PC-TC-05/2026
Personal Cover - Trauma Cover
SECTION A - DEFINED TERMS
DEFINED TERMS
In this Policy certain words have particular meanings. These words are in Bold and the meanings set out below. Interpretation Throughout this Policy ' We ', ' Our ', ' Us ' or ‘ AIA New Zealand’ means AIA International Limited - New Zealand Branch, and/or any related and/or authorised companies and/or agents (including company officers acting in the scope of their authority). ' You ' or ' Your ' means the Policy Owner(s) . Accelerated Benefit Means the Trauma Cover or Total Permanent Disability Cover taken out on an accelerated basis with Life Cover as set out in Your Policy Schedule . Payment of this Benefit will lead to a proportional reduction in the amount of the Life Cover.
Activities of Daily Living are: Type of activity Description
1.Washing
the ability to wash in the bath or shower (including getting into or out of the bath or shower) or wash satisfactorily by other means. the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances. the ability to feed oneself once food has been prepared and made available. the ability to use the lavatory or otherwise manage bowel and bladder function so as to maintain a satisfactory level of personal hygiene. the ability to move from place to place by walking, wheelchair or with assistance of a walking aid.
2. Dressing
3. Feeding
4. Toileting
5. Mobility
Adoption Means Adoption as defined in the Adoption Act 1955.
Benefit(s) Means the Benefit specified in the Policy Schedule (and subject to the terms and conditions of this Policy ). Child or Children Any person under the age of twenty one (21) who is either, the natural or legally adopted son/daughter of, or is under the legal guardianship of, a Life Assured or the spouse, Civil Union or de facto partner of the Life Assured .
Civil Union Means a Civil Union as defined in the Civil Union Act 2004.
Close Relative Means a relative who is the Life Assured's spouse, Civil Union or de facto partner, mother, father, step mother, step father, brother, sister, step brother, step sister, Child , grandfather or grandmother.
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Congenital Condition Means a health anomaly or defect, regardless of whether diagnosed or not, which is present at birth and for which the individual had signs and symptoms within three months of birth. Includes health anomalies or defects inherited or due to external environmental factors such as drugs, alcohol, or complications during pregnancy or delivery. Consumer Price Index Increase Means any increase in the index published by the Statistics Department of New Zealand for "All Groups" as at 30 September each year (or the nearest equivalent index should this index be replaced). Employment and/or Usual Occupation The occupation, business or Employment which the Life Assured was engaged in immediately before the injury or illness, and from which he or she was remunerated. Full-Time Care Means having primary responsibility and actively undertaking, whether shared or alone, the day-to-day care of persons who cannot safely take care of themselves without supervision. Heart Condition Means one (1) of the following illnesses (as defined in Clause 3 “Critical Illness” under Section D “Trauma Cover Benefit Definitions” below): • Angioplasty • Cardiac Defibrillator Insertion • Cardiomyopathy • Coronary Artery Bypass Surgery • Heart Attack • Heart Valve Replacement • Heart Valve Surgery • Out of Hospital Cardiac Arrest • Pacemaker Insertion • Percutaneous Repair Of The Abdominal Aorta • Pulmonary Arterial Hypertension (Primary) • Surgery to Aorta • Triple Vessel Angioplasty • Major Organ Transplant (for the Heart) Life Assured Means the person or people insured for the Benefit(s) as listed in Your Policy Schedule . Manifested Means that symptoms have arisen which cause an ordinarily prudent person to seek Diagnosis , care or treatment, or that medical advice or treatment has been recommended by or received from a Medical Practitioner .
Marriage Means a Marriage as defined in the Marriage Act 1955.
Medical Practitioner Shall mean any person approved by Us and registered with the Medical Council of New Zealand to render medical or surgical services, who holds an Annual Practising Certificate. For Diagnoses made outside New Zealand, this definition covers any appropriately qualified medical professional approved by Us . This definition excludes any person who is himself/herself the Life Assured , the Policy Owner , the spouse, de facto spouse, Civil Union partner, lineal relative, or business partner/associate of the Life Assured or Policy Owner .
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Policy Means this contract of insurance between You and Us . It includes the following parts: • Your application for insurance; and • this Policy wording; and • the Policy Schedule ; and • any addendum to the Policy Schedule ; and • any other written notice that We give You ; and • any written notice that You give Us . Policy Anniversary Date Means the anniversary of the Policy Commencement Date . Policy Commencement Date Means the commencement date of the Policy as specified in Your Policy Schedule . Policy Owner Means the Policy Owner identified in the most recent Policy Schedule issued to You by Us . Policy Schedule Means the most recent Policy Schedule issued to You by Us , including any endorsements or special conditions. Policy Year Means the twelve (12) month period which starts from the Policy Commencement Date and ends on the First Anniversary Date . Each subsequent Policy Year is from Policy Anniversary Date to Policy Anniversary Date . Premium Means the Premium specified in Your Policy Schedule or in any subsequent notice issued to You by Us . Premium Guarantee Period Means the period of time specified in Your Policy Schedule during which the Premium Rates applicable to Your Policy are guaranteed not to increase. Assuming Your cover doesn’t change, Your Premiums will remain the same for each renewal period as specified in Your Policy Schedule . Premium Rates Means the underlying Premium Rates We use to calculate Your Premium based on factors including the age, health, occupation and circumstances of the Life Assured .
Radical Surgery Means surgery to remove an entire diseased organ.
