TCM Business Comprehensive Living Assurance Policy Wording

852 TCB-LAC version 19 Effective 12 May 2026

TOTALCAREMAX BUSINESS

OPTIONAL BENEFIT APPENDIX

Comprehensive Living Assurance Benefit

This appendix only applies if cover under the schedule includes the Comprehensive Living Assurance Benefit (standalone or accelerated). This appendix forms part of and is incorporated into your TotalCare Max policy, the terms of which apply to this appendix .

Details of the benefit and the names of the people insured for the benefit (called the life or lives assured) are shown in the schedule .

1. When will Sovereign pay a Comprehensive Living Assurance Benefit?

Sovereign will pay you (subject to the provisions of this policy) a Comprehensive Living Assurance Benefit if the life assured suffers for the first time after the risk commencement date any of the conditions listed in the table below and survives for at least 14 days thereafter. An exception is the Optional Total Permanent Disablement condition , for which a 90 day survival period applies.

What stand down periods apply?

If, within the first 90 days after the risk commencement date , any of the conditions marked in the table below as having a 90 day stand down period occur, or symptoms or signs which lead to any of those conditions (whether or not a registered medical practitioner has been consulted) occur, then Sovereign will not pay a benefit for the life assured or any child of the life assured covered by the Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit.

Cover added under the Optional Business Safeguard Facility

A 180 day stand down period applies to increases made under the Optional Business Safeguard Facility, except where the claim is due to an accident , as outlined in Section 17. Where the claim is due to an accident , the 90 day stand down period is waived on such increases, provided the life assured has already served the 90 day stand down period on the original Comprehensive Living Assurance Benefit policy.

Newborn Children’s Benefit

A 12 month stand down period applies to the Newborn Children’s Benefit, meaning that Sovereign will only pay a claim for a biological child of a life assured where the birth of the child with one of the applicable conditions occurs at least 12 months after the risk commencement date .

This 12 month stand down period applies anew to all added cover from the date the added cover commences, including cover added using the Optional Business Safeguard Facility.

Medical Advancements Provision

If the medical diagnostic techniques and investigations used in our definitions of medical conditions 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 specialist medical practitioners.

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Optional Children’s and Maternity Benefit (Section 14)

Built-in Children’s Trauma Benefit (Section 4)

90 day stand down period

Full payment

Partial payment

Cancer

Carcinoma-in-situ

✓

Carcinoma-in-situ radical surgery Malignant tumours and blood cancers

✓

Prostate Cancer

✓

Heart

Angioplasty – less than 3 vessels Angioplasty – 3 vessels or more

✓

Aortic surgery

✓

Cardiac Defibrillator Insertion

✓

Cardiomyopathy

✓

Coronary artery bypass surgery

✓

Heart attack

✓

Heart valve surgery

✓

(partial payment unavailable)

Out-of-hospital cardiac arrest

✓

Pacemaker insertion

✓

Pulmonary hypertension

✓

Major neurological disease

Alzheimer’s disease

✓

Benign brain or spinal cord tumour

✓

(partial payment unavailable)

Cerebral Aneurysm

✓

Coma

✓

Creutzfeldt-Jakob disease

✓

Dementia

✓

(partial payment unavailable)

✓

Encephalitis

✓

(partial payment unavailable)

Idiopathic Parkinson’s disease

✓

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Optional Children’s and Maternity Benefit (Section 14)

Built-in Children’s Trauma Benefit (Section 4)

90 day stand down period

Full payment

Partial payment

Major head trauma

✓

Meningitis

✓

Motor neurone disease

✓

Multiple sclerosis

✓

Muscular dystrophy

✓

Peripheral neuropathy

✓

Stroke

✓

Paralysis and loss of functionality

Diplegia

✓

Hemiplegia

✓

Loss of independent existence

✓

Paraplegia

✓

Permanent blindness

✓

(partial payment unavailable)

✓

Permanent loss of hearing

✓

(partial payment unavailable)

Permanent loss of speech

✓

Permanent loss of use of limbs

✓

(partial payment unavailable)

Quadriplegia / Tetraplegia

✓

Other key conditions

✓

Advanced AIDS

Advanced diabetes

✓

Aplastic anaemia

✓

Chronic liver failure

✓

(partial payment unavailable)

Chronic lung disease

✓

Chronic renal failure

✓

Cognitive impairment

✓

HIV

✓

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Optional Children’s and Maternity Benefit (Section 14)

Built-in Children’s Trauma Benefit (Section 4)

90 day stand down period

Full payment

Partial payment

✓

Intensive care

✓

(partial payment unavailable)

Major transplant surgery

✓

Pneumonectomy

✓

Severe burns

✓

(partial payment unavailable)

Severe Crohn’s disease

✓

Severe illness or injury

✓

Severe osteoporosis

✓

Severe rheumatoid arthritis

✓

Severe ulcerative colitis

✓

Systemic lupus erythematosus with lupus nephritis

✓

Systemic sclerosis

✓

Terminal illness

✓

Optional condition

Total Permanent Disablement

✓

(Refer to Section 20 for a full description of these conditions .)

