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Key Aspects of Bright Grey's Critical Illness Cover for the Personal Protection Menu

Bright Grey’s Critical Illness Cover is provided through its Personal Protection Menu. With the Personal Protection Menu, the client can choose independent critical illness cover or Life and Critical Illness Cover.

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Quick Facts on Bright Grey Critical Illness

Availability Bright Grey’s Critical Illness Cover

  • Offered under the Personal Protection menu as:
    • Critical illness cover
    • Life or critical illness cover. The client can choose that both life and critical illness have the same level of coverage. Or, life and critical illness cover may have different amounts of coverage.

This can either be for a single or joint coverage. One can also choose the length of the term and the payment type.

For joint coverage, payment of claims is on a first event basis, meaning, once a claim for critical illness has been made, the Critical Illness Cover or Life or Critical Illness Cover will no longer be in effect and succeeding claims made by the “second” life will no longer be payable.

Payment of critical illness benefit

  • Critical illness Protection only. Pays the benefit amount
    • when the person insured is diagnosed with a covered critical illness;
    • when the person insured becomes totally and permanently disabled;
    • when the person’s child is diagnosed with a covered critical illness.
  • Life or Critical Illness Cover. Pays the benefit amount
    • when the person insured dies;
    • when the person insured is diagnosed with a covered critical illness;
    • when the person insured becomes terminally ill
    • when the person insured becomes totally and permanently disabled;
    • when the person’s child is diagnosed with a covered critical illness.

The cover stops once the benefit amount or sum assured is paid out in full.

Type of payment

A client can choose either:

  • Lump sum
  • Income

Condition for payout

  • Critical Illness protection.  The benefit amount is paid upon diagnosis of a covered critical illness and the person insured survives for at least 14 days after the diagnosis.
  • Diagnosis should be made by a specialist in the relevant area and this should be confirmed by Bright Grey’s chief medical officer.
  • The claimant should also be living in the UK or the list of countries stipulated in the policy.

Amount of cover

  • For the Critical Illness Benefit
    • There is no minimum sum insured.
    • Maximum sum insured: £1,000,000
    • The client has the option of getting increasing, decreasing or level coverage.
  • For the child critical illness cover: 50% of the sum insured or £20,000, whichever is lower

Age and other restrictions

  • For critical illness cover, the covered person must be 18 to 64 at the start of the cover.
  • For Life or Critical Illness cover, the covered person must be 18 to 59 at the start of the cover. The maximum age can be extended up to age 64 if premium payments are reviewable.
  • The Covered children must be between 30 days to 18 years of age
  • The cover is those living in the United Kingdom, as well as countries included in the list stipulated in the policy.

Length of coverage

Critical Illness Cover

  • Minimum term: 5 years
  • Maximum term: 40 years (Cover ends when the insured person reaches 74 years of age)

Life or Critical Illness Cover

  • Minimum term: 1 year
  • Maximum term: 40 years (Cover ends when the insured person reaches 69 years of age; can be extended to age 74 if premiums are reviewable.)

Premiums

  • For Critical Illness Protection only. Premiums are reviewable.
  • Life or Critical Illness Cover. Premiums may be reviewable or guaranteed.

Benefits automatically included

  • Terminal illness benefit
  • Children’s critical illness protection
  • Ductal carcinoma in situ of the breast/Low grade prostate cancer
  • Accident hospitalization cover (for hospital stays of up to 28 consecutive days)

Additional optional cover

  • Joint life separation option
  • Joint life reinstatement option
  • Mortgage repayment guarantee option
  • Cover increase option
  • Life Cover reinstatement option

What Is the Critical Illness Cover of Bright Grey?

Bright Grey’s Critical Illness Cover is sold as part of its Personal Protection Menu. It is offered under:

  • Critical Illness Cover and
  • Life or Critical Illness Cover

The Personal Protection Menu allows one to change:

  • The level of cover, which you can opt to change as needed
  • The persons covered, where you can add or remove a spouse or a partner
  • The length of the cover, which can be reduced or extended

Amount of Coverage

  • Maximum sum insured is £1,000,000, for the critical illness cover
  • Child critical illness cover is 50% of the sum insured or £20,000, whichever is lower.
  • The coverage amount can be level or fixed, decreasing or increasing, based on what the Insured Person wants.
  • If it is decreasing, the insured person can chose the monthly rate of decrease from between 0% and 15%. It can also be scheduled to coincide with the mortgage repayment guarantee.
  • If it is increasing, the insured person can choose a fixed rate from between 2% to 5%. It can also be scheduled to coincide with the prevailing retail price index (which can run between 2% and 10%).

