified severity

A definite diagnosis by a consultant rheumatologist of severe rheumatoid arthritis as evidenced by the following:i. morning stiffness of at least one hour’s duration,ii. arthritis of at least three joint groups with some soft tissue swelling or fluid observed by a physician,iii. arthritis involving at least one of the following groups:

• proximal interphalangeal,• metacarpophalangeal, or• wrists,


iv. symmetrical arthritis,v. subcutaneous nodules,vi. positive rheumatoid factor test,vii. radiographic changes typical of rheumatoid arthritis.

Terminal Illness – Before State Pension Age where death is expected within 12 months

A definite diagnosis by the attending consultant of an illness that satisfies both of the following: i. The illness has no known cure or has progressed to the point where it cannot be cured.ii. In the opinion of the attending consultant, the illness is expected to lead to death within 12 months.

Third degree burns – covering 20% of the body’s surface area

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.

Total and permanent disability – before state pension age and of specified severity

If, where insured, a spouse, civil partner or child is not in a gainful occupation immediately before the onset of disability, a claim for total and permanent disability before state pension age will be assessed against either definition (a) or (b) below.For all other insured persons: i. Where the relevant category in the schedule shows total and permanent disability as any occupation,

either definition (a) or (b) below will apply, andii. where the relevant category in the schedule shows total and permanent disability as own occupation,

either definition (a) or (c) below will apply.In all cases, to meet these definitions

• an insured person must be aged less than their state pension age,• the relevant specialists must reasonably expect that the disability will last throughout life with no prospect

of improvement, irrespective of when the cover ends or the insured person expects to retire, and• there must be a clear prognosis by the relevant specialists.

a) Loss of the physical ability through an illness or injury to do at least three of the six work tasks listed below ever again.

The insured person must need the help or supervision of another person and be unable to perform the task on their own, even with the use of special equipment routinely available to help and having taken any appropriate prescribed medication.

The work tasks are: Walking: The ability to walk a distance of 200 metres on a level surface. Bending: The ability to bend or kneel to touch the floor and straighten up again. Getting in and out of a car: The ability to get into a standard saloon car and out again. Lifting: The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before

replacing the object on the table. Writing: The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal

computer keyboard. Climbing: The ability to climb up a flight of 12 stairs and down again, using the handrail if needed.b) Loss of the physical or mental ability through an illness or injury to the extent that the insured person is

unable to do the duties of any occupation at all ever again. The duties are those that are normally required for, and/or form a significant and integral part of the performance of the occupation that cannot reasonably be omitted or modified.

Any occupation means any type of work at all, irrespective of location or availability.c) Loss of the physical or mental ability through an illness or injury to the extent that the insured person is

unable to do the duties of their own occupation ever again. The duties are those that are normally required for, and/or form a significant and integral part of the performance of the insured person’s own occupation that cannot reasonably be omitted or modified.

Own occupation means the insured person’s trade, profession or type of work they do for profit or pay. It is not a specific job with any particular employer and is irrespective of location or availability.

Traumatic head injury – resulting in permanent symptoms

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


The conditions that apply as related conditions under Part 3, Section 2 will include those listed in this Part 5. In addition, a related condition is any condition which we decide on the basis of medical evidence, to have contributed to or increased the likelihood of the occurrence of an insured condition.

1 Related conditions for core conditionsAlzheimer’s disease – resulting in permanent symptoms

Dementia, organic brain disease, circulatory brain disorder, amnesic disorder, aphasia, Parkinson’s disease, epilepsy, depression, psychosis, disease of the central nervous system, memory loss or disorder.

Cancer (including Hodgkin’s disease) – excluding less advanced cases

Polyposis coli, papilloma of the bladder, Crohn’s Disease, abnormal smear test, any carcinoma in situ or Ulcerative Colitis.

Coronary artery by-pass grafts – with surgery to divide the breastbone

Any disease or disorder of the heart, hypertension or any obstructive/occlusive arterial disease, diabetes mellitus, hypercholesterolaemia.

Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms


Heart attack – of specified severity


Kidney failure – requiring dialysis

Hypertension, familial polycystic kidney disease or any chronic renal disease or disorder, diabetes mellitus.

Major organ transplant

Cardiomyopathy, coronary artery disease, cardiac failure, chronic liver disease or failure, leukaemia, pulmonary hypertension, chronic kidney disease, chronic lung disease, diabetes mellitus, chronic pancreatitis, cystic fibrosis.

Motor neurone disease – resulting in permanent symptoms

Progressive muscular atrophy, primary lateral sclerosis, progressive bulbar palsy.

