Severity Level
Conditions
The signs of congestive heart failure include:
– Presence of third heart sound
– Jugular venous pressure above 6 cms
– Rales present in both bases on auscultation
– Cardiomegaly on chest x-ray
– Grade 3, or gross ascites, associated with marked abdominal distension
– Severe oedema to a level above the knee.
Severe peripheral vascular disease means severe restriction of blood flow through the arteries below the knee as measured by doppler readings of less than 30 per cent of normal and a claudication distance of 20 metres, resulting in amputation of the leg below the knee or higher. Heart attack resulting in permanent and irreversible left ventricular ejection fraction of 30 to 40% (two measurements of at least 6 months apart) whilst on ongoing optimal therapy for a minimum of six months, and significant and irreversible physical impairment to the degree of at least Class III of the New York Heart Association Functional Classification System of cardiac impairment.
Coronary artery bypass graft means the undergoing of surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of coronary arteries with by-pass grafts.
Aortic surgery means the undergoing of surgery or endovascular repair that is considered necessary to correct any narrowing, dissection or aneurysm of the thoracic or abdominal aorta.
2
Percutaneous coronary angioplasty 3 vessels means percutaneous coronary angioplasty or other percutaneous coronary artery procedures performed by a Consultant Cardiologist considered medically necessary on the basis of angiographic evidence to dilate and treat three or more coronary arteries within a period of sixty days. Cardiomyopathy means impaired ventricular function of variable aetiology, resulting in permanent and irreversible left ventricular ejection fraction of 30 to 40% (two measurements of at least 6 months apart) whilst on ongoing optimal therapy for a minimum of six months, and significant and irreversible physical impairment to the degree of at least Class III of the New York Heart Association Functional Classification System of cardiac impairment.
Heart attack (as defined above in the key term).
Heart valve surgery means the undergoing of open heart surgery that is considered necessary to correct or replace cardiac valves as a consequence of heart valve defects or abnormalities.
Permanent cardiac defibrillator insertion means the permanent insertion of an automatic implantable defibrillator after the occurrence of ventricular tachycardia or ventricular fibrillation.
3
Severe peripheral vascular disease means severe restriction of blood flow through the arteries below the knee as measured by doppler readings of less than 30 per cent of normal and a claudication distance of 20 metres, with gangrene and amputation of more than one toe. Percutaneous coronary angioplasty means percutaneous coronary angioplasty or other percutaneous coronary artery procedures performed by a Consultant Cardiologist considered necessary to dilate and considered medically necessary to treat one or two coronary arteries during the same procedure. The procedure may or may not involve the use of a stent.
The maximum amount payable is $75,000 across all Personal AIA policies per claim.
Permanent pacemaker insertion means the permanent insertion of an artificial pacemaker to correct an abnormal rhythm of the heart. The abnormal rhythm of the heart must have been documented on electrocardiograph (ECG) and be available to us.
4
Minor heart valve surgery means the undergoing of a catheter based endovascular valve repair or valve implantation as a consequence of heart valve defects or abnormalities.
Out-of-hospital cardiac arrest means cardiac arrest not associated with any medical procedure and that is documented by an electrocardiogram and occurs out of hospital, and is due to:
– cardiac asystole; or
– ventricular fibrillation with or without ventricular tachycardia.
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1106 AL-PC version 7 Effective 12 May 2026
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