Who Is Covered

The life insured. Age must be between 18 to 74 at the beginning of the cover.

The life insured’s children:

  • The cover includes financially dependent children by natural birth, adoption or stepchildren.
  • The children should be between 30 days to 18 years old at the time of diagnosis of the critical illness
  • For the critical illness benefit to be payable, the covered person must survive for at least 14 days from the day of the diagnosis

What You Will Receive

The critical illness benefit will pay:

  • The benefit amount, if you are diagnosed with a covered critical illness. That is, if the critical illness meets the definitions stated in the policy. The insured person should survive 14 days after the date of the diagnosis.
  • £15,000 or 20% of the sum insured, over and above what can be paid for a critical illness claim. This is for diagnosis of third degree burns, low grade prostate cancer and ductal carcinoma in situ, as well as accident hospitalization (requiring 28 consecutive days’ hospital stay).
  • £20,000 or 50% of the sum insured, whichever is lower, if your child is diagnosed with a covered critical illness.

Payments to Be Received

Claims payment can be made in various ways:

  • Level lump sum. Payment will be based on the amount stated in the policy’s cover summary.
  • Level regular payments.  Payments will be made in equal monthly installments until the end of the policy.
  • Increasing lump sum. Payments will be based on the higher of:
    • The amount stated in the policy cover
    • The amount stated in succeeding letters to notify the policyholder of the increase
    • Increasing regular payments. Payments will increase yearly and will be made on equal monthly installments until the end of the policy.
    • Decreasing lump sum based on mortgage repayment guarantee. If the cover was taken out for the purpose of protecting a loan or mortgage, payments will be based on the outstanding mortgage or loan amount, less any arrears of capital or interest. The policy holder is the one responsible to pay for any arrears.

      If the loan has already been fully paid or if the repayments have been changed or suspended, payments will be made based on the amount of loan that should have been outstanding at the time of the claim. Please note that changes in interest rate of the loan will not be automatically applied to the policy.

    • Decreasing lump sum. If the cover was taken out for the purpose of a loan or mortgage, payment will be based on the amount that should have been outstanding at the time of the claim.

Payment for total permanent disability. The cover will pay the benefit amount if the insured person becomes totally and permanently disabled. “Total Permanent Disability” is based on three definitions:

  • Own occupation
  • Working tasks
  • Living tasks (for claims of insured persons over 65 years of age)

Payment for Children’s Critical Illness Cover. Only one payment will be made for any child included in the cover. If the chosen coverage is an income benefit, the supposed income benefit amount will be given out as a lump sum. Only one claim per child will be paid out, regardless of the number of policies the parents has with Bright Grey. However, if both parents are covered by a separate single life critical illness policy, the child can be paid for each policy. Any claims for children’s critical illness protection will not affect the “main” benefit amount (or, the amount to be paid in case of a diagnosis of a covered illness). However, if the “main” benefit has already been paid out, the cover stops and any succeeding claims for children’s critical illness will no longer be payable.

Length of the Cover

The length of the cover is from 5 to 40 years.

Critical Illnesses Covered by Bright Grey

The Critical Illness Cover will pay the benefit amount (or a portion) for the following critical illnesses:

Critical Illness Covered Type of Definition Exclusions

Alzheimers Disease

ABI+

  • Other types of dementia

Aorta Graft Surgery

ABI+

  • Endovascular repair
  • Insertion of stents

Aplastic Anemia

Bright Grey

Bacterial meningitis

Bright Grey

  • Viral meningitis
  • Other forms of meningitis aside from the one defined

Benign Brain Tumour

ABI+

  • Tumours in the pituitary gland
  • Angiomas

Blindness

ABI

Cancer

ABI

Cardiomyopathy

Bright Grey

  • Myocarditis
  • Heart enlargement
  • Other forms of heart disease.
  • Cardiomyopathy related to alcohol or drug abuse

Chronic lung disease

Bright Grey

Coma

ABI+

  • Coma related to alcohol or drug abuse

Coronary Artery Bypass grafts

ABI+

  • Atherectomy
  • Balloon angioplasty
  • Insertion of stents
  • Laser treatments
  • Rotablation

