8 AM-9 PM CST. Mon-Fri
8 AM-5 PM CST. Sat-Sun
If you are a non-United States resident visiting the United States and suffer a Myocardial Infarction (heart attack in layman's terms) or Stroke and are admitted to a Hospital, this exclusion is waived in order to pay a $200 per night benefit for each night spent in the Hospital, up to a maximum benefit of $3,000. The term "Myocardial Infarction" shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of Diseases version 9 (ICD9), code sequences 410.0 - 410.9 and 414.1 - 419.9. The term "Stroke" shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of Diseases version 9 (ICD9), code sequence 430-438.9.
$200 per night is a flat benefit that works like an indemnity benefit. It is not considered as the covered medical expense and the insurance company would not process the claim. Therefore, there are no network negotiated fees for the rest of expenses.
e.g., Lets assume that you are admitted into the hospital for 3 days because of a heart attack and the medical expense is $25,000/night for a total of $75,000 in medical expenses. Lets assume that the network negotiated fees for the same would be $10,000/night for a total of $30,000. If it were a covered medical expense (not due to pre-existing conditions), insurance company would pay entire $30,000 (subject to your deductible and coinsurance). However, if it is determined that the heart attack was due to pre-existing conditions, the insurance company would pay a total of $600 (Six hundred dollars) and you would have to pay the remaining $74,600.
Please note that this per night benefit is only for the admission into the hospital due to attack or stroke that may be due to pre-existing conditions. This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this program. In other words, it does not provide any coverage for heart surgery, heart medicines, blood pressure medicines or complications, routine expenses, emergency room visits due to chest pain etc.