SMILE Extra Care Rider

A malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells with invasion and destruction of normal tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma.
​​For the above definition, the following are excluded:

1. All tumours which are histologically classified as any of the following: Pre-malignant; Non-invasive; Carcinoma-in-situ; Having borderline malignancy; Having any degree of malignant potential; Having suspicious malignancy; Neoplasm of uncertain or unknown behavior; or Cervical Dysplasia CIN-1, CIN-2 and CIN-3;

2. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;

3. Malignant melanoma that has not caused invasion beyond the epidermis;

4. All Prostate cancers histologically described as T1N0M0 (TNM Classification) or below or Prostate cancers of another equivalent or lesser classification;

5. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;

6. All tumours of the Urinary Bladder histologically classified as T1N0M0 (TNM Classification) or below;

7. All Gastro-Intestinal Stromal tumours histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs;

8. Chronic Lymphocytic Leukaemia less than RAI Stage 3; and

9. All tumours in the presence of HIV infection.

Death of heart muscle due to ischaemia, that is evident by at least three of the following criteria proving the occurrence of a new heart attack:

1. History of typical chest pain;

2. New characteristic electrocardiographic changes; with the development of any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block;

3. Elevation of the cardiac biomarkers, inclusive of CKMB above the generally accepted normal laboratory levels or Cardiac Troponin T or I at 0.5ng/ml and above;

4. Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. The imaging must be done by Cardiologist specified by the Company.

For the above definition, the following are excluded:

1. Angina;

2. Heart attack of indeterminate age; and

3. A rise in cardiac biomarkers or Troponin T or I following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.

Explanatory note: 0.5ng/ml = 0.5ug/L = 500pg/ml

The actual undergoing of major surgery to repair or correct an aneurysm, narrowing, obstruction or dissection of the aorta through surgical opening of the chest or abdomen.  For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches.

Surgery performed using only minimally invasive or intra-arterial techniques are excluded.

Chronic Relapsing Pancreatitis shall mean repeated attacks of inflammation of the pancreas, which has resulted in progressive fibrosis leading to loss of exocrine and endocrine tissue.  All of the following criteria must be met:

1. Medical record of at least three attacks of inflammation of the pancreas;

2. Evidence of pancreatic insufficiency causing malabsorption, where continuous pancreatic enzyme or insulin replacement therapy has been instituted;

3. The diagnosis of Chronic Relapsing Pancreatitis must be confirmed by a medical specialist in a relevant field.
Chronic pancreatitis due to alcohol or drug abuse is excluded.

Major stage lung disease, causing chronic respiratory failure. This diagnosis must be supported by evidence of all of the following:

1. FEV1 test results which are consistently less than 1 litre;

2. Permanent supplementary oxygen therapy for hypoxemia;

3. Arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 ≤ 55mmHg); and

4. Dyspnea at rest.

The diagnosis must be confirmed by a respiratory physician.

A submassive to massive necrosis of the liver by the Hepatitis virus, leading precipitously to liver failure. This diagnosis must be supported by all of the following:

1. Rapid decreasing of liver size as confirmed by abdominal ultrasound;

2. Necrosis involving entire lobules, leaving only a collapsed reticular framework;

3. Rapid deterioration of liver function tests;

4. Deepening jaundice; and

5. Hepatic encephalopathy.

End stage liver failure as evidenced by all of the following:

1. Permanent jaundice;

2. Ascites; and

3. Hepatic encephalopathy.

Liver disease secondary to alcohol or drug abuse is excluded.

Chronic persistent and irreversible bone marrow failure, confirmed by biopsy, which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following:

1. Blood product transfusion;

2. Bone marrow stimulating agents;

3. Immunosuppressive agents; or

4. Bone marrow or haematopoietic stem cell transplantation.

The diagnosis must be confirmed by a haematologist.

This is a hereditary cystic disease with all of the following symptoms.

1. Medulla cyst is found in the kidney

2. Have Tubular Atrophy and Interstitial Fibrosis

3. Chronic kidney failure

The diagnosis must be confirmed by results of renal biopsy.

Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant, irreversible and permanent neurological deficit.  The neurological deficit must persist for at least 6 weeks.  This diagnosis must be confirmed by:

1. The presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and

2. A consultant neurologist.

Bacterial Meningitis in the presence of HIV infection is excluded.

The occurrence of Poliomyelitis where the following conditions are met:

1. Poliovirus is identified as the cause,

2. Paralysis of the limb muscles or respiratory muscles must be present and persist for at least 3 months.

The diagnosis must be confirmed by a consultant neurologist or specialist in the relevant medical field.

Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging tests, arising from Alzheimer’s disease, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the insured. This diagnosis must be supported by the clinical confirmation of an appropriate consultant.

The disease must result in significant cognitive impairment which results in the need for permanent and continuous supervision of the insured or the permanent inability to perform 3 out of the 5 “Activities of daily living” without the assistance of another person.
Permanency must be diagnosed no sooner than 3 months.
The following are excluded:

1. Non-organic diseases such as neurosis and psychiatric illnesses; and

2. Alcohol related brain damage.

3. Dementia due to HIV

Benign brain tumour means a non-malignant tumour located in the cranial vault and limited to the brain, meninges or cranial nerves where all of the following conditions are met:

1. It has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit; and

2. Its presence must be confirmed by a neurologist or neurosurgeon and supported by findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques.

The following are excluded:​​​​

1. Cysts;
2. Abscess;
3. Angioma;
4. Granulomas;
5. Vascular Malformations;
6. Haematomas; and
7. Tumours of the pituitary gland, spinal cord and skull base.

Coma that persists for at least 96 hours. The diagnosis must be confirmed by a specialist who is a neurologist or neurosurgeon and must be supported by evidence of all of the following:

1. No response to external stimuli for at least 96 hours; and

2. Require intubation and mechanical ventilation to sustain life; and

​3. ​Brain damage ​resulting in permanent neurological deficit with persisting clinical symptoms which must be assessed at least 30 days after the onset of the coma.

For the​ above definition, ​medically induced coma and coma resulting directly from alcohol or drug abuse are excluded.​

Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum) caused by viral infection and resulting in permanent neurological deficit. This diagnosis must be certified by a consultant neurologist and the permanent neurological deficit must be documented for at least 3 months.

Encephalitis caused by HIV infection is excluded.​​

The actual undergoing of surgery to the brain under general anesthesia, during which a craniotomy is performed. Brain surgery due to accident is excluded. The procedure must be considered necessary by a medical specialist and supported by evidence such as imaging techniques (X-Ray/MRI/CT Scan) and treating neuro-surgeon’s certificate.

Transphenoidal surgery, burr hole surgery, and any other minimally invasive or endovascular procedures including Gamma knife procedures are excluded.

A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis. This diagnosis must be supported by all of the following conditions:

1. Evidence of permanent neurological damage which results in one of the three following deficits:

• Total and permanent loss of motor function in one or more limb
• Permanent loss of the ability to speak due to damage to the speech center in the brain
• Permanent inability to perform 3 out of 5 “Activities of daily living” without the assistance of another person

2. The evidence of any of the three deficits above must be confirmed by a neurologist at least 3 months after the event; and

3. Findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.

4. The following are excluded:

• Transient Ischaemic Attacks and any Reversible ischemic neurological deficit;
• Brain damage due to an accident or external injury, infection, vasculitis, inflammatory disease and migraine;
• Vascular disease affecting the eye or optic nerve; and Ischaemic disorders of the vestibular system.

A definite diagnosis of Progressive Supranuclear Palsy by a Consultant Neurologist which satisfies all of the following criteria:

1. There must be current clinical impairment of motor function,

2. There must be current clinical impairment of eye movements, and

3. The diagnosis must be confirmed by diagnostic techniques current at the time of claim.

4. The permanent and irreversible inability to perform without any assistance at least 3 out of 5 of the “Activities of daily living”  for a continuous period of at least 3 months.

