LIC JEEVAN AROGYA Benefit Illustration

LIC JEEVAN AROGYA Benefit Illustration

S.No. DAY CARE SURGERIES
Microsurgical Operations on the middle ear
1 Stapedotomy
2 Stapedectomy
3 Revision of Stapedectomy
4 Other operations on the auditory Ossicles
5 Myringoplasty (Type-I Tympanoplasty)
6 Tympanoplasty (Closure of Eardrum Perforation / reconstruction of the Auditory Ossicles)
7 Myringotomy with grommet insertion
8 Closure of Mastoid fistula
9 Revision of a Tympanoplasty
10 Other microsurgical operations on the Middle Ear
Other Operations on the Middle and Internal Ear
11 Myringotomy 
12 Benign Tumour removal from the external ear
13 Incision of the mastiod process and Middle ear
14 Simple Mastoidectomy
15 Reconstruction of the middle ear
16 Other excisions of the middle and inner ear
17 Fenestration of the inner ear
18 Revision of  fenestration of the inner ear
19 Petrous Apicectomy
20 Other microsurgical operations on the inner  Ear
Operations on the nose and nasal sinuses
21 Excision and destruction of diseased tissue of the nose
22 Operation on Nasal Turbinates
23 Septoplasty (medically necessitated)
24 Functional Endoscopic Sinus Surgery
25 Endoscopic placement /removal of stents
Operations on the Eyes
26 Dacrocystorhinostomy
27 Other Operations  for  tear gland/ duct lesions
28 Tarsorraphy
29 Excision of the diseased tissue of the eyelid
30 Operations of canthus and epicanthus when done for adhesions due to chronic infections
31 Corrective surgery of entropion
32 Corrective surgery for blepharoptosis
33 Excision of lacrimal sac and passage
34 Removal of a deep or embedded foreign body from cornea
35 Corrective surgery of ectropion
36 Operations for Pterygium with or without grafting
37 Other operations on the cornea
38 Removal of a foreign body from the lens of the eye
39 Removal of a foreign body from posterior chamber  of the eye
40 Removal of a foreign body from orbit  and eyeball
41 Cataract Surgery ( ECCE or Phacoemulsification with or without  intraocular lens implant)
42 Operation for glaucoma
43 Repair of corneal laceration or wound with conjunctival flap
Operations on the skin and subcutaneous tissues
44 Surgery for pilonidal sinus
45 Surgical wound toilet (Wound debridement) and removal of diseased tissue of the skin and subcutaneous tissues under anaesthesia
