Covered Critical Illnesses
Below are the critical illnesses we cover, with definitions and exclusions as defined by the policy.
1. "CANCER" means any malignant tumor characterized by uncontrolled growth and any invasion of normal tissue and/or spread.
This includes leukemia and Hodgkin's Disease. Diagnosis of cancer must be: (a) made by a Physician certified by the American Board of Pathology or the Osteopathic Board of Pathology to practice Pathological Anatomy; and (b) based on the study of the histocytologic architecture or pattern of the suspect tumor, tissue or specimen.
The following cancers are excluded: (a) cancer in the presence of HIV infection;1 (b) skin cancers and melanomas classified as Clark level III or lower and having a measured thickness less than 1.00 millimeter; (c) Carcinoma In Situ; and (d) early prostate cancer diagnosed as less than Gleason grade 7.
2. "HEART ATTACK" means death of a portion of the heart muscle due to inadequate blood supply that results in a clinical diagnosis of acute myocardial infarction. This diagnosis must be supported by: (a) a history consistent with a heart attack; (b) EKG changes consistent with a heart attack; and (c) elevation of the heart damage tests troponin or CK-MB. Each must show a definite myocardial infarction.
Other acute coronary syndromes, including but not limited to angina, are not covered.
3. "STROKE" means a neurological deficit occurring as a result of a cerebral embolism, cerebral infarction, or cerebral hemorrhage, persisting at least 21 days and verified by radiological testing. The following are excluded under this definition and are not covered: (a) neurological symptoms due to TIA (ministroke); (b) brain injury resulting from trauma or generalized loss of adequate oxygen to the brain; and (c) neurological deficit resulting from migraine.
4. "PARALYSIS" means the total irreversible loss of muscle function or sensation to the whole of any two limbs as a result of injury or disease. This disability must be permanent and supported by appropriate neurological evidence.
If you have any questions about these medical terms, or would like more information on what illnesses are covered under the Plan, call us at 1-866-642-1926.
