Sunday, 17 July 2011

36种严重疾病知多点

 

在你还没有签下保单之前,你是否有问过你的保险代理员,36种严重疾病当中包括什么疾病?你是否知道每一家保险公司的36种疾病都会有差异?有几个人会问?就算问了又是否有得到你要的答案?

曾经有几个保客问过我,36种疾病是指什么病?印象比较深刻的有两个。一个是父亲要投保,女儿是护士,理所当然问了我很多有关疾病和医疗的问题。因为是护士,所以她有足够的专业知识去了解那些疾病的诠释。还有一个保客,她纯粹想知道36种到底是哪36种,记得当时我告诉她每一家保险公司和每一段时期所购买的保单中的36种疾病都会有所不同。当时我只给她参考我随身带着的36种疾病表。等到我把保单送到她手上时,我才根据她的保单里的36种疾病以华语翻译复印一张给她。

有时候保客根本没有时间听你解释,有时候因为时间上的不允许,我们的解释也不够详细,只是简单地带过。所以我就想藉由我的部落格来做一个详细的解释,让跟多朋友可以更了解36种严重疾病的演变历史和诠释。

其实在2000年之前,每一家保险公司都可以自行决定哪一种疾病要受保,而且在疾病的解释方面也没有受到任何条文的规定和约束。各大保险公司因为面对竞争都会尽量加入更多的疾病以击败对手。从一开始时的3种疾病,接着别家公司推出8种疾病,另一家也不甘示弱推出12种,然后就这样逐年增加,直到有一天达到了今天的36种之多。

然后问题就开始产生了。有一个保客,曾向三家保险公司投保疾病保单。有一天很不幸地,他被诊断出患上了其中一种严重疾病。当他向保险公司索取赔偿金时,却意外地发现他只能从其中两家保险公司获得赔偿。另一家公司拒绝理赔,原因是保单里的疾病诠释跟保客所患病的情形不能符合。

这时候,身为监督所有银行和保险公司的国家银行(BNM)当然不会坐视不理,于是插手解决这个问题。国家银行强制所有保险公司都必须成立一个保险公会,以便制定一个统一的方案。结果马来西亚保险公会(LIAM)就敲定了一个统一的严重疾病种类与解释。

如今各大保险公司可以自由从42种严重疾病中选出各自的36种,但是有关疾病的诠释都必须是一致的。从42种中,爱滋病被分为3 种,但是保诚却选择将之合成为一。

1)      Full Blown Aids (完全病发性爱滋病)
2)      Aids due to Blood Tranfusion (因输血而引发爱滋病)
3)      Aids cover of Medical Staff  ( 医护人员因工作而引发爱滋病)

另一个例子就是,Coronary Artery Disease (冠状动脉疾病) 也被分为3种各别不同的疾病,但是很幸运地,保诚寿险公司也将之合为一体。

1)      Coronary Artery Disease Requiring Surgery (冠状动脉绕道手术)
2)      Other Serious Coronory Artery Disease (其他严重冠状动脉疾病)
3)      Angioplasty and Other Inasive Treatments for Coronary Artery Disease (冠状动脉疾病的血管成形术和其他微创治疗)

如果你翻开保单而觉得自己的保障不是很足够和完善时,请不要贸贸然跑去将保单取消掉。因为你现在买的保单肯定比以往的来得贵,因为年龄的问题,而且通常以往的保单受保范围也比较宽泛。 所以你能做的只有增加你所缺少的或没有在保单范围里面的保障。

我不打算将其它保险公司受保的疾病列在此,因为今天我是保诚公司的财务规划师,我只对我们公司的产品做分析。

以下是我在写此部落格时,保诚最新的人寿保单中的36种疾病的诠释。(ANNEXURE  DFN)

这篇博文只是让你更了解36种疾病的历史和种类,作为参考。我并没有代表保诚发表任何言论,纯粹只是为了让身边的朋友和保客多一点知识。

(1) AIDS (爱滋病)
(a) AIDS Due To Blood Transfusion(因输血而引发爱滋病)
Shall mean the Insured Life being infected by HIV virus or AIDS provided that:
(i) the infection is due to blood transfusion received in Malaysia or Singapore after the commencement of the Policy;
(ii) the Insured Life is not a haemophiliac; and
(iii) the Insured Life is not a member of any high risk groups such as but not limited to homosexuals, intravenous drug users or sex workers.
Notification & proof of incident will be required via a statement from a statutory Health Authority that the infection is medically acquired.

