Cancer - excluding less advanced cases

Any malignant tumour positively diagnosed with histological confirmation (tissue testing) and characterised by the uncontrolled growth of malignant cells and invasion of tissue.

The term malignant tumour includes:

• leukaemia,
• sarcoma and lymphoma, except those arising in and confined to the skin (including cutaneous lymphomas and sarcomas),
• pseudomyxoma peritonei,
• Merkel cell cancer.

• all cancers histologically classified as: pre-malignant, non-invasive, cancer in situ, of borderline malignancy, or of low malignant potential,
• all prostate tumours, unless histologically classified with a Gleason score of 7 or above, or having progressed to at least clinical TNM classification cT2bN0M0 or pT2N0M0 following a prostatectomy (removal of the prostate),
• neuroendocrine tumours without lymph node involvement or distant metastases, unless classified as WHO grade 2 or above,
• gastro-intestinal stromal tumours (GIST) without lymph node involvement or metastases, unless classified under AFIP/Miettinen and Lasota as of moderate or high risk of progression, or as stage II or above under UICC/TNM8,
• all urothelial tumours, unless histologically classified as having progressed to at least T1N0M0,
• malignant melanoma of skin confined to the epidermis (the outer layer of skin),
• any non-melanoma cancer arising in or confined to the layers of the skin (epidermis, dermis, subcutaneous tissue), including cutaneous lymphomas and sarcomas, unless it has spread to lymph nodes or distant organs.

Less advanced cancer of the breast - with surgical removal

A histologically confirmed diagnosis of cancer in situ, or a neuroendocrine tumour (NET) of low malignant potential, within the breast, with surgery to remove the tumour.

Less advanced cancer of the prostate - of specified severity and treatment

Prostate tumours histologically classified with a Gleason score between 2 and 6 inclusive, provided the tumour has progressed to a clinical TNM classification between T1N0M0 and T2aN0M0 and has been treated with one of the following:

• external beam radiotherapy or interstitial implant radiotherapy,
• cryotherapy,
• hormone therapy,
• high-intensity focused ultrasound (HIFU).

• prostate cancers treated by any method other than those listed above, or managed by active surveillance or watchful waiting alone.

Less advanced cancer of the larynx - with specified treatment

A histologically confirmed diagnosis of carcinoma in situ of the larynx treated by surgery, laser or radiotherapy.

Less advanced cancer of the ovary - with surgical removal

A histologically confirmed diagnosis of an ovarian tumour of borderline malignancy or low malignant potential that has resulted in the surgical removal of an ovary.

• removal of an ovary due to a cyst.

Less advanced cancer of the renal pelvis or ureter - of specified severity

A histologically confirmed diagnosis of carcinoma in situ of the renal pelvis or ureter.

• non-invasive papillary carcinoma,
• tumours with a TNM classification of stage Ta.

Less advanced cancer of the testicle - with specified surgery

A histologically confirmed diagnosis of intra-tubular germ cell neoplasia unclassified (ITGCNU) or a benign testicular tumour, resulting in an orchidectomy (removal of a testicle).

Less advanced cancer of the urinary bladder - of specified severity

A histologically confirmed diagnosis of carcinoma in situ of the urinary bladder.

• non-invasive papillary carcinoma,
• bladder cancer with a TNM classification of stage Ta.

Less advanced cancer in situ - with surgery

Cancer in situ diagnosed histologically, characterised by the uncontrolled growth of malignant cells confined to the epithelial linings of organs, treated by surgery to remove the tumour.

• any skin cancer (including melanoma),
• tumours treated by radiotherapy, laser therapy, cryotherapy, cone biopsy, large loop excision of the transformation zone (LLETZ), diathermy or topical treatment.

Under this definition you can claim more than once, provided the cancer in situ is at a different site from any previous claim and isn't covered by any of the named-site less advanced cancer definitions.

Less advanced gastro-intestinal stromal tumour (GIST) or neuroendocrine tumour (NET) - with surgery

Treated by surgery:

• neuroendocrine tumours of WHO grade 1 or below, or
• gastro-intestinal stromal tumours classified under AFIP/Miettinen and Lasota as of very low or low risk of progression, or as stage I under UICC/TNM8.

• tumours treated by radiotherapy, laser therapy, cryotherapy, diathermy or topical treatment.

