Hospital Services per Benefit Period. This plan covers Medicare Part A inpatient hospital services when you have services performed at a hospital that participates in the Plan 65 Select Hospital Network. Inpatient hospital services received from a hospital that is not a part of the Plan 65 Select Hospital Network are not covered, unless the services are required for emergency treatment or the services are not available within the Plan 65 Select Hospital Network. Except as indicated above, if you receive services at a non-participating Plan 65 Select hospital, you will be responsible to pay the applicable Medicare eligible expenses, Part A deductible and/or Part A copayment. To obtain a listing of the Plan 65 Select Hospital Network listing, please call the Medicare Concierge Team or visit our website. Contact information is in Section 9. The Medicare Part A inpatient hospital deductible for Medicare eligible expenses for your first sixty (60) days of inpatient hospitalization per benefit period is covered. This plan covers the Medicare Part A copayment for Medicare eligible expenses for the 61st through 90th day of your inpatient hospitalization. If you are hospitalized for more than ninety (90) days, this plan covers the Medicare Part A copayment for Medicare eligible expenses relating to the 91st to 150th day of lifetime inpatient reserve days. Lifetime inpatient hospital reserve days are limited to sixty (60) additional days of inpatient hospitalization once in your lifetime.
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Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement