The association policy shall pay only the usual, customary and reasonable charges for medically necessary eligible health care services which exceed the deductible and coinsurance amounts applicable under section 514E.6. Eligible expenses are the charges for the following health care services furnished by a health care provider in an emergency situation or furnished or prescribed by a health care provider:
1. Hospital services, including charges for the most common semiprivate room, for the most common private room if semiprivate rooms do not exist in the health care facility, or for the private room if medically necessary, but limited to a total of one hundred eighty days in a calendar year.
2. Professional services for the diagnosis or treatment of injuries, illnesses, or conditions, other than mental or dental, which are rendered by a health care provider, or at the direction of a health care provider, by a staff of registered nurses, licensed practical nurses, or other health care providers.
3. The first twenty professional visits for the diagnosis or treatment of one or more mental conditions, rendered during a calendar year by one or more health care providers, or at their direction, by their staff of registered nurses, licensed practical nurses, or other health care providers.
4. Drugs and contraceptive devices requiring a prescription.
5. Services of a nursing facility as defined in section 135C.1, for not more than one hundred eighty days in a calendar year.
6. Homemaker-home health services up to one hundred eighty days of service in a calendar year.
7. Use of radium or other radioactive material.
8. Oxygen.
9. Anesthetics.
10. Prostheses, other than dental.
11. Rental of durable medical equipment, other than eye glasses and hearing aids, which have no personal use in the absence of the condition for which prescribed.
12. Diagnostic X rays and laboratory tests.
13. Oral surgery for any of the following:
a. Excision of partially or completely erupted impacted teeth.
b. Excision of a tooth root without the extraction of the entire tooth.
c. The gums and tissues of the mouth when not performed in connection with the extraction or repair of teeth.
14. Services of a physical therapist and services of a speech therapist.
15. Professional ambulance services to the nearest health care facility qualified to treat the illness, injury, or condition.
16. Processing of blood, including but not limited to, collecting, testing, fractionating, and distributing blood.
86 Acts, ch 1156, § 4; 90 Acts, ch 1039, § 18
Referred to in § 514E.1, 514E.2, 514E.6
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