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 Sovereign. 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:
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Kidney
–
Heart
–
Lung
–
Liver
–
2
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. HIV - Infection with the Human Immunodeficiency Virus (HIV) must have been acquired by accident or violence during the course of the life assured 's normal occupation or through the medium of a blood transfusion, transfusion of blood products, organ transplant, assisted reproduction technique or other medical procedure or operation performed by a registered healthcare professional and/or in a registered hospital care institution, or surgical centre or surgical clinic. You must prove this to Sovereign's satisfaction. Sero-conversion to the HIV infection must occur within six months of the accident . HIV infection transmitted by any other means, including but not limited to sexual activity or non-medical intravenous drug use, is not covered under this appendix . Any incident giving rise to a potential claim must be reported to Sovereign within thirty days of the incident and be supported by a negative HIV Antibody Test taken within seven days after the incident. Sovereign may decline your claim if Sovereign is not given access to independently test all blood samples used, if Sovereign requires, or if the life assured does not allow Sovereign to take further
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866 TCB-PC version 12 Effective 12 May 2026
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