transfer to other parts of the body by spreading through blood vessels, lymphatic vessels and body cavities. It is clearly diagnosed by pathological findings, and the clinical
diagnosis belongs to the category of malignant tumors in the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10).
The following diseases are not covered:
1. Carcinoma in situ;
2. Chronic lymphocytic leukemia equivalent to Binet Stage A;
3. Hodgkin's disease equivalent to Ann Arbor Stage I;
4. Skin cancer (excluding malignant melanoma and metastatic skin cancer);
5. Skin cancer (excluding malignant melanoma and metastatic skin cancer);
5. Prostate cancer with TNM stage T1N0M0 or milder stage;
6. Malignant tumor infected with HIV or during AIDS.
2. Acute myocardial infarction: refers to partial myocardial necrosis caused by insufficient blood supply to the corresponding area due to coronary artery obstruction. At least three of the following conditions must be met:
1. typical clinical manifestations, such as acute chest pain;
2. recent electrocardiographic changes suggestive of acute myocardial infarction;
3. diagnostic elevation of 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 after examination. Examination confirms reduced left ventricular function, such as a left ventricular ejection fraction of less than 50%.
Third, the sequelae of cerebral stroke: cerebrovascular hemorrhage, embolism or infarction due to sudden cerebrovascular lesions, and lead to permanent neurological
systemic dysfunction. Permanent neurological dysfunction means that 180 days after the diagnosis of the disease, one or more of the following disorders remain:
1. Complete loss of the function of one limb or more limbs (Note 1);
2. Complete loss of the ability to speak or the ability to chew and swallow (Note 2);
Guoshou Kangning Whole Life Major Disease Insurance (2012 Edition) Benefit clauses (page 2)
3. Total loss of the ability to live independently, unable to independently perform three or more of the six basic activities of daily living (Note 3)
.
4. Major Organ Transplantation or Hematopoietic Stem Cell Transplantation: Major Organ Transplantation means that an allogeneic transplantation of kidneys, liver, heart or lungs has been performed due to the functional failure of the corresponding organ
. Hematopoietic Stem Cell Transplantation: Hematopoietic Stem Cell Transplantation means that an allogeneic transplantation of hematopoietic stem cells (including bone marrow hematopoietic stem cells, peripheral blood hematopoietic stem cells, and umbilical cord blood
hematopoietic stem cells) has been performed due to impairment of hematopoietic function or
malignant tumors of the hematopoietic system.
V. Coronary artery bypass grafting (or coronary artery bypass grafting): refers to the surgery of coronary artery vascular bypass grafting for the treatment of severe coronary artery disease, which is actually carried out
open chest.
Coronary stenting, cardiac catheterization balloon dilatation, laser radiofrequency technology and other non-open-chest interventional and lumpectomy
procedures are not covered.
VI. End Stage Renal Disease (or Chronic Renal Failure Uremic Stage): refers to the chronic irreversible failure of the function of both kidneys to
Uremic Stage, which has been diagnosed and treated with regular dialysis for a period of at least 90 days or a renal transplantation has been performed.
VII. Multiple Limb Loss: It refers to the complete severance of two or more limbs from the proximal end of the wrist or ankle joint
(near the end of the trunk) or more as a result of disease or accidental injury.
VIII. Acute or Subacute Severe Hepatitis: refers to acute hepatic
failure due to diffuse necrosis of liver tissues caused by hepatitis viral infection and confirmed by serologic or virologic tests, and all of the following conditions must be met:
1. Severe jaundice or rapidly aggravating jaundice;
2. Hepatic encephalopathy;
3. ultrasound or other imaging tests show rapid shrinkage of liver volume;
4. progressive deterioration of liver function indicators.
