There are 5 childhood illnesses eligible for full-benefit payout included in Sun Critical Illness Insurance:

Definition

Cerebral palsy means a definite diagnosis of a non-progressive neurological defect affecting muscle control. This defect is characterized by spasticity and incoordination of movements.

Survival period

The diagnosis of cerebral palsy must be made by a specialist. The insured person must survive for 30 days following the date of diagnosis.

Explanation

Cerebral palsy results in impaired muscle co-ordination and weakness caused by damage to the brain before or at birth. It can also occur after birth from a stroke or infection in the baby.

Definition

Congenital heart disease means a definite diagnosis of at least one of the covered heart conditions described below. It also means the specific conditions described below for which open-heart surgery is performed to correct the condition.

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 by a specialist licensed and practising in Canada or by another physician acceptable to us, and
  • Supported by cardiac imaging acceptable to us

The insured person must survive for a period of 30 days following the date of diagnosis.

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 licensed and practising in Canada or by another physician acceptable to us
  • Supported by cardiac imaging acceptable to us, and
  • Performed by a specialist licensed and practising in Canada or another physician acceptable to us

Survival period

For the first list of covered heart conditions, open-heart surgery is not required for the condition to be covered. The insured person must survive for a period of 30 days following the date of diagnosis. For the second list ("covered heart conditions if open-heart surgery is performed") open-heart surgery is required for the condition to be covered. The insured person must survive for a period of 30 days following the date of surgery.

Exclusions

Procedures not covered by this definition are:

  • Percutaneous atrial septal defect closure
  • Trans-catheter procedures which include balloon valvuloplasty

Explanation

Congenital heart disease refers to a group of cardiac malformations that are present at birth, but may not be diagnosed until later in childhood. The list of conditions that are covered regardless of method of treatment includes conditions that are generally serious, although not all of them are treated by surgery. The conditions listed under "Covered heart conditions if open-heart surgery is performed" includes conditions that vary in severity. Some cases may be mild, or even disappear on their own as the child grows. Generally, severe cases will be treated by surgery, and it is these cases requiring surgery that are covered by critical illness insurance.

Definition

Cystic fibrosis means a definite diagnosis of cystic fibrosis where the insured person has chronic lung disease and pancreatic insufficiency.

The diagnosis of cystic fibrosis must be made by a specialist.

Survival period

The insured person must survive for 30 days following the date of diagnosis.

Explanation

Cystic fibrosis is a genetic disorder that results in production of abnormally thick mucus leading to blockage of the pancreatic ducts, intestines and bronchi. In the lungs, the mucus can lead to breathing problems and lung disease. In the pancreas, the mucus can lead to malnutrition and problems with growth and development.

Definition

Muscular dystrophy means a definite diagnosis of muscular dystrophy where the insured person has well-defined neurological abnormalities, confirmed by electromyography and muscle biopsy.

The diagnosis of muscular dystrophy must be made by a specialist.

Survival period

The insured person must survive for 30 days following the date of diagnosis.

Explanation

Muscular dystrophy is a hereditary condition that is marked by progressive weakening and wasting of muscles.

Definition

Type 1 diabetes mellitus means a definite diagnosis where the insured person has total insulin deficiency and continuous dependence on exogenous insulin for survival. Dependence on insulin must persist for a continuous period of at least 3 months.

The diagnosis of type 1 diabetes mellitus must be made by a specialist.

Survival period

The insured person must survive for 30 days following the date of diagnosis.

Explanation

Type 1 diabetes mellitus is caused by a failure of the pancreas to produce insulin, resulting in a daily dependence on insulin injections for survival. Insulin lets sugar (glucose) enter body cells, where it is used for energy. Without insulin, sugar remains in the blood and the blood sugar level rises above what is safe for the body.