congenital condition
A health anomaly or defect, regardless of whether diagnosed or not:
major interventional treatment
Non-surgical procedures or treatments initiated to treat the claimed medical condition including but not limited to: stereotactic radiosurgery, laser therapy, ultrasonic aspiration, chemotherapy, radiotherapy, or immunotherapy. Pharmaceutical therapies administered outside of a clinical setting are excluded.
which is present at birth; and
for which the individual had signs or symptoms within three months of birth.
Includes health anomalies or defects inherited or due to external environmental factors such as drugs, alcohol, or
major invasive surgery
An invasive procedure occurring in a hospital
operating theatre involving the incision, excision, manipulation, or suturing of tissue, under general anaesthesia, spinal anaesthesia or epidural. Elective cosmetic procedures are excluded. A service or supply provided by a registered medical practitioner or specialist that
complications during pregnancy or delivery.
date of conversion
The later of the effective date or the actual date from which we receive the increased premium for the Life Cover Benefit and accelerated Progressive Care benefit cover. Working to generate income through personal efforts by using the life assured ’s time and skills. He or she can be self-employed, employed, earning fees, under contract, receiving commissions, working on contract or otherwise remunerated for his or her efforts. A specially staffed and equipped section of an intensive care complex that provides a level of care intermediate between intensive care and general ward care. Patients may be admitted to the high dependency unit: from the intensive care unit
medically necessary
Sovereign deems on reasonable grounds is
gainful employment
necessary for the treatment of the disease, illness, or injury involved. Under no circumstances shall the following services or supplies be considered medically necessary:
Those services or supplies that do not require the skills or services of a registered medical practitioner or specialist ; and Those services or supplies provided mainly for the comfort or convenience of the life assured.
high dependency unit
as a step-down prior to transfer to the ward, or directly from the ward, recovery or emergency areas.
pre-existing condition
Any disease or medical condition for which, prior to becoming covered under this policy, the individual consulted a registered medical practitioner , received treatment or services from a Registered Medical Practitioner , or took prescribed drugs and medicines. Any condition that Sovereign, in its sole discretion, deems to be directly or indirectly related to a previous claim's condition . This includes:
life assured
A ‘ Life assured ’ named in the schedule .
An arm, leg, hand or foot. In respect of this definition:
limb(s)
the arm starts from the shoulder joint and ends at the wrist joint; the hand starts from the wrist joint; the leg starts from the hip joint and ends at the ankle joint; and the foot starts from the ankle joint.
related condition
any increase in severity level of the same condition , and
any condition that is a recognised outcome
818 TCP-PC version 12 Effective 12 May 2026
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