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Serious Condition

Definition

Stroke – resulting in Permanent neurological deficit with persisting clinical symptoms

Death of brain tissue due to inadequate blood supply, bleeding within the skull or embolization from an extra cranial source resulting in Permanent neurological deficit with persisting clinical symptoms. The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist.

For the above definition, the following are not covered:

(i)  Transient ischemic attacks

(ii) Cerebral symptoms due to migraine

(iii) Traumatic injury to brain tissue or blood vessels

(iv) Vascular disease affecting the eye or optic nerve or vestibular functions.

Paralysis of Limbs

Total, Permanent and Irreversible loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused by illness or injury.

Heart Attack

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

(i) A history of typical chest pain;

(ii) New characteristic electrocardiographic changes; with the development of any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block and

(iii) Elevation of the cardiac biomarkers, inclusive of CPK-MB above the generally accepted normal laboratory levels or Troponins recorded at the following levels or higher:

• Cardiac Troponin T or Cardiac Troponin I > / = 0.5 ng/ml
  
  

The evidence must show the occurrence of a definite acute myocardial infarction which should be confirmed by a Doctor or Physician.

Coronary Artery By-Pass Surgery

Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of coronary artery by-pass grafting.

For the above definition, the following are not covered:

(i) angioplasty;

(ii) other intra-arterial or catheter based techniques;

(iii) keyhole procedures;

(iv) laser procedures.

Serious Coronary Artery Disease

The narrowing of the lumen of Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Circumflex Artery (not inclusive of their branches) occurring at the same time by a minimum of sixty percent (60%) in each artery as proven by coronary arteriography (non-invasive diagnostic procedures are not covered). A narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of the Left Anterior Descending Artery (LAD) and Circumflex Artery. This covered event is payable regardless of whether or not any form of coronary artery surgery has been performed.

Angioplasty and Other Invasive Treatments for Coronary Artery Disease

The actual undergoing 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 as shown by angiographic evidence. Intra-arterial investigative procedures are not covered.

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.

For the above definition, the following are not covered:

(i) Repair via intra-arterial procedure

(ii) Repair via key-hole surgery or any other similar techniques.

Cancer – of specified severity and does not cover very early cancers

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 leukemia, lymphoma and sarcoma.

For the above definition, the following are not covered:

(i) All cancers which are histologically classified as any of the following:

• pre-malignant

• non-invasive

• carcinoma in situ

• having borderline malignancy

• having malignant potential
  
  

(ii) All tumours of the prostate histologically classified as T1N0M0 (TNM classification)

(iii) All tumours of the thyroid histologically classified as T1N0M0 (TNM classification)

(iv) All tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification)

(v) Chronic Lymphocytic Leukemia less than RAI Stage 3

(vi) All cancers in the presence of HIV

(vii) Any skin cancer other than malignant melanoma.

Brain Surgery 

The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy (surgical opening of skull) is performed.For the above definition, the following are not covered:

(i) Burr hole procedures

(ii) Transphenoidal procedures

(iii) Endoscopic assisted procedures or any other minimally invasive procedures

(iv) Brain surgery as a result of an Accident.

Encephalitis – resulting in Permanent inability to perform Activities of Daily Living

Severe inflammation of brain substance, resulting in Permanent functional impairment. The Permanent functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. The covered event must be certified by a neurologist.

Encephalitis in the presence of HIV infection is not covered.

Parkinson’s Disease – resulting in Permanent inability to perform Activities of Daily Living

A definite diagnosis of Parkinson's Disease by a neurologist where all the following conditions are met:

(i) Cannot be controlled with medication;

(ii) Shows signs of progressive impairment; and

(iii) Confirmation of the Permanent inability of the Insured Life to perform without assistance three (3) or more of the Activities of Daily Living.

Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are not covered.

Alzheimer’s Disease/Severe Dementia

Deterioration or loss of intellectual capacity confirmed by clinical evaluation and imaging tests arising from Alzheimer's Disease or Severe Dementia as a result of Irreversible organic brain disorders. The covered event must result in significant reduction in mental and social functioning requiring continuous supervision of the Insured Life. The diagnosis must be clinically confirmed by a neurologist.

