Cancer
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Activities of Daily Living14
Clinical claims definitions: Medical Impairment Standard
BrightRock has worked in partnership with international clinical
and risk experts to ensure our clinical claims criteria are
objective, transparent and industry-leading. To give you and your
clients peace of mind that our claims definitions are comprehensive
and clinically objective, we provide a full list of our claims
definitions and criteria, divided by body system.
This document applies to your permanent expenses cover for the
following needs:
Cover for illness or injury with a financial impact
Additional expense needs
BrightRock Life Ltd, an authorised financial services provider and
registered insurer (FSP 11643, Registration number:
1996/014618/06). Sanlam Life Insurance Ltd, an authorised financial
services provider and registered insurer (FSP 2759, Registration
number: 1998/021121/06). Copyright ©November 2019 BrightRock. All
rights reserved. Terms and conditions apply. Document number:
30000007648.
Please note: In this document, we’ve provided our clinical claims
definitions accompanied with explanatory text for ease of
understanding. The information provided in the columns labelled
with the words “layman’s explanation” is provided purely for
information purposes. If there is any uncertainty or ambiguity,
then the wording provided under the column labelled “BrightRock
clinical definitions” will prevail.
With layman’s explanation
Total % pay-out
Cancer
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Activities of Daily Living14
Refractory pancytopaenia resulting from an irreversible,
treatment-resistant disorder with any two of the following: 1.
Persistent haemoglobin levels of ≤ 8g/dl OR 2. Neutropenia of <
1x109 WBC/l OR 3. Thrombocytopenia of < 100x109/l
Pancytopaenia (a lack of all types of blood cells) that persists as
a results of an irreversible disorder that doesn’t respond to
treatment and occurs with any two of the following:
1. Persistent haemoglobin levels of 8g/dl or less (haemoglobin is
the oxygen-carrying protein in red blood cells) OR 2. Neutropenia
(a lack of white blood cells) of 1x109 WBC/l or less OR 3.
Thrombocytopenia (a lack of platelets) of 100x109/l or less
100%
Total % pay-out
Cancer
11
13
14
12
Medically certified institutionalisation for a mental and
behavioural disorder1 of more than six months continuously
Medically certified admission to a recognised mental health
facility for a mental or behavioural1 problem
For more than six months at a time 100%
Confirmed diagnosis of schizophrenia1 with evidence of all of the
following criteria in the last year: 1. Uninterrupted compliance
with prescribed psychotropic medication (as prescribed by a
psychiatrist) AND 2. Admission to a psychiatric in-patient facility
for three months or longer in total
Confirmed diagnosis of schizophrenia With evidence of the following
in the last year 1. Consistent taking of psychotropic medication
(which treats the psychiatric disorder), as prescribed by a
psychiatrist AND 2. Admission to a psychiatric hospital or clinic
for at least three months at a time
100%
Documented treatment-resistant mental and behavioural disorder1
with evidence of all of the following criteria in the last two
years: 1. Uninterrupted compliance with prescribed psychotropic
medication (as prescribed by a psychiatrist) AND 2. Admission to a
psychiatric in-patient facility for four weeks or longer in total
AND 3. A full course of ECT
Documented mental and behavioural disorder1 that doesn’t respond to
treatment
With evidence of all of the following in the last two years: 1.
Consistent taking of psychotropic medication (which affects the
mental state), as prescribed by a psychiatrist AND 2. Admission to
a psychiatric hospital or clinic for at least four weeks AND 3. A
full course of ECT (electroconvulsive or shock therapy)
100%
Documented treatment-resistant mental and behavioural disorder1
with evidence of all of the following criteria in the last year: 1.
Uninterrupted compliance with prescribed psychotropic medication
(as prescribed by a psychiatrist) AND 2. Admission to a psychiatric
in-patient facility for 12 weeks or longer in total AND 3. A full
course of ECT
Documented mental and behavioural disorder1 that doesn’t respond to
treatment
With evidence of all of the following in the last year: 1.
Consistent taking of psychotropic medication (which treats the
psychiatric disorder), as prescribed by a psychiatrist AND 2.
Admission to a psychiatric hospital or clinic for at least 12 weeks
AND 3. A full course of ECT (electroconvulsive or shock
therapy)
100%
Total % pay-out
Cancer
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13
14
12
Medical Impairment Standard Definition sets B(V7.0), C(V7.0),
D(V6.0)
1. Documented treatment-resistant generalised epilepsy5 of at least
three months’ duration (despite optimal treatment and patient
compliance), with more than two seizures per week AND 2. Documented
neurological deficit as a result of the epilepsy, defined as two or
more of the following permanent (of more than six months’ duration)
findings: • Motor deficit (power < 3/5) • Cognitive deficit
(MMSE < 19/30) • Speech deficit and/or visual/hearing deficit,
all confirmed by a neurologist
Epilepsy 1. Documented generalised epilepsy5 of two fits per week
for at least three months. The fits do not respond to treatment,
despite taking the right medicine as prescribed by the treating
doctor AND 2. Documented permanent damage to the nervous system,
caused by the epilepsy and exhibiting two or more of the following
for at least six months (confirmed by a neurologist): • Impaired
muscle power measurement of less than 3 out of 5 • Impaired
cognitive skills (the ability to think, remember and judge clearly)
with a Mini-Mental State Examination (MMSE) score of less than 19
out of 30 • Impaired speech, vision and/or hearing, all confirmed
by a neurologist
100%
Non-traumatic organic cognitive disorder (excluding psychological
disorders) resulting in irreversible cognitive impairment2 as
evidenced by Mini Mental State Examinations (MMSE) < 19/30
Cognitive disorder Any condition affecting cognitive function (the
brain’s capacity to think, remember and judge clearly) that is not
due to physical injury (but that excludes psychological disorders).
