Benefits

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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 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 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 the Hospitalization, and a follow-up thereto; and
  8. Hospital ancillary charges (including but not limited to use of the operating room or an observation 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.

Benefit Period

Covered Expenses for a Covered Complication are payable until the earliest of:

  1. The date the Covered Complication no longer requires further Hospitalization, or Follow Up Physician Services; or
  2. The date the Maximum Benefit Amounts are paid; or
  3. The expiration of the Benefit Period (six months from the date of the original qualifying admission due to a Covered Complication).

Maximum Benefit Amounts:

The following amounts are the maximums that apply during any one Benefit Period for all Covered Complications due to the same Surgical Event:

Benefit Maximum Amount
Hospitalization of 24 hours or longer $5,000 per day up to a maximum of 45 days
ICU/Trauma Admittance Additional $1,000 per day up to a maximum of 10 days
Hospitalization of less than 24 hours $2,500
Ambulance Service $2,000
Follow Up Physician Services $1,500
Rule Out Deep Vein Thrombosis-Non Hospital procedure $750