List of 35 Covered Critical Conditions:




A Critical Condition means any of the conditions specified below from (1) to (35) and excludes all other illnesses.

1) Alzheimers Disease: Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging tests, arising from Alzheimer's disease, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the life assured. The diagnosis must be clinically confirmed by an appropriate consultant and be supported by the Company's appointed doctor.

Non-organic diseases such as neurosis and psychiatric illnesses, and alcohol related brain damage are excluded.

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2) Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease): resulting in permanent loss of physical abilities. A definite diagnosis of amyotrophic lateral sclerosis. The disease must result in a total inability to perform, by oneself, at least 3 out of 6 Activities of Daily Living for a continuous period of at least 3 months with no reasonable chance of recovery.

The diagnosis must be confirmed by a Consultant Neurologist and supported by nerve conduction studies (NCS) and electromyography (EMG).

For the above definition, the following are not covered:
  • Multifocal motor neuropathy (MMN) and inclusion body myositis
  • Spinal muscular atrophy
  • Polymyositis and dermatomyositis

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    3) Aplastic Anaemia: Chronic irreversible bone marrow failure, which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following:
  • permanent dependence on the transfusion of blood products
  • marrow stimulating agents
  • immunosuppressive agents
  • bone marrow transplantation
  • The diagnosis must be confirmed by a haematologist.

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    4) Benign Brain Tumour:A life threatening, non-cancerous tumour in the brain which either requires surgical excision by craniotomy or if inoperable, causes significant permanent clinical neurological deficit persisting for at least 6 consecutive months. Cysts, granulomas, malformations in, or of, the arteries or veins of the brain, haematomas and tumours in the pituitary gland or spinal cord are excluded. The surgery must be considered medically necessary by a Specialist.

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    5) Blindness:Total irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be certified by an ophthalmologist’s report. The blindness must not be able to be corrected by medical procedure. Blindness due to other causes is excluded.

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    6) Cancer: A malignant tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue.
    The cancer must be confirmed by histological evidence of malignancy by a qualified oncologist or pathologist.
    Cancer includes: Leukaemia, Malignant Lymphoma, Hodgkin’s Disease, Malignant bone marrow disorders & Metastatic skin cancer.
    It also covers “Cerebral Metastasis”, or the evidence of cancer of the brain where the primary lesion cannot be established. The diagnosis must be supported by a pathological report or progressive neurological deterioration. Diagnosis must be confirmed by a certified oncologist.

    The following are excluded:
  • ll tumours which are histologically described as benign, pre-malignant or dysplasia;
  • any lesions described as non invasive cancers in situ;
  • any skin cancer other than malignant melanoma;
  • all tumours in the presence of any human immunodeficiency virus;
  • Cervical Intra-epithelial Neoplasia (CIN I, CIN II, or CIN III) or Cervical Squamous Intra-epithelial Lesion;
  • Tumours of the ovary classified as T1aN0M0, T1bN0M0 or FIGO 1A, FIGO 1B;
  • Melanomas of less than 1.5mm Breslow thickness, or less than Clark Level 3
  • Prostate cancers which are histologically described as TNM Classification T1a, T1b, T1c or are of another equivalent or lesser classification;
  • all Thyroid cancers histologically classified as T1N0M0 (TNM Classification)
  • all tumours of the urinary bladder histologically classified as T1N0M0 (TNM Classification)
  • Chronic Lymphocytic Leukaemia less than Rai Stage 3.

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    7) Primary Cardiomyopathy: A definite diagnosis of one of the following primary cardiomyopathies:
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy (obstructive or non-obstructive)
  • Restrictive Cardiomyopathy
  • Arrhythmogenic Right Ventricular Cardiomyopathy

  • The disease must result in a 2D Echo with Left Ventricular Ejection Fraction (LVEF) of less than 40%, with or without any of the following:
  • Marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain (Class III or IV of the New York Heart Association classification) over a period of at least 6 months.
  • Implantation of an Implantable Cardioverter Defibrillator (ICD) for the prevention of sudden cardiac death. The diagnosis must be confirmed by a Consultant Cardiologist and supported by echocardiogram, cardiac MRI or cardiac CT scan findings. The implantation of an Implantable Cardioverter Defibrillator (ICD) must be determined to be medically necessary by a Consultant Cardiologist.

  • For the above definition, the following are not covered:
  • Secondary (ischaemic, valvular, metabolic, toxic or hypertensive) cardiomyopathy
  • Transient reduction of left ventricular function due to myocarditis
  • Cardiomyopathy due to systemic diseases
  • Implantation of an Implantable Cardioverter Defibrillator (ICD) due to primary arrhythmias (e.g. Brugada or Long-QT-Syndrome)

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    8) Chronic and Irreversible Kidney Failure: End stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which permanent renal dialysis has been initiated or renal transplantation has been planned or undergone. The diagnosis must be confirmed by a nephrologist.