(b) Full Blown AIDS(完全病发性爱滋病)
Shall mean the clinical manifestation of AIDS (Acquired Immune-deficiency Syndrome) must be supported by the results of a positive HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory Western Blot test. In addition, the Insured Life must have a CD4 cell count of less than two hundred (200) and one or more of the following criteria are met:
(i) Weight loss of more than 10% of body weight over a period of six (6) months or less (wasting syndrome); or
(ii) Kaposi Sarcoma; or
(iii) Pneumocystic Carinii Pneumonia; or
(iv) Progressive multifocal leukoencephalopathy; or
(v) Active Tuberculosis; or
(vi) Less than one-thousand (1000) lymphocytes; or
(vii) Malignant Lymphoma.

(2) Aplastic Anaemia (再生障碍性贫血)
Shall mean chronic persistent bone marrow failure which results in total aplasia of the bone marrow & requires treatment with at least one of the following:
(a) Regular blood product transfusion; or
(b) Marrow stimulating agents; or
(c) Immunosuppressive agents; or
(d) Bone marrow transplantation.

(3) Apallic Syndrome (去皮质综合症)
Shall mean universal necrosis of the brain cortex, with the brainstem remaining intact. Diagnosis must be confirmed by a neurologist & condition must be documented for at least one month.

(4) Alzheimer’s Disease (阿耳兹海默症)
Shall mean deterioration or loss of intellectual capacity or abnormal behavior as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer’s Disease or irreversible organic degenerative brain disorders excluding neurosis, psychiatric illness, and any drug or alcohol related organic disorder, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the life insured. The diagnosis must be clinically confirmed by an appropriate consultant.

(5) Benign Brain Tumor (良性脑肿瘤)
Shall mean a life-threatening, non-cancerous tumour in the brain giving rise to characteristic signs of increased intra-cranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumour must be confirmed by imaging studies such as CT Scan or MRI. The following are excluded:
(a) Cysts;
(b) Granulomas;
(c) Malformations in or of the arteries or veins of the brain;
(d) Haematomas;
(e) Tumours in the pituitary gland, or spine; and
(f) Tumours of the acoustic nerve.

(6) Blindness (失明)
Shall mean the total, permanent and irrecoverable loss of the sight of both eyes. Certification by an ophthalmologist is necessary.

(7) Brain Surgery (脑外科手术)
Shall mean the actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. Bur Hole & brain surgery as a result of an accident is excluded.

(8) Cancer (癌症)
Shall mean uncontrollable growth & spread of malignant cells and the invasion & destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered necessary. The cancer must be confirmed by histological evidence of malignancy.
The following conditions are excluded:-
(a) Carcinoma in situ including of the cervix;
(b) Ductal Carcinoma in situ of the breast;
(c) Papillary Carcinoma of the bladder & Stage 1 Prostate Cancer;
(d) All skin cancers except malignant melanoma;
(e) Stage I Hodgkin’s disease; and
(f) Tumors manifesting as complications of AIDS.

(9) Cardiomyopathy (心肌病)
Shall mean the unequivocal diagnosis by a consultant cardiologist of cardiomyopathy causing impaired ventricular function, suspected by ECG abnormalities and confirmed by cardiac echo of variable aetiology and resulting in permanent physical impairments to the degree of at least class III of the New York Association Classification of cardiac impairment.

Class III – Marked limitation – Such patients are comfortable at rest but performing less than ordinary activity will lead to symptoms of Congestive Cardiac Failure.
Class IV – Inability to carry out any activity without discomfort. Symptoms of Congestive Cardiac Failure are present even at rest. With any increase in physical activity, discomfort will be experienced.

Cardiomyopathy directly related to alcohol misuse is excluded.

