Common definitions of Dread Diseases covered by TM Asia Life

1. ALZHEIMER'S DISEASE
   Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging tests, arising from Alzheimer's disease or irreversible organic disorders, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the Life Assured. This diagnosis must be supported by the clinical confirmation of an appropriate consultant and supported by the company's appointed doctor.
   
   The following are excluded :
   
   1. non-organic diseases such as neurosis and psychiatric illnesses; and
   2. alcohol related brain damage.


2. APLASTIC ANAEMIA
   Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following :
   
   1. blood product transfusion;
   2. marrow stimulating agents;
   3. immunosuppressive agents; or
   4. bone marrow transplantation.
   
   The diagnosis must be confirmed by a haematologist.
   


3. BACTERIAL MENINGITIS
   Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant, irreversible and permanent neurological deficit. The neurological deficit must persist for at least 6 weeks. This diagnosis must be confirmed by :
   
   1. the presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and
   2. a consultant neurologist.
   
   Bacterial Meningitis in the presence of HIV infection is excluded.
   


4. BENIGN BRAIN TUMOUR
   A benign tumour in the brain where all of the following conditions are met :
   
   1. it is life threatening;
   2. it has caused damage to the brain;
   3. it has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit; and
   4. its presence must be confirmed by a neurologist or neurosurgeon and supported by findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques.
   
   The following are excluded :
   
   1. cysts;
   2. granulomas;
   3. vascular malformations;
   4. haematomas; and
   5. tumours of the pituitary gland or spinal cord.


5. BLINDNESS (LOSS OF SIGHT)
   Total and irreversible loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an ophthalmologist.
   


6. COMA
   A coma that persists for at least 96 hours. This diagnosis must be supported by evidence of all of the following :
   
   1. no response to external stimuli for at least 96 hours;
   2. life support measures are necessary to sustain life; and
   3. brain damage resulting in permanent neurological deficit which must be assessed at least 30 days after the onset of the coma.
   
   Coma resulting directly from alcohol or drug abuse is excluded.
   


7. CORONARY ARTERY BY-PASS SURGERY
   The actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist.
   
   Angioplasty and all other intra arterial, catheter based techniques, 'keyhole' or laser procedures are excluded.
   


8. DEAFNESS (LOSS OF HEARING)
   Total and irreversible loss of hearing in both ears as a result of illness or accident. This diagnosis must be supported by audiometric and sound-threshold tests provided and certified by an Ear, Nose, Throat (ENT) specialist.
   
   Total means "the loss of at least 80 decibels in all frequencies of hearing".
   


9. ENCEPHALITIS
   Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum) caused by viral infection and resulting in permanent neurological deficit. This diagnosis must be certified by a consultant neurologist and the permanent neurological deficit must be documented for at least 6 weeks.
   
   Encephalitis caused by HIV infection is excluded.
   


10. END STAGE LIVER DISEASE
    End stage liver failure as evidenced by all of the following :
    
    1. permanent jaundice;
    2. ascites; and
    3. hepatic encephalopathy.
    
    Liver disease secondary to alcohol or drug abuse is excluded.
    


11. END STAGE LUNG DISEASE
    End stage lung disease, causing chronic respiratory failure. This diagnosis must be supported by evidence of all of the following :
    
    1. FEV1 test results which are consistently less than 1 litre;
    2. permanent supplementary oxygen therapy for hypoxemia;
    3. arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 = 55mmHg); and
    4. dyspnea at rest.
    
    The diagnosis must be confirmed by a respiratory physician.
    


12. FULMINANT HEPATITIS
    A submassive to massive necrosis of the liver by the Hepatitis virus, leading precipitously to liver failure. This diagnosis must be supported by all of the following :
    
    1. rapid decreasing of liver size;
    2. necrosis involving entire lobules, leaving only a collapsed reticular framework;
    3. rapid deterioration of liver function tests;
    4. deepening jaundice; and
    5. hepatic encephalopathy.


13. HEART ATTACK
    Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. This diagnosis must be supported by three or more of the following five criteria which are consistent with a new heart attack :
    
    1. history of typical chest pain;
    2. new electrocardiogram (ECG) changes proving infarction;
    3. diagnostic elevation of cardiac enzyme CK-MB;
    4. diagnostic elevation of Troponin (T or I);
    5. left ventricular ejection fraction less than 50% measured 3 months or more after the event.


