Invasive cancer

A malignant tumour confirmed histologically, characterised by the uncontrolled growth of malignant cells and invasion of tissue (including leukaemia, sarcoma and lymphoma). A claim is valid when the malignant cancer invades and destroys adjacent tissue.

Not covered:

• pre-malignant, in-situ, borderline-malignancy or low-malignant-potential tumours;
• prostate tumours below Gleason 7 (without progression to at least cT2bN0M0 / pT2N0M0);
• low-grade neuroendocrine and gastro-intestinal stromal tumours (GIST) without lymph node involvement/metastases;
• melanoma confined to the epidermis and non-melanoma skin cancers confined to the skin (unless metastasised).

Cardiomyopathy - of specified severity

A definite diagnosis by a cardiologist, confirmed by echocardiography, resulting in at least one of: a left ventricular ejection fraction (LVEF) below 40% (twice on MRI at least 3 months apart), marked limitation of activity (NYHA class III/IV for at least 6 months), or the implantation of a cardioverter-defibrillator (ICD).

Not covered:

• other forms of heart disease, heart enlargement and myocarditis.

Heart attack - of specified severity

A definite diagnosis of acute myocardial infarction with death of heart tissue, confirmed by new characteristic ECG changes or new diagnostic imaging changes and a characteristic rise of cardiac enzymes or troponins.

Not covered:

• myocardial injury without infarction;
• angina without myocardial infarction.

Heart failure - of specified severity

A definite diagnosis by a cardiologist with permanent impairment of heart function: a permanent loss of the ability to exercise to at least NYHA class 3 and a permanent, irreversible ejection fraction of 39% or less.

Heart and vascular surgeries - as specified

Undergoing, on the advice of a cardiologist, one of: coronary artery bypass grafts, heart valve replacement or repair, structural heart surgery via sternotomy or thoracotomy, aorta graft surgery (with excision and graft replacement), pulmonary artery graft surgery, or cardiac arrest resulting in loss of consciousness and the implantation of an ICD/CRT-D.

Not covered:

• surgery to the branches of the aorta, the insertion of stents, balloon angioplasty, laser treatment or endovascular repair.

Pulmonary arterial hypertension - of specified severity

Pulmonary arterial hypertension of unknown cause resulting in all of: raised pulmonary artery pressure, right ventricular dysfunction and breathlessness.

Not covered:

• pulmonary hypertension with an established cause and other types of hypertension.

Benign tumour of the brain or spinal cord

A non-malignant tumour or cyst of the brain, spinal cord, cranial/spinal nerves or meninges, resulting in: a permanent neurological deficit with persisting symptoms, invasive surgery to remove the tumour, or stereotactic radiosurgery/chemotherapy to destroy tumour cells.

Not covered:

• pituitary tumours, tumours of bone tissue, angioma and cholesteatoma, granulomas, haematomas, abscesses, disc protrusions and osteophytes.

Brain injury due to trauma or reduced oxygen supply

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

Not covered:

• cases resulting from premature birth (before 37 weeks).

Coma

A state of unconsciousness with no reaction to external stimuli or internal needs, requiring life support for a period of 96 hours.

Not covered:

• a medically induced coma.

Dementia including Alzheimer's disease - of specified severity

A definite diagnosis by a geriatrician, neurologist, neuropsychologist or psychiatrist, supported by neuropsychometric testing among others, with permanent cognitive dysfunction and progressive deterioration in the ability to remember, reason, and perceive and express ideas.

Not covered:

• Mild Cognitive Impairment (MCI).

Intensive care cover - 10 days of ventilation

Sickness or injury requiring continuous mechanical ventilation by tracheal intubation for 10 consecutive days (24 hours a day) or more in an intensive care unit in a UK hospital.

Not covered:

• the consequences of self-inflicted harm and of premature birth (before 37 weeks).

Motor Neurone Disease (MND)

A definite diagnosis by a neurologist of one of the motor neurone diseases (ALS, PLS, PBP, PMA, Kennedy's disease/SBMA, SMA) with permanent impairment of motor function.

