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重病保险常包括的重病及常见定义
Critical Illness Insurance in Canada
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各公司重病保险包括的重病种类及其定义常略有不同。以下是各公司最常见包括的
24种重病及最常见的定义。资料来源是The Insurance Journal (August 2003)及
(Sun Life Financial 2009 重大疾病保险介绍单张)。
为了减少可能误差,我们这里以其英文原文列出。申请人在购买某一公司的重病保险产
品时,应以其公司的保单条文中的重病定义和要求为准。一些公司也将其公司对重病的定义详细列在了
网上,可参考相应的公司链节。
- Alzheimer's Disease(老年滞呆症): Progressive degeneration of the brain
resulting in the reduction of mental and social functioning and requiring
daily supervision. Some insurers do not cover other organic brain disorders
and psychological illnesses while others require the client to need
a minimum of eight hours of daily supervision.
- Aortic surgery (主动脉手术): Aortic surgery means the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches.
- Aplastic anaemia(再生障碍性贫血): 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:
marrow stimulating agents,
immunosuppressive agents,and
bone marrow transplantation.
- Bacterial Meningitis (细菌性脑膜炎): Bacterial meningitis means a definite diagnosis of meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria in culture, resulting in neurological deficit documented for at least 90 days from the date of diagnosis.
- Benign Brain Tumour(良性脑瘤): Permanent deficit of the neurological
system such as impaired speech, sight or walking. Some insurers cover
tumors of the bony cranium and pituitary microadenomas that are superior
to 10mm in diameter and aortic surgery, heart valve replacement and loss
of independent existence. For certain insurers, tumours or lesions in
the pituitary gland are not covered and others exclude cysts, granulomas,
meningiomas, malformations of the intracranial arteries or veins or
tumours of the cranial nerves, pituitary gland or spinal cord.
- Blindness(失明): The permanent loss of sight in both eyes, with a
corrected visual acuity worse than 20/200 in both eyes or a field of
vision less than 20 degrees in both eyes.
- Cancer(癌症): A malignant tumour characterized by the uncontrolled
growth and spread of mailignant cells and the invasion of tissue
including leukemia and Hodgkin's disease, but excludes, in general,
cancer in situ, Kaposi's sarcoma, skin cancer, except for those achieving
greater depth than 0.70 mm, early prostate cancer, tumours in the presence
of HIV, pre-malignant lesions, benign tumours and polyps.
- Coma(昏迷): State of deep
unconsciousness, during which the person insured only shows signs of
primary defensive reflexes to external stimuli for a continuous period
of at least four days for most insurers.
- Coronary Artery Bypass Surgery (冠状动脉搭桥手术): To undergo heart
surgery to correct narrowing or blockage of one or more coronary
arteries with bypass grafts excluding any elective surgery or
nonsurgical techniques such as balloon angioplasty or laser relief
of an obstruction.
- Deafness (失聪): The permanent and profound loss of hearing in
both ears with an auditory threshold of more than 90 decibels.
- Heart Attack (心脏病): The "death" of a portion of the heart as a
result of inadequate blood supply as evidence by electrocardiographic
(EGG) changes and an elevation in cardiac enzymes. Some insurers also
base it on the elevation of biochemical markers.
- Heart Valve Replacement (心瓣置换): Heart valve replacement means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve.
- HIV Infection (HIV病毒感染): Needs to have been contaminated accidentally
during the course of normal occupation. Some insurers require blood tests
to be taken within 14 days of the accidental injury and the result must
be negative and another test must be taken between 90 and 180 days after
the infection and the result must be positive.
- Kidney Failure (肾衰竭) : Failure of both kidneys needing treatment by
regular dialysis or transplant in some case.
- Loss of Limbs (肢体分离): Total and permanent severance of two or
more limbs from above the wrist or ankle joint. Some insurers add
that the amputation can be the result of an accident or medically
required amputation.
- Loss of Speech (哑症-失去语言能力) : For some insurers, the loss of
speech must be at least 180 days or 12 months required by other insurers.
- Major Burns (严重烧伤) : Most insurers define this illness as third
degree burns covering at least 20% of the body surface.
- Major Organ Transplant (主要器官移植) : See organ transplant.
- Major Organ Failure on Waiting List 轮后主要器官移植) : 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 usually requires to become enrolled as the recipient in a recognized transplant centre in Canada or the United States that performs the required form of transplant surgery.
- Motor Neuron disease (ALS or Lou Gehrig's disease)(肌萎缩侧索硬化,ALS,或
运动神经元疾病) : Also called Amyotrophic Lateral Sclerosis, it is the
unequivocal diagnoosis of motor neuron disease including primary lateral
sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy
and pseudo bulbar palsy. Some insurers require that this disease be
diagnosed prior to the age of 75.
- Multiple Sclerosis (多发性硬化症) : Neurological abnormalities persisting
for a continuous period of at least 6 months and confirmed by modern
investigational techniques (i.e. image scanning). Some insurers require
typical symptoms of demyelination with resultant impairment of the brain
stem or spinal cord. Some insurers require two episodes separated by at
least one month.
- Organ Transplant (主要器官移植) : Generally of the heart, liver,
lungs, kidneys, and bone marrow. In most cases, benefits are also
offered to clients who are on a waiting list for transplant.
- Paralysis (瘫痪) : Complete and permanent loss of use of two or more limbs
for a period of 90 days, during which time there has been no sign of
improvement.
- Parkinson's Disease (柏氏金森症) : Characterized by two or more of the
following symptoms: tremor, muscle rigidity and bradykinesia. Certain
insurers require the insured to be in need of substantial physical
assistance from another adult to perform two or more of six activities
of daily living.
- Stroke (中风) : A neurological deficit persisting for at least 30 days.
Most insurers exclude transient ischemic attacks while others have added
to their definition of stroke "all episodes of ischemia by rupture of
the thrombosis or embolism from extra-cranial source leading to permanent
neurological sequelae."
除以上定义的疾病外,若被诊断患有以下疾病的任何一种,一些保险公司会给与部分赔偿。
- Coronary Angioplasty (冠状动脉成型手术)
- Ductal Carcinoma in Situ of the Breast(早期乳癌)
- Stage A Prostate Cancer (早期前列腺癌)
- Stage 1A Malignant Melanoma (早期皮肤癌)
若有18岁以下子女投保,一些公司重大疾病保险计划还包括以下儿童期疾病。
- Cerebral Palsy(大脑性麻痹):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.
- Congenital Heart Disease (先天性心脏病):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.
- Cystic Fibrosis (囊性纤维化):Cystic fibrosis means a definite diagnosis of cystic fibrosis where the insured person has chronic lung disease and pancreatic insufficiency.
- Muscular Dystrophy (肌肉萎缩症):Muscular dystrophy means a definite diagnosis of muscular dystrophy where the insured person has well defined neurological abnormalities, confirmed by electromyography and muscle biopsy.
- Type 1 Diabetes Mellitus (1型糖尿病):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 three months.
以上资讯仅供参考,详细规定以您购买的重病保险计划保单中的重病定义和要求为准。
有关重病保险的常见问答参见重病保险常见问题解答 。若有兴趣做更进一步咨询了解,可填写我们的重病保险咨询预约申请表,预约我们提供进一步咨询讲解。
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