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Merritt Personal Lines Manual: Optional Coverage: Extra Miscellaneous Expense

EXTRA HOSPITAL MISCELLANEOUS EXPENSE COVERAGE

This coverage provides benefits when expense of $3,000 or more has been incurred for hospital services and supplies in one period of confinement. For any further expense incurred for such services and supplies in the same period of confinement for that person, we will pay:

(1) 80 per cent of the expense incurred

(2) up to the maximum benefit amount shown on page ____.

The services do not include the expense for hospital room or for professional services of a radiologist, pathologist, anesthesiologist, nurse, physician, or surgeon.

In order for benefits to be paid under this coverage, the hospital confinement:

(1) must be for an injury or sickness

(2) must begin while this coverage is in force for the person confined

(3) must be at the direction of and under the supervision of a physician or surgeon.

This is an optional coverage that provides an additional amount of insurance for miscellaneous hospital expenses charged while you are an inpatient. Coverage only applies to each insured for whom it is shown in the policy schedule. When purchased, the additional benefit amount will also be shown in the schedule (for example, an insured may purchase $7,000 of "extra" coverage for miscellaneous hospital charges). Benefits are paid at the rate of 80 percent of the additional charges that exceed $3,000 -- a 20 percent copayment applies.

An example: You have $3,000 of coverage for miscellaneous charges under your inpatient coverage and $7,000 of extra coverage for miscellaneous charges. If the hospital charges $5,000 for miscellaneous expenses while you're confined, your policy will pay $4,600 ($3,000 plus 80 percent of $2,000) and you will pay $400 (20 percent of $2,000).

Extra hospital expense coverage does not include benefits for the professional services of a radiologist, pathologist, anesthesiologist, nurse, physician or surgeon. In order for this coverage to apply, a period of confinement must occur because of injury or sickness, begin while coverage is in force for the insured person and be at the direction of a physician or surgeon.

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