保障表 保障項目 (1) 賠償限額 ( 港元 ) (a) 病房及膳食 每日 $750 每保單年度最多 180 日 (b) 雜項開支每保單年度 $14,000 (c) 主診醫生巡房費每日 $750 每保單年度最多 180 日 (d) 專科醫生費 (2) 每保單年度 $4,300 (e) 深切治療每日

Transcription

1 保障表 保障項目 (1) 賠償限額 ( 港元 ) (a) 病房及膳食 每日 $750 每保單年度最多 180 日 (b) 雜項開支每保單年度 $14,000 (c) 主診醫生巡房費每日 $750 每保單年度最多 180 日 (d) 專科醫生費 (2) 每保單年度 $4,300 (e) 深切治療每日 $3,500 每保單年度最多 25 日 (f) 外科醫生費每項手術, 按手術表劃分的手術分類 $50,000 $25,000 $12,500 $ 5,000 (g) 麻醉科醫生費外科醫生費的 35% (5) (h) 手術室費 外科醫生費的 35% (5) (i) 訂明診斷成像檢測 (2) (3) 每保單年度 $20,000 設 30% 共同保險 (j) 訂明非手術癌症治療 (4) 每保單年度 $80,000 (k) 入院前或出院後 / 日間手術前後的門診護理 (2) 每次 $580, 每保單年度 $3,000 住院 / 日間手術前最多 1 次門診或急症診症 出院 / 日間手術後 90 日內最多 3 次跟進門診 (l) 精神科治療每保單年度 $30,000 其他保障 完全及永久失去自理能力入息保障 (6) 每當受保人完全及永久失去自理能力 每星期 $500 賠償 52 星期 其他限額 保障項目 (a) (l) 的每年保障限額每保單年度 $420,000 保障項目 (a) (l) 的終身保障限額 無 註解 (1) 同一項目的合資格費用不可獲上述表中多於一個保障項目的賠償 (2) 本公司有權要求有關書面建議的證明, 例如轉介信或由主診醫生或註冊醫生在索償申請表內提供的陳述 (3) 檢測只包括電腦斷層掃描 ( CT 掃描 ) 磁力共振掃描 ( MRI 掃描 ) 正電子放射斷層掃描 ( PET 掃描 ) PET CT 組合及 PET MRI 組合 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 29

2 (4) 治療只包括放射性治療 化療 標靶治療 免疫治療及荷爾蒙治療 (5) 此百分比適用於外科醫生費實際賠償的金額或根據手術分類下外科醫生費的保障限額, 以較低者為準 (6) 詳情請參考第一補充文件 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 30

3 手術表 程序 / 手術 腹部及消化系統 食道 胃及十二指腸 食道病變組織切除術 / 經頸進行食道病變組織或組織破壞術 高選擇性胃迷走神經切斷術 腹腔鏡胃底摺叠術 腹腔鏡式食道裂孔疝氣修補術 食道胃十二指腸內窺鏡檢查, 連或不連活體組織檢查及 / 或息肉切除術 食道胃十二指腸內窺鏡檢查連異物清除 食道胃十二指腸內窺鏡連食道 / 胃靜脈曲張結紥 / 綁紥術 食道切除術 食道全切除術及腸插入手術 經皮膚進行胃造口術 永久胃切開術 / 胃腸造口術 部分胃切除術連或不連空腸移位術 部分胃切除術連十二指腸 / 空腸接合術 部分胃切除術連接合食道術 近端胃切除術 / 根治性胃切除術 / 全部胃切除術連或不連腸插入術 十二指腸撕裂縫合術 / 十二指腸潰瘍修補術 胃迷走神經切斷術及 / 或幽門成形術 空腸 迴腸及大腸開放式或腹腔鏡式闌尾炎切除術 肛裂切除術 肛瘻管切開術或切除術 肛周膿腫的切除術及引流術 修補直腸脫垂的德洛姆手術 結腸鏡檢查連或不連活體組織檢查 結腸鏡檢查, 連息肉切除術 乙狀結腸內窺鏡檢查 外痔或內痔切除術 痔瘡的注射療法或綁紮術 迴腸造口術或結腸造口術 開放式或腹腔鏡式直腸前位切除術 開放式或腹腔鏡式經腹部會陰切除術 開放式或腹腔鏡式結腸切除術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 分類 31

4 程序 / 手術 分類 開放式或腹腔鏡式直腸低前位切除術 腸扭結或腸套疊復位術 小腸切除術及接合術 膽管 開放式或腹腔鏡式膽囊切除術 逆行內窺鏡膽胰管造影術 逆行內窺鏡膽胰管造影術連乳突物手術 膽結石摘取或其他相關手術 肝臟 幼針抽吸肝活體組織檢查 肝移植手術 開放式肝病變組織 / 肝囊腫或肝膿腫袋形縫合術 開放式或腹腔鏡式移除肝病變組織 開放式或腹腔鏡式肝次葉切除術 開放式或腹腔鏡式肝葉切除術 開放式或腹腔鏡式肝揳形切除術 胰臟 閉合式胰管活體組織檢查 胰臟 / 胰管病變組織或組織的切除術或破壞術 胰臟十二指腸切除術 ( 惠普爾手術 ) 腹部 剖腹探查 腹腔鏡檢查 / 腹膜內窺鏡檢查 開放式或腹腔鏡式的單側疝切開 / 縫合術 開放式或腹腔鏡式的兩側疝切開 / 縫合術 開放式或腹腔鏡式的單側腹腔溝疝修補術 開放式或腹腔鏡式的兩側腹腔溝疝修補術 腦部及中樞神經系統 神經外科手術 腦部活體組織檢查 顱骨鑽孔術 顱骨切除術 顱神經減壓術 腦室引流沖洗術 腦室引流的維修清除術, 包括修正術 建立腦室腹腔引流或皮下腦脊液儲存器 顱內動脈瘤鉗夾術 顱內動脈瘤包裹術 顱內動靜脈血管畸型切除手術 聽覺神經瘤切除術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 32