46 Local excision or destruction of diseased tissue of skin and subcutaneous tissues under anaesthesia
47 Surgery for pilonidal cyst
48 Free skin transplantation, recipient site
49 Revision of skin plasty
50 Chemosurgery for skin cancer
Operations on the tongue
51 Incision, excision and destruction of diseased tissue of the tongue.
52 Partial glossectomy
53 Reconstruction of the tongue
54 Other Operations on the tongue
55 Incision and lancing of salivary glands and Salivary ducts
56 Excision of a diseased tissue of salivary glands and Salivary ducts
57 Resection of a salivary gland with or without  salivary duct
58 Reconstruction of a salivary gland and salivary duct
59 Open Sialolithotomy
Other operations on the mouth and face
60 External incision and drainage in the region of the mouth, jaw and face
61 Excision of the diseased hard and soft palate
62 Excision biopsy and/or destruction of diseased structures from the oropharynx.
63 Palatoplasty
64 Other operations in the mouth
Operations on the tonsils and adenoids
65 Transoral incision and drainage of a pharyngeal abscess
66 Tonsillectomy without adenoidectomy
67 Tonsillectomy with  adenoidectomy
68 Excision and destruction of a lingual tonsil
69 Drainage of tonsillar abscess/quinsy
Trauma surgery and orthopaedics
70 Incision and Drainage of the bone for septic and aseptic conditions
71 Closed reduction of fracture
72 Closed reduction of sub-luxation
73 Epiphyseolysis with osteosynthesis
74 Suture and other Operations on tendons and tendon sheath
75 Reduction of dislocation under GA
76 Arthoscopic knee aspiration
Operations on the breast
77 Incision and Drainage of breast abscess
78 Operations on the nipple except congenitally inverted nipples
Operations on the digestive tract
79 Incision and excision of tissue in the perianal region
80 Surgical treatment of anal fistulas
81 Surgical treatment of Haemorrhoids.
82 Division of the anal sphincter (sphincterotomy)
83 Other operations of the anus
84 Ultrasound guided aspiration of deep seated rectal abscess
85 Sclerotherapy
86 Dilation of digestive tract strictures
87 Endoscopic gastrotomy
88 Endoscopic decompression of colon
89 Endoscopic Polypectomy
Operations on the female reproductive organs
90 Incision of the ovary
91 Other operations on  the Fallopian tubes
92 Dilatation of the cervical canal
93 Conisation of the uterine cervix
94 Incision of the Uterus (Hysterotomy) not done as a part of MTP
95 Therapeutic / diagnoistic dilatation and  curettage ( not done as part of MTP)
96 Culdotomy
97 Hymenectomy
98 Local excision and destruction of diseased tissue of the vagina and the pouch of Douglas
99 Incision and drainage of the Vulva
100 Operations on the Bartholin's glands(cyst)
101 Hysteroscope guided biopsy of uterus
102 Suprapubic cytostomy
Operations on the prostate and seminal vesicles
103 Drainage of Prostatic abscess
104 Transurethral excision and destruction of prostate tissue
105 Percutaneous excision and destruction of prostate tissue
106 Excision of seminal vesicle
107 Incision  and excision of periprostatic tissue
Operations on the Scrotum and tunica vaginalis testis
108 Incision and Drainage of the Scrotum and tunica vaginalis testis
109 Operations on testicular hydrocele
110 Excision or Eversion of Hydrocele
Operations on the testis
111 Incision and drainage of the testis
112 Excision or destruction of testicular lesion
113 Unilateral orchidectomy
114 Other operations on the testis
Operations on the spermatic cord,Epididymis and ductus deferens
115 Surgical treatment of a varicocele and hydrocele of a spermatic cord
116 Excision of epididymal cyst
117 Epididymectomy
118 Other operations on the spermatic cord, epididymis and ductus deferens (other than vasectomy)
Operations on the Penis
119 Circumcision and other Operations on the foreskin (if medically necessitated)
120 Local excision and destruction of diseased tissue of the penis
121 Other operations on the penis
Operations on the Urinary system
122 Cystoscopic removal of stones
123 Lithotripsy
Other Operations
124 Coronary angiography
125 Bronchoscopic treatment of bleeding lesion
126 Bronchoscopic treatment of fistula/stenting
127 Bronchoalveolar lavage and biopsy
128 Pericardiocentesis
129 Insertion of filter in Inferior Vena cava
130 Insertion of gel foam in artery or vein
131 Carotid angioplasty
132 Renal angioplasty
133 Tumor embolisation
134 Endoscopic drainage of pseudo pancreatic cyst
135 Varicose vain stripping or ligation
136 Excision of dupuytren's contracture
137 Carpal tunnel Decompression
138 PCNS (Percutaneous neprostomy)
