term assurance and critical illness cover – policy terms and conditions

POLICY TERMS

AND CONDITIONS.

This pocket contains your policy schedule.

You should read this in conjunction with the

printed policy terms and conditions.

Please keep these documents in a safe place,

in case you need to refer to them later.

TERM ASSURANCE AND CRITICAL ILLNESS COVER

T&C 51

Legal & General Assurance Society Limited

Registered in England No.166055

Registered ofﬁce: One Coleman Street, London EC2R 5AA

We are authorised and regulated by the Financial Services Authority.

We are members of the Association of British Insurers.

W13368 11 / 11

www.legalandgeneral.com

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TERM ASSURANCE AND CRITICAL ILLNESS COVER – POLICY TERMS AND CONDITIONS

Our, us or we

Legal & General Assurance Society Limited.

Permanent

Expected to last throughout the insured person’s life, irrespective of when the cover ends or the

insured person retires.

Permanent neurological deficit with persisting clinical symptoms

Symptoms of dysfunction in the nervous system that are present on clinical examination and

expected to last throughout the insured persons life. Symptoms that are covered include numbness,

hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty in

swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy,

dementia, delirium and coma.

Policy

This policy issued by us, which consists of the policy terms and conditions and policy schedule.

Policy expiry date

The date that cover under this policy will end, as shown in your policy schedule.

Policy schedule

The schedule which shows the cover that you have and forms part of this policy.

Policy start date

The start date of this policy, as shown in your policy schedule.

Pre-existing condition

A pre-existing condition is any medical condition, disorder or handicap from which a child is already

suffering before the latest of:

 • thedatethepolicy is issued,

 • the30thdayafterthechild’sbirth,

 • forlegallyadoptedchildren,thedateofadoption.

Premium(s)

The amount you pay to us for this policy as shown in your policy schedule.

Principal office

Our principal office is:

City Park

The Droveway

Hove

East Sussex

BN3 7PY

Product

The type of cover, as shown in your policy schedule.

Relevant child

A natural child, legally adopted child (from the date of adoption) or stepchild of the life assured,

while such a child is aged more than 30 days and less than 18 years during the term of the policy.

Retail Prices Index (RPI)

The Retail Prices Index (RPI) provides an indication of inflation on a monthly basis. The RPI measures

and tracks the average change in the purchase price of goods and services such as housing expenses

and mortgage interest payments.

Successor in title

The person(s) legally entitled to the life assured’s estate upon the death of the life assured.

Sum assured

The amount of Term Assurance and Critical Illness Cover, as shown in your policy schedule. If

reviewable premiums are included in your policy schedule, this amount may change as described

in section 7.3.

If decreasing cover was chosen, the table in your policy schedule will show how the amount of

Term Assurance and Critical Illness Cover decreases.

You or your

The policyholder(s) of the policy who is/are legally entitled to receive the sum assured and shown

as the “grantee” in the policy schedule. This may include trustee(s), assignee(s) or personal

representative(s) (where appropriate) and may be the same person(s) as the life assured.

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CONTENTS.

1. INTRODUCTION

3. CRITICAL ILLNESS COVER

8. GENERAL CONDITIONS

10. THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS)

11. DEFINITIONS EXPLAINED

2. MAIN COVER

2.1 Who is covered?

2.2 How much cover is provided?

2.3 How long does this cover last?

2.4 How is the sum assured paid?

2.5 When is the sum assured payable?

2.6 Who is the sum assured paid to?

2.7 Exclusions

4. ADDITIONAL COVER

4.1 Mastectomy for Ductal Carcinoma In Situ

4.1.1 E xclu sions

4.2 Children’s Critical Illness Cover

4.2.1 Conditions

4.2.2 Exclusions

5. GUARANTEED INSURABILITY OPTION

5.1 Increasing the sum assured

5.1.1 When can you use the guaranteed insurability option?

5.1.2 Conditions

5.2 Business Protection – Increasing the sum assured

5.2.1 When can you use the guaranteed insurability option?

5.2.2 Conditions

7. PAYMENT OF PREMIUMS

7.1 When are premiums due to be paid?

7.2 Will the amount you pay ever change?

7.3 Reviewable premiums

7.3.1 Options at your premium review

7.4 What happens if you don’t pay your premiums?

9. HOW TO…

9.1 Contact us

9.2 Make a claim

9.3 Change this policy

9.4 Cancel this policy

9.5 Make a complaint

6. WAIVER OF PREMIUM BENEFIT

6.1 Conditions

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The main cover provided by this policy is:

  • LifeCover,and

  • CriticalIllnessCover.

We will pay the sum assured if the life assured:

  • diesor,

  • isdiagnosedwithacriticalillnessasdefinedinsection3,

whichever occurs first, on or after the policy start date and on or before the policy expiry date.

2.1 Who is covered?

The life assured is covered.

2.2 How much cover is provided?

The amount of cover provided is the sum assured as shown in the policy schedule.

2.3 How long does this cover last?

This cover starts on the policy start date and ends on:

  • thepaymentofthesum assured, or

  • ifnosum assured becomes payable, the policy expiry date.

Once this policy ends, no further benefits or premiums will be payable.

2.4 How is the sum assured paid?

The sum assured is paid as a lump sum unless otherwise shown in the policy schedule.

2.5 When is the sum assured payable?

The sum assured is payable on the death or diagnosis with a critical illness of the life assured, or

for a joint life policy, when the first of the lives assured dies or is diagnosed with a critical illness.