9, benign brain tumor: refers to benign tumors of the brain, has caused increased intracranial pressure, clinical manifestations of optic nerve papillary edema,
psychiatric symptoms, epilepsy and motor sensory deficits, and life-threatening. It must be confirmed by imaging tests such as cranial tomography (CT), magnetic **** vibration imaging (MRI)
or positron emission tomography (PET), and must meet at least one of the following conditions:
1. actual craniotomy performed to completely remove or partially remove the brain tumor;
2. actual radiation therapy performed to the brain tumor .
Pituitary Tumor, Brain Cyst and Cerebrovascular Disease are not covered.
X. Chronic Liver Failure Decompensated Stage: refers to liver failure due to chronic liver disease. All of the following conditions must be met:
1. persistent jaundice;
2. ascites;
3. hepatic encephalopathy;
4. congestive splenomegaly with hyper-splenism or esophagogastric fundal varices.
Liver failure due to alcohol or drug abuse is not covered.
XI. Post-Encephalitis Sequelae or Post-Meningitis Sequelae: permanent neurological dysfunction caused by encephalitis or meningitis
. Permanent neurological dysfunction means that 180 days after the diagnosis of the disease, one or more of the following disorders remain:
1. Complete loss of function of one or more limbs (Note 1);
2. Complete loss of speech or the ability to chew and swallow (Note 2);
3. Complete loss of the ability to live on one's own, and the inability to independently perform one of six basic activities of daily living (Note 3). activities of daily living (Note 3) or three or more
.
XII. Deep coma: It refers to the loss of consciousness due to illness or accidental injury, unresponsive to external stimuli and internal needs, with a coma score of 5 or less according to the Glasgow coma scale, and the use of
ventilators and other life support systems for more than 96 hours.
Deep coma due to alcohol or drug abuse is not covered.
XIII. Age-specific Binaural Hearing Loss: It means permanent irreversible (Note 4) loss of hearing in both ears due to disease or accidental injury after the insured person reaches the age of 3, with an average hearing threshold of more than 90 decibels at 500 hertz, 1,000 hertz, and 2,000 hertz speech frequencies, and
Guoshou Kangning Lifelong Major Disease Insurance (2012 Edition) Benefits Terms and Conditions (Page 3)
Confirmed by Pure Tone Hearing Test, Acoustic Conductance Impedance Test or Auditory Evoked Potentials Test.
Evidence of hearing loss diagnosis and examination at the time of claim must be provided at the time of claim application.
14. Age-specific double vision: It means permanent irreversible (Note 4) loss of vision in both eyes due to disease or accidental injury after the Insured Person reaches the age of 3, and at least one of the following conditions must be fulfilled in the better eye of both eyes:
1. loss or removal of the eyeballs;
2. corrected visual acuity of less than 0.02 (with the use of the International Standard Vision Scale (ISVS)), or the use of other vision scales, or the use of other vision scales. Conversion should be made if other vision scales are used);
3. Field of view radius less than 5 degrees.
Evidence of diagnosis and examination of loss of vision at the time of claim must be provided at the time of claim application.
15. Paralysis: refers to the permanent and complete loss of function of two or more limbs due to disease or accidental injury. Permanent total loss of limb function
means that 180 days after the diagnosis of the disease or 180 days after the accidental injury, two of the three major joints of each limb are still
completely stiff or unable to move with consciousness.
XVI Heart Valve Surgery: refers to the surgery to replace or repair
the heart valve which is actually performed open heart for the treatment of heart valve disease.
17. Severe Alzheimer's Disease: means a progressive, irreversible change in the brain resulting in severe deterioration or loss of intelligence, with clinical
bedside manifestations of significant cognitive impairment, behavioral abnormalities, and diminished social skills, and whose daily life must be continuously supervised by others.
Must be verified by imaging such as cranial tomography (CT), magnetic **** vibration imaging (MRI), or positron emission tomography (PET)
and have a complete loss of autonomy, and be unable to independently perform three or more than three of the six basic activities of daily living (Note 3)
.
Neurosis and mental illness are not covered.
