Heart Attack

fully covered

Definition

A rise and fall of biochemical cardiac markers to levels considered diagnostic of myocardial infarction, with at least one of the following:

  • Heart attack symptoms;
  • New electrocardiogram (ECG) changes consistent with a heart attack; or
  • Development of new pathological Q waves on ECG following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and/or coronary angioplasty


The diagnosis of Heart Attack must be made by a Specialist.


Waiting Period

30 days following the date the condition was diagnosed.

Exclusions

We will not pay a Critical Illness Benefit under this condition for:

  • ECG changes suggestive of a prior myocardial infarction;
  • Other acute coronary syndromes, including angina pectoris and unstable angina; or
  • Elevated cardiac biomarkers and/or symptoms that are due to medical procedures or diagnoses other than heart attack.

Heart Valve Replacement or Repair

fully covered

Definition

The undergoing of surgery to replace any heart valve with either a natural or mechanical valve, or to repair heart valve defects or abnormalities.

The surgery must be determined to be medically necessary by a Specialist.

Waiting Period

30 days following the date of surgery.

Exclusions

We will not pay a Critical Illness Benefit under this condition for:

  • Angioplasty (this is covered as an Covered Early Condition);
  • Intra-arterial procedures;
  • Percutaneous trans-catheter procedures; or
  • Non-surgical procedures.

Coronary Artery Bypass Surgery

fully covered

Definition

The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s).


The surgery must be determined to be medically necessary by a Specialist.

Waiting Period

30 days following the date of your surgery.

Exclusions

We will not pay a Critical Illness Benefit under this condition for:

  • Angioplasty (this is a Covered Early Condition);
  • Intra-arterial procedures;
  • Percutaneous trans-catheter procedures; or
  • Non-surgical procedures.

Aortic Surgery

fully covered

Definition

The undergoing of surgery for disease of the aorta requiring excision and surgical replacement of any part of the diseased aorta with a graft. Aorta means the thoracic and abdominal aorta but not its branches.


The surgery must be determined to be medically necessary by a Specialist.



Waiting Period

30 days following the date of surgery.

Exclusions

We will not pay a Critical Illness Benefit under this condition for:

  • Angioplasty (this is a Covered Early Condition);
  • Intra-arterial procedures;
  • Percutaneous trans-catheter procedures; or
  • Non-surgical procedures.

Cardiomyopathy

fully covered

Definition

A definite diagnosis of a non-alcohol related dilated, ischemic, hypertrophic and restrictive forms of cardiomyopathy. Cardiac imaging must show permanent left ventricular dysfunction as evidenced by one of the following:

  • Left ventricular ejection fraction of ≤35%;
  • Severe Grade III restrictive left ventricular diastolic dysfunction; or
  • Heart failure due to one of the above forms of cardiomyopathy which has required cardiac resynchronization therapy (CRT) upon the advice of an accredited electrophysiologist. CRT refers to biventricular pacing for the purposes of resynchronizing cardiac contractility in heart failure. This criterion does not apply to devices deployed purely for the treatment of electrical conduction system disease of the heart.


The Cardiomyopathy must result in permanent functional impairment to at least Class III of the New York Heart Association (NYHA) Classification which has persisted for at least six months while on optimal therapy. NYHA Class III means the Policyholder has marked limitation of physical activity and less than ordinary activity such as walking across a room causes fatigue, rapid/irregular heartbeat (palpitations) or shortness of breath (dyspnea).

The diagnosis of a Cardiomyopathy must be made by a Specialist.

Waiting Period

Until the criteria outlined above for this condition have been met.

Exclusions

We will not pay a Critical Illness Benefit under this condition for any form of Cardiomyopathy that is caused directly or indirectly by alcohol use.

Aortic Aneurysm (of specified severity)

partially covered

Definition

A definite diagnosis of aortic aneurysm, where the aorta is enlarged to at least 55 mm in diameter for males or 50 mm for females.

For the purposes of this definition, "aorta" means the thoracic and abdominal aorta, but not its branches.

The diagnosis of aortic aneurysm must be evidenced by appropriate imaging technique and confirmed by a Specialist.

Waiting Period

30 days after the date of diagnosis.

Exclusions

None

Coronary Angioplasty

partially covered

Definition

The undergoing of any interventional procedure to widen a narrowed or obstructed coronary artery which supplies blood to the heart.

The procedure must be considered medically necessary and performed by a Specialist.

Waiting Period

30 days following the date of your surgery.

Exclusions

None

Endovascular Aortic Surgery

partially covered

Definition

The actual undergoing of a percutaneous trans-vascular, catheter-based procedure to repair or correct an aneurysm, narrowing, obstruction or dissection of the aorta. For the purposes of this definition, "aorta" means the thoracic and abdominal aorta, but not its branches.

The surgical procedure must be considered medically necessary, evidenced by appropriate investigations and performed by a Specialist.

Waiting Period

30 days following the date of your surgery.

Exclusions

None

Implantation of a Permanent Cardiac Pacemaker

partially covered

Definition

The actual undergoing of the Implantation of a Permanent Cardiac Pacemaker for the treatment of electrical conduction system disease of the heart.

The procedure must be supported by appropriate investigations and be both deemed medically necessary and performed by a Specialist.

Waiting Period

30 days following the date of your surgery.

Exclusions

No Early Condition Benefit will be payable under this condition for:

  • Implantation of a non-permanent cardiac pacemaker; or
  • The use of a temporary cardiac pacemaker.

Implantation of a Permanent Implantable Cardioverter-Defibrillator (ICD)

partially covered

Definition

The actual undergoing of the Implantation of a Permanent Implantable Cardioverter-Defibrillator (ICD).

This definition covers for two types of permanent implantable cardioverter-defibrillator (ICD) systems: the conventional transvenous implantable cardioverter-defibrillator (TV-ICD) and the subcutaneous implantable cardioverter-defibrillator (S-ICD).

The procedure must be supported by appropriate investigations and be both deemed medically necessary and performed by a Specialist.

In addition, based on the opinion of an expert electrophysiologist, there must have been the deployment of a permanent implantable cardioverter-defibrillator for one of the following reasons:

  • Documented arrhythmias; or
  • Presumed arrhythmogenic syncope; or
  • As a primary prevention strategy where there is an expert view that the claimant is at a high risk of a lethal arrhythmia.

Waiting Period

30 days following the date of your surgery.

Exclusions

No Early Condition Benefit will be payable under this condition for:

  • Implantation of a non-permanent implantable cardioverter-defibrillator (ICD);
  • Use of a wearable (temporary) cardioverter-defibrillator.

No Early Condition Benefit will be payable under this condition if the Policyholder has received a payout for the Implantation of a Permanent Cardiac Pacemaker.