Common use of Hospital Services Clause in Contracts

Hospital Services. This plan covers services you get in a hospital. At an in-network hospital, you may get services from doctors or other providers who are not in your network. When you get covered services from non-contracted providers, you pay any amounts over the allowed amount. 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.

Hospital Services. This plan covers services you get in a hospital. At an in-network hospital, you may get services from doctors or other providers who are not in your network. When you get covered services from non-contracted providers, you pay any amounts over the allowed amount. 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.

Hospital Services. This plan covers services you get in a hospital. At an in-network hospital, you may get services from doctors or other providers who are not in your network. When you get covered services from non-contracted providers, you pay any amounts over the allowed amount. 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.