● Covered charges incurred for rental (not to exceed the purchase price) of one basic manual wheelchair, one basic hospital bed, one pair of basic crutches, the initial permanent basic artificial limb ort eye and oxygen and the basic equipment needed to administer oxygen; and the initial external breast prosthesis needed because of the medically necessary surgical removal of all or part of the breast, provided the surgical removal was done while the covered person was covered under the plan. ● Covered charges incurred for reconstructive surgery required due to an injury which occurred while the covered person is insured under the plan. ● Covered charges incurred for surgical treatment of temporomandibular joint (TMJ) or craniomandibular joint (CMJ) dysfunction, provided the charges are for services included in a dental treatment plan authorized by Assurant Health prior to the surgery; charges for non-surgical treatment of TMJ OR CMJ. ● Covered charges incurred for the following complications of pregnancy: spontaneous termination of pregnancy (miscarriage) which occurs before the 26th week of gestation; missed abortion (miscarriage); ectopic pregnancy when pregnancy is ended; and other medical conditions such as acute nephritis, nephrosis and cardiac decompensation. ● Covered charges incurred for the following organ transplants: heart, liver, and bone marrow. Tissue transplants include: cornea transplant; prosthetic tissue replacement, including joint replacement; vein or artery graft; heart valve replacement; and implantable prosthetic lens in connection with cataracts. The maximum amount we will pay for any and all organ transplants is limited to $250,000 for the covered person during his or her lifetime. ● Covered expense incurred for the treatment of AIDS, AIDS Related Complex (ARC) or related immuno deficiency disorders. Extension of Benefits: When the benefit period expires, coverage may be extended for a continuous injury sustained or sickness which commenced while the policy was in force and for which a covered person is then being treated. The extension of benefits provision will apply when: 1. The covered person receiving treatment remains totally disabled beyond the benefit period expiration date and is under the care of a physician for the disability during the benefit period. 2. The covered person who has met his or her deductible during the benefit period and is being treated for complications of or needs follow-up treatment for an injury sustained or sickness which commenced during the benefit period. Although the above provides a good description of the important features of the Short Term Medical plan, this is not the insurance contract and only the actual contract defines coverage. Benefits may vary by state and by the terms of the insurance contract. The policy itself sets forth in detail the rights and obligations of both you and the insurance company. |