Common use of Inpatient Services Clause in Contracts

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 10% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 10% - After deductible Not Covered Physician hospital visits 10% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not Covered

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 100% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 100% - After deductible Not Covered Physician hospital visits 100% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not Covered In a hospital or other health care facility 0% - After deductible Not Covered

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 1020% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 1020% - After deductible Not Covered Physician hospital visits 1020% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not Covered In a hospital or other health care facility 20% - After deductible Not Covered

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 10% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 10% - After deductible Not Covered Physician hospital visits 10% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not Covered In a hospital or other health care facility 10% - After deductible Not Covered

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 10unlimited days 0% - After deductible Not Covered 20% - After deductible Rehabilitation facility services* - Limited limited to 45 days per plan year. 100% - After deductible Not Covered Physician hospital visits 1020% - After deductible Not Covered Physician hospital visits. 0% - After deductible 20% - After deductible Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered 20% - After deductible Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered 20% - After deductible Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not CoveredCoverage varies based on type of service.

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 10% - After deductible Not Covered Rehabilitation facility services* - Limited to 45 days per plan year. 10% - After deductible Not Covered Physician hospital visits 10% - After deductible Not Covered Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered Mastectomy-related treatment - includes prostheses protheses and treatment for physical complications. 0% Not Covered

Inpatient Services. General hospital or specialty hospital services* - Unlimited Days 10unlimited days 0% - After deductible Not Covered 20% - After deductible Rehabilitation facility services* - Limited limited to 45 days per plan year. 100% - After deductible Not Covered Physician hospital visits 1020% - After deductible Not Covered Physician hospital visits 0% - After deductible 20% - After deductible Inpatient - see Mastectomy Services in Section 3 for details. 0% Not Covered 20% - After deductible Surgery services - includes mastectomy and reconstructive surgery. See Mastectomy Services in Section 3 for details. 0% Not Covered 20% - After deductible Mastectomy-related treatment - includes prostheses and treatment for physical complications. 0% Not CoveredCoverage varies based on type of service.