Cancer

A definite diagnosis by a UK Oncologist of a malignant cancer with histological confirmation - every malignant cancer.

Covered as an additional payout instead of a full payout:

• low-grade prostate cancer (Gleason 2-6, up to T2aN0M0) - a full payout on progression to Gleason 7+;
• carcinoma in situ with surgery; ovarian tumour of borderline malignancy; non-melanoma skin cancer without spread; pituitary tumours treated with surgery or radiotherapy; benign testicular tumour with orchidectomy.

Gastro-intestinal stromal tumour (GIST)

A definite diagnosis by a UK Oncologist of a gastro-intestinal stromal tumour with histological confirmation.

Neuroendocrine tumours

A definite diagnosis by a UK Oncologist of a neuroendocrine tumour with histological confirmation.

Not covered:

• pituitary neuroendocrine tumours.

Benign brain tumour

A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in surgery (or placement on the NHS waiting list), radiotherapy, chemotherapy, or permanent neurological deficit with persisting clinical symptoms.

Covered as an additional payout instead of a full payout:

• pituitary tumours.

Benign spinal cord tumour

A definite diagnosis by a UK Consultant of a non-malignant tumour or cyst originating from the spinal cord, spinal nerves or meninges.

Heart attack

Death of heart muscle, due to inadequate blood supply, that has resulted in a definite diagnosis of a new myocardial infarction by a UK Cardiologist - with no severity threshold.

Cardiac arrest

A sudden loss of heart function with interruption of blood circulation and unconsciousness, resulting in the implantation (or placement on the NHS waiting list for implantation) of an implantable cardioverter defibrillator (ICD) or a CRT-D device.

Cardiomyopathy

A definite diagnosis by a UK Consultant Cardiologist resulting in: a left ventricular ejection fraction below 40% (measured twice, at least 3 months apart), marked limitation of physical activity at NYHA Class III for at least 6 months, or implantation of an ICD.

Not covered:

• all other forms of heart disease, heart enlargement and myocarditis; cardiomyopathy secondary to alcohol or drug abuse.

Heart failure

A definite diagnosis by a UK Consultant Cardiologist: permanent and irreversible limitation of function to at least NYHA Class III, and a permanent and irreversible ejection fraction of 39% or less.

Heart valve replacement or repair

Surgery to replace or repair one or more heart valves - payable on placement on the NHS waiting list.

Coronary artery bypass grafts

Surgery to correct a narrowing or blockage of one or more coronary arteries with a bypass graft - payable on placement on the NHS waiting list.

Open-heart or structural heart surgery

Heart surgery requiring median sternotomy or thoracotomy, on the advice of a UK Consultant Cardiologist - also payable on placement on the NHS waiting list.

Not covered:

• any percutaneous, transluminal or investigative procedure.

Aorta graft surgery

Surgery for disease or trauma of the aorta requiring surgical replacement with a graft - payable on placement on the NHS waiting list.

Pulmonary artery surgery

Surgery to excise and replace the diseased pulmonary artery with a graft, on the advice of a UK Consultant Cardiologist - also payable on placement on the NHS waiting list.

Pulmonary hypertension

A definite diagnosis of pulmonary hypertension that has caused permanent and irreversible impairment of heart function of at least NYHA Class III.

Peripheral vascular disease

A definite diagnosis with objective imaging evidence of obstruction in the arteries, resulting in bypass graft surgery to the arteries of the legs (or placement on the NHS waiting list).

Not covered:

• angioplasty (covered as an additional payout).

Stroke

A definite diagnosis by a UK Neurologist of a stroke with clinical symptoms that have lasted at least 24 hours - no matter how severe.

Not covered:

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

Spinal stroke

Death of spinal cord tissue due to inadequate blood supply or haemorrhage within the spinal column, resulting in permanent neurological deficit with persisting clinical symptoms.

Traumatic brain injury

Death of brain tissue due to traumatic injury, with subsequent neurological symptoms and a corresponding neuroimaging abnormality.

Bacterial meningitis

A definite diagnosis by a UK Consultant Physician, supported by cerebrospinal fluid changes consistent with bacterial meningitis - with no requirement for permanent symptoms.

Encephalitis

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

Coma

A state of unconsciousness with no reaction to external stimuli or internal needs which requires the use of life support systems.

Not covered:

• coma secondary to alcohol or drug abuse.

Creutzfeldt-Jakob disease

A definite diagnosis by a UK Consultant Neurologist of Creutzfeldt-Jakob disease - the diagnosis alone is enough to pay out.

Dementia including Alzheimer's

A definite diagnosis (by a UK Consultant Neurologist, Geriatrician, Neuropsychologist or Psychiatrist), supported by evidence such as neuropsychometric testing, with permanent cognitive dysfunction and progressive deterioration in the ability to remember, reason, and perceive, understand, express and give effect to ideas.