If you receive a full payment claim for a life assured under this Comprehensive Living Assurance Benefit, cover will cease for that life assured .

If you receive a partial payment of this Comprehensive Living Assurance Benefit for a life assured , cover will continue for that life assured with the sum assured being reduced by the amount of the partial payment amount. The premium will reduce with the reduction in sum assured.

If the life assured suffers more than one condition (including the Optional Total Permanent Disablement condition ), Sovereign will pay a maximum of the Comprehensive Living Assurance Benefit sum assured for all claims (in total).

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 is aged from three months up to their 21 st birthday at the time he or she first suffers from that condition ; and

What effect does payment of an accelerated Comprehensive Living Assurance Benefit have on the Life Cover Benefit?

 survives for at least 14 days after suffering from the condition .

This section applies only if an accelerated Comprehensive Living Assurance Benefit is shown in the schedule .

What are the applicable conditions and how much will Sovereign pay?

When Sovereign pays an accelerated Comprehensive Living Assurance Benefit, the Life Cover Benefit for the life assured will decrease by the same amount. Any other accelerated benefits relating to that Life Cover Benefit will also be reduced, if necessary, so that those accelerated benefits do not exceed the decreased Life Cover Benefit. If the Life Cover Benefit is reduced to nil, all accelerated benefits relating to that Life Cover Benefit will be removed. The maximum combined amount payable under the Life Cover Benefit, Specified Terminal Conditions Benefit, Terminal Illness Benefit, Bereavement Support Benefit, Repatriation Benefit, accelerated Living Assurance Benefit and, if applicable, the accelerated Progressive Care Benefit and the accelerated Total Permanent Disablement Benefit is the amount of the Life Cover Benefit for that life assured .

For those conditions where the criteria for a full payment are met as detailed in Section 20 below the Benefit payable is the lower of $50,000 or 50% of the sum assured across all Comprehensive Living Assurance Benefit policies for the life assured . No payments are made under this Benefit for the Optional Total Permanent Disablement condition or any of those conditions where a partial payment applies, except for the following conditions :

Angioplasty – less than 3 vessels.



Carcinoma-in-situ.



For these conditions , the Benefit payable is the lower of $50,000 or 10% of the sum assured across all Comprehensive Living Assurance Benefit policies for the life assured . Sovereign will pay a maximum of one claim per child under either the Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit, across all Sovereign policies . The Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit is payable in addition to the Optional Children’s and Maternity Benefit (if applicable). Payment of the Built-in Children’s Trauma Benefit will not affect the amount of any Comprehensive Living Assurance Benefit payable for the life assured . Sovereign will not pay a benefit under the Built-in Children’s Trauma Benefit that arises as a direct or indirect consequence of:

Built-in Financial and Legal Advice Benefit

If Sovereign pays a full payment claim under this Comprehensive Living Assurance Benefit for a condition suffered by a life assured , then Sovereign will reimburse you for fees incurred up to $2,500 including GST (in total) that you pay for financial planning advice you receive from an accredited Adviser or legal advice received from a legal professional approved by Sovereign, subject to the following conditions:  You must pay for the financial planning or legal advice within the 12 months following Sovereign paying the Comprehensive Living Assurance Benefit claim.  Sovereign will only pay one Financial and Legal Advice Benefit per life assured across all Sovereign policies . This is in addition to the sum assured. The Built-in Financial and Legal Advice Benefit is not payable for a claim for a child of the life assured under the Built-in Children’s Trauma Benefit, the Built-in Parents Grieving Benefit, the Optional Children’s and Maternity Benefit or the Built-in Newborn Children’s Benefit.

a pre-existing condition ; or



any congenital condition .



The Built-in Children’s Trauma Benefit ceases on the child’s 21 st birthday.

Built-in Newborn Children’s Benefit

What is the Built-in Newborn Children’s Benefit?

Built-in Children’s Trauma Benefit

Sovereign will pay a Built-in Newborn Children’s Benefit if a biological child of a life assured is born with one of the following conditions and survives for thirty days after birth:

What is the Built-in Children’s Trauma Benefit?

Sovereign will pay a Built-in Children’s Trauma Benefit if a child of a life assured suffers one of the applicable conditions listed in Section 1 of this appendix .

Cleft palate.



Down’s syndrome.



This Benefit is only payable if the child of the life assured :

Spina bifida.



 first suffers a condition after the risk commencement date , subject to the applicable stand down period provisions where these apply;

Total blindness.



Absence of one or more limbs .



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Tetralogy of Fallot.

If the Optional Children’s and Maternity Benefit is shown on the schedule , it can also be converted to a standalone Comprehensive Living Assurance Benefit or an accelerated Comprehensive Living Assurance Benefit with an equal amount of Life Cover benefit, with a maximum Sum Assured of $75,000 without further medical evidence.



