Severity Level
Conditions
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. The maximum amount payable for severe osteoporosis diagnosed after the age of 50 is $10,000. Severe rheumatoid arthritis means that the life assured after the age of 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:
–
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.
The maximum amount payable for severe rheumatoid arthritis diagnosed after the age of 50 is $10,000.
28. Definitions of conditions for the Built-in Newborn Children’s Benefit and the Optional Children's and Maternity Benefit
Built-in Newborn Children’s Benefit conditions
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:
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866 TCB-PC version 12 Effective 12 May 2026
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