Hierarchy of Clinical Category Assignment
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Medical Diagnosis List by Category
The table below can be referred to check members eligibility for medical admissions. It has only limited examples. Hence in case of doubt, it is advised to refer to corresponding health insurance to check eligibility.
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| Clinical Category | Medical admission examples |
|---|---|
| Rehabilitation | Minimum Benefit Requirements |
| Palliative Care | Minimum Benefit Requirements |
| Hospital Psychiatric Services | Minimum Benefit Requirements |
| Mental & Behavioural Disorders due to Drug Addiction (includes withdrawal) | |
| Schizophrenia/ Schizoaffective Disorder | |
| Delusional Disorder | |
| Psychosis (nonorganic) | |
| Bipolar Disorder | |
| Manic/Mania or Hypomanic Episode | |
| Depression/Depressive Episode | |
| Cyclothymia/Dysthymia/ Persistent Mood Disorder | |
| Unspecified Mood Disorder | |
| Anxiety | |
| Adjustment Disorder | |
| Dissociative Disorder / Trance/Possession Disorder | |
| Somatoform / Pain Disorder | |
| Neurosis/Neurotic Disorder | |
| Eating Disorder (Anorexia, Bulimia, Overeating with Psychological disturbance) | |
| Sexual Dysfunction/ Excessive Sexual Desire | |
| Postnatal/Postpartum Depression | |
| Harmful Use of Nondependence substance | |
| Personality Disorder | |
| Psychosexual Disorder | |
| Autism (Asperger's Syndrome) | |
| Hallucinations (Auditory, Visual) | |
| Assisted reproductive services | Female infertility |
| Male infertility | |
| Artificial insemination | |
| In vitro fertilisation | |
| Back, neck and spine | Osteochondrosis |
| Spondylolysis | |
| Spondylolisthesis | |
| Ankylosing Spondylitis | |
| Spinal stenosis | |
| Collapsed vertebra | |
| Spinal instability | |
| Cervicalgia | |
| Sciatica | |
| Lumbago | |
| Blood | Blood clotting disorders /Haemophilia A, B C |
| Anaemias | |
| Immunoglobulin disorders | |
| Coagulation disorders | |
| Purpura (Haemorrhagic Conditions) | |
| Thrombocytopenia | |
| Neutropenia (Agranulocytosis) | |
| Bone, joint and muscle | Arthritis |
| Arthropathy | |
| Gout | |
| Osteomyelitis | |
| Carpal tunnel | |
| Bone spurs | |
| Brain and Nervous System | Stroke (Cerebrovascular accident) |
| Epilepsy (Fits/Fitting) | |
| Parkinson's Disease | |
| Brain Abscess | |
| Delirium | |
| Dementia | |
| Headache/Migraine | |
| Transient Ischaemic Attack (TIA) | |
| Meningitis | |
| Encephalitis | |
| Coma | |
| Alzheimer's Disease | |
| Huntington's Disease | |
| Subarachnoid Haemorrhage | |
| Intracerebral Haemorrhage | |
| Subdural/Extradural/Intracranial Haemorrhage | |
| Cerebral Infarction | |
| Embolism/Occlusion/Stenosis of Precerebral arteries (without infarction) | |
| Cerebral Aneurysm | |
| Ataxia | |
| Multiple Sclerosis (MS) | |
| Bell's Palsy | |
| Meralgia paraesthetica (Tarsal Tunnel Syndrome) | |
| Neuropathy / Polyneuropathy | |
| Guillian Barre Syndrome | |
| Cerebral Palsy | |
| Cerebrovascular Disease (CVD) / Cerebral Atherosclerosis / Cerebral Aneurysm (nonruptured) | |
| Breast surgery (medically necessary) | Congenital breast abnormalities |
| Breast injuries | |
| Breast tumours | |
| Gynaecomastia | |
| Diabetes Management (excluding insulin pumps) | Hypoglycaemia |
| Diabetes with poor control | |
| Complications of diabetes | |
| Contour problems due to insulin injections | |
| Digestive system | Oesophagitis |
| Gastro-oesophageal reflux disease without oesophagitis | |
| Barrett's oesophagus | |
| Gastric/Duodenal/Peptic ulcer | |
| Gastritis | |
| Polyp of stomach and duodenum | |