Skin cancer (not including melanoma)

Non-melanoma skin cancer, histologically confirmed, where the tumour is more than 2 centimetres across and has at least one of the following features:

• a tumour thickness of at least 4 millimetres,
• invasion into nerves in the skin (perineural invasion),
• poorly differentiated or undifferentiated cells (cells that appear very abnormal under a microscope), or
• recurrence despite previous treatment.

Bacterial meningitis - with permanent symptoms

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

• all other forms of meningitis, including viral meningitis.

Benign brain tumour - with permanent symptoms or specified treatment

A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in any of the following:

• permanent neurological deficit with persisting clinical symptoms, or
• undergoing invasive surgery to remove part or all of the tumour, or
• undergoing stereotactic radiosurgery or chemotherapy to destroy tumour cells.

• tumours in the pituitary gland,
• angiomas.

Brain injury due to trauma, anoxia or hypoxia - with specified symptoms

Death of brain tissue due to trauma or a reduced supply of oxygen (anoxia or hypoxia), resulting in permanent neurological deficit with persisting clinical symptoms.

Coma - with associated permanent symptoms

A state of unconsciousness with no reaction to external stimuli or internal needs which: requires the use of life support systems, and results in an associated permanent neurological deficit with persisting clinical symptoms.

Creutzfeldt-Jakob disease

A definite diagnosis of Creutzfeldt-Jakob disease made by a Consultant Neurologist.

Dementia - of specified severity (including Alzheimer's disease)

A definite diagnosis of dementia, including Alzheimer's disease, by a Consultant Geriatrician, Neurologist, Neuropsychologist or Psychiatrist, supported by evidence including neuropsychometric testing. There must be permanent cognitive dysfunction with progressive deterioration in the ability to: remember; reason; and perceive, understand, express and give effect to ideas.

• mild cognitive impairment (MCI).

Encephalitis - with permanent symptoms

A definite diagnosis of encephalitis by a Consultant Neurologist, resulting in permanent neurological deficit with persisting clinical symptoms.

Motor neurone disease - with permanent symptoms

A definite diagnosis by a Consultant Neurologist of one of the following motor neurone diseases: amyotrophic lateral sclerosis (ALS); Kennedy's disease; primary lateral sclerosis (PLS); progressive bulbar palsy (PBP); progressive muscular atrophy (PMA); spinal muscular atrophy (SMA). There must also be permanent clinical impairment of motor function.

Multiple sclerosis - where there have been symptoms

A definite diagnosis of multiple sclerosis by a Consultant Neurologist. There must have been clinical impairment of motor or sensory function caused by multiple sclerosis.

Paralysis of a limb - total and irreversible

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

Parkinson's disease - with permanent symptoms

A definite diagnosis of Parkinson's disease by a Consultant Neurologist or Geriatrician. There must be permanent clinical impairment of motor function with associated tremor or muscle rigidity.

• Parkinsonian syndromes,
• Parkinsonism.

Stroke or spinal cord stroke

Death of brain or spinal cord tissue due to inadequate blood supply or haemorrhage within the skull or spine, resulting in: permanent neurological deficit with persisting clinical symptoms; or definite evidence of death of tissue or haemorrhage on a brain or spinal scan, together with neurological deficit with persisting clinical symptoms lasting at least 24 hours.

• transient ischaemic attacks (TIA),
• death of tissue of the optic nerve or retina / eye stroke.

Benign spinal cord tumour - with permanent symptoms or specified treatment

A non-malignant tumour or cyst in the spinal cord, spinal nerves or meninges, resulting in any of the following: permanent neurological deficit with persisting symptoms; or invasive surgery to remove part or all of the tumour; or stereotactic radiosurgery or chemotherapy to destroy tumour cells.

• granulomas, haematomas, abscesses, disc protrusions and osteophytes.

Brain abscess - with specified treatment

A definite diagnosis of an intracerebral abscess by a Consultant Neurologist, resulting in: surgical removal, or surgical drainage of the abscess.

Intensive care - requiring mechanical ventilation for 10 consecutive days

Any sickness or injury resulting in the need for continuous mechanical ventilation by tracheal intubation for at least 10 consecutive days (24 hours a day) in an intensive care unit in a UK hospital.

Neuromyelitis optica (Devic's disease) - where there have been symptoms

A definite diagnosis of neuromyelitis optica or neuromyelitis optica spectrum disorder (Devic's disease) by a Consultant Neurologist. There must have been clinical impairment of motor or sensory function caused by the condition.

