Early Pay Critical Illness Rider (EPCIR)

Transcription

1 Early Pay Critical Illness Rider (EPCIR) Guide Book The Power of We AIA.COM.MY

2 Early Pay Critical Illness Rider (EPCIR) PROTECTION EARLY PAY CRITICAL ILLNESS RIDER We help you to seek early treatment when you need it most A plan that allows you to make early critical illness claims. The Power of We AIA.COM.MY Disclaimer: This Guide Book is solely for the use of AIA Agents only and is meant for the understanding of AIA Agents on the Early Pay Critical Illness Rider offered by AIA. This Guide Book is strictly confidential, and cannot be reproduced or circulated in whole or in part to anyone, including policyholders and potential prospects, for whatever purpose or reason. 2

3 Contents Product Overview 4 Key Benefits 5 Number of Critical Illness Events Covered 6 Payout Schedule 7 Underwriting Claims Mechanism and Scenarios 8 General Principle 9 Same Critica l Illness Category 11 Different Critical Illness Category 13 Different Critical Illness Events diagnosed on the same date 15 Additional Benefits of Diabetic Related 17 Pairings of Critical Illness Events under different Critical Illness Category Terms and Conditions 19 Terms and Conditions Exclusions 21 Waiting Period and Survival Period 22 Other Major Exclusions Appendix 23 List of Critical Illness Events 29 Critical Illness Events Definitions 51 Sample of Cost Of Insurance / Premium Rate 3

4 Product Overview Key Benefits Comprehensive Coverage - 95 CI events Early payout with 3 Levels:, 60% and Pays additional 20% on Diabetic Related No Waiting Period Between Claims Premium/COI based on remaining SA after claim

5 Product Overview Number of Critical Illness Events Covered Medium Angioplasty & 3 Other Invasive Treatments for Diabetic + + Major Coronary = Related s Artery 95 Critical Illness Events

6 Product Overview Payout Schedule % of EPCIR Sum Assured Critical Illness Event 91 CI Events Pay a percentage of EPCIR SA according to severity of specified illnesses Angioplasty and Other Invasive Treatments for Major Coronary Artery Medium 60% 10% or RM 25,000, whichever is lower Diabetic Related 3 Diabetic Related s Additional benefit on top of the of EPCIR SA Benefit is payable once only This claim will not reduce the EPCIR SA No benefit shall be payable if EPCIR has been terminated Additional 20%

7 Product Overview Underwriting Entry Age Minimum sum assured Maximum sum assured Coverage Term 4 weeks 60 years old RM 5,000 RM 250,000 per life (subject to underwriting up to max of RM 2mil per life for all CI plan) Age 85 or maturity of basic policy, whichever is earlier

8 Claims Mechanism and Scenarios General Principle first claim paid at the relevant severity level at low severity 70% of EPCIR SA preserved 60% at medium severity 40% of EPCIR SA preserved at high severity policy terminates subsequent claims condition unrelated to/different CI Category from the earlier claim benefit is paid at the relevant severity level, subject to EPCIR SA balance condition related to/same CI Category from the earlier claim benefit reduced by previous benefits for related conditions/same CI Category, subject to EPCIR SA balance

9 Claims Mechanism and Scenarios a) Critical Illness Events from the Same Critical Illness Category For a subsequent claim made from the same Critical Illness Category a)subsequent claim is more severe than earlier claim: Outcome: The corresponding % of EPCIR sum assured LESS previous claim amount, subject to maximum of the EPCIR sum assured b)subsequent claim is equivalent or less severe than earlier claim: Outcome: The subsequent claim is not payable Once a claim is paid, illnesses within the same or lower severity from the said category will no longer be claimable. 9

10 Claims Scenario 1: Same CI Category Medium Lung EPCIR SA: RM100,000 Severe Asthma 1 st Claim RM30,000 Remaining SA: RM70,000 Ms. A makes a claim for Severe Asthma and we will pay her of EPCIR SA. Surgical Removal of One Lung 2 nd Claim RM30,000 Remaining SA: RM40,000 She undergoes Surgical Removal of One Lung. Since it is a claim from the same category i.e. Lung of the earlier claim, we will pay her (60 30)% of EPCIR SA i.e. RM60K RM30K = RM30K. End Stage Lung 3 rd Claim RM40,000 EPCIR TERMINATES Later, she is diagnosed with End Stage Lung and we shall pay her the remaining SA of RM40,000 as the total maximum SA payable is of EPCIR SA. Total Claims Paid RM100,000 10

11 Claims Mechanism and Scenarios b) Critical Illness Events from Different Critical Illness Category For a subsequent claim made from a different Critical Illness Category : The corresponding % of EPCIR sum assured, subject to maximum of the EPCIR sum assured will be payable. 11

