Louisiana Administrative Code
Title 37 - INSURANCE Part
Part XIII - Regulations
Chapter 31 - Regulation 53-Basic Health Insurance Plan Pilot Program
Section XIII-3129 - Hospital Services

Universal Citation: LA Admin Code XIII-3129

Current through Register Vol. 50, No. 9, September 20, 2024

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.

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:244-247 of the Insurance Code.

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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