Severity Level
Conditions
Pneumonectomy means the undergoing of surgery to remove an entire lung. The treatment must be considered medically necessary by a relevant medical specialist . Systemic sclerosis means an unequivocal diagnosis of systemic sclerosis by a relevant medical specialist , 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. Systemic lupus erythematosus with lupus nephritis means that the life assured has been unequivocally diagnosed by a relevant medical specialist with systemic lupus erythematosus with lupus nephritis in the clinical setting, evidenced by the presence of any four or more of the following twelve criteria: – Malar rash: Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds. – Discoid rash: Erythematosus, raised patches with adherent kerotic scaling and follicular plugging, atrophic scarring may occur in older lesions. – Photosensitivity: Skin rash as a result of unusual reaction to sunlight, evidenced by patient history or specialist’s report.
– Oral ulcers: Oral or nasopharyngeal ulceration reported by physician.
– Arthritis: Non-erosive arthritis involving two or more peripheral joints, characterised by tenderness, swelling, or effusion. – Serositis: Pleuritis - convincing history of pleuritic pain or pleuritic rub heard by a physician or evidence of pleural effusion; or pericarditis - documented by ECG or rub or evidence of pericardial effusion. – Renal disorder: Persistent proteinuria greater than 0.5 grams per day; or greater than 2+ if quantitation not performed; or tubular casts - may be red cell, haemoglobin, granular, cellular or mixed. – Neurological disorder: Seizures - in the absence of offending drugs or known metabolic derangements, e.g. uraemia, ketoacidosis; or electrolyte imbalance. – Hematologic disorder: Hemolytic anaemia - with reticulocytosis; or leucopoenia - less than 3,500/mm3 on two (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 six (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 World Health Organisation (WHO) classification of lupus nephritis and be associated with persisting proteinuria (more than 2+).
Severe ulcerative colitis means diagnosis of ulcerative colitis that requires permanent immunosuppressive medication.
Severe Crohn’s disease means diagnosis of Crohn’s disease that requires permanent immunosuppressive medication. Severe osteoporosis means that the life assured before the age of 50 has been unequivocally diagnosed by an appropriate specialist as suffering from severe osteoporosis. The diagnosis must confirm that the life assured :
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– Suffers at least two vertebral body fractures or a fracture of the neck or the femur, due to osteoporosis; and
– Has a bone mineral density reading with a T-score of less than -2.5 (i.e. 2.5 standard
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1106 AL-PC version 7 Effective 12 May 2026
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