Transposition of Great Vessels.



Deafness.



Please refer to Section 21 for the definitions of these conditions .

The following conditions are applicable to both Children’s Trauma Conversion options:

In order for Sovereign to pay a claim under this Benefit, we will require medical information from a registered medical practitioner acceptable to us that conclusively evidences the condition . In circumstances where a conclusive diagnosis cannot be made at birth, we will defer our assessment of the claim until sufficient evidence can be supplied. For example, this might apply in the case of total blindness or deafness, where a conclusive diagnosis may not be possible until later in the child’s life. In these cases, the claims assessment will be based on the child’s sight or hearing impairment at the date that conclusive diagnosis is first possible. A claim is only payable under the Built-in Newborn Children’s Benefit if cover remains in effect for the life assured up to the date that the conclusive diagnosis for the child occurs.

 A conversion cannot occur if the child has claimed or was eligible to claim under the Built-in Children’s Trauma Benefit and/or Optional Children’s and Maternity Benefit; and  Your request for conversion must be received by Sovereign within 60 days of the anniversary date after the child’s 21st birthday; and

Your request must be received in writing.



An applicable premium will be payable on converted cover.

Built-in Standalone Conversion Facility

How much will Sovereign pay?

If the schedule shows the Comprehensive Living Assurance Benefit as standalone you can convert this to an accelerated Comprehensive Living Assurance Benefit with an equal amount of Life Cover Benefit without any further medical evidence subject to the following:

The Benefit payable is the lower of $50,000 or 50% of the sum assured across all Comprehensive Living Assurance Benefit policies for the life assured . Sovereign will pay a maximum of one claim per child under either the Built-in Newborn Children’s Benefit or the Built-in Children’s Trauma Benefit, across all Sovereign policies . The Built-in Newborn Children’s Benefit is only payable where the birth of the child with one of the applicable conditions occurs at least twelve months after the risk commencement date . This requirement applies anew to all added cover from the date the cover commences; including cover added using the Optional Business Safeguard Facility. The Built-in Children’s Trauma Benefit or the Built-in Newborn Children’s Benefit is payable in addition to the Optional Children’s and Maternity Benefit (if applicable). Payment of the Built-in Newborn Children’s Benefit will not affect the amount of any Comprehensive Living Assurance Benefit payable for the life assured .

The life assured was accepted with standard underwriting terms (e.g. there are no special terms, exclusions or premium loadings applicable to the life assured );



 The life assured is only eligible for the standalone Conversion Facility where the conversion occurs before age 60;  The life assured has not made a claim, with Sovereign or any other insurer, and is not eligible to make a claim under their Standalone Comprehensive Living Assurance Benefit. This includes any claim currently under assessment; and

 The premiums for their standalone Comprehensive Living Assurance Benefit are paid up to date; and

 The accelerated Comprehensive Living Assurance Benefit sum assured must be less than or equal to the standalone Comprehensive Living Assurance sum assured; and  The Life Cover Benefit sum assured does not exceed the accelerated Comprehensive Living Assurance sum assured. The premium for the conversion will be based on the age of the life assured and our premium rates at the date of conversion . If the death of the life assured occurs within three months of the date of conversion , other than by accidental death , then this conversion is void and the standalone Comprehensive

Built-in Children’s Trauma Conversion Facility

The Built-in Children’s Trauma Benefit can be converted to:

 a standalone Comprehensive Living Assurance Benefit; or

 an accelerated Comprehensive Living Assurance Benefit with an equal amount of Life Cover benefit,

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 amount.

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Living Assurance Benefit will be reinstated from the date of conversion.

 Sovereign must be provided with a receipt for the consultation and/or counselling being claimed.

The $2,500 including GST (in total) is payable once per life assured per policy. This is in addition to the sum assured.

Built-in Premium Conversion Facility

You may at any time prior to the life assured reaching age sixty five (65):

11. Built-in Parents Grieving Benefit

 Convert all or part of your Comprehensive Living Assurance Benefit from the premium shown in the schedule to a Level premium structure. The Comprehensive Living Assurance Benefit under your policy will be reduced by the sum assured amount converted; or  Convert a Level premium Term to a further Level premium Term, of which duration may be the same or less than current Level premium Term. We will not require you or the life assured to produce further medical evidence at the time of conversion. The terms and conditions of the new policy will be those which are then offered by us to the general public. Premiums will be calculated on the current age of the life assured . Any special terms, exclusion or premium loadings that applied to your existing Comprehensive Living Assurance Benefit will apply to your new Comprehensive Living Assurance Benefit. 9. Built-in Return Home Benefit We will pay a Return Home Benefit if the life assured is outside of New Zealand and suffers, for the first time, a covered condition . The Return Home Benefit will reimburse the cost of a standard economy flight back to New Zealand for the life assured and one support person. You will need to provide evidence of the transport costs satisfactory to us before a claim under the Return Home Benefit will be paid. In total the maximum we will pay over the life of the Policy under the Return Home Benefit is $10,000. A Return Home Benefit is paid in addition to the Comprehensive Living Assurance Benefit.