XVIII. Severe Brain Injury: refers to damage to an important part of the brain caused by a mechanical external force on the head, resulting in permanent
neurological dysfunction. It must be confirmed by imaging examinations such as cranial tomography (CT), magnetic **** vibration examination (MRI) or positron emission tomography (PET)
. Permanent neurological dysfunction means that 180 days after the brain injury, one or more of the following disorders remain:
1. complete loss of function of one or more limbs (Note 1);
2. complete loss of speech or the ability to chew and swallow (Note 2);
3. complete loss of the ability to live on one's own, unable to independently accomplish three or more of the six basic activities of daily living (Note 3)
.
19. Severe Parkinson's Disease: a degenerative disease of the central nervous system, clinically manifested by tremor paralysis, **** dysarthria
. All of the following conditions must be met:
1. Inability to control the disease with medication;
2. Complete loss of autonomy and inability to independently perform three or more of the six basic activities of daily living (Note 3)
.
Secondary Parkinson's Syndrome is not covered.
Twentieth, Severe Third Degree Burns: It means the degree of burns is Third Degree and the area of the Third Degree Burns reaches 20% or
20% or more of the body surface area of the whole body. The body surface area is calculated according to China's New Nine-point Method.
Xxi. Severe Primary Pulmonary Hypertension: refers to unexplained persistent increase in pulmonary artery pressure, progressive development of chronic disease caused by
, which has caused permanent irreversible (Note 4) limitation of physical activity, reaching the American New York Cardiological Society
Cardiac Function Status Class IV, and the average pressure of the pulmonary artery in resting state is more than 30mmHg.
This is the first time that a person has been diagnosed with pulmonary hypertension. 30 mmHg.
Xxii. Severe Motor Neuron Disease: a group of progressive degenerative diseases of the motor neurons of the central nervous system, including progressive spinal muscular atrophy, progressive medullary palsy, primary lateral sclerosis, and amyotrophic lateral sclerosis. The condition of complete loss of the ability to live independently
without being able to perform three or more of the six basic activities of daily living (Note 3) must be met.
Xxiii. Loss of Speech: A total loss of speech due to disease or accidental injury, which cannot be restored by available medical means after active treatment for at least
12 months (complete removal of the vocal cords is not subject to this time limit).
Loss of speech due to psychosomatic factors is not covered.
Guoshou Kangning Lifelong Major Disease Insurance (2012 Edition) Benefit Terms (Page 4)
XXXIV. Severe Aplastic Anemia: refers to anemia, neutropenia, and thrombocytopenia due to the chronic and persistent failure of bone marrow hematopoietic function. All of the following conditions must be met:
1. Bone marrow aspiration or bone marrow biopsy results support the diagnosis;
2. The peripheral blood picture must have the following three conditions:
(1) Absolute value of neutrophils ≤0.5×109/L;
(2) Reticulocytes <1%;
(3) Absolute value of platelets ≤20×109/L.
3) Absolute value of platelets ≤1%. 109/L.
Twenty-five, aortic surgery: refers to the treatment of aortic disease, the actual implementation of open chest or abdomen for the removal, replacement,
reparation of diseased aortic blood vessels surgery. Aorta means the thoracic aorta and the abdominal aorta, excluding the branch
branches of the thoracic aorta and the abdominal aorta.
Intra-arterial angioplasty is not covered.
XXVI Severe Cardiomyopathy: means chronic impairment of cardiac function due to cardiomyopathy, which has resulted in permanent irreversible (Note 4)
cardiac failure to the extent of the American College of Cardiology's Cardiac Function Status Class IV, and subject to the condition of permanent irreversible (Note 4) restriction of physical
ability to engage in any physical activity.
