21. Definitions of conditions for the Built-in Newborn Children’s Benefit
an average hearing threshold in both ears, whether aided or unaided, of 91db or greater as measured at 500, 1000 and 1500 Hz: or
the recommendation for the insertion of a cochlear ear implant.
Cleft palate A fissure of the palate at birth associated with possible separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip.
22. Definitions of conditions for the Optional Children’s and Maternity Benefit
The benefit will only be paid for those cases with cleft palate, or cleft lip and palate. No benefit is payable for cleft lip alone.
Pregnancy Complications Benefit conditions
Down’s syndrome A genetic disorder caused by trisomy of chromosome 21. Diagnosis must be confirmed through a confirmatory blood test evidencing the disorder. Spina bifida Congenital defective closure of the bone encasement of the Spinal cord through which the cord and meninges may or may not protrude. Only Spina Bifida associated with a meningeal cyst (meningocele) or a cyst containing both meninges and spinal cord (meningomyelocele) or only spinal cord (myelocele) shall be covered.
Disseminated intravascular coagulation (DIC) Over activation of the coagulation and fibrinolytic system resulting in microvascular thrombosis and consumption of platelets and coagulation factors. DIC complicating pregnancy may follow any major haemorrhage, pre-eclampsia, amniotic fluid embolism, endotoxic shock, and when foetal death occurs after 20 weeks. Eclampsia The occurrence of grand mal seizures in the presence of hypertension, proteinuria and oedema complicating a pregnancy, and not being due to other causes such as epilepsy. Hydatidiform mole Development of multiple fluid filled cysts in the uterus after the degeneration of the placenta which results in the death of the embryo as confirmed by a registered medical practitioner .
Total blindness Visual impairment in both eyes (whether aided or unaided and whether reversible or irreversible) evidenced by:
visual acuity of 6/36 or less in both eyes;
field of vision reduced to 10 degrees or less of arc in the better eye;
a combination of visual defects resulting in the same degree of visual impairment as either of the points above; or other evidence from a registered medical practitioner or specialist acceptable to AIA that confirms that the above requirements are likely to be satisfied. Tetralogy of Fallot A congenital anatomical abnormality of the heart with severe or total right ventricular outflow tract obstruction and a ventricular septal defect. The diagnosis must be confirmed
by an appropriate specialist and supported by an echocardiogram and must require surgical repair.
Transposition of Great Vessels The complete transposition of the aorta and pulmonary artery. The diagnosis must be confirmed by an appropriate specialist and supported by an echocardiogram and must require surgical repair. Deafness Congenital hearing impairment in both ears, identified during newborn hearing screening and confirmed by an appropriate specialist as resulting in:
1155 ALB-CC version 8 Effective 12 May 2026
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