Once the deductible has been satisfied, the Plan will provide reimbursement of covered expenses as shown in the table below. This copayment is waived if there is immediate confinement for the same accident or illness. Outpatient surgery and hospital charges for services connected with surgery that are billed by the hospital. Services not billed by the hospital may be recognized by the major medical coverage of the Plan. Emergency treatment is only covered within 72 hours after an accident, or within 24 hours of a sudden and serious illness.
Emergency treatment includes services billed by the hospital on their statement of charges.
Urgent care centers are not covered under the hospital portion of your benefits. They are recognized under the major medical coverage of the Plan. You are responsible for the difference between the semi-private and private room rate. A stay related to childbirth, miscarriage, ectopic pregnancy, or pre-mature termination of pregnancy is only covered if the patient is a participant or the spouse of a participant. A newborn's ordinary nursing care in the hospital is also covered.