1980 002 Ordinance - Laserfiche WebLink

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M®re Detailed Descripti®n ®f benefits 1. n/IAJ®R n/IE®IC.4L PLAN Unlimited IV9aximum Benefit Under the Group Security Program, the maximum amount payable for each covered person for charges in any combination of the following eligible expenses due to sickness or injury is unlimited with these exceptions: • The maximum for mental, psychoneurotic or personality disorders for any person will be 520,000, with up to S 1,000 of the used portion restored at the beginning of each calendar year. • Payments for drugs and medicines not furnished by a hospital and for private duty nursing for persons eligible for benefits under Medicare Part A will not exceed 52,000 in any calendar year or 510,000 while the policy is in force. • The maximum payable under Dental Expense Insurance (if included) is 51,200 per covered person per benefit year. V~/aivers Waivers may apply only to those employees or dependents who are late entrants, or to employees whose weekly disability income benefits are higher than 5200. A waiver excludes benefits for a specified health condition. It means, for example, that benefits are not payable for any charges relating to the health impairment specified for an employee or a dependent. When satisfactory evidence of insurability is required for late entrants, or those with excess weekly disability income benefits, waivers may be imposed for the duration of the policy or shorter periods such as two or five years. The alternative would be to deny all coverage. Waiver exclusions do not apply to life, dental, or accidental death and dismemberment insurance. A. Hospital Benefits (IVot Subject to a ®eductible) Prudential will pay 100% of eligible expenses up to a total of the 100% Hospital Benefit Maximum shown in Summary for all confinements considered related. In addition, Prudential will pay 80% of the eligible expenses beyond that maximum. Hospital Room and Board and Related Services Eligible hospital expenses are charges for: a. Room and board accommodations and all regular daily services and supplies furnished by the hospital. (For a private room eligible charges are limited to the hospital's standard semi-private room and board rate. If no semi-private rooms, 80% of the lowest private room rate.), b. Anesthetics and their administration, c. Local ambulance service, d. Other hospital-furnished services and supplies for medical care in the hospital such as operating room, drugs, X-rays, laboratory tests, etc., exclusive of professional services. ®utpatient Hospital Care If the hospital stay does not result in a room and board charge, hospital benefits will nevertheless be paid if charges are: a. For emergency care of an accidental injury within 48 hours of the injury, b. In connection with surgery performed at the hospital, c. For X-ray and laboratory examinations made within 10 days prior to a hospital confinement in connection with the same condition. 6