Critical Illness Claims

Sequence Order

Benefit

Claim Documents

Mandatory Document

Fully completed Critical Illness Claim Form

1

a)  Cancer

b)  Gender- Specific Cancer

c)  Non-Invasive Cancer (Carcinoma-in-Situ or Early-Stage Cancer)
 

• Critical illness medical report form

• Biopsy reports, cytology reports, Histopathology report, x-rays, CT Scan/ MRI, Bone Marrow Aspiration/ Trephine  Biopsy report (Leukemia only), other Imaging Studies, Laboratory Evidence, Surgical reports and any relevant hospital reports that are available.

2

Nerve and muscle related claims:

a)  Parkinson’s Disease

b)  Coma

c)  Paralysis of limbs

d)  Muscular dystrophy

e)  Elephantiasis

• Critical illness medical report form

a)   All Neurological reports, x-ray, CT Scan, MRI report and other imaging studies, laboratory evidence, cerebral angiogram and any relevant reports that is available.

b)  Doctor’s report stating that the Insured Person is in a state of unconsciousness with no reaction to external stimuli or internal needs, requiring the use of life support systems and resulting in a ‘Permanent Neurological Deficit’ with persisting clinical symptoms.

c)  X-ray report, CT scan, MRI report and a minimum assessment period of 6 months to confirm there is Total, Permanent and irreversible loss of use of both arms or both legs, or of one arm and one leg.

d)  Lumbar puncture, Electromyography (EMG) test results, Muscles Biopsy and all relevant investigation results in support of the diagnosis.

e)  Elephantiasis  -
CT scan and MRI report of the Brain and all the relevant laboratory evidences/tests.

3

Brain related claims:

a)  Multiple Sclerosis

b)  Alzheimer's Disease / Severe Dementia

c)  Stroke

d)  Bacterial Meningitis/ Encephalitis

e)  Brain surgery

f)  Motor Neuron Disease

g)  Major Head Trauma
 

• Critical illness medical report form
  

a) CT scan/MRI report of the Brain and Spine, Nerve conduction study/Evoked potential test, Assessment report by Consultant Neurologist.

b) Clinical evaluation and imaging test and all relevant investigation results in support of the diagnosis.

c)  CT scan/MRI report of the Brain, Assessment report by Consultant Neurologist and all other reports to support the diagnosis.

d)  CT scan/MRI report of the Brain &  Spine, Lumbar puncture test report and all other reports to support the diagnosis

e)  Brain surgery report, CT scan/MRI report of the Brain (Pre and post surgery, if any)

f)  All post operative reports, CT scan and MRI report of the Brain  and Spine, Electromyography (EMG ) test results and all relevant investigation results in support of the diagnosis.

g)  CT scan/MRI report of the Brain, Surgery report, Neurologist report to confirm the Permanent functional impairment result in an inability (to perform at least 3 out of 6 Activities of Daily Living as stated in the Policy) and Police report, if any.

4

Heart Related claims: 

a)  Heart Attack / Myocardial Infarction (MI)

b)  Surgery to Aorta

c)  Heart Valve Surgery

d)  Other Serious Coronary Artery Disease

e)  Cardiomyopathy

f)  Coronary Artery By-pass Surgery

g)  Angioplasty and other Invasive Treatments for Coronary Artery Disease

h)  Primary Pulmonary Arterial Hypertension

• Critical illness medical report form 

a)  ECG report, Cardiac Enzymes  Assay  results (CPK-MB, Troponin T/Troponin I), Echocardiogram report and Coronary Angiogram report.

b)  Aorta Surgery report.

c)  Heart Valve Surgery report.

d)  Coronary Angiogram report.

e)  Echocardiogram report and Cardiac Catheterization report.

f)  Coronary Artery By-pass  Surgery report

g)  Coronary Angiogram report, Percutaneous Coronary Intervention (PCI) or laser treatment report.

h)  All clinical and laboratory investigation results including cardiac  Catheterization and Echocardiogram report .

