2019 Vmware Taiwan

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2019 VMware Taiwan

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POLICY DESCRIPTION ...... 4

1. BENEFIT PLAN ...... 4 2. ELIGIBILITY RESTRICTIONS ON THE INSURED ...... 5 3. EFFECTIVE DATE ...... 5 4. PROCEDURES FOR ENROLLMENT AND CHANGE OF THE COVERAGE 5 5. PROTECTION FOR NEW FAMILY MEMBERS: ...... 6 6. END OF EFFECTIVENESS OF THE PLAN ...... 6 7. INSURANCE PREMIUM ...... 6 8. BENEFICIARIES ...... 6 9. INSURANCE INTEREST NON-TRANSFERABLE...... 6 10. DOCUMENTS REQUIRED TO BE SUBMITTED WITH AN APPLICATION FOR BENEFITS ...... 7 NEW TERM LIFE INSURANCE ...... 9

SCOPE OF COVERAGE ...... 9 BENEFIT ...... 9 EXCLUSIONS ...... 9 THE APPLICATION OF THE INDEMNITY ...... 10 ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE ...... 12

SCOPE OF COVERAGE ...... 12 PAYMENT OF DEATH BENEFITS OR FUNERAL EXPENSE BENEFITS ... 12 PAYMENT OF DISABILITY BENEFITS ...... 12 PAYMENT OF SEVERE BURN BENEFITS ...... 25 LIMITATIONS ON INSURANCE PAYMENT ...... 27 EXCLUSIONS ...... 27 EXCLUSIONS ...... 28 THE APPLICATION OF THE INDEMNITY ...... 28 ACCIDENTAL MEDICAL REIMBURSEMENT ...... 30

SCOPE OF COVERAGE ...... 30 PAYMENT OF PERSONAL INJURY MEDICAL BENEFITS ...... 30 EXCLUSIONS (CAUSES) ...... 30 EXCLUSIONS ...... 31 APPLICATION FOR INSURANCE BENEFITS ...... 31 DESIGNATION AND CHANGE OF BENEFICIARY ...... 31

DREAD DISEASE INSURANCE (NEW DEFINITIONS) (INCLUDE -2- DEATH) ...... 33

SCOPE OF COVERAGE ...... 33 BENEFIT ...... 33 PAYMENT OF TOTAL DISABILITY BENEFITS ...... 35 EXCLUSIONS ...... 36 THE APPLICATION OF THE INDEMNITY ...... 36

HOSPITAL & SURGICAL INSURANCE...... 38

DEFINITION OF TERMS ...... 38 SCOPE OF COVERAGE ...... 38 BENEFIT ...... 38 EXCLUSIONS ...... 42 THE APPLICATION OF THE INDEMNITY ...... 44 SURGERY ALLOWANCE ...... 46

DEFINITION OF TERMS ...... 46 PAYMENT OF SURGICAL BENEFITS ...... 46 EXCLUSIONS ...... 47 BURN UNIT BENEFITS ...... 96

PAYMENT OF BURN UNIT BENEFITS ...... 96 NO WAITING PERIOD GROUP HEALTH ENDORSEMENT...... 97

DEFINITION OF TERMS ...... 97 CANCER INSURANCE ...... 98

DEFINITION OF TERMS ...... 98 SCOPE OF COVERAGE ...... 98 BENEFIT ...... 99 EXCLUSIONS ...... 100 THE APPLICATION OF THE INDEMNITY ...... 100 RESTRICTIONS ON CANCER DIAGNOSIS CERTIFICATES AND HANDLING OF DOUBT CONCERNING A CANCER DIAGNOSIS ...... 101 APPENDED TABLE:...... 101

CANCER RADIATION THERAPY BENEFITS ...... 103

PAYMENT OF CANCER RADIATION THERAPY BENEFITS ...... 103

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POLICY DESCRIPTION 1. Benefit Plan Plan Spouse Employee Coverage Children New Term Life 22*BMS X

Dread Disease 6*BMS X

Accidental Death & Dismemberment 22*BMS X

Accidental Medical Reimbursement 10,000 10,000 Hospital & Surgical Daily Hospital Room 2,500 2,500 Inpatient Hospitalization 100,000 100,000 ICU Room 2,500 2,500 Pre- and Post-Hospitalization Outpatient 800 800 General Outpatient 650 650 Burn Room 2,500 2,500 Surgery Allowance 500 500 Cancer Cancer Inpatient Hospitalization 2,000 2,000 Cancer Surgery 60,000 60,000 Cancer Post-Hospitalization Convalescence 2,000 2,000 Cancer Outpatient Medical 1,000 1,000 Cancer radiotherapy 2,000 2,000

-4- 2. Eligibility Restrictions on the Insured 1. Employee of the company and his or her dependents may participate in the insurance. 2. The maximum age restrictions for enrollment in the insurance and renewal of the insurance are as follows: (1) Employee and spouse: Illness insurance: insurable from ages 15 to 65; renewable to age 70. Accident insurance: insurable from ages 15 to 70; renewable to age 75. (2) Children: insurable from the time of discharge in normal healthy condition from the hospital following birth to age 23; renewable to 23 years (age last birthday). 3. Effective Date The effective date of this plan is Jan 01, 2019. Present Employees--If any employee applies on or before the effective date of the plan, his coverage begins on that day. New Employees--The group insurance coverage of new employee shall be effective from the starting date that the new entrants are employed (ex. on the day of new entrants’ employment).

4. Procedures for Enrollment and Change of the Coverage 1. Enrollment: (1) The procedures for enrollment are complete when the Company has completed the enrollment information form and notified the insurance company. (2) The underwriting conditions such as of the following: Item Underwriting New Term Life and Dread Disease Provide Statement of Health sum insured more than 10 million (3) The information and materials above will take effect only after they have passed underwriting review by the insurance company.

2. Withdrawal or change: The procedures for withdrawal or change of coverage are complete when the Company has completed the withdrawal information form or change of coverage information form and related materials and notified the insurance company.

-5- 5. Protection for New Family Members: A new family member is eligible for protection from the date that family member status is obtained.

6. End of Effectiveness of the Plan 1. If any of the following circumstances applies to the employee, the insurance contract shall thereupon be terminated: (1) When the Insurance is terminated. (2) When the employee retires or departs from employment. (3) The premium ceases to be paid. (4) The employee himself or herself has reached age 75.

2. If any of the following circumstances applies to the dependents, the insurance contract shall thereupon be terminated: (1) When the Insurance is terminated. (2) When the effectiveness of the enrollment at company expense is terminated. (3) The employee or spouse has reached age 75. (4) Child: has reached 23 years (age last birthday).

7. Insurance premium The premiums for all kinds of coverage are borne in full by the Company.

8. Beneficiaries Beneficiary should follow Labor Standards Acts.

9. Insurance Interest Non-Transferable 1. Interests arising from the Insurance to an employee enrolled in this plan may not, in whole or in part, be transferred or used to offset any debt for which the employee is liable. 2. If there is any change in the insured status of the employee enrolled in this plan (e.g. marriage, birth of a child), please promptly take the initiative to notify the responsible person in the human resources department, so that timely enrollment can be done to protect your interests.

-6- 10. Documents Required to Be Submitted With an Application for Benefits 1. The proposer, insured, or beneficiary shall notify the insurance company within 10 days from becoming aware of an insured event or from the date the hospitalization of the insured began. 2. A right of claim for insurance benefits shall be extinguished if not exercised within two years from the date on which the claim may be asserted. 3. When a beneficiary applies for benefits, the insurance company may, when necessary, make inquiries regarding the insured, and with the beneficiary’s consent, may requisition information related to the insured's medical treatment, and the insurance company shall be liable for any expense thereby incurred.

-7- 【Documents Required to Be Submitted With a Claim】

Critical illness / first cancer Critical of illness instance hospitalization)Bonefracture allowance (without disappearance accidentalDisappearance / Claim relating to Medical Death Disablement treatment

Death from illness / cancer Deathfrom illness Accidental death Total burns / major Partialdisability Treatment / hospitalization for injury Cancer treatment

disability

Documents to be submitted

Claim application         

Death certificate   Autopsy certificate  household registration certificate from which the    insured's name has been struck Beneficiary's proof of identity     

Certificate of diagnosis / certificate of diagnosis of       disability (disability) Originals of receipts and   itemized statement of expenses Biopsy report / test reports  

Documentation of the       accidental injury event

X-rays 

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New Term Life Insurance Scope Of Coverage If the insured suffers permanent total disability or dies during the effective period of this Contract, the Company will pay insurance benefits as stipulated in this Contract. For the purposes of this Contract, "permanent total disability" means any of the permanent total disability degrees listed in the attached Schedule and incurred by an insured during the effective period of this Contract.

Benefit Payment Of Death Benefits Or Funeral Expense Benefits If during the effective period of this Contract, an insured event occurs that results in the death of the insured, the Company will pay death benefits according to the insured amount.

Payment Of Total Disability Benefits If, during the effective period of this Contract, an insured incurs permanent total disability of a degree set out in the attached Schedule, the Company will pay "total disability benefits" according to the insured amount.

When an insured simultaneously suffers two or more types of permanent total disability of a degree set out in the attached Schedule, the Company shall pay only one type of "total disability benefits".

Exclusions The Company will not be liable for payment of insurance benefits in any of the following circumstances: 1. The proposer deliberately causes or attempts to cause the death of the insured. 2. The insured deliberately commits or attempts suicide, or causes his or her own permanent total disability, provided that if, after two years of continuous enrollment in the insurance, the insured deliberately commits suicide resulting in death, the Company will be liable for payment of death benefits. 3. The insured is executed for a crime or dies or incurs permanent total disability as a result of resisting arrest or escaping from incarceration. If an insured incurs permanent total disability under a circumstance of the

-9- preceding paragraph, the Company will pay the total disability benefits. 4.A beneficiary that deliberately causes the death of the insured, or attempts unsuccessfully to do so, loses the right to benefits.

If, as a result of a beneficiary's loss of the right to benefits under circumstances set out in the preceding paragraph, there is no beneficiary to receive the insured amount, the insured amount shall be paid to the insured's estate. If there is another beneficiary or beneficiaries, after the portion to which the beneficiary who lost his or her right to benefits was originally entitled is calculated as originally stipulated, that portion shall be apportioned to the other beneficiary or beneficiaries.

The Application of the Indemnity A. Application for Death Benefits And Funeral Expense Benefits A beneficiary applying for "death benefits or funeral expense benefits" shall submit the following documents: 1. The insured's death certificate and household registration certificate from which the insured's name has been stricken. 2. Application for insurance benefits. 3. Proof of the beneficiary's identity.

B. A beneficiary applying for "total disability benefits" shall submit the following documents: 1. Certificate of diagnosis of disability. 2. Application for insurance benefits. 3. Proof of the beneficiary's identity.

When a beneficiary applies for "total disability benefits," the Company may require the insured to undergo a physical examination. When necessary the Company may, with the beneficiary's consent, also requisition, at the Company's expense, information regarding the insured's medical treatment.

Upon payment by the Company of total disability benefits as stipulated in this Article, the insurance coverage of the insured will automatically be terminated.

-10- Schedule: Item Degree of Permanent Total Disability 1. Bilateral blindness. (Note 1) Loss of wrist joints of both upper limbs or ankle joints of both 2. lower limbs. Loss of wrist joint from one upper limb and loss of ankle joint 3. from one lower limb. Blindness in one eye and loss of wrist joint of one upper limb, 4. or blindness in one eye and loss of ankle joint of one lower limb. Permanent loss of mastication (Note 2) or speech (Note 3) 5. function. 6. Permanent total loss of function of all four limbs. (Note 4) Severe residual impairment of central nervous system function or severe residual impairment of thoracic/abdominal organ 7. function resulting in a life-long inability to engage in work of any kind and requiring regular medical treatment and nursing care or professional comprehensive care. (Note 5)

Notes: 1. Determination of blindness (1) The International Vision Screening Chart will be used to test the corrected vision of each eye independently. (2) Blindness means that vision permanently tests at or below 0.02 using the International Vision Screening Chart. (3) Determination will in principle be made after 6 months of treatment from the date of injury, provided that this provision shall not apply where there has been surgical removal of the eyeball or other conditions from which recovery is clearly not possible. 2. Loss of mastication function means organic or functional impairment resulting in an inability to perform chewing motions such that nothing other than a liquid diet may be ingested. 3. Loss of speech function means the inability to constitute sounds three or more of the four speech functions that constitute speech: labial, dental, palatal, and laryngeal. 4. Permanent and total loss of function means complete loss of function that continues after 6 months. 5. Total reliance on the assistance of others to perform daily activities necessary to maintain life due to severe neurological impairment. -11- Accidental Death & Dismemberment Insurance Scope of Coverage If during the effective period of this Contract the insured suffers an accidental injury event resulting in bodily injury that leads to disability, severe burns, or death, the Company will pay insurance benefits as stipulated in this Contract.

"Accidental injury event" in the preceding paragraph means an unforeseen external event not caused by illness.

Payment of Death Benefits or Funeral Expense Benefits If, during the effective period of this Contract, an insured suffers an accidental injury event as stipulated and consequently dies within 180 days from the date of the event's occurrence, the Company will pay death benefits according to the insured amount of the insured, provided that if the insured dies after 180 days has elapsed, and the beneficiary can prove a cause-and-effect relationship between the death of the insured and the accidental injury event, the restriction shall not apply.

Payment of Disability Benefits 1. If, during the effective period of this Contract, an insured incurs an accidental injury event stipulated resulting in any degree of disability listed in the attached Schedule within 180 days from the date of the event's occurrence, the amount of disability benefits paid by the Company will be calculated based on the payment rate listed in the Schedule, provided that if the disability is incurred after 180 days has elapsed and the beneficiary is able to prove a cause-and-effect relationship between the insured's disability and the accidental injury event, the restriction does not apply.

2. When, as a result of the same accidental injury event, the insured incurs two or more of the disability degrees listed in the attached Schedule, the sum of all of those disability benefits to be paid by the Company shall be limited to not more than the insured amount. However, when different disability items occur in the same arm or the same leg, disability benefits will be paid for only one item; if the disability items are of different disability levels, disability benefits will be paid for the more severe item. -12-

3. If a disability resulting from the present accidental injury event, when combined with a previous disability (including disabilities existing prior to the establishment of this Contract), entitles the insured to claim for disability benefits for a more severe item listed in the attached Schedule, the Company will pay disability benefits for the more severe item, provided that disability benefits for the previous disability will be deemed to have been paid and shall be deducted.

Under the circumstances set out in the preceding paragraph, if the amount of the insurance benefits that the insured is entitled to receive after deduction of the previous disability is lower than the amount that may be claimed for the disability attributable to the present accidental injury event, the stipulations for combination of disabilities shall not apply.

When, during the effective period of this Contract, an insured applies for disability benefits due to different accidental injury events, the cumulative amount of payments by the Company will be limited to not more than the insured amount.

Schedule of Degrees of Disability and Benefit Payments Sub- Disability Benefit Main Items Degree of Disability Items level Rate Severe residual impairment of central nervous system function, including permanent vegetative state or tracheotomy with respiratory ventilator, with permanent inability to 1-1-1 work, total dependence on the 1 100% assistance of others for daily activities necessary to sustain life, 1. and requiring regular medical 1.Nervo Neurological treatment and nursing care or us impairment dedicated comprehensive care. system A high degree of residual impairment of central nervous system function, requiring a long-term bed stay or with the inability to turn oneself in bed, 1-1-2 2 90% resulting in a permanent inability to work and requiring the assistance of others for some of the daily activities necessary to sustain life.

-13- Significant residual impairment of central nervous system function resulting in a permanent inability 1-1-3 3 80% to work, while retaining the ability to independently perform daily activities necessary to sustain life. Residual impairment of central nervous system function with medically verifiable localized, 1-1-4 residual, persistent neurological 7 40% symptoms and a significant reduction in normal capacity for labor. Residual impairment of central nervous system function with medically verifiable localized, 1-1-5 11 5% residual, persistent neurological symptoms which usually do not interfere with labor. 2-1-1 Bilateral blindness. 1 100% Bilateral vision loss to level 0.06 or 2-1-2 5 60% lower. Bilateral vision loss to level 0.1 or 2-1-3 7 40% lower. Visual Blindness in one eye with vision 2. Eyes impairment 2-1-4 loss in that eye to level 0.06 or 4 70% (Note 2) lower. Blindness in one eye with vision 2-1-5 loss to that eye to level 0.1 or 6 50% lower. 2-1-6 Blindness in one eye. 7 40% Total loss of the eardrums in both Hearing 3-1-1 ears, or hearing loss of 90 5 60% 3. Ears impairment decibels or greater. (Note 3) Hearing loss in both ears of 70 3-1-2 7 40% decibels or greater. Loss and Nasal defect resulting in functional 4. Nose 4-1-1 permanent, residual, significant 9 20% impairment impairment of nasal function. (Note 4) Mastication, Permanent loss of mastication, 5-1-1 1 100% swallowing, swallowing, or speech function. 5. and speech Permanent, residual, significant Mouth function 5-1-2 impairment of mastication, 5 60% impairment swallowing, or speech functions.

-14- Permanent, residual, significant impairment of mastication, 5-1-3 7 40% swallowing, or speech articulation function. Residual, severe impairment of thoracic or abdominal organ function resulting in permanent 6-1-1 inability to engage in work of any 1 100% kind, and requiring regular medical treatment and nursing care or professional comprehensive care. Residual, severe impairment of thoracic or abdominal organ function Thoracic or resulting in permanent inability to abdominal 6-1-2 2 90% engage in work of any kind, and organ requiring the assistance of others in function 6. normal daily activities. impairment Thoraci Residual, significant impairment of (Note 6) thoracic or abdominal organ c/ abdomi function resulting in permanent nal 6-1-3 inability to engage in work of any 3 80% organs kind, but still able to perform normal daily activities independently. Residual, significant impairment of thoracic or abdominal organ function 6-1-4 7 40% resulting in permanent inability to engage in work of any kind. Resection of one-half or more of Organ 6-2-1 9 20% any major organ. resection 6-2-2 Resection of the spleen. 11 5% Bladder Total loss of bladder function with function 6-3-1 3 80% no artificial bladder implant. impairment Impairment Permanent, residual, significant of spinal 7-1-1 impairment of spinal column 7 40% 7. Trunk column mobility. mobility Permanent, residual impairment of 7-1-2 9 20% (Note 7) spinal column mobility. Loss of the wrist joints of both 8-1-1 1 100% upper limbs. Loss or Loss of two or more major joints impairment 8. 8-1-2 (including shoulder, elbow, and 5 60% of upper Upper wrist joints) of one upper limb. limbs limbs Loss of the wrist joint of one upper 8-1-3 6 50% limb. Finger loss Loss of all ten fingers of both 8-2-1 3 80% or hands. -15- impairment 8-2-2 Loss of the thumbs of both hands. 7 40% (Note 8) 8-2-3 Loss of all five fingers of one hand. 7 40% Loss of a total of four fingers of 8-2-4 one hand, including the thumb and 7 40% index finger. Loss of the thumb and index finger 8-2-5 8 30% of one hand. Loss of a total of three or more 8-2-6 fingers from one hand including 8 30% the thumb or index finger. two fingers from one hand, 8-2-7 9 20% including the thumb. Loss of the thumb from one hand, 8-2-8 or loss of the index finger from one 11 5% hand. Loss of a total of two fingers; either the thumb of one hand and 8-2-9 index finger of one hand, or the 11 5% thumb of one hand and any other finger other than an index finger. Permanent loss of function in the 8-3-1 shoulder, elbow, and wrist joints of 2 90% both upper limbs. Permanent loss of function in two major joints (including the 8-3-2 3 80% shoulder, elbow, and wrist joints) in each of the two upper limbs. Permanent loss of function in one major joint (including the shoulder, 8-3-3 6 50% elbow, and wrist joints) in each of the two upper limbs. Impairment Permanent loss of function in the of upper limb 8-3-4 shoulder, elbow, and wrist joints of 6 50% function one upper limb. (Note 9) Permanent loss of function in two major joints (including the 8-3-5 7 40% shoulder, elbow, and wrist joints) of one upper limb. Permanent loss of function in one major joint (including the shoulder, 8-3-6 8 30% elbow, and wrist joints) of one upper limb. Permanent, residual, significant impairment of mobility of the 8-3-7 4 70% shoulder, elbow, and wrist joints of both upper limbs.

-16- Permanent, residual, significant impairment of mobility in two major 8-3-8 joints (including the shoulder, 5 60% elbow, and wrist joints) of each of the two upper limbs. Permanent, residual, significant impairment of mobility in one 8-3-9 major joint (including the shoulder, 7 40% elbow, and wrist joints) of each of the two upper limbs. Permanent, residual, significant impairment of mobility in the 8-3-10 7 40% shoulder, elbow, and wrist joints of one upper limb. Permanent, residual, significant impairment of mobility in two major 8-3-11 8 30% joints (including the shoulder, elbow, and wrist joints) of one upper limb. Permanent, residual impairment of 8-3-12 mobility in the shoulder, elbow, and 6 50% wrist joints of both upper limbs. Permanent, residual impairment of 8-3-13 mobility in the shoulder, elbow, 9 20% and wrist joints of one upper limb. Permanent loss of function in all 8-4-1 5 60% fingers of both hands. Permanent loss of function in the 8-4-2 8 30% thumbs of both hands. Permanent loss of function of all 8-4-3 8 30% five fingers of one hand. Permanent loss of function in a total of four fingers on one hand, 8-4-4 8 30% including the thumb and index Impairment finger. of finger Permanent loss of function in the function 8-4-5 thumb and index finger of one 11 5% (Note 10) hand. Permanent, total loss of function in three or more fingers of one hand 8-4-6 9 20% including the thumb and index finger. Permanent loss of function in a total of three or more fingers on 8-4-7 10 10% one hand including the thumb or index finger and any other fingers. 9. Loss or Loss of ankle joints of both lower 9-1-1 1 100% Lower impairment limbs.

