- Hospital Room and Board
- Intensive Care Unit
- Surgeons' Fees
- Anesthesia
- Nursing Fees
- Prescribed Medications
- Emergency Local Ambulance
- Dental Treatment Due to Accident
- Physical Therapy
- Outpatient Care
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- Wellness Benefits*
- Emergency Room Treatment
- Diagnostic X-rays, MRI, CAT Scan
- Lab Services
- Reconstructive Surgery Due to Accident
- Supplies as Medically Necessary
- Pre-existing conditions*
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