Receipt of Application Means the date stamped on Your application, request for increase, or request for Policy reinstatement received by Us . The application submitted by You to Us must be totally completed for the Receipt of Application date to apply. If the submitted application is incomplete, We will delay issuing the Receipt of Application until We receive all the information required to complete the submitted application. Registered Medical Specialist A medical specialist in an appropriate discipline who is a member of a recognised specialist college and vocationally registered with the Medical Council of New Zealand in that speciality. This excludes general practitioners (who are considered to be Registered Medical Practitioners ). For Diagnoses made outside New Zealand, this
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definition covers any appropriately qualified medical professional approved by Us . This definition excludes any person who is himself/herself the Life Assured , the Policy Owner , the spouse, de facto spouse, Civil Union partner, lineal relative, or business partner/associate of the Life Assured or Policy Owner . Sum Assured Means the Sum Assured for the Benefit(s) as set out in Your Policy Schedule . Total Premium Means the sum of the Premium and policy fee together with any applicable GST as specified in Your Policy Schedule .
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SECTION B - TRAUMA COVER BENEFIT FEATURES
JURISDICTION AND CURRENCY
1
The laws of New Zealand apply to this Policy . The New Zealand courts have exclusive jurisdiction. All monetary amounts referred to in this Policy are expressed and payable in New Zealand dollars and include GST. A When You apply for insurance with AIA New Zealand and when You make a claim on the Policy , You have a legal duty of disclosure to AIA New Zealand . The duty of disclosure means that: 1. All the statements that You or any Life Assured make to AIA New Zealand (both written and oral), including the answers in: a. the application; b. any claim made by You ; and c. any other communication by You or any Life Assured with AIA New Zealand ; must be complete, true and correct. 2. You and any Life Assured must disclose everything that You or any Life Assured know, or could reasonably be expected to know, that is relevant to AIA New Zealand’s decision whether: a. to accept Your application for insurance, on what terms AIA New Zealand will accept it and how much it will cost; or b. to accept Your claim on the Policy . 3. This duty of disclosure in relation to Your application for insurance continues from the time You complete the application until either: a. the Policy Commencement Date or the date AIA New Zealand accepts Your application for insurance, whichever is later; or b. AIA New Zealand declines Your application for insurance. 4. You and any Life Assured also have the same duty of disclosure to AIA New Zealand throughout the term of the Policy whenever You or any Life Assured communicate with AIA New Zealand and whenever You extend, vary or reinstate Your insurance. IMPORTANT If You or any Life Assured do not comply with Your duty of disclosure, AIA New Zealand may at its discretion do any or all of the following: 1. Decline any claim that You make; 2. Alter the terms of any Benefits under the Policy ; 3. Remove any Benefits under the Policy ; 4. Void Your Policy from the Policy Commencement Date ; 5. Retain all Premiums , policy fees and recover any Benefits paid; 6. Terminate this Policy . If You are not sure whether You are required to disclose a particular fact, please ask AIA New Zealand or Your insurance adviser.
RESPONSIBILITY FOR TRUTHFULNESS
2
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B
If the age of the Life Assured was misstated in the application, the amount payable under this Policy will be adjusted to the amount that the Premiums would have purchased if the correct age had been disclosed. No increase in Premium Rates will apply to this Policy as a result of change in the health, occupation or circumstances of the Life Assured . However, We have the right to review at any time and from time to time the Premium Rates and handling fees applicable to all Trauma Cover policies and to apply the reviewed rates and fees to this Policy at the commencement of the next Premium Guarantee Period . With Our agreement the annual Total Premium may be paid by equal fortnightly, monthly, quarterly or half-yearly instalments but with such handling fees as We shall determine from time to time. We may cancel this arrangement at any time in respect of future Total Premiums . You may apply to Us to change the Premium or Benefits attributable to this Policy . Subsequent to this, We may change the Premium and/or alter any Benefits under this Policy in accordance with this instruction. We will charge You a policy fee, which forms part of Your Total Premium . The policy fee is used to pay the ongoing administration costs of this Policy . The policy fee is specified in Your Policy Schedule . We may change this policy fee from time to time. If this occurs any such change will be notified to You in writing.
PREMIUM RATES
3
PREMIUM PAYMENTS
4
POLICY FEE
5
PERIOD OF ASSURANCE
6
The term of this Policy and the period of assurance covered by each annual Total Premium , or instalment of annual Total Premium , terminate on the due date of the next annual Total Premium or instalment. A thirty (30) day grace period is allowed after the due date for payment of each Total Premium . This Policy will automatically terminate if the Total Premium is not paid before the expiration of the grace period. In such an instance this Policy can be reinstated subject to: • Our consent; and • such evidence of continued good health of the Life Assured as We may require; and • the payment of all Total Premiums in arrears together with such interest thereon as We may decide. We may vary Your Benefits , charge additional Premiums or not allow You to reinstate the Policy if the health, occupation, financial position or pastimes of the Life Assured have changed. Unless previously terminated, this Policy shall terminate on the earliest of: A The anniversary of the Policy Commencement Date following the Life Assured attaining the age of seventy five (75). B Payment of the Trauma Cover Benefit . C Written notification of cancellation from You to Us at any time. D Non-payment of Total Premium as set out in Clause 6 “Period of Assurance” above. E Death of the Life Assured .