2.6 Who is the sum assured paid to?

The sum assured is paid to you or your successors in title.

2.7 Exclusions

We will not pay the sum assured:

a) In any circumstances that are shown under the exclusions section in your policy schedule.

b) If within the first year of this policy the life assured commits suicide, in which case this policy

will be void. This condition will not apply where a mortgage lender is legally entitled to the proceeds

of this policy, in which case we will pay the mortgage lender the lower of:

i) the benefits payable under this policy; and

ii) the amount the mortgage lender is legally entitled to.

MAIN COVER

INTRODUCTION1

MAIN COVER2

This policy sets out your contract with us and should be kept in a safe place. Words that appear

in blue bold are explained in section 11.

This policy consists of:

  • thepolicy schedule and

  • thesepolicy terms and conditions.

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Alzheimer’s Disease –

resulting in permanent

symptoms

Aorta Graft Surgery –

requiring surgical

replacement

Aplastic Anaemia –

with permanent bone

marrow failure

Bacterial Meningitis –

resulting in permanent

symptoms

Benign Brain Tumour –

resulting in either surgical

removal or permanent

symptoms

A definite diagnosis of Alzheimer’s disease by a Consultant

Neurologist, Psychiatrist or Geriatrician.

There must be permanent clinical loss of the ability to do all

of the following:

• remember;

• reason;and

• perceive,understand,expressandgiveeffecttoideas.

For the above definition, the following is not covered:

• Othertypesofdementia.

The undergoing of surgery to the aorta with excision and

surgical replacement of a portion of the aorta with a graft.

The term aorta includes the thoracic and abdominal aorta

but not its branches.

For the above definition, the following is not covered:

• Anyothersurgicalprocedure,forexampletheinsertion

of stents or endovascular repair.

A definite diagnosis of Aplastic Anaemia by a Consultant

Haematologist. There must be permanent bone marrow failure

with anaemia, neutropenia and thrombocytopenia.

A definite diagnosis of Bacterial Meningitis resulting in

permanent neurological deficit with persisting clinical

symptoms.

For the above definition, the following is not covered:

• Allotherformsofmeningitisotherthanthosecaused

by bacterial infection.

A non-malignant tumour or cyst in the brain, cranial nerves

or meninges within the skull, resulting in either surgical

removal or permanent neurological deficit with persisting

clinical symptoms.

For the above definition, the following are not covered:

• Tumoursinthepituitarygland.

• Angiomas.

CRITICAL ILLNESS COVER3

If the life assured both contracts and is diagnosed with a critical illness as defined below, on or

after the policy start date and on or before the policy expiry date, the sum assured will be payable.

This cover is subject to the following condition:

  • Thecontractionanddiagnosisofacriticalillnessmustbeverifiedbyamedicalspecialist

who holds an appointment as a consultant at a hospital in the UK and whose specialism we

reasonably consider is appropriate to the critical illness.

Under certain circumstances, we will allow verification in other countries. We will act reasonably

when exercising our discretion to allow verification in another country.

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Blindness – permanent and

irreversible

Cancer – excluding less

advanced cases

Cardiomyopathy –

of specified severity

Coma – resulting in

permanent symptoms

Permanent and irreversible loss of sight to the extent that even

when tested with the use of visual aids, vision is measured

at 3/60 or worse in the better eye using a Snellen eye chart.

A state of unconsciousness with no reaction to external stimuli

or internal needs which:

• Requirestheuseoflifesupportsystems;and

• Resultsinpermanent neurological deficit with persisting

clinical symptoms.

For the above definition, the following is not covered:

• Comasecondarytoalcoholordrugabuse.

Any malignant tumour positively diagnosed with histological

confirmation and characterised by the uncontrolled growth

of malignant cells and invasion of tissue. The term malignant

tumour includes leukaemia, lymphoma and sarcoma.

For the above definition, the following are not covered:

• Allcancerswhicharehistologicallyclassifiedasany

of the following:

– pre-malignant;

– non-invasive;

– cancer in situ;

– having either borderline malignancy; or

– having low malignant potential.

• Alltumoursoftheprostateunlesshistologicallyclassifiedas

having a Gleason score greater than 6 or having progressed

to at least clinical TNM classification T2N0M0.

• Chroniclymphocyticleukaemiaunlesshistologicallyclassified

as having progressed to at least Binet Stage A.

• Anyskincancerotherthanmalignantmelanomathathas

been histologically classified as having caused invasion

beyond the epidermis (outer layer of skin).

A definite diagnosis of cardiomyopathy by a Consultant

Cardiologist. There must be clinical impairment of heart

function resulting in the permanent loss of ability to perform

physical activities to at least Class 3 of the New York Heart

Association’s classification of functional capacity*.

For the above definition, the following are not covered:

• Cardiomyopathysecondarytoalcoholordrugabuse.

• Allotherformsofheartdisease,heartenlargement

and myocarditis.

* NYHA Class 3. Heart disease resulting in marked limitation

of physical activities where less than ordinary activity causes

fatigue, palpitation, breathlessness or chest pain.

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Coronary Artery By-Pass

Grafts – with surgery to

divide the breastbone or

anterolateral thoracotomy

Creutzfeldt-Jakob Disease

(CJD) – resulting in

permanent symptoms

Deafness – permanent and

irreversible

Dementia – resulting in

permanent symptoms

Encephalitis – resulting in

permanent symptoms

Heart Attack – of specified

severity

Theundergoingofsurgeryrequiringmediansternotomy

(surgery to divide the breastbone) or anterolateral

thoracotomy on the advice of a Consultant Cardiologist to

correct narrowing or blockage of one or more coronary

arteries with by-pass grafts.

