HEALTH FUNDING AUTHORITIES - FEE PAYING PATIENTS
14 We will cover treatment carried out in a Public Hospital up to the limits specified under Your Policy , provided We have given Our approval and the Private Involvement Protocols (or any replacement protocols) set by the Ministry of Health for the treatment of private patients in Public
IN A PUBLIC HOSPITAL
Hospitals have been followed.
EXCESS WAIVER
15 If You suffer one (1) or more of the Trauma conditions listed below and as a result are admitted to a Private Hospital or admitted as a fee paying patient to a Public Hospital , We will waive the excess selected (if any). The Trauma conditions are: 1. Heart Attack 2. Stroke 3. Coronary Artery Bypass Surgery 4. Critical Cancer. Diagnosis must be made in writing by a Specialist , to Us and be based upon radiological, clinical, histological or laboratory evidence acceptable to Us . Trauma conditions defined as: 1 HEART ATTACK Heart Attack means the death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The basis for Diagnosis of a heart attack will be: • Confirmatory new electrocardiogram (ECG) changes indicative of ischaemia; and • A diagnostic rise and fall (other than as a result of cardiac or coronary intervention) in either: In addition, if the above criteria are not met, We will pay a claim based on evidence satisfactory to Us that You have been Diagnosed as having suffered a myocardial infarction resulting in: • A permanent reduction in the left ventricular ejection fraction to less than 50%, which is the result of the death of a portion of the heart muscle. For the purpose of this policy, the assessment of the ejection fraction should be made at least ninety (90) days after the event that lead to the Diagnosis of a heart attack. 1. Troponin I in excess on 2.0ug/L; or 2. Troponin T in excess on 0.6ug/L. 2 STROKE Stroke (resulting in functional loss) means any cerebrovascular accident or incident producing permanent neurological deficit causing either: • You to suffer at least 25% permanent impairment of whole person function^; or • You to be constantly and permanently unable to perform at least two (2) of the numbered activities of daily living without the physical assistance of someone else (if You can perform the activity on Your own by using special equipment, We will not treat You as unable to perform that activity). This requires clear evidence on a CT, MRI or similar scan that a stroke has occurred and evidence of:
BENEFIT
Page 10 of 22
PC-S3HC-04/2022
[AIA – INTERNAL]
Powered by FlippingBook