Multiple sclerosis – with persisting symptoms

Any form of neuropathy, encephalopathy, or myelopathy including, but not restricted to the following:abnormal sensation (numbness) of the extremities, trunk or face; weakness or clumsiness of a limb; double vision; partial blindness; ocular palsy; vertigo (dizziness); difficulty of bladder control; optic neuritis; spinal cord lesion; abnormal MRI scan; retrobulbar neuritis.

Parkinson’s disease – resulting in permanent symptoms

Treatment with psychotropic medication, tremor, extra pyramidal disease.

Pre-senile dementia – resulting in permanent symptoms


Stroke – resulting in permanent symptoms

Hypertension, any valvular disorder of the heart, transient ischaemic attacks, intra-cranial aneurysm or any obstructive/occlusive arterial disease, diabetes mellitus.

2 Related conditions for additional conditionsAngioplasty – to treat specific conditions of specified severity,


Aorta graft surgery – requiring surgical replacement,


5 RELATED CONDITIONS


Aplastic anaemia – with permanent bone marrow failure

Fanconi’s anaemia, cancer.

Balloon valvuloplasty – to relieve heart valvular abnormalities


Bacterial meningitis – resulting in permanent neurological deficit

Brain abscess, venous sinus thrombosis, sinusitis, mastoiditis, fungal meningitis, sarcoidosis.

Benign brain tumour – resulting in either surgical removal or permanent symptoms

Neurofibromatosis (Von Recklinghausen’s disease), haemangioma (Von Hippel-Lindau), acoustic neuroma.

Blindness – permanent and irreversible

Glaucoma, pituitary tumour, optic atrophy, papilloedema, retrobulbar neuritis, sarcoidosis, malignant exophthalmos, diabetes mellitus, transient ischaemic attack, stroke, multiple sclerosis, uveitis.

Cardiomyopathy – of specified severity


Coma – resulting in permanent symptoms

Multiple sclerosis, cerebral palsy, any lesion/ growth of the brain or spinal cord, any vascular lesion of the brain, muscular dystrophy, brain abscess, myasthenia gravis, fits or convulsions of unknown origin, a history of attempted suicide, any mental illness.

Deafness – permanent and irreversible

Mastoiditis, otitis media, middle ear infection or tumour, acoustic nerve injury, neurofibromatosis, cholesteatoma.

Encephalitis – resulting in permanent neurological deficit

Brain abscess, leptospirosis, subarachnoid haemorrhage, toxoplasmosis, tuberculosis.

Heart surgery – with surgery to divide the breastbone


Heart valve replacement or repair – with surgery to divide the breastbone


Liver failure – of advanced stage

Gall stones, cystic fibrosis, portal hypertension, primary sclerosing cholangitis, haemochromatosis, alpha 1 antitrypsin deficiency, chronic liver disease, including but not limited to hepatitis B & C, primary sclerosing cholangitis, and portal hypertension.

Loss of hands or feet – permanent physical severance

Vascular disease, bone and soft tissue cancer, congenital deformities of limbs, brachial plexus trauma, diabetes mellitus.

Loss of independent existence (including muscular dystrophy) – permanent and irreversible

Multiple sclerosis, whether a definite or tentative diagnosis, muscular dystrophy, family history of muscular dystrophy, cerebral palsy, or any disease or disorder of the brain, spinal cord or column, diabetes mellitus.

Loss of speech – permanent and irreversible

Transient ischaemic attack, stroke, motor neurone disease, multiple sclerosis, cancer, brain tumour, laryngeal polyps.

Paralysis of limbs – total and irreversible

Multiple sclerosis, whether a definite or tentative diagnosis, muscular dystrophy, family history of muscular dystrophy, cerebral palsy or any disease or disorder of the brain, spinal cord or column, diabetes mellitus.

Pulmonary artery surgery – to excise and replace with a graft

Pulmonary valve stenosis, Fallot’s tetralogy, patent ductus arteriosus, diabetes mellitus.


Respiratory failure – of advanced stage

COAD (chronic obstructive airways disease) / COPD (chronic obstructive pulmonary disease), emphysema, interstitial / infiltrative lung disease, adult respiratory distress syndrome, bronchiectasis.

Rheumatoid arthritis – of specified severity

Inflammatory polyarthropathies.

Total and permanent disability – before state pension age and of specified severity

Multiple sclerosis, whether a definite or tentative diagnosis, muscular dystrophy, family history of muscular dystrophy, cerebral palsy or any disease or disorder of the brain, spinal cord or column, diabetes mellitus.


