What Do You Mean It's Not Covered: Coverage for Diagnostic Surgery

We will pay up to 15% of the amount that is paid for an operation or diagnostic procedure toward the cost of anesthetic service. If more than one surgical operation is performed as the result of one accident or sickness, we will pay 15% of the greater benefit. We will not pay more than the amount charged or more than the expense.

The insured person need not be confined in the hospital for a benefit to be paid for this expense. In order for benefits to be paid: (1) the surgery must be for an injury or sickness (2) this coverage must be in force for the person undergoing the surgery (3) the surgery must be performed by a physician or surgeon.

In addition to the surgical expense benefit, the policy will pay up to 15 percent of the amount paid for an operation for anesthetic services. If more than one operation is performed, it will pay 15 percent of the greater benefit. In no case will the policy pay more than the actual charges for anesthetic services. Benefits for surgical and diagnostic procedures do not depend upon hospitalization. An insured does not need to be confined in a hospital to be entitled to these benefits. Benefits for surgical and diagnostic procedures or treatment of fractures will be paid only if the surgery is due to an injury or sickness, coverage is in force for the person when the surgery is performed, and the surgery is performed by a physician or surgeon.