The condition also leads to permanent cognitive impairment2 with a
Mini-Mental State Examination (MMSE) score of less than 19 out of
30
100%
Vestibular dysfunction3 presenting with attacks of nausea,
vomiting, vertigo and dizziness with at least 10 episodes per month
resulting from brainstem causes including: 1. Vascular lesions OR
2. Tumours of the cerebellum or fourth ventricle OR 3.
Demyelination disorders
Neurological vestibular (balance) disorder Results in attacks of
nausea, vomiting, dizziness and vertigo (a sense of falling), with
at least 10 episodes per month due to problems in the base of the
brain, including: 1. Disease of the blood vessels OR 2. Tumours of
the cerebellum or fourth ventricle of the brain OR 3. Demyelination
disorders (caused loss of the insulating sheath around
nerves)
100%
Central respiratory failure (a life-threatening problem with
breathing due to damage to the parts of the brain that control
breathing)
Confirmed permanent central respiratory failure, with the need for
a life support system
100%
Total % pay-out
Cancer
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The irreversible loss of language comprehension and production6
resulting from damage to the portions of the brain responsible for
language
Aphasia/dysphasia (communication disorders)
Permanent loss of the ability to understand, produce and/or use
words6, caused by damage to the parts of the brain that are
responsible for language
100%
Documented treatment-resistant sleep disorder7 (excluding sleep
apnoea) resulting in abnormal sleep cycles and sustained cognitive
impairment as evidenced by MMSE of less than 24/30
Sleep disorders A documented sleep disorder7 (excluding sleep
apnoea) that does not respond to treatment. The disorder is
characterised by abnormal sleep cycles and reduced mental
functioning, evidenced by a Mini-Mental State Examination (MMSE) of
less than 24 of a possible 30
100%
Disorders of cranial nerve VIII (the vestibulocochlear nerve)
Permanent vestibulocochlear nerve palsy4 (paralysis) on one side,
causing hearing-loss and vestibular dysfunction (balance disorder)
resulting in attacks of nausea, vomiting, dizziness and vertigo (a
sense of falling)
100%
Irreversible bulbar palsy4 as a result of bilateral impairment of
function of cranial nerves V, IX, X and XII that presents with loss
of facial sensation including dysarthria, dysphagia, dysphonia,
regurgitation and/or aspiration
Bulbar palsy (paralysis of the lower cranial nerves, which arise
from the brain itself)
Impaired function of cranial nerves V, IX, X and XII that leads to
permanent bulbar palsy4 (paralysis) on both sides, and includes
loss of facial sensation, dysarthria (the inability to speak
clearly), dysphagia (difficulty swallowing), dysphonia (impaired
voice sound production), regurgitation and/or aspiration (inhaling
stomach contents)
100%
Irreversible cerebellum dysfunction4 resulting in the inability to
stand without assistive devices
Disorders of the cerebellum (part of the brain responsible for
coordination and balance)
Permanent cerebellar dysfunction4 causing an inability to stand
without a cane or other supportive device
100%
Total % pay-out
Cancer
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Activities of Daily Living14
Confirmed diagnosis of any stage 4 cancer, including any cancer
classified by SCIDEP as level A. Includes: 1. Acute myeloid
leukaemia; 2. Chronic lymphocytic leukaemia, stage 3 or 4 on
the
Rai classification, or Binet C; 3. Chronic myeloid leukaemia
(requiring bone marrow
transplant); 4. Acute lymphocytic leukaemia (adults); 5.
Hodgkin’s/non-Hodgkin’s lymphoma stage 4 on Ann
Arbor classification system; 6. Multiple myeloma stage 3 on the
Durie- Salmon
scale; 7. WHO grade 3 or 4 brain tumour.
Any stage 4 cancer (includes any cancer classified by SCIDEP as
level A)
Includes: 1. Acute myeloid leukaemia (a type of cancer
characterised by an overproduction of immature white blood cells,
called myeloblasts);
2. Chronic lymphocytic leukaemia (a type of slow growing leukaemia
that affects developing white blood cells called B-lymphocytes),
stage 3 or 4 on the Rai classification, or Binet C;
3. Chronic myeloid leukaemia (a cancer where the bone marrow
produces too many white cells called granulocytes) requiring bone
marrow transplant;
4. Acute lymphocytic leukaemia in adults (a type of cancer
characterised by an overproduction of immature white blood cells
called lymphoblasts);
5. Hodgkin’s/non-Hodgkin’s lymphoma (cancerous tumour of the lymph
nodes) stage 4 on Ann Arbor classification system;
6. Multiple myeloma (a cancer that forms in a type of white blood
cell called a plasma cell) stage 3 on the Durie-Salmon scale;
7. Brain tumour that is considered WHO (World Health Organisation)
grade 3 or 4
100%
Confirmed diagnosis of any stage 3 cancer or WHO grade 2 brain
tumour (including any cancer that is classified by SCIDEP as level
B such as Hodgkin’s or non-Hodgkin’s lymphoma stage 3 on the Ann
Arbor classification system) for which the insured life has
undergone continuous cancer treatment for a perod of 12 months or
longer. This specifically excludes anti- hormonal treatments.
Any stage 3 cancer or WHO grade 2 brain tumour (includes any cancer
classified by SCIDEP as level B such as Hodgkin’s or non- Hodgkin’s
lymphoma stage 3 on the Ann Arbor classification system)
that:
1. Has undergone continuous cancer treatment for 12 months or
longer AND
2. Excludes anti-hormonal treatments
Total % pay-out
Cancer
11
13
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Activities of Daily Living14
Chronic gastrointestinal tract and/or liver and/or biliary
disorders1 resulting in: 1. Unintentional treatment-resistant
weight-loss of at least 25% over a 5 month period OR 2.