12 Claims Scenario 2: Different CI Category Medium Heart Attack Liver EPCIR SA: RM100,000 Cardiac Pacemaker or Defibrilator Insertion 1 st Claim RM30,000 Remaining SA: RM70,000 Ms. A undergoes a surgical of insertion of permanent Cardiac Pacemaker and we will pay her of EPCIR SA. Liver Cirrhosis 2 nd Claim RM60,000 Remaining SA: RM10,000 She is diagnosed with Liver Cirrhosis which is from different Critical Illness Category of the earlier claim, we will pay her the full benefit i.e. 60% of EPCIR SA. End Stage Liver Failure 3 rd Claim RM10,000 EPCIR TERMINATES Later, she is diagnosed with End Stage Liver Failure and we shall pay her the remaining SA of RM10,000 as the total maximum SA payable is of EPCIR SA. Total Claim Paid RM100,000 12

13 Claims Mechanism and Scenarios c) Different Critical Illness Events diagnosed on the same date In the event that there are 2 or more claims made under different Levels of the same Critical Illness Category diagnosed at the same date, the following shall apply: Only 1 claim will be payable, whichever is the highest claim. 13

14 Claims Scenario 3: Different CI Events diagnosed on the same date Medium Stroke EPCIR SA: RM100,000 Brain Aneurysm Surgery/ Cerebral Shunt Insertion Carotid Artery Surgery 1 st Claim RM60,000 Remaining SA: RM40,000 Ms. A submitted 2 Critical Illness Events claims which were diagnosed on the same date and both claims are within the same Critical Illness Category. Hence, we shall pay her the highest severity benefit i.e. 60% of EPCIR SA. Stroke 2 nd Claim RM40,000 EPCIR TERMINATES Later, she is diagnosed with Stroke and we shall pay her the remaining SA of RM40,000 as the total maximum SA payable is of EPCIR SA. Total Claims Paid RM100,000 14

15 Claims Mechanism and Scenarios d) Additional Benefit of Diabetic Related Diagnosis of Diabetic Related : an additional 20% of EPCIR SA shall be payable. This claim shall not reduce the EPCIR SA. This benefit is payable once only and no benefit shall be payable if EPCIR has been terminated. 15

16 Claims Scenario 4: Additional Benefit of Diabetic Related Medium Cancer Diabetic Related EPCIR SA: RM100,000 Carcinoma in situ/ Early Prostate Cancer/ Early Thyroid Cancer/ Early Bladder Cancer/ Early Chronic Lymphocytic Leukaemia Cancer Type 2 Surgery for Diabetic Retinopathy/ Limb Amputation due to Type 2 Diabetic Complications/ Severe Diabetic Nephropathy resulting in Kidney 1 st Claim RM30,000 2 nd Claim RM20,000 3 rd Claim RM70,000 Remaining SA: RM70,000 Remaining SA: RM70,000 EPCIR TERMINATES Ms. A is diagnosed with Carcinoma in situ of Breast and we will pay her of EPCIR SA. Then she undergoes Limb Amputation due to Type 2 Diabetic Complications. Since it is an additional benefit, we shall pay her an additional 20% of EPCIR SA. This benefit will not reduce EPCIR SA. Later, she is diagnosed with Cancer and we shall pay her the remaining SA of RM70,000 as the total maximum SA payable is of EPCIR SA. Total Claim Paid RM120,000 16

17 Claims Mechanism and Scenarios e) Pairings of Critical Illness Events Under Different Critical Illness Category 1 Early Loss of Independent Existence Early Alzheimer s Moderately Severe Alzheimer s Alzheimer s 2 Early Loss of Independent Existence Early Parkinson s Moderately Severe Parkinson s Parkinson s 3 Early Coronary Artery Pericardectomy y Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) 4 Pericardectomy y Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) Other Coronary Artery If claims fall under any 1 of the 4 pairings of Critical Illness Events as listed above: a) Subsequent claim is more severe than earlier claim : Outcome: The corresponding % of EPCIR sum assured LESS previous claim amount, subject to maximum of the EPCIR sum assured will be payable b) Subsequent claim is less or equivalent severe than earlier claim : Outcome: The subsequent claim is not payable 17

18 Claims Scenario 5: Pairings of Critical Illness Events under different CI Category Medium Coronary Artery Bypass Surgery Other Serious Artery Liver EPCIR SA: RM100,000 Pericardectomy 1 st Claim RM30,000 Remaining SA: RM70,000 Ms. A undergoes a Pericardectomy and we will pay her of EPCIR SA. Other Coronary Artery 2 nd Claim RM30,000 Remaining SA: RM40,000 Then she is diagnosed with Other Coronary Artery. Though this claim is as of different CI Category of the previous claim, however since the 2nd claim is of same pairing as the 1st claim, therefore 60% of EPCIR SA after deducting the benefit paid for the 1st claim, is payable. End Stage Liver Failure Total Claim Paid 3 rd Claim RM40,000 RM100,000 EPCIR TERMINATES Later, she is diagnosed with End Stage Liver Failure and we shall pay her the remaining SA of RM40,000 as the total maximum SA payable is of EPCIR SA. 18

