Page:United States Statutes at Large Volume 79.djvu/342

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PUBLIC LAW 89-97-JULY 30, 1965

[79 STAT.

"SCOPE OF B E N E F I T S

Post, p. 313.

"SEC. 1832. (a) The benefits provided to an individual by the insurance program established by this part shall consist of— "(1) entitlement to have payment made to him or on his behalf (subject to the provisions of this part) for medical and other health services, except those described in paragraph (2) (B);and "(2) entitlement to have payment made on his behalf (subject to the provisions of this part) for— " (A) home health services for up to 100 visits during a calendar year; and " (B) medical and other health services (other than physicians' services unless furnished by a resident or intern of a hospital) furnished by a provider of services or by others under arrangements with them made by a provider of services. "(b) For definitions of 'spell of illness', 'medical and other health services', and other terms used in this part, see section 1861. il

PAYMENT OF BENEFITS

"SEC. 1833. (a) Subject to the succeeding provisions of this section, there shall be paid from the Federal Supplementary Medical Post, p. 308. Insurance Trust Fund, in the case of each individual who is covered under the insurance program established by this part and incurs expenses for services with respect to which benefits are payable under this part, amounts equal to— "(1) in the case of services described in section 1832(a)(1)— 80 percent of the reasonable charges for the services; except that an organization which provides medical and other health services (or arranges for their availability) on a prepayment basis may elect to be paid 80 percent of the reasonable cost of services for which payment may be made under this part on behalf of individuals enrolled in such organization in lieu of 80 percent of the reasonable charges for such services if the organization undertakes to charge such individuals no more than 20 percent of such reasonable cost plus any amounts payable by them as a result of subsection (b); and "(2) in the case of services described in section 1832(a)(2)— 80 percent of the reasonable cost of the services (as determined Post, p. 322. yjjder section 1861(v)). Deductible pro"(j^) Before applying subsection (a) with respect to expenses ^*°"" incurred by an individual during any calendar year, the total amount of the expenses incurred by such individual during such year (which would, except for this subsection, constitute incurred expenses from which benefits payable under subsection (a) are determinable) shall be reduced by a deductible of $50; except that (1) the amount of the deductible for such calendar year as so determined shall first be reduced by the amount of any expenses incurred by such individual in the last three months of the preceding calendar year (or regarded under clause (2) as incurred in such preceding year with respect to services furnished in such last three months) and applied toward such individual's deductible under this section for such preceding year, and (2) the Ante, p. 29 2. amount of any deduction imposed under section 1813(a)(2)(A) with

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