activity of daily living for a continuous period of 90 days from first being admitted into the intensive care unit or high dependency unit (as applicable) as certified by an appropriate medical specialist . A medical condition arising from alcohol or drug abuse or other self-inflicted means is specifically excluded. This Benefit does not apply to any condition specifically excluded in this policy or where an underwriting exclusion has been applied.
Pneumonectomy The life assured has undergone surgery to remove an entire
lung. The treatment must be considered medically necessary by an appropriate medical specialist .
Severe burns
Full payment
The life assured has suffered severe tissue injury caused by thermal, electrical or chemical agents. As a result, the life assured has full thickness or third-degree burns to: at least 20% of the body surface area (as measured by age-appropriate use of The Rule of 9 or the Lund and Browder Body Surface Chart); or
Severe osteoporosis
The life assured has been unequivocally diagnosed by an appropriate specialist as suffering from severe osteoporosis. The diagnosis must confirm that the life assured :
50% of both hands, requiring surgical debridement and/or grafting; or
suffers at least two vertebral body fractures or a fracture of the neck of the femur, due to osteoporosis; and
25% of the face, requiring surgical debridement and/or grafting.
has a bone mineral density reading with a T-score of less than -2.5 (i.e. 2.5 standard deviations below the young adult mean for bone density). This must be measured in at least two sites by dual energy x-ray absorptiometry (DEXA). No benefit is payable in cases where there are spontaneous fractures or minimal traumas that are due to an accident but where coincidental osteoporosis exists.
Partial payment
The life assured has suffered severe tissue injury caused by thermal, electrical or chemical agents. As a result, the life assured has full thickness or third-degree burns to:
both hands, requiring surgical debridement and grafting; or
The benefit payable is:
the face, requiring surgical debridement and grafting.
25% of the sum assured up to a maximum of $75,000 across all Business Sovereign policies for the life assured if the unequivocal diagnosis occurs before the life assured is 50 years of age; or 25% of the sum assured up to a maximum of $10,000 across all Business Sovereign policies for the life assured if the unequivocal diagnosis occurs after the life assured is over 50 years of age.
The benefit payable is 25% of the sum assured to a maximum of $75,000 across all Business Sovereign policies for the life assured .
Severe Crohn’s disease
A life assured has been unequivocally diagnosed with Crohn’s disease that requires permanent immunosuppressive medication or as a result of the diagnosis has undergone a surgical procedure to remove the entire large bowel. The benefit payable is 25% of the sum assured to a maximum of $75,000 across all Business Sovereign policies for the life assured .
Severe rheumatoid arthritis
The life assured has been unequivocally diagnosed by an appropriate specialist as suffering from severe rheumatoid arthritis for at least six weeks, which affects at least three or more of the following joints:
Metacarpophalangeal joints in the hands;
Severe illness or injury
Proximal interphalangeal joints in the hands;
If the life assured suffers a medical condition that does not satisfy any condition leading to either a full or partial claim under this policy and it is deemed medically necessary to:
Metatarsophalangeal joints in the wrist, elbow, foot, knee, or ankle.
The diagnosis must be supported by a positive rheumatoid serology or other appropriate diagnostic test evidencing rheumatoid arthritis, together with evidence confirming at least three of the following criteria:
undergo major invasive surgery ; or
be treated using major interventional treatment ;
which results in: – a stay in an intensive care unit for a period greater than 48 continuous hours; or – a stay in a high dependency unit for a period greater than 96 continuous hours; and the life assured is unable to perform at least one basic
Simultaneous bilateral and symmetrical joint soft tissue swelling or fluid;
Joint deformity typical of rheumatoid arthritis;
Rheumatoid nodules beneath the skin;
852 TCB-LAC version 19 Effective 12 May 2026
Page 22 of 27
Powered by FlippingBook