19 Terms and Conditions There is a survival period of 30 days for each CI event There is no waiting period in-between claim for EPCIR An additional 20% of EPCIR SA shall be paid upon diagnosis of Diabetic Related, if the rider is still inforce Any amount payable under EPCIR will reduce the rider sum assured except Diabetic Related Premium/COI shall be based on the remaining SA after any claims payout The rider terminates when (excluding Diabetic Related ) of the EPCIR SA is fully paid In the event that there are 2 or more claims made under different Critical Illness Category (excluding Diabetic Related ) which are diagnosed on the same date, we will determine the condition to pay the benefits by arranging the order of diagnosis of these Critical Illness Events in an increasing order of their Levels, starting from, Medium to. The total amount payable shall not exceed of the EPCIR SA. EPCIR does not have Cash Value 19

20 Terms and Conditions Example on Waiting Period in-between claim There are no waiting period events: between claims for all CI 1 st Claim: Liver Surgery 2 nd Claim : Surgical Removal of one lung at any point of time. Can claim? Yes After 60 days Policy commencement/ reinstatement Date Policy Expiry 20

21 Exclusions Waiting Period and Survival Period Waiting Period The signs or symptoms of the Critical Illness Event shall not be within the following waiting period: 30 days All Critical Illness Events (except Cancer, Heart Attack, Coronary Artery By-Pass Surgery, Other Serious Coronary Artery and Angioplasty and Other Invasive Treatments for Major Coronary Artery ) 60 days Cancer Heart Attack Coronary Artery By-Pass Surgery Medium CI Events CI Events Other Serious Coronary Artery Angioplasty and Other Invasive Treatments for Major Coronary Artery Diabetic Related Survival Period EPCIR does not cover the insured if he/she did not survive for at least thirty (30) days after the diagnosis of a Critical Illness Event Note: This list is non-exhaustive. Please refer to the policy contract for full list of exclusions. 21

22 Exclusions Major Exclusion Self-Inflicted Injury Congenital Defect/ manifested/diagnosed before 17 years old Critical Illness* resulting from alchohol or drug abuse Critical Illness caused by AIDS Pre-Existing Condition * All CI events under and Medium Note: This list is non-exhaustive. Please refer to the policy contract for full list of exclusions. 22

23 List of Critical Illness Events Critical Illness Category Group of EPCIR SA Medium 60% of EPCIR SA of EPCIR SA 1 Cancer Carcinoma in situ/ situ/ Early Prostate Cancer / / Early Thyroid Cancer/ Early Bladder Cancer/ Early Chronic Lymphocytic Leukaemia Carcinoma in situ and other Early Cancers of Specified Organs Treated with Radical Surgery Cancer 2 Stroke Brain Aneurysm Surgery/ Cerebral Shunt Insertion Shunt Carotid Artery Surgery Stroke 3 Heart Attack Heart Attack Cardiac Pacemaker or Defibrillator Insertion Defibrillator - - Heart Attack 4 Other Serious Coronary Artery Early Coronary Artery Other Coronary Artery Other Serious Coronary Artery 5 Coronary Artery Artery By-Pass Surgery Surgery Pericardectomy my Minimally Invasive Direct Coronary Direct Artery Bypass Grafting (MIDCAB) Coronary Artery Bypass Coronary Artery By-pass Surgery Pass Surgery

24 List of Critical Illness Events Critical Illness Category Group of EPCIR SA Medium 60% of EPCIR SA of EPCIR SA 6 Heart Heart Valve Valve Surgery Surgery Percutaneous/ Percutaneous/ Valvuloplasty Valvuloplasty Percutaneous Percutaneous Valve Valve Replacement Heart Heart Valve Valve Surgery Surgery 7 Cardiomyopathy y Hypertrophic Cardiomyopathy hy Constrictive Pericarditis with Surgery Severe Cardiomyopathy hy 8 Aorta Aorta Large Large Asymptomatic Asymptomatic Aortic Minimally Minimally Invasive Invasive Surgery to Aorta Surgery Surgery to to Aorta Aorta 9 Primary Pulmonary Arterial Hypertension Early Primary Pulmonary Arterial Hypertension -- Primary Pulmonary Arterial Hypertension 10 Lung Lung Severe Severe Asthma Asthma Surgical Surgical Removal Removal of of One Lung End End Stage Stage Lung Lung 11 Liver Liver Surgery Liver Cirrhosis End Stage Liver Failure 12 Major Organ/Bone Marrow Transplant Small Bowel Transplant/ Corneal Transplant Major Organ/ Organ/Bone Marrow Transplant Marrow (on Transplant waiting list) Major Organ/Bone Marrow Transplant 13 Parkinson s Early Parkinson s Parkinson s list) Moderately Severe Parkinson s Severe Severe Parkinson s Parkinson s 24

