§ 2220.23. Basic Medical Service Benefits.

BASIC MEDICAL BENEFITS

A benefit for expenses incurred for professional calls of doctors, covering home, office and hospital calls or one or more of such types of calls, shall be deemed not sufficient to be of real economic value to the insured if:

(a) More than the first three home calls, the first three hospital calls, or the first three office calls as the case may be, (counting as a call for such purpose at least one such call actually made during any one twenty-four hour period), are eliminated from the benefit; or

(b) The benefit limits payment for call made and otherwise compensable to fewer than one per twenty-four hour period; or

(c) The amount payable per compensable call is less than $6.00 per home call and less than $6.00 per office or hospital call; or

(d) Compensation provided for expenses of covered calls (whether resulting from each separate accident or sickness or occurring in each separate policy year) is limited:

(1) To a number less than 30 where the limit of such coverage is expressed in terms of number of calls, or

(2) To an amount less than $180.00 where the limit of such coverage is expressed in terms of a stated amount.

This section does not prohibit a provision which provides that physician's calls are not covered for a period after a surgical procedure is performed if the policy form provides a surgical benefit for the surgical procedure performed.