For the above definition, the following is not covered:

Any other surgical procedure or treatment.

A definite diagnosis of Creutzfeldt-Jakob disease made by a

Consultant Neurologist. There must be permanent clinical loss

of the ability in mental and social functioning to the extent that

permanentsupervisionorassistancebyathirdpartyisrequired.

Permanent and irreversible loss of hearing to the extent that

thelossisgreaterthan95decibelsacrossallfrequenciesinthe

better ear using a pure tone audiogram.

A definite diagnosis of Dementia by a Consultant Neurologist,

Psychiatrist or Geriatrician. The diagnosis must be supported by

evidence of progressive loss of ability to do all of the following:

• remember;

• toreason;and

• toperceive,understand,expressandgiveeffecttoideas

For the above definition, the following is not covered:

• Dementiasecondarytoalcoholordrugabuse.

A definite diagnosis of Encephalitis by a Consultant Neurologist

resulting in permanent neurological deficit with persisting

clinical symptoms.

Deathofheartmuscle,duetoinadequatebloodsupply,

that has resulted in all of the following evidence of acute

myocardial infarction:

• Newcharacteristicelectrocardiographicchanges.

• ThecharacteristicriseofcardiacenzymesorTroponins

recorded at the following levels or higher:

– Troponin T > 1.0 ng/ml

–AccuTnI>0.5ng/mlorequivalentthresholdwithother

Troponin I methods.

The evidence must show a definite acute myocardial infarction.

For the above definition, the following is not covered:

• Otheracutecoronarysyndromesincludingbutnotlimited

to angina.

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HIV infection – caught from

a blood transfusion, physical

assault or accident at work.

Kidney failure –

requiring dialysis

Liver Failure –

of advanced stage

Loss of hand or foot –

permanent physical

severance

Loss of Speech – permanent

and irreversible

Liver failure due to cirrhosis and resulting in all of the following:

• permanent jaundice

• ascites

• encephalopathy

For the above definition, the following is not covered:

• Liverdiseasesecondarytoalcoholordrugabuse.

Permanent physical severance of a hand or foot at or above the

wrist or ankle joints.

Total permanent and irreversible loss of the ability to speak

as a result of physical injury or disease.

Chronic and end stage failure of both kidneys to function,

as a result of which regular dialysis is necessary.

Infection by Human Immunodeficiency Virus resulting from:

• abloodtransfusiongivenaspartofmedicaltreatment;

• aphysicalassault;or

• anincidentoccurringduringthecourseofperformingnormal

duties of employment;

after the start of the policy and satisfying all of the following:

• Theincidentmusthavebeenreportedtoappropriate

authorities and have been investigated in accordance with the

established procedures.

• WhereHIVinfectioniscaughtthroughaphysicalassault

or as a result of an incident occurring during the course of

performing normal duties of employment, the incident must

be supported by a negative HIV antibody test taken within five

days of the incident.

• TheremustbeafurtherHIVtestwithin12monthsconfirming

the presence of HIV or antibodies to the virus.

– The incident causing infection must have occurred in one

of the following countries: Australia, Austria, Belgium,

Bulgaria, Canada, the Channel Islands, Cyprus, the Czech

Republic, Denmark, Estonia, Finland, France, Germany,

Gibraltar, Greece, Hong Kong, Hungary, Iceland, the Isle

of Man, Italy, Japan, Latvia, Liechtenstein, Lithuania,

Luxembourg, Malta, the Netherlands, New Zealand,

Norway, Poland, Portugal, Republic of Ireland, Romania,

Slovakia, Slovenia, Spain, Sweden, Switzerland, the United

Kingdom and the United States of America.

For the above definition, the following is not covered:

• HIVinfectionresultingfromanyothermeans,including

sexual activity or drug abuse.

Heart Valve Replacement

or Repair – with surgical

thoracotomy

Theundergoingofsurgeryrequiringanterolateralthoracotomy

on the advice of a Consultant Cardiologist to replace or repair

one or more heart valves.

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Major Organ Transplant

Motor Neurone Disease –

resulting in permanent

symptoms

Multiple Sclerosis – with

persisting symptoms

Multiple System Atrophy –

resulting in permanent

symptoms

Open Heart Surgery –

with median sternotomy

Paralysis of a limb – total

and irreversible

Parkinson’s Disease –

resulting in permanent

symptoms

Primary Pulmonary

Hypertension – of specified

severity

The undergoing as a recipient of a transplant of bone marrow or

of a complete heart, kidney, liver, lung, or pancreas, or inclusion

on an official UK waiting list for such a procedure.

For the above definition, the following is not covered:

• Transplantofanyotherorgans,partsoforgans,tissues

or cells.

A definite diagnosis of Motor Neurone Disease by a Consultant

Neurologist. There must be permanent clinical impairment

of motor function.

A definite diagnosis of Multiple Sclerosis by a Consultant

Neurologist. There must be current clinical impairment of motor

or sensory function, which must have persisted for a continuous

period of at least six months.

A definite diagnosis of Multiple System Atrophy by a Consultant

Neurologist. There must be evidence of permanent clinical

impairment of either:

• motorfunctionwithassociatedrigidityofmovementor

• theabilitytocoordinatemusclemovementor

• bladdercontrolandposturalhypotension.