Unintentional treatment-resistant weight-loss resulting in a BMI of
less than 16
Digestive disorders, defined as: Chronic gastrointestinal tract
and/or liver and/ or biliary (relating to bile, the bile ducts or
the gallbladder) disorders1 resulting in: 1. Unintentional
weight-loss of at least 25% that
doesn’t respond to treatment in five months OR
2. Unintentional weight-loss that doesn’t respond to treatment and
that leads to a Body Mass Index (BMI) below 16
100%
Chronic irreversible liver disease1 with at least two of the
following: 1. Serum bilirubin > 51µmol/l 2. Serum albumin <
30g/dl 3. Prolonged prothrombin time of > 6 seconds or INR >
2.3 4. Ascites requiring ongoing surgical drainage 5. Hepatic
encephalopathy
Digestive disorders, defined as: Chronic, permanent liver disease1
with at least two of the following: 1. Serum bilirubin levels of
more than 51µmol/l
(bilirubin is a bile pigment formed in the liver) 2. Serum albumin
levels lower than 30g/dl
(albumin is a protein that’s produced by the liver and circulates
in the blood)
3. Prolonged prothrombin time (how long it takes for blood to clot)
of more than 6 seconds, or an international normalised ratio (INR)
of more than 2.3 seconds (INR is a standardised version of the
prothrombin time)
4. Ascites (free fluid in the abdominal cavity) that needs ongoing
draining through surgery
5. Hepatic encephalopathy (a state of mental confusion caused by
liver failure)
100%
Confirmed diagnosis of chronic irreversible liver failure¹
confirmed by a gastroenterologist (PLUS inclusion on a recognised
transplant list) with one of the following: 1. Serum bilirubin more
than 51 μmol/l 2. Serum albumin lower than 30g/dl 3. Prolonged
prothrombin time of more than six
seconds or INR more than 2.3 4. Ascites requiring ongoing surgical
drainage 5. Hepatic encephalopathy
Digestive disorders, defined as: Chronic, permanent liver failure¹
(PLUS inclusion on a recognised transplant list) with one of the
following: 1. Serum bilirubin levels of more than 51μmol/l
(bilirubin is a bile pigment formed in the liver) 2. Serum albumin
levels lower than 30g/dl
(albumin is a protein that’s produced by the liver and circulates
in the blood)
3. Prolonged prothrombin time (how long it takes for blood to clot)
of more than six seconds, or an international normalised ratio
(INR) of more than 2.3 seconds (INR is a standardised version of
the prothrombin time)
4. Ascites (free fluid in the abdominal cavity) that needs ongoing
draining through surgery
5. Hepatic encephalopathy (a state of mental confusion caused by
liver failure)
1 2
Total % pay-out
Cancer
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Activities of Daily Living14
100%
Irreversible biliary tract obstruction1 with clinical evidence of
cholestasis in the form of: 1. Ascending cholangitis 2. Jaundice
AND 3. Deranged liver enzymes (a two-fold increase or more)
Digestive disorders, defined as: Permanent blockage in the biliary
tract1, which transports bile from the liver to the small
intestine, with clinical evidence of cholestasis (blocked bile
ducts) in the form of: 1. Ascending cholangitis (inflammation of
the biliary tract) 2. Jaundice (a condition involving yellowing of
the skin and eyes caused by a build-up of pigment usually due to
liver or bile duct problems) AND 3. At least a two-fold increase in
liver enzymes
100%
Irreversible total dysphagia1 that has: 1. Resulted from organic
disease AND 2. Undergone more than one surgical and/ or
radiotherapeutic intervention
Digestive disorders, defined as: Permanent dysphagia1 (difficulty
swallowing): 1. Caused by an organic disease (any condition that’s
been confirmed by physical examination, lab tests or other
diagnostic studies) AND 2. That’s undergone more than one operation
and/or received radiation treatment
100%
Irreversible faecal incontinence1 treated by permanent
colostomy
Digestive disorders, defined as: Permanent faecal incontinence1
(loss of bowel control) treated by permanent colostomy (surgery
that brings the end of the large intestine out through an opening
in the abdominal wall)
100%
Irreparable abdominal or inguinal hernia (where surgery is now
contraindicated1) with documented persistent malabsorption syndrome
resulting from previous bowel loss
Digestive disorders, defined as: 1. Irreparable abdominal or
inguinal (groin) hernia, where surgery is not advised1 AND 2.
Documented persistent malabsorption syndrome (a problem absorbing
nutrients from food) that has been caused by previous bowel
loss
100%
Total % pay-out
Cancer
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13
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Activities of Daily Living14
Any recognised cardiovascular or cardio-pulmonary disorder1 that
results in the following cardiovascular assessments: 1. New York
Heart Association Functional Classification (NYHA) III/IV AND 2.
Permanent Ejection Fraction (EF) < 35% OR 3. Metabolic
Equivalents (METS) < 2
Any recognised heart, circulation and/ or lung disorder1 that meet
the following severity criteria:
1. A New York Heart Association Functional Classification (NYHA) of
III or IV AND
3. Metabolic Equivalents (METS) of less than 2 (METS is a measure
of the energy you burn and oxygen you use during exercise)
100%
Chronic peripheral arterial insufficiency (also known as ischaemia)
presenting with: 1. No palpable pulses AND 2. Doppler readings of
Ankle Brachial systolic pressure Index (ABI) ≤ 0.5 AND 3. Rest pain
OR 4. Ulceration OR 5. Gangrene with or without amputation
Chronic peripheral arterial insufficiency or ischaemia (due to
blockages in blood vessels to the upper and lower limbs) that leads
to:
1. No pulse felt on physical examination) AND 2. Doppler readings
of an Ankle Brachial Pressure Index (ABI) of 0.5 or less (a test
that measures the difference in blood pressure between the arteries
of your arm and ankle) AND 3. Pain in the limb when resting OR 4.
