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Critical Illness – Kidney Failure, Organ Transplant, Enrolment in Organ Transplant Program

Organ-Transplant

This is Part VII of VII in our series on covered conditions of critical illness insurance in Canada.

Kidney Failure

Kidney Failure means chronic Irreversible failure of both kidneys to function, as a result of which regular haemodialysis, peritoneal dialysis or renal transplantation is initiated.

In order for kidney failure to be a pay a benefit, both kidneys must fail, the failure must be irreversible, and at least one of the above three mentioned treatments must be initiated. Without the treatment, a benefit would not be paid.

Major Organ Transplant

Major Organ Transplant is defined as “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 Transplant, the Insured Person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities.

The diagnosis of the major organ failure must be made by a Specialist.

Enrolment in Organ Transplant Program

Major Organ Failure on Waiting List is defined as “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 must become enrolled as the recipient in a recognized transplant centre in Canada or the United States of America that performs the required form of transplant surgery. For the purposes of the Survival Period, the date of Diagnosis is the date of the Insured Person’s enrolment in the transplant centre. The diagnosis of the major organ failure must be made by a Specialist.

Notice that the transplant center must be in Canada or the United State. I guess that rules out any 3rd world country illegal organ harvesting programs. Note that they also extend the normal survival period for this covered condition. With all covered conditions, you must survive a time period from the diagnosis. With this covered condition, you must survive 30 days from the date of enrolment, not the date of the diagnosis of the organ failure.

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