Theundergoingofsurgeryrequiringmediansternotomy

(surgery to divide the breastbone) on the advice of a Consultant

Cardiologist to correct any structural abnormality of the heart.

Total and irreversible loss of muscle function to the whole

of any one limb.

A definite diagnosis of Parkinson’s disease by a Consultant

Neurologist. There must be permanent clinical impairment

of motor function with associated tremor, rigidity of movement

and postural instability.

A definite diagnosis of Primary Pulmonary Hypertension. There

must be clinical impairment of heart function resulting in the

permanent loss of ability to perform physical activities to at

least Class 3 of the New York Heart Association’s classification

of functional capacity.*

For the above definition, the following is not covered:

• PulmonaryHypertensionsecondarytoanyotherknown

cause ie not Primary.

* NYHA Class 3. Heart disease resulting in marked limitation

of physical activities where less than ordinary activity causes

fatigue, palpitation, breathlessness or chest pain.

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Progressive Supranuclear

Palsy – resulting in

permanent symptoms

Removal of an Eyeball –

due to injury or disease

Respiratory Failure –

of advanced stage

Stroke – resulting in

permanent symptoms

Systemic Lupus

Erythematosus – with

severe complications

Terminal Illness

Third Degree Burns –

covering 20% of the surface

area of the body or 20% of

the face or head

Advanced stage emphysema or other chronic lung disease,

resulting in all of the following:

• Theneedforregularoxygentreatmentonapermanent basis.

•  T h e  permanent impairment of lung function tests

as follows:

Forced Vital Capacity (FVC) and Forced Expiratory Volume

at 1 second (FEV1) being less than 50% of normal.

Deathofbraintissueduetoinadequatebloodsupply

or haemorrhage within the skull resulting in permanent

neurological deficit with persisting clinical symptoms.

For the above definition, the following are not covered:

• Transientischaemicattack.

• Traumaticinjurytobraintissueorbloodvessels.

A definite diagnosis of Systemic Lupus Erythematosus by a

Consultant Rheumatologist resulting in either of the following:

•  Permanent neurological deficit with persisting clinical

symptoms; or

•  T h e  permanent impairment of kidney function tests

as follows:

Glomerular Filtration Rate (GFR) below 30 ml/min.

Advanced or rapidly progressing incurable illness where, in the

opinions of an attending Consultant and our Medical Officer,

the life expectancy is no greater than 12 months.

For the above definition, the following is not covered:

• TerminalIllnessasdefinedaboveduringthelast18months

of the policy.

Burns that involve damage or destruction of the skin to its full

depth through to the underlying tissue and covering at least

20% of the body’s surface area or covering 20% of the area

of the face or head.

A definite diagnosis of Progressive Supranuclear Palsy by

a Consultant Neurologist. There must be permanent clinical

impairment of eye movements and motor function.

Surgical removal of an eyeball as a result of injury or disease

For the above definition the following is not covered:

• Selfinflictedinjuries.

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Traumatic head injury –

resulting in permanent

symptoms

Total and Permanent

Disability

Death of brain tissue due to traumatic injury resulting

in permanent neurological deficit with persisting

clinical symptoms.

a) Own Occupation Disability Criteria

If the life assured is in a gainful occupation immediately

before onset of disability and the own occupation

disability criteria is shown in the policy schedule, in the

event of a claim the sum assured will be payable if all of

the following conditions apply:

i) the life assured suffers through illness or accident

a mental or physical irreversible disability,

ii) in the opinion of our Medical Officer the life assured is

likely to remain permanently unable to continue in their

own occupation (being the occupation they were engaged

in immediately before the onset of disability).

b) Functional Assessment Tests Disability Criteria

Immediately before the onset of disability, if the life assured is:

 • notingainfuloccupation

 • ingainfuloccupation and the functional assessment tests

disability criteria, is shown in the policy schedule under

the occupation definition section, in the event of a claim

the sum assured will be payable if all of the following

conditions apply:

i) the life assured suffers through illness or accident

a mental or physical irreversible disability,

ii) in the opinion of our Medical Officer the life assured

is permanently unable to perform without the direct

assistance of another person, three or more of the

functional assessment tests listed below:

Walking:

The ability to walk a distance of 200 metres on flat

ground with or without the aid of a walking stick and

without stopping or experiencing discomfort.

Bending:

The ability to get into or out of a standard saloon car and

the ability to bend or kneel to pick up an object from the

floor and straighten up again.

Climbing:

Having the ability to climb up a flight of 12 stairs without

stopping or suffering severe discomfort.

Communicating:

The ability to answer a telephone and to take a message.

Reading:

   Havingtherequiredeyesight(correctedifnecessary)

to be able to read a daily newspaper.

Writing:

Having the physical ability to write legibly using a pen

or a pencil without aid.

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4 ADDITIONAL COVER

This policy provides the following additional cover, as shown in your policy schedule.

Claims paid under this cover will not reduce your sum assured or change your premiums.

4.1 Mastectomy for Ductal Carcinoma In Situ – requiring total removal of the breast

The undergoing of a mastectomy operation (total removal of all the tissue of at least one breast)

on the advice of the life assured’s hospital consultant following the diagnosis of ductal carcinoma

in situ of the breast.

