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Covered Medical Expenses

Medical Emergency

If an insured person incurs expenses as a result of a medical emergency, which does not require hospital confinement as a resident patient, hospital benefits for the initial visit will paid at 80% for the covered charge incurred. Initial treatment for a medical emergency must be received within 48 hours.

A Non-Emergency Medical Condition with Referral

For non-emergency medical situations, students must utilize services at Beu Health Center. If services are not available at Beu Health Center, the student will be referred by Beu Health Center staff to a hospital outpatient department.

Hospital Room and Board Benefit

When, by reason of injury or sickness, an insured person incurs expenses during a hospital confinement, we will pay for anesthesia, operating room, laboratory tests, oxygen tent, drugs, medicines, and dressings at 80%.

Hospital Expenses

Such expenses include room and board for semiprivate or intensive care accommodations and the following miscellaneous items provided by or upon the request of a doctor will be covered at 80%:

  • X-rays, radium therapy and mammograms (routine mammograms for ages 35 and over),
  • Laboratory tests
  • Anesthetic and its administration
  • Use of operating room
  • Temporary surgical appliances
  • Hospital-provided drugs, medicines, dressings, (excluding take-home drugs)
  • Blood plasma
  • Other necessary and prescribed hospital expenses
  • Medical and surgical supplies

Surgical Benefit

When, by reason of injury or sickness, an insured person requires surgery on an inpatient basis, we will pay the covered charges incurred at 80% of the usual, customary, and reasonable charge for the surgical expense, in connection with any one surgical procedure. Surgical expense includes charges by a doctor for a surgical procedure, necessary preoperative treatment during a hospital stay in connection with such procedure, and usual post-operative treatment.

When a sickness or injury requires multiple surgical procedures through the same incision, we will pay an amount not to exceed 80% of the usual, customary, and reasonable charge for the most expensive procedure being performed. Multiple surgical procedures performed during the same operative session but through different incisions shall be reimbursed in an amount not to exceed 80% of the usual, customary, and reasonable charge of the most expensive surgical procedure being performed, and with regard to the less expensive surgical procedure in an amount not to exceed 50% of the usual, customary, and reasonable charge of the procedure.

Oral surgery benefits are provided only for the following services:

  • Excision of tumor/cyst;
  • Correction injury when injury occurs between effective and termination dates
  • Treatment of fractures/dislocations external incisions, salivary glands or ducts

Assistant Surgeon Benefit

If, in connection with a surgical operation, an insured person requires the services of an assistant surgeon, we will pay the covered charges incurred at 50%.

Anesthetist Benefit (inpatient and outpatient)

If, in connection with a surgical operation, an insured person requires the services of an anesthetist, we will pay the covered charges incurred at 80%.

Professional Services

Doctors Visit in Hospital or Outpatient

When, by reason of injury or sickness an insured person requires the services of a doctor while confined as a resident bed-patient in a hospital or in a doctor’s office, we will pay the covered charges incurred at 80% for such services, limited to one visit per day. No benefit shall be payable if benefit allowed for surgery.

Outpatient Diagnostic X-ray and Laboratory Test Benefit*

If an insured person is prescribed by a doctor for diagnostic x-ray, mammograms (age 35 and over), and laboratory tests on an outpatient basis, we will pay the covered charges incurred at 80%.
*Note: An insured student must receive doctor’s services at Beu Health Center first or obtain a referral from Beu Health Center if residing locally.

Accidental Dental

If an insured person requires treatment for injury to sound natural teeth, we will pay the covered charges incurred at 80% up to a maximum of $500 per tooth.
Note: For Oral Surgery, see Surgical Benefit.

Chiropractic Benefit

If an insured person requires chiropractic services, we will pay the covered charges incurred at 80% up to the $30 per visit, up to a maximum of $500 per policy year. Benefits for chiropractic services will not be payable unless the student obtains a referral from Beu Health Center. If the student is away from the University campus, a doctor’s referral is required.

Consultant Benefit

If an insured person requires the service of a consultant, we will pay the covered charges incurred at 80%.

Mental and Nervous Benefit

Inpatient Benefit

If the insured person requires hospital confinement for treatment of a mental and nervous condition, we will pay the covered charges incurred according to the schedule of benefits at 80% of the usual, customary, and reasonable charges incurred for such hospital confinement on the same basis as any other sickness.

Outpatient Benefit

If the insured person is not hospital confined, we will pay the covered charge at 50% of the usual, customary and reasonable charges incurred for each session of outpatient services, limited to one visit per week, up to a maximum of $2,000 per policy year.

Alcohol and Substance Abuse Benefit

Inpatient Benefit

When the insured person is confined as an inpatient in a hospital, an approved detoxification facility, or an approved residential alcohol or substance abuse treatment program, we will pay the covered charges incurred at 80% of usual, customary, and reasonable charges for such confinement on the same basis as any other illness.

Outpatient Benefit

When the insured person is not hospital confined as an inpatient and incurs covered charges for outpatient treatment services for alcohol and substance abuse, we will pay the covered charges incurred at 50% of usual, customary, and reasonable charges up to a maximum of $30 per visit, limited to one visit per week with a $2,000 per policy year maximum. DUI court-ordered treatments are not covered. Outpatient alcohol and substance abuse benefits’ maximum is $2,000 per policy year.

Benefits for insured students referred to McDonough District Hospital’s intensified outpatient treatment program will be paid at 80%. The insured student must complete the entire program to be eligible for coverage.
Note: Outpatient mental health and alcohol and substance abuse benefits consisting of consultant or treatment sessions will not be payable unless these services are furnished by a doctor, psychotherapist, a licensed clinical social worker, or psychiatrist. A referral from Beu Health Center or the University Counseling Center is required.

Combined lifetime maximum for mental health alcohol and substance abuse is $20,000.00

Ambulance Benefit

If an insured person requires the use of an ambulance, we will pay the covered charges incurred at 80% of usual, customary, and reasonable charges.

Maternity Benefit

Maternity expenses will be covered the same as any other sickness. Insured students must be insured at the time service is rendered. Benefits including charges for total obstetrical care will be payable at 80% of the usual, customary, and reasonable charges for the covered charges incurred. Benefits provided for routine nursery care of a newborn child are covered under the mother’s charges for hospital confinement.

Physiotherapy Benefit

If an Insured person requires outpatient physical therapy after a covered surgical procedure or with a referral from Beu Health Center, we will pay the covered charges incurred at 80% to a policy maximum of $500 per policy year.

Student Health Services

We will pay 100% of the eligible expenses incurred for the eligible Beu Health Center services listed below:

  • Laboratory services
  • X-rays
  • Wart treatments
  • EKGs
  • Removal of skin lesions, moles, skin tags, and cysts
  • Electrodessication
  • Casting
  • Nail removal
  • Burn treatment
  • Sutures
  • IV infusion
  • Incision and removal of foreign body
  • Incision and drainage
  • Cryosurgery / cyrotherapy
  • Office visits (non-routine)

MEDEX Global Emergency Services

Benefits are available through MEDEX for “Global Emergency Medical Assistance Services.” Please refer to the brochure containing the detailed information of the services available. Included in this brochure, you will find an ID card that you will need to carry with you at all times.