5 程序 / 手術 腦腫瘤或腦膿腫切除術 顱神經腫瘤切除手術 治療三叉神經節氣囊的射頻溫熱凝固術 使用射頻進行閉合式三叉神經根切斷術 三叉神經根減壓術 / 開放式三叉神經根切斷術 大腦包括腦葉切除手術 大腦半球切除術 脊椎手術腰椎穿刺或小腦延髓池穿刺手術 心血管系統 脊髓或脊神經根減壓術 頸交感神經切除術 胸腔鏡或腰交感神經切除術 脊髓管内硬膜内或硬膜外的腫瘤切除術 心臟心臟導管插入 冠狀動脈分流手術 心臟移植 心臟起膊器置入 心包穿刺術 心包切開術 經皮刺穿冠狀動脈腔內成形術及有關程序, 包括 : 激光 支架置入 馬達扇頁切割 氣囊擴張或射頻切割技術 肺動脈瓣切開術 氣囊 / 腔內激光 / 腔內射頻術 經皮心瓣成形術 主動脈瓣擴張術 / 二尖瓣切開術 閉合式心瓣切開術 心臟直視心瓣成形術 心瓣置換 血管腹內動脈 / 脾靜脈腎靜脈 / 門靜脈腔靜脈分流術 腹腔血管切除術連置換 / 接合術 内分泌系統 腎上腺 腹腔鏡式或腹膜後腔鏡式單側腎上腺切除術 腹腔鏡式或腹膜後腔鏡式兩側腎上腺切除術 松果腺松果腺全切除術 腦下垂體腦下垂體腫瘤切除術 分類 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 33

6 程序 / 手術 甲狀腺幼針抽吸甲狀腺活組織檢查連或不連影像導引 耳鼻喉 / 呼吸系統 半甲狀腺切除術 / 部分甲狀腺切除術 / 大部分甲狀腺切除術 / 副甲狀腺切除術 甲狀腺全切除術 / 副甲狀旁腺全切除術 / 機械人輔助式甲狀腺全切除術 甲狀舌管囊腫切除術 耳耳道閉鎖 / 耳道狹窄的耳道成形術 耳前囊腫 / 耳前竇切除術 耳廓血腫引流 / 裝鈕 / 切除術 耳道成形術 分類 ( 耳科 ) 異物清除術 切開鼓室進行中耳腫瘤切除術 鼓膜切開術連或不連導管插入 鼓膜成形術 / 鼓室成形術 聽小骨成形術 全部 / 部分迷路切除術 乳突切除術 耳蝸手術及 / 或人工耳蝸植入 內淋巴囊手術 / 內淋巴囊減壓術 圓窗或卵圓窗瘻管修補術 鼓室交感神經切除術 前庭神經切除術 鼻 口及咽喉上頜竇穿刺及沖洗術 鼻粘膜燒灼術 / 鼻衂控制 鼻骨折閉合復位術 口竇瘻管閉合術 淚囊鼻腔造口術 鼻病變組織切除術 鼻咽鏡檢查或鼻鏡檢查連或不連鼻腔活體組織檢查連或不連清除異物 鼻瘜肉切除術 考一路二氏手術 / 以考一路二氏式進行 / 上頜竇切除術 篩竇 / 上頜竇 / 額竇 / 蝶竇內窺鏡手術 延伸性額竇內窺鏡手術連經中隔的額竇切開術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 34

7 程序 / 手術 額竇切開術或篩竇切除術 額竇切除術 功能性鼻竇內窺鏡手術 兩側功能性鼻竇內窺鏡手術 上頜竇 / 蝶竇 / 篩竇動脈結紮術 其他鼻內手術, 包括激光手術 ( 除了簡易的鼻鏡檢查 活體組織檢查及血管燒灼術 ) 鼻成形術 鼻咽腫瘤切除術 竇腔鏡連或不連活體組織檢查 鼻中隔成形術連或不連黏膜下層切除術 鼻中隔黏膜下層切除術 鼻甲切除術 / 粘膜下鼻甲切除術 腺樣體切除術 扁桃體切除術連或不連腺樣體切除術 咽囊 / 咽憩室切除術 咽成形術 治療睡眠相關呼吸疾病的舌骨懸吊術 上顎 / 下顎 / 舌頭前移術 激光懸吊術 / 切除術 射頻切割輔助垂腭咽成形術 垂腭咽成形術 治療舌下囊腫的袋形縫合術 / 切除術 表層腮腺清除術 腮腺清除術 / 腮腺切除術 下頜唾腺液清除術 下頜腺導管移位術 下頜腺切除術 呼吸系統杓狀軟骨半脫位 喉鏡復位術 分類 支氣管鏡檢查連或不連活體組織檢查 支氣管鏡連清除異物 喉鏡檢查連或不連活體組織檢查 喉頭 / 氣管狹窄 喉内 / 開放式支架置入術 / 重建術 喉頭分流術 喉切除術連或不連根治性頸淋巴組織切除術 喉顯微鏡檢查連或不連活體組織檢查, 連或不連小結 / 息肉 / 聲帶水腫切除術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 35

8 程序 / 手術 分類 喉腫瘤切除術 會厭窩囊腫清除術 喉骨折修補術 治療聲帶麻痺注射法 氣管食道穿刺術進行語音復建 治療聲帶麻痺的甲狀軟骨成形術 聲帶手術包括使用激光技術 ( 惡性腫瘤除外 ) 氣管造口術 臨時性 / 永久性 / 修正術 肺葉切除術 / 肺切除術 胸膜切除術 肺節段切除術 治療氣胸的胸腔穿刺術 / 胸管插入術 胸腔鏡連或不連活體組織檢查 胸廓成形術 胸腺切除術 眼部眼 眼瞼損傷組織切除術 / 刮除術 / 冷凍治療 眼瞼縫合術 / 眼緣縫合術 瞼內翻或瞼外翻修補術連或不連楔型切除術 部分皮層眼瞼重建術 結膜損傷組織切除術 / 破壞術 胬肉切除術 角膜移植術 嚴重傷口修復及角膜成形術, 包括角膜移植 激光清除術或角膜損傷組織破壞術 角膜異物清除術 角膜修復手術 角膜撕裂或受傷的縫補術 / 修補術連結膜移位 晶狀體囊抽吸術 晶狀體囊切開術, 包括使用激光 囊外 / 囊內晶狀體摘除術 去除眼內晶狀體 / 植入物 為脈絡膜視網膜損傷組織進行的手術 白內障超聲乳化手術連人工晶體植入 氣體視網膜粘結術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 36

