PHP- 15 Critical Illnesses

1. ALZHEIMER'S DISEASE / IRREVERSIBLE ORGANIC DEGENERATIVE BRAIN DISORDERS

The deterioration or loss of intellectual capacity or abnormal behavior as evidenced by clinical state and accepted standardised questionaires 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 Insured. The diagnosis must be clinically confirmed by an appropriate consultant.

2. APLASTIC ANAEMIA

Chronic persistent bone marrow failure which results in total aplasia of the bone marrow and requires treatment with at least one of the following:

Regular blood product transfusion;
Marrow stimulating agents;
Immuno-suppressive agents;
Bone marrow transplantation.

3. BENIGN BRAIN TUMOUR

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:

Cysts;
Granulomas;
Malformations in or of the arteries or veins of the brain;
Haematomas;
Tumors in the pituitary gland or spine;
Tumors of the acoustic nerve.

4. BLINDNESS

The total, permanent and irrecoverable loss of the sight of both eyes. The blindness must be certified by an ophthalmologist's report.

5. CANCER

Cancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and 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 are specifically EXCLUDED:

Carcinoma in situ including of the cervix;
Ductal Carcinoma in situ of the breast;
Papillary Carcinoma of the bladder and Stage 1 Prostate Cancer;
all skin cancers except invasive malignant melanomas;
stage 1 Hodgkin's Disease;
Tumors manifesting as complication of AIDS.

6. CHRONIC LIVER DISEASE

The end stage liver failure as evidenced by ALL of the following:

permanent jaundice;
ascites;
encephalopathy;
portal hypertension..

Wernicke's encephalopathy and liver failure secondary to alcohol or drug misuse is EXCLUDED.

7. 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 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.

8. CORONARY ARTERY BYPASS SURGERY

Refers to the actual undergoing of coronary bypass surgery by way of thoracotomy to correct or treat coronary artery disease but not including angioplasty, other intra arterial, keyhole or laser procedures.

9. 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 history of typical prolonged chest pain;
new electrocardiographic changes resulting from this occurrence; and
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.

10. HEART VALVE REPLACEMENT

The actual undergoing of open-chest surgery to repair or replace 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 Supplementary Policy.

Repair via valvotomy, intra-arterial procedure, key hole surgery or similar technique are specifically EXCLUDED.

11. 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 instituted or renal transplantation carried out.

12. MAJOR BURNS

Third degree burns covering at least 20% of the Insured's body surface area measured by 'rule 9' of the Lund and Browder Body Surface Chart.

13. MOTOR NEURONE DISEASE

Motor neurone disease of unknown aetiology is characterised by progressive degeneration of corticospinal tracts and interior horn cells or bulbar efferent neurones. These include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.

Diagnosis must be confirmed by a consultant neurologist.

14. MAJOR ORGAN TRANSPLANT

The actual undergoing of transplantation of the heart, lung, liver, pancreas, kidney or bone marrow, as a recipient.

Children are excluded from the definition.

15. STROKE

Defined as a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than six (6) months. Infarction of brain tissue, haemorrhage or embolisation 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 transcient ischaemic attacks, any reversible ischaemic neurological deficit, vertebrobasilar ischaemia, cerebral symptoms due to migraine, cerebral injury resulting from trauma or hypoxia and vascular disease affecting the eye or optic nerve or vestibular functions.