18 Special Conditions In Critical Illness Plans: What Are They?

18 special conditions in critical illness plans

[10 min read]

Critical illness plans are plans that provide a lump sum payout whenever you contract one of the 37 critical illnesses defined by the Life Association of Singapore. In addition, some insurance companies provide benefits for additional 18 special conditions in critical illness plans. These conditions range from the usual, e.g., diabetes, to the obscure, e.g., Wilson’s disease. We here at fundMyLife are biologists at heart, and the human body is a ceaseless source of wonders (and nightmares). In this article, fundMyLife lists all 18 special conditions in critical illness plans and details what they are.

Disclaimer

We’ve taken the definitions of the conditions that qualifies the consumer for special benefits from insurance company brochures. These definitions are presented in block quotes. We will also provide interesting facts about these conditions. However, bear in mind that this is NOT a definitive guide, since each insurance companies have slightly different definition of the special conditions in their respective terms and conditions. Make sure you look closely at your own policy’s disease definitions!

#1 Insulin Dependent Diabetes Mellitus

Diabetes mellitus is chronic hyperglycemia, caused by defective insulin secretion. IDDM is characterised by the continuous dependence on exogenous insulin for the preservation of life as diagnosed by an endocrinologist and such dependence must persist for not less than six (6) months

Diabetes, a condition that 1 in 9 Singaporeans face. It is a dreadful lifestyle disease that is due to obesity and a lack of exercise. Over time, your pancreas is unable to produce enough insulin, the chemical required to control glucose release in the liver. Your cells are also resistant to insulin, which prevents them from taking blood glucose into them for energy usage. The excess sugar thus circulates in the body and over time cause damage to your blood vessels all over the body.

#2 Diabetic Complications

Diabetic Complications including Diabetic Retinopathy, Diabetic Nephropathy or Amputation of Part of Limb due to Gangrene:

  • Diabetic Retinopathy with the need to undergo laser treatment certified to be absolutely necessary by an ophthalmologist with support of a Fluorescent Fundus Angiography report and vision is measured at 6/18 or worse in the better eye using a Snellen eye chart.
  • A definite diagnosis of diabetic nephropathy by a specialist and is evident by eGFR less than 30 ml/min/1.73 m2 with ongoing proteinuria greater than 300mg/24 hours.
  • The actual undergoing of amputation of a foot / toe / hand / finger to treat gangrene that has occurred because of a complication of diabetes.

Diabetes, when uncontrolled, leads to many complications. High blood sugar levels cause blood vessel damage over a long period of time, and poor oxygen flow. This special condition covers three main complications that arise – diabetic retinopathy, diabetic nephropathy, and amputation due to gangrene.

Diabetic retinopathy refers to the damage to the blood vessels in the eye due to high blood sugar level. Retinopathy causes vision loss and eventually blindness, if not addressed immediately.

Diabetic nephropathy refers to kidney disease that arises from diabetes. The kidneys become leaky, allowing protein to leak into the blood stream. The filtration capabilities weaken as well, and eventually fail – you’ll need dialysis at this stage.

As mentioned, high blood sugar level cause blood vessel and nerve damage. These leads to a devastating combination of a lack of circulation to your extremities, i.e. foot, and you may unwittingly injure your foot and let the wound fester due to a lack of sensation. Minor toe injuries in diabetic patients, for example, can lead to gangrene because the injury does not heal quickly and is thus more likely to get infected. Once the infection is uncontrollable, you may have to amputate the foot to stop the spread of infection.

#3 Angioplasty & Other Invasive Treatment for Coronary Artery

The actual undergoing of balloon angioplasty or similar intra-arterial catheter procedure to correct a narrowing of minimum sixty percent (60%) stenosis, of one or more major coronary arteries as shown by angiographic evidence. The revascularisation must be considered medically necessary by a consultant cardiologist.

Coronary arteries herein refer to left main stem, left anterior descending, circumflex and right coronary artery.

Diagnostic angiography is excluded.

Angioplasty is a medical procedure where the doctor inserts a catheter containing deflated balloon into your narrowed or obstructed arteries or veins, and inflates it to widen them.

Angioplasty 101
What happens during an angioplasty. Source: Total Vascular Wellness.

The inflated balloon forces expansion of the vessel, allowing normal blood circulation again. A doctor may use angiography for diagnotic purposes but that does not qualify you for the special condition benefit.

