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PARTICIPATION REQUIREMENT: For accounts where payment of membership fees is non-voluntary/non-

contributory, 100% enrollment of all regular employees is required. On the other hand, if an account is
voluntary/contributory, at least 75% of regular employees must enroll.

If account has coverage for the dependents, account should enroll all dependents under the program or the
number of dependents should reach at least 75% of the total number of principals.

If participation requirement is not met or should there be a significant decrease in number of enrollees per
membership type, the following adjustment in rates shall apply:

% of Final count in relation to Initial count per


membership type or % of Dependents participation Applicable Rates / Escalation Factor
in relation to Principal count
at least 75% Standard Rates
60% - 74.9% + 10% to Standard Rates
40% - 59.9% + 20% to Standard Rates
below 40% + 35% to Standard Rates

BENEFITS AND COVERAGE:

HEALTHCARE BENEFITS COVERAGE/LIMIT

A. OUT-PATIENT (OP) CARE


Consultations during regular clinic hours, except
1 Subject to MBL
prescribed medicines
2 Pre and Post Natal consultations Subject to MBL
Eye, ear, nose and throat (EENT) treatment
3 Subject to MBL
prescribed by an Accredited Physician/Specialist
Treatment for minor injuries such as lacerations,
4 Subject to MBL
mild burns, sprains and the like
Dressings, conventional casts (plaster of Paris)
5 Subject to MBL
and sutures.
X-Ray, laboratory examinations, routine, diagnostic
and therapeutic procedures prescribed by an
Accredited Physician/Specialist, provided however
6 Subject to MBL
that the cost of diagnostic and therapeutic
procedures covered shall be limited to a specific
amount.
7 Minor surgery not requiring confinement prescribed Subject to MBL
by an Accredited Physician /Specialist
Eye laser therapy only for retinal tear, retinal hole,
retinal detachment and glaucoma prescribed by an
8 Up to Php10,000/eye/member/year
Accredited Physician/Specialist. Eye correction
such as Lasik, PRK and the like are not covered.
Electrocauterization of skin lesions such as plantar
warts, flat warts, periungual warts, filiform warts
and molluscum contagiosum, in any part of the
9 Up to Php1,000/member/year
body, except genital warts and condyloma
acuminata, prescribed by an Accredited
Physician/Specialist.
Sclerotherapy for varicose veins (except medicines
and for cosmetic purposes) as prescribed by an
10 Up to Php5,000/leg/member/year
Accredited Physician, to be availed through
accredited vascular surgeons.
Allergy Testing/ allergy screening and other related
11 examinations prescribed by an Accredited Up to Php2,500/member/year
Physician
Covered as charged up to Php10,000/
member/year (reimbursement basis).
12 Speech therapy (for stroke patients only)
Note: Consultations shall be part of the limit
and treated as sessions
13 Tuberculin test Up to Php600/member/year

B. IN-PATIENT (IP) CARE


1 Room and Board Accommodation Subject to the Members Room and Board limit
Use of operating room, Intensive Care Unit (ICU),
2 isolation room (if prescribed by Attending Subject to MBL
Accredited Physician) and recovery room.
Professional fees in accordance with Maxicare
3 Subject to MBL
Schedule of Rates.
a. Attending Physicians
b. Surgeons
c. Anesthesiologists
d. Cardio-pulmonary clearance before surgery and
cardiac monitoring during surgery.
4 Standard Nursing Services Subject to MBL
5 Medicines for in-patient use Subject to MBL
Blood products transfusions and intravenous fluids,
6 Subject to MBL
including blood screening and cross matching.
X-Ray, laboratory examinations, routine, diagnostic
7 and therapeutic procedures incidental to Subject to MBL
confinement
Dressings, conventional casts (plaster of Paris)
8 Subject to MBL
and sutures
9 Anesthesia and its administration Subject to MBL
10 Oxygen and its administration Subject to MBL
11 Standard Admission kit Subject to MBL
All other items directly related in the medical
12 management of the patient, as deemed medically Subject to MBL
necessary by the Attending Accredited Physician

C. ROUTINE PROCEDURES (whether OP or IP)


1 Blood Chemistries 100% of Actual Cost subject to MBL
2 Chest X-Ray 100% of Actual Cost subject to MBL
3 Complete Blood Count (CBC) 100% of Actual Cost subject to MBL
4 Fecalysis 100% of Actual Cost subject to MBL
5 Urinalysis 100% of Actual Cost subject to MBL

