Appendix Critical Illness Events Definitions

No.

Critical Illness Category

Severity Level

Critical Illness Events

Percentage (%) of EPCIR Sum Assured 30%

1.

Cancer

Low Severity

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. 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. 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 CIS is also specifically excluded. This coverage is available to the first occurrence of CIS only; or Early Prostate Cancer Prostate Cancer that is histologically described using the TNM Classification as T1a or T1b or T1c or Prostate cancers described using another equivalent classification; or Early Thyroid Cancer Thyroid Cancer that is histologically described using the TNM Classification as T1N0M0 Papillary microcarcinoma of thyroid where the tumour is less than 1cm in diameter; or Early Bladder Cancer Papillary microcarcinoma of Bladder supported by histopathology report; or Early Chronic Lymphocytic Leukaemia Chronic Lymphoctic Leukaemia (CLL) RAI Stage 1 or 2. CLL RAI stage 0 or lower is excluded.

29

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured 60%

No.

Critical Illness Category

Severity Level

Critical Illness Events

Medium Severity

Carcinoma in situ and other Early Cancers of Specified Organs Treated with Radical Surgery The actual undergoing of a Radical Surgery to arrest the spread of carcinomatous cells in that specific organ, which must be considered as appropriate and necessary treatment. Radical Surgery is defined in this Supplementary Contract as the total and complete removal of tumour mass and ancillary lymph nodes for one of the following organs: breast (radical mastectomy), prostate (radical prostatectomy), thyroid (radical thyroidectomy), corpus uteri (radical hysterectomy), ovary (oopherectomy), and fallopian tube (salpingectomy). A radical surgery benefit will be paid for carcinoma in situ of the colon if upon actual undergoing of surgical resection of a length of colon with end to end anastomosis and a radical surgery benefit for carcinoma of the stomach will be payable if upon actual undergoing of a partial gastrectomy with end to end anastomosis. The diagnosis of the Carcinoma in situ and other early cancers must always be positively diagnosed upon the basis of a microscopic examination of fixed tissues additionally supported by a biopsy of the removed organ. Clinical diagnosis does not meet this standard. Early prostate cancer that is histologically described using the TNM Classification as T1a or T1b or T1c or Prostate cancers described using another equivalent classification is also covered if it has been treated with a radical prostatectomy. All grades of cervical intraepithelial neoplasia (CIN) and prostatic intraepithelial neoplasia (PIN) are specifically excluded. Early thyroid cancer that is histologically described using the TNM Classification as T1 or Thyroid cancers described using another equivalent classification is covered if it has been treated with a radical thyroidectomy. T1 thyroid tumours described as microcarcinoma less than 1cm in diameter will be excluded. Except in the case of carcinoma in situ of the colon and stomach partial surgical removal of an organ such as lumpectomy and partial mastectomy, partial prostatectomy, and partial thyroidectomy are specifically excluded.

30

Appendix Critical Illness Events Definitions

No.

Critical Illness Category

Severity Level

Critical Illness Events

Percentage (%) of EPCIR Sum Assured

Carcinoma in situ 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.

High Severity

Cancer Any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, lymphoma and sarcoma. For the above definition, the following are not covered: (a) All cancers which are histologically classified as premalignant, non-invasive; carcinoma in situ; having either borderline malignancy; or having low malignant potential; (b) All tumours of the prostate, thyroid and urinary bladder histologically classified as T1N0M0 (TNM classification); (c) Chronic Lymphocytic Leukaemia less than RAI Stage 3; (d) All cancers in the presence of HIV; (e) Any skin cancer other than malignant Melanoma.

100%

31

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured 30%

No.

Critical Illness Category

Severity Level

Critical Illness Events

2.

