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.
on 2 or more occasions; or thrombocytopenia – less than 100,000mm3 in the absence of offending drugs. Immunologic disorder: Positive LE cell preparation; or anti-DNA: antibody to native DNA in abnormal titre; or anti-Sm: presence of antibody to Sm (Smooth Muscle) nuclear antigen; or false positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilisation or fluorescent treponemal antibody absorption test. Antinuclear antibody: An abnormal titre of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs known to be associated with ‘drug-induced lupus' syndrome. Alopecia: Diffuse thinning and fragility of the hair in the absence of other causes (such as alopecia areata, drugs, iron deficiency and androgenic alopecia). In addition to the diagnosis of systemic lupus erythematosus, lupus nephritis must be confirmed by renal changes as measured by a renal biopsy that it is grade 3 to 5 of the WHO (World Health Organisation) classification of lupus nephritis and be associated with persisting proteinuria (more than 2+). Systemic Sclerosis The life assured has been unequivocally diagnosed by an appropriate specialist with systemic sclerosis, causing the life assured to be totally and irreversibly unable to perform any one of the activities of daily living without assistance of another adult person.
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.
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
Terminal illness
The life assured has been diagnosed as having an illness where in AIA’s opinion despite all reasonable medical treatment they are expected to live for no more than 12 months. The registered medical practitioner treating the illness must provide supporting evidence of the illness, possible medical treatment, the prognosis and confirm that the definition of Terminal Illness has been met. The claim payment will be paid if the life assured is alive 14 days following the medical certification. The Terminal Illness Benefit will be treated as an early payment of the Critical Conditions Benefit. The Critical Conditions Benefit will then be reduced by any amount paid by the Terminal Illness Benefit. This Benefit is only available if the words standalone Critical Conditions Benefit appears in the schedule . Death of the life assured as a result of accident is not covered under the Terminal Illness Benefit.
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: an average hearing threshold in both ears, whether aided or unaided, of 91db or greater as measured at 500, 1000 and 1500 Hz; or
23.
Definitions of conditions for the Built-in Newborn Children’s Benefit
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.
the recommendation for the insertion of a cochlear ear implant.
1105 AL-CC version 8 Effective 12 May 2026
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