9 程序 / 手術 視網膜光凝固療法視網膜脫落 / 撕裂的修補手術視網膜撕裂 / 脫落的修補術連扣帶術視網膜脫落扣帶術 / 環紮術睫狀體分離術小梁切除術, 包括使用激光青光眼手術治療包括置入植入物玻璃體診斷性抽吸術注入玻璃體替代物玻璃體切除術 / 移除術虹膜活體組織檢查虹膜 / 眼前半段 / 睫狀體損傷組織切除術脫垂虹膜切除術虹膜切開術虹膜切除術激光虹膜成形連或不連瞳孔成形術虹膜崁頓術及虹膜牽張術鞏膜造瘻術連或不連虹膜切除術鞏膜熱灼術連或不連虹膜切除術睫狀體縮減術眼外肌或肌腱活體組織檢查單一條眼外肌手術眼球穿孔傷口連箝閉或眼色素膜脫落修補術眼球摘除術眼球 / 眼內物摘除術眼球或眼眶修補術結膜淚囊鼻腔造口術結膜淚囊鼻腔造口術連導管或支架插入淚囊鼻腔造口術淚囊及淚道切除術淚腺切除術淚小管 / 鼻淚管探查連或不連冲洗淚小管修補術瞳孔成形術本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 分類 37

10 程序 / 手術 女性生殖系統 子宮頸子宮頸截除術 陰道鏡檢查連或不連活體組織檢查 子宮頸錐形切除術 使用切除術 / 冷凍手術 / 燒灼術 / 激光破壞子宮頸病變組織 子宮頸內膜刮除術 子宮頸電環切除術 子宮頸囊腫袋形縫合術 子宮頸修補術 子宮頸瘻管修補術 子宮頸 / 子宮 / 陰道撕裂縫合術 輸卵管及卵巢 ^ 輸卵管擴張術 / 吹氣術 開放式或腹腔鏡式切除 / 破壞輸卵管病變組織 輸卵管修補術 輸卵管造口術 / 輸卵管切開術 全部或部分輸卵管切除術 輸卵管成形術 卵巢囊腫抽吸術 開放式或腹腔鏡式卵巢囊腫切除術 開放式或腹腔鏡式卵巢楔形切除術 卵巢切除術 腹腔鏡式卵巢切除術 開放式或腹腔鏡式輸卵管卵巢切除術 開放式或腹腔鏡式輸卵管卵巢膿瘍引流術 ^ 除非另有說明, 此類別應用於單側或兩側 ( 輸卵管及卵巢 ) 子宮子宮頸擴張及刮宮術 宮腔鏡檢查連或不連活體組織檢查 宮腔鏡檢查連切除或破壞子宮及承重結構 子宮切開術 腹腔鏡輔助的陰道子宮切除術 經陰道切除子宮連或不連膀胱突出症及 / 或直腸突出症的修補術 開放式或腹腔鏡式經腹部切除全部 / 大部分子宮連或不連兩側輸卵管卵巢切除術 經腹部進行根治性子宮切除術 分類 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 38

11 程序 / 手術 分類 開放式或腹腔鏡式子宮肌瘤切除術 經陰道或宮腔鏡切除子宮肌瘤 腹腔鏡式盆腔膿腫引流術 陰道懸吊術 盆腔底修補術 盆腔臟器切除術 子宮懸吊術 陰道 使用切除術 / 冷凍手術 / 燒灼術 / 激光破壞陰道病變組織 陰道承托環的嵌入或移除 巴多林氏腺囊腫袋形縫合術 陰道剝脫術或陰道斷端術 陰道切開術 陰道部分切除術 陰道全切除術 根治性陰道切除術 陰道前壁修補術使用或不使用基利氏聯針法 陰道後壁修補術 陰道穹窿閉塞術 骶棘韌帶懸吊或陰道固定術 骶骨陰道固定術 經陰道進行腸疝修補術 尿道陰道瘻管閉合術 經陰道進行直腸陰道瘻管修補術 經腹部進行直腸陰道瘻管修補術 後穹窿穿刺術 子宮直腸凹切開術 陰道橫隔切除術 麥哥氏後穹窿整型術 陰道重建術 外陰及入口 使用切除術 / 冷凍手術 / 燒灼術 / 激光破壞外陰病變組織 闊邊局部外陰冷刀切除術或子宮頸電環切除術前庭腺炎切除術切除外陰活體組織檢查外陰及會陰切開術及引流術本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 39

12 程序 / 手術 分類 外陰粘連鬆解術 外陰或會陰瘻管修補術 外陰及 / 或會陰撕裂縫合術 / 修補術 外陰切除術 根治性外陰切除術 血液淋巴系統淋巴結 淋巴結病變組織 / 膿腫引流術 表面淋巴結活體組織檢查 / 切除 / 淋巴結構的單純切除術 頸淋巴結切開活組織檢查 / 幼針抽吸淋巴結活組織檢查 深淋巴結 / 淋巴管瘤 / 囊狀水瘤切除術 兩側腹股溝淋巴結切除術 頸淋巴結切除術 腹股溝及盤骨淋巴結切除術 根治性腹股溝清掃術 根治性盤腔淋巴結切除術 選擇性 / 根治性 / 功能性頸淋巴切除術 腋淋巴結廣泛性切除術 脾臟 開放式或腹腔鏡式脾切除術 男性生殖系統前列腺 前列腺膿腫外部引流術 激光前列腺氣化術 等離子激光前列腺氣化術 前列腺活體組織檢查 經尿道微波電療法 經尿道前列腺切除術 開放式或腹腔鏡式前列腺切除術 開放式或腹腔鏡式根治性前列腺切除術 陰莖 包皮環切術 痛性陰莖勃起鬆解術 隱藏陰莖修補術 / 陰莖抽出術 睾丸 ^ 附睾切除術 睾丸探查 腹腔鏡探查未降睾丸 睪丸固定術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 40

