What Is Severity of Illness?

The "Illness Definition and Use of Critical Illness Insurance", which has been in effect since April 3, 2007, stipulates that the insurance company names the product as "Major Illness Insurance" and the insurance period is mainly for adults (18 years or older). The disease scope covered by this product should include malignant tumors, acute myocardial infarction, sequelae of stroke, coronary artery bypass graft (or coronary artery bypass grafting), major organ transplantation or hematopoietic stem cell transplantation, end-stage in this specification. Nephropathy (or uremic stage of chronic renal failure); in addition to these six diseases, insurance companies can choose to use other disease types within the scope of this specification; at the same time, the above diseases should use the disease name and disease of this specification definition.

Major diseases

Major diseases refer to diseases that are costly to treat and seriously affect the normal work and life of patients and their families for a long period of time. They generally include: malignant tumors, severe cardiovascular and cerebrovascular diseases, surgery that requires major organ transplants, and possible Injuries, advanced chronic diseases, deep coma, permanent paralysis, severe brain injury, severe Parkinson's disease and severe mental illness that cause lifelong disability.

Scope of Major Illness Insurance

The "Illness Definition and Use of Critical Illness Insurance", which has been in effect since April 3, 2007, stipulates that the insurance company names the product as "Major Illness Insurance" and the insurance period is mainly for adults (18 years or older). The disease scope covered by this product should include malignant tumors, acute myocardial infarction, sequelae of stroke, coronary artery bypass graft (or coronary artery bypass grafting), major organ transplantation or hematopoietic stem cell transplantation, end-stage in this specification. Nephropathy (or uremic stage of chronic renal failure); in addition to these six diseases, insurance companies can choose to use other disease types within the scope of this specification; at the same time, the above diseases should use the disease name and disease of this specification definition.

Major disease malignancy

Insurance comics

Refers to the uncontrolled, progressive growth and spread of malignant cells, infiltration and destruction of surrounding normal tissues, and the ability to menstrualize.

Tubes, lymphatic vessels, and body cavities spread to other parts of the body. The diagnosis was confirmed by pathological examination.

, Clinical diagnosis belongs to the World Health Organization "International Statistical Classification of Diseases and Related Health Problems" (ICD-10

) Malignancy category. The following diseases are not covered:

(1) Carcinoma in situ;

(2) Chronic lymphocytic leukemia equivalent to stage A of the Binet staging plan;

(3) Hodgkin's disease equivalent to the stage I of Ann Arbor staging plan;

(4) Skin cancer (excluding malignant melanoma and metastatic skin cancer);

(5) Prostate cancer with TNM stage T1N0M0 stage or less;

(6) Malignant tumors during HIV infection or AIDS.

Major disease acute myocardial infarction

Refers to partial myocardial necrosis due to insufficient blood supply to the corresponding area due to coronary occlusion. Must meet at least the following

Three conditions:

(1) Typical clinical manifestations, such as acute chest pain;

(2) Recent ECG changes suggest acute myocardial infarction;

(3) Diagnosticly elevated myocardial enzymes or troponin, or dynamic changes consistent with acute myocardial infarction

;

(4) 90 days after the onset of the disease, the left ventricular function is confirmed to be reduced, such as the left ventricular ejection fraction is less than 50%.

Major illness sequelae of stroke

Refers to a cerebrovascular hemorrhage, embolism, or infarction caused by sudden pathological changes in the cerebrovascular system and causes permanent nervous system

disfunction. Permanent dysfunction of the nervous system means that one of the following or

More than one obstacle:

(1) Complete loss of limb function in one or more limbs (see 8.3);

(2) Complete loss of language ability or chewing and swallowing ability (see 8.4);

(3) Complete loss of the ability to live independently, unable to independently complete the six basic daily activities (see 8.5)

Of three or more.

Major Organ Transplantation or Hematopoietic Stem Cell Transplantation

Major organ transplantation, where kidney, liver, heart, or lungs have been performed due to failure of the corresponding organ

Allograft surgery.

Hematopoietic stem cell transplantation refers to a hematopoietic

Allogeneic transplantation of cells including bone marrow hematopoietic stem cells, peripheral blood hematopoietic stem cells, and cord blood hematopoietic stem cells

surgery.

Coronary artery bypass surgery (or coronary artery bypass grafting) for major diseases

Refers to the operation of coronary artery bypass grafting for the treatment of severe coronary heart disease.