Parkinson's plus syndromes - with permanent symptoms

A definite diagnosis by a Consultant Neurologist or Geriatrician of one of the following Parkinson's plus syndromes: multiple system atrophy; progressive supranuclear palsy; parkinsonism-dementia-ALS complex; diffuse Lewy body disease; corticobasal degeneration. There must also be permanent clinical impairment of at least one of: motor function; eye movement disorder; postural stability; or dementia.

• other Parkinsonian syndromes,
• Parkinsonism.

Syringomyelia or syringobulbia - requiring surgery

Undergoing surgery to treat a syrinx in the spinal cord or brain stem. An advance payment of the cover amount is made if you're placed on an NHS waiting list for this surgical treatment.

Cauda equina syndrome - with permanent symptoms

Compression of the lumbosacral nerve roots (cauda equina) resulting in all of the following: permanent bladder dysfunction; and permanent weakness and loss of sensation in the legs. The diagnosis must be supported by appropriate neurological evidence.

Cerebral or spinal aneurysm - with specified surgery

Undergoing one of the following procedures: surgical correction via craniotomy (opening the skull) or embolisation treatment using coils or other materials to treat a cerebral aneurysm; or surgical resection, wrapping, clipping or embolisation of a spinal aneurysm.

Cerebral or spinal arteriovenous malformation - with specified surgery

Undergoing one of the following procedures: surgical correction via craniotomy or endovascular treatment using coils or other materials to treat a cerebral arteriovenous malformation; or surgical correction or embolisation of a spinal arteriovenous malformation.

Drug resistant epilepsy - with specified surgery

Undergoing invasive surgery to brain tissue to control epilepsy that cannot be controlled with oral medication.

• deep brain stimulation.

Non-malignant pituitary adenoma - with specified treatment

A non-malignant pituitary tumour requiring radiotherapy or surgical removal.

• non-malignant pituitary tumours treated by any other method.

Aorta graft surgery

Undergoing surgery to the aorta with excision and surgical replacement of a portion of the affected aorta with a graft. The term aorta includes the thoracic and abdominal aorta, but not its branches.

• any other surgical procedures, e.g. the insertion of stents or endovascular repair.

An advance payment of the cover amount is made if you're placed on an NHS waiting list for this surgical treatment.

Cardiac arrest - with defibrillator insertion

A sudden loss of heart function with interruption of blood circulation around the body, resulting in unconsciousness and the surgical implantation of one of the following devices: an implantable cardioverter defibrillator (ICD); or cardiac resynchronisation therapy with a defibrillator (CRT-D).

Coronary artery bypass graft

Undergoing surgery, on the advice of a Consultant Cardiologist, to correct a narrowing or blockage of one or more coronary arteries with bypass grafts. An advance payment is made if you're placed on an NHS waiting list for this treatment.

Heart attack

A definite diagnosis of an acute myocardial infarction with death of heart muscle, evidenced by all of the following: new characteristic electrocardiographic changes or new diagnostic imaging changes; and a characteristic rise of cardiac enzymes or troponins. The evidence must show a definite acute myocardial infarction.

• angina without myocardial infarction,
• heart muscle damage without infarction.

Heart valve replacement or repair

Undergoing surgery, on the advice of a Consultant Cardiologist, to replace or repair one or more heart valves. An advance payment is made if you're placed on an NHS waiting list for this treatment.

Primary cardiomyopathy - of specified severity or with specified treatment

A definite diagnosis of primary cardiomyopathy by a Consultant Cardiologist. The condition must result in at least one of the following: a left ventricular ejection fraction (LVEF) below 40%, measured twice at an interval of at least 3 months by MRI; marked limitation of physical activity, where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain (NYHA Class III or IV) over a period of at least 6 months; implantation of a cardioverter defibrillator (ICD) on the advice of a Cardiologist for the prevention of sudden cardiac death.

• any secondary cardiomyopathy,
• all other forms of heart disease, heart enlargement and myocarditis.

Pulmonary arterial hypertension - of specified cause and severity

A definite diagnosis by a Consultant Cardiologist or Respiratory Physician of either: idiopathic pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. All of the following must be present: a systolic pulmonary artery pressure (PAP) above 50 mmHg for more than a year; permanent and irreversible dilatation and hypertrophy of the right ventricle, on echocardiogram and ECG.

Pulmonary artery surgery

Undergoing surgery requiring median sternotomy (division of the breastbone) or thoracotomy, on the advice of a Consultant Cardiologist, for: excision and replacement of the diseased pulmonary artery with a graft; or pulmonary endarterectomy. An advance payment is made if you're placed on an NHS waiting list.

