Medical Events Covered Under Trauma Insurance

At a glance:

• Trauma insurance covers serious conditions like cancer, heart attack, and major organ transplants.
• Proof of illness and medical documentation are essential to make a successful claim.
• Each covered medical event can only be claimed once under the policy.

 

 

Trauma insurance plays a critical role in providing financial support for individuals facing severe medical conditions. When life-altering health events occur, this coverage ensures that policyholders and their families can manage the financial impact without additional stress.

However, the specific medical events and surgeries covered under trauma insurance vary depending on the policy. This article aims to explain the key medical events typically covered under trauma insurance.

 

 

Breakdown of Covered Medical Events

 

Angioplasty

 

Angioplasty is a procedure used to open up narrowed or blocked arteries, typically those leading to the heart. The Aspect Underwriting policy specifies that it covers angioplasty if there is a 70% obstruction in two or more arteries or cases of stenotic heart valve disease.

The procedures included under this coverage are balloon angioplasty, stents, rotablation, and directional atherectomy, among others. To claim this benefit, detailed documentation from a qualified consultant is required, including pre-and post-procedure angiograms and proof that the condition could not be managed by less invasive treatments.

 

Aorta Surgery

 

Aorta surgery involves the surgical removal of a diseased part of the aorta, which is then replaced with a graft. This surgery is necessary when the aorta is severely damaged or diseased, putting the patient at risk for life-threatening complications.

It is important to note that the insurance covers diseases affecting the thoracic and abdominal sections of the aorta but does not extend to the aorta’s branches.

 

Benign Brain Tumour

 

Benign brain tumours, though non-cancerous, can cause significant damage if they affect critical areas of the brain, leading to permanent neurological deficits. While benign brain tumours are covered under trauma insurance, tumours or lesions affecting the pituitary gland are excluded. Coverage is contingent on the condition causing permanent neurological damage.

 

Cancer

 

Cancer is one of the most serious medical events covered by trauma insurance. The policy provides coverage for malignant tumours, including leukemia and Hodgkin’s disease. However, there are exclusions, such as pre-malignant tumours, non-invasive cancers (cancer in situ), and cancers associated with HIV, such as Kaposi’s Sarcoma. Most skin cancers are excluded as well, except for malignant melanoma, which is considered severe enough to warrant coverage.

 

Coronary Artery Bypass Surgery

 

Coronary artery bypass surgery is an open-heart procedure used to reroute blood flow around blocked or narrowed coronary arteries. This surgery is essential when the heart is not receiving enough blood, putting the patient at risk for a heart attack or other complications. While coronary artery bypass surgery is covered, other less invasive treatments, such as balloon angioplasty or laser procedures, are excluded.

 

Heart Attack

 

A heart attack, also known as a myocardial infarction, occurs when a portion of the heart muscle dies due to a lack of blood supply. The insurance policy defines a heart attack as requiring a combination of clinical symptoms (such as chest pain), changes in an electrocardiogram (ECG), and elevated cardiac enzymes to confirm the diagnosis. Coverage is provided once the heart attack is confirmed to meet all these criteria.

 

Heart Valve Replacement or Repair

 

Heart valve replacement or repair is typically performed through open-heart surgery. This procedure is necessary when one or more of the heart’s valves fail to function properly. Trauma insurance covers this surgery if deemed medically necessary. The coverage ensures financial protection for individuals undergoing this life-saving procedure.

 

Kidney Failure

 

Kidney failure is a chronic, irreversible condition in which both kidneys cease to function, requiring either dialysis or a kidney transplant. When kidney failure reaches its end stages, the financial and medical demands are substantial, making trauma insurance coverage essential for helping policyholders manage costs. The Aspect Underwriting policy provides coverage for individuals who require ongoing dialysis or a kidney transplant.

 

Major Organ Transplant

 

A major organ transplant is a critical procedure that can involve the heart, liver, lung, pancreas, or bone marrow. Trauma insurance covers the insured person either upon being listed for a transplant or after receiving the organ. This coverage is crucial due to the high costs and extensive recovery time associated with major organ transplants.

 

Multiple Sclerosis (MS)

 

Multiple Sclerosis (MS) is a degenerative disease affecting the brain and spinal cord. For MS to be covered, the diagnosis must be made by a neurologist and meet several criteria, including a persistent impairment of motor or sensory function for at least six months. The neurological damage must be confirmed by diagnostic techniques, which helps ensure that the diagnosis is accurate and valid for the insurance claim.

 

Stroke

 

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This leads to permanent neurological damage. Trauma insurance covers strokes that result in long-term deficits, such as infarction of brain tissue, hemorrhages, and embolisms. However, transient ischemic attacks (TIAs), which are temporary and often referred to as mini-strokes, are excluded from coverage.

 

 

Proof of Illness and Claim Requirements

 

To ensure a successful trauma insurance claim, proper documentation is crucial. Trauma insurance requires detailed medical proof to verify the condition or procedure. This typically includes clinical notes, radiological scans (like X-rays or MRIs), lab test results, and other supporting documents that confirm the diagnosis. The diagnosis must come from a registered medical practitioner and be backed by sufficient medical evidence.

For example, if you’re claiming for angioplasty, pre- and post-procedure angiograms are necessary to show the obstruction of arteries and the procedure performed.

Policyholders are generally responsible for obtaining these documents, and insurers may request additional information if needed. It’s important to work closely with your doctor to ensure all required documentation is clear, accurate, and complete. If the insurer requires special investigations—tests beyond routine medical documentation—the cost for these may be covered by the insurer, easing the financial burden.

Having all required evidence upfront not only helps speed up the claims process but also reduces the chances of delays or disputes over the claim. Therefore, it’s essential to be proactive and thorough when preparing your claim documentation.

 

Limitations and Single-Payment Rule

 

One of the key aspects of trauma insurance is the “Single-Payment Rule,” which means that for each medical event covered by the policy, you can only make one claim.

For example, if you claim for a heart attack and the benefit is paid out, no additional claims can be made for another heart attack or a related condition, even if it occurs again later in life. This limitation applies to each specific medical condition outlined in the policy.

This rule helps define the scope of trauma insurance—it’s designed to provide a financial safety net for significant, life-altering medical events, but it doesn’t cover recurring illnesses or ongoing treatments. Once the insurer has paid out for an illness, that specific illness is no longer covered by the policy.

Additionally, the total payout is limited to the amount specified in the policy for that particular medical event, ensuring the policyholder receives a one-time financial benefit per condition.

Understanding this limitation is critical because it affects how policyholders may use their coverage. Trauma insurance is intended to support you during the most severe health crises, and knowing that claims can only be made once for each event allows you to plan accordingly.

It’s wise to review the covered medical events in detail, ensuring you have an adequate safety net for the conditions you’re most at risk for.

 

Trauma insurance is a valuable financial safety net for individuals facing life-threatening medical events. The list of covered medical events—ranging from angioplasty and aorta surgery to cancer, kidney failure, and major organ transplants—highlights the importance of being adequately insured.

Policyholders should regularly review their trauma insurance coverage to ensure it aligns with their potential medical risks and financial needs. By understanding the specific conditions covered and the exclusions, individuals can make informed decisions that protect their financial future in the face of serious health challenges.

Aspect Underwriting’s trauma insurance policy offers comprehensive coverage for a wide range of medical events, helping individuals focus on their recovery instead of financial stress.

Protect yourself from life’s unexpected challenges. Explore how trauma insurance can provide financial security during critical medical events. Contact Aspect Underwriting today to review your coverage and ensure you’re prepared for the future.