When is a Parents Grieving Benefit payable?

Sovereign will make a Parents Grieving Benefit payment if:

 a child of a life assured dies prior to birth but after at least 24 weeks gestation; or

a child of a life assured dies.



Sovereign will not make any payment if the death occurs within 12 months of the risk commencement date except where it is an accidental death.

This Parents Grieving Benefit ceases on the child’s 21 st birthday.

How much will Sovereign pay for the Parents Grieving Benefit?

The Benefit payable:

 if the child is under 10 years of age Sovereign will pay a maximum of one claim of $2,000 per child under the Parents Grieving Benefit across Sovereign policies and AIA policies ; or  if the child is 10 years of age or over Sovereign will pay a maximum of one claim of $15,000 per child across all Sovereign policies and AIA policies for a life assured . Payment of the Parents Grieving Benefit will not reduce the sum assured of the Comprehensive Living Assurance Benefit for the life assured .

12. Optional Early Cancer Upgrade Benefit

The Optional Early Cancer Upgrade Benefit applies only if shown in the schedule .

Sovereign will pay an Optional Early Cancer Upgrade Benefit (subject to the provisions of this policy) if the life assured suffers for the first time one of the cancer conditions listed below, after the date cover commences under the Optional Early Cancer Upgrade Benefit. Sovereign will not pay an Optional Early Cancer Upgrade Benefit if the life assured suffers the cancer condition or has any symptoms or signs leading to the cancer condition (whether or not a registered medical practitioner has been consulted) within three months after the date cover commences under the Optional Early Cancer Upgrade Benefit. The Optional Early Cancer Upgrade Benefit does not apply to children of the life assured covered under the Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit.

No payment will be made if the life assured is covered for the same event with a travel insurance provider.

10. Built-in Counselling Benefit

The Counselling Benefit covers the cost of a Psychiatrist or Psychologist consultation and/or counselling for the life assured and/or a close relative of the life assured where the support treatments and/or consultations directly relate to a claim under the Comprehensive Living Assurance Benefit. After referral by an appropriate registered medical practioner we will reimburse up to $2,500 including GST (in total) per life assured , subject to the following conditions:  The consultation and/or counselling must be paid for within 12 months following Sovereign paying the Comprehensive Living Assurance claim; and

Only one claim per life assured can be made under the Optional Early Cancer Upgrade Benefit. The Optional Early

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Cancer Upgrade Benefit will cease once a claim is paid and your premiums will reduce accordingly. If at claim time, the life assured does not have a base Living Assurance Benefit, no Optional Early Cancer Upgrade Benefit will be payable and any premiums paid for the Optional Early Cancer Upgrade Benefit after the base Living Assurance Benefit has been cancelled will be refunded to the policy owner. The amount payable under the Optional Early Cancer Upgrade Benefit is 25% of the Comprehensive Living Assurance Benefit sum assured at the date cover commences under the Optional Early Cancer Upgrade Benefit, subject to a maximum of $75,000 per life assured across all Sovereign policies . The amount payable under the Optional Early Cancer Upgrade Benefit does not change with any subsequent changes in the Comprehensive Living Assurance Benefit sum assured, such as changes due to:  annual indexation increases after the date cover commences under the Optional Early Cancer Upgrade Benefit;

 Malignant tumour of the prostate histologically described as TNM classification T1 or has a Gleason score of 5 or less for which treatment is not considered medically necessary, and undertaken by an appropriate specialist to arrest the spread of malignancy including but not limited to prostatectomy, chemotherapy, radiotherapy, or surgery. The Optional Early Cancer Upgrade Benefit will cease when cover under the Comprehensive Living Assurance Benefit ceases. Where the life assured has the Optional Living Assurance Buyback Benefit, the Optional Early Cancer Upgrade Benefit can be reinstated in addition to their Living Assurance Buyback Benefit, subject to the life assured satisfying the terms of the Optional Living Assurance Buyback Benefit.

The Optional Living Assurance Buyback Benefit cannot be used to reinstate the Optional Early Cancer Upgrade Benefit.

