Aorta graft surgery - for disease and trauma *

The undergoing of, or inclusion on the NHS waiting list for, 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.

Not covered:

• any other surgical procedure, for example, the insertion of stents or endovascular repair.

Cardiac arrest - with insertion of a defibrillator

Sudden loss of heart function with interruption of blood circulation around the body resulting in unconsciousness and either of the following devices being surgically implanted:

• implantable cardioverter-defibrillator (ICD); or
• cardiac resynchronisation therapy with defibrillator (CRT-D)

Cardiomyopathy - of specified severity

A definite diagnosis of cardiomyopathy by a consultant cardiologist. The diagnosis must be supported by echocardiogram. The disease must result in at least one of the following:

• left ventricular ejection fraction (LVEF) of less than 40% measured twice at an interval of at least three months
• marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain (Class III or IV of the New York Heart Association classification) over a period of at least six months
• implantation of a Cardioverter Defibrillator (ICD) on the specific advice of a consultant cardiologist for the prevention of sudden cardiac death.

Not covered:

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

Coronary artery bypass graft *

The undergoing of, or inclusion on the NHS waiting list for, surgery on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with bypass grafts.

Heart attack - of specified severity

A definite diagnosis of acute myocardial infarction with death of heart muscle as evidenced by all of the following:

• the characteristic rise of cardiac enzymes or troponins
• new characteristic electrocardiographic changes or new diagnostic imaging changes. The evidence must show a definite acute myocardial infarction.

Not covered:

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

Heart surgery - with thoracotomy *

The undergoing of, or inclusion on the NHS waiting list for, heart surgery requiring thoracotomy on the advice of a consultant cardiologist to correct a structural abnormality of the heart.

Not covered:

• any percutaneous, transluminal or investigative procedure.

Heart valve replacement or repair *

The undergoing of, or inclusion on the NHS waiting list for, surgery on the advice of a consultant cardiologist to replace or repair one or more heart valve.

Pulmonary artery replacement - with surgery *

The undergoing of, or inclusion on the NHS waiting list for, 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.

Pulmonary hypertension - of specified severity

A definite diagnosis of pulmonary hypertension by a consultant cardiologist or specialist in respiratory medicine. There must be clinical impairment of the heart function resulting in the permanent loss of ability to perform physical activities to at least Class III of the New York Heart Association Classification of functional capacity. For the purposes of this condition, NYHA Class III means:

• a marked limitation of physical activity of the life assured due to symptoms of less than ordinary activity causing fatigue, palpitations, dyspnoea or anginal pain. The life assured is only comfortable at rest.

Benign brain tumour - resulting in permanent symptoms or specified treatment

A non-malignant tumour or cyst originating from 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 either stereotactic radiosurgery or chemotherapy treatment to destroy tumour cells.

Not covered:

• tumours in the pituitary gland
• angiomas and cholesteatoma.

Brain injury - resulting in permanent symptoms

Death of brain tissue due to traumatic injury or reduced oxygen supply (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
• with associated permanent neurological deficit with persisting clinical symptoms

Creutzfeldt-Jakob disease

A definite diagnosis of Creutzfeldt-Jakob disease by a consultant neurologist.

Dementia including Alzheimer’s disease - of specified severity

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 do all of the following:

• remember
• reason and
• perceive, understand, express and give effect to ideas.

Not covered:

• Mild Cognitive Impairment (MCI).

Encephalitis - resulting in permanent symptoms

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

Motor neurone disease and specified diseases of the motor neurones - resulting in permanent symptoms

A definite diagnosis of one of the following motor neurone diseases by a consultant neurologist:

• amyotrophic lateral sclerosis (ALS)
• primary lateral sclerosis (PLS)
• progressive bulbar palsy (PBP)
• progressive muscular atrophy (PMA)
• kennedy’s disease, also known as spinal and bulbar muscular atrophy (SBMA)
• spinal muscular atrophy (SMA). There must also be permanent clinical impairment of motor function.

Multiple sclerosis

A definite diagnosis of Multiple Sclerosis by a consultant neurologist that has resulted in either of the following:

• clinical impairment of motor or sensory function that has persisted from the time of diagnosis; or
• clinical impairment of motor or sensory function that has recovered with evidence on Magnetic Resonance Imaging (MRI).

