Welfare Summary Plan Description

5.7 OUTPATIENT HOSPITAL SERVICES

Covered Expenses for services provided by a Hospital on an outpatient basis include:

  • Diagnostic laboratory examinations, chemotherapy, diagnostic x-rays, radium or radioactive isotope therapy;
  • Outpatient hemodialysis, radiation therapy, and chemotherapy;
  • Surgical procedure(s) performed in the outpatient department; and
  • Medically Necessary Hospital services for the removal of impacted teeth or the removal of a dental root without extraction of an entire tooth. Covered Dental Expenses related to charges from a dentist or oral surgeon are paid under dental care benefits.