-17- limbs of lower Loss of two or more major joints limbs 9-1-2 (from among the hip, knee, and 5 60% ankle joints) of one lower limb. Loss of the ankle joint of one lower 9-1-3 6 50% limb. Impairment Permanent shortening of one by 9-2-1 lower limb by 5 centimeters or 7 40% shortening more. (Note 11) Impairment 9-3-1 Loss of all 10 toes of both feet. 5 60% by loss of toes 9-3-2 Loss of all five toes of one foot. 7 40% (Note 12) Permanent loss of function in the hip, 9-4-1 knee, and ankle joints of both lower 2 90% limbs. Permanent loss of function in two main joints (from among the hip, 9-4-2 3 80% knee, and ankle joints) of both of the lower limbs. Permanent loss of function in one main joint (from among the hip, knee, 9-4-3 6 50% and ankle joints) of each of the two lower limbs. Permanent loss of function in the 9-4-4 hip, knee, and ankle joints of one 6 50% lower limb. Permanent loss of function in two major joints (from among the hip, 9-4-5 7 40% Impairment knee, and ankle joints) of one of lower limb lower limb. function Permanent loss of function of one major joint (from among the hip, 9-4-6 8 30% knee, and ankle joints) of one lower limb. Permanent, residual, significant impairment of mobility in the hip, 9-4-7 4 70% knee, and ankle joints of both lower limbs. Permanent, residual, significant impairment of mobility of two or 9-4-8 more major joints (from among the 5 60% hip, knee, and ankle joints) of both lower limbs. Permanent, residual, significant impairment of mobility of one major 9-4-9 7 40% joint (from among the hip, knee, and ankle joints) of both lower limbs. -18- Residual, permanent, significant impairment of mobility in the hip, 9-4-10 7 40% knee, and ankle joints of one lower limb. Permanent, residual, significant impairment of mobility in two major 9-4-11 8 30% joints (from among the hip, knee, and ankle joints) of one lower limb. Permanent, residual impairment of 9-4-12 mobility in the hip, knee, and ankle 6 50% joints of both lower limbs. Permanent, residual impairment of 9-4-13 mobility of the hip, knee, and ankle 9 20% joints of one lower limb. Impairment Permanent loss of function of all 9-5-1 7 40% of toe toes of both feet. function Permanent loss of function of five 9-5-2 9 20% (Note 14) toes of one foot. Note 1: 1-1. When determining the level of neurological impairment, there must be materials serving as the basis of the determination, i.e., a certificate of diagnosis from a specialist physician, such as a psychiatrist, neurologist, neurosurgeon, or rehabilitative therapy physician, along with a relevant examination report (such as a Mini Mental State Examination (MMSE), modified Rankin Scale (mRS), Clinical Dementia Rating (CDR), neuro-electrophysiological test report, neuroimaging examination report, and a corresponding diagnostic examination report). When necessary, the insurer may separately designate a specialist physician to conduct a joint determination. (1) "Daily activities necessary to sustain life" refers to food intake, urinating and defecating, dressing and undressing, performing daily activities, walking, and bathing. (2) If focal symptoms such as aphasia, agnosia, or apraxia, or significant impairment such as quadriplegia, extrapyramidal symptoms (EPS), memory impairment, sensory impairment, affective disorder, lack of motivation, or personality change exist; or where there is low level paralysis and, although physical capabilities are still present, there is an inability to carry out work without receiving instructions from another in close proximity: Level 3. (3) Central nervous system impairment such as low level paralysis involving pyramidal and extrapyramidal symptoms, and mild brain atrophy or brain wave abnormalities only verifiable as central nervous system impairments based on imaging examinations. Such symptoms must be determined based on the examination and diagnostic results of a specialist physician. (4) If symptoms of central nervous system degeneration present as functional impairment in other than the central nervous system, the level shall be determined based on the location in which the functional impairment is discovered. If multiple impairments are simultaneously present, one symptom shall be chosen from among the entire complex of symptoms as the basis for determining the level of impairment; if the levels of symptoms are different,

-19- 1-2. Determination of the level of "balance function impairment and hearing impairment": when a head injury leads to concurrent hearing and balance function impairments, the impairment status of both conditions must be considered to determine the impairment level. 1-3. Determination of the level of impairment in "traumatic epilepsy": the determination shall take into account whether the onset of seizures or repeated seizures leads to personality changes such as dementia, personality disorder, or results in epileptic psychosis, and the determination shall be made in accordance with the guidelines in Note 1-1. During periods of epilepsy, the patient shall be treated by a specialist physician. When the specialist does not expect medical treatment to be effective, and or when symptoms are stable due to treatment, regardless of the type of epilepsy, the determination shall be based on the following standards: (1) Even with sufficient treatment, the frequency of onset is still once a week or more: Level 3. (2) Even with sufficient treatment, the frequency of onset is still once a month or more: Level 7. 1-4. Determination of the level of vertigo and balance function disorders: vertigo and balance function disorders caused by head trauma or central nervous system damage are not solely caused by inner ear impairment. Numerous cases have been discovered that are the result of central nervous system impairment of the cerebellum, brain stem, and frontal lobe. Determination standards are as follows: (1) It is still possible to perform normal daily activities necessary to sustain life, but there is a lifelong inability to engage in work of any kind due to severe balance function disability: Level 3. (2) If due to a moderate balance function disability the ability to engage in physical labor is clearly lower than the average person: Level 7. 1-5. Determination of the level of "traumatic spinal cord injury": according to the degree of damage, if there is discovered impairment of mobility of limbs etc., sensory impairment, intestinal impairment, urinary tract impairment, genital organ impairment, etc., select the appropriate level in accordance with the principals in Note 1-1 based on the overall symptoms. 1-6. Determination of the level of "carbon monoxide poisoning sequelae": in carbon monoxide poisoning sequelae, judge and determine the level of impairment based on the overall sequelae syndrome in accordance with the basic principles set out in the notes for determination of levels of mental or neurological impairment.

Note: 2: 2-1. For "vision" testing: (1) The International Vision Screening Chart is used to test vision after correction, provided that in cases where correction is impossible, naked vision testing may be used. (2) In testing visual impairment, passing an examination for malingering will be required when necessary. 2-2. "Blindness" refers to vision permanently testing at or below 0.02 using the International Vision Screening Chart, and includes loss or removal of the eyeballs, visual ability limited to distinguishing light from dark, distinguishing hand movements within 1 meter from the eyes, or distinguishing a certain number of fingers within 5 centimeters of the eyes.

-20- 2-3. Determination will in principle be made after six months of treatment from the date of injury, provided that this provision shall not apply where there has been surgical removal of the eyeball or other conditions from which recovery is clearly not possible.。

Note 3: 3-1. When the degree of hearing impairment in the two ears is different, determination shall be made based on the ear with the better hearing ability. 3-2. Testing of hearing impairment must be done by audiometer, and the average rate of hearing loss shall be expressed in decibels. 3-3. In the determination of balance function impairment resulting from inner ear injury, the levels prescribed for neurological impairment shall be applied mutatis mutandis to determine the level of impairment.

Note 4: 4-1. "Nasal defect" refers to a degree of defect of one-half or more of the nasal cartilage. "Permanent, residual, significant impairment of nasal function" means blockage of both nostrils, uncorrectable difficulty breathing through the nose, or complete loss of olfactory sense on both sides.

Note 5: 5-1. Impairment of mastication function refers exclusively to functional impairment due to causes other than the teeth (such as impairment of the cheek, tongue, hard or soft palate, jaw, or temporomandibular joint). Swallowing impairments due to causes such as esophagostenosis, anomaly of tongue, or pharyngolaryngeal neuroparalysis generally involve complications of impairment of mastication function, so the two kinds of impairment are jointly defined as "impairment of mastication or swallowing function." （1）Loss of mastication or swallowing function refers to organic impairment or functional impairment causing inability to chew or swallow, and inability to ingest or swallow anything but liquid foods. （2）"Residual, significant impairment of mastication or swallowing function" refers to inability to fully perform chewing or swallowing motions, and inability to ingest or swallow anything but porridge, gruel, or similar foods. 5-2. Speech function impairment refers to impairments such as apraxia, dysarthria, or asyllabia due to causes other than injury to the teeth: （1）"Loss of speech" function refers to the inability to constitute sounds in three or more of the four speech functions that constitute speech (labial, dental, palatal, and laryngeal, as listed below). （2）"Residual, significant impairment of speech function" refers to the inability to constitute sounds in two or more of the four speech functions that constitute speech (labial, dental, palatal, and laryngeal, as listed below). A. Bilabial: ㄅㄆㄇ (pronounced by both lips) B. Labiodental: ㄈ (pronounced by the lips and teeth) C. Apical: ㄉㄊㄋㄌ (pronounced by the tongue tip and gum) D. Velar: ㄍㄎㄏ (pronounced by the back of the tongue and soft palate)

-21- E. Lingua-palatal: ㄐㄑㄒ (pronounced by the blade of the tongue and the hard palate) F. Blade-palatals: ㄓㄔㄕㄖ (pronounced by the tongue tip and hard palate) G. Dentals: ㄗㄘㄙ (pronounced by the tongue tip and upper gum) 5-3. If due to residual, significant asyllabia another person will be unable to understand the person's meaning when expressed through speech only, the level prescribed for residual, significant impairment of speech function shall apply mutatis mutandis.

Note 6: 6-1. Thoracic or abdominal organs: （1）Thoracic organs, including the heart, pericardium, aorta, trachea and bronchi, lungs, pleura, and esophagus. （2）Abdominal organs, including the stomach, liver, gall bladder, pancreas, small and large intestines, mesenteric ganglion, and spleen. （3）Urinary organs refers to the kidneys, adrenal glands, ureters, bladder, and urethra. （4）Genital organs refers to the internal and external genital organs. 6-2.1 "Major organ" in "resection of one-half or more of any major organ" refers to the heart, lungs, esophagus, stomach, liver, pancreas, small or large intestine, kidney, adrenal gland, ureter, bladder, or urethra. 6-2.2 The standard for determination of "one-half or more," as used above, shall be hemi-resection, with respect to a symmetrical organ, and resection of two lobes with respect to the lungs. 6-3. Determination of the level of thoracic or abdominal organ impairment: for residual impairment of thoracic and abdominal organ function, it is necessary to weigh the overall symptoms and the permanent impact on daily life activities and needs for the assistance of others, make an overall determination of the level of impairment in accordance with the basic principles for determination of levels of neurological impairment. 6-4. "Complete loss of bladder function" means permanent elimination of urine through the abdominal wall or long-term catheterization (including permanent use of an ileal conduit or Koch pouch, or a ureterostomy).

Note 7: 7-1. When residual spinal column impairment is concurrent with neurological impairment, one symptom shall be chosen from among the entire complex of symptoms as the basis for determining the level of impairment; if the levels of symptoms are different, determination shall be made based on the more severe among them. 7-2. A diagnosis of impaired spinal column mobility may only be made by inspection of X-ray photographs. If there is a diagnosis of a clear bone fracture, dislocation, or deformation, examination and approval shall be based on the following: (1) "Residual significant impairment of mobility" means the fixation of 4 successive vertebral bodies in the spine and 3 intervertebral discs (inclusive) or more, with the loss of one-half or more of the physiological range of motion. (2) "Residual impairment of mobility" means the fixation of 4 successive vertebral bodies in the spine and 3 intervertebral discs (inclusive) or more, with the loss of one-third or more of the physiological range of motion. -22- (3) Non-apparent impairment of spinal mobility, or fixation of 3 successive vertebral bodies in the spine and 3 intervertebral discs (inclusive) or less, does not fall within the scope of compensation.

Note 8: 8-1. "Loss of fingers" refers to: (1) The severing of the thumb at the interphalangeal joint. (2) The severing of other fingers at the proximal interphalangeal joint. 8-2. If after the reattachment of fingers a permanent total loss of function persists, it is deemed severance. This rule also applies to toes. 8-3. When a big toe is amputated and attached to replace a thumb, if the severance of the thumb already constituted disability, it will still be deemed loss of a thumb even if full normal function is regained through the attachment, and the amputation of the big toe will be excluded from calculation. Note 9: 9-1. "Permanent loss of function in the shoulder, elbow, and wrist joints of one upper limb" refers to the total disability of one upper limb, e.g.: （1）Complete rigidity or complete paralysis of the shoulder, elbow, and wrist joints of one upper limb, and the permanent loss of function of all five fingers of that hand. （2）The complete rigidity or complete paralysis of the shoulder, elbow and wrist joints of one upper limb. 9-2. " Permanent, residual, significant impairment of mobility in the shoulder, elbow, and wrist joints of one upper limb" refers to significant impairment of mobility of all the joints of one upper limb, e.g.: （1）Permanent, residual, significant impairment of mobility of the shoulder, elbow, and wrist joints of one upper limb and the permanent loss of function of all five fingers of that hand. （2）Permanent, residual, significant impairment of mobility of the shoulder, elbow, and wrist joints of one upper limb. 9-3. Range of physiological movement is the standard for determining joint impairment, as follows: （1）"Loss of function" refers to a state of complete rigidity or complete paralysis of joints. （2）"Significant impairment of mobility" refers to loss of range of physiological movement by 1/2 or more. （3）"Impairment of mobility" means loss of range of physiological movement by 1/3 or more. 9-4. Testing of limitation of movement: （1）Testing is based on the range of physiological movement of each joint. When the cause and extent of the impairment in function (movement) is obvious, the range of physiological movement should be assessed by the range of active movement. When the cause and degree of the impairment is not obvious, then the range of physiological movement should assessed by reference to the probable range of passive movement. （2）The range of movement of patients in casts should be appropriately determined by taking into consideration the probable degree of subsequent recovery. 9-5. Please refer to the Diagram for the name of the upper and lower limb joints.

-23-

Note 10: 10-1. "Permanent loss of finger function" refers to: （1）In the thumb, loss of range of physiological movement by 1/2 or more in the metacarpophalangeal joint or interphalangeal joint. （2）In other fingers, loss of range of physiological movement by 1/2 or more in the metacarpophalangeal joint or proximal interphalangeal joint. （3）Severance of the distal phalanx of the thumb or other finger by 1/2 or more.

Note 11: 11-1. To determine the degree of shortening of a lower limb, the distances between the anterior superior iliac spine and the bottom of the medial malleolus of both legs should be measured and compared.

Note 12: 12-1. "Loss of toes" refers to the complete loss of toe due to severance of the toe from the metatarsophalangeal joint.

Note 13: 13-1. "Permanent loss of function in the hip, knee, and ankle joints of one lower limb" refers to complete disability of one lower limb, e.g.: （1）Complete rigidity or complete paralysis of all three major joints of one lower limb, and loss of function of the five toes of the foot. （2）Complete rigidity or complete paralysis of all three major joints of one lower limb. 13-2. The determination of functional impairments of "loss of function", "significant impairment of mobility", or "impairment of mobility" of the lower limbs follows the same guidelines as for the upper limbs.

Note 14: 14-1. "Permanent loss of function of toes" refers to: （1）In the toe, severance of the distal phalanx by 1/2 or more, or loss of range of physiological movement by 1/2 or more of the possible range of movement of the metatarsophalangeal joint or interphalangeal joint. （2）In the second toe, severance from the distal interphalangeal joint or above, or loss of range of physiological movement by 1/2 or more of the metatarsophalangeal joint or proximal interphalangeal joint. （3）In the third, fourth, and fifth toes, severance from the distal interphalangeal joint or above, or complete rigidity of both the metatarsophalangeal joint and the proximal interphalangeal joint.

Note 15: 15-1. A determination of permanent loss of function and residual impairment at any level should be based on an outcome in which symptoms have stabilized after the insured has undergone 6 months of treatment since the day of the insured's accident, such that no efficacy can be expected from further treatment. However, this rule does not apply to cases in which permanent loss of function or significant impairment can be immediately determined.

-24-

Table of Physiological Range of Motion of Upper and Lower Limb Joints

Upper limbs: Forward flexion Extension Range of motion Left shoulder (Normal 180 degrees) (Normal 60 degrees) (Normal 240 degrees) Forward flexion Extension Range of motion Right shoulder (Normal 180 degrees) (Normal 60 degrees) (Normal 240 degrees) Flexion Extension Range of motion Left elbow (Normal 145 degrees) (Normal 0 degrees) (Normal 145 degrees) Flexion Extension Range of motion Right elbow (Normal 145 degrees) (Normal 0 degrees) (Normal 145 degrees) Flexion Extension Range of motion Left wrist (Normal 80 degrees) (Normal 70 degrees) (Normal 150 degrees) Flexion Extension Range of motion Right wrist (Normal 80 degrees) (Normal 70 degrees) (Normal 150 degrees)

Lower limbs: Flexion Extension Range of motion Left hip (Normal 125 degrees) (Normal 10 degrees) (Normal 135 degrees) Flexion Extension Range of motion Right hip (Normal 125 degrees) (Normal 10 degrees) (Normal 135 degrees) Flexion Extension Range of motion Left knee (Normal 140 degrees) (Normal 0 degrees) (Normal 140 degrees) Flexion Extension Degree of motion Right knee (Normal 140 degrees) (Normal 0 degrees) (Normal 140 degrees) Dorsiflexion Plantar flexion Range of motion Left ankle (Normal 45 degrees) (Normal 20 degrees) (Normal 65 degrees) Dorsiflexion Plantar flexion Range of motion Right ankle (Normal 45 degrees) (Normal 20 degrees) (Normal 65 degrees)

If the insured can prove that the range of motion in the corresponding joint of the limb on the other, normal side of the body is larger than the range of motion given in the above table, then the range of motion in the joint of the limb on the other, normal side will be taken as the standard for determining the physiological range of motion.

Payment Of Severe Burn Benefits If, during the effective period of this Contract, an insured suffers an accidental injury event as stipulated, such that severe burns as stipulated result within 180 days of the date of the event's occurrence, the Company

-25- will pay severe burn benefits of an amount calculated as 35% of the insured amount, provided that if the severe burns result after 180 days have elapsed from the event’s occurrence and the beneficiary can prove a cause-and-effect relationship between the severe burns of the insured and the accidental injury, the restriction shall not apply.

“Severe burns” means skin damage or injury, or pulmonary dysfunction caused by flames, chemicals, electrical appliances, radiant energy, explosion, or heat, and of which the degree of severity reaches any of the following four degrees, and the injured person is still alive on the 15th day after the date of the occurrence of the accidental injury event.

1. Second degree burns on 20% or more of body surface area. 2. Third degree burns on 10% or more of body surface area. 3. Facial burns combined with impairment of the facial organs (face, eyes, ears, nose, and mouth), and both of the following circumstances are met. (1) Burns on the eyes and their accessory organs (such as lens, pupil, cornea, retina). (2) Burns on the face and head, with deep necrosis of underlying tissues (depth of third degree), combined with injury on some body parts.

4. Pulmonary dysfunction caused by inhalation of hot air or smoke. Pulmonary dysfunction is determined by a respiratory (thoracic) physician through pulmonary function testing and deemed severe, and improvement is not seen after 3 months of treatment.

Body surface area of burns shall be calculated pursuant to the “Rule of Nine” (see Attachment) to obtain the percentage of the area of burns to the total body surface area.

When the insured, during the effective period of this Contract, applies for severe burn benefits from different accidental injury events, the cumulative amount of payments by the Company shall be limited to not more than the insured amount.

Note: "The Rule of 9" (note)

-26-

Note: The head, the two upper two limbs, the thorax, the abdomen, the upper back, the lower back, and the anterior and posterior aspects of the lower two limbs each account for nine percent, and the perineal area accounts for one percent, for a total of one hundred percent.

Limitations on Insurance Payment When during the effective period of this Contract, as a result of the same accidental injury event, the insured incurs disability and subsequently dies, and meets the requirement for claims of this Contract, the combined total amount to be paid by the Company shall be limited to not more than the insured amount.

If in the case provided in the preceding paragraph, the beneficiary has received disability benefits, the Company shall be liable for payment only of the difference between the insured amount and the amount already received.

Exclusions The Company will not be liable for payment of insurance benefits when death 、disability、severe burn injury or hurt of an insured is incurred by any of the following causes: 1. A deliberate act of the proposer or the insured. 2.A beneficiary that deliberately injures an insured loses the right to benefits. If, as a result of a beneficiary's loss of the right to benefits under circumstances set out in the preceding paragraph, there is no beneficiary to receive the insured amount, the insured amount shall be paid to the insured's estate. If there is another beneficiary or beneficiaries, after the portion to which the beneficiary who lost his or her right to benefits was -27- originally entitled is calculated as originally stipulated, that portion shall be apportioned to the other beneficiary or beneficiaries. 3. A criminal act committed by the insured. 4. Driving (or riding) by the insured of a vehicle after ingesting alcohol, where the insured's breath or blood alcohol content exceeds the permissible standard set by traffic laws or regulations. 5. War (whether declared or undeclared), civil disorder, or another similar form of armed conflict, provided that this provision shall not apply where this Coverage Extension provides otherwise. 6. Explosion, heat, radiation, or contamination caused by an atomic or nuclear energy device, provided that this provision shall not apply where this Coverage Extension provides otherwise.

When the circumstances under subparagraph 1 of the preceding paragraph (excepting a deliberate act of the insured) result in the disability of an insured, the Company will still pay disability benefits.

Exclusions Unless otherwise stipulated in this Coverage Extension, the Company bears no liability for payment of insurance benefits if the insured incurs an injury by engaging in any of the following activities: 1. The insured engages in a competition or performance involving a contest of strength, wrestling, judo, karate, taekwondo, equestrian skill, boxing, or stunt performance. 2. The insured engages in an automobile, motorcycle, or bicycle race or performance.

The Application of the Indemnity A. Application For Death Benefits And Funeral Expense Benefits A beneficiary applying for "death benefits or funeral expense benefits" shall submit the following documents: 1. Application for insurance benefits. 2. An autopsy report or death certificate, provided that when necessary the Company may require submission of documentary proof of an accidental injury event. 3. The insured's death certificate and household registration certificate from which the insured's name has been stricken. 4. Proof of the beneficiary's identity.

B. Application For Disability Benefits

-28- A beneficiary applying for "disability benefits" shall submit the following documents: 1. Application for insurance benefits. 2. Certificate of diagnosis of disability; provided that when necessary, the Company may require provision of documentary proof of the accidental injury event. 3. Proof of the beneficiary's identity. When a beneficiary applies for disability benefits, the Company may require the insured to undergo a physical examination. When necessary the Company also may, with the beneficiary's consent, requisition, at the Company's expense, information regarding the insured's medical treatment.

C. Application For Severe Burn Injury Benefits A beneficiary applying for severe burn injury benefits shall submit the following documents: 1. Application for insurance benefits. 2. The policy or a copy of the policy. 3. Certificate of diagnosis; for meeting the criteria of a "severe burn injury," a physician's certificate of diagnosis must additionally be provided, provided that when necessary the Company may require submission of documentary proof of the accidental injury event. 4. Proof of the beneficiary's identity. When a beneficiary applies for severe burn injury benefits, the Company may require the insured to undergo a physical examination. When necessary, with the consent of the beneficiary, the Company also may requisition, at the Company's expense, information related to the insured's medical treatment.

-29-

Accidental Medical Reimbursement Scope of Coverage If during the effective period of this Rider the insured suffers an accidental injury event resulting in bodily injury, the Company will pay insurance benefits as stipulated in this Rider. "Accidental injury event" in the preceding paragraph means an unforeseen external event not caused by illness

Payment of Personal Injury Medical Benefits If during the effective period of this Rider the insured suffers an accidental injury event stipulated in Article 3, and receives treatment at a registered, qualified hospital or clinic within 180 days from the date of occurrence of the accidental injury event, the Company will pay personal injury medical benefits for the portion of the insured's actual medical expenses in excess of the amount paid by National Health Insurance (NHI), provided that if the treatment continues beyond 180 days and the beneficiary is able to prove a cause-and-effect relationship between the insured's treatment and the accidental injury event, the restriction does not apply.

The total amount of benefits paid per any instance of injury under the preceding paragraph may not exceed the "limit on medical reimbursement benefits per instance of injury" as stated in the insurance policy.

If the insured is hospitalized for treatment not in the status of an insured under NHI, or undergoes hospitalized and treatment at a hospital that is not an NHI-contracted hospital, so that the medical expenses are not covered by NHI payments, the Company will pay benefits at 100 percent of the expenses actually paid by the insured, provided that the payments will still be limited by the stipulated limits on benefits referred to above.

Exclusions (Causes) The Company will not be liable for payment of insurance benefits when disability of an insured is incurred by any of the following causes: 1. A deliberate act of the proposer or the insured. 2. A criminal act committed by the insured. 3. Driving (or riding) by the insured of a vehicle after ingesting alcohol, where the insured's breath or blood alcohol content exceeds the permissible standard set by traffic laws or regulations.

-30- 4.War (whether declared or undeclared), civil disorder, or another similar form of armed conflict, provided that this provision shall not apply where this Coverage Extension provides otherwise. 5. Explosion, heat, radiation, or contamination caused by an atomic or nuclear energy device, provided that this provision shall not apply where this Coverage Extension provides otherwise.

Application for Insurance Benefits A beneficiary shall submit the following documents when applying for benefits: 1. Application for insurance benefits. 2. Certificate of diagnosis; provided that when necessary the Company may require submission of documentary proof of the accidental injury event. 3. Receipts for medical expenses and itemized statement of medical expenses 4. Proof of the beneficiary's identity.

When necessary, the Company may require the insured to undergo a physical examination, the expense of which will be borne by the Company.

Designation and Change of Beneficiary The beneficiary of personal injury medical benefits under this Rider is the insured himself or herself, and the Company will accept no designation or change thereof.

-31- The Company shall pay personal injury medical benefits only upon a claim made directly by a beneficiary.

In the event of death of the insured, if benefits under this Rider have not been paid or have not fully been paid, the lawful heirs of the insured shall be the beneficiaries for the unpaid portion of the benefits.

