Accidental Medical Expense Benefits
Benefits are provided up to $5,000 for accidental injuries for which medical treatment by a physician, surgeon, dentist, registered nurse, hospital services, ambulance services, or x-rays are rendered. The initial treatment must be rendered within 90 days of the accident and benefits are limited to treatment rendered within 52 weeks of the date of the accident. Specific benefit levels are as shown below:
Hospital Room and Board
The expenses actually incurred are allowed not to exceed the usual and customary charge per day.
Hospital Inpatient Miscellaneous Expense
The expenses actually incurred are allowed not to exceed the usual and customary charge as the result of any one injury.
Surgical Expense
The expense actually incurred is allowed not to exceed $400 times the unit value of the 1974 California Relative Value studies, or $5,000 in total for surgical operation(s) performed for any one injury.
Ambulance Expense
The expense actually incurred is allowed not to exceed the usual and customary charge for any one injury.
Physician's Expense
The Usual and Customary Charge is allowed not to exceed $5,000 for any one injury.
Registered Graduate Nurse Expense
The expense actually incurred is allowed subject to a maximum benefit of the usual and customary charge per 24-hour period.
Outpatient Miscellaneous Expense
The expense actually incurred is allowed subject to a maximum $5,000 as the result of any one injury.
Dental Expense
The Company will pay up to the usual and customary charge per tooth with a maximum of $500 per injury for treatment to sound and natural teeth injured in a covered accident.
Physiotherapy Benefit
Up to the usual and customary charge per visit is allowed subject to a maximum of $5,000 for any one injury.
Prescription Drug Expense
The expense actually incurred is allowed subject to a maximum of the usual and customary charge per injury.
Anesthesia Expense
The expense actually incurred is allowed up to 30% of the surgeon's allowance under the policy subject to a maximum of $2,500 for any one injury.
Consultant's Expense
The expense actually incurred is allowed up to the usual and customary charge per covered injury.