23 CAR § 86-303. Basic medical-surgical expense coverage

"Basic medical-surgical expense coverage" is a policy of accident and health insurance that provides coverage for each person insured under the policy for the expenses incurred for the necessary services rendered by a physician for treatment of an injury or sickness for at least the following: (1) Surgical services, in amounts not less than: (A) Those provided on a fee schedule based on the relative values contained in the State of New York Certified Surgical Fee Schedule, the 1964 California Relative Value Schedule, or other acceptable relative value scale of surgical procedures up to a maximum of at least one thousand six hundred dollars ($1,600) for any one (1) procedure; or (B) Eighty percent (80%) of the reasonable charges; (2) Anesthesia services, consisting of administration of necessary general anesthesia and related procedures in connection with covered surgical service rendered by a physician other than the physician (or his or her assistant) performing the surgical services, in an amount not less than: (A) Eighty percent (80%) of the reasonable charges; or (B) Fifteen percent (15%) of the surgical service benefit; and (3) In-hospital medical services, consisting of physician services rendered to a person who is a bed patient in a hospital for treatment of sickness or injury other than that for which surgical care is required, in an amount not less than: (A) Eighty percent (80%) of the reasonable charges; or (B) Twenty-five dollars ($25.00) per day for not less than thirty-one (31) days during one (1) period of confinement.