Surgical Benefit Schedule (3)

Health Insurance Coverage Surgical Benefit Schedule (3)
Description of Surgical Operation Percentage of Maximum Benefits
Joints and Dislocations	Incision into Joint for disease and disorder, except as herein otherwise provided and except tapping	12.50%
	Incision into shoulder, elbow, hip knee joint, tapping excepted	37.50%
	Excision, fixation by cutting operation, disarticulation or arthroplasty on Shoulder, hip or spine	75.00%
	Knee, elbow, wrist, or ankle	37.50%
	Dislocation of Fingers or toes, each	5.00%
	Shoulder, or elbow, wrist or ankle	15.00%
	Lower Jaw	6.25%
	Hip or knee (cap excepted)	20.00%
	Knee cap	5.00%
	Tenolysis	12.50%
	For a dislocation requiring an oper operation the maximum benefit for such dislocation shall be twice the applicable amount listed above.
Nose	Antrum puncture	2.50%
	Intranasal sinus operation	17.50%
	Extranasal sinus operation	37.50%
	Ploypus, removal one or more	5.00%
	Submucous resection	25.00%
	Turbinectomy	7.50%
Paracentesis	Tapping of Abdomen, Trachlostomy, Insertion of central venous catheter and open cannulation of vein	12.50%
	Chest or bladder, catheterization excepted	7.50%
	Ear drum, Hydrocele, joints or spine	5.00%
Rectum	Radical resection for malignancy, all stages, including colostomy	100.00%
	Hemorrhoids, external only, excision complete procedure	7.50%
	Hemorrhoids, internal or internal and external including prolapsed rectum, total for excision or complete injection treatment	20.00%
	Fistula in ano	17.50%
	Fissure in ano	5.00%
	Other cutting operations on rectum	17.50%
	Sigmoidoscope & Colonoscope	12.50%
Skull	Cutting into cranial cavity, trephining and tapping excepted	100.00%
	Removal of bone trephining or decompression	31.25%
Throat	Tonsillectomy or tonsillectomy and adenoidectomy	25.00%
	Use or Laryngoscope for diagosis	5.00%
Tumors	Surgical removal of Malignant tumors except those of the mucous membrane, skin and subcutancous tissue	50.00%
	Malignant tumors of the mucous membrane, skin and subcutaneous tissue	25.00%
	Polonidal sinus or cyst, cutting operation	25.00%
	Benign tumors of the testicle or breast	20.00%
	Ganglion	3.75%
	Warts or moles	2.50%
	Benign tumors, one or more, except as otherwise herein provided, requiring hospital residence	12.50%
	Not requiring hospital residence	5.00%
	In the case of X-Ray or radium treatment for any of the above listed tumors, the maximum benefit payable for the entire course of treatment including surgical removal shall be that provided for its surgical removal.
Veins	Varicose-Complete procedure on all veins cutting operation or injection treatment, one leg	20.00%
	Cutting operation or injection treatment, two legs	30.00%

If the surgical operation performed is not listed in the Schedule of Operations, the Company will determine the maximum surgical benefit for such operation. A surgical operation of equivalent gravity and severity listed in the above Schedule shall be use as a basis for the Company's settlement