Vascular ulcers (loss of skin) OR 5. Gangrene (tissue death) with
or without complete surgical removal (amputation)
100%
* *
2. Permanent Ejection Fraction (EF) of less than 35% (the permanent
ejection fraction is a measure of the volume of blood that the
heart pumps out with every contraction) OR
With layman’s explanation
Total % pay-out
Cancer
11
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Activities of Daily Living14
Documented treatment-resistant hypertension2 complicated by at
least two of the following: 1. Chronic kidney disease (CKD) stage 4
or 5, with an estimated glomerular filtration rate (eGFR) of <
30ml/min OR 2. Radiological evidence of a stroke (CVA) OR 3. Grade
III or IV hypertensive retinopathy OR 4. Documented left
ventricular hypertrophy (septal wall thickness to posterior LV wall
thickness of 1:1.3 on ECHO) OR 5. Congestive cardiac failure (CCF)
defined as: • New York Heart Association Functional Classification
(NYHA) II AND • Permanent Ejection Fraction (EF) < 45% OR •
Metabolic Equivalents (METS) 2 - 5
Documented high blood pressure2 that doesn’t respond to treatment
and is complicated by at least two of the following:
1. Advanced and severe chronic kidney disease (CKD) of stage 4 or
5, with an estimated glomerular filtration rate (eGFR) of less than
30ml/min (eGFR is an indication of overall kidney function)
OR
2. Evidence of a stroke on any brain scan OR 3. Grade III or IV
hypertensive retinopathy (significant damage to the retina of the
eye) OR 4. Thickening or increased size of the muscle wall of the
heart’s left ventricle measured as 1:13 on a heart sonogram (ECHO)
OR 5. Congestive cardiac failure (CCF) defined as: • New York Heart
Association Functional Classification (NYHA) II AND • Permanent
Ejection Fraction (EF) of less than
45% (the permanent ejection fraction is a measure of the volume of
blood that the heart pumps out with every contraction) OR
• Metabolic Equivalents (METS) of 2 to 5 (METS is a measure of the
energy you burn and oxygen you use during exercise)
100%
Total % pay-out
Cancer
11
13
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Activities of Daily Living14
Advanced AIDS1, confirmed by: 1. A positive HIV antibody test AND
2. A current CD4 cell count of less than 200, despite optimal
anti-retroviral combination therapy AND 3. A confirmed diagnosis of
at least one of the following diseases: • Kaposi’s sarcoma •
Pneumocystis carinii pneumonia • Progressive multifocal
leukoencephalopathy • Extrapulmonary or MDRD/XDR pulmonary
tuberculosis • Pulmonary cryptococcus
Advanced AIDS, confirmed by: 1. A positive HIV antibody test AND 2.
A current CD4 cell count of less than 200, even with optimal
anti-retroviral medication AND 3. Confirmed diagnosis of at least
one of the following conditions: • Kaposi’s sarcoma (a cancer that
causes lesions in the skin or internal organs ) • Pneumocystis
carinii pneumonia (an infection of the lungs caused by a fungus) •
Progressive multifocal leukoencephalopathy (a viral infection that
causes progressive damage to the white matter of the brain) •
Extrapulmonary tuberculosis (TB infection in organs other than the
lungs), multidrug resistant pulmonary tuberculosis (MDR-TB), or
extensively drug-resistant pulmonary tuberculosis (XDR-TB) - the
latter two refer to TB infection in the lungs that doesn’t respond
to standard TB treatment • Pulmonary cryptococcus (a fungal
infection of the lungs)
100%
Total % pay-out
Cancer
11
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Activities of Daily Living14
Signs of established endocrine disorders1, including documented
diabetes mellitus type 1 or 2, complicated by at least two of the
following: 1. Chronic kidney disease (CKD) stage 3B with an
estimated glomerular filtration rate (eGFR) of 30 to 44ml/min OR 2.
Radiological evidence of a stroke (CVA) OR 3. Grade III diabetic
retinopathy OR 4. Coronary artery disease which has undergone
coronary artery bypass
Established endocrine disorder (problems with hormone-secreting
glands)1
Documented type 1 or 2 diabetes, complicated by at least two of the
following: 1. Chronic kidney disease (CKD) stage 3B, with an
estimated glomerular filtration rate (eGFR, an indication of
overall kidney function) of 30 to 44ml/min OR 2. Evidence of a
stroke (cerebrovascular accident or CVA) on a scan OR 3. Grade III
diabetic retinopathy (damage to the retina in the eye) OR 4.
Coronary artery disease (disease of the heart’s blood vessels) that
has undergone a coronary artery bypass
100%
Documented diabetes mellitus type 1 or 2 complicated by: • Grade IV
or V diabetic retinopathy
Documented type 1 or 2 diabetes complicated by:
Grade IV or V diabetic retinopathy (damage to the retina of the
eye)
100%
Cushing’s syndrome as evidenced by at least two of the following:
1. Documented profound proximal myopathy resulting in the permanent
use of assistive devices
OR 2. New-onset persistent diabetes mellitus diagnosed after the
diagnosis of Cushing’s syndrome and requiring ongoing insulin OR 3.