(10) Chronic Liver Disease (慢性肝病)
Shall mean end stage liver failure evidenced by all of the following:
(a) Permanent jaundice;
(b) Ascites;
(c) Encephalopathy; and
(d) Portal hypertension

Wernicke’s encephalopathy & liver failure secondary to alcohol or drug misuse is excluded.

(11) Chronic Lung Disease (慢性肺病)
Shall mean end stage respiratory failure including chronic interstitial lung disease.
The following criteria must be met:
(a) Requiring permanent oxygen therapy as a result of a consistent FEV1 test value of less than one liter. (Forced Expiratory Volume during the first second of a forced exhalation);
(b) Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less;
(c) Dyspnoea at rest.

(12) Coma (昏迷)
Shall mean a state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least 96 hours, requiring the use of life support systems and resulting in a neurological deficit, lasting more than 30 days. Confirmation by a neurologist must be present.

Coma resulting directly from self-inflicted injury, alcohol or drug misuse is excluded.

(13) Coronary Artery Disease (冠状动脉疾病)
(a) Coronary Artery Disease Requiring Surgery (冠状动脉绕道手术)
Shall mean the actual undergoing of Coronary artery by-pass surgery by way of thoracotomy to correct or treat coronary artery disease but not including angioplasty, other intra-arterial, keyhole or laser procedures.

(b) Other Serious Coronary Artery Disease (其他严重冠状动脉疾病)
Shall mean the narrowing of the lumen of at least three major arteries i.e. Circumflex, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD), by a minimum of 60 percent or more as proven by coronary arteriography. This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed.

(c) Angioplasty and Other Invasive Treatments for Coronary Artery Disease (冠状动脉疾病的血管成形术和其他微创治疗)
Shall mean the actual undergoing for the first time of Coronary Artery Ballon Angioplasty, artherectomy, laser treatment or the insertion of a stent to correct a narrowing or blockage of one or more coronary arteries. Intra-arterial investigative procedures are not included.

Medical evidence shall include all of the following:
(i) Evidence of significant and relevant ECG changes (ST segment depression of 2 millimeters or more) and
(ii) Angiographic evidence to confirm the location of stenosis.

(14) Deafness (失聪/耳聋)
Shall mean total, permanent and irreversible loss of hearing in both ears as a result of disease or accident. Medical evidence in the form of an audiometry and sound-threshold test must be provided.

(15) Encephalitis (脑炎)
Shall mean severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of 30 days and certified by a consultant neurologist. The permanent deficit must result in an inability to perform at least three (3) of the following Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefit, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.
The Activities of Daily Living are:
(a)        Transfer
Getting in & out of a chair without requiring any physical assistance.
(b)        Mobility
The ability to move from room to room without requiring any physical assistance.
(c)        Continence
The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d)       Dressing
Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e)        Bathing / Washing
The ability to wash in the bath and shower (including getting in or out of the bath or shower) or wash by any other means.
(f)        Eating
All tasks of getting food into the body once it have been prepared.

Encephalitis as a result of HIV infection is excluded.

(16) Fulminant Viral Hepatitis (病毒性急性肝炎)
Shall mean a sub massive to massive necrosis of the liver caused by any virus leading precipitously to liver failure.
The diagnostic criteria to be met are:
(a) A rapidly decreasing liver size as confirmed by abdominal ultrasound;
(b) Necrosis involving entire lobules, leaving only a collapsed reticular framework;
(c) Rapidly deteriorating liver functions tests; and
(d) Deepening jaundice.

Hepatitis B infection or carrier status alone does not meet the diagnostic criteria.

(17) Heart Attack (心脏病)
Shall mean death of a portion of the heart muscle (myocardium) as a result of inadequate blood supply and being evidenced by:-
(a) A history of typical prolonged chest pain;
(b) New electrocardiographic changes resulting from this occurrence; and
(c) Elevation of the cardiac enzyme (CPK-MB) above the generally accepted laboratory levels of normal.
Diagnosis based on the elevation of Troponin T test alone shall not be considered diagnostic of a heart attack.Angina is specifically excluded.

(18) Heart Valve Replacement (更换心脏瓣膜)
Shall mean the actual undergoing of open-chest surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities that have occurred after the date of issue or date of reinstatement of this contract.
Repair, via valvotomy, intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded.