TERMINATION
7
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CLAIMS
8
Written notice of a claim must be given to Us within ninety (90) days after the Diagnosis of any Critical Illness . Notice can be given by You or on Your behalf. Written proof of Diagnosis of any Critical Illness must be furnished to Us within ninety (90) days after the date of such Diagnosis . Any expense incurred in providing due proof of a claim shall be borne by You . We shall have the right and opportunity to call for an examination of the Life Assured at Our expense when and as often as We may reasonably require during the assessment of a claim. If this Policy is avoided or is terminated under any of the terms and conditions of this Policy , all Total Premiums paid shall be absolutely forfeited to Us . Cover under this Policy applies twenty-four (24) hours a day, anywhere in the world. If you are overseas during the period of a claim, Benefits will be paid in New Zealand currency. This Policy is the entire contract of insurance between You and AIA New Zealand . It comprises the following parts: • Your application for insurance; and • this Policy wording; and • the Policy Schedule ; and • any other written notice that AIA New Zealand gives You ; and • any written notice that You give Us . In the event of any changes in taxation after the Policy Commencement Date which affects the Benefits or Our liability, We may make such amendments or modifications to the Premium and Benefits and this Policy as We consider appropriate. If there is more than one (1) Life Assured shown on the Policy Schedule, We will pay the Trauma Cover Benefits for each Life Assured . The amount of the Benefit payable for a Critical Illness will be the Benefit payable for that person under this Policy. The Trauma Cover Benefit will end when all Lives Assured’s have suffered a Critical Illness , and to the extent a Trauma Cover Benefit is payable in respect to each of them, that Benefit has been paid.
PROOF OF POSITIVE DIAGNOSIS
9
FORFEITURE OF PREMIUMS
10
WORLDWIDE COVER 11
ENTIRE CONTRACT
12
TAX CHANGES
13
TRAUMA COVER BENEFITS PAYABLE WHERE MORE THAN ONE (1) LIFE ASSURED
14
GENERAL
15 A
This Policy does not participate in bonus distributions or acquire a cash surrender, loan or maturity value.
B Where this Policy refers to an Act of Parliament, this includes any Regulations made under it. It also includes any Act or Regulations enacted in substitution. C Your life insurance Policy is part of the AIA New Zealand Statutory Fund, effective 1 st September 2013. This is a requirement under the Insurance (Prudential Supervision) Act 2010, for policyholder protection.
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FREE LOOK PERIOD 16
To enable You to consider the Policy in detail You will have a free look period of fourteen (14) days after You receive Your Policy document. During this period, if You decide that the Policy does not suit Your needs then You may return it to Us and receive a full refund of all Total Premiums paid and the Policy will be cancelled. Should You write to Us about this Policy , You must send the letter to Our head office in New Zealand as notified by Us to You from time to time. The postal address of AIA New Zealand’s head office is: AIA New Zealand Private Bag 300981 Albany AUCKLAND CITY 0752 The street address of AIA New Zealand’s head office is: AIA New Zealand Level 15 5-7 Byron Avenue Takapuna AUCKLAND CITY 0622
NOTICES
17
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SECTION C - TRAUMA COVER BENEFITS
BENEFIT
1
If the Life Assured is Diagnosed (as defined below) to be suffering from a Critical Illness , We will pay the Trauma Cover Benefit specified on the Policy Schedule (adjusted in accordance with this Policy ) provided that: A The Trauma Cover Benefit Total Premium has been paid. B For those conditions underlined in paragraph D below, We will pay the Benefit after the Policy Commencement Date shown in the Policy Schedule provided that the Life Assured first suffers that condition at any time after ninety (90) days from the Receipt of Application , including any reinstatements and/or increases (other than Consumer Price Index Increases ) of the Policy . To be covered, the Critical Illness condition must have first Manifested itself at least ninety (90) days from the Receipt of Application , including reinstatements and/or a commencement of a Benefit , or increase (other than Consumer Price Index Increases ) of the Policy . This provision is always subject to Clause 13 “Survival For At Least Fourteen (14) Days” below. C For those conditions not underlined in paragraph D below, We will pay the Benefit provided the Life Assured is still alive fourteen (14) days after the event causing the claim subject to the terms under Clause 13 “Survival For At Least Fourteen (14) Days” below. To be covered, the Critical Illness condition must have first Manifested itself after the Policy Commencement Date shown in the Policy Schedule , or the date of any reinstatement, commencement of a Benefit , or increase (other than Consumer Price Index Increases ) of the Policy . D The Critical Illness is one (1) of the following illnesses included within the definition of Critical Illness set out in Clause 3 “ Critical Illness ” under Section D “Trauma Cover Benefit Definitions”:
Accidentally Acquired HIV
•
• Advanced Acquired Immunodeficiency Syndrome (AIDS) • Advanced Diabetes • Alzheimer's Disease • Angioplasty • Aplastic Anaemia • Benign Brain or Spinal Cord Tumour • Blindness • Cardiac Defibrillator Insertion • Cardiomyopathy • Chronic Liver Failure • Chronic Lung Disease • Cognitive Impairment • Coma • Coronary Artery Bypass Surgery • Creutzfeldt-Jakob Disease • Critical Cancer • Dementia • Encephalitis • Heart Attack • Heart Valve Replacement • Heart Valve Surgery • Intensive Care Treatment • Kidney Failure
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Loss of Independence
• •
Loss of one limb
• Loss of use of Limbs and Sight of one eye • Major Head Trauma • Major Organ Transplant • Malignant Melanoma • Meningitis and/or Meningococcal Disease • Motor Neurone Disease • Multiple Sclerosis • Muscular Dystrophy • Out of Hospital Cardiac Arrest • Pacemaker Insertion • Paralysis (Quadriplegia, Paraplegia, Diplegia, Hemiplegia) • Parkinson's Disease • Percutaneous Repair of the abdominal aorta • Peripheral Neuropathy • Permanent Loss of Hearing • Permanent Loss of Speech • Pneumonectomy • Prostate Cancer • Pulmonary Arterial Hypertension (Primary) • Rheumatoid Arthritis • Serious Burns • Severe Burns • Severe Inflammatory Bowel Disease • Severe Osteoporosis • Stroke • Surgery to Aorta • Systemic Lupus Erythematosus • Systemic Sclerosis • Terminal Illness • Triple Vessel Angioplasty
MEDICAL ADVANCEMENTS
2
If the medical diagnostic techniques and investigations used in Critical Illness definitions have been superseded due to medical advancements, We will consider other appropriate and medically recognised methods or tests that conclusively Diagnose the condition to at least the same severity. The following requirements must be met for a claim to be considered: • The new diagnostic techniques and investigations are not experimental and are medically necessary and medically equivalent or superior to the original diagnostic technique or investigation. • Any new diagnostic techniques and investigations must be deemed medically acceptable based on medical standards and medically recognised in Australia or New Zealand by a Registered Medical Specialist .
