CRITICAL ILLNESS DESCRIPTION
1. STROKE
Defined as a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than six months. Infarction of brain tissue, hemorrhage and embolisation from an extra-cranial source are included. The diagnosis must be based on changes seen in a CT scan or MRI & certified by a neurologist.
Specifically excluded are cerebral symptoms due to transient ischaemic attacks, any reversible ischaemic neurological deficit, vertebrobasilar ischaemia, cerebral symptoms due to migraine, cerebral injury resulting from trauma or hypoxia & vascular disease affecting the eye or optic nerve or vestibular functions.
2. HEART ATTACK (MYOCARDIAL INFARCTION)
The death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply and being evidenced by:
(a) A history of typical prolonged chest pain,
(b) New electrocardiographic changes resulting from this occurrence,
(c) Elevation of the cardiac enzyme (CPK-MB) above the generally accepted laboratory levels of normal.
Diagnosis based on the elevation of Troponin T test alone shall not be considered diagnostic of a heart attack.
Angina is specifically excluded.
3. KIDNEY FAILURE
End stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis initiated or renal transplantation is carried out.
4. CANCER
Cancer is defined as the uncontrollable growth & spread of malignant cells and the invasion & destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered necessary. The cancer must be confirmed by histological evidence of malignancy.
The following conditions are excluded: -
Carcinoma in situ including of the cervix,
(a) Ductal Carcinoma in situ of the breast,
(b) Papillary Carcinoma of the bladder & Stage 1 Prostate Cancer.
(c) All skin cancers except malignant melanoma;
(d) Stage I Hodgkin's disease,
(e) Tumors manifesting as complications of AIDS.
5. CORONARY ARTERY BYPASS SURGERY
Refers to the actual undergoing of Coronary artery by-pass surgery by way of thoracotomy to correct or treat coronary artery disease but not including angioplasty, other intra-arterial, keyhole or laser procedures.
6. BALLOON ANGIOPLASTY
Means the actual undergoing for the first time of Coronary Artery Balloon Angioplasty or the insertion of a stent to correct a narrowing or blockage of one or more coronary arteries. Intra-arterial investigative procedures are not included. Medical evidence shall include all of the following:
(a) Evidence of significant and relevant ECG changes (ST segment depression of 2 millimetres or more) and
(b) Angiographic evidence to confirm the location of stenosis.
Payment under this clause is limited to 10% of the Critical Illness coverage under this Certificate subject to a maximum of RM25, 000. This benefit is payable once only & shall be deducted from the amount of this Contract, thereby reducing the amount of the Lump Sum Payment which may be payable herein. This benefit shall cease upon payment of one Limited Payment.
7. CORONARY ARTERY LASER THERAPY OR ANY OTHER INVASIVE CORONARY PROCEDURE
Means the actual undergoing for the first time of Laser treatment or artherectomy to correct a narrowing or blockage of one or more coronary arteries. Intra-arterial investigative procedures are not included.
Medical evidence shall include all of the following:
(a) Evidence of significant and relevant ECG changes (ST segment depression of 2 millimeters or more) and
(b) Angiographic evidence to confirm the location of stenosis.
The payment under this clause is limited to 10% of the Critical Illness coverage under this Certificate subject to a maximum of RM25,000. This benefit is payable once only & shall be deducted from the amount of this Contract, thereby reducing the amount of the Lump Sum Payment which may be payable herein. This benefit shall cease upon payment of one Limited Payment.Misuse is excluded.
8. CHRONIC LIVER DISEASE
End stage liver failure evidenced by all of the following:-
(a) Permanent jaundice
(b) Ascites
(c) Encephalopathy
(d) Portal hypertension
Wernicke's encephalopathy & liver failure secondary to alcohol or drug misuse is excluded
9. FULMINANT VIRAL HEPATITIS
This is defined as a sub massive to massive necrosis of the liver caused by any virus leading precipitously to liver failure.
The diagnostic criteria to be met are:
(a) A rapidly decreasing liver size as confirmed by abdominal ultrasound;
(b) Necrosis involving entire lobules, leaving only a collapsed reticula framework;
(c) Rapidly deteriorating liver functions tests; and
(d) Deepening jaundice.
Hepatitis B infection or carrier status alone does not meet the diagnostic criteria
10. COMA
A state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least 96 hours, requiring the use of life support systems and resulting in a neurological deficit, lasting more than 30 days. Confirmation by a neurologist must be present.
Coma resulting directly from self-inflicted injury, alcohol or drug misuse is excluded.
11. BENIGN BRAIN TUMOR
A life-threatening, non-cancerous tumor in the brain giving rise to characteristic signs of increased intra-cranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumor must be confirmed by imaging studies such as CT Scan or MRI.
The following are excluded:
(a) Cysts
(b) Granulomas
(c) Malformations in or of the arteries or veins of the brain
(d) Haematomas
(e) Tumors in the pituitary gland, or spine
(f) Tumors of the acoustic nerve
12. PARALYSIS/PARAPLEGIA
The complete and permanent loss of use of both arms or both legs, or one arm and one leg, through paralysis caused by illness or injury persisting for at least six (6) months from the date of trauma or illness.