Stroke

Low Severity

Brain Aneurysm Surgery The actual undergoing of burr hole surgery to repair either an intracranial aneurysm or to remove an arterio-venous malformation. Intra-arterial surgeries are excluded; or 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 absolutely necessary by a consultant neurologist. Carotid Artery Surgery The actual undergoing of an endarterectomy of the Internal Carotid Artery or Common Carotid Artery as a result of a neurological deficit caused by a narrowing of a minimum of eighty percent (80%) arterial narrowing. The neurological complication should have been documented before the endarterectomy procedure. Endarterectomy of blood vessels other than the carotid artery is specifically excluded. Stroke Defined as a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than three (3) months. Infarction of brain tissue, hemorrhage and remobilization from an extra-cranial source are included. The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist. Specifically excluded are cerebral symptoms due to transient ischemic attacks, any reversible ischemic neurological deficit, vertebrobasilar ischemia, cerebral symptoms due to migraine, cerebral injury resulting from trauma or hypoxia and vascular disease affecting the eye or optic nerve or vestibular functions. Cardiac Pacemaker or Defibrillator Insertion 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 surgical procedure must be certified as absolutely necessary by a consultant cardiologist.

Medium Severity

60%

High Severity

100%

3.

Heart Attack

Low Severity

30%

32

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured 100%

No.

Critical Illness Category

Severity Level

Critical Illness Events

High Severity

Heart Attack The death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply and being evidenced by all of the following criteria:(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 or troponins recorded at the following levels or higher: -Troponin T > 1.0 ng/ml or equivalent threshold with other Troponin I methods. Angina is specifically excluded.

4.

Other Serious Coronary Artery Disease

Low Severity

Early Coronary Artery Disease The narrowing of the lumen of at least one (1) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (non-invasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem (a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed. Other Coronary Artery Disease The narrowing of the lumen of at least two (2) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (non-invasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem (a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed. Other Serious Coronary Artery Disease The narrowing of the lumen of at least three (3) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (noninvasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem

30%

Medium Severity

60%

High Severity

100%

33

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured

No.

Critical Illness Category

Severity Level

Critical Illness Events

(a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed. 5. Coronary Artery By-Pass Surgery Low Severity Pericardectomy The undergoing of a pericardectomy performed by keyhole or port access techniques as a result of pericardial disease. These surgical procedures must be certified to be absolutely necessary by a consultant cardiologist. Other procedures on the pericardium including pericardial biopsies, and pericardial drainage procedures by needle aspiration are excluded. Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) Coronary Artery Bypass Grafting performed by port access procedures (thoracoscopic techniques) or MIDCAB procedures (open coronary artery bypass grafting where median sternotomy is not required) to correct blockages in the coronary arteries. All intravascular procedures are excluded. Coronary Artery By-Pass Surgery Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of Coronary Artery By-Pass Grafting. Angioplasty and all other intra-arterial, catheter based techniques, keyhole or laser procedures are excluded. Percutaneous Valvuloplasty This benefit is payable where a heart valve is repaired by percutaneous balloon valvuloplasty techniques not involving a thoracotomy. Percutaneous valve replacements are excluded. Percutaneous Valve Replacement The actual undergoing of replacing the heart valve via percutaneous intravascular technique. Balloon valvuloplasty and other open chest heart valve procedures are excluded. Heart Valve Surgery The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. Repair via intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded. 30%

Medium Severity

60%

High Severity

100%

6.

Heart Surgery

Valve

Low Severity

30%

Medium Severity

60%

High Severity

100%

34

Appendix Critical Illness Events Definitions

No. 7.

