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?>~•; ,;_. .; ,~. .. <br />.. h r c e r S d zT3 T3 CTT~UTt _~'f --ZT1E-'~FIIULTTIIT'E ;-TJETTETTZS' <br />:, <br />, joint (TMJ ysfunctiom:;syndrome, regardl of the nature of such <br />-. ~ treatment,~ll be limited to ~a Tifetime rr~ium aggregate payment of <br />~1,Dp0.00. <br />Section 3. - <br />SUPPL~EMENTAL ACCIDENT BENEFIT <br />Payment shall be in full up to $300.00 for services connected with in~ury <br />and rendered within 90 days of such injury. Balances will be paid after <br />satisfaction of the deductible according to Section 1 of this certificate. <br />Payment is to be made.for. each separate accident. This provision is subject <br />to all other provisions"of this certificate. <br />Payment of ,injury care shall°include those items listed under eligible <br />expenses. Payment made for injuries is intended for emergency service for <br />an injury such as suturing, fractures, dislocations, etc. However, payment <br />shall be made as.set forth .in this paragraph on the condition that said <br />injury is treated by a doctor-within 12 hours from the time such injury <br />occurred. <br />Section 4. ,. <br />MAXIMUM BENEFIT <br />The amount of a member's maximum benefit for all covered medical expenses <br />herein. comb:ined is -$1,000,000.00 for the life of the member, or during the <br />time of effective. coverage, whichever ends first. This maximum benefit <br />applies separately to each insured member. <br />Sect'ion 5. <br />EXCLUSIONS AND LIMITATIONS <br />The following items ar~e excluded and limited as hereinafter set forth: <br />1. Hospitalization for diagnost`ic- -x=r_ay: and laboratory work ordinarily <br />obtainable as an out-patient and not accompanied by treatment of an <br />illness or injury. ~ <br />2. Medical examinations or tests not connected with the care and treatment <br />of an illness, disease or injury, immunizations; services not directly <br />related to :the member's symptoms; hospitalization for rest cure, <br />~ hospitalization for diet,'or where no specific ~treatment is given; <br />dental services except as specified herein; hearing tests; eye <br />examinations; eye exercises or any devices to improve hearing or sight <br />including glasses, frames and hearing aids. <br />3. Cherges for services. or supplies which are furnished, paid for or <br />otherwise provided for by_ reason of the past or present service of any <br />person in the armed forces of a government unless specified herein. <br />8 . (Sec. 3) 1/87 <br />