#4 Osteoporosis with Fractures

Osteoporosis is a degenerative bone disease that results in loss of bone. The diagnosis must be supported by a bone density reading which satisfies the World Health Organisation (WHO) definition of osteoporosis with a bone density reading T-score of less than –2.5. There must also be a history of three (3) or more osteoporotic fractures involving either femur, wrist or vertebrae. These fractures must directly cause the Life Assured’s inability to perform (whether aided or unaided) at least one (1) of the following six (6) “Activities of Daily Living” for a continuous period of at least six (6) months.

Activities of Daily Living:

  • 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;
  • Dressing- the ability to put on, take off, secure and unfasten all
    garments and, as appropriate, any braces, artificial limbs or other
    surgical appliances;
  • Transferring- the ability to move from a bed to an upright chair or
    wheelchair and vice versa;
  • Mobility- the ability to move indoors from room to room on level
    surfaces;
  • Toileting- the ability to use the lavatory or otherwise manage bowel
    and bladder functions so as to maintain a satisfactory level of
    personal hygiene;
  • Feeding- the ability to feed oneself once food has been prepared
    and made available.

For the purpose of this definition, “aided” shall mean with the aid of special equipment, device and/or apparatus and not pertaining to human aid.

Osteoporosis (Greek for porous bone)  is a disease where you have higher bone weakness, increasing your chances of breaking your bones. It commonly affects older folks, and in women. Risk factors include advanced age, estrogen deficiency after menopause, removal of ovaries, decrease in testosterone, not having enough calcium, etc. Drink your milk folks!

Note: this is a very narrow definition of disease, especially when it has to satisfy WHO’s definition of osteoporosis and have more than 3 fractures in very specific parts of your body. On top of that, you must be unable to do one of the six basic activities for six months.

#5 Osteogenesis Imperfecta

This is a genetic disorder characterised by brittle, osteoporotic, easily fractured bones. The Life Assured must be diagnosed as a type III Osteogenesis Imperfecta confirmed by the occurrence of all of the following conditions:

  • the result of physical examination indicating growth retardation and
    hearing impairment; and
  • the result of X-ray studies reveals multiple fracture of bones and
    progressive kyphoscoliosis; and
  • positive result of skin biopsy.

Diagnosis of Osteogenesis Imperfecta must be confirmed by a pediatrician.

Osteogenesis imperfecta is also known as brittle bone disease, where symptoms include bones that break easily, blue tinted eyes, short stature, hearing loss, and loose joints. It is hereditary, and has no cure. There are at least nine different types of osteogenesis imperfecta – Type I to Type IX. Type I is the most common and mildest, whereas Type III is progressive and gets worse over time from birth.

#6 Severe Rheumatoid Arthritis

Widespread joint destruction with major clinical deformity of three (3) or more of the following joint areas: hands, wrists, elbows, spine, knees, ankles, feet. The diagnosis must be supported by all of the following:

  1. Morning stiffness
  2. Symmetric arthritis
  3. Presence of rheumatoid nodules
  4. Elevated titres of rheumatoid factors
  5. Radiographic evidence of severe involvement

The diagnosis must be confirmed by a consultant rheumatologist.

Rheumatoid athritis is a long-term autoimmune disease, where your immune system attacks the joints. This causes constant inflammation and constant pain. The requirements for the payout are severe, as it involves arthritis so bad that your joint areas are deformed, and has to fulfill all five conditions.

#7 Severe Juvenile Rheumatoid Arthritis (Still’s Disease)

A form of juvenile chronic arthritis characterised by high fever and signs of systemic illness that can exist for months before the onset of arthritis. The condition must be characterised by cardinal manifestations which include high spiking, daily (quotidian) fevers, evanescent rash, arthritis, splenomegaly, lymphadenopathy, serositis, weight loss, neutrophilic leucocytosis, increased acute phase proteins and sero-negative tests for Antinuclear Antibodies (ANA) and Rheumatoid Factor (RF). A claim for this benefit will be admitted only if the diagnosis is confirmed by a paediatric rheumatologist and the condition has to be documented for at least six (6) months.

Think only old people can get arthritis? Think again! Children suffer from a form of rhematoid arthritis kmown as Still’s Disease as well. Similar to adult arthritis, juvenile arthritis is an auto-immune disease that attacks your joints. It results in growth retardation. Left untreated, children develop joint deformities which eventually lead to irrecoverable loss of function.

