Illness Benefit
- Will pay covered medical expenses incurred within 52 weeks from the date of first treatment for illness
- Will pay according to the following Schedule of Benefits:
Hospital Confined as an In-Patient
1. Hospital Room and Board: Pays semi-private rate for the first three days, when confinement is prescribed by a physician, then up to $356 per day for the next 67 days per illness.
2. Hospital Miscellaneous Expenses: Pays up to $3,000 per illness for eligible expense other than room and board incurred during the period covered by the room and board benefit; for necessary services and supplies other than physician's and nurse's fees.
3. Physician's Fee: Pays for one visit per day up to 30 visits per illness, not to exceed $30 per visit nor more than one visit per day, during the period covered by the room and board benefit.
In or Out of Hospital
4. Outpatient Surgery Miscellaneous: Pays Hospital Room and miscellaneous expenses up to $3,000 per illness when outpatient surgery is performed.
5. Surgery: Pays expenses incurred up to $2,000 according to the percentages specified in the surgical schedule attached to the Policy. Benefits for multiple surgical procedures performed within the same operative field are limited to 150% of the amount payable for the primary procedure
6. Anesthetist Fee: Pays up to 20% of the surgical benefit.
7. Specialist's Fee: Pays up to $85 per illness when approved and/or referred by University Medical Services or by the attending physician for services required of a specialist or consultant.
Outpatient Benefits
8. Emergency Medical Expense, Diagnostic Lab, and X-Ray: Pays eligible expenses for emergency room charges, urgent care charges, Diagnostic Laboratory and/or X-ray expense, not to exceed a maximum benefit of $2,000 per illness.
9. Physician's Fee: Pays $30 per visit per illness, starting with the first visit when away from Campus or when referred by UMS; maximum total benefit of $150 per illness.
10. Prescription Drugs: Pays up to $100 per illness for drugs prescribed by a physician; subject to a $10 deductible.
11. Ambulance Service: Pays up to $50 per illness for professional ambulance service to or from the hospital.