The following is a list of conditions that should be included in your Critical Illness Insurance policies, along with their definitions. Please note, however, that different providers may use different definitions in relation to Critical Illness Cover.
Cancer
Any malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkin's disease but the following are excluded:
- All forms of lymphoma in the presence of any Human Immunodeficiency Virus.
- All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0M0.
- All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ.
- Any skin cancer other than invasive malignant melanoma.
- Kaposi's sarcoma in the presence of any Human Immunodeficiency Virus.
Coronary artery by-pass surgery
The undergoing of open heart surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts but excluding balloon angioplasty, laser relief or any other procedures.
Heart attack
The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:
- typical chest pain;
- new characteristic electrocardiographic changes;
- the characteristic rise of cardiac enzymes, troponins or other biochemical markers;
- where all of the above shows a definite acute myocardial infarction.
Other acute coronary syndromes, including but not limited to angina, are not covered under this definition.
Kidney failure
End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated.
Major organ transplant
The actual undergoing as a recipient of, or inclusion on an official UK waiting list for, a transplant of a heart, liver, lung, pancreas or bone marrow.
Multiple sclerosis
A definite diagnosis by a Consultant Neurologist of Multiple Sclerosis which satisfies all of the following criteria:
- There must be current impairment of motor or sensory function, which must have persisted for a continuous period of at least six months.
- The diagnosis must be confirmed by diagnostic techniques current at the time of the claim.
Stroke
A cerebrovascular incident resulting in permanent neurological damage. Transient Ischaemic Attacks are specifically excluded.
Additional Conditions
The following conditions may usually be covered for an additional premium.
Aorta graft surgery
Undergoing surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches.
Benign brain tumour
A non-malignant tumour in the brain resulting in permanent deficit to the neurological system. Tumours or lesions in the pituitary gland are not covered.
Blindness
Total permanent and irreversible loss of all sight in both eyes.
Coma
A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously with the use of life support systems for a period of at least 96 hours and resulting in permanent neurological deficit. Coma secondary to alcohol or drug misuse is not covered.
Deafness
Total permanent and irreversible loss of all hearing in both ears.
Heart valve replacement or repair
Undergoing open heart surgery from medical necessity to replace or repair one or more heart valves.
Loss of limbs
The permanent physical severance of two or more limbs from above the (elbow or wrist) or (knee or ankle) joint.
Loss of speech
Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.
Motor neurone disease (before age x)
Confirmation by a Consultant Neurologist of a definite diagnosis of Motor Neurone Disease (before age x).
Paralysis / paraplegia
Total irreversible loss of muscle function or sensation to the whole of any two limbs as a result of injury or disease. The disability must be permanent and supported by appropriate neurological evidence.
Parkinson's disease (before age x)
Confirmation by a Consultant Neurologist of a definite diagnosis of Parkinson's Disease (before age x). Parkinson's Disease secondary to alcohol or drug misuse is not covered.
Terminal illness
Advanced or rapidly progressing incurable illness where, in the opinion of an attending Consultant and our Chief Medical Officer, the life expectancy is no greater than 12 months. (AIDS is specifically excluded and not covered under this definition.)
Third degree burns
Third degree burns covering at least 20% of the body surface area.
