AIA Living Personal Severe Trauma Policy Wording

This appendix only applies if cover under the schedule for your policy includes the Severe Trauma Benefit. This appendix forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix. This Severe Trauma Benefit may be standalone or accelerated. Details of the benefit and the life/lives assured are shown in the schedule.

AIA LIVING - PERSONAL OPTIONAL BENEFIT APPENDIX

Severe Trauma Benefit

This Severe Trauma Benefit may be standalone or accelerated. Details of the benefit and the life/lives assured are shown in the schedule .

When will AIA pay a Severe Trauma Benefit?

AIA will pay you a Severe Trauma Benefit if the life assured suffers for the first time after the risk commencement date any of the conditions listed in the table below and survives for at least 14 days thereafter. An exception is the Optional Total Permanent Disablement condition , for which a 90 day survival period applies.

What stand down periods apply?

If, after the risk commencement date but within the first three months of the receipt of application , any of the conditions marked in the table below as having a 90 day stand down period occur, or symptoms or signs which lead to any of those conditions (whether or not a registered medical practitioner has been consulted) occur, then AIA will not pay a benefit for the life assured or any child of the life assured covered by the Built-in Children’s Trauma Benefit.

Cover added under the Severe Trauma Future Insurability Benefit or the Special Events Increase Facility

A 180 day stand down period applies to increases made under the Built-in Severe Trauma Future Insurability Benefit or the Built- in Special Events Increase Facility, except where the claim is due to an accident , as outlined in Sections 8 and 9. Where the claim is due to an accident , the 90 day stand down period is waived on such increases, provided the life assured has already served the 90 day stand down period on the original Severe Trauma Benefit policy.

Cover added under the Special Events TPD/Trauma Facility

A 180 day stand down period applies to any accelerated Severe Trauma Benefit cover added for the life assured using the Special Events TPD/Trauma Facility under the Life Cover Benefit, except where the claim is due to an accident , as outlined in the Life Cover Benefit appendix . Where the claim is due to an accident , the 90 day stand down period applies to the added cover from the date the added cover commences, for any of the conditions marked in the table below as having a 90 day stand down period.

Medical Advancements Provision

If the medical diagnostic techniques and investigations used in our definitions of medical conditions have been superseded due to medical advancements, we will consider other appropriate and medically recognised methods or tests that conclusively diagnose the condition to at least the same severity. The following requirements must be met for a claim to be considered:  The new diagnostic techniques and investigations are not experimental and are medically necessary and medically equivalent or superior to the original diagnostic technique or investigation.  Any new diagnostic techniques and investigations must be deemed medically acceptable based on medical standards and medically recognised in Australia or New Zealand by specialist medical practitioners.

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Table of conditions

Refer to Section 19 for the definition of each of these medical conditions , including the full description of the criteria and severity required to give rise to a claim.

90 day stand down period

Condition

Loss of independent existence

Cancer

Paraplegia

Cancer



Permanent blindness

Heart

✓

Permanent loss of hearing

Cardiomyopathy

Permanent loss of speech

Heart attack

✓

Permanent loss of use of limbs (including sight)

Primary Pulmonary hypertension

Quadriplegia / Tetraplegia

Major neurological disease

Other key conditions

Alzheimer’s disease

Advanced AIDS

Coma

Advanced diabetes

Creutzfeldt-Jakob disease

✓

Aplastic anaemia

Dementia

Chronic liver failure

Encephalitis

✓

Chronic lung disease

Idiopathic Parkinson’s disease

✓

Chronic renal failure

Major head trauma

Cognitive impairment

Meningitis

Intensive care

Motor neurone disease

Major transplant surgery

Multiple sclerosis

✓

Severe burns

Muscular dystrophy

Systemic sclerosis

Peripheral neuropathy

Terminal illness

Stroke

✓

Optional condition (not applicable to the Built- in Children’s Trauma Benefit)

Paralysis and loss of functionality

Diplegia

Total Permanent Disablement

Hemiplegia

If you receive a payment for a claim that reduces the sum assured for a life assured to nil under this Severe Trauma Benefit, cover will cease for that life assured .

If the life assured suffers more than one condition (including the Optional Total Permanent Disablement condition ), AIA will pay a maximum of the Severe Trauma Benefit sum assured for all claims (in total).

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What effect does payment of an accelerated Severe Trauma Benefit have on the Life Cover Benefit?

Built-in Children’s Trauma Benefit

What is the Built-in Children’s Trauma Benefit?

AIA will pay a Built-in Children’s Trauma Benefit if a child of a life assured suffers one of the applicable conditions listed in Section 1 of this appendix .

This section applies only if an accelerated Severe Trauma Benefit is shown in the schedule .

