Carcinoma in situ (non-invasive cancer)

partially covered

Definition

Carcinoma in situ is defined as any tumour histologically confirmed to be a carcinoma in situ (superficial cancer which has not invaded the organ of origin) and that is classified as (Tis).


The diagnosis of cancer must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

No benefit will be payable under this condition for:

  • All tumours which are histologically described as benign, pre-malignant; borderline malignant, low malignant potential; all grades of dysplasia, all grades of squamous intraepithelial lesions (HSIL and LSIL), and all grades of intra-epithelial neoplasia unless considered to be Tis;
  • Carcinoma in situ of the skin;
  • Melanoma in situ;
  • Ductal Carcinoma in situ of the Breast or Lobular Carcinoma in situ of the Breast (covered elsewhere);
  • Stage TaN0M0 papillary urothelial carcinoma of the bladder; or
  • All cancers only identified from tumour cells, pieces of DNA, or any other biomarkers, any of which may be present in the blood, saliva, urine, or other bodily fluids, including, but not limited to, tests known as “liquid biopsies”.

For the purposes of this exclusion, the terms “Tis and carcinoma in situ as per AJCC classification” are to be applied as defined in the American Joint Committee on Cancer (AJCC) Staging Manual, 8 th Edition, 2018.

Carcinoma in situ (CIS) of the Breast Treated with Total Mastectomy

partially covered

Definition

The actual undergoing of a mastectomy to totally remove one or both breast(s) due to a diagnosis of carcinoma in situ of the breast (CIS).

The surgery must be considered medically necessary, be supported by appropriate pathology reports and performed by a Specialist.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for general conditions that apply to all cancer conditions covered under this Policy.

No Early Condition Benefit will be payable under this condition for Carcinoma in situ (CIS) of the breast treated by any other means other than total mastectomy.

Chronic Lymphocytic Leukemia - Stage 0

partially covered

Definition

A definite diagnosis of Chronic Lymphocytic Leukemia Rai stage 0.

The diagnosis of Chronic Lymphocytic Leukemia Rai stage 0 must be confirmed by blood tests or other clinically approved diagnostic tests and made by a Specialist.

For the purposes of this definition, the term “Rai stage 0” is to be applied as set out in KR Rai, A Sawitsky, EPConkite, AD Chanana, RN Levy and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood46:219, 1975.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Dermatofibrosarcoma

partially covered

Definition

A definite diagnosis of Dermatofibrosarcoma which is confined to the skin (which includes the epidermis, dermis and hypodermis/subcutaneous tissue), without lymph node or distant metastasis.

The diagnosis of Dermatofibrosarcoma must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Breast Cancer: Ductal Carcinoma in situ of the Breast or Lobular Carcinoma in situ of the Breast

partially covered

Definition

A definite diagnosis of Ductal Carcinoma in situ of the Breast or Lobular Carcinoma in situ of the Breast.

The diagnosis of Early-Stage Breast Cancer: Ductal Carcinoma in situ of the Breast or Lobular Carcinoma in situ of the Breast must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Gastrointestinal Stromal Tumour (GIST)

partially covered

Definition

A definite diagnosis of Gastrointestinal Stromal Tumour, classified as AJCC prognostic Stage 1 tumour.

The diagnosis of Early-Stage Gastrointestinal Stromal Tumour must be made by a Specialist and must be confirmed by a final pathology report.

For the purposes of this Policy:

  • The term AJCC prognostic Stage 1 is as defined in the American Joint Committee on Cancer (AJCC) Staging Manual, 8 th Edition, 2018.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Malignant Melanoma

partially covered

Definition

A definite diagnosis of Malignant Melanoma of the skin that is less than or equal to 1.0 mm in thickness, without ulceration, lymph node or distant metastasis.

The diagnosis of Early-Stage Malignant Melanoma must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Neuroendocrine Tumours (including carcinoid tumours)

partially covered

Definition

A definite diagnosis of an Early-Stage Neuroendocrine Tumours classified as AJCC prognostic Stage 1 tumour.

The diagnosis of Early-Stage Neuroendocrine Tumours must be made by a Specialist and must be confirmed by a final pathology report.

For the purposes of this Policy:

  • The term AJCC prognostic Stage 1 is as defined in the American Joint Committee on Cancer (AJCC) Staging Manual, 8th Edition, 2018.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Papillary Thyroid Cancer or Follicular Thyroid Cancer

partially covered

Definition

A definite diagnosis of Papillary Thyroid Cancer or Follicular Thyroid Cancer, or both, that is less than or equal to 2.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis.

