HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within 60 days preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitioner. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured does not result in hospital confinement for the treatment of the medical condition diagnosed.
HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within 60 days preceding confinement in a Hospital and provided that such consultation is Medically Necessary. SURGEON FEE - Reimbursement of the Reasonable and Customary Charges for a Medically Necessary surgery by the Specialists, including pre-surgical assessment Specialist’s visits to the Insured Person and post-surgery care up to 90 days inclusive both before and after the date of surgery, but within the maximum indicated in the Schedule of Benefits. If more than one surgery is performed for Any One Disability, the total payments for all the surgeries performed shall not exceed the maximum stated in the Schedule of Benefits. ANAESTHETIST FEE - Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefit. SECOND SURGICAL OPINION – Charges for consultation or opinion with a second specialist to determine whether a surgical operation for the same disease or injury is required in view of the Insured’s medical condition. When considered medically necessary by the second specialist and such that this reaffirms the opinion expressed by the first specialist, the consultation fee incurred shall be payable but not exceed the maximum limit as stated in the Schedule of Benefits. The second consultation must be rendered within 30 days of the first consultation for this benefit to be payable. IN-HOSPITAL PHYSICIAN VISIT - Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while confined for a non-surgical disability subject to a maximum of 2 visits per day not exceeding the maximum number of days as set forth in the Schedule of Benefit. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within 90 days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for 31 days as set forth in the Schedule of Benefits. AMBULANCE FEE - Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services inc...
HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within the maximum number of days and amount as set forth in the Schedule of Benefits preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitioner. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured Person does not result in hospital confinement for the treatment of the medical condition diagnosed. Reimbursement of the Reasonable and Customary Charges for Medically Necessary ECG, X-ray and laboratory tests which are performed for diagnostic purposes on account of an injury or illness when in connection with a Disability preceding hospitalization within the maximum number of days and amount as set forth in the Schedule of Benefits in a Hospital and which are recommended by a qualified medical practitioner. No payment shall be made if upon such diagnostic services, the Insured Person does not result in surgery of the medical condition diagnosed. Medications and consultation charged by the medical practitioner will not be payable. Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while confined for a non-surgical disability subject to a maximum of 1 visit per day not exceeding the maximum number of days and amount as set forth in the Schedule of Benefits. Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-isurgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for the maximum number of days as set forth in the Schedule of Benefits.