13 程序 / 手術 分類 腹腔鏡式睾丸切除術或睪丸固定術 睪丸扭轉復位及固定術 睾丸活體組織檢查 睪丸鞘膜積水高位結紮術 睾丸鞘膜積水抽液手術 精索靜脈曲張及睪丸鞘膜積液切除術 精索靜脈曲張切除術 ( 顯微外科 ) ^ 如非特別說明, 此類別應用於單側或兩側 ( 睾丸 ) 輸精管 輸精管結紮手術 肌肉骨骼系統骨 單肢的手指 / 腳趾截肢術 單臂 / 單手 / 單腿 / 單腳截肢術 拇趾囊腫切除術 拇趾囊腫切除術並進行軟組織矯正及第一蹠骨切除術 橈骨頭切除術 因良性疾病切除下頜骨 膝蓋骨切除術 部分面骨骨切除術 面部死骨切除術 腕 / 手 / 腿骨的楔形截骨術 上臂 / 下臂 / 大腿的楔形截骨術 肩胛骨 / 鎖骨 / 胸骨的楔形截骨術 關節 關節鏡引流及清創手術 關節鏡移除關節內游離體關節鏡檢查連或不連活體組織檢查關節鏡輔助進行韌帶重建術關節鏡班卡特修補術經關節鏡肩關節上盂唇由前往後撕裂的修補術關節鏡旋轉套修復術肩峰切除術肩關節融合術肘關節融合術 / 三關節融合術膝關節 / 髖關節融合術手 / 手指 / 足 / 足趾的關節置換連植入術本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 41

14 程序 / 手術 分類 腕融合術 腕滑膜切除術 腳趾指骨間關節融合術 手指指骨間關節融合術 肩關節切除術 / 半肩關節置換術 髖關節 / 膝關節 / 手腕關節 / 肘關節切除術 髖關節 / 膝關節切除術連局部釋放抗生素 顳顎關節成形術連或不連自體移植 關節抽吸術 / 注射 麻醉下進行關節鬆弛治療 金屬股骨頭置入術 前十字韌帶重建術 開放式或關節鏡式鏡半月板切除術 後十字韌帶重建術 副韌帶修復術 十字韌帶修補術 踝及足關節囊或韌帶的縫合術 全肩置換術 全膝置換術 全髖置換術 部分髖關節置換術 肌肉及肌腱 跟腱修補術 跟腱切斷術 肌肉或肌腱放鬆或收緊手術 ( 除手部以外 ) / 肌肉損傷組織切除術 手部肌肉或肌腱放鬆或收緊手術 肌肉損傷組織切除術 肌腱延長, 包括腱切斷術 開放式肌肉活體組織檢查 橈骨莖突狹窄性腱鞘炎 板機指鬆解術 網球肘 ( 肱骨外上髁炎 ) 鬆解術 肌肉轉移 / 移植 / 再接合術 不涉及手部的肌腱修復術 / 縫合術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 42

15 程序 / 手術 手肌腱修復術 / 縫合術 腱鞘滑膜切除術 / 滑膜切除術 手腕 / 手肌腱移位術 二期肌腱修補術, 包括移植 轉移及 / 或假體置入 骨折及脫位顳顎 / 指間骨 / 肩峰關節脫位閉合復位術 肩膀 / 肘 / 腕 / 踝骨脫位閉合復位術 科雷氏骨折閉合復位術連經皮膚克氏缐固定治療 手臂 / 腿骨 / 髕骨 / 盤骨骨折閉合復位術連內固定術 顎骨骨折閉合復位術連內固定術 肩胛骨 / 鎖骨 / 指骨 / 髕骨骨折閉合復位術不連內固定術 上臂 / 前臂 / 手腕 / 手 / 腿 / 足骨骨折閉合復位術不連內固定術 肩胛骨 / 手骨 / 踝骨 / 足骨骨折閉合復位術連內固定術 股骨骨折閉合復位術連或不連内固定術 關節窩骨折閉合 / 開放復位術連内固定術 顎骨骨折開放復位術連内固定術 肩胛骨 / 手 / 足骨骨折開放復位術 ( 除腕骨 / 踝骨 / 跟骨外 ) 連或不連內固定術 手臂 / 腿骨 / 髕骨 / 鎖骨骨折開放復位術連或不連內固定術 股骨 / 跟骨 / 踝骨骨折開放復位術連或不連内固定術 使用外固定支架及徹底傷口清創術的複合性骨折手術治療 拆除因舊骨折而裝上的螺絲 釘 金屬板及其他金屬 ( 股骨除外 ) 脊椎人造頸椎間盤置換術 頸 / 頸胸 / C4/5 及 C5/6 前脊柱融合術連鎖定骨板 除頸 / 頸胸 / C4/5 及 C5/6 以外的前脊柱融合術連鎖定骨板 前脊椎融合術連儀器設置 頸椎板成形術 椎板切除術或椎間盤切除術 椎板切除術連椎間盤切除術 胸 / 頸胸 / 胸腰 / T5 至 L1 / 環 樞椎後脊椎融合術 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 分類 ( 除胸 / 頸胸 / 胸腰 / T5 至 L1 / 環 樞椎以外的 ) 後脊椎融合術 後脊椎融合術連儀器設置 脊椎活體組織檢查 脊椎融合術, 連或不連椎間孔切開術, 連或不連椎板切除術, 連或不連椎間盤切除術脊椎截骨術 43

16 程序 / 手術 分類 椎體成形術 / 椎體矯正術 其他 神經節 / 滑囊切除術 掌腱膜攣縮的閉合式 / 經皮膚刺針筋膜切開術 掌腱膜攣縮的根治性或全部筋膜切開術 開放式或內窺鏡式腕道或踝管鬆解術 周圍神經鬆解術 尺神經移位術 滑動式 / 復位式下巴整形術 皮膚及乳房皮膚 皮膚或皮下病變組織切除術 / 冷凍術 / 電灼術 / 激光治療 指甲下血腫或膿腫引流術 脂肪瘤切除術 用於移植的切皮手術 皮膚膿腫切開術及 / 或引流術 皮膚及 / 或皮下組織切開術及 / 或異物清除 皮膚及皮下病變組織的局部切除術或破壞術 皮膚傷口縫合術 外科洗滌及縫合術 趾甲楔形切除術 乳房 乳房腫瘤 / 腫塊切除術連或不連活體組織檢查 幼針抽吸乳房囊腫檢查 乳房活體組織檢查 改良式根治性乳房切除術 部分或簡易乳房切除術 部分或根治性乳房切除連腋窩淋巴切除術 全部或根治性乳房切除術 乳管內乳頭狀瘤切除術 男性乳腺增生切除術 泌尿系統腎臟 因泌尿系統結石進行的體外衝擊波碎石術 腎石切除術 / 腎盂切開術 腎內窺鏡 經皮膚插入腎造口管手術 腎活體組織檢查 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 44

