AIA Living Personal Critical Conditions Policy Wording

1105 AL-CC version 7 Effective 21 May 2025

AIA LIVING - PERSONAL OPTIONAL BENEFIT APPENDIX

Critical Conditions Benefit

This appendix only applies if cover under the schedule for your policy includes the Critical Conditions Benefit. This appendix forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix .

This Critical Conditions 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 Critical Conditions Benefit?

AIA will pay you a Critical Conditions 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 or the Optional Children’s and Maternity Benefit.

Cover added under the Critical Conditions Future Insurability Benefit or the Special Events Increase Facility

A 180 day stand down period applies to increases made under the Built-in Critical Conditions Future Insurability Benefit or the Built-in Special Events Increase Facility, except where the claim is due to an accident , as outlined in Sections 9 and 10. 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 Critical Conditions Benefit policy.

Cover added under the Special Events TPD/Trauma Facility

A 180 day stand down period applies to any accelerated Critical Conditions 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.

Built-in Newborn Children’s Benefit

A 12 month stand down period applies to the Built-in Newborn Children’s Benefit, meaning that AIA will only pay a claim for a child of a life assured, where the life assured is the biological parent, if birth of the child with one of the applicable conditions occurs at least 12 months after the risk commencement date . This 12 month stand down period applies anew to all added cover from the date the added cover commences, including cover added using the Critical Conditions Future Insurability Benefit, the Special Events Increase Facility, or the Special Events TPD/Trauma Facility under the Life Cover Benefit.

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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Built-in Children’s Trauma Benefit (Section 4)

Optional Children’s and Maternity Benefit (Section 17)

90 day stand down period

Full payment

Partial Payment

Cancer

Carcinoma-in-situ

✓

Carcinoma-in-situ radical surgery Malignant tumours and blood cancers

✓

Prostate Cancer

✓

Heart Angioplasty – less than 3 vessels Angioplasty – 3 vessels or more

✓

Aortic surgery

✓

Cardiac Defibrillator Insertion

✓

Cardiomyopathy

✓

Coronary artery bypass surgery

✓

Heart attack

✓

Heart valve surgery

✓

(partial payment unavailable)

Out-of-hospital cardiac arrest

✓

Pacemaker insertion

✓

Pulmonary hypertension

✓

Major neurological disease

Alzheimer’s disease

✓

Benign brain or spinal cord tumour

✓

(partial payment unavailable)

Cerebral Aneurysm

✓

Coma

✓

Creutzfeldt-Jakob disease

✓

Dementia

✓

(partial payment unavailable)

✓

Encephalitis

✓

(partial payment unavailable)

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Built-in Children’s Trauma Benefit (Section 4)

Optional Children’s and Maternity Benefit (Section 17)

90 day stand down period

Full payment

Partial Payment

Idiopathic Parkinson’s disease

✓

Major head trauma

✓

Meningitis

✓

Motor neurone disease

✓

Multiple sclerosis

✓

Muscular dystrophy

✓

Peripheral neuropathy

✓

Stroke

✓

Paralysis and loss of functionality

Diplegia

✓

Hemiplegia

✓

Loss of independent existence

✓

Paraplegia

✓

Permanent blindness

✓

(partial payment unavailable)

✓

Permanent loss of hearing

✓

(partial payment unavailable)

Permanent loss of speech

✓

Permanent loss of use of limbs

✓

(partial payment unavailable)

Quadriplegia / Tetraplegia

✓

Other key conditions

✓

Advanced AIDS

Advanced diabetes

✓

Aplastic anaemia

✓

Chronic liver failure

✓

(partial payment unavailable)

Chronic lung disease

✓

Chronic renal failure

✓

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Built-in Children’s Trauma Benefit (Section 4)

Optional Children’s and Maternity Benefit (Section 17)

90 day stand down period

Full payment

Partial Payment

Cognitive impairment

✓

Intensive care

✓

(partial payment unavailable)

Major transplant surgery

✓

Pneumonectomy

✓

Severe burns

✓

(partial payment unavailable)

Severe Crohn’s disease Severe illness or injury

✓

Severe osteoporosis

✓

Severe rheumatoid arthritis Severe ulcerative colitis Systemic lupus erythematosus with lupus nephritis

✓

Systemic sclerosis

✓

Terminal illness

✓

Optional condition

Total Permanent Disablement

✓

(Refer to Section 22 for a full description of these conditions .)

