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OMA Priority Insurance Program

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OMA Priority Insurance Program: OPIP critical illness insurance update: revised illness definitions reflect current clinical practice, offer enhanced coverage for members.
OMA Insurance
6/1/2011
Revised illness definitions reflect current clinical practice, and offer enhanced coverage for members. OMA Insurance has introduced improvements to the OMA Priority Insurance Program Critical Illness insurance definitions. The new definitions, developed in consultation with industry physicians, add clarity, reflect advancements in modern medicine, and provide enhanced coverage for members.

After a recent program review, OMA insurance has introduced improvements to the OMA priority insurance program (OPIP) critical illness insurance definitions. The new definitions, developed in consultation with industry physicians, add clarity, reflect advancements in modern medicine, and provide enhanced coverage for members. In addition, these new definitions have been adopted by the Canadian Life and Health Insurance Association, whose member companies represent nearly 99% of Canada's life and health insurance business. The following is an overview of the major changes OMA Insurance has negotiated with Sun Life Financial. Heart attack (myocardial infarction). A more liberal definition of heart attacks means that more incidents will be covered under the new definition. The previous definition required electrocardiographic (ECG) changes as part of the diagnosis, while the new definition does not. Under the old definition, a rise in markers of myocardial necrosis occurring at the time of angioplasty would not have qualified as a heart attack due to the lack of ECG changes. Now that the definition has been broadened, it has been necessary to add an exclusion for a rise in biomarkers caused by angioplasty. A major heart attack resulting in new Q waves, however, would be covered ­— even if it happened at the time of angioplasty. Cancer The definition of cancer has been adjusted to reflect current clinical practice. The thinnest malignant melanomas have never been covered because of their favourable prognosis and ease of treatment. The revised definition increases the malignant melanoma depth for covered tumours from 0.75 mm to 1 mm. This amendment aligns the definition with the American Joint Committee on Cancer (AJCC) staging for melanoma, which is based on prognosis, and classifies tumours less than 1 mm as T1 tumours. A tumour in the presence of HIV is now included, which is an enhancement to the current definition. Cancer in-situ, pre-malignant lesions and benign tumours are not covered because they do not demonstrate invasion of tissue. Therefore, they do not meet the definition for cancer. This is not a change but is now expressly stated in the definition. Benign brain tumour The first change in the definition is to make it clear that only tumours that require treatment are covered. Historically, the discovery of a brain tumour meant surgery, radiation or both. Today, because so many people have CT scans and/or MRIs, it's more common to discover small benign brain tumours which are not growing or causing any symptoms. They are incidental findings when a person has a scan for some other reason. These intracranial incidentalomas do not require treatment, and therefore, cannot be considered a critical illness. The previous definition excluded all meningiomas (tumours of the meninges), all pituitary tumours and tumours of the cranial nerves (which are mainly acoustic neuromas). These tumours are now covered, with the exception of pituitary microadenomas (less than 10 mm). The majority of benign brain tumours fall into one of these categories, so the new definition is a significant improvement in coverage. The final change to this definition is the introduction of a 90-day moratorium, which has been a standard in the individual Critical Illness insurance market for years. The purpose of the moratorium is to prevent someone from attempting to purchase coverage for a tumour they already have. Freedom to recover on your terms. As a physician, you know better than anyone that a serious illness can have a devastating impact on one's life. Critical Illness insurance takes the financial worry out of a difficult diagnosis. It allows you to focus on what matters most — recovery. Surviving a serious illness can be quite costly, especially when you consider:

  • Loss of income if your spouse took time off work to help take care of you
  • Child care and home maintenance
  • Modifications to your home Personal support workers
  • Travel to/from hospitals, accommodations, parking and meals
  • Drugs not covered by provincial plans
  • Experimental treatments or alternative treatments that are not covered
  • Treatment outside of Canada
  • Regular, daily expenses

Critical Illness insurance through OMA Insurance can help provide financial support during a difficult time. It provides a one-time benefit if you are diagnosed with one of the covered conditions and complete the survival period. The benefit is paid in a lump-sum once your claim is approved. How you spend the benefit is up to you.