25 List of Critical Illness Events Critical Illness Category Group of EPCIR SA Medium 60% of EPCIR SA of EPCIR SA / Irreversible Organic Degenerative Brain Disorders Brain Early Alzhemier s Coma Coma Coma Coma for for hours Loss of Sight Loss of Sight in One eye Moderately Severe Alzheimer s Coma Coma for for hours Retinitis Pigmentosa Severe Alzheimer s / Irreversible Organic Degenerative Organic Brain Coma Coma Disorders Blindness/Total loss al loss of Sight of 17 Loss of Hearing Partial Loss of Hearing/ Cavernous Sinus Thrombosis Surgery Thrombosis Cochlear Implant Surgery Deafness/Total Loss l Loss of of Hearing 18 Kidney Kidney Failure Failure Surgical Surgical Removal Removal of of One kidney Chronic Chronic Kidney Kidney End End Stage Stage Kidney Kidney Failure Failure 19 Blood Occupationall Occupationalyl Acquired y Hepatitis B or C -- HIV Due To Blood Transfusion Aplastic Anaemia Bacterial Meningitis Meningitis Reversible Aplastic Anaemia Bacterial Meningitis with full recovery Chronic Aplastic Anaemia Bacterial Meningitis Meningitis 25

26 List of Critical Illness Events Critical Illness Category Group of EPCIR SA Medium 60% of EPCIR SA of EPCIR SA 22 Brain Tumour Surgical Removal of Pituitary Tumour via Trans STrans phenoidal Hypophysectomy -- Benign Brain Tumour 23 Brain Surgery Hypophysect Surgery omy for Subdural Haematoma -- Brain Surgery 24 Encephalitis Encephalitis Encephalitis Encephalitis with with Full Full Recovery - Encephalitis Encephalitis 25 Head Trauma Head Trauma Mild Head Trauma Mild Head -- Major Head Trauma Major Head 26 Loss of Speech Loss of Speech (other than injury or illness to the vocal illness cords) to the -- Loss of Speech 27 Medullary Cystic Chronic Glomerulonephritis hritis -- Medullary Cystic 28 Loss of Independent Existence Early Loss of Independent Existence -- Loss of Independent Existence 29 Motor Neurone Early Motor Neurone Neurone - - Motor Neurone Neurone 26

27 List of Critical Illness Events Critical Illness Category Group of EPCIR SA Medium 60% of EPCIR SA of EPCIR SA 30 Multiple Sclerosis Early Multiple Sclerosis - Multiple Sclerosis 31 Muscular Dystrophy Spinal Cord or Injury resulting resulting Bowel and in Bladder Bowel an Dysfunction d -- Muscular Dystrophy 32 Paralysis / Paraplegia Dysfunction Loss of Use of One Limb - Paralysis / Paraplegia 33 Burns Moderately Severe Burns - Major Burns 34 Fulminant Viral Hepatitis -- - Fulminant Viral Hepatitis 35 Terminal Illness -- - Terminal Illness 27

28 List of Critical Illness Events Others Critical Illness Illness Category Category Group Critical Illness Event Critical Illness Event Percentage (%) of EPCIR SA EPCIR SA 36 Angioplasty and Other Invasive Treatment for Major Major Coronary Artery Coronary Angioplasty and other Invasive Treatment for Major Coronary Artery 10% 10% or or RM25,000, RM25,000, whichever whichever is is lower lower Additional Benefits Critical Critical Illness Illness Category Category Critical Illness Event Percentage (%) of EPCIR SA Diabetic Related Surgery for Type 2 Diabetic Retinopathy/ Limb Amputation* due to Type 2 Diabetic Complications/ Severe Diabetic Nephropathy resulting in Kidney Failure Additional 20% * limb amputation shall cover leg/foot/toe/arm/hand/finger 28

29 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 1. Cancer Carcinoma in situ Carcinoma in situ (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 diagnosis of the Carcinoma in situ must always be supported by a histopathological report. Furthermore, the diagnosis of Carcinoma in situ must always be positively diagnosed upon the basis of a microscopic examination of the fixed tissue, supported by a biopsy result. Clinical diagnosis does not meet this standard. In the case of the cervix uteri, Pap smear alone is not acceptable and should be accompanied with cone biopsy or colposcopy with cervical biopsy. Clinical diagnosis or Cervical Intraepithelial Neoplasia (CIN) classification which reports CIN I, CIN II and CIN III (severe dysplasia without carcinoma in situ) does not meet the required definition and are specifically excluded. Non-melanoma CIS is also specifically excluded. This coverage is available to the first occurrence of CIS only; or Early Prostate Cancer Prostate Cancer that is histologically described using the TNM Classification as T1a or T1b or T1c or Prostate cancers described using another equivalent classification; or Early Thyroid Cancer Thyroid Cancer that is histologically described using the TNM Classification as T1N0M0 Papillary microcarcinoma of thyroid where the tumour is less than 1cm in diameter; or Early Bladder Cancer Papillary microcarcinoma of Bladder supported by histopathology report; or Early Chronic Lymphocytic Leukaemia Chronic Lymphoctic Leukaemia (CLL) RAI Stage 1 or 2. CLL RAI stage 0 or lower is excluded. 29

