This is the second article (Part II of VII) in our series of covered conditions of critical illness insurance. In this article we’ll look at definitions and covered conditions of heart attacks and strokes.
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 1 of the following:
- heart attack symptoms;
- new electrocardiogram (ECG) 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.
Exclusion: No benefit will be payable under this Critical Illness Insured 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, ECG changes suggesting a prior myocardial infarction does not satisfy the above definition of Heart Attack.
The diagnosis of heart attack must be made by a specialist.
Notice that simply having a heart attack is insufficient to receive a benefit under your policy. You must have a heart attack AND either have symptoms or have the specific testings and readings noted in the definition.
Further, only heart attacks where there is death of heart muscle due to obstruction of blood flow is covered. There are other causes of heart attacks (i.e. viral) that are specifically not covered.
Coronary Artery Bypass Surgery
Defined as the undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s), excluding any non-surgical or trans-catheter techniques such as balloon angioplasty or laser relief of an obstruction. The surgery must be determined to be medically necessary by a Specialist.
Note that the surgery is only covered for coronary arteries, and only for bypass grafts. Other type of coronary surgeries are not covered. Like all covered conditions with critical illness, the exact definition is precise and may exclude surgeries a consumer would expect would be covered.
Heart Valve Replacement
Heart Valve Replacement is defined as “the undergoing of surgery to replace any heart valve with either a natural or mechanical valve. The surgery must be determined to be medically necessary by a Specialist. Exclusion: No benefit will be payable under this condition for heart valve repair.
Note that only replacement is covered, not repair. Surgery for heart valve repair would not be covered and would not result in a benefit payment.
Aortic Surgery is the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches. The surgery must be determined to be medically necessary by a Specialist.
Note that only specific aortas are covered, and only surgery for disease. Aortic surgery for reasons other than disease (i.e defective aortas) are not covered.
While angioplasty is not a covered condition, under some conditions some policies may offer partial coverage for angioplasty. Coverage would typically be 10-15% of the benefit amount.
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,
Exclusion: No benefit will be payable under this Critical Illness Insured 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.
Note that to meet the definition of stroke, you must have acute onset of symptoms, new neruological deficits and they must be backed up by testing. Incidents due to trauma are not covered. Further, these symptoms must persist for more than 30 days – if they do not, then the stroke is not a covered condition.