12. When will this appendix terminate for a life assured? This appendix will terminate and eligibility for the Essential Disability Income Benefit will cease for a life assured:
Any other information that Sovereign may deem relevant to the ongoing assessment of the claim.
11. When will Sovereign cease paying a benefit?
At the expiry of the benefit term as shown in the schedule .
Sovereign will cease paying a benefit if:
(a) The life assured fails to undergo and complete:
When the life assured dies.
any surgical operation; and/or
When the benefit is cancelled.
any medical rehabilitation programme; and/or
13. Exclusions – when Sovereign wo n’t pay a benefit Sovereign will not pay any of the benefits listed in this appendix where any of the following (and in each case either directly or indirectly) cause or contribute to the disability: The life assured (or a child in respect of the Children’ s Benefit) deliberately injures himself or herself or attempts to do so. The life assured (or a child in respect of the Children’s Benefit) engages in or is part of any conduct that is criminal. Pregnancy of, or childbirth by, the life assured, unless the disability lasts for more than 90 days after the end of pregnancy, in which case the waiting period will start from the 91 st day. The life assured does not comply with the treatment recommended by the attending treatment providers. Sovereign will not pay a Children’s Benefit for the relevant condition if the condition directly or indirectly arises from an injury caused by you , the child’s parents or guardian (s). Sovereign will also not pay a Children’s Benefit if the disability is directly or indirectly caused, or contributed to, by:
any social rehabilitation programme; and/or
any vocational rehabilitation programme,
which a registered medical practitioner approved by Sovereign considers reasonably necessary.
(b) The life assured fails to undertake any medical examinations that Sovereign requires the life assured to have, at our expense. (c) The life assured fails to comply with the requirements of Section 10 above. (d) Sovereign determines that the life assured is no longer totally disabled or partially disabled. (e) The benefit payment period expires in relation to the life assured. (f) The life assured or anyone acting on behalf of the life assured makes a false or fraudulent statement in respect of a claim or supports any claim with false evidence.
(g) The life assured is in prison for any reason.
(h) The life assured dies.
(i) The ongoing cause of disablement ceases to be the condition that gave rise to the claim. No amount will be payable where the ongoing cause of disablement is a secondary condition that is not one of the conditions covered by this appendix , such as depression. If Sovereign ceases paying a benefit in accordance with paragraphs (a), (b) or (c) and the life assured subsequently complies with the relevant requirement(s), then: > The date that the life assured complied with the relevant requirement(s) will, subject to the provisions of this appendix, be treated as the disablement date for a new claim.
a pre-existing condition ; or
any congenital condition.
If the life assured is imprisoned for any reason, no monthly benefit will be payable during the term of imprisonment.
14. Definitions of medical conditions
Cancer
Carcinoma-in-situ
As a result of a carcinoma-in-situ, an operation to arrest spread of the malignancy is performed that is considered medically necessary by an appropriate specialist . This benefit only covers the following carcinoma-in-situ surgeries: Carcinoma-in-situ of the breast requiring the removal of the entire breast.
> The waiting period will be waived for the new claim.
> If the benefit payment period is five years, the original claim and the new claim will be considered to be the same claim in respect of the benefit payment period . > No monthly benefit payments will be payable retrospectively for any period of time before the date that the life assured subsequently complies with the relevant requirement(s).
Carcinoma-in-situ of the cervix requiring a total hysterectomy.
Carcinoma-in-situ of the ovaries or fallopian tubes requiring a total hysterectomy and/or oophorectomy.
Carcinoma-in-situ of the vagina requiring a pelvic
809 TCP-EDI version 6 Effective 21 May 2019
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