Critical Illness Category

Severity Level

Critical Illness Events

Percentage (%) of EPCIR Sum Assured 30%

Cardiomyopathy

Low Severity

Hypertrophic Cardiomyopathy This benefit will be paid on the diagnosis of symptomatic hypertrophic cardiomyopathy HCM. The diagnosis of asymmetric septal cardiac hypertrophy must be made by a consultant cardiologist and proven on echocardiographic criteria. The condition must require surgical myomectomy or septal ablation according to accepted guidelines. All other forms of ventricular hypertrophy including apical hypertrophic cardiomyopathy are excluded from the benefit. Constrictive Pericarditis with Surgery The actual undergoing of the stripping and removal of the entire pericardium at open thoracotomy due to constrictive pericarditis. Constrictive pericarditis refers to pericardial disease resulting in symptoms and signs of congestive cardiac failure. The diagnosis of constrictive pericarditis must be based on the findings on cardiac catheterization. Severe Cardiomyopathy An impaired function of the heart muscle, unequivocally diagnosed as Cardiomyopathy by a cardiologist, and resulting in permanent physical impairment of at least Class III of the New York Heart Association's classification of cardiac impairment. The diagnosis has to be supported by echocardiographic findings of compromised ventricular performance. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. Cardiomyopathy directly related to alcohol or drug abuse is excluded. Large Asymptomatic Aortic Aneurysm Large asymptomatic abdominal or thoracic aortic aneurysm or aortic dissection 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.

Medium Severity

60%

High Severity

100%

8.

Aorta

Low Severity

30%

35

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured 60%

No.

Critical Illness Category

Severity Level

Critical Illness Events

Medium Severity

Minimally Invasive Surgery to Aorta The actual undergoing of surgery via minimally invasive (i.e. percutaneous intraarterial techniques) to repair or correct an aneurysm, narrowing, obstruction or dissection of the aorta, as evidenced by a cardiac echocardiogram, CT, MRI or any other appropriate diagnostic test that is available and confirmed by a consultant cardiologist or specialized vascular surgeon. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. Surgery to Aorta The actual undergoing of surgery via a thoracotomy or laparotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. Angioplasty and all other intra-arterial, catheter based techniques, keyhole or laser procedures are excluded. Early Primary Pulmonary Arterial Hypertension Means Primary Pulmonary Arterial Hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class II of the New York Heart Association (NYHA) classification of cardiac impairment. The diagnosis needs to be made by a cardiologist. Ongoing specialist monitoring and treatment with drugs indicated for pulmonary arterial hypertension according to current treatment guidelines are also required. Pulmonary arterial hypertension resulting from other causes and secondary pulmonary arterial hypertension shall be excluded from this benefit. The NYHA Classification of Cardiac Impairment for Class II to Class IV means the following:Class II: Slight limitation of physical activity. Comfortable at rest but ordinary activity causes symptoms. Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.

High Severity

100%

9.

Primary Pulmonary Arterial Hypertension

Low Severity

30%

36

Appendix
Critical Illness Events Definitions
Percentage (%) of EPCIR Sum Assured 100%

No.

Critical Illness Category

Severity Level

Critical Illness Events

High Severity

Primary Pulmonary Arterial Hypertension Means Primary Pulmonary Arterial Hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment. Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.

10.

Lung Disease

Low Severity

Severe Asthma Evidence of an acute attack of Severe Asthma with persistent status asthmaticus that requires hospitalisation and assisted ventilation with a mechanical ventilator for a continuous period of at least four (4) hours on the advice of a respiratory physician. Treatment by continuous positive airways pressure delivered by CPAP or BIPAP mask is excluded. There should also be evidence to show that FEV is continuously less than fifty percent (50%) predicted despite compliance with oral steroid therapy for at least six (6) months. Surgical Removal of One Lung Complete surgical removal of the entire right or left lung as a result of an illness or an accident of the Insured. Partial removal of a lung is not included in this benefit. End Stage Lung Disease End stage lung disease causing chronic respiratory failure. All of the following criteria must be met: (a) Requiring permanent oxygen therapy as a result of a consistent FEV1 test value of less than one (1) liter (Forced Expiratory Volume during the first second of a forced exhalation); (b) Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less; (c) Dyspnea at rest.

30%

Medium Severity

60%

High Severity

100%

37

Appendix Critical Illness Events Definitions

Critical Illness Category Severity Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 30%

No. 11.