30 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Medium Carcinoma in situ and other Early Cancers of Specified Organs Treated with Radical Surgery The actual undergoing of a Radical Surgery to arrest the spread of carcinomatous cells in that specific organ, which must be considered as appropriate and necessary treatment. Radical Surgery is defined in this Supplementary Contract as the total and complete removal of tumour mass and ancillary lymph nodes for one of the following organs: breast (radical mastectomy), prostate (radical prostatectomy), thyroid (radical thyroidectomy), corpus uteri (radical hysterectomy), ovary (oopherectomy), and fallopian tube (salpingectomy). A radical surgery benefit will be paid for carcinoma in situ of the colon if upon actual undergoing of surgical resection of a length of colon with end to end anastomosis and a radical surgery benefit for carcinoma of the stomach will be payable if upon actual undergoing of a partial gastrectomy with end to end anastomosis. The diagnosis of the Carcinoma in situ and other early cancers must always be positively diagnosed upon the basis of a microscopic examination of fixed tissues additionally supported by a biopsy of the removed organ. Clinical diagnosis does not meet this standard. Early prostate cancer that is histologically described using the TNM Classification as T1a or T1b or T1c or Prostate cancers described using another equivalent classification is also covered if it has been treated with a radical prostatectomy. All grades of cervical intraepithelial neoplasia (CIN) and prostatic intraepithelial neoplasia (PIN) are specifically excluded. Early thyroid cancer that is histologically described using the TNM Classification as T1 or Thyroid cancers described using another equivalent classification is covered if it has been treated with a radical thyroidectomy. T1 thyroid tumours described as microcarcinoma less than 1cm in diameter will be excluded. Except in the case of carcinoma in situ of the colon and stomach partial surgical removal of an organ such as lumpectomy and partial mastectomy, partial prostatectomy, and partial thyroidectomy are specifically excluded. 60% 30

31 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Carcinoma in situ 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 diagnosis of the Carcinoma in situ must always be supported by a histopathological report. Furthermore, the diagnosis of Carcinoma in situ must always be positively diagnosed upon the basis of a microscopic examination of the fixed tissue, supported by a biopsy result. Clinical diagnosis does not meet this standard. Cancer Any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, lymphoma and sarcoma. For the above definition, the following are not covered: (a) All cancers which are histologically classified as premalignant, non-invasive; carcinoma in situ; having either borderline malignancy; or having low malignant potential; (b) All tumours of the prostate, thyroid and urinary bladder histologically classified as T1N0M0 (TNM classification); (c) Chronic Lymphocytic Leukaemia less than RAI Stage 3; (d) All cancers in the presence of HIV; (e) Any skin cancer other than malignant Melanoma. 31

32 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 2. Stroke Brain Aneurysm Surgery The actual undergoing of burr hole surgery to repair either an intracranial aneurysm or to remove an arterio-venous malformation. Intra-arterial surgeries are excluded; or Cerebral Shunt Insertion The actual undergoing of surgical implantation of a shunt from the ventricles of the brain to relieve raised pressure in the cerebrospinal fluid. The need of a shunt must be certified to be absolutely necessary by a consultant neurologist. Medium Carotid Artery Surgery The actual undergoing of an endarterectomy of the Internal Carotid Artery or Common Carotid Artery as a result of a neurological deficit caused by a narrowing of a minimum of eighty percent (80%) arterial narrowing. The neurological complication should have been documented before the endarterectomy procedure. Endarterectomy of blood vessels other than the carotid artery is specifically excluded. 60% Stroke Defined as a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than three (3) months. Infarction of brain tissue, hemorrhage and remobilization 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 neurologist. Specifically excluded are cerebral symptoms due to transient ischemic attacks, any reversible ischemic neurological deficit, vertebrobasilar ischemia, 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. Heart Attack Cardiac Pacemaker or Defibrillator Insertion Insertion of a permanent cardiac pacemaker or defibrillator that is required as a result of serious cardiac arrhythmia which cannot be treated via other means. The surgical procedure must be certified as absolutely necessary by a consultant cardiologist. 32

33 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Heart Attack The death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply and being evidenced by all of the following criteria:- (a) A history of typical prolonged chest pain; (b) New electrocardiographic changes resulting from this occurrence; (c) Elevation of the cardiac enzyme, CPK-MB above the generally accepted laboratory levels of normal or troponins recorded at the following levels or higher: -Troponin T > 1.0 ng/ml or equivalent threshold with other Troponin I methods. Angina is specifically excluded. 4. Other Serious Coronary Artery Early Coronary Artery The narrowing of the lumen of at least one (1) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (non-invasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem (a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed. Medium Other Coronary Artery The narrowing of the lumen of at least two (2) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (non-invasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem (a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed. 60% Other Serious Coronary Artery The narrowing of the lumen of at least three (3) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (noninvasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem 33