Refractory hypertension (blood pressure > 140/90
in four or more separate readings taken at least two months apart
within the last 12 months) and with newly diagnosed ischaemic heart
disease
(angina, MI, stent or CABG) OR 4. Newly diagnosed psychotic
disorder treated with continuous antipsychotic medication for at
least 12 months (as diagnosed and treated by a psychiatrist)
Cushing’s syndrome (a condition caused by high levels of cortisol
in the blood), evidenced by at least two of the following:
1. Documented serious proximal myopathy (weakness and wasting of
the limb muscles closest to the body) leading to the permanent use
of walking or supporting aids OR 2. New-onset, persistent diabetes
mellitus that is diagnosed after the Cushing’s syndrome and
requires ongoing insulin treatment OR 3. Refractory hypertension
(high blood pressure that does not respond to treatment), with
levels higher than 140/90 in four or more separate readings taken
at least two months apart within the last 12 months AND with newly
diagnosed ischaemic heart disease (reduced blood flow to the
heart), in the form of angina, a heart attack, a stent or Coronary
Artery Bypass Graft procedure (CABG) OR 4. New-onset psychotic
disorder needing continuous antipsychotic medication for at least
12 months (diagnosed and treated by a psychiatrist)
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Refractory syndrome of inappropriate antidiuretic hormone secretion
(SIADH) with: 1. Na+ < 130mmol/l AND 2. No evidence of
hypovolaemia AND 3. Normal blood pressure, pulse and serum
urea:creatinine ratio demonstrated by two or more readings taken at
least two months apart within the last six months) AND
4. As a result of any of the following: • Small cell lung cancer •
Mesothelioma • GI tract malignancy • Pancreatic malignancy •
Asbestosis • Progressive multiple sclerosis
Syndrome of inappropriate antidiuretic hormone secretion (SIADH), a
problem with the secretion of the antidiuretic hormone
With evidence of the following: 1. Sodium (Na+) level of less than
130mmol/l AND 3. No evidence of hypovolaemia (reduced blood volume)
AND 4. Normal blood pressure, pulse and serum urea:creatinine ratio
shown by two or more readings taken at least two months apart
within the last six months AND 5. Caused by any of the following: •
Small cell lung cancer OR • Mesothelioma (cancer of the tissue that
lines the chest, abdomen or around the heart) OR • Cancer of the
gastrointestinal tract • Cancer of the pancreas • Asbestosis (a
lung condition caused by inhaling asbestos fibres) • Progressive
multiple sclerosis (a condition involving increasing damage to the
nerves in the brain and spinal cord and affecting all body
functions)
100%
Refractory hypocalcaemia resulting from parathyroid disorders with
evidence of the following: Chronic hypocalcaemia (serum calcium
< 2.3mmol/l, as evidenced by three or more separate readings
taken at least two months apart within the last six months) and
with any of the following: • New-onset seizure disorder on
permanent
anti-convulsant medication (diagnosed and treated by a neurologist)
OR • Raised intracranial pressure necessitating surgical
intervention OR • Refractory new-onset prolonged QT interval on ECG
OR • Osteomalacia OR • New-onset psychotic disorder requiring
continuous antipsychotic medication for at least 12 months (as
diagnosed and treated by a psychiatrist)
Refractory hypocalcaemia (a lack of calcium that doesn’t respond to
treatment) caused by disorders of the parathyroid glands and with
evidence of the following:
Chronic hypocalcaemia (too little calcium), with levels below
2.3mmol/l in three or more separate tests taken at least two months
apart within the last six months. These results must be accompanied
by any of the following: • Newly-diagnosed seizure disorder that
requires permanent anti-seizure medication (diagnosed and treated
by a neurologist) OR • Raised intracranial pressure (increased
pressure within the brain) that requires surgical correction OR •
New-onset prolonged QT interval (a conduction disturbance in the
heart) that’s seen on an electrocardiogram (ECG) and doesn’t
respond to treatment OR • Osteomalacia a (bone disorder that leads
to bone softening) OR • Newly-diagnosed psychotic disorder
requiring continuous antipsychotic medication for at least 12
months (as diagnosed and treated by a psychiatrist)
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Refractory hypercalcaemia resulting from parathyroid disorders with
evidence of the following: Chronic hypercalcaemia (serum calcium ≥
3.0mmol/l as evidenced by three or more separate readings,
following correction for serum albumin, taken at least two months
apart within the last six months) and with any of the following: •
Chronic pancreatitis OR • New-onset irreversible dementia
(confirmed by MMSE of < 24/30 on three separate tests at least
three months apart over the preceding 12 months, and diagnosed and
treated by a psychiatrist) OR • New-onset psychotic disorder
requiring continuous antipsychotic medication for at least 12
months (as diagnosed and treated by a psychiatrist) OR •
Unintentional treatment resistant weight-loss of at
least 15% in a three month period, or unintentional weight-loss
resulting in a BMI of < 18 within the last year OR
• Cardiac arrhythmias necessitating a permanent pacemaker
Refractory hypercalcaemia (a surplus of calcium that doesn’t
respond to treatment) caused by disorders of the parathyroid glands
and with evidence of the following:
Chronic hypercalcaemia (too much calcium), with levels of at least
3.0mmol/l in three or more separate tests after correction for
albumin levels. The tests must have been taken at least two months
apart within the last six months, and the results must be
accompanied by any of the following: • Chronic pancreatitis
(inflammation of the pancreas) OR • New-onset, permanent dementia
(loss of brain function), confirmed by Mini-Mental State
Examination (MMSE) score of less than 24 out of 30 in three
separate tests that were taken at least three months apart over the
last 12 months (diagnosed and treated by a psychiatrist) OR •
New-onset psychotic disorder that needs continuous antipsychotic
medication for at least 12 months (diagnosed and treated by a
psychiatrist) OR • Unintentional weight-loss of at least 15%
over three months that does not respond to treatment or
unintentional weight-loss leading to a Body Mass Index (BMI) score
of less than
18 within the last year OR • Cardiac arrhythmias (disorders of the
heart rhythm) that require a permanent pacemaker
100%
Panhypopituitarism, defined as more than 80% loss of the anterior
pituitary gland as evidenced by: 1. Growth hormone deficiency AND
2. Gonadotrophin deficiency AND 3. TSH deficiency AND 4. ACTH
deficiency
Panhypopituitarism (reduced production of all or most pituitary
gland hormones)
Defined as more than 80% loss of the anterior (front portion)
pituitary gland, shown by: 1. Growth hormone (a hormone that
promotes growth of the body) deficiency AND 2. Gonadotrophin (a
hormone that stimulate the ovaries or testes) deficiency AND 3.