When AIA pays an accelerated Severe Trauma Benefit, the Life Cover Benefit for the life assured will decrease by the same amount. Any other accelerated benefits relating to that Life Cover Benefit will also be reduced, if necessary, so that those accelerated benefits do not exceed the decreased Life Cover Benefit. If the Life Cover Benefit is reduced to nil, all accelerated benefits relating to that Life Cover Benefit will be removed. The maximum combined amount payable under the Life Cover Benefit, Specified Terminal Conditions Benefit, Terminal Illness Benefit, Bereavement Support Benefit, Repatriation Benefit, accelerated Severe Trauma Benefit and, if applicable, the accelerated Critical Conditions Benefit, the accelerated Progressive Care Benefit and the accelerated Total Permanent Disablement Benefit is the amount of the Life Cover Benefit for that life assured .

This Benefit is only payable if the child of the life assured :

 first suffers a condition after the risk commencement date , subject to the applicable stand down period provisions where these apply;

 is aged from three months up to their 21 st birthday at the time he or she first suffers from that condition ; and

 survives for at least 14 days after suffering from the condition .

What are the applicable conditions and how much will AIA pay?

For those conditions where the criteria for payment are met as detailed in Section 19 below, the Benefit payable is the lower of $50,000 or 50% of the sum assured across all Severe Trauma Benefit policies for the life assured .

Built-in Financial and Legal Advice Benefit

No payments are made under this Benefit for the Optional Total Permanent Disablement condition.

If AIA pays a full payment claim under this Severe Trauma Benefit for a condition suffered by a life assured , then AIA will reimburse you for fees up to $2,500 including GST (in total) that you pay for financial planning you receive from an accredited Adviser or legal advice received from a legal professional approved by AIA , subject to the following conditions:  You must pay for the financial planning or legal advice within the three months following AIA paying the Severe Trauma Benefit claim.  You must provide AIA with a completed claim form and a receipt satisfactory to AIA for the fees you are claiming.  AIA will only pay one Financial and Legal Advice Benefit per life assured across all AIA policies . This is in addition to the sum assured. The Built-in Financial and Legal Advice Benefit is not payable for a claim for a child of the life assured under the Built- in Children’s Trauma Benefit or the Built-in Parents Grieving Benefit.

AIA will pay a maximum of one claim per child under the Built-in Children’s Trauma Benefit across all AIA policies .

Payment of the Built-in Children’s Trauma Benefit will not affect the amount of any Severe Trauma Benefit payable for the life assured . AIA will not pay a benefit under the Built- in Children’s Trauma Benefit that arises as a direct or indirect consequence of:

a pre-existing condition ; or



any congenital condition .



The Built- in Children’s Trauma Benefit ceases on the child’s 21 st birthday.

Built- in Children’s Trauma Conversion Facility

The Built- in Children’s Trauma Benefit can be converted to :

 a standalone Severe Trauma Benefit; or

 an accelerated Severe Trauma Benefit with an equal amount of Life Cover Benefit,

with a maximum sum assured of $50,000 or 50% of the life assure d’s original sum assured whichever is the lesser, without further medical evidence. Where the life a ssured’s sum assured has reduced the conversion will be calculated on the reduced amount.

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Built-in Premium Conversion Facility

The following conditions are applicable to the Children’s Trauma Conversion option:

You may at any time prior to the life assured reaching age 65:

 A conversion cannot occur if the child has claimed or was eligible to claim under the Built- in Children’s Trauma Benefit; and  Your request for conversion must be received by AIA within 60 days of the anniversary date after the child’s 21 st birthday; and

 Convert all or part of your Severe Trauma Benefit from the premium type shown in the schedule to a Level premium structure; or  Convert a Level premium structure to an alternate Level premium structure, of which term duration may be the same or less than current Level premium structure.

Your request must be received in writing.



An applicable premium will be payable on converted cover.

AIA will not require you or the life assured to produce further medical evidence at the time of conversion.

Built-in Standalone Conversion Facility

You will be issued a new policy for the sum assured amount of the Severe Trauma Benefit being converted, in which case:

If the schedule shows the Severe Trauma Benefit as standalone you can convert this to an accelerated Severe Trauma Benefit with an equal amount of Life Cover Benefit without any further medical evidence subject to the following:

 The Severe Trauma Benefit under this policy will be reduced by the sum assured amount converted;

The life assured was accepted with standard underwriting terms (e.g. there are no special terms, exclusions or premium loadings applicable to the life assured );



 The new policy will be issued based on the information provided at the time of conversion, together with the information provided in the original proposal;

 The terms and conditions of the new policy will be those which are then offered by us to the general public;

 The life assured is only eligible for the Standalone Conversion Facility where the conversion occurs before age 60;  The life assured has not made a claim, with AIA or any other insurer, and is not eligible to make a claim under their standalone Severe Trauma Benefit. This includes any claim currently under assessment;

 Premiums will be calculated on the current age of the life assured ;

 Any special terms, exclusions or premium loadings that applied to your existing Severe Trauma Benefit under this policy will apply to your new Severe Trauma Benefit under the new policy.

 The premiums for their standalone Severe Trauma Benefit are paid up to date;

Built-in Special Events Increase Facility

 The accelerated Severe Trauma Benefit sum assured must be less than or equal to the standalone Severe Trauma Benefit sum assured; and

What is the Special Events Increase Facility?