17 程序 / 手術 膀胱 輸尿管及尿道 牙科 開放式或使用腹腔鏡或後腹腔鏡的腎切除術部分 / 下端腎切除術腎移植手術膀胱鏡檢查連或不連活體組織檢查膀胱鏡連輸尿管導管插入 / 經尿道膀胱清除術膀胱鏡連電灼術 / 激光碎石術尿道肉阜切除術尿道或尿管支架植入開放式或腹腔鏡式膀胱憩室切除術經尿道切除膀胱腫瘤開放式或腹腔鏡式部分膀胱切除術開放式或腹腔鏡式根治性 / 全部膀胱切除術開放式或使用腹腔鏡或後腹腔鏡的尿管切石術尿道直腸瘻管閉合術尿道瘻管修補術膀胱陰道瘻管修補術結腸膀胱瘻管修補術尿道破裂修補術應力性尿失禁修補術迴腸導管建造, 包括輸尿管植入迴腸或結腸代替輸尿管手術單邊輸尿管再植入腸或膀胱雙邊輸尿管再植入腸或膀胱任何因意外受傷而進行的牙科手術 分類 本頁內容屬於自願醫保認可產品 ( 編號 : S00023) 的條款及保障 45

18 Benefit Schedule Benefit items (1) (a) Room and board (b) Miscellaneous charges (c) Attending doctor's visit fee (d) Specialist's fee (2) (e) Intensive care (f) Surgeon's fee Benefit limit (in HKD) $750 per day Maximum 180 days per Policy Year $14,000 per Policy Year $750 per day Maximum 180 days per Policy Year $4,300 per Policy Year $3,500 per day Maximum 25 days per Policy Year Per surgery, subject to surgical category for the surgery/procedure in the Schedule of Surgical Procedures $50,000 $25,000 $12,500 $5,000 (g) Anaesthetist's fee 35% of Surgeon's fee payable (5) (h) Operating theatre charges 35% of Surgeon's fee payable (5) (i) Prescribed Diagnostic Imaging Tests (2) (3) $20,000 per Policy Year Subject to 30% Coinsurance (j) Prescribed Non-surgical Cancer Treatments (4) (k) Pre- and post- Confinement/Day Case Procedure outpatient care (2) (l) Psychiatric treatments Other benefits Total and Permanent Incapacity income benefit (6) Other limits Annual Benefit Limit for benefit items (a) (l) $80,000 per Policy Year $580 per visit, up to $3,000 per Policy Year 1 prior outpatient visit or Emergency consultation per Confinement/Day Case Procedure 3 follow-up outpatient visits per Confinement/Day Case Procedure (within 90 days after discharge from Hospital or completion of Day Case Procedure) $30,000 per Policy Year Upon each time the Insured Person suffers from Total and Permanent Incapacity $500 per week payable for 52 weeks $420,000 per Policy Year 38

19 Lifetime Benefit Limit for benefit items (a) (l) Nil 39

20 Notes (1) Eligible Expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the table above. (2) The Company shall have the right to ask for proof of recommendation e.g. written referral or testifying statement on the claim form by the attending doctor or Registered Medical Practitioner. (3) Tests covered here only include computed tomography ( CT scan), magnetic resonance imaging ( MRI scan), positron emission tomography ( PET scan), PET-CT combined and PET-MRI combined. (4) Treatments covered here only include radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy. (5) The percentage here applies to the Surgeon's fee actually payable or the benefit limit for the Surgeon's fee according to the surgical categorisation, whichever is the lower. (6) Please refer to Supplement No. 1 for details. 40

21 Schedule of Surgical Procedures Procedure / Surgery ABDOMINAL AND DIGESTIVE SYSTEM Oesophageal / stomach / duodenum Jejunum, ileum and large intestine Excision of oesophageal lesion / destruction of lesion or tissue of oesophagus, cervical approach Highly selective vagotomy Laparoscopic fundoplication Laparoscopic repair of hiatal hernia Oesophagogastroduodenoscopy (OGD) +/- biopsy and/or polypectomy OGD with removal of foreign body OGD with ligation / banding of oesophageal/ gastric varices Oesophagectomy Total oesophagectomy and interposition of intestine Percutaneous gastrostomy Permanent gastrostomy / gastroenterostomy Partial gastrectomy +/- jejunal transposition Partial gastrectomy with anastomosis to duodenum / jejunum Partial gastrectomy with anastomosis to oesophagus Proximal gastrectomy / radical gastrectomy / total gastrectomy +/- intestinal interposition Suture of laceration of duodenum / patch repair, duodenal ulcer Vagotomy and / or pyloroplasty Appendicectomy, open or laparoscopic Anal fissurectomy Anal fistulotomy / fistulectomy Incision & drainage of perianal abscess Delorme operation for repair of prolapsed rectum Colonoscopy +/- biopsy Colonoscopy with polypectomy Sigmoidoscopy Haemorrhoidectomy, internal or external Injection / banding of haemorrhoid Ileostomy or colostomy Anterior resection of rectum, open or laparoscopic Category 41

22 Procedure / Surgery Abdominoperineal resection, open or laparoscopic Colectomy, open or laparoscopic Low anterior resection of rectum, open or laparoscopic Reduction of volvulus or intussusception Category Resection of small intestine and anastomosis Biliary tract Cholecystectomy, open or laparoscopic Endoscopic retrograde cholangio-pancreatography (ERCP) ERCP with papilla operation, stone extraction or other associated operation Liver Fine needle aspiration (FNA) biopsy of liver Liver transplantation Marsupialization of lesion / cyst of liver or drainage of liver abscess, open approach Removal of liver lesion, open or laparoscopic Sub-segmentectomy of liver, open or laparoscopic Segmentectomy of liver, open or laparoscopic Wedge resection of liver, open or laparoscopic Pancreas Closed biopsy of pancreatic duct Excision / destruction of lesion of pancreas or pancreatic duct Pancreaticoduodenectomy (Whipple's Operation) Abdominal wall Exploratory laparotomy Laparoscopy / peritoneoscopy Unilateral repair of inguinal hernia, open or laparoscopic Bilateral repair of inguinal hernia, open or laparoscopic Unilateral herniotomy / herniorrhaphy, open or laparoscopic Bilateral herniotomy / herniorrhaphy, open or laparoscopic BRAIN AND NERVOUS SYSTEM Brain Brain biopsy Burr hole(s) Craniectomy Cranial nerve decompression Irrigation of cerebroventricular shunt Maintenance removal of cerebroventricular shunt, including revision Creation of ventriculoperitoneal shunt or subcutaneous cerebrospinal fluid reservoir 42