PREMIUM
3
The annual Total Premium (or instalment) is payable for the entire duration of the Benefit .
If the Policy Schedule shows You have selected a Level Premium option for the first three (3) years from the Policy
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Commencement Date, We will guarantee not to increase Your Premium Rates . After the three (3) year Premium Guarantee Period ends, Your Policy may be subject to any increase in AIA New Zealand’s underlying Premium Rates . At the end of the selected Level Premium period the Premium will be recalculated based on the age of the Life Assured . Subsequent Level Premiums will be recalculated at each Policy Anniversary Date based on the age of the Life Assured .
Or
If the Policy Schedule shows that you have selected a one (1) Year Premium Step option, Your Trauma Cover Benefit Premium specified in the Policy Schedule will be recalculated at the expiration of the initial and subsequent Premium Guarantee Periods , based on the age of the Life Assured on their next birthday. If the Policy Schedule shows You have selected the Inflation Adjusted Benefit option, the Trauma Cover Benefit will increase on each anniversary of the Policy Commencement Date by an amount equal to the Consumer Price Index Increase for the year ended 30 September for which figures are available at the date the Sum Assured is to be increased. You may decline any Consumer Price Index Increase . This option expires upon termination of the Policy in accordance with Clause 7 “Termination” under Section B above. If the Policy Schedule shows that You have selected the Level Benefit option, the Trauma Cover Benefit will remain at the amount specified on the Policy Schedule . If the Policy Schedule shows that You have selected the Level Indexed Benefit option, the Trauma Cover Benefit will increase on each anniversary of the Policy Commencement Date by the percentage amount shown on the Policy Schedule . This option expires upon termination of the Policy in accordance with Clause 7 “Termination”, Section B. This Benefit will expire on the Policy Anniversary Date after the Life Assured reaches seventy (70) years old. If the Policy Schedule shows that You have selected the Children’s Trauma Top Up Benefit option, the following Benefits will apply:
INFLATION ADJUSTED BENEFIT OPTION
4
LEVEL BENEFIT OPTION
5
LEVEL INDEXED BENEFIT OPTION
6
CHILDREN'S TRAUMA TOP UP BENEFIT OPTION
7
Children’s Trauma Benefit
• •
Pregnancy Complications Benefit ; and
• Children’s Congenital Conditions Benefit
as set out below.
The Reinstatement Option under Clause 17 applies to the Children’s Trauma Top Up Benefit option, subject to the Insured Child satisfying the terms of Clause 17.
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CHILDREN’S TRAUMA BENEFIT We will pay You , $75,000 if an Insured Child (as defined below) is first Diagnosed (defined in Section D of this Policy ) as suffering from any one (1) of the Critical Illnesses defined in Clause 3 of Section D of this Policy , during the term of the Policy . Insured Child means a Child who: 1. has been nominated by You on the application form for this Policy ; and 2. has never been the subject of a Children’s Trauma Top Up Benefit option or Children’s Benefit claim under an AIA New Zealand Trauma Cover Benefit . The Children’s Trauma Benefit will only be payable once for each Insured Child . A claim paid under the Children’s Trauma Benefit will not affect the amount of any Trauma Cover Benefit which may be claimed in respect of the relevant Life Assured . The Children’s Trauma Benefit does not increase with the Consumer Price Index . Exclusions The Children’s Trauma Benefit is not payable for any Insured Child’s Critical Illness , which directly or indirectly, was caused by, resulted from or was in any way connected to: 1. a pre-existing condition; and/or 2. a condition that has Manifested prior to the commencement date of the Children’s Trauma Top Up Benefit option; and/or 3. a Congenital Condition ; and/or 4. an injury caused by You , a parent of the Child and/or a guardian. PREGNANCY COMPLICATIONS BENEFIT If the Policy Schedule shows that You have selected the Children’s Trauma Top Up Benefit option, We will pay You $10,000 if You suffer for the first time and at least twelve (12) months after the Policy Commencement Date one of the defined pregnancy complication conditions:
• Disseminated Intravascular Coagulation.
Eclampsia.
•
• Hydatidiform Mole . Payment of the Pregnancy Complications Benefit will not reduce the Trauma Cover Benefit . We will not pay the Pregnancy Complications Benefit if the Life Assured suffers the pregnancy complication condition or has any symptom(s) or signs leading to the pregnancy complication condition (whether or not a Registered Medical Specialist has been consulted) within twelve (12) months after the Policy Commencement Date . Disseminated intravascular coagulation (DIC) means over activation of the coagulation and fibrinolytic system resulting in microvascular thrombosis and consumption of platelets and
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coagulation factors. DIC complicating pregnancy may follow any major haemorrhage, pre-eclampsia, amniotic fluid embolism, endotoxic shock, and when foetal death occurs after twenty (20) weeks. Eclampsia means the occurrence of grand mal seizures in the presence of hypertension, proteinuria and oedema complicating a pregnancy, and not being due to other causes such as epilepsy. Hydatidiform Mole means development of multiple fluid filled cysts in the uterus after the degeneration of the placenta which results in the death of the embryo as confirmed by a Registered Medical Specialist .
