Home About PatientInsure Benefits

Benefits

Benefits will be paid for the usual and customary covered expenses incurred by the patient of a PatientInsure Participating Physician, up to the applicable Maximum Benefits Amounts, if the patient develops a Covered Complication as detailed in the Qualifying Admissions section of this website.

Covered Expenses are the charges for the following Medically Necessary medical services, supplies and treatments that are incurred by an Insured: a) during a Qualifying Hospital Admission or; b) Non-Hospital procedure to Rule Out Deep Vein Thrombosis; or c) treatment in an Accredited Surgical Center; or d) for Follow Up Physician Services:

Covered Expenses for Hospitalization of 24 hours or longer and ICU/Trauma Admittance:

  1. Services of physicians, other than the Cosmetic Surgeon who performed the Covered Procedure, and registered nurses (R.N.)s;
  2. Anesthetics and their administration;
  3. Laboratory tests;
  4. Oxygen and its administration;
  5. Blood and blood derivatives that are not donated or replaced, and their administration;
  6. Radiological procedures;
  7. Prescription drugs prescribed during the Hospitalization, and a follow-up thereto; and
  8. Room and board up to the most common charge for a semi-private room or ICU/Trauma, when required, and hospital ancillary services (including but not limited to use of operating room).

Covered Expenses for Hospitalization of less than 24 hours:

  1. Services of physicians, other than the Plastic Surgeon who performed the Covered Procedure, and registered nurses (R.N.)s;
  2. Anesthetics and their administration;
  3. Laboratory tests;
  4. Oxygen and its administration;
  5. Blood and blood derivatives that are not donated or replaced, and their administration;
  6. Radiological procedures;
  7. Prescription drugs prescribed during the Hospitalization, and a follow-up thereto; and
  8. Hospital ancillary charges (including but not limited to use of the operating room or an observation room).

Covered Expenses for Non-Hospital Rule-Out Deep Vein Thrombosis:

  1. Services of Physicians, other than the Cosmetic Surgeon who performed the Covered Procedure;
  2. Laboratory tests;
  3. Radiological procedures.

Covered Expenses for Follow-up Physician Services:

  1. Services of Physicians, other than the Cosmetic Surgeon who performed the Covered Procedure;
  2. Anesthetics and their administration;
  3. Laboratory tests;
  4. Oxygen and its administration;
  5. Blood and blood derivatives that are not donated or replaced, and their administration;
  6. Radiological procedures;
  7. Prescription drugs prescribed during a follow up visit or as a follow-up thereto.

Benefit Period:

Covered Expenses for a Covered Complication are payable until the earliest of:

  1. The date the Covered Complication no longer requires further Hospitalization, or Follow Up Physician Services; or
  2. The date the Maximum Benefit Amounts are paid; or
  3. The expiration of the Benefit Period (six months from the date of the original qualifying hospital admission due to a Covered Complication).

Maximum Benefit Amounts:

The following amounts are the maximums that apply during any one Benefit Period for all Covered Complications due to the same Surgical Event:

Benefit Maximum Amount
Hospitalization of 24 hours or longer $5,000 per day up to a maximum of 35 days
ICU/Trauma Admittance Additional $1,000 per day up to a maximum of 10 days
Hospitalization of less than 24 hours $2,500
Follow Up Physician Services $1,500
Rule Out Deep Vein Thrombosis
- Non Hospital procedure 		$750

About PatientInsure