What if your Policies are Purchased 5 to 10 years ago?

After flipping through various policy documents, and researching the different versions of Annexures for Critical Illnesses under PRUDENTIAL ASSURANCE (M) BERHAD, I came to a conclusion. There are altogether 3 versions of Annexure namely Annexure DFH, DFL, and the latest being DFN.

Annexure DFH was introduced much earlier than year 2000, but I have no record when the Annexure was finally replaced by Annexure DFL and DFN. Well, let's talk about the latest versions of Annexure DFL and DFN first. Many must be curious is there any differences? YES, I found out that the only difference between Annexure DFL & DFN is the numbering for item (20) Loss of Independent Existence and item (21) Loss of Speech. Everything else are exactly the same for arrangements, numbering and wordings.

I have attached a copy of the initial Annexure DFH for policies prior to year 2000 below. If you have gone through all the items below like myself and comparing it to the latest Annexure DFN (published in previous post), you would have noticed that there are significant differences in the wordings, descriptions, and items. For certain illnesses, it seems the wordings are more lenient and not so many details or qualifications listed. There are these so called gray area where you stand a chance to "fight" if you wish. I also noticed that the phrase "as is appropriate if applicable" was totally removed in the latest Annexure DFL & DFN altogether, unlike Annexure DFH which uses quite a number of them.

Now, many would have wonder why I wasted so much time finding the differences? Just for fun? 

The rational of finding the differences is to answer the question, should we increase the coverage in older policies, or should we purchase new policy with the newer Annexure DFN which comes with clearer but stricter definitions?

But wait a minute, isn't it if you add on the Critical Illness cover today, your coverage will follow the latest Annexure DFN? 

Yes, at first we also thought that if we add on the coverage for critical illness, be it in older policies or getting new policy, we will get the latest Annexure DFN, but NO. Upon confirming with company, it is confirmed that, if the extra coverage will follow old Annexure. 

So, should we add on to older policies (if you have one), or should we just get a new one? Or should we cancel off the old policy and consolidates all into new one?

To the first question, preferably to get new policy with latest Annexure DFN because the 36 types included did not overlap itself unlike the old one. 

To the 2nd question, like I mentioned in previous posting, never cancel an older policy just to get a new one. Agents who influenced you to do so can be sued. It was because older policies are generally cheaper than newer policies, as the age of entry are different. Furthermore, it is clearly stated that Critical Illnesses shall means any one of the following illnesses as defined separately hereunder occuring more than 30 days (60 days for Heart Attack, Coronary Artery Heart Disease or Cancer) after the Commencement Date of the Policy as specified in the Schedule or the date of any Revival of Benefit(s) or the date of any Endorsement of Benefit(s) secured under the Policy or the date issue of this Annexure whichever is latest. Anything less than the waiting period is considered PRE-EXISTING ILLNESS, and is not covered. So, you are advisable to get additional coverage under new policy.

(1) Heart Attack

The death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis in respect of this illness must be based on the meeting of all of the following criteria:
(i) a history of typical chest pain;
(ii) new electrocardiographic changes; and
(iii) elevation of the cardiac enzyme.

(2) Coronary Artery Disease Requiring Surgery

The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts in persons with limiting anginal symptoms, but excluding non-surgical techniques such as balloon angioplasty or laser relief of an obstruction.

(3) Stroke

Any cerebrovascular incident producing neurological sequelae lasting more than twenty four hours and including infarction of brain tissue, haemorrhage and embolisation from an extra-cranial source. There must be evidence of permanent neurological deficit.

(4) Cancer

A malignant tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This includes leukaemia but excludes non-invasive cancers in situ, tumours in the presence of any Human Immunodeficiency Virus and any skin cancer other than malignant melanoma.

(5) Kidney Failure

End stage renel disease, due to whatever cause or causes, with the insured undergoing regular peritoneal dialysis or haemodialysis or having had renel transplantation.

(6) Paralysis

The complete and permanent loss of use of two or more limbs through paralysis.

(7) Major Organ Transplantation

The actual undergoing as a recipient of a transplant of a heart, heart and lung, liver, pancreas, kidney or bone marrow.

(8) Multiple Sclerosis

The unequivocal diagnosis by a consultant neurologist registered in Malaysia or Singapore confirming more than one episode of well-defined neurological deficit, with persisting signs of involvement of the optic nerves, brain stem and spinal cord together with impairment of co-ordination and motor and sensory function, with the Assured or the Life Assured (as is appropriate if applicable) not necessarily confined to a wheelchair.

(9) Fulminant Viral Hepatitis

A submassive to massive necrosis of the liver caused by the Hepatitis virus, leading precipitously to liver failure. The diagnostic in respect of this illness must be based on the meeting of all of the following criteria:
(i) a rapidly decreasing liver size;
(ii) necrosis involving entire lobules, leaving only a collapsed reticular framework;
(iii) rapidly degenerating liver functions tests; and
(iv) deepening jaundice.

Excluding however the diagnosis of this illness if such diagnosis is directly or indirectly caused by attempted suicide, poisoning, drug overdose and excessive alcohol ingestion.

(10) Pulmonary Arterial Hypertension

Primary pulmonary hypertension as established by clinical and laboratary investigations including cardiac catheterization.

(11) Coma

A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously with the use of life support systems for a period of at least 96 hours and resulting in permanent neurological deficit.

(12) Blindness

A total, permanent and irrecoverable loss of all vision in both eyes.

(13) Heart Valve Surgery

The undergoing of open heart surgery to correct valvular abnormalities.

