Congenital heart disease means a definite diagnosis of at least one of the covered heart conditions.
Covered heart conditions
- Coarctation of the aorta
- Ebstein's anomaly
- Eisenmenger syndrome
- Tetralogy of Fallot
- Transposition of the great vessels
The diagnosis of the heart condition must be:
- Made before the insured person’s 24th birthday
- Made by a specialist, and
- Supported by cardiac imaging acceptable to us
The insured person must survive for 30 days following the date of diagnosis.
Congenital heart disease also covers specific conditions described below for which open heart surgery is performed to correct the condition.
Covered heart conditions if open-heart surgery is performed
These heart conditions are covered only if open-heart surgery is performed to correct at least one of them:
- Aortic stenosis
- Atrial septal defect
- Discrete subvalvular aortic stenosis
- Pulmonary stenosis
- Ventricular septal defect
Procedures not covered by this definition are:
- Percutaneous atrial septal defect closure
- Trans-catheter procedures which include balloon valvuloplasty
The diagnosis of the heart condition must be made and the surgery:
- Recommended by a specialist
- Supported by cardiac imaging acceptable to us, and
- Performed by a specialist
The insured person must survive for a period of 30 days following the date of surgery.