Thyroid (TSH - a hormone that stimulates the thyroid gland)
stimulating hormone deficiency AND 4. Adrenocorticotropic (the
hormone that stimulates the adrenal gland) hormone (ACTH)
deficiency
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Any of the following endocrine conditions1: 1. Polyglandular
autoimmune syndrome II 2. Multiple endocrine neoplasia I or
II
Any of the following hormonal conditions1: 1. Polyglandular
autoimmune syndrome II - a condition where the immune system
attacks several hormone-secreting glands including the thyroid,
adrenal glands and the pancreas 2. Multiple endocrine neoplasia I
or II - tumours of several hormone-secreting glands including the
parathyroids, pituitary, and pancreas (multiple endocrine neoplasia
I) or the thyroid, parathyroids and adrenal glands (multiple
endocrine neoplasia II)
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Lifelong haemo- or peritoneal dialysis Lifelong haemo- or
peritoneal dialysis A lifelong need for dialysis (treatment for
severe kidney failure where fluid and body waste products are
filtered and removed by a dialysis machine). This can be either
haemodialysis (which filters blood through a vein) or peritoneal
dialysis (which filters blood through the abdominal cavity)
100%
Irreversible chronic kidney disease (CKD) stage 4 or 5 with eGFR
< 30ml/min
Irreversible chronic kidney disease (CKD) Permanent stage 4 or 5
chronic kidney disease (CKD) with an estimated glomerular
filtration rate (eGFR) of below 30ml/min (eGFR is an indication of
overall kidney function)
100%
Urinary incontinence or urethral dysfunction resulting in a
permanent indwelling catheter
Incontinence Urinary incontinence (loss of bladder control) or
urethral dysfunction (abnormal flow of urine in the bladder outflow
tract), leading to the insertion of a permanent catheter tube
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
With layman’s explanation
Total % pay-out
Cancer
11
13
12
Documented respiratory disorder1 resulting in irreversible
respiratory impairment of: • FEV1 ≤ 40% OR • FVC ≤ 40% OR • DCO ≤
40%
A documented respiratory problem1 that leads to irreversible
impairment and the following measurements:
1. A Forced Expiration Volume or FEV1 (the volume of air that can
be blown out in the first second) of 40% or less, indicating
reduced lung function OR
2. A Forced Vital Capacity or FVC (the volume of air that can be
blown out after inhaling fully) of 40% or less, indicating reduced
lung function OR
3. A Diffusion Capacity or DCO of 40% or less, indicating the
lungs’ reduced ability to transfer oxygen
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Paraplegia Paralysis from the waist down Permanent and complete
100%
Quadriplegia Paralysis from the neck down Permanent and complete
100%
Hemiplegia Paralysis on one side of the body, including the arm,
leg and trunk
Permanent and complete 100%
Diplegia Paralysis of the upper or lower limbs on both sides of the
body
Permanent and complete 100%
Loss or complete loss of use of both lower limbs (defined as the
lower limb from above the ankle)
Loss of both legs above the ankle, or the complete loss of the
ability to use them
Permanent and complete 100%
Loss or complete loss of use of one or both upper limb(s) above the
elbow, or one or both lower limb(s) above the knee
Loss of one or both arms above the elbow, or one or both legs above
the knee, or the complete loss of the ability to use them
Permanent and complete 100%
Loss or complete loss of use of an entire hand Loss of a hand, or
the complete loss of the ability to use it
Permanent and complete 100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Persistent documented neurological impairment1, despite optimal
treatment, and with evidence of the following: 1. 50% or more
compression fracture of a vertebral body or multiple level
compression fractures AND 2. Two or more spinal operations
including laminectomy AND/OR discectomy AND/OR fusion AND/OR
surgical motion-preserving technologies such as discarthroplasty
and dynamic stabilisation techniques on separate occasions within a
five-year period
Spinal disorder Nerve damage that persists even after optimal
treatment, and with evidence of the following: 1. A compression
fracture that has collapsed 50% or more of the vertebral body (the
largest, central part of a vertebra), or compression fractures of
several vertebrae AND 2. Two or more spinal operations within the
last five years, including a laminectomy (removal of the back of a
vertebral bone to relieve pressure on the spinal cord), AND/OR a
discectomy (removal of part or all of a cartilage disc between
vertebrae), AND/OR a fusion (surgical joining of two or more
vertebrae to reduce pain and abnormal movement), AND/OR non fusion
(motion-preserving) techniques, such as discarthroplasty
(replacement of a damaged disc with an artificial one) and dynamic
stabilisation (insertion of a device that stabilises the spine
without eliminating its ability to move)
100%
Persistent documented neurological impairment1, despite optimal
treatment, and with evidence of the following: 1. Corresponding
clinical and radiological evidence of a radiculopathy, defined as
motor and sensory deficit, muscle atrophy and clinical signs of
nerve tension AND 2. Two or more spinal operations including
laminectomy AND/OR discectomy AND/OR fusion AND/OR surgical
motion-preserving technologies such as discarthroplasty and dynamic
stabilisation techniques on separate occasions within a five-year
period
Spinal disorder Nerve damage that persists even after optimal
treatment, and with evidence of the following: 1. Evidence of a
radiculopathy, (a “pinched nerve”) on examination and an X-ray.
