No. |
Organs Part |
Critical Illness List |
Definition |
1 | Cancer | Early Cancer – Carcinoma in situ | Carcinoma in situ (CIS) means the focal autonomous new growth of carcinomatous cells confined to the cells in which it originated and has not yet resulted in the invasion and/or destruction of surrounding tissues. 'Invasion' means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The diagnosis of the Carcinoma in situ must always be supported by a histopathological report. Furthermore, the diagnosis of Carcinoma in situ must always be positively diagnosed upon the basis of a microscopic examination of the fixed tissue, supported by a biopsy result. Clinical diagnosis does not meet this standard. This coverage is available to the first occurrence of CIS only. In the case of the cervix uteri, Pap smear alone is not acceptable and should be accompanied with cone biopsy or colposcopy with cervical biopsy. Exclusion:
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2
|
Cancer
|
Early Prostate Cancer
|
Prostate Cancer that is histologically described using the TNM Classification as T1N0M0 or Prostate cancers described using another equivalent classification. Exclusion: Prostatic Intraepithelial Neoplasia (PIN). |
3
|
Cancer
|
Early Thyroid Cancer
|
Thyroid Cancer that is histologically described using the TNM Classification as T1N0M0. |
4
|
Cancer
|
Early Bladder Cancer
|
Bladder Cancer that is histologically described using the TNM Classification as T1N0M0 as well as Papillary microcarcinoma of the bladder (TaN0M0). |
5
|
Cancer
|
Early Chronic Lymphocytic Leukemia
|
Chronic Lymphocytic Leukemia (CLL) RAI Stage 1 or 2. Exclusion: CLL RAI stage 0 or lower is excluded. |
6
|
Cancer
|
Gastro-intestinal Stromal Cancer
|
All Gastro-intestinal Stromal Tumours histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs which are treated with surgery or chemotherapy as recommended by an oncologist. |
7
|
Heart
|
Insertion of a Permanent Cardiac Pacemaker or Defibrillator
|
Insertion of a permanent cardiac pacemaker or defibrillator that is required as a result of serious cardiac arrhythmia which cannot be treated via other means. The insertion of the cardiac pacemaker must be certified to be Medically Necessary by a Specialist in the relevant field. The pacemaker/defibrillator must be certified to be Medically Necessary by a cardiac Physician. |
8
|
Heart
|
Coronary Angioplasty
|
The actual undergoing of coronary artery balloon angioplasty or similar intra-arterial catheter procedure to correct a narrowing of a minimum 60% stenosis, of one or more major coronary arteries as shown by angiographic evidence. The revascularization must be considered Medically Necessary by a consultant cardiologist. Coronary arteries herein refer to left main stem, left anterior descending, circumflex and right coronary artery. Exclusion: Diagnostic/investigative procedures are excluded. |
9
|
Heart
|
Minimally Invasive Surgery to Aorta
|
The actual undergoing of surgery via minimally invasive or intra-arterial techniques to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta, as evidenced by an appropriate diagnostic test, and confirmed by a Specialist. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. Exclusion: Intra-arterial investigative procedures are excluded. |
10
|
Heart
|
Pericardiectomy
|
The undergoing of a pericardiectomy performed by keyhole or port access techniques as a result of pericardial disease. These surgical procedures must be certified to be Medically Necessary by a consultant cardiologist or Specialist in the relevant medical field. Exclusion: Other procedures on the pericardium including pericardial biopsies, and pericardial drainage procedures by needle aspiration are excluded. |
11
|
Heart
|
Insertion of a vena-cava filter
|
The surgical insertion of a vena-cava filter after there has been documented proof of recurrent pulmonary emboli. The need for the insertion of a vena-cava filter must be certified to be Medically Necessary by a Specialist in the relevant field. |
12
|
Brain
|
Secondary pulmonary hypertension
|
Secondary pulmonary hypertension with established right ventricular hypertrophy resulting in permanent functional heart impairment. The definite diagnosis of secondary pulmonary arterial hypertension must be made by a Specialist and should include the following:
Exclusion: Idiopathic causes of pulmonary arterial hypertension is excluded. |
13
|
Brain
|
Large Asymptomatic Aortic Aneurysm
|
Large asymptomatic abdominal or thoracic aortic aneurysm as evidenced by appropriate imaging technique. The aorta must be enlarged and greater than 55mm in diameter and the diagnosis must be confirmed by a consultant cardiologist. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. |
14
|
Brain
|
Cerebral Arteriovenous Malformation (AVM) / Cerebral Aneurysm Surgery
|
The actual undergoing of
The need for the procedure must be certified to be Medically Necessary by a Specialist in the relevant field. |
15
|
Brain
|
Less Severe Coma (persist at least 48 hour)
|
Coma that persists for at least forty-eight (48) hours. This diagnosis must be supported by evidence of all of the following:
Exclusion:
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16
