Common use of TRANSPLANT PROCEDURES Clause in Contracts

TRANSPLANT PROCEDURES. Coverage for transplantation of human organs, cells and tissues is provided only within the insurer’s Provider Network for Transplant Pro- cedures. There is no coverage outside the Provider Network for Transplant Procedures. The maximum amount payable for this benefit is one million dollars (US$1,000,000) per insured, per diagnosis, per lifetime, after the applicable deductible. Bone marrow transplants derived from a cancer diagnosis will be covered under the cancer benefit, as indicated in the Table of Benefits. This transplant benefit begins once the need for transplantation has been determined by a physician, has been certified by a second surgical or medical opinion, and has been approved by USA Medical Services, and is subject to all the terms, conditions and exclusions of the policy. (a) Pre-transplant care, including those services directly related to evaluation of the need for transplantation, evaluation of the insured for the transplant procedure, and preparation and stabilization of the insured for the transplant procedure. (b) Pre-surgical workup, including all laboratory and X-ray exams, CT scans, Magnetic Resonance Imaging (MRI’s), ultrasounds, biopsies, scans, medications and supplies. (c) The costs of organ, cell or tissue procurement, transportation, and harvesting including bone marrow and stem cell storage or banking are covered up to a maximum of forty thousand dollars (US$40,000) per diagnosis, which is included as part of the maximum transplant benefit. The donor workup, including testing of potential donors for a match is included in this benefit. (d) The hospitalization, surgeries, physician and surgeon’s fees, anesthesia, medication, and any other treatment necessary during the transplant procedure. (e) Post-transplant care including, but not limited to any medically necessary follow-up treatment resulting from the transplant and any complications that arise after the transplant procedure, whether a direct or indirect consequence of the transplant. (f) Medication or therapeutic measures used to ensure the viability and permanence of the transplanted organ, cell or tissue. (g) Home health care, nursing care (e.g. wound care, infusion, assessment, etc.), emergency transportation, medical attention, clinic or office visits, transfusions, supplies, or medication related to the transplant. There is an optional rider available for additional transplant coverage.

TRANSPLANT PROCEDURES. Coverage The maxi- mum amount payable for transplantation the transplan- tation of human organs, cells cells, and tissues is provided only within the insurer’s Provider Network for Transplant Pro- cedures. There is no coverage outside the Provider Network for Transplant Procedures. The maximum amount payable for this tissue benefit is one million six hundred thousand dollars (US$1,000,000600,000) per insured, per diagnosis, per lifetime, lifetime after the applicable deductible. Bone marrow transplants derived from a cancer diagnosis will be covered under the cancer benefit, as indicated in the Table of Benefits. This transplant benefit begins once the need for transplantation has been determined deter- mined by a physician, has been certified by a second surgical or medical opinion, and has been approved by USA Medical Services, and is subject to all the terms, conditions provisions, and exclusions of the policy.. This benefit includes: (a) Pre-transplant care, including those services directly related to evaluation of the need for transplantation, evaluation evalu- ation of the insured for the transplant procedure, and preparation and stabilization stabi- lization of the insured for the transplant trans- plant procedure. (b) Pre-surgical workup, including all laboratory and X-ray exams, CT scans, Magnetic Resonance Imaging (MRI’s), ultrasounds, biopsies, scans, medications medica- tions and supplies. (c) The costs of organ, cell or tissue procurement, transportation, and harvesting including bone marrow and marrow, stem cell or cord blood storage or banking are covered up to a maximum of forty twenty-five thousand dollars (US$40,00025,000) per diagnosis, which is included as part of the maximum transplant benefit. The donor workup, including testing of potential donors for a match is included in this benefit. (d) The hospitalization, surgeries, physician physi- cian and surgeon’s fees, anesthesia, medication, and any other treatment necessary during the transplant procedure. (e) Post-transplant care including, but not limited to any medically necessary follow-up treatment resulting from the transplant and any complications that arise after the transplant procedure, whether a direct or indirect consequence conse- quence of the transplant. (f) Medication or therapeutic measures used to ensure the viability and permanence of the transplanted organ, cell or tissue. (g) Home health care, nursing care (e.g. wound care, infusion, assessment, etc.), emergency transportation, medical attention, clinic or office visits, transfusions, supplies, or medication related to the transplant. There is an optional rider available for additional transplant coverage.