23 Procedure / Surgery Clipping of intracranial aneurysm Wrapping of intracranial aneurysm Excision of arteriovenous malformation, intracranial Excision of acoustic neuroma Excision of brain tumour or brain abscess Excision of cranial nerve tumour Radiofrequency thermocoagulation of trigeminal ganglion Closed trigeminal rhizotomy using radiofrequency Decompression of trigeminal nerve root/ open trigeminal rhizotomy Excision of brain, including lobectomy Hemispherectomy Category Spine Lumbar puncture or cisternal puncture Decompression of spinal cord or spinal nerve root Cervical sympathectomy Thoracoscopic or lumbar sympathectomy Excision of intraspinal tumour, extradural or intradural CARDIOVASCULAR SYSTEM Heart Cardiac catheterization Vessels Coronary artery bypass graft (CABG) Cardiac transplantation Insertion of cardiac pacemaker Pericardiocentesis Pericardiotomy Percutaneous transluminal coronary angioplasty (PTCA) and related procedures, including use of laser, stenting, motor-blade, balloon angioplasty, radiofrequency ablation technique, etc. Pulmonary valvotomy, Balloon / Transluminal laser / Transluminal radiofrequency Percutaneous valvuloplasty Balloon aortic / mitral valvotomy Closed heart valvotomy Open heart valvuloplasty Valve replacement Intra-abdominal venous shunt/ spleno-renal shunt / portal-caval shunt 43

24 Procedure / Surgery Category ENDOCRINE SYSTEM Resection of abdominal vessels with replacement / anastomosis Adrenal Gland Unilateral adrenalectomy, laparoscopic or retroperitoneoscopic Bilateral adrenalectomy, laparoscopic or retroperitoneoscopic Pineal gland Total excision of pineal gland Pituitary Gland Operation of pituitary tumour Thyroid Gland Fine needle aspiration (FNA) of thyroid gland +/- imaging guidance Hemithyroidectomy / partial thyroidectomy / subtotal thyroidectomy / parathyroidectomy Total thyroidectomy / complete parathyroidectomy / roboticassisted total thyroidectomy Excision of thyroglossal cyst EAR/ NOSE / THROAT / RESPIRATORY SYSTEM Ear Canaloplasty for aural atresia / stenosis Nose, mouth and pharynx Excision of preauricular cyst / sinus Haematoma auris, drainage / buttoning / excision Meatoplasty Removal of foreign body Excision of middle ear tumour via tympanotomy Myringotomy +/- insertion of tube Myringoplasty / tympanoplasty Ossiculoplasty Labyrinthectomy, total / partial excision Mastoidectomy Operation on cochlea and / or cochlear implant Operation on endolymphatic sac / decompression of endolymphatic sac Repair of round window or oval window fistula Tympanosympathectomy Vestibular neurectomy Antral puncture and lavage Cauterization of nasal mucosa / control of epistaxis Closed reduction for fracture nasal bone Closure of oro-antral fistula 44

25 Procedure / Surgery Dacryocystorhinostomy Excision of lesion of nose Nasopharyngoscopy / rhinoscopy +/- including rhinoscopic biopsy +/- removal of foreign body Polypectomy of nose Caldwell-Luc operation / Maxillary sinusectomy with Caldwell- Luc approach Endoscopic sinus surgery on ethmoid / maxillary / frontal / sphenoid sinuses Extended endoscopic frontal sinus surgery with trans-septal frontal sinusotomy Frontal sinusotomy or ethmoidectomy Frontal sinusectomy Functional endoscopic sinus surgery (FESS) Functional endoscopic sinus surgery (FESS) bilateral Maxillary / sphenopalatine / ethmoid artery ligation Other intranasal operation, including use of laser (excluding simple rhinoscopy, biopsy and cauterisation of vessel) Rhinoplasty Resection of nasopharyngeal tumour Sinoscopy +/- biopsy Septoplasty +/- submucous resection of septum Submucous resection of nasal septum Turbinectomy / submucous turbinectomy Adenoidectomy Tonsillectomy +/- adenoidectomy Excision of pharyngeal pouch / diverticulum Pharyngoplasty Sleep related breathing disorder hyoid suspension, maxilla / mandible / tongue advancement, laser suspension / resection, radiofrequency ablation assisted uvulopalatopharyngoplasty, uvulopalatopharyngoplasty Marsupialization / excision of ranula Parotid gland removal, superficial Parotid gland removal / parotidectomy Removal of submandibular salivary gland Submandibular duct relocation Category 45

26 Procedure / Surgery Category Respiratory system Submandibular gland excision Arytenoid subluxation laryngoscopic reduction Bronchoscopy +/- biopsy Bronchoscopy with foreign body removal Laryngoscopy +/- biopsy Laryngeal / tracheal stenosis endolaryngeal / open operation with stenting / reconstruction Laryngeal diversion Laryngectomy +/- radical neck resection Microlaryngoscopy +/- Biopsy +/- excision of nodule / polyp / Reinke's edema Partial / total resection of laryngeal tumour Removal of vallecular cyst Repair of laryngeal fracture Injection for vocal cord paralysis Tracheoesophageal puncture for voice rehabilitation Thyroplasty for vocal cord paralysis Vocal cord operation, including use of laser (excluding carcinoma) Tracheostomy, temporary / permanent / revision Lobectomy of lung / pneumonectomy Pleurectomy Segmental resection of lung Thoracocentesis / insertion of chest tube for pneumothorax Thoracoscopy +/- biopsy Thoracoplasty Thymectomy EYE Eye Excision / curettage / cryotherapy of lesion of eyelid Blepharorrhaphy / tarsorrhaphy Repair of entropion or ectropion +/- wedge resection Reconstruction of eyelid, partial-thickness Excision / destruction of lesion of conjunctiva Excision of pterygium Corneal grafting, severe wound repair and keratoplasty, including corneal transplant 46