On each occasion when one of the following circumstances occurs for a life assured on the Severe Trauma Benefit:

 The Life Cover Benefit sum assured does not exceed the accelerated Severe Trauma Benefit sum assured.

having a child (by birth or legal adoption);



The premium for the conversion will be based on the age of the life assured and our premium rates at the date of conversion . If you are issued a new policy for the amount of the standalone Severe Trauma Benefit being converted, the new policy will be issued based on the information provided at the time of conversion, together with the information provided in the original proposal. If the death of the life assured occurs within 90 days of the date of conversion , other than by accidental death , then this conversion is void and the standalone Severe Trauma Benefit will be reinstated from the date of conversion.

 becoming married or entering into a civil union;

 becoming legally separated, divorced or the dissolution of the life assured ’s civil union;

 financially supporting a dependent child through a first course of full-time tertiary education;  the commencement of secondary school for the first time by a child of the life assured ;  taking out or increasing a home loan because the life assured has purchased a new home, a new residential investment property, a vacation home, or a bare block of land zoned as residential, or is making extensions to a residential property or residential investment property owned by the life assured ;

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 becoming responsible for the full-time care or payment for long term care of a close relative ;

 You must make the request within 60 days either side of the relevant special event and provide AIA with suitable evidence of the occurrence of the event.  A life assured is only eligible for Special Events Increases where the special event occurs from the age of 16 and before age 55.  If, at any time before you seek to exercise the Facility, a claim for the life assured had been accepted by us or notified to us, AIA will have discretion in determining whether the Facility can be exercised. In exercising discretion, we will consider whether, based on the medical evidence submitted in support of the claim, the life assured represents an increased risk of claim for the benefit being added under this Facility.

 receiving an annual salary increase (this special event is not available to a life assured who is self-employed); or

 experiencing the death of a spouse, civil or de facto partner,

you may write to AIA asking us to increase the Severe Trauma Benefit for that life assured .

What is the maximum cover that can be added?

The maximum increase for each special event cannot exceed the lower of:  50% of the original Severe Trauma Benefit for the life assured ; or

 Only one of the following is available in any 12 month period:

$250,000.



A Severe Trauma Future Insurability Benefit increase (see Section 9 below).

−

The total of all increases made under this Facility cannot exceed the lower of:  100% of the original Severe Trauma Benefit for the life assured ; or

− A Special Events Increase under a Critical Conditions Benefit, Severe Trauma Benefit or Progressive Care Benefit.

(If applicable) exercising the Special Events TPD/Trauma Facility under the Life Cover Benefit and/or similar benefits to add an accelerated Critical Conditions Benefit, accelerated Severe Trauma Benefit or an accelerated Progressive Care Benefit.

−

$750,000.



In the case of taking out or increasing a home loan, the individual increase cannot exceed the amount of the home loan or the increase in the home loan. In the case of an annual salary increase, the individual increase cannot exceed five times the annual salary increase. The maximum increases outlined above each apply in respect of all Critical Conditions Benefits, Severe Trauma Benefits, Progressive Care Benefits, and similar benefits for that life assured across all AIA policies . Both of the following maximum sum assured limits also apply across all AIA policies for each life assured :  the total of the sum assured for all Critical Conditions Benefits, Severe Trauma Benefits, Progressive Care Benefits, and similar trauma benefits (combined), including increases under this Facility must not exceed $2,000,000; and  the total of the sum assured for all trauma benefits combined must not exceed $2,000,000 and the total sum assured for all trauma and Total Permanent Disablement Benefits (and similar benefits) combined must not exceed $5,000,000.

AIA will increase the Severe Trauma Benefit for a life assured from the date we accept your request.

Each increase will require an increase in premium . This increase will be calculated on the rates applicable at the time the Built-in Special Events Increase Facility is exercised. Any loadings, exclusions or special terms on the original Severe Trauma Benefit sum assured will be applied to the increased amount. If you have the Optional Severe Trauma Buyback Benefit or the Optional Life Cover Buyback Benefit selected on the policy for your original Severe Trauma Benefit, you can choose to add these benefits to the portion of the increased sum assured when you exercise the Special Events Increase Facility.

When will AIA not pay a claim for an increase under this Facility?

Increases in sum assured added to this policy

After an increase under this Facility has been made, AIA will not pay the increased benefit amount if, before the increase, or within six months of the Facility being exercised, the life assured :

What are the other conditions applying to this Facility?

You do not need to produce any medical evidence regarding the life assured when you request this increase, but any Special Events Increase is subject to the following conditions:

 suffers any condition for the first time other than due to an accident under the Severe Trauma Benefit; or

 has any symptoms or signs leading to a condition

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(whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Severe Trauma Benefit.

b. The total of the sum assured for all trauma benefits combined must not exceed $2,000,000 and the total sum assured for all trauma and Total Permanent

Disablement Benefits (and similar benefits) combined must not exceed $5,000,000.

