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' . J-. '~'rt.s~=.~ .' , <br />~. ~iiar~yes rur intien~ ive-'care` vmz'~nrvr-aT•-~..~r~,.~T-T--~,~-~.,T-~-~.-~-~...__..._. _. <br />', hospital sh be paid on the`~basi's of two a one-half times the semi- <br />•' : private ro •ate when,.in the judgment e attending physician, <br />•such .care i ~~ecessary (balances do not apply ~ the deductible but are <br />member's.responsibility).~ , ~ <br />C. Hospital benefits for mental.diseases or disorders will be provided for <br />confinements in a licensed general hospital to a maximum of 30 days in <br />any calendar year. ~ ~ <br />D. " After the first 12 months of enrollment, treatment for alcoholism shall <br />be provided to a•maximum of $4;500.00 in any 24-consecutive month <br />perio_d. Benefits will~be limited to treatment provided by a health <br />care facility licensed or accredited by, the Joint Commission on <br />Accreditation of Hospitals; or a rehabilitation clinic and agency <br />estabTished,.maintained, contracted witfi or operated by the Mental <br />Health Division, State of Oregon. Not to include addiction to any <br />other chemical substance. <br />E. Out-patient service .when.charge made by the hospital is for required <br />su"rgery. _ <br />F. Rehabilitation - Benefits will be provided in a licensed general <br />hospital for no.more than 30 days. <br />G. Maternity <br />1. Care is provided for maternity expense incurred by a member who <br />has been continuously enrolled, in a membership of two or more, <br />for a period in excess of twelve months immediately preceding the <br />normal~expected date of delivery: We will not accept a pregnant <br />woman or her.family for coverage until 30 days after the baby is <br />born. <br />2. Maternity benefits shall apply and be payable for the benefit of <br />enrolled-female but shall not be available to dependent children, <br />and shall be payable only where the member is in good standing at <br />the time of delivery. <br />H. Newborn <br />1. Newborn babies are automatically covered from birth and eligible <br />for benefits of this plan. Refer to page 16 under 'Newborn <br />Babies' for enrollment ,requirements. 'Well-baby care' shall be <br />excluded. <br />2. In the event of congenital birth defect, or injury due to birth, <br />payment shall not exceed 80~ of hospital and doctor charges after <br />deductible has been met. <br />6 (D & G1) 1/S1 <br />