Not covered:

• mild cognitive impairment.

Parkinson's disease

A definite diagnosis by a UK Consultant Neurologist, with permanent clinical impairment of motor function including an associated tremor or muscle rigidity.

Parkinson-plus syndromes

A diagnosis of one of 5 syndromes (including multiple system atrophy, progressive supranuclear palsy, diffuse Lewy body disease), with permanent clinical impairment of motor function, an eye movement disorder, or dementia.

Motor neurone disease (and specified diseases)

A diagnosis by a UK Consultant Neurologist of one of 6 diseases (including amyotrophic lateral sclerosis, Kennedy's disease, spinal muscular atrophy), with permanent clinical impairment of motor function.

Multiple sclerosis

A definite diagnosis by a UK Consultant Neurologist; there must have been clinical impairment of motor or sensory function - symptoms don't need to be present at the point of claim, and no MRI evidence is needed.

Neuromyelitis optica (Devic's disease)

A definite diagnosis by a UK Consultant Neurologist, with clinical impairment of motor or sensory function having occurred.

Drug resistant epilepsy

Epilepsy that can't be controlled by oral medication, resulting in invasive surgery to brain tissue (including the insertion of electrodes for deep brain stimulation) or the implantation of a vagus nerve stimulator.

Cauda equina syndrome

A definite diagnosis of compression of the lumbosacral nerve roots, resulting in permanent bladder dysfunction and permanent weakness and loss of sensation of the legs.

Kidney failure

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

Liver failure

End-stage liver failure resulting in permanent jaundice, ascites and encephalopathy.

Not covered:

• liver disease secondary to alcohol or drug abuse.

Respiratory failure

Confirmation by a UK Consultant Physician of severe lung disease, evidenced by the need for continuous daily oxygen therapy on a permanent basis.

Interstitial lung disease

A definite diagnosis by a UK Consultant Respiratory Physician, with radiological evidence of pulmonary fibrosis and a permanent, irreversible DLCO below 40% of predicted.

Pneumonectomy

Surgery to remove a complete lung due to disease or injury - also payable on placement on the NHS waiting list.

Covered as an additional payout instead of a full payout:

• removal of a lobe of the lungs (lobectomy).

Major organ transplant

Undergoing, as a recipient, a transplant of bone marrow, haematopoietic stem cells (after total bone marrow ablation), a complete heart, kidney, liver, lung or pancreas, or a lobe of liver or lung - or their replacement with an artificial device. Payable on placement on the NHS waiting list.

Crohn's disease

A definite diagnosis by a UK Consultant Gastroenterologist. There must have been at least one surgical intestinal resection.

Ulcerative colitis

A definite diagnosis by a UK Consultant Gastroenterologist. There must have been at least one surgical intestinal resection.

Total colectomy

Surgery to remove the whole of the colon, creating a permanent ileostomy - also payable on placement on the NHS waiting list.

Removal of urinary bladder

The undergoing of surgery to remove the urinary bladder due to injury or disease (total cystectomy).

Aplastic anaemia

A definite diagnosis by a UK Consultant Haematologist, with permanent bone marrow failure (anaemia, neutropenia and thrombocytopenia).

Human immunodeficiency virus (HIV)

Infection by HIV resulting from a blood transfusion given as part of medical treatment, a physical assault, or an accident during the normal duties of employment - with the required incident reports and tests.

Not covered:

• HIV infection from any other means, including sexual activity or drug abuse.

Intensive care benefit

Any sickness or injury requiring continuous mechanical ventilation by tracheal intubation for 7 consecutive days (24 hours a day) or more in an intensive care unit in a UK hospital.

Not covered:

• sickness or injury as a result of drug or alcohol misuse.

Necrotising fasciitis

A definite diagnosis of necrotising fasciitis or gas gangrene, requiring removal of necrotic tissue and intravenous antibiotic treatment.

Chronic severe rheumatoid arthritis

A definite diagnosis by a UK Consultant Rheumatologist, evidenced by widespread joint destruction with major clinical deformity, resulting in the permanent inability to perform at least 3 of 8 activities of daily living.

Systemic lupus erythematosus

A definite diagnosis by a UK Consultant Rheumatologist resulting in permanent neurological deficit with persisting clinical symptoms, or permanent impairment of kidney function (GFR below 30 ml/min).

Blindness

Permanent and irreversible loss of sight: best corrected visual acuity of 6/60 or worse in the better eye (Snellen), or a loss of peripheral visual field with a central visual field of no more than 20 degrees in total.

Deafness

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 speech

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

Loss of hand or foot

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

Paralysis of limb

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

Surgical removal of an eye ball

Surgical removal of a complete eyeball as a result of injury or disease.

