Prudential Life Assurance Kenya

Critical Illness Definitions


Following diagnosis of a disease in the list of critical illnesses defined below, an amount equal to the critical illness sum assured will be payable by the Company. Each of the below illnesses must be diagnosed by a registered medical practitioner and must be supported by clinical, radiological, histological and laboratory evidence acceptable to the Company. Only one critical illness benefit will be paid over the policy term.

Major Cancers

A malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells with invasion and destruction of normal tissue.

The term malignant tumour includes leukaemia, lymphoma and sarcoma.

For the above definition, the following are excluded:

  • All tumours which are histologically classified as any of the following:
    • Pre-malignant; Non-invasive;
    • Carcinoma-in-situ;
    • Having borderline malignancy;
    • Having any degree of malignant potential;
    • Having suspicious malignancy;
    • Neoplasm of uncertain or unknown behaviour; or
    • Cervical Dysplasia CIN-1, CIN-2 and CIN-3;
  • Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
  • Malignant melanoma that has not caused invasion beyond the epidermis;
  • All Prostate cancers histologically described as T1N0M0 (TNM Classification) or below; or Prostate cancers of another equivalent or lesser classification;
  • All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
  • All tumours of the Urinary Bladder histologically classified as T1N0M0 (TNM Classification) or below;
  • All Gastro-Intestinal Stromal tumours histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs;
  • Chronic Lymphocytic Leukaemia less than RAI Stage 3; and
  • All tumours in the presence of HIV infection.

Heart Attack of Specified Severity

Death of heart muscle due to obstruction of blood flow, that is evident by at least three of the following criteria proving the occurrence of a new heart attack:

  • History of typical chest pain;
  • New characteristic electrocardiographic changes; with the development of any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block;
  • Elevation of the cardiac biomarkers, inclusive of CKMB above the generally accepted normal laboratory levels or Cardiac Troponin T or I at 0.5ng/ml and above;
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. The imaging must be done by Cardiologist specified by the Company.

For the above definition, the following are excluded:

  • Angina;
  • Heart attack of indeterminate age; and
  • A rise in cardiac biomarkers or Troponin T or I following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.

Stroke

A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, intracerebral embolism and cerebral thrombosis resulting in permanent neurological deficit with persisting clinical symptoms. This diagnosis must be supported by all of the following conditions:

  • Evidence of permanent clinical neurological deficit confirmed by a neurologist at least 6 weeks after the event; and
  • Findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.

The following are excluded:

  • Transient Ischaemic Attacks;
  • Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
  •  Vascular disease affecting the eye or optic nerve; and
  • Ischaemic disorders of the vestibular system.

Coronary Artery Bypass Surgery

The actual undergoing of open-chest surgery or Minimally Invasive Direct Coronary Artery Bypass surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist.

Angioplasty and all other intra-arterial, catheter based techniques, ‘keyhole’ or laser procedures are excluded.

Kidney Failure

Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation.

Aplastic Anaemia

Chronic persistent bone marrow failure, confirmed by biopsy, which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following:

  • Blood product transfusion;
  • Marrow stimulating agents;
  • Immunosuppressive agents; or
  • Bone marrow transplantation.

The diagnosis must be confirmed by a haematologist.

End Stage Lung Disease

End stage lung disease, causing chronic respiratory failure. This diagnosis must be supported by evidence of all of the following:

  • FEV1 test results which are consistently less than 1 litre;
  • Permanent supplementary oxygen therapy for hypoxemia;
  • Arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 ≤ 55mmHg); and
  • Dyspnoea at rest.

The diagnosis must be confirmed by a respiratory physician.

End Stage Liver Failure

End stage liver failure as evidenced by all of the following:

  • Permanent jaundice;
  • Ascites; and
  • Hepatic encephalopathy.

Liver disease secondary to alcohol or drug abuse is excluded.

Coma

A coma that persists for at least 96 hours. This diagnosis must be supported by evidence of all of the following:

  • No response to external stimuli for at least 96 hours;
  • Life support measures are necessary to sustain life; and
  • Brain damage resulting in permanent neurological deficit which must be assessed at least 30 days after the onset of the coma.

Coma resulting directly from alcohol or drug abuse is excluded.

Major Organ / Bone Marrow Transplantation

The receipt of a transplant of:

  • Human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation; or
  • One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible end stage failure of the relevant organ. Other stem cell transplants are excluded

Multiple Sclerosis

The definite occurrence of Multiple Sclerosis. The diagnosis must be supported by all of the following:

  • Investigations which unequivocally confirm the diagnosis to be Multiple Sclerosis;
  • Multiple neurological deficits which occurred over a continuous period of at least 6 months; and
  • Well documented history of exacerbations and remissions of said symptoms or neurological deficits.

Other causes of neurological damage such as SLE and HIV are excluded.