Structural heart surgery

Undergoing heart surgery requiring median sternotomy or thoracotomy, on the advice of a Consultant Cardiologist, to correct a structural abnormality of the heart. An advance payment is made if you're placed on an NHS waiting list.

Heart failure - of specified severity

A definite diagnosis by a Consultant Cardiologist of failure of the heart to function as a pump, evidenced by all of the following: permanent and irreversible limitation of function to at least NYHA Class III (heart disease with marked limitation of activity, where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain); a permanent and irreversible ejection fraction of 39% or less.

Peripheral vascular disease - requiring bypass graft surgery

A definite diagnosis of peripheral vascular disease by a Consultant Cardiologist or Vascular Surgeon, with objective imaging evidence of obstruction in the arteries requiring bypass graft surgery to the arteries of the legs.

• angioplasty.

An advance payment is made if you're placed on an NHS waiting list.

Aortic aneurysm - with endovascular repair

Undergoing endovascular repair of an aneurysm of the thoracic or abdominal aorta using a graft (stent graft).

• procedures on any branches of the thoracic or abdominal aorta.

Carotid artery stenosis - with surgical repair

Undergoing endarterectomy or angioplasty with or without stent, on the advice of a Consultant, to treat severe symptomatic stenosis of the carotid artery. The procedure must relate to a narrowing of at least 50% of the diameter, confirmed by angiographic evidence.

Central retinal artery or vein occlusion - with permanent visual damage

Death of optic nerve or retinal tissue due to inadequate blood supply or haemorrhage within the central retinal artery or vein, resulting in permanent visual damage to the affected eye.

• branch retinal artery or vein occlusion or haemorrhage,
• traumatic damage to optic nerve or retinal tissue.

Coronary angioplasty - with specified treatment

Percutaneous coronary intervention (PCI) to correct a narrowing or blockage of the left main stem coronary artery, or of two or more main coronary arteries. Multiple vessels must be treated at the same time or as part of a planned, staged procedure within 60 days of the first PCI. The main coronary arteries are: the right coronary artery, the left anterior descending artery, the circumflex artery, or their branches. PCI means any intra-arterial catheter-based treatment, including balloon angioplasty or stenting.

• diagnostic angioplasty,
• two angioplasty procedures on one main artery or its branches.

Kidney failure - requiring permanent dialysis

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

Liver failure

Chronic liver disease amounting to end-stage liver failure due to cirrhosis, resulting in all of the following: permanent jaundice; ascites; encephalopathy.

Major organ transplant

Undergoing, as a recipient, a transplant of: bone marrow; or haematopoietic stem cells preceded by total bone marrow ablation; or a complete heart, kidney, liver, lung or pancreas from another donor; or a whole lobe of the lung or liver from another donor; or inclusion on an official UK waiting list for such a procedure.

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

Respiratory failure - of specified severity

Confirmation by a Consultant of severe lung disease with permanent impairment of lung function, evidenced by all of the following: the need for daily oxygen therapy for at least 15 hours a day for a minimum of six months; a forced expiratory volume in one second (FEV1) below 50% of normal; a forced vital capacity (FVC) below 50% of normal.

Third degree burns - of specified severity

Burns involving damage or destruction of the skin to its full depth, through to the underlying tissue, covering at least 20% of the body's surface area, or at least 20% of the surface area of the face or head.

Crohn's disease - treated with two resections or a colectomy

A definite diagnosis of Crohn's disease by a Consultant Gastroenterologist, resulting in: surgical intestinal resection (removal of part of the small or large intestine) on at least two separate occasions; or a total colectomy (removal of the entire large intestine).

Interstitial lung disease - of specified severity

A definite diagnosis of interstitial lung disease by a Consultant Respiratory Physician, resulting in all of the following: radiological evidence of pulmonary fibrosis; a permanent and irreversible DLCO (diffusing capacity of the lung for carbon monoxide) below 40% of predicted.

Necrotising fasciitis

A definite diagnosis of necrotising fasciitis or gas gangrene by a Consultant, requiring surgery to remove the necrotic tissue and intravenous antibiotic treatment.

• all other forms of gangrene or cellulitis.

Pneumonectomy (removal of a complete lung)

Undergoing surgery, on the advice of a Consultant, to remove an entire lung due to disease or injury.