1 Commencement of InsuranceThe insurance under this policy starts at the inception date and continues until the date notified by you or us in accordance with this policy.

2 Termination of InsuranceRegardless of anything in these policy terms to the contrary the insurance under this policy of an insured person will end:i. immediately in the event of the insured member reaching the benefit termination date, orii. immediately in the event of the insured member no longer being in employment (or being an equity

partner or an LLP member), oriii. immediately if the insured member no longer meets the eligibility terms, oriv. immediately if the insured member is no longer a member of the scheme, orv. immediately on the death of the insured member, orvi. immediately on the death of that insured person, orvii. immediately on the expiry of a period of temporary absence from the insured member’s normal

employment, orviii. immediately, where the insured person who is a child, spouse or civil partner, no longer meets the policy

definition of a child, spouse or civil partner, orix. on the date you tell us to end the policy in accordance with the terms of the policy. x. on the date of expiry of any period of notice to end the policy given by us in accordance with the terms of

the policy.For (ii) above, the transfer of an insured member from employment with one of the employers to employment with another of the employers will not be viewed as termination of his employment.For (v) above, benefit will remain prospectively payable in respect of a child, and where covered a spouse or civil partner, who had met the definition of an insured condition before the insured member’s death but who hadn’t completed the survival period.

3 Temporary Absence from Employmenta) The insurance in respect of an insured member (and where applicable, for their child, spouse or civil

partner) will continue during a temporary absence from active employment provided they remain employed by you.

If the insured member’s cover is a based on a multiple of scheme earnings, we will continue to provide cover based on his current scheme earnings. However, if his scheme earnings are reduced because he is absent from work, cover will continue at the same level as before the first reduction.

b) The insurance in respect of an insured member who is an equity partner or LLP member (and where applicable, for their child, spouse or civil partner) will continue during temporary absence only whilst he remains an equity partner or LLP member.

4 Parental LeaveThe insurance will continue for an insured member during any period in which he or she is away from work on: i. maternity leave, orii. paternity leave, oriii. adoption leave, oriv. shared parental leave, or v. any other similar statutory right and is entitled under any statutory or contractual provision to the benefit under the terms and conditions of his or her employment. The terms of this policy will continue to apply as if the insured member was actively engaged in such employment.

COMMENCEMENT AND TERMINATION OF INSURANCE AND RELATED PROVISIONS

6


5 Financial Crime Risk ManagementWe have the right by giving you written notice to:i. cancel this policy; andii. not pay benefit; and iii. take other reasonable actionin order to comply with laws, regulations, sanctions regimes, international guidance and/or demands from any authorities, relating to Financial Crime Risk Management Activity.

6 Total Discontinuance a) The insurance in respect of all insured persons will end:

i. on the date you tell us to end the policy in accordance with the terms of the policy; orii. on the expiry date of any period of notice given to end the policy in accordance with its terms.

b) Subject to the terms of this policy, benefit will remain prospectively payable in respect of an insured person who met an insured condition definition before the date the policy ends but hadn’t completed the survival period.

c) We will work out the final policy account on the policy’s expiry. Either we will refund any overpayments, or you will immediately pay us any premiums you owe.

If we don’t receive the expiry information we need for the final account within 30 days after the policy expiry date, we will work out the final policy account in accordance with Part 7, Section 2 (h).

7 Partial Discontinuance If payment of premiums under the policy stops in respect of the employees of any employer other than the principal employer the terms of Section 6 of this Part of the policy will apply but only for those insured members who are in the employment of such employer.

8 Overseas CoverIf we have agreed cover for an insured member who is employed or temporarily seconded overseas; and where applicable, for a child, spouse or civil partner who resides overseas:a) The rate for converting his scheme earnings to GBP Pound Sterling will be fixed at the start of each

accounting period for the whole of that accounting period.b) We reserve the right to require the insured person to be examined by a consultant in a country chosen

by us.c) We will only pay costs for medical examinations and evidence overseas required to support the claim up to

a reasonable level in relation to the costs for the same in the United Kingdom.d) All diagnoses and medical reports must be in English. You will pay for translations if medical reports in

English aren’t available.


1 Provision of Information and Evidencea) You will provide us with all data, information and evidence as stated in this policy or as we reasonably

require in connection with this insurance. We will not be liable for any errors or omissions on our part that arise solely from any errors in or

omissions from any data, information or evidence provided by you. Examples include, but are not limited to:

i. We will not pay benefit for a person who is missing from the data we asked for, unless that person became eligible for benefit at a date later than the effective date of such data.

ii. We will not pay benefit for a person included in the data who is not an insured person.iii. We will restrict benefit if the data is understated.iv. We will not pay amounts in excess of the benefit if the data is overstated.

