Definition of 36 Critical Illnesses or Dread Diseases in Insurance Policy

Most policy holder who bought the common 36 critical illnesses coverage (also known as 36 dread diseases), will have the definition clearly stated in their life insurance policy. Here is the definition taken from Great Eastern Life insurance policy. Other life insurance company also uses the same definition although some wordings might vary. Anyway, the general definition should be the same. Here is the list:

1. Heart Attack

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; and
(b) New electrocardiographic changes resulting from this occurrence; and
(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.

2. 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 and certified by a Consultant 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 and vascular disease affecting the eye or optic nerve or vestibular functions.

3. Coronary Artery Disease Requiring 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.

4. 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 conditions are excluded:-
(a) Carcinoma in situ including of the cervix
(b) Ductal Carcinoma in situ of the breast
(c) Papillary Carcinoma of the bladder and Stage 1 Prostate Cancer
(d) All skin cancers except malignant melanoma
(e) Stage I Hodgkin’s disease
(f) Tumors manifesting as complications of Acquired Immune Deficiency Syndrome.

5. 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 carried out.

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

7. 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

8. 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.

9. Multiple Sclerosis

Unequivocal diagnosis by a Consultant 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; and
(b) A multiplicity or discrete lesions; and
(c) A well-documented history of exacerbation and remissions of said symptoms / neurological deficits.

10. 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, and resulting in the Life Assured being unable to perform his/her usual occupation.

11. Blindness

The total, permanent and irrecoverable loss of the sight of both eyes. Certification by an ophthalmologist is necessary.

12. 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.

13. 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 test must be provided.

14. Surgery To 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.

15. 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.

16. Alzheimer’s 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 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 Assured. The diagnosis must be clinically confirmed by an appropriate consultant.

17. Major Burns

Third degree burns covering at least twenty percent (20%) of the Life Assured’s body surface area as measured by “The Rule of 9″ of the Lund & Browder Body Surface Chart.

18. 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 Consultant Neurologist must be present.
Coma resulting directly from self-inflicted injury, alcohol or drug misuse is excluded.

19. Terminal Illness

The Life Assured must be suffering from a condition, which in the opinion of an appropriate Medical Practitioner is highly likely to lead to death within 12 months. The Life Assured must no longer be receiving active treatment other than that for pain relief.

20. 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.

21. AIDS Due To Blood Transfusion

The Life Assured 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 Policy; and
(b) the Life Assured is not a haemophiliac; and
(c) the Life Assured is not a member of any high risk groups such as but not limited to homosexuals, intravenous drug users or sex workers.
Notification and proof of incident will be required via a statement from a statutory Health Authority that the infection is medically acquired.

22. Parkinson’s Disease

Unequivocal diagnosis of Parkinson’s Disease by a Consultant Neurologist where the condition:
(a) Cannot be controlled with medication; and
(b) Shows signs of progressive impairment; and
(c) Activities of Daily Living assessment confirm the inability of the Life Assured 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.

23. Chronic Liver Disease

End stage liver failure evidenced by permanent jaundice, ascites, encephalopathy and portal hypertension.
Wernicke’s encephalopathy and liver failure secondary to alcohol or drug misuse is excluded.

24. 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 liter.
(Forced Expiratory Volume during the first second of a forced exhalation); and
(b) Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less; and
(c) Dyspnoea at rest.

25. Major Head Trauma

Physical head injury causing significant 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 Consultant Neurologist and duly concurred by the Company’s Medical Officer and must result in an inability to perform at least three (3) 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.

26. 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:
(a) Regular blood product transfusion
(b) Marrow stimulating agents
(c) Immunosuppressive agents
(d) Bone marrow transplantation

27. 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
No benefit will be payable under this Covered Event before the Life Assured had reached the age of 12 years next birthday.

28. 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.
Cysts, granulomas, malformations in or of the arteries or veins of the brain, haematomas, tumors in the pituitary gland or spine and tumors of the acoustic nerve are excluded.

29. Encephalitis

Defined as severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of 30 days and certified by a Consultant Neurologist. The permanent deficit must result in an inability to perform at least three (3) 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.
Encephalitis as a result of HIV infection is excluded.

30. 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.

31. Brain Surgery

The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. Bur Hole and brain surgery as a result of an accident is excluded.

32. 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 and resulting in a permanent inability to perform at least three (3) 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.

33. Other Serious Coronary Artery Disease

The narrowing of the lumen of at least three major arteries i.e. Circumflex, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD), by a minimum of 60 percent or more as proven by coronary arteriography. This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed.

34. Apallic Syndrome

Universal necrosis of the brain cortex, with the brainstem remaining intact. Diagnosis must be confirmed by a Consultant Neurologist and condition must be documented for at least one month.