Civil Code Part V "Succession", shall apply in determining the order of succession of the lawful heirs under the preceding paragraph and the percentage of insurance benefits to which each heir is entitled.

-32- Dread Disease Insurance (New Definitions) (include death) Scope of Coverage If during the effective period of this contract the insured suffers total disability, death, or a dread disease, the company will pay insurance benefits as stipulated in this contract. The company shall pay only one type of "dread disease policy benefit". Dread disease insurance benefits may be collected once and only once when an insured simultaneously suffers from two or more types of dread disease. Benefit For the purposes of this contract, "Dread Disease" means an illness that, during the effective period of this contract and as positively diagnosed by a hospital physician, is suffered by an insured for the first time and conforms to a definition below: 1. Acute myocardial infarction (severe): Means obstruction of a coronary artery resulting in necrosis of the heart muscle. The diagnosis thereof, in addition to left ventricular ejection fraction lower than or equal to 50 percent at or later than 90 days after onset as documented by cardiac imaging examination, also must simultaneously include at least two of the conditions listed below: (1) Typical chest pain symptoms. (2) Abnormal change in the most recent cardiogram, indicating myocardial infarction. (3) Abnormal elevation of CK-MB, or Trop T > 1.0 ng/ml or Trop I > 0.5 ng/ml. 2. Coronary bypass surgery: Means coronary artery bypass surgery undergone because of angina or heart failure resulting from persistent ischemia due to coronary artery disease. Other surgery is not included herein. 3. Post-stroke disability (severe): Means a sudden-onset cerebral artery pathology causing bleeding, embolism, or infarction of a cerebral artery and resulting in permanent neurological dysfunction. "Permanent neurological dysfunction" means that, 6 month after the event occurs, one of the following disabilities remains present as determined by a physician specializing in neurology, neurosurgery, or rehabilitative therapy: (1) A vegetative condition. -33- (2) One of the following disabilities remains present in the three major joints of one upper limb or the three major joints of one lower limb: i. Complete loss of voluntary mobility in the joint. ii. Muscle strength of 2 points or less (muscle strength of 2 points means capable of horizontal movement but unable to resist gravity). The three major joints of an upper limb include the shoulder, elbow, and wrist joints; the three major joints of a lower limb include the hip, knee, and ankle joints. (3) Impairment of movement or feeling in two or more limbs resulting in an inability to independently perform normal daily activities. The phrase "inability to independently perform normal daily activities" means a condition characterized by inability to eat, defecate, urinate, dress, undress, perform daily activities, walk, and bathe on one's own, and all such activities regularly require the assistance of others. (4) Loss of speech or mastication function. Loss of speech means damage to the nerves of the speech center resulting in aphasia. Loss of mastication function means functional impairment due to causes other than the teeth, causing inability to chew, and inability to ingest anything but liquid foods.

4. End-stage renal disease: Means long-term and planned dialysis has begun due to chronic and irreversible failure of the kidneys.

5. Cancer (severe): Means a malignant tumor characterized by the presence among tissue cells of malignant cells continuously growing, spreading, and invading tissue, or malignant leukemia, that, as determined by a pathologic examination, is classified as a malignant tumor illness in conformance with the most recently adopted version of the International Classification of Diseases, Injuries, and Causes of Death, and that does not fall in any of the following categories: (1) Stage I or Stage II chronic lymphocytic leukemia (according to the Rai staging system). (2) Stage I lymphogranulomatosis (Hodgkin's disease) of 10 cm or less. (3) Stage I prostate cancer. (4) Stage I papillary carcinoma of bladder. (5) Papillary thyroid microcarcinoma (means a papillary carcinoma 1

-34- cm or smaller in diameter within the thyroid). (6) Borderline ovarian cancer. (7) Stage I melanoma. (8) Stage I breast cancer. (9) Stage I cervical cancer. (10) Stage I colorectal cancer. (11) Carcinoma in situ or stage 0 cancer. (12) Stage I malignant carcinoid. (13) Stage II or less skin cancer (including skin appendage carcinoma and dermatofibrosarcoma) that is not malignant melanoma. 6. Paralysis (severe): Means one of the following disabilities remains present in two or more of the three major joints of both upper limbs, or of both lower limbs, or of one upper and one lower limb, and there has not been recovery or improvement after 6 months. (1) Complete loss of voluntary mobility in the joint. (2) Muscle strength of 2 points or less (muscle strength of 2 points means capable of horizontal movement but unable to resist gravity). The three major joints of an upper limb include the shoulder, elbow, and wrist joints; the three major joints of a lower limb include the hip, knee, and ankle joints.

7. Major organ transplant or hematopoietic stem cell transplantation: Major organ transplant means to have received a heart, lung, liver, pancreas, or kidney (none of the above includes stem cell transplants) due to failure in the function of the respective organ. Hematopoietic stem cell transplantation means to have received an allogeneic hematopoietic stem cell transplantation (including bone marrow hematopoietic stem cells, peripheral blood hematopoietic stem cells, or umbilical cord blood hematopoietic stem cells) due to damage to the hematopoietic function or malignant neoplasm of the hematopoietic system.

Payment of Total Disability Benefits Dread Disease insurance benefits may be collected once and only once. When an insured simultaneously suffers from two or more types of Dread -35- Disease as set out in benefit, the company shall pay only one type of "Dread Disease Policy Benefit." Please see New Term Life Insurance Policy.

Exclusions The company will not be liable for payment of insurance benefits in any of the following circumstances: 1. The proposer deliberately causes or attempts to cause the death of the insured. 2. The insured deliberately commits or attempts suicide, or causes his or her own permanent total disability, provided that if, after two years of continuous enrollment in the insurance, the insured deliberately commits suicide resulting in death, the company will be liable for payment of death benefits. 3. The insured is executed for a crime or dies or incurs permanent total disability as a result of resisting arrest or escaping from incarceration. If an insured incurs permanent total disability under a circumstance of the preceding paragraph, the Company will pay the total disability benefits. 4. A beneficiary that deliberately causes the death of the insured, or attempts unsuccessfully to do so, loses the right to benefits.

The Application of the Indemnity A. Application For Death Benefits And Funeral Expense Benefits A beneficiary applying for "death benefits or funeral expense benefits" shall submit the following documents: 1. The insured's death certificate and household registration certificate from which the insured's name has been stricken. 2. Application for insurance benefits. 3. Proof of the beneficiary's identity.

B. A beneficiary applying for "total disability benefits" shall submit the following documents:

-36- 1. Certificate of diagnosis of disability. 2. Application for insurance benefits. 3. Proof of the beneficiary's identity.

When a beneficiary applies for "total disability benefits," the company may require the insured to undergo a physical examination when necessary the company may, with the beneficiary's consent, also requisition, at the company's expense, information regarding the insured's medical treatment. Upon payment by the Company of total disability benefits as stipulated, the insurance coverage of the insured will automatically be terminated.

C. An insured applying for Dread Disease insurance benefits shall submit the following documents: 1. Certificate of diagnosis for the Dread Disease and the relevant examination or pathology reports. 2. Application for insurance benefits. 3. Proof of the insured's identity.

When a beneficiary applies for Dread Disease insurance benefits, the company may require the insured to undergo a physical examination. When necessary the company may, with the beneficiary's consent, also requisition at the Company's expense, information regarding the insured's medical treatment.

Upon payment by the Company of Dread Disease insurance benefits as stipulated, the insurance coverage of the insured involved will be automatically terminated.

-37- Hospital & Surgical Insurance Definition of Terms For the purposes of this Contract, "injury" means an injury resulting from an accidental injury event suffered by an insured during the effective period of this Contract.

For the purposes of this Contract, "accidental injury event" means an unforeseen external event not caused by illness.

For the purposes of this Contract, "hospital" means a public or private hospital, or a hospital incorporated as a foundation, that has an operating license and is equipped with hospital rooms for the inpatient treatment of patients, as provided in the Medical Act.

For the purposes of this Contract, "physician" means a person who lawfully holds a physician's license and practices the profession, and who is not the insured himself or herself.

For the purposes of this Contract, the term "hospitalized" or "hospitalization" means that an insured has been diagnosed by a physician who has determined that the insured's illness or accidental injury event requires admission to a hospital, and the insured has been hospitalized for treatment for 6 hours or longer.

For the purposes of this Contract, "any single event" means an event in which an insured requires hospitalization because of the same accidental injury event or illness and resultant complications. However, if the insured is hospitalized again for the same reason after 14 days following discharge, it will be deemed a separate event.

Scope of Coverage If during the effective period of this Contract the insured suffers an illness or injury stipulated, upon the insured being diagnosed and treated by a physician, the Company will pay insurance benefits as stipulated in this Contract.

Benefit A. Payment of Daily Hospital Room Benefits If the insured is hospitalized for diagnosis and treatment as stipulated,

-38- the Company will pay "daily hospital room benefits" for any of the expenses listed below that are incurred during the insured's hospitalization period and are required by National Health Insurance to be borne by the covered party and are not within the scope of National Health Insurance benefit coverage, provided that the daily benefits may not exceed the "inpatient hospitalization per diem" limit stated on the insurance policy, and that the maximum duration of hospitalization per any single event may not exceed 365 days: 1. Extra expenses for a hospital room at a class higher than covered. 2. Board expenses other than for tube feeding. 3. Nursing expenses other than for special care nurses.

B. Payment of Inpatient Hospitalization Benefits If the insured is hospitalized for diagnosis or treatment as stipulated, the Company will pay "inpatient hospitalization benefits" for any of the expenses listed below that are incurred during the insured's hospitalization period and are required by National Health Insurance to be borne by the covered party and are not within the scope of National Health Insurance benefit coverage, provided that the benefits for any single event may not exceed 40 times the "inpatient hospitalization per diem" limit stated on the insurance policy. (1) Medicine expenses (based on the receipts issued by the hospital; receipts may also be recognized for medicine that is required for treatment and prescribed by a physician and is purchased outside of the hospital) (2) Expenses for dressings, general surgical and orthopedic splints and casts. (3) Laboratory test expenses. (4) Electrocardiogram text expenses. (5) Basal metabolic rate test expenses. (6) Physical therapy expenses. (7) Expenses for anesthesia, oxygen, and their treatment. (8) X-ray test expenses. (9) Surgical expenses. (10) Expenses for blood, plasma, and infusions thereof. (11) Physician examination expenses. (12) Ambulance expenses. (13) Registration fees and documentation.

-39- C1. Payment Of General Outpatient Benefits If the insured receives outpatient diagnosis or treatment as stipulated in Article 5, the Company will pay "general outpatient benefits " for outpatient expenses actually paid at the hospital by the insured, provided that the benefits may not exceed the "outpatient expenses per visit" limit stated on the insurance policy.

Outpatient visits referred to in the preceding paragraph shall be limited to not more than one per day, and not more than 30 per year in total.

C2.Pre- and Post-Hospitalization Outpatient Benefits When the insured is hospitalized for diagnosis or treatment as stipulated, for one week before and one week after any single hospitalization, or for two weeks before and two weeks after any single hospitalization in the case of surgery, the Company will pay "pre- and post-hospitalization benefits" for outpatient expenses actually paid at the hospital by the insured, provided that the benefits may not exceed the "pre- and post-hospitalization outpatient expenses per hospitalization" limit stated on the insurance policy.

D. Payment of Hospitalization Compensation Benefits If during the effective period of this Contract, the insured is unable to provide receipts for medical expenses incurred during any single period of hospitalization as stipulated, and has not applied to the Company for benefits as Payment Of Daily Hospital Room Benefits or Payment Of Inpatient Hospitalization Benefits, the Company will pay hospitalization compensation benefits based on the actual number of days of the insured's hospitalization multiplied by the "inpatient hospitalization per diem" stated on the insurance policy, and the maximum number of days of payment per hospitalization shall be limited to 90.

After applying for "hospitalization compensation benefit, the beneficiary may not further apply to the Company for benefits as or

If during the effective period of this Contract the insured suffers an accidental injury event resulting in a bone fracture and is not hospitalized, or is hospitalized but for a period less than the number of days specified per type of bone fracture listed in the table below, and has not applied to the Company for benefits as Payment Of Daily Hospital Room Benefits or

-40- Payment Of Inpatient Hospitalization Benefits, the Company will pay benefits for the fracture for which there was no hospitalization, calculated by multiplying the number of days specified per type of bone fracture listed below by one-half the "inpatient hospitalization per diem" stated on the insurance policy. The combined number of days for which payment is made shall be limited to not more than the number of days specified per type of bone fracture.

The term "bone fracture" as used in the preceding paragraph means a complete fracture of the bone. For a partial bone fracture, payment will be made based on one-half the number of days specified for a complete fracture; for a hairline fracture, payment will be based on one-fourth the number of days specified for a complete fracture. If two or more of the types of fractures listed below are suffered simultaneously, medical benefits will be paid only for the one type of the higher level.

When medical benefits for bone fracture have previously been claimed and received under the preceding paragraph, if the insured subsequently is then hospitalized for treatment for the same injury event, and the amount as calculated by the actual days of hospitalization is greater, the Company will pay benefits based on the actual number of days of hospitalization instead, after deducting the amount of non-hospitalization bone fracture medical benefits already claimed and received. However, the restriction of a maximum of 90 days of payment in paragraph 1 of this article shall still apply.

Number of days Bone fractures for complete fracture 1. Nose , orbital bone (including the zygomatic bone) 14 days 2. Metacarpal, phalanx 14 days 3. Metatarsal, phalanx of the foot 14 days 4. Mandible (excepting treatment of the dental alveoli) 20 days 5. Rib 20 days 6. Clavicle 28 days 7. Radius or ulna 28 days 8. Patella 28 days 9. Scapula 34 days 10. Vertebra (including thoracic vertebrae and the coccyx) 40 days 11. Pelvis (including the ilium, pubis, ischium, and sacrum) 40 days 12. Skull 50 days 13. Humerus 40 days 14. Radius and ulna 40 days -41- 15.Carpal bone (one or both hands) 40 days 16. Tibia or fibula 40 days 17. Astragalus (one or both ankles) 40 days 18. Femur 50 days 19. Tibia and fibula 50 days 20. Femoral neck 60 days

E. Payment Of Intensive Care Compensation Benefits If during the effective period of this Contract the insured is hospitalized for diagnosis and treatment as stipulated, in addition to paying "daily hospital room benefits" under as or "hospitalization compensation benefits", the Company will additionally pay "intensive care compensation benefits" calculated by multiplying the "intensive care unit per diem" stated on the insurance policy by the number of days of actual hospitalization in the intensive care unit, provided that these benefits shall be limited to not more than 14 days per any single event.

Exclusions The Company will not be liable for payment of benefits for illness or injury of the insured resulting from any of the following causes: 1. A deliberate act of the insured (including suicide or attempted suicide). 2. A criminal act of the insured. 3. Illegal use by the insured of any drug as defined in laws and regulations related to contraband drugs.

-42- iii. Placenta praevia. iv. Abruptio placenta. v. Postpartum hemorrhage. vi. Pre-eclampsia. vii. Eclampsia. viii. Fetal atrophy. ix. Surgery for fetal chromosomal abnormality. (2) Medically necessary abortion, including: i. The insured or the insured's spouse suffers from a genetic, infectious, or psychiatric disease detrimental to reproductive health. ii. A relative within the fourth degree of consanguinity of the insured or the insured's spouse suffers from a genetic disease detrimental to reproductive health. iii. By medical consideration, pregnancy or delivery is considered a lethal risk to her or detrimental to her physical and mental health. iv. By medical consideration, the fetus is considered at risk of teratogenesis. v. The pregnancy results from forcible rape, seduction, sexual intercourse between people who are statutorily prohibited from marriage. (3) Medically necessary cesarean section, where the following conditions are met: i. Prolonged labor (dystocia): sufficient induction has been performed but the latent phase of the first stage of labor is prolonged (exceeding 14 hours in a patient who is multiparas or 20 hours in a patient who is nulliparas), or in the active phase of the first stage of labor the cervix has not further dilated after 2 hours, or in the second stage of labor the fetal head has not descended after 2 hours. ii. Fetal distress, meaning any of the following conditions: a. In the absence of uterine contractions, fetal heart monitor indicates a persistent heart rate of over 160 beats per minute (bpm) or under 100 bpm, or fetal heart rate more than 30 bpm below baseline heart rate and persisting for 60 seconds or longer. b. fetal scalp pH test measuring less than 7.20

-43- iii. Cephalopelvic disproportion, meaning any of the following conditions: a. Excessively large fetal head (fetal head circumference of 37 cm or greater) b. Fetal ultrasound indicates macrosomia (fetal weight of 4,000 grams or more) c. Deformed or contracted pelvis (pelvic inlet of 10 cm or less or midpelvis of 9.5 cm or less), confirmed by pelvic radiography d. Pelvic tumor (including lower segment pelvic tumor, cervical tumor, or pelvic tumor that would cause pressure or constriction of the birth canal), if it would affect delivery. iv. Malpresentation v. Multiple birth vi. Umbilical cord prolapse without the cervix having completely opened. vii. Two or more stillbirths (after 24 weeks or more of pregnancy and fetal weight of 560 grams or more). viii. Delivery disorders: a. Placenta praevia b. Pre-eclampsia and eclampsia. c. Abruptio placenta. d. Premature rupture of membranes exceeding 24 hours with signs of infection. e. Maternal cardiopulmonary disorders: (a) Severe arrhythmia, with a cardiologist's certificate of diagnosis or electrocardiogram results confirming that caesarian section is necessary. (b) A third or fourth degree cardiac disorder measured by the cardiopulmonary function scale used in cardiology, with a certificate of diagnosis. (c) Severe emphysema, with a certificate of diagnosis by a pulmonologist. 5. Infertility, assisted pregnancy, or contraceptive or sterilization surgery for purposes other than medical treatment.

The Application of the Indemnity 1. Application for insurance benefits.

-44- 2. Diagnosis certificate, provided that a proposer or an insured who is a physician may not issue a diagnosis certificate for the insured. 3. Receipts for medical expenses and itemized statement of medical expenses. 4. Medical certificate or proof of hospitalization. When applying for intensive care compensation benefits, the content shall include the initial and final dates of the actual stay in the intensive care unit. 5. If non-hospitalization benefits are being claimed for a bone fracture, an x-ray must additionally be submitted.

When a beneficiary applies for benefits, the Company when necessary may, with consent, also requisition, at the Company's expense, information regarding the insured's medical treatment.

-45- Surgery Allowance Definition of Terms For the purposes of this Contract, "hospital" means a public or private hospital, or a hospital incorporated as a foundation, that has an operating license and is equipped with hospital rooms for the inpatient treatment of patients, as provided under the Medical Act.

For the purposes of this Contract, "physician" means a person who holds a physician's license and lawfully practices the profession.

For the purposes of this Contract, "accidental injury event" means an insured, during the effective period of the Contract, suffers an accidental injury resulting in bodily injury.

"Accidental injury event" in the preceding paragraph means an unforeseen external event not caused by illness.

For the purposes of this Contract, "illness" means an illness that begins to occur to an insured after 30 consecutive days from the effective date or reinstatement date of this Contract, provided that the 30-day restriction does not apply in the case of renewal.

Payment of Surgical Benefits If during the effective period of this Contract the insured suffers an illness or accidental injury event that is positively diagnosed by a hospital, and is treated with any of the surgeries listed in the “Schedule of Surgical Benefits” (see the attached Schedule), the Company will, according to the specific surgical operation, pay surgical benefits calculated by multiplying the insured amount stipulated in this Contract by the multiplier stated in the Table of Surgical Benefits.

When an insured, during the same surgical session, receives two or more surgeries on the same surgical location, the Company shall calculate the total surgical benefits in combination by the method listed below:

1. Primary surgery: namely the surgery that has the highest percentage multiplier; the benefits will be calculated for payment in full by multiplying the insured amount stipulated in this Contract by the percentage multiplier stated in the Table of Surgical Benefits and paid in full. -46-

2. Other surgeries: the benefits will be calculated for payment by multiplying the insured amount stipulated in this Contract by the percentage multiplier stated in the Table of Surgical Benefits and then multiplying the product by 50%, provided that benefits will not be paid for any incidental surgery that is not necessary for treatment.

3. There shall be only one primary surgery; if two or more surgeries have the same percentage multiplier, only one of them may be the primary surgery, and the calculation method in subparagraph 2 shall apply to the other surgeries.

During the period of insurance under this Contract, the payment of surgical benefits for each insured shall be limited at maximum to 100 times the insured amount of the insured.

Exclusions

The Company will not be liable for payment of benefits for illness or injury of the insured resulting from any of the following causes: 1. A deliberate act of the insured (including suicide or attempted suicide). 2. A criminal act of the insured. 3. Illegal use by the insured of any drug as defined in laws and regulations related to contraband drugs.

The Company will not be liable for payment of benefits when the insured receives diagnosis or treatment by a physician for any of the following events: 1. Cosmetic surgery or plastic surgery, except for plastic surgery necessary for the reconstruction of fundamental functions of the insured. 2. Externally visible congenital deformities. 3. Dental 4. Fitting of a false tooth, prosthetic limb, artificial eye, eyeglasses, hearing aid, or any other accessory, except as necessitated by an accidental injury event, in which case only one fitting is covered. 5. Medical examination, therapeutic convalescence, restorative convalescence, drug detoxification, alcohol detoxification, nursing care, or geriatric care that are for purposes other than providing direct patient treatment. 6. Pregnancy, miscarriage/abortion, or childbirth, and their complications, except for the following conditions: -47- (1) Illnesses relating to pregnancy: i. Extra-uterine pregnancy. ii. Molar pregnancy. iii. Placenta praevia. iv. Abruptio placenta. v. Postpartum hemorrhage. vi. Pre-eclampsia. vii. Eclampsia. viii. Fetal atrophy. ix. Surgery for fetal chromosomal abnormality. (2) Medically necessary abortion, including: i. The insured or the insured's spouse suffers from a genetic, infectious, or psychiatric disease detrimental to reproductive health. ii. A relative within the fourth degree of consanguinity of the insured or the insured's spouse suffers from a genetic disease detrimental to reproductive health. iii. By medical consideration, pregnancy or delivery is considered a lethal risk to her or detrimental to her physical and mental health. iv. By medical consideration, the fetus is considered at risk of teratogenesis. v. The pregnancy results from forcible rape, seduction, sexual intercourse between people who are statutorily prohibited from marriage. (3) Medically necessary cesarean section, where the following conditions are met: i. Prolonged labor (dystocia): sufficient induction has been performed but the latent phase of the first stage of labor is prolonged (exceeding 14 hours in a patient who is multiparas or 20 hours in a patient who is nulliparas), or in the active phase of the first stage of labor the cervix has not further dilated after 2 hours, or in the second stage of labor the fetal head has not descended after 2 hours. ii. Fetal distress, meaning any of the following conditions: a. In the absence of uterine contractions, fetal heart monitor indicates a persistent heart rate of over 160 beats per minute (bpm) or under 100 bpm, or fetal heart rate more than 30 bpm below baseline heart rate and persisting for 60 seconds or longer. b. fetal scalp pH test measuring less than 7.20

-48- iii. Cephalopelvic disproportion, meaning any of the following conditions: a. Excessively large fetal head (fetal head circumference of 37 cm or greater) b. Fetal ultrasound indicates macrosomia (fetal weight of 4,000 grams or more) c. Deformed or contracted pelvis (pelvic inlet of 10 cm or less or midpelvis of 9.5 cm or less), confirmed by pelvic radiography d. Pelvic tumor (including lower segment pelvic tumor, cervical tumor, or pelvic tumor that would cause pressure or constriction of the birth canal), if it would affect delivery. iv. Malpresentation v. Multiple birth vi. Umbilical cord prolapse without the cervix having completely opened. vii. Two or more stillbirths (after 24 weeks or more of pregnancy and fetal weight of 560 grams or more). viii. Delivery disorders: a. Placenta praevia b. Pre-eclampsia and eclampsia. c. Abruptio placenta. d. Premature rupture of membranes exceeding 24 hours with signs of infection. e. Maternal cardiopulmonary disorders: (a) Severe arrhythmia, with a cardiologist's certificate of diagnosis or electrocardiogram results confirming that caesarian section is necessary. (b) A third or fourth degree cardiac disorder measured by the cardiopulmonary function scale used in cardiology, with a certificate of diagnosis. (c) Severe emphysema, with a certificate of diagnosis by a pulmonologist. 7. Infertility, assisted pregnancy, or contraceptive or sterilization surgery for purposes other than medical treatment.

