Severity Level
Conditions
– Proximal interphalangeal joints in the hands; and
– Metatarsophalangeal joints in the wrist, elbow, foot, knee, or ankle; and
b. positive rheumatoid serology or other appropriate diagnostic test evidencing rheumatoid arthritis, together with evidence confirming at least three of the following criteria:
– Simultaneous bilateral and symmetrical joint soft tissue swelling or fluid;
– Joint deformity typical of rheumatoid arthritis;
– Rheumatoid nodules beneath the skin; or
– X-ray imaging showing erosion to joints typical of rheumatoid arthritis.
Degenerative osteoarthritis and all other arthritides are excluded.
The maximum amount payable for severe rheumatoid arthritis diagnosed after the age of 50 is $10,000.
31. 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 benefit will only be paid for those cases with cleft palate, or cleft lip and palate. No benefit is payable for cleft lip alone.
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 by an appropriate specialist and supported by an echocardiogram and must require surgical repair.
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1106 AL-PC version 7 Effective 12 May 2026
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