The Hospital Stay must meet all of the following: 1.
be at the direction and under the care of a Physician; 2. begin within 90 days of the Covered Accident; 3. begin while the Covered Person’s insurance is in effect; and 4. The Covered Person must be admitted for at least 23 hours or on an Inpatient basis.
The benefit will be paid for each day of a continuous Hospital Stay. If the Hospital Stay begins during the Benefit Waiting Period, the benefit will be paid for each continuous day that extends after the end of the Benefit Waiting Period, as shown in the Schedule of Benefits. If benefits are calculated on a monthly basis, pro rata payments will be made for confinements of less than one month.
Benefit Limitations 1.
This benefit will not be payable for hospital re-admission for same Covered Accident. 2. If a benefit is payable under the Hospital Stay Benefit as well as under the Intensive Care Unit Stay Benefit, only 1 benefit will be paid for the same Covered Accident, which is the greater amount. 3. If the Covered Person leaves the Hospital and then returns within 90 days for the same or a related Covered Accident, We will still count that as one Hospital Stay. However, if the Covered Person is out of the Hospital for at least 90 days and then returns for the same or a related Covered Accident, We will count that as a different Hospital Stay.
The exclusions that apply to this benefit are in the Common Exclusions Section.
Exclusions:
INTENSIVE CARE UNIT STAY BENEFIT
We will pay the benefit shown in the Schedule of Benefits subject to the following conditions and exclusions, if the Covered Person is confined in an ICU of a Hospital due to a Covered Accident resulting directly and independently of all other causes from a Covered Accident. Benefits are payable only for up to 365 days spent in an ICU for each Stay.
Benefit Conditions The ICU Stay must meet all of the following: 1.
be at the direction and under the care of a Physician; 2. begin within 90 days of the Covered Accident; 3. begin while the Covered Person’s insurance is in effect. 4. the Covered Person must be admitted for at least 23 hours or on an Inpatient basis.
The benefit will be paid for each day of a continuous ICU Stay. If the ICU Stay begins during the Benefit Waiting Period, the benefit will be paid for each continuous day that extends after the end of the Benefit Waiting Period, as shown in the Schedule of Benefits. If benefits are calculated on a monthly basis, pro rata payments will be made for confinements of less than one month.
Benefit Limitations 1.
This benefit will not be payable for Hospital re-admission for same Covered Accident. 2. If a benefit is payable under the Hospital Stay Benefit as well as under the Initial Intensive Care Unit Benefit, only 1 benefit will be paid for the same Covered Accident, which is the greater amount. 3. If the Covered Person leaves the ICU and then returns within 90 days for the same or a related Covered Accident, We will still count that as one Stay. However, if the Covered Person is out of the ICU for at least 90 days and then returns for the same or a related Covered Accident, we will count that as a different Stay in an ICU.
For purposes of this benefit:
Definition
ICU means an Intensive care or cardiac care unit of a Hospital that: a. is for the treatment of patients who are in acute or critical condition; b. is furnished with emergency life-saving equipment and supplies that are immediately at hand; c. is staffed 24 hours a day by Nurses who are specially trained to work in an intensive care unit; and d. is equipped and staffed to monitor each patient's vital signs around-the-clock.
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