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Financial Protection Critical Illness Definitions | Critical Illness Definitions |
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 The following model definitions are extracted from the ABI's Statement of Best Practice for Critical Illness Cover (May 2002). Each model definition represents a minimum standard of cover that ABI members selling critical illness insurance must offer, if the policy covers that condition (all ABI members must cover at least heart attack, cancer and stroke).Companies are free to offer more generous cover if they wish, so you may find that the particular policy you are looking at uses a different definition for a particular condition. It is the definitions on the policy you purchase, rather than the model definitions below, which will be applied in the event of you claiming on your policy. But if the policy comes from an ABI member, and a different definition is used, you can be sure that it will be more favourable than the model definition. If you are in any doubt about the status of the model definitions below, you should read the whole of the ABI Statement of Best Practice for Critical Illness Cover. A. The Model Definitions for the Core ConditionsCancerAny malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkin’s disease but the following are excluded: • All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ. • All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0M0. • All forms of lymphoma in the presence of any Human Immunodeficiency Virus. • Kaposi's sarcoma in the presence of any Human Immunodeficiency Virus. • Any skin cancer other than invasive malignant melanoma. Coronary artery by-pass surgery The undergoing of open heart surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts but excluding balloon angioplasty, laser relief or any other procedures. Heart attack The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: • typical chest pain; • new characteristic electrocardiographic changes; • the characteristic rise of cardiac enzymes, troponins or other biochemical markers; • where all of the above shows a definite acute myocardial infarction. Other acute coronary syndromes, including but not limited to angina, are not covered under this definition. Kidney failure End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated. Major organ transplant The actual undergoing as a recipient of, or inclusion on an official UK waiting list for, a transplant of a heart, liver, lung, pancreas or bone marrow. Multiple sclerosis A definite diagnosis by a Consultant Neurologist of Multiple Sclerosis which satisfies all of the following criteria: • There must be current impairment of motor or sensory function, which must have persisted for a continuous period of at least six months. • The diagnosis must be confirmed by diagnostic techniques current at the time of the claim. Stroke A cerebrovascular incident resulting in permanent neurological damage. Transient Ischaemic Attacks are specifically excluded. B. The Model Definitions for Additional ConditionsAorta graft surgeryUndergoing surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches. Benign brain tumour A non-malignant tumour in the brain resulting in permanent deficit to the neurological system. Tumours or lesions in the pituitary gland are not covered. Blindness Total permanent and irreversible loss of all sight in both eyes. Coma A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously with the use of life support systems for a period of at least 96 hours and resulting in permanent neurological deficit. Coma secondary to alcohol or drug misuse is not covered. Deafness Total permanent and irreversible loss of all hearing in both ears. Heart valve replacement or repair Undergoing open heart surgery from medical necessity to replace or repair one or more heart valves. Loss of limbs The permanent physical severance of two or more limbs from above the [elbow/wrist] or [knee/ankle] joint. Loss of speech Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease. Motor neurone disease [before age x] Confirmation by a Consultant Neurologist of a definite diagnosis of Motor Neurone Disease [before age x]. Paralysis / paraplegia Total irreversible loss of muscle function or sensation to the whole of any two limbs as a result of injury or disease. The disability must be permanent and supported by appropriate neurological evidence. Parkinson’s disease [before age x] Confirmation by a Consultant Neurologist of a definite diagnosis of Parkinson’s Disease [before age x]. Parkinson’s Disease secondary to alcohol or drug misuse is not covered. Terminal illness Advanced or rapidly progressing incurable illness where, in the opinion of an attending Consultant and our Chief Medical Officer, the life expectancy is no greater than 12 months. [AIDS is specifically excluded and not covered under this definition.] Third degree burns Third degree burns covering at least 20% of the body surface area. C. The Model Definitions for ExclusionsAviationTaking part in any flying activity, other than as a passenger in a commercially licensed aircraft. Criminal acts Taking part in a criminal act. Drug abuse Alcohol or solvent abuse, or the taking of drugs except under the direction of a registered medical practitioner. Failure to follow medical advice Unreasonable failure to seek or follow medical advice. Hazardous sports and pastimes Taking part in (or practising for) boxing, caving, climbing, horse-racing, jet skiing, martial arts, mountaineering, off-piste skiing, pot-holing, power-boat racing, under-water diving, yacht racing or any race, trial or timed motor sport. HIV/AIDS Infection with Human Immunodeficiency Virus (HIV) or conditions due to any Acquired Immune Deficiency Syndrome (AIDS). Living abroad Living outside of the European Union for more than 13 consecutive weeks in any 12 months. Self-inflicted injury Intentional self-inflicted injury. War and civil commotion War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution or taking part in a riot or civil commotion. - - - - - Information kindly provided by the Association of British Insurers (ABI) Further information can be obtained from: http://www.abi.org.uk |
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