"Basic hospital expense coverage" is a policy of disability insurance which provides coverage for a period of not less than 31 days during any continuous hospital confinement for each person insured under the policy for expense incurred for necessary treatment and services rendered as a result of accident or sickness for at least the following:
(1) Daily hospital room and board in an amount not less than the lesser of 80% of the charges for semi-private room accommodations or $50 per day;
(2) Miscellaneous hospital services for expenses incurred for the charges made by the hospital for services and supplies which are customarily rendered by the hospital and provided for use only during the period of confinement in an amount not less than either 80% of the charges incurred up to at least $1,000 or ten times the daily hospital room and board benefits; and
(3) Hospital outpatient services consisting of:
(a) Hospital services on the day surgery is performed, and accidental injury, in an amount not less than $50; and
(b) Hospital services rendered within 72 hours after accidental injury, in an amount not less than $50; and
(c) X-ray and laboratory tests to the extent that benefits for such services would have been provided to an extent not less than $100 if rendered to an in-patient of the hospital.
(4) Benefits provided under subsections (1) and (2) of this section may be provided subject to a combined deductible amount not in excess of $100.
[Order R-76-4, § 284-50-335, filed 10/29/76, effective 3/1/77.]