Bacterial Meningitis

fully covered

Definition

A definite diagnosis of meningitis, confirmed by cerebrospinal fluid showing the presence of pathogenic bacteria. The presence of pathogenic bacteria must be confirmed by culture or other generally medically accepted microbiological testing. The Bacterial Meningitis must result in objective Neurological Deficits persisting for at least 90 days from the date of diagnosis.
The diagnosis of Bacterial Meningitis 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 viral meningitis.

Benign Brain Tumour

fully covered

Definition

A definite diagnosis of a non-malignant tumour located in the cranial vault and limited to the brain, meninges, cranial nerves or pituitary gland. The tumour must require surgical or radiation treatment or cause irreversible objective Neurological Deficit(s).

These deficits must be corroborated by diagnostic imaging showing changes that are consistent in character,location, and timing with the Neurological Deficit(s).

The diagnosis of a Benign Brain Tumour must be made by a Specialist.

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

  • Pituitary adenomas less than 10 mm;
  • Vascular malformations;
  • Cholesteatomas; or
  • Infectious or inflammatory tumours.

Coma

fully covered

Definition

A definite diagnosis of a state of unconsciousness, with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow Coma Score must be 4 or less.


The diagnosis 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 for the following conditions:

  • A medically induced coma;
  • A coma which results directly from alcohol or drug use; or
  • A diagnosis of brain death.

Dementia, including Alzheimer’s Disease

fully covered

Definition

A definite diagnosis of Dementia characterized by a progressive deterioration of memory and at least one of the following areas of cognitive function:

  • Aphasia (a disorder of speech);
  • Apraxia (difficulty performing familiar tasks);
  • Agnosia (difficulty recognizing objects); or
  • Disturbance in executive functioning (e.g. inability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behaviour), which is affecting daily life.

The Policyholder must exhibit:

  • Dementia of at least moderate severity, which must be evidenced by a Mini Mental State exam of 20/30 or less, or equivalent score on another generally medically accepted test or tests of cognitive function; and
  • Evidence of progressive worsening in cognitive and daily functioning either by serial cognitive tests or by history over at least a six-month period.

For purposes of this Policy, reference to the Mini Mental State exam is to Folstein MF, Folstein SE, McHugh PR, J Psychiatr Res 1975;12(3):189.

The diagnosis of Dementia 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 affective or schizophrenic disorders, or delirium.

Motor Neuron Disease (including ALS)

fully covered

Definition

A definite diagnosis of one of the following:

  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease);
  • Primary lateral sclerosis;
  • Progressive spinal muscular atrophy;
  • Progressive bulbar palsy; or
  • Pseudo bulbar palsy.

The diagnosis of Motor Neuron Disease must be made by a Specialist.


Waiting Period

There is no Waiting Period for this condition.

Exclusions

None

Paralysis

fully covered

Definition

A definite diagnosis of the total loss of muscle function of two or more limbs as a result of injury or disease tothe nerve supply of those limbs, for a period of at least 90 days following the precipitating event.

The diagnosis of Paralysis must be made by a Specialist.

Waiting Period

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

Exclusions

None

Parkinson’s Disease and Specified Atypical Parkinsonian Disorders

fully covered

Definition

A definite diagnosis of primary Parkinson’s Disease, a permanent neurologic condition which must becharacterized by bradykinesia (slowness of movement) and at least one of muscle rigidity; or rest tremor.

The Policyholder must exhibit objective signs of progressive deterioration in function for at least one year, for which the treating neurologist has recommended dopaminergic medication or other generally medically accepted equivalent treatment for Parkinson’s Disease.

Specified Atypical Parkinsonian Disorders are defined as a definite diagnosis of progressive supranuclear palsy,corticobasal degeneration, or multiple system atrophy.

The diagnosis of Parkinson’s Disease or a Specified Atypical Parkinsonian Disorder must be made by aneurologist.

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 other types of Parkinsonism.

1-year exclusion:

We will not pay a Critical Illness Benefit under this condition if, within the first year following the later of: (i) the Effective Date; and (ii) the most recent Effective Date of Reinstatement, the Policyholder has any of the following:

  • Signs, symptoms or investigations leading directly or indirectly to a diagnosis of Parkinson’s Disease, a Specified Atypical Parkinsonian Disorder or any other type of parkinsonism, regardless of when the diagnosis is made; or
  • A diagnosis of Parkinson’s Disease, or a Specified Atypical Parkinsonian Disorder or any other type of parkinsonism.

Medical information about the diagnosis and any signs, symptoms or investigations leading to the diagnosis must be reported to us within six months of the date of the diagnosis. If this information is not provided within this period, we have the right to deny any claim for Parkinson’s Disease or Specified Atypical Parkinsonian Disorders or any critical illness caused by Parkinson’s Disease or Specified Atypical Parkinsonian Disorders or its treatment.

Stroke (cerebrovascular accident resulting in persistent neurological deficits)

fully covered

Definition

A definite diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis or hemorrhage, or embolism, with:

  • Acute onset of new neurological symptoms; and
  • New objective Neurological Deficits on clinical examination,

persisting continuously for more than 30 days following the date of diagnosis. These new symptoms and deficits must be corroborated by diagnostic imaging testing showing changes that are consistent in character, location and timing with the new Neurological Deficits.

The diagnosis of Stroke 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:

  • Transient Ischemic Attacks;
  • Intracerebral vascular events due to trauma;
  • Ischaemic disorders of the vestibular system;
  • Death of tissue of the optic nerve or retina without total loss of vision of that eye; or
  • Lacunar infarcts which do not meet the definition of stroke as described above

Acquired Brain Injury

fully covered

Definition

A definite diagnosis of new damage to brain tissue caused by traumatic head injury, resulting in a newly developed significant Neurological Deficit (defined in Section 3 – Definitions) that:

  • Results from an external trauma severe enough to have prompted the Policyholder to seek a medical consultation in less than a week after the occurrence of the trauma;
  • Is present and verifiable on clinical examination;
  • Is corroborated by abnormal magnetic resonance (MR) and/or computed tomography (CT) brain imaging studies, that confirm brain trauma; and
  • Persists for more than 180 consecutive days following the date of diagnosis.


The diagnosis of Acquired Brain Injury must be made by a Specialist.



Waiting Period

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

Exclusions

We will not pay the Critical Illness Benefit for this condition for:

  • An abnormality seen on imaging studies of the brain without corresponding clinical impairment;
  • Neurological deficit without corresponding imaging study lesions; and
  • A concussion that does not have abnormal imaging studies.