Hospital
Services and Supplies – 90%
Inpatient
Hospital
Benefits are provided for a
semiprivate room and hospital services and supplies to treat an illness or
injury. Intensive and coronary care units are also covered when medically
necessary.
All
inpatient hospital admissions must be
precertified.
Covered hospital services and
supplies include:
- Operating
rooms and equipment.
- Nursing
services (other than the services of a private-duty nurse or
attendant).
- Diagnostic
or therapeutic items or services that are ordinarily furnished by the hospital
for the care and treatment of the patient.
- Drugs,
biologicals, supplies, appliances, and equipment for use in the hospital that
are ordinarily furnished by the hospital for the care and treatment of the
patient.
Benefits
are not
provided for a bed or room set aside for a
patient while the individual is in a special care unit.
Outpatient
Hospital
Benefits are provided
for:
- Facility
fees for outpatient surgery, a same-day surgical center or an ambulatory
surgical center.
- Treatment
including x-ray, radium therapy and other radioactive substances, chemotherapy,
and laboratory and diagnostic radiology and imaging.
- Care
in a hospital emergency room. There is a $50 copayment for each visit to the
emergency room. The $50 copayment is waived if the individual is admitted as an
inpatient directly following treatment in the emergency
room.
Benefits
are
not
provided for facility fees for a hospital, ambulatory surgical center or other
surgical facility for surgical services commonly and primarily performed in a
clinic or in a physician’s office.
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