What Do You Mean It's Not Covered: Conditions of Surgical Coverage

When more than one surgical operation or diagnostic procedure is performed as the result of an accident or sickness, we will pay benefits a follows: For Sickness We will pay only the procedure which provides the larger benefit: (1) when two or more surgical procedures are performed, (2) when two or more diagnostic procedures are performed, and (3) when both a surgical and diagnostic procedure are performed. For Accident If as the result of one accident multiple injuries are sustained which require more than one operation to be performed in separate operative fields and through separate incisions: (1) we will pay up to the stated percent of the maximum for the most severe operation performed, and (2) we will also pay 50% of the stated percent of the maximum for each additional operation or diagnostic procedure performed. We will not pay for more than 3 operations (which includes diagnostic procedures). If an operation or procedure is not listed in the Schedule of Operations, we will determine the amount to be paid based on other procedures of like severity.