Increases in sum assured issued as an additional new policy

 Where this Severe Trauma Benefit is shown in the schedule as accelerated against the Life Cover Benefit, the Severe Trauma Benefit, including the total of all Severe Trauma Future Insurability Benefit increases, cannot exceed the sum assured of the Life Cover Benefit. See Section 2 ‘ What effect does payment of an accelerated Severe Trauma Benefit have on the Life Cover Benefit ’ for details.  A life assured is only eligible for Severe Trauma Future Insurability Benefit increases from the age of 16, and before age 55.

Where this policy or any part of the sum assured under it, has been issued as the result of an increase under the Built- in Special Events Increase Facility, then:  the Special Events Increase Facility will not be available under this policy for the proportion of the sum assured that represents the increase;  AIA will not pay the increased benefit amount if, before the increase, or within six months of the increase, the life assured : − suffers any condition for the first time other than due to an accident under the Severe Trauma Benefit; or − has any symptoms or signs leading to a condition (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Severe Trauma Benefit.

 AIA will increase the Severe Trauma Benefit for a life assured from the date we accept your request.

 If, at any time before you seek to exercise an increase under this Benefit, a claim for the life assured had been accepted by us or notified to us, AIA will have discretion in determining whether the increase will be accepted. In exercising discretion, we will consider, based on the medical evidence submitted in support of the claim, whether the life assured represents an increased risk of claim for the cover being added under this Benefit.  Only one of the following is available in any 12 month period: − A Built-in Critical Conditions or Severe Trauma Future Insurability Benefit increase; − A Special Events Increase under a Critical Conditions Benefit, Severe Trauma Benefit or Progressive Care Benefit; or

Built-in Severe Trauma Future Insurability Benefit

At every third policy anniversary date you may write to AIA asking us to increase the Severe Trauma Benefit for a life assured . You do not need to produce any medical evidence regarding the life assured when you request this increase, but any increase in sum assured under this Benefit is subject to the following conditions:  You must request the increase by providing written advice to AIA within 60 days either side of the applicable anniversary date . Outside of this time frame, the Severe Trauma Future Insurability Benefit is not available.  Each individual increase cannot exceed 20% of the original Severe Trauma Benefit sum assured or $200,000, whichever is the lesser.

−

Each Built-in Severe Trauma Future Insurability Benefit increase in sum assured will require an increase in premium . This increase will be calculated on the rates applicable at the time the Built-in Severe Trauma Future Insurability Benefit is exercised. Any loadings, exclusions or special terms on the original Severe Trauma Benefit sum assured will be applied to the increased amount. If you have the Optional Severe Trauma Buyback Benefit or the Optional Life Cover Buyback Benefit selected on the policy for your original Severe Trauma Benefit, you can choose to add these benefits to the portion of the increased sum assured when you exercise the Built-in Severe Trauma Future Insurability Benefit.

 The total of all Severe Trauma Future Insurability Benefit increases for a life assured cannot exceed 100%

of the original Severe Trauma Benefit for that life assured or $500,000, whichever is the lesser.

 Both of the following maximum sum assured limits also apply across all AIA policies for each life assured : a. The total of the sum assured for all Critical Conditions Benefits, Severe Trauma Benefits, Progressive Care Benefits, and similar trauma benefits (combined), including increases under this Benefit must not exceed $2,000,000; and

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11.

Built-in Parents Grieving Benefit

When will AIA not pay a claim for an increase under this Benefit?

When is a Parents Grieving Benefit payable?

Increases in sum assured added to this policy

AIA will pay a Parents Grieving Benefit if a child of a life assured dies:

After a Built-in Severe Trauma Future Insurability Benefit increase has been made, AIA will not pay the increased amount if, before the increase, or within six months of the increase, the life assured :

 prior to birth but after at least 24 weeks gestation, provided the child would have been born at least 12 months after the risk commencement date if the pregnancy continued to full term, where the life assured is the biological mother of the child ; or

 suffers any condition for the first time other than due to an accident under the Severe Trauma Benefit; or

 has any symptoms or signs leading to a condition (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Severe Trauma Benefit.

 after birth and at least 12 months after the risk commencement date.

This Parents Grieving Benefit ceases on the child ’s 21 st birthday.

Increases in sum assured issued as an additional new policy

How much will AIA pay for the Parents Grieving Benefit?

The benefit payable is:

Where this policy or any part of the sum assured under it, has been issued as the result of an increase under the Built- in Severe Trauma Future Insurability Benefit, then the Built- in Severe Trauma Future Insurability Benefit under this policy will not be available for the proportion of the sum assured that represents the increase.

 $2,000 if the child is under 10 years of age, or

 $15,000 if the child is 10 years of age or over.

Payment of the Parents Grieving Benefit will not reduce the sum assured of the Severe Trauma Benefit for the life assured . AIA will pay a maximum of one claim per child under the Parents Grieving Benefit across all AIA policies for a life assured .

AIA will not pay the increased amount if, before the increase, or within six months of the increase, the life assured :

 suffers any condition for the first time other than due to an accident under the Severe Trauma Benefit; or

12.