D. DIAGNOSTIC PROCEDURES (whether OP or IP)


1 12-Lead Electrocardiogram (ECG) 100% of Actual Cost subject to MBL
2 24-hour Electroencephalogram (EEG) Monitoring 100% of Actual Cost subject to MBL
3 24-hour Holter Monitoring 100% of Actual Cost subject to MBL
4 Adrenocortical Function 100% of Actual Cost subject to MBL
Anti-Nuclear Antibody, C-Reactive Protein, Lupus
5 100% of Actual Cost subject to MBL
Cell Exam
6 Arterial Blood Gas 100% of Actual Cost subject to MBL
7 Arthroscopic Procedures, Orthopedic Arthroscopy 100% of Actual Cost subject to MBL
8 Audiograms and Tympanograms 100% of Actual Cost subject to MBL
9 Bone Densitometry Scan (Dexascan) 100% of Actual Cost subject to MBL
10 Bone Mineral Density Studies 100% of Actual Cost subject to MBL
Cardiac Stress Tests (Thallium and Dipyridamole
11 100% of Actual Cost subject to MBL
Stress Tests)
12 Computed Tomography (CT) Scans 100% of Actual Cost subject to MBL
13 Diagnostic Radiographs:
a. Biliary tract: Cholecystogram and
100% of Actual Cost subject to MBL
Cholangiogram
b. Chest, ribs, sternum and clavicle 100% of Actual Cost subject to MBL
c. Digestive: Plain film of the abdomen, Barium
Enema, Upper Gastrointestinal (GI) Series, Lower 100% of Actual Cost subject to MBL
GI Series, Small Bowel series
d. Face (including sinuses), Head and Neck 100% of Actual Cost subject to MBL
e. Urinary: Kidney, Ureter and Bladder
100% of Actual Cost subject to MBL
(KUB)Pyelograms and Cystograms
f. X-ray of the extremities and pelvis 100% of Actual Cost subject to MBL
g. X-ray of the spine (cervical, thoracic, lumbo-
100% of Actual Cost subject to MBL
sacral)
14 Diagnostic Ultrasounds:
a. 2D-Echo with Doppler 100% of Actual Cost subject to MBL
b. Abdomen 100% of Actual Cost subject to MBL
c. Duplex Scan 100% of Actual Cost subject to MBL
d. Digestive and Urinary Systems 100% of Actual Cost subject to MBL
e. Ultrasound of the Lungs 100% of Actual Cost subject to MBL
15 Electroencephalogram (EEG) Monitoring 100% of Actual Cost subject to MBL
16 Electromyelography and Nerve Conduction Studies 100% of Actual Cost subject to MBL
17 Endoscopic Procedures 100% of Actual Cost subject to MBL
18 Fluorescein Angiography 100% of Actual Cost subject to MBL
19 Impedance Plethysmography 100% of Actual Cost subject to MBL
20 Magnetic Resonance Angiography (MRA) 100% of Actual Cost subject to MBL
21 Magnetic Resonance Imaging (MRI) 100% of Actual Cost subject to MBL
22 Mammogram and Sonomammogram 100% of Actual Cost subject to MBL
23 Myelogram 100% of Actual Cost subject to MBL
24 Nuclear Radioactive Isotope Scan 100% of Actual Cost subject to MBL
25 Pap's Smear 100% of Actual Cost subject to MBL
26 Perfusion Scan 100% of Actual Cost subject to MBL
27 Plasma Urinary Cortisol, Plasma Aldosterone 100% of Actual Cost subject to MBL
28 Polysomnograms (Sleep Recording) 100% of Actual Cost subject to MBL
29 Pulmonary Function Tests 100% of Actual Cost subject to MBL
30 Radioisotope Scans and Function Studies:
a. Cardiac 100% of Actual Cost subject to MBL
b. Gastrointestinal 100% of Actual Cost subject to MBL
c. Liver 100% of Actual Cost subject to MBL
d. Parathyroid Bone, Pulmonary (Perfusion/
100% of Actual Cost subject to MBL
Ventilation Lung Scans)
e. Renal 100% of Actual Cost subject to MBL
f. Thyroid Scans 100% of Actual Cost subject to MBL
g. Total Body Scans 100% of Actual Cost subject to MBL
31 Radionuclide Ventriculography 100% of Actual Cost subject to MBL
32 Surface Electromyography (SEMG) 100% of Actual Cost subject to MBL
33 Thallium Scintigraphy 100% of Actual Cost subject to MBL
34 Treadmill Stress Test (TMST) 100% of Actual Cost subject to MBL