5

Other Critical Illness Claims:

a)  Burns

b)  Lung Disease

c)  Liver Failure

d)  Kidney Failure

e)  Deafness / loss of Hearing

f)  Blindness/Loss of Sight

g)  Loss of Speech

h)  Medullary Cystic Disease

i)  Major Organ/Bone Marrow Transplant

j)  Loss of Independent Existence

k)  Chronic Aplastic Anemia

l)  Fulminant Viral Hepatitis

m)  Systemic Lupus Erythematosus

n)  Terminal Illness

o)  HIV infection due to Blood Transfusion

p)  Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection

• Critical illness medical report form 

a)  Total Body Surface Area Burn Assessment report.

b)  Pulmonary Function Test result, Arterial Blood Gas test result, FEV 1 Test result and all relevant investigation results.

c)  Liver Function Test, CT scan of Liver, all  laboratory, pathology, hepatitis screening, ultrasound and histology report.

d)  Kidney Dialysis report, Kidney transplantation report, Blood test results and copy of bill and original receipts.

e)  Pure Tone Audiometry Test and Sound, Threshold Test results and Brainstem Auditory Evoked Response (BAER) report.

f)  Visual Acuity report on both eyes to be done by an ophthalmologist. 
Assessment report to be completed by an Ophthalmologist.

g)  Laryngoscopy report and report by speech Pathologist/Therapist

h)  Renal Biopsy report

i)  Surgical report

j)  CT Scan/MRI report, Ultrasound report, Surgery report, Blood test reports.

k)  Bone Marrow Aspiration report, Blood transfusion records, Bone Marrow transplant report, Full Blood Picture reports.

l)  Liver Function Test results, CT Scan report of Liver, Abdominal ultrasound, Hepatitis viral serology test, Any other laboratory or pathology reports.

m)  Lupus Erythematosus (LE) cell blood test result, Anti-DNA Antibodies, Urine FEME results over past 6 months, Renal function tests with eGFR results over past 6 months, Renal biopsy report.

n)  All relevant investigation results in support of the diagnosis.

o)  HIV antibody test by ELISA method on the date of blood transfusion, HIV antibody test by ELISA method 3 - 6 months from date transfusion, Statement from statutory Health Authority to confirm that the disease was medically acquired, Western Blot test.

p)  HIV antibody test by ELISA method on the date of blood transfusion, HIV antibody test by ELISA method 3 - 6 months from date transfusion, Statement from statutory Health Authority to confirm that the disease was occupationally  acquired, Western Blot test

6

Specified Outpatient Treatment - Chemotherapy or Radiotherapy

a)  Blood Test Results

b)  CT scan report

c)  Copy of bill and original receipts.

7

Specified Outpatient Treatment - Kidney Dialysis

a)  Kidney Dialysis report

b)  Blood Test results

c)  Copy of bill and original receipts.

8

Daily Hospital Cash / Daily Hospital Cash for Intensive Care Unit (ICU) / Surgical Cash

a)  Hospital discharge summary

b)  Hospital billing statement.

9

Recovery Assistance Services

i.   Physiotherapy (Per visit/ Up to 12 visits)

ii.  Psychological Counselling (Per visit/ Up to 12 visits)

iii. Dietician/Nutritionist (Per visit/ Up to 12 visits)

iv. Occupational Therapy (Per visit/ Up to 12 visits)

v.  Speech Therapy (Per visit/ Up to 12 visits)

vi. Smoking Cessation Program (Per month/ Up to 6 months)

a)  Hospital billing statement

b)  Original receipts

c)  Summary reports from the Recovery Assistance Services’ provider (s) to support the claim.

10

Home Nursing  

a)  Hospital discharge summary.

b)  Hospital billing statement.

c)  Doctor’s report stating that the Insured Person is unable to perform at least 3 out of 6 Activities of Daily Living for a continuous and uninterrupted period of time and the receipts from the nursing care service provider for the expenses incurred.  

d)  Original payment receipts and invoice for home nursing.

11

Bill Protection

a)  Hospital discharge summary

b)  Hospital billing statement

12

Home Alteration and Vehicle Modification

a)  Doctor’s written confirmation  that any modification and installation in the Insured Person’s home or personal vehicle which are necessary to perform the Activities of Daily Living.

b)  Original Invoices and original receipts from the renovation contractor for the modifications and installations to Insured Person’s home and Personal vehicle.

13

Recovery Support – Housekeeping Services

a)  Doctor’s report stating that the Insured Person is unable to perform at least 3 out of 6 Activities of Daily Living for a continuous and uninterrupted period of time and require to engage the services of a housekeeper.

b)  Documentation evidence of the Registered housekeeping service provider with its terms and conditions.

c) Original invoice and original receipts from the Housekeeping Service Provider for the Service  of the Housekeeper.

d)  Hospital discharge summary or Hospital billing statement.

14

Funeral Expenses

a)  Death Certificate