ACCIDENT MEDICAL EXPENSE BENEFITS
Any benefit limits and Benefit Percentages for Accident Medical Expense Benefits apply, unless otherwise specified, on a per-Covered Person per-Covered Accident basis. Any applicable Deductibles must be satisfied within the time periods specified before benefits are payable.
Scope of Coverage Applicable to Accident Medical Benefits Full Excess Medical Expense
Other Health Plan
Reduction 50%
Medical Expense Benefits
Total Maximum for all
Accident Medical Expense Benefits $25,000
First Covered Expenses must
be Incurred within 180 days after a Covered Accident
Benefit Period 2 years
Deductible $750
applies to each Covered Accident
does notInclude Covered Expenses paid under another Health Care Plan
Covered Expenses
In-Patient Hospital Services
Daily ICU or CCU Benefit 100% Policy Limit
Daily In-Hospital Benefit 100% of the average Semi-private room
Miscellaneous Services 100% Policy Limit
Ambulatory Medical Center 100% Policy Limit
Emergency Room Treatment 100% Policy Limit
Physician Services
Surgery Benefit 100% Policy Limit
Assistant Surgeon 100% Policy Limit
Physician's Surgical Facilities 100% Policy Limit
Second Opinion or Consultation 100% Policy Limit
Physician's Assistant 100% Policy Limit
Anesthesia Benefit 100% Policy Limit
Inpatient Visits 100% Policy Limit
Office Visits 100% Policy Limit
Outpatient X-ray, CT Scan, 100% Policy Limit
Outpatient Physiotherapy 100% Policy Limit
Nursing Services 100% Policy Limit
Ambulance Services 100% Policy Limit
Medical Equipment Rental 100% Policy Limit
Medical Services and Supplies 100% Policy Limit
Dental Services 100% Policy Limit
Prescription Drug Benefit 100% Policy Limit
