Critical illnesses are dangerous conditions that can leave you unable to work or earn an income. Generally, takaful companies provide coverage for critical illnesses in their end stages.
The following is a list of illnesses covered by AIA Public Takaful Berhad:
Stroke
- Defined as a cerebrovascular accident or event causing permanent neurological sequelae, lasting for at least six months. This includes brain tissue infarction, haemorrhage, and embolism originating from an extracranial source. The diagnosis must be based on changes observed in a CT Scan or MRI and confirmed by a qualified Consultant Neurologist.
Cancer
The manifestation of a malignant tumour, characterised by uncontrolled growth and spread of malignant cells and tissue invasion. The term cancer includes leukaemia (except chronic lymphocytic leukaemia) and Hodgkin’s disease. The diagnosis must be supported by histological evidence of malignancy. All skin cancers except malignant melanoma, all tumours histologically described as pre-malignant or showing only early malignant changes, carcinoma in situ, stage 1 Hodgkin’s disease, and papillary cancer of the bladder are excluded.
Heart Attack
Death of a portion of the heart muscle (myocardium) due to inadequate blood supply, evidenced by: a history of typical prolonged chest pain; new electrocardiographic changes resulting from this event; and elevation of cardiac enzyme (CPK-MB) levels above those generally accepted by laboratories as normal. Cardiac enzymes or biomarkers showing significant elevation indicate a recent event has occurred.
A diagnosis based solely on Troponin T testing is not considered diagnostic of a heart attack. Diagnosis of ischaemia by other means not supported by a significant increase in cardiac enzymes or biomarkers will be excluded. Angina is specifically excluded.
End-Stage Liver Failure
Diagnosis of end-stage liver disease as evidenced by all of the following:
- Permanent jaundice
- Ascites
- Encephalopathy
Liver disease secondary to alcohol or drug abuse is excluded.
End-Stage Lung Disease
The following criteria must be met:
- Requires permanent oxygen therapy due to FEV1 test results not exceeding one (1) litre. (Forced Expiratory Volume during the first second of a forced exhalation)
- Arterial Blood Gas Analysis with partial oxygen pressure of 55mmHg or less
- Dyspnoea at rest
End-Stage Kidney Failure
End-stage kidney failure due to any cause, shown as chronic irreversible failure of both kidneys to function, resulting in regular kidney dialysis or kidney transplantation.
Primary Pulmonary Arterial Hypertension
Means primary pulmonary hypertension with substantial right ventricular enlargement as determined by investigation including cardiac catheterisation, resulting in permanent physical impairment to the degree of at least Class 3 of the New York Heart Association Classification of Cardiac Impairment, and resulting in the Insured Person being unable to perform their usual occupation.
Coronary Artery Bypass Surgery
On the recommendation of a Consultant Cardiologist, undergoing open-heart surgery to correct narrowing or blockage of coronary arteries with bypass grafts. Angiographic evidence of actual disease must be provided. Angiography and Cardiac Catheterisation are excluded.
Angioplasty and Other Invasive Treatments for Major Coronary Artery Disease
Procedures used to open blocked or narrowed blood vessels or arteries of the heart. These procedures restore blood flow to the heart muscle. These procedures restore blood flow to the heart muscle.
Serious Coronary Artery Disease
Narrowing of the lumen of at least three coronary arteries by a minimum of seventy-five percent (75%). Angiographic evidence of actual disease must be provided.
Heart Valve Surgery
Undergoing replacement of one or more heart valves for the treatment of heart valve disease. Undergoing open-heart surgery to replace or repair heart valves as a consequence of heart valve defects or abnormalities occurring after the Policy and/or Annexure issue date or reinstatement date, whichever is later.
Repair via intra-arterial procedures, valvotomy, keyhole surgery or similar techniques are not included. Heart valve repair and valvatomy are specifically excluded. Heart valve repairs and valvotomies are specifically excluded.
Fulminant Viral Hepatitis
A diagnosis of liver failure characterized by severe liver necrosis caused by Fulminant Viral Hepatitis. The following diagnostic criteria must be met:
- Rapid decrease in liver size
- Necrosis involving entire lobules, leaving only a collapsed reticular framework
- Rapid deterioration of liver function
- Deepening jaundice
However, this diagnosis is excluded if it is directly or indirectly caused by suicide attempts, poisoning, drug overdose, or excessive alcohol consumption.
Aortic Surgery
Undergoing surgery for diseased aorta that requires excision and replacement of the diseased aorta with a graft. In this context, aorta refers only to the thoracic and abdominal aorta.
Chronic Aplastic Anemia
Bone marrow failure diagnosed by a hematologist as aplastic, resulting in anemia, neutropenia, and thrombocytopenia requiring treatment with at least one of the following:
- Blood product transfusion
- Bone marrow stimulating agents
- Immunosuppressive agents
- Bone marrow transplantation
Major Organ/Bone Marrow Transplant
Undergoing transplantation as a recipient of a heart (including mechanical heart), lung, liver, pancreas, or bone marrow.