If you receive a full payment claim for a life assured under this Critical Conditions Benefit, cover will cease for that life assured .

If you receive a partial payment of this Critical Conditions Benefit for a life assured , cover will continue for that life assured with the sum assured being reduced by the amount of the partial payment amount. The premium will reduce with the reduction in sum assured.

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

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

What effect does payment of an accelerated Critical Conditions Benefit have on the Life Cover Benefit?

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

This section applies only if an accelerated Critical Conditions Benefit is shown in the schedule .

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

When AIA pays an accelerated Critical Conditions 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 Critical Conditions Benefit and, if applicable, the accelerated Progressive Care Benefit, the accelerated Severe Trauma Benefit and the accelerated Total Permanent Disablement Benefit is the amount of the Life Cover Benefit for that life assured .

For those conditions where the criteria for a full payment are met as detailed in Section 22 below, the Benefit payable is the lower of $50,000 or 50% of the sum assured across all Critical Conditions Benefit policies for the life assured . No payments are made under this Benefit for the Optional Total Permanent Disablement condition or any of those conditions where a partial payment applies, except for the following conditions :

Angioplasty – less than 3 vessels;



Carcinoma-in-situ.



For these conditions , the Benefit payable is the lower of $50,000 or 10% of the sum assured across all Critical Conditions Benefit policies for the life assured . AIA will pay a maximum of one claim per child under either the Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit, across all AIA policies . The Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit is payable in addition to the Optional Children’s and Maternity Benefit (if applicable). Payment of the Built-in Children’s Trauma Benefit will not affect the amount of any Critical Conditions 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:

Built-in Financial and Legal Advice Benefit

If AIA pays a full payment claim under this Critical Conditions Benefit for a condition suffered by a life assured , then AIA will reimburse you for fees incurred 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 12 months following AIA paying the Critical Conditions Benefit claim.  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, the Built-in Parents Grieving Benefit, the Optional Children’s and Maternity Benefit or the Built-in Newborn Children’s Benefit.

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 Newborn Children’s Benefit

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

Built-in Children’s Trauma Benefit

AIA will pay a Built-in Newborn Children’s Benefit if a child of a life assured, where the life assured is the biological parent, is born with one of the following conditions and survives for thirty days after birth:

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 .

Cleft palate.



Down’s syndrome.



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

Spina bifida.



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

Total blindness.



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Built-in Children’s Trauma Conversion Facility

Absence of one or more limbs .



Tetralogy of Fallot.



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

Transposition of Great Vessels.



 a standalone Critical Conditions Benefit; or

Deafness.



 an accelerated Critical Conditions Benefit with an equal amount of Life Cover benefit,

Please refer to Section 23 for the definitions of these conditions .

with a maximum sum assured of $50,000 or 50% of the life assured’s original sum assured whichever is the lesser, without further medical evidence. Where the life assured’s sum assured has reduced the conversion will be calculated on the reduced amount. If the Optional Children’s and Maternity Benefit is shown on the schedule , it can also be converted to a standalone Critical Conditions Benefit or an accelerated Critical Conditions Benefit with an equal amount of Life Cover benefit with a maximum sum assured of $75,000 without further medical evidence.

In order for AIA to pay a claim under this Benefit, we will require medical information from a registered medical practitioner acceptable to us that conclusively evidences the condition . In circumstances where a conclusive diagnosis cannot be made at birth, we will defer our assessment of the claim until sufficient evidence can be supplied. For example, this might apply in the case of total blindness or deafness, where a conclusive diagnosis may not be possible until later in the child’s life. In these cases, the claims assessment will be based on the child’s sight or hearing impairment at the date that conclusive diagnosis is first possible. A claim is only payable under the Built-in Newborn Children’s Benefit if cover remains in effect for the life assured up to the date that the conclusive diagnosis for the child occurs.