Multiple Sclerosis (MS)

A definite diagnosis by a neurologist, with clinical impairment of motor or sensory function and positive MRI findings.

Neurological deficit caused by specific conditions

A definite diagnosis by a neurologist of one of: bacterial meningitis, Creutzfeldt-Jakob disease (CJD), encephalitis or neuromyelitis optica (Devic's disease), resulting in a permanent neurological deficit with persisting symptoms.

Not covered:

• other forms of meningitis, including viral meningitis.

Paralysis of limb - total and irreversible

Total and irreversible loss of muscle function of a whole limb, due to accident or illness; the disability must be permanent.

Parkinson's disease - with permanent symptoms

A definite diagnosis by a neurologist, with permanent impairment of motor function with associated tremor or muscle rigidity.

Not covered:

• Parkinsonian syndromes / Parkinsonism.

Parkinson Plus syndromes - with permanent symptoms

A definite diagnosis by a neurologist of one of the syndromes (multiple system atrophy, progressive supranuclear palsy, parkinsonism-dementia-ALS complex, corticobasal degeneration, diffuse Lewy body disease) with at least one of: permanent motor impairment, a permanent eye movement disorder or permanent postural instability.

Stroke of the brain or spinal cord

Death of brain or spinal cord tissue due to inadequate blood supply or haemorrhage, resulting in a neurological deficit with symptoms lasting at least 24 hours and definite evidence of tissue death or haemorrhage on imaging.

Not covered:

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

Systemic Lupus Erythematosus (SLE) - of specified severity

A definite diagnosis by a rheumatologist resulting in: a permanent neurological deficit with persisting symptoms, or permanent impairment of kidney function with a GFR below 30 ml/min.

Total Permanent Disability (TPD)

An optional extra. Under the "own occupation" definition: the loss of the physical or mental ability to carry out the essential duties of your own occupation ever again. Under the "work tasks" definition: the loss of the ability to perform at least 3 of 6 tasks (walking, climbing stairs, lifting, bending, getting in and out of a car, writing). The disability must be permanent and irreversible.

Not covered:

• partial or temporary disability;
• TPD is not included in children's cover.

Aplastic anaemia - with permanent bone marrow failure

A definite diagnosis by a haematologist, resulting in permanent and irreversible bone marrow failure and requiring treatment with at least one of: blood transfusions, marrow-stimulating agents, immunosuppressive drugs or a bone marrow transplant.

Not covered:

• other forms of anaemia.

Kidney failure - requiring permanent dialysis

Chronic end-stage failure of both kidneys, as a result of which permanent regular dialysis or a transplant is required.

Liver failure - at an advanced stage

A definite diagnosis by a doctor of irreversible end-stage liver failure due to cirrhosis, resulting in all of: permanent jaundice, ascites and encephalopathy.

Not covered:

• liver disease secondary to self-inflicted harm.

Major organ transplant - from another donor

Being the recipient of a transplant from another donor of: bone marrow, a complete heart, kidney, liver, lung or pancreas, or a whole lobe of the lung or liver - or placement on an official NHS waiting list for such a procedure.

Not covered:

• transplants of other organs, parts of organs, tissues or cells;
• being an organ donor.

Respiratory failure - at an advanced stage

Advanced emphysema or another chronic lung disease diagnosed by a respiratory physician, resulting in: the need for continuous daily oxygen therapy and permanent impairment of lung function tests (FVC and FEV1 below 50% of normal).

Third degree burns - of specified extent

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

Blindness - permanent and irreversible

Permanent and irreversible loss of sight, even with visual aids, to the level of: acuity of 3/60 or worse in the better eye, or 6/60 or worse in the better eye with a loss of visual field (a central field of no more than 20 degrees).

Not covered:

• temporary blindness.

Deafness - permanent and irreversible

Permanent and irreversible loss of hearing greater than 70 decibels across all frequencies in the better ear (pure tone audiogram) - you can only hear sounds louder than 70 dB, even with hearing aids.