#8 Rheumatic Fever with Valvular Impairment

A confirmed diagnosis by a consultant cardiologist of acute rheumatic fever according to the revised Jones criteria for its diagnosis. There must be involvement of one (1) or more heart valves and at least mild valve incompetence attributable to rheumatic fever as confirmed by quantitative investigations of the valve function by a consultant cardiologist.

Rheumatic fever is an inflammatory disease that occurs after an infection. The infection is so bad that it creates heart valvular infection that creates abnormal antibodies that destroy valvular tissues. Symptoms include breathlessness, irregular heart beats, fatigue.

#9 Dengue Haemorrhagic Fever

It covers Dengue Haemorrhagic Fever Stage 3 or Stage 4, based on the World Health Organisation case definition, with unequivocal evidence of the Dengue Shock Syndrome and confirmation of dengue infection, with confirmatory serological testing of dengue; and as may be exemplified by the following findings:

  • history of continuous high fever (for two (2) or more days),
  • minor or major haemorrhagic manifestations,
  • thrombocytopenia (less than or equal to 100000 per mm3),
  • haemoconcentration (haemotocrit increased by 20% or more),
  • evidence of plasma leakage (i.e. pleural effusion, ascites or hypoproteinaemia, etc.), and
  • evidence of the Dengue Shock Syndrome (DSS), confirmed by a consultant physician, with the following criteria being met:
    • hypotension (less than 80 mm Hg) or narrow pulse pressure (20 mm Hg or less), and
    • evidence of tissue hypoperfusion such as cold, clammy skin, oliguria, or a metabolic acidosis.
Chances are that you might have encountered plenty of posters about this Aedes mosquito.

Dengue fever is a mosquito-borne illness that occurs in tropical and sub-tropical countries. Symptoms can be mild and typically include fever, rash, and muscle and joint pain. Spend a night or two in the hospital with a drip and you’re good as new. People rarely die from dengue fever. However, it can progress to a more serious form know as dengue haemorrhagic fever. This form involves internal bleeding, i.e. under the skin, vomiting, and abdominal pain.

The benefit covers stages 3 and 4, which are the most severe stages. At Stage 3, you experience circulatory failure and in stage 4 you experience profound shock where you have undetectable pulse and blood pressure.

#10 Severe Haemophilia

The Life Assured must be suffering from severe haemophilia A (VIII deficiency) or haemophilia B (IX deficiency) with factor VIII or factor IX activity levels less than one percent (1%). Diagnosis must be confirmed by a haematologist.

When you’re cut, you stop bleeding after a while because your blood clots. Blood clotting is a complex process that involves 20 proteins. We take blood clotting for granted, but individuals with haemophilia experience prolonged or even spontaneous bleeding. Severe haemophilia A and B happens when you have severely low levels of clotting factors – Factor VIII and Factor IX respectively.

#11 Mastectomy

Mastectomy means surgical removal of at least three quadrants of the tissue of a breast due to carcinoma-in-situ or a malignant condition. Proof of having undergone the breast reconstructive surgery is not required.

The definition more or less explains what mastectomy is – the total removal of breast tissue when there is cancerous tissue on the breasts. It is a dramatic form of treatment, and the 10-year survival rate for patients that undergo mastectomy is >80% for early breast cancer cases. There is no payout for the the alternative procedure – lumpectomy, where only the tumor and some surrounding tissue is removed.

#12 Hysterectomy due to Cancer

The removal of the uterus (at least the corpus and cervix or corpus only) with supporting evidence of carcinoma of the uterus, fallopian tube, ovary, vagina or endometrium, advanced cervical carcinoma, or hydatidiform mole.

Hysterectomy is the surgical removal of a part, or the entire uterus. It is done in cases where cancerous tissue is found on the uterus itself, cervix, or ovaries.

#13 Chronic Adrenal Insufficiency (Addison’s Disease)

An autoimmune disorder causing a gradual destruction of the adrenal gland resulting in the need for life long glucocorticoid and mineral corticoid replacement therapy. The disorder must be confirmed by a specialist in endocrinology through one of the following:

  • ACTH simulation tests;
  • insulin-induced hypoglycemia test;
  • plasma ACTH level measurement;
  • Plasma Renin Activity (PRA) level measurement.

Only autoimmune cause of primary adrenal insufficiency is included. All other causes of adrenal insufficiency are excluded.