The following conditions are applicable to both Children’s Trauma Conversion options:

 A conversion cannot occur if the child has claimed or was eligible to claim under the Built-in Children’s Trauma Benefit and/or Optional Children’s and Maternity 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

How much will AIA pay?

The Benefit payable is the lower of $50,000 or 50% of the sum assured across all Critical Conditions Benefit policies for the life assured . AIA will pay a maximum of one claim per child under either the Built-in Newborn Children’s Benefit or the Built-in Children’s Trauma Benefit, across all AIA policies . The Built-in Newborn Children’s Benefit is only payable where the birth of the child with one of the applicable conditions occurs at least 12 months after the risk commencement date . This requirement applies anew to all added cover from the date the cover commences; including cover added using the Built-in Critical Conditions Future Insurability Benefit, the Special Events Increase Facility, or the Special Events TPD/Trauma Facility under the Life Cover Benefit. The Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit is payable in addition to the Optional Children’s and Maternity Benefit (if applicable). Payment of the Built-in Newborn Children’s Benefit will not affect the amount of any Critical Conditions Benefit payable for the life assured .

Your request must be received in writing.



An applicable premium will be payable on converted cover.

Built-in Standalone Conversion Facility

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

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 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 Critical Conditions Benefit. This includes any claim currently under assessment;

 The premiums for their standalone Critical Conditions Benefit are paid up to date;

 The accelerated Critical Conditions Benefit sum assured

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Built-in Special Events Increase Facility

must be less than or equal to the standalone Critical Conditions sum assured; and

What is the Special Events Increase Facility?

 The Life Benefit Cover sum assured does not exceed the accelerated Critical Conditions sum assured.

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

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 Critical Conditions 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 Critical Conditions Benefit will be reinstated from the date of conversion.

having a child (by birth or legal adoption);



 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 ;

Built-in Premium Conversion Facility

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

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

 Convert all or part of your Critical Conditions 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.

 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 Critical Conditions Benefit for that life assured .

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

What is the maximum cover that can be added?

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

The maximum increase for each special event cannot exceed the lower of:

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

 50% of the original Critical Conditions Benefit for the life assured ; or

$250,000.



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

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

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

$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, Progressive Care Benefits, Severe Trauma Benefits, and similar benefits for that life assured across all AIA policies .

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

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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, Progressive Care Benefits, Severe Trauma 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.

Any loadings, exclusions or special terms on the original Critical Conditions Benefit sum assured will be applied to the increased amount. If you have the Optional Critical Conditions Buyback Benefit or the Optional Life Cover Buyback Benefit selected on the policy for your original Critical Conditions 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

What are the other conditions applying to this Facility?

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 :

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:  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.

 suffers any condition for the first time other than due to an accident under the Critical Conditions 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 Critical Conditions Benefit.

Increases in sum assured issued as an additional new policy

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 Critical Conditions 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 Critical Conditions Benefit.

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

− A Critical Conditions Future Insurability Benefit increase (see Section 10 below).

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

−

 The Optional Early Cancer Upgrade Benefit is not available for the purposes of determining Special Event Increases.

10.

Built-in Critical Conditions Future Insurability Benefit

At every third policy anniversary date you may write to AIA asking us to increase the Critical Conditions 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:

AIA will increase the Critical Conditions 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.

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 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 Critical Conditions Future Insurability Benefit is not available.  Each individual increase cannot exceed 20% of the original Critical Conditions Benefit sum assured or $200,000, whichever is the lesser.  The total of all Critical Conditions Future Insurability Benefit increases for a life assured cannot exceed 100% of the original Critical Conditions 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, Progressive Care Benefits, Severe Trauma Benefits, and similar trauma benefits (combined), including increases under this Benefit must not exceed $2,000,000; and 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

Conditions Benefit, an accelerated Progressive Care Benefit, or Severe Trauma Benefit.

