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DESCRIPTION OF BENEFITS
WHAT ARE THE BENEFITS?
Covered Expenses* are as follows:
- Room, board and routine nursing services that are provided to all inpatients while confined in a semi-private room, ward, coronary care or other intensive care unit in a Hospital.
- Other Hospital services including any service performed in a Hospital's outpatient department or free-standing surgical facility.
- Physician services and surgical services.
- X-ray, radioactive treatment, laboratory charges and anesthesia services.
- Professional ambulance service to the nearest Hospital able to handle the Sickness or Injury.
- Skilled Nursing Facility care (up to 30 days), following a hospital confinement.
- Home Health Care (up to 40 visits).
- Outpatient Physical Medicine (up to 10 visits); inpatient rehabilitation (up to 30 days).
- Rental (up to purchase price) or purchase, when approved in advance, of a basic wheelchair; basic hospital-type bed or crutches.
- Whole blood, blood plasma and blood products.
- Drugs which require the written prescription of a Physician.
*Definition of Covered Expense:
An expense incurred by an insured for services, treatment or supplies prescribed by a Physician, as the result of Sickness or Injury; for Medically Necessary Care; and incurred while this plan is in force. A Covered Expense does not include any charge in excess of the reasonable and customary charge.
WHAT SERVICES ARE NOT COVERED?
*
Intentionally self-inflicted Injury or Sickness, whether sane or insane.
Free services provided by a federal, veteran's, state or municipal hospital.
Mental Disorders, Mental Illness or Substance Abuse except as may be provided by Amendment Rider.
Injury or Sickness to the extent that benefits are paid by Medicare or any other government law or program (except Medicaid); or medical coverage under any automobile insurance.
Injury or Sickness covered by Worker's Compensation or Occupational Disease Laws.
Treatment of Sickness or Injury caused by or contributed to by war or act of war; or participation in the military service of any country.
Dental treatment unless a Hospital stay is required due to the Injury. Then only the hospital charges are covered.
Treatment of temporomandibular joint disorders (TMJ), except as provided by contract (see plan).
Cosmetic surgery or reconstructive surgery, except as provided by contract (see plan).
Routine physical exams and immunizations; eyeglasses, contact lenses, or eye exams; hearing aids.
Normal pregnancy or childbirth; routine well child care.
Sterilization; treatment for infertility; genetic testing or counseling.
Treatment or removal or repair of tonsils or adenoids, except on an Emergency basis.
Expenses incurred for weight reduction or weight control programs; treatment, medication or hormones to stimulate growth.
Expenses resulting from the commission of a felony or while under the influences of illegal narcotics or non-prescribed controlled substances.
Custodial Care.
Services rendered or supplies purchased from your Immediate Family.
Experimental or Investigative Treatment; inpatient treatment of chronic pain disorders.
Private duty nursing; charges for standby Physicians.
Taxes; provider administrative expenses; travel, transportation or living expenses.
Therapy or treatment for learning disorders or disability or developmental delays.
Complications of any treatment or surgery for an excluded service or procedure.
Sclerotherapy for veins of the extremities.
Expenses incurred outside of the United States, its possessions, territories, or Canada.
* Definition of Preexisting Condition: Any Sickness, Injury, Disease or Physical Condition for which medical treatment or advice was received from a Physician or which produced symptoms prior to the Effective Date of this Policy. The Exclusion Period varies by state. The maximum period is 5 years.
ABOUT THIS WEB SITE
This web site provides a brief description of the important features of this plan. This is not the insurance contract. The actual plan sets forth in detail the rights and obligations of both you and your insurance company. State mandated benefits, if applicable, are incorporated through a rider attached to your plan.
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E-mail us for more information and a free quote or CALL TOLL FREE
1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.)
Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
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