36 Penyakit Kritikal Prudential



What is the 36 Critical Illness covered

4.A CRITICAL ILLNESS – shall mean any one of the following illnesses as defined separately hereunder occurring more than sixty days after the Commencement Date of the Policy as specified in the Schedule or the date of any Revival of Benefits(s) or the date of any Endorsement of Benefit(s) secured under the Policy or the date of issue of this Annexure whichever is the lasts.

 (1)HEART ATTACKThe death of the position of the heart muscle (myocardium) as a result of inadequate blood supply and being evidenced by:-i.A history of typical prolonged chest pain; and ii.New electrocardiographic changes resulting from this occurrence; and iii.Elevation of the cardiac enzyme (CPK-MB) above the generally accepted laboratory levels of normal.Diagnosis based on the elevation of Troponin T test alone shall not considered diagnostic of a heart attack.Angina is specifically excluded.  

(2)NORONARY ARTERY DISEASE REQUIRING SURGERYRefers to the actual undergoing of coronary artery by-pass surgery by way of thoracotomy to correct or treat coronary artery disease but not including angioplasty, other intra-arterial, keyhole or laser procedures. 

(3)STROKEDefined as a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than six (6) months. Infarction of brain tissue, haemorrhage and embolisation from an extra-cranial source are included. The diagnosis must be based on changes seen in CT scan or MRI and certified by neurologist.Specifically excluded are cerebral symptoms due to transient ischaemic attacks, any reversible ischaemic neurological deficit, vertebrobasilar ischaemia, cerebral symptoms due to migraine, cerebral injury resulting from trauma by hypoxia and vascular disease affecting the eye or optic nerve or vestibular functions. 

(4)CANCERCancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal issue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered necessary. The cancer must be confirmed by histological evidence of malignancy.The following conditions are excluded:-i.Carcinoma in situ including of cervix.ii.Ductal carcinoma in situ of breast.iii.Papillary carcinoma of the bladder and Stage 1 Prostate Cancer.iv.Stage 1 Hodgkin’s disease.v.Tumours manifesting as complications of AIDS. 

 (5)KINDNEY FAILUREEach stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a results of which regular renal is initiated or renal transplantation is carried out. 

(6)PARALYSISThe complete and permanent loss of use of both legs, or one arm and one leg, through paralysis caused by illness or injury persisting for at least six(6) months from the date of trauma or illness.

 (7)MAJOR ORGAN TRANSPLANTATIONThe actual undergoing of a transplant as a recipient of one of the following human organs:i.Kidney.  ii.Lung(s).iii.Liver.iv.Heart.v.Bone marrow. 

(8)MULTIPLE SCLEROSISUnequivocal diagnosis by a consultant neurologist confirming the following combination, which has persisted for at least a continuous period of six (6) months:i.Symptoms referable to tracts (white matter) involving the optic nerves, brain stem and spinal cord, producing well-defined neurological deficits; andii.A multiplicity or discrete lesions; andiii.A well-documented history of exacerbation and remissions of the above said symptoms/neurological deficits.         

(9)FULMINANT VIRAL HEPATITISThis is defined as a sub-massive necrosis of liver caused by any virus leading precipitously to liver failure.The diagnostic criteria to be met are:i.A rapidly decreasing liver size as confirmed by abdominal ultrasound; and ii.Necrosis involving entire lobules, leaving only a collapsed reticular framework; and iii.Rapidly deteriorating liver function tests; andiv.Deepening jaundice.Hepatitis B infection or carrier status alone does not meet the diagnostic criteria.

 (10)PRIMARY PULMONARY ARTERIAL HYPERTENSION Means primary pulmonary hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting I permanent irreversible physical impairment to the degree of at least Class 3 of the New York Heart Association Classification of cardiac impairment, and resulting in the Life Assured being unable to perform his/her usual occupation. 

 (11)COMAA state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least 96 hours, requiring the use of life support systems and resulting in a neurological deficit, lasting more than thirty (30) days. Confirmation by neurologist is required.Coma resulting directly from self-inflicted injury, alcohol or drug misuse is excluded.  

(12)BLINDNESSThe total, permanent and irrecoverable loss of the sight of both eyes. Certification by an ophthalmologist is necessary. 

 (13)HEART VALVE REPLACEMENTThe actual undergoing of open-chest surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities that have occurred after the date of issue or date of revival of this contract.Repair via valvotomy, intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded. 