Creutzfeldt-Jakob Disease

Bright Grey

  • Other types of dementia

Deafness

ABI

Encephalitis

Bright Grey

  • Chronic fatigue syndrome
  • Myalgic encephalomyelitis

Heart Attack

ABI+

  • Other acute coronary syndromes
  • Angina

Heart valve replacement

ABI+

HIV Infection

ABI

Intensive care

Bright Grey

  • Injury or illness resulting from acts of self-injury
  • Injury or illness resulting from intake of alcohol and drugs

Kidney failure

ABI

Liver failure

Bright Grey

  • Liver failure caused by drug or alcohol abuse

Loss of hands or feet

ABI

Loss of independence

Bright Grey

Loss of speech

ABI

Major Organ Transplant

ABI

Motor Neurone Disease

ABI

Multiple Sclerosis

ABI

Multiple system atrophy

Bright Grey

Open Heart Surgery

Bright Grey

  • Any surgery that does not divide the breastbone

Paralysis of limbs

ABI

Parkinson’s Disease

ABI

Pneumonectomy

Bright Grey

  • Lobectomy or surgery to remove a lobe of the lungs
  • Lung incision or resection

Pre-senile dementia

Bright Grey

Primary Pulmonary Hypertension

Bright Grey

  • Pulmonary hypertension where the cause is not primary

Progressive Supranuclear Palsy

Bright Grey

Pulmonary Artery Graft Surgery

Bright Grey

Stroke

ABI+

  • Transient ischaemic attack

Systemic Lupus Erythematosus

Bright Grey

  • Indications that the neurological deficit does not have persisting clinical symptoms and that the illness has responded to modifying drugs within 12 months

Terminal illness

ABI

Traumatic Head Injury

ABI

Additional Conditions Cover

For the covered events (listed below), Bright Grey will pay the lower of

  • £15,000
  • 20% of the lump sum amount stated in the main cover (for policies based on the lump sum) or,  for policies with increasing or decreasing lump sums, 20% of the amount the main cover has increased or decreased
  • 20% of the total amount of remaining regular payments (computed as the amount of cover times the remaining years of the policy’s term)

Payment of this claim will not affect future critical illness claims. However, if a claim for critical illness is made and the full sum insured is paid out, the cover stops and any accident hospitalization claims after the policy is no longer effective will not be payable. The policy will pay for only one Additional Conditions Cover per life, up to the maximum limit.

Accident hospitalization cover. If the insured person suffers from physical injury due to an accident, and this injury requires a hospital stay of 28 consecutive days (under the advice of a specialist), the cover will pay the lower of £15,000 or 20% of the sum insured, whichever is lower. The accident should not be a result of self-inflicted act, or a result of intake of alcohol or drugs. Any claim for accident hospitalization will not affect future critical illness claims. However, if a claim for critical illness is made, the cover stops and any accident hospitalization claims after the policy is no longer effective will not be payable.

Ductal Carcinoma in Situ.  This involves:

  • total mastectomy
  • partial mastectomy
  • segmentectomy
  • lumpectomy

that is undergone based on a consultant oncologist’s advice and based on histological confirmation of ductal carcinoma in situ (DCIS) of the breast.  The cover does not include: Surgery, prophylactic mastectomy or other procedures done without historical evidence or cancer in situ, as well as lumpectomy, partial mastectomy and partial or total subcutaneous mastectomy.

Low Grade Prostate Cancer.  This involves tumours that fall between 2 and 6 inclusive in the Gleason score. The low grade prostate cancer should also be:

  • histologically classified
  • have progressed to a clinical classification of at least T1N0M0
  • treated with the use of interstitial implant radiotherapy, complete removal of the prostate or external beam radiotherapy.

This benefit will not pay for prostate cancer where treatment included cryotherapy, transurethral resection of the prostate, hormones and “experimental” treatments

Third degree burns. The burns should involve surface area loss of the body of at least 10% but less than 20% or surface area loss of the face (including the forehead and ears) of at least 25% but less than 50%. The burns will have caused surface area loss due to destruction or damage of the skin’s underlying tissue.