For the above definition, the following are not covered:

  • Prophylacticmastectomywithouthistologicalevidenceofductalcarcinomainsitu,and

  • Anyothersurgicalproceduressuchaslumpectomy,partialmastectomyandpartialortotalsub

cutaneous mastectomy.

Provided that the diagnosis takes place on or after the policy start date, and on or before the policy

expiry date, the amount payable will be the lower of:

  • 25%ofthesum assured, or

  • £25,000.

Only one claim per policy can be made.

4.1.1 E xclu sions

We will not pay a claim in any circumstances that are shown under the exclusions section in your

policy schedule.

4.2 Children’s Critical Illness Cover

We will provide Children’s Critical Illness Cover if shown as included in the policy schedule.

We will pay this cover if a relevant child is diagnosed with any of the following:

  • Acriticalillnessasdefinedinsection3,excludingTotalandPermanent Disability and Terminal Illness;

  • MastectomyforDuctalCarcinomaInSitu–requiring total removal of the breast.

The amount payable per relevant child under this poliacy will be the lower of:

  • 50%ofthesum assured; or

  • £25,000.

4.2.1 Conditions

This cover is subject to the following conditions:

a) The relevant child must survive for at least 14 days from the date of diagnosis.

b) Diagnosis must take place on or after the policy start date and on or before the policy expiry date.

c) If diagnosis takes place on or before the policy expiry date, but the 14 day survival period expires

after the policy expiry date, we will pay a claim provided that the relevant child survives for at

least 14 days from the date of diagnosis.

d) the 14 day survival period may extend beyond their 18th birthday.

e) Only one claim per relevant child will be paid under this policy.

f) We will pay a claim on a maximum of two relevant children under this policy. After two claims

have been paid under this policy, the Children’s Critical Illness Cover will end.

g) If the same relevant child is covered by more than one policy issued by us, we will pay

amaximumof£50,000forthatrelevant child.

h) No premiums under this policy are outstanding.

i) Children’s Critical Illness Cover will cease if a claim is made on the policy or the policy ends.

4.2.2 Exclusions

We will not pay a claim under Children’s Critical Illness Cover:

a) If the death of a relevant child occurs before the expiry of 14 days from the date of diagnosis.

b) When the diagnosis of a relevant child is a direct or indirect result of congenital (present at birth),

hereditary or pre-existing conditions.

c) For Total and Permanent Disability.

d) For Terminal Illness.

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If the guaranteed insurability option is shown as included in the policy schedule, you have the option

of increasing the sum assured with no need for further medical evidence on the occurrence of

specified events.

These events and related conditions are shown in section 5.1 unless the policy schedule shows the

guaranteed insurability option is for business protection, in which case see section 5.2 instead:

5.1 Increasing the sum assured

5.1.1 When can you use the guaranteed insurability option?

You can use this option in the event of:

a) the life assured entering into marriage or a registered civil partnership, or

b) the birth of the life assured’s child, or

c) the life assured legally adopting a child, or

d) an increase to the life assured’s mortgage by reason of a house move or undertaking major

home improvements, or

e) an increase in the life assured’s salary due to a change of employment or promotion.

5.1.2 Conditions

a) This option must be used within six months of the event and if werequestrelevantdocumentsin

relation to the events, you must provide them to us.

b) For all increases, the sum assured may only be increased on each occasion by the lower of:

   • 50%oftheoriginalsum assured or,

   • £150,000,or

   • If5.1.1(d)applies,theamountoftheincreaseinthemortgage,or

   • If5.1.1(e)applies,theamountequaltotheoriginalsum assured multiplied

by the percentage increase in salary.

c) This option may only be used three times in total, but only once in respect of either entering into

marriage or a registered civil partnership.

  d)Themaximumtotalofallincreasespermittedis£200,000.

If you use this option an additional policy will be issued in respect of the increase which will:

e) not contain a guaranteed insurability option,

f) not extend beyond the life assured’s 65th birthday or one year after the policy expiry date of

this original policy, whichever is earlier, and

g) be subject to the premiums, terms and conditions for such policies at the time the additional policy

is issued.

Should a Term Assurance and Critical Illness Cover policy not be available at that time, we may

offer you a different type of policy.

This option will not be available to you:

h) after the life assured’s 55th birthday or for a joint life policy, the 55th birthday of the oldest

life assured,

i) if waiver of premium benefit is shown in the policy schedule and a claim under this has been

made, until the end of the period of incapacity,

j) if the life assured has been diagnosed with or is receiving or has received medical treatment for a:

   • criticalillness,asdefinedinsection3,

   • MastectomyforDuctalCarcinomaInSitu–requiring total removal of the breast.

k) If the life assured has had a medical consultation with a general practitioner or a hospital

consultant, who advise that the life assured should undergo further medical tests in order to

confirm whether the life assured has a condition covered by this policy, and the results of these

tests are outstanding.

In these circumstances, this option will only be available to the life assured where the test results

confirm that the life assured does not have a condition covered by this policy.

5 GUARANTEED INSURABILITY OPTION

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5.2 For Business Protection – Increasing the sum assured

5.2.1 When can you use the guaranteed insurability option?

a) If this policy has been taken out to cover a business loan, for the purpose of:

   • abusinessacquisition,or

   • abusinessexpansion,or

   • buying,extendingoralteringabusinesspremises,

you will have the option of increasing the sum assured in the event that the loan is increased.

b) If this policy has been taken out to cover loss of profit in the event of:

   • thelife assured’s death, or

   • thelife assured being diagnosed with a critical illness

you will have the option of increasing the sum assured if:

   • thelife assured’s value to the business increases, or

   • thelife assured receives a pay increase.

c) If this policy has been taken out to cover a working Partner’s, Director’s, Shareholder’s or members

of a limited liability partnership;

   • ownership,or

   • interestinabusiness,

you will have the option of increasing the sum assured in the event that there is an increase in the value

of that ownership or interest.

