Approved Conventional Providers & Services Include: 

• Ambulance  & Med Flight - The urgent care you when and where you need it

• Diagnostics, X-ray's and Laboratory Services – Inpatient/Outpatient/Independent lab

• Emergency Room Hospital And Physician Services – (Routine treatment excluded)

• Home Health Care – Limit 30 days per Incident

• Hospital  – Inpatient limited to the average semi-private room rate.

• Maternity Care – Delivery including physician charges, office visits, hospital charges and birthing centers cesarean section and/or complications treated as new incident with new per incident limits

• Physician Office Services – Per incident visit. All other physician office services included per incident. (Charges billed by a physician if performed in the physician’s office: injection, surgery, lab, x-ray, special diagnostic interpretation.)

• Prescription Drugs – Per incident (charges must occur within 45 the days before or after any related medical incident)

• Surgery – Surgeon, Assistant Surgeon and Anesthesiologist Services. Inpatient/Outpatient services. Outpatient surgery facility

• Therapy – Limit 20 visits per Calendar Year: (Combined with Speech, Respiratory, Physical, Occupational Therapy)

• Other Expenses – (Unless limited by the guidelines)

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*Unlicensed practitioners need to work through a licensed practitioner