Parkinson plus syndrome - resulting in permanent symptoms

A definite diagnosis by a consultant neurologist or consultant geriatrician of one of the following Parkinson plus syndromes:

• Corticobasal ganglionic degeneration
• Diffuse Lewy body disease
• Multiple system atrophy
• Parkinsonism-dementia-amyotrophic lateral sclerosis complex
• Progressive supranuclear palsy. There must also be permanent clinical impairment of at least one of the following:
• motor function; or
• eye movement disorder; or
• postural instability; or
• dementia.

Parkinson’s disease - resulting in permanent symptoms

A definite diagnosis of Parkinson’s disease by a consultant neurologist or consultant geriatrician. There must be permanent clinical impairment of motor function with associated tremor or muscle rigidity.

Not covered:

• Parkinsonian syndromes/Parkinsonism.

Spinal stroke

Death of spinal cord tissue due to inadequate blood supply or haemorrhage within the spinal column resulting in either:

• permanent neurological deficit with persisting clinical symptoms
• definite evidence of death of spinal cord tissue or haemorrhage within the spinal column on a relevant scan and neurological deficit with persistent clinical symptoms lasting at least 24 hours.

Not covered:

• transient ischaemic attacks.

Stroke - resulting in specified symptoms

Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in either:

• permanent neurological deficit with persisting clinical symptoms; or
• definite evidence of death of tissue or haemorrhage on a brain scan; and
• neurological deficit with persistent clinical symptoms lasting at least 24 hours.

Not covered:

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

Interstitial lung disease

A definite diagnosis of interstitial lung disease by a consultant respiratory physician resulting in all of the following:

• radiological evidence of pulmonary fibrosis
• permanent and irreversible DLCO (diffusing capacity of the lung for carbon monoxide) below 40% of predicted

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 - end stage

End stage liver failure due to cirrhosis and resulting in all of the following:

• permanent jaundice
• ascites
• encephalopathy.

Major organ transplant from another donor *

The undergoing as a recipient of a transplant from either a human donor, animal or insertion of an artificial device, or inclusion on an official UK waiting list, for any of the following:

• transplant of bone marrow;
• transplant of haematopoietic stem cells preceded by total bone marrow ablation;
• transplant of a complete heart, kidney, liver, lung or pancreas;
• transplant of a lobe of liver or lung.

Not covered:

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

Pneumonectomy - for disease or trauma *

The undergoing of, or inclusion on the NHS waiting list for, surgery on the advice of a consultant physician to remove an entire lung due to disease or trauma.

Not covered:

• removal of a lobe of the lungs (lobectomy)
• lung resection or incision.

Respiratory failure - of specified severity

Confirmation by a consultant physician of severe lung disease with permanent impairment of lung function resulting in all of the following:

• the need for daily oxygen therapy for a minimum of 15 hours per day for at least six months
• forced expiratory volume at 1 second (FEV1) below 50% of normal; and
• forced vital capacity (FVC) below 50% of normal.

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.

Cancer - 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, essential thrombocythaemia, polycythaemia rubra vera and primary myelofibrosis
• Lymphoma and sarcoma except those that arise from and are confined to the skin (including cutaneous lymphomas and sarcomas)
• Pseudomyxoma peritonei
• Merkel cell cancer.

Not covered:

• all cancers which are histologically classified as any of the following: - pre-malignant; - cancer in-situ; - having borderline malignancy; or - having low malignant potential.
• all tumours of the prostate unless histologically classified as having a Gleason score of 7 or above or having progressed to at least TNM classification cT2bN0M0 or pT2N0M0 following prostatectomy (removal of the prostate).
• all urothelial tumours unless histologically classified as having progressed to at least TNM classification T1N0M0.
• Neuroendocrine tumours (NETs) without lymph node involvement or distant metastases unless classified as WHO Grade 2 or above.
• Gastrointestinal stromal tumours (GISTs) without lymph node involvement or distant metastases unless classified by either AFIP/Miettinen and Lasota as having a moderate or high risk of progression, or UICC/ TNM8 stage II or above.
• malignant melanoma skin cancers that are confined to the epidermis (outer layer of skin).
• any non-melanoma skin cancer that arises from and is confined to one or more of the epidermal, dermal, and subcutaneous tissue layers of the skin (including cutaneous lymphomas and sarcomas).