Liver Disease

Low Severity

Liver Surgery Partial hepatectomy of at least one (1) entire lobe of the liver that has been found necessary as a result of illness or accident as suffered by the Insured. Liver donation is excluded. Liver Cirrhosis Cirrhosis of Liver with a HAI-Knodell Score of six (6) and above as evident by liver biopsy. The diagnosis of liver cirrhosis must be unequivocally confirmed by a hepatologist and based on the histological findings of the liver biopsy. End Stage Liver Failure End stage liver failure as evidenced by all of the following: (a) Permanent jaundice; (b) Ascites; and (c) Hepatic encephalopathy. Liver failure secondary to alcohol or drug abuse is excluded.

Medium Severity

60%

High Severity

100%

12.

Major Organ/Bone Marrow Transplant

Low Severity

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; or Corneal Transplant The receipt of a transplant of a whole cornea due to irreversible scarring with resulting reduced visual acuity, which cannot be corrected with other methods. Major Organ/Bone Marrow Transplant (on the waiting list) This benefit covers those who are on an official organ transplant waiting list for the receipt of a transplant of: (a) Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or (b) One (1) of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end stage failure of the relevant organ. Other stem cell transplants are excluded.

30%

Medium Severity

60%

High Severity

Major Organ/Bone Marrow Transplant The receipt of a transplant of: (a) Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or

100%

38

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured

No.

Critical Illness Category

Severity Level

Critical Illness Events

(b) One (1) of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end stage failure of the relevant organ. Other stem cell transplants are excluded. 13. Parkinsons Disease Low Severity Early Parkinsons Disease Unequivocal diagnosis of Parkinson's Disease by a 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 Insured to perform without assistance at least one (1) of the Activities of Daily Living. Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded. Moderately Severe Parkinsons Disease Unequivocal diagnosis of Parkinson's Disease by a 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 Insured to perform without assistance at least two (2) of the Activities of Daily Living. Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded. Severe Parkinsons Disease Unequivocal diagnosis of Parkinson's Disease by a 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 Insured to perform without assistance three (3) or more of the Activities of Daily Living. Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded. Early Alzheimers Disease Deterioration or loss of intellectual capacity or abnormal behavior as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer's Disease or irreversible organic degenerative brain disorders resulting in inability to perform at least one (1) of the Activities of Daily Living. The diagnosis must be clinically confirmed by a neurologist. 30%

Medium Severity

60%

High Severity

100%

14.

Alzheimers Disease/Irreversible Organic Degenerative Brain Disorders

Low Severity

30%

39

Appendix Critical Illness Events Definitions

Severity Level Percentage (%) of EPCIR Sum Assured

No.

Critical Illness Category

Critical Illness Events

Non organic brain disorders such as neurosis and psychiatric illnesses are excluded. Medium Severity Moderately Severe Alzheimers Disease Deterioration or loss of intellectual capacity or abnormal behavior as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimers Disease or irreversible organic degenerative brain disorders resulting in inability to perform at least two (2) of Activities of Daily Living. The diagnosis must be clinically confirmed by a neurologist. Non organic brain disorders such as neurosis and psychiatric illnesses are excluded. Severe Alzheimers Disease/ Irreversible Organic Degenerative Brain Disorders Deterioration or loss of intellectual capacity or abnormal behavior as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer's Disease or irreversible organic degenerative brain disorders resulting in significant reduction in mental and social functioning (such that continuous supervision is required). The diagnosis must be clinically confirmed by a neurologist. The following are excluded: (a) Non organic brain disorders such as neurosis and psychiatric illnesses; and (b) Drug or alcohol related brain damage. Coma for 48 hours Coma that persists for at least forty eight (48) hours. This diagnosis must be supported by evidence of all of the following: (a) no response to external stimuli for at least forty eight (48) hours; (b) the use of life support measures to sustain life; and (c) brain damage resulting in permanent neurological deficit which must be assessed at least thirty (30) days after the onset of the coma. Medically induced coma also does not fulfill this definition. 60%

High Severity

100%

15.

Coma

Low Severity

30%

Medium Severity

Coma for 72 hours Coma that persists for at least seventy two (72) hours. This diagnosis must be supported by evidence of all of the following: (a) No response to external stimuli for at least seventy two (72) hours;

60%

40

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured

No.