139 PCNL(Percutaneous nephro lithotomy)
140 Nail bed deformity/resection and reconstruction
 
MAJOR SURGICAL BENEFIT ANNEXURE
Sl. No. LIST OF MAJOR SURGERIES % of
Major Surgical Benefit Sum Assured
Category
1 Major Surgery of Aorta 100% Category 1
2 CABG (two or more coronary arteries must be bypassed) via open chest surgery 100% Category 1
3 Heart Valve Replacement using mechanical prosthesis 100% Category 1
4 Heart/Heart-Lung Transplant 100% Category 1
5 Aortic root transplantation with coronary artery reimplantation for proximal aortic aneurysm 100% Category 1
6 Pericardiotomy / Pericardectomy 60% Category 2
7 Initial implantation of permanent pacemaker in the heart 60% Category 2
8 Mitral valve repair 60% Category 2
9 Aortic valve repair 60% Category 2
10 Tricuspid valve repair 60% Category 2
11 Pulmonary valve repair 60% Category 2
12 Coronary Angioplasty with stent implantation (two or more coronary arteries must be stented) 40% Category 3
13 Major vein repair with or without grafting for traumatic & nontraumatic lesions 40% Category 3
II HAEMIC AND LYMPHATIC SYSTEM    
14 Bone Marrow transplant (as recipient) 100% Category 1
15 Major Excision and grafting of Lymphoedema 60% Category 2
16 Splenectomy 60% Category 2
III NERVOUS SYSTEM    
17 Repair of Cerebral or Spinal Arterio- Venous Malformations or aneurysms 100% Category 1
18 Craniotomy for malignant Cerebral tumours 100% Category 1
19 Excision of pineal gland 100% Category 1
20 Excision of the pituitary gland 100% Category 1
21 Craniotomy for  non malignant space occupying lesions 60% Category 2
22 Operations on Surbaracahnoid space of brain 60% Category 2
23 Intracranial transection of Cranial nerve 60% Category 2
24 Other operations on the meninges of the Brain 60% Category 2
25 Microvascular decompression of cranial nerves/nervectomy 60% Category 2
26 Craniotomy for Drainage of Extradural, subdural or intracerebral space 40% Category 3
27 Decompression surgery for Entrapment Syndrome 40% Category 3
28 Unilateral or Bilateral sympathectomy 40% Category 3
29 Peripheral nerve Graft 40% Category 3
30 Free Fascia Graft for Facial Nerve Paralysis 40% Category 3
31 Excision of deep seated peripheral nerve tumour 40% Category 3
32 Multiple Miscrosurgical Repair of digital nerve 40% Category 3
33 Bur-hole Drainage of Extradural, subdural or intracerebral space 20% Category 4
IV RESPIRATORY SYSTEM    
34 Lung Transplantation 100% Category 1
35 Unilateral Pneumonectomy 60% Category 2
36 Diaphragmatic/Hiatus Hernia  Repair 60% Category 2
37 Thoracotoplasty 60% Category 2
38 Open Lobectomy of Lung 60% Category 2
39 Excision of benign mediastinal lesions 60% Category 2
40 Partial Extirpation of Bronchus 60% Category 2
41 Partial Pharyngectomy 60% Category 2
42 Total Pharyngectomy 60% Category 2
43 Total Laryngectomy 60% Category 2
44 Excision of Diaphragmatic tumours 60% Category 2
45 Pleurectomy or Pleural decortication 40% Category 3
46 Tracheal reconstruction  for various lesion 40% Category 3
V DIGESTIVE SYSTEM    
47 Excision of esophagus and stomach 100% Category 1
48 Abdominal-Perineal Pull Through Resection of rectum with Colo-Anal Anastomosis 100% Category 1
49 Total excision of oesophagus 60% Category 2
50 Total excision of stomach 60% Category 2
51 Resection and Anastomosis of any part of digestive tract 40% Category 3
52 Open Surgery for treatment of Peptic Ulcer 40% Category 3
53 Artificial opening into stomach 20% Category 4
VI ENDOCRINE SYSTEM    
54 Complete excision of adrenal glands 60% Category 2
55 Complete excision of Thyroid gland 60% Category 2
56 Complete excision of Parathyroid gland 60% Category 2
57 Partial excision of adrenal glands 40% Category 3
58 Partial excision of Thyroid gland 40% Category 3
59 Partial excision of Parathyroid gland 40% Category 3
VII ENT    
60 Total ear amputation with reconstruction 60% Category 2
61 Transmastoid removal cholesteatoma with extended Mastoidectomy 60% Category 2
62 Total Nasal Reconstruction due to Traumatic lesions   Category 2
63 Labyrinthotmy for various lesions 40% Category 3
VIII ORAL    
64 Wide excision and Major reconstruction of malignant  Oro-pharyngeal tumours 60% Category 2
65 Total Glossectomy 40% Category 3
66 Wide local Excision for oral leukoplakia 20% Category 4
IX EYE    
67 Orbit Tumour Exenteration /Flap reconstruction 40% Category 3
68 Corneal or Retinal Repair for Traumatic eye injuries 20% Category 4
69 Penetrating injuries of the eye or repair of ruptured globe 20% Category 4
X LIVER, GALL BLADDER & PANCREAS    