Bacterial meningitis - resulting in permanent symptoms

A definite diagnosis of bacterial meningitis by a consultant neurologist. There must be inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit with persisting clinical symptoms.

Not covered:

• all other forms of meningitis including viral meningitis.

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 6/60 or worse in the better eye using a Snellen eye chart, or visual field is reduced to 20 degrees or less of an arc, as certified by an ophthalmologist.

Deafness - permanent and irreversible

Permanent and irreversible loss of hearing to the extent that the quietest sound that can be heard is 90 decibels across all frequencies in the better ear using a 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 joints.

Loss of speech - total permanent and irreversible

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

Paralysis of limb - total and irreversible

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

Removal of an eyeball as a result of injury or disease - permanent physical severance

Permanent surgical removal of an eyeball as a result of injury or disease.

Third-degree burns - covering 20% of the body’s surface area or 20% of the face’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 or covering 20% of the face’s surface area.

Systemic lupus erythematosus - of specified severity

A definite diagnosis of systemic lupus erythematosus by a consultant rheumatologist resulting in either of the following

• permanent neurological deficit with persisting clinical symptoms; or
• permanent impairment of kidney function with Glomerular Filtration Rate (GFR) below 30 ml/min.

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:

• the illness either has no known cure or has progressed to the point where it cannot be cured; and
• in the opinion of the attending consultant, the illness is expected to lead to death within 12 months.

Less advanced cancer of the breast - with surgical removal

A positive diagnosis with histological confirmation of either of the following that has been treated by surgery to remove the tumour:

• cancer in situ of the breast, or
• neuroendocrine tumour (NET) of the breast without lymph node involvement or distant metastases classified as WHO grade 1.

Less advanced cancer of the prostate - requiring specified treatment

Tumours of the prostate histologically classified with a Gleason score of 6 that have progressed to at least clinical TNM classification T1N0M0 and must have resulted in the undergoing of any treatment to remove or destroy tumour cells.

Not covered:

• Tumours undergoing active surveillance or observation only.

Benign spinal cord tumour - resulting in 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 clinical symptoms; or
• surgical removal of part or all of the tumour; or
• undergoing either stereotactic radiosurgery or chemotherapy treatment to destroy tumour cells.

Not covered:

• angiomas.

Brain abscess - drained via craniotomy

Surgical drainage of an intracerebral abscess within the brain tissue through a craniotomy by a consultant neurosurgeon. There must be evidence of an intracerebral abscess on CT or MRI imaging.

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.

Heart failure - of specified severity

A definite diagnosis of heart failure by a consultant cardiologist. There must be permanent clinical impairment of heart function resulting in all of the following:

• permanent loss of ability to perform physical activities to at least Class III of the New York Heart Association (NYHA) classification of functional capacity (heart disease resulting in marked limitation of physical activities where less than ordinary activity causes fatigue, palpitations, breathlessness or chest pain); and
• permanent and irreversible ejection fraction of less than 40%.

Intensive care - ten days continuous duration

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

Not covered:

• children born prematurely (before 37 weeks of pregnancy).

Mental health condition - of specified severity

A severe mental health condition diagnosed by a consultant psychiatrist that has resulted in all of the following:

• an admission to a psychiatric ward, on the advice of a consultant psychiatrist, where treatment was provided for at least 14 consecutive nights, or continuous home care by a Crisis Resolution and Home Treatment Team for at least 14 consecutive days, requiring at least 2 visits per day; and
• chronic unremitting symptoms; and
• no response to comprehensive management and treatment, under the supervision of a consultant psychiatrist, for which the person has completed on best clinical practice for more than 1 year; and
• the inability to perform any type of work for payment or reward for a period of at least one year or if not in employment at the time of diagnosis, in the opinion of the treating consultant, the life assured will be unable to perform any type of work for payment or reward for a period of at least one year.