E. THERAPEUTIC PROCEDURES
Up to six (6) sessions subject to MBL for OP;
1 Arthrocentesis
Up to MBL for IP
Continuous Positive Airway Pressure (CPAP)
2 Up to Php60,000 shared limit for OP and IP
titration for sleep study
3 Dialysis Up to MBL shared limit for OP and IP
4 Intravenous Chemotherapy Up to MBL shared limit for OP and IP
5 Oral chemotherapy Up to Php60,000 shared limit for OP and IP
Up to six (6) sessions subject to MBL for OP;
6 Phlebotomy
Up to MBL for IP
Shared limit of up to twelve (12)
Physical therapy / Occupational therapy excluding sessions/member/year subject to MBL for OP;
7 subspecialties such as cardiac rehabilitation, Up to MBL for IP
pulmonary rehabilitation and the like. Note: Therapy of one (1) body area shall be
considered as one (1) session
Up to six (6) sessions subject to MBL for OP;
8 Thoracentesis
Up to MBL for IP
9 Therapeutic Radiology:
a. Brachytherapy Up to MBL shared limit for OP and IP
b. Cobalt Up to MBL shared limit for OP and IP
c. Linear Accelerator Therapy Up to MBL shared limit for OP and IP
d. Radioactive Cesium Up to MBL shared limit for OP and IP
e. Radioactive Iodine Up to MBL shared limit for OP and IP

F. PREVENTIVE CARE
Passive and active vaccines for treatment of Up to Php18,000/member/year
1
tetanus and animal bites
2 Periodic monitoring of health problems Covered
Health-education and counseling on diets or
3 Covered
exercise
4 Health habits and Family Planning counseling Covered

G.ADDITIONAL PROCEDURES AND MODALITIES (shared limit for OP and IP; Professional Fees,
Hospital Bills and other incidental expenses relative to the procedure shall form part of the limit)
Angiography (gastrointestinal, brain, retinal and
1 100% of Actual Cost subject to MBL
peripheral vascular)
Coronary Angiogram and/or Angioplasty/Coronary 100% of Actual Cost subject to MBL (shared
2
Artery Bypass Graft limit)
3 Cryosurgery 100% of Actual Cost subject to MBL
4 Gamma Knife Surgery 100% of Actual Cost subject to MBL
5 Hysteroscopic Myoma Resection 100% of Actual Cost subject to MBL
6 Hysteroscopically-guided D&C 100% of Actual Cost subject to MBL
7 Laparoscopy 100% of Actual Cost subject to MBL
8 Lithotripsy 100% of Actual Cost subject to MBL
9 Percutaneous Ultrasonic Nephrolithotomy 100% of Actual Cost subject to MBL
10 Stereotactic Brain Biopsy 100% of Actual Cost subject to MBL
11 Conventional Hemorrhoidectomy 100% of Actual Cost subject to MBL
12 Scalpel Hemorrhoidectomy 100% of Actual Cost subject to MBL
13 Stapled Hemorrhoidectomy Up to Php5,000/member/year
14 Mammotome Up to Php5,000/member/year
15 4D Ultrasound except for maternity-related cases Up to Php5,000/member/year
16 Esophageal Manometry Up to Php5,000/member/year
17 Intensified Modulated Radiotherapy Up to Php5,000/member/year
Botox which is not cosmetic in nature nor for
18 Up to Php5,000/member/year
beautification purpose
19 Positron Emission Tomography (PET) Scan Up to Php5,000/member/year
20 CT Pulmonary Angiography Up to Php5,000/member/year
21 Photodynamic Therapy Up to Php5,000/member/year
Other medically necessary modalities not
mentioned above and those for which there are no
22 Up to Php5,000/procedure/member/year
comparable, conventional or traditional
counterparts
23 Transurethral Microwave Therapy of Prostate Up to Php25,000/member/year