The Application of The Indemnity A beneficiary applying for benefits under this Contract shall submit the following documents: 1. Application for insurance benefits. 2. Surgical diagnosis certificate, provided that a proposer or an insured

-49- who is a physician may not issue a diagnosis certificate for the insured. 3. Proof of the insured's identity.

When a beneficiary applies for benefits, the Company when necessary may, with consent, also requisition, at the Company's expense, information regarding the insured's medical treatment.

Benefit No. Location Name of Surgery Multiplier Integumentary 1 Wound treatment <10 cm 0.25 system Integumentary 2 Wound treatment >10 cm 0.5 system Integumentary 3 Wound debridement - within 5 cm 1 system Integumentary 4 Wound debridement - 5 to 10 cm 2 system Integumentary 5 Wound debridement - over 10 cm 3 system Integumentary 6 Repair of facial laceration - within 5 cm 1 system Integumentary Repair of facial laceration - 5cm or more but less than 10 7 2 system cm Integumentary 8 Repair of facial laceration - 10 cm or more 3 system Integumentary 9 Excision of facial skin tumor - within 1 cm in diameter 0.25 system Integumentary 10 Excision of facial skin tumor - 1 to 2 cm in diameter 1 system Integumentary 11 Excision of facial skin tumor - over 2 cm in diameter 3 system Integumentary Excision of cutaneous or subcutaneous tumor (except 12 0.25 system face) within 2 cm Integumentary Excision of cutaneous or subcutaneous tumor (except 13 0.5 system face) - 2 to 4 cm Integumentary Excision of cutaneous or subcutaneous tumor (except 14 0.75 system face) - 4 to 10 cm Integumentary 15 Surgery on epidermal mole, wart, or corn 0.25 system Integumentary Excision of tumor in muscle or deep tissue and removal 16 2 system of foreign body Integumentary 2 17 Split thickness skin graft (STSG) - within 25 cm 5 system Integumentary 2 2 18 STSG - 25 cm or more but less than 100 cm 9 system Integumentary 19 STSG - 100 cm2 or more but less than 200 cm2 10 system Integumentary 2 2 20 STSG - 200 cm or more but less than 300 cm 15 system Integumentary 2 2 21 STSG - 300 cm or more but less than 400 cm 20 system

-50- Integumentary 2 2 22 STSG - 400 cm or more but less than 500 cm 25 system Integumentary 2 2 23 STSG - 500 cm or more but less than 600 cm 30 system Integumentary 2 2 24 STSG - 600 cm or more but less than 700 cm 35 system Integumentary 2 2 25 STSG - 700 cm or more but less than 800 cm 40 system Integumentary 2 26 STSG - 800 cm or more 45 system Integumentary 2 27 Full thickness skin graft (FTSG) - within 10 cm 5 system Integumentary 2 2 28 FTSG - 10 cm or more but less than 20 cm 10 system Integumentary 2 2 29 FTSG - 20 cm or more but less than 30 cm 13 system Integumentary 2 2 30 FTSG - 30 cm or more but less than 40 cm 15 system Integumentary 2 2 31 FTSG - 40 cm or more but less than 50 cm 20 system Integumentary 2 2 32 FTSG - 50 cm or more but less than 60 cm 23 system Integumentary 2 2 33 FTSG - 60 cm or more but less than 70 cm 25 system Integumentary 2 2 34 FTSG - 70 cm or more but less than 80 cm 27 system Integumentary 2 35 FTSG - 80 cm or more 32 system Integumentary 36 Argon laser therapy 2 system Integumentary 37 CO laser operation 2 system 2 Integumentary 38 Skoog operation - bilateral 5 system Integumentary Excision of skin cancer with split skin graft (SSG) - within 39 10 system 2 cm in diameter Integumentary Excision of skin cancer with SSG - 2 cm or more but less 40 20 system than 5cm in diameter Integumentary Excision of skin cancer with SSG - 5 cm or more in 41 30 system diameter Integumentary 42 Z-plasty 5 system Integumentary 43 V-Y plasty 5 system Integumentary 44 Muscle flap or myocutaneous flap 19 system Integumentary 45 Pharyngeal flap surgery 20 system Integumentary 46 Local flap (within 1 cm) 1 system Integumentary 47 Loca flap (1 to 2 cm) 3 system 48 Integumentary Local flap (over 2 cm) 5 -51- system Integumentary 49 Deltopectoral flap 20 system Integumentary 50 Tongue flap 10 system Integumentary 51 Musculus pectoralis major flap surgery 40 system Integumentary 52 Abbe flap surgery 17 system Integumentary 53 ExlanderExlander flap surgery 17 system Integumentary 54 Cross-finger flap surgery 11 system Integumentary 55 Cross-leg flap surgery 20 system Integumentary 56 Cross-palm flap surgery 14 system Integumentary 57 Cross-arm flap surgery 17 system Integumentary 58 Groin flap surgery 15 system Integumentary 59 Rotation flap surgery (except hands) 10 system Integumentary 60 Advance flap surgery 10 system Integumentary 61 Tube pedicle graft 18 system Integumentary 62 Muscle rotation flap surgery 20 system Integumentary 63 Myocutaneous roation flap surgery 20 system Integumentary 64 Fasciocutaneous roation flap surgery 20 system Integumentary 65 Microvascular free flap surgery - cutaneous 40 system Integumentary 66 Microvascular free flap surgery - muscle 43 system Integumentary 67 Microvascular free flap - bone 50 system Integumentary 68 Microvascular free flap surgery - omentum 57 system Integumentary 69 Microvascular free flap surgery - intestinal flap 57 system Integumentary 70 Microvascular free flap surgery - free fascia flap 43 system Integumentary Microvascular free flap surgery - free functioning muscle 71 57 system transfer Integumentary 72 Micro and general dermabrasion (within 5 cm) 0.5 system Integumentary 73 Micro and general dermabrasion (5 to 10 cm) 0.75 system Integumentary 74 Micro and general dermabrasion (over 5 cm) 1 system -52- 75 Breast Partial mastectomy - unilateral 2 76 Breast Partial mastectomy - bilateral 3 77 Breast Simple mastectomy - unilateral 10 78 Breast Simple mastectomy - bilateral 20 79 Breast Excision of breast tumor - unilateral 2 80 Breast Excision of breast tumor - bilateral 3 81 Breast Radical mastectomy - unilateral 25 82 Breast Radical mastectomy - bilateral 50 83 Breast Breast tumor biopsy 1 84 Breast Subcutaneous mastectomy 5 Musculoskeletal 85 Bone fenestration 9 system Musculoskeletal 86 Bone or osteochondral graft 3 system Musculoskeletal 87 Osteoplasty - shortening 20 system Musculoskeletal 88 Osteoplasty - lengthening 22 system Musculoskeletal 89 Application of external fixation appratus 9 system Musculoskeletal 90 Ostectomy 3 system Musculoskeletal 91 Epiphysiodesis 10 system Musculoskeletal 92 Excision of tumor mass in bone and joint 12 system Musculoskeletal 93 Hemipelvectomy 34 system Seguestretomy or saucerization with debridement for Musculoskeletal 94 osteomyelitis - including phalanx, metacarpus, and 12 system metatarsus Seguestretomy or saucerization with debridement for Musculoskeletal 95 osteomyelitis - including tibia, fibula, radius, ulna, patella, 13 system and pelvis Seguestretomy or saucerization with debridement for Musculoskeletal 96 osteomyelitis - including skull, cranium, sternum, femur, 13 system rib, and vertebra Musculoskeletal 97 Removal of internal fixator - other locations 2 system Musculoskeletal Removal of internal fixator - pelvis, os coxae, humerus, 98 5 system femur, ulna, radius, or tibia Musculoskeletal 99 Removal of internal fixator - vertebra 10 system Musculoskeletal 100 Corrective osteotomy - other locations, except pelvis 5 system Musculoskeletal Corrective osteotomy - humerus, ulna, radius, femur, 101 10 system tibia, or fibula Musculoskeletal 102 Open reduction for nasal fracture 5 system Musculoskeletal 103 Closed reduction for nasal bone fracture 2 system Musculoskeletal 104 Costo-transversectomy 10 system -53- Musculoskeletal 105 Total spondylectomy 28 system Musculoskeletal 106 Patellectomy 9 system Musculoskeletal 107 Excision of radial head 10 system Musculoskeletal 108 Rib excision 8 system Musculoskeletal 109 Immobilization of rib fracture 0.25 system Musculoskeletal 110 Open reduction for fracture of sternum or rib 9 system Musculoskeletal 111 Radical curettage of thoracic cold abscess 5 system Musculoskeletal 112 Excision of carpal or tarsal bone 7 system Musculoskeletal 113 Partial excision of clavicle 9 system Musculoskeletal 114 Total excision of clavicle 12 system Musculoskeletal 115 Open Reduction for fracture of clavicle 11 system Musculoskeletal 116 Immobilization of clavicular fracture 2 system Musculoskeletal 117 Limb amputation - thigh 14 system Musculoskeletal 118 Limb amputation - shank, arm, or forearm 12 system Musculoskeletal 119 Limb amputation - wrist or ankle 9 system Musculoskeletal 120 Limb amputation - finger or toe 8 system Musculoskeletal Revision of amputated stump (need osteoplasty) - thigh, 121 9 system shank, arm, or forearm Musculoskeletal Revision of amputated stump (need osteoplasty) - finger 122 3 system or toe Musculoskeletal 123 Open reduction for fracture of femoral shaft 20 system Musculoskeletal Open reduction for fracture of femoral neck - including 124 22 system intertrochan or peritrochanteric fracture Musculoskeletal Open reduction for fracture of femoral neck, with 125 25 system muscle pedicle bone graft Musculoskeletal 126 Open reduction for fractrue of spine 24 system Musculoskeletal 127 Open reduction for fractrue of pelvis 20 system Musculoskeletal 128 Open reduction for fracture of tibia 20 system Musculoskeletal 129 Open reduction for fracture of acetabulum 15 system Musculoskeletal 130 Open reduction for unimalleolar fracture 10 system 131 Musculoskeletal Open reduction for bimalleolar or trimalleolar fracture 10 -54- system Musculoskeletal 132 Open reduction for fracture of radius or ulna 10 system Musculoskeletal 133 Open reduction for fracture of humerus 6 system Musculoskeletal Open reduction for closed or open fracture of humeral 134 10 system tuberosity, humeral shaft, or condyle Musculoskeletal 135 Open reduction for scapula fracture juxta-articular 10 system Musculoskeletal 136 Open reduction for fracture of patella 10 system Musculoskeletal 137 Open reduction for fracture of navicular 6 system Musculoskeletal Open reduction for fracture of carpus, tarsus, 138 6 system metacarpus, or metatarsus Musculoskeletal 139 Open reduction for fracture of phalanx 5 system Musculoskeletal Closed reduction for fracture and dislocation of coccyx 140 3 system joint Musculoskeletal 141 Close reduction for fracture of femur 3 system Musculoskeletal 142 Close reduction for fracture of vertebra or pelvis 3 system Musculoskeletal 143 Close reduction for fracture of tibia or humerus 3 system Musculoskeletal 144 Close reduction for fracture of forearm bone 3 system Musculoskeletal 145 Close reduction for fracture of carpus 3 system Musculoskeletal 146 Close reduction for fracture of ankle bone 3 system Musculoskeletal 147 Close reduction for fracture of metacarpus 2 system Musculoskeletal 148 Close reduction for fracture of metatarsus 2 system Musculoskeletal 149 Close reduction for fracture of phalanx 1 system Musculoskeletal 150 Patella realignment 10 system Musculoskeletal 151 Arthrotomy for acute septic joint - hip joint 14 system Musculoskeletal Arthrotomy for acute septic joint - shoulder, ellbow, wrist, 152 12 system knee, or ankle joint Musculoskeletal 153 Synovectomy or capsulectomy - hip joint 16 system Musculoskeletal 154 Synovectomy or capsulectomy - knee joint 14 system Musculoskeletal Synovectomy or capsulectomy - shoulder, elbow, wrist, 155 11 system or ankle joint Musculoskeletal 156 Synovectomy or capsulectomy - phalanx 5 system Musculoskeletal Excision of tibial tubercle (Osgood-Schlatter disease) or 157 10 system bone fusion surgery -55- Musculoskeletal 158 Open reduction for dislocation of hip joint 14 system Musculoskeletal 159 Open reduction for dislocation of shoulder joint 10 system Musculoskeletal 160 Open reduction for dislocation of elbow joint 12 system Musculoskeletal 161 Open reduction for dislocation of knee joint 12 system Musculoskeletal 162 Open reduction for dislocation of wrist joint 9 system Musculoskeletal 163 Open reduction for dislocation of ankle joint 9 system Musculoskeletal 164 Open reduction for dislocation of finger or toe 7 system Musculoskeletal 165 Open reduction for dislocation of sternoclavicular joint 9 system Musculoskeletal 166 Open reduction for dislocation of acromioclavicular joint 10 system Musculoskeletal Open reduction and capsular shift procedure for 167 15 system recurrent anterior shoulder dislocation Musculoskeletal 168 Close reduction for dislocation of hip joint 3 system Musculoskeletal 169 Close reduction for dislocation of shoulder joint 3 system Musculoskeletal 170 Close reduction for dislocation of elbow joint 3 system Musculoskeletal 171 Close reduction for dislocation of knee joint 3 system Musculoskeletal 172 Close reduction for dislocation of wrist joint 3 system Musculoskeletal 173 Close reduction for dislocation of ankle joint 3 system Musculoskeletal 174 Close reduction for dislocation of finger or toe 1 system Musculoskeletal 175 Brisement force (manipulation of joint) 2 system Musculoskeletal 176 Surgery for trigger finger 3 system Musculoskeletal 177 Surgery for psoas, gluteal, or femoral myositis 5 system Musculoskeletal 178 Surgery for myositis - other locations 3 system Musculoskeletal 179 Myotomy of scalaneus muscle 5 system Musculoskeletal 180 Surgery for torticollis 5 system Musculoskeletal 181 Excision of cervical fistula or cervical cyst 5 system Musculoskeletal 182 Excision of benign tumor in neck - simple 10 system Musculoskeletal 183 Excision of ganglion or hygroma 5 system 184 Musculoskeletal Close reduction for zygoma 7 -56- system Musculoskeletal 185 Open reduction for zygoma - simple 8 system Musculoskeletal 186 Open reduction for zygoma - complicated 16 system Musculoskeletal 187 Extirpation of benign tumor in palate or tongue 1 system Musculoskeletal 188 Open reduction for fracture of palate - single fracture 8 system Musculoskeletal 189 Open reduction for fracture of palate - multiple fractures 11 system Musculoskeletal 190 Mandibular osteotomy 12 system Musculoskeletal 191 Mandibular resection - marginal 9 system Musculoskeletal 192 Mandibular resection - partial 12 system Musculoskeletal 193 Mandibular resection - hemi-resection 13 system Musculoskeletal 194 Reduction of mandibular dislocation 2 system Musculoskeletal 195 Open reduction for mandibular fracture (simple) 10 system Musculoskeletal Excision of malignant tumor in lower jaw with 196 19 system lymphadenectomy Musculoskeletal Excision of malignant tumor in lower jaw with neck 197 32 system dissection Musculoskeletal 198 Maxilla suspension wiring 11 system Musculoskeletal 199 Inter-maxillary wiring (inter-dental wiring) 12 system Musculoskeletal 200 Open reduction for maxilla, simple 9 system Musculoskeletal 201 Open reduction for maxilla, complicated 17 system Musculoskeletal Excision of malignant tumor in upper jaw with 202 19 system lymphadenectomy Musculoskeletal Excision of malignant tumor in upper jaw with neck 203 32 system dissection Musculoskeletal 204 Open reduction for orbital floor - silicon sheet implant 14 system Musculoskeletal 205 Open reduction for orbital floor - autograft 14 system Musculoskeletal 206 Acromioplasty 8 system Musculoskeletal 207 Release of temporomandibular joint ankylosis 11 system Musculoskeletal 208 Arthoplasty of temporomandibular joint 10 system Musculoskeletal 209 Subcutaneous tenorrhaphy 5 system Musculoskeletal 210 Subcutaneous tenectomy 5 system -57- Musculoskeletal 211 Tendon repair - single 5 system Musculoskeletal 212 Tendon repair - multiple 6 system Musculoskeletal 213 Capsulectomy of digital joint 5 system Musculoskeletal 214 ATF (Anterior tibio fibular ligament) repair 10 system Musculoskeletal 215 Repair of AFT + CF (Calcanco fibular ligament) 10 system Musculoskeletal Repair of ATF + PTF (Posterior tibio-fibalar ligament) + 216 10 system CF Musculoskeletal 217 Repair of deltoid ligament of ankle 10 system Musculoskeletal 218 Repair of rotator cuff tear - mild 11 system Musculoskeletal 219 Repair of rotator cuff tear - massive 14 system Musculoskeletal 220 Repair of ruptured achilles tendon 10 system Musculoskeletal 221 Repair of ruptured patella tendon 7 system Musculoskeletal 222 Repair of ruptured biceps tendon 10 system Musculoskeletal 223 Repair of ruptured quadriceps tendon 10 system Musculoskeletal Release of contracture of musculus gluteus maximus or 224 10 system musculus deltoideus Musculoskeletal 225 Release of scar contracture 0.5 system Musculoskeletal 226 Release of scar contracture in face or neck 1.5 system Musculoskeletal 227 Patella subluxation lateral release 5 system Musculoskeletal 228 Drilling or shaving for chondromalacia patella 5 system Musculoskeletal 229 Hallux valgus 10 system Musculoskeletal 230 Ligament reconstruction for basal joint 10 system Musculoskeletal 231 Ligament interposition for basal joint 10 system Musculoskeletal 232 Fascial interposition for carpal bone 21 system Musculoskeletal 233 Regional hand pedicle flap surgery 10 system Musculoskeletal 234 Division of pedicle flap 9 system Musculoskeletal 235 Replantation - one finger 10 system Musculoskeletal 236 Replantation - two fingers 15 system 237 Musculoskeletal Replantation - three fingers 20 -58- system Musculoskeletal 238 Replantation - four fingers 25 system Musculoskeletal 239 Replantation - five fingers 30 system Musculoskeletal 240 Limb replantation - arm, leg, metatarsus, or foot 30 system Musculoskeletal 241 Hip disarticulation 26 system Musculoskeletal 242 Shoulder disarticulation 20 system Musculoskeletal 243 Elbow disarticulation 11 system Musculoskeletal 244 Wrist disarticulation 11 system Musculoskeletal 245 Knee disarticulation 20 system Musculoskeletal 246 Ankle disarticulation 11 system Musculoskeletal 247 Disarticulation of finger or toe 3 system Musculoskeletal 248 Total hip replacement 34 system Musculoskeletal 249 Total shoulder replacement 34 system Musculoskeletal 250 Total knee replacement 34 system Musculoskeletal 251 Total elbow replacement 17 system Musculoskeletal 252 Total wrist replacement 17 system Musculoskeletal 253 Total ankle replacement 17 system Musculoskeletal 254 Total finger or toe replacement 4 system Musculoskeletal 255 Prothetic arthroplasty of basal joint 5 system Partial joint replacement with arthroplasty - replace only Musculoskeletal 256 one of the following: condyle of femur, tibial plateau, half 20 system of knee joint, and patella Partial joint replacement with arthroplasty - replace only Musculoskeletal 257 one of the following: acetabulum cup, femur, hemi-hip 20 system joint, and hemi-shoulder joint Musculoskeletal 258 Hip arthroplasty 24 system Musculoskeletal 259 Elbow arthroplasty 13 system Musculoskeletal 260 Shoulder arthroplasty 16 system Musculoskeletal 261 Wrist arthroplasty 13 system Musculoskeletal 262 Ankle arthroplasty 16 system

-59- Musculoskeletal 263 Knee arthroplasty 16 system Musculoskeletal Arthroplasty of finger, toe, or metacarpal or metatarsal 264 12 system joint Musculoskeletal 265 Hip arthrodesis 25 system Musculoskeletal 266 Shoulder arthrodesis 17 system Musculoskeletal 267 Knee arthrodesis 17 system Musculoskeletal 268 Elbow arthrodesis 16 system Musculoskeletal 269 Arthrodesis of wrist joint, carpal joint, or metacarpal joint 12 system Musculoskeletal 270 Ankle arthrodesis 16 system Musculoskeletal 271 Arthrodesis of finger or toe 3 system Musculoskeletal 272 Cruciate ligament reconstruction 10 system Musculoskeletal 273 Cruciate ligament repair 10 system Musculoskeletal 274 Tendon graft 10 system Musculoskeletal 275 Tendon transposition or tendon transfer 10 system Musculoskeletal 276 Tendon lengthening 8 system Musculoskeletal 277 Tenolysis 5 system Musculoskeletal 278 Repair of complete disruption of tendon or ligament 5 system Musculoskeletal 279 Repair of incomplete disruption of tendon or ligament 3 system Musculoskeletal 280 Tenotomy or fasciotomy 5 system Musculoskeletal 281 Tenodesis 5 system Musculoskeletal 282 Removal of prosthesis - hip, shoulder, or knee 10 system Musculoskeletal 283 Removal of prosthesis - wrist or ankle 5 system Musculoskeletal 284 Removal of prosthesis - finger or toe 4 system Musculoskeletal 285 Revision of total hip replacement 34 system Musculoskeletal 286 Revision of total knee replacement 34 system Musculoskeletal 287 Revision of bipolar prothesis 15 system Musculoskeletal 288 Wide excision of malignant bone tumor (one stage) 40 system 289 Musculoskeletal Wide excision of malignant bone tumor (two-stage) 40 -60- system Musculoskeletal 290 Curettage and bone graft 3 system Musculoskeletal 291 Wide excision of malignamt tumor in soft tissue 30 system Musculoskeletal 292 Excision of benign tumor in soft tissue, large or deep 8 system Musculoskeletal 293 Reconstruction of ruptured achilles tendon 10 system Musculoskeletal 294 Reconstruction of distal radioulnar joint 12 system Musculoskeletal 295 Reconstruction of ruptured patella tendon 10 system Musculoskeletal 296 Repair of medial or lateral ligament of knee 10 system Musculoskeletal 297 Reconstruction of medial or lateral ligament of knee 10 system Musculoskeletal 298 ATF reconstruction 10 system Musculoskeletal 299 Reconstruction of ATF + CF 10 system Musculoskeletal 300 Reconstruction of ATF + PTF + CF 10 system Musculoskeletal 301 Reconstruction of deltoid ligament of ankle 10 system Musculoskeletal 302 Nail reconstruction 10 system Musculoskeletal 303 Pollicization 10 system Musculoskeletal 304 Partial menisetomy or meniscus repair 5 system Musculoskeletal 305 Forequater amputation 30 system Musculoskeletal 306 Girdlestone procedure of hip 18 system Musculoskeletal 307 Shoulder joint hemiarthroplasty 15 system Musculoskeletal 308 Volar plate arthroplasty 15 system Musculoskeletal 309 Regional fasciectomy 10 system Musculoskeletal 310 Free vascularized bone graft or free muscle graft 34 system Musculoskeletal 311 Cord decompression for ANFH (trephining) 12 system Musculoskeletal Arthroscopic surgery - arthroscopy with synovial biopsy, 312 7 system irrigation & larvage, and debridement Arthroscopic surgery - arthroscopic shaving or abrasion Musculoskeletal 313 arthroplasty, with drilling or pinning and removal of loose 15 system body or osteochrondral fragment Musculoskeletal 314 Endoscopic carpal tunnel release (ECTR) 3 system 315 Musculoskeletal Club foot release 5 -61- system Musculoskeletal 316 Baker's cyst excision 5 system Musculoskeletal Facial bone graft (congenital malformation or excision of 317 18 system traumatic tumor) Musculoskeletal 318 Pelvic triple osteotomy and femorl shortening (CHD) 20 system Musculoskeletal 319 Corrective osteotomy (one vertebral body) 13 system Musculoskeletal 320 Corrective osteotomy (two vertebral bodies) 18 system Musculoskeletal 321 Corrective osteotomy (thrree vertebral bodies) 23 system Musculoskeletal 322 Corrective osteotomy (four vertebral bodies) 28 system Musculoskeletal 323 Corrective osteotomy (five vertebral bodies or more) 35 system Musculoskeletal 324 Curettage or excision of single vertebral body 13 system Musculoskeletal 325 Curettage or excision of two vertebral bodies 18 system Musculoskeletal 326 Curettage or excision of three vertebral bodies 23 system Musculoskeletal 327 Curettage or excision of four vertebral bodies 28 system Musculoskeletal 328 Curettage or excision of five vertebral bodies or more 35 system 329 Respiratory system Nasal polypectomy - single 1 330 Respiratory system Nasal polypectomy - multiple 2 331 Respiratory system Electric cauterization 1 332 Respiratory system Total or partial turbinectomy 5 333 Respiratory system Biopsy of nasal soft tissue 1 334 Respiratory system Nasopharyngenal biopsy 1 335 Respiratory system Cryosurgery 1 336 Respiratory system Maxillectomy - partial 27 337 Respiratory system Maxillectomy - total 32 338 Respiratory system Caldwell Luc's operation, unilateral 6 339 Respiratory system Antrostomy for maxillary sinus 4 340 Respiratory system Caldwell Luc's operation and ethmoidectomy 10 341 Respiratory system Sinus fistula repair 8 342 Respiratory system External ethmoidectomy 15 343 Respiratory system Endonasal ethmoidectomy 9 344 Respiratory system Multiple sinusectomy 17 345 Respiratory system Pansinusectomy 19 346 Respiratory system Excision of postoperative cheek cyst 10 347 Respiratory system Dacryocystorhinostomy 13 348 Respiratory system Daeryoaploifinostomy and canalialar intubation 10 349 Respiratory system Rhinoplasty 16 350 Respiratory system Inferior basal concha turbinoplasty 5 351 Respiratory system Excision of nasopharyngeal tumor 5 352 Respiratory system Excision of nasal tumor with skin graft 14 353 Respiratory system Excision of intranasal tumor 10

