• $2 million coverage maximum per policy period (or $1 million for 365-day policies)
• Covered charges incurred for: physician and surgical services.
• Covered charges incurred for drugs which require the written prescription of a physician.
• Covered charges incurred for: room, board and routine nursing services that are generally provided to all persons while confined in a hospital. If the covered person is confined in a private room, only charges up to the average semi-private rate of the hospital are covered.
• Covered charges incurred for outpatient medical care and treatment provided by a hospital or freestanding ambulatory surgical facility.
• Covered charges incurred for x-ray, radioactive treatment, laboratory and anesthesia services, including one screening mammographic exam per benefit period for a covered female, age 35 or over.
• Covered charges incurred for the first 30 days of confinement in a rehabilitation or skilled nursing facility for the covered person per benefit period.
• Covered charges incurred for the first 40 home health care visits for the covered person per benefit period.
• Covered charges incurred for up to 10 outpatient physical medicine visits for the covered person per benefit period. (Includes chiropractic care in most states.)
• Covered charges incurred for professional ambulance service to the nearest hospital that is able to handle the sickness or injury.
• Covered charges incurred for rental (not to exceed the purchase price) of one basic manual wheelchair, one basic hospital bed, one pair of basic crutches, the initial permanent basic artificial limb or eye and oxygen and the basic equipment needed to administer oxygen; and the initial external breast prosthesis needed because of the medically necessary surgical removal of all or part of the breast, provided the surgical removal was done while the covered person was covered under the plan.
• Covered charges incurred for reconstructive surgery required due to an injury which occurred while the covered person is insured under the plan.
• Covered charges incurred for surgical treatment of temporomandibular joint (TMJ) or craniomandibular joint (CMJ) dysfunction, provided the charges are for services included in a dental treatment plan authorized by Fortis Health prior to the surgery; charges for nonsurgical treatment of TMJ or CMJ.
• Covered charges incurred for the following complications of pregnancy: spontaneous termination of pregnancy (miscarriage) which occurs before the 26th week of gestation; missed abortion (miscarriage); ectopic pregnancy when pregnancy is ended; and other medical conditions such as acute nephritis, nephrosis and cardiac decompensation.
• Covered charges incurred for the following organ transplants: heart, liver, and bone marrow. Tissue transplants include: cornea transplant; prosthetic tissue replacement, including joint replacement; vein or artery graft; heart valve replacement; and implantable prosthetic lens in connection with cataracts. The maximum amount we will pay for any and all organ transplants is limited to $250,000 for the covered person during his or her lifetime.
• Covered expense incurred for the treatment of AIDS, AIDS Related Complex (ARC) or related immuno deficiency disorders.

Trained medical professionals work with you and your physicians to review the course of treatment and advise you of your eligibility for benefits. The identification card you receive with your policy provides a toll-free number for easy access to this service. The authorization process must be followed in its entirety to receive maximum benefits. The contract explains the authorization process in detail.

Authorization is required in advance of:

• All hospital or skilled nursing facility admissions
• Outpatient or day surgeries
• Rehabilitation programs
• Home health care
• Physical medicine/Chiropractic care
• Transplants

The number to call for preauthorization is 1-800-800-2412. The Short Term Medical identification card, which is attached to a copy of the insurance contract, also lists the preauthorization phone number.

Benefits for unauthorized services of otherwise covered expenses will be reduced. No benefits will be paid for a transplant if the procedure was not authorized prior to the beginning of the donor search and selection.