Critical Illness Category

Severity Level

Critical Illness Events

(b) The use of life support measures to sustain life; and (c) Brain damage resulting in permanent neurological deficit which must be assessed at least thirty (30) days after the onset of the coma. Medically induced coma also does not fulfill this definition. High Severity Coma A state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least ninety six (96) hours, requiring the use of life support systems and resulting in a permanent neurological deficit, lasting more than thirty (30) days. Confirmation by a neurologist must be present. Coma resulting directly from self-inflicted injury, alcohol or drug abuse is excluded. Loss of Sight in One Eye Total and irreversible loss of sight in one eye: (a) as a result of illness or accident; and (b) must be certified by an ophthalmologist. 100%

16.

Loss of Sight

Low Severity

30%

Medium Severity

Retinitis Pigmentosa This benefit is payable for retinitis pigmentosa where the field of vision is restricted to ten (10) degrees or less in the better eye. The condition must be certified by a specialist ophthalmologist and not be amenable to any form of treatment or correction. Blindness/Total Loss of Sight Total and irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an ophthalmologist. Partial Loss of Hearing Permanent binaural hearing loss with the loss of at least sixty (60) decibel in all frequencies of hearing as a result of illness or accident. The hearing loss must be established by an Ear, Nose and Throat (ENT) specialist and supported by an objective diagnostic test to indicate the quantum loss of hearing; or Cavernous Sinus Thrombosis Surgery The actual undergoing of a surgical drainage for Cavernous Sinus Thrombosis. The definite diagnosis of Cavernous Sinus Thrombosis as well as the requirement for surgical intervention must be certified to be absolutely necessary by a specialist in the relevant field. A diagnostic report should be required.

60%

High Severity

100%

17.

Loss of Hearing

Low Severity

30%

41

Appendix Critical Illness Events Definitions

Critical Illness Category Severity Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 60%

No.

Medium Severity

Cochlear Implant Surgery The actual undergoing of a surgical cochlear implant as a result of permanent damage to the cochlea or auditory nerve. The surgical procedure as well as the insertion of the implant must be certified to be absolutely necessary by an Ear, Nose and Throat (ENT) specialist. Deafness/Total Loss of Hearing Total and irreversible loss of hearing in both ears as a result of illness or accident. Total means the loss of at least eighty (80) decibels in all frequencies of hearing. Medical evidence in the form of an audiometry and soundthreshold tests must be provided and certified by an Ear, Nose, and Throat (ENT) specialist. Surgical Removal of One kidney The complete surgical removal of one (1) kidney necessitated by any illness or accident. The need for the surgical removal of the kidney must be certified to be absolutely necessary by a nephrologist. Kidney donation is excluded. Chronic Kidney Disease A nephrologist must make a diagnosis of chronic kidney disease with permanently impaired renal function. There must be laboratory evidence that shows that renal function is severely decreased with GFR less than 15 ml/min, persisting for a period of six (6) months or more. End Stage Kidney Failure End stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis is initiated or renal transplantation is carried out. Occupationally Acquired Hepatitis B or C Infection with the Hepatitis B or C virus which resulted from an accident occurring after the Issue Date or Commencement Date of this Supplementary Contract, whichever is the later whilst the Insured was carrying out the normal professional duties of his or her occupation in Malaysia or Singapore, provided that all of the following are proven to the Companys satisfaction: (a) Proof of the accident giving rise to the infection must be reported to the Company within thirty (30) days of the accident taking place; (b) Proof that the accident involved a definite source of the hepatitis B or C infected fluids; (c) There is a need for antiviral therapy as a consequence of proven seroconversion;

High Severity

100%

18.

Kidney Failure

Low Severity

30%

Medium Severity

60%

High Severity

100%

19.

Blood

Low Severity

30%

42

Appendix Critical Illness Events Definitions

Critical Illness Category Severity Level Critical Illness Events Percentage (%) of EPCIR Sum Assured

No.