Twenty-seven, severe myasthenia gravis: refers to an autoimmune disease of nerve-muscle junction transmission disorders, clinical
characterized by local or generalized transverse muscle fatigue and weakness during activities, the cranial nerves of the extraocular muscles are most likely to involve, but also involve the respiratory muscles,
proximal lower limb muscle groups and the whole body muscles. And must meet all of the following conditions:
1. After medication or thymus surgery for more than a year can not control the disease, the loss of normal working ability;
2. The appearance of eyelid ptosis, or medulla oblongata muscle involvement caused by the difficulty of sound, choking and coughing on food, or due to the involvement of muscle weakness in medulla oblongata muscle,
respiratory muscle and lead to the respiratory function of the organism abnormal state of the critical state that is the crisis of myasthenia gravis;
3. a history of alternating remissions, relapses, and worsening of symptoms, and clinical treatment with anticholinesterase drugs such as neostigmine.
XXVIII. Severe multiple sclerosis: refers to a demyelinating disease of the central nervous system resulting in irreversible motor or sensory dysfunction
with clinical manifestations such as impaired visual acuity, paraplegia, balance disorders, dysarthria, dysfunction of urinary and fecal functions, and other symptoms. Irreversible
means that the motor or sensory dysfunction needs to last more than 180 days after the initial diagnosis. It must be confirmed by imaging tests such as tomography (CT), magnetic resonance imaging (MRI)
or positron emission tomography (PET), and all of the following conditions must be met:
1. definite occurrence of the above clinical symptoms due to damage to the optic nerves, the brainstem, or the spinal cord;
2. scattered and diversified neurological damage;
3. repeated episodes of the above clinical symptoms. >3. a documented history of recurrent and worsening of the above clinical symptoms and neurologic injury.
Severe polio: motor dysfunction or reduced respiratory function caused by poliovirus infection lasting more than three months,
which must result in permanent total loss of function of one or more limbs. Permanent Total Loss of Limb Function,
means that 180 days after the diagnosis of the disease, two of the three major joints in each limb are still completely stiff or unable to move with consciousness.
Thirty, severe rheumatoid arthritis: refers to widely distributed chronic progressive polyarthropathy, manifested by severe deformation of the joints,
involving at least three major joints (wrist, elbow, shoulder, ankle, knee, hip) or groups of joints (e.g.,
multiple interphalangeal joints, metacarpophalangeal joints of the hand, and multiple toes and metatarsophalangeal joints of the foot, etc.). Rheumatoid arthritis must be definitively diagnosed and have achieved
permanent irreversible (Note 4) joint dysfunction at Rheumatoid Arthritis Functional Classification Grade IV and all of the following must be met:
1. Morning stiffness;
2. Symmetric arthritis;
3. Rheumatoid subcutaneous nodules;
4. Elevated rheumatoid factor titers;
5. Severe joint (cartilage and bone) destruction and joint deformity on X-ray.
31. Severe systemic lupus erythematosus nephropathy: Systemic lupus erythematosus (SLE) is an immune disease with multiple autoantibodies involving multiple systems and organs
. Systemic lupus erythematosus nephropathy, also known as lupus nephritis, is a condition in which systemic lupus erythematosus (SLE) involves the
kidneys, causing renal impairment. Lupus nephritis must be confirmed by renal pathology or clinically diagnosed and meet the following WHO diagnostic criteria
GuoShou KangNing Lifelong Major Disease Insurance (2012 Edition) Benefit Terms (Page 5)
Accurate definition of Lupus Nephritis Type III to Type V.
World Health Organization (WHO) lupus nephritis types:
Type I (microscopic lesions): microscopically negative, normal urine;
Type II (membranous lesions): moderate proteinuria, occasional changes in urinary sediment;
Type III (focal and segmental hyperplasia): proteinuria, changes in urinary sediment;
Type IV (diffuse hyperplasia) : acute nephritis with urinary sediment changes or nephrotic syndrome;
Type V (membranous): nephrotic syndrome or severe proteinuria.
Other types of lupus erythematosus, such as discoid lupus, systemic lupus erythematosus that only involves other systems, such as blood and joints, are not
covered.
