Dear Valued Hospital Partners,

Thank you for your continued dedication and expertise in providing quality care to our clients. We are introducing some updates to our day surgery processes to improve care and efficiency for our clients.

Why Day Surgery Matters

Daycare surgeries offer a cost-effective alternative to the conservative inpatient procedures, allowing patients to receive necessary medical care without the need for extended hospital stays. This approach not only helps manage medical expenses but also promotes quicker recovery times and improve the patient outcomes.

Optimised Coverage and Processes

To support the effort of promoting Day Surgery, we are pleased to announce an update on day surgery coverage and our day surgery claim process.

• Expanded List of Covered Day Surgeries

To further support this initiative, we have expanded the list of covered day surgeries, allowing the doctors more opportunities to provide exceptional care to our customers. Please refer to Appendix 1 below for our latest listing of daycare surgeries procedures.

• Revised Cashless Facility Process

Procedures that are commonly performed as day surgeries will now be issued as "Daycare Initial Pre-Authorization Letter (IPAL)" rather than inpatient IPAL effective 2nd January 2025. For cases requiring more than a day admission, the attending doctor must provide additional justification for it. Without this justification or if the additional days are not medically justifiable based on the client’s benefit terms and condition, we will only cover the first day, and the rest of the charges will be excluded from the coverage.

Additionally, we may need to withhold the Final Authorization Letter for further review. The claims team will specify the ‘non-payable amount’ that the hospital should collect from the patient.

We believe that these changes will ensure our patients benefit from the most advanced and efficient care options available. We appreciate your cooperation and support in this initiative.

Should you have any questions or require further information, please do not hesitate to contact us at Medical Management Hotline: 03-2778 3872.

Appendix 1 - List of Day Surgery Procedure

Endoscopy

1. Diagnostic Bronchoscopy with/without Biopsy

2. Gastroscopy with/without Biopsy

3. Manometry and pH study

4. Colonoscopy with/without Biopsy/ Proctoscopy/Sigmoidoscopy

5. Endoscopic Ultrasound with/without Biopsy

General Surgery

1. Excision of Breast Lump

2. Excision Biopsy of Lump (All types)

3. Haemorrhoidectomy

4. Removal of ganglion / fibroma

5. Needle biopsy/aspiration/FNAC

Ear, Nose, & Throat

1. Myringotomy and grommet insertion

2. Oesophagoscopy/Laryngoscopy/microlaryngoscopy with/without biopsy

3. Excision of Nasal Polyps

4. Suction Clearance including Removal of Foreign Bodies

5. Aural Polypectomy

6. Cautery

Ophthalmology

1. Excision of Chalazion/ pterygium/ eye/ eyelid lesions

2. Vitrectomy

3. Yag Iridotomy

4. Extraction of Cataract / Phaco-Emulsification with IOL

5. Correction of Squint (not related to congenital)

6. Corrective surgery for Blepharoptosis (not related to congenital /cosmetic)

7. Tear Duct Probing

8. Correction of entropion/ectropion/trichiasis

9. Eye injection

10. Glaucoma surgery

11. Retinal photocoagulation

Urology

1. Cystoscopy Examination with/without Biopsy

2. Extracorporeal Shock Wave Lithotripsy (ESWL)

3. Removal of DJ Stent

4. Ureteroscopy (URS) with/without Biopsy

5. Injection of substance into bladder

Vascular

1. Arterial Venous Fistula (AVF)

2. Endoveneous Laser Therapy (LA)/(GA)

3. Stripping of Varicose Vein (LA)/(GA)

4. Injection into Varicose Veins

Orthopaedic

1. Carpal Tunnel Syndrome Release/ Decompression (CTS) - Single/Bilateral

2. Release Trigger Finger

3. Excision of Dupuytren’s Contracture

4. Excision of Neuroma/ Ganglion / Giant Cell Tumour

5. Bunion Operations

6. Suture and Other Operations on Tendons and Tendon Sheath

7. Tenotomy

8. Intra-articular Injection (Day Care/ Clinic)

9. Partial or Complete Removal of Nails

10. Injection of Trigger finger

Gynaecology

1. Dilatation and Curettage /Hysteroscopy

2. Colposcopy with/without biopsy

3. Cone Biopsy, Punch Biopsy

4. Marsupialization / Excision of Bartholin's Gland

5. Diathermy / Cauterisation / Excision of lesions/polyps of cervix/vagina/vulva

Oral Surgery

1. Excision or Biopsy of Oral Lesions

Dermatology

1. Excision or Biopsy of Sebaceous Cysts / Local Skin Lesions/Warts (non-cosmetic)

Others

1. Insertion of Chemoport / Hickman Line (Oncology)

2. Chemoport Removal (Oncology)

3. Brachytherapy/Radiotherapy (Oncology)

4. Chemotherapy

5. Bone Marrow Aspiration and Biopsy

6. Hormonal or Non-hormonal therapy implant (subcutaneous/intramuscular)

Note: Please be informed that the procedures listed are PruBSN’s recommendation only. The decision and necessity for any in-hospitalisation management shall be at the discretion of the attending Doctor.

1. This list is available on PruBSN corporate website. This list is non-exhaustive, and it will be subject to revision at the discretion of Prudential BSN Takaful Berhad, from time to time.

2. Coverage is subject to certificate holder benefit entitlement, which is based on their certificate benefit, coverage and exclusions.