• other lung surgery, including removal of a lobe of the lung (lobectomy) or lung resection.

An advance payment is made if you're placed on an NHS waiting list.

Ulcerative colitis - with total colectomy

A definite diagnosis of ulcerative colitis by a Consultant Gastroenterologist, treated with a total colectomy (removal of the entire large intestine). An advance payment is made if you're placed on an NHS waiting list.

Crohn's disease - treated with one intestinal resection

A definite diagnosis of Crohn's disease by a Consultant Gastroenterologist, treated with a surgical intestinal resection.

Removal of one or more lobe(s) of the lung

Undergoing surgery to remove one or more lobes of the lung due to disease or injury, on the advice of a Consultant.

Third degree burns - at least 5% of the body or 10% of the face/head

Burns involving damage or destruction of the skin to its full depth, through to the underlying tissue, covering at least 5% of the body's surface area, or at least 10% of the surface area of the face or head.

Aplastic anaemia - with 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.

Systemic lupus erythematosus - of specified severity

A definite diagnosis of systemic lupus erythematosus by a Consultant Rheumatologist, resulting in one of the following: permanent neurological deficit with persisting symptoms; or permanent impairment of kidney function with a glomerular filtration rate (GFR) below 30 ml/min.

Rheumatoid arthritis - of specified severity

Severe chronic rheumatoid arthritis with widespread destruction and deformity of at least three major joint groups, resulting in the inability to perform three of the following: bending or kneeling to pick up an object from the floor; using the hands or fingers to pick up or manipulate small objects (cutlery, a pen); lifting or carrying an everyday object (e.g. a kettle); walking 200 metres on flat ground, with or without a stick, without severe discomfort.

Aplastic anaemia - of specified severity

A definite diagnosis of aplastic anaemia by a Consultant Haematologist. There must be bone marrow hypocellularity confirmed by biopsy, with at least two of the following: an absolute neutrophil count (ANC) below 0.5 x 10^9/L; a platelet count below 20 x 10^9/L; haemoglobin (Hb) below 100 g/L (below 10 g/dL).

• other types of anaemia.

Diabetes mellitus type 1

A definite diagnosis of type 1 diabetes mellitus, requiring the permanent use of insulin injections.

• gestational diabetes,
• type 2 diabetes (including type 2 diabetes treated with insulin).

Guillain-Barre syndrome - with persisting symptoms

A definite diagnosis of Guillain-Barre syndrome by a Consultant Neurologist. There must be clinical impairment of motor or sensory function which has persisted continuously for at least six months.

Blindness - permanent and irreversible

Permanent and irreversible loss of sight to the extent that, even with the use of visual aids, visual acuity in the better eye is 6/60 or worse (Snellen chart), or the visual field is reduced to 20 degrees of arc or less, as confirmed by an ophthalmologist.

Deafness - permanent and irreversible

Permanent and irreversible loss of hearing to the extent that the quietest sound that can be heard in the better ear is 70 decibels across all frequencies (pure tone audiogram).

Loss of hand or foot - permanent physical severance

Permanent physical severance of a hand or foot at or above the wrist or ankle joint.

Significant visual loss - permanent and irreversible

Permanent and irreversible loss of sight to the extent that, even with the use of visual aids, visual acuity in the better eye is 6/24 or worse (Snellen chart), or the visual field is reduced to 45 degrees of arc or less, as confirmed by an ophthalmologist.

Psychosis and bipolar affective disorder - of specified severity

A definite diagnosis by a Consultant Psychiatrist of one of: bipolar affective disorder; delusional disorder; schizoaffective disorder; or schizophrenia. The diagnosis must result in at least three of the following within one year:

• being under the care of a psychiatrist, psychiatric nurse, community mental health team or an approved social worker,
• chronic symptoms lasting at least a year, or requiring continuous therapy or medication,
• admission to a psychiatric ward for at least 14 consecutive nights, or continuous home care from a crisis intervention team for 14 consecutive days (at least 2 visits a day),
• an order being made by the Court of Protection under the Mental Capacity Act.

• delirium without a psychiatric basis,
• conditions caused or exacerbated by alcohol or drug abuse.

Terminal illness - where death is expected within 12 months

A definite diagnosis by the attending Consultant of an illness that satisfies both of the following: it either has no known cure or has progressed to the point where it cannot be cured; and, in the opinion of the attending Consultant, it is expected to lead to death within 12 months. Terminal illness is not included in the children's cover.