Hospital Services and Supplies—90%
Inpatient Hospital
Inpatient Admissions Must Be Precertified With the
Medical Review Agency
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.
- Anesthesia including administration and
materials.
- 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 patient is in a
special care unit.
Outpatient Hospital
Benefits are provided for:
- Services and supplies otherwise provided
on an inpatient hospital basis.
- 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 patient is admitted as an inpatient
directly following treatment in the
emergency room.
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