1. A. The LA Health Plan provides for the following minimum or their actuarial equivalent inpatient hospital services:

   1. 1. 15 days of hospital inpatient care (hospital/medical) per calendar year. A $50 per day co-payment is required;
   2. 2. surgical procedures and related expenses are covered up to a maximum of $5,000 per insured per calendar year. A $50 per surgical procedure co-payment is required;

   3. 3. the LA Health Plan will pay for covered expenses incurred for services in a participating hospital for the following services based on the limitations above;

      1. a. daily room, board, and general nursing care at the semiprivate rate charged by the participating hospital;
      2. b. confinement in an intensive care or coronary care unit with such payment being in lieu of expenses covered under §3129.A.3.a;
      3. c. services and supplies furnished by the participating hospital which are necessary for inpatient medical care and treatment, including diagnostic x-ray and lab services;
   4. 4. maternity care;
   5. 5. newborn nursery care from the moment of birth;
   6. 6. medical care and treatment by a participating provider while confined as an inpatient in a hospital;
   7. 7. radiological services by a licensed radiologist while confined as an inpatient in a hospital;
   8. 8. radiation therapy.

2. B. The LA Health Plan provides for the following minimum or their actuarial equivalent outpatient hospital services:

   1. 1. the LA Health Plan shall pay covered expenses incurred for outpatient diagnostic services for pre-admission tests, diagnostic X-ray and laboratory services at a participating facility. The outpatient benefit is limited to $1,000 per insured per calendar year;
   2. 2. payment of outpatient hospital services is prohibited on the date of admission or during an admitted stay in a hospital as an inpatient.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:11, R.S. 22:2241-2247, and the Administrative Procedure Act, R.S. 49:950 et seq

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Insurance, Office of the Commissioner, LR 20:1012 (September 1994).