New Search
. ,..,,.. ..... ....." ~,...,.., • --... _ ... .. ...... ....Nr ~ ~ c., ~ cyu ~ I CU I~l ..-GTiC'"'CI'CQ'C1fTCnS:"VT___-. ._ .__ _ ~_. <br />illness ,or in' ry. These benefits shall ,be p'd only to- the extent of ' <br />~~ ,' regular and ~stomary fees for services~ •formed or materials. ' <br />furnished an ,nich are necessary for_treatm~ of;the member c • <br />. overed <br />and ordered by a physicien. ~, <br />.J. Reasonable and customary fees shall :..also-. be paid for. graduate <br />registered nurses. and licensed practical' nurses= for, priVate duty <br />nursing services employed in the event of serious il~.lness.or injury at <br />the request of the attending physician for in-patient care. There <br />shall be no payment to a.nurse who r,esides.in tfi e same;household as the <br />employee or who is related-by blood, marriage, or legal adoption to the <br />employee or the employee's spouse. <br />K. G.O.H.S. shall pay such reasonable and customary charges for services <br />of licensed doctors as defined on page 4, legally qualified to practice <br />medicine for medical care,.treatment and surgical operations. <br />L. Doctor of dental surgery for treatment of :~~fractured jaw or ~aw <br />dislocation, tumors of the.,mouth not r.elated to~ tooth structure and <br />tumors of the jaw. G.O.H.S. shall not pay any expenses~incurred for <br />the restoration of teeth or the repair of teeth. <br />M. Diagnostic x-ray and laboratory services prescribed by attending <br />physician and surgeon in the treatment of illness or. injury. ~ <br />N. Radioactive isotope, radium and x-ray therapy. <br />0. Anesthesia and administration thereof. <br />P. Initial artificial limbs and eyes, splints,.casts, trusses and braces. <br />Rental of crutches and iron lung, when required for treatment of the <br />member covered and which are ordered by the attending physician while <br />under treatment. <br />Q. G.O.H.S, will pay for ambulance service necessary for conveying <br />seriously ill or injured members to the nearest hospital, or for the <br />transfer to another hospital as prescribed necessary by attending <br />physician. No other expenses in connection with travel are included. <br />R. Physical xherapy treatments provided by a registered physical therapist <br />prescribed by a licensed physician. . . <br />S. Benefits payable for cosmetic surgery necessary to restore body <br />function or to repair scarring which resulted .from injuries sustained <br />while a member under this insurance agreement for which benefits were <br />paid for said injuries. There sha11 -be no coverage for any other <br />cosmetic surgery. <br />T. Ambulatory Surgical Center Services for services rendered within the <br />scope of their license. <br />U. Eligible prescription drugs. <br />7 <br />