In the following you will see what conditions are covered under a Critical Illness plan with Great West Life. To achieve this many definitions, we used Great West Life’s Critical Illness plan with the “Critical Conditions Plus” rider. We also offer other insurance companies but for the ease of introducing the product we will use these definitions from Great West. Should you decide to review other insurance companies, we can compare the differences.
Critical Illness coverage includes the following:
- Acquired brain injury
- Aortic surgery
- Aplastic anaemia
- Bacterial meningitis
- Benign brain tumour
- Blindness
- Coma
- Coronary artery bypass surgery
- Deafness
- Dementia, including Alzheimer’s disease
- Heart valve replacement
- Heart Attack
- Kidney failure
- Life-threatening cancer
- Loss of independent existence
- Loss of limbs
- Loss of speech
- Major organ failure on waiting list
- Major organ transplant
- Motor neuron disease
- Multiple sclerosis
- Occupational HIV infection
- Paralysis
- Parkinson’s disease and specified atypical parkinsonian disorders
- Severe burns
- Stroke
Detailed Definitions of Critical Illnesses:
Acquired brain injury means new damage to brain tissue caused by a traumatic injury, anoxia, hypoxia or
encephalitis resulting in signs and symptoms of neurological impairment that:
- are present and verifiable on clinical examination or neuro-psychological testing;
- are corroborated by Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) studies of the brain showing changes that are consistent in character, location and timing with the new damage; and
- persist for a period of at least 180 days from the date of the new damage.
For greater certainty, no benefit will be payable under this critical condition for:
- an abnormality seen on imaging studies of the brain without definite related signs and symptoms; or
- neurological signs occurring without symptoms or imaging abnormalities.
Aortic surgery means 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.
Exception: No benefit will be payable under this critical condition for angioplasty, intra-arterial procedures,
percutaneous trans-catheter procedures or non-surgical procedures.
Aplastic anaemia means chronic persistent bone marrow failure, confirmed by biopsy, which results in anaemia,
neutropenia and thrombocytopenia requiring blood product transfusion, and treatment with at least one of the
following:
- Marrow stimulating agents;
- Immunosuppressive agents; or
- Bone marrow transplantation.
Bacterial meningitis means meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria
in culture, resulting in neurological deficit documented for at least 90 days from the date of diagnosis.
Exception: No benefit will be payable under this critical condition for viral meningitis.
Benign brain tumour means a non-malignant tumour located in the cranial vault and limited to the brain,
meninges, cranial nerves or pituitary gland. The tumour must require surgery or radiation treatment or cause
irreversible objective neurological deficits.
Exception: No benefit will be payable under this critical condition for pituitary adenomas less than 10mm.
Benefits for benign brain tumour are subject to the exception for certain critical conditions provision of the policy.
Blindness means the total and irreversible loss of vision in both eyes, evidenced by:
- The corrected visual acuity being 20/200 or less in both eyes; or
- The field of vision being less than 20 degrees in both eyes.
Coma means 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 four or less.
Exception: No benefit will be payable under this critical condition for medically induced coma.
Coronary artery bypass surgery means the undergoing of heart surgery to correct narrowing or blockage of one
or more coronary arteries with bypass grafts.
Exception: No benefit will be payable under this critical condition for angioplasty, intra-arterial procedures,
percutaneous trans-catheter procedures or non-surgical procedures.
Deafness means the total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels
or greater within the speech threshold of 500 to 3,000 hertz.
Dementia, including Alzheimer’s disease means dementia, which must be 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 insured must exhibit:
- dementia of a 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 6 month period.
Exception: No benefit will be payable under this critical condition for affective or schizophrenic disorders, or delirium.
Heart Attack means the death of heart muscle due to obstruction of blood flow, that results in the 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 changes consistent with a heart attack;
- Development of new Q waves during or immediately following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.
Exception: No benefit will be payable under this critical condition for elevated biochemical cardiac markers after an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty, in the absence of new Q waves. For greater certainty, new electrocardiogram changes suggesting a prior myocardial infarction does not satisfy the above definition of heart attack.
Heart valve replacement means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve or to repair heart valve defects or abnormalities.
Exception: No benefit will be payable under this critical condition for angioplasty, intra-arterial procedures, percutaneous trans-catheter procedures or non-surgical procedures.
Kidney failure means chronic irreversible failure of both kidneys to function, as a result of which regular haemodialysis, peritoneal dialysis or renal transplantation is initiated.
Life-threatening cancer means a tumour, which must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma.
Exception: No benefit will be payable under this critical condition for the following:
- Lesions described as benign, pre-malignant, uncertain, borderline, non-invasive, carcinoma in-situ (Tis), or tumors classified as Ta;
- Malignant melanoma skin cancer that is less than or equal to 1.0 mm in thickness, unless it is ulcerated or is accompanied by lymph node or distant metastasis;
- Any non-melanoma skin cancer, without lymph node of distant metastasis;
- Prostate cancer classified as T1a or T1b, without lymph node or distant metastasis;
- Papillary thyroid cancer or follicular thyroid cancer, or both, that is less than or equal to 2.0 cm in greatest diameter and classified as T1, without lymph node or distant metastasis;
- Chronic lymphocytic leukemia classified less than Rai stage 1; or
- Malignant gastrointestical stromal tumours (GIST) and malignant carcinoid tumours, classified less than AJCC Stage 2.
