加拿大各保險公司的重病保險包括的重病種類及其定義常略有不同。以下是各公司最常見包括的 24種重病及其最常見的定義。資料來源是The Insurance Journal (August 2003)及(Sun Life Financial 2009 重大疾病保險介紹單張)。為了減少可能誤差,我們這裡以其英文原文列出。申請人在購買某一公司的重病保險產品時,應以其公司的保單條文中的重病定義和要求為準。一些公司也將其公司對重病的定義詳細列在了網上,可參考相應的公司鏈節。

  • Alzheimer's Disease(老年滯呆症): Progressive degeneration of the brain resulting in the reduction of mental and social functioning and requiring daily supervision. Some insurers do not cover other organic brain disorders and psychological illnesses while others require the client to need a minimum of eight hours of daily supervision.
  • Aortic surgery (主動脈手術): Aortic surgery means the undergoing of surgery for disease of the aorta requiring excision and surgical replacement of the diseased aorta with a graft. Aorta refers to the thoracic and abdominal aorta but not its branches.
  • Aplastic anaemia(再生障礙性貧血): Aplastic anemia means a definite diagnosis of a chronic persistent bone marrow failure, confirmed by biopsy, which results in anemia, neutropenia and thrombocytopenia requiring blood product transfusion, and treatment with at least one of the following: marrow stimulating agents, immunosuppressive agents,and bone marrow transplantation.
  • Bacterial Meningitis (細菌性腦膜炎): Bacterial meningitis means a definite diagnosis of meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria in culture, resulting in neurological deficit documented for at least 90 days from the date of diagnosis.
  • Benign Brain Tumour(良性腦瘤): Permanent deficit of the neurological system such as impaired speech, sight or walking. Some insurers cover tumors of the bony cranium and pituitary microadenomas that are superior to 10mm in diameter and aortic surgery, heart valve replacement and loss of independent existence. For certain insurers, tumours or lesions in the pituitary gland are not covered and others exclude cysts, granulomas, meningiomas, malformations of the intracranial arteries or veins or tumours of the cranial nerves, pituitary gland or spinal cord.
  • Blindness(失明): The permanent loss of sight in both eyes, with a corrected visual acuity worse than 20/200 in both eyes or a field of vision less than 20 degrees in both eyes.
  • Cancer(癌症): A malignant tumour characterized by the uncontrolled growth and spread of mailignant cells and the invasion of tissue including leukemia and Hodgkin's disease, but excludes, in general, cancer in situ, Kaposi's sarcoma, skin cancer, except for those achieving greater depth than 0.70 mm, early prostate cancer, tumours in the presence of HIV, pre-malignant lesions, benign tumours and polyps.
  • Coma(昏迷): State of deep unconsciousness, during which the person insured only shows signs of primary defensive reflexes to external stimuli for a continuous period of at least four days for most insurers.
  • Coronary Artery Bypass Surgery (冠狀動脈搭橋手術): To undergo heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts excluding any elective surgery or nonsurgical techniques such as balloon angioplasty or laser relief of an obstruction.
  • Deafness (失聰): The permanent and profound loss of hearing in both ears with an auditory threshold of more than 90 decibels.
  • Heart Attack (心臟病): The "death" of a portion of the heart as a result of inadequate blood supply as evidence by electrocardiographic (EGG) changes and an elevation in cardiac enzymes. Some insurers also base it on the elevation of biochemical markers.
  • Heart Valve Replacement (心瓣置換): Heart valve replacement means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve.
  • HIV Infection (HIV病毒感染): Needs to have been contaminated accidentally during the course of normal occupation. Some insurers require blood tests to be taken within 14 days of the accidental injury and the result must be negative and another test must be taken between 90 and 180 days after the infection and the result must be positive.
  • Kidney Failure (腎衰竭) : Failure of both kidneys needing treatment by regular dialysis or transplant in some case.
  • Loss of Limbs (肢體分離): Total and permanent severance of two or more limbs from above the wrist or ankle joint. Some insurers add that the amputation can be the result of an accident or medically required amputation.
  • Loss of Speech (啞症-失去語言能力) : For some insurers, the loss of speech must be at least 180 days or 12 months required by other insurers.
  • Major Burns (嚴重燒傷) : Most insurers define this illness as third degree burns covering at least 20% of the body surface.
  • Major Organ Transplant (主要器官移植) : See organ transplant.
  • Major Organ Failure on Waiting List 輪後主要器官移植) : Major organ failure on waiting list means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary. To qualify under major organ failure on waiting list, the insured person usually requires to become enrolled as the recipient in a recognized transplant centre in Canada or the United States that performs the required form of transplant surgery.
  • Motor Neuron disease (ALS or Lou Gehrig's disease)(肌萎縮側索硬化,ALS,或 運動神經元疾病) : Also called Amyotrophic Lateral Sclerosis, it is the unequivocal diagnoosis of motor neuron disease including primary lateral sclerosis, progressive spinal muscular atrophy, progressive bulbar palsy and pseudo bulbar palsy. Some insurers require that this disease be diagnosed prior to the age of 75.
  • Multiple Sclerosis (多發性硬化症) : Neurological abnormalities persisting for a continuous period of at least 6 months and confirmed by modern investigational techniques (i.e. image scanning). Some insurers require typical symptoms of demyelination with resultant impairment of the brain stem or spinal cord. Some insurers require two episodes separated by at least one month.
  • Organ Transplant (主要器官移植) : Generally of the heart, liver, lungs, kidneys, and bone marrow. In most cases, benefits are also offered to clients who are on a waiting list for transplant.
  • Paralysis (癱瘓) : Complete and permanent loss of use of two or more limbs for a period of 90 days, during which time there has been no sign of improvement.
  • Parkinson's Disease (柏氏金森症) : Characterized by two or more of the following symptoms: tremor, muscle rigidity and bradykinesia. Certain insurers require the insured to be in need of substantial physical assistance from another adult to perform two or more of six activities of daily living.
  • Stroke (中風) : A neurological deficit persisting for at least 30 days. Most insurers exclude transient ischemic attacks while others have added to their definition of stroke "all episodes of ischemia by rupture of the thrombosis or embolism from extra-cranial source leading to permanent neurological sequelae."