Coronary stent implantation, cardiac catheter balloon dilation, laser radiofrequency technology and other non-thoracotomy interventional hands

Surgery and endoscopic surgery are not covered.

Major disease end-stage renal disease (or uremia in chronic renal failure)

Refers to chronic irreversible failure of kidney function, reaching the uremia stage, which has been performed for at least 90 days after diagnosis

Regular dialysis treatment or kidney transplantation.

Major illness multiple limbs missing

Refers to two or more limbs from the proximal end of the wrist or ankle (close to the trunk) due to illness or accidental injury

End) above complete disconnection.

Major illness acute or subacute severe hepatitis

Refers to diffuse necrosis of liver tissue caused by hepatitis virus infection, leading to acute liver failure, and serological

Or confirmed by virological examination and must meet all of the following conditions:

(1) Severe jaundice or rapid increase in jaundice;

(2) hepatic encephalopathy;

(3) B-mode ultrasound or other imaging studies show rapid liver atrophy;

(4) Progressive deterioration of liver function indicators.

Benign brain tumor

A benign tumor of the brain that has caused an increase in intracranial pressure. The clinical manifestations are optic nerve papillary edema and mental symptoms

, Epilepsy and motor dysfunction, etc., and life-threatening. CT scan, magnetic resonance imaging

Imaging (MRI) or positron emission tomography (PET) imaging verification and must meet at least the following

One condition:

(1) The operation of complete or partial resection of brain tumors performed by craniotomy is actually performed;

(2) Radiation therapy for brain tumors was actually implemented.

Pituitary tumors, brain cysts, and cerebrovascular diseases are not covered.

Major disease chronic liver failure decompensation

Refers to liver failure due to chronic liver disease. All the following conditions must be met:

(1) persistent jaundice;

Major illness insurance

(2) ascites;

(3) hepatic encephalopathy;

(4) Congestive splenomegaly with hypersplenism or esophageal gastric varices.

Liver failure due to alcohol or drug abuse is not covered.

Major disease sequelae of encephalitis or sequelae of meningitis

Permanent dysfunction of the nervous system caused by encephalitis or meningitis. Nervous system permanent function

Obstacle means that one or more of the following disorders remain after 180 days of diagnosis:

(1) Complete loss of limb function in one or more limbs;

(2) Complete loss of language ability or chewing and swallowing ability;

(3) Completely lost the ability to live independently, unable to independently complete three or three of the six basic daily activities

More than items.

Major coma

Refers to the loss of consciousness due to illness or accidental injury, no response to external stimuli and internal needs, coma

According to the Glasgow coma scale, the result is 5 or less, and

Continue to use ventilator and other life support systems for more than 96 hours.

Deep coma due to alcohol or drug abuse is not covered.

Major illness deafness

Refers to permanent or irreversible loss of hearing in both ears due to illness or accidental injury (see 8.6), at 500 Hz,

At 1000 Hz and 2000 Hz speech frequencies, the average listening threshold is greater than 90 decibels.

Confirmed by impedance detection or auditory evoked potential detection.

During the 0 to 3 year policy anniversary, the insured person's deafness is not covered.

Major illness binocular blindness

Refers to permanent or irreversible loss of vision due to illness or accidental injury. The better of both eyes must meet the following

At least one condition:

(1) The eyeball is missing or removed;

(2) corrected visual acuity is less than 0.02 (using international standard vision chart, if other vision chart is used, it should be converted

);

(3) The field of view radius is less than 5 degrees.

Paralysis of major diseases

Refers to permanent or complete loss of limb function due to illness or accidental injury. Permanent limb function

Total loss refers to two of the three major joints of each limb, 180 days after the disease was diagnosed or 180 days after the accidental injury occurred

The joints remain completely stiff or unable to move with consciousness.

Major disease heart valve surgery

Refers to the operation of heart valve replacement or repair in order to treat heart valve disease.

Major disease severe Alzheimer's disease

Refers to the severe decline or loss of intelligence caused by progressive and irreversible changes in the brain.

Intellectual disability, behavioral abnormalities, and decreased social ability must continue to be monitored by others. must

Skull tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET), etc.

Imaging studies confirmed that he had completely lost the ability to live independently and was unable to independently complete the six basic daily living tasks.

Three or more items in motion.

Neurosis and mental illness are not covered.