70 Liver Transplantation 100% Category 1
71 Partial Resection of Liver 60% Category 2
72 Partial Pancreatectomy 60% Category 2
73 Cholecystectomy /Choledochotomy  for various Gall bladder lesions 40% Category 3
XI MUSCULOSKELETAL SYSTEM (due to accident only)    
74 Replantation of upper limb 60% Category 2
75 Replantation of lower limb 60% Category 2
76 Total prosthetic replacement of hip joint using cement 40% Category 3
77 Total prosthetic replacement of hip joint not using cement 40% Category 3
78 Other total prosthetic replacement of hip joint 40% Category 3
79 Total prosthetic replacement of knee joint using cement 40% Category 3
80 Total prosthetic replacement of knee joint not using cement 40% Category 3
81 Other total prosthetic replacement of knee joint 40% Category 3
82 Total prosthetic replacement of other joint using cement 40% Category 3
83 Total prosthetic replacement of other joint not using cement 40% Category 3
84 Other total prosthetic replacement of other joint 40% Category 3
85 Prosthetic replacement of head of femur using cement 40% Category 3
86 Prosthetic replacement of head of femur not using cement 40% Category 3
87 Other prosthetic replacement of head of femur 40% Category 3
88 Prosthetic replacement of head of humerus using cement 40% Category 3
89 Prosthetic replacement of head of humerus not using cement 40% Category 3
90 Other prosthetic replacement of head of humerus 40% Category 3
91 Prosthetic replacement of any other bone using cement 40% Category 3
92 Prosthetic replacement of any other bone not using cement 40% Category 3
93 Other prosthetic replacement of any other bone 40% Category 3
94 Prosthetic interposition reconstruction of joint 40% Category 3
95 Other interposition reconstruction of joint 40% Category 3
96 Excision reconstruction of joint 40% Category 3
97 Other reconstruction of joint 40% Category 3
98 Implantation of prosthesis for limb 40% Category 3
99 Amputation of arm 40% Category 3
100 Amputation of leg 40% Category 3
101 Fixation of fracture of spine 40% Category 3
102 Elevation, Exploration and Fixation of fractured Zygoma 40% Category 3
103 Amputation of hand 20% Category 4
104 Amputation of foot 20% Category 4
105 Therapeutic endoscopic operations on cavity of knee joint 20% Category 4
106 Replantation of finger following traumic amputation 20% Category 4
107 Surgical Drainage and Curettage for osteomyelitis 20% Category 4
XII ORO-MAXILLOFACIAL SURGERY    
108 Major reconstructive oro-maxillafacial surgery due to trauma or burns and not for cosmetic purpose 60% Category 2
109 Osteotomy including segmental resection with bone grafting for Mandibular and maxillary lesions 60% Category 2
XIII KIDNEY/URINARY TRACT/REPRODUCTIVE SYSTEM    
110 Renal transplant (recipient) 100% Category 1
111 Hysterectomy for malignant conditions 60% Category 2
112 Radical prostatovesiculectomy 60% Category 2
113 Microvascular reattachment of penis following traumatic amputation 60% Category 2
114 Total nephrectomy due to medical advice (not as a transplant donor) 40% Category 3
115 Partial excision of kidney 40% Category 3
116 Open extirpation of lesion of kidney 40% Category 3
117 Excision of ureter 40% Category 3
118 Total excision of bladder 40% Category 3
119 Kidney injury repair 40% Category 3
120 Pyloplasty / Ureterocalcycostomy  for pelvic ureteric junction obstruction 40% Category 3
121 Amputation of penis 40% Category 3
122 Excision of vagina 40% Category 3
123 Unilateral or Bilateral excision of adnexa of uterus 40% Category 3
124 Partial excision of bladder 20% Category 4
125 Therapeutic ureteroscopic operations on ureter 20% Category 4
126 Urinary diversion 20% Category 4
127 Replantation of ureter 20% Category 4
128 Unilateral or Bilateral excision of testes 20% Category 4
129 Other operations on  Scrotum and tunica vaginalis testis 20% Category 4
130 Reconstruction of the testis 20% Category 4
131 Open surgical excision and destruction of prostate tissue 20% Category 4
132 Extirpation of lesion of vulva 20% Category 4
133 Excision of vulva 20% Category 4
XIV Operations on the sinuses    
134 Operations on frontal sinus 40% Category 3
135 Operations on maxillary antrum using sublabial approach 20% Category 4
XV Others    
136 Radical Mastectomy 60% Category 2
137 Malignant soft tissue tumour excision and reconstruction 40% Category 3
138 Excision and Major Flap Repair of skin and Subcutaneous tissue due to Major Burns 40% Category 3
139 Simple Mastectomy 20% Category 4
140 TIPS procedure for portal Hypertension 20% Category 4
 

No comments:

Post a Comment