Common use of Inpatient Care Clause in Contracts

Inpatient Care. Covered services include: • Room and board, general duty nursing and special diets • Doctor services and visits • Use of an intensive care or special care units • Operating rooms, surgical supplies, anesthesia, drugs, blood, dressing, durable medical equipment and oxygen • X-ray, lab and testing Outpatient Care Covered services include: • Operating rooms, procedure rooms and recovery rooms • Doctor services • Anesthesia • Services, medical supplies and drugs that the hospital provides for your use in the hospital • Lab and testing services billed by the hospital and done with other hospital services This benefit does not cover: • Hospital stays that are only for testing, unless the tests cannot be done without inpatient hospital facilities, or your condition makes inpatient care medically necessary • Any days of inpatient care beyond what is medically necessary to treat the condition Mental Health, Behavioral Health and Substance Abuse This plan covers mental health care and treatment for alcohol and drug dependence. This plan will also cover alcohol and drug services from a state- approved treatment program. You must also get these services in the lowest cost type of setting that can give you the care you need. When medically appropriate, services may be provided in your home. This plan will comply with federal mental health parity requirements. Some services require prior authorization. See Prior Authorization for details.

Inpatient Care. Covered services include: •  Room and board, general duty nursing and special diets •  Doctor services and visits •  Use of an intensive care or special care units •  Operating rooms, surgical supplies, anesthesia, drugs, blood, dressing, durable medical equipment and oxygen •  X-ray, lab and testing Outpatient Care Covered services include: •  Operating rooms, procedure rooms and recovery rooms •  Doctor services •  Anesthesia •  Services, medical supplies and drugs that the hospital provides for your use in the hospital •  Lab and testing services billed by the hospital and done with other hospital services This benefit does not cover: •  Hospital stays that are only for testing, unless the tests cannot be done without inpatient hospital facilities, or your condition makes inpatient care medically necessary •  Any days of inpatient care beyond what is medically necessary to treat the condition Mental Health, Behavioral Health and Substance Abuse This plan covers mental health care and treatment for alcohol and drug dependence. This plan will also cover alcohol and drug services from a state- approved treatment program. You must also get these services in the lowest cost type of setting that can give you the care you need. When medically appropriate, services may be provided in your home. This plan will comply with federal mental health parity requirements. Some services require prior authorization. See Prior Authorization for details.