SFS Group Life Insurance Scheme

Critical Illness Defined

The following are the defined conditions under which benefits are payable and which must be established to the satisfaction of Unum's Chief Medical Officer before benefit will be paid.

Alzheimer's Disease - A global impairment of brain function such that permanent supervision or assistance by a third party is required. The diagnosis must be made by an appropriate consultant who should be satisfied that there is no other discernible cause.

Aorta Graft Surgery - The undergoing of surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches.

Balloon Angioplasty - The undergoing of any interventional technique, on the advice of a Consultant Cardiologist, involving the use of transluminal coronary catheters to correct significant stenosis of at least 50% diameter narrowing of two or more coronary arteries as part of a single procedure. Angiographic evidence to support the necessity for the above operation will be required.

Balloon Valvuloplasty - The actual insertion, on the advice of a Consultant Cardiologist, of a balloon catheter through the orifice of one of the valves of the heart and the inflation of the balloon to relieve valvular abnormalities.

Benign Brain Tumour - A non-malignant tumour in the brain, resulting in permanent deficit to the neurological system. Tumours or lesions in the pituitary gland are not covered.

Blindness - The degree of sight remaining after correction in the better eye is 3/60 or less on the Snellen Scale (i.e. only able to see at 3 feet what you would normally be able to see at 60 feet) and an appropriate specialist has confirmed that the condition is permanent and without expectation of recovery.

Cancer - Any malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkin's Disease, but the following are excluded:

1. All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ
2. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0M0
3. All forms of lymphoma in the presence of any Human Immunodeficiency Virus
4. Kaposi's sarcoma in the presence of any Human Immunodeficiency Virus
5. 5) Any skin cancer other than invasive malignant melanoma.

Chronic Lung Disease, including Emphysema - Severe and permanent restrictive lung disease where there is a dyspnoea at rest with markedly abnormal pulmonary function tests. The diagnosis must be evidenced by all of the following:

1. The need for continuous daily oxygen therapy
2. Vital Capacity being less than 50% of normal
3. FEV1 (Forced Expiratory Volume at 1 second) being less than 50% of normal.

Coma - A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously with the use of life support systems for a period of at least 96 hours and resulting in permanent neurological deficit. Coma secondary to alcohol or drug misuse is not covered.

Coronary Artery Bypass Surgery - The undergoing of open heart surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with bypass grafts but excluding balloon angioplasty, laser relief or any other procedures.

Creutzfeldt Jakob Disease - Diagnosis of Creutzfeldt-Jakob disease or New Variant CJD made by a Consultant Neurologist, evidenced by a significant reduction in mental and social functioning so that permanent supervision or assistance by a third party is required.

Deafness - Total and irreversible loss of hearing in both ears as confirmed by an appropriate specialist.

Heart attack - The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

1. Typical chest pain;
2. New characteristic electrocardiographic changes;
3. The characteristic rise of cardiac enzymes, troponins or other biochemical markers;

where all of the above shows a definite acute myocardial infarction. Other acute coronary syndromes, including but not limited to angina, are not covered under this definition.

Heart Valve Replacement or Repair - Undergoing open-heart surgery from medical necessity to replace or repair one or more heart valves.

HIV Infection/AIDS contracted in the course of duty - Infection by any Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) or other similar or related syndrome provided that:

1. The Member is a medical practitioner, a person involved in a medical facility, a prison officer, a dentist, or a member of the fire, police or ambulance emergency services
2. The infection must have arisen in the course of the Member's normal duties and must have been acquired as a result of contact with an HIV-infected patient, prisoner or recipient of emergency assistance or with an HIV-infected medical instrument
3. The incident that results in such a contact must have occurred after the Member's entry to the scheme and must have been reported, investigated and documented in accordance with established procedures for the facility in which it occurred and
4. The Member must have been tested within 14 days after the incident and shown not to have antibodies to the Human Immunodeficiency Virus. A subsequent test must be performed within 12 months of the incident indicating infection with a Human Immunodeficiency Virus.

HIV Infection/AIDS contracted due to a blood transfusion or other specified transfusion therapies - Where:

1. There is satisfactory evidence to indicate that the infection is due to a blood transfusion or other specified transfusion therapy received in the United
2. The institution providing the transfusion or therapy admits liability

Blood transfusion includes whole blood, white blood cells and platelets. Specified other transfusion therapies are: gammaglobulin therapy; intravenous immunoglobulin therapy; factor VIII and other factors, plasma exchange therapy, leucophoresis, rhesus therapy, cryoglobulin removal therapy.

Kidney Failure - End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated.

Loss of Limbs - The permanent physical severance of two or more limbs from above the wrist or ankle joint.

Loss of Speech - Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

Major Organ Transplant - The actual undergoing as a recipient of, or inclusion on an official UK waiting list for, a transplant of a heart, liver, lung, pancreas or bone marrow.

Motor Neurone Disease - Confirmation by a Consultant Neurologist of a definite diagnosis of Motor Neurone Disease.

Multiple Sclerosis - A definite diagnosis by a Consultant Neurologist of Multiple Sclerosis which satisfies all of the following criteria:

1. There must be current impairment of motor or sensory function, which must have persisted for a continuous period of at least six months;
2. The diagnosis must be confirmed by diagnostic techniques current at the time of the claim.

Open Heart Surgery - The undergoing of open heart surgery, on the advice of a Consultant Cardiologist, to correct valvular and structural abnormalities.

Paralysis / Paraplegia - Total irreversible loss of muscle function or sensation to the whole of any two limbs as a result of injury or disease. The disability must be permanent and supported by appropriate neurological evidence.

Parkinson's Disease - Confirmation by a Consultant Neurologist of a definite diagnosis of Parkinson's Disease. Parkinson's Disease secondary to alcohol or drug misuse is not covered.

Permanent Total Disability (PTD) - Permanent Total Disability (PTD) is defined as a permanent disability caused by any illness (not just a Critical Illness) or any injury. The Member will be entitled to benefit under PTD if, as a result of illness or injury, they have been unable to perform any occupation for a continuous period of six months and will remain unable to do so for the remainder of their life.

Pre-Senile Dementia - Progressive deterioration in mental function of at least 6 months duration resulting in abnormal behaviour or deterioration of intellectual capacity such that permanent supervision or assistance is required to maintain existence. The deterioration must be due to organic brain disease, diagnosed by an appropriate consultant who is satisfied there is no other discernible cause.

Pulmonary Artery Surgery - The actual undergoing of surgery on the advice of a Consultant Cardiothoracic Surgeon for a disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft.

Rheumatoid Arthritis - Widespread joint destruction with major clinical deformity of three or more of the following joint areas: hands, wrists, elbows, cervical spine, knees, ankles, metatarsophalangeal joints in the feet.

The severity of the disease shall be such that the Member will have been disabled for a continuous period of at least six months and prevented from performing their usual occupation and any other to which suited by education, training or experience.

Severe Head Injuries - Accidental injury to the head resulting in residual brain damage. There must be permanent neurological deficit causing significant functional impairment as defined by a Consultant Neurologist using standard measures of head injury (for example, a score of five or less on the Glasgow Coma Scale for Head Injuries).

Stroke - A cerebrovascular incident resulting in permanent neurological damage. Transient ischaemic attacks are specifically excluded.

Third Degree Burns - Third degree burns covering at least 20% of the body surface area.

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