13. Optional Total Permanent Disablement condition

 cover added using the Optional Business Safeguard Facility;

 reductions in the Comprehensive Living Assurance Benefit sum assured due to voluntary reduction or due to a partial payment claim. Payment of the Optional Early Cancer Upgrade Benefit may be in addition to any other payments made under this policy. Payment of the Optional Early Cancer Upgrade Benefit will not reduce the Comprehensive Living Assurance Benefit sum assured. The Optional Early Cancer Upgrade Benefit covers carcinoma-in-situ of the following sites and is defined as a focal autonomous new growth of carcinomatous cells which has not yet resulted in the invasion of normal tissue. ‘Invasion’ means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The carcinoma-in-situ must be positively diagnosed by biopsy and be classified as TIS according to the TNM staging method or FIGO Stage 0:

The Optional Total Permanent Disablement condition applies only if shown in the schedule and, subject to the provisions of this appendix , is included as a full payment condition under the Comprehensive Living Assurance Benefit. The Optional Total Permanent Disablement condition does not apply to any child of a life assured covered under the Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit.

The Optional Total Permanent Disablement condition does not apply once the life assured attains age 65.

14. Optional Children’s and Maternity Benefit

The Optional Children’s and Maternity Benefit applies only if shown in the schedule .

The Benefit is payable in addition to any Benefit payable under the Children’s Trauma Benefit or the Newborn Children’s Benefit.

Breast.



Cervix.



Vagina.



Children’s Critical Conditions Benefit

Vulva.



What is the Children’s Critical Conditions Benefit?

Ovary.



Sovereign will pay a Children’s Critical Conditions Benefit if a child of a life assured suffers one of the applicable conditions listed in Section 1 of this appendix .

 Fallopian tube: tumour limited to tubal mucosa.

The Optional Early Cancer Upgrade Benefit also covers the following cancers:

This Benefit is only payable if the child of the life assured :

 Chronic lymphocytic leukaemia: where there must be the presence of chronic lymphocytic leukaemia which is histologically described as at least RAI Stage 0.  Malignant melanoma which is determined by histological examination to be less than Clark Level 3 depth of invasion, and less than 1.0mm maximum thickness as measured using the Breslow method, and shows no evidence of ulceration.

 first suffers a condition after the risk commencement date , subject to the three month stand down period provisions where these apply;

 is aged from three months up to their 21 st birthday at the time he or she first suffers from that condition ; and

 survives for at least 14 days after suffering from the condition .

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Sovereign will pay a maximum of one claim for a child under the Children’s Critical Conditions Benefit across all Sovereign policies for a life assured . In cases where two policies each name a distinct parent of the child as a life assured , both policies are eligible to claim under the Children’s Critical Conditions Benefit for that child , provided the Optional Children’s and Maternity Benefit is shown in the schedule of both policies.

How much will Sovereign pay for the Pregnancy Complications Benefit?

The Benefit payable is $10,000.

Payment of the Pregnancy Complications Benefit will not reduce the Comprehensive Living Assurance Benefit.

What are the applicable conditions and how much will Sovereign pay?

For those conditions where the criteria for a full payment are met as detailed in Section 20 below the Benefit payable is the lower of $75,000 or 50% of the Comprehensive Living Assurance Benefit sum assured. No payments are made under this Benefit for the Optional Total Permanent Disablement condition or any of the conditions where a partial payment applies, except for the following conditions :

Children’s Congenital Conditions Benefit

When is the Children’s Congenital Conditions Benefit payable?

This Benefit is payable if at least 12 months after the risk commencement date a child of a life assured is unequivocally diagnosed by an appropriate specialist and undergoes treatment or therapy for one of the congenital conditions listed below.

Angioplasty – less than 3 vessels.



Carcinoma-in-situ.



For these conditions , the Benefit payable is the lower of $75,000 or 10% of the Comprehensive Living Assurance Benefit sum assured. Before cover for a child can commence under the Children’s Critical Conditions Benefit, you must advise us in writing of the child’s name, date of birth and gender. Cover for a child will only commence once we have confirmation of the child’s details in writing.

What congenital conditions are covered?

Coarctation of the Aorta.



Infantile Hydrocephalus.



Anal atresia.



Oesophageal atresia.



Pregnancy Complications Benefit

Congenital diaphragmatic hernia.



When is a Pregnancy Complications Benefit payable?

Tracheo-oesophageal fistula.



Truncus arteriosis.



This Benefit is payable if a life assured for the Comprehensive Living Assurance Benefit suffers for the first time and at least 12 months after the risk commencement date one of the defined pregnancy complication conditions . Sovereign will not pay this benefit if the life assured suffers the condition or has any symptom or signs leading to the condition (whether or not a

Retinopathy of prematurity.



How much will Sovereign pay for the Children’s Congenital Conditions Benefit?

The Benefit payable is $5,000, regardless of the number of congenital conditions diagnosed. Sovereign will pay a maximum of one claim for a child under the Children’s Congenital Conditions Benefit across all policies for a life assured where AIA New Zealand Limited is the insurer. In cases where two policies each name a distinct parent of the child as a life assured , both policies are eligible to claim under the Children’s Congenital Conditions Benefit for that child , provided the Optional Children’s and Maternity Benefit is shown in the schedule of both policies.

registered medical practitioner has been consulted) within 12 months after the risk commencement date .

What pregnancy complication conditions are covered?