We will not pay any additional amount of benefit claimed by reference to information or evidence requested by us, which was not provided within a reasonable period stated by us.

We will recover from you or, if payment was made directly to any person or persons directed by you, from such person or persons, any overpayment of benefit arising from errors in, or the failure to disclose, data, information or evidence.

b) We have the right to vary the terms and conditions of the policy or give you written notice terminating it with immediate effect if:i. you do not tell us of all persons who become eligible to be included under the policy, in such written

form and times stated by us, or ii. any person who becomes eligible under the policy after the inception date is not included at the first

opportunity.c) Evidence of the age of an insured person, satisfactory to us, will be required before any benefit is paid

under this policy in respect of that insured person. If the date of birth notified to us in respect of that insured person proves to be incorrect, we reserve the right to adjust the amount of benefit payable under this policy in respect of that insured person as we reasonably consider appropriate.

d) You will tell us of a potential claim for HIV infection within the period specified in the definition of this condition.

You will tell us of a potential claim for the condition total and permanent disability within a period of 30 days from the end of three consecutive months of disability.

You will tell us of a potential claim for the condition terminal illness before the insured person’s death and within 30 days of the confirmation required in the definition of the insured condition. We will not pay benefit for the condition terminal illness if you tell us after the insured person’s death.

For all other insured conditions, you will tell us of a potential claim in respect of an insured person within 30 days of: i. the day that a diagnosis is made in respect of an insured condition which refers to diagnosis within

its definition.ii. the day confirmation is given in respect of an insured condition which refers to confirmation being

required within its definition.iii. the day the insured person undergoes a procedure referred to in the definition of an insured condition.

We can ask for whatever evidence we reasonably need to ensure the validity of the claim before we pay any benefit.

We will not pay benefit in respect of an insured condition that you tell us about more than two years after the survival period ends.

e) You shall provide us in respect of each person for whom cover is required, such evidence of his health and insurability as we may at any time reasonably require in accordance with Part 8. Ifi. this evidence is not provided when required by us, or ii. we receive evidence from any source that his health is below the standard acceptable to us for the

purposes of insurance under this policy on normal terms, oriii. evidence from any source discloses any special risk or hazard,

the insurance in respect of him (or the part of the insurance which evidence is required) will be subject to terms, conditions and restrictions (including declinature) that we may state.

GENERAL CONDITIONS7


f) You shall tell us in writing in the event of: i. any of the employers other than the principal employer no longer participating in this policy, or ii. a change in the identity of the principal employer, or iii. an additional employer wishing to participate in this policy after the inception date, or iv. any change in, or addition to, the nature of the business, undertaking or constitution of any of

the employers. We reserve the right to vary the terms and provisions of this policy on the happening of any of the above

events. In respect of (iii) above, the insurance of any benefit will not commence until notification has been given to you by us.

2 Provision of Insurance and Policy Changes a) If the insurance of any person under this policy has at any time been terminated, declined or subject to

special terms, any subsequent insurance or continuation of insurance under this policy in respect of them (whether or not arising on that person fulfilling or having fulfilled the eligibility terms) may be declined or be subject to terms, conditions and restrictions specified by us.

b) We have the right to refuse insurance of, or to impose terms and conditions we consider necessary for, any benefit in excess of such an amount notified by us to you from time to time.

c) Any alteration or addition to the insured basis is subject to terms that we set and will not start until we give you written notification of our acceptance.

d) We can change the terms of this policy (other than the unit rate or premium rates which can be changed in accordance with Part 1, Section 3) as long as we give you at least 30 days’ notice in writing from an annual renewal date that immediately follows a guarantee expiry date.

e) We can immediately amend the terms of this policy or terminate it in the event of an amendment or termination of any associated policy.

f) If you don’t meet the requirements of Part 7, Section 1 in relation to any annual renewal date within 30 days after that date, we can:i. restrict benefit to the last data you gave us, orii. restrict benefit to the levels you last provided data increased by a reasonable amount.

