Page 6 - Nationwide_Care Access Plan
P. 6
Covered critical illness descriptions
Benefits payable are subject to the following diagnosis of each covered critical illness. Diagnosis must be made by
a legally qualified physician through the use of clinical and/or laboratory findings. The critical illness benefit is not
available in all states.
›› Cancer in situ: A diagnosis of cancer wherein the tumor cells ›› Life-threatening cancer: A malignant neoplasm is
still lie within the tissue of origin without having invaded characterized by the uncontrolled growth and spread of
neighboring tissue. Cancer in situ must be diagnosed pursuant malignant cells and the invasion of tissue and which is not
to a pathological or clinical diagnosis. Cancer in situ includes specifically excluded. Leukemias or lymphomas are included.
early prostate cancer diagnosed as T1N0M0 or equivalent Cancer must be diagnosed pursuant to a pathological or
staging and melanoma not invading the dermis. Cancer in clinical diagnosis.
situ does NOT include: other skin malignancies, pre-malignant
lesions (such as intraepithelial neoplasia), or benign tumors ›› Life-threatening cancer does not include: Pre-malignant
or polyps. lesions (such as intraepithelial neoplasia), benign tumors
or polyps, any skin cancer (other than invasive malignant
›› Major organ transplant: The clinical evidence of major melanoma in the dermis or deeper or skin malignancies that
organ(s) failure which requires the malfunctioning organ(s) or have become metastatic), or early prostate cancer diagnosed
tissue of the covered person to be replaced with an organ(s) as T1N0M0 or equivalent staging.
or tissue from a suitable human donor (excluding the covered
person) under generally accepted medical procedures. The ›› Kidney (renal) failure: End-stage renal failure is a chronic
organs and tissues covered by this definition are limited to: and irreversible failure of both kidneys, which requires the
liver, kidney, lung, entire heart, small intestine, pancreas, covered person to undergo periodic and ongoing dialysis.
pancreas-kidney or bone marrow. In order for the major organ The diagnosis must be made by a legally qualified physician
transplant to be covered under this rider, the covered person board-certified in nephrology.
must be registered by the United Network of Organ Sharing or
the National Marrow Donor Program. ›› Stroke: Any acute cerebrovascular accident producing
neurological impairment and resulting in paralysis or
›› Severe burn: The diagnosis, by a legally qualified physician other measurable objective neurological deficit persisting
board-certified as a plastic surgeon, that the body has for at least 96 hours and expected to be permanent. The
sustained third degree burns covering at least 20 percent of diagnosis must be made by a legally qualified physician
the surface area of the covered person’s body. board-certified as a neurologist. A stroke does NOT include
transient ischemic attack (mini-Stroke), head injury, chronic
›› Heart attack: An acute myocardial infarction resulting in the cerebrovascular insufficiency and reversible ischemic
death of a portion of the heart muscle due to a blockage neurological deficits.
of one or more coronary arteries, and resulting in the loss
of normal function of the heart. The diagnosis must be ›› Coma: The diagnosis, by a legally qualified physician board-
made by a legally qualified physician board-certified as a certified as a neurologist, that a covered person is in a state of
cardiologist and based on both new clinical presentation and unconsciousness from which the person cannot be aroused,
electrocardiographic changes consistent with an evolving in which external stimulation will produce no more than
heart attack, and serial measurement of cardiac biomarkers primitive avoidance reflexes, and that this state has persisted
showing a pattern and to a level consistent with the diagnosis continuously for at least 96 hours.
of a heart attack. A heart attack does NOT include an
established (old) myocardial infarction. The schedule of benefits outlines the critical illness benefit amounts.
Brochure Care Access Plan L 0518 6
Benefits payable are subject to the following diagnosis of each covered critical illness. Diagnosis must be made by
a legally qualified physician through the use of clinical and/or laboratory findings. The critical illness benefit is not
available in all states.
›› Cancer in situ: A diagnosis of cancer wherein the tumor cells ›› Life-threatening cancer: A malignant neoplasm is
still lie within the tissue of origin without having invaded characterized by the uncontrolled growth and spread of
neighboring tissue. Cancer in situ must be diagnosed pursuant malignant cells and the invasion of tissue and which is not
to a pathological or clinical diagnosis. Cancer in situ includes specifically excluded. Leukemias or lymphomas are included.
early prostate cancer diagnosed as T1N0M0 or equivalent Cancer must be diagnosed pursuant to a pathological or
staging and melanoma not invading the dermis. Cancer in clinical diagnosis.
situ does NOT include: other skin malignancies, pre-malignant
lesions (such as intraepithelial neoplasia), or benign tumors ›› Life-threatening cancer does not include: Pre-malignant
or polyps. lesions (such as intraepithelial neoplasia), benign tumors
or polyps, any skin cancer (other than invasive malignant
›› Major organ transplant: The clinical evidence of major melanoma in the dermis or deeper or skin malignancies that
organ(s) failure which requires the malfunctioning organ(s) or have become metastatic), or early prostate cancer diagnosed
tissue of the covered person to be replaced with an organ(s) as T1N0M0 or equivalent staging.
or tissue from a suitable human donor (excluding the covered
person) under generally accepted medical procedures. The ›› Kidney (renal) failure: End-stage renal failure is a chronic
organs and tissues covered by this definition are limited to: and irreversible failure of both kidneys, which requires the
liver, kidney, lung, entire heart, small intestine, pancreas, covered person to undergo periodic and ongoing dialysis.
pancreas-kidney or bone marrow. In order for the major organ The diagnosis must be made by a legally qualified physician
transplant to be covered under this rider, the covered person board-certified in nephrology.
must be registered by the United Network of Organ Sharing or
the National Marrow Donor Program. ›› Stroke: Any acute cerebrovascular accident producing
neurological impairment and resulting in paralysis or
›› Severe burn: The diagnosis, by a legally qualified physician other measurable objective neurological deficit persisting
board-certified as a plastic surgeon, that the body has for at least 96 hours and expected to be permanent. The
sustained third degree burns covering at least 20 percent of diagnosis must be made by a legally qualified physician
the surface area of the covered person’s body. board-certified as a neurologist. A stroke does NOT include
transient ischemic attack (mini-Stroke), head injury, chronic
›› Heart attack: An acute myocardial infarction resulting in the cerebrovascular insufficiency and reversible ischemic
death of a portion of the heart muscle due to a blockage neurological deficits.
of one or more coronary arteries, and resulting in the loss
of normal function of the heart. The diagnosis must be ›› Coma: The diagnosis, by a legally qualified physician board-
made by a legally qualified physician board-certified as a certified as a neurologist, that a covered person is in a state of
cardiologist and based on both new clinical presentation and unconsciousness from which the person cannot be aroused,
electrocardiographic changes consistent with an evolving in which external stimulation will produce no more than
heart attack, and serial measurement of cardiac biomarkers primitive avoidance reflexes, and that this state has persisted
showing a pattern and to a level consistent with the diagnosis continuously for at least 96 hours.
of a heart attack. A heart attack does NOT include an
established (old) myocardial infarction. The schedule of benefits outlines the critical illness benefit amounts.
Brochure Care Access Plan L 0518 6