13. BLINDNESS
The total, permanent and irrecoverable loss of the sight of both eyes. Certification by an ophthalmologist is necessary.
14. LOSS OF HEARING/DEAFNESS
Total, permanent and irreversible loss of hearing in both ears as a result of disease or accident. Medical evidence in the form of an audiometry and sound-threshold tests must be provided.
15. MAJOR BURNS
Third degree burns covering at least twenty percent (20%) of the person covered's body surface area as measured by "The Rule of 9" of the Lund & Browder Body Surface Chart.
16. HIV BY BLOOD TRANSFUSION
The Person covered being infected by HIV virus or AIDS provided that:
(a) The infection is due to blood transfusion received in Malaysia or Singapore after the commencement of the Certificate;
(b) The Person covered is not a haemophiliac; and
(c) The Person covered is not a member of any high risk groups such as but not limited to homosexuals, intravenous drug users or sex workers.
Notification & proof of incident will be required via a statement from a statutory Health Authority that the infection is medically acquired.
The clinical manifestation of AIDS (Acquired Immuno-deficiency Syndrome) must be supported by the results of a positive HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory Western Blot test. In addition, the life Person coveredmust have a CD4 cell count of less than two hundred (200) and one or more of the following criteria are met: Weight loss of more than 10% of body weight over a period of six (6) months or less (wasting syndrome);
(a) Kaposi Sarcoma;
(b) Pneumocystic Carinii Pneumonia;
(c) Progressive multifocal leukoencephalopathy;
(d) Active Tuberculosis;
(e) Less than one-thousand (1000) Iymphocytes
(f) Malignant Lymphoma.
In the event of a claim, only 50% of the sum covered in force under the Basic Certificate is payable. The balance of the sum covered, if in force, will be payable in the event of a total and permanent disability claim or death or on the first diagnosis of another dread disease. The takaful charge under the Basic Certificate will be waived.
18. OCCUPATIONALLY ACQUIRED HIV INFECTION
The Applicant/Owner being infected by Human Immuno-deficiency Virus (HIV) where it was acquired as a result of an accident occurring during the course of carrying out normal occupational duties with sero-conversion to HIV infection occurring within six (6) months of the accident. Any accident giving rise to a potential claim must be reported to the Company within thirty (30) days of the accident taking place supported by a negative HIV test taken within seven (7) days of the accident. Infection in any other manner including infection as a result of sexual activity, blood transfusions or recreational intravenous drug use is specifically EXCLUDED.
In the event of a claim, takaful charge payable to be waived shall be based on only 50% of the sum covered in force under the Basic Certificate and this Supplementary Contract. The takaful charge payment on the balance of the sum covered under the Basic Certificate and this Supplementary Contract will be continued to keep the Certificate in force and shall be waived in the event of death or total and permanent disability or on the first diagnosis of another dread disease, provided however this Supplementary Contract is in force.
19. CHRONIC LUNG DISEASE
End stage respiratory failure including chronic interstitial lung disease.
The following criteria must be met:
(a) Requiring permanent oxygen therapy as a result of a consistent FEV1 test value of less than one litre. (Forced Expiratory Volume during the first second of a forced exhalation)
(b) Arterial Blood Gas analysis with partial oxygen pressures
of 55mmHg or less
(c) Dyspnoea at rest.
Defined as severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of 30 days & certified by a consultant neurologist. The permanent deficit must result in an inability to perform at least three (3) of the following Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefit, the word "permanent", shall mean beyond the hope of recovery with current medical knowledge and technology.
The Activities of Daily Living are: -
(a) Transfer - Getting in & out of a chair without requiring physical assistance.
(b) Mobility - The ability to move from room to room without requiring any physical assistance.
(c) Continence - The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d) Dressing - Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e) Bathing/Washing - The ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.
(f) Eating - All tasks of getting food into the body once it has been prepared.
21. MAJOR ORGAN TRANSPLANT
The actual undergoing of a transplant as a recipient of one of the following human organs:
(a) Kidney
(b) Lung(s)
(c) Liver
(d) Heart
(e) Bone marrow
22. LOSS OF SPEECH
Total and irrecoverable loss of the ability to speak for a continuous period of 12 months. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an appropriate (Ear, Nose, Throat) specialist. All psychiatric related causes are excluded.
23. BRAIN SURGERY
The actual undergoing of surgery to the brain under general anaesthesia during which a craniotomy is performed. Bur Hole & brain surgery as a result of an accident is excluded.
24. HEART VALVE REPLACEMENT
The actual undergoing of open-chest surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities that have occurred after the date of issue or date of reinstatement of this contract. Repair, via valvotomy, intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded.
25. TERMINAL ILLNESS
The life person covered must be suffering from a condition, which in the opinion of an appropriate medical consultant is highly likely to lead to death within 12 months. The person covered must no longer be receiving active treatment other than that for pain relief.