We will give you written notice if we do this. We will remove this benefit restriction if you subsequently meet all the requirements of Part 7, Section 1

before the earlier of the next annual renewal date, and the date the next insured person:• has the first blood test in respect of an HIV Infection claim, or• meets an insured condition definition.

g) We can cancel this policy or change the terms of this policy by giving you 30 days’ written notice if: i. at any time the number of insured members under this policy falls below five, orii. the requirements of Part 7, Section 1 in relation to any annual renewal date are not met within the three

months following that date, oriii. the requirements of Part 7, Section 1 in relation to the inception date are not met within the three months

following that date. In this event, we reserve the right to terminate the policy from the inception date and refund any premium paid after deducting an amount for expenses incurred.

h) If you don’t meet the requirements of Part 7, Section 1 in relation to the policy’s expiry date within 30 days after that date, we can work out the final policy account based on the information you gave us for the previous account. We will not update the final account after it’s sent if you later meet these requirements.

i) We can change the terms of this policy to reflect any levy, charge or imposition made under the Financial Services Compensation Scheme or other statutory or regulatory provision which affects directly or indirectly the insurance under this policy.

j) We can change the terms of this policy or terminate it if there is:i. any change in the law or practice affecting the taxation or operation of Legal & General, our assets or

this policy, or ii. any change in circumstances which, in our opinion, makes it impossible or impracticable to carry out one

or more of the conditions of this policy.


1 IntroductionThis Part of the policy describes when we need details about an employee’s health and hobbies before we can consider cover in respect of them. For the purposes of this section reference to an employee also includes an equity partner and a LLP member.We can ask for details about the health and hobbies of employees in other circumstances and formats that aren’t shown in this Part before we consider cover in respect of them. If we do, we will tell you these additional terms and conditions:i. in the quote you accepted to set up this policy; orii. in a quote you accept to revise the policy. Unless we tell you otherwise, we will not need evidence of the health and insurability of a spouse, civil partner or child.In the event of a conflict, our in force quote terms and conditions relating to the health and hobbies of employees will take precedence over this Part of the policy.

2 Providing medical evidenceYou are the first to know about new employees needing cover and benefit increases. You must identify and tell us about any employees who need to give us details of their health and hobbies.We can ask for details in the form of:i. full medical evidence; orii. a discretionary entrant application for cover form; oriii. another format described in a quote you accept.In respect of (i) and (ii) of this Section 2 of Part 8 of the policy, we can provide temporary accident cover shown in Section 8 of this Part of the policy for a limited period while details of health and hobbies are supplied to us, and we consider full cover. In respect of (i), (ii) and (iii) of this Section 2 of Part 8 of the policy, if you don’t tell us in writing about an employee who needs to give us details of their health and hobbies, we will not cover the member’s benefit to which these requirements relate. We will also use this restricted member’s benefit to work out any children’s benefit and spouse’s or civil partner’s benefit.

3 Full medical evidencea) We will need full medical evidence before we will consider full cover for:

i. member’s benefit above the free limit; andii. member’s benefit where we needed a discretionary entrant application for cover form to consider, but

couldn’t accept because of the answers given on this form; andiii. any member’s benefit the accepted quote describes as being subject to medical evidence or a Member’s

Declaration. In respect of (i) of this Section 3 (a) of Part 8 of the policy, we can change the free limit from time to time

and will tell you in writing if this happens.b) We will assess the full medical evidence and notify you:

i. if we can provide cover for; andii. if we will apply any special terms to;

the benefit for which full medical evidence was supplied.c) If we accept cover for benefit for which full medical evidence was supplied:

i. Any special terms set by us will apply to that member’s benefit. The new special terms will not apply to previously agreed cover.

ii. If any special terms set by us restrict the amount of member’s benefit, we will use the restricted amount of member’s benefit to work out any children’s benefit and spouse’s or civil partner’s benefit.

iii. If you do not agree to any special terms set by us, then you must write to us within 30 days of us setting the special terms to cancel the cover to which the special terms relate.

iv. Unless we tell you otherwise the pre-existing conditions exclusion and related conditions exclusion will no longer apply to the member’s benefit. However the pre-existing conditions exclusion and related conditions exclusion will continue to apply to cover for any children’s benefit and spouse’s or civil partner’s benefit.

EVIDENCE OF HEALTH AND INSURABILITY8


4 Eligible entrantsWe will provide cover in respect of a new eligible entrant up to the free limit. We will apply the pre-existing conditions exclusion and related conditions exclusion to his member’s benefit, and any spouse’s or civil partner’s benefit and children’s benefit.The terms outlined in Section 3 of this Part 8 of the policy will apply to any member’s benefit above the free limit.

