SURGICAL BENEFITS
Bone Marrow Transplant for Cancer Actual charges incurred for bone marrow transplants or other forms of stem cell rescue and all related services and supplies. Lifetime maximum of $10,000. This benefit is in lieu of any other benefit associated with the treatment, service, or procedure underlying Bone Marrow Transplant, with the exception of the Transportation and Lodging for Bone Marrow Donors benefit. In AR, additional benefits may be available for a live donor. Breast Reconstruction/Breast Prosthesis Actual Charges incurred for reconstructive surgery, and an external or internal breast prosthesis and the surgeon’s fee for implantation following a mastectomy. Except in OK, lifetime maximum of $5,000. This benefit is in lieu of the surgical benefit provided in this policy. Artificial Limb and Prosthesis Pays per prosthetic device or artificial limb and the reconstructive procedure to affix or implant it. Benefits limited to only two of the same type of prosthetic device or artificial limb. Not payable if a breast reconstruction and breast prosthesis benefit is payable. Outpatient Surgery Benefit Payable for outpatient surgery in a hospital or ambulatory surgical center. Not payable for surgery in a physician’s office or clinic, or for skin cancer treatment. Additional Surgical Opinions Pays for a second and third surgical opinion if the surgical opinions differ. Anesthesia Pays for the procedure in which anesthesia is used. We will pay $50 for the administration of anesthesia for each skin cancer operation. Skin Cancer • If the diagnosis is made by a physician other than a pathologist, $150 per calendar year for removal of skin cancer to a lifetime maximum of $600 . • If the diagnosis is made by a pathologist, actual charges to the maximum amount for such surgery shown in the surgical benefits schedule.
Pays actual charges, lifetime maximum of $10,000.
Pays actual charges. Lifetime maximum of $5,000.
Actual charges to $1,500
Pays $375 per operation for drugs, medicines and lab tests. Pays maximum of 150% of surgery shown in surgical benefits schedule.
$200 each opinion
Pays 25% of the surgical benefit amount paid
Pays $150 per calendar year. Lifetime maximum benefit $600.
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