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If injury or illness occurs during the period of coverage and the insured person requires medical or surgical treatment, this plan will pay, subject to the co-insurance and selected deductible, reasonable and customary charges for the following covered expenses, up to the selected policy maximum. The covered charges shall in no event include any amount which is in excess of reasonable and customary charges for the geographical area where the services are rendered, as determined by Combined Insurance Company. Benefits payable under this plan may not be assigned in advance.

Covered Expenses:

1. Charges made by a hospital for a room and board, floor nursing and other services inclusive of charges, for professional services and with the exception of personal services of a non-medical nature provided, however, that the expenses do not exceed the hospital's average for semi-private room and board accommodation, or two times the average semi-private room charge made by the servicing hospital if confinement to an intensive care unit is required, or the average charge for intensive care unit made by the servicing hospital, whichever is less.
2. Charges made for diagnosis, treatment and surgery by a physician.
3. Charges made for the cost and administration of anesthetics.
4. Charges for medication, X-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusion, iron lungs; and medical treatment.
5. Charges for physiotherapy, if recommended by a physician, for the treatment of a specific disablement; and administered by a licensed physiotherapist.
6. Dressings, drugs, and medicines that can only be obtained upon a written prescription of a physician.

Emergency Medical Evacuation - if you or any covered dependents become ill or injured during the period of coverage and it has been determined that an emergency medical evacuation is required to either the nearest medical facility, where appropriate medical treatment can be obtained, or to your Home County or Country of Residence, all eligible expenses incurred are covered up to a maximum of $50,000. An emergency medical evacuation must be recommended by a legally licensed physician who certifies that the severity of the injury or illness necessitates such an emergency medical evacuation, and approved in advance by Combined Insurance Company.

Emergency Reunion - In the event of an emergency medical evacuation due to a covered injury or illness, where the physician feels that it would be beneficial for you to have a family member at your side during transport, you will be reimbursed for travel and lodging expenses, for that relative up to US $10,000, provided that all travel arrangements are coordinated in advance by the assistance provider. Benefits payable include economy air ticket and other travel related expenses not to exceed $250.00 a day for a maximum of five days.

Repatriation of Remains Expenses - If injury or illness commencing during the period of coverage results in death, all reasonable expenses incurred for preparation and return of the remains to your Home Country or Country of Residence, are covered up to a maximum of $20,000.

Excess Benefits - All Coverage, except Accidental Death & Dismemberment, shall be in excess of all other valid and collectible insurance.

Home Country Coverage - Provides coverage for eligible medical expenses incurred while an insured person is in their Home Country or Country of Residence. Such coverage is available up to a maximum of 2 months per 12 months of coverage. Coverage shall be pro rated in the event that an insured person's coverage is less than 12 months.

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