34 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured (a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed. 5. Coronary Artery By-Pass Surgery Pericardectomy The undergoing of a pericardectomy performed by keyhole or port access techniques as a result of pericardial disease. These surgical procedures must be certified to be absolutely necessary by a consultant cardiologist. Other procedures on the pericardium including pericardial biopsies, and pericardial drainage procedures by needle aspiration are excluded. Medium Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) Coronary Artery Bypass Grafting performed by port access procedures (thoracoscopic techniques) or MIDCAB procedures (open coronary artery bypass grafting where median sternotomy is not required) to correct blockages in the coronary arteries. All intravascular procedures are excluded. 60% Coronary Artery By-Pass Surgery Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery (CAD) by way of Coronary Artery By-Pass Grafting. Angioplasty and all other intra-arterial, catheter based techniques, keyhole or laser procedures are excluded. 6. Heart Surgery Valve Percutaneous Valvuloplasty This benefit is payable where a heart valve is repaired by percutaneous balloon valvuloplasty techniques not involving a thoracotomy. Percutaneous valve replacements are excluded. Medium Percutaneous Valve Replacement The actual undergoing of replacing the heart valve via percutaneous intravascular technique. Balloon valvuloplasty and other open chest heart valve procedures are excluded. 60% Heart Valve Surgery The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. Repair via intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded. 34

35 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 7. Cardiomyopathy Hypertrophic Cardiomyopathy This benefit will be paid on the diagnosis of symptomatic hypertrophic cardiomyopathy HCM. The diagnosis of asymmetric septal cardiac hypertrophy must be made by a consultant cardiologist and proven on echocardiographic criteria. The condition must require surgical myomectomy or septal ablation according to accepted guidelines. All other forms of ventricular hypertrophy including apical hypertrophic cardiomyopathy are excluded from the benefit. Medium Constrictive Pericarditis with Surgery The actual undergoing of the stripping and removal of the entire pericardium at open thoracotomy due to constrictive pericarditis. Constrictive pericarditis refers to pericardial disease resulting in symptoms and signs of congestive cardiac failure. The diagnosis of constrictive pericarditis must be based on the findings on cardiac catheterization. 60% Severe Cardiomyopathy An impaired function of the heart muscle, unequivocally diagnosed as Cardiomyopathy by a cardiologist, and resulting in permanent physical impairment of at least Class III of the New York Heart Association's classification of cardiac impairment. The diagnosis has to be supported by echocardiographic findings of compromised ventricular performance. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:- Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. Cardiomyopathy directly related to alcohol or drug abuse is excluded. 8. Aorta Large Asymptomatic Aortic Aneurysm Large asymptomatic abdominal or thoracic aortic aneurysm or aortic dissection as evidenced by appropriate imaging technique. The aorta must be enlarged and greater than 55mm in diameter and the diagnosis must be confirmed by a consultant cardiologist. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. 35

36 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Medium Minimally Invasive Surgery to Aorta The actual undergoing of surgery via minimally invasive (i.e. percutaneous intraarterial techniques) to repair or correct an aneurysm, narrowing, obstruction or dissection of the aorta, as evidenced by a cardiac echocardiogram, CT, MRI or any other appropriate diagnostic test that is available and confirmed by a consultant cardiologist or specialized vascular surgeon. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. 60% Surgery to Aorta The actual undergoing of surgery via a thoracotomy or laparotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. Angioplasty and all other intra-arterial, catheter based techniques, keyhole or laser procedures are excluded. 9. Primary Pulmonary Arterial Hypertension Early Primary Pulmonary Arterial Hypertension Means Primary Pulmonary Arterial Hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class II of the New York Heart Association (NYHA) classification of cardiac impairment. The diagnosis needs to be made by a cardiologist. Ongoing specialist monitoring and treatment with drugs indicated for pulmonary arterial hypertension according to current treatment guidelines are also required. Pulmonary arterial hypertension resulting from other causes and secondary pulmonary arterial hypertension shall be excluded from this benefit. The NYHA Classification of Cardiac Impairment for Class II to Class IV means the following:- Class II: Slight limitation of physical activity. Comfortable at rest but ordinary activity causes symptoms. Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. 36

37 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Primary Pulmonary Arterial Hypertension Means Primary Pulmonary Arterial Hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment. Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit. The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:- Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. 10. Lung Severe Asthma Evidence of an acute attack of Severe Asthma with persistent status asthmaticus that requires hospitalisation and assisted ventilation with a mechanical ventilator for a continuous period of at least four (4) hours on the advice of a respiratory physician. Treatment by continuous positive airways pressure delivered by CPAP or BIPAP mask is excluded. There should also be evidence to show that FEV is continuously less than fifty percent (50%) predicted despite compliance with oral steroid therapy for at least six (6) months. Medium Surgical Removal of One Lung Complete surgical removal of the entire right or left lung as a result of an illness or an accident of the Insured. Partial removal of a lung is not included in this benefit. 60% End Stage Lung End stage lung disease causing chronic respiratory failure. All of the following criteria must be met: (a) Requiring permanent oxygen therapy as a result of a consistent FEV1 test value of less than one (1) liter (Forced Expiratory Volume during the first second of a forced exhalation); (b) Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less; (c) Dyspnea at rest. 37