27 Procedure / Surgery Laser removal / destruction of corneal lesion Removal of corneal foreign body Repair of cornea Suture / repair of corneal laceration or wound with conjunctival flap Aspiration of lens Capsulotomy of lens, including use of laser Extracapsular / intracapsular extraction of lens Intraocular lens / explant removal Chorioretinal lesion operations Phacoemulsification and implant of intraocular lens Pneumatic retinopexy Retinal Photocoagulation Repair of retinal detachment / tear Repair of retinal tear / detachment with buckle Scleral buckling / encircling of retinal detachment Cyclodialysis Trabeculectomy, including use of laser Surgical treatment for glaucoma including insertion of implant Diagnostic aspiration of vitreous Injection of vitreous substitute Mechanical vitrectomy / removal of vitreous Biopsy of iris Excision of lesion of iris / anterior segment of eye / ciliary body Excision of prolapsed iris Iridotomy Iridectomy Iridoplasty +/- coreoplasty by laser Iridencleisis and iridotasis Scleral fistulization +/- iridectomy Thermocauterization of sclera +/- iridectomy Diminution of ciliary body Biopsy of extraocular muscle or tendon Operation on one extraocular muscle Category 47

28 Procedure / Surgery Category Eyeball, perforating wound of, with incarceration or prolapse of uveal tissue repair Enucleation of eye Evisceration of eyeball / ocular contents Repair of eyeball or orbit Conjunctivocystorhinostomy Conjunctivorhinostomy with insertion of tube / stent Dacryocystorhinostomy Excision of lacrimal sac and passage Excision of lacrimal gland / dacryoadenectomy Probing +/- syringing of lacrimal canaliculi / nasolacrimal duct Repair of canaliculus Coreoplasty FEMALE GENITAL SYSTEM Cervix Amputation of cervix Fallopian tubes and ovaries^ Colposcopy +/- biopsy Conization of cervix Destruction of lesion of cervix by excision/ cryosurgery / cauterization / laser Endocervical curettage Loop electrosurgical excision procedure (LEEP) Marsupialization of cervical cyst Repair of cervix Repair of fistula of cervix Suture of laceration of cervix / uterus / vagina Dilatation / insufflation of fallopian tube Excision / destruction of lesion of fallopian tube, open or laparoscopic Repair of fallopian tube Salpingostomy / salpingotomy Total or partial salpingectomy Tuboplasty Aspiration of ovarian cyst Ovarian cystectomy, open or laparoscopic Wedge resection of ovary, open or laparoscopic 48

29 Procedure / Surgery Oophorectomy Oophorectomy, laparoscopic Salpingo-oophorectomy, open or laparoscopic Category Drainage of tubo-ovarian abscess, open or laparoscopic ^ The category applies to both unilateral and bilateral procedures unless otherwise specified. Uterus Dilatation and curettage of Uterine (D&C) Hysteroscopy +/- biopsy Hysteroscopy with excision or destruction of uterus and supporting structures Hysterotomy Laparoscopic assisted vaginal hysterectomy (LAVH) Vaginal hysterectomy +/- repair of cystocele and/or rectocele Total / subtotal abdominal hysterectomy +/- bilateral salpingooophorectomy, open or laparoscopic Radical abdominal hysterectomy Myomectomy, open or laparoscopic Uterine myomectomy, vaginal or hysteroscopic Laparoscopic drainage of female pelvic abscess Colposuspension Pelvic floor repair Pelvic exenteration Uterine suspension Vagina Destruction of lesion of vagina by excision / cryosurgery / cauterization / laser Insertion / removal of vaginal supportive pessaries Marsupialization of Bartholin's cyst Vaginal stripping of vaginal cuff Vaginotomy Partial vaginectomy Vaginectomy, complete Radical vaginectomy Anterior colporrhaphy +/- Kelly plication Posterior colporrhaphy Obliteration of vaginal vault 49

30 Procedure / Surgery Sacrospinous ligament suspension or fixation of the vagina Sacral colpopexy Vaginal repair of enterocoele Closure of urethro-vaginal fistula Repair of rectovaginal fistula, vaginal approach Repair of rectovaginal fistula, abdominal approach Culdocentesis Culdotomy Excision of transverse vaginal septum McCall's culdeplasty / culdoplasty Category Vulva and introitus Vaginal reconstruction Destruction of lesion of vulva by excision / cryosurgery / cauterization / laser Wide local excision of vulva with cold knife or LEEP Excision of vestibular adenitis Excision biopsy of vulva Incision and drainage of vulva and perineum Lysis of vulvar adhesions Repair of fistula of vulva or perineum Suture of lacerations / repair of vulva and/or perineum Vulvectomy Radical vulvectomy HEMIC AND LYMPHATIC SYSTEM Lymph Nodes Drainage of lesion / abscess of lymph node Biopsy / excision of superficial lymph nodes / simple excision of lymphatic structure Incisional biopsy of cervical lymph node / fine needle aspiration (FNA) biopsy of lymph nodes Excision of deep lymph node / lymphangioma / cystic hygroma Bilateral inguinal lymphadenectomy Cervical lymphadenectomy Inguinal and pelvic lymphadenectomy Radical groin dissection Radical pelvic lymphadenectomy 50

31 Procedure / Surgery Category Selective / radical / functional neck dissection Wide excision of axillary lymph node Spleen Splenectomy, open or laparoscopic MALE GENITAL SYSTEM Prostate External drainage of prostatic abscess Penis Photoselective vaporization of prostate Plasma vaporization of prostate Prostate biopsy Transurethral microwave therapy Transurethral prostatectomy or TURP Prostatectomy, open or laparoscopic Radical prostatectomy, open or laparoscopic Circumcision Release of chordee Repair of buried / avulsion of penis Testicles^ Epididymectomy Exploration of testis Exploration for undescended testis, laparoscopic Orchidopexy Orchidectomy or orchidopexy, laparoscopic Reduction of torsion of testis and fixation Testicular biopsy High ligation of hydrocoele Tapping of hydrocele Excision of varicocoele and hydrocoele of spermatic cord Varicocelectomy (microsurgical) ^ The category applies to both unilateral and bilateral procedures unless otherwise specified. Spermatic cord Vasectomy MUSCULOSKELETAL SYSTEM Bone Amputation of finger(s) / toe(s) of one limb Amputation of one arm / hand / leg / foot Bunionectomy Bunionectomy with soft tissue correction and osteotomy of the first metatarsal 51