H.EMERGENCY CARE
1 In Accredited Hospitals
a. Doctors services Subject to MBL
b. Emergency Room Fees Subject to MBL
c. Medicines used for immediate relief during
Subject to MBL
treatment
d. Oxygen, Intravenous fluids and blood products Subject to MBL
e. Dressings, conventional casts (plaster of Paris)
Subject to MBL
and sutures
f. X-Rays, laboratory and diagnostic examinations,
and other medical services related to the Subject to MBL
emergency treatment of the patient
g. Room Upgrade in case of room unavailability Up to 24 hours
Reimbursable up to 80% of hospital bills &
professional fees based on Maxicare rates
2 In Non-Accredited Hospitals
incurred during the first 24 hrs. of treatment up
to Php30,000/availment /member/year
Reimbursable up to 100% of actual cost up to
3 Outside the Philippines
Php30,000/availment/member/year
4 Areas without Accredited Hospital 100% based on Maxicare rates up to MBL
Ambulance Service (Accredited Hospital/Clinic to
5 Up to MBL
Accredited Hospital/Clinic)
Ambulance Service (Non-Accredited
6 Reimbursable up to Php2,500 per conduction
Hospital/Clinic to Accredited Hospital/Clinic)
Note: The ambulance service provided herein shall be available regardless of the location within the
Philippines.
Covered for the first 24 hrs. from the time of
7 Initial treatment of Animal bites bite subject to MBL

I. PRE-EXISTING CONDITIONS
1 Dreaded Conditions Covered
2 Non-Dreaded Conditions Covered

J. CONDITIONS WITH SPECIFIC LIMITATIONS


Work Related Conditions based on conditions
1 Up to MBL (For Principals only)
covered by ECC
2 Motor Vehicular Accidents Subject to MBL and exclusions and limitations
Provoked and Unprovoked Assault, including
3 domestic violence, whether initiated by the Up to MBL
Member or by a known or unknown third party
Up to Php20,000/member/year (shared limit for
Scoliosis including necessary procedures, except OP and IP)
4 physical therapy sessions, whether congenital, Note: Physical Therapy sessions shall form
pre-existing, developmental or acquired part of the Physical therapy/ Occupational
therapy limits.
Up to Php20,000/member /year (shared limit
for OP and IP)
Congenital Conditions except physical therapy
5 Note: Physical Therapy sessions shall form
sessions and developmental disorders
part of the Physical therapy/ Occupational
therapy limits.
Congenital Hernia Up to MBL
6 Chronic Dermatoses Consultations only
7 Scabies Consultations and treatments
8 Exclusion #25 Up to MBL
9 Hepatitis B except vaccines and screening Up to MBL (if acquired)

K. DENTAL CARE
1 Dental Provider Maxicare Dental Hub
2 Dental examination/consultation only Covered
3 Oral prophylaxis Covered - once a year
Uncomplicated tooth extraction (anterior tooth,
4 Covered
posterior tooth, )
5 Temporary filling Covered, as advised by Dentist
Desensitization of hypersensitive teeth (limited to
6 the application of necessary medicament to the up to 2 teeth
affected teeth)
7 Simple denture adjustment and repair Covered
Recementation of loose jacket crowns, bridges,
8 Covered
inlays and onlays
Palliative treatment for simple mouth sores and
9 Covered
blisters
10 Open incision and drainage (intraoral) Covered
11 Dental Nutrition and Dietary Counseling Covered
12 Dental Health Education Covered
13 Pre-natal consultation on teeth and gums Covered
14 Temporo Mandibular Joint Consultation Initial Consultation -Covered
15 Permanent Fillings 2 teeth per year

