{
  "vertical": "trauma",
  "insurer": {
    "slug": "aia",
    "name": "AIA New Zealand",
    "brand_family": "aia"
  },
  "product": {
    "slug": "living-critical-conditions",
    "name": "AIA Living Critical Conditions Cover",
    "status": "active",
    "positioning_summary": null
  },
  "wording": {
    "version": "2026-05-18",
    "ingested_at": "2026-05-18T11:11:53.884642+00:00",
    "pdf_hash": "da6ac4e333ee331030c680cc48e0322d3d6156eb33a91e1fda93b0382be80ec0",
    "source_url": "https://www.aia.co.nz/content/dam/nz/en/docs/our-products/policy-wordings/aia-living/personal/aia-living-personal-critical-conditions-policy-wording.pdf",
    "page_count": null
  },
  "confidence_tier": "verified",
  "facts": {
    "exclusions": [
      "The life assured (or the child in the case of a Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit) deliberately injures himself or herself or attempts to do so.",
      "The life assured (or the child in the case of a Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit) engages in or is part of any conduct that is criminal.",
      "Any condition or any symptom or signs leading to the condition (whether or not a registered medical practitioner has been consulted) that existed before the risk commencement date, unless AIA is satisfied that you or the life assured could not have known of the existence of the condition or symptom or signs leading to the condition, or the condition or symptom or signs leading to the condition were declared on your application and accepted by AIA.",
      "Any intentional act by you or by any parent or guardian of the life assured, or child (where the life assured or child is under age 21 at the time).",
      "Any intentional act by someone who lives with or supervises the life assured, or child (where the life assured or child is under age 21 at the time).",
      "A benefit under the Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit that arises as a direct or indirect consequence of a pre-existing condition.",
      "A benefit under the Built-in Children's Trauma Benefit or the Optional Children's and Maternity Benefit that arises as a direct or indirect consequence of any congenital condition, except where expressly covered under the Children's Congenital Conditions Benefit.",
      "No payment will be made under the Built-in Return Home Benefit if the life assured is covered for the same event with a travel insurance provider.",
      "Cardiac Defibrillator Insertion partial benefit is not payable if the life assured satisfies the criteria for a claim payment under another heart condition across all Personal AIA policies."
    ],
    "buyback_rules": "The Optional Critical Conditions Buyback Benefit allows the Critical Conditions Benefit (and where applicable the Optional Early Cancer Upgrade Benefit and/or Optional Children's and Maternity Benefit) to be reinstated without further medical evidence following a Critical Conditions Benefit claim that has reduced the sum assured to nil, subject to: the life assured surviving 12 months after the claim payment date; reinstatement requested within 60 days of the first anniversary of the claim payment date; maximum reinstatement of 100% of the claim payment or $2,000,000 whichever is lesser; only one buyback exercise available per life assured per policy; not available following a partial payment claim; not available if the life assured has suffered a claim event under a Terminal Illness Benefit or Specified Terminal Conditions Benefit. A new policy is issued on then-current terms; original exclusions and special terms carry over; no further reinstatement available under the new policy. A premium discount applies where buyback follows a full claim for cancer, stroke or heart attack.",
    "inbuilt_benefits": [
      "Built-in Financial and Legal Advice Benefit (up to $2,500 including GST reimbursement for financial planning or legal advice within three months of a full payment claim)",
      "Built-in Children's Trauma Benefit",
      "Built-in Newborn Children's Benefit",
      "Built-in Children's Trauma Conversion Facility",
      "Built-in Standalone Conversion Facility",
      "Built-in Premium Conversion Facility",
      "Built-in Special Events Increase Facility",
      "Built-in Critical Conditions Future Insurability Benefit",
      "Built-in Return Home Benefit (reimbursement up to $10,000 for standard economy flights back to New Zealand for life assured and one support person)",
      "Built-in Parents Grieving Benefit ($2,000 if child under 10; $15,000 if child 10 or over)",
      "Built-in Counselling Benefit (up to $2,500 including GST reimbursement for psychiatrist/psychologist consultation or counselling)",
      "Built-in Suspension of Cover Benefit (up to 12 months suspension)"
    ],
    "trauma_conditions": [
      "Carcinoma-in-situ",
      "Carcinoma-in-situ radical surgery",
      "Malignant tumours and blood cancers",
      "Prostate Cancer",
      "Angioplasty – less than 3 vessels",
      "Angioplasty – 3 vessels or more",
      "Aortic surgery",
      "Cardiac Defibrillator Insertion",
      "Cardiomyopathy",
      "Coronary artery bypass surgery",
      "Heart attack",
      "Heart valve surgery",
      "Out-of-hospital cardiac arrest",
      "Pacemaker insertion",
      "Pulmonary hypertension",
      "Alzheimer's disease",
      "Benign brain or spinal cord tumour",
      "Cerebral Aneurysm",
      "Coma",
      "Creutzfeldt-Jakob disease",
      "Dementia",
      "Encephalitis",
      "Idiopathic Parkinson's disease",
      "Major head trauma",
      "Meningitis",
      "Motor neurone disease",
      "Multiple sclerosis",
      "Muscular dystrophy",
      "Peripheral neuropathy",
      "Stroke",
      "Diplegia",