-62- 354 Respiratory system Excision of nasopalatinal cyst 17 355 Respiratory system Exploratory antrotomy 1 356 Respiratory system Lysis of nasal synechia 2 357 Respiratory system Nasal laser surgery 2 358 Respiratory system Nasal button insertion 14 359 Respiratory system Closure of nasal septum perforation 4 360 Respiratory system Septoplasty 5 361 Respiratory system Septomeatal plasty - unilateral 4 362 Respiratory system Septomeatal plasty - bilateral 5 363 Respiratory system Drainage of nasal septal abscess or hematoma 1 Drainage of intranasal abscess or hematoma in lateral 364 Respiratory system 1 nasal cartilage 365 Respiratory system Submucous turbinectomy (SMT) - unilateral 5 366 Respiratory system Submucous turbinectomy (SMT) - bilateral 6 367 Respiratory system S.M.RSubmucous resection (SMR) of septum 5 368 Respiratory system Atrophic rhinitis operation - unilateral 5 369 Respiratory system Ordinary conchotomy 5 370 Respiratory system Submucosal diathermy 1 371 Respiratory system Vidian neurectomy 10 372 Respiratory system Nasopharyngeal exploration through palate approach 15 373 Respiratory system Opening of choanal atresia 14 374 Respiratory system Radical operation on maxillary ethmoid sphenoid sinus 18 375 Respiratory system Tumor excision, from frontal sinus 10 376 Respiratory system Tumor excision, from maxillary sinus 10 377 Respiratory system Tumor excision, from ethmoidal sinus 10 378 Respiratory system Choanal plasty - transnasal 14 379 Respiratory system Choanal plasty - transoral 23 380 Respiratory system Denker's Denker's operation 17 381 Respiratory system KillianKillian's operation 18 382 Respiratory system Sphenoidectomy 11 383 Respiratory system Oroantral fistula repair 5 384 Respiratory system Intranasal repair of choanal atresia 14 385 Respiratory system Transseptal repair of choanal atresia 14 386 Respiratory system Yranspalatine repair of choanal atresia 13 387 Respiratory system Craniofacial resection 43 388 Respiratory system Degloving midfacial surgery with facial bone reposition 26 Degloving midfacial surgery without facial bone 389 Respiratory system 15 reposition 390 Respiratory system External ethmoidectomy for CSF rhiorrhea 19 External frontoethmoidectomy with mucoperitoneal flap 391 Respiratory system 25 reconstruction 392 Respiratory system External frontoethmoidectomy 20 393 Respiratory system Lynch's operation 18 394 Respiratory system Osteoplastic approach for frontal sinus surgery 25 395 Respiratory system Trephination of frontal sinus 18 396 Respiratory system Sinoscop with biopsy - unilateral 1 397 Respiratory system Sinoscop with biopsy - bilateral 1 398 Respiratory system Endoscopic functional sinus surgery - unilateral 3 399 Respiratory system Endoscopic functional sinus surgery - bilateral 5 400 Respiratory system Lateral rhinotomy with facial bone reposition 30 401 Respiratory system Lateral rhinotomy without facial bone reposition 20 402 Respiratory system Excision of parapharyngeal tumor - through mandible 10 -63- Simple laryngoscopy with excision or stripping of tumor 403 Respiratory system 5 in vocal cords or epiglottis Complicated laryngoscopy with excision or stripping of 404 Respiratory system 8 tumor in vocal cords or epiglottis 405 Respiratory system Teflon intracordal injection 2 406 Respiratory system Supraglottic laryngectomy 25 407 Respiratory system Thyroitomy 15 408 Respiratory system Laryngeal plasty - simple 8 409 Respiratory system Laryngeal plasty - complicated 10 410 Respiratory system Laryngoscopy with biopsy 1 411 Respiratory system Laryngotomy 12 412 Respiratory system Laryngofissure 15 413 Respiratory system Laryngectomy without neck lymphadenectomy 33 414 Respiratory system Laryngectomy with radical neck lymphadenectomy 50 415 Respiratory system Laryngectomy with tracheoesophageal shunt (T-E shunt) 43 416 Respiratory system Hemilaryngectomy - horizontal 30 417 Respiratory system Hemilaryngectomy - vertical (lateral or anterior) 29 418 Respiratory system Larynx reconstruction 25 419 Respiratory system Laryngopharyngectomy 43

420 Respiratory system Laryngo microsurgery with CO2 laser 5 421 Respiratory system Radical neck lymphadenectomy 10 422 Respiratory system Arytenoidectomy or arytenoidopexy 20 423 Respiratory system Endoscopic arytenoidectomy 14 424 Respiratory system Laryngotracheal reconstruction 20 425 Respiratory system Stomaplasty 10 426 Respiratory system Permanent tracheostomy with skin graft 11 427 Respiratory system Thyroid cartilage plasty - two types 6 428 Respiratory system Thyroid cartilage plasty - simple 6 429 Respiratory system Thyroid cartilage plasty - complicated 12 430 Respiratory system Uvulopalatopharyngoplasty (UPPP) 17 431 Respiratory system Cricopharyn geal myotomy 18 432 Respiratory system Total excision of thyroglossal duct cyst 10 433 Respiratory system Excision of branchial arch cyst 5 434 Respiratory system Chest wall resection (10cm) 10 435 Respiratory system Chest wall resection (10cm) 20 436 Respiratory system Wide excision of malignant tumor in chest wall 30 437 Respiratory system Chest wall resection and myoplasty 44 438 Respiratory system Thoracoplasty with myoplasty or prosthetic mesh repair 30 439 Respiratory system Intrapleural pneumonolysis 23 440 Respiratory system Extrapleura pneumonolysis 23 441 Respiratory system Pleurodesis 15 442 Respiratory system Exploratory thoracotomy 10 443 Respiratory system Rethroacotomy 7 444 Respiratory system Bronchoscopic excision with removal of tumor 22 445 Respiratory system Endobronchial dilatation 1 446 Respiratory system Closure of bronchial fistula 37 Removal of foreign body in trachea, bronchus, or 447 Respiratory system 5 bronchiole - by bronchoscopy Removal of foreign body in trachea, bronchus, or 448 Respiratory system 30 bronchiole - by thoracotomy 449 Respiratory system Tracheabronchial tree repair 29 450 Respiratory system Tracheobronchial tree reconstruction 32 -64- 451 Respiratory system Tracheal stent intubation 12 452 Respiratory system Transthoracic vagotomy 17 453 Respiratory system Thymectomy 27 454 Respiratory system Extensive thymectomy 30 455 Respiratory system Closed drainage 5 456 Respiratory system Open drainage 12 457 Respiratory system Simple debridement of chest wall 10cm 5 458 Respiratory system Complicated debridement of chest wall >10cm 8 459 Respiratory system Exploratory pneumonotomy 15 460 Respiratory system Total pneumonectomy 45 461 Respiratory system Segmental resection of lung 20 462 Respiratory system Wedge or partial resection of lung 20 463 Respiratory system Combined resection of lung cancer 40 464 Respiratory system Sleeve resection 20 465 Respiratory system Incision of lung abscess 15 466 Respiratory system Decortication of pleura 39 Pneumonectomy with concomitent thoracoplasty or 467 Respiratory system 45 bronchoplasty 468 Respiratory system Pulmonary lobectomy - one lobe 20 469 Respiratory system Pulmonary lobectomy - two lobes 30 470 Respiratory system Plombage thoracoplasty 15 471 Respiratory system Cavernostomy 20 472 Respiratory system Surgery for portal hypertension 24 473 Respiratory system Reconstruction of congenital funnel or pigeon chest 30 474 Respiratory system Complicated correction of chest wall deformity 40 475 Respiratory system Correction of adult chest wall deformity 40 Cardiovascular Exploratory cardiotomy: including removal of foreign 476 34 system body Cardiovascular 477 Exploratory pericardiotomy 19 system Cardiovascular 478 Pericardiocentesis 3 system Cardiovascular 479 Pericardiectomy 29 system Cardiovascular 480 Cardiorrhaphy for cardiac wound or injury 30 system Cardiovascular 481 Excision of intracardiac tumor and bypass surgery 46 system Cardiovascular 482 Repair of ventricular aneurysm 62 system Cardiovascular 483 Repair of endocardial cushion defect 55 system Cardiovascular 484 Endocardium biopsy 5 system Cardiovascular 485 Epicardium biopsy 3 system Cardiovascular 486 Heart procurement 28 system Cardiovascular 487 Heart implantation 68 system Cardiovascular 488 Fontan operation (6-year-old) 50 system

-65- Cardiovascular 489 Fontan operation (> 6-year-old) 50 system Cardiovascular A.S.D. Blalock-HanlonCreation of atrial septal defect 490 30 system (ASD), Blalock-Hanlon type Cardiovascular 491 A.S.D. RashkindCreation of ASD, Rashkind type 20 system Cardiovascular 492 A.S.D.Creation of ASD with inflow occlusion 30 system Cardiovascular 493 A.S.D.Atrial septal defect (ASD) repair 43 system Cardiovascular Insertion or replacement of permanent interal pacenaker 494 25 system and myocardial electrodes by thoracotomy Cardiovascular Insertion or replacement of permanent pacemaker - 495 8 system single electrode catheter Cardiovascular Insertion or replacement of permanent pacemaker - 496 10 system multiple electrode catheters Cardiovascular 497 Transvenous insertion of temporary electrode 9 system Cardiovascular 498 Annuloplasty 25 system Cardiovascular 499 Single valve replacement 25 system Closed mitral commissurotomy or open mitral Cardiovascular 500 commissurotomy. Note: Also applicable to pulmonary 45 system valve commissurotomy. Cardiovascular 501 Double valve replacement 63 system Cardiovascular 502 Triple valve replacement 64 system Cardiovascular 503 Extracorporeal circulation - first time 19 system Cardiovascular 504 Valsalva-sinus Repair of fistula in sinus of Valsalva 49 system Cardiovascular 505 Coronary artery bypass graft (CABG) - one vessel 58 system Cardiovascular 506 Coronary artery bypass graft (CABG) - two vessels 63 system Cardiovascular 507 Coronary artery bypass graft (CABG) - three vessels 64 system Cardiovascular 508 Repair of anomalous venous return, total or partial 56 system Cardiovascular 509 Ventricular septal defect (VSD) repair 35 system Cardiovascular 510 Repair of tetralogy of Fallot (TOF) 50 system Cardiovascular 511 Blalock-Taussig shunt for TOF 48 system Cardiovascular 512 Corrective surgery for transposition of great arteries 50 system Cardiovascular 513 Lung procurement 26 system Cardiovascular 514 Single-lung transplantation 68 system

-66- Cardiovascular Bilateral-sequential lung transplantation or en bloc 515 73 system double-lung transplantation Cardiovascular 516 Embolectomy on pulmonary artery 30 system Cardiovascular 517 Balloon pulmonary valvuloplasty 43 system Cardiovascular 518 Pulmonary artery ligation 31 system Cardiovascular 519 Carotid artery ligation 10 system Cardiovascular 520 Excision of tumor in carotid body 22 system Cardiovascular 521 Jugular venous ligation 10 system Cardiovascular 522 Femoral vein ligation 11 system Cardiovascular 523 A-V shunt with goretex graft 10 system Cardiovascular ScribnerInsertion of Quinton-Scribner arteriovenous 524 3 system cannula Cardiovascular 525 Aortopulmonary window repair 44 system Cardiovascular 526 Coarctation of the aorta (CoA) repair 40 system Cardiovascular 527 Bentall procedure 57 system Cardiovascular Percutaneous transluminal septal myocardial ablation 528 11 system (PTSMA) Cardiovascular 529 Venous thrombectomy 13 system Cardiovascular 530 Endarterectomy with or without bypass graft 28 system Cardiovascular 531 Arterial embolectomy 13 system Cardiovascular 532 Arterial catheter embolectomy 13 system Cardiovascular 533 Arteriorrhaphy 10 system Cardiovascular 534 Vascular exploration 3 system Cardiovascular 535 Cannulation for hemodialysis (vein to vein) 2 system Cardiovascular 536 Blood vessel anastomosis 8 system Cardiovascular Ligation and division of short saphenous vein at 537 3 system sapheno-popliteal junction Cardiovascular 538 Suture, ligation, or stripping of minor varicose vein 3 system Cardiovascular Radical subfascial stripping (i.e. Linton operation), with 539 16 system or without skin graft Cardiovascular Ligation and division of hypogastric artery or uterine 540 10 system artery 541 Cardiovascular Ligation and division of long saphenous vein at 11 -67- system sapheno-femoral junction Cardiovascular Ligation, division, and complete stripping of long or short 542 11 system saphenous vein - unilateral Cardiovascular Ligation, division, and complete stripping of long or short 543 15 system saphenous vein - bilateral Cardiovascular Ligation, division, and complete stripping of long and 544 14 system short saphenous veins - unilateral Cardiovascular Ligation, division, and complete stripping of long and 545 16 system short saphenous veins - bilateral Cardiovascular Excision and bypass graft or direct repair of A-V fistula of 546 22 system neck or extremity Cardiovascular Excision and bypass graft or direct repair of A-V fistula of 547 45 system chest or abdomen - aorta ascendens Cardiovascular Excision and bypass graft or direct repair of A-V fistula of 548 45 system chest or abdomen - aortic arch Cardiovascular Excision and bypass graft or direct repair of A-V fistula of 549 45 system chest or abdomen - aorta descendens Cardiovascular Exploration for postoperative hemorrhage or thrombosis 550 11 system - neck Cardiovascular Exploration for postoperative hemorrhage or thrombosis 551 10 system - chest Cardiovascular 552 Surgical obliteration for patent ductus arteriosus (PDA) 30 system Cardiovascular 553 Repair and anastomosis of peripheral vessel 8 system Cardiovascular Repair and anastomosis of peripheral vessel with 554 16 system vascular graft Hemic & 555 Splenectomy 19 Lymphatic systems Hemic & 556 Splenorrhaphy 21 Lymphatic systems Hemic & 557 Partial splenectomy 21 Lymphatic systems Hemic & 558 Autoimplantation of spleen 13 Lymphatic systems Hemic & 559 Splenorenal shunt (including splenectomy) 22 Lymphatic systems Hemic & 560 Lymph node biopsy 1 Lymphatic systems Hemic & 561 Excision of TB lymphadenitis fistula - superficial 3 Lymphatic systems Hemic & 562 Excision of TB lymphadenitis fistula - deep 4 Lymphatic systems Hemic & 563 Removal of axillary lymph node 5 Lymphatic systems Hemic & 564 Dissection of axillary lymph node 14 Lymphatic systems Hemic & 565 Excision of inguinal lymph node 5 Lymphatic systems Hemic & 566 Radical dissection of inguinal lymph node 15 Lymphatic systems Hemic & 567 Pelvic lymphadenectomy 26 Lymphatic systems -68- Hemic & 568 Retroperitoneal lymphadenectomy 20 Lymphatic systems Hemic & 569 Ileo-inguinal lymphadenectomy - unilateral 17 Lymphatic systems Hemic & 570 Ileo-inguinal lymphadenectomy - bilateral 24 Lymphatic systems Hemic & 571 Lymphocelectomy 12 Lymphatic systems Hemic & Radical lymphadenectomy (at the time of pulmonary 572 24 Lymphatic systems lobectomy or pneumonectomy) Hemic & 573 Dissection of mediastinal or throacic lymph node 16 Lymphatic systems Hemic & 574 Mediastinotomy 15 Lymphatic systems Hemic & 575 Resection of malignant mediastinal tumor 50 Lymphatic systems Hemic & 576 Simple resection of benign mediastinal mass (<5 cm) 30 Lymphatic systems Hemic & Complicated resection of benign mediastinal mass (5 577 40 Lymphatic systems cm) Hemic & Removal of foreign body, mediastinum transthoracic and 578 18 Lymphatic systems intercostal approach Hemic & 579 Diaphragmatic fundoplication 21 Lymphatic systems Hemic & 580 Diaphragmatic hernia repair, transabdominal 21 Lymphatic systems Hemic & 581 Diaphragmatic hernia repair, transthoracic 21 Lymphatic systems Hemic & 582 Repair of acute traumatic diaphragmatic hernia 21 Lymphatic systems Hemic & Repair of diaphragmatic hernia, combined 583 32 Lymphatic systems thoraco-abdominal approach Hemic & Mediastinotomy with exploration or drainage, cervical 584 12 Lymphatic systems approach Hemic & Mediastinotomy with exploration or drainage, 585 19 Lymphatic systems transthoracic intercostal apporach Hemic & Mediastinotomy with exploration or drainage, by sternal 586 20 Lymphatic systems split Hemic & 587 Removal foreign body in mediastinum, cervical approach 10 Lymphatic systems Hemic & 588 Removal foreign body in mediastinum by sternal split 19 Lymphatic systems 589 Digestive system Oral tumor or oropharynx excision 10 Oral tumor or oropharynx excision, with radical neck 590 Digestive system 40 lymphadenectomy 591 Digestive system Oral mucosal biopsy 1 592 Digestive system COMMANDO operation 30 593 Digestive system Composite resection for oral cancer 30 594 Digestive system Incision of ranula 1 595 Digestive system Excision of ranula 3 596 Digestive system Resection of platine tonsils 10 597 Digestive system Lingual tonsillectomy 10 598 Digestive system Adenoid tonsillectomy 10 -69- 599 Digestive system Cryotherapy on tonsil 2 600 Digestive system Ablation of submaxillary gland 15 601 Digestive system Excision of parotid tumor 15 Excision of tongue cancer with lymphadenectomy and 602 Digestive system 40 radical neck dissection 603 Digestive system Suprahyoid dissection 30 604 Digestive system Partial or wedge glossectomy 15 605 Digestive system Repair of lingual laceration 6 606 Digestive system Hemiglossectomy 17 607 Digestive system Total glossectomy 27 608 Digestive system Replantation of amputated tongue 40 609 Digestive system Ligation of internal maxillary artery 10 610 Digestive system Parotidectomy, total lobectomy 30 611 Digestive system Parotidectomy, excision 26 612 Digestive system Deep neck incision and drainage 5 613 Digestive system Esophageal myomectomy 21 614 Digestive system Excision of esophageal diverticulum 28 615 Digestive system Endoesophageal intubation 15 616 Digestive system Esophagofundostomy bypass 49 617 Digestive system Esophagogastrostomy 50 618 Digestive system Esophagogastrostomy bypass 50 619 Digestive system Retrograde esophageal dilatation 4 620 Digestive system Esophagogastric fistula closure 16 621 Digestive system Esophagectomy 57 622 Digestive system Esophagectomy and reconstruction 63 623 Digestive system Esophagotomy 25 624 Digestive system Excision of esophageal tumor and cyst 18 625 Digestive system Esophageal reconstruction - with gastric tube 56 626 Digestive system Repair of esophageal laceration 27 Simple excision of esophageal cancer (including lymphadenectomy). Note: Simple excision means 627 Digestive system 40 excision of a cancer of Stage II or below (Stage I or II) according to pathological reports. Complicated excision of esophageal cancer (including lymphadenectomy). Note: Complicated excision means 628 Digestive system 50 excision of a cancer of Stage II or above according to pathological reports. Ligation of esophageal varices, transthoracic or 629 Digestive system 25 transabdominal Ligation of esophageal varices, splenectomy with 630 Digestive system 40 devascularization - transthoracic Ligation of esophageal varices, splenectomy with with 631 Digestive system 40 devascularization - transabdominal Esophagogastric stenting (for gastric cardia cancer or 632 Digestive system 20 esophageal cancer) 633 Digestive system Esophageal reconstruction - with colon 45 634 Digestive system Esophageal reconstruction - with small intestine 48 635 Digestive system Belsey Mark IV procedure 5 636 Digestive system Gastrotomy - for exploration 15 637 Digestive system Gastrotomy - for removal of foreign body 15 638 Digestive system Gastrotomy - for suture of bleeding ulcer 15 639 Digestive system Fredet-Ramstedt pyloromyotomy 13