 The Optional Early Cancer Upgrade Benefit is not available for the purposes of determining Built-in Critical Conditions Future Insurability Benefit increases.

Each Built-in Critical Conditions 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 Critical Conditions Future Insurability Benefit is exercised. Any loadings, exclusions or special terms on the original Critical Conditions Benefit sum assured will be applied to the increased amount. The Built-in Critical Conditions Future Insurability Benefit is not available for the Optional Early Cancer Upgrade Benefit or the Optional Children’s and Maternity Benefit. If you have the Optional Critical Conditions Buyback Benefit or the Optional Life Cover Buyback Benefit selected on the policy for your original Critical Conditions Benefit, you can choose to add these benefits to the portion of the increased sum assured when you exercise the Built-in Critical Conditions Future Insurability Benefit.

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

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

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

Increases in sum assured added to this policy

After a Built-in Critical Conditions 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 :

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

 AIA will increase the Critical Conditions 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.

Increases in sum assured issued as an additional new policy

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 Critical Conditions Future Insurability Benefit, then the Built-in Critical Conditions Future Insurability Benefit under this policy will not be available for the proportion of the sum assured that represents the increase.

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

− A Built-in Critical Conditions Future Insurability Benefit increase;

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

−

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 Critical Conditions 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 Critical Conditions Benefit.

support treatments and/or consultations directly relate to a claim under the Critical Conditions 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 12 months following AIA paying the Critical Conditions Benefit; and

11.

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 Critical Conditions 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.

14.

Built-in Suspension of Cover Benefit

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

go on parental leave;



go on leave without pay for any reason;



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

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

12.

Built-in Parents Grieving Benefit

When is a Parents Grieving Benefit payable?

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



AIA will pay a Parents Grieving Benefit if:

 a child of a life assured dies prior to birth but after at least 24 weeks gestation; or

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

a child of a life assured dies .



AIA will not make any payment if the death occurs within 12 months of the risk commencement date except where it is an accidental death .

 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 acknowledgement.

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

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

How much will AIA pay for the Parents Grieving Benefit?

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.

The benefit payable:

 if the child is under 10 years of age AIA will pay a maximum of one claim of $2,000 per child under the Parents Grieving Benefit across all AIA policies ; or  if the child is 10 years of age or over AIA will pay a maximum of one claim of $15,000 per child across all AIA policies for a life assured . Payment of the Parents Grieving Benefit will not reduce the sum assured of the Critical Conditions Benefit for the life assured .

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

13.

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

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

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

payment claim.

Payment of the Optional Early Cancer Upgrade Benefit may be in addition to any other payments made under this policy.

15.

Optional Early Cancer Upgrade Benefit

Payment of the Optional Early Cancer Upgrade Benefit will not reduce the Critical Conditions Benefit sum assured.

The Early Cancer Upgrade Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Early Cancer Upgrade Benefit. AIA will pay an Optional Early Cancer Upgrade Benefit (subject to the provisions of this policy) if the life assured suffers for the first time one of the cancer conditions listed below, after the date cover commences under the Optional Early Cancer Upgrade Benefit. AIA will not pay an Optional Early Cancer Upgrade Benefit if the life assured suffers the cancer condition or has any symptoms or signs leading to the cancer condition (whether or not a registered medical practitioner has been consulted) within 90 days after the date cover commences under the Optional Early Cancer Upgrade Benefit. The Optional Early Cancer Upgrade Benefit does not apply to children of the life assured covered under the Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit. Only one claim per life assured can be made under the Optional Early Cancer Upgrade Benefit. The Optional Early Cancer Upgrade Benefit will cease once a claim is paid and your premiums will reduce accordingly. If at claim time, the life assured does not have a base Critical Conditions Benefit, no Optional Early Cancer Upgrade Benefit will be payable and any premiums paid for the Optional Early Cancer Upgrade Benefit after the base Critical Conditions Benefit has been cancelled will be refunded to the policy owner . The life assured’s Optional Early Cancer Upgrade Benefit sum assured under this policy is shown in the schedule and is subject to the following maximums: a. 25% of the Critical Conditions Benefit sum assured at the date cover under the Optional Early Cancer Upgrade Benefit first commences for the life assured ; and

