The Amigo Short Term Medical Plan covers the following expenses:

After the deductible amount you selected has been met, the plan will pay eligible expenses according to the coinsurance selected up to the maximum of your certificate, per covered person, per coverage period. Benefits are based on usual and customary charges of the geographical area in which the charges are incurred.

Inpatient and outpatient charges made by a hospital, including inpatient prescription drugs

• Charges incurred at an urgent care center (except for co-payment)
• 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 made by a licensed extended care facility upon direct transfer from an acute care hospital
• Emergency local ambulance transport in connection with injury or sickness resulting in inpatient hospitalization
• Expenses related to complications of pregnancy
• Charges for physical therapy that is prescribed in advance by a physician in relation to a covered injury or sickness