-70- 640 Digestive system Stomach biopsy - transoral 2 641 Digestive system Stomach biopsy - by laparotomy 5 642 Digestive system Local excision of gastric ulcer or tumor 19 Total gastrectomy with lymphadenectomy and 643 Digestive system 46 reconstruction Total gastrectomy with splenectomy or partital 644 Digestive system 41 pancreatectomy 645 Digestive system Total gastrectomy with reconstruction 37 95% (near-total) gastrectomy with lymphadenectomy 646 Digestive system 30 and reconstruction Radical subtotal gastrectomy with lymphadenectomy 647 Digestive system 30 and reconstruction 648 Digestive system Re-exploration for postgastrectomy bleeding 15 Proximal gastrectomy and esophagectomy with 649 Digestive system 46 reconstruction 650 Digestive system Plication of stomach 21 651 Digestive system Gastropexy for gastric volvulus 20 652 Digestive system Gastric partition 29 653 Digestive system Laparoscopic gastric partition 29 654 Digestive system Gastrostomy and pyloroplasty 19 655 Digestive system Resection of retained antrum, postgastrectomy 22 Subtotal gastrectomy or hemigastrectomy with 656 Digestive system 30 gastroduodenostomy - without vagotomy Subtotal gastrectomy or hemigastrectomy - with 657 Digestive system 37 vagotomy Subtotal gastrectomy or hemigastrectomy with 658 Digestive system 30 gastrojejunostomy - without vagotomy Subtotal gastrectomy or hemigastrectomy with 659 Digestive system 30 Roux-en-Y gastrojejunostomy - without vagotomy 660 Digestive system Vagotomy and pyloroplasty 25 661 Digestive system Pyloroplasty 17 662 Digestive system Gastroduodenostomy 18 Revision of gastroduodenostomy with or without 663 Digestive system 25 vagotomy 664 Digestive system Gastrojejunostomy 19 665 Digestive system Gastrojejunostomy (with vagotomy) 22 666 Digestive system Revision of gastrojejunostomy 25 667 Digestive system Gastroenterostomy 19 668 Digestive system Gastrostomy 15 669 Digestive system Closure of gastrostomy 15 Gastrorrhaphy (suture or repair of perforated ulcer and 670 Digestive system 18 wound in stomach) 671 Digestive system Duodenorrhpahy (suture of perforated ulcer) 19 672 Digestive system Duodenostomy 18 673 Digestive system Excision of duodenum tumor 17 674 Digestive system Excision or inversion of duodenal diverticulum 16 675 Digestive system Closure of duodenal fistula 21 676 Digestive system Duodenal obstruction 20 677 Digestive system Highly selective vagotomy 22 678 Digestive system Vagotomy 15 679 Digestive system Transduodenal sphincteroplasty 27 680 Digestive system Endoscopic papillectomy (EPT) on hepatopancreatic 23

-71- ampulla 681 Digestive system Enterolysis 19 682 Digestive system Enterolysis - with bowel decompression 20 683 Digestive system Enterolysis - with bowel resection and anastomosis 24 684 Digestive system Exteriorization of intestine (Mikulicz resection) 14 685 Digestive system Reduction of intussusception 17 Reduction of intussusception with bowel resection and 686 Digestive system 22 anastomosis Reduction of intussusception with enterostomy or 687 Digestive system 21 colostomy 688 Digestive system Excision of benign bowel lesion 17 689 Digestive system Meckel's diverticulectomy 16 Left hemicolectomy or sigmoid colectomy, with 690 Digestive system 30 anastomosis Left hemicolectomy or sigmoid colectomy, with 691 Digestive system 40 anastomosis and lymphadenectomy 692 Digestive system Subtotal colectomy with ileostomy or cecostomy 36 693 Digestive system Subtotal colectomy with ileostomy 36 Radical hemicolectomy with anastomosis, ascending 694 Digestive system 44 colon 695 Digestive system Partial colectomy with anastomosis 19 696 Digestive system Total or subtotal colectomy 33 697 Digestive system Total colectomy with proctectomy and ileostomy 36 698 Digestive system Revision of colostomy or enterostomy, simple 10 699 Digestive system Closure of loop enterostomy or colostomy 15 700 Digestive system Closure of double-barrel enterostomy or colostomy 12 701 Digestive system Enterorrhaphy 10 Enterostomy (including colostomy, jujunostomy, and 702 Digestive system 18 permanent enterostomy) 703 Digestive system Closure of intestinal fistula - enterocutaneous fistula 16 Closure of intestinal fistula - entero-colic fistula or 704 Digestive system 20 entero-entero fistula Closure of intestinal fistula - fistula between bowel and 705 Digestive system 25 other organs or fistula with complications 706 Digestive system Closure of colonic fistula - colocutaneous fistula 17 Closure of colonic fistula - gastroclic fistula (without 707 Digestive system 20 gastrectomy) Closure of colonic fistula - gastroclic fistula (with 708 Digestive system 22 gastrectomy) Closure of colonic fistula - fistula between colon and 709 Digestive system 23 other organs or fistula with complications Anastomosis of bowel-entero-enterostomy (or 710 Digestive system 18 duodeno-enterostomy) 711 Digestive system Anastomosis of bowel-ileo-colostomy, with bypass 21 712 Digestive system Anastomosis of bowel - for intestinal atresia or stenosis 17 713 Digestive system Repair of intestinal perforation 17 714 Digestive system Small bowel resection with anastomosis 22 715 Digestive system Resection of intestinal polyp 16 716 Digestive system Intestinal plication, Noble type 16 Closure of enterostomy or colostomy with enterectomy 717 Digestive system 19 and anastomosis, by laparotomy 718 Digestive system Revision of ileal conduit urinary diversion 20

-72- 719 Digestive system Closure of ileostomy 17 Take-down of anastomosis, revision of ileocolostomy 720 Digestive system 20 and reconstruction 721 Digestive system Antireflux procedure on intestine 11 722 Digestive system Suture and repair of mesentery 14 723 Digestive system Revision of colostomy or enterostomy, complicated 10 724 Digestive system Tube enterostomy or tube cecostomy 11 725 Digestive system Transabdominal drainage of appendiceal abscess 4 726 Digestive system Appendectomy 5 727 Digestive system Closure of appendiceal fistula 18 728 Digestive system Incision and drainage of periproctal abscess 2 729 Digestive system Incisional biopsy of rectum 1 730 Digestive system Repair of rectal laceration or injury 20 731 Digestive system Rectopexy 14 Radical proctectomy (including pelvic 732 Digestive system 40 lymphadenectomy) 733 Digestive system Harmann's operation 30 734 Digestive system Colonic polypectomy, transrectal 2 735 Digestive system Colonoscopic polypectomy 2 Radical surgery for rectal procidentia, with perineal 736 Digestive system 21 approach and anastomosis Surgery for rectal procidentia, with abdominal-perineal 737 Digestive system 26 approach and anastomosis :Excision of benign sacrococcygeal teratoma. (Note: 738 Digestive system 17 Also applicable to perianal or perirectal tumor) Extensive excision of sacrococcygeal rectal villous 739 Digestive system 23 adenoma or local excision of malignancy 740 Digestive system Rectoplasty for stricture or stenosis 10 741 Digestive system Restorative proctectomy with coloanal anastomosis 53 Restorative proctocolectomy with ileal pouch-anal 742 Digestive system 54 anastomosis (IPAA) 743 Digestive system Closure of rectovesical fistula 22 744 Digestive system Combined abdomino perineal resection for rectal cancer 40 Proctosigmoidectomy with coloanal pull-through 745 Digestive system 45 anastomosis Posterior proctotomy, trans-acrococcygeal excision of 746 Digestive system benign lesion. Note: Including Kraske's operation and 20 Mason's operation. Posterior proctotomy, trans-acrococcygeal excision of 747 Digestive system malignant tumor. Note: Including Kraske's operation and 23 Mason's operation. Proctosigmoidectomy with coloanal pull-through 748 Digestive system 52 anastomosis and reconstruction with colonic pouch 749 Digestive system Cryptectomy - single 4 750 Digestive system Cryptectomy - multiple 5 751 Digestive system Hemorrhoidectomy for external hemorrhoid 3 752 Digestive system Thrombectomy for external hemorrhoid 2 753 Digestive system Hemorrhoidectomy for internal or external hemorrhoid 3 Partial hemorrhoidectomy for internal or external 754 Digestive system 2 hemorrhoid 755 Digestive system Anal papillectomy - single 4 756 Digestive system Anal papillectomy - multiple 4

-73- 757 Digestive system Anal sphincterotomy 4 758 Digestive system Anal fistulectomy or fistulotomy with hemorrhoidectomy 7 759 Digestive system Anal fissurectomy or ulcerectomy 5 760 Digestive system Anoplasty for stricture or imperforate 20 761 Digestive system Sphincteroplasty for anal incontinence 28 762 Digestive system Removal of Karlex sponge s/p APR 10 763 Digestive system Hemostasis for anal or colonic bleeding 3 764 Digestive system Anal reconstruction or anoplasty with S-pedicle graft 20 765 Digestive system Transanal removal of foreign body 2 766 Digestive system Levator plication procedure 13 767 Digestive system Simple subcutaneous fistulotomy or fistulectomy 3 Complicated subcutaneous fistulotomy or fistulectomy. Note: Applicable to, for example, high-type 768 Digestive system intersphincteric fistulas, transsphincteric fistulas, 9 horseshoe fistulas, suprasphincteric fistulas, and supralevator fistulas. 769 Digestive system Wedge biopsy of liver (laparotomy) 2 770 Digestive system Partial hepatectomy 30 771 Digestive system Segemental hepatectomy- one segement 34 772 Digestive system Segemental hepatectomy- two segements 36 773 Digestive system Segemental hepatectomy- three segements 53 774 Digestive system Drainage or marsupialization of liver cyst or abscess 18 775 Digestive system Hepatorrhaphy (suture of wound < 5cm in liver) 20 Hepatorrhaphy with drainage of choledochous duct or 776 Digestive system 26 gallbladder Hepatorrhaphy (suture of complicated wound or wound > 777 Digestive system 21 5cm in liver) 778 Digestive system Hepatic artery ligation for liver bleeding 10 779 Digestive system Hepatoenterostomy (Longmire's operation) 33 780 Digestive system Portocavo shunt (H-graft) 31 781 Digestive system Warren's shunt 31 782 Digestive system Right hepatic lobectomy 41 783 Digestive system Left hepatic lobectomy 41 784 Digestive system Extended right hepatic lobectomy 60 785 Digestive system Extended left hepatic lobectomy 60 786 Digestive system Hepaticotomy or hepaticostomy for removal of calculus 25 787 Digestive system Liver transplantation 80 788 Digestive system Closure of hepatic fistula 24 789 Digestive system Plasty of extrahepatic bile duct 29 790 Digestive system ROUX-EN-Y hepaticojejunostomy 21 791 Digestive system Choledocholithotomy (transduodenal) 23 792 Digestive system Choledochoplasty 27 793 Digestive system Biopsy of biliary tract 2 794 Digestive system Cholecystostomy 16 795 Digestive system Cholecystoenterostomy 20 796 Digestive system Cholecystectomy 21 797 Digestive system Laparoscopic cholecystectomy 21 798 Digestive system Choledochojejunostomy 25 799 Digestive system Total excision of common bile duct with reconstruction 26 800 Digestive system Choledochotomy with T-tube drainage 24 801 Digestive system Choledocholithotomy with T-tube drainage 36 802 Digestive system Choledochoduodenostomy 25 -74- 803 Digestive system Incisional biopsy of pancreas 2 804 Digestive system Pancreatic fistulectomy 22 805 Digestive system Marsupialization of pancreatic cyst 20 Anastomosis of pancreatic cyst to gastrointestinal tract, 806 Digestive system 22 with direct internal drainage Anastomosis of pancreatic cyst to gastrointestinal tract, 807 Digestive system 25 with direct internal drainage (Roux-en-Y) 808 Digestive system Drainage of pancreatic abscess or cyst or pancreatitis 15 809 Digestive system Excision or enucleation of pancreatic tumor or cyst 21 810 Digestive system Distal partial pancreatectomy 21 811 Digestive system Partial pancreatectomy 21 812 Digestive system Removal of pancreatic calculus 20 813 Digestive system Subtotal pancreatectomy 26 814 Digestive system Total pancreatectomy 38 815 Digestive system Pancreaticojejunostomy 27 816 Digestive system Distal partial pancreatectomy - with spleen preservation 21 817 Digestive system Partial pancreatectomy - with spleen preservation 21 Pancreaticoduodenectomy (Whipple procedure) with 818 Digestive system 50 reconstruction Pancreaticoduodenectomy (Whipple procedure) with 819 Digestive system 50 reconstruction and pylorus preservation 820 Digestive system Drainage of abdominal wall abscess 2 821 Digestive system Excision of benign tumor in abdominal wall 3 822 Digestive system Excision of malignant tumor in abdominal wall 20 823 Digestive system Ventral hernia repair - with bowel resection 20 824 Digestive system Ventral hernia repair - without bowel resection 5 Incarcerated ventral hernia repair - without bowel 825 Digestive system 5 resection 826 Digestive system Recurrent ventral hernia repair - without bowel resection 5 827 Digestive system Inguinal hernia repair - with bowel resection 20 828 Digestive system Inguinal hernia repair - without bowel resection 5 Incarcerated inguinal hernia repair - without bowel 829 Digestive system 5 resection Recurrent inguinal hernia repair - without bowel 830 Digestive system 5 resection 831 Digestive system Lumbar hernia repair 16 832 Digestive system Femoral hernia repair - without bowel resection 5 833 Digestive system Laparoscopic herniorrhaphy 5 834 Digestive system Peritoneal lavage 4 Drainage of intraabdominal abscess for acute perforation 835 Digestive system 19 peritonitis 836 Digestive system Drainage of subphrenic abscess 18 837 Digestive system Drainage of pelvic abscess - transabdominal 16 838 Digestive system Drainage of pelvic abscess - transanal 8 839 Digestive system Exploratory laparotomy 10 840 Digestive system Retroperitoneal exploratory laparotomy 15 841 Digestive system Excision of benign retroperitoneal tumor 15 Excision of malignant retroperitoneal tumor with 842 Digestive system 45 retroperitoneal lymphadenectomy 843 Digestive system Excision of benign intraabdominal tumor 20 844 Digestive system Excision of malignant intraabdominal tumor 30 845 Digestive system Removal of intraabdominal foreign body 15

-75- 846 Digestive system Peritoneovenous shunt 18 Simple repair of abdominal wall injury, with or without 847 Digestive system 5 reconstruction Extensive repair of abdominal wall injury, with 848 Digestive system 10 reconstruction or prosthesis Suture of abdominal wall for dehiscence and 849 Digestive system 10 evisceration, secondary closure Excision of urachus or urachal fistula with partial 850 Digestive system 18 cystectomy Urinary & genital 851 Drainage of perirenal or renal abscess 10 system Urinary & genital 852 Pyelotomy with exploration drainage or pyelolithotomy 15 system Urinary & genital 853 Open renal biopsy 2 system Urinary & genital 854 Nephrectomy 19 system Urinary & genital 855 Laparoscopic nephrectomy 19 system Urinary & genital 856 Radical nephrectomy 23 system Urinary & genital 857 Partial nephrectomy 26 system Urinary & genital 858 Renel decapsulation, unilateral 12 system Urinary & genital Radical nephrectomy with lymphadenectomy, or with 859 30 system regional lymphadenectomy Urinary & genital 860 Radical nephrectomy with IVC tumor thrombectomy 30 system Urinary & genital 861 Marsupialization of renal cyst 14 system Urinary & genital 862 Nephropexy - fixation or suspension 11 system Urinary & genital 863 Nephrostomy (operative) 8 system Urinary & genital 864 Nephrolithotomy and pyelolithotomy 17 system Urinary & genital 865 Nephro-pyelolithotomy for staghorn stone 23 system Urinary & genital 866 Percutaneous nephrostolithotomy (PCNL) 17 system Urinary & genital 867 Anatrophic nephrolithotomy 26 system Urinary & genital 868 Renal puncture 2 system Urinary & genital 869 Nephrorrhaphy 10 system Urinary & genital 870 Pyeloplasty 23 system Urinary & genital 871 Pyelostomy 13 system Urinary & genital 872 Enucleation of renal hematoma 26 system -76- Urinary & genital 873 Renal implantation 40 system Urinary & genital 874 Endoscopic pyelotomy 13 system Urinary & genital 875 PCNL with nephroscope 14 system Urinary & genital Nephroureterectomy without excision of ureter and 876 34 system bladder cuff Urinary & genital Nephroureterectomy with excision of ureter and bladder 877 40 system cuff Urinary & genital Ureterolithotomy - one third of ureter, upper or lower 878 5 system section Urinary & genital 879 Ureterolithotomy - one third of ureter, middle section 5 system Urinary & genital 880 Nephroureterectomy with bladder cuff excision 19 system Urinary & genital 881 Ureteroplasty - unilateral 10 system Urinary & genital 882 Ureteroplasty - bilateral 17 system Urinary & genital 883 Ureterolysis - unilateral 3 system Urinary & genital 884 Ureterolysis - bilateral 5 system Urinary & genital 885 Ureteropyelostomy or ureteropyeloplasty 22 system Urinary & genital 886 Ureteroureterostomy 22 system Urinary & genital 887 Transureteroureterostomy 22 system Urinary & genital 888 Ureterosigmoidostomy 20 system Urinary & genital 889 Ureteroneocystomy - unilateral 22 system Urinary & genital 890 Ureteroneocystomy - bilateral 25 system Urinary & genital 891 Uretero-intestinal anastomosis - unilateral 15 system Urinary & genital 892 Uretero-intestinal anastomosis - bilateral 18 system Urinary & genital Replacement of all or part of unilateral ureter with bowel 893 20 system segment, including bowel anastomosis Urinary & genital Replacement of all or part of bilateral ureters with bowel 894 26 system segment, including bowel anastomosis Urinary & genital 895 Ureterocutaneostomy - unilateral 13 system Urinary & genital 896 Ureterocutaneostomy - bilateral 16 system Urinary & genital 897 Uretero-ileal-cutaneous anastomosis 30 system Urinary & genital 898 Closure of urethrocutaneous fistula 10 system 899 Urinary & genital Closuer of ureterovesical fistula 16 -77- system Urinary & genital 900 Ureter catheterization 2 system Urinary & genital 901 Internal dilatation of ureteral stricture 2 system Urinary & genital 902 Ureteroscopic biopsy 1 system Urinary & genital 903 Laparoscopic ureterolithotomy 5 system Urinary & genital Ureteroscopy and removal of ureteral stone - by simple 904 5 systems endoscopy Urinary & genital Ureteroscopy and removal of ureteral stone - with 905 5 systems ultrasonic lithotripsy or electrohydraulic lithotripsy (EHL) Urinary & genital Ureteroscopy and removal of ureteral stone - with 906 5 systems Nd-YAG laser Urinary & genital 907 Ureterorrhapy 30 systems Urinary & genital 908 Ureteroileal cutaneous diversion (unilateral) 20 systems Urinary & genital 909 Ureteroileal cutaneous diversion (bilateral) 26 systems Urinary & genital 910 Endoscopic ureterotomy 10 systems Urinary & genital 911 Transurethral incision of ureterocele 8 systems Urinary & genital 912 Bladder aspiration with catheterization 2 systems Urinary & genital 913 Cystostomy - open surgery 10 systems Urinary & genital 914 Cystostomy - Trocar method 7 systems Urinary & genital 915 Closure of cystostomy 10 systems Urinary & genital 916 Repair of bladder rupture 6 systems Urinary & genital 917 Bladder neck incision 10 systems Urinary & genital Cystotomy for excision of bladder diverticulum (single or 918 8 systems multiple) Urinary & genital 919 Partial cystectomy with excision of bladder diverticulum 7 systems Urinary & genital 920 Fulguration of bladder diverticulum 6 systems Urinary & genital Cystotomy for excision of bladder tumor - transurethral 921 10 systems resection of bladder tumour (TURBT) Urinary & genital 922 Cystotomy for excision of bladder tumor - open surgery 10 systems Urinary & genital 923 Partial cystectomy 18 systems Urinary & genital Cystectomy (without pelvic lymphadenectomy, 924 30 systems urethrectomy, or bladder reconstruction) Urinary & genital 925 Cystectomy with pelvic lymphadenectomy 32 systems -78- Urinary & genital 926 Cystectomy with urethrectomy 33 systems Urinary & genital 927 Cystectomy with orthotopic neobladder reconstruction 40 systems Urinary & genital Cystectomy with urethrectomy and pelvic 928 41 systems lymphadenectomy Urinary & genital Cystectomy with urethrectomy and continent urinary 929 48 systems reservoir reconstruction Urinary & genital Cystectomy with pelvic lymphadenectomy and orthotopic 930 51 systems neobladder reconstruction Cystectomy with pelvic lymphadenectomy, Urinary & genital 931 urethrectomy, and continent urinary reservoir 56 systems reconstruction Urinary & genital Cystoprostatectomy without pelvic lymphadenectomy, 932 28 systems urethrectomy, or bladder reconstruction Urinary & genital 933 Cystoprostatectomy with pelvic lymphadenectomy 35 systems Urinary & genital Cystoprostatectomy with orthotopic neobladder 934 42 systems reconstruction Urinary & genital Cystoprostatectomy with pelvic lymphadenectomy and 935 52 systems orthotopic neobladder reconstruction Urinary & genital 936 Cystoplasty or cystourethroplasty 14 systems Urinary & genital Cystourethroplasty with unilateral or bilateral 937 20 systems uretero-neocystotomy Urinary & genital Anterior vesicourethropexy or Marshall-Marchetti-Krantz 938 10 systems urethropexy Urinary & genital 939 Cystorrhaphy 6 systems Urinary & genital 940 Closure of vesicovaginal fistula, abdominal approach 20 systems Urinary & genital 941 Closure of vesicouterine fistula, with hysterectomy 20 systems Urinary & genital 942 Enterocystoplasty with bowel anastomosis 21 systems Urinary & genital 943 Cutaneous vesicostomy 13 systems Urinary & genital 944 Cystourethroscopy with internal ureterotomy 10 systems Urinary & genital 945 Transurethral resection (TUR) of bladder neck 8 systems Urinary & genital 946 Cystolithotomy 5 systems Urinary & genital 947 Cystourethroscopy with removal of ureteral calculus 5 systems Urinary & genital Simple endoscopic cystolitholapaxy (crushing calculus in 948 7 systems the bladder and remove it) Urinary & genital 949 Complicated endoscopic cystalitholapaxy 8 systems Urinary & genital 950 Transabdominal urinary incontinence surgery 9 systems Urinary & genital Transvaginal urinary incontinence surgery (including 951 9 systems Kelly plication)

