1980 002 Ordinance - Laserfiche WebLink

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C. Optional Benefits Eligible charges in excess of those payable under these benefits may be eligible charges under the previously described benefits of the Major Medical Insurance. Surgical Expenses Prudential will pay eligible charges for surgical procedures (except for pregnancy) performed in or out of the hospital up to the amount provided under the Table of Surgical Procedures contained in the certificate issued to each insured employee. The maximum for all related procedures under the Table is twice the highest scheduled limit in the Table. Supplemental Accident Expenses Prudential will pay up to 5300 per person for eligible charges incurred for the following services and supplies in connection with the treatment of injuries received in an accident. Treatment must be administered within 90 days of the injury. These services and supplies are: a. Services and supplies (including room and board) furnished by a hospital for medical care in that hospital, b. Doctors' services for surgical procedures and other medical care, c. X-ray and laboratory examinations, d. Private duty professional nursing services by a registered graduate nurse other than a close relative. Diagnostic X-ray and Laboratory Expenses Prudential will pay up to S 100 per person for eligible charges for all diagnostic examinations (except for pregnancy or in connection with a hospital confinement for which benefits were payable under A. above) during a calendar year. In-Hospital Doctor Calls Expenses Prudential will pay the amount actually charged for doctors' calls in a hospital or convalescent nursing home up to the amount per day shown in the Summary times the number of days of confinement, but not more than 120 days for all related stays. Calls made in a convalescent nursing home are eligible only when convalescent nursing home benefits are payable. Calls made the day of, or any day after, a surgical procedure and calls made in connection with pregnancy are not covered. D. Maternity Benefits These benefits are provided for all covered females. Prudential will pay benefits for eligible charges for obstetrical procedures and for hospital services and supplies connected with pregnancy up to 'these limits- • The amount shown in the Summary if pregnancy terminates by normal delivery, • One-and-a-half times that amount if pregnancy terminates by Cesarean section or an obstetrical procedure for extra-uterine pregnancy. • One-half the normal delivery maximum if pregnancy terminates by an abortion or miscarriage. Benefits will not be paid unless the pregnancy begins while the person is covered for these benefits under the plan. E. Limited Medical Expense Benefit (Automatically Included in a GSP Plan Containing Health Care Benefits) This benefit applies when a covered person becomes eligible for Medicare Part A benefits because of age, and applies in place of all other health care benefits. (No benefits are provided for any of the types of charges covered under Medicare Part B.) Pays for each qualified person for the following eligible charges connected with one spell of illness- For inpatient confinement in a hospital as defined by Medicare: • Charges for covered inpatient hospital services and supplies up to the Medicare Part A deductible. • Daily covered hospital charges up to one-quarter of the inpatient hospital deductible of Medicare Part A for the 61st through the 90th day of hospital confinement. 8