Major illness severe brain injury

Refers to a mechanical external force on the head that causes damage to important parts of the brain and causes permanent dysfunction of the nervous system

hinder. CT scan, magnetic resonance imaging (MRI) or positron emission tomography

(PET) and other imaging studies confirmed. Permanent dysfunction of the nervous system, which means that after 180 days of brain injury,

Leaving one or more of the following obstacles:

(1) Complete loss of limb function in one or more limbs;

(2) Complete loss of language ability or chewing and swallowing ability;

(3) Completely lost the ability to live independently, unable to independently complete three or three of the six basic daily activities

More than items.

Major disease severe Parkinson's disease

It is a degenerative disease of the central nervous system, with clinical manifestations of tremor paralysis and ataxia. Must meet

All the following conditions:

(1) Medical treatment cannot control the condition;

(2) Completely lost the ability to live independently, unable to independently complete three or three of the six basic daily activities

More than items.

Secondary Parkinson's syndrome is not covered.

Major illness severe third degree burn

It means that the degree of burn is degree, and the area of degree burn reaches 20% or more of the total body surface area. body

The surface area is calculated according to the "Chinese New Nine Cents Law".

Major disease severe primary pulmonary hypertension

Refers to a persistent increase in pulmonary artery pressure of unknown cause, a chronic disease caused by progressive development, which has caused

Permanently and irreversibly limited physical activity, reaching the New York Heart Association Heart Function Class IV

Grade, and the mean pulmonary artery pressure in resting state exceeds 30mmHg.

Major disease severe motor neuron disease

It is a group of progressive degenerative diseases of central nervous system motor neurons, including progressive spinal muscular atrophy, progressive

Progressive bulbar palsy, primary lateral sclerosis, amyotrophic lateral sclerosis. Must meet the ability of autonomous living

Complete loss of strength, unable to independently complete three or more of the six basic daily activities.

Major illness language loss

Refers to a total loss of language ability due to illness or accidental injury, after active treatment for at least 12 months (end of vocal cord

Total resection is not limited by this time), and still cannot be recovered by existing medical methods.

The loss of language ability caused by psychological factors is not covered by the guarantee.

During the 0 to 3 year policy anniversary, the loss of language ability of the insured is not covered.

Major illness severe aplastic anemia

Refers to anemia, neutropenia, and thrombocytopenia caused by chronic persistent failure of bone marrow hematopoietic function.

All the following conditions must be met:

(1) The results of bone marrow aspiration or bone marrow biopsy support the diagnosis;

(2) The peripheral blood picture must meet the following three conditions:

Absolute value of neutrophil 0.5 × 109 / L;

Reticulocytes <1%;

The absolute value of platelets is 20 × 109 / L.

Major Disease Aortic Surgery

Refers to active resection, replacement, and repair of lesions performed in the open chest or abdomen for the treatment of aortic disease

Vessel surgery. Aorta refers to the thoracic aorta and abdominal aorta, excluding the points of the thoracic aorta and abdominal aorta

Branch blood vessels.

Intra-arterial angioplasty is not covered.

The following major diseases are defined by the company in the China Insurance Industry Association and the Chinese Medical Doctors Association.

Increased disease outside the scope of the disease.

Major disease severe multiple sclerosis

Refers to irreversible body parts dysfunction caused by demyelination of the central nervous system.

The doctor provides a clear diagnosis and a diagnosis report with CT or MRI results. Irreversible body parts

Dysfunction means that it must have lasted more than 180 days after diagnosis of dysfunction.

A clear diagnosis provided by a neurologist must include the following:

(1) Clear clinical manifestations caused by optic nerve, brain stem and spinal cord injury;

(2) Multiple lesions scattered in the nervous system;

(3) Have a clear history of the above symptoms and repeated deterioration and reduction of nerve damage.

1 Major illness severe type 1 diabetes

Severe type 1 diabetes is a chronic increase in blood glucose due to absolute insufficient insulin secretion, which has been persistent

Rely on exogenous insulin for more than 180 days. Blood insulin test, blood C peptide test or urine C peptide test

The results were abnormal and were clearly diagnosed by a specialist in endocrinology. And must be within the validity period of this additional insurance contract,

Meet at least one of the following conditions:

(1) Proliferative retinopathy has occurred;

(2) A pacemaker must be implanted to treat heart disease;

(3) At least one toe must be removed due to gangrene.

Major disease erosive hydatidiform mole (or malignant hydatidiform mole)

This type of disease refers to the invasive growth of abnormally proliferated villous tissue that penetrates into the myometrium or transfers to other organs or

The hydatidiform mole is organized and has been treated with chemotherapy or surgery.

