Reso 98-109 - Laserfiche WebLink

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Ronda Municipal Insurance Trust Medical Master Plan of Benefits connection with proven malignancies or for radium, radon or isotope therapy, (9) Obstetrical Care.. - Maternity benefits will be provided to participants, subject to the same limitations and exclusions applied to as all other benefits provided under this Plan; provided, however, dependent children shall not be entitled to maternity benefits. Complications of pregnancy (excluding false labor, occasional spotting, prescribed rest, morning sickness, hyperemesis gravidarum, pre-eclampsia and similar conditions not constituting a nosologically distinct complication) are eligible for benefits on the same basis as any other illness. (10) Newborn Care - Eligible hospital services as provided herein for participants shall also be provided for a newborn dependent child of a participant from the moment of birth and shall include mentally diagnosed congenital defects, birth abnormalities or prematurity. A newborn infant of a dependent child is eligible and shall be covered so long as the dependent child is covered under the provisions of this Plan but not to exceed eighteen (18) months. Physician Services - The expenses incurred for the following physician services will be paid as stated in the Schedule of Benefits (in excess of any deductible and/ or coinsurance) for reasonable fees up to the Lifetime Maximum of this Plan or to the end of the calendar year whichever first occurs. (1) Surgical Services - wherever performed, limited to operative procedures for the treatment of accident or sickness. The surgical allowance includes post- operative treatment. (2) Surgical Assistant - provided the assistance is medically necessary, no intern, resident, or other staff Physician is available, and the condition of the patient and the type of eligible surgery performed require such assistance. (3) Consultations - which are medically necessary due to complications, complexity or different diagnosis. A consultation report must be part of the hospital medical records. (4) Anesthesia Administration - when rendered in connection with a covered surgical or obstetrical" procedure. is) Obstetrical Care" - this expense will be considered incurred at the termination of the pregnancy. Dependent children shall not be entitled to maternity benefits. (6) Professional Component Expenses - of radiology, pathology and laboratory. (7) Medically Necessary Hospital Visits - not including post-operative treatment. (8) Medically Necessary Care - rendered outside of the hospital. Routine physical examination expenses are not covered, unless otherwise specifically stated in the Schedule of Benefits. (9) Dental Care and Treatment - rendered by a physician or dentist within ninety (90) days of an accident when, as the result of the accident, natural teeth have been damaged or fractured or a dislocated jaw requires setting. (10) Concurrent Care - combining medical surgical and obstetrical" care whereby the Trust will pay for necessary eligible medical, surgical, or obstetrical** care and nec'essary eligible surgical obstetrical" care in addition to other eligible medical expense during a single hospital confinement. . .Unl~ otherwise mte<! 'n the Schedule of Beneflb (7/98) Page 13