(Typical wording*)

Subject to all Policy limitations, exclusions, applicable deductibles, co-pays and maximums, the Company agrees to pay for policy-defined covered expenses for the following described services, if they are medically necessary:

2. Outpatient Surgery at a Hospital or an Ambulatory Surgical Center: Subject to satisfaction of each applicable Surgery Co-Pay, the following services Provided by the following Participating Providers in connection with surgery performed on an Insured on an Outpatient basis:

a. Hospital or Ambulatory Surgical Center (subject to Surgery Co-Pay) – expenses that constitute Covered Expenses will be considered for payment for the pre-operation, operation, and recovery rooms, as well as for medications, and other miscellaneous items, services and supplies; provided television, telephone and radio are not considered Covered Expenses; b. Primary Surgeon Fees - subject to Surgery Co-Pay; c. Assistant Surgeon – professional fees that constitute Covered Expenses will be considered for payment for one assistant surgeon in connection with surgery for which a Benefit payment has been made under this Section for the professional fees of a primary surgeon; d. Anesthesiologist or nurse Anesthetist – professional fees that constitute Covered Expenses will be considered for payment, for a Participating Provider who is either an anesthesiologist or a nurse anesthetist for services rendered during administration and monitoring of anesthesia, during surgery for which a Surgery Co-Pay has been applied hereunder for the professional fees of a primary surgeon; and e. Pathologist Fees – professional fees that constitute Covered Expenses will be considered for payment for a pathologist's evaluation and/or interpretation of any tissue specimen removed during or in connection with such surgery.