Major disease Systemic lupus erythematosus with severe renal impairment

Systemic lupus erythematosus with severe renal impairment

This type of illness coverage is limited to women.

This type of disease refers to an autoimmune connective tissue disease with a large number of pathogenic autoantibodies and immune

Complex, causing tissue damage. The diagnosis of systemic lupus erythematosus must be clearly diagnosed by a specialist and must be

The following conditions are also met:

(1) The clinical manifestations meet at least 4 of the following conditions:

Butterfly erythema or disk erythema;

light sensitive;

Oral and nasal mucosal ulcers;

Non-orthodox arthritis or polyarticular pain;

pleurisy or pericarditis;

nervous system damage (epilepsy or mental symptoms);

Hematology abnormalities (less than 4000 / l white blood cells or less than 100,000 platelets or hemolytic anemia)

(2) The test results meet at least two of the following conditions:

anti-dsDNA antibody is positive;

Anti-Sm antibody is positive;

positive antinuclear antibody;

Skin lupus band test (non-lesioned area) or kidney biopsy;

C3 is lower than normal.

(3) Lupus nephritis results in weakened renal function, and endogenous creatinine clearance is lower than 30ml per minute.

Major disease severe primary cardiomyopathy

Refers to a class of myocardial diseases caused by unknown causes, including primary dilated cardiomyopathy and primary hypertrophic myocardium

Disease and primary restricted cardiomyopathy, the lesions must have caused obvious ventricular dysfunction and appear obvious

Heart failure (meaning that the heart function reaches level 4 according to the New York Heart Association Heart Function Classification Standards), and

Relevant hospital medical records indicate that Grade 4 heart failure status persists for at least 180 days.

The disease must be clearly diagnosed by a specialist. Myocardium secondary to systemic or other organ system diseases

Lesions are not covered.

* New York Heart Association Classification Standard Heart Function Level 4 means that the hospital's medical records indicate that the patient cannot perform

Heart failure, such as palpitations and dyspnea, is present at any activity.

Total loss of limb function

Refers to two of the three major joints of the limb that are stiff or unable to move with consciousness. Limb refers to the shoulder joint

The entire upper limb or the entire lower limb including the hip joint.

Completely loss of speech or chewing ability

Complete loss of language ability, meaning the inability to make four kinds of speech (including lip, tongue, mouth, and throat)

Sound), or all three of the vocal cords are removed, or aphasia is caused by damage to the language center of the brain.

Complete loss of chewing and swallowing ability, which refers to an organic or functional disorder caused by reasons other than teeth,

It can be used for chewing and swallowing. It cannot be swallowed or swallowed except for liquid food.

Six basic daily activities of major diseases

The six basic daily activities are:

(1) Dressing: You can dress and undress yourself;

(2) Move: from one room to another;

(3) Action: Get in or out of bed or wheelchair yourself;

(4) Go to the toilet: control your own urine and stool;

(5) Eat: take food from prepared bowls or dishes and put it in your mouth;

(6) Take a bath: Take a shower or bath yourself.

Major illness accident

Refers to an external, sudden, unintended, non-illnessing objective event that causes physical harm.

Major illness infected with HIV or AIDS

AIDS virus refers to human immunodeficiency virus, the English abbreviation is HIV. AIDS refers to the human immunodeficiency virus

Acquired immunodeficiency syndrome, the English abbreviation is AIDS.

Positive HIV or antibodies detected in human blood or other samples without clinical symptoms

Or signs of HIV infection; if symptoms or signs are apparent

AIDS.

Major disease hereditary disease

A disease caused by mutations or aberrations in the genetic material (chromosomes and genes) of germ cells or fertilized eggs

, Usually has the characteristics of vertical transmission from parent to offspring.

Major diseases Congenital malformations, deformities or chromosomal abnormalities

Refers to deformities, deformities, or chromosomal abnormalities that the insured person has at birth. Congenital deformities, deformations and staining

Physical abnormalities are determined in accordance with the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10)

set.

New Critical Illness Policy

On September 4, 2012, the Ministry of Health stated that for some major domestic diseases, the Ministry of Health will use the new rural medical measures to make the compensation level for major catastrophic diseases reach 90%.

It is reported that six major diseases including severe mental illness, tuberculosis, cervical cancer of women, breast cancer, end-stage renal disease (uremia), and opportunistic infection of AIDS are included in the coverage.