Built-in Counselling Benefit

The Counselling Benefit covers the cost of a Psychiatrist or Psychologist consultation and/or counselling for the life assured and/or a close relative of the life assured where the support treatments and/or consultations directly relate to a claim under the Severe Trauma Benefit. After referral by an appropriate specialist we will reimburse up to $2,500 including GST (in total) per life assured , subject to the following conditions:  The consultation and/or counselling must be paid for within three months following AIA paying the Severe Trauma Benefit; and

10.

Built-in Return Home Benefit

AIA will pay a Return Home Benefit if the life assured is outside of New Zealand and suffers, for the first time, a covered condition . The Return Home Benefit will reimburse the cost of a standard economy flight back to New Zealand for the life assured and one support person. You will need to provide evidence of the transport costs satisfactory to us before a claim under the Return Home Benefit will be paid. In total the maximum we will pay over the life of the policy under the Return Home Benefit is $10,000. A Return Home Benefit is paid in addition to the Severe Trauma Benefit.

 AIA must be provided with a receipt for the consultation and/or counselling being claimed.

The $2,500 is payable once per life assured per policy. This is in addition to the sum assured.

13.

Built-in Suspension of Cover Benefit

A life assured can suspend their cover under this benefit appendix for up to 12 months if they:

No payment will be made if the life assured is covered for the same event with a travel insurance provider.

go on parental leave;



go on leave without pay for any reason;



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15.

Optional Life Cover Buyback Benefit

become unemployed or redundant;



 experience at least a 20% reduction in pay (comparing the most recent payslip against a previous payslip from the same year); or

The Life Cover Buyback Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Life Cover Buyback Benefit and if you have selected an accelerated Severe Trauma Benefit. Where an Optional Life Cover Buyback Benefit is selected, this allows the Life Cover Benefit to be reinstated without the need to provide further medical evidence following an accelerated Severe Trauma Benefit claim, subject to the following conditions:  The Life Cover Benefit can be reinstated to the level applying immediately before the accelerated Severe Trauma Benefit claim.

if self-employed, experience a 30% reduction in revenue (by comparing one month’s revenue against the same month for the previous year),



provided that:

 you notify AIA within 90 days of one of the above listed suspension events occurring and provide evidence to AIA of the suspension event; and

 AIA acknowledges in writing receipt of that notification.

Cover for the life assured will be suspended from the date set out in AIA ’s written acknowledg ement.

 The Optional Life Cover Buyback Benefit can be exercised:

No premium will be payable during the period that the cover is suspended.

− within 60 days of the accelerated Severe Trauma Benefit claim payment; or

No claim under this benefit appendix will be payable for any condition that occurs during, the period that the cover is suspended. A claim may only be payable if the life assured first meets the criteria for an eligible claim under this policy after their cover is reinstated. Cover under this benefit appendix may be reinstated at the end of the suspension period in accordance with this Section without the need to provide further medical evidence, provided that the benefit has been suspended for no longer than 12 months.

− within 60 days of the life assured surviving a period of six months after an accelerated Severe Trauma Benefit claim payment for one of the following conditions :

Paraplegia;

•

Quadriplegia;

•

Diplegia;

•

Hemiplegia;

•

At the end of the suspension period, the benefit will be automatically reinstated for the life assured .

Alzheimer’s disease ;

•

Permanent blindness;

•

Cover for the life assured will be reinstated from the date set out in AIA ’s written acknowledgement.

Permanent loss of hearing;

•

The premium payable for the reinstated benefit will be based on AIA ’s premium rates at the time of the reinstatement.

Dementia;

•

Permanent loss of use of limbs (including sight);

•

14.

Optional Total Permanent Disablement condition

Multiple sclerosis;

•

Idiopathic Parkinson’s disease ; or

•

The Optional Total Permanent Disablement condition is available once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Total Permanent Disablement condition and, subject to the provisions of this appendix , is included as a condition under the Severe Trauma Benefit. The Optional Total Permanent Disablement condition does not apply to any child of a life assured covered under the Built-in Children’s Trauma Benefit .

− Within 60 days of the life assured surviving a period of twelve months after an accelerated Severe Trauma Benefit claim payment for all other conditions (including the Optional Total Permanent Disablement condition , where applicable).

 Only one Life Cover Buyback reinstatement will apply per life assured per policy.

 The maximum Life Cover Benefit that can be reinstated is 100% of the accelerated Severe Trauma Benefit claim or $2,000,000, whichever is the lesser.

The Optional Total Permanent Disablement condition does not apply once the life assured attains age 65.

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What is the maximum amount of cover that can be reinstated?

What other conditions apply to cover reinstated under the Optional Life Cover Buyback Benefit?

The maximum Severe Trauma Benefit that can be reinstated is 100% of the Severe Trauma Benefit claim payment or $2,000,000, whichever is the lesser.