(14) Surgery To The Aorta

The undergoing of surgery to correct any narrowing, dissection or aneurysm of the thoracic and abdominal aorta.

(15) Alzheimer’s Disease

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 disorders, excluding neurosis and psychiatric illness, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the Assured or the Life Assured (as is appropriate where applicable).

(16) Deafness

Total and irreversible loss of hearing in both ears.

(17) Loss of Speech

Total and irrecoverable loss of the ability to speak due to physical damage to the vocal cord.

(18) Major Burns

Third degree burns covering at least 20% of the surface area of the Assured’s or the Life Assured’s body (as is appropriate where applicable).

(19) Terminal Illness

In the opinion of the medical specialist involved and subject to the acceptance of the Company’s appointed medical officer the advent of death is highly likely within 12 months.

(20) AIDS Due To Blood Transfusion

The Assured or the Life Assured (as is appropriate where applicable) being infected by Human Immunodeficiency Virus or Acquired Immune Deficiency Syndrome provided that:
(i) the infection is due to blood transfusion received in Malaysia after the commencement of the Policy;
(ii) the infected Assured or Life Assured (as is appropriate where applicable) is not a haemophiliac;
(iii) there is no known cure.

(21) Motor Neurone Disease

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.

Claims shall only be admitted if the condition is confirmed by a consultant neurologist registered in Malaysia or Singapore as progressive and resulting in irreversible damage to the nervous system.

(22) Parkinson’s Disease

Slowly progressive degenerative disease of the central nervous system as a result of loss of pigment containing neurons of the brain.

Unequivocal diagnosis of Parkinson’s Disease must include the following conditions:

(i) cannot be controlled with medication;
(ii) shows signs of progressive impairment;

(iii) inability of the Assured or the Life Assured (as is appropriate where applicable) to  perform three or more of the following – bathing, dressing, using the lavatory, eating, ability to move in or out of bed or chair.

and must be made by a consultant neurologist registered in Malaysia or Singapore. Only idiopathic Parkinson’s Disease is covered. All other forms of Parkinsonism are excluded. 

(23) Chronic Liver Disease

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

(i) permanent jaundice;

(ii) ascites;

(iii) encephalopathy.

Liver disease secondary to excessive alcohol ingestion, drug misuse or attempted suicide is excluded.

(24) Chronic Lung Disease

End stage lung disease including interstital lung disease requiring extensive and permanent oxygen therapy as well as a FEV1 test result of consistently less than one liter.

(25) Aplastic Anaemia

Bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following:
(i) blood product transfusion;
(ii) marrow stimulating agents;
(iii) immunosuppressive agents;
(iv) bone marrow transplantation.

(26) Muscular Dystrophy

A hereditary muscular dystrophy confirmed by a consultant neurologist registered in Malaysia or Singapore resulting in the inability to perform without assistance three or more of the following – bathing, dressing, using the lavatory, eating, ability to move in or out of bed or chair.

(27) Poliomyelitis

Unequivocal diagnosis by a consultant neurologist registered in Malaysia or Singapore of infection by the polio virus 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 are specifically excluded.

(28) Bacterial Meningitis

Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit, the diagnosis to be confirmed by a consultant neurologist registered in Malaysia or Singapore.

(29) Benign Brain Tumor

A non-cancerous tumour in the brain. Cysts, granulomas, malformations in, or of, the arteries or veins of the brain, haematomas and tumours in the pituitary gland or spine are excluded.

(30) Encephalitis

Severe inflammation of brain substance which results in significant and permanent neurological sequelae as certified by a consultant neurologist registered in Malaysia or Singapore. Encephalitis as a result of HIV infection is excluded.

(31) Full Blown AIDS

Clinical manifestation of AIDS (Acquired Immune-deficiency Syndrome), which 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 diagnosis in respect of this illness must be based on the meeting of all of the following criteria at the time of the diagnosis:

(i) the Assured or the Life Assured (as is appropriate where applicable) must have a CD4 cell count of less than 200 and have evidence of opportunistic infection and/or AIDS related tumours; and

(ii) there is no known cure.

In the event of a claim except for PRUpayor, PRUspouse payor and PRUparent payor, 50% of all applicable Benefits (up to a maximum of RM500,000 on any one life under this and all other policies) payable in respect of this illness will be paid. The balance amount shall be payable on death, total permanent disability or the diagnosis of another Critical Illness whichever shall first occur.

(32) Other Serious Coronary Artery Disease

The narrowing of the lumen of at least three coronary arteries by a minimum of 75%, as proven by coronary arteriography carried out in Malaysia or Singapore, regardless of whether any form of coronary artery surgery has been performed.

(33) Brain Surgery

The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed. Brain surgery following an accident is excluded.

(34) Appalic Syndrome

Universal necrosis of the brain cortex, with the brainstem remaining intact. The definite diagnosis must be confirmed by a consultant neurologist registered in Malaysia or Singapore. The condition has to be medically documented for at least one month.

(35) Major Head Trauma

Accidental head injury resulting in cerebral damage (as demonstrated by modern scanning or imaging techniques and certified by a consultant neurologist registered in Malaysia or Singapore) leading to permanent functional impairment and the inability to perform without assistance of at least 3 of the following activities of daily living: - bathing, dressing, using the lavatory, eating, ability to move in or out of bed or chair.

(36) Loss of Limbs

A complete and permanent loss of use of two or more limbs. Loss of use must be established for a continuous period of at least six months and be supported by appropriate medical evidence confirmed by a consultant neurologist registered in Malaysia or Singapore.