Merritt Personal Lines Manual: Outpatient Services
If you have coverage for outpatient services under your plan, the plan will usually pay for 80 percent of covered outpatient services and supplies, subject to the maximum benefit amount shown in your policy's benefit schedule. You will be required to pay the other 20 percent of the charges or copayment.
Here's a list of outpatient services and supplies that health plans typically cover:
- x-ray and fluoroscopic examinations;
- radium and other radioactive substance;
- electrocardiograms, microscopic and laboratory tests;
- drugs and medicines which may be purchased only on the attending physician's written prescription and which are dispensed by a licensed pharmacist;
- casts, splints, braces, crutches and artificial limbs;
- oxygen and equipment used for its administration.
Outpatient services are covered only when rendered due to injury or sickness, while coverage is in force for the insured person and as the direction of a physician or surgeon. These outpatient benefits do not include benefits for the services of a radiologist, pathologist, anesthesiologist, physician or surgeon.
