§ 2220.21. Basic Scheduled Surgical Benefits.

Latest version.

BASIC MEDICAL BENEFITS
A basic surgical benefit in which surgical operations are listed by name or description with a limiting amount on each item shall be deemed not sufficient to be of real economic value to the insured if the amount provided for the most severe operation is less than $300.00 and the amounts provided for other operations are not reasonably related to such maximum amount and if it fails to contain a proviso that any operation not named and not otherwise excluded will be paid for in an amount which shall be objectively determined by the company on the basis of the gravity and severity of the unnamed operation as compared to analogously named operations.

                    
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