When AIA has paid the equivalent of the sum assured of the Life Cover Benefit, your cover under this benefit will change from accelerated to standalone. This will require you to pay an increased premium . This increase will be calculated on the rates applicable at the time to the standalone Progressive Care Benefit.
5. The balance of the sum assured available for future claims under the category that the claim is paid under is then calculated as the sum assured minus the amount paid for the first claim.
b) Subsequent claims
Any claim made for a life assured after the first claim paid to you under this appendix for that life assured is a subsequent claim. AIA will determine whether or not the condition relied upon for a subsequent claim is a related condition to a previous Progressive Care Benefit claim for that life assured . The way subsequent claims are determined depends upon the length of time that has passed since the previous claim event date and whether the condition claimed for is a related condition or not. More than 12 months after previous claim event date or related condition If the subsequent claim's claim event date is more than 12 months after the preceding claim's claim event date or if the subsequent claim is for a related condition , then AIA determines the amount to be paid for the subsequent claim as follows:
5. The severity level
The lump sum amount that AIA will pay at claim time will depend on the severity level of the life assured's condition and your sum assured/balance of the sum assured you have available under the applicable category . The severity level of the life assured's condition determines the percentage of the sum assured that is used to determine the lump sum benefit that AIA will pay you . The percentage of the sum assured for each severity level is shown below.
Severity Level
Percentage
1 (most severe)
100%
2
75%
3
50%
4
25%
1. AIA determines if the life assured has suffered the condition .
5 (least severe)
10%
2. AIA identifies the category that the condition falls under i.e. Cancer , Heart and Arteries, Brain and Nerves, Loss of Function or Other Health Events. A subsequent claim can be made in the same category or a different category to the previous claim.
The severity level of a condition is stated in the Schedule of Categories for the category the condition comes within.
Some of the conditions do not have all five severity levels.
6. The amount of cover
3. AIA determines the severity level percentage that applies for the condition :
The sum assured is the maximum amount of cover you have for each category. After the first claim is paid under a category , the balance of the sum assured is the maximum amount AIA will pay you for any subsequent claim under that category . Once the balance of the sum assured is exhausted for a category , no further claims will be paid under that category .
(a) For a condition that is not a related condition, the severity level percentage is then multiplied by the sum assured . This will be the amount paid for the subsequent claim, unless the balance of the sum assured for the category that the condition falls under is less, in which case the balance of the sum assured for the category will be the amount paid for the subsequent claim. (b) For a related condition , the severity level percentage of the related condition must be higher than the severity level percentage of the previous condition that it relates to. The amount by which the severity level percentage increases from the previous severity level percentage is then multiplied by the sum assured . This will be the amount paid for the subsequent claim, unless the balance of the sum assured for the category is less, in which case the balance of the sum assured for the category will be the amount paid for the subsequent claim. For the avoidance of doubt, you cannot claim more than the sum assured in total for the life assured’s first claim and all subsequent related claims to that first claim.
a) First claim
The amount paid for the first claim for a life assured under this appendix is determined by AIA as follows:
1. AIA determines if the life assured has suffered the condition .
2. AIA identifies which category the condition falls under i.e. Cancer , Heart and Arteries, Brain and Nerves, Loss of Function or Other Health Events.
3. AIA determines the severity level percentage that applies to the condition .
4. The severity level percentage is then multiplied by the sum assured . This is the amount paid for the first claim.
1156 ALB-PC version 7 Effective 12 May 2026
Page 5 of 31
Powered by FlippingBook