Benefits will be paid for the usual and customary covered expenses incurred by the patient of a CosmetAssure Participating Physician, up to the applicable Maximum Benefit Amounts, if the patient develops a Covered Complication as detailed in the Qualifying Admissions section of this website.

Covered Expenses are the charges for the following Medically Necessary medical services, supplies and treatments that are incurred by an insured: a) during a Qualifying Hospital Admission or; b) with respect to ambulance services, while en route to a Hospital; or c) Non-Hospital procedure to Rule Out Deep Vein Thrombosis; or d) treatment in an Accredited Surgical Center; or e) for Follow Up Physician Services:

Covered Expenses for Hospitalization of 24 hours or longer and ICU/ Trauma Admittance:

1. Services of physicians, other than the Plastic Surgeon who performed the Covered Procedure, and registered nurses (R.N.)s;
2. Anesthetics and their administration;
3. Laboratory tests;
4. Oxygen and its administration;
5. Blood and blood derivatives that are not donated or replaced, and their administration;
6. Radiological procedures;
7. Prescription drugs prescribed during the Hospitalizations, and a follow-up thereto; and
8. Room and board up to the most common charge for a semi-private room or ICU/Trauma, when required, and hospital ancillary services (including but not limited to use of operating room).

Covered Expenses for Hospitalization of less than 24 hours:

1. Services of physicians, other than the Plastic Surgeon who performed the Covered Procedure, and registered nurses (R.N.)s;
2. Anesthetics and their administration;
3. Laboratory tests;
4. Oxygen and its administration;
5. Blood and blood derivatives that are not donated or replaced, and their administration;
6. Radiological procedures;
7. Prescription drugs prescribed during Hospitalization, and a follow-up thereto; and
8. Room and board up to the most common charge for a semi-private room or ICU/Trauma, when required, and hospital ancillary services (including but not limited to use of operating room).

Covered Expenses for Non-Hospital Rule-Out DVT:

1. Services of Physicians, other than the Plastic Surgeon who performed the Covered Procedure;
2. Laboratory tests;
3. Radiological procedures.

Covered Expenses for Ambulance Service:

1. Professional ambulance service to a Hospital within 50 miles of the patient's home;
2. Air ambulance service to a Hospital when such service is ordered by a Physician and is accomplished in an aircraft used primarily for transporting sick or injured persons.

Covered Expenses for Follow-up Physician Services:

1. Services of Physicians, other than the Plastic Surgeon who performed the Covered Procedure;
2. Anesthetics and their administration;
3. Laboratory tests;
4. Oxygen and its administration;
5. Blood and blood derivatives that are not donated or replaced, and their administration;
6. Radiological procedures;
7. Prescription drugs prescribed during a follow up visit or as a follow-up thereto.

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