Disseminated intravascular coagulation.



Eclampsia.



Payment of the Children’s Congenital Conditions Benefit will not reduce the Critical Conditions Benefit.

Hydatidiform mole.



See Section 21 for a full description of these conditions .

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▪

When will Sovereign not pay a claim under the Optional Children’s and Maternity Benefit? Sovereign will not pay a benefit under the Optional Children’s and Maternity Benefit that arises as a direct or indirect consequence of:

Permanent loss of use of limbs ;

▪

Multiple sclerosis;

▪

Idiopathic Parkinson’s disease; or

within 60 days of the life assured surviving a period of twelve months after an accelerated Comprehensive Living Assurance Benefit claim payment for all other conditions (including the Optional Total Permanent Disablement condition , where applicable).

−

a pre-existing condition ; or



 any congenital condition , unless expressly covered under the Children’s Congenital Condition’s Benefit.

The Optional Children’s and Maternity Benefit will cease if cover under the Comprehensive Living Assurance Benefit ceases. Where the life assured has the Optional Living Assurance Buyback Benefit, the Optional Children’s and Maternity Benefit can be reinstated in addition to their Comprehensive Living Assurance Benefit, subject to the life assured satisfying the terms of the Optional Living Assurance Buyback Benefit.

 The Life Cover Benefit can be reinstated following a full payment claim or a partial payment claim.

 Only one Life Cover Buyback reinstatement will apply per life assured per policy.

 The maximum Life Cover Benefit that can be reinstated is 100% of the accelerated Comprehensive Living Assurance Benefit claim or $2,000,000, whichever is the lesser.

The Optional Children’s and Maternity Benefit ceases on the child’s 21 st birthday.

The Benefit(s) can only be reinstated on one occasion.

15. Optional Life Cover Buyback Benefit

What other conditions apply to cover reinstated under the Optional Life Cover Buyback Benefit?

What is the Optional Life Cover Buyback Benefit?

No reinstated Life Cover Benefit is payable:



The Optional Life Cover Buyback Benefit applies only if shown in the schedule and if you have selected an accelerated Comprehensive Living Assurance Benefit. Where an Optional Life Cover Buyback Benefit is selected, this allows the Life Cover Benefit to be reinstated without the need to provide further medical evidence following an accelerated Comprehensive Living Assurance Benefit claim, subject to the following conditions:  The Life Cover Benefit can be reinstated to the level applying immediately before the accelerated Comprehensive Living Assurance Benefit claim.

− within six months (for the conditions listed above that require a six month survival period); or

− within twelve months (for all other conditions , including the Optional Total Permanent Disablement condition, where applicable),

from the date of the accelerated Comprehensive Living Assurance Benefit claim payment, except where the claim event is for accidental death.  No Life Cover Buyback Benefit is available if the life assured has suffered a claim event under a Terminal Illness Benefit or a Specified Terminal Conditions Benefit under any Sovereign policy , whether or not a claim has been made.  Any exercise of the Life Cover Buyback Benefit may require an increase in premium . This premium increase will be calculated on the rates applicable at the time the Life Cover Benefit is reinstated.  Any accelerated benefits relating to the Life Cover Benefit for the life assured that have been reduced or removed as a result of an accelerated Comprehensive Living Assurance Benefit claim will not be reinstated.

 The Optional Life Cover Buyback can be exercised:

within 60 days of the accelerated Comprehensive Living Assurance Benefit claim payment; or

−

within 60 days of the life assured surviving a period of six months after an accelerated Comprehensive Living Assurance Benefit claim payment for one of the following conditions:

−

▪

Paraplegia;

▪

Quadriplegia;

▪

Diplegia;

16. Optional Living Assurance Buyback Benefit

▪

Hemiplegia;

▪

Alzheimer’s disease;

What is the Optional Living Assurance Buyback Benefit?

▪

Permanent blindness;

The Optional Living Assurance Buyback Benefit applies only if shown in the schedule .

▪

Permanent loss of hearing;

Where an Optional Living Assurance Buyback Benefit is selected, this allows the Comprehensive Living Assurance

▪

Dementia;

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under an Optional Living Assurance Buyback Benefit will be available in respect of the reinstated Benefit(s).

Benefit and where applicable, the Optional Early Cancer Upgrade Benefit and/or Optional Children’s and Maternity Benefit to be reinstated without the need to provide further medical evidence following a Comprehensive Living Assurance Benefit claim, subject to the following conditions:  The life assured must have had a claim paid on their Comprehensive Living Assurance Benefit that has reduced the sum assured to a nil balance.  Buyback of the Benefit(s) is not available following a Comprehensive Living Assurance claim for a condition listed in Section 1 which results in a partial payment.  No Living Assurance Buyback Benefit is available if the life assured has suffered a claim event under a Terminal Illness Benefit or a Specified Terminal Conditions Benefit under any Sovereign policy , whether or not a claim has been made.  A life assured can only exercise the Living Assurance Buyback Benefit for the cover provided under this policy once.

