LAC 37:XIII.3129. Hospital Services

A. The LA Health Plan provides for the following minimum or their actuarial equivalent inpatient hospital services: 1. 15 days of hospital inpatient care (hospital/medical) per calendar year. A $50 per day co-payment is required; 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. 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; a. daily room, board, and general nursing care at the semiprivate rate charged by the participating hospital; b. confinement in an intensive care or coronary care unit with such payment being in lieu of expenses covered under §3129.A.3.a; 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. maternity care; 5. newborn nursery care from the moment of birth; 6. medical care and treatment by a participating provider while confined as an inpatient in a hospital; 7. radiological services by a licensed radiologist while confined as an inpatient in a hospital; 8. radiation therapy. B. The LA Health Plan provides for the following minimum or their actuarial equivalent outpatient hospital services: 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. payment of outpatient hospital services is prohibited on the date of admission or during an admitted stay in a hospital as an inpatient.