32 Procedure / Surgery Category Joint Excision of radial head Mandibulectomy for benign disease Patellectomy Partial ostectomy of facial bone Sequestrectomy of facial bone Wedge osteotomy of bone of wrist / hand / leg Wedge osteotomy of bone of upper arm / lower arm / thigh Wedge osteotomy of scapula / clavicle / sternum Arthroscopic drainage and debridement Arthroscopic removal of loose body from joints Arthroscopic examination of joint +/- biopsy Arthroscopic assisted ligament reconstruction Arthroscopic Bankart repair Arthroscopic repair for superior labral tear from anterior to posterior of shoulder Arthroscopic rotator cuff repair Acromioplasty Arthrodesis of shoulder Arthrodesis of Elbow / Triple arthrodesis Arthrodesis of knee / hip Arthroplasty of hand / finger / foot / Toe joint with implant Fusion of wrist Synovectomy of wrist Interphalangeal joint fusion of toes Interphalangeal fusion of finger Excisional arthroplasty shoulder / hemiarthroplasty of shoulder Excisional arthroplasty of hip / knee / Wrist / Elbow Excisional arthroplasty of hip / knee with local antibiotic delivery Temporomandibular arthroplasty +/- autograft Joint aspiration / injection Manipulation of joint under anesthesia Metal femoral head insertion Anterior cruciate ligament reconstruction Meniscectomy, open or arthroscopic 52

33 Procedure / Surgery Category Muscle/ Tendon Fracture/ dislocation Posterior cruciate ligament reconstruction Repair of the collateral ligaments Repair of the cruciate ligaments Suture of capsule or ligament of ankle and foot Total shoulder replacement Total knee replacement Total hip replacement Partial hip replacement Achilles tendon repair Achillotenotomy Change in muscle or tendon length (except hand) / excision of lesion of muscle Change in muscle or tendon length of hand Excision of lesion of muscle Lengthening of tendon, including tenotomy Open biopsy of muscle Release of De Quervain's disease Release of trigger finger Release of tennis elbow Transfer / transplantation / reattachment of muscle Tendon repair / Suture of tendon not involving hand Tendon repair / Suture of tendon of hand Tenosynovectomy / synovectomy Transposition of tendon of wrist / hand Secondary repair of tendon, including graft, transfer and / or prosthesis Closed reduction of dislocation of temporomandibular / interphalangeal / acromioclavicular joint Closed reduction of dislocation of shoulder / elbow / wrist / ankle Closed reduction for Colles' fracture with percutaneous k-wire fixation Closed reduction for fracture of arm / leg / patella / pelvis with internal fixation Close reduction for mandibular fracture with internal fixation Closed reduction for fracture of clavicle / scapula / phalanges / patella without internal fixation 53

34 Procedure / Surgery Category Spine Closed reduction for fracture of upper arm / lower arm / wrist / hand / leg / foot bone without internal fixation Closed reduction for fracture of clavicle / hand / ankle /foot with internal fixation Closed reduction for fracture of femur +/- internal fixation Closed / open reduction of fracture of acetabulum with internal fixation Open reduction for mandibular fracture with internal fixation Open reduction for clavicle / hand / foot (except carpal / talus / calcaneus) +/- internal fixation Open reduction for arm / leg / patella / scapula +/- internal fixation Open reduction for femur / calcaneus / talus/ +/- internal fixation Operative treatment of compound fracture with external fixator and extensive wound debridement Removal of screw, pin and plate, and other metal for old fracture except fracture femur Artificial cervical disc replacement Anterior spinal fusion, cervical / cervicothoracic/ C4/5 and C5/6 and locking plate Anterior spinal fusion (excluding cervical / cervicothoracic/ C4/5 and C5/6 and locking plate) Anterior spinal fusion with instrumentation Laminoplasty for cervical spine Laminectomy / diskectomy Laminectomy with diskectomy Posterior spinal fusion, thoracic / cervico-thoracic / thoracolumbar / T5 to L1/ atlas-axis Posterior spinal fusion, (excluding thoracic / cervico-thoracic / thoracolumbar / T5 to L1 / atlas-axis) Posterior spinal fusion with instrumentation Spinal biopsy Spinal fusion +/- foraminotomy +/- laminectomy +/- diskectomy Spine osteotomy Vertebroplasty / kyphoplasty Others Excision of ganglion / bursa Closed/ Percutaneous needle fasciotomy for Dupuytren disease 54

35 Procedure / Surgery Radical (or total) fasciectomy for Dupuytren disease Release of carpal / tarsal tunnel, open or endoscopic Release of peripheral nerve Transposition of ulnar nerve Sliding / reduction genioplasty SKIN AND BREAST Skin Curettage / cryotherapy / cauterization / laser treatment of lesion of skin Drainage of subungual haematoma or abscess Excision of lipoma Excision of skin for graft Incision and /or drainage of skin abscess Incision and /or removal of foreign body from skin and subcutaneous tissue Local excision or destruction of lesion or tissue of skin and subcutaneous tissue Suture of wound on skin Surgical toilet and suturing Wedge resection of toenail Category Breast URINARY SYSTEM Breast tumour/ lump excision +/- biopsy Fine needle aspiration (FNA) of breast cyst Incisional breast biopsy Modified radical mastectomy Partial or simple mastectomy Partial or radical mastectomy with axillary lymphadenectomy Total or radical mastectomy Duct papilloma excision Gynaecomastia excision Kidney Extracorporeal shock wave lithotripsy for urinary stone (ESWL) Nephrolithotomy / pyelolithotomy Nephroscopy Percutaneous insertion of nephrostomy tube Renal biopsy Nephrectomy, open or laparoscopic or retroperitoneoscopic 55

36 Procedure / Surgery Category Bladder, ureter and urethra DENTAL Nephrectomy, partial/ lower pole Kidney transplant Cystoscopy +/- biopsy Cystoscopy with catheterization of ureter/ transurethral bladder clearance Cystoscopy with electro-cauterisation/ laser lithotripsy Excision of urethra caruncle Insertion of urethral/ureter stent Diverticulectomy of urinary bladder, open or laparoscopic Transurethral resection of bladder tumour Partial cystectomy, open or laparoscopic Radical/ total cystectomy, open or laparoscopic Ureterolithotomy, open or laparoscopic or retroperitoneoscopic Closure of urethro-rectal fistula Repair of urethral fistula Repair of vesicovaginal fistula Repair of vesicocolic fistula Repair of rupture of urethra Repair of urinary stress incontinence Formation of ileal conduit, including ureteric implantation Ileal or colonic replacement of ureter Unilateral reimplantation of ureter into bowel or bladder Bilateral reimplantation of ureter into bowel or bladder Any kind of dental surgery due to injury caused by an Accident 56