Blindness – Permanent and Irreversible
Permanent and total loss of sight in both eyes, whether corrected or uncorrected. Accepted medical evidence confirming the loss of sight must be provided.
Loss of Speech
Total and irreversible loss of the ability to speak due to physical damage to the vocal cords. Accepted medical evidence confirming the loss of speech must be provided.
Coma
A state of unconsciousness with no response to external stimuli or internal needs, persisting continuously with the use of life support systems for at least ninety-six (96) hours, resulting in permanent neurological deficit. Evidence of permanent neurological deficit must be submitted as required by AIA’s underwriters.
Deafness – Permanent and Irreversible
Total and irreversible loss of hearing in both ears. Accepted medical evidence confirming the loss of hearing must be provided.
Third Degree Burns
Third-degree burns covering at least twenty percent (20%) of the body surface area.
Multiple Sclerosis
An accurate diagnosis by a consultant neurologist of Multiple Sclerosis, supported by clinical evidence of more than one clearly defined neurological deficit, with persistent signs involving the optic nerves, brain stem, and spinal cord, as well as impairment of coordination and motor and sensory functions, continuing for at least six months.
Paralysis of Limbs
Complete and permanent loss of use of both arms or both legs, or one arm and one leg, due to paralysis resulting from illness or injury persisting for at least six (6) months from the date of trauma or illness.
Muscular Dystrophy
A diagnosis of muscular dystrophy confirmed by a Consultant Neurologist, consisting of a combination of 3 out of 4 of the following conditions:
- Family history of other affected individuals
- Clinical presentation including absence of sensory disturbance, normal cerebrospinal fluid, and mild tendon reflex reduction
- Characteristic electromyogram
- Clinical suspicion confirmed by muscle biopsy
Alzheimer’s Disease / Severe Dementia
A condition of presenile dementia caused by deterioration or loss of intellectual capacity, as evidenced by clinical state and accepted standardized questionnaires or tests of Alzheimer’s disease, and irreversible organic degenerative disorders resulting in significant decline in mental and social functioning, requiring assistance with at least three of the following activities of daily living:
Activities of daily living are:
- Moving and Mobility: the ability to move from one room to an adjacent room or from one place to another within a room, or to sit down or get up from a bed or chair without requiring physical assistance from another person.
- Continence: the ability to control bladder and bowel functions in a managed way to maintain personal hygiene.
- Dressing: putting on and removing all necessary pieces of clothing without requiring assistance from others.
- Toileting: entering and exiting the toilet, sitting down on and getting up from the toilet bowl, and managing related personal hygiene.
- Eating: performing all movements to consume food that has been prepared.
- For the purpose of this benefit, “permanent” means there is no hope for recovery with current medical knowledge and technology. Neurosis and psychotic-related illnesses are excluded.
Motor Neuron Disease
An accurate diagnosis by a consultant neurologist of Motor Neuron Disease. The etiology of the disease is unknown and is characterized by progressive degeneration of the corticospinal tract and anterior horn cells or bulbar efferent neurons. This includes spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis, and primary lateral sclerosis.
Parkinson’s Disease
An accurate diagnosis by a consultant neurologist of Idiopathic Parkinson’s Disease (paralysis agitans) requiring treatment with dopamine precursors. All other forms of Parkinsonism are excluded.
Terminal Illness
A terminal illness is considered as a patient with no hope of recovery and awaiting death that may occur at any time. Criteria for terminal illness:
- Incurable disease
- Leading to death
- Clear medical diagnosis
- There is no medicine to cure
- Negative prognosis
- Progressive in nature
Encephalitis
Severe inflammation of brain substance resulting in significant and permanent neurological sequelae as confirmed by a Consultant Neurologist satisfying the association/company. Encephalitis due to HIV infection is excluded.
Benign Brain Tumor
Non-cancerous tumor in the brain. Cysts, granulomas, malformations in or of the arteries or veins of the brain, hematomas, and tumors in the pituitary gland or spine are excluded.
Major Head Trauma
Accidental head injury causing cerebral damage (as shown by modern scanning or imaging techniques and confirmed by a consultant neurologist) resulting in permanent functional impairment and inability to perform at least three of the following activities of daily living without assistance:
Bathing, dressing, eating, the ability to move in and out of a bed or chair, and controlling bowel or bladder function in a controlled manner, with or without the use of mechanical equipment, special devices or other aids and adaptations for the disabled.
For the purpose of this benefit, “permanent” means there is no hope for recovery with current medical knowledge and technology.
Bacterial Meningitis
An accurate diagnosis by a consultant neurologist of Bacterial Meningitis causing inflammation of the brain or spinal cord membranes resulting in permanent neurological deficit.
