3. La culpa en victimarios, una mirada desde la ASD hacia la Construcción de
3.1 Complejidades del contexto y de la vinculación a los grupos armados
Tier 2 Outpatient Procedures
Breast Breast reduction Digestive Exploratory laparoscopy Laparoscopic appendectomy Laparoscopic cholecystectomy Ear/Nose/Throat/Mouth Erthmoidectomy Mastoidectomy Septoplasty Stapedectomy Tympanoplasty Tympanotomy Eye Cataract surgery Corneal surgery (penetrating keratoplasty) Glaucoma surgery (trabeculectomy) Vitrectomy Muscoloskeletal System
Arthroscopic knee surgery w/ menisectomy (knee cartilage repair)
Arthroscopic shoulder surgery Clavicle resection
Dislocations (ORH- open reduction with internal fi xation) Fracture (ORIF - open reduction with internal fi xation) Removal or implantation of cartilage
Tendon/ligament repair Gynecological Myomectomy Cardiac Angioplasty Cardiac catherization Thyroid Excision of a mass
Contagious Disease/Outpatient Surgical Recovery. We will pay the amount specifi ed on the Schedule of Benefi ts if a Covered Person misses work while suff ering from a covered Contagious Disease or while recovering from Outpatient Surgery as covered under the Policy. This benefi t does not overlap with Daily Hospital Benefi t.
Maximum of 5 days per Calendar Year for the Primary Covered Person only. Maximum of 10 days in total for the
Primary Covered Person and Covered Dependents (5 per person maximum).
Family Support Benefi t. We will pay the amount specifi ed on the Schedule of Benefi ts if a Covered Person receives at least 15 days of Daily Hospital Benefi t for 1 period of confi nement.
1 lump sum payment per Covered Person per Calendar Year. Maximum total of 3 lump sum payments per Calendar Year
for all Covered Persons combined.
Diagnostic Procedure Benefi t. We will pay the amount specifi ed on the Schedule of Benefi ts only if the result is positive. See attached list of eligible procedures. If also payable under Outpatient Surgery Benefi t, then we will only pay the Diagnostic Procedure Benefi t.
Maximum of 1 benefi t per Covered Person per Calendar Year. Maximum total of 3 benefi ts for all Covered Persons
combined.
Rehabilitation Benefi t. We will pay the amount specifi ed in the Schedule of Benefi ts. The Covered Person must be transferred immediately to a Rehabilitation Unit after a covered period of Hospital Confi nement.
Benefi t per day up to a maximum of 15 days per confi nement and 30 day maximum per Covered Person per Calendar Year. Maximum total benefi t of 60 days per Calendar Year for all
Covered Persons combined.
Waiver of Premium Benefi t. Waiver of Premium. After 60 continuous days of Total Disability,
Form Number: HIC-GP-HI-SB-KS
Surgical Schedule (1 Unit)
BONE BRAIN BREAST
Bone marrow biopsy or aspiration $120 Burr holes not followed by surgery $375 Incisional biopsy $120
Removal of knee cartilage $180 Ventriculoperitoneal shunt $625 Needle biopsy $120
Total knee replacement $600 Exploratory craniotomy $875 Breast reduction $360
Total hip replacement $900 Excision of brain tumor $1,250 Lumpectomy $240
Hemispherectomy $1,250 Stereotactic biopsy $120
DIGESTIVE Axillary node dissection $180
Exploratory laparotomy $360 SPINE Partial mastectomy $360
Appendectomy $240 Discectomy $600 Breast reconstruction $600
Colostomy $240 Fusions $900 Mastectomy
ERCP $240 Laminectomy $600 Simple $360
Vagotomy $360 Radical $720
Partial colectomy $480 HEART
Colectomy $720 Insertion of pacemaker $240 LIVER
Colectomy with ileostomy $720 Angioplasty Needle biopsy $120
Cholecystectomy $720 One vessel $600 Wedge biopsy $180
Esophagectomy $900 Two vessels $900 Resection of liver $900
Gastrectomy Coronary artery with graft $1,200
