Guide to Critical Illness Definitions For guidance purposes only

Transcription

1 LIFE PROTECTION Guide to Critical Illness Definitions For guidance purposes only Lift art drawn by LoBianco Studios 5/99

2 About this booklet This booklet has been produced for guidance purposes only. Please read it in conjunction with your policy terms and conditions. The medical definitions in our policy terms and conditions are precise wordings used to assess claims under the policy, taking into account the medical details of the case and advice from the medical profession. The definitions contain medical terminology that you may not be familiar with. This guide is intended to help you understand what you are covered for by providing explanations of some of the technical terms. We hope you find it useful. This guide does not replace, vary or enhance the policy terms and conditions. You must consider the actual definition contained in your policy, together with any applicable exclusions, to determine the extent of your cover. Policies you may have taken out previously may have different definitions and/or explanations to those described here. Critical Illnesses Covered The following list shows the critical illness definitions covered within the booklet. They relate to conditions within Life Protection policies. Alzheimer s disease Aorta graft surgery for disease Benign brain tumour Blindness permanent and irreversible Cancer excluding less advanced cases Coma Coronary artery bypass graft with surgery to divide the breastbone Creutzfeldt-Jakob disease Deafness permanent and irreversible Heart valve replacement or repair with surgery to divide the breastbone Kidney failure requiring dialysis Loss of limbs permanent physical severance Loss of speech permanent and irreversible Major organ transplant Motor neurone disease Multiple sclerosis with persisting symptoms Paralysis of limbs total and irreversible Parkinson s disease Stroke Third degree burns covering 20% of the body s surface area Total permanent disablement Heart attack of specified severity Alzheimer s disease A definite diagnosis of Alzheimer s disease by a Consultant Neurologist, Psychiatrist or Geriatrician. There must be permanent clinical loss of the ability to do all of the following: remember; reason; and perceive, understand, express and give effect to ideas. Other types of dementia. Alzheimer s disease is a progressive form of dementia. Symptoms can include forgetfulness, failure to reason and other mental problems. Aorta graft surgery for disease The undergoing of surgery for disease to the aorta with excision and surgical replacement of a portion of the diseased aorta with a graft.

3 The term aorta includes the thoracic and abdominal aorta but not its branches. Any other surgical procedure, for example the insertion of stents or endovascular repair. Surgery following traumatic injury to the aorta. The aorta is the largest artery in the body carrying oxygencontaining blood to the limbs, neck and major organs. When it becomes diseased, surgery can remove and replace the diseased portion with a piece of healthy tissue. The parts of the aorta that supply blood to the chest (thoracic) and abdomen (abdominal) are covered. As the thoracic aorta descends in to the thorax, the aorta gives off several paired branches of arteries. These branches are not covered. As the abdominal artery travels down the wall of the abdomen, the aorta gives off three further branches. These arterial branches are also not covered. If the damage to the aorta is as a result of injury, this surgery is not covered. Benign brain tumour A non-malignant tumour or cyst in the brain, cranial nerves or meninges within the skull, resulting in permanent neurological deficit with persisting clinical symptoms. Tumours in the pituitary gland. Angiomas. A benign brain tumour is a non-cancerous tumour in the brain, the thin layer of tissue covering the brain or nerves relating to the brain. For the purpose of a claim it must result in persisting symptoms showing permanent brain damage. Tumours or breakdowns of tissue in the gland that release substances directly into the blood stream (pituitary gland) in the brain, and knots of swollen blood vessels (angiomas) are not covered. Blindness permanent and irreversible Cancer excluding less advanced cases Any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, sarcoma, and lymphoma except cutaneous lymphoma (lymphoma confined to the skin). For the above definition the following are not covered: All cancers which are histologically classified as any of the following: - pre-malignant; - non-invasive; - cancer in situ; - having either borderline malignancy; or - having low malignant potential. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0. Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A. Any skin cancer (including cutaneous lymphoma) other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin). Cancer is the uncontrolled and abnormal growth of cells, which can destroy healthy tissue if it spreads throughout the body. When such a growth occurs, this is known as malignancy. This includes types of cancer called leukaemia (involving the blood-forming organs such as the spleen) and Hodgkin s Disease (involving the lymph nodes which act as filters for the body). There are a number of cancer types that are excluded. Tumours that have not spread to other parts of the body and are in the early stages of development are not covered. This includes prostate tumours up to a particular stage of advancement and skin cancers (other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin)). In addition, non-malignant conditions that can become malignant are not covered whilst in their non-malignant state, as well as persistent cancer of white blood cells (known as chronic lymphocytic leukaemia). Coma A state of unconsciousness with no reaction to external stimuli or internal needs which: requires the use of life support systems for a continuous period of at least 96 hours; and results in permanent neurological deficit with persisting clinical symptoms. For the above definition, the following is not covered: Coma secondary to alcohol or drug abuse. The Policy defines a coma as a deep and prolonged unconsciousness where the patient cannot be woken. It will result in symptoms of