Medullary Cystic Disease
Medullary cystic kidney disease (MCKD). End-stage renal failure seen as permanent chronic damage to both kidneys resulting in their dysfunction, consequently requiring routine renal dialysis treatment or renal transplant surgery.
Brain Surgery
Undergoing brain surgery under general anesthesia when a craniotomy is performed. Brain surgery and Bur Hole due to accidents are not included.
Specifically excluded are cerebral symptoms due to transient ischemic attacks, any reversible ischemic neurological deficit, any vertebrobasilar ischemic attacks, cerebral signs due to migraine, cerebral injury due to trauma or hypoxia, and vascular disease affecting the eye or optic nerve or vestibular functions.
Loss of Independent Existence
Confirmation by a medical consultant of loss of self-capability causing permanent inability to perform at least three (3) of the following activities of daily living:
Bathing, dressing, eating, the ability to move in and out of a bed or chair, and controlling bowel or bladder function in a controlled manner, with or without the use of mechanical equipment, special devices or other aids or adaptations for the disabled.
For the purpose of this benefit, “permanent” means there is no hope for recovery with current medical knowledge and technology.
Cardiomyopathy
A disease related to the myocardium or heart muscle where there are structural and functional abnormalities of the heart muscle without the presence of chronic heart disease, hypertension, or other heart-related disorders. An accurate diagnosis by a consultant cardiologist of cardiomyopathy causing ventricular dysfunction of various etiologies and resulting in physical impairment to at least class three (III) or class four (IV) according to the New York Heart Association of Cardiac Impairment.
HIV Due to Blood Transfusion
A claim can be made if:
- The infection was caused by a blood transfusion received in Malaysia or Singapore after the start of the Policy.
- It is not a hereditary disease (Hemophilia).
- Not from high-risk groups such as but not limited to homosexuals, intravenous drug users, or sex workers.
Confirmation and proof of the incident will be required through a statement from the statutory Health Authority that the infection was medically acquired.
AIDS with Full-Blown Symptoms
The clinical disease of AIDS (Acquired Immune Deficiency Syndrome) must be supported by positive HIV (Human Immunodeficiency Virus) antibody test results and confirmation tests. Additionally, the Protected Person must have a CD4 cell count of less than two hundred (200)/μL and one or more of the following criteria are met:
- Weight loss of more than 10% within six (6) months or less
- Kaposi’s Sarcoma
- Pneumocystis Carinii Pneumonia
- Progressive Multifocal Leukoencephalopathy
- Active Tuberculosis
- Less than one thousand (1000) Lymphocytes/μL
- Chronic Lymphoma
Human Immunodeficiency Virus (HIV) Infection Through Occupation
HIV infection (only for Medical Personnel as defined below), where it is acquired as a result of an accident occurring during the course of normal duties and occupation with seroconversion to HIV infection occurring within six (6) months of the accident.
Any accident that potentially gives rise to a claim must be reported to AIA’s underwriters within thirty (30) days of the accident, supported by a negative HIV test taken within seven (7) days of the accident.
“Medical Personnel” is defined as doctors (Medical Specialists and General Practitioners), traditional practitioners, nurses, paramedics, laboratory technicians, dentists, dental nurses, ambulance workers working in medical centers or hospitals or dental clinics/polyclinics in Malaysia. Doctors, traditional practitioners, nurses, and dentists must be registered with the Ministry of Health Malaysia.
Systemic Lupus Erythematosus with Severe Kidney Complications
Diagnosed Systemic Lupus Erythematosus confirmed by a rheumatologist. For this definition, the covered event will only be paid if it results in Type III to Type V Lupus Nephritis as established by renal biopsy. Other forms such as discoid lupus or those involving only hematological or surgical procedures are not covered.
WHO Classification of Lupus:
- Type III – Focal Segmental glomerulonephritis
- Type IV – Diffuse glomerulonephritis
- Type V – Membranous glomerulonephritis
Exclusions
No coverage for:
- Pre-existing Conditions before the Date of Participation or Start Date of the rider, whichever is later; or
- Diagnosis of Fulminant Viral Hepatitis, Cancer, Encephalitis, Bacterial Meningitis, Alzheimer’s Disease/Severe Dementia or Terminal Illness caused directly or indirectly by Acquired Immune Deficiency Syndrome (AIDS), or infection by any Human Immunodeficiency Virus (HIV); or
- Cancer, Heart Attack, Coronary Artery Bypass Surgery, Serious Coronary Artery Disease and/or Angioplasty and Other Invasive Treatments for Coronary Artery Disease with first signs or symptoms occurring within 60 days after the Date of Participation or Start Date of the rider, whichever is later; or
- Other critical illnesses with first signs or symptoms occurring within 30 days after the Date of Participation or Start Date of the rider, whichever is later; or
- Diagnosed critical illness caused, directly or indirectly, by congenital defects or diseases that were clearly shown or diagnosed before the insured person reaches the age of 17 years.
