Mandated Benefits
The plan will pay benefits for the following mandated benefits and any other applicable mandate in accordance with Pennsylvania Insurance Laws.
Maternity Expense
We will pay benefits for Hospital confinement due to pregnancy, childbirth, or miscarriage. To receive benefits, a female must be insured under the Policy at the time of conception and during the entire period of pregnancy. We pay benefits for a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed by the state. Pregnancy and complications of pregnancy will be considered as any other sickness. This benefit is subject to the hospital limits outlined above.
Mammography Benefits
Benefits will be provided on the same basis as benefits for any other sickness for mammography. We will pay for: (1) one baseline mammogram examination every year for women who are forty years of age or older; and (2) Any mammogram recommended by a physician for women under age 40. This benefit is subject to the hospital limits outlined above.
Women's Preventative Health Services Benefit
The Company will pay the following benefits for any Insured: (1) an annual gynecological examination, including a pelvic examination and clinical breast examination; and (2) routine pap smears in accordance with the recommendations of the American College of Obstetricians and Gynecologists. These benefits will be considered as any other sickness. This benefit is subject to the hospital benefits listed above.
Mental or Nervous Disorders Benefit
The Company will pay for services rendered by a psychiatric consultant (in or out of the hospital) when an Insured is referred for counseling. The Company will pay $30.00 a visit up to a maximum of $300 worth of visits.
Childhood Immunizations Benefit
The Company will pay benefits for the Usual and Customary Charges incurred for those childhood immunizations, including the immunizing agents, which as determined by the Department of Health, conform with the standards of the (Advisory Committee on Immunization Practices of the Center for Disease Control) U.S. Department of Health and Human Services. Such benefits are not subject to the limits stated above.
Alcoholism and Drug Abuse Treatment Expense Benefit
When an Insured incurs expense for the treatment of substance abuse as prescribed by a doctor of medicine, the Company will provide benefits to the same extent as for any other sickness under this Policy subject to the following limitations: Inpatient or outpatient care must be in a licensed Hospital; In a licensed, certified, or state approved residential treatment facility under a program that meets the minimum standards of care equivalent to those prescribed by the Joint Commission on Hospital Accreditation.