The reinstated Benefit(s) may require an increase in premium . This premium increase will be calculated at the rates applicable at the time the Benefit(s) are reinstated. However, where the Benefit(s) are reinstated after a full Comprehensive Living Assurance Benefit claim has been paid for cancer, stroke or heart attack, a discount will be applied to the Living Assurance Benefit premium .



 Any special terms, exclusions or premium loadings that applied to the original Benefit(s) will also apply to the reinstated Benefit(s) under the new policy.  If you had selected the Optional Total Permanent Disablement condition at the time of the first Comprehensive Living Assurance Benefit claim, this condition will be included under the reinstated Comprehensive Living Assurance Benefit, except where the Optional Total Permanent Disablement condition was the subject of the Comprehensive Living Assurance Benefit claim.  If you had selected the Optional Early Cancer Upgrade Benefit at the time of the first Comprehensive Living Assurance Benefit claim, this benefit can be reinstated alongside the original Comprehensive Living Assurance Benefit, except where you have previously received a claim payment under the Optional Early Cancer Upgrade Benefit.

What is the maximum amount of cover that can be reinstated?

The maximum Comprehensive Living Assurance Benefit that can be reinstated is 100% of the Comprehensive Living Assurance Benefit claim payment or $2 million, whichever is the lesser.

When can the life assured exercise the Optional Living Assurance Buyback Benefit?

 If you had selected the Optional Children’s and

Maternity Benefit at the time of the first Comprehensive Living Assurance Benefit claim, this benefit can be reinstated alongside the original Comprehensive Living Assurance Benefit.

The Optional Living Assurance Buyback Benefit can be exercised:  within 60 days of the Comprehensive Living Assurance Benefit claim payment; or

In the event of a claim in respect of the reinstated Comprehensive Living Assurance Benefit, no claim will be paid for:

 within 60 days of the first anniversary of the Comprehensive Living Assurance Benefit claim payment.

Any condition for the subsequent claim that is a related condition to the condition which was the subject of the first Comprehensive Living Assurance Benefit claim, as determined by Sovereign. The same condition for which Sovereign has paid a claim under a Comprehensive Living Assurance Benefit for the life assured , unless the original claim was for any of the conditions under the category of cancer , in which case : − any subsequent claims under the category of cancer will be excluded if the condition occurs with the 12 months immediately following the original claim event date; and



The Benefit(s) can only be reinstated on one occasion.

What other conditions apply to cover reinstated through the Optional Living Assurance Buyback Benefit?



On Sovereign’s acceptance of an application for reinstatement of the Comprehensive Living Assurance Benefit, and, where applicable, to the Optional Early Cancer Upgrade Benefit and/or Optional Children’s and Maternity Benefit, you will be issued a new policy for the Benefit(s) and sum assured amount(s) being reinstated in which case:  The new policy will be issued based on the information provided at the time of buyback, together with the information provided in the original proposal.

−

following this period then the same condition shall include any cancer that is either:

▪

of the same organ system as the original cancer; considered by the treating oncologist as likely to be a secondary cancer of the original cancer; or

▪

The terms and conditions of the new policy will be those which are then offered by us to the general public, with the exception that no further reinstatements



▪

a related cancer .

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Any heart (or heart-related) condition if the original claim was for a heart condition or a stroke, except where the claim in respect of the reinstated Comprehensive Living Assurance Benefit is for heart valve surgery or pulmonary hypertension, and these conditions have not previously been claimed for and are not considered by an appropriate specialist as likely to be secondary or directly resulting from the original condition .  Stroke, or any condition directly resulting from a stroke, if the original claim was for a heart (or heart- related) condition , except where the original claim was for heart valve surgery or pulmonary hypertension.



Comprehensive Living Assurance Benefit or $2,000,000.

Example 1: Original benefit = $100,000 Original benefit x 5 = $500,000 Cover available after the use of this Facility cannot exceed $500,000 Total increase under this Facility cannot exceed $400,000 Example 2: Original benefit = $500,000 Original benefit x 5 = $2,500,000 Cover available after the use of this Facility cannot exceed $2,000,000 Total increase under this Facility cannot exceed $1,500,000  The Comprehensive Living Assurance Benefit for a life assured under this policy after the use of this Facility cannot exceed the Life Cover Benefit for that life assured .  After the use of this Facility, the Comprehensive Living Assurance Benefit for a life assured under this policy plus any other living assurance type cover held on the life assured with any insurer cannot exceed $2,000,000.  The Optional Business Safeguard Facility cannot be exercised within six months of the risk commencement date .

 Any exclusion which applied to the original Comprehensive Living Assurance Benefit.