5.2.2 Conditions

a) This option must be used within six months of the event and weareentitledtorequestrelevant

documents in relation to the events.

b) For all increases the sum assured may only be increased on each occasion by the lower of:

   • 50%oftheoriginalsum assured, or

   • £150,000,

   • if5.2.1(a)applies,theincreaseinthevaluetothebusinessloan,

   • if5.2.1(b)applies,theincreaseinthelife assured’s pay or their value to the business,

   • if5.2.1(c)applies,theincreaseinvalueofthelife assured’s ownership or interest.

c) This option may only be used three times in total.

  d)Themaximumtotalforallincreasespermittedis£250,000.

If you use this option, an additional policy will be issued in respect of the increase which will:

e) not contain a guaranteed insurability option,

f) not extend beyond the life assured’s 65th birthday or the policy expiry date of the original policy,

whichever is earlier, and

g) be subject to the premiums, terms and conditions for such policies at the time the additional policy is

issued.

Should a Term Assurance and Critical Illness Cover policy not be available at that time, we may offer

you a different type of policy.

This option will not be available to you:

h) after the life assured’s 55th birthday or for a joint life policy, the 55th birthday of the oldest life assured,

i) if waiver of premium claim has been made, until the end of the period of incapacity,

j) if the life assured has been diagnosed with or is receiving or has received medical treatment for a:

   • criticalillness,asdefinedinsection3,

   • MastectomyforDuctalCarcinomaInSitu–requiring total removal of the breast.

k) If the life assured has had a medical consultation with a general practitioner or a hospital consultant,

who advise that the life assured should undergo further medical tests in order to confirm whether the

life assured has a condition covered by this policy, and the results of these tests are outstanding.

In these circumstances, this option will only be available to the life assured where the test results

confirm that the life assured does not have a condition covered by this policy.

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7.1 When are premiums due to be paid?

Premiums are due from the policy start date and at monthly or annual intervals as shown in your policy schedule.

7.2 Will the amount you pay ever change?

The premiums for this policy will not increase unless:

a) reviewable premiums are shown as included in the policy schedule, in which case the premiums could

change as described in section 7.3, or

b) this policy is changed under section 9.3.

7.3 Reviewable premiums

If reviewable premiums are shown as included in the policy schedule, the premiums are guaranteed for the

first five years of the policy. Reviews will be carried out to determine whether the premiums will be changed

at the fifth anniversary and every five years thereafter. This is to establish whether the premiums you are

paying are enough to provide the level of cover selected.

At a review we will assess the underlying assumptions relating to the expected future number and timing of

claims made for this type of policy.

We will assess any change to premiums fairly. When we review the premiums, the factors we look at are:

  • numberofclaimswe have had;

  • numberofclaimswe expect to have; and when we expect them to be made;

  • insuranceindustryclaimsexperience;

  • expectedimpactoffuturemedicaladvances;and

  • changestoapplicablelaws,regulationsortaxtreatment.

The life assured’s state of health or individual circumstances won’t be a factor at review.

We will write to you about the outcome of the premium review and tell you at least three months in advance

about the options you have and what action you may have to take. If, after a premium review we recalculate

your premium to within 5% of what you have already been paying, we won’t make any changes. The amount

your premium may increase or decrease by, following a review, is not limited.

7 PAYMENT OF PREMIUMS

If waiver of premium is shown in the policy schedule, we will waive your premiums due under this policy

after 26 weeks from the date of incapacity, until the earlier of:

   • theendoftheperiodofincapacity, or

   • paymentofthesum assured, or

   • thepolicy expiry date.

6.1 Conditions

This benefit is subject to the following conditions:

a) You must tell us within four months of the start of the life assured’s incapacity, otherwise we will

consider the start of their incapacity to be four months before the date we are told. We may not insist on

this if there are exceptional medical or other reasons why you cannot tell us within four months of the

start of incapacity.

b) You must complete and return the claim form issued by us so that we can consider your claim.

c) The life assuredmayberequiredtohaveamedicalexaminationbyanappropriatemedicalspecialist

appointed by us.

d) As proof of the life assured’s incapacity, you or the life assured must provide any documents reasonably

requestedbyus.

e) No premiums under this policy are outstanding.

f) This benefit will only apply whilst the life assured:

i) resides or travels within the European Union, and

ii) resides temporarily or travels outside of the European Union for a period not exceeding

three consecutive months in any 12 months. If this period is exceeded, this benefit shall not

be available unless we have given you prior written confirmation. If the life assured resides

or travels outside the European Union for more than 12 consecutive months, we will be entitled

to cancel this benefit.

6 WAIVER OF PREMIUM BENEFIT

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8 GENERAL CONDITIONS

8.1 If the life assured’s date of birth as shown in the policy schedule is incorrect, the terms of this policy

shall be adjusted to those that would have applied if the correct date of birth had been given. We are

entitled to cancel this policy if it would not have been issued if the correct date of birth had been given.

8.2 If you or the life assured intentionally provide us with an incorrect date of birth or fail to disclose any

material fact, we are entitled to cancel this policy.