L. GROUP LIFE INSURANCE WITH ACCIDENTAL DEATH AND DISABLEMENT (AD&D) BENEFITS
The Philippine American Life & General
1 Insurance Provider
Insurance Company
2 Death (Amount of Insurance) Php25,000/member
3 Corporate Personal Accidental Death & Dismemberment (AD&D)
A. Schedule of Losses for AD&D Coverage
i.) Loss of Life 100% of amount of insurance
ii.) Accidental Dismemberment or Loss of Use
of Limbs
Both Hands 100% of amount of insurance
Both Feet 100% of amount of insurance
One hand and One foot 100% of amount of insurance
One hand 50% of amount of insurance
Arm between elbow and wrist 60% of amount of insurance
Arm at or above elbow 70% of amount of insurance
Leg below knee 60% of amount of insurance
Leg at or above knee 70% of amount of insurance
iii.) Loss of sight
Both eyes 100% of amount of insurance
One eye 50% of amount of insurance
iv.) Loss of speech 100% of amount of insurance
v.) Loss of hearing
Both ears 100% of amount of insurance
One ear 50% of amount of insurance
vi.) Accidental Dismemberment or Loss of Use
of Fingers
All of one hand 50% of amount of insurance
vii.) Accident Permanent Total Disability Benefit
3% of the amount of insurance (less any
Monthly cash benefit to an Insured member
amount paid or payable) starting on the 7th
who has been totally and permanently disabled for
month up to 32 months, and 4% of the amount
6 months due to accidental causes.
of insurance on the 33rd month.
viii.) Murder and Homicide
100% of amount of insurance (but not
Injury due to murder or any attempt thereof
exceeding 250,000)
Injury due to homicide or any attempt thereof not
100% of amount of insurance
occasioned by provocation of Insured member
ix.) Flying Coverage
Pays a benefit if the Insured member suffers an injury while a passenger boarding or alighting from a
certified passenger aircraft provided by a commercial airline on any regular, scheduled or non-
scheduled, special or chartered flight and operated by a properly certified pilot flying between duly
established and maintained airports over an established passenger route.
B. Renewal Bonus
Increases the original amount of insurance for Accident Insurance (up to the first P250,000) of the
Insured by 5% each year for the first five (5) consecutive years, starting on the second year.
4 Terminal Illness Benefit
A lump sum benefit of 50% of the applicable amount of insurance in-force up to a maximum of
P250,000 if the Insured member is medically diagnosed as terminally ill with a life expectancy of
twelve (12) months or less.
5 Exclusions
Any loss or expense caused by or resulting from the following will not be paid:
i.) Suicide during the first year
ii.) War, Invasion or Act of Foreign Enemy
iii.) Service in the Armed Forces of any country or international authority whether in peace or war.
6 General Guidelines
A. Eligibility Age
Life AD&D
Principals 18-65 years old 18-65 years old

M. EXCLUSIONS AND LIMITATIONS


Notwithstanding any provisions to the contrary, the following shall not be covered except otherwise
specified in the Benefits and Coverage:
Services obtained for non-emergency conditions from Physicians and Hospitals in any of the
following circumstances:
1 non-Accredited Physicians in non- Accredited Hospitals
non-Accredited Physicians in Accredited Hospitals
Accredited Physicians in non-Accredited Hospitals or other non-accredited healthcare
facility.
Additional hospital charges and physicians professional fees resulting from:
room-upgrading beyond Members allowable time during emergency care
extension of hospital stay despite release of discharge order from Members attending
physician
fees of the assistant surgeons / resident doctors who assisted the Attending Physician in the
process of rendering the medical services shall not be chargeable to the Member and/or
Maxicare except for hospitals that do not have resident physicians to assist during surgeries
subject to the prior approval of Maxicare
use of extra bed, TV, electric fan, DVD/ VCD, and other similar items unless such appliances
2 and items are necessarily and ordinarily included in the Members Room & Board
Accommodation
extra food
toilet articles like face towel, soap, toothbrush and the like
difference in room and board, the incremental rate differences for professional fees,
diagnostic and laboratory examinations, and other ancillary medical services brought about
by obtaining a room accommodation higher than the Members Room and Board
Accommodation limit
services of a private or a special nurse
all other items not medically necessary in the medical management of the patient.
3 Custodial, domiciliary, convalescent and intermediate care.
Long-term rehabilitation and psychiatric and/or psychological illnesses and conditions including
4
neurotic and psychotic behavior disorders; anxiety disorders.
Treatment for injury and its complications resulting from self-inflicted injuries including infections as a
5 result of tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party
or attempted suicide or self-destruction, whether sane or insane.
Developmental disorders including functional disorders of the mind, such as but not limited to
Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum
6
Disorders, Bipolar Disorders, Central Auditory Processing Disorder (CAPD), Cerebral Palsy, Down
Syndrome, Neural Tube Defects, and Mental Retardation.
Treatment of any injury received when there is negligence, unauthorized use of prohibited drugs or
regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime
7 whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent
danger, knowingly or unknowingly or hazard to health, by the Member. Maxicare may rely on the
Police or Doctor's report to evaluate such claim.
Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment for any beautification
8 purposes except if necessary to treat a functional defect due to accidental injury within the initial
confinement.
Oral surgery following accidental injury to teeth for purposes of beautification. Dental examinations,
extractions, fillings, other dental treatment and their complications except to the extent that are
9
medically necessary for repair or alleviation of damage to the Member caused solely by an accident.
Medical care resulting from any dental related conditions.
Maternity care and all other conditions (except pre and post natal consultations) related to and/or
10 resulting from pregnancy and/or delivery which affect the conditions of the Member and the unborn
child.
Circumcision (except for treatment of urological conditions), sex transformation, diagnosis, treatment
11 and procedures related to fertility or infertility, artificial insemination, sterilization or reversal of such
and their complications.
12 Experimental medical procedures and its complications.