The Pregnancy Complications Benefit does not increase with the Consumer Price Index .
CHILDREN’S CONGENITAL CONDITIONS BENEFIT
If the Policy Schedule shows that You have selected the Children’s Trauma Top Up Benefit option, We will pay You $5,000 if at least twelve (12) months after the Policy Commencement Date an Insured Child is unequivocally diagnosed by a Registered Medical Specialist with and undergoes treatment or therapy for one of the conditions below: • Coarctation of the Aorta. • Infantile Hydrocephalus. • Anal atresia. • Oesophageal atresia. • Congenital diaphragmatic hernia. • Tracheo-oesophageal fistula. • Truncus arteriosis. • Retinopathy of prematurity. We will pay You a maximum of one claim for an Insured Child under the Children’s Congenital Conditions Benefit across all policies for a Life Assured where AIA New Zealand Limited is the insurer, regardless of the number of congenital conditions diagnosed. In cases where two policies each name a distinct parent of the Insured Child as a Life Assured , both policies are eligible to claim under the Children’s Congenital Conditions Benefit for that Insured Child , provided the Children’s Trauma Top Up Benefit option is shown in the Policy Schedule of both policies.
The Children’s Congenital Conditions Benefit does not increase with the Consumer Price Index .
CHILDREN’S BENEFIT (INBUILT)
8
We will pay You , the lesser of $50,000 or 50% of the Life Assured’s Sum Assured , if an Insured Child (as defined below) is first Diagnosed (defined in Section D of this Policy ) as suffering from any one (1) of the Critical Illnesses defined in Clause 3 of Section D of this Policy, during the term of the Policy .
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Insured Child means a Child who has never been the subject of a Children’s Benefit or Children’s Trauma Top Up Benefit option claim under an AIA New Zealand Trauma Cover Benefit . The Children’s Benefit will only be payable once for each Insured Child irrespective of the number of Trauma Cover Benefits the Insured Child’s parent(s) or legal guardian(s) hold with AIA New Zealand . A claim paid under the Children’s Benefit will not affect the amount of any Trauma Cover Benefit which may be claimed in respect of the relevant Life Assured . The Children’s Benefit does not increase with the Consumer Price Index . Exclusions The Children’s Benefit is not payable for any Insured Child’s Critical Illness , which directly or indirectly, was caused by, resulted from or was in any way connected to: 1. a pre-existing condition; and/or 2. a condition that has Manifested prior to the commencement date of the Children’s Benefit ; and/or 3. a Congenital Condition ; and/or 4. an injury caused by You , a parent of the Child and/or a guardian. The Children’s Benefit can be converted to: • Standalone Trauma Cover; or • Accelerated Trauma Cover with an equal amount of Life Cover, with a maximum Sum Assured of $50,000 or 50% of the Life Assured’s original Sum Assured whichever is the lesser, without further medical evidence. Where the Life Assured’s Sum Assured has reduced the conversion will be calculated on the reduced Sum Assured . Once converted an applicable premium will be payable. If the Policy Schedule shows You have selected the Children’s Trauma Top Up Benefit option this can be converted to Standalone Trauma Cover with a maximum Sum Assured of $75,000), without further medical evidence. Once converted an applicable premium will be payable. The conditions that apply to the Children’s Benefit Conversion Option are as follows: • Conversion cannot occur if the Insured Child has claimed or was eligible to claim under the Children’s Benefit and/or Children’s Trauma Top Up Benefit option; and • Your request for conversion must be received by AIA New Zealand in writing; and • Your request must be received by AIA New Zealand within sixty (60) days of the Policy anniversary after the Insured Child’s twenty first (21 st ) birthday. If the Policy Schedule shows that You have selected the Woman’s Additional Cancer Benefit option a Woman’s Additional Cancer Benefit may be paid to You in respect of the Life Assured . Such a Benefit will be limited to 25% of the Sum Assured or $75,000 whichever is the lesser.