      "Hemiplegia",
      "Loss of independent existence",
      "Paraplegia",
      "Permanent blindness",
      "Permanent loss of hearing",
      "Permanent loss of speech",
      "Permanent loss of use of limbs",
      "Quadriplegia / Tetraplegia",
      "Advanced AIDS",
      "Advanced diabetes",
      "Aplastic anaemia",
      "Chronic liver failure",
      "Chronic lung disease",
      "Chronic renal failure",
      "Cognitive impairment",
      "Intensive care",
      "Major transplant surgery",
      "Pneumonectomy",
      "Severe burns",
      "Severe Crohn's disease",
      "Severe illness or injury",
      "Severe osteoporosis",
      "Severe rheumatoid arthritis",
      "Severe ulcerative colitis",
      "Systemic lupus erythematosus with lupus nephritis",
      "Systemic sclerosis",
      "Terminal illness",
      "Total Permanent Disablement (Optional)"
    ],
    "child_trauma_cover": "Built-in Children's Trauma Benefit: inbuilt benefit covering children of the life assured aged from three months up to their 21st birthday. Benefit payable is the lower of $50,000 or 50% of the sum assured across all Critical Conditions Benefit policies for the life assured (for full payment conditions). For Angioplasty – less than 3 vessels and Carcinoma-in-situ the benefit is the lower of $50,000 or 10% of the sum assured. Maximum one claim per child across all AIA policies (combined with Built-in Newborn Children's Benefit). Does not apply to Optional Total Permanent Disablement condition. Excludes pre-existing conditions and congenital conditions. Child must survive at least 14 days after suffering the condition. Three month stand down period applies where marked. Ceases on child's 21st birthday. Optional Children's and Maternity Benefit (rider): children's critical conditions benefit payable is the lower of $75,000 or 50% of the Critical Conditions Benefit sum assured (full payment conditions); for Angioplasty – less than 3 vessels and Carcinoma-in-situ the benefit is the lower of $75,000 or 10% of the Critical Conditions Benefit sum assured. Payable in addition to Built-in Children's Trauma Benefit.",
    "max_sum_insured_nzd": "The total of the sum assured for all Critical Conditions Benefits, Progressive Care Benefits, and similar trauma benefits (combined) must not exceed $2,000,000 across all AIA policies for each life assured. The total sum assured for all trauma and Total Permanent Disablement Benefits (and similar benefits) combined must not exceed $5,000,000.",
    "survival_period_days": 14,
    "waiting_periods_days": {
      "general": 90,
      "newborn_children_benefit_months": 12,
      "special_events_increase_facility_days": 180,
      "pregnancy_complications_benefit_months": 12,
      "children_congenital_conditions_benefit_months": 12,
      "critical_conditions_future_insurability_benefit_days": 180
    },
    "trauma_conditions_matrix": {
      "coma": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Coma [marked in table as Full payment, no stand down period]"
      },
      "stroke": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Stroke [marked in table as Full payment, with three month stand down period]"
      },
      "deafness": {
        "qualifier": "Permanent loss of hearing; full payment available, partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Permanent loss of hearing [marked in table as both Full payment and Partial Payment, no stand down period]"
      },
      "blindness": {
        "qualifier": "Permanent blindness; full payment available, partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Permanent blindness [marked in table as both Full payment and Partial Payment, with three month stand down period]"
      },
      "paralysis": {
        "qualifier": "Diplegia, Hemiplegia, Paraplegia, Quadriplegia / Tetraplegia",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Diplegia, Hemiplegia, Paraplegia, Quadriplegia / Tetraplegia [all marked in table as Full payment, no stand down period]"
      },
      "angioplasty": {
        "qualifier": "Less than 3 vessels",
        "payout_status": "partial",
        "payout_percent": null,
        "source_paragraph": "Angioplasty – less than 3 vessels [marked in table as Partial Payment, with three month stand down period]. Angioplasty – 3 vessels or more [marked in table as Full payment, with three month stand down period]"
      },
      "encephalitis": {
        "qualifier": "Full payment available; partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Encephalitis [marked in table as both Full payment and Partial Payment, no stand down period]"
      },
      "heart-attack": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Heart attack [marked in table as Full payment, with three month stand down period]"
      },
      "severe-burns": {
        "qualifier": "Full payment available; partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Severe burns [marked in table as both Full payment and Partial Payment, no stand down period]"
      },
      "liver-failure": {
        "qualifier": "Chronic liver failure; full payment available, partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Chronic liver failure [marked in table as both Full payment and Partial Payment, with three month stand down period]"
      },
      "aortic-surgery": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Aortic surgery [marked in table as Full payment, with three month stand down period]"
      },
      "cardiomyopathy": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Cardiomyopathy [marked in table as Full payment, no stand down period]"
      },
      "early-melanoma": {
        "qualifier": "Less than Clark Level 3 depth of invasion, and less than 1.0mm maximum thickness (Breslow), no evidence of ulceration",
        "payout_status": "partial",
        "payout_percent": null,
        "source_paragraph": "Malignant melanoma which is determined by histological examination to be less than Clark Level 3 depth of invasion, and less than 1.0mm maximum thickness as measured using the Breslow method, and shows no evidence of ulceration. [Optional Early Cancer Upgrade Benefit]"
      },
      "kidney-failure": {
        "qualifier": "Chronic renal failure",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Chronic renal failure [marked in table as Full payment, no stand down period]"
      },
      "loss-of-speech": {
        "qualifier": "Permanent loss of speech",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Permanent loss of speech [marked in table as Full payment, no stand down period]"
      },
      "cancer-invasive": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Malignant tumours and blood cancers [marked in table as Full payment, with three month stand down period]"
      },
      "aplastic-anaemia": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Aplastic anaemia [marked in table as Full payment, no stand down period]"
      },
      "occupational-hiv": {
        "qualifier": null,
        "payout_status": "not_on_file",
        "payout_percent": null,
        "source_paragraph": null
      },
      "terminal-illness": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Terminal illness [marked in table as Full payment, no stand down period]"
      },
      "carcinoma-in-situ": {
        "qualifier": "A focal autonomous new growth of carcinomatous cells which has not yet resulted in the invasion of normal tissue",
        "payout_status": "partial",
        "payout_percent": null,
        "source_paragraph": "Carcinoma-in-situ [marked in table as Partial Payment, with three month stand down period]. Built-in Children's Trauma Benefit pays lower of $50,000 or 10% of sum assured."
      },
      "dementia-advanced": {
        "qualifier": "Dementia; full payment available, partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Dementia [marked in table as both Full payment and Partial Payment, no stand down period]"
      },
      "major-head-trauma": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Major head trauma [marked in table as Full payment, no stand down period]"
      },
      "alzheimers-disease": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Alzheimer's disease [marked in table as Full payment, no stand down period]"
      },
      "dcis-breast-cancer": {
        "qualifier": "Carcinoma-in-situ of breast, classified as TIS according to TNM staging or FIGO Stage 0",
        "payout_status": "partial",
        "payout_percent": null,
        "source_paragraph": "The Optional Early Cancer Upgrade Benefit covers carcinoma-in-situ of the following sites...Breast...positively diagnosed by biopsy and be classified as TIS according to the TNM staging method or FIGO Stage 0"
      },
      "multiple-sclerosis": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Multiple sclerosis [marked in table as Full payment, with three month stand down period]"
      },
      "parkinsons-disease": {
        "qualifier": "Idiopathic Parkinson's disease",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Idiopathic Parkinson's disease [marked in table as Full payment, no stand down period]"
      },
      "benign-brain-tumour": {
        "qualifier": "Benign brain or spinal cord tumour; full payment available, partial payment also available",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Benign brain or spinal cord tumour [marked in table as both Full payment and Partial Payment, no stand down period]"
      },
      "chronic-lung-disease": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Chronic lung disease [marked in table as Full payment, with three month stand down period]"
      },
      "meningitis-bacterial": {
        "qualifier": "Meningitis (bacterial type not explicitly distinguished in table)",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Meningitis [marked in table as Full payment, no stand down period]"
      },
      "early-prostate-cancer": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Prostate Cancer [marked in table as Full payment, with three month stand down period]"
      },
      "motor-neurone-disease": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Motor neurone disease [marked in table as Full payment, no stand down period]"
      },
      "hiv-medically-acquired": {
        "qualifier": null,
        "payout_status": "not_on_file",
        "payout_percent": null,
        "source_paragraph": null
      },
      "major-organ-transplant": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Major transplant surgery [marked in table as Full payment, no stand down period]"
      },
      "heart-valve-replacement": {
        "qualifier": "Full payment available; partial payment also available under certain conditions",
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Heart valve surgery [marked in table as both Full payment and Partial Payment, with three month stand down period]"
      },
      "pregnancy-complications": {
        "qualifier": "Disseminated intravascular coagulation, Eclampsia, Hydatidiform mole; requires Optional Children's and Maternity Benefit",
        "payout_status": "partial",
        "payout_percent": null,
        "source_paragraph": "Pregnancy Complications Benefit...if a life assured...suffers for the first time and at least 12 months after the risk commencement date one of the defined pregnancy complication conditions...Disseminated intravascular coagulation. Eclampsia. Hydatidiform mole...The Benefit payable is $10,000."
