We will cover five (5) Critical Illness under this Policy, as listed below. This section provides their respective definitions, limitations, and exclusions.
End-stage lung disease, causing chronic respiratory failure, as evidenced by all of the following:
FEV1 test results consistently less than one (1) liter,
the requirement for permanent supplementary oxygen therapy for hypoxemia,
arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 < 55mmHg), and
dyspnoea at rest.
The Diagnosis must be confirmed by a pulmonologist acceptable to MaxiLife.
A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. The cancer must be confirmed by histological evidence of malignancy and an oncologist acceptable to MaxiLife.
The following are not classified as Major Cancer:
Early Bladder Cancer: Papillary micro-carcinoma of bladder
Early Chronic Lymphocytic Leukemia: Chronic Lymphoctic Leukemia (CLL) RAI Stage 1 or 2
Early Prostate Cancer: Prostate Cancer histologically described using the TNM Classification as T1a or T1b or Prostate cancers described using another equivalent classification
Early Thyroid Cancer: Thyroid Cancer histologically described using the TNM Classification as T1N0M0 including Papillary micro-carcinoma of thyroid where the tumour is less than 1 cm in diameter
Early Invasive Melanomas: Invasive melanomas of less than 1.5 mm Breslow thickness or less than Clark Level 3
Tumours of the Ovary: Tumours of the ovary classified as T1aN0M0, T1bN0M0 or FIGO 1A, FIGO 1B, or
Carcinoma in situ: as defined below.
‘Carcinoma in situ’ or (CIS) means the focal autonomous new growth of carcinomatous cells confined to the cells in which it originated and has not yet resulted in the invasion and/or destruction of surrounding tissues. 'Invasion' means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The CIS diagnosis must be supported by both a histopathological report and microscopic examination of the fixed tissue and supported by a biopsy result. Non-melanoma skin cancer and all carcinoma in-situ of skin or earlier stages do not meet the definition of Major Cancer.
A cerebro-vascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis, as evidenced by all of the following:
there is evidence of permanent neurological damage confirmed by a neurologist acceptable to MaxiLife for a continuous period of at least six (6) weeks after the event,
there are findings on Magnetic Resonance Imaging, Computerized Tomography scan, 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.
Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. The Diagnosis must be met by three (3) or more of the following five (5) criteria, which are consistent with a new heart attack:
a history of typical chest pain,
new electrocardiogram (ECG) changes proving infarction,
diagnostic elevation of cardiac enzyme CK-MB,
cardiac troponin T or I at 0.5ng/ml and above, or
left ventricular ejection fraction less than fifty percent (50%), measured three (3) months or more after the event.
Chronic irreversible failure of both kidneys, requiring either permanent renal dialysis or kidney transplantation. The Diagnosis must be confirmed by a Physician acceptable to MaxiLife.