Merritt Personal Lines Manual: Optional Coverage: Doctor's Visits
COVERAGE FOR PHYSICIAN'S VISITS
The maximum benefit amount we will pay for each visit by a physician is shown on page ____. We will not pay more than the amount charged for each visit. The visit must be for medical treatment. We will not pay for more than one visit per day.
We will not pay for more than 31 visits during any one period of confinement. If the attending physician requests a consulting physician's opinion, we will pay for up to 2 such consultations during one period of confinement for one accident or sickness
The benefit amount shall be the same as we would otherwise pay for a physician visit. We will not pay for more than one visit per day.
We will begin paying with the first visit for an injury and with the second visit for a sickness.
We will not pay for more than 25 visits for any one accident or sickness.
In order for benefits to be paid under this coverage:
(1) the treatment must be for an injury or sickness
(2) the treatment must begin while this coverage is in force for the person being treated and
(3) the medical treatment must be by a physician.
Benefits will not be paid for a physician visit which relates to an injury or sickness for which surgery is performed.
This is an optional coverage that provides benefits for physician's visits. Coverage only applies to each insured for whom it is shown in the policy schedule. The maximum benefit is also shown in the schedule. The policy will not pay more than the actual charge for each visit, nor will it pay for more than one visit per day.
During one period of hospital confinement, the policy will not pay for more than 31 doctor visits. Within this total, it will pay for up to two visits by other doctors if the attending physician requests a consulting physician's opinion.
Outpatient benefits are limited to a maximum of 25 visits for any one accident or sickness. These visits may occur at the doctor's office, at a clinic, or at the insured's home. Benefits for an accidental injury begin with the first visit, but benefits for sickness begin with the second visit (the first doctor's visit is not covered).
Benefits are not payable for any visit related to a condition for which surgery is performed. Physician visits are covered only when treatment is given for injury or sickness, treatment begins while coverage is in force and treatment is made by a physician.
COVERAGE FOR PHYSICIAN'S VISITS
(including Coverage for Clinical Social Worker)
The maximum benefit amount we will pay for each visit by a physician or clinical social worker is shown on page ____. We will not pay more than the amount charged for each visit. The visit must be for medical treatment. We will not pay for more than one visit per day.
We will not pay for more than 31 visits during any one period of confinement. If the attending physician requests a consulting physician's opinion, we will pay for up to 2 such consultations during one period of confinement for one accident or sickness.
The benefit amount shall be the same as we would otherwise pay for a physician visit. We will not pay for more than one visit per day.
We will begin paying with the first visit for an injury and with the second visit for a sickness.
We will not pay for more than 25 visits for any one accident or sickness. In order for benefits to be paid under this coverage:
(1) the treatment must be for an injury or sickness
(2) the treatment must begin while this coverage is in force for the person being treated and
(3) the medical treatment must be by a physician.
Benefits will not be paid for a physician visit which relates to an injury or sickness for which surgery is performed.
Clinical social worker shall mean an individual who is licensed as such by the state.
This is an optional coverage that provides benefits for visits by a physician or a state licensed clinical social worker. The persons insured and the amount of the maximum benefit must be shown in the policy schedule.
This coverage is identical to the optional coverage for physician's visits except that it also covers visits by clinical social workers. Benefits are also limited to one visit per day, 31 visits during any one period of hospital confinement and 25 outpatient visits for any one accident or sickness.
