Pancreas; or
person
An individual, employer, company, partnership, association, organisation or trust.
Bone marrow; or
Intestine.
The transplant of all other organs, parts of organs or any other tissue transplant is excluded.
pre-disability income
1) For employed:
Means the average monthly earnings of the life assured before tax from their principal employment in the 12 months immediately before the disablement date . Any benefits for which fringe benefit tax would
15. Key terms
benefit term
The term for which the life assured is insured for the Essential Disability Income Benefit as stated in the schedule . The maximum period for which the Essential Disability Income Benefit is payable as stated in the schedule . For a benefit payment period of five years;
be payable under the tax legislation applying at the
benefit payment period
disablement date would also be included. Sovereign will calculate the value of these benefits in accordance with the formula used by the Inland Revenue Department.
the benefit period will cease when the five year period expires or when the life assured turns 65, whichever is earlier; and the five year period is the total period for which benefits will be payable for all claims arising from the same or a related illness or injury.
2) For self-employed:
1/12 th of the taxable income of the life assured earned from their business or occupation (after business or professional expenses) during a continuous 12 month period chosen by the life assured from the 36 months immediately before the disablement date . Any disease or medical condition for which, prior to becoming covered under this appendix , the individual consulted a registered medical practitioner , received treatment or services from a registered medical practitioner , or took prescribed drugs and medicines. A registered medical practitioner who has an approved fellowship in one of the approved surgical, anaesthetic or traditional nonsurgical colleges and who is registered with the New Zealand Medical Council. These include, but are not limited to, the following disciplines: general surgery, orthopaedic surgery, urology, neurosurgery, anaesthesiology, cardiology, endocrinology, gastroenterology, haematology, paediatrics, gynaecology, obstetrics, neurology, oncology, renal specialists and rheumatology.
condition(s)
A treatment, illness, surgical procedure or event as specified in this appendix which leads to a claim being paid under the specified definition. A health anomaly or defect which is present at birth, whether it is recognised or not, and whether it is inherited or due to external environmental factors such as drugs, alcohol, or complications during pregnancy or delivery.
pre-existing condition
congenital condition
specialist
disablement date
The date the life assured became totally disabled .
eligible sources
Your business, employer, former employer, business partnership, family trust or company.
full-time care
Care for 16 hours per day or more, provided by a nursing service approved by Sovereign whose profession it is to provide nursing services.
homemaker
A person who manages the household of his or her own family as a principal occupation.
totally disabled / total disablement
See Section 3 of this appendix for the meaning of these key terms.
809 TCP-EDI version 6 Effective 21 May 2019
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