5 Early entrantsWe will provide cover in respect of an early entrant up to the free limit if his cover starts on the first day of his employment, or within the following three months.Any other early entrant will need to fill in and return a discretionary entrant application for cover form before we can consider cover in respect of him up to the free limit.In respect of all early entrants, we will apply the pre-existing conditions exclusion and related conditions exclusion to the member’s benefit, and any spouse’s or civil partner’s benefit and children’s benefit.The terms outlined in Section 3 of this Part 8 of the policy will apply to any member’s benefit above the free limit, and cover we cannot accept using a discretionary entrant application for cover form.

6 Late entrantsWhere eligibility for this policy is subject to an employee being a member of your employer’s retirement benefits arrangement, we will provide cover for a late entrant up to the free limit. We will apply the pre-existing conditions exclusion and related conditions exclusion to his member’s benefit, and any spouse’s or civil partner’s benefit and children’s benefit.The terms outlined in Section 3 of this Part 8 of the policy will apply to any member’s benefit above the free limit, and cover we cannot accept using a discretionary entrant application for cover form.

7 Increases in respect of insured personsThe pre-existing conditions exclusion and related conditions exclusion will apply to all increases in member’s benefit, and any spouse’s or civil partner’s benefit and children’s benefit.We will tell you in writing of any additional terms and conditions we will apply in respect of insured members if:i. member’s benefit is above the free limit; orii. special terms apply to any part of the benefit; oriii. cover for any part of the benefit has been subject to full medical evidence.

8 Temporary accident covera) If we have asked for full medical evidence or a discretionary entrant application for cover form to help us

consider full cover, we can provide temporary accident cover in respect of that benefit for up to 90 days starting from the later of:i. the day you need the cover to start; andii. the day we were first aware of the need for medical evidence.

If we have given temporary absence cover for member’s benefit, we will also give temporary accident cover any corresponding children’s benefit and spouse’s or civil partner’s benefit.

We will apply the limits described in Section 8 (b) of this Part 8 of the policy.b) Temporary accident cover limits:

i. We will only consider claims for benefit resulting from an accident that occurs during a period of temporary accident cover.

ii. We will not pay claims caused directly or indirectly in whole or in part by alcoholic intoxication, the influence of narcotics or drugs and medical or surgical treatment (except as made necessary because of the accident).

iii. We will not pay claims caused by, or happening through, attempted suicide or intentional self-injury.iv. We will end the temporary accident cover when we send our decision letter.


Accident

Means an unforeseen and undesigned casualty or mishap caused by violent accidental external and visible means, and is the exclusive and immediate cause of disablement of the insured condition.An accident does not include insured conditions:i. caused directly or indirectly in whole or in part by alcoholic intoxication, the influence of narcotics or

drugs and medical or surgical treatment (except as made necessary because of the accident); orii. caused by, or happening through, attempted suicide or intentional self-injury.

Accounting method

Means the method for calculating premiums due under this policy as specified in the schedule and defined in this Part 9 of the policy.

Accounting period

Means the period starting on the inception date and ending on the day before the first annual renewal date and thereafter any period starting on an annual renewal date and ending on the day before the next annual renewal date.

Additional conditions

Means the conditions shown in Part 4, Section 2 of this policy.Annual renewal date

Means the annual renewal date shown in the schedule.Associated policy

Means any policy associated to this policy as shown in the schedule.Basic annual salary

Means at any date for each insured member the annual rate of his basic pay from the employers. If an insured member is paid on an hourly basis, the annual rate of his basic pay shall be taken as 52 times the weekly rate for the employer’s standard working week which is appropriate to the nature of his employment. Pay in respect of any hours of work in excess of the employer’s standard working week shall be ignored for the purposes of working out the weekly rate.

Benefit

Means member’s benefit, children’s benefit and where covered spouse or civil partner’s benefit.Benefit alteration date

Means the benefit alteration date shown for the relevant category in the schedule.Benefit termination date

Means the benefit termination date shown for the relevant category in the schedule.Category

Means the category terms applicable to an insured member.Category terms

Means the terms shown in the schedule for the relevant category.Child

Means in relation to an insured member at any date any child who is aged not less than 30 days but less than 21 years of age, and who is:i. unmarried,ii. a child of the insured member, oriii. a step child of the insured member by virtue of a marriage or civil partnership entered into by the

insured member who is financially dependent upon the insured member, oriv. legally adopted by the insured member.

Children’s benefit

Means the children’s benefit shown in the schedule for the relevant category.Civil Partner

Means at any date, a person with whom the insured member has registered a Civil Partnership as defined in the Civil Partnerships Act 2004 which has not been dissolved or annulled and who is aged less than 70 years.