Not covered:

• conditions related to or exacerbated by alcohol or drug abuse.

Necrotising fasciitis

A definite diagnosis of life threatening necrotising fasciitis or gas gangrene by a consultant physician, requiring immediate surgery to remove necrotic tissue and intravenous antibiotic treatment to prevent imminent death.

Not covered:

• all other forms of gangrene or cellulitis.

Neurodegenerative disorders not already covered - of specified severity

A definite diagnosis by a consultant neurologist, psychiatrist or geriatrician of a neurodegenerative disorder resulting in permanent clinical impairment of motor function affecting body movement.

Not covered:

• symptoms of psychological or psychiatric origin
• essential tremor, fibromyalgia or chronic fatigue syndrome
• conditions related to or exacerbated by alcohol or drug usage.

Neuromyelitis optica (Devic’s disease) - with persisting clinical symptoms

A definite diagnosis of neuromyelitis optica by a consultant neurologist. There must have been clinical impairment of motor or sensory function caused by neuromyelitis optica.

Peripheral vascular disease - with bypass surgery *

A definite diagnosis of peripheral vascular disease with objective evidence from an ultrasound of obstruction in the arteries which results in the undergoing of, or inclusion on the NHS waiting list for, bypass graft surgery to the arteries of the legs.

Not covered:

• Angioplasty.

Primary sclerosing cholangitis - of specified severity

A definite diagnosis of primary sclerosing cholangitis as evidenced by imaging confirmation of typical multifocal formation of bile duct strictures and dilation of intrahepatic and/or extrahepatic bile ducts.

Not covered:

• all other causes of bile duct stricture formation and dilation.

Severe bowel disease - treated with two intestinal resections or total colectomy

A definite diagnosis by a consultant gastroenterologist of a bowel disease resulting in either:

• surgical intestinal resection to remove part of the small intestine or bowel on at least two separate occasions; or
• total colectomy (removal of the entire large bowel).

Syringomyelia or syringobulbia - requiring surgery *

The undergoing of, or inclusion on the NHS waiting list for, surgery to treat a syrinx in the spinal cord or brain stem.

Accident hospitalisation

An accident that results in physical injury which requires the life assured to stay in hospital for 28 consecutive days or more on the advice of an appropriate consultant.

Aortic aneurysm - with endovascular repair

The undergoing of endovascular repair of an aneurysm of the thoracic or abdominal aorta with a graft.

Not covered:

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

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:

• absolute neutrophil count (ANC) < 0.5 x 10^9/L
• platelet count <20 x 10^9/L
• Hb < 100 g/L (<10g/dL)

Not covered:

• other types of anaemia.

Bladder removal

Complete surgical removal of the urinary bladder (total cystectomy).

Not covered:

• urinary bladder biopsy
• removal of a portion of the urinary bladder.

Bowel disease - with specified surgery **

A definite diagnosis by a consultant gastroenterologist of a bowel disease treated with, or inclusion on the NHS waiting list for, surgical intestinal resection.

Not covered:

• local excision and polypectomy.

Carotid artery stenosis - with surgical repair

The undergoing of endarterectomy or angioplasty with or without stent on the advice of a consultant physician to treat severe symptomatic stenosis in a carotid artery. This operation must be to treat at least 50% diameter narrowing which has been confirmed by angiographic evidence.

Central retinal artery occlusion or central retinal vein occlusion (eye stroke) - resulting in permanent visual loss

Death of optic nerve or retinal tissue due to inadequate blood supply within the central retinal artery or vein. This must result in permanent visual impairment.

Not covered:

• branch retinal artery or branch retinal vein occlusion or haemorrhage
• traumatic injury to tissue of the optic nerve or retina.

Cerebral or spinal aneurysm - with specified surgery

The undergoing of either of the following surgical procedures:

• surgical correction via craniotomy (surgical opening of the skull) or embolisation treatment using coils or other materials, in order to treat a cerebral aneurysm; or
• surgical resection, wrapping, clipping or embolisation of a spinal aneurysm.

