5 full-payout childhood illnesses

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.

The diagnosis of cerebral palsy must be:

• made before the insured person’s 24th birthday, and
• made by a specialist.

Definition

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

Survival period

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

Survival period

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

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 before the insured person’s 24th birthday, and
• made by a specialist.

Definition

Muscular dystrophy means a definite diagnosis of muscular dystrophy where the insured person has well defined neurological abnormalities, confirmed by electromyography and either muscle biopsy or other testing acceptable to us that confirms the diagnosis.

The diagnosis of muscular dystrophy must be:

• made before the insured person’s 24th birthday, and
• made by a specialist.

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 before the insured person’s 24th birthday, and
• made by a specialist.