Severity Level
Conditions
Severe illness or injury means the life assured suffers a medical condition that does not satisfy any condition leading to a claim under this policy and it is deemed medically necessary to:
– undergo major invasive surgery ; or
– be treated using major interventional treatment ;
which results in: – a stay in an intensive care unit for a period greater than 48 continuous hours; or
– a stay in a high dependency unit for a period greater than 96 continuous hours;
and the life assured is unable to perform at least one basic activity of daily living for a continuous period of 90 days from first being admitted into the intensive care unit or high dependency unit (as applicable) as certified by a registered medical specialist . A medical condition arising from alcohol or drug abuse or other self-inflicted means is specifically excluded.
This benefit does not apply to any condition specifically excluded in this policy or where an underwriting exclusion has been applied.
Stage 4 Chronic Obstructive Pulmonary Disease (COPD) means a disease of the airways of the lung causing obstruction to the exhalation of air. There must be permanent and irreversible reduction of the maximum volume of air expelled in one second (FEV1) of 30% or less of predicted. There must be permanent and irreversible obstruction to airflow demonstrated by a FEV1/ FVC ratio of less than 50% and there must be less than 5% variation in three repeated measurements, (which must be performed under the direction of a specialist respiratory physician) whilst on optimal therapy. They must be measured in a respiratory laboratory, which has regular quality control audits available to AIA . These measurements must be repeated after an interval of at least three months and must also satisfy the criteria mentioned above for a claim to be considered. Major organ transplant (or Transplant waiting list) means the life assured has undergone, or been placed on the major organ transplant waiting list in New Zealand or Australia for, a transplant from a human donor of one or more of the following organs or substances:
– Kidney
2
– Heart
– Lung
– Liver
– Pancreas
– Intestine
The transplant of all other organs or parts of any organ or any other tissue or stem cell transplant is excluded.
The transplant must be considered medically necessary and the condition affecting the organ deemed untreatable by any means other than organ transplant, as confirmed by a relevant medical specialist.
Acute renal dialysis means undergoing more than two treatments of haemodialysis over a three week period or a cumulative total of more than 24 hours haemofiltration due to a rapid decline of renal function leading to renal failure. Stage 3 Chronic Obstructive Pulmonary Disease (COPD) means a disease of the airways of the lung causing obstruction to the exhalation of air. There must be permanent and irreversible reduction of the maximum volume of air expelled in one second (FEV1) of between 31% and 49% of predicted. There must be permanent and irreversible obstruction to airflow demonstrated by a FEV1/ FVC ratio of less than 50% and there must be less than 5% variation in three repeated measurements, (which must be performed under the direction of a specialist respiratory physician) whilst on optimal therapy. They must be measured in a respiratory laboratory, which has regular quality control audits available to AIA . These measurements must be repeated after an interval of at least three months and must also satisfy the criteria mentioned above for a claim to be considered.
3
Removal of large bowel means that the life assured has undergone a surgical procedure to remove the entire large bowel.
Page 29 of 33
1106 AL-PC version 7 Effective 12 May 2026
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