4 permanent brain damage and the patient needs to be kept on life support systems for at least 96 hours. If the coma follows alcohol or drug abuse, this is not covered. Coronary artery by-pass graft with surgery to divide the breastbone The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. When the arteries that take blood to the heart, narrow or become blocked, surgery can resolve the problem by creating an alternative blood vessel to re-route blood flow. Creutzfeldt-Jakob disease An unequivocal diagnosis of Creutzfeldt-Jakob disease made by a Consultant Neurologist. Creutzfeldt-Jakob disease is a rare brain disorder. Symptoms include failing memory, behavioural changes, lack of coordination and visual disturbances. As the disease progresses, symptoms worsen, including blindness and sometimes coma can occur. Deafness permanent and irreversible Heart attack of specified severity Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: Typical clinical symptoms (for example, characteristic chest pain). New characteristic electrocardiographic changes. The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher: - Troponin T>1.0ng/ml - AccuTnl > 0.5 ng/ml or equivalent threshold with other Troponin I methods. The evidence must show a definite acute myocardial infarction. Other acute coronary syndromes including but not limited to angina. A heart attack occurs when there is a reduction in the blood supply to the heart. This results in the death of a portion of the heart muscle. There will be typical chest pain at the time of the heart attack. The doctor will measure the electrical activity of the heart and this will indicate if a heart attack has occurred. In addition, when heart muscle dies, specific chemicals (cardiac enzymes and troponins) are released into the blood stream and blood tests would show the levels of these chemicals to be higher than normal if a heart attack has occurred. Other heart conditions, including angina, which is chest pain due to restricted blood supply but without death of the heart muscle, are not covered. Heart valve replacement or repair with surgery to divide the breastbone The undergoing of surgery requiring median sternotomy (surgery to divide the breastbone) on the advice of a Consultant Cardiologist to replace or repair one or more heart valves. The heart has four valves, which are made up of flaps of strong tissue attached to the heart and they can only open in one direction. They allow the blood to flow smoothly into the next heart chamber, and prevent blood from leaking back against the flow. The heart valves can either become narrowed so blood cannot flow through, or they can stop closing properly, allowing blood to leak back. Surgery can either replace or repair one or more of the heart valves. Kidney failure requiring dialysis Chronic and end stage failure of both kidneys to function, as a result of which regular dialysis is necessary. The kidneys act as filters in the body for blood and control the levels of specific chemicals. Kidney failure occurs when both kidneys fail to function and the patient has to be regularly treated using a machine that filters the blood instead. The kidney failure must be permanent. Loss of limbs permanent physical severance Loss of speech permanent and irreversible

5 Major organ transplant The undergoing as a recipient of a transplant of bone marrow or of a complete heart, kidney, liver, lung, or pancreas, or inclusion on an official UK waiting list for such a procedure. For the above definition, the following is not covered: Transplant of any other organs, parts of organs, tissues or cells. If there are no other options for a patient, they can be placed on the official UK waiting list to receive an organ or bone marrow from another patient. For the purpose of a claim, this organ must be a complete heart, liver, lung or pancreas. Motor neurone disease A definite diagnosis of motor neurone disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function. Motor neurone disease is a declining disease that affects the ability to move due to permanent damage to areas such as the spinal cord. Multiple sclerosis with persisting symptoms A definite diagnosis of multiple sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months. Multiple sclerosis is a declining disease of the brain and spinal cord that causes harm to movement and causes symptoms such as vertigo, fatigue, blindness and muscle weakness. Symptoms must have persisted for at least 6 months and confirmed by tests at the time of claim. Paralysis of limbs total and irreversible Total and irreversible loss of muscle function or sensation to the whole of any two limbs. Paralysis can occur as a result of a number of conditions, including accidental bodily injury. When any two arms or legs cannot move at all, or feel any sensation, this is termed paralysis. The paralysis also has to be total and irreversible. Parkinson s disease A definite diagnosis of Parkinson s disease by a Consultant Neurologist. There must be permanent clinical impairment of motor function with associated tremor, muscle rigidity and postural instability. For the above definition, the following is not covered: Parkinson s disease secondary to drug abuse. Other Parkinsonian syndromes. Parkinson s disease is a progressive disease of the brain that affects walking, talking and writing, together with tremors and movement becomes stiff and rigid. Stroke Death of brain tissue due to inadequate blood supply or haemorrhage within the skull resulting in permanent neurological deficit with persisting clinical symptoms. Transient ischaemic attack. Traumatic injury to brain tissue or blood vessels. A stroke is the death of brain tissue as a result of a reduction in blood supply to the brain. This results in permanent damage to the brain and persisting clinical symptoms. Minor incidents are not covered, as they leave no permanent symptoms. Often when diagnosing a stroke, a scan is required and there can be incidental scan findings which do not present any clinical impairment. Third degree burns covering 20% of the body s surface area See policy terms & conditions for an explanation. Total permanent disablement See policy terms & conditions for an explanation.

6 MetLife Europe Limited (trading as MetLife) is authorised by the Central Bank of Ireland and subject to limited regulation by the Financial Conduct Authority. Details about the extent of our regulation by the Financial Conduct Authority are available from us on request. Registered address: 20 on Hatch, Lower Hatch Street, Dublin 2. Registration number UK branch address: One Canada Square, Canary Wharf, London, E14 5AA. Branch registration number BR PEANUTS 2012 Peanuts Worldwide COMP10019ML 2013 M l DEC 2013