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. ' ~ ~~ <br />-7rvrlC~n+er.--S~-'4vlRpensatrvn,..-tvvc--:--~-•-T.--~pet.-ov..Q.-~~..~~-~-~.... __.~e...~~•.T....o~---~orw..~..- <br />arising out of or in the course of employment aw self-employment. The only <br />exception would'be if inember or member's insured dependent is exempt from state <br />or Federal Workers' Compensation. - <br />BENEFITS <br />Section 1. <br />THE DEDUCTIBLE <br />A. There shall be a$ 500.00 deductible imposed once in each calendar <br />year against each member for eligible expenses before payment shall be <br />made_by G.O.H.S. for all covered medical expense, however, payment made <br />by member for eligible expe`nses as hereinafter listed, during the last <br />three months of a calendar year which are not considered as they do not <br />exceed the deductible, may be applied toward the deductible_required <br />for the next calendar year. After the deducti6le_has been satisfied, <br />eligible expenses will be paid as listed in the schedule for the <br />remainder of the calendar year. <br />B. When three (3) persons in a family satisfy their deductible, not <br />exceeding $ 50 0.00 . per family member du.ring a calendar year for <br />eligible expenses, it shall satisfy the deductible requirement for all <br />remaining family members enrolled for the remainder of the calendar <br />year. The amounts paid by member on charges wherein G.O.H.S. has paid <br />benefits under the major medical benefits .shall not apply to the <br />required three-member_family deductible. . <br />C. After satisfaction of the deductible, eligible expenses will be paid on <br />the following schedule: <br />1. The next $5,000.00 of oovered medical expenses shall be paid at <br />80~ in any calendar year; ~-' <br />2. Thereafter, to $1,000,000.00 maximum or. the end of the calendar <br />year, whichever occurs first, coyered medical expenses shall be <br />paid at 100%. . <br />Section 2. <br />ELIGIBLE EXPENSES <br />A. Hospital services, when necessarily confined as a registered bed <br />patient includ~ing board and room and general nursing care on a basis of <br />the hospital's semi-private room rate, or lowest bed rate of hospital <br />where only private rooms are available (balances do not apply to the <br />deductible but are member's responsi6ility), plus hospital extras <br />including blood and blood plasma, if not obtainable from a blood bank <br />or from voluntary donors, x-ray and clinical labor.atory examinations, <br />anesthetic materials, use of surgeries, oxygen, medicines, dressings <br />and supplies ordered by attending physician. ~ <br />5 (Sec.l) 1/87 <br />