Partial $600 Replacement of aortic or mitral valve $1,200 LUNGS
Total $1,200 Needle biopsy $240
LARYNX Thoracotomy $480
Tracheostomy $120 Pneumonectomy $900
GYNECOLOGIC Laryngectomy $600 Wedge resection of lung $600
Dilation & curettage (D&C) $120 Laryngectomy with radical neck dissection $1,200 Lobectomy $900
Vaginal delivery $240
Cesarean delivery $240 MISCELLANEOUS URINARY
Vaginal Hysterectomy Foot surgery $180 Biopsy prostate $120
Partial $480 Repair of hernia $300 Hydrocele $120
Total $900 Carpal tunnel release (one hand or two) $120 Cystotomy $240
Abdominal hysterectomy with or Fractures Orchiectomy
without tubes and ovaries $900 Open reduction $300 (unilateral, bilateral) $240
Vulvectomy Mandibulectomy $480 Biopsy of kidney $480
Partial $240 Organ transplant $1,250 TUR bladder $360
Radical $360 Vasectomy $180 TUR prostate $360
Prostatectomy, radical $900
EAR/NOSE LYMPHATIC Cystectomy (bladder)
Tympanotomy $120 Biopsy lymph node $120 Partial $600
Adenoidectomy $180 Splenectomy $360 Complete $900
Myringoplasty $180 Lymphadenectomy (bilateral) $600 Nephrectomy $900
Mastoidectomy
Simple $180 THYROID
Radical $360 Biopsy $180
Tonsillectomy with or without Thyroidectomy
adenoids $180 One lobes $240
Two lobes $600
PANCREAS
jejunostomy $250 EYE
Pancreatectomy $625 Cataract $240
Whipple procedure $1,250 Enucleation $600
Comeal transplant $900
Diagnostic Procedures
Breast
Biopsy (incisional, needle, sterotactic) Renal Biopsy Lymphatic Biopsy Ear/Nose/Throat/Mouth Laryngoscopy Gynecological Cervical biopsy Cone biopsy Endometrial biopsy Hysteroscopy
Loop Electrosurgical Excisional Procedure (LEEP)
Respiratory
Biopsy Bronchoscopy
Pulmonary Function Test (PFT)
Diagnostic Radiology
Computerized Tomography Scan (CT Scan)
Electroencephalogram (EEG) Magnetic Resonance Imaging (MRI) Myelogram
Nuclear medicine test
Positron Emission Tomography Scan (PET Scan)
Urinary
Cystoscopy
Miscellaneous
Bone marrow aspiration/biopsy
Liver Biopsy Skin Biopsy Excision of lesion Cardiac Angiogram Arteriogram Thallium Stress Test
Transesophageal Echocardiogram (TEE)
Digestive
Barium Enema/Lower GI series Barium Swallow/Upper GI series Esophagogastroduodenoscopy (FGD)
Thyroid
Form Number: HIC-GP-HI-SB-KS
Limitations and Exclusions
No Benefi ts under this Policy will be paid for loss that is caused by, contributed to by, occurs during or results from:
1. intentionally self-infl icted Injury;
2. suicide or any attempted suicide, while sane or insane;
3. Mental or emotional disorders without demonstrable organic disease; 4. taking part in an illegal occupation;
5. treatment for Drug Addiction or for the use of drugs, except when the drugs are prescribed by and used as ordered by a Physician;
6. treatment of Drug Intoxication, except when caused by drugs when the drugs are prescribed by and used as ordered by a Physician;
7. treatment of Alcoholism, or treatment for the use of alcohol; 8. rest cures;
9. Dental treatment or services unless needed due to Injury; 10. routine eye examinations, eye glasses or the fi tting thereof; 11. hearing aids or the fi tting thereof;
12. Sickness or Injury if Workers Compensation or Employer s Liability benefi ts are payable;
13. war, declared or undeclared;
14. taking part in a riot, felony or insurrection; 15. parachute jumping or sky diving;
16. travel in or on any kind of aircraft, unless as a fare paying passenger on a commercial airline, passenger on a private airline charter or as a passenger on a privately owned and operated airplane that seats more than 10 passengers; 17. military or naval services (On written notice to Us, We will refund premiums
pro rata for any period not covered because of such service.)