No reinstated Life Cover Benefit is payable:



− within six months (for the conditions listed above that require a six month survival period); or

When can the life assured exercise the Optional Severe Trauma Buyback Benefit?

within twelve months (for all other conditions , including the Optional Total Permanent Disablement condition , where applicable),

−

The Optional Severe Trauma Buyback Benefit can be exercised:

from the date of the accelerated Severe Trauma Benefit claim payment, except where the claim event is for accidental death .  No Life Cover Buyback Benefit is available if the life assured has suffered a claim event under a Terminal Illness Benefit or a Specified Terminal Conditions Benefit under any AIA policy , whether or not a claim has been made.  Any exercise of the Life Cover Buyback Benefit may require an increase in premium . This premium increase will be calculated on the rates applicable at the time the Life Cover Benefit is reinstated.  Any accelerated benefits relating to the Life Cover Benefit for the life assured that have been reduced or removed as a result of an accelerated Severe Trauma Benefit claim will not be reinstated.

 Within 60 days of the Severe Trauma Benefit claim payment; or

 Within 60 days of the first anniversary of the Severe Trauma Benefit claim payment.

The Benefit(s) can only be reinstated on one occasion.

What other conditions apply to cover reinstated under the Optional Severe Trauma Buyback Benefit?

On AIA’s acceptance of an application for reinstatement of the Severe Trauma Benefit, you will be issued a new policy for the Benefit(s) and sum assured amount(s) being reinstated in which case:  The new policy will be issued based on the information provided at the time of buyback, together with the information provided in the original proposal.

16.

Optional Severe Trauma Buyback Benefit

The terms and conditions of the new policy will be those which are then offered by us to the general public, with the exception that no further reinstatements under an Optional Severe Trauma Buyback Benefit will be available in respect of the reinstated Benefit(s). The reinstated Benefit(s) may require an increase in premium . This premium increase will be calculated at the rates applicable at the time the Benefit(s) are reinstated. However, where the Benefit(s) are reinstated after a Severe Trauma Benefit claim has been paid for cancer, stroke or heart attack – a discount will be applied to the Severe Trauma Benefit premium .



What is the Optional Severe Trauma Buyback Benefit?

The Optional Severe Trauma Buyback Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Severe Trauma Buyback Benefit. Where an Optional Severe Trauma Buyback Benefit is selected, this allows the Severe Trauma Benefit to be reinstated without the need to provide further medical evidence following a Severe Trauma Benefit claim, subject to the following conditions:  The life assured must have had a claim paid on their Severe Trauma Benefit that has reduced the sum assured to a nil balance.  No Severe Trauma Buyback Benefit is available if the life assured has suffered a claim event under a Terminal Illness Benefit or a Specified Terminal Conditions Benefit under any AIA policy , whether or not a claim has been made.  A life assured can only exercise the Severe Trauma Buyback Benefit for the cover provided under this policy once.



 Any special terms, exclusions or premium loadings that applied to the original Benefit(s) will also apply to the reinstated Benefit(s) under the new policy.  If you had selected the Optional Total Permanent Disablement condition at the time of the first Severe Trauma Benefit claim, this condition will be included under the reinstated Severe Trauma Benefit, except where the Optional Total Permanent Disablement condition was the subject of the Severe Trauma Benefit claim.

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In the event of a claim in respect of the reinstated Severe Trauma Benefit, no claim will be paid for:

condition (whether or not a registered medical practitioner has been consulted) that existed before the risk commencement date , unless AIA is satisfied that you or the life assured could not have known of the existence of the condition or symptom or signs leading to the condition , or the condition or symptom or signs leading to the condition were declared on your application and accepted by AIA . AIA will not pay any benefit described in this appendix where any of the following occurs before a life assured (or any child in the case of a Built-in Children’s Trauma Benefit ) reaches age 21, and (in each case either directly or indirectly) causes or contributes to a claim for that life assured (or child ):

Any condition for the subsequent claim that is a related condition to the condition which was the subject of the first Severe Trauma Benefit claim, as determined by AIA . The same condition for which AIA has paid a claim under a Severe Trauma Benefit for the life assured , unless the original claim was for any of the conditions under the category of cancer , in which case: o any subsequent claims under the category of cancer will be excluded if the condition occurs within 36 months immediately following the original claim event date; and



 any intentional act by you or by any parent or guardian of the life assured , or child .

 any intentional act by someone who lives with or supervises the life assured, or child.

following this period the same condition shall include any cancer that is either: − of the same organ system as the original cancer; − considered by the treating oncologist as likely to be a secondary cancer of the original cancer; or

AIA will not pay a benefit under the Built-in Children’s Trauma Benefit that arises as a direct or indirect consequence of:

a pre-existing condition ; or



any congenital condition .



− a related cancer .

These exclusions apply to any subsequent benefit increase you make.

 Any heart (or heart-related) condition if the original claim was for a heart condition or a stroke, except where the claim in respect of the reinstated Severe Trauma Benefit is for pulmonary hypertension, and it has not previously been claimed for and is not considered by an appropriate specialist as likely to be secondary or directly resulting from the original condition .  Stroke, or any condition directly resulting from a stroke, if the original claim was for a heart (or heart- related) condition , except where the original claim was for pulmonary hypertension.

18.

How to make a claim

To make a claim, refer to the section in your AIA Living policy entitled ‘How to make a claim’.

In addition, for a Severe Trauma Benefit claim, AIA will require information acceptable to us, including medical evidence and reports, showing proof of the condition giving rise to the claim. AIA may require the life assured or his or her child (if applicable) to have an examination by a registered medical practitioner appointed by AIA before accepting liability for a claim.

 Any exclusion which applied to the original Severe Trauma Benefit.

Where the Optional Total Permanent Disablement condition is the condition giving rise to the claim, AIA will also require:

17.

Exclusions – when AIA won’t pay a benefit

 An AIA claims form completed by the life assured and a registered medical practitioner (at your expense).

AIA will not pay any benefit described in this appendix where any of the following (and in each case either directly or indirectly) causes or contributes to the claim:  The life assured (or the child in the case of a Built-in Children’s Trauma Benefit ) deliberately injures himself or herself or attempts to do so.  The life assured (or the child in the case of a Built-in Children’s Trauma Benefit ) engages in or is part of any conduct that is criminal.

 Other information which AIA may reasonably request to help assess the claim, which may include evidence of earnings, taxable income, business accounts, ACC details or similar.  The life assured to undergo medical and/or surgical treatment (including any operation or vocational, medical and/or social rehabilitation) at your expense which the life assured ’s registered medical practitioner, or a registered medical practitioner approved by AIA ,

 Any condition or any symptom or signs leading to the

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19.

Definitions of medical conditions

considers necessary.

 Any other information that AIA may deem relevant to the assessment of the claim.

Cancer

The life assured has suffered or undergone one of the following conditions :

For advice about submitting a claim you can phone AIA on 0800 500 108 or your Adviser. Find claim information online at AIA.co.nz

Cancer

 Any metastatic cancer classified as, Stage III (3) based on TNM classification, where all treatment modalities have failed and been exhausted and where no other therapies are available and where progression of the cancer can be identified, or Stage IV (4) based on TNM classification; or  Advanced lymphoma classified as, Ann-Arbor Stage III (3) where all treatment modalities have failed and been exhausted and where no other therapies are available and where progression of the cancer with resultant ongoing and continuous symptomatology can be identified, or Ann-Arbor Stage IV (4) classification; or  Leukaemia where all treatment modalities have failed and been exhausted and where no other therapies are available, where progression of the cancer can be identified, and where there is resultant ongoing and continuous symptomatology; or  Malignant brain tumour classified as Grade III (3) based on the WHO grading system for malignant neuroepithelial tumours of the central nervous system, where all treatment modalities have failed and been exhausted and where no other therapies are available and where progression of the cancer can be identified, or Grade IV (4) based on the WHO grading system for malignant neuroepithelial tumours of the central nervous system; or  Multiple myeloma where all treatment modalities have failed and been exhausted and where no other therapies are available, where progression of the cancer can be identified, and where there is resultant ongoing and continuous symptomatology.

Heart

The life assured has suffered or undergone one of the following conditions :

Cardiomyopathy Cardiomyopathy means impaired ventricular function of variable aetiology, resulting in permanent and irreversible left ventricular ejection fraction of less than 40% (two measurements at least six months apart) whilst on ongoing optimal therapy for a minimum of six months, and significant and irreversible physical impairment to the degree of at least Class III (3) of the New York Heart Association Functional Classification System of cardiac impairment.

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Major neurological disease

Heart attack Heart attack resulting in permanent and irreversible left ventricular ejection fraction of less than 40% (two measurements at least six months apart) whilst on ongoing optimal therapy for a minimum of six months, and significant and irreversible physical impairment to the degree of at least Class III (3) of the New York Heart Association Functional Classification System of cardiac impairment. Heart attack means the death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply to the relevant area, confirmed by a cardiologist or general physician and evidenced by:  Typical rise and/or fall of cardiac biomarkers with at least one value above the 99 th percentile of the upper reference limit;

The life assured has suffered or undergone one of the following conditions :

Alzheimer’s disease The unequivocal diagnosis of Alzheimer's disease, resulting in significant cognitive impairment or permanent irreversible inability to perform two activities of daily living . The diagnosis is confirmed by an appropriate specialist in psychogeriatrics, psychiatry, neurology or geriatrics. Coma Means a state of unconsciousness with no reaction to external stimuli or internal needs which, at the recommendation of an appropriate specialist , results in continuous mechanical ventilation by means of tracheal intubation for at least seven days or the admission to the intensive care ward of a hospital for at least fifteen consecutive days.

and at least one of the following:

 Signs and symptoms of ischaemia which are consistent with myocardial infarction; or  Confirmatory new (or presumed new) ECG changes associated with myocardial infarction with the development of any one of the following:

Coma caused by alcohol or drug abuse is specifically excluded.

ST changes;

−

Creutzfeldt-Jakob disease The diagnosis of Creutzfeldt-Jakob disease confirmed by an appropriate specialist neurologist. The life assured must exhibit signs and symptoms of cerebellar dysfunction, severe progressive dementia, uncontrolled muscle spasm, tremor and athetosis, resulting in the life assured requiring permanent and continual medical supervision. Dementia The unequivocal diagnosis of dementia, resulting in significant cognitive impairment or permanent irreversible inability to perform two activities of daily living . The diagnosis is confirmed by an appropriate specialist in psychogeriatrics, psychiatry, neurology or geriatrics. Encephalitis The unequivocal diagnosis of severe inflammatory disease of the brain diagnosed by an appropriate specialist approved by AIA . The life assured must have also sustained a neurological deficit resulting in total and irreversible inability to perform one of the activities of daily living . Idiopathic Parkinson’s disease The unequivocal diagnosis of Idiopathic Parkinson’s disease as confirmed by an appropriate specialist and resulting in total and irreversible inability of the life assured to perform one of the activities of daily living.

T wave inversion;

−

Left bundle branch block (LBBB);

−

Pathological Q waves; or

−

 Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. A rise in cardiac biomarkers resulting from a percutaneous procedure for coronary artery disease is excluded unless the baseline value is normal and the elevation is greater than five times the 99 th percentile of the upper reference limit. If the above evidence is inconclusive or superseded by technological advances, we will consider other appropriate and medically recognised tests that unequivocally diagnose that a myocardial infarction of the degree of severity or greater as outlined above has occurred. Other acute coronary syndromes including but not limited to angina pectoris are excluded. Primary pulmonary hypertension Primary pulmonary hypertension means the presence of irreversible raised pressure in the pulmonary arteries. The measurement reported must be the average level measured by cardiac catheterisation and be at least 30mmHG (mm of mercury) at rest. There must also be right ventricular dilatation and hypertrophy on echocardiogram with characteristic ECG changes.

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Major head trauma An accidental cerebral injury diagnosed by an appropriate specialist approved by AIA . The life assured must have also sustained a neurological deficit resulting in total and irreversible inability to perform one of the activities of daily living .

Stroke Stroke resulting in total and irreversible inability of the life assured to perform one of the activities of daily living . If required, the assessment may need to be deferred until all rehabilitation has been completed, or until any other appropriate time necessary to determine permanency, at which point a specialist can determine the irreversibility of the condition. Stroke means a cerebrovascular event producing neurological deficit. This requires clear evidence on CT, MRI (Magnetic Resonance Imaging) or similar appropriate scan or investigation that a stroke has occurred. This requires evidence of:

Major head trauma arising from drug and alcohol abuse is specifically excluded.

Meningitis The diagnosis of meningitis by an appropriate specialist approved by AIA . The life assured must have also sustained a neurological deficit resulting in total and irreversible inability to perform one of the activities of daily living .

infarction of brain tissue; or



intracranial or subarachnoid haemorrhage.



Excluded from this definition are transient ischaemic attacks (TIA), cerebral symptoms due to migraine, cerebral injury from trauma or hypoxia and vascular disease affecting the eye, optic nerve or vestibular functions.

Motor neurone disease The unequivocal diagnosis of motor neurone disease diagnosed by an appropriate specialist approved by AIA .

Paralysis and loss of functionality

Multiple sclerosis The unequivocal diagnosis of multiple sclerosis as confirmed by an appropriate specialist and resulting in total and irreversible inability of the life assured to perform at least one of the activities of daily living .

The life assured has suffered or undergone one of the following conditions :

Diplegia Total and permanent loss of function of both arms or both legs due to injury or disease of the spinal cord.

Multiple sclerosis means a disease characterised by demyelination in the brain and/or spinal cord.

Hemiplegia Total and permanent loss of function of one side of the body due to brain injury or disease.

There must be more than one episode of well-defined neurological deficit with persisting neurological abnormalities. Neurological investigations such as lumbar puncture, MRI (Magnetic Resonance Imaging) evidence of lesions in the central nervous system, evoked visual responses, and evoked auditory responses are required to confirm diagnosis. Muscular dystrophy The unequivocal diagnosis of muscular dystrophy diagnosed by an appropriate specialist approved by AIA and resulting in total and irreversible inability of the life assured to perform at least one of the activities of daily living. Peripheral neuropathy Irreversible inflammation or degradation of a peripheral nerve, diagnosed by an appropriate specialist approved by AIA . The life assured must have also sustained a neurological deficit resulting in total and irreversible inability to perform one of the activities of daily living .

Loss of independent existence The life assured is totally and irreversibly disabled, with the effect that he or she is unable, as a result of sickness or injury, to perform at least two activities of daily living . Alternatively, the life assured is totally and irreversibly unable to perform one of the activities of daily living and his or her intellectual capacity has reduced or deteriorated to such an extent that the life assured requires full-time care .

Paraplegia Total and permanent loss of function of both legs due to injury or disease of the spinal cord.

Permanent blindness Irrecoverable loss of sight of both eyes as a result of sickness or injury. This is evidenced by:  visual acuity on the Snellan Scale after correction by suitable lenses is less than 6/60 in both eyes;  field of vision is reduced to 20 degrees or less of arc in the better eye; or

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