  除以上定義的疾病外,若被診斷患有以下疾病的任何一種,一些保險公司會給與部分賠償。

  • Coronary Angioplasty (冠狀動脈成型手術)
  • Ductal Carcinoma in Situ of the Breast(早期乳癌)
  • Stage A Prostate Cancer (早期前列腺癌)
  • Stage 1A Malignant Melanoma (早期皮膚癌)

  若有18歲以下子女投保,一些公司重大疾病保險計劃還包括以下兒童期疾病。

  • Cerebral Palsy(大腦性麻痺):Cerebral palsy means a definite diagnosis of a non-progressive neurological defect affecting muscle control. This defect is characterized by spasticity and incoordination of movements.
  • Congenital Heart Disease (先天性心臟病):Congenital heart disease means a definite diagnosis of at least one of the covered heart conditions described below. It also means the specific conditions described below for which open heart surgery is performed to correct the condition.
  • Cystic Fibrosis (囊性纖維化):Cystic fibrosis means a definite diagnosis of cystic fibrosis where the insured person has chronic lung disease and pancreatic insufficiency.
  • Muscular Dystrophy (肌肉萎縮症):Muscular dystrophy means a definite diagnosis of muscular dystrophy where the insured person has well defined neurological abnormalities, confirmed by electromyography and muscle biopsy.
  • Type 1 Diabetes Mellitus (1型糖尿病):Type 1 diabetes mellitus means a definite diagnosis where the insured person has total insulin deficiency and continuous dependence on exogenous insulin for survival. Dependence on insulin must persist for a continuous period of at least three months.

  以上資訊僅供參考,詳細規定以您購買的重病保險計劃保單中的重病定義和要求為準。

  有關重病保險的常見問答參見重病保險常見問題解答 。若有興趣做更進一步咨詢瞭解,可填寫我們的重病保險咨詢預約申請表,預約我們提供進一步咨詢講解。