13 Acupuncture, chirotherapy and other forms of therapies and its complications.


All expenses incurred in the process of organ donation and transplantation if the Member is the
14
donor of such donation or transplantation, and its complications.
Routine physical examinations required for obtaining or continuing employment, requirement in
15
school, insurance/travel or government licensing, health permit and other similar purposes
Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen except
16
during covered in-patient care
Corrective appliances, prosthetics and orthotics such as but not limited to eye glasses and contact
lenses, hearing aids, pacemaker, artificial limbs, valves, knee-tibial insert for total knee
17 arthroplasty, vascular grafts, titanium thread, myringotomy tube, intravascular catheters, vascular
stents, bone screws/plates, pins, wires, balloons, orthopedic internal fixator/fixation systems,
orthopedic external fixator/fixation systems, intraocular lens, braces, crutches
Take-home medicine and out-patient medicine except
18 chemotherapy medicine
medicine administered during an emergency treatment.
Congenital, genetic and hereditary diseases and their complications (except for hernias) affecting
19
functions of individuals.
20 All physical deformities prior to enrollment.
Treatment of injuries/illnesses caused directly or indirectly by engaging in any professional sport or
hazardous activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing,
21
rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and
bungee jumping, except for activities under company-sponsored sports activities.
22 Injuries resulting from direct participation in riots, strikes, and other civil disturbances.
Treatment of injuries or illnesses resulting from war or any combat-related activities while in military
23
service.
24 Sexually transmitted diseases, genital warts, AIDS and AIDS related diseases
Valvular heart disease (congenital and/or acquired) including Cardiomyopathies, Chronic
Glomerulonephritis, previous craniotomy sequelae/hearing impairment/ Neurologic disease and
Spinal Stenosis (if pre-existing)/Poliomyelitis/Slipped disc (if pre-existing) and Guillain-Barre
25
Syndrome, Diabetes and its complications (if pre-existing), Complicated Hypertension (e.g. those
with history of stroke, myocardial ischemia or infarction and poor kidney function), and all malignant
tumors (if pre-existing)
26 Treatment for chronic dermatoses.
Infectious diseases (i.e. Avian Flu, Meningococcemia, etc.) that are declared epidemic or pandemic
27
by the Department of Health, World Health Organization or any recognized health authority.
28 Pre-existing Hepatitis B and screening and vaccines for all types of Hepatitis.

29 Animal bite/scratch/lick or snake bite including its complications.


Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided
30
for by law.
31 Laser procedures/treatments.

32 Speech therapy for developmental and congenital diseases.


Weight reduction programs, surgical operation or procedure for treatment of obesity, including gastric
33
stapling or balloon procedures and liposuction.
Routine, diagnostic, therapeutic and other procedures of the same or similar nature not otherwise
34
specified in this Agreement.
35 Cost of vaccines for immunization including its administration.

36 Cost of medico-legal cases.

37 All screening tests.

38 Intravenous Immunoglobulin (IVIG).


Treatment of work-related injuries of high-risk occupations such as but not limited to construction
39
workers, miners, loggers and drillers.
40 Cost of the medical services and professional fees in excess of the MBL.