“Major medical expense coverage" or "comprehensive health expense coverage" is a policy of accident and health insurance that provides hospital, medical, and surgical expense coverage to an aggregate maximum of not less than thirty-five thousand dollars ($35,000), copayment by the covered person not to exceed twenty-five percent (25%) of covered charges, a deductible stated on a per-person, per-family, per-illness, per-benefit period, or per-year basis or a combination of such bases not to exceed five percent (5%) of the aggregate maximum limit under the policy, unless the policy is written to compliment underlying hospital and medical insurance, in which case such deductible may be increased by the amount of the benefits provided by such underlying insurance that is then in force or thereafter issued for each covered person for at least:

1. (1) Daily hospital room and board expenses, prior to application of the copayment percentage, for not less than one hundred twenty-five dollars ($125) daily or the actual semiprivate room rate, whichever is less, for a period of not less than thirty-one (31) days during continuous hospital confinement;
2. (2) Miscellaneous hospital services, prior to application of the copayment percentage, for an aggregate maximum not less than five thousand dollars ($5,000) or thirty-one (31) times the daily room and board rate if specified in dollar amounts;
3. (3) Surgical services, prior to application of copayment percentage, to a maximum of not less than one thousand six hundred dollars ($1,600) for the most severe operation with the amounts provided for other operations reasonably related to such maximum amount;

4. (4) Anesthesia services, prior to application of the copayment percentage, for a maximum of:

   1. (A) Not less than fifteen percent (15%) of the covered surgical fees; or
   2. (B) Alternatively, if the surgical schedule is based on relative values, not less than the amount provided therein for anesthesia services at the same unit value as used for the surgical schedule;
5. (5) In-hospital medical services, prior to application of the copayment percentage, as defined in 23 CAR § 86-303(3);

6. (6) Out-of-hospital care, prior to application of the copayment percentage, consisting of:

   1. (A) Physicians’ services rendered on an ambulatory basis where coverage is not provided elsewhere in the policy for diagnosis and treatment of sickness or injury; and
   2. (B) Diagnostic X-ray, laboratory services, radiation therapy, and hemodialysis ordered by a physician; and

7. (7) Not fewer than three (3) of the following additional benefits, prior to application of the copayment percentage, for an aggregate maximum of such covered charges of not less than three thousand two hundred dollars ($3,200):

   1. (A) In-hospital private-duty graduate registered nurse services;
   2. (B) Convalescent nursing home care;
   3. (C) Diagnosis and treatment by a radiologist or physiotherapist;
   4. (D) Rental of special medical equipment, as defined by the insurer in the policy;
   5. (E) Artificial limbs or eyes, casts, splints, trusses, or braces;
   6. (F) Treatment for functional nervous disorders and mental and emotional disorders; and
   7. (G) Out-of-hospital prescription drugs and medications.