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    9) Coma: A coma that persists for at least 96 hours and confirmed by an appropriate consultant where all the following conditions are met:
  • there is no response to external stimuli for at least 96 hours,
  • life support measures are necessary to sustain life and
  • there is brain damage that results in a significant neurological deficit.
  • Coma resulting directly from alcohol or drug abuse is excluded.

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    10) Coronary Artery Bypass Graft Surgery (CABG): The actual undergoing of open heart surgery with thoracotomy or sternotomy to correct the narrowing or blockage of one (1) or more coronary arteries with bypass grafts. Angiographic evidence of significant coronary artery obstruction must be provided and the procedure must be considered medically necessary by a consultant cardiologist. Angioplasty (PTCA) and all other intra arterial, catheter based techniques or laser procedures, Key-hole bypass and MIDCAB procedures are excluded.

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    11) Deafness (loss of hearing): Total, irreversible loss of hearing for all sounds as a result of sickness or accident only. Medical evidence to be supplied by an appropriate ENT (Ear, Nose and Throat) specialist and to include audiometric and sound-threshold test. The deafness must not be able to be corrected by medical procedure.

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    12) Dissecting Aortic Aneurysm: An illness where the inner lining of the aorta (intima layer) is interrupted so that blood enters the wall of the aorta and separates its layers which requires aortic graft insertion surgery with thoracotomy. Diagnosis must be confirmed by CT scan, MRI, MRA or angiogram and attested by a cardiovascular specialist. A proven diagnosis by a specialist is also required.

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    13) Encephalitis: Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum) resulting in significant and permanent neurological deficit as certified by a neurologist. Cause may either be bacterial or viral

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    14) End Stage Liver Disease: Permanent and irreversible failure of liver function that has resulted in at least two of the following:
  • a. permanent jaundice; and
  • b. ascites; and
  • c. hepatic encephalopathy.

  • The diagnosis must be confirmed by a specialist. Liver failure secondary to drug or alcohol abuse is excluded.

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    15) End Stage Lung Disease: The final or end stage of lung disease, causing chronic respiratory failure, as demonstrated by all of the following:
  • FEV1 test results consistently less than one (1) litre
  • requiring permanent supplementary oxygen therapy for hypoxemia
  • arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 < 55mmHg)
  • dyspnea at rest

  • The diagnoses must be confirmed by a pulmonologist.

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    16) Fulminant Hepatitis: A sub-massive or massive necrosis of the liver due to the Hepatitis virus, leading to rapid liver failure. The diagnosis must be evidenced as secondary to the hepatitis virus, and all of the following must be demonstrated:
  • rapid decrease in liver size
  • rapid degeneration of liver function tests
  • deepening jaundice
  • necrosis of entire liver lobules (if histology is available)

  • Liver failure due to alcohol, toxins or drugs are excluded.

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    17) Heart Attack: The death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis must be based on all of the following:
  • a history of typical chest pain including chest heaviness; and
  • new or presumed new electrocardiographic (ECG) changes indicating myocardial infarction;
  • and
  • diagnostic elevation of cardiac enzymes indicating myocardial damage.

  • Angina or unstable angina with no evidence of acute infarction is specifically excluded.

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    18) Heart Valve Surgery: The first occurrence of open heart valve surgery, performed to replace or repair one or more heart valves, as a consequence of defects that cannot be repaired by intra arterial catheter procedures alone. The surgery must be performed after a recommendation by a consultant cardiologist.

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    19) Loss of Speech: Total and irrecoverable loss of the ability to speak which must be established for a continuous period of twelve (12) months. Medical evidence is to be supplied by an appropriate (Ear, Nose and Throat) specialist and to confirm disease to the vocal chords.

    All psychiatric related causes are excluded. The condition must not be able to be corrected by medical procedure.

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    20) Major Organ Transplantation: The receipt, of a transplant of:
  • one of the following human organs:
  • a. heart,
  • b. lung,
  • c. liver,
  • d. kidney,
  • e. pancreas, or
  • human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation, as a result of irreversible end stage failure of the relevant organ.
  • Other stem cell transplants are excluded.

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    21) Medullary Cystic Disease: Unequivocal diagnosis of Medullary Cystic Disease where the following criteria are met:
  • the diagnosis must be certified by a nephrologist supported by imaging evidence of multiple medullary cysts with cortical atrophy;
  • clinical manifestations of anaemia, polyuria, and progressive deterioration in kidney function; and
  • the Diagnosis of Medullary Cystic Disease is confirmed by renal biopsy
  • Isolated or benign kidney cysts are specifically excluded from this benefit.