38 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 11. Liver Liver Surgery Partial hepatectomy of at least one (1) entire lobe of the liver that has been found necessary as a result of illness or accident as suffered by the Insured. Liver donation is excluded. Medium Liver Cirrhosis Cirrhosis of Liver with a HAI-Knodell Score of six (6) and above as evident by liver biopsy. The diagnosis of liver cirrhosis must be unequivocally confirmed by a hepatologist and based on the histological findings of the liver biopsy. 60% End Stage Liver Failure End stage liver failure as evidenced by all of the following: (a) Permanent jaundice; (b) Ascites; and (c) Hepatic encephalopathy. Liver failure secondary to alcohol or drug abuse is excluded. 12. Major Organ/Bone Marrow Transplant Small Bowel Transplant The receipt of a transplant of at least one (1) meter of small bowel with its own blood supply via a laparotomy resulting from intestinal failure; or Corneal Transplant The receipt of a transplant of a whole cornea due to irreversible scarring with resulting reduced visual acuity, which cannot be corrected with other methods. Medium Major Organ/Bone Marrow Transplant (on the waiting list) This benefit covers those who are on an official organ transplant waiting list for the receipt of a transplant of: (a) Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or (b) One (1) of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end stage failure of the relevant organ. Other stem cell transplants are excluded. 60% Major Organ/Bone Marrow Transplant The receipt of a transplant of: (a) Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or 38

39 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured (b) One (1) of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end stage failure of the relevant organ. Other stem cell transplants are excluded. 13. Parkinson s Early Parkinson s Unequivocal diagnosis of Parkinson's by a 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 Insured to perform without assistance at least one (1) of the Activities of Daily Living. Only idiopathic Parkinson's is covered. Drug-induced or toxic causes of Parkinsonism are excluded. Medium Moderately Severe Parkinson s Unequivocal diagnosis of Parkinson's by a 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 Insured to perform without assistance at least two (2) of the Activities of Daily Living. Only idiopathic Parkinson's is covered. Drug-induced or toxic causes of Parkinsonism are excluded. 60% Severe Parkinson s Unequivocal diagnosis of Parkinson's by a 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 Insured to perform without assistance three (3) or more of the Activities of Daily Living. Only idiopathic Parkinson's is covered. Drug-induced or toxic causes of Parkinsonism are excluded. 14. Alzheimer s /Irreversible Organic Degenerative Brain Disorders Early Alzheimer s 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 or irreversible organic degenerative brain disorders resulting in inability to perform at least one (1) of the Activities of Daily Living. The diagnosis must be clinically confirmed by a neurologist. 39

40 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Non organic brain disorders such as neurosis and psychiatric illnesses are excluded. Medium Moderately Severe Alzheimer s 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 or irreversible organic degenerative brain disorders resulting in inability to perform at least two (2) of Activities of Daily Living. The diagnosis must be clinically confirmed by a neurologist. Non organic brain disorders such as neurosis and psychiatric illnesses are excluded. 60% Severe Alzheimer s / 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 or irreversible organic degenerative brain disorders resulting in significant reduction in mental and social functioning (such that continuous supervision is required). The diagnosis must be clinically confirmed by a neurologist. The following are excluded: (a) Non organic brain disorders such as neurosis and psychiatric illnesses; and (b) Drug or alcohol related brain damage. 15. Coma Coma for 48 hours Coma that persists for at least forty eight (48) hours. This diagnosis must be supported by evidence of all of the following: (a) no response to external stimuli for at least forty eight (48) hours; (b) the use of life support measures to sustain life; and (c) brain damage resulting in permanent neurological deficit which must be assessed at least thirty (30) days after the onset of the coma. Medically induced coma also does not fulfill this definition. Medium Coma for 72 hours Coma that persists for at least seventy two (72) hours. This diagnosis must be supported by evidence of all of the following: (a) No response to external stimuli for at least seventy two (72) hours; 60% 40

41 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured (b) The use of life support measures to sustain life; and (c) Brain damage resulting in permanent neurological deficit which must be assessed at least thirty (30) days after the onset of the coma. Medically induced coma also does not fulfill this definition. Coma A state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least ninety six (96) hours, requiring the use of life support systems and resulting in a permanent neurological deficit, lasting more than thirty (30) days. Confirmation by a neurologist must be present. Coma resulting directly from self-inflicted injury, alcohol or drug abuse is excluded. 16. Loss of Sight Loss of Sight in One Eye Total and irreversible loss of sight in one eye: (a) as a result of illness or accident; and (b) must be certified by an ophthalmologist. Medium Retinitis Pigmentosa This benefit is payable for retinitis pigmentosa where the field of vision is restricted to ten (10) degrees or less in the better eye. The condition must be certified by a specialist ophthalmologist and not be amenable to any form of treatment or correction. 60% Blindness/Total Loss of Sight Total and irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an ophthalmologist. 17. Loss of Hearing Partial Loss of Hearing Permanent binaural hearing loss with the loss of at least sixty (60) decibel in all frequencies of hearing as a result of illness or accident. The hearing loss must be established by an Ear, Nose and Throat (ENT) specialist and supported by an objective diagnostic test to indicate the quantum loss of hearing; or Cavernous Sinus Thrombosis Surgery The actual undergoing of a surgical drainage for Cavernous Sinus Thrombosis. The definite diagnosis of Cavernous Sinus Thrombosis as well as the requirement for surgical intervention must be certified to be absolutely necessary by a specialist in the relevant field. A diagnostic report should be required. 41