-79- Urinary & genital 952 Burch colposuspension 18 systems Urinary & genital 953 Bladder suspension surgery 8 systems Urinary & genital 954 Artificial urinary sphincter implantation 15 systems Urinary & genital 955 Cystoscopy with urethral dilation for interstitial cystitis 2 systems Urinary & genital 956 Bladder augmentation 20 systems Urinary & genital 957 Incision and drainage of periurethral abscess 2 systems Urinary & genital 958 Removal of urethral stone or foreign body 3 systems Urinary & genital 959 Resection of urethral tumor 5 systems Urinary & genital 960 Urethrostomy 5 systems Urinary & genital 961 Urethral fistulectomy (anterior) 5 systems Urinary & genital 962 Urethral fistulectomy (posterior) 5 systems Urinary & genital 963 Repair of rupture in corpus spongiosum 5 systems Urinary & genital 964 Repair of rupture in corpora spongiosa 8 systems Urinary & genital 965 Repair of urethral stricture - anterior urethra 10 systems Urinary & genital 966 Repair of urethral stricture - posterior urethra 12 systems Urinary & genital 967 Urethral diverticulectomy - anterior (or posterior) urethra 11 systems Urinary & genital 968 Urethroplasty - repeat procedure 11 systems Urinary & genital Urethroplasty - including urinary diversion, penile or 969 16 systems penoscrotal Urinary & genital 970 Repair of urethral rupture - posterior urethra 10 systems Urinary & genital 971 Repair of urethral rupture - anterior urethra 8 systems Urinary & genital 972 One-stage reconstruction of hypospadias 15 systems Urinary & genital 973 Operation for hypospadias - glandular type 15 systems Urinary & genital 974 Operation for hypospadias - others 15 systems Urinary & genital Reconstruction of hypospadias and correction of painful 975 15 systems erection Urinary & genital 976 Otis urethrotomy 2 systems Urinary & genital 977 Optical urethrotomy 9 systems 978 Urinary & genital Polypectomy, external urethral 1 -80- systems Urinary & genital 979 Transurothral incision (TUI) of prostate 10 systems Urinary & genital 980 Total urethrectomy 14 systems Urinary & genital 981 Repair of urethral cutaneous fistula 6 systems Urinary & genital 982 Penile biopsy 1 systems Urinary & genital 983 Partial penectomy 10 systems Urinary & genital 984 Total penectomy 19 systems Urinary & genital 985 Total penectomy for penile cancer 19 systems Urinary & genital Total penectomy for penile cancer with perineal 986 22 systems cutaneous urethrostomy Urinary & genital Partial penectomy for penile cancer with inguinal 987 24 systems lymphadenectomy Urinary & genital Total penectomy for penile cancer with 988 28 systems lymphadenectomy and perineal cutaneous urethrostomy Urinary & genital 989 Repair of severe penile trauma 6 systems Urinary & genital 990 Nesbit procedure for penile curvature 11 systems Urinary & genital 991 Hydrocelectomy 9 systems Urinary & genital 992 Removal of foreign body in scrotum 4 systems Urinary & genital 993 Resection of scrotum 9 systems Urinary & genital 994 Scrotal repair 4 systems Urinary & genital 995 Incision and drainage of scrotal abscess 2 systems Urinary & genital 996 Testicular biopsy - unilateral incision 1 systems Urinary & genital 997 Testicular biopsy - bilateral incision 1 systems Urinary & genital 998 Laparoscopic orchiectomy 8 systems Urinary & genital 999 Orchiectomy - unilateral 8 systems Urinary & genital 1000 Orchiectomy - bilateral 12 systems Urinary & genital 1001 Orchiopexy - unilateral 12 systems Urinary & genital 1002 Orchiopexy - bilateral 17 systems Urinary & genital 1003 Orchiopexy for undescended testis - unilateral 8 systems Urinary & genital 1004 Orchiopexy for undescended testis - bilateral 16 systems -81- Urinary & genital 1005 Suture or repair of testicular injury 9 systems Urinary & genital 1006 Orchidectomy for malignant tumor 15 systems Urinary & genital Orchidectomy for malignant tumor with 1007 30 systems lymphadenectomy Urinary & genital 1008 Epididymectomy - unilateral 5 systems Urinary & genital 1009 Epididymectomy - bilateral 12 systems Urinary & genital 1010 Incision and drainage of epididymal abscess 5 systems Urinary & genital 1011 Epididymo-vasostomy - unilateral 14 systems Urinary & genital 1012 Epididymo-vasostomy - bilateral 17 systems Urinary & genital 1013 Vasotomy - unilateral or bilateral 6 systems Urinary & genital 1014 Vesiculectomy 14 systems Urinary & genital 1015 Excision of lesion of spermatic cord 7 systems Urinary & genital 1016 Varicocelectomy 10 systems Urinary & genital 1017 High ligation of internal spermatic vein for varicocele 11 systems Urinary & genital 1018 Punch biopsy of prostate 1 systems Urinary & genital 1019 Incisional biopsy of prostate 1 systems Urinary & genital 1020 Incision and drainage of prostatic abscess 5 systems Urinary & genital 1021 Laparoscopic resection of prostatic cyst 5 systems Urinary & genital 1022 Transurethral biopsy of prostate 1 systems Urinary & genital 1023 Suprapubic prostatectomy 17 systems Urinary & genital 1024 Retropubic prostatectomy 17 systems Urinary & genital :Radical prostatectomy without pelvic lymphadenectomy. 1025 30 systems Note: Include vesiculectomy. Urinary & genital Radical prostatectomy with bilateral pelvic 1026 40 systems lymphadenectomy Urinary & genital Transurethral resection of the prostate (TURP) - 1027 17 systems resected prostrate weighs 5 to 15 g Urinary & genital 1028 TURP - resected prostrate weighs 15 to 50 g 17 systems Urinary & genital 1029 TURP - resected prostrate weighs over 50g 17 systems Urinary & genital 1030 Incision and drainage of perineal abscess (non-obstetric) 2 systems 1031 Urinary & genital Repair of perineum 2 -82- systems Urinary & genital 1032 Repair of perineum and anal defects 2 systems Urinary & genital 1033 Repair of perineum and sphincter 2 systems Urinary & genital 1034 Excision of genital leukoderma 2 systems Urinary & genital 1035 Extensive drainage of abscess in external genitalia 2 systems Urinary & genital 1036 Marsupialization of Bartholin's gland cyst 2 systems Urinary & genital 1037 Excision of Bartholin's gland 3 systems Simple vulvectomy or wide local excision of valvar Urinary & genital 1038 cancer (without reconstruction of cutaneous or 15 systems subcutaneous tissue) Urinary & genital Vulvectomy (with reconstruction of cutaneous or 1039 30 systems subcutaneous tissue) Urinary & genital 1040 Radical vulvectomy 40 systems Urinary & genital 1041 Female circumcision 2 systems Urinary & genital 1042 Clitoridectomy 4 systems Urinary & genital 1043 Clitoroplasty 5 systems Urinary & genital 1044 Hymenotomy 1 systems Urinary & genital 1045 Excision of vaginal cyst 3 systems Urinary & genital 1046 Resection of vaginal septum 6 systems Urinary & genital 1047 Incision of posterior fornix 4 systems Urinary & genital Repair of vaginal wall (suture of injury in vagina, 1048 7 systems non-obstetric) Urinary & genital Colpoperineorrhaphy, suture of injury in vagina and 1049 8 systems perineum (non-obstetric) Urinary & genital 1050 Vaginotomy for exploration or drainage of pelvic abscess 5 systems Urinary & genital 1051 Partial resection of vagina 9 systems Urinary & genital 1052 Complete resection of vagina - vaginal approach 12 systems Urinary & genital Complete resection of vagina - combined abdominal and 1053 15 systems vaginal approach Urinary & genital 1054 LeFort colpocleisis 10 systems Urinary & genital 1055 Anterior colporrhaphy 7 systems Urinary & genital 1056 Posterior colporrhaphy 6 systems 1057 Urinary & genital Anterior and posterior colporrhaphy 10 -83- systems Urinary & genital Anterior and posterior colporrhaphy: including repair of 1058 11 systems enterocele Urinary & genital 1059 Colposuspension 10 systems Urinary & genital 1060 Laparoscopic colpopexy 10 systems Urinary & genital 1061 Abdominoperineal urethral suspension 21 systems Urinary & genital 1062 Transabdominal colpopexy 14 systems Urinary & genital 1063 Colpopexy, vaginal approach 16 systems Urinary & genital 1064 Vaginal dilation under anesthesia 3 systems Laparoscopic fulguration or excision of pelvic Urinary & genital 1065 endometriosis - minimal to mild: Total points of 10 systems endometriosis staging are 5 or less. Laparoscopic fulguration or excision of pelvic Urinary & genital 1066 endometriosis - moderate: Total points of endometriosis 10 systems staging are 6 to 40. Laparoscopic fulguration or excision of pelvic Urinary & genital 1067 endometriosis - severe: Total points of endometriosis 10 systems staging are over 40. Vaginal pelvic floor reconstruction (with colpopexy and Urinary & genital 1068 anterior-posterior colporrhaphy, but without urinary 22 systems incontinence surgery) Combined abdominal and vaginal pelvic floor Urinary & genital reconstrction (with hysterectomy, colpopexy, and 1069 22 systems anterior-posterior colporrhaphy, but without urinary incontinence surgery) Vaginal pelvic floor reconstruction (with hysterectomy, Urinary & genital 1070 colpopexy, and anterior-posterior colporrhaphy, but 26 systems without urinary incontinence surgery) Urinary & genital Reconstruction of vagina (vaginal stenosis or vaginal 1071 16 systems defects) - without skin graft Urinary & genital Reconstruction of vagina (vaginal stenosis or vaginal 1072 24 systems defects) - with skin, colon, or other graft Urinary & genital 1073 Primary recto-vaginal fistula repair 10 systems Urinary & genital 1074 Recurrent recto-vaginal fistula repair 10 systems Urinary & genital 1075 Urethrovaginal fistula repair 8 systems Urinary & genital 1076 Vesicovaginal fistula repair 10 systems Urinary & genital 1077 Cervical polypectomy 2 systems Urinary & genital 1078 Cervical cerclage 3 systems Urinary & genital 1079 Cervical conization 3 systems 1080 Urinary & genital Dilation and curettage of cervical stump 3

-84- systems Urinary & genital 1081 Cervical amputation 5 systems Urinary & genital 1082 Tracheloplasty 6 systems Urinary & genital 1083 Vaginal trachelectomy 6 systems Urinary & genital 1084 Vaginal excision of cervical stump 10 systems Urinary & genital Manchester operation (transvaginal uterine suspension 1085 17 systems with partial cervicectomy) Urinary & genital 1086 Abdominal trachelectomy 10 systems Urinary & genital 1087 Abdominal excision of cervical stump 10 systems Urinary & genital 1088 Radical trachelectomy 44 systems Urinary & genital Diagnostic or therapeutic dilation and curettage 1089 3 systems (non-obstetric) Urinary & genital 1090 Uncomplicated myomectomy 6 systems Urinary & genital Hysteroscopic resection of uterine septum or 1091 6 systems hysteroscopic myomectomy Urinary & genital 1092 Complicated myomectomy 10 systems Urinary & genital 1093 Subtotal hysterectomy 15 systems Urinary & genital 1094 Uncomplicated total hysterectomy 20 systems Urinary & genital 1095 Laparoscopy hysterectomy 20 systems Complicated total hysterectomy, defined as removal of a fibroid over 8 cm in diameter, fibroids of 5 or more in Urinary & genital 1096 number, a cervical or parametrial ligament fibroid, or an 25 systems adhesion between uterine and intestinal tissues that is sufficient to obstruct an operation. Urinary & genital 1097 Radical hysterectomy for cervical cancer 26 systems Urinary & genital 1098 Extended hysterectomy 30 systems Urinary & genital 1099 Radical vaginal hysterectomy (Schauta operation) 28 systems Urinary & genital 1100 Partial or complete adnexectomy 6 systems Urinary & genital 1101 Laparoscopic partial or complete adnexectomy 6 systems Urinary & genital 1102 Uterine suspension 6 systems Urinary & genital 1103 Hysterorrhaphy 10 systems Urinary & genital Hysteroplasty for repair of uterine anomaly (Strassman 1104 15 systems type) 1105 Urinary & genital Repair or resection of broad ligament 6

-85- systems Urinary & genital 1106 Hysterosalpingostomy 12 systems Urinary & genital 1107 Hysteroscopic removal of foreign body or polyp 3 systems Urinary & genital 1108 Spalding-Richardson operation for uterine prolapse 16 systems Urinary & genital 1109 Hysterotomy for termination of pregnancy 5 systems Urinary & genital 1110 Ectopic pregnancy surgery 6 systems Urinary & genital 1111 Dilation and curettage (12 weeks) 3 systems Urinary & genital 1112 Dilation and curettage (<12 weeks) 5 systems Urinary & genital 1113 Dilation and evacuation after induction failure 5 systems Urinary & genital 1114 Septic abortion treatment 8 systems Urinary & genital 1115 Destructive operation on the dead fetus 9 systems Urinary & genital 1116 Cesarean section 17 systems Urinary & genital Cesarean section due to placenta previa or placenta 1117 17 systems accreta Urinary & genital 1118 Subtotal hysterectomy after Cesarean section 24 systems Urinary & genital 1119 Total hysterectomy after Cesarean section 25 systems Urinary & genital Endometrial ablation and transcervical endometrial 1120 6 systems resection Urinary & genital Hysteroscopic lysis of intrauterine adhesion or 1121 6 systems endometrial ablation Fulguration or excision of pelvic endometriosis - minimal Urinary & genital 1122 to mild: Total points of endometriosis staging are 5 or 9 systems less. Fulguration or excision of pelvic endometriosis - Urinary & genital 1123 moderate: Total points of endometriosis staging are 6 to 9 systems 40. Urinary & genital Fulguration or excision of pelvic endometriosis - severe: 1124 9 systems Total points of endometriosis staging are over 40. Urinary & genital 1125 Lysis of pelvic (abdominal) adhesion 7 systems Urinary & genital 1126 Surgical debulking of pelvic cancer 24 systems Urinary & genital 1127 Second-look laparotomy for gynecologic oncology 20 systems Staging surgery for gynecologic oncology, including Urinary & genital 1128 BSO, omentectomy, ATH, and retroperitoneal 40 systems lymphadenectomy Urinary & genital 1129 Laparoscopic staging surgery for gynecologic oncology 42 systems 1130 Urinary & genital Debulking surgery for gynecologic oncology, including 52

-86- systems BSO, omentectomy, ATH, and retroperitoneal lymphadenectomy Urinary & genital 1131 Salpingoplasty 14 systems Urinary & genital 1132 Salpingolysis 3 systems Urinary & genital 1133 End-to-end anastomosis of fallopian tubes 5 systems Urinary & genital 1134 Salpingostomy 14 systems Urinary & genital 1135 Fallopian tube reimplantation 14 systems Urinary & genital 1136 Incisional biopsy of ovary 1 systems Urinary & genital 1137 Incision and drainage of ovarian abscess 5 systems Urinary & genital 1138 Oophorectomy with omentectomy 25 systems Urinary & genital 1139 Second-look operation for ovarian cancer 15 systems Urinary & genital 1140 Removal of molar pregnancy or choriocarcinoma 10 systems Urinary & genital 1141 Presacral neurectomy 10 systems Urinary & genital 1142 Laparoscopic presacral neurectomy 10 systems 1143 Endocrine system Unilateral subtotal thyroidectomy 10 1144 Endocrine system Bilateral subtotal thyroidectomy 19 1145 Endocrine system Unilateral total thyroidectomy 10 1146 Endocrine system Bilateral total thyroidectomy 23 1147 Endocrine system Excision of thyroid nodule or thyroglossal duct cyst 10 Total thyroidectomy on one side and subtotal 1148 Endocrine system 23 thyroidectomy on the other side Radical thyroidectomy with unilateral neck 1149 Endocrine system 30 lymphadenectomy 1150 Endocrine system Parathyroid gland reimplantation 12 1151 Endocrine system Parathyroidectomy with autotransplantation 16 1152 Endocrine system Parathyroidectomy 17 1153 Endocrine system Re-exploration after parathyroidectomy 17 1154 Endocrine system Neck lymphadenectomy - unilateral 18 1155 Endocrine system Neck lymphadenectomy - bilateral 32 1156 Endocrine system Adrenalectomy - unilateral 19 1157 Endocrine system Laparoscopic adrenalectomy 19 Adrenalectomy with retorperitoneal tumor dissection - 1158 Endocrine system 21 unilateral Adrenalectomy with retorperitoneal tumor dissection - 1159 Endocrine system 22 bilateral 1160 Nervous system Scalp tumor 2 1161 Nervous system Radiofrequency coagulation 3 1162 Nervous system Brain biopsy 5 1163 Nervous system Microvascular decompression surgery 35 Brain tumor resection - surgery operating time within 4 1164 Nervous system 50 hours -87- Brain tumor resection - surgery operating time of 4 to 8 1165 Nervous system 60 hours Brain tumor resection - surgery operating time over 8 1166 Nervous system 70 hours 1167 Nervous system Laminoplasty 29 1168 Nervous system Laminectomy for decompression 2 segments 20 1169 Nervous system Laminectomy for decompression >2 segments 30 1170 Nervous system Subtemporal decompression - unilateral 20 1171 Nervous system Subtemporal decompression - bilateral 25 Decompression surgery on median nerve of wrist - 1172 Nervous system 3 unilateral Decompression surgery on median nerve of wrist - 1173 Nervous system 4 bilateral Decompression surgery on lateral femoral cutaneous 1174 Nervous system 10 nerve - unilateral Decompression surgery on lateral femoral cutaneous 1175 Nervous system 14 nerve - bilateral 1176 Nervous system Facial nerve decompression surgery 20 1177 Nervous system Surgery for depressed skull fracture - simple fracture 10 1178 Nervous system Surgery for depressed skull fracture - open fracture 20 Burr hole or trephination surgery (for hemostasis, 1179 Nervous system 5 drainage, or ventricular puncture) 1180 Nervous system Cranioplasty 19 1181 Nervous system Craniectomy 20 1182 Nervous system Diskectomy - cervical vertebra 36 1183 Nervous system Diskectomy - thoracic vertebra 29 1184 Nervous system Diskectomy - lumbar vertebra 24 1185 Nervous system Cervical sympathectomy 14 1186 Nervous system Dorsal sympathectomy 27 1187 Nervous system Lumbar sympathectomy 16 1188 Nervous system Myelotomy 30 1189 Nervous system Posterior rhizotomy 27 1190 Nervous system Neurectomy 10 1191 Nervous system Hypoglossal-facial nerve anastomosis 23 1192 Nervous system Removal of epidural hematoma 25 1193 Nervous system Removal of acute subdural hematoma 28 1194 Nervous system Removal of chronic subdural hematoma 19 1195 Nervous system Removal of intracerebral hematoma 31 1196 Nervous system Bemign intraspinal tumor excision 41 1197 Nervous system Malignant intraspinal tumor excision 43 1198 Nervous system Intraspinal intramedullary tumor excision 47 Spinal fusion - anterior spinal fusion without spinal 1199 Nervous system 28 instrumentation for 4 motion segments or less Spinal fusion - anterior spinal fusion without spinal 1200 Nervous system instrumentation for every additional 4 or less motion 33 segments Spinal fusion - anterior spinal fusion with spinal 1201 Nervous system 34 instrumentation for 4 motion segments or less Spinal fusion - anterior spinal fusion with spinal 1202 Nervous system instrumentation for every additional 4 or less motion 39 segments 1203 Nervous system Spinal fusion - posterior spinal fusion without spinal 28

-88- instrumentation Spinal fusion - posterior spinal fusion with spinal 1204 Nervous system 35 instrumentation for 6 motion segments or less Spinal fusion - anterior spinal fusion with spinal 1205 Nervous system instrumentation for every additional 6 or less motion 42 segments 1206 Nervous system Excision of intraspinal AVM2 segments 50 1207 Nervous system Excision of intraspinal AVM2 segments 60 1208 Nervous system External ventricular drainage (EVD) 8 1209 Nervous system Ventriculoperitoneal (VP) shunt 20 1210 Nervous system Ventriculoatrial (VA) shunt for hydrocephalus 20 1211 Nervous system Revision of cerebrospinal fluid (CSF) shunt 20 1212 Nervous system Repair of meningocele or encephalocele 40 1213 Nervous system Ommaya reservoir implantation 9 1214 Nervous system External lumbar cistern drainage 5 1215 Nervous system -Lumbar-peritoneal shunt 14 1216 Nervous system Temporal lobectomy for epilepsy 63 1217 Nervous system Transsphenoidal removal of pituitary adenoma 44 1218 Nervous system Carotid artery embolization 15 1219 Nervous system Carotid artery ligation - acute ligation 10 Carotid artery ligation - gradual occlusion with special 1220 Nervous system 10 clamp application Carotid artery ligation - gradual occlusion with special 1221 Nervous system 10 clamp removal 1222 Nervous system Carotid endarterectomy 22 1223 Nervous system Extracranial to intracranial (EC-IC) bypass 39 Craniotomy for vascular lesions - asymptomatic 1224 Nervous system 63 aneurysms Craniotomy for vascular lesions - symptomatic 1225 Nervous system 63 aneurysms 1226 Nervous system Craniotomy for vascular lesions - giant aneurysms 64 Craniotomy for vascular lesions - small arteriovenous 1227 Nervous system 58 malformation (D2.5cm), superficial Craniotomy for vascular lesions - small arteriovenous 1228 Nervous system 63 malformation (D2.5cm), deep Craniotomy for vascular lesions - medium arteriovenous 1229 Nervous system 63 malformation (2.5cmD5cm), superficial Craniotomy for vascular lesions - medium arteriovenous 1230 Nervous system 64 malformation (2.5cmD5cm), deep Craniotomy for vascular lesions - large arteriovenous 1231 Nervous system 65 malformation (D6cm) 1232 Nervous system Craniosynostosis surgery - simple suturectomy 16 1233 Nervous system Craniosynostosis surgery - morcellation 17 1234 Nervous system Intracranial pressure (ICP) monitoring 14 1235 Nervous system Skull base tumor surgery 67 1236 Nervous system Stereotaxic procedure - for biopsy 5 1237 Nervous system Stereotaxic procedure - for aspiration 20 1238 Nervous system Stereotaxic procedure - for radio isotope implantation 44 1239 Nervous system Stereotaxic procedure - for functional disorder 44 1240 Nervous system Facial tic - alcohol block 2 1241 Nervous system Facial tic - selective neurectomy 11 1242 Nervous system Excision of neuroma or neurofibroma 6

