Severity Level
Conditions
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 :
– 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 deviations below the young adult mean for bone density). This must be measured in at least two sites by dual energy x-ray absorptiometry (DEXA). – An exclusion applies in cases where there are spontaneous fractures or minimal traumas that are due to an accident but where coincidental osteoporosis exists. Severe rheumatoid arthritis means that the life assured before age 50 has been unequivocally diagnosed by an appropriate specialist as suffering from severe rheumatoid arthritis for at least six weeks, which affects at least three or more of the following joints:
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–
Metacarpophalangeal joints in the hands;
– Proximal interphalangeal joints in the hands; and
– Metatarsophalangeal joints in the wrist, elbow, foot, knee, or ankle.
The diagnosis must be supported by a 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.
Type 1 diabetes means a definite diagnosis with total insulin deficiency and continuous dependence on exogenous insulin for survival. Dependence on insulin must persist for a continuous period of at least three months. Advanced Type 2 Diabetes means that the life assured suffers severe diabetes mellitus, either insulin or non-insulin dependent, as certified by an appropriate specialist and resulting in at least one of the following:
– Severe diabetic retinopathy resulting in visual acuity uncorrected and corrected of 6/36 or worse in both eyes; or
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– Severe diabetic neuropathy causing motor and/or autonomic impairment; or
– Diabetic gangrene leading to surgical intervention; or
– Severe diabetic nephropathy causing chronic irreversible stage 4 renal impairment.
Severe osteoporosis means that the life assured after 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 :
– Suffers at least two vertebral body fractures or a fracture of the neck or the femur, due to
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866 TCB-PC version 12 Effective 12 May 2026
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