Cerebral or spinal arteriovenous malformation - with specified surgery

The undergoing of either of the following surgical procedures:

• surgical correction via craniotomy (surgical opening of the skull) or endovascular treatment using coils or other materials, in order to treat a cerebral arteriovenous malformation; or
• surgical correction or embolisation of a spinal arteriovenous malformation.

Coronary angioplasty

The undergoing of balloon angioplasty, including atherectomy, laser treatment or stent insertion on the advice of a consultant cardiologist to the Left Main Stem or two or more main coronary arteries to correct narrowing or blockages. The main coronary arteries for this purpose are defined as Right Coronary Artery, Left Anterior Descending and Circumflex. Angiographic evidence will be required. Two coronary angioplasty procedures performed in different arteries at different times is covered.

Not covered:

• diagnostic angioplasty
• two angioplasty procedures to a single main artery or branches of the same artery.

Diabetes Mellitus Type 1

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).

Drug resistant epilepsy - with specified surgery

Epilepsy that cannot be controlled by oral medication resulting in either of the following:

• invasive surgery to brain tissue, including the insertion of electrodes for deep brain stimulation; or
• the implantation of a vagus nerve stimulator

Not covered:

• brain stimulation from external devices.

Facial reconstruction surgery

Le Fort III Reconstruction of the maxillofacial bones for severe facial trauma.

Guillain-Barré syndrome - with persisting clinical symptoms

A definite diagnosis of Guillain-Barré syndrome by a consultant neurologist. There must be clinical impairment of motor or sensory function which must have persisted for a continuous period of at least six months.

Infective bacterial endocarditis

A definite diagnosis by a consultant cardiologist of infective bacterial endocarditis.

Less advanced cancer of the larynx - with specified treatment

A positive diagnosis with histological confirmation of cancer in situ of the larynx treated with surgery, laser or radiotherapy.

Less advanced cancer of the ovary - with surgical removal

A positive diagnosis with histological confirmation of ovarian tumour of borderline malignancy/low malignant potential and has resulted in surgical removal of an ovary.

Not covered:

• removal of an ovary due to a cyst.

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

A positive diagnosis with histological confirmation of cancer in situ of the renal pelvis or ureter.

Not covered:

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

Less advanced cancer of the testicle - with specified surgery

A positive diagnosis with histological confirmation of benign testicular tumour or intra-tubular germ cell neoplasia unclassified (ITGCNU) resulting in orchidectomy (removal of a testicle).

Less advanced cancer of the urinary bladder - of specified severity

A positive diagnosis with histological confirmation of cancer in situ of the urinary bladder.

Not covered:

• non-invasive papillary carcinoma
• TNM classification stage Ta bladder cancer.

Less advanced cancer of other sites - with surgical removal

A positive diagnosis with histological confirmation of any of the following that has been treated by surgery to remove the tumour:

• cancer in situ, or
• neuroendocrine tumour (NET) without lymph node involvement or distant metastases classified as WHO grade 1, or
• gastrointestinal stromal tumour (GIST) without lymph node involvement or distant metastases classified as being either: - no, very low or low risk of progression by AFIP/Miettinen and Lasota, or - stage I by UICC/TNM8.

Not covered:

• any skin cancer (including melanoma)
• tumours treated with radiotherapy, laser therapy, conisation, loop excision, cryotherapy or diathermy treatment
• intra-epithelial neoplasia grade 1 or 2. A claim can be made more than once under this definition for less advanced cancers of different sites. Once a claim has been accepted, the life assured will no longer be covered for the same cancer in situ, NET or GIST against this or any of the other definitions under this policy.

Liver resection

The undergoing of a partial hepatectomy (liver resection) on the advice of a specialist surgeon in gastroenterology and hepatology.

Not covered:

• surgery for liver donation (as a donor)
• liver biopsy.

Non-malignant pituitary adenoma - with specified treatment

Diagnosis of a non-malignant pituitary tumour requiring radiotherapy or surgical removal.

Not covered:

• non-malignant tumours of the pituitary gland treated by other methods.

Pericarditis - chronic constrictive pericarditis or requiring surgery

A definite diagnosis by a consultant cardiologist of either of the following:

• chronic constrictive pericarditis; or
• pericarditis treated with surgery to remove fluid or heart tissue.