The Optional Early Cancer Upgrade Benefit covers carcinoma-in-situ of the following sites and is defined as a focal autonomous new growth of carcinomatous cells which has not yet resulted in the invasion of normal tissue. ‘Invasion’ means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The carcinoma-in-situ must be positively diagnosed by biopsy and be classified as TIS according to the TNM staging method or FIGO Stage 0:

Breast.



Cervix.



Vagina.



Vulva.



Ovary.



 Fallopian tube: tumour limited to tubal mucosa.

The Optional Early Cancer Upgrade Benefit also covers the following cancers:

 Chronic lymphocytic leukaemia: where there must be the presence of chronic lymphocytic leukaemia which is histologically described as at least RAI Stage 0.  Malignant melanoma which is determined by histological examination to be less than Clark Level 3 depth of invasion, and less than 1.0mm maximum thickness as measured using the Breslow method, and shows no evidence of ulceration.  Malignant tumour of the prostate histologically described as TNM classification T1 or has a Gleason score of 5 or less for which treatment is not considered medically necessary , and undertaken by an appropriate specialist to arrest the spread of malignancy including but not limited to prostatectomy, chemotherapy, radiotherapy, or surgery. The Optional Early Cancer Upgrade Benefit will cease when cover under the Critical Conditions Benefit ceases. Where the life assured has the Optional Critical Conditions Buyback Benefit, the Optional Early Cancer Upgrade Benefit can be reinstated in addition to their Critical Conditions Buyback Benefit, subject to the life assured satisfying the terms of the Optional Critical Conditions Buyback Benefit. The Optional Critical Conditions Buyback Benefit cannot be used to reinstate the Optional Early Cancer Upgrade Benefit following a claim payment under the Optional Early Cancer Upgrade Benefit.

b. $75,000 per life assured across all AIA policies .

The sum assured amount is calculated when cover under the Optional Early Cancer Upgrade Benefit first commences for the life assured under this policy and does not change with any subsequent changes that increase or decrease the life assured’s Critical Conditions Benefit sum assured, such as:  annual indexation increases after the date cover commences under the Optional Early Cancer Upgrade Benefit;

 cover added using the Special Events Increase Facility or the Special Events TPD/Trauma Facility;

 Critical Conditions Future Insurability Benefit increases; or

 reductions in the Critical Conditions Benefit sum assured due to voluntary reduction or due to a partial

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16.

Optional Total Permanent Disablement condition

For those conditions where the criteria for a full payment are met as detailed in Section 22 below, the Benefit payable is the lower of $75,000 or 50% of the Critical Conditions Benefit sum assured. No payments are made under this Benefit for the Optional Total Permanent Disablement condition or any of the conditions where a partial payment applies, except for the following conditions :

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 full payment condition under the Critical Conditions Benefit. The Optional Total Permanent Disablement condition does not apply to any child of a life assured covered under the Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit.

Angioplasty – less than 3 vessels.



Carcinoma-in-situ.



For these conditions , the Benefit payable is the lower of $75,000 or 10% of the Critical Conditions Benefit sum assured. Before cover for a child can commence under the Children’s Critical Conditions Benefit, you must advise us in writing of the child’s name, date of birth and gender. Cover for a child will only commence once we have confirmation of the child’s details in writing.

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

17.

Optional Children’s and Maternity Benefit

The Children’s and Maternity Benefit is available as an option once the life assured reaches age 16. The schedule will specify if you have chosen the Optional Children’s and Maternity Benefit. The Benefit is payable in addition to any Benefit payable under the Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit.

Pregnancy Complications Benefit

When is a Pregnancy Complications Benefit payable?