The diagnosis of Early-Stage Papillary Thyroid Cancer or Follicular Thyroid Cancer must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Prostate Cancer

partially covered

Definition

A definite diagnosis of Prostate Cancer that is either T1a or T1b tumour of the prostate, without lymph node or distant metastasis.

The diagnosis of stage T1a or T1b Prostate Cancer must be made by a Specialist and must be confirmed by a final pathology report.

For the purposes of this Policy:

  • T1a or T1b prostate cancer means a clinically inapparent tumour that was not palpable on digital rectal examination and was incidentally found in resected prostatic tissue; and
  • The terms T1a and T1b are as defined in the American Joint Committee on Cancer (AJCC) Staging Manual, 8 th Edition, 2018.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 for terms that apply to all cancer-related conditions covered under this Policy.

Early-Stage Prostate Cancer Treated with Radical Prostatectomy

partially covered

Definition

The actual undergoing of a radical prostatectomy to totally remove the entire prostate gland for the diagnosis of Early-Stage Prostate Cancer which is defined as a T1a or T1b tumour of the prostate.

The surgery must be considered medically necessary, be supported by appropriate pathology reports and performed by a Specialist.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for general conditions that apply to all cancer conditions covered under this Policy.

No Early Condition Benefit will be payable under this condition for Early-Stage Prostate Cancer (T1a or T1b) treated by any other means other than radical prostatectomy.

Primary Cutaneous Lymphoma

partially covered

Definition

A definite diagnosis of primary cutaneous T-cell, NK-cell, or B-cell lymphoma which are confined to the skin (which includes the epidermis, dermis and hypodermis/subcutaneous tissue), without lymph node or distant metastasis.

The diagnosis of cutaneous lymphoma without distant metastasis must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

Cancer of specified severity

fully covered

Definition

A definite diagnosis of a malignant tumour as evidenced by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The term cancer includes carcinoma, melanoma, leukemia, non-cutaneous lymphoma, and non-cutaneous sarcoma.


The diagnosis of cancer must be made by a Specialist and must be confirmed by a final pathology report.

Waiting Period

There is no Waiting Period for this condition.

Exclusions

Please see Section 1.7 in the Sample Policy for terms that apply to all cancer-related conditions covered under this Policy.

No Critical Illness Benefit will be payable under this condition for the following:

  • Lesions described as benign, non-invasive, pre-malignant, of low and/or uncertain malignant potential, borderline, carcinoma in-situ, or tumours classified as Tis or Ta;
  • All grades of dysplasia, all grades of squamous intraepithelial lesions (HSIL and LSIL), and all grades of intra-epithelial neoplasia;
  • Malignant melanoma of skin that is less than or equal to 1.0 mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis;
  • All ocular (uveal) melanomas confined to the eye unless treatment with resective surgery, brachytherapy, external beam radiotherapy, chemotherapy, or targeted systemic therapy has been undertaken;
  • Any non-melanoma skin cancer, without lymph node or distant metastasis. This includes but is not limited to, cutaneous lymphoma, dermatofibrosarcoma, basal cell carcinoma, squamous cell carcinoma or Merkel cell carcinoma, all of which are confined to the skin (which includes the epidermis, dermis and hypodermis/subcutaneous tissue);
  • Prostate cancer classified as T1a or T1b, without lymph node or distant metastasis;
  • Papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis
  • All bone marrow malignancies and non-cutaneous lymphomas (including, but not limited to, leukemia, myeloproliferative neoplasms, essential thrombocythemia, primary myelofibrosis, polycythemia vera, and myelodysplastic syndrome), unless the bone marrow malignancy or non-cutaneous lymphoma requires treatment with systemic chemotherapy, targeted cancer therapies, bone marrow transplant or hematopoietic stem cell transplant, or a permanent reliance on blood product replacement or therapeutic phlebotomies;
  • All neuroendocrine tumours (including carcinoid tumours) and gastrointestinal stromal tumors that are AJCC prognostic Stage I or less;
  • Thymomas (stage 1) confined to the thymus, without evidence of invasion into the capsule or spread beyond the thymus; or
  • All cancers only identified from tumour cells, genetic material, or any other biomarkers, any of which may be present in the blood, saliva, urine, or other bodily fluids, including, but not limited to, tests known as “liquid biopsies”.

For the purposes of this Policy:

  • T1a or T1b prostate cancer means a clinically inapparent tumour that was not palpable on digital rectal examination and was incidentally found in resected prostatic tissue;
  • The terms Tis, Ta, T1a, T1b, T1, Stage 1 and AJCC prognostic Stage 1 are as defined in the American Joint Committee on Cancer (AJCC) Staging Manual, 8th Edition, 2018; and
  • The term Rai stage 0 is as defined in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975.