Cancer and Blood Disorders

Aplastic Anaemia

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of irreversible bone marrow failure that causes anaemia, neutropenia and thrombocytopenia, that requires at least one of the following treatments:

• Marrow stimulating agents
• Bone marrow transplant
• Peripheral blood stem cell transplantation
• Blood product transfusions
• Immunosuppressive agents

Benign Brain Tumour or Spinal Cord Tumour

Full Critical Illness Benefit Criteria

An unequivocal diagnosis by an appropriate specialist of a histologically described, non-cancerous tumour in either the brain, cranial nerves, meninges or the spinal cord, that either:

• Results in neurological damage and functional impairment that an appropriate specialist considers permanent
• Is medically necessary to remove through surgery (whether it can be removed or not)

We do not cover:

• Cysts, granulomas and cerebral abscesses
• Malformations in one or more of the arteries or veins of the brain or spinal cord
• Haematomas

We also do not cover tumours in the pituitary gland unless an appropriate specialist considers that the tumour either:

• Is creating permanent neurological damage and functional impairment
• Needs surgery to remove it

Cancer

Full Critical Illness Benefit Criteria

The 90-day stand-down applies to this condition.

An unequivocal diagnosis by an appropriate specialist of a malignant tumour or malignant melanoma.

Malignant tumours – including leukaemia, lymphoma and Hodgkin’s disease – must be characterised by the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue.

Malignant melanomas require one or more of the following to apply:

• A histological examination finds evidence of ulceration
• There’s at least Clark level 3 depth of invasion
• A histological examination finds thickness measuring at least 1.0mm using the Breslow method

We exclude:

• All tumours showing the malignant changes of carcinoma in situ (including cervical dysplasia CIN-1, CIN-2 and CIN-3) or which are histologically described as premalignant or non-invasive, unless it results in either:

  • Treatment by either radiotherapy or systemic chemotherapy
  • Radical surgery. Radical surgery is surgery to remove all of a diseased organ

  The treatment must be undertaken to specifically stop the spread of malignancy and must be considered most appropriate and necessary by an appropriate specialist.

• Prostatic cancers histologically described as TNM Classification T1 or Gleason score of equal to or less than 5 (or equivalent histological classification), unless it results in either:

  • Treatment by either radiotherapy or chemotherapy
  • The removal of the entire prostate

  The treatment must be undertaken to specifically stop the spread of malignancy and must be considered most appropriate and necessary by an appropriate specialist.

• All other types of skin cancers, unless there’s evidence of metastases

• Chronic lymphocytic leukaemia less than Rai Stage 1