There are 26 illnesses eligible for full-benefit payout automatically included in Sun Critical Illness Insurance.
There are 26 illnesses eligible for full-benefit payout automatically included in Sun Critical Illness Insurance.
Acquired brain injury due to external trauma means a definite diagnosis of new damage to brain tissue caused by traumatic head injury resulting in newly developed significant neurological deficit that:
The diagnosis of acquired brain injury due to external trauma must be made by a specialist.
New neurological deficits must be detectable by a physician and may include, but are not restricted to:
Headache or fatigue will not be considered a neurological deficit.
Exclusion
No benefit will be payable under this condition for:
Aortic surgery means the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of any part of the diseased aorta with a graft. Aorta means the thoracic and abdominal aorta but not its branches.
The surgery must be determined to be medically necessary by a specialist.
The insured person must survive for 30 days following the date of surgery.
No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans catheter procedures or non surgical procedures.
Aplastic anemia means a definite diagnosis of a chronic, persistent bone-marrow failure, confirmed by biopsy, which results in anemia, neutropenia and thrombocytopenia requiring blood product transfusion, and treatment with at least one of the following:
The diagnosis of aplastic anemia must be made by a specialist.
Bacterial meningitis means a definite diagnosis of meningitis, confirmed by cerebrospinal fluid showing the presence of pathogenic bacteria. The presence of pathogenic bacteria must be confirmed by culture or other generally medically accepted microbiological testing. The bacterial meningitis must result in new objective neurological deficits persisting for at least 90 consecutive days from the date of diagnosis.
The diagnosis of bacterial meningitis must be made by a specialist.
New neurological deficits must be detectable by a physician and may include, but are not restricted to:
Headache or fatigue will not be considered a neurological deficit.
No benefit will be payable under this condition for viral meningitis.
Benign brain tumour means a definite diagnosis of a non‑malignant tumour located in the cranial vault and limited to the brain, meninges, cranial nerves or pituitary gland. The tumour must require surgical or radiation treatment or cause irreversible new objective neurological deficit(s) .
These deficits must be corroborated by diagnostic imaging showing changes that are consistent in character, location and timing with the neurological deficits.
The diagnosis of benign brain tumour must be made by a specialist.
New neurological deficits must be detectable by a physician and may include, but are not restricted to:
Headache or fatigue will not be considered a neurological deficit.
No benefit will be payable under this condition for pituitary adenomas less than 10 mm.
90 day exclusion period for benign brain tumour
No benefit will be payable for benign brain tumour if, within the first 90 days following the later of:
the insured person has any of the following:
Your responsibility to notify us about benign brain tumour
You have a responsibility to notify us about benign brain tumour, regardless of when a diagnosis is made:
To notify us, contact us at the toll free phone number shown at the beginning of this policy. We will then send you the appropriate form to be completed.
Blindness means a definite diagnosis of the total and irreversible loss of vision in both eyes, evidenced by:
The diagnosis of blindness must be made by a specialist.
Cancer means a definite diagnosis of a malignant tumour. This tumour must be characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. Types of cancer include carcinoma, melanoma, leukemia, lymphoma, and sarcoma.
The diagnosis of cancer must be made by a specialist and must be confirmed by a histopathology report or appropriate pathological testing in the case of non solid tumours.
No benefit will be payable for the following:
For purposes of the policy, the terms Tis, Ta, T1a, T1b, T1 and AJCC Stage 2 are to be applied as defined in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th Edition, 2010. For purposes of the policy, the term Rai staging is to be applied as set out in KR Rai, A Sawitsky, EP Cronkite, AD Chanana, RN Levy and BS Pasternack: Clinical staging of chronic lymphocytic leukemia. Blood 46:219, 1975.
90 day exclusion period for cancer
No benefit will be payable for cancer if, within the first 90 days following the later of:
the insured person has any of the following:
Your responsibility to notify us about cancer
You have a responsibility to notify us about cancer, regardless of when a diagnosis is made:
To notify us, contact us at the toll free phone number shown at the beginning of this policy. We will then send you the appropriate form to be completed.
Coma means a definite diagnosis of a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less.
The diagnosis of coma must be made by a specialist.
No benefit will be payable under this condition for:
Coronary artery bypass surgery means the undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s).
The surgery must be determined to be medically necessary by a specialist.
The insured person must survive for 30 days following the date of surgery.
No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans catheter procedures or non surgical procedures.
Deafness means a definite diagnosis of the total and irreversible loss of hearing in both ears, with an auditory threshold of 90 decibels or greater within the speech threshold of 500 to 3,000 hertz.
The diagnosis of deafness must be made by a specialist.
Dementia, including Alzheimer’s disease means a definite diagnosis of dementia, which must be characterized by a progressive deterioration of memory and at least one of the following areas of cognitive function:
The insured person must exhibit:
The diagnosis of dementia must be made by a specialist.
No benefit will be payable under this condition for affective or schizophrenic disorders, or delirium.
