Kindly note that there is an update on UTES Medical Assistance Scheme further to our review of list of chronic illness which took effect on 1 April 2014. UTES has now included Type 1 Diabetes and Type 2 Diabetes in the list of chronic illness. The full list is as follows:

 

List of Chronic Illnesses and their Definitions

1. Tuberculosis

Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis.

It usually affects the lungs (pulmonary tuberculosis), but other parts of the body can also be affected (extrapulmonary tuberculosis), such as brain, lymph nodes, the kidneys, bones and joints.

2. Kidney Failure

Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation.

3.  Leprosy

Leprosy is a chronic disease caused by a bacillus, Mycobacterium laprae.

4.  Cancer

A malignant tumour characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue.

5.  Liver Cirrhosis and Liver Failure

Liver cirrhosis is an abnormal liver condition in which there is irreversible scarring of the liver.

Liver failure is evidenced by all of the following:

• Permanent jaundice;
• Ascites; and
• Hepatic encephalopathy

Liver disease secondary to alcohol or drug abuse is excluded.

6.  Mental Illness

Depression, bipolar disorder, schizophrenia, eating disorders, and anxiety disorders are some common mental illnesses that affect adults

7.  Heart Diseases

For example heart attack, coronary artery by-pass surgery, surgery to aorta, heart valve surgery, angioplasty and other invasive treatment for coronary artery.

8. Stroke

A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis.

This diagnosis must be supported by all of the following conditions:

• evidence of permanent neurological damage confirmed by a neurologist at least 6 weeks after the event; and
• findings on magnetic resonance imaging, computerised tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.

The following are excluded:

• transient ischaemic attacks;
• brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
• vascular disease affecting the eye or optic nerve; and
• ischaemic disorders of the vestibular system.

9. Major Organ/Bone Marrow Transplantation

The receipt of a transplant of:

• human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation; or
• one of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible end stage failure of the relevant organ.

Other stem cell transplants are excluded.

10. Blindness (Loss of Sight)

Total and irreversible loss of sight in one eye or both eyes as a result of illness or accident. The blindness must be confirmed by an ophthalmologist.

11. Paralysis (Loss of Use of Limbs)

Total and irreversible loss of use of limbs due to injury or disease. This condition must be confirmed by a consultant neurologist.

Self-inflicted injuries are excluded.

12. Multiple Sclerosis

The definite occurrence of Multiple Sclerosis.

The diagnosis must be supported by all of the following:

• investigations which unequivocally confirm the diagnosis to be Multiple Sclerosis;
• multiple neurological deficits which occurred over a continuous period of at least 6 months; and
• well documented history of exacerbations and remissions of said symptoms or neurological deficits.

Other causes of neurological damage such as SLE and HIV are excluded.

13. Alzheimer’s Disease/Severe Dementia

Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging tests, arising from Alzheimer's disease or irreversible organic disorders, resulting in significant reduction in mental and social functioning requiring the continuous supervision of the member.

The following are excluded:

• non-organic disease such as neurosis and psychiatric illnesses; and
• alcohol related brain damage.

14. Coma

A coma that persists for at least 96 hours.

This diagnosis must be supported by evidence of all of the following:

• No response to external stimuli for at least 96 hours;
• Life support measures are necessary to sustain life; and
• Brain damage resulting in permanent neurological deficit which must be assessed at least 30 days after the onset of the coma.

Coma resulting directly from alcohol or drug abuse is excluded.

15. Major Burns

Third degree (full thickness of the skin) burns covering at least 20% of the surface of the member’s body.

16. Motor Neurone Disease

Motor neurone disease characterised by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurones which include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.

This diagnosis must be confirmed by a neurologist as progressive and resulting in permanent neurological deficit.

17. Muscular Dystrophy

A group of hereditary degenerative diseases of muscle characterised by weakness and atrophy of muscle. The diagnosis of muscular dystrophy must be unequivocal and made by a consultant neurologist.

The condition must result in the inability of the member to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living" for a continuous period of at least 6 months:

 

• Washing -	the ability to wash in the bath or shower (including getting into or out of the bath or shower) or wash satisfactorily by other means;
• Dressing -	the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances;
• Transferring -	the ability to move from a bed to an upright chair or wheelchair and vice-versa;
• Mobility -	the ability to move indoors from room to room on level surfaces;
• Toileting -	the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
• Feeding -	the ability to feed oneself once food has been prepared and made available.

 

 

18. Parkinson's Disease

The unequivocal diagnosis of idiopathic Parkinson's Disease by a consultant neurologist.

This diagnosis must be supported by all of the following conditions:

• the disease cannot be controlled with medication;
• signs of progressive impairment; and
• inability of the member to perform (whether aided or unaided) at least 3 of the following 6 "Activities of Daily Living" for a continuous period of at least 6 months:

 

• Washing -	the ability to wash in the bath or shower (including getting into or out of the bath or shower) or wash satisfactorily by other means;
• Dressing -	the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances;
• Transferring -	the ability to move from a bed to an upright chair or wheelchair and vice-versa;
• Mobility -	the ability to move indoors from room to room on level surfaces;
• Toileting -	the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
• Feeding -	the ability to feed oneself once food has been prepared and made available.

 

Drug-induced or toxic causes of Parkinsonism are excluded.

19. Aplastic Anaemia

Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following:

• blood product transfusion;
• marrow stimulating agents;
• immunosuppressive agents; or
• bone marrow transplantation.

The diagnosis must be confirmed by a haematologist.

20. Bacterial Meningitis

Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant, irreversible and permanent neurological deficit. The neurological deficit must persist for at least 6 weeks.

This diagnosis must be confirmed by:

• the presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and
• a consultant neurologist.

Bacterial Meningitis in the presence of HIV infection is excluded.

21. Benign Brain Tumour

A benign tumour in the brain where all of the following conditions are met:

• it is life threatening;
• it has caused damage to the brain;
• it has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit; and
• its presence must be confirmed by a neurologist or neurosurgeon and supported by findings on magnetic resonance imaging, computerised tomography, or other reliable imaging techniques.

The following are excluded:

• cysts;
• granulomas;
• vascular malformations;
• haematomas; and
• tumours of the pituitary gland or spinal cord.

22. Encephalitis

Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum) caused by viral infection and resulting in permanent neurological deficit.

This diagnosis must be certified by a consultant neurologist and the permanent neurological deficit must be documented for at least 6 weeks.

Encephalitis caused by HIV infection is excluded.

23.       Diabetes

           

        Diabetes is a medical condition in which the blood glucose levels remain persistently higher than normal.

• Type 1 Diabetes
  • no insulin is produced due to damaged pancreatic cells
  • usually diagnosed in children or young adults although it can occur at any age
  • insulin is needed for treatment
  • complications are sudden and life-threatening
• Type 2 Diabetes
• insulin produced is not enough or not effective (insulin resistance)
• occurs more frequently in people over 40 years old, particularly those who are overweight and physically inactive
• more younger adults and children are developing Type 2 Diabetes
• can be controlled with proper diet and exercise but most diabetics also need oral medication