Not covered:

• other forms of pericarditis.

Permanent pacemaker or ICD insertion - for heartbeat abnormalities

The definite diagnosis of an abnormal rhythm of heartbeat by a consultant cardiologist resulting in the insertion of an artificial pacemaker or implantable cardioverter defibrillator (ICD) on a permanent basis.

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

The undergoing of surgery for the removal of one or more lobes of the lung due to underlying disease or trauma. The surgery must be carried out on the advice of a consultant physician.

Severe sepsis - resulting in admission to a critical care unit for 3 days or more

A definite diagnosis of sepsis by a consultant physician resulting in admission to either an intensive care unit (ICU) or a high dependency unit (HDU) for at least 3 continuous days.

Significant hearing loss - permanent and irreversible

Permanent and irreversible loss of hearing to the extent that the quietest sound that can be heard is 70-89 decibels across all frequencies in the better ear using a pure tone audiogram.

Significant visual loss - 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 6/24 or worse in the better eye using a Snellen eye chart, or visual field is reduced to 45 degrees or less of an arc, as certified by an ophthalmologist.

Skin cancer - advanced stage as specified

Non-melanoma skin cancer diagnosed with histological confirmation that the tumour is larger than 2 centimetres across and has at least one of the following features:

• tumour thickness of at least 4 millimetres (mm);
• invasion into subcutaneous tissue (Clark level V);
• invasion into nerves in the skin (perineural invasion);
• poorly differentiated or undifferentiated (cells are very abnormal as demonstrated when seen under a microscope); or
• has recurred despite previous treatments.

Not covered:

• melanoma.

Third-degree burns - less extensive - covering 5% of the body’s surface area or 19% of the face’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 5% of the body’s surface area or 19% of the face’s surface area.

Cerebral palsy before age seven

A definite diagnosis of cerebral palsy before age seven made by an attending consultant.

Craniosynostosis - requiring surgery

A definite diagnosis of craniosynostosis by a consultant neurosurgeon which has been treated surgically.

Cystic fibrosis

A definite diagnosis of cystic fibrosis made by an attending consultant.

Down’s syndrome

A definite diagnosis of Down’s syndrome by an attending paediatrician.

Edwards’ syndrome

A definite diagnosis of Edwards’ syndrome by an appropriate medical specialist.

Hydrocephalus before age seven - treated with insertion of a shunt

A definite diagnosis of hydrocephalus before age seven which is treated with the insertion of a shunt.

Muscular dystrophy before age seven

A definite diagnosis of muscular dystrophy before age seven made by a consultant neurologist.

Osteogenesis Imperfecta before age seven

A definite diagnosis of Osteogenesis imperfecta before age seven by an appropriate medical specialist.

Not covered:

• Type 1 Osteogenesis Imperfecta.

Patau’s syndrome

A definite diagnosis of Patau’s syndrome by an appropriate medical specialist.

Spina bifida

A definite diagnosis of spina bifida myelomeningocele or rachischisis by an attending paediatrician.

Not covered:

• spina bifida occulta
• spina bifida with meningocele.

Cleft lip

A definite diagnosis of a cleft lip by a paediatrician or cleft nurse requiring the undergoing of surgery to repair the defect.

Cleft palate

A definite diagnosis of a cleft palate by a paediatrician or cleft nurse requiring the undergoing of surgery to repair the defect.

Congenital talipes equinovarus (Club foot)

A definite diagnosis of congenital talipes equinovarus following the routine post-birth examination and requiring treatment using the Ponseti method.

Developmental dysplasia of the hip

A definite diagnosis of a developmental dysplasia of the hip by a paediatrician consultant requiring surgery followed by a minimum of six weeks in plaster cast or abduction brace.

Specified Complications of Pregnancy

A definite diagnosis by a consultant obstetrician of one of the following conditions:

• benign hydatidiform mole
• disseminated intravascular coagulation (DIC)
• eclampsia
• ectopic pregnancy
• foetal death in utero between 20 and 24 weeks’ gestation
• placental abruption

Not covered:

• pre-eclampsia