Addison’s Disease is a long-term endocrine disorder, where your adrenal glands do not produce enough steroid hormones. Without the right amount of hormones, you will experience low blood pressure, darkening of skin, lethargy, fever, and a whole host of other physical discomforts. Replacement hormonal therapy will bring the steroid hormone levels back to normal.

#14 Chronic Relapsing Pancreatitis

More than three (3) attacks of pancreatitis resulting in pancreatic dysfunction causing malabsorption needing enzyme replacement therapy.

The diagnosis must be made by a consultant gastroenterologist and confirmed by Endoscopic Retrograde CholangioPancreatography (ERCP).

Chronic Relapsing Pancreatitis caused by alcohol use is excluded.

Chronic relapsing pancreatitis is a long-term damage or inflammation of your pancreas, impairing its function. Besides pain and nausea, you’d suffer from malnutrition since the pancreas secretes enzymes that aid digestion. The body does not absorb fats properly, leading to oily stool. Alcohol use is one of the factors for pancreatitis, but is an exclusion criteria for the benefits to kick in.

#15 Wilson’s Disease

A potentially fatal disorder of copper toxicity characterised by progressive liver disease and/or neurologic deterioration due to copper deposit. The diagnosis must be confirmed by a hepatologist and the treatment with a chelating agent must be documented for at least six (6) months.

Wilson’s Disease is a genetic disease in which copper builds up in your body, due to a mutation in a protein that transports copper that you consume into bile for excretion. The copper accumulates in the liver and brain, leading to liver disease and neurological and psychiatric problems. Symptoms of Wilson’s Disease appear between ages 5 to 35. For treatment, a doctor administers chelating agent – a compound that binds to metals – to remove the copper in the body for you.

#16 Kawasaki Disease

This is acute, febrile and multisystem disease of children, characterised by non-suppurative cervical adenitis, skin and mucous membrane lesions. Diagnosis must be confirmed by a pediatrician and there must be echocardiograph evidence of cardiac involvement manifested by dilatation or aneurysm formation in the coronary arteries which persists for at least six (6) months after the initial acute episode.

Kawasaki Disease is a rare disease that affects children. It is an autoimmune disease, causing inflammation in your blood vessels throughout the body.

Clinical manifestations of Kawasaki Disease over a period of time.
Clinical manifestations of Kawasaki Disease over a period of time. Source: Wikipedia.

There are three stages of the disease, with various clinical manifestations. The most important aspect of Kawasaki Disease is the heart complications – coronary aneurysms (weak blood vessels) form after the initial stage, which may lead to myocardial infarctions. In other words, juvenile heart attacks.

#17 Glomerulonephritis with Nephrotic Syndrome

A confirmed diagnosis of glomerulonephritis with nephrotic syndrome by a nephrologist and who should confirm that a treatment regimen appropriate to the clinical presentation has been followed throughout the period to which syndrome relates. The syndrome must have continued for a period of at least six (6) months with or without intervening periods of remission.

Glomerulonephritis is a disorder of glomeruli (clusters of microscopic blood vessels in the kidneys with small pores through that filters blood). The condition involves body tissue swelling (edema), high blood pressure, and the presence of red blood cells in the urine.

#18 Type I Juvenile Spinal Amyotrophy

Degenerative diseases of the anterior horn cells in the spinal cord and motor nuclei of the brainstem characterised by profound proximal muscular weakness and wasting, primarily in the legs, followed by distal muscle involvement. The damage must result independently of all other causes and directly in the Life Assured’s permanent inability to perform (whether aided or unaided) at least three (3) of the “Activities of Daily Living” (ADLs) for a continuous period of six (6) months. The diagnosis must be made by a neurologist with appropriate neuromuscular testing such as Electromyogram (EMG).

Only Life Assured whose Age is between six (6) and seventeen (17) years on first diagnosis is eligible to receive a benefit under this illness.

Activities of Daily Living:

  • 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;
  • Dressing- the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances;
  • Transferring- the ability to move from a bed to an upright chair or wheelchair and vice versa;
  • Mobility- the ability to move indoors from room to room on level surfaces;
  • Toileting- the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
  • Feeding- the ability to feed oneself once food has been prepared and made available.

For the purpose of this definition, “aided” shall mean with the aid of special equipment, device and/or apparatus and not pertaining to human aid.

Type I juvenile spinal amyotrophy is a condition where your motor neurons degenerate, leading to muscle atrophy over time. It stabilizes after two to five years, where the condition neither improves or worses. It is common to males aged 20 to 50. Unfortunately, it is untreatable.

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