| Ulcerative colitis | |
| Ileus | |
| Irritable bowel syndrome | |
| Constipation | |
| Anorectal fistula | |
| Rectal abscess | |
| Anal polyp | |
| Polyp of colon | |
| Haemorrhoids | |
| Peritoneal adhesions | |
| Cirrhosis of liver | |
| Hepatic failure | |
| Abscess of liver | |
| Fatty (change of) liver | |
| Gallstones/Gallbladder calculus | |
| Cholecystitis | |
| Pancreatitis | |
| Haematemesis/Melaena/GI bleeding | |
| Nausea and vomiting | |
| Ear, nose and throat | Perforation of tymphanic membrane |
| Sinusitis / Nasopharyngitis /Rhinitis | |
| Laryngitis - Acute | |
| Nasal Polyps | |
| Otitis Externa | |
| Otitis Media | |
| Mastoiditis | |
| Salivary gland disorders | |
| Thyroid Disorders | |
| Eye (not cataracts surgery) | Retinal detachment |
| Eyelid Disorders | |
| Eye infections | |
| Conjunctivitis | |
| Glaucoma | |
| Macular Degeneration | |
| Retinitis | |
| Strabismus | |
| Cornea disorders | |
| Gynaecology | Gynaecological tumours |
| Endometriosis | |
| Polycystic ovaries | |
| Female sterilisation | |
| Cervical cancer | |
| Acute vaginitis | |
| Heart and vascular system | Hypertension |
| Hypotension | |
| Chest pain | |
| Congestive heart failure | |
| Myocardial infarction | |
| Angina | |
| Ischaemic heart disease | |
| Atrial fibrillation (AF) | |
| Congenital heart anomolies | |
| Hernia and appendix | Hernia |
| Appendicitis | |
| Kidney and bladder | Urinary Tract Infection (UTI) |
| Incontinence (Urinary/Stress) | |
| Urinary retention | |
| Nephrotic Syndrome | |
| Haematuria | |
| Pyelonephritis | |
| Urethral Stricture | |
| Ureter stricture (Kinking) | |
| Kidney Failure | |
| Calculus of Kidney/Bladder/Urethra | |
| Cystitis | |
| Dysuria/Painful Micturition/ Burning Micturition | |
| Lung and chest | Asthma |
| Pneumonia | |
| Tuberculosis | |
| Whooping cough | |
| Pulmonary embolism | |
| Bronchitis | |
| Emphysema | |
| Bronchiectasis | |
| Bronchiolitis | |
| COPD | |
| Pleural effusion | |
| Pneumothorax | |
| Male reproductive system | Orchitis |
| Pain in testicle | |
| Hyperplasia of Prostate | |
| Hydrocele | |
| Torsion of testis | |
| Phimosis | |
| Paraphimosis | |
| Ulcer of Penis | |
| Swollen testicle(s) | |
| Male sterilisation | |
| Circumcision | |
| Prostate cancer | |
| Miscarriage and termination of pregnancy | Ectopic pregnancy |
| Miscarriage/Abortion/Termination of pregnancy | |
| Pregnancy and birth | Caesarean section |
| Pre-eclampsia | |
| Hyperemesis | |
| Vaginal delivery | |
| Instrumental delivery | |
| Skin | Skin Lesions |
| Eczema | |
| Molluscum | |
| Skin melanoma | |
| Abscess, furuncle or carbuncle of skin | |
| Cellulitis | |
| Pilonidal cyst | |
| Pruritus | |
| Psoriasis | |
| Urticaria | |
| Pressure injury | |
| Skin ulcer | |
| Burns | |
| Sleep studies | Disorders of sleep-wake schedule |
| Obstructive Sleep Apnoea (OSA) | |
| Narcolepsy | |
| Snoring | |
| Tonsils, adenoids and grommets | Tonsillitis |
| Adenoiditis (Enlarged adenoids) | |
| Enlarged adenoids | |
| Chemotherapy, radiotherapy and immunotherapy for cancer | MBS only |
| Dental surgery | MBS only |
| Dialysis for chronic kidney failure | MBS only |
| Implantation of hearing devices | MBS only |
| Insulin pumps | MBS only |
| Joint reconstructions | MBS only |
| Joint replacements | MBS only |
| Podiatric surgery (provided by a registered podiatric surgeon) | MBS only |
| Weight loss surgery | MBS only |
| Plastic and reconstructive surgery (medically necessary) | MBS only |
| Gastrointestinal endoscopy | MBS only |
| Pain management | MBS only |
| Pain Management with Device | MBS only |
| Cataracts | MBS only |