CHILDREN’S BENEFIT CONVERSION OPTION
9
A
B
C
OPTIONAL WOMAN’S ADDITIONAL CANCER BENEFIT
10
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Payment of this Benefit will result in an equal reduction in the Trauma Cover Benefit under this Policy . This Benefit provides cover for carcinoma-in-situ of the cervix, vagina, vulva, fallopian tubes and ductal carcinoma-in-situ of the breast as defined in Clause 4 “Optional Woman’s Additional Cancer Benefit ” under Section D of this Policy . We will pay the Benefit provided the Life Assured first suffers that condition at any time after one hundred and eighty (180) days from the Policy Commencement Date shown in the Policy Schedule , or the date of any reinstatement or increase (other than Consumer Price Index Increases ). This is always subject to Clause 13 “Survival For At Least Fourteen (14) Days”. The Reinstatement Option under Clause 17 applies to the Optional Women’s Additional Cancer Benefit , subject to the Life Assured satisfying the terms of Clause 17. The Trauma Cover Benefit may be renewed up to the anniversary of the Policy Commencement Date following the Life Assured attaining age seventy five (75). We will pay You a Funeral Benefit of $15,000 if the Life Assured dies during the term of this Policy and no Trauma Cover Benefit is payable. Payment shall not be made if the death was a result of suicide whether the Life Assured was sane or insane, within thirteen (13) months from the Policy Commencement Date or date of the last reinstatement or increase (other than Consumer Price Index Increases ) of this Policy . A Funeral Benefit shall not be paid if the Policy Schedule shows that you have selected an Accelerated Benefit . A Trauma Cover Benefit will not be paid if the Life Assured dies as a result of a Critical Illness event within the fourteen (14) day period following the date of Diagnosis of the Critical Illness event. If the Policy Schedule shows that You have selected a Standalone Benefit , this Benefit will be cancelled when We make payment of the Trauma Cover Benefit . If the Policy Schedule shows that you have selected an Accelerated Benefit Your Life Cover Benefit will be reduced by the amount of the Accelerated Benefit paid. Any other Accelerated Benefit on Your Policy Schedule will be reduced to the new Life Cover Benefit . If as a result of the payment of the Accelerated Benefit the Life Cover Benefit is reduced to nil the Life Cover Benefit and any remaining Accelerated Benefits on Your Policy Schedule will be terminated. If the Policy Schedule shows that You have selected an Accelerated Trauma Cover Benefit and a claim has been paid, You may effect Life Cover with Us under a Policy or Policies , without needing to provide evidence of health of the Life Assured , for a sum not exceeding the claim amount paid under the Accelerated Trauma Cover Benefit as follows:
RENEWAL
11
FUNERAL BENEFIT
12
SURVIVAL FOR AT LEAST FOURTEEN (14) DAYS
13
PAYMENT OF STANDALONE BENEFIT PAYMENT OF ACCELERATED BENEFIT
14
15
BUYBACK LIFE COVER BENEFIT
16
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• within 60 days of the Accelerated Trauma Cover claim payment; or • within 60 days of the date the Benefit is eligible to be reinstated as described below: For any of the following covered conditions, the date the Benefit is eligible to be reinstated will be based on a six (6) month wait period from the date the Accelerated Trauma Cover claim was paid: • Paraplegia, Quadriplegia, Diplegia and Hemiplegia • Parkinson’s Disease • Alzheimer’s Disease • Dementia • Blindness • Loss of use of Limbs and Sight of one eye • Multiple Sclerosis • Permanent loss of hearing. For any other covered conditions (set out in Section D, Clause 3), the date the Benefit is eligible to be reinstated will be based on a twelve (12) month wait period from the date the Accelerated Trauma Cover claim was paid. The Life Cover will be based on the age of the Life Assured and Our Premium Rates at the time, and will be subject to any loadings or restrictions (if any) which apply to this Policy . The Life Cover will not be eligible for the Inflation Adjusted Benefit option, Special Events Increase Option or the Level Indexed Benefit Option. No reinstated Life Cover Benefit is payable: • within six (6) months (for the conditions listed above that require a six (6) month wait period); or • within twelve (12) months (for any other covered conditions set out in Section D, Clause 3), from the accelerated Trauma Cover Benefit claim payment date, other than for Accidental Death . If the option to effect Life Cover with Us under the Buyback Life Benefit has not been exercised in the manner and at the times specified above, the option to effect such cover shall lapse. This option is also available in the event of an Angioplasty claim being made. In order to exercise this option, the Policy Owner(s) must make the request in writing to Us .
REINSTATEMENT OPTION
17
What is the Reinstatement Option?
If the Policy Schedule shows You have selected the Reinstatement Option, You may reinstate the Trauma Cover Benefit and where applicable, the Optional Women’s Additional Cancer Benefit and/or the Children’s Trauma Top Up Benefit option with Us under a Policy or Policies , without
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needing to provide evidence of health of the Life Assured , for a sum assured not exceeding 100% of the claim amount paid under the Trauma Cover Benefit . You may reinstate the Trauma Cover Benefit : • within 60 days of the Trauma Cover claim payment; or • within 60 days of the first anniversary of the Trauma Cover claim payment. What conditions apply to cover reinstated under the Reinstatement Option? • The reinstated Benefit(s) will be issued based on the information provided at the time You exercise the option, together with the information provided in the original application. • The terms and conditions of the reinstated Benefit(s) will be those which are offered by Us at the time of reinstatement . • The reinstated Benefit(s) may require an increase in Premium . The Premium will be based on the age of the Life Assured and Our Premium Rates at the time of reinstatement and will be subject to any loadings or restrictions (if any) which apply to the original Policy . • If the original Trauma Cover claim was for either Critical Cancer , Stroke (as defined in Clause 3 “ Critical Illness ” under Section D “Trauma Cover Benefit Definitions”), or a Heart Condition , a discount will apply to the Premium on the reinstated Benefit . • If this option is not exercised at either of the two occasions described above, the option to effect such covers shall lapse. • In order to exercise this option, You must sign the declaration in the Reinstatement Offer letter and return it to Us . • The reinstated Benefit(s) will not be subject to the Inflation Adjusted Benefit Option, Special Events Increase Option or the Level Indexed Benefit Option. • You cannot exercise this Reinstatement Option where a Trauma Claim payment has been made for any partial or Advance Payment . • Any special terms or exclusions that applied to the original Policy will also apply to the reinstated Benefit(s). • If the Policy Schedule shows that You had selected the Optional Women’s Additional Cancer Benefit at the time of the first Trauma Cover claim, this Benefit can be reinstated alongside the original Trauma Cover Benefit , except where You have previously had an eligible claim under the Optional Women’s Additional Cancer Benefit . • If the Policy Schedule shows You had selected the Children’s Trauma Top Up Benefit option at the time of the first Trauma Cover claim, this Benefit can be reinstated alongside the original Trauma Cover Benefit.
