The severity level of the life assured's condition determines the percentage of the sum assured that is used to determine the lump sum benefit that Sovereign will pay you. The percentage of the sum assured for each severity level is shown below.
If the subsequent claim's claim event date is more than 12 months after the preceding claim's claim event date or if the subsequent claim is for a related condition , then Sovereign determines the amount to be paid for the subsequent claim as follows: 1. Sovereign determines if the life assured has suffered the condition . 2. Sovereign identifies the category that the condition falls under i.e. Cancer , Heart and Arteries, Brain and Nerves, Loss of Function or Other Health Events. A subsequent claim can be made in the same category or a different category to the previous claim. 3. Sovereign determines the severity level percentage that applies for the condition : (a) For a condition that is not a related condition, the severity level percentage is then multiplied by the sum assured . This will be the amount paid for the subsequent claim, unless the balance of the sum assured for the category that the condition falls under is less, in which case the balance of the sum assured for the category will be the amount paid for the subsequent claim. (b) For a related condition , the severity level percentage of the related condition must be higher than the severity level percentage of the previous condition that it relates to. The amount by which the severity level percentage increases from the previous severity level percentage is then multiplied by the sum assured . This will be the amount paid for the subsequent claim, unless the balance of the sum assured for the category is less, in which case the balance of the sum assured for the category will be the amount paid for the subsequent claim. For the avoidance of doubt, you cannot claim more than the sum assured in total for the life assured’s first claim and all subsequent related claims to that first claim.
Severity Level
Percentage
1 (most severe)
100%
2
75%
3
50%
4
25%
5 (least severe)
10%
The severity level of a condition is stated in the Schedule of Categories for the category the condition comes within.
Some of the conditions do not have all five severity levels.
6. The amount of cover
The sum assured is the maximum amount of cover you have for each category. After the first claim is paid under a category , the balance of the sum assured is the maximum amount Sovereign will pay you for any subsequent claim under that category . Once the balance of the sum assured is exhausted for a category , no further claims will be paid under that category .
a) First claim
The amount paid for the first claim for a life assured under this appendix is determined by Sovereign as follows: 1. Sovereign determines if the life assured has suffered the condition . 2. Sovereign identifies which category the condition falls under i.e. Cancer , Heart and Arteries, Brain and Nerves, Loss of Function or Other Health Events. 3. Sovereign determines the severity level percentage that applies to the condition . 4. The severity level percentage is then multiplied by the sum assured . This is the amount paid for the first claim. 5. The balance of the sum assured available for future claims under the category that the claim is paid under is then calculated as the sum assured minus the amount paid for the first claim.
Within 12 months of the previous claim event date and not a related condition
If you make a subsequent claim, where the claim event date is within 12 months of the immediately preceding claim's claim event date and the subsequent claim is not for a related condition , then Sovereign will deduct all claims paid under this appendix for that life assured within the previous 12 months from the amount determined in accordance with steps 1 to 3 immediately above. This may mean that no benefit is payable. This deduction will not apply if the current or previous claim is/was for a condition that is the result of an accident.
b) Subsequent claims
Any claim made for a life assured after the first claim paid to you under this appendix for that life assured is a subsequent claim. Sovereign will determine whether or not the condition relied upon for a subsequent claim is a related condition to a previous Progressive Care Benefit claim for that life assured . The way subsequent claims are determined depends upon the length of time that has passed since the previous claim event date and whether the condition claimed for is a related condition or not.
c) Two or more claims for conditions arising simultaneously from one event
If a single event causes the life assured to have one or more simultaneously arising conditions, Sovereign will only pay one claim. For each condition , Sovereign will determine the amount in accordance with steps 1 to 3 in b) above and the amount paid will be the highest of these amounts. The balance of the sum assured will reduce for the category that the condition with the highest amount falls under, while the balance of the sum assured will be unchanged for other categories .
More than 12 months after previous claim event date or related condition
Page 5 of 30
866 TCB-PC version 12 Effective 12 May 2026
Powered by FlippingBook