Consultant

Means a recognised consulting doctor on the specialist register or holding an appointment in a hospital in the UK, Republic of Ireland or in such other country that we may agree to in any particular case.

DEFINITIONS9


Core conditions

Means the conditions shown in Part 3, Section 1 of this policy.Discretionary entrant application for cover

Means a short form an employee (or equity partner or LLP member) completes that asks questions about their health. We use the details given by the employee (or equity partner or LLP member) to asses if we can give full cover, or if we need full medical evidence before we can consider full cover.

Early entrant

Means an employee (or equity partner or LLP member) you want us to include for cover under the policy before they complete the qualifying service or reach the first entry date.

Effective date

Means the effective date shown in the schedule.Eligible entrant

Means an employee included in accordance with Part 2, Section 1 of this policy at his first entry date.If the eligibility terms are subject to membership of the employer’s retirement benefits arrangement, an eligible entrant will have joined for retirement benefits at their first opportunity.

Eligibility terms

Means the terms set out for the relevant category in the schedule for inclusion as an insured member. This includes the description under the category terms as well as the criteria set out under eligibility terms.

Employer

Means collectively the principal employer and any other employer whose employees have been included for cover under this policy. Inclusion of employers in this policy after the inception date will be subject to our agreement and to such changes to the terms and conditions of this policy that we specify. In respect of any insured member “employer” means one of the employers by which he is employed.

Employment

Means in respect of each insured member being in the employment of the employer or being an equity partner or a LLP member, and within an eligible category of employment for membership of the policy as described in the eligibility terms.

Entry date

Means the entry date as shown for the relevant category in the schedule.Equity partner

Means a partner with an equity share in the partnership that is included as an employer and whose income from the partnership is taxed as trade profits.

Exact cost accounting

Means that premiums payable under this policy for each accounting period will be calculated by us using the member’s benefit and premium rates for each insured member at the first day of such accounting period. The premium calculated will be subject to adjustment to take account of:i. any changes in member’s benefit for each insured member that occur during the accounting period, and ii. any changes in insured members that occur during the accounting period. We will notify you of any extra premium needed or of any refund to be made arising from such adjustment.

Free limit

Means the free limit shown in the schedule, being the maximum amount of cover we will provide to an insured member without the need for medical evidence or details of their hobbies. We will tell you the free limit as a level of member’s benefit or scheme earnings.

Full medical evidence

Means a completed Member’s Declaration form and any other details about an employee’s, equity partner’s or LLP member’s health and hobbies we may subsequently ask for to help us consider full cover. This may include a medical examination and or blood and other tests.

Guarantee expiry date

Means the guarantee expiry date shown in the schedule and any subsequent date we tell you in writing.Guarantee period

Means the period starting on the inception date and ending on the guarantee expiry date and thereafter any period ending on a guarantee expiry date notified to you by us.

Inception date

Means the inception date shown in the schedule.Insured condition

Means an illness, condition or procedure for which the insurance is provided under this policy. The insured conditions covered, subject to any overriding provisions, will be either core conditions only or core conditions and additional conditions as shown in the relevant category in the schedule.


If we insure additional conditions the schedule will also confirm if total and permanent disability is an insured condition and its definition. Where the schedule states there is no cover for total and permanent disability, we will not include terminal illness as an insured condition.

Insured member

Means a member who is accepted for insurance under this policy. Insured Person

Means the insured member, any child and where covered a spouse or civil partner who has been accepted for insurance under this policy.

Irreversible

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

Late entrant

Means, where the eligibility terms are subject to membership of the employer’s retirement benefits arrangement, an employee who joins for retirement benefits after the date they were first eligible to join.

LLP member

Means a member of a Limited Liability Partnership that is included as an employer whose income from the partnership is taxed as trade profits.

Member

Means a person who is included as a member of the scheme in accordance with the eligibility terms.Member’s benefit

Means the member’s benefit shown in the relevant category in the schedule. Monthly change accounting

Means we will work out premiums payable under this policy for each accounting period by multiplying one twelfth of the total member’s benefit at the start of the accounting period and at the beginning of each subsequent month by the unit rate then in force.

No change accounting

Means we will work out premiums payable under this policy for each accounting period by multiplying the total member’s benefit at the first day of such accounting period by the unit rate then in force.

Occupation

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

Overriding provisions

Means those additional provisions which apply to this policy and are set out in the schedule.Partnership earnings

Means the insured member’s average annual income from the employers over the previous three years for which accounts have been produced.