(d) Hepatitis B or C infection resulting from any other means including sexual activity and the use of intravenous drugs is excluded. This benefit is only payable when the occupation of the Insured is a medical practitioner, housemen, medical student, state registered nurse, medical laboratory technician, dentist (surgeon and nurse) or paramedical worker, working in medical centre or clinic (in Malaysia or Singapore). We would not be liable if there had been failure to observe any proper defined procedural practice or occupation required vaccination practices. High Severity HIV Due To Blood Transfusion Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following conditions are met: (a) The blood transfusion was medically necessary or given as part of a medical treatment; (b) The blood transfusion was received in Malaysia or Singapore after the commencement of the Supplementary Contract; (c) The source of the infection is established to be from the Institution that provided the blood transfusion and the Institution is able to trace the origin of the HIV tainted blood; (d) The Insured does not suffer from Hemophilia; and (e) The Insured is not a member of any high risk groups such as but not limited to intravenous drug users. 100%

20.

Aplastic Anaemia

Low Severity

Reversible Aplastic Anaemia Acute reversible bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with any two (2) of the following: (a) Blood product transfusion; (b) Marrow stimulating agents; or (c) Immunosuppressive agents. The diagnosis must be confirmed by a haematologist and a bone marrow biopsy. Chronic Aplastic Anaemia Irreversible persistent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring treatment with at least two (2) of the following: (a) Regular blood product transfusion; (b) Marrow stimulating agents; (c) Immunosuppressive agents; or (d) Bone marrow transplantation. The diagnosis must be confirmed by a bone marrow biopsy.

30%

High Severity

100%

43

Appendix Critical Illness Events Definitions

Critical Illness Category Severity Level Percentage (%) of EPCIR Sum Assured 30%

Critical Illness Events

No.

21.

Bacterial Meningitis

Low Severity

Bacterial Meningitis with Full Recovery Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord which requires hospitalization. This diagnosis must be confirmed by: (a) The presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and (b) A consultant neurologist. Bacterial Meningitis in the presence of HIV infection is excluded. 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 thirty (30) days and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living. The diagnosis is to be confirmed by: (a) an appropriate specialist; (b) the presence of bacterial infection in the cerebrospinal fluid by lumbar puncture. Surgical Removal of Pituitary Tumour via Trans Sphenoidal Hypophysectomy The actual undergoing of surgical removal of a pituitary tumour via trans sphenoidal hypophysectomy. The presence of the underlying tumour must be confirmed by imaging studies such as CT scan or MRI. Removal of pituitary tumours by open craniotomy is specifically excluded. Benign Brain Tumour A life-threatening, non-cancerous tumor in the brain or meninges within the cranium, 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) Hematomas; (e) Tumors in the pituitary gland or spine; (f) Tumors of the acoustic nerve.

High Severity

100%

22.

Brain Tumour

Low Severity

30%

High Severity

100%

23.

Brain Surgery

Low Severity

Surgery for Subdural Haematoma The actual undergoing of burr hole surgery to the head to drain a subdural haematoma as a result of a traumatic vascular injury. The need for the burr hole surgery must be certified to be absolutely necessary by a specialist in the relevant field.

30%

44

Appendix
Critical Illness Events Definitions
Critical Illness Category Percentage (%) of Supplementary Contract Sum Assured

No.

Severity Level

Critical Illness Events

Subdural haematoma resulted from neurological surgery or congenital malformation of intracranial blood vessels should be excluded. High Severity Brain Surgery The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. The following are excluded: (a) Burr hole procedures, transphenoidal procedures and other minimally invasive procedures; (b) Brain surgery as a result of an accident. 100%

24.

