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
44	Operations on the skin and subcutaneous tissues
45	Surgery for pilonidal sinus
46	Surgical wound toilet (Wound debridement) and removal of diseased tissue of the skin and subcutaneous tissues under anaesthesia
47	Local excision or destruction of diseased tissue of skin and subcutaneous tissues under anaesthesia
48	Surgery for pilonidal cyst
49	Free skin transplantation, recipient site
50	Revision of skin plasty
51	Chemosurgery for skin cancer
	Operations on the tongue
52	Incision, excision and destruction of diseased tissue of the tongue.
53	Partial glossectomy
54	Reconstruction of the tongue
55	Other Operations on the tongue
56	Incision and lancing of salivary glands and Salivary ducts
57	Excision of a diseased tissue of salivary glands and Salivary ducts
58	Resection of a salivary gland with or without  salivary duct
59	Reconstruction of a salivary gland and salivary duct
60	Open Sialolithotomy
	Other operations on the mouth and face
61	External incision and drainage in the region of the mouth, jaw and face
62	Excision of the diseased hard and soft palate
63	Excision biopsy and/or destruction of diseased structures from the oropharynx.
64	Palatoplasty
65	Other operations in the mouth
	Operations on the tonsils and adenoids
66	Transoral incision and drainage of a pharyngeal abscess
67	Tonsillectomy without adenoidectomy
68	Tonsillectomy with  adenoidectomy
69	Excision and destruction of a lingual tonsil
70	Drainage of tonsillar abscess/quinsy
	Trauma surgery and orthopaedics
71	Incision and Drainage of the bone for septic and aseptic conditions
72	Closed reduction of fracture
73	Closed reduction of sub-luxation
74	Epiphyseolysis with osteosynthesis
75	Suture and other Operations on tendons and tendon sheath
76	Reduction of dislocation under GA
77	Arthoscopic knee aspiration
	Operations on the breast
78	Incision and Drainage of breast abscess
79	Operations on the nipple except congenitally inverted nipples
	Operations on the digestive tract
80	Incision and excision of tissue in the perianal region
81	Surgical treatment of anal fistulas
82	Surgical treatment of Haemorrhoids.
83	Division of the anal sphincter (sphincterotomy)
84	Other operations of the anus
85	Ultrasound guided aspiration of deep seated rectal abscess
86	Sclerotherapy
87	Dilation of digestive tract strictures
88	Endoscopic gastrotomy
89	Endoscopic decompression of colon
90	Endoscopic Polypectomy
	Operations on the female reproductive organs
91	Incision of the ovary
92	Other operations on  the Fallopian tubes
93	Dilatation of the cervical canal
94	Conisation of the uterine cervix
95	Incision of the Uterus (Hysterotomy) not done as a part of MTP
96	Therapeutic / diagnoistic dilatation and  curettage ( not done as part of MTP)
97	Culdotomy
98	Hymenectomy
99	Local excision and destruction of diseased tissue of the vagina and the pouch of Douglas
100	Incision and drainage of the Vulva
101	Operations on the Bartholin's glands(cyst)
102	Hysteroscope guided biopsy of uterus
103	Suprapubic cytostomy
	Operations on the prostate and seminal vesicles
104	Drainage of Prostatic abscess
105	Transurethral excision and destruction of prostate tissue
106	Percutaneous excision and destruction of prostate tissue
107	Excision of seminal vesicle
108	Incision  and excision of periprostatic tissue
	Operations on the Scrotum and tunica vaginalis testis
109	Incision and Drainage of the Scrotum and tunica vaginalis testis
110	Operations on testicular hydrocele
111	Excision or Eversion of Hydrocele
	Operations on the testis
112	Incision and drainage of the testis
113	Excision or destruction of testicular lesion
114	Unilateral orchidectomy
115	Other operations on the testis
	Operations on the spermatic cord,Epididymis and ductus deferens
116	Surgical treatment of a varicocele and hydrocele of a spermatic cord
117	Excision of epididymal cyst
118	Epididymectomy
119	Other operations on the spermatic cord, epididymis and ductus deferens (other than vasectomy)
	Operations on the Penis
120	Circumcision and other Operations on the foreskin (if medically necessitated)
121	Local excision and destruction of diseased tissue of the penis
122	Other operations on the penis
	Operations on the Urinary system
123	Cystoscopic removal of stones
124	Lithotripsy
	Other Operations
125	Coronary angiography
126	Bronchoscopic treatment of bleeding lesion
127	Bronchoscopic treatment of fistula/stenting
128	Bronchoalveolar lavage and biopsy
129	Pericardiocentesis
130	Insertion of filter in Inferior Vena cava
131	Insertion of gel foam in artery or vein
132	Carotid angioplasty
133	Renal angioplasty
134	Tumor embolisation
135	Endoscopic drainage of pseudo pancreatic cyst
136	Varicose vain stripping or ligation
137	Excision of dupuytren's contracture
138	Carpal tunnel Decompression
139	PCNS (Percutaneous neprostomy)
140	PCNL(Percutaneous nephro lithotomy)
141	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	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
	Operations on the sinuses
134	Operations on frontal sinus	40%	Category 3
135	Operations on maxillary antrum using sublabial approach	20%	Category 4
	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