42 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured Medium Cochlear Implant Surgery The actual undergoing of a surgical cochlear implant as a result of permanent damage to the cochlea or auditory nerve. The surgical procedure as well as the insertion of the implant must be certified to be absolutely necessary by an Ear, Nose and Throat (ENT) specialist. 60% Deafness/Total Loss of Hearing Total and irreversible loss of hearing in both ears as a result of illness or accident. Total means the loss of at least eighty (80) decibels in all frequencies of hearing. Medical evidence in the form of an audiometry and soundthreshold tests must be provided and certified by an Ear, Nose, and Throat (ENT) specialist. 18. Kidney Failure Surgical Removal of One kidney The complete surgical removal of one (1) kidney necessitated by any illness or accident. The need for the surgical removal of the kidney must be certified to be absolutely necessary by a nephrologist. Kidney donation is excluded. Medium Chronic Kidney A nephrologist must make a diagnosis of chronic kidney disease with permanently impaired renal function. There must be laboratory evidence that shows that renal function is severely decreased with GFR less than 15 ml/min, persisting for a period of six (6) months or more. 60% End Stage 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 is carried out. 19. Blood Occupationally Acquired Hepatitis B or C Infection with the Hepatitis B or C virus which resulted from an accident occurring after the Issue Date or Commencement Date of this Supplementary Contract, whichever is the later whilst the Insured was carrying out the normal professional duties of his or her occupation in Malaysia or Singapore, provided that all of the following are proven to the Company s satisfaction: (a) Proof of the accident giving rise to the infection must be reported to the Company within thirty (30) days of the accident taking place; (b) Proof that the accident involved a definite source of the hepatitis B or C infected fluids; (c) There is a need for antiviral therapy as a consequence of proven seroconversion; 42

43 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured (d) Hepatitis B or C infection resulting from any other means including sexual activity and the use of intravenous drugs is excluded. This benefit is only payable when the occupation of the Insured is a medical practitioner, housemen, medical student, state registered nurse, medical laboratory technician, dentist (surgeon and nurse) or paramedical worker, working in medical centre or clinic (in Malaysia or Singapore). We would not be liable if there had been failure to observe any proper defined procedural practice or occupation required vaccination practices. HIV Due To Blood Transfusion Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following conditions are met: (a) The blood transfusion was medically necessary or given as part of a medical treatment; (b) The blood transfusion was received in Malaysia or Singapore after the commencement of the Supplementary Contract; (c) The source of the infection is established to be from the Institution that provided the blood transfusion and the Institution is able to trace the origin of the HIV tainted blood; (d) The Insured does not suffer from Hemophilia; and (e) The Insured is not a member of any high risk groups such as but not limited to intravenous drug users. 20. Aplastic Anaemia Reversible Aplastic Anaemia Acute reversible bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with any two (2) of the following: (a) Blood product transfusion; (b) Marrow stimulating agents; or (c) Immunosuppressive agents. The diagnosis must be confirmed by a haematologist and a bone marrow biopsy. Chronic Aplastic Anaemia Irreversible persistent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring treatment with at least two (2) of the following: (a) Regular blood product transfusion; (b) Marrow stimulating agents; (c) Immunosuppressive agents; or (d) Bone marrow transplantation. The diagnosis must be confirmed by a bone marrow biopsy. 43

44 Critical Illness Events Definitions No. Critical Illness Category Level Critical Illness Events Percentage (%) of EPCIR Sum Assured 21. Bacterial Meningitis Bacterial Meningitis with Full Recovery Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord which requires hospitalization. This diagnosis must be confirmed by: (a) The presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and (b) A consultant neurologist. Bacterial Meningitis in the presence of HIV infection is excluded. 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 thirty (30) days and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living. The diagnosis is to be confirmed by: (a) an appropriate specialist; (b) the presence of bacterial infection in the cerebrospinal fluid by lumbar puncture. 22. Brain Tumour Surgical Removal of Pituitary Tumour via Trans Sphenoidal Hypophysectomy The actual undergoing of surgical removal of a pituitary tumour via trans sphenoidal hypophysectomy. The presence of the underlying tumour must be confirmed by imaging studies such as CT scan or MRI. Removal of pituitary tumours by open craniotomy is specifically excluded. Benign Brain Tumour A life-threatening, non-cancerous tumor in the brain or meninges within the cranium, 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. The following are excluded: (a) Cysts; (b) Granulomas; (c) Malformations in or of the arteries or veins of the brain; (d) Hematomas; (e) Tumors in the pituitary gland or spine; (f) Tumors of the acoustic nerve. 23. Brain Surgery Surgery for Subdural Haematoma The actual undergoing of burr hole surgery to the head to drain a subdural haematoma as a result of a traumatic vascular injury. The need for the burr hole surgery must be certified to be absolutely necessary by a specialist in the relevant field. 44