Reso 98-109 - Laserfiche WebLink

Home Browse Search

Ronda Municipal Insurance Trust Medical Master Plan of Beneftts Pre-Admission Laboratory or Radiolo~ Testinl - The expenses incurred for pre- admission laboratory or radiology testing will be payable at 100% of the reasonable fees, not subject to the calendar year deductible. The testing must be ordered by a physician, must not be duplicated by the hospital and must be performed no later than four (4) days prior to an inpatient hospital confmement or an outpatient surgical procedure in order to be covered by this provision. All other expenses incurred for pre-admission laboratory or radiology testing shall be subject to the calendar year deductible and coinsurance. Physical Therapy Services - Services of a Physical Therapist for physical therapy provided such services are provided on an outpatient basis and further provided such services are limited to 40 visits, up to a $2,000** per calendar year maximum. Second SurJical Opinions - Second surgical opmlOns may be required prior to surgery for the following surgical procedures: (l) Arthoplasty - plastic operation on a joint or the formation of an artificial joint when performed on the knee or hip; (2) Arthroscopy - internal examination performed by the use of a scope, when performed on the knee; (3) Cholecystectomy - removal of the gall bladder; (4) Coronary Bypass and Pacemaker Insertion; (5) Dilation and Curettage (D&C); (6) Hemorrhoidectomy - removal of a mass of swollen varicose veins in the rectal mucous membrane; (7) Hysterectomy - removal of the uterus by excision; (8) Laminectomy or Laminotomy - removal of or incision into a disk; (9) Prostatectomy - excision of the prostrate gland; ( 10) Subcutaneous Mastectomy - excision of cyst, tumor, or lesion of the breast; (11) Submucous resection/ rhinoplasty - surgical correction of deviated septum, . plastic surgery on the nose; (12) Tonsillectomy/adenoidectomy - removal of the tonsils and adenoids. Mental and Nervous Disorders** - The reasonable fees of the services of physicians, psychiatrists, licensed psychologists who hold a PsyD, and hospital for the treatment of mental and nervous disorders, as defmed in the standard nomenclature of the American Psychiatric Association, limited to the maximum number of visits shown on the Schedule of Benefits, up to a $10,000 per calendar year maximum and a $25,000 lifetime maximum. Medicare SuplJlement Benefits - A participant over the age of 65 who retires from the employ of the employer while this Plan is in force is eligible for the Medicare Supplement coverage of this Plan. The supplement benefits are: (l) For initial hospital expenses for confmement as a hospital inpatient, the Plan will pay ~e Part A Medicare deductible. (2) For hospital inpatient expenses from the 61st day through 150th day of confinement per spell of illness, the Plan will pay the amount of the daily ..tJ"I~", !"l"'~~ ~.aA 'n...... ~.J"t.!~",,, "f OIlof"DflI..... f7/QQ'