(14)SURGERY TO THE AORTAThe actual undergoing of surgery via a thoracotomy or laprotomy to repair or correct an aortic aneurysm, an obstruction of aorta or coarctation of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches. 

(15)ALZHEIMER’S DISEASEDeterioration or loss of intellectual capacity or abnormal behavior as evidence by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer’s Disease or irreversible organic degenerative brain disorders excluding neurosis, psychiatric illness, and any drug or alcohol related organic disorder, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the Life Assured. The diagnosis must be clinically confirmed by an appropriate medical consultant. 

(16)DEAFNESSTotal, permanent and irreversible loss of hearing in both ears as a result of disease or accident. Medical evidence in the form of an audiometry and sound-threshold tests must be provided.

 (17)LOSS OF SPEECHTotal and irrecoverable loss of ability to speak for a continuous period of twelve (12) months. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an appropriate (Ear, Nose, Throat) specialist.All psychiatric related causes are excluded. 

  (18)MAJOR BURNS Third degree burns covering at least twenty percent (20%) of the Life Assured’s body surface area as measured by “The Rule of 9” of the Lund and Browder Body Surface Chat.

 (19)TERMINAL ILLNESS The Life Assured being must be suffering from a condition, which in the opinion of an appropriate medical consultant is highly to lead to death within twelve (12) months. The Life Assured must no longer be receiving active treatment other than that for pain relief.

 (20)AIDS DUE TO BLOOD TRANSFUSION The Life Assured being infected by HIV virus or AIDS provided that:i.The inflection is due to blood transfusion received in Malaysia or Singapore after the commencement of the policy;ii.The Life Assured is not a haemophiliac; andiii.The Life Assured is not a member of any high risk groups such as but not limited to homosexuals, intravenous drug users or sex workers.Notification and proof of incident will be required via a statement from a statutory Health Authority that the inflection is medically acquired. 

(21)MOTOR NEURONE DISEASE Motor neurone disease of unknown aetiology is characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons. These include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.Diagnosis must be confirmed by a consultant neurologist.   

(22)PARKINSON’S DISEASE Unequivocal diagnosis of Parkinson’s Disease by a consulting neurologist where the conditions:-i.TransferGetting in and out of a chair without requiring physical assistance.ii.MobilityThe ability to move from room to room without requiring any physical assistance.iii.ContinenceThe ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.iv.DressingPutting on and taking off all necessary clothing without requiring of another person.v.Bathing/washingThe ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means. vi.EatingAll tasks of getting food into body once it has been prepared.Only idiopathic Parkinson’s Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded. 


 (23)CHRONIC LIVER DISEASEEnd stage liver failure evidence by all of the following:-i.Permanent jaundice.ii.Ascites.iii.Encephalopathy.iv.Portal hypertension.Wernicke’s encephalopathy and liver failure secondary to alcohol or drug misuse are excluded.

(24) CHORONIC LUNG DISEASEEnd stage respiratory failure including chronic interstitial lung disease.All of the following criteria must be met:-i.Requiring permanent oxygen therapy as a result of a consistent FEVI test value of less than one lite.(Forced Expiratory Volume during the first second of a forced exhalation)ii.Arterial Blood Gas analysis with partial oxygen pressures of 55 mmHg or less.iii.Dyspnoea at rest.


(25)APLASTIC ANAEMIAChronic persistent bone marrow failure which results in total aplasia of the bone marrow and requires treatment with at least one of the following:-i.Regular blood product transfusion.ii.Marrow stimulating agents.iii.Immunosuppressive agents.iv.Bone marrow transplantation.


(26)MUSCULAR DYSTROPHYThe diagnosis of muscular dystrophy shall require a confirmation by consultant neurologist of the combination of 3 out of 4 of the following conditions:i.Family history of other affected individuals.ii.Clinical presentation including absence of sensory disturbance, normal cerebro-spinal fluid and mild tendon reflex reduction.iii.Characteristic electromyogram.iv.Clinical suspicion confirmed by muscle biopsy.Children age twelve(12) years and below are exclude from the definition.


(27)POLIOMYELITISUnequivocal diagnosis by a consultant neurologist of infection with the Poliovirus leading to paralytic disease as evidence by impaired motor function or respiratory weakness. Cases not involving paralysis will not be eligible for this benefit. Other causes of paralysis (such as Guillain–Barre syndrome) are specifically excluded.