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No claim will be paid in respect of the reinstated Trauma Cover Benefit for:
a) A Critical Illness that occurs prior to the cover being reinstated.
b) A Critical Illness which: •
arises in connection with;
is a complication of;
• • • •
results from;
is a consequence of;
is a complication of treatment for; a Critical Illness event for which We paid a claim under the original Trauma Cover Benefit . c) The same Critical Illness for which We have paid a claim under Trauma Cover Benefit for the Life Assured , unless the second claim event is for Critical Cancer, Malignant Melanoma or Prostate Cancer, and meets all of the following: • The Critical Cancer , Malignant Melanoma or Prostate Cancer claim event occurs at least twelve (12) months after the original claim event date; • arises in a different organ system as the original cancer; • is not considered by the treating oncologist as likely to be secondary of the original cancer; • is an unrelated or different type of cancer. d) Any Heart Condition if the original claim was for either a Heart Condition or Stroke (as defined in Clause 3 “ Critical Illness ” under Section D “Trauma Cover Benefit Definitions” below), except where the claim in respect of the reinstated Trauma Cover Benefit is for Heart Valve Replacement, Heart Valve Surgery, or Pulmonary Arterial Hypertension (Primary), and these illnesses have not previously been claimed for; and are not considered as likely to be secondary or directly resulting from the original Critical Illness. e) Stroke (as defined in Clause 3 “ Critical Illness ” under Section D “Trauma Cover Benefit Definitions” below) or any condition directly resulting from a Stroke, if the original claim was for a Heart Condition , except where the original claim was for Heart Valve Replacement, Heart Valve Surgery, or Pulmonary Arterial Hypertension (Primary). f) Any exclusion which applied to the original Trauma Cover Benefit . In the event of a claim in respect of the reinstated Children’s Trauma Top Up Benefit option , no claim will be paid for: • the Children’s Trauma Top Up Benefit option where an Insured Child has already had an eligible claim under this Benefit ; or • the Children’s Congenital Conditions Benefit where an Insured Child has already had an eligible claim under this Benefit ; or • any Exclusion which applied to the original Children’s Trauma Top Up Benefit option .
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SPECIAL EVENTS INCREASE
18
You may at any time prior to the Life Assured reaching age sixty five (65) increase the Sum Assured for the Trauma Cover Benefit under this Policy on the occurrence of any of the Special Events (A-J) listed below without further evidence of health. Requests for increases must be made within twelve (12) months of a Special Event except where the request relates to a Mortgage covering a residential investment property which must be made within ninety (90) days of taking out the Mortgage . You can make more than one Special Events increase during each Policy Year . You may increase the Sum Assured more than once in respect of each Special Event (A-J) listed below during the term of the Policy . Evidence will need to be provided as specified below, together with any further evidence that We may request. A Special Events increase is NOT available if the Life Assured has made a claim or is eligible to claim under any Disability Income , Total and Permanent Disability Cover , Trauma Cover and/or Life Cover Policy with AIA New Zealand . For the sake of clarity this includes any claim currently under assessment. The increase in respect of each Special Event is up to 50% of the original Sum Assured up to a maximum of $300,000. The minimum increase in respect of each Special Event is 10% of the original Sum Assured . The Premium for the increased cover will be based on the age of the Life Assured and Our Premium Rates at the time the option is exercised. Any loadings, exclusions or special terms on the original Sum Assured will be applied to the increased amount. In the event of the increase being for a salary increase for the Life Assured , the amount of increase will be restricted to the lesser of: 1. $300,000; or 2. 50% of the original Sum Assured ; or 3. Five (5) times the increase in wage or salary on an annualised basis. In the event of the increase being for a mortgage, the amount of increase will be restricted to the lesser of: 1. $300,000; or 2. 50% of the original Sum Assured ; or 3. The mortgage amount or increase in mortgage amount. The total increase in the Sum Assured in respect of the aggregate of all Special Events is limited to $600,000 across all polices for each Life Assured.
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SPECIAL EVENTS
A
MARRIAGE or CIVIL UNION of the Life Assured A copy of the Marriage Certificate or Copy of Particulars of Civil Union must be provided to Us confirming the date of Marriage or Civil Union .
B DIVORCE or LEGAL SEPARATION of the Life Assured A copy of the Dissolution Order or Separation Order must be provided to Us confirming the date of the Divorce or Legal Separation . C BIRTH of a Child of the Life Assured A copy of the Birth Certificate showing the relationship to the Life Assured must be provided to Us . D ADOPTION by the Life Assured A copy of the Adoption papers showing the relationship to the Life Assured must be provided to Us . E SALARY INCREASE for the Life Assured Evidence of the increase in wage or salary must be provided in a form that is acceptable to Us . This option is not available if the Life Assured is a controlling director, self-employed or if the Life Assured can control their level of wage or salary. F TAKING FULL-TIME CARE OF A DEPENDANT of the Life Assured The Life Assured becoming responsible for the Full-Time Care of a relative who is the mother, father, brother, sister, son, daughter, grandfather or grandmother of the Life Assured . Evidence must be provided that is acceptable to Us . G TERTIARY EDUCATION of a Child of the Life Assured The commencement of a first course of full-time tertiary education by a Child of the Life Assured . The course must commence within three (3) years of the Child leaving secondary education, and must be of at least twelve (12) months duration. The course must directly lead to a qualification that is approved by the New Zealand Ministry of Education, and must take place at a tertiary education institution approved by the New Zealand Ministry of Education within New Zealand. Supporting evidence must be provided that is acceptable to Us . H MORTGAGE The taking out or increasing of a mortgage for the purchase
of, or making extensions to, a residential property or residential investment property, a vacation home, or bare block of land zoned as residential to be owned by the Life Assured , or Child of the Life Assured where the Life Assured is acting as a guarantor for the mortgage. A copy of the appropriate mortgage documentation must be provided to Us . CHILD OF THE LIFE ASSURED STARTING SECONDARY EDUCATION The commencement of secondary school for the first time by a Child of the Life Assured . A copy of the Child’s birth certificate and enrolment form must be provided to Us . DEATH OF SPOUSE OR PARTNER Death of spouse or partner of the Life Assured as defined in the Property (Relationships) Act 1976. A copy of the death certificate for the Life Assured’s spouse or partner must be provided to Us .