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    22) Bacterial Meningitis: Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant, irreversible and permanent neurological deficit confirmed by an appropriate consultant. Confirmation of bacterial infection in cerebrospinal fluid by lumbar puncture is required and the neurological deficit must persist for at least 30 days Viral meningitis is excluded.

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    23) Motor Neuron Disease: Unequivocal diagnosis of Motor Neuron Disease by a consulting neurologist supported by definitive evidence of appropriate and relevant neurological signs and investigations. The condition must be progressive and must have resulted in significant clinical neurological deficit.

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    24) Multiple Sclerosis: Multiple neurological deficit over a period of more than six (6) months, as a result of demyelination in the brain and spinal cord. The diagnosis has to be unequivocal and made by a consultant neurologist, following more than one (1) episode of well-defined neurological symptoms, involving any combination of deficit in the optic nerves, brain stem, spinal cord, coordination or sensory function.

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    25) Muscular Dystrophy: The diagnosis of muscular dystrophy confirmed by a consulting neurologist, and based on a combination of all of the following:
  • clinical presentation including absence of sensory disturbance, normal cerebrospinal fluid and mild tendon reflex reduction
  • characteristic electromyogram
  • clinical suspicion confirmed by muscle biopsy

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    26) Paralysis: The total loss of function of two (2) or more limbs due to injury or disease of the spinal cord or brain, where such functional loss is considered to be permanent by a neurologist. Loss of function of limbs classified as Diplegia, Hemiplegia, Tetraplegia and Quadriplegia are included.

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    27) Parkinson’s Disease: Unequivocal diagnosis of Parkinson’s disease by a consulting neurologist, based on definitive signs of progressive and permanent neurological impairment, where the life has permanent inability to perform at least three (3) out of six (6) Activities of Daily Living, as defined in the Policy, in spite of being on optimal medication.

    Drug induced, accidental, or toxic causes of Parkinson’s Disease are excluded

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    28) Poliomyelitis: Unequivocal diagnosis by a consultant neurologist of infection by the Polio virus leading to paralytic disease as evidenced by impaired motor function or respiratory weakness. This condition has to be medically documented for at least three (3) months. Cases not involving paralysis will not be eligible for this benefit. Other causes of paralysis are specifically excluded.

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    29) Primary Pulmonary Arterial Hypertension (PPAH): Primary Pulmonary Arterial Hypertension associated with right ventricular enlargement established by investigations including catheterisation resulting in significant permanent physical impairment to the degree of at least Class 4 of the New York Heart Association classification of cardiac impairment.*

    *NYHA Class 4 cardiac impairment means that the patient is symptomatic during ordinary daily activities despite the use of medication and dietary adjustment, and there is evidence of abnormal ventricular function on physical examination & laboratory studies.

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    30) Progressive Bullbar Pallsy (PBP): Characterized by progressive degeneration of the muscle innervated by cranial nerve and corticobulbar tracts leading to difficulty in chewing, swallowing and talking. The condition must result in significant clinical neurological deficit and the diagnosis must be made by a Neurologist and must be confirmed with appropriate neuromuscular testing including Electromyogram (EMG).

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    31) Progressive Muscular Atrophy: Characterized by progressive muscle wasting and marked weakness in the arms, shoulders, and legs. The condition must result in significant clinical neurological deficit and the diagnosis must be made by a Neurologist and must be confirmed with appropriate neuromuscular testing including Electromyogram (EMG).

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    32) Severance of Limbs: The total and irrecoverable loss of two (2) or more limbs due to illness or accident only. This includes the loss of use of both hands or both feet or the use of one (1) hand and one (1) foot.

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    33) Stroke: A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis, where all of the following conditions are met:
  • there is evidence of significant neurological damage confirmed by an appropriate consultant and
  • there are findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.

  • The following are excluded:
  • transient ischaemic attacks,
  • brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease,
  • vascular disease affecting the eye or optic nerve and
  • ischaemic disorders of the vestibular system
  • asymptomatic silent stroke found on imaging.

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    34) Surgery to the Aorta: Major surgery of the thoracic or abdominal aorta for life threatening vascular disease. This includes coarctation repair, surgical grafts for aortic aneurisms or aortic dissections but minimally invasive stent grafting is excluded. Surgery on the branches of the aorta is not covered.

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    35) Terminal Illness: The conclusive diagnosis of a condition that is expected to result in death of the Life Assured within twelve (12) months. The diagnosis must be supported by written confirmation from an appropriate specialist and confirmed by the Company’s appointed doctor.

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