Heart attack (acute myocardial infarction) means a definite diagnosis of the death of heart muscle due to obstruction of blood flow, that results in a rise and fall of biochemical cardiac markers to levels considered diagnostic of acute myocardial infarction, with at least one of the following:
Survival period
The diagnosis of heart attack (acute myocardial infarction) must be made by a specialist. The insured person must survive for 30 days following the date of diagnosis.
No benefit will be payable under this condition for:
Heart valve replacement or repair means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve or to repair heart valve defects or abnormalities.
The surgery must be determined to be medically necessary by a specialist.
The insured person must survive for 30 days following the date of surgery.
No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans catheter procedures or non surgical procedures.
Kidney failure means a definite diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular haemodialysis, peritoneal dialysis or renal transplantation is initiated.
The diagnosis of kidney failure must be made by a specialist.
Loss of independent existence means a definite diagnosis of the total inability to perform, by oneself, at least 2 of the following 6 activities of daily living for a continuous period of at least 90 days with no reasonable chance of recovery.
The diagnosis of loss of independent existence must be made by a specialist.
Activities of daily living are:
If the insured person has a loss of independent existence before the policy anniversary nearest their 18th birthday, you must wait to send us a claim for this illness. The earliest you may submit a claim is the policy anniversary nearest the insured person’s 18th birthday. The latest you may submit a claim is the policy anniversary nearest the insured person’s 19th birthday.
Loss of limbs means a definite diagnosis of the complete severance of 2 or more limbs at or above the wrist or ankle joint as the result of an accident or medically required amputation.
The diagnosis of loss of limbs must be made by a specialist.
Loss of speech means a definite diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease, for a period of at least 180 days.
The diagnosis of loss of speech must be made by a specialist.
No benefit will be payable under this condition for all psychiatric-related causes.
Major organ transplant means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under major organ transplant, the insured person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities.
The diagnosis of the major organ failure must be made by a specialist.
Major organ failure on waiting list means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under major organ failure on waiting list, the insured person must become enrolled as the recipient in a recognized transplant centre in Canada or the United States that performs the required form of transplant surgery.
The date of diagnosis is the date of the insured person's enrollment in the transplant centre. The diagnosis of the major organ failure must be made by a specialist.
Motor neuron disease means a definite diagnosis of one of the following conditions and is limited to these conditions:
The diagnosis of motor neuron disease must be made by a specialist.
Multiple sclerosis means a definite diagnosis of at least one of the following:
The diagnosis of multiple sclerosis must be made by a specialist.
Occupational HIV infection means a definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the insured person's normal occupation, which exposed the person to HIV-contaminated body fluids.
The accidental injury leading to the infection must have occurred after the later of:
Payment under this condition requires satisfaction of all of the following:
The diagnosis of occupational HIV infection must be made by a specialist.
No benefit will be payable under this condition if:
Paralysis means a definite diagnosis of the total loss of muscle function of two or more limbs as a result of injury or disease to the nerve supply of those limbs, for a period of at least 90 days following the precipitating event.
The diagnosis of paralysis must be made by a specialist.
Parkinson’s disease means a definite diagnosis of primary Parkinson’s disease, a permanent neurologic condition which must be characterized by bradykinesia (slowness of movement) and at least one of:
The insured person must exhibit objective signs of progressive deterioration in function for at least 1 year, for which the treating neurologist has recommended dopaminergic medication or other generally medically accepted equivalent treatment for Parkinson’s disease.
Specified atypical parkinsonian disorders means a definite diagnosis of progressive supranuclear palsy, corticobasal degeneration, or multiple system atrophy.
The diagnosis of Parkinson’s disease or a specified atypical parkinsonian disorder must be made by a neurologist.
No benefit is payable under this condition for all other types of parkinsonism.
1 year exclusion period for Parkinson's disease and specified atypical parkinsonian disorders
No benefit will be payable for Parkinson’s disease or specified atypical parkinsonian disorders if, within 1 year following the later of:
the insured person has any of the following:
Your responsibility to notify us about Parkinson’s disease and specified atypical parkinsonian disorders
You have a responsibility to notify us about Parkinson’s disease or specified atypical parkinsonian disorders, regardless of when a diagnosis is made:
Severe burns means a definite diagnosis of third-degree burns over at least 20% of the body surface.
The diagnosis of severe burns must be made by a specialist.
Stroke (cerebrovascular accident) resulting in persistent neurological deficits means a definite diagnosis of an acute cerebrovascular event caused by intracranial thrombosis or haemorrhage, or embolism from an extracranial source, with:
persisting for more than 30 consecutive days following the date of diagnosis.
These new symptoms and deficits must be corroborated by diagnostic imaging testing showing changes that are consistent in character, location and timing with the new persistent neurological deficits.
The diagnosis of stroke (cerebrovascular accident) must be made by a specialist. The insured person must survive for 30 days following the date of diagnosis.
New neurological deficits must be detectable by a physician and may include, but are not restricted to:
Headache or fatigue will not be considered a neurological deficit.
Exclusion
No benefit is payable under this condition for: