1. A. The LA Health Plan provides for the following emergency room benefits:

   1. 1. outpatient health care received in the emergency room of a participating hospital is covered, limited to a maximum of $1,500 per insured per calendar year. This benefit is subject to an $85 co-payment per visit;
   2. 2. the co-payment of $85 per visit shall be waived if such a visit is followed by an admission to the participating hospital for the care of the illness or injury for which the person was treated in the emergency room.
2. B. An insured receiving emergency room care resulting from an illness or injury outside the service area of the authorized carrier shall have benefits of 50 percent of those for services received at a participating hospital.

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).