|
| |
 |
| |
| |
SYNOPSIS OF COVERAGE
ACCIDENT MEDICAL
SCOPE OF COVERAGE |
| |
We will provide the benefits described in this Policy to all Covered Persons who suffer a covered loss which is within the scope of the DESCRIPTION OF BENEFITS PROVIONS and results, directly and independently of all other causes, from bodily injury which is suffered in an Accident, and occurs while the person is a Covered Person under this Policy and is within the scope of the risks set forth in the DESCRIPTION OF HAZARDS provisions.
Insured persons include all members and their lawful spouses under age 70.
Accident means a sudden, unforeseeable external event which causes injury to one or more Covered Personas and occurs while coverage is in effect for the Covered Person.
THIS IS LIMITED ACCIDENT ONLY INSURANCE. IT IS AN ACCIDENT ONLY POLICY AND DOES NOT COVER LOSS OR EXPENSE RESULTING FROM SICKNESS, DISEASE, OR BODILY INFIRMITY. In order to receive benefits, an insured person must sustain an injury while the policy is in force and such injury directly and independently causes a loss covered by the policy.
Benefits are payable for Eligible Expenses for non-work related Injuries on the following basis:
DESCRIPTION OF BENEFITS
Benefit Amount: $25,000 per Injury Deductible:$1,000 per Injury
If, as a result of injury, an insured incurs covered expenses starting within 90 days from the date of the accident causing the injury, we will pay, less the deductible as shown above and not to exceed the maximum benefit amount shown therein, all covered expenses incurred within one year from such date.
Covered expenses mean the usual, reasonable and customary charges for local professional ambulance service to or from a hospital and/or surgical center as well as the following usual, reasonable and customary charges for treatment, services and supplies provided or prescribed by a Doctor:
(1) Hospital Room & Board, or Surgical Center care and treatment; (2) Outpatient Hospital Emergency Room; (3) Surgical Benefits; (4) Doctor’s Visits In-Hospital; (5) Doctor Visits Out-Patient; (6) X-ray and Laboratory; (7) Nursing care; (8) Physiotherapy; (9) Ambulance; (10) Medical Equipment Rental Charges; (12) Medical Services and Supplies (Blood, Blood Transfusions, Oxygen); (13) Prescription Drugs; (14) Dental Treatment as a result of Injury to Natural Teeth. |
| |
| |
| |
|
