Merritt Personal Lines Manual: How the Policy Defines Various Kinds of Service

Professional Medical Services. Insured expenses for professional medical services are the regular and customary charges for physician's services, whether in or out of the hospital, surgery and diagnostic procedures; private duty nursing, while hospital confined, rendered by a graduate registered nurse or a licensed vocational nurse, other than a member of your family; anesthesia services; and diagnostic work or treatment rendered by a radiologist, pathologist or physiotherapist.

Coverage is provided for a variety of professional medical services. These include physician services (in or out of a hospital), surgery, diagnostic procedures, private duty nursing (only while confined in a hospital), anesthesia services and services performed by a radiologist, pathologist or physiotherapist. Once again, only the regular and customary charges are covered.

Out-of-Hospital Services. Insured expenses for out-of-hospital medical services are the regular and customary charges for out-patient x-rays, laboratory tests; electrocardiograms; emergency room; operating room; drugs and medicines requiring written prescription of a physician; casts, splints, braces, crutches; surgical dressings and suture trays. These insured expenses are payable when furnished or rendered on an out-patient basis at a hospital, clinic, doctor's office or by an ambulatory surgical center.

Insured expenses for out-of-hospital medical services also include the regular and customary charges for emergency ambulance service in the state of residence, or 200 miles; rental of a wheelchair, hospital bed, iron lung or other mechanical treatment of respiratory paralysis; and oxygen and equipment used in its administration.

Coverage is provided for the regular and customary charges made for a variety of outpatient services, which may be performed at a hospital, clinic, doctor's office, or at an ambulatory surgical center. These services include x-rays, lab tests, emergency room treatment, operating room services, prescription drugs or medicines, casts or splints, surgical dressings, oxygen, emergency ambulance service and rental of wheelchairs and other mechanical devices.