14. HEART VALVE SURGERY
    The actual undergoing of open-heart surgery to replace or repair heart valve abnormalities.
    
    The diagnosis of heart valve abnormality must be supported by cardiac catheterization or echocardiogram and the procedure must be considered medically necessary by a consultant cardiologist.
    


15. HIV DUE TO BLOOD TRANSFUSION AND OCCUPATIONALLY ACQUIRED (HIV)
    
    1. Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following conditions are met :
       
       1. The blood transfusion was medically necessary or given as part of a medical treatment;
       2. The blood transfusion was received in Singapore after the date of issue of the Policy or Rider, as the case may be, or the reinstatement of the Policy, whichever is the later;
       3. The source of the infection is established to be from the Institution that provided the blood transfusion and the Institution is able to trace the origin of the HIV tainted blood; and
       4. The Life Assured does not suffer from Thalassaemia Major or Haemophilia.
    
    
    2. Infection with the Human Immunodeficiency Virus (HIV) which resulted from an accident occurring after the date of issue of the Policy or Rider as the case may be, or reinstatement of the Policy, whichever is the later whilst the Life Assured was carrying out the normal professional duties of his or her occupation in Singapore, provided that all of the following are proven to the company's satisfaction :
       
       1. Proof of the accident giving rise to the infection must be reported to the Society within 30 day of the accident taking place;
       2. Proof that the accident involved a definite source of the HIV infected fluids;
       3. Proof of sero-conversion from HIV negative to HIV positive occurring during the 180 days after the documented accident. This proof must include a negative HIV antibody test conducted within 5 days of the accident; and
       4. HIV infection resulting from any other means including sexual activity and the use of intravenous drugs is excluded.
    
    This benefit is only payable when the occupation of the Life Assured is a medical practitioner, houseman, medical student, state registered nurse, medical laboratory technician, dentist (surgeon and nurse) or paramedical worker, working in medical centre or clinic (in Singapore).
    
    This benefit will not apply under either section (a) or (b) where a cure has become available prior to the infection. "Cure" means any treatment that renders the HIV inactive or non-infectious.
    


16. KIDNEY FAILURE
    Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation.
    


17. LOSS OF SPEECH
    Total and irrecoverable loss of the ability to speak as a result of injury or disease to the vocal cords. The inability to speak must be established for a continuous period of 12 months. This diagnosis must be supported by medical evidence furnished by an Ear, Nose, Throat (ENT) specialist.
    
    All psychiatric related causes are excluded.
    


18. MAJOR BURNS
    Third degree (full thickness of the skin) burns covering at least 20% of the surface of the Life Assured's body.
    


19. MAJOR CANCERS
    A malignant tumour characterised by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. This diagnosis must be supported by histological evidence of malignancy and confirmed by an oncologist or pathologist.
    
    The following are excluded :
    
    1. tumours showing the malignant changes of carcinoma-in-situ and tumours which are histologically described as pre-malignant or non-invasive, including, but not limited to : Carcinoma-in-Situ of the Breasts, Cervical Dysplasia CIN-1, CIN-2 and CIN-3;
    2. hyperkeratoses, basal cell and squamous skin cancers, and melanomas of less than 1.5mm Breslow thickness, or less than Clark Level 3, unless there is evidence of metastases;
    3. prostate cancers histologically described as TNM Classification, T1a or T1b or Prostate cancers of another equivalent or lesser classification, T1N0M0 Papillary micro-carcinoma of the Thyroid less than 1 cm in diameter, Papillary micro-carcinoma of the Bladder, and Chronic Lymphocytic Leukaemia less than RAI Stage 3; and
    4. all tumours in the presence of HIV infection.


20. MAJOR ORGAN TRANSPLANTATION
    The receipt of a transplant of :
    
    1. human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation; or
    2. one of the following human organs : heart, lung, liver, kidney, pancreas, that resulted from irreversible end stage failure of the relevant organ.
    
    Other stem cell transplants are excluded.
    


