Severity Level
Conditions
– Lung
– Liver
– Pancreas
– Intestine
The transplant of all other organs or parts of any organ or any other tissue or stem cell transplant is excluded.
The transplant must be considered medically necessary and the condition affecting the organ deemed untreatable by any means other than organ transplant, as confirmed by a relevant medical specialist. HIV - Infection with the Human Immunodeficiency Virus (HIV) must have been acquired by accident or violence during the course of the life assured 's normal occupation or through the medium of a blood transfusion, transfusion of blood products, organ transplant, assisted reproduction technique or other medical procedure or operation performed by a registered healthcare professional and/or in a registered hospital care institution, or surgical centre or surgical clinic. You must prove this to Sovereign's satisfaction. Sero-conversion to the HIV infection must occur within six (6) months of the accident . HIV infection transmitted by any other means, including but not limited to sexual activity or non-medical intravenous drug use, is not covered under this appendix . Any incident giving rise to a potential claim must be reported to Sovereign within 30 days of the incident and be supported by a negative HIV Antibody Test taken within 7 days after the incident. Sovereign may decline your claim if Sovereign is not given access to independently test all blood samples used, if Sovereign requires, or if the life assured does not allow Sovereign to take further independent blood tests. Acute renal dialysis means undergoing more than two treatments of haemodialysis over a three week period or a cumulative total of more than 24 hours haemofiltration due to a rapid decline of renal function leading to renal failure. Stage 3 Chronic Obstructive Pulmonary Disease (COPD) means a disease of the airways of the lung causing obstruction to the exhalation of air. There must be permanent and irreversible reduction of the maximum volume of air expelled in one second (FEV1) of between 31% and 49% of predicted. There must be permanent and irreversible obstruction to airflow demonstrated by a FEV1/ FVC ratio of less than 50% and there must be less than 5% variation in three repeated measurements, (which must be performed under the direction of a specialist respiratory physician) whilst on optimal therapy. They must be measured in a respiratory laboratory, which has regular quality control audits available to Sovereign. These measurements must be repeated after an interval of at least three months and must also satisfy the criteria mentioned above for a claim to be considered.
Removal of large bowel means that the life assured has undergone a surgical procedure to remove the entire large bowel.
Pneumonectomy means the undergoing of surgery to remove an entire lung. The treatment must be considered medically necessary by a relevant medical specialist .
3
Systemic sclerosis means an unequivocal diagnosis of systemic sclerosis by a relevant medical specialist , causing the life assured to be totally and irreversibly unable to perform any one of the activities of daily living without assistance of another adult person. Systemic lupus erythematosus with lupus nephritis means that the life assured has been unequivocally diagnosed by a relevant medical specialist with systemic lupus erythematosus with lupus nephritis in the clinical setting, evidenced by the presence of any four or more of the following twelve criteria: – Malar rash: Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds. – Discoid rash: Erythematosus, raised patches with adherent kerotic scaling and follicular plugging, atrophic scarring may occur in older lesions. – Photosensitivity: Skin rash as a result of unusual reaction to sunlight, evidenced by patient history or specialist’s report. – Oral ulcers: Oral or nasopharyngeal ulceration reported by physician.
818 TCP-PC version 12 Effective 12 May 2026
Page 30 of 34
Powered by FlippingBook