BENEFICIOS DESPUÉS DE LA EDAD DE 69 AÑOS Sample Clauses

BENEFICIOS DESPUÉS DE LA EDAD DE 69 AÑOS. (a) Después de la edad de 69 años, todas las enfermedades y lesiones cubiertas bajo este contrato deben ser tratadas por un proveedor dentro de la “Red de Proveedores Preferidos”, excepto como se describe abajo: i. El contrato provee cobertura para tratamiento médico de emergencia fuera de la Red de Proveedores Preferidos en aquellos casos en que el tratamiento médico es requerido para evitar la pérdida de la vida o de la integridad física. Los cargos cubiertos relacionados con una admisión de emergencia a un proveedor fuera de la Red de Proveedores Preferidos serán pagados hasta veinticinco mil ($25,000) dólares con el deducible normal de su plan y copago (si es aplicable). Para estar cubierto por esta estipulación, el inicio de la condición e índole de la emergencia xxxxxx ser tal que imposibilite al Afiliado o al proveedor médico contactar a USA Medical Services antes del tratamiento. ii. Fuera de la Red de Proveedores Preferidos no hay cobertura para enfermedades o lesiones que no son relacionadas a una emergencia. (b) La cobertura máxima del contrato se modifica de la siguiente manera: Xxxx Xxxxxxxxx Xxxxxx 00-00 años $500,000 por vida 76 años o más $250,000 por vida EXCLUSIONES Y LIMITACIONES
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BENEFICIOS DESPUÉS DE LA EDAD DE 69 AÑOS. (a) Después de la edad de 69 años, todas las enfermedades y lesiones cubiertas bajo este contrato deben ser tratadas por un proveedor dentro de la “Red de Proveedores Preferidos”, excepto como se describe abajo: i. El contrato provee cobertura para tratamiento médico de emergencia fuera de la Red de Proveedores Preferidos en aquellos casos en que el tratamiento médico es requerido para evitar la pérdida de la vida o de la integridad física. Los cargos cubiertos relacionados con una admisión de emergencia a un proveedor fuera de la Red de Proveedores Prefe- ridos serán pagados hasta veinticinco mil ($25,000) dólares con el deduc- ible normal de su plan y copago (si es aplicable). Para estar cubierto por esta estipulación, el inicio de la condición e índole de la emergencia xxxxxx ser tal que imposibilite al Afil- iado o al proveedor médico contactar a USA Medical Services antes del trata- miento.

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