Symptoms include motor and sensory damage, muscle atrophy and
clinical signs of nerve tension 2. Two or more spinal operations
within the last five years, including a laminectomy (removal of the
back of a vertebral bone to relieve pressure on the spinal cord),
AND/OR a discectomy (removal of part or all of a cartilage disc
between vertebrae), AND/OR a fusion (surgical joining of two or
more vertebrae to reduce pain and abnormal movement), AND/OR non
fusion (motion-preserving) techniques, such as discarthroplasty
(replacement of a damaged disc with an artificial one) and dynamic
stabilisation (insertion of a device that stabilises the spine
without eliminating its ability to move)
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
A disorder of the spine resulting in a diagnosis of bladder
incontinence with a permanent indwelling catheter or bowel
incontinence with a permanent colostomy
Spinal disorder Disorder has caused bladder or bowel incontinence
and the need for a permanent catheter or colostomy
100%
Diagnosis of cauda equina syndrome Cauda equina syndrome (a serious
condition caused by compression of the nerves in the lower portion
of the spinal canal, which leads to permanent loss of bowel and
bladder control, and paralysis of the legs)
Diagnosed 100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
With layman’s explanation
Total % pay-out
Cancer
11
13
12
Irreversible binaural loss of hearing1 of greater than 85%
as measured by audiometry at hearing thresholds of 500Hz, 1000Hz,
2000Hz and 3000Hz and with a speech discrimination threshold of
less than 60%
Hearing loss Permanent hearing loss1 of more than 85% in both ears
(binaural), measured at hearing thresholds (sound levels) of 500Hz,
1000Hz, 2000Hz and 3000Hz, with a speech discrimination threshold
(ability to hear and understand speech) of less than 60%
100%
Irreversible and complete loss of hearing1 in both ears (total loss
of hearing bilaterally)
Hearing loss Total and permanent hearing loss1 in both ears
100%
Bilateral loss of visual acuity as evidenced by a Snellen chart
reading of 20/200 or worse in the best eye after full
correction
Visual loss Loss of clear vision in both eyes, with a Snellen chart
(eye-testing chart) reading of 20/200 or worse in the
better-functioning eye, even after fully correcting your eyesight
with the strongest available lens
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
With layman’s explanation
Total % pay-out
Cancer
11
13
12
Full-thickness burns of more than 18% of the body surface
Burns Full-thickness burns (involving all the layers of the tissue)
of more than 18% of the body surface
100%
Full-thickness burns of 9% to 18% of the body surface including the
palms of both hands or soles of both feet
Burns Full-thickness burns (involving all the layers of the tissue)
of 9 to 18% of the body surface, including the palms of both hands
or soles of both feet
100%
Full-thickness burns of more than 25% of the face Burns
Full-thickness burns (involving all the layers of the tissue) of
more than 25% of the face
100%
Irreversible disfigurement of more than 50% of the body surface
caused by a chronic treatment-resistant skin disorder and
accompanied by systemic organ involvement of the central nervous
system OR the heart OR lungs OR liver OR kidneys, due to the
chronic treatment-resistant skin disorder itself
Skin disorders 1. Permanent disfigurement of more than 50% of the
body surface, caused by a chronic skin disorder that does not
respond to treatment AND 2. That has affected another internal
organ, namely the central nervous system, heart, lungs, liver or
kidneys
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
A state of unresponsiveness, as evidenced by a Glasgow Coma Scale
of 8 and less, which persists for more than 96 hours.
(medically-induced comas are excluded)
Coma (being unconscious) A coma that lasts longer than four days
and scores 8 and less on the Glasgow Coma Scale (a scale for
measuring the level of unconsciousness or severity of a brain
injury) (medically-induced comas are excluded)
100%
A traumatic injury to the brain, with resultant documented Glasgow
Coma Scale of less than 12/15, caused by an external physical force
with: 1. Irreversible cognitive impairment of MMSE < 21/30 OR 2.
Permanent neurological deficit (motor and/ or sensory impairment)
resulting in continuous professional care and supervision of more
than four hours a day
Traumatic (physical) brain injury Caused by an external physical
force and leading to a Glasgow Coma Scale (which quantifies the
level of unconsciousness or severity of a brain injury) score of
less than 12 out of 15, as well as: 1. Permanently reduced mental
function with a Mini–Mental State Examination (MMSE) score of less
than 21 of a possible 30 OR 2. Permanent damage to the nervous
system that impairs movement and/or sensation and requires
professional care and supervision for more than four hours per
day
100%
Irreversible anatomical distortion of 25% to 50% of the face caused
by an external physical force, and which has undergone multi-stage
facial reconstructive surgery
Facial injury Permanent distortion of 25% to 50% of the anatomy of
the face, caused by an external physical force, and which has
undergone several stages of reconstructive surgery
100%
Irreversible anatomical distortion of more than 50% of the face
caused by an external physical force
Facial injury Permanent distortion to more than 50% of the anatomy
face, which was caused by an external physical force
100%
Total % pay-out
Cancer
11
13
12
Activities of Daily Living14
Permanent failure of 4 out of 5 BrightRock Activities of Daily
Living (excluding cognitive failure)
ADL failure Has resulted in permanent inability to perform four out
of five BrightRock Activities of Daily Living (excluding cognitive
impairment. Cognitive impairment is where the brain’s capacity to
think, remember and judge clearly is reduced)
100%
Permanent failure of cognitive BrightRock Activities of Daily
Living (see definition) with an irreversible MMSE of ≤ 18
ADL failure Has resulted in permanent inability to perform the
cognitive BrightRock Activities of Daily Living (this refers to the
brain’s capacity to think, remember and judge clearly) and a
permanent score of 18 or less when a neurologist tests the person’s
cognitive (thinking) skills with the Mini Mental State Examination
(MMSE)
100%
BrightRock Activities of Daily Living (ADLs)
1. Washing: You rely entirely on someone else to help you wash,
bath or shower.
