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WHAT IS COVERED

What Is Covered

As you read the following section, you’ll see that the MILA National Health Plan considers most hospital, surgical and medical services to be covered expenses. But your expenses will be covered only when they are for “medically necessary care.” Also note that if you go Out-of-Network, your eligible expenses are reimbursed only up to what the Claims Administrator determines is the “reasonable and customary” charge for that particular service or supply. In contrast, In-Network charges are always considered “reasonable and customary.” It’s also important to understand that certain procedures require advance approval to be eligible for reimbursement. Each of these important Plan provisions is described in the following sections.