Total Permanent Disability.  The coverage will pay the benefit amount if the insured person becomes permanently and totally disabled. The diagnosis must be made by a consultant specialist and confirmed by Bright Grey’s own chief medical officer. The consultant specialist should be working at a hospital located in a country that is in the list stated in the policy. The diagnosis must also be the first diagnosis of Total Permanent Disability.

The application of “Total Permanent Disability” will depend on whether it is for:

  • Own occupation
  • Working tasks
  • Living tasks (for those over age 65)

Total Permanent Disability for Children’s Critical Illness Cover.  The coverage will pay if the child becomes permanently and totally disabled. The diagnosis must be made by a consultant specialist and confirmed by Bright Grey’s own chief medical officer. The consultant specialist should be working at a hospital located in a country that is in the list stated in the policy. The diagnosis must also be the first diagnosis of Total Permanent Disability.

The application of “Total Permanent Disability” covers an injury or illness that results in the child being confined in a hospital, another medical institution or his own home. The child’s condition and impairment must be permanent, without any prospect of improvement and will require constant care and attention.

Additional Options

Cover increase options. The person insured has the option to increase the level of coverage without the need to undergo additional medical tests. The increase will be for the following events (marriage, increase in mortgage and an additional child either by birth or adoption).  This is when the Critical Illness Cover or Life or Critical Illness Cover is issued on standard terms.

Joint life separation option. In the event of a joint life policy, a couple who is separating or divorcing can change the policy into two single plans.

Joint life reinstatement option. For a joint life policy, the coverage stops once there is a claim for the critical illness or death (for Life or Critical Illness Cover). After the claim, the other life can opt to get the same level of cover within 90 days after payment of the claim.

Life cover reinstatement option. This is applicable for the Life or Critical Illness Cover. If a critical illness claim or total permanent disability has already been paid out, the policy will no longer be effective. However, the insured person can take out a new Life cover. This is subject to the terms and conditions offered by Bright Grey.

What You Are NOT Covered For

There will be no payouts for:

  • Diagnoses that does not match the definitions provided for a specific critical illness or additional condition (i.e. low grade prostate cancer, etc.)
  • Claims made where the insured failed to survive for at least 14 days after the diagnosis
  • Injuries or illness resulted from acts of intentional self-injury
  • The critical illness is a result of an excluded cause
  • Claims for additional conditions cover when the policy has already ended (cancelled, lapsed or ended its term)

For Children’s Critical Illness Cover, there will be no Critical Illness payouts for:

  • Illnesses that arise from pre-existing conditions (the symptoms were present at birth or before the cover became effective)
  • Claims made where the child failed to survive for at least 14 days after the diagnosis
  • The child failed to meet the age requirements (between 30 days to 18 years old) at the time of the claim
  • The illness or injury does not meet the definitions stated in the policy
  • Injuries or illness resulted from acts of intentional self-injury
  • The claim is for additional conditions cover, which is not included in the Children’s Critical Illness Cover

Making a Claim

To make a claim, the insured person or representative:

  • Submit the completed claims form
  • Submit documents requested by Bright Grey
  • Submit to additional tests. Bright Grey will shoulder the reasonable cost of the tests or medcial evidence requested.

Claims must be based on:

  • Diagnosis made by a consultant working in a hospital located in the countries included in the list. The consultant must also be a specialist in the area relevant to the critical illness being claimed against.
  • Diagnosis confirmed by Bright Grey’s own chief medical officer
  • A critical illness, terminal illness, total permanent disability or additional condition  that is unequivocally diagnosed for the first time

The included countries are:

  • The United Kingdom
  • Australia
  • Austria
  • Belgium
  • Canada
  • Channel Islands
  • Cyprus
  • Czech Republic
  • Denmark
  • Estonia
  • Finland
  • Germany
  • Gibraltar
  • Greece
  • Hong Kong
  • Hungary
  • Iceland
  • Ireland
  • Isle of Man
  • Italy
  • Japan
  • Latvia
  • Lithuania
  • Luxembourg
  • Malta
  • The Netherlands
  • New Zealand
  • Norway
  • Poland
  • Portugal
  • Slovakia
  • Slovenia
  • Spain
  • Sweden
  • Switzerland
  • USA

Submitting a claim should be done as soon as possible – after the diagnosis of a critical illness.

This article is for informational pruposes only and should not be considered a financial advice. Contact Bright Grey directly for information about their products.

Last updated on: 25.07.2012

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