List of Covered Critical Illnesses and Their Definition
Stroke (cerebrovascular accident) is defined as:
A cerebrovascular event producing neurological sequelae lasting more than thirty (30) days and caused by thrombosis or hemorrhage, or embolism from an extra-cranial source. There must be evidence of measurable, objective neurological deficit. Transient ischemic attacks (TIAs) are specifically excluded.
Cancer is defined as:
A tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The diagnostic of Cancer must be made by a specialist.
The following forms of cancer are excluded:
- carcinoma in situ;
- stage 1A malignant melanoma as defined by the TNM classification (melanoma less than or equal to one point zero [1.0] millimetre in thickness, not ulcerated and without Clark level IV or level V invasion);
- any non-melanoma skin cancer that has not become metastatic (spread to adjacent organs);
- stage A (T1a or T1b) prostate cancer.
No benefit is payable for any Cancer when the earliest of the following dates occurs within ninety (90) days of the effective date of this coverage:
- the date of diagnosis of any Cancer, whether covered or excluded; or
- the date on which any early signs or symptoms for any Cancer, whether covered or excluded, appear; or
- the date of medical consultations and tests leading to the diagnosis of any Cancer, whether covered or excluded.
Any diagnosis of Cancer (whether covered or excluded under this benefit) or any sign or symptom or any medical consultation or test leading to a diagnosis of Cancer (whether covered or excluded under this benefit) that appears during the moratorium period must be reported in writing to the Insurer within six (6) months of the diagnosis. Failure to do so entitles the Insurer to refuse any claim under this coverage.
Coronary surgery (coronary artery bypass)
is defined as:
Heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s). Non-surgical procedures such as angioplasty and laser relief of obstruction are not covered.
Heart attack (myocardial infarction) is defined as:
The death of a portion of cardiac muscle as a result of inadequate blood supply, as evidenced by:
- recent electrocardiographic (ECG) changes indicative of a myocardial infarction; and
l’élévation des marqueurs biochimiques cardiaques à des niveaux attestant le diagnostic d’un infarctus.
- elevation of cardiac biochemical markers to levels considered diagnostic for infarction.
Heart attack during an angioplasty is covered provided that there are diagnostic changes of new Q-wave infarction on the ECG in addition to elevation of cardiac markers.
Heart attack does not include an incidental finding of ECG changes suggesting a prior symptomless myocardial infarction or a prior myocardial infarction or a past myocardial infarction in the absence of a corroborating medical event.