      },
      "childbirth-complications": {
        "qualifier": "The Optional Children's and Maternity Benefit covers only specific pregnancy complications (Disseminated intravascular coagulation, Eclampsia, Hydatidiform mole) at a fixed $10,000. Childbirth complications per se are not listed as a covered condition anywhere in the wording.",
        "payout_status": "not_covered",
        "payout_percent": null,
        "source_paragraph": "This Benefit is payable if a life assured for the Critical Conditions Benefit suffers for the first time and at least 12 months after the risk commencement date one of the defined pregnancy complication conditions... Disseminated intravascular coagulation. Eclampsia. Hydatidiform mole."
      },
      "severe-rheumatoid-arthritis": {
        "qualifier": null,
        "payout_status": "partial",
        "payout_percent": null,
        "source_paragraph": "Severe rheumatoid arthritis [marked in table as Partial Payment, with three month stand down period]"
      },
      "coronary-artery-bypass-grafts": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Coronary artery bypass surgery [marked in table as Full payment, with three month stand down period]"
      },
      "loss-of-independent-existence": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Loss of independent existence [marked in table as Full payment, no stand down period]"
      },
      "pulmonary-arterial-hypertension": {
        "qualifier": null,
        "payout_status": "full",
        "payout_percent": null,
        "source_paragraph": "Pulmonary hypertension [marked in table as Full payment, no stand down period]"
      }
    },
    "partial_payment_conditions": [
      "Carcinoma-in-situ — 25% of sum assured to a maximum of $75,000",
      "Angioplasty – less than 3 vessels — 25% of sum assured to a maximum of $75,000",
      "Cardiac Defibrillator Insertion — 25% of sum assured to a maximum of $75,000",
      "Pacemaker insertion — partial payment",
      "Heart valve surgery — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Benign brain or spinal cord tumour — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Cerebral Aneurysm — partial payment",
      "Dementia — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Encephalitis — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Permanent blindness — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Permanent loss of hearing — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Permanent loss of use of limbs — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Chronic liver failure — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Intensive care — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Severe burns — partial payment available (not available under Built-in Children's Trauma Benefit or Optional Children's and Maternity Benefit)",
      "Severe Crohn's disease — partial payment",
      "Severe osteoporosis — partial payment",
      "Severe rheumatoid arthritis — partial payment",
      "Severe ulcerative colitis — partial payment"
    ],
    "future_insurability_options": "Built-in Critical Conditions Future Insurability Benefit: at every third policy anniversary the sum assured can be increased without medical evidence. Each individual increase cannot exceed 20% of the original Critical Conditions Benefit sum assured or $200,000 (whichever is lesser). Total of all Future Insurability increases cannot exceed 100% of the original sum assured or $500,000 (whichever is lesser). Available from age 16 and before age 55. Request must be made within 60 days either side of the applicable anniversary date. Six month stand down period applies to increases, except where claim is due to an accident. Built-in Special Events Increase Facility: increases available on specified life events (e.g. birth/adoption of child, marriage/civil union, separation/divorce, tertiary education of dependent child, child starting secondary school, new home loan, care of close relative, annual salary increase, death of spouse/partner). Maximum increase per event is the lower of 50% of the original Critical Conditions Benefit or $250,000. Total of all Special Events increases cannot exceed the lower of 100% of the original Critical Conditions Benefit or $750,000. Available from age 16 and before age 55. Request must be made within 60 days either side of the relevant special event. Six month stand down period applies to increases, except where claim is due to an accident. Both facilities are subject to overall cap of $2,000,000 for combined trauma benefits across all AIA policies."
  },
  "endpoints": {
    "summary": "/api/trauma/product/aia/living-critical-conditions/summary.md",
    "wording": "/api/trauma/product/aia/living-critical-conditions/wording.md",
    "history": "/api/trauma/product/aia/living-critical-conditions/history.json"
  },
  "canonical_url": "https://insurenz.co.nz/api/trauma/product/aia/living-critical-conditions/facts.json",
  "generated_at": "2026-09-06T06:19:09.144Z",
  "license": "CC BY 4.0 — attribute https://insurenz.co.nz"
}