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: • infarction of brain tissue; and • intracranial or subarachnoid haemorrhage ; or • embolisation. Cerebral symptoms due to transient ischaemic attacks, cerebral injury resulting from trauma or hypoxia, and vascular disease affecting the eye or optic nerve or vestibular functions are excluded. ^as defined in the American Medical Association publication ‘Guides to the Evaluation of Permanent Impairment’ 6th Edition. 3 CORONARY ARTERY BYPASS SURGERY Coronary Artery Bypass Surgery means the actual undergoing of surgery to correct the narrowing or blockage of one (1) or more coronary arteries with bypass grafts for the first time, due to disease of those arteries. The operation must be considered necessary by a Specialist Cardiologist. Non-surgical techniques such as Angioplasty , catheter based techniques, laser or other intra-arterial procedures are excluded. 4 CRITICAL CANCER Critical Cancer means the presence of one (1) or more malignant tumours, characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue, provided the Diagnosis is unequivocal as confirmed by histopathology. This includes leukaemia, lymph omas, Hodgkin’s disease, malignant bone marrow disorders but excludes the following: • Malignant Melanoma less than 1.5 mm maximum thickness as determined by histological examination based on Breslow thickness and Malignant Melanoma less than Clark Level 3. • A growth histologically described as Carcinoma-in-Situ. • All hyperkeratosis or basal cell carcinomas of the skin. • All squamous cell carcinomas of the skin unless there has been spread to other organs. • Kaposis Sarcoma and other cancers which are directly attributed to AIDS and HIV infections. • All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least a clinical TNM classification T2N0M0 as defined by AJCC 6 th Edition 2002. • Tumours treated by endoscopic procedures alone. • We will allow cover for carcinoma-in-situ of the breast where it results in the entire removal of the breast specifically to arrest the spread of malignancy. This procedure must be the appropriate and necessary treatment.
PC-SHC-04/2022
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