1. MEDICAL CHECK-UP
The Insured Person will be entitled to a yearly medical examination on Blood Test, Pap Smear, Mammogram and Abdomen/Pelvis Ultrasound with a Medical Practitioner appointed by the Company. Coverage is on a reimbursement basis (pay first, then claim) and up to a maximum of RM100.
2. FEMALE CANCERS
A malignant tumour characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue to any of the following sites: breast, cervix uteri, uterus, ovary, fallopian tube, vagina and vulva.
This excludes secondary cancer, which has originated from other organs and spread to the female genital tract and breast, non-invasive cancer-in-situ, and tumours in the presence of any Human Immunodeficiency Virus (HIV).
Diagnosis must be supported by histological evidence of malignancy.
3. FEMALE CARCINOMA-IN-SITU (BREAST and CERVIX UTERI)
Focal autonomous new growth of carcinomatous cells, which have not yet resulted in the invasion of normal tissues. 'Invasion' means an infiltration and/or active destruction of tissue or surrounding tissue beyond the basement membrane. The disease of carcinoma-in-situ covered is limited only to cervix uteri or the breast. The diagnosis of carcinoma-in-situ must always be positively diagnosed upon the basis of a microscopic examination of fixed tissue additionally supported, in the case of cervix uteri by cone biopsy or colposcopy with cervical biopsy and, in the case of breast, by a biopsy. Clinical diagnosis does not meet this standard.
Cervical Intraepithelial Neoplasia (CIN) classification including CIN I, CIN II, and CIN III (severe dysplasia without carcinoma-in-situ) and all carcinoma-in-situ in the presence of any Human Immunodeficiency Virus (HIV) are specifically excluded.
These benefits will not be payable if, at the point of claim for these benefits, the Insured has already qualified for Female Cancers benefit as stated in Item 2. under the same period of time.
4. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) WITH LUPUS
Refers to a multisystem, multifactorial, autoimmune disorder which affects mostly females in their childbearing years and is characterised by the development of auto-antibodies, directed against various self-antigens.
In respect of this contract, SLE will be restricted to those forms of systemic lupus erythematosus, which involves the kidneys (Type III to Type V Lupus Nephritis, established by renal biopsy). Other forms, discoid lupus, and those forms with only haematological and joint involvement will specifically be excluded.
WHO Lupus Classification:-
- Class I (minimal change) - negative, normal urine
- Class II (mesangial) - moderate proteinuria, active sediment
- Class III (focal segmental) - proteinuria, active sediment
- Class IV (diffuse) - acute nephritis with active sediment and/or nephrotic syndrome
- Class V (membranous) - nephrotic syndrome or severe proteinuria
5. HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HSIL) WITH SEVERE DYSPLASIA
Positively diagnosed on the basis of microscopic examination of fixed tissue additionally supported by a cone biopsy or colposcopy with cervical biopsy showing high-grade squamous intraepithelial lesion with severe dysplasia (which must be at a grading of not less than CIN III and has not yet resulted in the invasion of normal tissues.)
One or more benign tumour(s) of fibrous and muscular tissue which has developed in the muscular wall of the uterus (leiomyoma uteri), resulting in the actual undergoing of medically necessary surgery for myomectomy or hysterectomy.
7. OVARIAN CYST
One or more fluid or semi-solid material filled sac(s) that has developed in the ovary(ies) or on their surface resulting in the actual undergoing of medically necessary surgery for the removal of the cyst(s).
Cysts of less than three (3) mm in diameter, follicular cysts and corpus luteum cysts are specifically excluded.
8. FACIAL RECONSTRUCTIVE SURGERY DUE TO ACCIDENT
The actual undergoing of plastic or reconstructive surgery (above the neck) performed under general anaethesia which, in the opinion of the Company's medical advisor, is deemed medically necessary for the treatment of facial disfigurement being a direct result of an accident requiring inpatient treatment and subsequently the performance of such surgery.
Facial/neck disfigurement as a result of an accident occurring before the Issue Date or any reinstatement date of the contract, whichever is later, is excluded
9. BREAST RECONSTRUCTIVE SURGERY DUE TO ACCIDENT
Plastic or reconstructive surgery of the breast performed by a registered surgeon after an accident or mastectomy following diagnosis of invasive Breast Cancer (as defined in the Supplementary Contract). The surgery must, in the opinion of the Company's medical advisor, be deemed medically necessary.
Cosmetic breast surgery is excluded.
10. FRACTURES DUE TO OSTEOPOROSIS
A condition of reduced bone mass with decreased cortical thickness and a decrease in the number and size of the trabeculae of cancellous bone (but normal chemical composition, resulting in increased fracture incidence).
Only osteoporosis of the hip or femur resulting in the actual undergoing of medically necessary invasive surgery to repair or replace parts of the hip or femur bones are covered.
11. RHEUMATOID ARTHRITIS WITH COMPLICATION
Widespread joint destruction with major clinical deformity of three (3) or more of the following joint areas:-
- Cervical spine;
- Ankles; and
- Metatarsophalangeal joints in the feet.
Only severe cases of Rheumatoid Arthritis are covered. The diagnosis must be confirmed by a Medical Practitioner and supported by physicians appointed by the Company, as well as the presence of all of the following diagnostic criteria:-
- Morning joint stiffness;
- Symmetric arthritis of joints;
- Presence of rheumatoid nodules;
- Elevated titres of rheumatoid factors;
- Radiographic evidence of severe involvement of joint destruction.