Not covered:

• self-inflicted injuries.

Third degree burns

Burns involving damage or destruction of the skin to its full depth through to the underlying tissue, covering at least 10% of the body's surface area or 20% loss of surface area of the face (including the forehead and ears).

Total permanent disability (TPD)

Permanent inability to do your own occupation ever again, permanent loss of the ability to perform 3 of 8 activities of daily living, mental incapacity, or a specified severe mental illness (including schizophrenia and bipolar affective disorder) meeting the conditions in the terms.

Not covered:

• disabilities without a clear diagnosis and prognosis; mental illness caused or exacerbated by alcohol or drug abuse.

Angioplasty

Balloon angioplasty or stent insertion to correct a lesion shown to produce ischaemia, on the advice of a UK Consultant Cardiologist - also payable on placement on the NHS waiting list.

Brain abscess

The surgical drainage of an intracerebral abscess within the brain tissue by a UK Consultant Neurosurgeon.

Carcinoma in situ

A positive diagnosis of any carcinoma in situ, with histological confirmation and surgery to remove the tumour. Payable more than once - for carcinoma in situ found at different organs.

Not covered:

• carcinoma in situ of the skin; tumours treated with radiotherapy, cryotherapy, conisation and similar.

Carcinoma in situ of the breast

A positive diagnosis of carcinoma in situ of the breast, with histological confirmation and surgery to remove the tumour.

Carotid artery stenosis

Undergoing endarterectomy or angioplasty (with or without stent) to treat symptomatic stenosis of at least 50% diameter narrowing of the carotid artery, supported by angiographic evidence.

Central retinal artery or vein occlusion

Death of optic nerve or retinal tissue due to inadequate blood supply or haemorrhage, resulting in permanent visual impairment of the affected eye.

Not covered:

• branch retinal artery or vein occlusion or haemorrhage.

Cerebral aneurysm

Treatment of a cerebral aneurysm using craniotomy, stereotactic radiotherapy or endovascular embolisation, on the advice of a UK Neurosurgeon.

Cerebral arteriovenous malformation

The undergoing of surgery, embolisation or radiosurgery to treat an arteriovenous malformation of the brain.

Connective tissue disorder

A definite diagnosis of one of 8 conditions (including giant cell arteritis, polyarteritis nodosa, polymyositis, rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis) resulting in the permanent inability to perform at least 1 of 8 activities of daily living.

Endovascular procedure

Any endovascular procedure to widen one or more narrowed or obstructed arteries with 50% or more stenosis (including any angioplasty procedures), on the advice of a UK Consultant Cardiologist.

Lobectomy

Surgery to remove one or more lobes of the lung due to disease or trauma - also payable on placement on the NHS waiting list.

Low-grade prostate cancer

A malignant tumour of the prostate histologically classified as Gleason 2-6 and progressed to clinical classification T1N0M0-T2aN0M0. On progression to Gleason 7+ or T2bN0M0 - a full payout.

Non-melanoma skin cancer

High-risk (tumour larger than 20 mm, thickness of at least 6 mm, invasion into subcutaneous tissue or nerves): 50% of cover. Low-risk (spread beyond the epidermal layer, up to 20 mm): 10% of cover, max £50,000.

Not covered:

• carcinoma in situ of the skin (including Bowen's disease).

Ovarian tumour of borderline malignancy

An ovarian tumour of borderline malignancy / low malignant potential that has resulted in the surgical removal of an ovary.

Not covered:

• removal of an ovary due to a cyst.

Pituitary tumour

A tumour in the pituitary gland resulting in surgical removal of the tumour, or the use of radiotherapy to destroy tumour cells.

Serious Accident Cover

Any accident resulting in continuous hospitalisation for more than 28 consecutive days (24 hours a day).

Significant visual impairment

Permanent and irreversible loss of sight in the better eye: acuity of up to 6/24 with moderate contraction of the field (or aphakia / opacities), or 6/18 or better with a gross defect of visual fields of both eyes.

Spinal aneurysm

Treatment of a spinal aneurysm using surgical resection, wrapping, clipping or embolisation, on the advice of a UK Neurosurgeon.

Spinal arteriovenous malformation

Treatment of a spinal arteriovenous malformation using surgical resection or removal, endovascular embolisation, stereotactic radiosurgery or radiation therapy.

Syringomyelia or syringobulbia

The undergoing of surgery to treat a syrinx in the spinal cord or brain stem.

Testicular cancer of low grade

The undergoing of an orchidectomy (removal of a testicle) following diagnosis of intra-tubular germ cell neoplasia unclassified or a benign testicular tumour.

Third degree burns (5%)

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.

Type 1 insulin-dependent diabetes mellitus

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

Not covered:

• gestational diabetes; Type 2 diabetes (including Type 2 diabetes treated with insulin).