Sickness Medical Expense Benefits
Sickness benefits will be paid up to $5,000 for medical expenses incurred within 52 weeks of the date of the first medical treatment subject to the following:
Hospital Room and Board
The expense actually incurred is allowed not to exceed the semi-private rate per day.
Hospital Inpatient Miscellaneous Expense
The expenses actually incurred are allowed not to exceed $1,000 as the result of any one sickness.
Surgical Expense
The expense actually incurred is allowed not to exceed the usual and customary charge, or $1,000 in total for all surgical operation(s) performed for any one sickness.
Ambulance Expense
The expense actually incurred is allowed not to exceed the usual and customary charge for any one sickness.
Physician's Expense
The Usual and Customary Charge is allowed not to exceed $300 for any one sickness subject to the following limitations: Payment will begin with with the first call when confined to a hospital as a bed patient or beginning with the second call when hospital confinement is not required. The allowance will be $30 per day per visit.
Registered Graduate Nurse Expense
The expense actually incurred is allowed subject to a maximum benefit of $50 per 24-hour period or or the usual and customary charge per 24-hour period or $500 as the result of any one sickness.
Outpatient Miscellaneous Expense
The expense actually incurred is allowed subject to a maximum $350 as the result of any one sickness.
Prescription Drug Expense
The expense actually incurred is allowed up to a maximum of subject to a maximum of $50 per covered sickness.
Anesthesia Expense
The expense actually incurred is allowed up to 30% of the surgeon's allowance under the policy subject to a maximum of $300 for any one sickness.
Consultant's Expense
The expense actually incurred is allowed up to $100 per covered sickness.