I
J
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GUARANTEED PASS BACK OF BENEFIT ENHANCEMENTS
19
If We make future enhancements to Our Policy wordings We will pass back the enhanced benefit, feature and/or condition automatically to You. The enhanced benefit, feature and/or condition will only apply to claimable events which occur after the date We pass back the enhanced benefit, feature and/or condition to You. Any underwriting exclusion or special terms that apply to this Policy will not be altered by any enhanced benefit, feature and/or condition. This Benefit is to ensure that You are not disadvantaged as a result of the enhanced benefit, feature and/or condition. If You are inadvertently disadvantaged in anyway then the previous Policy wording will apply. You can apply for a Suspension of Premium Benefit for a period of up to twelve (12) months. The request must be made in writing by You to Us and accepted by Us . At the end of your requested suspension period cover will recommence and Premium payments must resume. Valid reasons for the Suspension of Premium Benefit are listed below: • Employer approved leave without pay; • Overseas travel; • Employer approved parental leave; • Tertiary Education; • Unempolyment or Redundancy; • Reduction in pay of at least 20% (comparing the most recent payslip against a previous payslip from the same year); • If self-employed, reduction in revenue of at least 30% (by comparing one month’s revenue against the same month for the previous year); or • Any other event We agree to, at Our sole discretion. Whilst this Benefit is in force no claim is payable by Us to You under this Policy . When Premium payments resume, no claim will be considered in respect of any claim event that first meets the criteria for an eligible claim during the period of Premium suspension. If the Policy Schedule shows that You have selected the Total and Permanent Disability Benefit option, then one (1) of the following conditions will be covered under this Benefit . If the Policy Schedule shows You have selected the “any occupation” option the definition is: The Life Assured being absent from his or her immediate pre-disability Employment as a result of injury or illness for a period of three (3) consecutive months and is so disabled that in Our opinion, after consideration of medical evidence satisfactory to Us , that he or she is unlikely ever to engage in work in any occupation for reward that he or she is reasonably qualified by education, training or experience which would remunerate at a rate greater than 25% of his or her earnings over the last twelve (12) consecutive months period of Employment . Or If the Policy Schedule shows You have selected the “own occupation” option the definition is: The Life Assured being absent from his or her immediate pre-disability Employment as a result of injury or illness for a period of three (3) consecutive months and is so disabled that
SUSPENSION OF PREMIUM BENEFIT
20
TOTAL AND PERMANENT DISABILITY BENEFIT OPTION
21
A
B
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in Our opinion, after consideration of medical evidence satisfactory to Us , is unlikely to ever resume work in or ever attend to his or her Usual Occupation . This Total and Permanent Disability Benefit expires on the Life Assured’s sixty-fifth (65th) birthday. We will pay a Return To Home Benefit if the Life Assured is outside of New Zealand and suffers, for the first time, a Critical Illness . The Return To Home Benefit will reimburse the cost of a standard economy flight back to New Zealand for the Life Assured and one (1) support person. You will need to provide evidence of the transport costs satisfactory to Us before a claim under the Return To Home Benefit will be paid. In total the maximum We will pay over the life of the Policy under the Return To Home Benefit is $10,000. A Return To Home Benefit is paid in addition to the Trauma Cover Benefit. No payment will be made if the Life Assured is covered for the same event with a travel insurance provider. You may convert Stand Alone Trauma Cover to Accelerated Trauma Cover with an equal amount of Life Cover without any further medical evidence provided that: a. The Life Assured was not accepted on special terms and/or with additional exclusions and/or with a Premium loading; and b. This option is exercised at least five (5) years prior to the expiry date of this Policy ; and c. The age of the Life Assured does not exceed sixty (60) years of age at the Date of Conversion ; and d. The Life Assured has not made a claim and is not eligible to claim under their Stand Alone Trauma policy. For the sake of clarity this includes any claim currently under assessment; and e. The Accelerated Trauma Sum Assured does not exceed the Stand Alone Trauma Sum Assured ; and f. The Life Cover Sum Assured does not exceed the Accelerated Trauma Cover Sum Assured . The Premium for the conversion will be based on the age of the Life Assured and Our Premium Rates at the time this option is exercised. If a claim is payable under the Accelerated Trauma Cover Benefit , this is subject to Section C, Clause 13 “Survival For At Least Fourteen (14) Days”. If the death of the Life Assured occurs within three (3) months of the Date of Conversion , other than by Accidental Death , then this conversion is void and the Stand Alone Trauma Cover Benefit will be reinstated from the Date of Conversion . Date of Conversion means the later of the effective date or the actual date from which We receive the increased Premium for the Life Cover and Accelerated Trauma Cover. Accidental Death means death which is the result of external or internal bodily injury caused directly by violent external visible means, not attributable to any other event.
RETURN TO HOME BENEFIT
22
STAND ALONE CONVERSION OPTION
23
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