|First Diagnosis Payment||
| Tele-Medicine Access (2nd Opinion & Case Management)
Access to Medical Advice From World-Class Doctors
Annual Premium (RM)
Who Can Apply?
All citizens and permanent residents of Malaysia aged 15 days to 60 years old.
Do I need to go through a medical check-up?
What are the Critical Illnesses covered under this policy?
Critical Illnesses shall mean any of the following illnesses:
Defined as cerebrovascular accident or incident producing neurological sequelae of a permanent nature,
having lasted not less than six months. Infarction of brain tissue, hemorrhage and embolization from an
extracranial source are included. The diagnosis must be based on changes seen in a CT scan or MRI & certified by a 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 & vascular disease affecting the eye or optic nerve or vestibular functions.
(3) Coronary Artery Disease
(a) 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
(b) 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.
(c) Angioplasty and Other lnvasive Treatments for 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 correct a narrowing or blockage of one or more coronary arteries. Intra-arterial investigative procedures are not included.
Payment hereunder shall be limited to 10% of the Critical Illness coverage payable under Option 3 of
Section Ill of this policy subject to a maximum of RM25,000. This benefit is payable once only & shall be deducted from the amount payable under Option 3 of Section Ill of this policy, thereby reducing the amount of the Lump Sum Payment which may be payable under Option 3 of Section Ill of this policy. This benefit shall cease upon payment of one limited payment.
Medical evidence shall include all of the following:
- Evidence of significant and relevant ECG changes (ST segment depression of 2 millimeters or more) and
- Angiographic evidence to confirm the location of stenosis.
Cancer is defined as the uncontrollable growth & spread of malignant cells and the invasion & 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 & Stage 1 Prostate Cancer,
(d) All skin cancers except malignant melanoma,
(e) Stage 1 Hodgkin's disease,
(f) Tumours manifesting as complications of AIDS.
(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) Major Organ Transplantation
The actual undergoing of a transplant as a recipient of one of the following human organs:
(e) Bone Marrow
(7) Paralysis I 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.
(8) 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) Symptom referable to tracts (white matter) involving the optic nerves, brain stem and spinal cord, producing well-defined neurological deficits;
(b) A multiplicity or discrete lesions; and
(c) A well-documented history of exacerbation and remissions of said symptoms/neurological deficits.
(9) 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 lnsured Person being unable to perform histher usual occupation.
(10) 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 lobules, 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.
(11) 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 Policy Effective Date or reinstatement of this policy pursuant to the provisions of Section VII of this policy.
Repair, via valvotomy, intra-arterial procedure, keyhole surgery or similar techniques are specifically excluded.
(12) 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.
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 neurologist must be present. Coma resulting directly from self-inflicted injury, alcohol or drug misuse is excluded.
(14) Major Burns
Third degree burns covering at least twenty percent (20%) of the Insured Person's body surface area as measured by "The Rule of 9" of the Lund & Browder Body Surface Chart.
(15) Terminal Illness
The Insured Person must be suffering from a condition, which in the opinion of an appropriate medical consultant is highly likely to lead to death within 12 months. The lnsured Person must no longer be receiving active treatment other than that for pain relief. Terminal Illness due to AIDS (Acquired Immune
Deficiency Syndrome) is excluded.
(16) Alzheimer's Disease I 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 lnsured Person. The diagnosis must be clinically confirmed by an appropriate consultant.
(17) Benign Brain Tumour
A life-threatening, non-cancerous tumour in the brain giving rise to characteristic signs of increased intracranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumour must be confirmed by imaging studies such as CT scan or MRI.
The following are excluded:
(c) Malformations in or of the arteries or veins of the brain
(e) Tumours in the pituitary gland, or spine
(f) Tumours of the acoustic nerve
The total, permanent and irrecoverable loss of the sight of both eyes. Certification by an ophthalmologist is necessary.
(19) 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 FEVI test value of less than one liter. (Force Expiratory Volume during the first second of a forced exhalation)
(b) Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less
(c) Dyspnoea at rest.
(20) Chronic Liver Disease
End stage liver failure as evidenced by all of the following:
(a) Permanent jaundice
(d) Portal hypertension
Wernicke's encephalopathy & liver failure secondary to alcohol or drug misuse is excluded.
(21) 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 tests must be provided.
Severe inflammation of brain substance resulting in permanent neurological deficit lasting for a minimum period of 30 days & 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.
The Activities of Daily Living are as previously defined in Section 1 above.
Encephalitis as a result of HIV infection is excluded.
(23) 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.
(24) 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.
The Activities of Daily Living are as previously defined in Section I above.
(25) Motor Neurone Disease
Motor neurone disease of unknown etiology 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.
(26) Parkinson's Disease
Unequivocal diagnosis of Parkinson's disease by consulting 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 life assured to perform without assistance three (3) or more of the Activities of Daily Living (as previously defined in Section I above).
Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded.
(27) 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 & 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.
The Activities of Daily Living are as previously defined in Section I above. The diagnosis is to be confirmed by a consultant neurologist.
(28) 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 cerebrospinal fluid and mild tendon reflex reduction
(c) Characteristic electromyogram
(d) Clinical suspicion confirmed by muscle biopsy
Children are excluded from the definition.
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.
(30) Aplastic Anaemia
Chronic persistent bone marrow failure, which results in total aplasia of the bone marrow & requires treatment with at least one of the following:
(a) Regular blood product transfusion
(b) Marrow stimulating agents
(c) lmmunosuppressive agents +. (d) Bone marrow transplantation.
(31) Appalic Syndrome
Universal necrosis of the brain cortex, with the brain stem remaining intact. Diagnosis must be confirmed by a neurologist and the condition must be documented for at least one month.
(32) Loss of Independent Existence
Confirmation by Consultant Physician of the loss of independent existence lasting for a minimum period of 6 months 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 scope of recovery with current medical knowledge and technology. The Activities of Daily Living are as previously defined in Section I above.
(33) Systemic Lupus Erythematosus (Sle) With Lupus Nephritis
Refers to a multisystem, multifactorial, autoimmune disorder, which affects mostly females in their childbearing years & is characterized by the development of autoantibodies, directed against various self-antigens. For purposes of this policy, SLE will be restricted to those forms of systemic lupus erythematosus, which involve the kidneys (Type Ill to Type IV Lupus Nephritis, established by renal biopsy). Other forms, discoid lupus, and those forms with only hematological and joint involvement are specifically excluded.
WHO Lupus Classification:
Class I (minimal change) - Negative, normal urine
Class II (Mesangial) -Moderate proteinuria, active sediment
Class III (Focal Segmental) - Proteinuria, active sediment
Class IV (Diffuse) -Acute nephritis with active sediment and / or nephritic syndrome
Class V (Membranous) - Nephrotic Syndrome or severe proteinuria.
(34) 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 renal biopsy.
(35) Brain Surgery
The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. However, burr hole and brain surgery as a result of an Accident is excluded.
The unequivocal diagnosis by a consultant cardiologist of cardiomyopathy causing impaired ventricular function suspected by ECG abnormalities and confirmed by cardiac echo of variable etiology and resulting in permanent physical impairments to the degree of at least class Ill of the New York Association Classification of cardiac impairment.
Class Ill: Marked limitation - Such patients are comfortable at rest but performing less than ordinary activity will lead to symptoms of Congestive Cardiac Failure.
Class IV: Inability to carry out any activity without discomfort. Symptoms of Congestive Cardiac Failure
are present even at rest. With any increase in physical activity, discomfort will be experienced.
Cardiomyopathy directly related to alcohol misuse is excluded.