18. Hospitalization, treatment or services for members or ex-members of the armed forces in any military or veteran s Hospital, soldier s home or Hospital contracted for or operated by any national government or agency thereof unless the Covered Person is legally required to pay the charges therefore in the absence of insurance;
19. cosmetic services or treatment, except when the care is due to medically necessary reconstructive plastic surgery. Medically necessary reconstructive plastic surgery means surgery:
• to restore a normal bodily function;
• to improve functional impairment by anatomic alteration
made necessary as a result of a congenital birth defect; or • for breast reconstruction following mastectomy; or
20. routine well-baby care or losses related to pregnancy that begins before the Covered Person s Start Date of Insurance.
No Benefi ts under this Policy will be paid for loss that takes place outside of the United States.
Portability
On the date the Policy terminates or the date the Insured ceases to be a member of an eligible class, Insureds and their Covered Dependents will be eligible to exercise the portability privilege. Portability coverage may continue beyond the termination date of the Policy, subject to the timely payment of premiums. Portability coverage will be eff ective on the day after insurance under the Policy terminates.
The benefi ts, terms and conditions of the portability coverage will be the same as those provided under the Policy when the insurance terminated. The initial portability premium rate is the rate in eff ect under the Policy for active employees who have the same coverage. The premium rate for portability coverage may change for the class of Covered Persons on portability on any premium due date.
Termination of Insurance – Covered Persons
Subject to the Waiver of Premium and Portability provision(s), all insurance ends on the earliest of the following dates:
• Your retirement
• the Maximum Renewal Age shown on the Schedule
• the end of the Grace Period, if Premium for this coverage is not paid • the end of the Calendar Month when the Covered Person is no longer Eligible • the Policy s termination date
• the end of the Calendar Month when We receive a request to end this insurance
• the date that a Child reaches Age 26 • the date that a Spouse reaches age 70 • Your death
When Your coverage ends, insurance on other persons covered by this Certifi cate will also end. Termination of insurance on a Covered Person or of the Policy is without prejudice to claims that occur or start prior to the date of termination.
Pre-Existing Condition Limitation
Pre-existing Condition means a condition which a Physician has treated or for
which a Physician has advised treatment of the Covered Person within 90 days before the Covered Person s Eff ective Date of Insurance. It is also one which would cause a person to seek diagnosis or care within the same 90 day period. Any loss due to a Pre-existing Condition will not be covered if the loss begins within 90 days after the Covered Person s Eff ective Date of Insurance. However, Benefi ts may be paid for a loss due to a Pre-existing Condition of a Covered Person who was covered:
• by a Replaced Policy; and
• by the Policy on its Initial Eff ective Date.
Covered Persons
Covered Dependent means: a.) Your spouse, unless divorced or legally separated
from You; b.) Your unmarried Child(ren) who are less than age 19 and primarily dependent on You for support and maintenance. c.) Your unmarried Child(ren) who are at least age19 but less than age 26 who:
(1) regularly attend an institution of learning, and (2) are primarily dependent on You for support and maintenance. d.) Your unmarried Child(ren) who are at least age 19 who are chiefl y dependent on You for support and are incapable of self- sustaining employment due to mental incapacity or physical handicap. You must furnish Us with proof of mental incapacity or physical handicap within 31 days after the Child s eligibility would otherwise end. Thereafter, We may require proof, but not more frequently than annually.
Child (Children) means the Primary Covered Person s unmarried child,
including a natural child from the moment of birth, stepchild, foster or legally adopted child, or child in the process of adoption (including a child while the Primary Covered Person is a party to a proceeding in which the adoption of such child by the Primary Covered Person is sought); a child for whom the Primary Covered Person is required by a court order to provide medical support, and grandchildren who are dependent on the Primary Covered Person for federal income tax purposes at the time of application.
Child does not include a:
• person not meeting the above Child defi nition; • Child living outside of the United States; or
• Child on active military duty for a period in excess of 30 days.
This Sales Brochure is not a contract. It is intended only as a brief description of the policy provisions in the planning of your program. The benefi ts are determined by the terms and conditions of the policy and certifi cate alone. This is not a Medicare Supplement Policy.
If you are eligible for Medicare, see the Medicare Supplement Buyer s Guide available from the Company In all cases, consult your certifi cate for full details. Upon receipt of your policy, please review it and your application.
If any information is incorrect, please contact:
Bay Bridge Administrators
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