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Medical Equipment Rental Charges Maximum Benefit Amount: URC <br />Medical Services and Supplies Maximum Benefit Amount <br />(Blood, Blood Transfusions, Oxygen): URC <br />Dental Treatment For Injury Only <br />Maximum Benefit Amount: URC <br />OUT -PATIENT PRESCRIPTION DRUG BENEFIT <br />Maximum Benefit Amount: <br />URC <br />ACCIDENTAL DEATH, DISMEMBERMENT, LOSS OF SIGHT, SPEECH, OR HEARING <br />Principal Sum: $2,500.00 <br />GAC26932 <br />