(19) Kidney Failure (肾脏病)
Shall mean end stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis is initiated or renal transplantation carried out.

(20) Loss of Independent Existence (丧失独立生活能力)
Shall mean confirmation by a Consultant Physician of the loss of independent existence lasting for a minimum period of 6 months and resulting in a permanent inability to perform at least three (3) of the following Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefit, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.
The Activities of Daily Living are:
(a)        Transfer
Getting in & out of a chair without requiring any physical assistance.
(b)        Mobility
The ability to move from room to room without requiring any physical assistance.
(c)        Continence
The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d)       Dressing
Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e)        Bathing / Washing
The ability to wash in the bath and shower (including getting in or out of the bath or shower) or wash by any other means.
(f)        Eating
All tasks of getting food into the body once it have been prepared.

(21) Loss of Speech (失去语言能力)
Shall mean total and irrecoverable loss of the ability to speak for a continuous period of 12 months. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an appropriate (Ear, Nose, Throat) specialist.
All psychiatric related causes are excluded.

(22) Major Burns (严重烧伤)
Shall mean third degree burns covering at least twenty percent (20%) of the Insured Life’s body surface area as measured by “The Rule of 9” of the Lund & Browder Body Surface Chart.

(23) Major Head Trauma (严重头部创伤)
Shall mean physical head injury causing significant permanent functional impairment lasting for a minimum period of three (3) months from the date of the trauma or injury. The resultant permanent functional impairment is to be verified by a consultant neurologist and duly concurred by the Company’s Medical Officer and must result in an inability to perform at least three (3) of the following Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefit, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.
The Activities of Daily Living are:
(a)        Transfer
Getting in & out of a chair without requiring any physical assistance.
(b)        Mobility
The ability to move from room to room without requiring any physical assistance.
(c)        Continence
The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d)       Dressing
Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e)        Bathing / Washing
The ability to wash in the bath and shower (including getting in or out of the bath or shower) or wash by any other means.
(f)        Eating
All tasks of getting food into the body once it have been prepared.

(24) Major Organ Transplant (主要器官移植)
Shall mean the actual undergoing of a transplant as a recipient of one of the following human organs:
(a) Kidney(s)
(b) Lung(s)
(c) Liver
(d) Heart
(e) Bone marrow

(25) Medullary Cystic Disease (肾髓质蘘性病)
Shall mean a progressive hereditary disease of the kidneys characterized by the presence of cysts in the medulla, tubular atrophy and intestitial fibrosis with the clinical manifestations of anaemia, polyuria and renel loss of sodium, progressing to chronic renal failure. Diagnosis should be supported by renel biopsy.

(26) Meningitis (脑膜炎)
Shall mean bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit lasting for a minimum period of 30 days & resulting in a permanent inability to perform at least three (3) of the following Activities of Daily Living either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons. For the purpose of this benefit, the word “permanent”, shall mean beyond the hope of recovery with current medical knowledge and technology.
The Activities of Daily Living are:
(a)        Transfer
Getting in & out of a chair without requiring any physical assistance.
(b)        Mobility
The ability to move from room to room without requiring any physical assistance.
(c)        Continence
The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d)       Dressing
Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e)        Bathing / Washing
The ability to wash in the bath and shower (including getting in or out of the bath or shower) or wash by any other means.
(f)        Eating
All tasks of getting food into the body once it have been prepared.

(27) Motor Neurone Disease (运动神经元疾病)
Shall mean motor neurone disease of unknown aetiology is characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons. These include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.

Diagnosis must be confirmed by a consultant neurologist.

(28) Multiple Sclerosis (多发性硬化)
Shall mean unequivocal diagnosis by a consulting neurologist confirming the following combination, which has persisted for at least a continuous period of six (6) months:
(a) Symptoms referable to tracts (white matter) involving the optic nerves, brain stem and spinal cord, producing well-defined neurological deficits;
(b) A multiplicity or discrete lesions; and
(c) A well-documented history of exacerbation and remissions of said symptoms / neurological deficits.

