What Is Covered?
All benefits, except Hospital Indemnity, Lost Checked Luggage, Accidental Death & Dismemberment and Common Carrier Accidental Death, are subject to the Deductible and Coinsurance. Limits apply to all benefits (See Schedule of Benefits and Limits): Medical:
- Inpatient and Outpatient charges made by a Hospital.
- Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case.
- Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home.
- Charges for diagnostic testing using radiology, ultrasonographic or laboratory services.
- Charges for oxygen and other gases and anesthetics and their administration.
- Charges for prescription drugs for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs.
- Charges made by a licensed Extended Care Facility upon direct transfer from an acute care Hospital.
- Emergency local ambulance transport incurred in connection with Injury or Illness resulting in inpatient hospitalization.