From the above definition, the following are not covered:

(i) Non organic brain disorders such as neurosis

(ii) Psychiatric illnesses

(iii) Drug or alcohol related brain damage

Systemic Lupus Erythematosus with Severe Kidney Complications

A definite diagnosis of Systemic Lupus Erythematosus confirmed by a rheumatologist. For this definition, the covered event is payable only if it has resulted in Type III to Type V Lupus Nephritis as established by renal biopsy. Other forms such as discoid lupus or those forms with only hematological or joint involvement are not covered.

WHO Lupus Classification:

Type III - Focal Segmental glomerulonephritis
Type IV - Diffuse glomerulonephritis
Type V - Membranous glomerulonephritis

Crohn’s Disease with Intestinal Fistula, Obstruction or Perforation

Crohn’s Disease is a chronic granulomatous inflammatory bowel disease. Crohn’s Disease must have resulted in fistula formation, or intestinal obstruction or intestinal perforation that has required surgery and continuous immunosuppressive treatment or continuous treatment with immunomodulating drugs. Crohn’s Disease must be proven on biopsy and there must be continuous treatment under the care of a gastroenterologist.

Serious Accident - including Major Head Trauma with Permanent inability to perform Activities of Daily Living

Inability to perform at least three (3) of the Activities of Daily Living resulting from serious accident.

Advanced Treatment

Coverable Conditions

Cryoablation

Primary therapy alternative to surgery for individuals with localized disease or as a salvage therapy for recurrent cancer following failure of radiation therapy.

• Prostate cancer

• Lung cancer with endobronchial obstruction

• Renal Cell Cancer

• Cardiac arrhythmia - Drug resistant or drug intolerant Atrial fibrillation, with evidence of a localised site(s) of origin

• Skin cancer (Malignant melanoma, Basal Cell Carcinoma or Squamous Cell Carcinoma - where surgery or radiation is contraindicated or impractical)

• Soft tissue sarcoma

Immunotherapy

Immunotherapy is used to stimulate the body's immune system against cancer. Some forms of immunotherapy:
1. Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and by blocking them, these drugs allow immune cells to respond more strongly to cancer.

2. T-cell transfer therapy, which is a treatment that boosts the natural ability of T cells to fight cancer.

3. Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system.

4. Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

5. Immune system modulators, which enhance the body’s immune response against cancer.

• Blood cancers (Classical Hodgkin lymphoma)

• Gastrointestinal cancers (Upper gastrointestinal tract tumors, Metastatic squamous cell anal carcinoma, Colorectal cancer, small bowel adenocarcinoma, appendicle carcinoma)

• Genitourinary cancers (Bladder cancer, Primary carcinoma of the urethra, Urothelial carcinoma of the prostate)

• Hepatocellular carcinoma

• Kidney cancer

• Skin cancer (Melanoma)

• Lung cancer (Malignant pleural mesothelioma, Non-small cell lung cancer, Small cell lung cancer)

• Head and neck cancer

• Advanced gynaecology malignancy (Ovarian, uterine, and cervix)

Proton Beam Radiotherapy (PBRT)

Proton beam radiation therapy (PBRT) is a type of external beam radiation therapy (EBRT) that utilizes protons (positively charged subatomic particles) that are precisely targeted to a specific tissue mass.

• Brain tumor

• Breast cancer

• Bone cancer including Chrondroma or Chondrosarcoma especially in children

• Gastrointestinal tumor

• Prostate cancer

• Eye cancer including Uveal melanoma

Neutron Beam Radiation Therapy (NBRT)

Neutron Beam Radiation Therapy (NBRT) is a form of external beam radiation therapy (ERBT) used in inoperable tumours or tumours that are resistant to conventional radiation therapy. It involves a sophisticated stereotactic method in which high energy neutrons (neutral charge subatomic particles) are exerted to accurately target the diseased tissue mass localised using computed tomography (CT).

• Salivary gland cancer

• Soft tissue sarcoma

• Prostate cancer

Stem Cells for Hematopoietic Cell Transplant

Hematopoietic stem cell transplantation (HSCT) refers to intravenous infusion of healthy hematopoietic progenitor cells, either autologous (stem cells from the same person going for transplant), or allogeneic (stem cells from compatible donor other that the patient), harvested from bone marrow or peripheral blood to replace aberrant or dysfunctional cells in a patient.

