INPATIENT BENEFITSRoom & Board up to the Semi-Private Room Rate 80% of PPO Allowance 70% of R&CIntensive Care Unit 80% of PPO Allowance 70% of R&CHospital Miscellaneous including Intensive CareMiscellaneous80% of PPO Allowance 70% of R&CPhysiotherapy 80% of PPO Allowance 70% of R&CSurgery 80% of PPO Allowance 70% of R&CAssistant Surgeon 25% of Surgery Allowance 25% of Surgery AllowanceAnesthesia (professional services) 25% of Surgery Allowance 25% of Surgery AllowanceRegistered Nurse (private duty nursing) 80% of PPO Allowance 70% of R&CDoctor’s Visits (1 visit per day when not related to surgery) 80% of PPO Allowance 70% of R&CPsychotherapy (1 visit per day) 80% of PPO Allowance 70% of R&COUTPATIENT BENEFITSSurgery 80% of PPO Allowance 70% of R&CDay Surgery Facility / Miscellaneous 80% of PPO Allowance 70% of R&CAssistant Surgeon 25% of Surgery Allowance 25% of Surgery AllowanceAnesthesia (professional services) 25% of Surgery Allowance 25% of Surgery AllowanceDoctor’s Visits and Urgent Care Expense(1 visit per day when not related to surgery)includes routine physical exams only when required byacademic departments for program participation such asnursing students and other students in a practicum.80% of PPO Allowance(after $10 per visit copay)70% of R&C(after $10 per visit copay)Physiotherapy (1 visit per day), if deemed MedicallyNecessary80% of PPO Allowance(after $10 per visit copay)70% of R&C(after $10 per visit copay)X-rays, Laboratory, Tests and Procedures (includesSickle Cell Anemia Testing)80% of PPO Allowance(after $10 per service copay)70% of R&C(after $10 per service copay)Chemotherapy / Radiation Therapy 80% of PPO Allowance 70% of R&C