8.3 If the life assured resides outside any part of the countries that form the European Union, USA, Canada,

Australia, New Zealand, the Isle of Man or the Channel Islands for more than 12 consecutive months we

reserve the right to decline a claim under the Critical Illness Cover provided by this policy.

8.4 We may make changes to the policy terms and conditions that we reasonably consider are appropriate

due to a change in any applicable legislation, regulation or taxation. In such circumstances, we will

notify you in writing in advance of any changes being made.

8.5 Benefits can only be paid in Sterling to a bank account in the UK. If you wish to receive payments

outside the UK, then arrangements for such transfers must be made by you or the assignee at your own

expense. Where the policy has been assigned to a third party, the benefit will be paid to that third party

until the benefit ceases to be paid.

8.6 This policy is governed by English Law.

8.7 All communication in relation to this policy will be in English.

8.8 The right to exercise any option under this policy or to exercise any right conferred by this policy is

limited to such as are allowed in the terms of the policyandasarecompatiblewiththerequirementsof

Paragraph19(3)ofSchedule15oftheIncomeandCorporationTaxesAct1988foraqualifyingpolicy.

8.9 All notices of assignment should be sent to our principal office.

7.3.1 Options at your premium review

a Your premium reduces or stays the same.

If the premium has reduced or stayed the same your direct debit will automatically be updated. If your

premium stays the same your direct debit will remain unchanged.

b) The premium increases.

If your premium has increased you can choose to:

  • Accepttheincreasedpremium. If you choose this option, your direct debit will automatically

be updated; or

  • Keepyour premiums the same but reduce the level of cover. If this is the option you want to

take you will need to contact us within 30 days of receiving a premium review letter from us.

This will ensure there is sufficient time for us to process yourrequestpriortoyour review date.

It is important to ensure the level of cover still meets your needs, as the option you select cannot

be changed at a later date.

7.4 What happens if you don’t pay your premiums?

We are entitled to cancel this policy if any premiums are not paid within 30 days of their due date.

If we cancel this policy, the policy will end and no further benefits or premiums will be payable.

We will not refund any premiums already paid.

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10 THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS)

The Financial Services Compensation Scheme (FSCS) is designed to pay customers compensation

if they lose money because a firm is unable to pay them what they owe for any reason. Your ability

to claim from the scheme and the amount you may be entitled to will depend on the specific

circumstances of your claim. Most customers, including most individuals and small businesses,

are covered by the scheme. You can find out more about the FSCS (including amounts and eligibility

to claim) by visiting its website www.FSCS.org.uk or calling 0800 678 1100.

The FSCS may arrange to transfer your policy to another insurer, provide a new policy or if these are

not possible, provide compensation. FSCS compensation covers payment up to 90% of the value

of the claim per firm. There is no upper financial limit on the claim. However, the rules of the FSCS

may change and the FSCS may take a different approach on the application of these rules to a firm

depending on the circumstances of the failure of that firm.

9.1 Contact us

If you haveanyenquiriesorwanttouseanyofthe

options in relation to this policy please call us on

0370 010 4080 or write to us at our principal office.

Pleasequoteyour policy number as shown in your

policy schedulewhenmakinganyenquiries.

We may record and monitor calls.

Call charges will vary.

9.2 Make a claim

In the event of a claim under this policy, please call us:

for life claims on 0800 137 101,

for critical illness claims on 0800 068 0789,

for waiver of premium claims on 0800 027 9830,

or write to us at our principal office.

We may record and monitor calls.

Wewillrequirethedeathcertificateorproofof

diagnosis of a critical illness of the life assured,

along with the policy schedule and any other

documents wemayreasonablyrequest.

 Ifanyinformationreasonablyrequiredtoassess

the claim is withheld, we reserve the right not

to process the claim until it is made available.

9.3 Change this policy

You should contact us at our principal office if you

wanttorequestanyofthefollowingchanges:

a) Extend or reduce the term,

b) Increase or decrease the sum assured,

c) Remove a life assured,

  d)Changethefrequencyofyour premiums

from annually to monthly or monthly to

annually.

 Allchangesrequestedwillbeassessedbasedon

the life assured’s circumstances at that time.

We may take into account the life assured’s age,

health, medical history, residency, leisure activities

andareentitledtorequestanydocuments

reasonablyrequiredbyus.

We will confirm if the change means this policy

has to be cancelled and a new policy issued,

which may have different terms and conditions. If

there is more than one policyholder, the consent

of all policyholders may be needed before the

change is made.

A change may affect the premiums that are

payable.

9.4 Cancel this policy

a) You can cancel this policy at any time.

b) Once this policy starts we will send you a

notice of your right to cancel. If you cancel

this policy within 30 days of receiving both

the notice and this policy, we will refund any

premiums paid.

If you cancel this policy at a later stage, you

will not get any money back.

c) If you cancel this policy, the policy will end

and no further benefits or premiums will be

payable.

9.5 Make a complaint

If you wish to complain about the service you have

received from us, or you would like us to send you

a copy of our internal complaint handling

procedure, please contact our helpdesk on

0845 071 1439.

We may record and monitor calls. Call charges will

vary.