This Benefit is payable if a life assured for the Critical Conditions Benefit suffers for the first time and at least 12 months after the risk commencement date one of the defined pregnancy complication conditions . AIA will not pay this benefit if the life assured suffers the condition or has any symptom or signs leading to the condition (whether or not a registered medical practitioner has been consulted) within 12 months after the risk commencement date .

Children’s Critical Conditions Benefit

What is the Children’s Critical Conditions Benefit?

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

What pregnancy complication conditions are covered?

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

first suffers a condition after the risk commencement date , subject to the 90 day 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



Disseminated intravascular coagulation.



Eclampsia.



Hydatidiform mole.



See Section 24 for a full description of these conditions.

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



How much will AIA pay for the Pregnancy Complications Benefit?

AIA will pay a maximum of one claim for a child under the Children’s Critical Conditions Benefit across all AIA policies for a life assured . In cases where two policies each name a distinct parent of the child as a life assured , both policies are eligible to claim under the Children’s Critical Conditions Benefit for that child , provided the Optional Children’s and Maternity Benefit is shown in the schedule of both policies.

The Benefit payable is $10,000.

Payment of the Pregnancy Complications Benefit will not reduce the Critical Conditions Benefit.

Children’s Congenital Conditions Benefit

When is the Children’s Congenital Conditions Benefit payable?

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

This Benefit is payable if at least 12 months after the

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18.

Optional Life Cover Buyback Benefit

risk commencement date a child of a life assured is unequivocally diagnosed by an appropriate specialist and undergoes treatment or therapy for one of the congenital conditions listed below.

What is the Optional Life Cover Buyback Benefit?

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 Critical Conditions 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 Critical Conditions Benefit claim, subject to the following conditions:  The Life Cover Benefit can be reinstated to the level applying immediately before the accelerated Critical Conditions Benefit claim.

What congenital conditions are covered?

Coarctation of the Aorta.



Infantile Hydrocephalus.



Anal atresia.



Oesophageal atresia.



Congenital diaphragmatic hernia.



Tracheo-oesophageal fistula.



Truncus arteriosis.



Retinopathy of prematurity.



How much will AIA pay for the Children’s Congenital Conditions Benefit?

 The Optional Life Cover Buyback Benefit can be exercised:

The Benefit payable is $5,000, regardless of the number of congenital conditions diagnosed. AIA will pay a maximum of one claim for a child under the Children’s Congenital Conditions Benefit across all AIA policies for a life assured . In cases where two policies each name a distinct parent of the child as a life assured , both policies are eligible to claim under the Children’s Congenital Conditions Benefit for that child , provided the Optional Children’s and Maternity Benefit is shown in the schedule of both policies.

− within 60 days of the accelerated Critical Conditions Benefit claim payment; or

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

Paraplegia;

•

Quadriplegia;

•

Payment of the Children’s Congenital Conditions Benefit will not reduce the Critical Conditions Benefit.

Diplegia;

•

Hemiplegia;

•

When will AIA not pay a claim under the Optional Children’s and Maternity Benefit? AIA will not pay a benefit under the Optional Children’s and Maternity Benefit that arises as a direct or indirect consequence of:

Alzheimer’s disease;

•

Permanent blindness;

•

Permanent loss of hearing;

•

a pre-existing condition ; or



Dementia;

•

 any congenital condition , except where expressly covered under the Children’s Congenital Conditions Benefit.

Permanent loss of use of limbs;

•

Multiple sclerosis;

•

The Optional Children’s and Maternity Benefit will cease if cover under the Critical Conditions Benefit ceases.

Idiopathic Parkinson’s disease; or

•

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

Where the life assured has the Optional Critical Conditions Buyback Benefit, the Optional Children’s and Maternity Benefit can be reinstated in addition to their Critical Conditions Benefit, subject to the life assured satisfying the terms of the Optional Critical Conditions Buyback Benefit.

 The Life Cover Benefit can be reinstated following a full payment claim or a partial payment claim.

The Optional Children’s and Maternity Benefit ceases on the child’s 21 st birthday.

 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 Critical Conditions Benefit

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