-89- 1243 Nervous system Transendoscopic dorsal sympathectomy 9 1244 Nervous system Brachial plexus repair 27 1245 Nervous system Neurolysis - nerves of hand or foot 5 1246 Nervous system Neurolysis - nerves of arm, forearm, thigh, or shank 15 Neurolysis - nerves above shoulder or hip joint, including 1247 Nervous system 17 brachial plexus and sciatic nerve 1248 Nervous system Nerve graft - nerves of hand or foot 32 1249 Nervous system Nerve graft - nerves of arm, forearm, thigh, or shank 32 Nerve graft - nerves above shoulder or hip joint, 1250 Nervous system 30 including brachial plexus and sciatic nerve 1251 Nervous system Nerve repair - nerves of hand or foot 6 1252 Nervous system Nerve repair - nerves of arm, forearm, thigh, or shank 18 Nerve repair - nerves above shoulder or hip joint, 1253 Nervous system 21 including brachial plexus and sciatic nerve 1254 Nervous system Nerve transfer - nerves below wrist or ankle joint 8 1255 Nervous system Nerve transfer - nerves above wrist or ankle joint 14 Nerve transfer - nerves above shoulder or hip joint, 1256 Nervous system 27 including cranial nerves 1257 Hearing organ Myringotomy with TD plunger 3 1258 Hearing organ Myringoplasty 15 1259 Hearing organ Suture of postauricular fistula 6 1260 Hearing organ Excision of preauricular fistula or cyst 7 1261 Hearing organ Incision and drainage of auricle abscess or hematoma 6 1262 Hearing organ Sacculotomy for Meniere's disease 17 1263 Hearing organ Drainage of otogenic epidural abscess 23 1264 Hearing organ Ear replantation 25 1265 Hearing organ Surgery for otogenic intracranial complications 26 1266 Hearing organ Suture of external auditory canal injury 3 Removal of foreign body in external auditory canal with 1267 Hearing organ 4 otoscope, under anesthesia Removal of tumor in external auditory canal with 1268 Hearing organ 8 microscope 1269 Hearing organ External ear canal plastic surgery 15 1270 Hearing organ Traumatic otoplasty 20 1271 Hearing organ Meatoplasty and canaloplasty 20 1272 Hearing organ Removal of malignant tumor in external auditory canal 25 1273 Hearing organ Polypectomy in middle ear 9 1274 Hearing organ Myringotomy 6 Myringotomy with ventilation tube insertion, under 1275 Hearing organ 8 microscope 1276 Hearing organ Exploratory tympanotomy 10 1277 Hearing organ Myringoplasty 12 1278 Hearing organ Tympanoplasty - without mastoidectomy 21 1279 Hearing organ Tympanoplasty - with mastoidectomy 27 1280 Hearing organ Ossiculoplasty 21 1281 Hearing organ Mastoidectomy - simple 14 1282 Hearing organ Mastoidectomy - modified 18 1283 Hearing organ Stapedectomy with prosthesis 19 1284 Hearing organ Stapes mobilization 11 1285 Hearing organ Petrosectomy 23 1286 Hearing organ Temporal bone resection with mastoidectomy 36 1287 Hearing organ Labyrinthectomy 21 -90- 1288 Hearing organ Endolymphatic sac decompression 18 1289 Hearing organ Labyrinthotomy 18 1290 Hearing organ Labyrinthectomy 20 1291 Hearing organ Acoustic neuroma excision (translabyrinthine approach) 50 1292 Hearing organ Semicircular canal fenestration 14 1293 Visual organ Enucleation of eye 13 1294 Visual organ Evisceration of eyeball 12 1295 Visual organ Repair of eyeball wound - scleral perforation 10 1296 Visual organ Repair of eyeball wound - corneoscleral perforation 10 1297 Visual organ Relief of symblepharon with conjunctiva or mucosa graft 12 1298 Visual organ Incision and curettage of chalazion 0.5 1299 Visual organ Excision of pterygium - primary 0.5 1300 Visual organ Excision of pterygium - complicated or recurrent 0.5 1301 Visual organ Simple excision of pterygium with keratectomy 6 1302 Visual organ Complicated excision of pterygium with keratectomy 7 1303 Visual organ Keratotomy 6 1304 Visual organ Corneal paracentesis 4 1305 Visual organ Removal of corneal stitches under microscope 1 1306 Visual organ Suture of cornea 3 1307 Visual organ Peritomy 4 1308 Visual organ Corneoscleral trephination 4 1309 Visual organ Removal of foreign body embedded in cornea 4 1310 Visual organ Keratectomy 8 1311 Visual organ Epikeratophakia 20 1312 Visual organ Lamellar keratoplasty 20 1313 Visual organ Penetrating keratoplasty 23 1314 Visual organ Limbal transplantation 10 1315 Visual organ Removal of foreign body in anterior chamber 9 Diagnostic drainage of aqueous humor from anterior 1316 Visual organ 4 chamber 1317 Visual organ Anterior chamber paracentesis for vitreal prolapse 6 1318 Visual organ Goniopuncture 5 1319 Visual organ Goniotomy 10 1320 Visual organ Air injection into anterior chamber 4 1321 Visual organ Removal of hyphema 7 1322 Visual organ Elliot's operation (for sclerectomy) 3 1323 Visual organ Posterior sclerotomy with fluid drainage 9 Posterior sclerotomy with magnetic extraction of 1324 Visual organ 11 intraocular foreign body Posterior sclerotomy with non-magnetic extraction of 1325 Visual organ 12 intraocular foreign body 1326 Visual organ Any type of scleral repair for perforating injury of eyeball 18 1327 Visual organ Sclerectomy with graft or buckling 10 1328 Visual organ Sclera graft 7 1329 Visual organ Removal of foreign body in scleral surface 4 1330 Visual organ Sclerectomy 7 1331 Visual organ Biopsy of ciliary body 1 1332 Visual organ Cyclocryotherapy 3 1333 Visual organ Cyclodiathermy 3 1334 Visual organ Cyclodialysis 5 1335 Visual organ Excision of prolapse of ciliary body 10 1336 Visual organ Trabeculotomy 0.5 -91- 1337 Visual organ Trabeculectomy 5 1338 Visual organ Optical iridectomy 7 1339 Visual organ Peripheral iridectomy 7 1340 Visual organ Scheie's operation 13 1341 Visual organ Iridotomy 7 1342 Visual organ Iridencleisis for glaucoma 8 1343 Visual organ Corneoscleral iridocyclectomy 12 1344 Visual organ Repair of iridodialysis 11 1345 Visual organ Synechiotomy of iris 13 1346 Visual organ Complete iridectomy 17 1347 Visual organ Iris cauterization 6 1348 Visual organ Iridocystectomy 11 1349 Visual organ Iridotasis 10 1350 Visual organ Iridoplasty - fixation transfixation (microsurgery) 8 1351 Visual organ Iridoplasty - transplantation (microsurgery) 20 1352 Visual organ Division of synechiae 3 1353 Visual organ Sclerotomy for glaucoma 10 1354 Visual organ Ahmed glaucoma valve (AGV) surgery 10 1355 Visual organ Discission of membranous cataract 5 1356 Visual organ Linear extraction for cataract 5 1357 Visual organ Capsulectomy for cataract 5 Capsulotomy and aspiration of crystalline lens under 1358 Visual organ 5 microscope 1359 Visual organ Extracapsular (or intracapsular) lens extraction 10 Intracapsular (or extracapsular) lens extraction and 1360 Visual organ 10 intraocular lens (IOL) insertion 1361 Visual organ Phacoemulsification 5 1362 Visual organ Pars plana lensectomy 10 1363 Visual organ IOL implantation - primary 5 1364 Visual organ IOL implantation - secondary 5 1365 Visual organ IOL implantation - reposition 5 1366 Visual organ Intravitreous injection 4 1367 Visual organ Optic iridectomy 5 1368 Visual organ Anterior vitrectomy 5 1369 Visual organ Anterior segment reconstruction 5 1370 Visual organ Discission of anterior hyaloid for pupillary block 5 1371 Visual organ Pars plana vitrectomy - simple 10 :Pars plana vitrectomy - complicated (i.e. including 1372 Visual organ 20 removal of epiretinal membrane) 1373 Visual organ Lensectomy with vitrectomy 23 1374 Visual organ Removal of dislocated lens with vitrectomy 31 1375 Visual organ Vitreous aspiration 5 1376 Visual organ Vitreous transplantation with sclerotomy 5 1377 Visual organ Vitrectomy for pathologic vitreous 18 1378 Visual organ Removal of intraocular foreign body 13 1379 Visual organ Removal of silicon oil 4 1380 Visual organ Fluid-gas exchange 4 Magnetic extraction of superficial intraocular foreign 1381 Visual organ 1 body Magnetic extraction of embedded intraocular foreign 1382 Visual organ 2 body 1383 Visual organ Retinal reattachment by diathermy or cryopexy 8 -92- 1384 Visual organ Lamellar sclera resection 7 1385 Visual organ Retinal reattachment and drainage 8 1386 Visual organ Cryotherapy for retinal degeneration or breaks 9 1387 Visual organ Photocoagulation therapy - simple 8 1388 Visual organ Photocoagulation therapy - complicated 17 1389 Visual organ Recession and resection for strabismus - one muscle 2 1390 Visual organ Recession and resection for strabismus - two muscles 5 - Recession and resection for strabismus - over two 1391 Visual organ 7 muscles 1392 Visual organ Extraocular muscle transplantation 7 1393 Visual organ Suture or tucking of extraocular muscle tendon 5 1394 Visual organ Exploratory orbitotomy 15 1395 Visual organ Orbitotomy with drainage of intraorbital abscess 5 Orbitotomy with removal of intraorbital foreign body or 1396 Visual organ 5 benign tumor 1397 Visual organ Orbital tumor removal - anterior approach 10 1398 Visual organ Orbital tumor removal - lateral approach 24 1399 Visual organ Orbital tumor removal - cranial approach 28 1400 Visual organ Orbital socket reconstruction 18 1401 Visual organ Orbital exenteration 10 1402 Visual organ Orbital decompression 21 1403 Visual organ Repair of orbital floor 15 1404 Visual organ Orbital lesion excision with bone graft 17 1405 Visual organ Excision of benign lid tumor 1 1406 Visual organ Excision of malignant lid tumor 11 1407 Visual organ Excision of lid tumor with lid reconstruction 10 :Frontalis sling procedure for ptosis (not applicable to 1408 Visual organ 3 cosmetic surgery) :Fascia lata sling procedure for ptosis (not applicable to 1409 Visual organ 3 cosmetic surgery) 1410 Visual organ Skin graft for ectropion or entropion 5 1411 Visual organ Z-plasty for eyelid 2 1412 Visual organ Corrective operation for ectropion 3 1413 Visual organ Corrective operation for entropion 3 1414 Visual organ Simple operation for entropion 2 1415 Visual organ Lacerated eyelid repair 1 1416 Visual organ Tarsorrhaphy for intermargin lid adhesion 1 1417 Visual organ Blepharorrhaphy 1 1418 Visual organ Suture of eyelid 1 1419 Visual organ Cryotherapy for benign lid tumor 1 1420 Visual organ Cryotherapy for malignant lid tumor 2 1421 Visual organ Resection of levator palpebrae superioris muscle 5 1422 Visual organ Blepharoplasty 3 1423 Visual organ Relief of symblepharon 7 1424 Visual organ Relief of ankyloblepharon 7 1425 Visual organ Hard palate grafting 13 1426 Visual organ Eyelid myectomy for essential blepharospasm 16 1427 Visual organ Canthotomy 2 1428 Visual organ Canthoplasty 1 1429 Visual organ Wheeler's operation 9 1430 Visual organ Excision of tarsal plate 5 1431 Visual organ Hughes's flap 13 -93- 1432 Visual organ Mllerectomy and levator aponeurosis recession 5 1433 Visual organ Correction of lower lid retraction and corneal exposure 5 1434 Visual organ Suture of conjunctiva 2 1435 Visual organ Conjunctival biopsy 1 1436 Visual organ Excision of conjunctiva lesion 3mm 1 1437 Visual organ Excision of conjunctiva lesion3mm 3 Excision of malignant conjunctiva lesion with mucous 1438 Visual organ 10 membrane graft 1439 Visual organ Conjunctivoplasty - with graft 9 1440 Visual organ Conjunctivoplasty - without graft 6 1441 Visual organ Conjunctival flap peritectomy 5 1442 Visual organ Cryotherapy of benign conjunctival tumor 1 1443 Visual organ Cryotherapy for malignant conjunctival tumor 2 1444 Visual organ Plastic surgery of conjunctival sac, partial 5 1445 Visual organ Plastic surgery of conjunctival sac, total 8 1446 Visual organ Combined plastic surgery of conjuntiva and skin 9 Conjunctival graft for perforating injuries or secondary 1447 Visual organ 6 closure of operative 1448 Visual organ Removal of conjunctival stitches under microscope 1 1449 Visual organ Biopsy of external eye 1 1450 Visual organ Drainage of lacrimal gland abscess 2 1451 Visual organ Dacryoadenectomy 5 1452 Visual organ Dacryocystectomy 5 1453 Visual organ Excision of tumor in lacrimal gland or lacrimal sac 10 1454 Visual organ Dacryocystorhinostomy 10 1455 Visual organ Canaliculotomy 2 1456 Visual organ Plastic operation on canaliculus 5 1457 Visual organ Suture of canaliculus 5 1458 Visual organ Primary repair of lacrimal apparatus 7 1459 Visual organ Secondary repair of lacrimal apparatus 7 1460 Visual organ Suture of punctum lacrimale 3 1461 Visual organ Fistulectomy for lacrimal fistula 3 1462 Visual organ Conjunctivodacryocystostomy 8 1463 Visual organ Conjunctivodacryocystorhinostomy (CDCR) 16 1464 Visual organ Dacryocystorhinostomy - simple 5 1465 Visual organ Dacryocystorhinostomy - complicated 10 Therapeutic Surgery for necrotizing enterocolitis, with bowel 1466 surgery for 40 resection and anastomosis congenital defects Therapeutic Surgery for necrotizing enterocolitis, with jejunostomy or 1467 surgery for 40 ileostomy congenital defects Therapeutic 1468 surgery for Meconium peritonitis 40 congenital defects Therapeutic 1469 surgery for Choledochocyst excision with choledocho-jejunostomy 50 congenital defects Therapeutic Esophagoplasty with repair of tracheoesophageal fistula 1470 surgery for 50 (TEF) congenital defects 1471 Therapeutic Repair of idiopathic gastric perforation in neonate 20

-94- surgery for congenital defects Therapeutic 1472 surgery for Repair of diaphragmatic hernia 21 congenital defects Therapeutic 1473 surgery for Excision of omphalomesenteric fistula 40 congenital defects 1474 Oral & Maxillofacial Enucleation of cyst < 2cm 1 1475 Oral & Maxillofacial Enucleation of cyst - 2 to 4cm 3 1476 Oral & Maxillofacial Enucleation of cyst > 4cm 5 1477 Oral & Maxillofacial Intraoral excision of soft tissue tumor 1 1478 Oral & Maxillofacial Repair of oroantral fistula 8 1479 Oral & Maxillofacial Soft tissue biopsy 1 1480 Oral & Maxillofacial Hard tissue biopsy 1 1481 Oral & Maxillofacial Marsupialization 4 1482 Oral & Maxillofacial Simple sequestrectomy - one-third of maxilla or less 2 Complicated sequestrectomy - one-third of maxilla or 1483 Oral & Maxillofacial 3 more 1484 Oral & Maxillofacial Nerve avulsion 4 1485 Oral & Maxillofacial Sialolithotomy - in gland 5 1486 Oral & Maxillofacial Sialolithotomy - in duct 5 1487 Oral & Maxillofacial Flap repair within 4 cm2 3 1488 Oral & Maxillofacial Flap repair of 4 to 16 cm2 5 1489 Oral & Maxillofacial Flap repair over 16 cm2 7 1490 Oral & Maxillofacial Excision of bone tumor2 cm 3 1491 Oral & Maxillofacial Excision of bone tumor2 cm 5 1492 Oral & Maxillofacial Unilateral subcondylar osteotomy or arthroplasty 17 1493 Oral & Maxillofacial Unilateral condylectomy 8 1494 Oral & Maxillofacial Open reduction of condylar fracture - unilateral 12 1495 Oral & Maxillofacial Saucerization and sequestrectomy 9 1496 Oral & Maxillofacial Saucerization 3 1497 Oral & Maxillofacial Palatoplasty 7 1498 Oral & Maxillofacial Sialoadenectomy - superficial or benign 6 1499 Oral & Maxillofacial Sialoadenectomy - malignant 9

-95-

Burn unit benefits Payment Of Burn Unit Benefits If during the effective period of this Coverage Extension the insured suffers an accidental injury event and consequently receives treatment in a hospital burn unit, the Company will pay "burn unit benefits" by multiplying that insured's insured amount stated on the insurance policy by the actual number of days of hospitalization in the burn unit. The actual number of days for which "burn unit benefits" are paid for the same single hospitalization shall be limited to not more than 60 days.

-96-

No Waiting Period Group Health Endorsement Definition of Terms This No Waiting Period Group Health Insurance Endorsement by the proposer of the Hospital and Surgical Insurance, and having been approved by the Company, is entered into as a supplement to the Master Contract.

For the purposes of this Endorsement, "illness" means an illness that occurs to the insured from the effective date, provided that the 30-day restriction does not apply in the case of renewal by an individual insured.

-97- Cancer Insurance Definition of Terms For the purposes of this Contract, "cancer" means any disease characterized by a malignant tumor resulting from the uncontrollable growth and spread of malignant cells in the human body and the invasion of tissue, or from leukemia, and that is classified as a malignant tumor or carcinoma in situ (see Appended Table) in the latest edition of the International Statistical Classification of Diseases, Injuries, and Causes of Death published by the Department of Health, Executive Yuan, and that has been positively diagnosed by a hospital pathologic examination of fixed tissue.

“Positive Diagnosis of Cancer” shall mean a doctor’s confirmation of the diagnosis of cancer based on pathology reports, such confirmation having been conducted at one of the hospital ales designated by the Insurer.

Due to complications should be arising from the cancer directly.

Scope of Coverage The "cancer insurance liability commencement date" is the 31st day counting inclusively from the inception date of this Contract (or from the next day after the enrollment date in the case of an insured who is enrolled after the Contract is entered into). In the case of renewal, however, if 31 days have already elapsed from the inception (or enrollment) date, the Company's cancer insurance liability under this Contract shall begin from the renewal date; if 31 days have not yet elapsed, the Company's cancer insurance liability commencement date for that insured upon the renewal shall be calculated as the 31st day less the number of days that have already currently elapsed at renewal.

If during the period prior to the cancer insurance liability commencement date under this Contract, the insured is positively diagnosed by a hospital to have cancer, the Company will refund all premium already received for that insured, and the coverage for that insured under this Contract will thereupon be terminated. -98-

From the cancer insurance liability commencement date under this Contract, if the insured is positively diagnosed by a hospital to have cancer, the Company will pay insurance benefits as stipulated in this Contract.

Benefit Cancer Inpatient Hospitalization Benefits If the insured during the effective period of this Contract, from the cancer insurance liability commencement date, is positively diagnosed by a physician as having cancer for the first time and, as a direct result of the cancer, or due to complications arising from the cancer, is diagnosed by a physician as requiring hospitalization, the Company will pay "cancer inpatient hospitalization benefits" calculated by multiplying the actual number of days of hospitalization of the insured by the "cancer inpatient hospitalization benefits" stated in the insurance policy.

Cancer Surgery Benefits If the insured during the effective period of this Contract, from the cancer insurance liability commencement date, is positively diagnosed by a physician as having cancer for the first time and, as a direct result of the cancer, or due to complications arising from the cancer, is diagnosed by a physician as requiring surgical treatment (including as a recipient of a bone marrow transplant performed to treat cancer), the Company will pay for each surgery "cancer surgery benefits" as stated in the insurance policy.

Cancer Post-Hospitalization Convalescence Benefits If an insured undergoes inpatient hospitalization as described, after the insured is discharged from the hospital, the Company will pay benefits calculated by multiplying the number of days of hospitalization for which the insured received cancer hospitalization benefits by the "cancer post-hospitalization convalescence benefits" stated in the insurance policy, provided that "cancer post-hospitalization convalescence benefits" will be paid for no more than 21 days per instance.

Once an insured has received "cancer post-hospitalization convalescence benefits", if during the period of the number of days for which the cancer post hospitalization convalescence benefits were paid, the insured is re-hospitalized because of cancer, dies because of cancer, or the contract is terminated, the days that have not yet elapsed for which cancer post-hospitalization convalescence benefits were received shall be

-99- deducted from the benefits.

Cancer Outpatient Medical Benefits If the insured during the effective period of this Contract, from the cancer insurance liability commencement date, is positively diagnosed by a physician as having cancer for the first time and, as a direct result of the cancer, or due to complications arising from the cancer, receives outpatient medical treatment at a hospital on a physician's instructions the Company will pay "cancer outpatient medical benefits" as stated on the insurance policy for each treatment based on the actual number of treatments received by the insured.

However, cancer outpatient medical benefits will be paid for no more than 90 treatments of the insured during a single insurance period under this Contract, and the medical treatments for which cancer outpatient medical benefits will be paid are limited to receiving injection chemotherapy, radiation therapy, and other necessary outpatient cancer treatments.

Exclusions The Insurer shall not be liable for any cancer benefits if any of the following conditions exits: The Insured is positively diagnosed as having cancer before the “Effective Date of Liability” as stated in Item 3 Under such circumstances, the Insurer shall cancel the Policy and return the premium paid with no interest. Doctor’s diagnosis of cancer and / or pathology reports is missing.

The Application of The Indemnity A beneficiary applying for benefits under this Contract shall submit the following documents: 1. Application for insurance benefits. 2. Cancer diagnosis certificate, and the pathological tissue examination report 3. Applications for any kind of benefits except "cancer death benefits" must be accompanied by a cancer inpatient hospitalization certificate, cancer surgery certificate, or cancer outpatient treatment certificate. ((However, a proposer or an insured who is a physician may not issue a diagnosis or hospitalization certificate for the insured.) 4. An application for "cancer death benefits" must be accompanied by the insured's death certificate and household registration certificate from -100- which the insured's name has been stricken. 5. Proof of the beneficiary's identity.

When a beneficiary applies for any kind of benefits under this Contract except "cancer death benefits", the Company may, when necessary and with consent, requisition, at the Company's expense, information related to the insured's medical treatment.

Restrictions on Cancer Diagnosis Certificates and Handling of Doubt Concerning a Cancer Diagnosis A cancer diagnosis certificate issued by an insured or a proposer who is a physician may not be submitted with an application for benefits.

When an application for benefits is made, the Company may additionally require the insured to undergo a physical examination by a designated physician, the expense of which will be borne by the Company.

Appended Table: Diseases classified as a malignant tumor in the International Statistical Classification of Diseases, Injuries, and Causes of Death are classified as follows: Category Disease 140～149 Malignant Neoplasm Of Lip, Oral Cavity, And Pharynx 140 Malignant neoplasm of lip 141 Malignant neoplasm of tongue 142 Malignant neoplasm of major salivary glands 143 Malignant neoplasm of gum Malignant neoplasm of floor of mouth 144 Malignant neoplasm of other and unspecified parts of mouth 145 Malignant neoplasm of oropharynx 146 Malignant neoplasm of nasopharynx 147 Malignant neoplasm of hypopharynx 148 Malignant neoplasm of other and ill-defined sites within the lip, 149 oral cavity, and pharynx Malignant Neoplasm Of Digestive Organs And Peritoneum 150~159 Malignant neoplasm of esophagus 150 Malignant neoplasm of stomach 151 Malignant neoplasm of small intestine including duodenum 152 Malignant neoplasm of colon 153 Malignant neoplasm of rectum, rectosigmoid junction, and anus -101- 154 Malignant neoplasm of liver and intrahepatic bile ducts 155 Malignant neoplasm of gallbladder and extrahepatic bile ducts 156 Malignant neoplasm of pancreas 157 Malignant neoplasm of retroperitoneum and peritoneum 158 Malignant neoplasm of other and ill-defined sites within the 159 digestive organs and peritoneum

Malignant Neoplasm Of Respiratory And Intrathoracic Organs 160~165 Malignant neoplasm of nasal cavities, middle ear, and accessory 160 sinuses 161 Malignant neoplasm of larynx 162 Malignant neoplasm of trachea, bronchus, and lung 163 Malignant neoplasm of pleura 164 Malignant neoplasm of thymus, heart, and mediastinum 165 Malignant neoplasm of other and ill-defined sites within the respiratory system and intrathoracic organs

170~175 Malignant Neoplasm Of Bone, Connective Tissue, Skin, And 170 Breast 171 Malignant neoplasm of bone and articular cartilage 172 Malignant neoplasm of connective and other soft tissue 173 Malignant melanoma of skin 174 Other malignant neoplasm of skin 175 Malignant neoplasm of female breast Malignant neoplasm of male breast 179~189 179 Malignant Neoplasm Of Genitourinary Organs 180 Malignant neoplasm of uterus-part unspecified 181 Malignant neoplasm of cervix uteri 182 Malignant neoplasm of placenta 183 Malignant neoplasm of body of uterus 184 Malignant neoplasm of ovary and other uterine adnexa 185 Malignant neoplasm of other and unspecified female genital 186 organs 187 Malignant neoplasm of prostate 188 Malignant neoplasm of testis 189 Malignant neoplasm of penis and other male genital organs Malignant neoplasm of bladder 190~199 Malignant neoplasm of kidney and other and unspecified urinary 190 organs 191 192 Malignant Neoplasm Of Other And Unspecified Sites -102- 193 Malignant neoplasm of eye 194 Malignant neoplasm of brain 195 Malignant neoplasm of other and unspecified parts of nervous 196 system 197 Malignant neoplasm of thyroid gland 198 Malignant neoplasm of other endocrine glands and related 199 structures Malignant neoplasm of other and ill-defined sites 200~208 Secondary and unspecified malignant neoplasm of lymph nodes 200 Secondary malignant neoplasm of respiratory and digestive 201 systems 202 Secondary malignant neoplasm of other specified sites 203 Malignant neoplasm without specification of site 204 205 Malignant Neoplasm Of Lymphatic And Hematopoietic Tissue 206 Lymphosarcoma and reticulosarcoma 207 Hodgkin's disease 208 Other malignant neoplasms of lymphoid and histiocytic tissue Multiple myeloma and immunoproliferative neoplasms 230~234 Lymphoid leukemia 230 Myeloid leukemia 231 Monocytic leukemia 232 Other specified leukemia 233 Leukemia of unspecified cell type 234 Carcinoma In Situ Carcinoma in situ of digestive organs Carcinoma in situ of respiratory system Carcinoma in situ of skin Carcinoma in situ of breast and genitourinary system Carcinoma in situ of other and unspecified sites

Cancer Radiation Therapy Benefits Payment Of Cancer Radiation Therapy Benefits If the insured during the effective period of this Coverage Extension, from the cancer insurance liability commencement date, is positively diagnosed by a hospital physician as having cancer and, as a result of the cancer, or due to complications arising therefrom, is diagnosed by a physician as requiring radiation therapy at a hospital (regardless of whether it is -103- administered on an inpatient or outpatient basis), the Company will pay for each radiation therapy session " cancer radiation therapy benefits" according to the insured amount stated in the insurance policy. Payments for " cancer radiation therapy benefits" referred to in the preceding paragraph shall be limited to one session per day.

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This summary is for reference only! all the terms and conditions should follow Chinese policy wording.

新光人壽保險股份有限公司 SHIN KONG LIFE INSURANCE CO., LTD.

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