What's not covered.

Pre-existing conditions exclusion means we won’t pay benefit for any insured condition which the member:

• has suffered from or undergone before they joined the scheme;
• is already in a qualifying period for an insured condition when they join the scheme. For example, as part of the qualification for multiple sclerosis – with persisting symptoms, specified symptoms must persist for six continuous months; or
• has previously received benefit under the scheme for that insured condition.

For this purpose, we’ll consider the suffering or the undergoing of the following to be the same disease:

• Angioplasty – to treat specific conditions of specified severity 
• Aorta graft surgery – requiring surgical replacement 
• Balloon valvuloplasty – to relieve heart valvular abnormalities 
• Cardiomyopathy – of specified severity
• Coronary artery by-pass grafts – with surgery to divide the breastbone 
• Heart attack – of specified severity 
• Heart surgery – with surgery to divide the breastbone 
• Heart transplant 
• Heart valve replacement or repair – with surgery to divide the breastbone 
• Pulmonary artery surgery – to excise and replace with a graft 
• Stroke – resulting in permanent symptoms

Also, where an insured person has suffered from any malignant tumours, defined as cancer – excluding less advanced cases, then we’ll not pay benefit for any subsequent cancer. For this purpose, the cancer doesn’t have to be connected to, or associated with, the earlier diagnosis of cancer.

We will not pay benefit for the following conditions if the disablement or illness started before the insured person joined the scheme:

• Loss of independent existence (including muscular dystrophy) – permanent and irreversible;
• Terminal illness – before the greater of age 65 or state pension age; or
• Total and permanent disability – permanent, irreversible and before the greater of age 65 or state pension age.

For the following illnesses;

• Loss if independent existence (including muscular dystrophy) – permanent and irreversible;
• Paralysis of limbs – total and irreversible;
• Terminal illness – before the greater of age 65 or state pension age; and
• Total and permanent disability – permanent, irreversible and before the greater of age 65 or state pension age;

we will not pay benefit if:

• the insured person has at any time, suffered or undergone any of the insured conditions; or
• a medical adviser chosen by us, believes it has resulted from any condition which the insured person was known to be suffering from at, or before, joining the scheme.

As long as a later diagnosis confirms this, we’ll consider an insured person to have:

• suffered;
• undergone; or
• been in a duration period included in the definition of;

an insured condition before they joined the scheme, whether the insured condition had been formally diagnosed or not.

We’ll not pay benefit for any insured condition occurring within two years of an insured person joining the scheme that has resulted from any related condition.  Related conditions include those for which the insured person, on or before the date they join the scheme:

• has received treatment;
• has suffered symptoms of;
• has sought advice on; or
• was aware of.

For this exclusion, the insured condition may have directly or indirectly resulted from a related condition. The decision as to whether a condition is a related condition will be based on the opinion of a medical adviser chosen by us.

Conditions that apply as related conditions for the various insured conditions are included in our quotation and policy.