Group Hospital & Surgical Benefit
.........Group Hospital & Surgical Benefit is a Supplementary Contract in conjunction with Group Life Policy (basic policy). This benefit will reimburse Insured Member for medical expense incurred when he is admitted into hospital as a result of sickness or accidental injury.

Coverage
 .........This benefit covers 24 hours, everywhere all over the world and both in and out of occupation when Insured Member is admitted into hospital as an inpatient for at least 6 consecutive hours as a result of sickness or accidental injury.

Benefits
  1. Room & Board
    The amount of benefit shall be paid for the actual charges for room & board and general nursing services made by hospital during Insured Member's confinement but not exceeding the maximum amount per day and max. no. of days per disability as shown is the Supplementary Contract's Schedule. In case of confinement in ICU of hospital, the amount of benefit shall be equal to the actual R & B charge but not exceeding two times the rate of the maximum per day as shown in the same Schedule and subject to a maximum of seven (7) days.
  2. This benefit shall be paid for hospital's actual & customary charges for services rendered during the Insured Member's confinement such as drugs, medical aids & Instruments, operating room, laboratory, ambulance etc. However, the total reimbursement for all those services together have not to exceed maximum per disability as shown in the Supplymentary Contract's schedule.
  3. Surgical Benefit
    The surgical benefit shall be paid for the actual charge of any surgical operation but not exceeding the amount per each operation calculated by multiplying the percentage shown for that operation in the Surgical Schedule of Fees by the maximum surgical benefit benefit per any one disability as shown in the Supplementary Contract Schedule.
  4. In - Hospital Doctor Consultation This benefit shall be paid for Consultation Fees actually charged by doctor (s) while Insured Member is hospitalized but not exceeding the maximum amount for a visit and only one visit per day shall be covered with limit to no. of days as shown in the Supplementary Contract Schedule.
  5. Emergency Out - Patient Treatment (Accident)
    This benefit shall be paid for the actual charges incurred when Insured Member requires emergency out - patient treatment in OPD of a hospital or a clinic within 24 hours following an injury occurred to him and also for the follow - up treatment within 31 days after that. This is provided such benefit payable shall not exceed the maximum Emergency Out - Patient Treatment Benefit as shown in the Supplementary Contract Schedule. In case that the insured Member is hospitalized for the same disability, this Emergency Out - Patient Treatment Benefit shall be payable under the item (2) of of Other Hospital Services Benefit and such actual charges, when incorported with other hospital service charges also incurred for that same disability, have not to exceed the maximum Other Hospital Services Benefit as shown in the Supplementary Contract Schedule.
  6. Specialist Consultation Benefit
    The Specialist Consultation Benefit shall be paid for the amount actually charged by a Registered Specialist for consultation provided during Insured Member's hospitalizations but not exceeding the maximum benefit for any one disability as shown in the Supplementary Contract Schedule. This benefit is usually incorporated in the total maximum of item (2) Other Hospital Services Benefit but in case where a surgery is performed, it shall be included in the total - maximum of item (3) Surgical Benefit.
Limitation
               If Insured Member is entitled to benefit payable under Employees' Compensation Legislation, any government or public program of medical benefits, other group or individual insurance, the benefits payable under this Supplementary Contract shall be limited to the balance of expenses. not covered by those benefit schemes or the amount that computed on accordance with this Supplementary Contract Schedule, whichever is less.

Exclusions
No benefit shall be payable under this Supplementary Contract for any one of the following occurrences:
  1. Pre - existing conditions for which Insured Member receive medical treatment during ninety (90) days pre - ceding the effective date of his coverage except for that such Insured Member has been covered under this Supplementary Contract for twelve (12) consecutive months.
  2. Self - destruction or intentional self - inflicted injuries related to functional disorders of mind due to anxiety, depression, neurosed, neuras thenia, drug addiction or alcoholism.
  3. Injuries arising from war, revolution or any warlike operations.
  4. Injuries arising from riot, strikes or participation in brawl.
  5. Special nursing care; general physical check - up or tests not incidental to or necessary for treatment of an actual sickness; any dental treatments or surgeries except that such procedure is necessitated for treatment of an injury.
  6. Congenital anomalies; treatment occasioned by or resulting from pregnancy, childbirth, miscarriage or abortion or relating to birth control, sterilization of either sex, treatments pertaining to infertility.
  7. Cosmetic treatment or surgery for purpose of beautification; non - medical personal services such as radio, telephone and the like; procurement or use of special braces, appliances or equipments.
SURGICAL TABLE OF FEES
        
Description of Surgical Operation
% of Maximum benefit
a.
Appendectomy
50
b.
Hemorrihoidectomy, internal & external, complex or extensive
55
c.
Hepatectomy (resection of liver), partial lobectomy
75
d.
Cholecystotomy or cholecystotomy with or without exploration,Drainage or removal of calculus
55
e.
 Exploratory laparotomy : exploralory celiotomy
45
f.
Inguinal, age twelve or over
45
g.
Nephrolithotomy, removal of calculus
75
h.
Renal homotransplantation, with unilateral recipient nephrectomy
100
i.
Transurethral resection of prostate
75
j.
Pneumonectomy, total
100
k.
Wedge resection or enucleation of lesion, single or multiple
75
l.
Thoracic aortic ameurysm - transverse arch graft
100
m.
Abdominal aortic aneurysm with or without ileo - femoral
100
n.
Splenectomy
65
etc.