|
Brain
|
Cerebral Shunt Insertion
|
The actual undergoing of surgical implantation of a shunt from the ventricles of the brain to relieve raised pressure in the cerebrospinal fluid. The need of a shunt must be certified to be Medically Necessary by a Specialist in the relevant field. |
17
|
Brain
|
Surgery for Subdural Hematoma
|
The actual undergoing of burr hole surgery to the head to drain a subdural hematoma as a result of accidental traumatic vascular injury. The need for the burr hole surgery must be certified to be Medically Necessary by a Specialist in the relevant field. Exclusion: Subdural hematoma resulting from neurological surgery is excluded. |
18
|
Brain
|
Carotid Artery Surgery
|
The actual undergoing of endarterectomy of the carotid artery which has been medically necessitated as a result of at least eighty percent (80%) narrowing of the carotid artery as diagnosed by arteriography or any other appropriate diagnostic test that is available. Exclusion: Endarterectomy of blood vessels other than the carotid artery are specifically excluded. |
19
|
Liver
|
Liver Surgery
|
Partial hepatectomy of at least one (1) entire lobe of the liver that has been found Medically Necessary as a result of illness or accident of the Life Insured and confirmed by a Specialist. Exclusion: Liver donation and liver disease secondary to alcohol or drug abuse is excluded. |
20
|
Liver
|
Hepatitis with Cirrhosis
|
Inflammation of the liver by the Hepatitis virus leading to cirrhosis. There must be a definite diagnosis of liver cirrhosis due to hepatitis virus as confirmed by a Specialist Medical Practitioner that must be supported by a liver biopsy showing histological stage F4 by Metavir grading or a Knodell fibrosis score of 4. Exclusion: All liver diseases due or related to alcohol or drug abuse. |
21
|
Kidney
|
Nephrectomy / Removal of one Kidney
|
The complete surgical removal of one (1) kidney medically necessitated by any illness or accident. The need for the surgical removal of the kidney must be certified to be Medically Necessary by a Specialist in the relevant field. Exclusion: Partial removal of a kidney or kidney donation is excluded. |
22
|
Lung
|
Surgical Removal of One Lung
|
Complete surgical removal of a lung as a result of an illness or an accident of the Life Insured. Exclusion: Partial removal of a lung or lung donation is excluded |
23
|
Lung
|
Permanent Tracheostomy
|
The performance of tracheostomy for the treatment of lung disease or airway disease or as a ventilatory support measure following major trauma or burns. The Life Insured must have been a patient in a designated Intensive Care Unit (ICU) under the care of a medical Specialist. The benefit only payable if the tracheostomy is required to remain in place and functional for a minimum period of three months. |
24
|
Organ Transplant
|
Small Bowel Transplant
|
The receipt of a transplant of at least one (1) meter of small bowel with its own blood supply via a laparotomy resulting from intestinal failure. As confirmed by Specialist Surgeon. |
25
|
Dismemberment
|
Amputation of One Limb
|
Severance of one entire limb as a result of illness or accident. This condition must be confirmed by a consultant neurologist. Exclusion: Self-inflicted injuries are excluded. |
26
|
Dismemberment
|
Loss of Sight of One Eye
|
Total and irreversible loss of sight in one eye:
|
27
|
Other
|
Tuberculous Myelitis
|
Myelitis caused by tubercle bacilli, resulting in permanent neurological deficit with persisting clinical symptoms for at least a continuous period of three (3) months. The diagnosis must be confirmed by a neurologist and supported by analysis of cerebrospinal fluid by lumbar puncture. Exclusion: Tuberculous myelitis in the presence of HIV infection is excluded. |
28
|
Other
|
Less Severe Burn
|
Second degree (partial thickness of the skin) burns covering at least fifty percent (50%) of the surface of the Life Insured’s body measured by the Lund & Browder Body Surface Chart. The skin burns should be identified as needing treatment in a recognized burns unit in a hospital and require operative debridement. Second degree burns refer to burns which involve the entire epidermis and which extend into the dermis. |
29
|
Other
|
Less severe Systemic Lupus Erythematosus (SLE)
|
Less Severe Systemic Lupus Erythematosus shall mean a multisystem autoimmune disorder, characterized by the development of auto-antibodies. All of the following criteria must be met: 1. Presence of at least three (3) of the five (5) criteria below:
2. Diagnosis of systemic lupus erythematosus must be confirmed by an appropriate Specialist. Exclusion: Other forms, discoid lupus and those forms with only hematological involvement will be specifically excluded. |
30
|
Other
|
Adrenalectomy for Adrenal Adenoma
|
The actual undergoing of Adrenalectomy for treatment of malignant systemic hypertension that was secondary to an aldosterone secreting adrenal adenoma. The malignant hypertension must have been uncontrolled by medical therapy and the adrenalectomy must be considered Medically Necessary for the management of poorly controlled hypertension by a Specialist in the relevant field. |