therapies administered outside of a clinical setting are excluded. An invasive procedure occurring in a hospital operating theatre involving the incision, excision, manipulation, or suturing of tissue, under general anaesthesia, spinal anaesthesia or epidural. Elective cosmetic procedures are excluded. A service or supply provided by a registered medical practitioner or specialist that Sovereign deems on reasonable grounds is necessary for the treatment of the disease, illness, or injury involved. Under no circumstances shall the following services or supplies be considered medically necessary:
for which the individual had signs or symptoms within three months of birth.
major invasive surgery
Includes health anomalies or defects inherited or due to external environmental factors such as drugs, alcohol, or complications during pregnancy or delivery. The later of the effective date or the actual date from which we receive the increased premium for the Life Cover Benefit and accelerated Progressive Care Benefit cover. Working to generate income through personal efforts by using the life assured ’s time and skills. He or she can be self-employed, employed, earning fees, under contract, receiving commissions, working
medically necessary
date of conversion
gainful employment
Those services or supplies that do not require the skills or services of a registered medical practitioner or specialist ; and Those services or supplies provided mainly for the comfort or convenience of the life assured.
on contract or otherwise remunerated for his or her efforts.
A specially staffed and equipped section of an intensive care complex that provides a level of care intermediate between intensive care and general ward care. Patients may be admitted to the high dependency unit: from the intensive care unit
high dependency unit
pre-existing condition
Any disease or medical condition for which, prior to becoming covered under this policy, the individual consulted a registered medical practitioner , received treatment or services from a registered medical practitioner , or took prescribed drugs and medicines. Any condition that Sovereign, in its sole discretion, deems to be directly or indirectly related to a previous claim's condition . This includes:
as a step-down prior to transfer to the ward; or directly from the ward, recovery or emergency areas.
life assured
A ‘ Life assured ’ named in the schedule .
related condition
limb(s)
An arm, leg, hand or foot. In respect of this definition:
the arm starts from the shoulder joint and ends at the wrist joint;
any increase in severity level of the same condition ; and any condition that is a recognised outcome and/or complication of a previous claim or a recognised complication of any
the hand starts from the wrist joint;
the leg starts from the hip joint and ends at the ankle joint; and
treatment administered in relation to a previous claim. Any two conditions that are both related conditions of a third condition will be treated as related conditions to each other for calculating the amount payable. The Schedule of Related Conditions detailed in Section 22 outlines some of the
the foot starts from the ankle joint.
Non-surgical procedures or treatments initiated to treat the claimed medical condition including but not limited to: stereotactic radiosurgery, laser therapy, ultrasonic aspiration, chemotherapy, radiotherapy, or immunotherapy. Pharmaceutical
major interventional treatment
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866 TCB-PC version 12 Effective 12 May 2026
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