Alternatively, you can write to us at:

Complaints Department

Legal & General Assurance Society Limited

Knox Court

10 Fitzalan Place

Cardiff

CF24 0TL

If you remain dissatisfied, you can complain to:

The Financial Ombudsman Service

South Quay Plaza

183 Marsh Wall

London

E14 9SR

Telephone: 0845 080 1800

Email: complaint.info@financial-ombudsman.org.uk

Website: www.financial-ombudsman.org.uk

Making a complaint will not affect your legal

rights.

9 HOW TO ...

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Benefits

The sum assured and any other benefits included in this policy.

Exclusions

What you are not covered for, as shown in your policy schedule.

Incapacity

The life assured is totally incapable of carrying out their normal occupation by reason of an illness or

injury which has occurred after the policy start date, necessitating medical or surgical treatment and

is not carrying out any other occupation or in gainful employment.

If the life assured is not in gainful employment and they are unable to do three or more of the

following as a direct result of an illness or injury which occurred after the policy start date:

Walking:

The ability to walk a distance of 200 metres on flat ground with or without the aid of a walking stick

and without stopping or experiencing discomfort.

Bending:

The ability to get into or out of a standard saloon car and the ability to bend or kneel to pick up an

object from the floor and straighten up again.

Climbing:

The ability to climb up a flight of 12 stairs without stopping or suffering severe discomfort.

Communicating:

The ability to answer a telephone and to take a message.

Reading:

Therequiredeyesight(correctedifnecessary)tobeabletoreadadailynewspaper.

Writing:

The physical ability to write legibly using a pen or a pencil without aid.

Interest rate

Where decreasing cover was chosen, the interest rate at which the sum assured decreases, as shown

in your policy schedule.

Irreversible

Cannot be reasonably improved upon by medical treatment and/or surgical procedures used by the

National Health Service in the UK at the time of the claim.

Life assured

The person who is insured under this policy. If there is more than one life covered under this policy,

as shown in the policy schedule, this definition covers all lives insured.

Material fact

A fact that would be important to us in deciding whether to insure the life assuredfortherequested

cover, the terms of that cover, and duration of this policy.

Examples of a material factinclude,butarenotlimitedtoanswerstothequestionsintheoriginal

application form including:

  • medicaldisclosures

  • familyhistory

•occupation

  • travelorresidence

  • pastimes

  • alcoholconsumption

  • smoker/nonsmoker

  • useofrecreationaldrugs,forexamplecocaineorheroin.

Occupation

A trade, profession or type of work undertaken for profit or pay. It is not a specific job with any

particular employer and is independent of location.

11 DEFINITIONS EXPLAINED

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TERM ASSURANCE AND CRITICAL ILLNESS COVER – POLICY TERMS AND CONDITIONS

Our, us or we

Legal & General Assurance Society Limited.

Permanent

Expected to last throughout the insured person’s life, irrespective of when the cover ends or the

insured person retires.

Permanent neurological deficit with persisting clinical symptoms

Symptoms of dysfunction in the nervous system that are present on clinical examination and

expected to last throughout the insured persons life. Symptoms that are covered include numbness,

hyperaesthesia (increased sensitivity), paralysis, localised weakness, dysarthria (difficulty in

swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy,

dementia, delirium and coma.

Policy

This policy issued by us, which consists of the policy terms and conditions and policy schedule.

Policy expiry date

The date that cover under this policy will end, as shown in your policy schedule.

Policy schedule

The schedule which shows the cover that you have and forms part of this policy.

Policy start date

The start date of this policy, as shown in your policy schedule.

Pre-existing condition

A pre-existing condition is any medical condition, disorder or handicap from which a child is already

suffering before the latest of:

 • thedatethepolicy is issued,

 • the30thdayafterthechild’sbirth,

 • forlegallyadoptedchildren,thedateofadoption.

Premium(s)

The amount you pay to us for this policy as shown in your policy schedule.

Principal office

Our principal office is:

City Park

The Droveway

Hove

East Sussex

BN3 7PY

Product

The type of cover, as shown in your policy schedule.

Relevant child

A natural child, legally adopted child (from the date of adoption) or stepchild of the life assured,

while such a child is aged more than 30 days and less than 18 years during the term of the policy.

Retail Prices Index (RPI)

The Retail Prices Index (RPI) provides an indication of inflation on a monthly basis. The RPI measures

and tracks the average change in the purchase price of goods and services such as housing expenses

and mortgage interest payments.

Successor in title

The person(s) legally entitled to the life assured’s estate upon the death of the life assured.

Sum assured

The amount of Term Assurance and Critical Illness Cover, as shown in your policy schedule. If

reviewable premiums are included in your policy schedule, this amount may change as described

in section 7.3.

If decreasing cover was chosen, the table in your policy schedule will show how the amount of

Term Assurance and Critical Illness Cover decreases.

You or your

The policyholder(s) of the policy who is/are legally entitled to receive the sum assured and shown

as the “grantee” in the policy schedule. This may include trustee(s), assignee(s) or personal

representative(s) (where appropriate) and may be the same person(s) as the life assured.

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POLICY TERMS

AND CONDITIONS.

This pocket contains your policy schedule.

You should read this in conjunction with the

printed policy terms and conditions.

Please keep these documents in a safe place,

in case you need to refer to them later.

TERM ASSURANCE AND CRITICAL ILLNESS COVER

T&C 51

Legal & General Assurance Society Limited

Registered in England No.166055

Registered ofﬁce: One Coleman Street, London EC2R 5AA

We are authorised and regulated by the Financial Services Authority.

We are members of the Association of British Insurers.

W13368 11 / 11

www.legalandgeneral.com

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