Thirty-two, end-stage lung disease: refers to chronic respiratory failure, subject to all of the following conditions:
1. lung function test FEV1 consistently less than 0.75 liters;
2. the patient's hypoxia must be extensively and continuously on the treatment of oxygen infusion;
3. arterial blood gas analysis of the partial pressure of oxygen is less than 55mmHg.
Thirty-three, severe clonus: refers to a chronic granulomatous enteritis with characteristic histologic changes of clonus pathology,
which must be confirmed by pathological findings, and has resulted in the formation of a fistula with intestinal obstruction or intestinal perforation.
34. Severe ulcerative colitis: acute fulminant ulcerative colitis with fatal electrolyte disorders, involving the entire colon, manifested by severe bloody stools and systemic signs and symptoms, confirmed by pathologic findings, and the presence of a colectomy or ileostomy.
XXV. Persistent vegetative state: a disease state in which there is severe damage to the brain or brainstem due to severe craniocerebral trauma, hypoxia, severe encephalitis, or some kind of neurotoxin, resulting in a loss of consciousness and loss of function of the central nervous system, and in which only phytovascular
functions are left, and the vegetative state must have lasted for more than 30 days.
Thirty-six: Severe insulin-dependent diabetes mellitus: chronic elevation of blood glucose due to absolute insulin insufficiency, confirmed by
blood insulin measurement, blood c-peptide measurement, or urinary c-peptide measurement, and continuous dependence on exogenous insulin for more than 180 days; at least one of the following conditions shall be fulfilled:
1. Proliferative retinopathy;
2. Implantation of a pacemaker for cardiac disease;
3. Removal of at least one toe due to gangrene.
37. Severe Coronary Heart Disease (CHD): severe stenotic
lesions of the three major blood vessels (reduction of lumen diameter of at least one blood vessel by more than 75% and of the other two blood vessels by more than 60%) clearly diagnosed on the basis of the results of coronary artery angiography. The major vessels of the coronary arteries were defined as the left main coronary artery, anterior descending branch, circumflex branch, and right coronary artery, excluding the anterior descending branch, circumflex branch, and branches of the right
coronary artery.
Thirty-eight, acute necrotizing pancreatitis open surgery: refers to the treatment of acute necrotizing pancreatitis, the actual implementation of open abdominal
necrotic tissue removal, lesion resection or partial pancreatectomy.
Open surgery for the treatment of acute necrotizing pancreatitis caused by alcoholism is not covered.
39. Human Immunodeficiency Virus Infection Caused by Blood Transfusion: The insured person is infected with Human Immunodeficiency Virus (HIV),
and all of the following conditions must be met:
1. Infection caused by blood transfusion;
2. The blood transfusion center or hospital that provided the blood transfusion treatment reports that the transfusion infection is a medical liability accident, or the court's final
decision.
The court makes a final determination of medical liability and does not allow an appeal;
3. The infected Insured Person is not a hemophiliac.
Any Human Immunodeficiency Virus (HIV) infection due to other modes of transmission (including: sexual transmission or intravenous drug use)
is not covered. The Company has the right to obtain and use all blood samples from the Insured Person and the right to be able to carry out independent tests on these samples
.
40. Non-Alzheimer's Disease Caused Severe Dementia: This refers to permanent irreversible (Note 4) severe dementia caused by organic diseases of the brain other than Alzheimer's Disease, resulting in cerebral failure, which is clinically manifested by significant cognitive impairment, behavioral abnormalities, and diminished social
ability. The insured person's ability to live on his/her own is completely lost and he/she is unable to independently perform three or more of the six basic activities of daily living (Note 3)
Guoshou Kangning Lifelong Major Disease Insurance (2012 Edition) Benefit Clause (Page 6)
and daily living must be under the supervision of another person on a continuous basis. The disease causing the dementia must be clearly diagnosed and confirmed by complete clinical, laboratory and imaging findings
.
Neurosis, mental illness and brain damage due to alcoholism are not covered.