We will pay this benefit, up to the amount on the Schedule for the following
Covered Expenses incurred by you, subject to the following:
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Covered Expenses will only be payable at the Usual and Customary level of
payment;
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Benefits will be payable only for Covered Expenses resulting from a Sickness
that first manifests itself or an Injury that occurs while on a Covered Trip;
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Benefits payable as a result of incurred Covered Expenses will only be paid
after benefits have been paid under any Other Valid and Collectible Group
Insurance in effect for you or in accordance with the coordination of benefits
provision, which is set forth below in jurisdictions where excess coverage
provisions are not permitted.
We will pay that portion of Covered Expenses which exceed the amount of benefits
payable for such expenses under your Other Valid and Collectible Group
Insurance.
Please refer to the Definitions for an explanation of Pre-Existing Conditions
which are excluded under the Medical or Dental Expense Benefits.
Covered Expenses:
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Expenses for the following Physician-ordered medical services: services of
legally qualified Physicians and graduate nurses, charges for Hospital
confinement and services, local ambulance services, prescription drugs and
medicines, and therapeutic services, incurred by you within one year from the
date of your Sickness or Injury;
Your duties in the event of a Medical or Dental Expense:
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You must provide us with all bills and reports for medical and/or dental
expenses claimed.
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You must provide any requested information, including but not limited to, an
explanation of benefits from any other applicable insurance.
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You must sign a patient authorization to release any information required by
us, to investigate your claim.
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