SMILE Group Critical Illness Cost Protection Rider

“Diagnosis” means a clear evidence-based physician’s diagnosis as reference to the critical illness as defined in this rider.  In case of lack of such clear evidence, the replaceable evidence could be the report from radiological, clinical, histological, or laboratory examination.

“Physician” means contemporary physician who holds medical certificate recognized by Ministry of Health and is legally registered with the Medical Council of Cambodia to practice medical treatments or surgical services who is not the Insured Member, the Insured Member’s spouse or descendent.

“Critical Illness” means the Insured Member is diagnosed with critical illness that incurred at least 90 days after the Company accepts to insure or from the last reinstatement and the Insured Member survives for at least 30 days from the date that Insured Member diagnoses with critical illness.

The Critical Illness covered under this rider are the following 5 diseases:

 a) ​Cancer​​​​​

Cancer is identified by the diagnosis of a malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. The cancer must be confirmed by histological evidence of malignancy by a qualified oncologist or pathologist.

Cancer also includes: Leukemia, Lymphoma or Sarcoma.

The following are excluded:
1. Tumor which is histologically classified as pre-malignant, non-invasive, having either borderline malignancy or low malignancy potential, or carcinoma in situ including but not limited to cervical dysplasia, Cervix cancer CIN-1, CIN-2 & CIN-3;
2. Early prostate cancer, thyroid cancer, bladder cancer histologically classified as T1N0M0 or a lower stage according to TNM Classification or equivalent classification ;
3. Chronic Lymphocytic Leukemia classified as less than RAI Stage III;
4. All non-melanomas skin cancer and malignant melanomas of the skin histologically classified as less than Stage II according to the melanoma staging system of the American Joint Committee on Cancer (AJCC);
5. All tumors in the presence of HIV infection.

 b) ​Stroke​​​

A cerebrovascular incident caused by cerebral thrombosis or intracerebral hemorrhage or extracranial embolism which results in permanent neurological deficit lasting for at least 60 days. The diagnosis must be supported by new changes on a CT or MRI scan and confirmed by a neurologist.

The following are excluded:
1. Infarction of brain tissue or intracranial bleeding as a result of external injury;
2. Cerebral symptoms due to transient ischemic attacks;
3. Any reversible ischemic neurological deficit;
4. Vascular disease affecting the eye or optic nerve or vestibular functions

c)​​ Heart Attack​​​

​​Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. This diagnosis must be supported by three or more of the following four criteria which are consistent with a new heart attack:​​

​​1. History of typical chest pain;
​2. New electrocardiogram (ECG) changes proving infarction;
​3. Diagnostic elevation of cardiac enzyme CK-MB or Troponin (T or I) at level above the generally accepted laboratory levels of normal;
​4. Left ventricular ejection fraction less than 50% measured 3 months or more after the event.

d) ​​​End Stage Lung Disease​​​

The end stage of lung disease, causing chronic respiratory failure, as demonstrated by all of the following:

1. FEV1 test results consistently less than 1 liter,
2. Requiring permanent supplementary oxygen therapy for hypoxemia
3. Arterial blood gas analyses with partial oxygen pressures of 55 mmHg or less (PaO2 < 55 mmHg), and
4. Dyspnea at rest.

e) ​​End Stage Kidney Disease​​​

​​End stage kidney disease presenting as chronic irreversible failure of both kidneys to function. This must be evidenced by the undergoing of regular renal dialysis or renal transplantation carried out.​​​