Encephalitis

Low Severity

Encephalitis with Full Recovery Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum) caused by viral infection requiring hospitalization. The diagnosis must be confirmed by a consultant neurologist and supported with appropriate investigations proving acute viral infection of the brain. Encephalitis caused by HIV infection is excluded. Encephalitis Defined as severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of thirty (30) days and certified by a neurologist. The permanent neurological deficit must result in an inability to perform at least three (3) of the Activities of Daily Living. Encephalitis in the presence of HIV infection is specifically excluded. Mild Head Trauma Physical head injury causing permanent functional impairment lasting for a minimum period of three (3) months from the date of the trauma or injury. The resultant permanent functional impairment is to be verified by a neurologist and must result in an inability to perform at least two (2) of the Activities of Daily Living. Major Head Trauma Physical head injury causing permanent functional impairment lasting for a minimum period of three (3) months from the date of the trauma or injury. The resultant permanent functional impairment is to be verified by a neurologist and must result in an inability to perform at least three (3) of the Activities of Daily Living. Loss of Speech (other than injury or illness to the vocal cords) Total and irrecoverable loss of the ability to speak due to disease or injury. The inability to speak must be established for a continuous period of twelve (12) months. This diagnosis must be supported by medical evidence furnished by an Ear, Nose and Throat (ENT) specialist.

30%

High Severity

100%

25.

Head Trauma

Low Severity

30%

High Severity

100%

26.

Loss of Speech

Low Severity

30%

45

Appendix
Critical Illness Events Definitions

No.

Critical Illness Category

Severity Level

Critical Illness Events

Percentage (%) of EPCIR Sum Assured 100%

High Severity

Loss of Speech Total and irrecoverable loss of the ability to speak for a continuous period of twelve (12) months. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an Ear, Nose, and Throat specialist. All psychiatric related causes are excluded. Chronic Glomerulonephritis This benefit is payable on the diagnosis of chronic glomerulonephritis resulting in permanent and irrecoverable loss of renal function defined by a GFR <30 ml/min for three (3) months despite treatment under the care of a specialist nephrologist. The diagnosis of glomerulonephritis must be made by a consultant nephrologist and supported by a renal biopsy. Diabetic nephropathy and all other causes of renal failure not identified on renal biopsy as being caused by glomerulonephritis are excluded. Medullary Cystic Disease A progressive hereditary disease of the kidneys characterized by the presence of cysts in the medulla, tubular atrophy and interstitial fibrosis with the clinical manifestations of anemia, polyuria and renal loss of sodium, progressing to chronic renal failure. Diagnosis should be supported by a renal biopsy. Early Loss of Independent Existence Confirmation by Consultant Physician of the loss of independent existence lasting for a minimum period of six (6) months and resulting in a permanent inability to perform at least two (2) of the 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. Only Insured aged between 15 and 75 on first diagnosis is eligible to receive a benefit under this illness and any such illness resulting directly or indirectly, wholly or partly, from congenital conditions is excluded.

27.

Medullary Cystic Disease

Low Severity

30%

High Severity

100%

28.

Loss of Independent Existence

Low Severity

30%

46

Appendix
Critical Illness Events Definitions
Percentage (%) of EPCIR Sum Assured 100%

No.

Critical Illness Category

Severity Level

Critical Illness Events

High Severity

Loss of Independent Existence Confirmation by an appropriate specialist of the loss of independent existence lasting for a minimum consecutive period of six (6) months and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living. Early Motor Neurone Disease Refers to a progressive degeneration of the 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. A neurologist must make the definite diagnosis of a motor neurone disease and this diagnosis must be supported by appropriate investigations. Motor Neurone Disease Refers to a progressive degeneration of the 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. The diagnosis must be confirmed by a neurologist as progressive and resulting in permanent neurological deficit.

29.

Motor Neurone Disease

Low Severity

30%

High Severity

100%

30.

Multiple Sclerosis

Low Severity

Early Multiple Sclerosis There must be a definite diagnosis of Multiple Sclerosis confirmed by a neurologist. The diagnosis must be supported by all of the following: (a) Investigations that unequivocally confirm the diagnosis to be Multiple Sclerosis; and (b) Well documented history of exacerbations and remissions of neurological signs. Other causes of neurological damage such as SLE and HIV are excluded. 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 of discrete lesions; and (c) A well-documented history of exacerbation and remissions of said symptoms/neurological deficits.

