![]() ![]() There is a 30-day waiting period for sickness on the Accident and Sickness Limited Benefit Health Insurance. Maximum Number of Trips per Sickness and Accident per Year Benefit is payable once per Covered Sickness or Accident. The ambulance transportation must be within 90 days after a Covered Sickness or Accident. Pays a benefit for any day a licensed professional ambulance company transports a Covered Person by ground transportation to or from a Hospital or between medical facilities, where treatment is received as the result of a Covered Sickness or Accident. Benefit will not be payable if Covered Person is confined in a Hospital as a result of the injuries received in the Covered Accident or due to the Covered Sickness that caused the visit to the Emergency Room. Visits due to injuries received in a Covered Accident must occur within 72 hours after the date of the Covered Accident. Services must be rendered by a Physician. Pays a daily benefit for any day a Covered Person incurs charges for and requires medical care from an emergency room due to injuries received in a Covered Accident or due to a Covered Sickness. Maximum Benefit for All Basic Pathology, Basic Radiology and Advance Studies per Insured per Membership Year This benefit is not payable if Hospital Confinement, Emergency Room or Doctor Office benefit is paid.īenefit per Day for Basic Pathology (laboratory tests)īenefit per Day for Basic Radiology (x-rays, ultrasounds and other medical imaging)īenefit per Day for Advance Studies (CT scan, PET scan, MRI, EEG, and other tests listed in The test must be ordered by a Physician because of a Covered Accident or Covered Sickness and must be performed in a Hospital, Ambulatory Surgical Center, Doctor's office or Diagnostic Center or Facility. Pays a daily benefit for any day a Covered Person incurs charges for diagnostic x-ray and/or laboratory testing caused by a Covered Accident or Covered Sickness. Maximum Days per Insured per Membership Year 5ĭiagnostic X-Ray & Laboratory Tests Benefit (including interpretation) Services must be rendered by a licensed Physician acting within the scope of their license. Pays a daily benefit for any day a Covered Person incurs charges for and requires a Doctor's office visit due to injuries received in a Covered Accident or due to a Covered Sickness. The charges must be incurred as a result of injuries received in a Covered Accident or due to a Covered Sickness. Pays a daily benefit for any day a Covered Person incurs charges for a surgical procedure performed in an Ambulatory Surgical Center or in a Hospital on an outpatient basis. ![]() Maximum Days in which Inpatient or Outpatient Surgery is Performed per Membership YearĪnesthesia Benefit - Percentage of Surgical Fee Schedule Per Day of Surgery % of Surgical Fee Schedule for Any Day in which Surgery is performed on an Outpatient Basis % of Surgical Fee Schedule for Any Day in which Surgery is performed on an Inpatient Basis Anesthesia must be administered by a licensed anesthesiologist or certified registered nurse anesthetist (CRNA). The procedure must be performed by a board certified surgeon in a Hospital or an Ambulatory Surgical Center. Pays a benefit for any day a Covered Person undergoes a surgical procedure due to a Covered Accident or Covered Sickness. Surgery Benefit (percentage of Surgical Fee Schedule) 3 Maximum Days per Insured per Membership Year 2 This benefit is not payable for emergency room treatment.īenefit for the First Day of Hospitalization Pays a benefit for the first day of hospitalization if a Covered Person incurs charges for and is Confined in a Hospital for a period of no less than 20 continuous hours due to injuries received in a Covered Accident or due to a Covered Sickness. This benefit is payable if the Hospital Confinement benefit is payable and is paid in addition to the Hospital Confinement Benefit. Pays a daily benefit if a Covered Person incurs charges for and is Confined in a Hospital Intensive Care Unit due to injuries received in a Covered Accident or due to a Covered Sickness. Hospital Intensive Care Unit Confinement Benefit Maximum Days per Insured per Membership Year This benefit is not payable for emergency room or outpatient treatment. Pays a daily benefit if a Covered Person incurs charges for and is Confined in a Hospital for a period of no less than 20 continuous hours due to injuries received in a Covered Accident or due to a Covered Sickness. Accident and Sickness Limited Benefit Insurance Unified Life Insurance Company Benefit Description
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