• Leukaemia - Chronic Myeloid Leukaemia, Acute Myeloid Leukaemia

• Lymphoma - Hodgkin and non-Hodgkin Lymphoma

• Multiple myeloma

Implantable Neural Stimulator for Epilepsy and Parkinson Disease

Implantable neural stimulators represent an advanced treatment adjunct to medication for pharmacoresistant epilepsy and alternative for patients that are not good candidates for resective surgery. The technology involves the surgical implantation of an electrode to deliver intermittent stimulation to the vagus nerve or part of brain.

Types of Implantable neural stimulator are :
• Vagus nerve stimulation (VNS)- An implantable vagus nerve stimulator that triggers the vagus nerve with electrical impulses. VNS is used to treat complex type epilepsy that is resistant to conventional and standard medication for epilepsy.

• Deep brain stimulation (DBS) involves implanting electrodes within certain areas of the brain. These electrodes produce electrical impulses that regulate abnormal impulses. DBS is commonly used for treatment of intractable tremors as a consequence of Parkinson's disease with appropriate assessment of the independence in his/her daily life to meet the medical necessity.

• Epilepsy

• Parkinson Disease

   

   

Brachytherapy

Brachytherapy is a type of internal radiation therapy, also known as interstitial radiation, intracavitary radiation, or internal radiation therapy. It is a radiotherapy technique where radioactive devices are inserted near tumors to safely deliver high doses of radiation to eliminate and shrink tumors. Brachytherapy is commonly used in conjunction with surgical management.

• Breast cancer

• Eye tumors

• Genitourinary cancers (including penile cancer, bladder cancer, prostate cancer, urethral cancer)

• Gynecologic cancers (including cervical, endometrial, vaginal or vulvar cancer)

• Head and neck cancers (including buccal mucosa cancer, lip cancer, mouth cancer, nasopharyngeal cancer, salivary gland cancer, soft palate cancer, tonsillar fossa/pillar cancer)

• Respiratory (including lung cancer, pleural mesotheliomas)

• Gastrointestinal tract cancers (including colorectal cancer, pancreatic cancer, oesophageal cancer)

• Skin cancer

• Soft tissue sarcomas.

Gamma Knife Radiosurgery

Gamma Knife radiosurgery is a non-invasive radiation therapy for brain tumours that allow most of the patient’s healthy brain tissue to be preserved. It is a specific form of radiation therapy that focuses intense beams of gamma rays with pinpoint precision to treat brain lesions. Usually, only sedation or local anaesthesia is needed for this treatment. Patients do not have to go under the knife and its outcome is similar to that of a surgical procedure.

• Brain tumor

• Arteriovenous malformation (AVM)

• Acoustic neuroma

• Pituitary tumors

Robotic Prostatectomy

Also known as robotic-assisted laparoscopic radical prostatectomy. This laparoscopic surgery is performed using a robotic approach which can only be controlled by experienced surgeons to remove the prostate and nearby diseased tissues with more precision through small abdominal incisions. It is less invasive than conventional prostatectomy.

Prostate cancer

Targeted Therapy For Cancer

Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack certain types of cancer cells. This treatment targets proteins that help cancer cells grow and spread throughout the body.

• Lung cancer

• Breast cancer

• Colorectal cancer

• Lymphoma

• Leukaemia

Cartilage Scaffold Treatment

Biological scaffold is designed to repair traumatic or arthrosis chondropathy. It aims to regenerate cartilage, reduce pain and delay joint replacement.

Knee, anke, and hip joint cartilage disorders.

Fistula Tract Laser Closure (FiLaC)

FiLaC is a less invasive surgery for treatment of complicated perianal fistula which are located within closed proximity of sphincter muscle. The FiLaC procedure is performed using a specialised thin fiber probe that generate laser heat energy. The laser fiber is introduced into the fistula tract via the external orifice which then delivered laser energy, causing shrinkage of the fistula tract around the fiber.

Complex and recurrent perianal fistula with high protential of sphincter incontinence.