PAYE earnings

Means for each insured member his total earnings from the employer (as taken into account for pay as you earn purposes before the deduction of any contributions to a retirement benefits arrangement) during the year ending on 5 April. If his earnings from the employer for that period of 12 months is lower than it would otherwise have been because he has been temporarily absent or has not been in the employment of the employer for the whole of the 12 months, his PAYE earnings in respect of that period shall be taken as such amount as shall be reasonably estimated by the employer.

Permanent

Means expected to last throughout the insured person’s life with no prospect of improvement, irrespective of when the cover ends or the insured person expects to retire.

Permanent neurological deficit with persisting clinical symptoms

Means dysfunction in the nervous system that is present on clinical examination and expected to last throughout that insured person’s life. This includes numbness, hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty in swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, dementia, delirium and coma. The following are not covered:i. An abnormality seen on the brain or other scans without definite related clinical symptoms,ii. Neurological signs occurring without symptomatic abnormality, for example brisk reflexes without other

symptoms,iii. Symptoms of psychological or psychiatric origin.


Policy

Means this policy and the schedule issued by us, which constitutes the contract between you and us.Pre-existing conditions exclusion

Means the exclusion described in Part 3, Section 1 of this policy. Premium rates

Means at any given date the rates of premium in use by us for calculating premiums under this policy when the accounting method is exact cost accounting.

Principal employer

Means the employer to whom this policy is issued as shown in the schedule.Related conditions

Means the conditions shown in Part 5 of this policy.Related conditions exclusion

Means the exclusion described in Part 3, Section 2 of this policy.Retirement benefits arrangement

Means in respect of an insured member any pension scheme provided by the employers. Schedule

Means the schedule to this policy.Scheme

Means the scheme set up by the principal employer to provide lump sum critical illness benefits for its employees.

Scheme earnings

Means the employee’s earnings as shown in the relevant category in the schedule.Special terms

Means the terms that we offer for cover which we cannot accept at ordinary rates. This will include medical extra premium loadings, exclusions, restrictions, postponements or where cover is declined.

Spouse

Means in relation to an insured member at any date, the wife or husband to whom he or she is married at that date and who is aged less than 70 years.

Spouse’s or civil partner’s benefit

Means the spouse’s or civil partner’s benefit shown in the relevant category in the schedule. Spouse or civil partner’s benefit will not be shown for categories where it is not covered.

State pension age

Means in respect of the insured person the later of:i. his state pension age or state pension date; andii. his 65th birthday.

Survival period means:

a) if the insured condition is total and permanent disability, a period of six months after the diagnosis of that condition,

b) if the insured condition is HIV infection, the period ending with the confirmation of the diagnosis of the condition through the second blood test, or

c) for any other insured condition the survival period shown for the relevant category in the schedule after the:i. date that a diagnosis is made in respect of an insured condition which refers to a diagnosis within its

definition, ii. date confirmation is given in respect of an insured condition which refers to confirmation being

required within its definition,iii. date the insured person undergoes a procedure referred to in the definition of an insured condition,

and at the end of which the insured person is still surviving.Sweep up accounting

Means we will work out premiums payable under this policy for each accounting period by multiplying the total member’s benefit at the first day of the accounting period by the unit rate then in force. The premium calculated will be subject to adjustment to take account of any changes in the amount of the total member’s benefit occurring during the accounting period. We will notify you of any additional premium required or of any refund to be made to you arising from such adjustment.

Temporary absence

Means the insured member’s absence from normal employment for a period of time as shown in the relevant category in the schedule.


Total earnings

Means for each insured member his total earnings from the employer (as taken into account for Pay As You Earn purposes before the deduction of any contributions to a retirement benefits arrangement) during the year ending on the day prior to the last benefit alteration date. If his earnings from the employer for that year is lower than it would otherwise have been because he has been temporarily absent or has not been in the employment of the employer for the whole of that year, his total earnings in respect of that period shall be taken as such amount as shall be reasonably estimated by the employer.

Total members’ benefit

Means the total members’ benefit in respect of all insured members.Unit rate

Means an annual rate of premium for each £100 of total member’s benefit calculated by us to be effective from the inception date or any subsequent date in accordance with the terms of this policy.

We, Us and Our

Means Legal & General Assurance Society Limited.You and Your

Means the principal employer to whom this policy is issued.

Legal & General Assurance Society Limited Registered in England and Wales No. 166055 Registered office: One Coleman Street, London, EC2R 5AA

Legal & General Assurance Society Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

Q0052987 08/16 Terms Vintage CIC 11/15

CONTACT US

www.legalandgeneral.com/workplacebenefits/employers/protection/

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