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Rorlda Municipal Insurance Trust Medical Master Plan of Benefits SECTION VI - COVERED EXPENSES If the employer and the participant have satisfied the terms and conditions provided in this Plan for coverage and for the payment of benefits and services, the participant is entitled to the benefits and services listed below when incurred while the Plan is in force and when medically necessary and consistent with the accident or sickness for which the participant is being treated. The Trust will pay the reasonable fee for such benefits and services and, all such benefits and services, unless otherwise expressly provided herein, shall be subject to any calendar year deductible andj or coinsurance shown on the Schedule of Benefits. Pre-Admission Certification - All non-emergency hospital admissions must be: (1) certified seven (7) days prior to a planned admission; (2) certified within 48 hours or the first working day after the admission. Failure to obtain certification will result in a 20% reduction of benefits paid. Pre-admission certification is not required for the birth of a child, provided the hospital or birthing center length of stay does not exceed: ( 1) 48 hours following a vaginal delivery, or (2) 96 hours following a cesarean delivery. Inpatient Hospital Services - The expense incurred for the following services will be paid as stated in the Schedule of Benefits (in excess of any deductible andj or coinsurance) for reasonable fees up to the Lifetime Maximum of this Plan or to the end of the calendar year whichever frrst occurs. (1) Hospital room and board up to but not to exceed the average semi-private room rate. ** (2) Intensive care unit (including cardiac and neonatal care units) not to exceed three (3)** times the average semi-private room rate. (3) Progressive care unit up to but not to exceed one and one-half (1 V2 ) time.s the average semi-private room rate only if incurred immediately following a confmement in an intensive care unit, (4) Miscellaneous services and supplies provided such as operating and recovery room charges, x-ray and other diagnostic procedures, laboratory tests, pathological services, medications and dressings, (5) Transfusion supplies and services including blood administration expenses but not including blood, blood plasma and/or blood derivatives unless otherwise specifically stated in this Plan. (6) Anesthesia services, including supplies, equipment and physician's charges for regional, intravenous, inhalation, intraspinal and caudal anesthesia services when performed by a regular salaried hospital employee and when performed in connection with surgical, obstetrical**, electro-shock, or dental services~* covered under this Plan. (7) Oxygen therapy, diathermy and physiotherapy. (8) Roentgenologic (x-ray) and cobalt bomb therapy when such therapy is m