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Summary Of Player Benefits

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

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