Entitled to receive the insurance benefit?
When am I entitled to receive the insurance benefit?
Here you find a list of diagnoses typically covered by the insurance plan. Please note that each diagnosis is subject to severity criteria that must be met before the insurance benefit becomes payable. Also, which diagnoses that are covered may differ - depending on whether your insurance plan is established through your employer/organisation or bank or whether it is established as a private plan.
Diagnoses typically covered by the insurance:
- Large blood clot in the heart
- Balloon angioplasty (PCI)/Bypass surgery of the coronary arteries
- Chronic cardiac insufficiency with severe symptoms and reduced functional capacity
- Implantation of an implantable cardioverter defibrillator (ICD) due to life-threatening cardiac valve irregularities
- Heart valve surgery due to heart valve defect
- Cerebral haemorrhage/blood clot in the brain (apoplexy) with permanent after-effects
- Aneurism (protrusion of an artery) in the brain or AV malformation (intracranial vascular malformation) – that requires surgery
- Severe illness in the aorta (main artery)
- Certain types of cancer tumours
- Certain types of cancer in the blood and blood-forming organs
- Certain benign tumours in the brain and spinal cord where surgery is necessary
- Disseminated sclerosis (DS) and NMO (if certain criteria of diagnosis are met)
- Amyotrophic lateral sclerosis (ALS), motor neuron disease (MND), progressive bulbar palsy (PBP), progressive muscular atrophy (PMA) and primary lateral sclerosis (PLS)
- Chronic renal failure with the need for permanent dialysis treatment
- Major organ transplant
- AIDS
- HIV infection due to blood transfusion or occupational infection
- Muscular atrophy with lasting symptoms
- Myasthenia gravis with lasting symptoms
- Total blindness in both eyes or tunnel vision with a limitation of the visual field to less than 10 %
- Total deafness in both ears
- Parkinson’s Disease
- Creutzfeldt-Jakob Disease
- Permanent injuries of at least 15 % due to neurological sequelae of inflammation of the brain or meningitis (inclusive of Lyme disease and Tick-Born-Encephalitis TBE)
- Serious burns (including frostbites and corrosive burns) of the third degree that covers at least 20 per cent of the surface of the body
- Terminal illness.
The cover on PFA Critical Illness – children, depends on which type of PFA Critical Illness you have. If you have the insurance type with individual children’s diagnoses, the following diagnoses will be covered:
- Heart disease that requires surgery
- Implantation of an implantable cardioverter defibrillator (ICD) due to life-threatening cardiac valve irregularities
- Cerebral haemorrhage or blood clot in the brain (apoplexy) with permanent sequelae
- Aneurism (protrusion of an artery) in the brain or AV malformation (intracranial vascular mal-formation) – that requires surgery
- Cancer with the exception of less aggressive types
- Cancer in the blood and blood-forming organs with the exception of less aggressive types
- Certain benign tumours in the brain and spinal cord where surgery is necessary
- Disseminated sclerosis (DS) and NMO (if certain criteria of diagnosis are met)
- Chronic renal failure that requires permanent dialysis
- Major organ transplantation
- Muscular atrophy (myopathy and neuropathy) with lasting progressive symptoms
- Permanent severe neurological sequelae of inflammation of the brain or meningitis (inclusive of Lyme disease and Tick-Born-Encephalitis TBE)
- Major burns (ambustio), frostbite or corrosive burns that cover at least 10 % of the child’s body surface
- Terminal illness
- Type 1 diabetes
Go to your terms and conditions at My PFA and find out the exact coverage of your children