21. MOTOR NEURONE DISEASE
    Motor neurone disease characterised by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurones which include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis. This diagnosis must be confirmed by a neurologist as progressive and resulting in permanent neurological deficit.
    


22. MULTIPLE SCLEROSIS
    The definite occurrence of Multiple Sclerosis. The diagnosis must be supported by all of the following :
    
    1. investigations which unequivocally confirm the diagnosis to be Multiple Sclerosis;
    2. multiple neurological deficits which occurred over a continuous period of at least 6 months; and
    3. well documented history of exacerbations and remissions of said symptoms or neurological deficits.
    
    Other causes of neurological damage such as SLE and HIV are excluded.
    


23. MUSCULAR DYSTROPHY
    A group of hereditary degenerative diseases of muscle characterised by weakness and atrophy of muscle. The diagnosis of muscular dystrophy must be unequivocal and made by a consultant neurologist. The condition must result in the inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living" for a continuous period of at least 6 months :
    
    Activities of Daily Living :
    
    1. Washing - the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means;
    2. Dressing - the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances;
    3. Transferring - the ability to move from a bed to an upright chair or wheelchair and vice versa;
    4. Mobility - the ability to move indoors from room to room on level surfaces;
    5. Toileting - the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
    6. Feeding - the ability to feed oneself once food has been prepared and made available.


24. PARALYSIS (LOSS OF USE OF LIMBS)
    Total and irreversible loss of use of at least 2 entire limbs due to injury or disease. This condition must be confirmed by a consultant neurologist.
    
    Self-inflicted injuries are excluded.
    


25. PARKINSON'S DISEASE
    The unequivocal diagnosis of idiopathic Parkinson's Disease by a consultant neurologist. This diagnosis must be supported by all of the following conditions :
    
    1. the disease cannot be controlled with medication;
    2. signs of progressive impairment; and
    3. inability of the Life Assured to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living" for a continuous period of at least 6 months :
    
    Activities of Daily Living :
    
    1. Washing - the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means;
    2. Dressing - the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances;
    3. Transferring - the ability to move from a bed to an upright chair or wheelchair and vice versa;
    4. Mobility - the ability to move indoors from room to room on level surfaces;
    5. Toileting - the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
    6. Feeding - the ability to feed oneself once food has been prepared and made available.
    
    Drug-induced or toxic causes of Parkinsonism are excluded.
    


26. POLIOMYELITIS
    The occurrence of Poliomyelitis where the following conditions are met :
    
    1. poliovirus is identified as the cause,
    2. paralysis of the limb muscles or respiratory muscles must be present and persist for at least 3 months.


27. PRIMARY PULMONARY HYPERTENSION
    Primary Pulmonary Hypertension with substantial right ventricular enlargement confirmed by investigations including cardiac catheterisation, resulting in permanent physical impairment of at least Class IV of the New York Heart Association (NYHA) Classification of Cardiac Impairment.
    
    The NYHA Classification of Cardiac Impairment (Source: "Current Medical Diagnosis & Treatment ?39th Edition") :
    
    • Class I : No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or anginal pain.
    • Class II : Slight limitation of physical activity. Ordinary physical activity results in symptoms.
    • Class III : Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms.
    • Class IV : Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.


28. STROKE
    A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis. This diagnosis must be supported by all of the following conditions :
    
    1. evidence of permanent neurological damage confirmed by a neurologist at least 6 weeks after the event; and
    2. findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.
    
    The following are excluded :
    
    1. Transient Ischaemic Attacks;
    2. brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
    3. vascular disease affecting the eye or optic nerve; and
    4. Ischaemic disorders of the vestibular system.


29. SURGERY TO AORTA
    The actual undergoing of major surgery to repair or correct an aneurysm, narrowing, obstruction or dissection of the aorta through surgical opening of the chest or abdomen. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches.
    
    Surgery performed using only minimally invasive or intra arterial techniques are excluded.
    


30. TERMINAL ILLNESS
    The conclusive diagnosis of an illness that is expected to result in the death of the Life Assured within 12 months. This diagnosis must be supported by a specialist and confirmed by the company's appointed doctor.
    
    Terminal illness in the presence of HIV infection is excluded.