2. Dressing Skills: You need the help of another person to help you
fasten clothes (open/close zips, fasten/unfasten buttons, close
belts, tie laces) and, if applicable,
attach and fasten any braces, prosthetics or other surgical
appliances that you usually wear.
3. Eating and feeding: You’re physically unable to feed yourself
and need someone’s help.
4. Mobility: You need physical help when moving between rooms on a
level surface, despite the use of an assistive device such as a
walking cane or wheelchair.
5. Transferring: You need someone’s help when moving between a bed
and a chair.
6. Cognitive Impairment: You have suffered irreversible brain
damage, and can no longer perform the Activities of Daily Living
without medical help or supervision.
This must be confirmed by a neurologist or psychiatrist and
formally tested by a neuropsychologist.
Permanence will be established not less than three months after the
event
Appendix
Cancer
11
13
12
Activities of Daily Living14
Reference notes
Brain and nerves 1. Examples of mental and behavioural disorders
that result in the severity criteria as specified here include but
are not limited to:
• Dementia
• Anxiety disorders
2. Irreversible cognitive impairment must be confirmed by a
neuropsychologist assessment.
3. The diagnosis of vestibular dysfunction must be confirmed by a
neurologist with supporting investigations (i.e. brain imaging
studies). Neurological vestibular conditions excluded from this
benefit include vasospastic conditions, such as migraines.
4. Must be confirmed by a neurologist with supporting
investigations.
5. The diagnosis of treatment-resistant generalised epilepsy is
defined as the failure to control seizure activity by surgery or an
adequate trial (despite full patient compliance) of at least three
antiepileptic medications. At least two must have been used in
combination (confirmed by therapeutic blood levels where possible).
This diagnosis must be confirmed by a neurologist, with supporting
investigations i.e. EEG and brain imaging studies. Non-Epileptic
Attack Disorder (NEAD) and psychogenic non-epileptic seizure (PNES)
are excluded from this benefit category.
6. Loss of language comprehension and production must be confirmed
by a neurologist with radiographic evidence in keeping with the
clinical findings.
7. The diagnosis of treatment-resistant sleep disorder must be
confirmed by formal neurophysiological testing as performed in an
accredited sleep laboratory.`
The following mental and behavioural disorders are specifically
excluded from this benefit category:
• Factitious disorders
• Substance-use disorders.
Digestive system
1. Eating and functional disorders are excluded from this benefit
category.
Heart and blood vessels
1. Examples of cardiovascular or cardio-pulmonary disorders that
result in the severity criteria we’ve specified include, but are
not limited to:
• Myocardial infarction
• Aortic disease, e.g. aneurysm.
2. Treatment resistant hypertension is high blood pressure that is
treated with more than four medicines.
HIV/AIDS
1. For these conditions, claims for insured lives who have already
been diagnosed as HIV-positive prior to taking out their cover with
BrightRock are excluded.
1 2 3
Cancer
11
13
12
Activities of Daily Living14
Reference notes
Hormones 1. The endocrine disorders (as confirmed by an
endocrinologist) must be supported by the relevant laboratory and
radiological investigations and shown to be persistent despite full
compliance with optimal medical and surgical treatment. Psychogenic
polydipsia is excluded.
Lungs and breathing
1. Examples of respiratory disorders that result in the severity
criteria as specified here include but are not limited to:
• Chronic obstructive airways disease
Muscles, bones and joints
1. Neurological impairment must include evidence of a lower motor
neuron lesion with evidence of:
• Motor weakness of the muscles corresponding to the nerve level
involved AND
• Prominent muscle wasting.
Sensory system
1. The hearing loss must be permanent and completely uncorrectable
by surgery or a fitted hearing aid/device.
2. Vestibular conditions excluded from this benefit include:
• Viral labyrinthitis
• Vestibular neuronitis
1 2 3
* Condition-specific alcohol exclusion:
For the conditions marked with the * symbol, claims for injuries or
illnesses related to long-term alcohol or drug abuse are
excluded.
** Our optimal treatment requirement doesn’t apply to these
conditions
We won’t apply the requirement for optimal treatment to a claim on
clinical definitions marked with the ** symbol.
** Our optimal treatment requirement doesn’t apply to these
conditions
We won’t apply the requirement for optimal treatment to a claim on
clinical definitions marked with the ** symbol, but only where the
limb(s) or finger(s) have been amputated.
Appendix
Cancer
11
13
12
Activities of Daily Living14
Appendix
BrightRock has the right to ask for a second opinion if the medical
information we initially receive is not sufficient to prove
conclusively that the client has met the claims criteria. For
example, if the information provided is not sufficient to confirm
the client’s diagnosis. Depending on the case, BrightRock may
recommend a medical professional for the second opinion or the
client may consult a medical professional of their own
choosing.
“Confirmed” means that the diagnosis has been made with appropriate
and supporting medical evidence in the form of reports, blood
tests, histological findings, imaging, scans or any other relevant
investigations.
BrightRock has no explicit general survival or general waiting
periods on our permanent expenses cover (condition-specific waiting
periods, however, do apply for certain conditions. Please refer to
the clinical definitions contained in this document to see which
ones have this type of waiting period). This gives you greater
certainty of claim. If the insured life has a valid permanent
expenses claim that meets our clinical criteria but dies before we
have made the pay-out, BrightRock will still pay the claim out.
This applies as long as the insured life was alive at the time of
the diagnosis that led to the permanent expenses claim.
Unless otherwise specified, if you become ill or injured, you must
get medical treatment as soon as possible to qualify for a claim
against your permanent expenses cover on your BrightRock policy.
You must fully comply with your doctor’s advice and finish your
full treatment regime. If you don’t seek and receive optimal
treatment and fail to comply with your treatment, the claim will be
invalid.
1 2 3
Blood production disorders
HIV/ AIDS 1
Sensory System 1
Trauma
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