26. BACTERIAL MENINGITIS
Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit lasting for a minimum period of 30 days & resulting in a permanent inability to perform at least three (3) of the following Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefit, the word "permanent", shall mean beyond the hope of recovery with current medical knowledge and technology.
The Activities of Daily Living are: -
(a) Transfer - Getting in & out of a chair without requiring physical assistance.
(b) Mobility - The ability to move from room to room without requiring any physical assistance.
(c) Continence - The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d) Dressing - Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e) Bathing/Washing - The ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.
(f) Eating - All tasks of getting food into the body once it has been prepared.
The diagnosis is to be confirmed by a consultant neurologist.
27. POLIOMYELITIS
Unequivocal diagnosis by a consultant neurologist of infection with the Poliovirus leading to paralytic disease as evidenced by impaired motor function or respiratory weakness. Cases not involving paralysis will not be eligible for this benefit. Other causes of paralysis (such as Guillain-Barre syndrome) are specifically excluded.
28. APLASTIC ANAEMIA
Chronic persistent bone marrow failure which results in total aplasia of the bone marrow & requires treatment with at least one of the following:
(a) Regular blood product transfusion
(b) Marrow stimulating agents
(c) Immunosuppressive agents
(d) Bone marrow transplantation
29. MOTOR NEURONE DISEASE
Motor neurone disease of unknown aetiology is characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons. These include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.
Diagnosis must be confirmed by a consultant neurologist.
30. PARKINSON’S DISEASE
Unequivocal diagnosis of Parkinson's disease by a consulting neurologist where the condition:
(a) Cannot be controlled with medication
(b) Shows signs of progressive impairment
Activities of daily living assessment confirm the inability of the life person covered to perform without assistance three (3) or more of the following:
(a) Transfer - Getting in & out of a chair without requiring physical assistance.
(b) Mobility - The ability to move from room to room without requiring any physical assistance.
(a) Continence - The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(b) Dressing - Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(c) Bathing/Washing - The ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.
(d) Eating - All tasks of getting food into the body once it has been prepared.
Only idiopathic Parkinson's disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded.
31. ALZHEIMER’S DISEASE/IRREVERSIBLE ORGANIC DEGENERATIVE BRAIN DISORDERS
Deterioration or loss of intellectual capacity or abnormal behaviour as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer's disease or irreversible organic degenerative brain disorders excluding neurosis, psychiatric illness, and any drug or alcohol related organic disorder, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the life insured. The diagnosis must be clinically confirmed by an appropriate consultant.
32. MUSCULAR DYSTROPHY
The diagnosis of muscular dystrophy shall require a confirmation by a consultant neurologist of the combination of 3 out of 4 of the following conditions.
(a) Family history of other affected individuals
(b) Clinical presentation including absence of sensory disturbance, normal cerebro-spinal fluid and mild tendon reflex reduction
(c) Characteristic electromyogram
(d) Clinical suspicion confirmed by muscle biopsy
Children are excluded from the definition.
33. SURGERY OF THE AORTA
The actual undergoing of surgery via a thoracotomy or laprotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a coarctation of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches.
34. MULTIPLE SCLEROSIS
Unequivocal diagnosis by a consulting neurologist confirming the following combination, which has persisted for at least a continuous period of six (6) months:
(a) Symptoms referable to tracts (white matter) involving the optic nerves, brain stem and spinal cord, producing well-defined neurological deficits;
(b) A multiplicity or discrete lesions; and
(c) A well-documented history of exacerbation and remissions of said symptoms/neurological deficits.
35. PRIMARY PULMONARY ARTERIAL HYPERTENSION
Means primary pulmonary hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent irreversible physical impairment to the degree of at least Class 3 of the New York Heart Association Classification of cardiac impairment, & resulting in the Life Person covered being unable to perform his/her usual occupation.
36. CARDIOMYOPATHY
The unequivocal diagnosis by a consultant cardiologist of cardiomyopathy causing impaired ventricular function, suspected by ECG abnormalities and confirmed by cardiac echo of variable aetiology and resulting in permanent physical impairments to the degree of at least class III of the New York Association Classification of cardiac impairment.
Class III - Marked limitation - Such patients are comfortable at rest but performing less than ordinary activity will lead to symptoms of Congestive Cardiac Failure.
Class IV - Inability to carry out any activity without discomfort. Symptoms of Congestive Cardiac Failure are present even at rest. With any increase in physical activity, discomfort will be experienced.
Cardiomyopathy directly related to alcohol misuse is excluded.
List of Additional 10 Dread Diseases:
1.Apallic Syndrome / Vegetative State
2.Creutzfeldt-Jacob Disease (Mad Cow Disease)
3.Myasthenia Gravis
4.Other Serious Coronary Artery Disease
5.Progressive Scleroderma
6.Brachial Plexus Injury resulting in total paralysis one limb
7.Medullary Cystic Disease
8.Major Head Trauma
9.Loss Of Independent Existence
10.Systemic Lupus Erythematosus with Lupus Nephritis
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