Assistant Surgeon Benefit If, in connection with such operation, a Covered Person requires the services of an Assistant Surgeon, We will pay the Covered Expense incurred.
9. Emergency Room Benefit $250 per visit Co-Pay. We will pay if the Covered Person requires Emergency Room treatment due to a Covered Loss resulting directly and independently of all other causes from a Covered Accident or Sickness. Emergency Room means a trauma center or special area in a Hospital that is equipped and staffed to give people Emergency treatment on an Outpatient basis. An Emergency Room is not a clinic or Physician’s office.
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10. Pre-Admission Testing Benefit We will pay benefits for charges for Pre admission testing (inpatient confinement must occur within 3 days of the testing).
11. Anesthesia Benefit We will pay benefits for Anesthesia for pre-operative screening and administration of anesthesia during a surgical procedure whether on an Inpatient or Outpatient basis.
Diagnostic X-Ray and Laboratory Benefit We will pay if the Covered Person requires diagnostic x -ray and/or laboratory examinations and services due to a Covered Loss.
13. Physiotherapy/Chiropractic Expense Benefit We will pay benefits as described in the Schedule of Benefits for eligible Physiotherapy expenses incurred by the Covered Person. In no event will the Company’s Maximum liability exceed the Maximum stated in the Schedule of Benefits, as to Eligible Expenses during any Period of Insurance.
For the purpose of this section, Physiotherapy means charges for physiotherapy if recommended by a Physician for the treatment of a specific Disablement or following hospitalization and administered by a licensed physiotherapist as an Outpatient, up to the Maximum amount shown in the Schedule of Benefits for the Outpatient Physiotherapy benefit.
Charges include treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, microtherm, chiropractic, adjustments, manipulation, acupuncture, or any form of physical therapy.
14. Ambulance Benefit When, by reason of Injury or Sickness, a Covered Person requires the use of a community or Hospital Ambulance in a Medical Emergency,
We will pay up to $350 for transportation, within the metropolitan area in which the Covered Person is located at that time the
service is used. Ambulance Service is transportation by a vehicle designed, equipped and used only to transport the sick and injured from home, the scene of the Accident or Medical Emergency to a Hospital or between Hospitals.
Surface trips must be to the closest local facility that can provide the covered service appropriate to the condition. If there is no such facility available, coverage is for trips to the closest facility outside the local area. Air transportation is covered up to $350 when Medically Necessary because of a life threatening Injury or Sickness or if the Covered Person is in a rural area, then air ambulance transportation to the nearest metropolitan area will be considered an Eligible Expense.
Air Ambulance is air transportation by a vehicle designed, equipped and used only to transport the sick and injured to and from a Hospital for inpatient care. Search and rescue charges are not covered.
9. Emergency Room Benefit $250 per visit Co-Pay. We will pay if the Covered Person requires Emergency Room treatment due to a Covered Loss resulting directly and independently of all other causes from a Covered Accident or Sickness. Emergency Room means a trauma center or special area in a Hospital that is equipped and staffed to give people Emergency treatment on an Outpatient basis. An Emergency Room is not a clinic or Physician’s office.
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10. Pre-Admission Testing Benefit We will pay benefits for charges for Pre admission testing (inpatient confinement must occur within 3 days of the testing).
11. Anesthesia Benefit We will pay benefits for Anesthesia for pre-operative screening and administration of anesthesia during a surgical procedure whether on an Inpatient or Outpatient basis.
Diagnostic X-Ray and Laboratory Benefit We will pay if the Covered Person requires diagnostic x -ray and/or laboratory examinations and services due to a Covered Loss.
13. Physiotherapy/Chiropractic Expense Benefit We will pay benefits as described in the Schedule of Benefits for eligible Physiotherapy expenses incurred by the Covered Person. In no event will the Company’s Maximum liability exceed the Maximum stated in the Schedule of Benefits, as to Eligible Expenses during any Period of Insurance.
For the purpose of this section, Physiotherapy means charges for physiotherapy if recommended by a Physician for the treatment of a specific Disablement or following hospitalization and administered by a licensed physiotherapist as an Outpatient, up to the Maximum amount shown in the Schedule of Benefits for the Outpatient Physiotherapy benefit.
Charges include treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, microtherm, chiropractic, adjustments, manipulation, acupuncture, or any form of physical therapy.
14. Ambulance Benefit When, by reason of Injury or Sickness, a Covered Person requires the use of a community or Hospital Ambulance in a Medical Emergency,
We will pay up to $350 for transportation, within the metropolitan area in which the Covered Person is located at that time the
Surface trips must be to the closest local facility that can provide the covered service appropriate to the condition. If there is no such facility available, coverage is for trips to the closest facility outside the local area. Air transportation is covered up to $350 when Medically Necessary because of a life threatening Injury or Sickness or if the Covered Person is in a rural area, then air ambulance transportation to the nearest metropolitan area will be considered an Eligible Expense.
Air Ambulance is air transportation by a vehicle designed, equipped and used only to transport the sick and injured to and from a Hospital for inpatient care. Search and rescue charges are not covered.
15. Mental and Nervous Conditions Expense Benefit If a Covered Person requires treatment for a Mental or Nervous Condition, We will pay for such treatment as follows:
Benefits for Inpatient Hospital Confinement -When a Covered Person requires Hospital Confinement for treatment of a Mental or Nervous Condition,
We will pay the Covered Percentage of the Eligible Expenses incurred for such Hospital Confinement. Such confinement must be in a licensed or certified facility, including Hospitals.
We will pay the Covered Percentage of the Eligible Expenses incurred for such Hospital Confinement. Such confinement must be in a licensed or certified facility, including Hospitals.
Benefits for Outpatient Services - We will pay the Eligible Expenses incurred for the Outpatient treatment of Mental and Nervous Conditions as defined.
The Mental and Nervous Condition must, in the professional judgment of healthcare providers, be treatable, and the treatment must be Medically Necessary. Outpatient treatment and Physician services include charges made by an Outpatient treatment department of a Hospital or community mental health facility, or charges for services rendered in a Physician’s office. Treatment may be provided by any properly licensed Physician, psychologist or other provider as required by law.
The Mental and Nervous Condition must, in the professional judgment of healthcare providers, be treatable, and the treatment must be Medically Necessary. Outpatient treatment and Physician services include charges made by an Outpatient treatment department of a Hospital or community mental health facility, or charges for services rendered in a Physician’s office. Treatment may be provided by any properly licensed Physician, psychologist or other provider as required by law.
Biologically Based Mental Sickness means a mental, nervous, or emotional disorder caused by a biological disorder of the brain which results in a clinically significant, psychological syndrome or pattern that substantially limits the functioning of the person with the Sickness.
16. Alcohol and Drug Abuse Expense Benefit If a Covered Person requires treatment on account of alcoholism, Alcohol Abuse, Drug Abuse or drug dependency, We will pay for such treatment as follows:
Benefits for Inpatient Hospital Confinement - When a Covered Person is confined as an inpatient in: (i) a Hospital; or (ii) a Detoxification Facility for the treatment of alcoholism, Alcohol Abuse, Drug Abuse or drug dependency, We will pay the Covered Percentage of the Eligible Expenses incurred for such Hospital Confinement. Such Confinement must be in a licensed or certified facility, including Hospitals.
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