DESCRIPTION OF COVERAGES AND BENEFITS
This Description of Coverages and Benefits Section describes the Accident Coverages and Benefits provided by this Policy. Benefit amounts, benefit periods and any applicable aggregate and benefit maximums are shown in the Schedule of Benefits. Certain words capitalized in the text of these descriptions have special meanings within this Policy and are defined in the General Definitions section. Please read these and the Common Exclusions sections in order to understand all of the terms, conditions and limitations applicable to these coverages and benefits.
INITIAL CARE AND EMERGENCY BENEFITS
EMERGENCY CARE TREATMENT
We will pay the benefit shown in the Schedule of Benefits, if a Covered Person requires Emergency Room Treatment due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.
Benefit Conditions 1.
This benefit is payable once per Covered Accident, per Covered Person. 2. Treatment must occur within 30 days of accident for benefit to be payable.
For purposes of this benefit: Emergency Room means a trauma center or a special area in a Hospital that is equipped and staffed to give people emergency treatment on an outpatient basis. An Emergency Room is not a clinic or Physician’s office. Immediate Family Member means a person who is related to the Insured in any of the following ways: Spouse, and child (includes legally adopted child or stepchild).
Definition
Benefits will not be payable for treatment provided by an Immediate Family Member.
Exclusions
Other exclusions that apply to this benefit are in the Common Exclusions Section.
PHYSICIAN OFFICE VISIT
We will pay the benefit shown in the Schedule of Benefits, if a Covered Person requires a Physician Office Visit due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident. (Includes urgent care)
Benefit Conditions Must be diagnosed and treated by a Physician within 90 days of the Covered Accident.
Benefit Limitations 1. This benefit is not payable if a Covered Person is eligible to receive a benefit under Emergency Care Treatment. 2. Only 1 benefit will be paid for each Covered Person per Covered Accident.
This benefit is not payable for visits by a surgeon while confined in a Hospital.
Exclusions:
Other exclusions that apply to this benefit are in the Common Exclusions Section.
DIAGNOSTIC EXAM BENEFIT
We will pay the benefit shown in the Schedule of Benefits if the Covered Person requires diagnostic x-ray and laboratory examinations due to a Covered Injury as prescribed by a Physician that results directly and independently of all other causes from a Covered Accident. This benefit will be payable in addition to Emergency Care Treatment and/or Physician Office Visit benefits.
Benefit Conditions Examination must occur within 90 days of the Covered Accident.
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