The definite diagnosis of Multiple Sclerosis, and must be supported by all of the following:

1. Investigations which unequivocally confirm the diagnosis to be Multiple Sclerosis; and

2. Multiple neurological deficits which occurred over a continuous period of at least 6 months.

Other causes of neurological damage such as Systemic Lupus Erythematous (SLE) and HIV are excluded.

The unequivocal diagnosis of muscular dystrophy must be made by a consultant neurologist. The condition must result in the inability of the insured to perform (whether aided or unaided) at least 3 of the 5 “Activities of Daily Living” for a continuous period of at least 3 months.

For the purpose of this definition, “aided” shall mean with the aid of special equipment, device and/or apparatus and not pertaining to human aid

An autoimmune disorder causing a gradual destruction of the adrenal gland resulting in the need for life long glucocorticoid and mineral corticoid replacement therapy. The disorder must be confirmed by a specialist in endocrinology through one of the following:

1. ACTH simulation tests;

2. Insulin-induced hypoglycemia test;

3. Plasma ACTH level measurement;

4. Plasma Renin Activity (PRA) level measurement.

Only autoimmune cause of primary adrenal insufficiency is included. All other causes of adrenal insufficiency are excluded.

Crohn’s Disease is a chronic, transmural inflammatory disorder of the bowel. To be considered as severe, there must be evidence of continued inflammation in spite of optimal therapy, with all of the following having occurred:

1. Stricture formation causing intestinal obstruction requiring admission to hospital, and

2. Fistula formation between loops of bowel, and

3. At least one bowel segment resection.

The diagnosis must be made by a Registered Doctor who is a specialist Gastroenterologist and be proven histologically on a pathology report and/or the results of sigmoidoscopy or colonoscopy.

The Severe Rheumatoid Arthritis with all of the following factors.

1. Is in accordance with the criteria on Rheumatoid Arthritis of the American College of Rheumatology and has been diagnosed by the Rheumatologist.

2. At least 3 joints are damaged or deformed such as finger joint, wrist, elbow, knee joint, hip joint, ankles, cervical spine or feet toe joint as confirmed by clinical and radiological evidence and cannot perform at least 3 of the following 5 “Activities of daily living” permanently for at least 90 days, unless the insured passes away during such period due to critical illness or direct consequence from critical illness under this item.

An acquired autoimmune disorder of neuromuscular transmission leading to fluctuating muscle weakness and fatiguability, where all of the following criteria are met:

1. Presence of permanent muscle weakness categorized as Class IV or V according to the Myasthenia Gravis Foundation of America Clinical Classification below; and

2. The Diagnosis of Myasthenia Gravis and categorization are confirmed by a Registered Medical Practitioner who is a neurologist.

Myasthenia Gravis Foundation of America Clinical Classification:
Class I: Any eye muscle weakness, possible ptosis, no other evidence of muscle weakness elsewhere

Class II: Eye muscle weakness of any severity, mild weakness of other muscles

Class III: Eye muscle weakness of any severity, moderate weakness of other muscles

Class IV: Eye muscle weakness of any severity, severe weakness of other muscles

Class V: Intubation needed to maintain airway

This means Lupus Nephritis at level 3 or above according to the classification of WHO as confirmed by the Renal biopsy result or Urine Examination, Urine Protein, Blood Urea Nitrogen (BUN) and Creatinine. Lupus Nephritis is caused by the Systemic Lupus Erythematosus.

Note: Lupus Nephritis from Systemic Lupus Erythematosus must be diagnosed by a Rheumatologist, the Immunologist or Nephrologist and full diagnosis according to American College of Rhuumatology.

The WHO Classification of Lupus Nephritis

Class I: Minimal change Glomerulonephritis

Class II: Pure Masangial Alterations (Mesangiopathy)

Class III: Focal segmental glomerulonephritis (associated with mild or moderate mesangial alterations)

Class IV: Diffuse glomerulonephritis (Severe mesangial, endocapillary, or mesangiocapillary proliferation, and/or extensive subendothelial deposits. Mesangial deposits are present invariably and subepithelial deposits often, and may be numerous.

Class V: Diffuse Membranous glomerulonephritis

Class VI: Advanced Sclerosing glomerulonephritis