In the event of a claim in respect of the reinstated Optional Early Cancer Upgrade Benefit, no claim will be paid for:  The same cancer condition for which Sovereign has paid a claim under a Comprehensive Living Assurance Benefit for the life assured . The same cancer condition shall include any cancer that is either: − of the same organ system as the original cancer; − considered by the treating oncologist as likely to be a secondary cancer of the original cancer; or

a related cancer .

−

In the event of a claim in respect of the reinstated Optional Children’s and Maternity Benefit, no claim will be paid for:

 In any 12 month period you can make only two increases under this Facility.

 The Children’s Critical Conditions Benefit where you have already received a claim payment for the same child under the original Children’s Critical Conditions Benefit;  The Children’s Congenital Conditions Benefit where you have already received a claim payment for the same child under the original Children’s Congenital Conditions Benefit; or

 You must make the request within three months of the relevant business event.

 To apply for the increase in cover, you need to write to Sovereign to satisfy us that the value of the life assured 's financial interest is at least equal to the requested increase to the amount of cover. You must include: - a valuation of the business or valuation of the life assured to the business (as provided by an independent qualified accountant or business valuer); and/or

 Any exclusion which applied to the original Optional Children’s and Maternity Benefit.

17. Optional Business Safeguard Facility

- evidence of the loan guarantee, and any other contractual or financial evidence we may request.

The Optional Business Safeguard Facility applies only if shown in the schedule and if you have selected an accelerated Comprehensive Living Assurance Benefit. On each occasion that the financial interests of a life assured in the business increases, or their loan guarantee increases, or their value to the business increases, you may write to Sovereign asking us to increase the Comprehensive Living Assurance Benefit for that life assured without the need to provide medical evidence, subject to the following conditions:  The Comprehensive Living Assurance Benefit for a life assured under this policy after the use of this Facility cannot exceed the lesser of five times the original

 Any increase is subject to approval by Sovereign.

 The method chosen to value the business or life assured must be in accordance with established business valuation practice for the industry. The independent qualified accountant or business valuer cannot be a family member, business partner, employee or employer of you or the life assured . The method of valuation and valuer must be satisfactory to Sovereign.

 In the first six months following an increase, the life assured will only be covered for the amount of the

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19. How to make a claim

increase if the life assured ’s condition occurs as a direct and sole result of an accident .

To make a claim, refer to the section in your TotalCare Max policy entitled ‘How to make a claim’.

 You cannot apply for an increase under this Facility at any time when you have made, or are entitled to make, a claim under your Life Cover Benefit or Comprehensive Living Assurance Benefit.

In addition, for a Comprehensive Living Assurance Benefit claim, Sovereign will require information acceptable to us, including medical evidence and reports, showing proof of the condition giving rise to the claim. Sovereign may require the life assured or his or her child (if applicable) to have an examination by a registered medical practitioner appointed by Sovereign before accepting liability for a claim. Where the Optional Total Permanent Disablement condition is the condition giving rise to the claim, Sovereign will also require:

 Each Optional Business Safeguard Facility increase will require an increase in premium . This increase will be

calculated on the rates applicable at the time the Optional Business Safeguard Facility is used.

18. Exclusions – when Sovereign won’t pay a benefit

Sovereign will not pay any benefit described in this appendix where any of the following (and in each case either directly or indirectly) causes or contributes to the claim:  The life assured (or the child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) deliberately injures himself or herself or attempts to do so.  The life assured (or the child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) engages in or is part of any conduct that is criminal.  Any condition or any symptom or signs leading to the condition (whether or not a registered medical practitioner has been consulted) that existed before the risk commencement date , unless Sovereign is satisfied that you or the life assured could not have known of the existence of the condition or symptom or signs leading to the condition , or the condition or symptom or signs leading to the condition were declared on your application and accepted by Sovereign. Sovereign will not pay any benefit described in this appendix where any of the following occurs before a life assured (or any child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) reaches age 21, and (in each case either directly or indirectly) causes or contributes to a claim for that life assured (or child ):

 A Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense).

 Other information which Sovereign may reasonably request to help assess the claim, which may include evidence of earnings, taxable income, business accounts, Accident Compensation Corporation details or similar.  The life assured to undergo medical and/or surgical treatment (including any operation or vocational, medical and/or social rehabilitation programme) at your expense which the life assured ’s registered medical

practitioner or a registered medical practitioner approved by Sovereign considers necessary.

 Any other information that Sovereign may deem relevant to the assessment of the claim.

For advice about submitting a claim you can phone Sovereign on 0800 500 108 or your Adviser. Find claim information online at sovereign.co.nz

 any intentional act by you or by any parent or guardian of the life assured , or child.

 any intentional act by someone who lives with or supervises the life assured, or child.

Sovereign will not pay a children’s benefit under the Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit that arises as a direct or indirect consequence of:

a pre-existing condition ; or



 any congenital condition , except where expressly covered under the Children’s Congenital Conditions Benefit.

These exclusions apply to any subsequent benefit increase you make.

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