30%

High Severity

100%

47

Appendix Critical Illness Events Definitions

No. 31.

Critical Illness Category

Severity Level

Critical Illness Events

Percentage (%) of EPCIR Sum Assured 30%

Muscular Dystrophy

Low Severity

Spinal Cord Disease or Injury resulting in Bowel and Bladder Dysfunction Spinal cord disease or chorda equina injury resulting in permanent bowel dysfunction and bladder dysfunction requiring permanent regular self catheterisation or a permanent urinary conduit. The diagnosis must be supported by a consultant neurologist and the permanency assessed at six (6) months. Spina bifida, meningocele and meningomyelocele are all excluded. Muscular Dystrophy The diagnosis of muscular dystrophy shall require a confirmation by a neurologist of the combination of three (3) out of four (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 No benefit will be payable under this Critical Illness Event before the Insured has reached the age of twelve (12) years last birthday.

High Severity

100%

32.

Paralysis/ Paraplegia

Low Severity

Loss of Use of One Limb The complete and permanent loss of use of one (1) arm or one (1) leg, through paralysis caused by illness or injury persisting for at least six (6) months from the date of trauma or illness.

30%

High Severity

Paralysis / Paraplegia The complete and permanent loss of use of both arms or both legs, or of one (1) arm and one (1) leg, through paralysis caused by illness or injury persisting for at least six (6) months from the date of trauma or illness. Moderately Severe Burns Second degree (partial thickness of the skin) burns covering at least twenty percent (20%) of the surface of the Insureds body. The skin burns should be identified as needing treatment in a recognized burns unit in hospital and require operative debridement. Major Burns Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface area.

100%

33.

Burns

Low Severity

30%

High Severity

100%

48

Appendix Critical Illness Events Definitions

Critical Illness Category Severity Level Percentage (%) of EPCIR Sum Assured 100%

Critical Illness Events

No. 34.

Fulminant Viral Hepatitis

High Severity

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 lobes, leaving only a collapsed reticular framework; (c) Rapidly deteriorating liver functions tests; and (d) Deepening jaundice. Hepatitis B infection or carrier status alone does not meet the diagnostic criteria.

35.

Terminal Illness

High Severity

Terminal Illness The conclusive diagnosis of a condition that is expected to result in death of the Insured within twelve (12) months. The Insured must no longer be receiving active treatment other than that for pain relief. The diagnosis must be supported by written confirmation from the appropriate specialist and confirmed by the Companys appointed doctor. Angioplasty and Other Invasive Treatments for Major Coronary Artery Disease Means the actual undergoing for the first time of Coronary Artery Balloon Angioplasty, artherectomy, laser treatment or the insertion of a stent to re-vascularise a narrowing or blockage of one or more coronary arteries as shown by angiographic evidence. Intra-arterial investigative procedures are not included.

100%

36.

Angioplasty and Other Invasive Treatments for Major Coronary Artery Disease

High Severity

10% or RM25,000, whichever is lower.

49

Appendix Critical Illness Events Definitions

Percentage (%) of EPCIR Sum Assured 20%

Critical Illness Category No. 1. Diabetic Related Disease

Critical Illness Event

Surgery for Type 2 Diabetic Retinopathy Diabetic Retinopathy with the need to undergo laser treatment certified to be absolutely necessary by an ophthalmologist with support of a Fluorescent Fundus Angiography report and vision is measured at 6/18 or worse in the better eye using a Snellen eye chart; or Limb Amputation due to Type 2 Diabetic Complications The actual undergoing of amputation of a leg / foot / toe / arm / hand / finger to treat gangrene that has occurred because of a complication of diabetes; or Severe Diabetic Nephropathy resulting in Kidney Failure A definite diagnosis of diabetic nephropathy by a nephrologist and is evident by GFR less than 30 ml/min with ongoing proteinuria greater than 300mg/24 hours.

50