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also be telangectasia
(dilated capillaries) and
Raynaud’s Phenomenon
causing artery spasms in
the extremities.
Advanced Stage1
The diagnosis must be
confirmed by a consultant
neurologist or specialist in
the relevant medical field.
Primary Pulmonary
Hypertension
Primary Pulmonary
Hypertension with
substantial right ventricular
enlargement confirmed by
investigations including
cardiac catheterisation,
resulting in permanent
physical impairment of at
least Class IV of the New
York Heart Association
(NYHA) Classification of
Cardiac Impairment.
The NYHA Classification
of Cardiac Impairment:
Class I: No limitation of
physical activity. Ordinary
physical activity does not
cause undue fatigue,
dyspnea, or anginal pain.
Class II: Slight limitation of
physical activity. Ordinary
physical activity results in
symptoms.
Class III: Marked limitation
of physical activity.
Comfortable at rest, but
less than ordinary activity
causes symptoms.
Class IV: Unable to
engage in any physical
activity without discomfort.
Symptoms may be present
even at rest.
Progressive
Scleroderma
A systemic collagenvascular disease causing
progressive diffuse fibrosis
in the skin, blood vessels
and visceral organs. This
diagnosis must be
unequivocally confirmed
by a consultant
rheumatologist and
supported by biopsy or
equivalent confirmatory
test and serological
evidence and the disorder
must have reached
systemic proportions to
involve the heart, lungs or
kidneys.
The following are
excluded:
• Localised scleroderma
(linear scleroderma or
morphea);
• Eosinophilic fascitis; and
• CREST syndrome.
Manulife CI FlexiCare (Deluxe) v0123
Page 29 of 42
Manulife (Singapore) Pte. Ltd.
A Manulife Company
Conditions
Early Stage
32. Stroke with
Permanent
Neurological
Deficit
Brain Aneurysm Surgery
The actual undergoing of
surgical repair of an
intracranial aneurysm or
surgical removal of an
arterio-venous
malformation via
craniotomy or
endovascular procedures.
The surgical intervention
must be certified to be
absolutely necessary by a
specialist in the relevant