Loss of hand or foot - permanent physical severance

Permanent physical severance of a hand or foot at or above the wrist or ankle joint, with no possibility of surgical reattachment.

Loss of speech - permanent and irreversible

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

Not covered:

• temporary loss of speech or loss of speech of psychological origin.

Carcinoma in situ - with surgery

A diagnosis of carcinoma in situ confirmed histologically, with malignant cells confined to the epithelium of the organ, treated with surgery to remove the tumour.

Not covered:

• any skin cancer (including melanoma);
• tumours treated with radiotherapy, laser, cryotherapy, cone biopsy, LLETZ or diathermy;
• carcinoma in situ of the urinary bladder and other separately listed conditions.

Carcinoma in situ of the urinary bladder

A diagnosis of carcinoma in situ of the urinary bladder, confirmed histologically and by a consultant.

Not covered:

• non-invasive papillary carcinoma, stage Ta bladder cancer and other forms of non-invasive cancer.

Gastrointestinal stromal tumour (GIST) - low risk, with surgery

A GIST without lymph node involvement or metastases, classified as no/low risk of progression (AFIP/Miettinen-Lasota) or stage I (UICC/TNM8), treated with surgery to remove the tumour.

Neuroendocrine tumour (NET) - low grade, with surgery

A NET without lymph node involvement or metastases, classified as WHO grade 1, treated with surgery to remove the tumour.

Low grade prostate cancer - requiring treatment

Treatment, on the advice of a consultant, following a diagnosis of a malignant prostate tumour with a Gleason score of 6 and progression to TNM classification T1c or T2a.

Not covered:

• prostatic intraepithelial neoplasia (PIN);
• observation/surveillance without treatment;
• surgical biopsy.

Ovarian tumour of borderline malignancy - with specified surgery

A diagnosis of an ovarian tumour of borderline malignancy / low malignant potential, confirmed histologically, resulting in the surgical removal of an ovary.

Not covered:

• removal of an ovary due to a cyst.

Pituitary tumour - permanent symptoms or surgery

A diagnosis of a non-malignant pituitary tumour resulting in a permanent neurological deficit with persisting symptoms or the surgical removal of the tumour.

Not covered:

• tumours treated with radiotherapy;
• cases without symptoms under ongoing drug treatment.

Heart and vascular surgeries - as specified

Undergoing, on the advice of a cardiologist or vascular surgeon, one of: angioplasty to at least two main coronary arteries (stenosis of 70% or more, or FFR below 0.8), endovascular repair of a thoracic/abdominal aortic aneurysm with a graft, the insertion of a permanent pacemaker for heartbeat abnormalities, bypass graft surgery to the arteries of the legs for peripheral vascular disease, or endarterectomy/angioplasty of a carotid artery (stenosis of 70% or more).

Infective bacterial endocarditis

A definite diagnosis of infective bacterial endocarditis by a cardiologist.

Cerebral or spinal aneurysm or arteriovenous malformation - with specified treatment

An aneurysm or arteriovenous malformation of the brain or spinal cord resulting in one of: craniotomy, stereotactic radiosurgery or endovascular treatment using coils (coiling).

Central retinal artery or vein occlusion - with permanent visual loss

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

Not covered:

• branch retinal occlusion or haemorrhage;
• traumatic injury to the optic nerve or retina.

Cerebral palsy - with permanent symptoms

A definite diagnosis of cerebral palsy by a paediatrician, resulting in a permanent neurological deficit with persisting symptoms.

Cystic fibrosis

A definite diagnosis of cystic fibrosis by the attending consultant.

Hydrocephalus - with shunt insertion

A definite diagnosis of hydrocephalus by a paediatrician, treated with the insertion of a shunt.

Muscular dystrophy

A definite diagnosis of muscular dystrophy by a neurologist.

Spina bifida - myelomeningocele or rachischisis

A definite diagnosis by a paediatrician of spina bifida of the myelomeningocele or rachischisis type (the most severe forms, with protrusion of the spinal cord).

Not covered:

• spina bifida occulta;
• spina bifida with meningocele.