For purposes of this critical condition, the terms:
Tis, Ta, T1a, T1b, T1 and AJCC Stage 2 are to be applied as defined in the American Joint Committee on
Cancer (AJCC) cancer staging manual, 7
th Edition, 2010; and
Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS
Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975.
Benefits for life-threatening cancer are subject to the exception for certain critical conditions provision of the
policy.
Loss of independent existence means: (for critical condition plus rider only) the total inability to perform, by
oneself, at least 2 of the following 6 activities of daily living for a continuous period of at least 90 days with no
reasonable chance of recovery.
Activities of daily living are:
- Bathing – the ability to wash oneself in a bathtub, shower or by sponge bath, with or without the aid of
assistive devices;
- Dressing – the ability to put on and remove necessary clothing, braces, artificial limbs or other surgical
appliances with or without the aid of assistive devices;
- Bladder and bowel continence – the ability to manage bowel and bladder function with or without any protective undergarments or surgical appliances so that a reasonable level of hygiene is maintained;
- Toileting – the ability to get on and off the toilet and maintain personal hygiene;
- Transferring – the ability to move in and out of a bed, chair or wheelchair, with or without the aid of assistive devices; and
- Feeding – the ability to consume food or drink that already have been prepared and made available, with or without the use of assistive devices.
Loss of limbs means the complete severance of two or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation.
Loss of speech means the total and irreversible loss of the ability to speak as the result of physical injury or disease for a period of at least 180 days.
Exception: No benefit will be payable under this critical condition for all psychiatric related causes.
Major organ failure on waiting list means irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under major organ failure on waiting list, the insured must become enrolled as the recipient in a recognized transplant centre in Canada or the United States that performs the required form of transplant. For the purposes of the survival period, the date of the critical condition is the date of the insured’s enrollment in the transplant centre.
Major organ transplant means irreversible failure of the heart, both lungs, liver, both kidneys, or bone marrow, and transplantation must be medically necessary. To qualify under major organ transplant, the insured must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities.
Motor neuron disease means 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, and limited to these conditions.
Multiple sclerosis means at least one of the following:
- Two or more separate clinical attacks, confirmed by magnetic resonance imaging of the nervous system, showing multiple lesions of demyelination;
Well-defined neurological abnormalities lasting more than six months, confirmed by magnetic resonance imaging of the nervous system, showing multiple lesions of demyelination; or
- A single attack, confirmed by repeated magnetic resonance imaging of the nervous system, which shows multiple lesions of demyelination which have developed at intervals at least one month apart.
Occupational HIV infection means infection with human immunodeficiency virus resulting from accidental injury during the course of the insured’s normal occupation, which exposed the insured to human immunodeficiency virus contaminated body fluids. The accidental injury leading to the infection must have occurred following the later of the benefit effective date of this rider, or the last date of reinstatement of this rider.
Payment under this condition requires satisfaction of all of the following:
- The accidental injury must be reported to Great-West Life within 14 days of the accidental injury;
- A serum human immunodeficiency virus (HIV) test must be taken within 14 days of the accidental injury and the result must be negative;
- A serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
- All HIV tests must be performed by a duly licensed laboratory in Canada or the United States; and
- The accidental injury must have been reported, investigated and documented in accordance with current Canadian or United States workplace guidelines.
Exceptions: No benefit will be payable under this critical condition if:
- The insured has elected not to take any available licensed vaccine offering protection against HIV; or
- A licensed cure for HIV infection has become available prior to the accidental injury.
For greater certainty, non-accidental injury including, but not limited to, sexual transmission or intravenous drug use does not satisfy the definition of occupational HIV infection.
Paralysis means total loss of muscle function of two or more limbs as a result of injury or disease to the nerve
supply of those limbs, for a period of at least 90 days following the precipitating event.
Parkinson’s disease and specified atypical parkinsonian disorders
Parkinson’s disease means primary Parkinson’s disease, a permanent neurologic condition which must be characterized by bradykinesia (slowness of movement) and at least one of: muscular rigidity or rest tremor. The Insured 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 mean progressive supranuclear palsy, corticobasal degeneration, or multiple system atrophy.
Exception: No benefit will be payable under Parkinson’s disease and specified atypical parkinsonian disorders for any other type of parkinsonism.
Benefits for Parkinson’s disease and specified atypical parkinsonian disorders are subject to the exception for certain critical conditions provision of this policy.
Severe burns means third degree burns over at least 20 per cent of the body surface
Stroke means an acute cerebrovascular event caused by intra-cranial thrombosis or haemorrhage, or embolism from an extra-cranial source, with:
- Acute onset of new neurological symptoms, and
- New objective neurological deficits on clinical examination,persisting for more than 30 days following the date of the critical condition. These new symptoms and deficits must be corroborated by diagnostic imaging testing.
Exception: No benefit will be payable under this critical condition for:
- Transient ischaemic attacks; or
- Intracerebral vascular events due to trauma.
For greater certainty, lacunar infarcts which do not have the neurological symptoms and deficits set out above, persisting for more than 30 days, do not satisfy the definition of stroke.