(28)BACTERIAL MENINGITISBacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit lasting for a minimum period of thirty (30) days and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled person.  For the purpose of this benefits, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.The Activities od Daily Living are:-i.TransferGetting in and out of a chair without requiring physical assistance.ii.MobilityThe ability to move from room to room without requiring any physical assistance.iii.Continence The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.iv.DressingPutting on and taking off all necessary items of clothing without requiring assistance of another person.v.Bathing/WashingThe ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.vi.EatingAll task of getting food into the body once it has been prepared.The diagnosis is to be confirmed by a consultant neurologist.


(29)BENIGN BRAIN TUMOURA life-threatening, non-cancerous tumour in the brain giving rise to characteristic signs of increased intra-cranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumour must be confirmed by imaging studies such as CT scan or MRI.The following are excluded:i.Cysts.ii.Granulomas.iii.Malformations in or of the arteries of veins of the brain.iv.Haematomas.v.Tumours in the pituitary gland, or spine.vi.Tumour of the acoustic nerve.


(30)ENCEPHALITISDefined as severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of thirty (30) days and certified by a consultant neurologist. The permanent  deficit must in an inability to perform at least three (3) of Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefits, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.The Activities of Daily Living are:-i.TransferGetting in and out of a chair without requiring physical assistance.ii.MobilityThe ability to move from room to room without requiring any physical assistance.iii.ContinenceThe ability to voluntarily control bowel and bladder function such as to maintain personal hygiene.iv.DressingPutting on and taking off all necessary items of clothing without requiring assistance of another person.v.Bathing/WashingThe ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.vi.Eating All tasks of getting food into the body once it has been prepared.Encephalitis as a result of HIV infection is included.


(31)FULL BLOWN AIDSThe clinical manisfestation of AIDS (Acquired Immuno-deficiency Syndrome) must be supported by the result of a positive HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory Western Blot test. In addition, the life Assured must have a CD4 cell count of less than two hundred (200) and one or more of the following criteria are met:-i.Weight loss of more than 10% of body weight over a period of six (6) months or less (wasting syndrome);ii.Kaposi Sarcoma;iii.Pneumocystic Carinii Rneumonia;iv.Progressive multifocal leukoeneephalopathy;v.Active Tuberculosis;vi.Less than one-thousand (1000) lymphocytes.vii.Malignant Lymphoma.In the event of a claim except for PRUpayor basic, PRUspouse payor basic and PRUparent payor basic, PRUpayor PSA, PRUspouse payor PSA, PRUparentpayor PSA, PRUwaiver, PRUspouse waiver, PRU parent waiver, 50% of all applicable Benefits (up to a maximum of RM500,000 on any one life under this and all other policies) payable in respect of this illness will be paid. The balance amount shall be payable on death, total and permanent disability or the diagnosis of another Critical illness whichever shall first occur.


(32)OTHER SERIOUS CORONARY ARTERY DISEASEThe narrowing of the lumen of at least three major arteries i.e. Circumflex, Right Coronary Artery (RCA), Left  Anterior Descending Artery (LAD), by a minimum of 60% or more as proven by coronary arteriography. This benefits is payable regardless of whether or not any form of coronary artery surgery has been performed.


(33)BRAIN SURGERYThe actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. Bur Hole and brain surgery as a result of an accident is excluded.


(34)APALLIC SYNDROMEUniversal necrosis of the brain cortex, with the brainstem remaining intact. Diagnosis must be confirmed by a consultant neurologist and condition must be documented for at least one (1) month.


(35)MAJOR HEAD TRAUMAPhysical head injury causing significant permanent functional impairment lasting for a minimum period of three (3) month from the date of the trauma of injury. The resultant permanent functional impairment is to be verified by a consultant neurologist and duly concurred by the Activities of Daily Living either with or with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefits, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.The Activities of Daily Living are:-i.TransferGetting in and out of a chair without requiring physical assistance.ii.MobilityThe ability to move from room to room without requiring any physical assistance.iii.ContinenceThe ability to voluntarily control bowel and bladder function such as to maintain personal hygiene.iv.DressingPutting on and taking off all necessary items of clothing without requiring assistance of another person.v.Bathing/WashingThe ability to wash in the bath or shower (including getting in or out of the bath or shower) or wash by any other means.vi.EatingAll tasks of getting food into the body once it has been prepared.


(36)LOSS OF LIMBSThe complete and irreversible physical severance of both arms above the wrists, or both legs above the ankles, or one arm above the wrist and one leg above the ankle due to injury.