(29) Muscular Dystrophy (肌肉营养障碍症)
Shall mean the diagnosis of muscular dystrophy shall require a confirmation by a consultant neurologist of the combination of 3 out of 4 of the following conditions:
(a) Family history of other affected individuals; or
(b) Clinical presentation including absence of sensory disturbance, normal cerebro-spinal fluid and mild tendon reflex reduction; or
(c) Characteristic electromyogram; or
(d) Clinical suspicion confirmed by muscle biopsy.

Children are excluded from the definition.

(30) Paralysis (瘫痪)
Shall mean the complete and permanent loss of use of both arms or both legs, or one arm and one leg, through paralysis caused by illness or injury persisting for at least six (6) months from the date of trauma or illness.

(31) Parkinson’s Disease (帕金森氏症)
Shall mean unequivocal diagnosis of Parkinson’s Disease by a consulting neurologist where the condition:
(a) Cannot be controlled with medication
(b) Shows signs of progressive impairment
Activities of daily living assessment confirm the inability of the life insured to perform without assistance three (3) or more of the following:
(a)        Transfer
Getting in & out of a chair without requiring any physical assistance.
(b)        Mobility
The ability to move from room to room without requiring any physical assistance.
(c)        Continence
The ability to voluntarily control bowel and bladder functions such as to maintain personal hygiene.
(d)       Dressing
Putting on and taking off all necessary items of clothing without requiring assistance of another person.
(e)        Bathing / Washing
The ability to wash in the bath and shower (including getting in or out of the bath or shower) or wash by any other means.
(f)        Eating
All tasks of getting food into the body once it have been prepared.

Only idiopathic Parkinson’s Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded.

(32) Poliomyelitis (脊髓灰质炎)
Shall mean unequivocal diagnosis by a consultant neurologist of infection with the Poliovirus leading to paralytic disease as evidenced by impaired motor function or respiratory weakness. Cases not involving paralysis will not be eligible for this benefit. Other causes of paralysis (such as Guillain-Barre syndrome) are specifically excluded.

(33) Primary Pulmonary Arterial Hypertension (初级肺动脉高血压)
Shall mean primary pulmonary hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent irreversible physical impairment to the degree of at least Class 3 of the New York Heart Association Classification of cardiac impairment, & resulting in the Life Assured being unable to perform his/her usual occupation.

(34) Stroke (中风)
Shall mean a cerebrovascular accident or incident producing neurological sequelae of a permanent nature, having lasted not less than six months. Infarction of brain tissue, haemorrhage and embolisation from an extra-cranial source are included. The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist.

Specifically excluded are cerebral symptoms due to transient ischaemic attacks, any reversible ischaemic neurological deficit, vertebrobasilar ischaemia, cerebral symptoms due to migraine, cerebral injury resulting from trauma or hypoxia & vascular disease affecting the eye or optic nerve or vestibular functions.

(35) Surgery To Aorta (主动脉手术)
Shall mean the actual undergoing of surgery via a thoracotomy or laprotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a coarctation of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches.

(36) Systemic Lupus Erythematosus Lupus Nephritis (系统性红斑狼疮狼性肾炎)
Shall mean a multisystem, multifactorial, autoimmune disorder which affects mostly females in their childbearing years & is characterized by the development of auto-antibodies, directed against various self-antigens.

In respect f this contract, SLE will be restricted to those forms of systemic lupus erythematosus which involve the kidneys (Type III to Type IV Lupus Nephritis, established by renel biopsy). Other forms, discoid lupus, and those forms with only haematological and joint involvement will be specifically excluded.

WHO Lupus Classification:
Class I (minimal change)                     - Negative, normal urine
Class II (Mesangial)                            - Moderate proteinuria, active sediment
Class III (Focal Segmental)                - Proteinuria, active sediment
Class IV (Diffuse)                              - Acute nephritis with active sediment and/or nephritis Syndrome
Class V (Membranous)                       - Nephrotic Syndrome or severe proteinuria.

3 comments:

  1. To read the blog in English, refer http://marvynchoong.blogspot.com/2011/07/brief-history-and-developments-of.html

    Thanks Penny for taking time to translate my blog into Mandarin...

    ReplyDelete
  2. ya, u did a great job to blog on this...
    希望能够给身边的朋友多一点的保险知识。

    ReplyDelete
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