35. AIDS Cover of Medical Staff

Infection by any Human Immunodeficiency Virus (HIV) only if the Life Assured is a Medical Staff as defined below, and that such infection was considered by the medical authorities involved to be caused by a needlestick/sharp instrument injury or by exposure to blood or bloodstained body fluid which occurred after the commencement of the Policy. The accident must have occurred whilst the Life Assured was following his normal occupational duties and reported in accordance with the established occupational procedures for such accidents. The Life Assured must, within 5 days of the accident have undergone a blood test indicating the absence of HIV or its antibodies but a further blood test performed within 6 months of the accident must indicate the presence of HIV or its antibodies after the commencement of the Policy.
However, the benefit payable will not apply if any medical cure is found for Acquired Immune Deficiency Syndrome or the effects of the HIV virus or a medical treatment is developed which results in the prevention of the occurrence of AIDS.
‘Medical Staff’ is defined as Doctors (General Physicians and Specialists), nurses, laboratory technicians, dentists (surgeons and nurses), ambulance workers who are working in the medical centre or hospital or dental clinics/polyclinics in
Malaysia.

36. Full Blown AIDS

The clinical manifestation of AIDS (Acquired Immune-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 Assured must have a CD4 cell count of less than two hundred (200) and one or more of the following criteria are met:
(a) Weight loss of more than 10% of body weight over a period of six (6) months or less (wasting syndrome)
(b) Kaposi Sarcoma
(c) Pneumocystic Carinii Pneumonia
(d) Progressive multifocal leukoencephalopathy
(e) Active Tuberculosis
(f) Less than one-thousand (1000) lymphocytes
(g) Malignant Lymphoma

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18 Comments

  • kok leong

    Reply Reply June 1, 2008

    KC:

    Another question from me if we alr have the Medical Card policy and let say i am hit by Female Illness(cancer) which policy will take place.

    I understand that the latter will pay a lump sum upon disagosed with the illness. How about if i did not have the Females Illness policy can i still undergo operation and the fess be obsorp by the Medical Card plan.

    • KCLau

      Reply Reply June 3, 2008

      Regardless of whether you own the critical illness policies, medical card (hospitalization and surgical) will still compensate your medical fees, paid to the hospital.

    • KCLau

      Reply Reply June 3, 2008

      Hi Kok Leong,
      This is a very hard question to answer because when we buy a life insurance plan, it includes all kind of benefits, with different charges and also different premium.

  • CH

    Reply Reply December 19, 2009

    Hi… been thinking of getting an insurance plan after reading your book – Top Money Tips for Malaysians.. I am working in the healthcare sector and is Great Eastern the only company which includes AIDS cover for medical staff under its list of 36 critical illnesses? One insurance agent told me the list of 36 critical illnesses covered is the same for all the companies as outlined by Bank Negara. Thank you.

  • Loo

    Reply Reply February 4, 2010

    Hi KC,

    Hi,

    I admitted hospital recently due to encephalitis for 2 weeks time.
    Before that, I had bought 2 Great Eastern policies which covering 36 critical illness?
    Am I eligible to claim (partial claim) under 36 critical illness despite term of the policy is at least 30days.
    I believe the term (30 days) is referring to Full Claim. Right?

    Thanks!

    Rgds,
    Loo

  • Mok

    Reply Reply June 19, 2010

    I would like to comment on Loss of Hearing part. The criteria mentioned is not specific enough. What is the definition for ‘Total’ loss? What decibel level at which speech frequencies? Most profound loss (>90dB) hearing impaired can’t understand speech sound but could still detect the sound, so, does it fall into claim criteria?
    Moreover, it doesn’t cover loss due to presbycusis (aging). Not good enough.

    • KCLau

      Reply Reply June 21, 2010

      Hi Mok, thanks a lot of your information.

  • Micheline Breckle

    Reply Reply September 1, 2010

    Would like to know whether “Rheumatoid Arthritis” is also considered as a “Dread Disease”?
    Looking forward to hearing your comments.
    Kind Regards

    Micheline

  • Benjamin Teng

    Reply Reply January 31, 2011

    KCLau, there is 3-4 changes had been made in Prudential policy where is much much more comprehensive of coverage. For example, our Cornary artery Disease for angioplasty and other invasive treatments is cover where evidence is needed. The other one is loss of hearing or deafness is been replace with Loss of independent existence. And other more. Check out our lates policy document of PruLink One.

  • Noxolo

    Reply Reply November 24, 2011

    for two years now my daughter is been in out of hospital for serious illness due to Colony of the Bowel 4times all big operations I personally seek help on that what it says 4years having a life policy does covers her on that because her medical condition has taken it’s toll on us

  • Sara

    Reply Reply March 22, 2013

    what is the defination of drear disease.

    • KCLau

      Reply Reply October 16, 2013

      Dread disease is simply referring to major illnesses that is life threatening.

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