Medical - Inpatient Hospital Services

exam room

Includes medical, mental health and maternity services.

Inpatient Service

In-Network Provider1, 2, 3

Non-network Provider2, 4

Semi-Private Room

Pays 90% of network rates

50% of non-network rates

Lab Tests, X-rays & Imaging

Pays 90% of network rates

50% of non-network rates

General supplies

Pays 90% of network rates

50% of non-network rates

Nursing services

Pays 90% of network rates

50% of non-network rates

Medication

Pays 90% of network rates

50% of non-network rates

Physicians & Specialists

Pays 90% of network rates

50% of non-network rates

Surgery

Pays 90% of network rates

50% of non-network rates

1Inpatient admissions: $250 co-pay per inpatient admission.

2Inpatient hospital services are subject to the $450 deductible (per plan year).

3Covered medical expenses incurred for the treatment of hypertension, diabetes, and pre/cervical cancer with network providers are not subject to the deductible, copay, or coinsurance. 

4Inpatient hospital services with non-network providers are subject to a $500 co-pay per inpatient admission. 

Note: Inpatient hospital care in connection with childbirth will be covered for at least 48 hours following a normal delivery (96 hours following a cesarean section).