Regular Group Plan: Special Benefits
Reconstructive
Surgery – for
Functional Defect resulting from disease
or accident
Rehabilitative
Conditionings
| |
Physical
Therapy |
| |
Chemotherapy
(intravenous only) |
AIDS
and Sexually Transmitted Disease
Latest
Modalities of Treatment
Partial
coverage of the following:
| |
Magnetic
Resonance Imaging (MRI) |
|
P
5,000 |
| |
Nuclear
/ Radioactive Isotope Scan (NRIS) |
|
P 5,000 |
| |
Lithotripsy |
|
P 30,000 |
| |
Laparoscopic
Cholecystectomy |
|
P 35,000 |
| |
Laparoscopic
Myoma Resection |
|
P 20,000 |
| |
Laparoscpoic
Adrenalectomy |
Unilateral |
P 75,000
* |
| |
|
Bilateral |
P 85,000
* |
| |
|
|
|
| |
Transurethral
Microwave Therapy of Prostate |
|
P 30,000 |
| |
Hysteroscopically-guided
Biopsy/D&C |
|
P 10,000 |
| |
Percutaneous
Ultrasonic Nephrolithotomy |
|
P 40,000 |
| |
Ureterolithotripsy |
Lithotripsy
limit + |
P 5,000 |
| |
Stereotactic
Brain Biopsy |
|
P 120,000* |
| |
Cryosurgery |
|
P 1,000
/ area |
| |
Sleep Study
and Neuroscan |
|
P 5,000 |
| |
Sclerotherapy
(for varicose veins) |
|
P 5,000 |
| |
Pelvic
Laparoscopic (for endometriosis) |
|
P 5,000 |
Coverage for the latest modalities
of treatment based on the limits set
forth below or subject to the maximum
plan limit whichever is lesser:
All new modalities
of treatment and/or diagnosis for
which there are no comparable conventional
or traditional equivalent or counterparts
will have a maximum limit of P5,000.
The availment of Laparoscopic
Cholecystectomy, Lithotripsy, Transurethral
Microwave Therapy of Prostate, Percutaneous
Ultrasonic Nephrolithotomy, Ureterolithotripsy
or Cryosurgery procedure is limited
only to once per contract year. When
a Member chooses the new modalities
of treatment enumerated above, PRUDENTIALIFECARE
will no longer be liable for the cost
of further traditional modes of treatment/diagnostics
for the same illness or its complications
should they be necessary. If a Member
refuses to follow the recommended
treatment or procedure and the PRUDENTIALIFECARE
Physician or Affiliated Physician
believes that no professionally acceptable
alternative exists, then PRUDENTIALIFECARE
shall no longer be responsible to
provide for the condition under treatment.
