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Early-Stage Critical Illness

The following Critical Illness conditions are covered under the Early-Stage Critical Illness Benefit:

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: 

  • Clinical diagnosis or Cervical Intraepithelial Neoplasia (CIN) classification which reports CIN I, CIN II and CIN III (severe dysplasia without carcinoma in situ) does not meet the required definition and are specifically excluded.

  • Non-melanoma skin CIS is also specifically excluded.

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: 

  1. Symptoms of right ventricular heart failure including shortness of breath, exertional chest pain, exertional syncope, or weight gain from fluid retention, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment. 
  2. Echocardiographic findings of right ventricular heart failure including increased right ventricular wall thickness and size with decreased right ventricular function. 

  3. Right Heart Catheterization with a mean pulmonary artery pressure ≥ 20mmHg and a mean pulmonary capillary wedge pressure (PCWP) ≤ 15 mmHg.  

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  

  1. surgical repair of an intracranial aneurysm or surgical removal of an arterio-venous malformation via craniotomy, performed by a consultant neurosurgeon or  

  2. An endovascular treatment procedure by a consultant radiologist using coils to cause thrombosis of a cerebral arteriovenous malformation or cerebral aneurysm.  

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:

  1. No response to external stimuli for at least forty-eight (48) hours; and

  2. The use of life support measures to sustain life for at least forty-eight (48) hours; and

  3. Brain damage resulting in permanent neurological deficit with persisting clinical symptoms which must be assessed at least thirty (30) days after the onset of the coma.

Exclusion: 

  • Coma resulting directly from alcohol or drug abuse.

  • Medically induced coma or sedation.

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: 

  1. As a result of illness or accident; and 

  2. Must be certified by an ophthalmologist; and 

  3. (c) vision is measured at 3/60 or worse in the affected eye using a Snellen eye chart or equivalent test. 

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: 

  • Arthritis: non-erosive arthritis, involving 2 or more joints; 

  • Serositis: pleuritis or pericarditis; 

  • Renal Disorder: persistent proteinuria > 0.5 g per day or cellular casts; 

  • Hematologic disorder: hemolytic anemia, Leukopenia, Lymphopenia, or thrombocytopenia;
  • Positive anti-nuclear antibody, Anti-dsDNA or anti-Smith antibody. 

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.